Body Procedures

Liposuction Risks – San Jose

The potential risks of liposuction San Jose surgeon Dr. Lowen described below. Visit our center near Palo Alto and San Jose to learn how Dr. Lowen’s experience and careful treatment planning help minimize these risks.

Fluid Overload

Giving too much fluid, too fast, in relation to a person’s body weight and circulatory system capacity will lead to excess fluid in the lungs and stress on the heart. This can result in pulmonary edema (fluid in the lungs) and heart failure. Fluid overload is avoided by doing one area of liposuction San Jose at a time and limiting fluid instillation to a safe amount, as determined by surgical judgment, training, and experience. This experience is best obtained in a surgical training residency such as general and plastic surgery where problems of shock, trauma, fluid balance, burn care, resuscitation, and the body’s response to injury are part of the core curriculum of training.

If one wants to perform a typical liposuction San Jose of 3000 cc on a patient who is 5′6″, 140 lb., with removal of excess fat of the abdomen, flanks and hips, one proceeds from area to area. One does not instill 4-5000 cc of fluid all at once. About 60 to 80 percent of the fluid instilled will remain in the body, and this is taken into account by the anesthesiologist so excess fluid is not given intravenously. Retention of fluid in the body is a good thing, since after surgery; the area liposuctioned will draw fluid out of the circulatory system. The 60 to 80 percent retained fluid acts as a reservoir to prevent a drain on the circulatory system, which could otherwise cause dizziness, low blood pressure, or even shock.

The post-operative compression garment also acts as a G-suit (aviator’s gravity suit) to keep excess fluid from re-accumulating in the suctioned areas. By keeping the garment on for three to five days, fluid equilibrium is gradually re-established and the patient is protected from sudden fluid shifts out of the circulatory system during this period.

After one or more areas are suctioned and fat and fluid are removed, a margin of safety is provided for additional fluid added to the next area to be suctioned. In this way it is possible to remove 5000 cc’s of fat safely, although the typical liposuction case is less than that. Large men and women with fat in a circumferential distribution around the thighs can easily approach the 5,000 level. If, however, one attempted to take 5,000 cc of fat out with a 3:1 ratio of fluid to aspirate “tumescent” technique, and instilled a total of 15,000 cc of fluid or 15 liters, it is easy to see how problems of fluid overload could occur. If the fluid were not instilled slowly and extracted sequentially, it would be possible to put the patient into a state of fluid overload and pulmonary edema (fluid in the lungs). If the liposuction procedure were done in an office setting, and not in an accredited surgical facility fully equipped for cardiopulmonary resuscitation and staffed with trained and experienced nursing and anesthesia personnel, the chances of adequately treating respiratory failure, cardiac failure, or cardiac arrest would be decreased.

Scars from Liposuction San Jose

Papers published to show the results of lipoplasty often show scars in places where scars are not desired and are a poor trade-off for the results obtained. Since the quality of scar healing is a combination of gentle tissue handling and a patient’s own healing potential, it is best to place the scars where they will be least visible. Dr Lowen thinks that scars should not be created in visible areas like the lateral abdomen, the mid-back or in the bra-line. They are not in natural folds or wrinkles and are tip-offs of surgery. When Smartlipo is done, the incisions are only 2-3 mm. They do not require stitches and usually heal very well. Nevertheless, Dr. Lowen tries to avoid placing them in any area where they may be visible in a bathing suit.

To minimize scarring for his liposuction San Jose patients, Dr. Lowen tailors the procedure to their specific needs. If he is treating the under arm or lateral back, he works from a hidden, underarm incision and a small flank incision with the skin edges protected from friction injury by a small plastic skin protector. The abdomen is treated by non-visible incisions in the pubic hair and umbilicus. The lateral hips by a single incision in the buttock crease, if possible, and an additional incision at the upper part of the hip bulge if necessary for larger fat deposits. The anterior thighs are treated through a groin incision and the knees and lower thighs by an incision behind the knee in a skin crease. Dr. Lowen tries to avoid an incision on the anterior knee when the front of the thigh is treated, but sometimes this is necessary. Asian and Hispanic patients tend to form thicker or darker scars, and this should be discussed when incisions located in more visible areas such as the front of the knee are planned.

Dark or raised liposuction scars are treated at our practice by ruby laser (removes brown pigment), vascular laser (flattens raised or persistently red scars), or surgical revision, depending on which technique is most likely to improve the scar in a given patient.

Infection

The risk of infection after liposuction San Jose is very low, and it is even lower in our practice than the usually quoted rate of one percent for clean surgery. Should it occur, it is usually a local reaction with redness and discomfort around one of the access incisions. These superficial skin infections are easily treated with oral antibiotics. However, serious, life-threatening, and fatal infections have been reported after liposuction. These infections can strike fast, spread quickly under tissue planes, and result in death of skin and the need to surgically remove the infected skin to prevent further spread, septic shock, and a potentially fatal outcome. The medical term for this severe infection is necrotizing fasciitis (fash-e-itis). The bacteria involved are usually a combination of streptococcus and gas-forming organisms that grow best under conditions of low oxygen.

The post-operative course of liposuction San Jose is usually one of mild discomfort or achiness during the first several after the procedure. Oral pain medications should be sufficient. If, however, there is an unusual and increasing pain, that can be an indication of infection and must be investigated promptly. If a serious infection is suspected or diagnosed, the patient must be hospitalized, wound cultures taken, and IV antibiotics started immediately. Further treatment may include surgical debridement (removal) of infected skin, and after all infection is controlled, reconstructive surgery. The result will be some degree of undesired scarring as a result of skin grafting or flap reconstruction, but the need for surgical treatment in the interest of the patient’s survival obviously takes precedence. This degree of infection has never occurred in Dr. Lowen’s practice to date.

When the operating surgeon has completed a 5-7 year surgical residency, like plastic surgery, the techniques of sterile surgery are well known and observed carefully. The performance of liposuction San Jose in an office minor surgery suite or in an office exam room may pose an increased risk of infection unless sterile technique is meticulously followed. Smartlipo MPX using local tumescent anesthesia is safe to do in the office operating room. The risks of infection are small, and they are minimized by formal surgical prepping and draping, and formal surgical garb including gown, gloves, and mask. Performing liposuction wearing only gloves is sub-optimal in terms of sterility.

Venous or Fat Emboli

Emboli are uncommon risks, which can occur, in the post-operative period. Blood clots, which may form in the legs, can travel to the heart and impair circulation. Small fat particles or metabolic products of fat called free-fatty acids are thought to damage cell membranes in the lungs, causing fluid to accumulate. While there is no specific prevention for these conditions, precautions such as calf-compression devices are usually worn during surgery. Secondary symptoms would be shortness of breath, rapid heart rate, and chest discomfort. Treatment is medical, supportive, and directed at the underlying cause.

Perforation of a Body Cavity

A liposuction cannula should be used delicately and with care, since it is possible for it to go under the abdominal muscle into the abdominal cavity and injure the liver or bowel. Deaths have been reported from this error. Liposuction is not just grossly removing fat. The person performing liposuction potentially has your life in his or her hands. Particularly around the abdomen, waist, flanks, chest, and rib cage, care must be exercised to maintain the direction of cannula movement parallel to the body surface with the tip directed in an outward direction. This is quite possible to do accurately and well, with direct observation of the cannula position, intentional directing of the cannula tip, and use of the opposing hand to feel the cannula through the skin.

If after a liposuction San Jose procedure on the abdomen or flanks, abdominal pain, nausea, dizziness, or weakness is noted, the matter must be brought to the attention of the attending surgeon and the possibility of abdominal perforation must be ruled out. The situation would be similar to a perforated appendix. Delay makes matters worse, and if in doubt, or if you were unable to reach your surgeon promptly, a trip to the emergency room for evaluation by a general surgeon is critical and urgent.

While it might be reassuring to think that such an event could not happen if your surgery was performed by a board-certified plastic surgeon, you should know that such abdominal perforations have occurred when the procedure was done by well-trained plastic surgeons. Therefore, you should be well informed and aware of the potential problem.

Delay

The main factors involved in severe patient morbidity and death after liposuction are failure to recognize and treat or refer for treatment the symptoms of infection and abdominal perforation. Fluid overload is usually recognized in the immediate post-operative period. Lidocaine toxicity may not be manifested until after the patient returns home, and infection usually becomes symptomatic one or two days after the procedure.

Lidocaine Toxicity

The amount of lidocaine, the local anesthetic used in tumescent liposuction surgery, San Jose, that can be safely given to a particular patient depends on that patient’s body weight. When given in a salt solution combined with dilute adrenaline, a vasoconstrictor, the total amount of lidocaine that can be given safely is much greater than the amount one could administer without adrenaline. This is the principal behind the tumescent liposuction surgery, San Jose technique and why it is an effective drug-delivery system to achieve local anesthesia. The lidocaine must be distributed throughout the fat deposit for it to be an effective anesthetic. This is why sufficient fluid must be used, as a vehicle, in the tumescent technique. Surgeons doing cases under general anesthesia usually put some lidocaine into their infiltration solutions, more for post-operative pain control than for anesthesia for the liposuction procedure. Lidocaine toxicity would not occur with these small amounts, but if the procedure is done solely under local in a doctor’s office, then the risk of lidocaine toxicity must be recognized and avoided.

Recognized safety levels for Smartlipo tumescent local anesthesia is 45 mgm/kgm of body weight. Less can be used. The goal is adequate anesthesia so the patient is comfortable during the procedure. If there are multiple areas that need treatment, the surgery should be done in staged procedures. Then there will be enough local anesthesia in the areas treated at one time. Using too little xylocaine may not provide adequate anesthesia if the total allowable dose is diluted too much and distributed over too many areas.

With a comprehensive approach to fat removal and sculpting, working around the abdomen and rib cage and doing multiple areas during the procedure, Dr. Lowen has found, as most plastic surgeons have, that general anesthesia is needed. For a more limited number of areas or volume of fat, then local tumescent anesthesia works very well. Local anesthesia is ideal for Smartlipo MPX laser lipoplasty because the procedures are limited in area and scope. If a patient wants multiple areas treated that are just too much to do in one session, than we schedule another session to do those areas.

Lidocaine toxicity is manifested by ringing in the ears, a feeling of numbness around the mouth, dizziness, then seizures, low blood pressure, followed by circulatory collapse and cardiac arrest. Since individuals vary in their susceptibility to lidocaine toxicity, it is wise to use only that amount necessary to do the procedure and not to exceed maximum levels of 45 mgm/kgm.

Waviness, Unevenness, Surface Depressions, Abnormal Appearance

These liposuction San Jose complications are minimized by careful technique with even, incremental removal of fat using small diameter cannulas. Excess removal of fat in a woman’s abdomen or hips can lead to an undesirable wrinkled appearance or masculinization of the abdomen. One should not “take out all the fat” as patients sometimes request. The use of methods such as laser-assisted Smartlipo MPX or Vaser ultrasonic liposuction greatly decrease the chance of waviness or irregularity. In fact, Dr. Lowen has found these techniques extremely helpful in correcting previous liposuction problems, such as lumpiness or irregularities. The laser and the vaser pass through the fibrous tissue and fatty tissue in a very uniform way, breaking down the fat little by little until the surface both looks smooth and feels smooth. The laser can be felt to make its way gently through previously treated, fibrous resistant tissue until all irregularities are smoothed out and skin redistributes itself smoothly.

The ability to avoid uneven fat removal still depends on the experience and judgment of the surgeon.

To learn more about liposuction Risks, please contact our practice serving San Jose, Palo Alto, and the entire San Francisco Bay Area, please contact our plastic surgery center today.

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