Liposuction of the arms.

Liposuction of arms when properly performed with realistic expectations is almost always a "patient pleaser." Patients routinely marvel at the degree of skin contraction that typically occurs. Before and after photos, even as early as 1 week, routinely show dramatic skin contraction when significant volumes of fat are removed although textural changes may evolve for weeks to months (Figs. 14-19). Only the lower abdomen and neck consistently obtain such profound and predictable contraction. I am convinced that historically liposuction of the arms has been performed in a substandard fashion. Inadequate fat removal will often produce irregularity and will always result in less than maximal skin contraction. As I have performed progressively larger-volume cases, the indications for brachioplasty, in my opinion, are nearly nonexistent. My present approach, except in the most extreme cases, is to initially recommend liposuction and possibly even a second liposuction prior to performing or recommending brachioplasty. Even massive arms with good skin tone will usually obtain an aesthetically pleasing result when treated properly. Massive arms with poor skin tone, however, may not. One does not "burn bridges," however, by performing liposuction alone in these questionable candidates. If brachioplasty is subsequently desirable, in spite of the major drawback of the resultant scar, it can be performed at a later date. In summary, the key concepts for maximizing the potential of liposuction of the arms are to perform thorough but gentle fat removal and to avoid immediate subdermal fat removal or trauma to the underside of the dermis.

Liposuction of the knees, calves, and ankles.

Lipodystrophy of the knees, calves, ankles, and neck are somewhat unique in comparison to other sites because they are more difficult to camouflage. The calves and ankles, in particular, are less dependent on body weight and more resistant to diet and exercise. Calf and ankle lipodystrophy is usually present from early adolescence.

Infusion rates and levels of premedication in tumescent liposuction.

BACKGROUND: Tumescent liposuction has proven to be an extremely safe and effective method of liposuction. However, the infusion of tumescent anesthesia can take 1 hour or more to complete. OBJECTIVE: To document the types, dosages, and routes of administration of premedication utilized by four experienced tumescent liposuction surgeons. To determine if infusion rates for tumescent anesthesia are affected by types of premedication. METHODS: Four experienced liposuction surgeons were asked to review their most recent 100 tumescent liposuction patients with respect to types and dosages of premedication and routes of administration. Data were also provided on corresponding infusion pump settings and infusion rates. Volumes of tumescent anesthesia and corresponding volumes of fat aspirated were also collected on the same 400 patients. RESULTS: Infusion of tumescent anesthesia could be performed more rapidly in patients who were given greater amounts of premedication. Volumes of tumescent anesthesia infused were generally two or more times the volume of fat aspirated. Patients could be infused with less premedication if slow infiltration was employed. CONCLUSION: Infusion rates for tumescent anesthesia can be increased of greater amounts of premedication are given. However, this must be balanced against the safety of the premedication.

Liposuction: the tumescent technique.

The tumescent technique involves the removal of moderate to large amounts of fat from several body areas in an office setting using only local anesthesia. The technique eliminates significant blood loss, rendering transfusion unnecessary. Less bruising and swelling, more even fat removal, and decreased expense are other features of this procedure.

The tumescent technique for liposuction surgery.

The tumescent technique, developed by dermatologists, has revolutionized the approach to liposuction. It has eliminated concerns about blood loss, fluid replacement and fluid shifts, and the risks and morbidity of general anesthesia. It has also significantly decreased the cost of liposuction by eliminating the need for general anesthesia, an anesthesiologist, a hospital or outpatient operating room, and the need for blood transfusion.

Liposuction for treatment of axillary hyperhidrosis.

Axillary hyperhidrosis is a common and often troublesome problem. Current therapy includes topical antiperspirants, systemic anticholinergic medications, iontophoresis, and surgery. Axillary liposuction promises to be the surgical treatment of choice for those patients refractory to other modalities.

Liposuction surgery under local anesthesia: limited blood loss and minimal lidocaine absorption.

A large volume of lidocaine with epinephrine can be administered in dilute concentrations into the subcutaneous space, resulting in minimal blood lidocaine levels. This allows large-volume, multiple-area liposuction to be done painlessly under local anesthesia with only oral and intramuscular sedation and analgesia. Other advantages include minimal blood loss, decreased patient morbidity and expense, and elimination of the risks of general anesthesia and intravenous anesthesia/sedation.

Neonatal lupus syndrome in successive pregnancies.

Two female siblings, born 15 months apart, developed neonatal lupus syndrome. Both had cutaneous lupus erythematosus (LE) lesions resolving with telangiectasis. Their cutaneous lesions were temporally related to transplacental passage of anti-SS-A (Ro) autoantibodies from their asymptomatic mother. Infants with this transient collagen vascular syndrome may have LE skin lesions, congenital heart block, and liver or hematologic abnormalities, and are possibly at risk for developing systemic lupus erythematosus (SLE) later in life. It is important to recognize that this syndrome may occur in successive pregnancies.

Antimalarial therapy for lupus erythematosus: an apparent advantage of quinacrine.

A retrospective study of 26 quinacrine-treated lupus erythematosus patients failed to show evidence of drug-induced ocular changes. Although quinacrine commonly produces minor side effects, such as yellow discoloration of the skin, and may rarely produce very serious side effects, such as aplastic anemia, it appears to produce much less oculotoxicity than does chloroquine.

Multiple tumors arising in nevus sebaceus.

A forty-three year old woman with nevus sebaceus of Jadassohn involving the scalp is described. The unusual features of this case include the presence of adenoidal basal cell epithelioma, pigmented basal cell epithelioma, syringocystadenoma papilliferum, and nevocytic nevus. This case suggests the importance of prophylactic removal and close follow-up of nevus sebaceus.

Cutaneous metastatic carcinoma and elephantiasis symptomatica.

An elderly man had elephantiasis of a lower extremity that was partially covered with verrucose papules, but also had sharply delineated islands of normal-appearing skin. Biopsy showed cutaneous metastases to be responsible, at least in part, for the clinical appearance. Patients with elephantiasis with "skipped areas" should be suspected of having cutaneous metastatic malignant neoplasms.