Microcannulas require additional attention because the small size and multiple apertures render them susceptible to residual desiccated debris, which is often not easily removed and may become adherent. The cosmetic surgeons initially soak cannulas in germicidal solution immediately after use and then rinse them. The cannulas are then repeatedly flushed with enzymatic cleaner under pressure with a 30-ml or larger syringe. Surgical brushes designed for this purpose are then used to vigorously clean the inside of the tubing. The cannulas are then again flushed with an enzymatic agent under pressure and are then placed in an ultrasonic cleaner, rinsed with distilled water, and autoclaved.
Consultation prior to liposuction surgery is an important aspect of liposuction surgery. Areas of treatment are established and a decision made as to whether more than one liposuction session is required on the basis of the amount of fat to be removed and the anticipated tumescent fluid volumes to be used. Clear goals and realistic outcomes and expectations should be emphasized. The health status of the patient, including relevant history, medications, and drug allergies, should be known in advance of performing the liposuction surgery. Additionally, routine preoperative serum laboratory values should be checked. On the day of liposuction surgery, all medications are reviewed to ensure that no medications that interact with lidocaine metabolism are being taken. The patient’s weight is obtained to calculate the amount of lidocaine that will be infiltrated based on the 35–55- mg/kg upper limit. At this time, any ancillary medications that will be utilized, such as clonidine, lorazepam, or meperidine, may be administered. Before the patient is taken to the operating suite, detailed topographical markings are completed to designate the areas where infiltration of tumescent fluid and subsequent liposuction will be performed. Generally, concentric circles are used with denser markings indicating areas where more lipoaspiration will be performed.
Peripheral areas should be marked for feathering to allow maximal blending and even contouring. Markings also include port sites, so the entire procedure is planned in advance of tumescent fluid infiltration. Aspiration ports must be closer than the length of the cannula since the procedure requires that aspiration of the fat be overlapping from multiple port sites. Usually, we make the distance between the ports sites about half the length of the cannula. Not all port sites are actually incised intraoperatively, but the cosmetic surgeons strongly recommend anticipating and marking the maximum number needed in advance.
The tumescent technique has been refined such that minimal analgesia or additional sedation is required. The areas to be treated are tumesced with the standard combination of lidocaine, epinephrine, and bicarbonate in normal saline. The usual tumescent mixture is 500 mg lidocaine (50-ml bottle of 1% plain lidocaine), 1 mg epinephrine, and 10 mEq sodium bicarbonate in 1 l of normal saline resulting in a 0.05% lidocaine concentration. This concentration can be enhanced to 0.075, 0.1, or even 0.15% depending on the areas being treated and the total lidocaine dose and tumescent fluid volumes anticipated. Different concentrations of lidocaine are chosen depending on the area and volume required. For example, infusing a neck can be performed with higher lidocaine concentrations, where considerably less total fluid is required. This contrasts with the abdomen and flanks, where significantly larger volumes of tumescent fluid are required, making use of higher concentrations potentially problematic, especially when total lidocaine dosing approaches the upper limit of 35–55 mg/kg. Fluid is perfused until the tissue is swollen and moderately distended and has a fully tumesced feeling. The skin should have a firm edematous quality and may demonstrate pallor and may be slightly cool. Overinfiltration may actually render the lipoaspiration more difficult. Typically the infiltrated volume is on the order of 2:1 or 3:1 fluid to aspirate. A period of 15–30 min should elapse to allow maximum anesthesia. Thus, the cosmetic surgeon may wish to sequentially tumesce areas to be sculpted and then return to the first area to begin aspiration.
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1. Natural Remedies for Soft Supple and Glowing Skin
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