ST. LOUIS Beware of the patient who considers liposuction just another type of "extreme makeover," Richard L. Schloemer, M.D., said at the World Congress on Liposuction Surgery.
"You cannot stress enough that liposuction is a major operation, and that if not done right it can lead to deformity, major complications, and death," he said.
Liposuction is not for weight loss, though it can contribute to an overall weight loss plan. It's absolutely essential that patients lower their body mass index one level before surgery, and that they maintain a diet afterward, said Dr. Schloemer, a surgeon in private practice in Troy, Ala. "I recommend the 'no white diet.' If it's white, don't eat itpotatoes, bread, rice, dairy products," he said at the congress, sponsored by the American Academy of Cosmetic Surgery.
Informed consent is vital. "You can't give a person too much information, and even when you do, you'd be surprised at how little they retain," he said. For example, one of his patients ignored instructions and took a soapy whirlpool bath 4 hours post procedure, and then spent 3 days in the hospital with a soap burn.
Preventing hypothermia is another important consideration. A cold operating room, cold solutions, and sedation can contribute to severe shaking.
But never use electric heating pads, he said. That practice resulted in a third-degree burn requiring a skin graft in one of his patients. "A heating pad that may fluctuate to greater than 100° F, and a wet solution in a numb patient can be a terrible combination. You have to warm the room and the solutions even if it is uncomfortable for you," Dr. Schloemer said.
Given the availability of tumescent anesthesia and intravenous sedation, general anesthesia is simply not necessary for liposuction. It's generally advisable to keep the lidocaine dose at 50 mg/kg or below to prevent toxicity, however.
"At the end of the procedure, have the patient stand up so you can assess the effects of gravity and ensure symmetry," he said. "Finally, don't promise too much, and remember that liposuction isn't for everyone. Declining to operate often shows good judgment and gains patient respect," he said.