Anesthesia

All of our procedures were done under local anesthesia plus intravenous sedation. The anesthesiologist starts the light sedation by using Precedex and Deprivan.

Induction by using 2 mg Midazolam + 50 mg fentanyl.

Maintaining by dexmedetomidine (Precedex) 1 mic/kg bolus over 15 min then IV infusion 0.2–1 microgram (mic)/kg/h.

The tumescence solution used was in the form 20 cc of 2% xylocaine and 1 mg of 1 mL epinephrine for each 1 L of normal saline.

When VASER is used, 70%, pulsed mode was used and applied immediately following infiltration. Special ports are used to guard against skin burns from the cannula. The cannula is applied in a different fanning manner while taking care not to become too superficial as not to endanger the skin vascularity. The end point for the VASER is when the surgeon feels that all the septa were broken, there is no resistance, and flow of infiltrate from the port site is yellow. We call this the fat soup.

Liposuction was done using Power-assisted techniques using the Lipomatic by Euromai.

We started by the lateral position for liposuction of the waist, iliac, lateral chest, and back regions. This was followed by the other lateral side (where the same areas were treated).

Then, the patient was placed in supine position for liposuction of the abdomen, chest, and thigh (if planned). Finally, the patient was turned into prone position for completion of liposuction of the gluteal region, upper posterior thighs, and gluteal fat grafting, if needed.

The end point for aspiration was either 0.5 cm smooth skin pinch without any irregularities or bloody aspirate.

A silicone drain was placed in the inguinal region, one on each side and in the iliac region as well (Fig. ​(Fig.2).2). The drains were placed from the same sites used for liposuction. The remaining incisions sites were left open at the end of the procedure. This was crucial to help drainage and reduce seroma formation. Daily dressing with antibiotic cream containing fusidic acid was done around the drains. Sterile dressings were then placed over the drains to absorb the fluids and minimize soaking. Drains were removed after 1 week.

Silicone drains placed in the inguinal and iliac regions on both sides, making a total of 4 drains. These are the same openings used for liposuction.

All patients were padded with cotton dressings and placed in a pressure garment on the operating table immediately after finishing the procedure.

One of the frequent challenges when performing liposuction is hypothermia, especially with large volumes of fluids being infiltrated.³ This can be avoided/managed by the following simple steps:

1) Warm betadine solutions during draping and sterilization

2) Warm draping sheets/frequent removal of wet sheets

3) Warmer, plus AC is turned off

4) Warm infiltration/maintenance solutions

5) Rapid pressure garment application with a conscious patient

Patients were kept in the hospital overnight with close monitoring of the vital signs, urine output, signs of hypothermia, and xylocaine toxicity.