BACKGROUNDLiposuction has become one of the most popular aesthetic procedures today. Among the different anesthesia methods, tumescent local anesthesia (TLA) has been shown to be the safest. Liposuction is typically performed as an outpatient procedure under minimal oral sedation and without the need for any intravenous (IV) fluid administration.OBJECTIVETo record complications in a larger series of patients undergoing liposuction in TLA.MATERIALS AND METHODSBetween 2003 and 2020, 9,002 consecutive patients underwent liposuction in TLA with the same team of surgeons. The occurrence of complications was recorded in detail.RESULTSThere were neither fatal complications nor damage to deeper structures such as nerves, blood vessels, muscles, lungs, abdominal organs, nor permanent lymphedema. A total of 19 of the following side effects, mainly minor, required closer follow-up or intervention: allergic drug reaction to doxycycline (0.06%), seroma (0.04%), large hematoma (0.03%), erysipelas (0.02%), transient acrocyanosis (0.02%), deep vein thrombosis (0.01%), skin necrosis (0.01%), and generalized edema (0.01%)CONCLUSIONLiposuction in TLA is a reliable and safe procedure if it is performed by an experienced surgeon and the guidelines of care are strictly followed.

In high-definition liposculpture (HDL), the body is shaped in such a way that an athletic appearance and a defined, contoured look is created. Typical areas in the male patient include arms, pectoralis region, the area over the serratus muscle, lower back, as well as medial and lateral abdomen. This procedure is sometimes combined with fat grafting to areas over the deltoid muscle and/or pectorals. The objective was to evaluate the safety and satisfaction of HDL in a large series of patients using reciprocating power-assisted liposuction under local anesthesia. In this bicenter study, we performed HDL on 82 male patients using reciprocating power-assisted liposuction under tumescent local anesthesia with both lidocaine and prilocaine. No drains were used. Intraoperative and postoperative data were collected, and complication and satisfaction rates were evaluated after 6 months. All overall patients’ satisfaction was high. There were no major complications. Minor complications included seroma (n = 4), and 3 patients required touch-up surgery. There were no side-effects from the anesthesia, and there was no fluid overload. High-definition liposculpture using reciprocating power-assisted liposuction in local anesthesia is a safe procedure with a high satisfaction rate.

In power-assisted high definition liposuction (PA-HDL), large areas of the body surface are treated, followed by superficial aspiration along definition lines between muscle groups. Both factors can contribute to seroma formation. The purpose of this study was to evaluate if the use of vibration amplification of sound energy at resonance (VASER) prior to PA-HDL would increase the frequency of seroma formation. In this retrospective study, 164 male patients underwent PA-HDL with (n = 82) or without VASER (n = 82). No drains were used. Lymphatic drainage was performed in all patients. Seroma formation was determined by physical examination 1 and 2 weeks postoperatively. The incidence of seroma was 11% (n = 9) in the group with VASER treatment prior to PA-HDL, and 4.9% (n = 4) in the group without previous VASER use. The difference was statistically not significant ( P > .05). The most frequent area of seroma formation was at the lower part of the linea semilunaris. PA-HDL has an increased risk of seroma formation, which in our series was mainly located at the lower part of the linea semilunaris. VASER treatment prior to PA-HDL showed a tendency to further increase the risk of seroma formation in an open drainage—no-drains technique, albeit the difference was not statistically significant.

Large-volume fat transfer to the buttocks and breast has rapidly become popular. Lipofilling using syringes is tedious, time-consuming, and carries the risk of contamination. Most often, systemic anesthesia is being used. This study aims to evaluate the efficacy of large-volume lipofilling in local anesthesia. Local anesthesia was performed with 2 anesthetics: lidocaine and prilocaine. We performed vibration amplification of sound energy at resonance (VASER) and reciprocating power-assisted liposuction (PAL) for fat collection in a closed-loop system using a peristaltic pump. In a reverse pump setting, fat was then used for expansion vibration lipofilling. Pre- and postoperative data were collected. There were no major complications. Liposuction volumes up to 3.100 mL were extracted, and injection volumes ranged from 200 to 1600 mL. Mean operation time was 96 minutes. Satisfaction rate was high. Anesthesia was sufficient in all patients. Using a closed-loop system for fat extraction–purification and transfer is not only time- and cost-effective but also ideal for large-volume fat grafting. Recovery time is 1 to 2 days and satisfaction rate is high.

Neck liposuction in local anesthesia is a minimally invasive technique for fat reduction and skin tightening. The purpose of this study was to evaluate the clinical safety of reciprocating power assisted liposuction (PAL) of the neck. Neck liposuction with PAL was performed on 104 consecutive patients (male = 39, female = 65), and the occurrence of side effects were noted. There were no hematomas and no marginal mandibular nerve dysfunction. Transient alopecia at the site of liposuction was found in 3 out of the 39 male patients. In the hands of an experienced surgeon, reciprocating PAL of the neck is a safe method with a very low complication rate.