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Liposuction is one of the most commonly performed procedures, but the limitations and advantages of the procedure must be explained to the patient. Alternative procedures should be discussed, which usually include abdominoplasty. This will help to guide the patient in making an informed decision when choosing liposuction of the abdomen versus abdominoplasty. There are many different ways and techniques of performing liposuction. The vibrotumescent liposuction technique has many advantages.It is explained to the patient that liposuction has a rapid recovery time and the patient can usually return back to a normal daily routine after only a few days and there is much less morbidity and mortality associated with liposuction in contrast to abdominoplasty. A much more sculpted appearance can be obtained with liposuction than with a conventional abdominoplasty since when an abdominoplasty is performed, many surgeons prefer not to liposuction the flanks and the sides of the abdomen. Liposuction of the lower abdomen and the upper abdomen allows sculpturing of the lateral areas to a degree that has a properly esthetic appearance in combination with the patient's hips and lateral thighs. When performing liposuction, there is always the question of skin retraction. With the vibrotumescent technique, good skin retraction can be achieved depending on the type skin and the age of the patient (Fig. 20.1). Even stretch marks of the skin can be improved ( Fig. 20.2). The vibrotumescent liposuction also has minimum bruising and minimal blood loss during and after surgery (Figs. 20.1, 20.2). Minimal blood loss during surgery and minimal bruising after surgery is also partly dependent upon preoperative care instructions. The vibrotumescent technique can achieve better results than with conventional tumescent liposuction even with the addition of internal ultrasound and/or external ultrasonic assisted liposuction. There are fewer complications, skin necrosis, and skin burn. One other advantage is improvement of cellulite. Although there may be claims that liposuction can treat the cellulite problem, most patients having vibroliposuction have noticed improvement in their cellulite, decreasing by over 50 %. The vibrotumescent technique appears to break up the trabecular attachments of the skin to the underlying structures, which is the primary cause of the cellulite formation. Another advantage of the vibrotumescent technique is the even distribution of the tumescent fluid, which is infiltrated into the subcutaneous fat of the areas undergoing liposuction. This will alChapter 20

The axillary approach to breast augmentation is used because of the hidden scar that is produced high in the axilla. There is, however, the possibility of neurologic injury because of the proximity of both motor and sensory nerves in the region of the dissection. Full knowledge of the anatomy of the axillary nerves is essential for the surgeon using the axillary approach. There are also techniques that can be used to prevent neurological involvement.

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