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Management of Contour Irregularities following Superficial Liposuction

Castello, Manuel Francisco M.D.; Lazzeri, Davide M.D.; Agostini, Tommaso M.D.; Silvestri, Alessandro M.D.; Gasparotti, Marco M.D.; D'Aniello, Carlo M.D.

Plastic and Reconstructive Surgery: August 2011 - Volume 128 - Issue 2 - p 601-602
doi: 10.1097/PRS.0b013e31821ef017

Division of Plastic and Aesthetic Surgery; Clinica Ars Medica; Rome, Italy (Castello)

Plastic and Reconstructive Surgery Unit; University Hospital of Siena; Siena, Italy (Lazzeri)

Burn Center Unit; Hospital of Pisa; Pisa, Italy (Agostini)

Division of Plastic and Aesthetic Surgery; Clinica Ars Medica; Rome, Italy (Silvestri, Gasparotti)

Plastic and Reconstructive Surgery Unit; University Hospital of Siena; Siena, Italy (D'Aniello)

Correspondence to Dr. Castello; Divisione di Chirurgia Plastica e Ricostruttiva; Clinica Ars Medica; Via C. Ferrero di Cambiano, 29; 00191 Rome, Italy;

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We read with much interest the article by Youn Hwan Kim et al. entitled “Analysis of Postoperative Complications for Superficial Liposuction: A Review of 2398 Cases” (Plast Reconstr Surg. 2011;127:863–871).1 The article reports their 14-year experience in performing superficial liposuction and analyzes postoperative complications associated with these procedures in three subgroups of patients who underwent power-assisted liposuction alone (subgroup 1), power-assisted liposuction combined with ultrasound energy (subgroup 2), and power-assisted liposuction combined with external ultrasound and postoperative Endermologie (subgroup 3). We think the surgical technique performed by the authors is safe and effective, and we appreciated their accurate, well-documented article; however, we have a few comments regarding some of the topics.

Among major complications analyzed in their series, they reported contour irregularities in 3 percent of patients (n = 71). Although superficial liposuction has been popularized because of its redraping effect of the dermal flap by destroying connections between dermis and the subcutaneous fat, skin irregularities and depressions appearing after the initial healing phase following liposuction may be a frequent cause of the patient's disappointment about cosmetic outcomes.

A global consensus in treating these complications is lacking. Following the suggestions of Gasperoni and Gasperoni,2 Youn Hwan Kim et al. in their article1 highlighted the need to correct depressions immediately because of excessive fatty tissue removal by injecting some of the aspirated fat from areas not crushed by the ultrasonic energy. Unfortunately, as the authors stated,1 major visible skin irregularities, such as severe dimpling and retractions caused by excessive fat removal, could be dramatically appreciated only after the healing process, including areas that are insufficiently reduced by lipoaspiration. We agree with them in approaching false depressions by resuctioning the undertreated surrounding areas and true depression with fat tissue transfer in the overcorrected regions because areas of excessive or insufficient fat removal can yield an asymmetrical, unnatural, or otherwise disappointing result.

In our experience, secondary liposuction most often requires more surgical access for cannulas, allowing the surgeon to perform additional, strategic localized liposuction to correct asymmetries and areas that were insufficiently reduced by the primary procedure and autologous fat transfer in areas overreduced by the primary treatment. In this way, it should be possible to prevent further deformities by adopting extremely selective aspiration and injection and avoiding additional iatrogenic overtreatment and undertreatment. A careful evaluation to document the anticipated amount of secondary lipoaspirate or augmentation with fat grafts should be made, taking care to plan honestly the surgical removal of the persistent skin redundancy when present. Nevertheless, rarely should skin excision techniques such as brachioplasty, abdominoplasty, medial thighplasty, and circumferential body lift be combined with the treatment modalities described previously for areas of inadequate skin retraction, especially when patients remain dissatisfied after several operations.3

Patients are urged to maintain realistic expectations when considering corrective liposuction reintervention. As are all cosmetic procedures, secondary liposuction is far more complicated than performing the procedure the first time, even in experienced hands.

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The authors have no financial interest to declare in relation to the content of this communication.

Manuel Francisco Castello, M.D.

Division of Plastic and Aesthetic Surgery

Clinica Ars Medica

Rome, Italy

Davide Lazzeri, M.D.

Plastic and Reconstructive Surgery Unit

University Hospital of Siena

Siena, Italy

Tommaso Agostini, M.D.

Burn Center Unit

Hospital of Pisa

Pisa, Italy

Alessandro Silvestri, M.D.

Marco Gasparotti, M.D.

Division of Plastic and Aesthetic Surgery

Clinica Ars Medica

Rome, Italy

Carlo D'Aniello, M.D.

Plastic and Reconstructive Surgery Unit

University Hospital of Siena

Siena, Italy

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1. Kim YH, Cha SM, Naidu S, Hwang WJ. Analysis of postoperative complications for superficial liposuction: A review of 2398 cases. Plast Reconstr Surg. 2011;127:863–871.
2. Gasperoni C, Gasperoni P. Subdermal liposuction: Long-term experience. Clin Plast Surg. 2006;33:63–73.
3. Iverson RE, Pao VS. MOC-PS(SM) CME article: Liposuction. Plast Reconstr Surg. 2008;121:1–11.

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