Abstract:

Aim: Liposuction is a popular plastic surgery procedure with a growing number of cases. Despite advancements, complications remain a significant concern. Modifications like ultrasound-assisted techniques aim to improve safety and efficacy. The aim of this study was to assess the postoperative complications in patients who underwent a vibration amplification of sound energy at resonance (VASER®)-assisted liposuction (VAL) procedure. Materials and Methods: A retrospective study of 1,486 VAL cases was conducted. Patient demographics, surgical procedures, postoperative care, and complications were recorded. Results: Of 1,486 patients, 45 (3.02%) experienced minor complications including loss of sensitivity, tissue stiffness, seroma, hyperpigmentation, and prolonged edema. No major complications or fatalities were observed. There was no significant correlation between fat aspirate volume and complications. Conclusion: VAL demonstrates safety and effectiveness, with a relatively low complication rate. Sensory loss and tissue stiffness were the most common complications. Hyperpigmentation was transient and resolved with postoperative care. Attention to patient selection, meticulous technique application, fluid management, and postoperative care is crucial to minimize complications in VAL procedures. Further studies are required to explore the specific impacts of ultrasound-assisted liposuction on patient outcomes. INTRODUCTION As of 2021, liposuction stands out as the most prevalent plastic surgery procedure, for both women and men, with an increasing popularity, boasting a 25% increase, which corresponds to approximately two million cases in the United States alone1. Furthermore, the report also describes the liposuction as the second most common plastic surgery procedure, accounting for 59,696 cases, which is 12.9% of all cases. The liposuction is briefly defined as a suction-assisted removal of fat tissue using various cannulas, and the procedure can be conducted under either general or local anesthesia. The amount of adipose tissue removed during liposuction can vary significantly, ranging from a few hundred milliliters to several liters. However, irrespective of the surgeon’s expertise and the utilized technique, the procedure causes significant complications due to several factors such as inappropriate selection of patients, disturbances in the perioperative and postoperative care, and several unpredictable issues2. In order to overcome these challenges and possible complications, several modifications, including ultrasound-assisted liposuction (UAL), the injection of a tumescent solution into the targeted area, a subdermal or superficial approach, and the utilization of a wide-range of cannulas, have been suggested. All these modifications aim to enhance the safety and efficacy of the liposuction procedure. In the existing literature, the overall complication rate associated with liposuction has been documented within the range of 8.6-20%. The most prevalent complication is contour deformity, which has been reported in approximately 20% of cases. Other complications include seroma, hyperpigmentation, asymmetry, and hypertrophic scar, but these are less common3,4. Major or life-threatening complications, including skin necrosis, infection, necrotizing fasciitis, pulmonary embolism, and fatal outcomes, have been documented in approximately 0.02-0.25% of liposuction cases5,6. In this article, we briefly reviewed and discussed the postoperative complications in our patients who underwent a vibration amplification of sound energy at resonance (VASER®)-assisted liposuction (VAL) procedure. MATERIALS AND METHODS The study cohort comprised 45 patients in 1,486 VAL cases, who experienced complications following the procedures performed between January 2018 and February 2023. All patients provided informed consent, and the study was conducted in accordance with the Declaration of Helsinki. Ethical approval for the study was granted by the İstanbul Atlas University Local Ethics Committee (document no: 27247, date: 10.05.2023). Patients with pre-existing chronic medical conditions such as diabetes mellitus, anemia, or disorders affecting the cardiovascular, renal, or hepatopancreaticobiliary systems were excluded for liposuction procedures. The inclusion criteria encompassed patients who had undergone VAL procedures, did not exhibit the aforementioned exclusion criteria, and had developed postoperative complications. These patients were closely monitored until the resolution of their complications. All operations were performed by the same board-certified plastic surgeon under general anesthesia. Prior to surgery, the patient’s surgical site was prepared with a povidone-iodine solution, and the patient was draped in a sterile manner and given the prone position. A tumescent solution prepared with 1 mg adrenaline and 10% anti-arrhythmic (lidocaine hydrochloride) into each 1000 mg Ringer’s lactate solution was infiltrated in the areas of liposuction and fat harvesting. The liposuction procedures employed third-generation VASER® technology and encompassed multiple areas of aspiration, including the abdomen, gluteal region, arms, flanks, back, and thighs. During the procedure, VASER® cannulas with dimensions of 3.7, 2.9, and 2.2 mm were employed, operating in both continuous and pulse modes. The VASER® mode was configured at 100% energy (C) using a 3.7 mm 5-groove probe, with an infiltration rate of 100 mL per minute, allowing the fat emulsification. The liposuction was performed using the conventional technique, employing 3-4, and 5 mm reverse triangular cannulas on specific regions and maintaining a flow rate of 24-26 mmHg per second. Patients were given prophylactic antibiotherapy with a single dose of the first-generation cephalosporins prior to, and pain medication with non-steroidal anti-inflammatory drugs such as acetaminophen or ibuprofen after the procedure. Patients were advised to wear compression garments for a minimum of one-month post-surgery and to undergo regular lymph drainage massage for at least 15 days. To ensure proper postoperative care, all patients were scheduled for follow-up visits, including check-ups, and photographs were taken of those residing abroad.

Keywords: