What is facial liposuction and how is it performed


Like body liposuction, the tumescent technique is advocated for removing facial adipose deposits. The entire face and neck region is prepared with chlorohexidine solution. After intravenous sedation with Ketamine and a mild tranquilizer, the tumescent mixture of normal saline and 1% lidocaine with 1:100,000 epinephrine in a ratio of 4:1 is infiltrated into the subcutaneous tissue with a 25-ml syringe and a long 22-gauge needle. The injection technique follows a radial pattern, fanning across the cheek down into the submental region, or across the intended area of liposuction from a point at the lobule–cheek interface. After infiltration of the tumescent/anesthetic solution, the skin should be relatively tense and somewhat blanched in appearance, typically achieved after infiltration of 20–25 ml into the each side of the face and 10–15 ml into the neck per side. A stab incision with a no. 11 Bard-Parker blade is undertaken again at the lobule–cheek interface, and Metzenbaum scissors are used to dissect a small pocket of 1–2 mm in dimension at the incision site.

A 3-mm liposuction cannula, not attached to wall suction, is introduced through the incision and passed in a radial fashion through the deeper subcutaneous plane from the facial to the cervical region in the intended area for liposuctioning. This undermining will facilitate uniform and uncomplicated liposuctioning. The cannula is then connected to the wall suction device in order to begin liposuctioning. The non-dominant hand should tent the skin upwards and guide the passage of the liposuctioning cannula, as the dominant hand controls movement and direction of the cannula. The cannula should be passed in a radial fashion from the deep subcutaneous plane eventually to the more superficial plane, all the time rotating the cannula. The senior cosmetic surgeon uses a proprietary liposuctioning cannula that permits freehand rotation of the cannula around a rotating bezel located at the base of the cannula. The non-dominant hand should always register the amount of thickness remaining in the skin flap and deeper tissues to gauge when to terminate the liposuction procedure. At the end of the procedure, the stab incisions are not approximated with any suture but left to close by secondary intention. A 4×4 gauze is used to roll out any remaining blood under the flap, which is expressed through the stab incision before a bulky pressure dressing is applied and retained for 48 h. A submental incision is avoided in the Asian patient, as this may predispose toward unfavorable healing. The lobule–cheek interface provides the least conspicuous point of entry for cervico-facial liposuction as well as optimal access to the face and neck regions. No more than 70% of the total fat should be removed so that adequate skin contraction can occur. Removal of greater than 70% may leave behind some loose skin that fails to contract and adhere to the underlying soft tissue.

In an individual who is older than 50 years of age, a more conservative estimate of 50% of fat should be removed owing to the poorer elastic quality of mature skin unless a concomitant rhytidectomy is planned to remove the excess skin. Liposuction alone with consequent skin adherence may provide the benefit of a mini-facelift. Unlike the thinner Caucasian skin, Asian skin is thicker and more resilient; therefore, a rhytidectomy that may be recommended for a 50-year-old Caucasian may be unnecessary in an equivalently aged Asian. Clearly, skin elasticity should be assessed prior to liposuction surgery in order to determine the best course of action. The cheek is an area that is more technically difficult to achieve uniform liposuctioning, and only 30% of the total adipose tissue should be removed. Care should be taken to assess flap thickness and uniformity as the procedure is undertaken.

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