Faculty Bibliography

BACKGROUND: There is increasing national dialogue on who should perform liposuction and where it should be performed. OBJECTIVE: To determine the effect of the location of liposuction surgery and the specialty of the physician on the incidence of malpractice claims. METHODS: Physicians Insurance Association of America malpractice data from 1995-1997 was analyzed. RESULTS: Hospital-based liposuction had more than 3 times the rate of malpractice settlements than office-based liposuction. Dermatologists accounted for less than 1% of malpractice claim settlements in liposuction. CONCLUSION: Dermatologic liposuction education has emphasized small volume cases performed under local anesthesia using the tumescent technique. The safety of this approach appears to be validated in terms of decreased malpractice settlements.

BACKGROUND: Tumescent liposuction has proven to be an extremely safe and effective method of liposuction. However, the infusion of tumescent anesthesia can take 1 hour or more to complete. OBJECTIVE: To document the types, dosages, and routes of administration of premedication utilized by four experienced tumescent liposuction surgeons. To determine if infusion rates for tumescent anesthesia are affected by types of premedication. METHODS: Four experienced liposuction surgeons were asked to review their most recent 100 tumescent liposuction patients with respect to types and dosages of premedication and routes of administration. Data were also provided on corresponding infusion pump settings and infusion rates. Volumes of tumescent anesthesia and corresponding volumes of fat aspirated were also collected on the same 400 patients. RESULTS: Infusion of tumescent anesthesia could be performed more rapidly in patients who were given greater amounts of premedication. Volumes of tumescent anesthesia infused were generally two or more times the volume of fat aspirated. Patients could be infused with less premedication if slow infiltration was employed. CONCLUSION: Infusion rates for tumescent anesthesia can be increased of greater amounts of premedication are given. However, this must be balanced against the safety of the premedication

Cutaneous resurfacing with lasers is still in its infancy. As with all new techniques, its proper place will be determined in the context of established procedures. Dermabrasion and chemical peeling have been used by dermatologists for cutaneous resurfacing for over a century. In many patients, any one of these three procedures can be used to achieve excellent results. For others, a specific procedure is clearly more beneficial. For many patients, combining the use of these three techniques achieves maximum benefit. This article discusses the use of combined techniques and when they are indicated

Since the importation of liposuction surgery into the United States more than a decade ago, we have witnessed a number of major technique changes and practice trends occur. One of us (L.M.F.) was the first dermatologic surgeon to undergo the 'lipsuction experience' (Paris, 1977) under the tutelage of Giorgio and Arpad Fisher and Pierre Fournier, and another (R.S.N.) the first to undergo training with Yves Illouz (also Paris). All three co-workers have served on teaching faculties of both the International and American Societies for Dermatologic Surgery, the American Society of Liposuction Surgery, and the American Academy of Cosmetic Surgery, have performed many hundreds of procedures, and have lectured/published on this subject on repeated occasions. We recognize certain vital changes and expansions have occurred during the past decade, and share our impressions of these with you

Dermatologists have been performing liposuction surgery safely since it was first introduced in the United States. Dermatologic surgeons have been in the forefront of development of new machines and cannulas and have safely adapted the procedure to an office surgical setting. They have made important contributions with the introduction of high volume dilute lidocaine/epinephrine solutions for local infiltration, in many cases using these solutions as the only anesthesia. The safety record for dermatologic surgeons performing liposuction has been excellent