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Cited by 184Body Contouring and SurgeryFacial Rejuvenation and Surgery TechniquesDermatologic Treatments and Research

A Classification of Facial Wrinkles

Open access
Lemperle, Gottfried, Holmes, Ralph E., Cohen, Steven R., Lemperle, Stefan M.·2001·Plastic and Reconstructive Surgery
DOI 10.1097/00006534-200111000-00050
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Abstract

Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management techniques, increasingly larger and larger volumes of liposuction aspirations have been reported. Unfortunately, with these larger volumes of liposuction being routinely performed, greater rates of complications have also been reported, with the worst of these resulting in deaths. In a response to the increasing concerns over the safety of large-volume liposuction, a critical review of the senior author's own series has been performed to evaluate risks and benefits and to recommend guidelines for safe and effective large-volume liposuction. A retrospective chart review was performed on 631 consecutive patients who underwent liposuction procedures of at least 3000 cc total aspirate. All procedures were performed by the same senior surgeon between January of 1986 and March of 1998. Before September of 1996, traditional liposuction techniques were used. After September of 1996, ultrasound-assisted liposuction was performed. The superwet technique of fluid management was employed for all procedures performed after 1991. The particulars of the surgical and anesthetic techniques used are reviewed in the article. Data collection included preoperative patient demographics, preoperative and postoperative weights and measurements, and preoperative and postoperative photographs. Total aspirate volumes, fluid intakes, and fluid outputs were measured, and all complications were tallied. Average follow-up was 1 year. Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight. Total aspirate volumes ranged from 3 to 17 liters, with 94.5 percent of these under 10 liters. Fluid balance measurements showed an average of 120 cc/kg positive fluid balance at the end of the procedure, with none of these patients experiencing any significant fluid balance abnormalities. Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative seromas. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have uneventful recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Meticulous fluid balance calculations are necessary to avoid volume abnormalities, and experience is mandatory when performing the largest aspirations. Cosmetic benefits are excellent, and overall complication rates are low.

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  • Recent advances in liposuction techniques make it possible to remove considerable amounts of subcutaneous adipose tissue.

    “Recent advances in liposuction techniques now make it possible to remove considerable amounts of subcutaneous adipose tissue.9”

    From Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease (2004) · cites this paper as [9]

    The Objectives and Measurements sections discuss classifying and measuring facial wrinkles, not liposuction. Searches for liposuction, subcutaneous fat removal, and suction lipectomy found no passage addressing whether recent techniques permit removal of considerable amounts of adipose tissue. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 3

  1. [14]14. Kesselring, U. Direkte Faltenexzision im Gesicht. In G. Lemperle (Ed.), Aesthetische Chirurgie. Landsberg: Ecomed-Verlag, 1998.
  2. [23]23. Pfeiffer, J. The character of CEREC 2. In W. H. Moer- mann (Ed.), CEREC l0-Year Anniversary Symposium. Chicago: Quintessence, 1996.
  3. [24]24. Fleiss, J. L. The Design and Analysis of Clinical Experiments. New York: Wiley, 1986.

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Authors
Lemperle, G., Holmes, R. E., Cohen, S. R., & Lemperle, S. M.
ORCID
Venue
Plastic and Reconstructive Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2001-11
Volume
108
Issue
6
Pages
1751-1752
ISSN
0032-1052 (ISSN-L)
DOI
10.1097/00006534-200111000-00050
OpenAlex
W2057486472
Semantic Scholar
0becd0269687a2dfa6f0b0a19f48b63119d098b8
Cited by
184
References
35
Citations by year
2026: 1 · 2025: 5 · 2024: 7 · 2023: 12 · 2022: 11 · 2021: 10 · 2020: 14 · 2019: 9 · 2018: 7 · 2017: 3 · 2016: 11 · 2015: 6 · 2014: 3 · 2013: 5 · 2012: 3
FWCI
4.62
Type
journal article
Language
en
Open access
Locations
  • Plastic & Reconstructive Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Body Contouring and Surgery
  • Health Sciences › Medicine › Dermatology › Facial Rejuvenation and Surgery Techniques
  • Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
Keywords
large-volume liposuction, ultrasound-assisted liposuction, fluid management, fluid balance, seroma, pulmonary edema, postoperative pneumonia, cosmetic outcome, patient safety guidelines, postoperative weight loss, postoperative weight gain
MeSH terms
Adolescent, Adult, Aged, Anesthesia, Body Weight, Epinephrine, Female, Humans, Male, Middle Aged, Obesity, Retrospective Studies, Water-Electrolyte Balance, Lipectomy

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