Large Volume Liposuction A Safe Adjunct in the Management of the Obese Patient

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1 Large Volume Liposuction A Safe Adjunct in the Management of the Obese Patient Dr Josef Goldbaum MBBS FAMAC FACNEM FFMACCS Liposuction Australia 668 Chapel Street, South Yarra 3141 MELBOURNE, AUSTRALIA Presented to ACCS, CPSA & AAFPS CONFERENCE 2006 Adelaide April, 2006 Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

2 YUCK!!! Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

3 Liposuction is widely accepted as a safe method of removing unwanted / or excess fatty deposits. What is still debatable is the maximum volume of fat that can be removed at any one time, without subjecting the patient to unnecessary dangers. Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

4 Current Advised Standards By volume 5 6 litres By relationship to body weight Less than 5% of body weight By the number of additional surgical procedures Large volume liposuction should not be combined with other surgical procedures By the type of anaesthesia used Dilute local anaesthesia allows larger volumes of fat to be removed safely. Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

5 Removal of large volumes of fat is safe provided that v Adequate monitoring (cardio pulmonary) v Stress free procedure v Local anaesthesia only v Primarily fat, aspiration with minimal serous/blood aspirate v Concentration of fat deposits into specific areas v Fat is aspirated easily v Cannula size is 4 mm or less Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

6 The scope of full tumescent (turgid) local anaesthesia is limited by the quantity of Xylocaine required. The wet / superwet technique of dilute local anaesthesia allows more areas and larger areas to be treated, whilst still maintaining a safe level of Xylocaine. Thus this modification of tumescent local anaesthesia has expanded the cosmetic applications of liposuction to include a therapeutic application by the significant lowering of overall body fat content. Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

7 Liposuction can be Therapeutic Chest Arms / Axilla Abdomen Hips TOTAL Weight of fat removed Body weight 800 ml 2000 ml 3000 ml 1500 ml 7200 mls 7100 mls 124 to 117 kgs Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

8 Liposuction can be Therapeutic The removal of large numbers of nonregenerative fat cells has the potential to Reduce the cardiovascular and other risks known to be associated with torso obesity. Reduce insulin resistance Increase basal metabolic rates Increase self awareness and body image Increase self esteem and motivation Body weight Abdomen Hips Medial Thigh Lateral Thigh 67 kgs 1600 mls 1200 mls 800 mls 600 mls TOTAL 4200 mls Weight of fat removed 3900 mls Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

9 Patients Review Number of Patients Studied = 100 Period of Study - Jan Apr 2004 Sex of Patient Male 16% Prerequisite Removal of 4000ml of fat or greater at the one time. Female 84% Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

10 BMI - % % 45 - plus 4% 4% % plus Weight of Patient - Kg 10% % 24% % % % % N = 100 Patients % % N = 100 patients Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

11 Technique Patients receive oral anxiolysis (Ativan 2.5mg), as premedication, followed by IM Pethidine mg and Phenergan mg. Deep infiltration is commenced slowly and gently followed by rapid infiltration of middle and superficial layers. After minutes delay, liposuction is commenced with occasional top-ups of infiltrate if and when required. Final body contouring is carried out on the or standing patient. seated and/ Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

12 Volume of Fat Removed - mls plus 5% % % Mls % Total Volume of Fat Removed Litres 32% 100 Patients Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

13 Weight of Fat Removed Weight of fat is approximately 10% less than volume Gm Patients Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

14 Weight of Fat Vs Weight of Patient % 5.5% Average Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug %

15 Body weight 92.4 kgs Abdomen Hips Buttocks / Outer Thigh 2800 mls 1400 mls 3000 mls Weight of fat 6500 gms % weight of fat over weight of patient 7.03% Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

16 15 July July March 04 Body weight 94 kgs 92 kgs 86 kg Waist 93 cm 90cm Umbilicus 104 cms 99 cm Hips 122 cm 114 cm Volume of fat removed Weight of fat over weight of patient % 7000 ml 4200 ml Abdomen hips & buttocks Medial thigh & knee 2100 ml Arm & Axilla 6.7% 4.1% 2.2% Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

17 8000 Infiltrate - Total Amount - Xylocaine (Mg) 8% 8% Infiltrate - Total Amount - Xylocaine (Mg) 11% plus % Mgs % Patients Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

18 Xylocaine Mg per Kg Average Patients Mg per Kg Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

19 % Mg Xylocaine per Litre of Fat Removed 762 Average 100 Patients % Mg/Lt A Xylocaine concentration of 1000 mg per litre allows removal of 1 litre of fat using 760 mls of infiltrate. A Xylocaine concentration of 1200 mg per litre allows removal of 1 litre of fat using 630 mls of infiltrate. Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

20 Total volume of fat removed 5.5 litres in one procedure Total volume of fat removed litres in two procedures Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

21 Complications - Intraoperative / Post operative 5 Number of Patients Transient Post Hightened operative Sensitivity Nausea/Vomiting Requiring additional analgesia (pethidine) Transient Hypertension DVT / PE Allergy Infec tion Xyloc aine Toxicity Complications Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

22 3 Dec Jan March May 2002 TOTALS Weight 109 kg 99 kg 97 kg 92 kg 17 kg Waist 102 cm 98 cm 96 cm 6 cm Umbilicus 118 cm 102 cm 101 cm 17 cm Hip 136 cm 123 cm 114 cm 22 cm Thigh 82 cm 74 cm 74 cm 69 cm 13 cm Areas Treated Hips, buttocks & outer Thighs Arms, axilla, back, waist, abdomen & chin Front and inner thigh, & knee Volume of Fat Removed 8600 mls 5400 mls 3800 mls 17.8 litres Weight of fat removed 7.3 kg 4.8 kg 3.2 kg 15.3 kg Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

23 Observations In this series of 100 patients treated over 3 years, large volumes of fat were removed utilising the wet technique of dilute local anaesthesia. The volume of fat removed represented a significant loss of adipose tissue as well as a reduction in body mass /weight. There were no significant complications in this series and all procedures were performed in the tightly controlled office environment of the author. In addition to reduction in fat mass and body weight, attention to aesthetics allowed even the obese patient to look and feel good about themselves. With the rare exception of peculiar skin types, skin retraction never became an issue of discontent. Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

24 27 August October 03 Body weight 89 kg 82 kg Waist 93 cm 87 cm Hips 119 cm 115 cm Thighs 80 cm 69 cm Volume of fat removed 6400 mls Abdo 1800 mls Butt/ot 4600 mls % weight of fat over weight of patient Xylocaine Xylocaine required per litre of fat removed 6.5% 3200 mgs in 3 litres of infiltrate resulting in 36 mgs per kg body weight 500 mg Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

25 Phew!!! Thank goodness that s out. Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug

26 Conclusion Large Volume Liposuction is a Safe Adjunct in the Management of the Obese Patient Dr Josef Goldbaum MBBS FAMAC FACNEM FFMACCS Liposuction Australia 668 Chapel Street, South Yarra 3141 MELBOURNE, AUSTRALIA Presented to ACCS & CPSA COMBINED ANNUAL CONFERENCE 2004 Canberra 27th 30th August, 2004 Dr Josef Goldbaum ACCS & CPSA Annual Conference 27 Aug 30 Aug