Introduction: Managing and avoiding complications of VASER Liposuction
As with all surgical procedures, VASER Liposuction can incur complications. However, surgeons can manage and avoid most of these complications with precautions and careful planning. Below you will find a few of the most frequent side effects associated with VASER liposuction.
Hyperpigmentation Secondary to activation of melanocytes
Hyperpigmentation occurs secondary to over-activation of melanocytic cells.
Avoid this complication by utilizing several of the measures below :
- Addition of dexamethasone to the tumescent solution in the operating room
- Administration of Medrol dose pack in the early postop period
- Application of topical hydrocortisone for the first 2 weeks
- Patients are also asked to avoid direct sunlight for the first 3 months after surgery
- If hyperpigmentation is noted, patients are treated aggressively with topical hydroquinone 4% topically and placed on glutathione therapy (topical oral and intravenous)
- Identify patients prone to this complication who possess olive skin or are of Asian descent
Hyperinflammatory fibrosis may be observed because of two factors. The first factor involves unnecessary trauma from either mechanical irritation of the liposuction cannulas or excess ultrasound energy administration. The second factor results from avoidable swelling of tissues in the postoperative period.
Minimize risk of this complication by minimizing postoperative swelling and by optimizing VASER application and liposuction protocols.
- Post op swelling may be avoided by suppressing oozing of hyperinflammatory elements from the vessels into the tissues during surgery by avoidance of blood thinners well in advance of surgery.
- Minimizing tissue trauma by judicious use of liposuction cannulas to minimize mechanical trauma.
- Minimize intraoperative swelling with the addition of dexamethasone in the tumescent solution.
- Administration of Medrol dose pack taken by mouth in the early postoperative period will suppress postoperative swelling.
- Strict wearing of customized compression garments for two weeks after surgery is critical to restricting swelling.
- Avoid soft tissue fibrosis is avoided intraoperative with meticulous application of ultrasound energy to avoid unnecessary heating and injury to soft tissues and cells.
- Another technical modification involves performing all superficial ultrasound immediately following tumescent solution injection in to avoid heat transmission to the skin
- Precise ultrasound administration allows for emulsification of the fat without heat injury to the adjacent structures
- Recent VASER modles provide heat sensitive shut-off mechanism that avoids heat injuries
- Use of 5-ring instead of 2-ring VASER probes help avoid focal energy and subsequent burns as well
Finally, liposuction techniques have been optimized to manage any irritation of the soft tissues and cells:
- Avoid scarring and tissue complications by aggressive topical treatment of any areas that demonstrate vascular(blood flow) compromise as observed by mottling or bruising; these measures include judicious application of:
- Xeroform contains bismuth molecule that soothes the skin to optimize healing
- Bacitracin provides antimicrobial molecules that help against an infection
- Nitropaste increases blood flow to the injured areas to avoid vascular compromise
Contour Irregularities may occur from poorly employed intraoperative techniques or noncompliance with postoperative protocols.
Several measures can be taken to avoid intraoperative and postoperative period contour irregularities which include:
- During the intraoperative period, we caution against irregularities by performing accurate and uniform fat removal during both VASER emulsification of fat and the suction of the fat.
- In the early postoperative period, we minimize the risk of irregularity with the use of foam in-lays that are customized to ensure uniform pressures and ensure that fat cells settle evenly.
- Aggressive lymphatic massage daily for 10 days to avoid any clumping of the fat cells as they convert back to a solid state.
- Encourage reinstating your workout regime which will further ensure quick resolution of swelling and uniform settling of fat cells
- Weight maintenance throughout the postoperative period is critical to ensure optimized results
Conclusion: Managing and Avoiding Complications of VASER Liposuction
Managing and avoiding complications of VASER liposuction are quintessential when producing high definition body contouring results. Experience is critical to developing protocols and skills required to effectively use VASER liposuction to its full potential.