Many authors describe their approach to different body sites. Consent is obtained. Photographs are taken. The skin is prepared with a disinfectant. A sterile marking pen is used to draw a topographic map of the areas to be aspirated while the patient is standing. The insertion sites are marked. The patient is placed on sterile drapes and/or towels, and standard local anesthetic is used to infiltrate the skin of the insertion sites. A small entry is made into these sites by using a No. 11 blade, a NoKor needle, or a 1.5-mm punch.
The site is widened and pretunneled into the subcutaneous tissue by using a small, curved hemostat. A blunt infusion catheter is then inserted via this tunnel into the proposed surgical site, and tumescent anesthetic is delivered first to the deepest layer in a radial fashion and then successively more superficially. Infiltration of anesthetic is achieved with an electric-powered peristaltic pump. Some physicians prefer to use a spinal needle for infiltration without regard to specific insertion sites.
The liposuction cannulae, whether hooked up to machine aspirations or a syringe technique, are placed through insertion sites while the nondominant hand continually monitors the placement and the trajectory of the cannula. This “brain hand” also enables the surgeon to feel the progress of the area and to determine the endpoint of surgery. Once the desired result is obtained on the surgical table, the physician can have the awake patient stand up to judge if certain areas were missed and immediately return the patient to the table to complete the surgery. This technique has decreased the number of secondary procedures compared with the initial wet technique when patients were under general anesthesia or sedation.
Some surgeons choose to suture the insertion sites immediately postoperatively, whereas other surgeons allow them to heal with second intent to allow for more drainage, less bruising, and less inflammation. Compression garments and absorptive pads are applied for the immediate postoperative period. This varies from several days to several weeks depending on the surgeon. The garments actually provide better comfort for many patients. The immediate swelling is related to the anesthetic, and, as this decreases, surgical swelling is noted in the first 2 weeks. The size of the garment is often decreased as this swelling resolves. Return to physical activities may be within a few days depending on the patient’s comfort. Mild activity in the initial postoperative period is better than bed rest because it allows for better drainage and resorption of fluids, and it decreases stasis of blood flow in the extremities.
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