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Liposuction (Lateral Thigh)

Liposuction (Lateral Thigh)

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Preoperative Considerations

Consent:

  • Bruising, swelling, and pain in the treated areas.
  • Risks associated with anesthesia.
  • Infection at the site of incision.
  • Irregular contours or asymmetries.
  • Changes in skin sensation or numbness.
  • Scarring.
  • Excessive fluid loss or fluid accumulation.
  • Deep vein thrombosis, cardiac, and pulmonary complications.
  • Persistent swelling or pain.
  • Need for revision surgery or additional treatments.

Anesthesia/Positioning:

  • Supine

Other:

  • None

Armamentarium:

SUPPLIES:

  • 1 Basic Pack
  • 1 Split Sheet
  • 1 Mayo Cover
  • 1 Raytec
  • 1 Specimen Cup
  • 1 Lipovage Set
  • 2 Pack Sterile Towels
  • 3 Gowns
  • 1 Yankeur (HOLD)
  • 1 Tumescent Tubing
  • 1 Bed Cover
  • 2 Gloves (8)
  • 2 Gloves Scrub
  • 1 BSS
  • 1 4x4 Gauze
  • 1 Blue Pad
  • 1 Bandaid
  • 4 Carpules
  • 1 Dental Needle 30g
  • 1 Spinal Needle 22g
  • 5 Syringes 1 cc
  • 2 Syringe 5cc
  • 1 Blade #11
  • 2 Donuts

PREP:

  • Tumescent Handle
  • Tumescent Tubing
  • Spinal Needle 22g
  • 4x4 Gauze
  • Specimen Cup
  • Small Bowl
  • Carpules (4)
  • Gloves (8)
  • Dental Syringe
  • Dental Needle 30g

MAYO:

  • Deans
  • Browns
  • Knife Handle #7
  • Small Needle Driver
  • Large Bowl
  • Fat Transfer Cannulas

SUTURE:

  • 1 Plain Gut 5-0 P-3

DRESSINGS:

  • Bandaid
  • Bacitracin Ointment

INSTRUMENTS:

  • Light Handle
  • Tumescent Unit
  • Fat Transfer Set
  • Soft Tissue Set

EQUIPMENT:

  • Tumescent Unit

Notes:

  • If the patient is a woman, take fat from thigh.
  • If the patient is a man, take fat from abdomen.
  • If fat transfer ONLY, ensure to pull a knife handle #7, needle driver, scissors, and stat.

Technique

Postoperative Considerations

Immediate:

  • Encourage ambulation

Follow Up:

  • Reinforce that irregularities will smoothen out with time

Operative Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): ***

Anesthesia: General

Implants: None

Specimen:***

Drains: None

Fluids: See anesthesia record

EBL: Minimal

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

Tumescent solution mixture was prepared by combining 50cc 2% lidocaine, 10cc TXA, 1cc of 1:1,000 epinephrine in 500cc of 0.9% normal saline. This preparation was injected into the left lateral thigh in the subcutaneous plane (500 cc); in the subperiosteal and subpericranial space of the forehead and scalp to the vertex and in the superficial temporal spaces bilaterally (500 cc); subcutaneous plane of the face and neck (500 cc); subcutaneous plane of the face and neck (500 cc). The surgical sites were again prepped with Chlorohexidine scrub and draped in the standard sterile fashion.


Autologous fat transfer:
An #11 blade was used to make a 7 mm access incision in the left lateral thigh. Liposuction was performed using a 3 mm single hole blunt cannula attached to the LipiVage syringe. Liposuction was completed with minimal pressure on the cannula ensuring parallel movement in all directions and staying in the subcutaneous plane. Increments of 5 cc were harvested, cleaned, compressed, and transferred into 1 cc syringes. A total of 15 cc of fat was harvested and the access port was closed with 4-0 plain gut.

Next, an #11 blade was used to make access incisions in the nasal alar bases bilaterally. The harvested fat was injected in a submuscular plane using a 1.2 mm two hole luer lock blunt tipped cannula into the bilateral midface, nasolabial folds,

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

Coding

  • 15771 (fat grafting to the face for contouring, volume restoration, or rejuvenation)
  • 20926 - This code covers tissue grafts involving fat, dermis, or other soft tissues. It's used for the actual transfer of the harvested tissue to another site, such as from the thigh to the face.

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