**6.3 Our philosophy and liposculpture**

Body contouring and three-dimensional sculpture surgeons are a self-selecting group who aspire to achieve excellence. This a commonality shared with artists who create 3 dimensional figurines.

It is important not to be bogged by the different names given to three-dimensional sculpturing of a human figure; however, the emphasis should be put on patient selection, safety, developing and refining skills. Embracing new advances in technology, is important, however, must come with appropriate training keeping patient safety at all times. We as plastic surgeons must stay true to form, and aspire to achieve more yet maintain a high level of safety and excellence in clinical outcomes.

Our philosophy is simple we use the relevant technology from traditional mechanical liposuction to energy delivery liposculpture based on what the patient and we wish to achieve.

For small areas like in submental fat removal we favour traditional syringe liposuction with fine cannulas (**Figure 1**).

When it comes to debulking and three-dimensional liposculpting we favour combining VASER, and a power assisted devices including Power-X and/or Microair for a safe, time efficient and excellent body contouring cosmetic outcomes (**Figures 2** and **3**).

#### **Figure 1.**

*A 57-year-old female underwent syringe liposuction with 2 mm cannula for her neck. The figure shows preoperative and 3 months postoperative results.*

#### **Figure 2.**

*A 36-year-old female BMI 28 underwent VASER body contouring and liposculpture. Figure shows preoperative and 7 months postoperative results.*

**Figure 3.**

*A 38-year-old female patient, BMI 29.5 underwent VASER body contouring, and body sculpture. The figure shows preoperative and 6 months postoperative results.*

More importantly we perform a large number of the cases under local anaesthetic with or excluding sedation. This facilitates a quicker patient recovery, removing the risks of general anaesthetic yet maintaining a high level of safety.

Our choice of infiltration is normal saline 1 litre, 50 mls of 1% Lidocaine, 1:1000 1 mg of adrenaline with 10 mls of 8.4% bicarbonate to reduce the acidity of the local anaesthetic and normal saline. Tranexamic acid one gram is given intravenously 30 min prior to surgery and 4 hours after induction to reduce bruising, bleeding, and possible haematomas post op. The total dose of Tranexamic acid for the first 24 hours is 2-3 grams.

We use a ratio of infusate to lipoaspirate of 1:1, effectively the superwet technique, however, using a tumescent fluid mixture and we allow for 15-20 minutes of time prior to commencing the treatment. Accepting that BAAPS, ASPS, ASAPS limit the lipoaspirate volume to 5 litres per session; however, in our practice and based on our philosophy and experience we limit the lipoaspirate to 4 litres in any one sitting for safety reasons with an infusate of up to 4 litres. Hartmann's solution is another choice for the infusion mixture instead of normal saline as it is less acidic with a lesser sodium load thus reducing fluid overload in large volume liposuction. We do not exceed a Lidocaine dose of 35 mg/kg and we do not exceed an adrenaline dose of 0.07 mg/kg.
