44 March 2016 March 2016 45 Expert guide: Aesthetics & Cosmetology 2016 Modern Liposuction has evolved from humble beginnings as a rather experimental procedure some 40 years ago, to being one of the most popular procedures in aesthetic surgery today. It was the second most popular aesthetic proce-dure globally (1,372,901 cases) 1 in 2014, as well as in the United States (222,051 cases) in 2015, up 5% from 2014.2 Subsequent to Illouz’s presentation of a tech-nique for removing subcutaneous fat with a blunt cannula attached to a suction generat-ing device at the 1982 Annual Meeting of the American Society of Plastic and Reconstructive Surgeons, the procedure has undergone many refinements and evolved with improvement in techniques and technology.3 My endeavour in this article is to briefly discuss current evidence based best practice principles and highlight future trends. Potential liposuction patients who strive to improve their appearance through diet, exer-cise, and a healthy lifestyle are more likely to be satisfied with their long-term postoperative results.4 It is paramount for both the patient and the surgeon to remember that liposuction is not a weight-loss technique, it is a body reshaping (contouring) technique.A consensus statement on large-volume lipo-suction (defined as >5 litres of total aspirate), regardless of anaesthetic method, has under-scored the recommendation for operating in either an acute-care hospital or in an accredited or licensed facility when removing large vol-umes.5 Depending on patient characteristics liposuc-tion can be done either in a hospital or office based setting, but the American Society of Plas-tic Surgeons Practice Advisory recommends avoiding neuraxial anaesthesia (i.e., spinal, epi-dural) in office-based settings because of poten-tial hypotension and volume overload issues.6 The superwet (infiltration of 1 mL per estimated mL of expected aspirate) and the tumescent (3 to 4 mL of wetting solution per mL aspirated) are the most widely used wetting techniques in operation. The maximum recommended safe dose of lidocaine is 55mg/kg and that of epi-nephrine .07mg/kg in the solution.7, 8 Recent data suggest that, for patients undergoing gen-eral anaesthesia with the superwet technique, the lidocaine component may be reduced and/or eliminated without postoperative sequela of Dr. Salil Bharadwaj www.bsh.com.bh salil.bharadwaj@bsh.com.bh +973 3605 5143 Liposuction: Current evidence based practice guidelines and future trends By Dr. Salil Bharadwaj Bahrain