Minor and transient irregularities are the rule with liposuction of the cervicofacial regions as compared with the potentially serious complications after whole-body liposuction procedures. Unlike body liposuction procedures where large-volume fat reductions can cause rapid fluid shifts, blood loss, and blood pressure problems, liposuction in the head and neck rarely influences the patient's hemodynamic status. As indicated earlier, typical volumes extracted range from 10 to 100 cm of fat.
Infections are rare, occurring in less than 1% of patients.8Preoperative antibiotics are not required, but most surgeons in the private-practice arena are utilizing at least one dose of perioperative intravenous antibiotic. Hematoma, seroma, or sialocele is seen in less than 1% of patients when liposuction is used as a primary procedure. Sialocele is more common when liposuction is done over the parotid bed, and treatment may require a pressure wrap, use of anticholinergics, or drainage. When liposuction is used as an adjunctive technique, the more invasive procedure, such as rhytidectomy, may increase the rate of fluid collection. Effective treatment of a fluid collection is usually done with simple needle aspiration or expression from an incision line.
Longstanding irregularities may exist in the form of saggy skin or dermal scarring. Extra sagging skin may result from poor patient selection or unexpected senile or presenile skin changes, and may require a rhytidectomy. Scarring may be the result of poor healing, poor operative technique, or infection. Excessive thinning of the dermal fat cover or mis-direction of the cannula lumen may create this problem. Options for correction of dermal scarring are limited.
Uneven aspiration may create asymmetry and usually diminishes with surgical experience. A touch-up procedure may be accomplished in the office suction technique, coupled with a small sculpting cannula. Areas that are too small for even sculpting may be addressed with cautious injection of 0.1 to 0.2 cm3 of 10 mg/mL triamcinolone acetate solution at 4- to 6-week intervals. Overinjection or too frequent injections may result in dermal thinning, dimpling, and formation of spider telangiectasias.
Small, localized postoperative depressions usually require a soft-tissue filler. Collagen or autologous fat may be effective for this purpose but is usually a temporary fix. Larger deficiencies may require use of synthetic materials, such as submalar cheek implants, or dermal graft materials, such as an acellular dermal sheeting graft (AlloDerm) (Fig. 19-12).
Figure 19-12 Operative intervention in the form of facelift and placement of acellular dermal grafting material, for the correction of buccal/jowl defects after liposuction.
Obviously, the best treatment is prevention, and this cannot be emphasized enough.
Permanent injury to the marginal mandibular branch of the facial nerve is rare as is hypesthesia secondary to injury to the great auricular nerve. When paresis, paresthesia, or paralysis occurs, it is almost always short-lived and resolves with the tincture of time.
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