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2 Surgical Anatomy oftheBody inRelation toLipocontouring
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Fig. 2.20 The Bermuda
triangle marked in red
27
2.4 The Lower Extremity
Thighs are one of the biggest concerns in people who are
short and specially women of the Indian subcontinent. The
major blood vessels as well as the nerve supply are well hidden in the deeper muscles, as seen in Fig.2.21. The only area
where injury to important structures is possible during liposuction is in the femoral triangle.
The most common area of localized fatty deposits (lipo
dysmorphia) on the thighs that causes the maximum concern and requests for treatment is the trochanteric area of the
lateral thigh or saddlebag area (Fig.2.22). The second most
commonly requested area for liposuction treatment includes
the upper portion of medial thighs most of the times, including the area from the adjacent anterior-medial or posteriormedial thighs (Fig.2.22). Sometimes, the fatty deposition
can extend along the entire internal medial thigh extending
to the knee. These fat deposits cause a medial bulge below
the inguinal ligament extending into the groin area.
The fat of the anterior thigh is spread out more diffusely
rather than being localized as in other anatomical locations.
The fat in the supra-patellar area is another problem that most
women request to be treated separately from the rest of the
anterior thigh area. The supra-patellar area of the anterior
thigh is many a times associated with ne waviness and
crepey skin that may need skin tightening treatment along
with fat removal. The posterior thigh is the area that is least
requested for liposuction with a very regular exception being
the proximal infragluteal fold or so-called “banana fold.” In
contrast to the rest of the posterior thigh, this fatty roll is a
rather common problem (discussed in Chap. 20). There exists
a distinct plane in the subcutaneous tissue, which is the lamellar layer present deep to the supercial fascia that allows passage of liposuction cannula with least resistance. This is the
right layer in which fat deposits should be aspirated.
2.4.1 Trochanteric Regions
• There is a signicant fat deposit in the lamellar layer that
makes the panniculus very heavy.
• People who do not have a predisposition for localized adiposity have very good proportion between the areolar and
the lamellar layers when they have normal weight. This
proportion remains intact; even if they put on weight the
body stays in shape and maintains the overall balanced
contour.
• When people have a localized deformity, it usually is
caused by excessive fat deposition in the lamellar layer,
which can be eight to ten times thicker than in normal
people, while the areolar layer only doubles in
thickness.
• Therefore, liposuction treatment in the trochanteric region
should be carried out at a deeper level maintaining a
respectable 3 cm thickness of the overlying panniculus
made of the areolar layer all over the area to achieve a
uniform smooth aesthetic result unlike the 2cm panniculus that has to be left behind in the abdomen.
28
5
4
3
ab
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Fig. 2.21 (a) The primary
arterial and venous supply
(femoral artery and vein) and
femoral nerve as they pass
below the inguinal ligament
onto the anterior thigh below
the muscles. (b) Lymphatic
drainage of the lower limb
into the supercial and deep
inguinal group of lymph
nodes
Superficial inguinal
lymph nodes (1)
(superior group)
Deep inguinal
lymph nodes (2)
Superficial inguinal
lymph nodes (3)
(inferior group)
M. Thomas and J. D’silva
Femoral vein
(5)
Saphenous
opening (6)
1
Great saphenous
vein (4)
2
6
Fig. 2.22 Images showing the medial, anterior, and trochanteric areas of fat deposits in a typical female pattern fat deposit
2 Surgical Anatomy oftheBody inRelation toLipocontouring
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29
2.4.2 Anterior Surface oftheThigh
• Skin of the anterior thigh is thick and adheres rmly to the
subcutaneous layer.
• The subcutaneous tissue is almost entirely composed of
the areolar layer that has round and turgid cells adherent
rmly to the dermis (Fig.2.23).
• In thin patients the lamellar layer is practically
nonexistent.
• The muscle aponeurosis and the areolar layer are separated by the fascia supercialis.
• Since the subcutaneous tissue and skin can slide very easily in this region, the thickness can be very easily assessed
by the Illouz test and liposuction in this area has to be
done with caution as most of the fat is supercial.
It is very common for patients to complain of “cellulite”
in this region.
Applied Anatomy Visible surface irregularities are very
common with radical removal of fat from this region, which
is seen in the form of unsightly waves.
2.4.3 External Surface oftheThigh
• This area that is very similar to the anterior surface of the
thigh has a thinner areolar layer with a nonexistent lamel-
lar layer; hence this area is considered as a zone of
adherence.
• The fascia is between the areolar and the
aponeurosis (ilio-tibial tract). As a result, release of skin
fascia adhesions by liposuction can cause the panniculus
to slide on the muscular level and leave tissue laxity in the
supra-knee area.
2.4.4 Posterior Surface
• The anatomical distribution of fat in this area and its histology is similar to that seen on its anterior surface.
• Hence, liposuction should not be performed or performed
with adequate caution on the posterior, external, and anterior surfaces of the thigh (Fig.2.24).
2.4.5 Medial Thigh
The medial thigh can be divided into three segments: upper,
lower, and middle.
• The upper third of the medial thigh has very thin skin with
a thin soft areolar layer and a prominent lamellar layer
even in thin people. The lamellar layer deposits more fat
in people who have a tendency for localized adiposity
while the areolar layer retains its same thickness. This
region is good for liposuction.
Fig. 2.23 The three surfaces
of the thigh: anterior, external
or lateral, and the posterior.
The thickness of the areolar
layer is less on the posterior,
lower lateral while very
prominent in the anterior,
upper lateral and medial
thighs
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M. Thomas and J. D’silva
Fig. 2.24 The thickness of
subcutaneous layer in the
upper and lower thigh
• The lower third of the thigh is prone to develop localized
adiposity and is a good region for liposuction.
• The central part of the medial surface is called a zone of
adherence as the lamellar layer is absent and the areolar
layer is similar to that on the lateral and posterior surfaces
of the thigh. This area is not good for liposuction.
Applied Anatomy Functional problems result from rub-
bing of enlarged medial thighs during ambulation. The skin
of the upper third being soft does not shrink completely after
liposuction. It is important to be conservative when undertaking liposuction in this area.
Gluteal-thigh
SL
DL
Leg
• The superior part of the posterior surface is made of voluminous muscles (gastrocnemius and soleus) and is not
indicated for surgery.
Applied Anatomy Liposuction in the legs should be under-
taken with care using very ne cannulas as there is very high
risk of compartment syndrome and even higher risk of
unevenness. Gradual fat reduction can be achieved by undertaking injection lipolysis.
2.5 The Upper Extremity
2.4.6 Knees
• This area has a very thin skin due to the need for skin
mobility; as a result the areolar and lamellar layers are
very thin except in people who have a tendency of localized adiposity. In such people increase in weight will
cause increased fat deposit in the lamellar layer, which
shows like a bulge in the inner knee and is very unsightly.
• From the surgical point of view, only the medial surface
of the knee should be considered for liposuction.
2.4.7 Legs
• The legs have very poor subcutaneous cellular tissue that
is dense and not suitable for liposuction.
• On the anteromedial surface the skin is attached directly
to the bone. The anterolateral surface has a strong muscular area covered by rm and thick skin and a thin
layer of subcutaneous tissue formed by the areolar
tissue.
The arm is unique with respect to the subcutaneous tissue as
the areolar layer (supercial) is located directly beneath the
skin and the fat cells have a vertical orientation separated or
encapsulated by arches of connective tissue (cutis retinacula)
and has the lymphatics and vascular structures. The lamellar
layer has a trabeculae-like structure for the passage of blood
vessels, formed by the connective tissue along with the fat
cells that are positioned in an elongated horizontal manner.
Fat deposits are prominent in the deep layer if a person puts
on weight and if a change in the diet is made the deep layer
tends to lose fat; on the contrary, supercial fat is very minimally affected by changes in diet.
• The posterolateral aspect of the arm has the maximum fat
deposit that is primarily accumulated in the lamellar layer,
as seen in Fig.2.25. This area has no major vascular structures as the primary blood supply of the hand is through
the brachial artery that is surrounded by the branches of
the brachial plexus and is on the medial aspect of the arm
in the bicipital groove.
• The areolar layer usually does not deposit much fat as
much as the lamellar (Fig.2.26).
Radial collateral a.
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31
Fig. 2.25 Anatomical basis of fat distribution in the arm according to Avelar: (1) anterior, (2) lateral, (3) posterior, and (4) medial zones of the
arm. Zone 3 is prone to storing a large amount of deep lamellar fat
Fig. 2.26 The blood supply
and nerve supply of the upper
limb. Note that in the arm all
the important vascular and
nervous structures except the
cephalic vein are under the
deep fascia in the bicipital
groove
Ulnar collateral a.
Cephalic v.
Brachial a.
Musculocutaneous n.
Brachial v.
Basilic v.
32
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M. Thomas and J. D’silva
Anterolateral
Anteromedial
Fig. 2.27 The maximum fat deposit as seen on the posterolateral
aspect where there are no vital structures
• Illouz pinch test can help estimate the thickness of the
panniculus as well as the amount of fat in the lamellar
layer (Fig.2.27).
• The panniculus slides over the aponeurotic layer normally. When this layer is thick the panniculus does not
slide because of the numerous perforating vessels.
Applied Anatomy Liposuction on the posterolateral aspect
of the arm is safe but it has to be carried out at the lamellar
layer (deeper). Liposuction should not be carried out in the
areolar layer lest it causes deformities.
2.6 Supercial Vessels
The supercial lymphatics run in association with the subcutaneous arteries and veins. Lymphatic vessels draining
the lumbar and outer gluteal regions accompany the supercial circumex iliac vessels supplying the area and draining into the lateral limb of the supercial inguinal lymph
nodes. The infraumbilical skin is drained by the lymphatics
that accompany the supercial inferior epigastric vessels
draining into the medial group of supercial inguinal lymph
nodes. The area above the umbilicus is drained by lymphatic vessels that run obliquely along the supercial superior epigastric vessels and drain to the pectoral and
subscapular axillary nodes; also, there is some drainage to
the parasternal nodes.
2.7 Deep Vessels
The deep lymphatic vessels from the upper abdomen accompany the deep superior epigastric arteries and drain into the
parasternal lymph nodes while lymphatic vessels from the
lower abdomen drain into the inferior epigastric, circumex
iliac, and then into the external iliac group of nodes. The
lateral and posterior abdominal wall lymphatics accompany
the lumbar arteries to drain into the lateral aortic and retroaortic nodes.
References
1. Kaminski MV. The adipocyte anatomy, physiology, and
metabolism/nutrition. In: Shiffman M, editor. Autologous
fat transfer. Berlin, Heidelberg: Springer; 2010. https://doi.
org/10.1007/978- 3- 642- 00473- 5_4.
2. Lancerotto L, Stecco C, Macchi V, Porzionato A, Stecco A,
De Caro R. Layers of the abdominal wall: anatomical investigation of subcutaneous tissue and supercial fascia. Surg
Radiol Anat. 2011;33(10):835–42. https://doi.org/10.1007/
s00276- 010- 0772- 8.
3. Frank K, Hamade H, Casabona G, Gotkin RH, Kaye KO, Tiryaki T,
etal. Inuences of age, gender, and body mass index on the thickness of the abdominal fatty layers and its relevance for abdominal
liposuction and abdominoplasty. Aesthet Surg J. 2019;39:1085.
https://doi.org/10.1093/asj/sjz131.
4. Shiffman M. Prevention and treatment of liposuction complications. In: Shiffman M, Di Giuseppe A, editors. Liposuction—principles and practice. 1st ed. New York, NY: Springer New York
LLC; 2006.
5. Markman B, Barton FE Jr. Anatomy of the subcutaneous tissue of the trunk and lower extremity. Plast Reconstr Surg.
1987;80(2):248–54.
6. Rohrich RJ, Smith PD, etal. The zones of adherence: role in minimizing and preventing contour deformities in liposuction. Plast
Reconstr Surg. 2001;107:1562–9.
7. Huger WE.The anatomic rationale for abdominal lipectomy. Am
Surg. 1979;45(9):612–7.
8. Figge FHJ.Sobotta Atlas of human anatomy. Baltimore: Urban &
Schwarzenber; 1977.
9. Spalteholz W.Atlas de anatomia humana. 5th ed. Espanha: Editora
Labor; 1970.
10. Chamosa M. Lipectomy of fat rolls. Aesthet Plast Surg.
2006;30(4):417–21. https://doi.org/10.1007/s00266- 006- 0029- 4.
11. Sharma D, Bitterly TJ. Buffalo hump in HIV patients: surgical management with liposuction. J Plast Reconstr Aesthet Surg.
2009;62(7):946–9. https://doi.org/10.1016/j.bjps.2007.10.086.
12. Cuenca-Guerra R, Lugo-Beltran I.Beautiful buttocks: characteristics and surgical techniques. Clin Plast Surg. 2006;33:321–32.
13. Singh D. Adaptive significance of female physical attractiveness: role of waist-to-hip ratio. J Pers Soc Psychol.
1993;65:293–307.
14. Abulezz T.A review of recent advances in aesthetic gluteoplasty
and buttock contouring. Plast Surg Mod Tech. 2019;6:147.
Preoperative Consultation
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andEvaluation
MohanThomas andJamesD’silva
3
Goal of any consultation for cosmetic procedures should be to
make sure that the expectations of patients are brought down to
the level of realistic possibility of achieving the best result for
them and to make sure that the surgeon and the patient are on
the same page regarding the treatment process.
3.1 Consultation
3.1.1 Purpose ofConsultation [1]
A complete preoperative consultation improves surgical outcomes as they have to be value based and centered along
patient requirements. There are several other relevant factors
that a patient needs to know other than a good surgical result,
such as desirable perioperative outcomes, including reduction in anxiety, adequate pain control system, quick recovery,
and knowing about how soon a person can get back to a normal and professional life.
Surgeons should also advise patients who consult for
body contouring to lose some weight before undertaking the
procedure to check the compliance of patients. It has to be
conveyed very clearly to them that “body contouring is in the
hands of the surgeon, but the nonconformity could be because
of poor lifestyle habits.”
The major focus of cosmetic surgeons’ training at the
present moment is directed to prevent and manage perioperative complications, which is much relevant to modern cosmetic surgery practice. This training will majorly help in
prevention of medical complications. For example, deep vein
thrombosis (DVT) is a major worry in any body contouring
procedure. It is the duty and responsibility of the cosmetic
surgeon to make sure that the patient is covered well in terms
of proper perioperative care regarding DVT.
M. Thomas (*) ∙ J. D’silva
Cosmetic Plastic Surgery, Breach Candy Hospital and D.Y. Patil
University, Mumbai, Maharashtra, India
Consultation enables the surgeon to analyze the patient
for various medical conditions. A doctor with adequate medical experience can request for required tests that the patient
has to do before a nal call on surgery is taken. It is very
important that such nal call about surgery has to be made
only after the test reports are analyzed completely.
The experience of the surgeon also helps in making the
right treatment plan. A simple differentiation of subcutaneous fat vs. visceral fat goes a long way in making the right
plan and advising the same to the patient. It also becomes
imperative on part of the surgeon to make it clear to overweight patients and/or patients looking for weight loss that
body contouring procedure is not a weight loss surgery.
About the postoperative care, patients should not have
any surprises regarding standard protocols to be followed
barring any untoward incidents.
3.2 A Preoperative Psychosocial Screen
forElective Facial Cosmetic Surgery
Patients [2]
It is well known through the literature that 10–20% of
patients undergoing cosmetic procedures are unhappy with
the results and report dissatisfaction. Poor perception about
outcomes can be a cause for concern both for the treating
physician and the patient as it can result in depression, anxiety, social ostracism and isolation, injuries to self-including
suicide and homicide, absence from work, patient demands
for corrections, increased complaints to regulatory bodies,
litigation, and even placing adverse comments on social
media.
Choosing the right patient for cosmetic surgery after a
detailed assessment reduces not only the extent of dissatisfaction but also patient management difculties. Evaluation
of the psychosocial risk factors in a patient and referring the
patients with such risk factors for extensive psychological
evaluation and management can improve the outcome of a
cosmetic surgeon as well as improve the quality of care in a
patient.
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022
M. Thomas, J. D’silva (eds.), Manual of Cosmetic Surgery and Medicine, https://doi.org/10.1007/978-981-19-4997-5_3
33
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M. Thomas and J. D’silva
Even though picking a patient with adverse psychologic
risk factors is so important, there is absence of a clear roadmap that can help treating physicians to select inappropriate
patients and guide them further. Patient characteristics to be
chosen preoperatively, which indicate a possibility of patient
dissatisfaction with results, have come from clinical experience only. There is not any serious clinical research that has
been conducted in this regard. Napoleon’s study about the
impact of personality disorders in elective cosmetic surgery
patients is an exception, which found that satisfaction of the
outcome was highly dependent on the patient personality
type, with narcissistic and borderline personalities being
regarded as more likely to be unsatised with the surgical
outcome. In spite of there being a lack of empirical investigations, it is a general consensus that in young males preoperative anxiety and depression, body dysmorphic disorder and/
or dissatisfaction with previous surgeries, low self-esteem,
and unrealistic patient expectations are the factors associated
with unsatisfactory outcomes.
Lavell and Lewis [3] derived the SAFE guide, based on
which they suggested that the following four patient characteristics should be considered in order to determine patient
suitability for cosmetic surgery:
Table 3.1 Histrionic personality
Frequency in
practice
Areas of
concern
Demeanor Coquettish, seductive, energetic, “Southern
Compliance Good, if special attention is paid to the issue of
Benecial
treatment
Detrimental
treatment
Staff responses Female staff generally dislike these patients;
Legal issues Moderate to high risk, if paired with a self-
Relationship to
physician
Diagnostic and statistical manual of mental disorders (DSM III-R)
prevalence: this disorder is apparently common and is diagnosed much
more frequently in females than in males
Moderately high (9.5%)
Breasts, eyes, and lips
Belle” or “Damsel in Distress” roles are acted
out
patient demands; otherwise, compliance can be
problematic
Reassuring; these patients are responsive if
special attention is afforded to them; alert female
staff to their behavioral tendencies
Cold; analytic treatment is counterproductive;
hurt feelings and sexual overtones are a reality
with these patients
male staff may be attracted to them
disorder; sexual harassment suits may arise from
this population
May assume role of mistress if surgeon is male;
will avoid female physicians.
1. Self-evaluation of attractiveness (positive self-image)
2. Anxiety (conscious awareness of generalized distress)
3. Fear (excessive involvement in detailed preparation for
surgery)
4. Expectation (unrealistic anticipation of postsurgical life
changes)
According to the existing literature, the worse postoperative outcomes are associated with a generalized unhappiness
of the patient with their physical appearance and an unfound
concern with the shape and size of many different parts of
the body, rather than the extent of concern with physical
appearance, global self-esteem, or the extent of investment in
appearance.
3.3 The Presentation ofPersonalities
inPlastic Surgery [4] (Tables 3.1, 3.2,
3.3, 3.4, and3.5)
Table 3.2 Borderline personality
Frequency in
practice
Presenting
complaints
Demeanor Self–other boundaries ore blurred; watch for
Compliance They vacillate between all and nothing responses
Benecial
treatment
Detrimental
treatment
Staff response The staff may consider these patients to be
Legal issues Extremely high risk; these patients are frequently
Relationship to
physician
DSM III-R prevalence: borderline personality disorder is apparently
common
Moderately high (9.0%)
Body dysmorphic disorder, cuts, and numerous
areas of concern
immediate and unquestioned idealization of the
physician
Assured; be consistent in time and place; avoid
nebulous or qualied instructions; be very careful
of injections and cautious of medications
This patient can “split” the physician from all
good to all bad; this can be done quickly and
without warning; errors are translated easily into
“bad” doctor
obtrusive and inappropriate
involved in malpractice suits directly or indirectly
Physician is viewed as saint or satan
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Table 3.3 Dependent personality
Frequency in
practice
Areas of concern Supercial, breasts
Demeanor Warm, needy, and charming; they can be
Compliance Good, though they may require nurturant
Benecial
treatment
Detrimental
treatment
Staff response The staff may designate these patients as
Legal issues Low risk
Relationship to
physician
DSM III-R prevalence: the disorder is apparently common and is diagnosed more frequently in females
Table 3.4 Narcissistic personality
Frequency in
practice
Areas of concern Age-related, especially eyes and abdomens
Demeanor Arrogant, fashionable, and assertive; look for
Compliance Good, if results are excellent and manifest early
Benecial
treatment
Detrimental
treatment
Staff response The staff may consider these patients to be
Legal issues High risk, fueled by grandiosity and
Relationship to
physician
DSM 11I-R prevalence: this disorder appears to be more common
recently than in the past, but this may be due only to more professional
interest in it
Table 3.5 Obsessive-compulsive personality
Frequency in
practice
Areas of
concern
Demeanor Careful, precise, wordy, and vigilant
Compliance Usually “to the letter”
Benecial
treatments
Detrimental
treatments
Staff response These patients are seen as “picky”
Legal issues Low risk; these patients keep meticulous records
Relationship to
physician
DSM III-R prevalence: the disorder seems to be common and is more
frequently diagnosed in males
Moderately high (12.0%)
demanding
reinforcement
Reassuring; warmth with personalized care
will elicit positive results
Business-like approach or group care is to be
avoided
“pets”; may be seen as demanding and spoiled
Parent–child
Very high (25%)
tanning salon skin color
Assured; praise for this patient along with an
air of condence on the part of the physician is
a must
The casual approach, “folksy” style, low-rent
ofce all present problems for this patient
population
arrogant, pushy, and demanding
entitlement
Physician is perceived as simply another part of
the patient’s self
Infrequent (4.0%)
Supercial
Assured; these patients respond well to written,
dened, and precise instructions
Impatience on the part of the staff or physician is
perceived as rejection
just for this eventuality, though the actual risk is
minimal
The physician can be used as a sounding board;
physicians can have a negative transference to
these questioning and cynical patients
3.4 Art ofConsulting
3.4.1 Marketing
• In the current times, marketing has gone digital. People
get to know the doctor through various means on the
Internet.
• A strong presence on the Internet lets the word out.
• The initiation of any consultation begins from marketing.
• The pattern and the nature of promotions on the Internet
give patients a fair idea about the doctor they are going to
visit.
• So, it is up to the doctor to put the right content on the
Internet.
3.4.2 Role ofFront Desk Sta
• Front desk staff plays an important role in getting the
patient in.
• Front desk staff makes the rst point contact with the
patient on behalf of the clinic and doctor. Strong web
presence and marketing along with efcient front desk
communication increase the chances of patient opting to
consult the doctor.
• They also extend warmest welcome to the patient once
they enter the clinic.
• They hand over the clinical form to elicit the past history
of the patient, which the patient has to ll.
3.4.3 Role ofNursing Sta
• Nursing staff takes over the patient from the front desk
staff.
• They introduce themselves and take them to the nursing
area to check vital parameters of the patient. This act gives
patients a feel of the state of healthcare system of the clinic.
• In case of liposuction patient, it is imperative to check the
height and weight of the patient for body mass index
(BMI) evaluation.
• These assessments by the nursing staff help the doctor in
assessing the gait pattern, built, and behavioral pattern of
the patient before the doctor actually comes into contact
with the patient.
3.4.4 Role oftheDoctor
• Doctor has to take inputs from the front desk and nursing
staff to know more details about the patient before he/she
actually sees the patient.
• Based on the inputs given by the front desk personnel and
the nursing staff, the doctor welcomes the patient into the
consulting area and begins the consultation.
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M. Thomas and J. D’silva
• The doctor has to wish the patient and introduce himself/
herself to the patient. It is important for the doctor to
introduce himself/herself even though the patient has
come looking for that particular doctor because that certain gesture implies a thorough professional attitude.
• During the due process of consultation, Doctor has to analyze the psychosocial aspects of the patient.
3.5 Evaluation
3.5.1 Evaluation ofSocial Status
• Social status is an important aspect of any cosmetic procedure simply because of elective nature of most of such
procedures.
• It is essential to make patients understand whether they
actually require cosmetic procedure or not.
• The nal call regarding opting for or against the procedure is always left to the patient.
3.5.2 Evaluation ofCompliance ofPatient
• Compliance by patient in most cases leads to longstanding results. In fact, it is the duty of a patient to maintain
the contoured body by adapting healthy lifestyle.
• From the physician perspective, therapeutic compliance
is of major importance for two reasons. Firstly, noncompliance with treatment advised can have a major effect on
the nal outcome, which is a direct clinical consequence.
Secondly, noncompliance can have poor outcomes in
those who are associated with comorbid conditions [5].
3.6 Patient History
3.6.1 Medical History
Detailed medical Information regarding medicines prescribed or consumed for pulmonary or cardiac issues; bleeding tendencies; chronic conditions such as hypertension,
diabetes mellitus, and thyroid issues; allergies if any; etc.
should be extracted from the patient and recorded in detail.
History should also be taken about connective tissue disorders such as rheumatoid arthritis, systemic lupus erythematosis (SLE), and Hashimoto’s disease.
3.6.2 Drug History
Detailed history about medicines such as aspirin, nonsteroidal anti-inammatory drugs, herbal medications and diet
pills, antihypertensives, antidiabetics and anticoagulants,
and hormones, especially in body builders, should be
recorded. Allergies to medications should be prominently
noted.
3.6.3 Family History
Questions should inquire about history of bleeding tendencies or thromboembolism, fat gene, and diabetes in the
family.
3.6.4 Past Surgeries
3.5.3 Evaluation ofDiet Habits
• Consulting a nutritionist helps keep track of the number
of calories being consumed every day. There should not
be any major uctuation in weight after cosmetic body
contouring procedures because that may lead to uneven
fat deposits.
3.5.4 Psychiatric Evaluation
• Psychiatry is one specialty that cosmetic surgeons give a
lot of importance to.
• Sometimes, opinion of a specialist would be of immense
help to understand the mental status of the patient and
their expectation levels.
• Undertaking any cosmetic procedure on patients who are
having mental health issues would be a disaster for both
the patient and the doctor.
• Psychiatric treatment makes the patient understand the
scope and possibility of intended outcomes.
Any anesthetic or bleeding complication from previous surgeries or any allergy to local anesthetic drug should be
recorded. Also, healing and scar formation should be discussed. If the patient has undergone liposuction, then postsurgical maintenance has to be discussed and any gain or loss
in weight recorded.
3.6.5 Psychiatric History
1. Any psychiatric illness in past?
(a) Counseling may be required in perioperative period.
(b) Patient may not adhere to postoperative regimen,
which can lead to wound-healing complications.
2. Is the patient on any psychiatric drugs?
3. Evaluation of body dysmorphic disorder (BDD).
(a) Patient with BDD will rarely be satised with the
results that are considered great by other cosmetic
surgeons and from other patients’ perspective.
(b) These patients are more often to le lawsuits and cre-
ate bad publicity for the surgeon.
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