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New Orleans — As the number of male patients undergoing liposuction grows, experience shows that these patients' outcomes, as well as the techniques and instrumentation required to achieve them, differ from those of female patients.
Members of the American Society for Cosmetic Surgery performed approximately 55,000 liposuctions in 2003, about 20 percent of them in male patients. This figure represents a five percent increase over 2002. Likewise, among more than 300,000 liposuctions performed by members of the American Society for Plastic Surgery in 2003, about 62,000 involved men.
The most obvious clinical difference between male and female liposuction patients is physical appearance.
Metabolism, enzymes, hormones and genetic factors contribute to those differences.
"Those differences should be radiologically detected as changes in either the dermis and/or the fat," she says. "Histology is consistent with that statement. Ultimately, it makes a difference in patients' body mass index and waist-to-hip circumference. Therefore, when you're performing the procedure, you must take these factors into consideration."
Top treatment spots in men Areas where male patients most frequently desire treatment include the submandibular skin, the breast, the abdomen and the flank. Less commonly, Dr. Toombs and her colleagues also have performed liposuction on the arms, inner thighs and hips of male patients.
"In those particular cases, there are no differences in the procedure. The tissues seem to be relatively similar (to women's), particularly in the minor amount of fat that a man may have on the hip," Dr. Toombs says.
Conversely, while male patients generally lack wide hips and saddle bags, they often possess prominent flanks. The thick, fibrous nature of tissue in this area requires careful choice of cannulas.
Correcting the problem zones For debulking the flank area, Dr. Toombs typically uses a Becker grater cannula inserted through an incision placed 4 cm posterior to the tubercle of the iliac crest (cannula vendors Dr. Toombs uses include Cosmetic Surgery Supplies and Miller Medical).
"The purpose of the grater in our experience is to help break up the tissue so that it's more easily suctioned," she says.
Dr. Toombs next uses a basket-type cannula, whose wide opening is able to catch and snag the tough tissue. She follows that with a candy cane cannula for actual suctioning.
In the submandibular area, pinch testing shows that when comparing male and female patients with similar body mass indexes, this tissue is thicker in males.
"What we find on performing the suction is that following the procedure, as the skin redrapes and conforms to the mandible and underlying tissue, the results, although very good in men, are not quite as good as they are in females. That tissue does not contract as well, although the suctioning cannulas are very aggressive," Dr. Toombs says.
In this regard, she recommends a 3 mm blunt-tipped triport or a 10 to 15 mm three-port radial cannula. What's unique to treating this area is that the cannula's aperture must actually face the dermis, as well as the underlying tissue. This requires one to turn the cannula 180 degrees.
"However, in abrading the dermis, which is what you want to do to get that skin to contract, one must be careful not to abrade too aggressively because there's a possibility of destroying the hair follicles," Dr. Toombs notes.
In the breast area, one can use the same approach to liposuction regardless of whether one is treating gynecomastia or pseudogynecomastia.