Overcoming the Achilles' heel of orthostatic hypotension during interactive standing liposculpture.

[BACKGROUND] Orthostatic hypotension (OH) is a major obstacle to standing liposculpture.

[AIMS] To investigate the feasibility of a novel "interactive standing liposculpture" procedure under local anesthesia to avoid possible general anesthesia-related complications and overcome standing-associated OH.

[METHODS] A total of 68 subjects undergoing IsLipo were divided into three groups: Individuals with normal body weight (18 ≤ BMI < 23, n = 21, Group 1), overweight or mildly obese subjects (23 ≤ BMI < 30, n = 29, Group 2), and those with moderate-to-severe obesity (BMI ≥ 30, n = 18, Group 3). A 4-area liposculpture technique was adopted with alternate change in position from recumbent to standing for each area. Subjects with symptoms of OH (ie, dizziness or/and nausea) were allowed to rest in a supine position before resuming the procedure. Incidence of OH and duration of liposculpture for each area were recorded and analyzed.

[RESULTS] The incidence of OH was 15 (four subjects experienced two episodes during the same procedure). All OH episodes occurred in Group 3 subjects. The total liposuction time significantly increased from Group 1 to Group 3 (all P < .001). The IsLipo time in Group 3 was also substantially longer than that in Group 1 and Group 2 (P < .001). Mean arterial blood pressure dropped and heart rate increased significantly in all subjects experiencing OH without fluctuation in arterial oxygen saturation. All subjects with OH recovered after a 10-minute rest and resumed the IsLipo procedure. Successful liposculpture were performed in all subjects.

[CONCLUSION] Orthostatic hypotension associated with interactive standing liposculpture, which predominantly occurred in subjects with moderate-to-severe obesity, could be resolved with an intraoperative resting strategy.