Dr Daniel Lanzer

About Dr Daniel Lanzer

Looking back over the last decade I am able toidentify a number of key points that have played a significant role in my development as a Dermatologist and my interest in Cosmetic Surgery.

My specialised training in Dermatology in Australia gave me the necessary basis for being an expert in the management of skin, the knowledge of which I call upon on a daily basis.

Dermatologist Dr Jeffery Klein pioneered and developed the Liposuction technique that has now made this procedure so popular. In 1992 I convened the first Australian conference to teach other Surgeons this technique.This was all followed and highlighted on multiple television programmes which brought me into the face of the media directly.There was tremendous interest in cosmetic surgery at that time which resulted in me being asked to be a regular guest on The Midday Show with Ray Martin, the Steve Vizard Today Tonight programme, Good Medicine, A Current Affair and a regular column writer for the New Idea magazine.

I was also privileged to be one of the Doctors to convene conferences on the new process of using lasers in cosmetic surgery, which was also first described by a dermatologist in the USA. My approach to cosmetic surgery has always been to understand what are the areas that really bother my patients and to focus in on them. At the same time we’re always looking for the procedure that has the lowest risks the quickest recovery and that produces the most natural appearance. The majority of my patients are able to keep their procedures private but just look healthier and fitter without obvious signs of having had surgery. There’s no age barrier in cosmetic surgery and my experience has been that cosmetic surgery can be used to enhance ones self confidence and inner self happiness.

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SAFETY OF LARGE-VOLUME LIPOSUCTION, DANIEL LANZER, M.D.

SAFETY OF LARGE-VOLUME LIPOSUCTION, DANIEL LANZER, M.D.

ABSTRACT

Large-volume liposuction in excess of 4 liters supernatant fat can be performed safely. However, it requires special care and treatment. The following paper illustrates the authors approach, which is directed to reduce the risks of the potential causes of mortality. The study outlines the guidelines that the author followed in treating more than 5,000 patients over a ten-year period.

INTRODUCTION

LIPOSUCTION has been practiced for more than 20 years. Initial liposuction performed by Giorgio Fischer in Italy in 1975 was a procedure associated with blood loss and other significant complications. The major breakthrough occurred in 1987 with the development of the tumescent technique by dermatologic surgeon Jeffrey Klein.(1) He showed that by infiltrating extremely large volumes of a dilute local-anesthetic- containing solution he was able to reduce bleeding, and the procedure could be performed under local anesthetic or light sedation. Many specialties have taken to liposuction. However, a study by Grazer and de Jong(2) of plastic surgeons indicated that there has been a significantly high death rate from liposuctions during the last few years. Although other specialties have shown a significantly lower rate of mortality, there are lessons for all surgeons to learn.

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Liposuction Australia

Liposuction Australia

BREAST REDUCTION WITH LIPOSUCTION, DANIEL LANZER, M.D

HYPERTROPHIC LARGE BREASTS are a common problem to women of all ages. Complaints include back and shoulder pain, disturbance of posture, and indenting of bra straps all related to the excessive weight from breast hypertrophy. Other problems include persistent submammary maceration and psychological disturbances due to the prominence of this area. The traditional method of breast reduction has been surgical excision mammoplasty. It involves excision of breast tissue and skin with a localized flap. The procedure is complex and extensive with significant risks that include unsightly scars, keloid, necrosis, permanent numbness, prolonged postoperative recovery, blood loss, reduction in the ability to breastfeed, and radiographic changes on mammography that
may cause confusion with breast cancer. Klein(1) and Dryden(2) reported early studies on the method of tumescent liposuction alone for breast reduction. Liposuction is comparatively rapid, less invasive, essentially nonscarring, and has fewer risks. The initial work was on selected individuals and more extensive studies were necessary to ascertain if the results were reproducible, if risks were likely to occur, and to determine guidelines for patient assessment.

METHOD

A total of 250 patients underwent breast reduction by tumescent liposuction alone. All patients underwent routine preliposuction work-up, which included blood tests and administration of preoperative antibiotics and antiseptics. A personal and family history of previous breast cancer or cysts was taken. Patients were asked why they wanted reduction, what their current bra size was, and what they would ideally like it to be. Patients were asked if they had breastfed in the past and if they had a significant desire to be able to breastfeed in the future. No patient had a previous history of breast cancer. All patients with a family history of breast cancer were referred to a breast cancer surgeon for assessment and long-term follow-up. Preoperative assessment included a visual examination for assessment of shape, extent of droopiness, stretch marks, skin elasticity, and for asymmetry. Physical examination of the breast was carried out both to exclude any obvious breast lumps and to assess the nature of the breasts. Breasts were graded from 1 to 10:10 corresponded to a soft, spongy texture as one would expect if the breast tissue was made up of fat primarily; 1 described hard, firm breasts.Preoperative mammography and ultrasound were performed on all patients. Of the total, 248 patients had general anesthesia in an accredited surgical setting, 1 had sedation, and 1 local anesthesia. The breasts were marked into four or six sections with attention paid to the apex of the breast, for signs of asymmetry, and the axillary tail if relevant. Approximately five 1–2 mm nicks were made at the base of the breasts and three smaller nicks midway up the breast (excluding the medial upper regions in order to avoid any signs of surgery in this area). Both breasts were filled simultaneously with Klein tumescent fluid using 20 gauge needles. The lidocaine level was diluted to 125 g/1000 ml when performed under general anesthetic. Between 1 and 2 L were infiltrated in each breast until maximum tension was produced. Suction was via a 14 gauge Klein microcannula of the capastrano variety. Two surgeons simultaneously operated from each side of the table, mirroring each move.

Fat was sequentially extracted from superficial, midbody, and the base of the breasts. Suction was performed from all different directions, with the angle of suction varied to allow maximum and even fat removal. In large and very dense breasts, 12 gauge needles were then used. Patients wore a compression chest binder continuously for 2 weeks postoperatively and for 2 weeks intermittently. Attention was paid to keeping the nipples elevated during this phase.

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