Uribe, Laura C. Cala

BACKGROUND: Use of cold tumescent solutions in liposuction is hypothesized to enhance vasoconstriction, potentially reducing bleeding and improving clinical outcomes. However, evidence for its efficacy in arm liposculpture remains inconclusive. PURPOSE: To compare the effects of cold (4°C) and warm (37°C) tumescent solutions on postoperative outcomes in arm liposculpture, focusing on pain, bruising, and fat emulsification quality. METHODS: This double-blinded, randomized clinical trial enrolled patients undergoing bilateral arm liposculpture. One arm was infiltrated with a cold tumescent solution and the other with a warm solution, randomly assigned. Liposuction was performed using VASER-assisted fat emulsification followed by Power-Assisted Liposuction (PAL) or conventional suction-assisted liposuction (SAL). Outcomes included pain (Visual Analog Scale) assessed at Days 1, 8, 15, and 30; bruising, and lipocrit values. RESULTS: A total of 104 arms were analyzed from 52 female participants (mean age: 39.7 years; mean BMI: 24.7 kg/m²). Pain scores were similar between groups at all time points (Day 1: Cold = 5 [2–9], Warm = 6 [2–9]; p = 0.9). Bruising areas were comparable (Cold: 40,444 mm²; Warm: 41,212 mm²; p > 0.05). Lipocrit values for Microaire and SAL techniques showed no significant differences (p > 0.05). Patients reported high satisfaction, with 78.7% "very satisfied" and 96.1% recommending the procedure. CONCLUSIONS: Cold tumescent solutions do not significantly enhance outcomes in arm liposculpture compared to warm solutions. Surgeons should exercise caution with cold solutions due to potential hypothermia risks. Further research is warranted to assess the potential long-term effects of cold tumescent infiltration.

Summary: Incorporation of new technologies to assist the liposuction procedure is becoming increasingly common. These technologies allow for a softer technique, balanced shaping, elimination of excess adipose tissue, and skin tightening. Some of these technologies include ultrasound (US; US-assisted liposculpture, VASER-assisted liposuction), power suction (power-assisted liposuction), radiofrequency (RF; RF-assisted lipolysis), and laser (laser-assisted liposuction). In addition, some of these devices have been shown to reduce the incidence of hematomas/inflammation and shorten recovery time. We report our experience in high-definition liposculpture of the arms in addition to new technologies to improve skin retraction, comparing their results in terms of complications, satisfaction score, and aesthetic outcomes. We included patients with mild-to-moderate arm dermatochalasis (Duncan classification) fat deposits in the upper extremities who were considered candidates for third-generation US-assisted liposculpture, power-assisted liposuction, RF-assisted lipolysis/skin tightening, and laser-assisted liposuction. A total of 683 consecutive patients met the inclusion criteria for the study. Most of them were women (n = 605, 88%). Fat grafting was performed in 80 patients (11.7%). A significant portion of the patients were secondary cases (n = 223, 33%). Age ranged from 18 to 70 years (median = 38 years). BMI ranged from 17.8 to 34.8 kg/m2 (mean = 24.3 kg/m2). RF-assisted and laser-assisted high-definition liposculpture of the arms are both effective and reproducible techniques for patients who seek an athletic and slim arm contour. A low rate of complications and high satisfaction index support our findings.