Читать книгу Anti-Aging Therapeutics Volume XIV - A4M American Academy - Страница 44

1.Prepare then anesthetize area halfway between iliac crest and gluteal crease. Men: 4 ml 2% lidocaine with epinephrine, 4 ml. 2% without epinephrine, or 4 ml 0.5% Marcaine®. Women: Use 1/2 to 2/3 of the above doses. (Fig. 2).

Figure 2. Prepare and anesthetize the area

2.Find the plane of subcutaneous fat (requires physician training and practice). This is more difficult in men with low body fat, and is easy to find on obese people. You may encounter fibrous septae requiring a twisting motion (like a screwdriver, clockwise/counterclockwise). Avoid overly traumatizing subcutaneous tissue and fat to minimize post-procedure bleeding. The approximate angle of anesthesia and trocar insertion is 15-30°. If needle is too shallow, the patient will experience a sharp or burning pain. If the needle is too deep the patient will feel muscle twitching (with anesthesia). If the angle is correct needle insertion should be pain-free as long as it is done slowly. (Fig. 3).

Figure 3. Getting the angle of insertion correct (15-30°) is important

Figure 4. The pellets are inserted with a blunt probe

3.It is now time to insert the pellets. These are pushed in with a blunt probe (Fig 4.). If implanting several tracts, redirect the trocar after implanting 3-4 pellets and implant 3- 4 more to avoid having them clumped all together. Then remove completely, create a new tract in a different direction (within the zone of anesthesia) and repeat. Men: Implant up to 4-5 x 100 mg pellets per tract. Women: Usually one 100 mg. pellet or one plus a smaller pellet (can cut or order smaller sized pellets, depending on the lab). With practice, cutting 100 mg pellets is easy and fairly precise (a few mg discrepancy does not affect outcomes). Progressive cutting of pellets can be done if one needs 50 mg, 25 mg, or 12.5 mg in order to yield a dose of 150 mg, 125 mg, or 112.5 mg.

4.After pellet insertion is complete the insertion site should be dressed (Fig. 5). In our office we use a large Band-Aid placed over a gauze pad folded in half 3-times. We then use waterproof plastic tape around the edges so that patient can shower the next morning.

Figure 5. Dressing the insertion site

5.After dressing, 8 minutes of pressure (with ice pack) should be applied (Fig. 6). For aspirin users I advise a 10 full minutes or pressure. However, ideally aspirin users should refrain from using aspirin for at least 3-4 days before procedure to avoid post procedure hematomas.

Figure 6. Pressure should be applied for 8 minutes after dressing