Dual-Plane Lipoplasty for the Superficial and Deep Layers

Abstract

Two embryologically and histologically distinct layers of the subcutaneous adipose tissue were treated individually by different modalities. The authors performed ultrasound-assisted lipoplasty at the superficial layer and traditional suction-assisted lipectomy in the deep subcutaneous tissue. The ultrasound procedure allowed tissue-specific destruction of the superficial layer supported by dense fibrous networks without disrupting them. Skin retractions caused by this procedure could diminish the necessity of surgical dermolipectomy such as an abdominoplasty in moderately deformed cases. On the other hand, the traditional liposuction was performed to remove the excessive deep fat contained in the loose fibrous network in a limited area. Although the advancement of ultrasound devices and regimens has now reduced their operating times significantly, the ultrasonic lipoplasty was slower than traditional liposuction at the beginning of our procedure. In the abdominal wall, the procedure was performed only in a confined area, because the skin retractions made over the locally managed areas created a circumferential tightness around the trunk, using the nontreated area as a bridge. Confinement on the managed area prevented unnecessary blood loss and tissue destruction. It was less a matter of fat volume to remove in the superficial layer; rather, a precise application to the exact target area was required to get a more natural result. Dual-plane lipoplasty was performed for 2 years in 35 patients, mostly for the abdomen. No serious complication such as seromas or skin loss was observed in our series of patients.