In vivo Endoscopy of Septal Fibers following Different Liposuction Techniques Reveals Varying Degrees of Traumatization

Abstract

Introduction: The removal of fat via liposuction requires disruption of adipose tissue and the intrinsic collagen-based septal fiber network that supports and protects the blood and nerve supply to adipose tissue. Using septal fiber preservation as a marker for the relative trauma of a given liposuction technique, we quantified and compared the number of intact septal fibers following various liposuction methods using in vivo endoscopy. Materials and Methods: Pilot studies using endoscopic imaging and quantification were conducted in 3 study groups that included 52 abdominoplasty patients, 12 cadavers, and 32 liposuction patients. Liposuction techniques performed included laser-assisted (924/975-nm LAL), power-assisted (PAL), suction-assisted (SAL), ultrasound-assisted (UAL), and power water-assisted liposuction (WAL). Gross dissection and in vivo endoscopy were used to qualitatively and quantitatively evaluate septal fiber preservation. Results: The highest numbers of intact septal fibers were observed following either 924/975-nm LAL or PAL. SAL treatments left, on average, two thirds the number left after LAL or PAL. UAL and WAL were the most damaging, leaving one half or one third the number of fibers seen after LAL or PAL, respectively. In addition, 924/975-nm LAL and PAL were associated with less skin necrosis and blood in the aspirate as compared with WAL. Microscopy studies revealed that the greatest adipocyte cell membrane disruption occurred following 924/975-nm LAL. Conclusions: These findings demonstrate that 924/975-nm LAL and PAL were associated with the greatest preservation of septal fibers while UAL and WAL were the most damaging. The 924-nm LAL was also the most effective technique for disrupting adipocyte cell membranes.