Liposuction Research Articles

Abdominal Etching-A Novel Classification Method for Surgical Approach.

The abdomen is the aesthetic and physical center of the body. Abdominal etching is used to enhance the appearance of the abdominal musculature. Body contouring and abdominal etching are popular among both men and women, and these procedures have been shown to result in high patient satisfaction and are considered safe. The aim of this study was to describe a novel classification for abdominal etching based on the senior author's technique and experience. This single surgeon, nonrandomized, retrospective study was conducted from December 2016 to September 2022. Patients were classified into 4 groups based on their body habitus, abdominal skin pinch test and skin quality, and the surgical plan was tailored accordingly. Sixty-two patients (42 male) with an average age of 36years underwent abdominal etching during the study period. Subgrouping included 4 (6.45%) in Class 1, 22 (35.5%) in Class 2, 32 (51.6%) in Class 3 and 4 (6.45%) in Class 4. The most common complication was seroma. Concomitant procedures included silicone implants to the pectoral region (male), fat injection to the buttocks, breast reduction and mastopexy and treatment of post-liposuction irregularities. The abdominal etching technique is safe and reproducible. It has demonstrated long-lasting results and high patient satisfaction. Our classification of patients will enable surgeons to better understand the problem presented and provide aesthetic and efficient results. Use of these guidelines and tailoring treatment options will further improve patient and physician satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Understanding and controlling the variables for stromal vascular fraction therapy.

In regenerative medicine, the isolation of mesenchymal stromal cells (MSCs) from the adipose tissue's stromal vascular fraction (SVF) is a critical area of study. Our review meticulously examines the isolation process of MSCs, starting with the extraction of adipose tissue. The choice of liposuction technique, anatomical site, and immediate processing are essential to maintain cell functionality. We delve into the intricacies of enzymatic digestion, emphasizing the fine-tuning of enzyme concentrations to maximize cell yield while preventing harm. The review then outlines the filtration and centrifugation techniques necessary for isolating a purified SVF, alongside cell viability assessments like flow cytometry, which are vital for confirming the efficacy of the isolated MSCs. We discuss the advantages and drawbacks of using autologous vs allogeneic SVF sources, touching upon immunocompatibility and logistical considerations, as well as the variability inherent in donor-derived cells. Anesthesia choices, the selection between hypodermic needles vs liposuction cannulas, and the role of adipose tissue lysers in achieving cellular dissociation are evaluated for their impact on SVF isolation. Centrifugation protocols are also analyzed for their part in ensuring the integrity of the SVF. The necessity for standardized MSC isolation protocols is highlighted, promoting reproducibility and successful clinical application. We encourage ongoing research to deepen the understanding of MSC biology and therapeutic action, aiming to further the field of regenerative medicine. The review concludes with a call for rigorous research, interdisciplinary collaboration, and strict adherence to ethical and regulatory standards to safeguard patient safety and optimize treatment outcomes with MSCs.

Broken and Retained Tip of Liposuction Cannula in the Scalp.

Broken and Retained Tip of Liposuction Cannula in the Scalp.

Assessment of liposuction cannulas' interior: insights from visual inspection using a borescope

Introduction: Alterations in liposuction cannulas compromise their use and patient safety in healthcare services. Aim: to evaluate the interior of liposuction cannulas through visual inspection aided by a borescope. Design: this is a descriptive, quantitative study conducted at a materials and sterilization center of a public hospital in Minas Gerais, Brazil, from October 2023 to January 2024. Liposuction cannulas were randomly selected, chosen systematically. Visual inspection assisted by a borescope was conducted, and the data were recorded in a semi-structured instrument, analyzed using descriptive statistics. Results: Liposuction cannulas of sizes 3.0 mm and 4.0 mm were evaluated with equal frequency, as they are reusable devices without control regarding the number of sterilizations they have undergone since acquisition. The majority exhibited alterations detected through the borescope (66.7%), with notable occurrences of oxidation, stains, and/or discoloration (60.0%), residues or debris (33.3%), and grooves (25.0%). Implications: Tracking of liposuction cannulas identified alterations that compromise their usage, observed with the assistance of a borescope. The findings call for changes in current legislation within sterilization centers due to the absence of indication of this equipment as mandatory for aiding visual inspection.

Abdominal Etching with Renuvion Helium Plasma

Abstract Goals/Purpose Differential liposuction with abdominal etching is a powerful technique in high definition liposculpture to achieve an athletic aesthetic. Etching is performed in a superficial plane to create indentures mirroring the dermal-fascial inscriptions of the underlying desired musculature. Renuvion radiofrequency-helium plasma energy (Apyx Medical, Clearwater, FL) is an emerging technology that is used for subdermal coagulation and contraction of the subcutaneous tissue. This case series describes combination of differential liposuction with abdominal etching and Renuvion helium plasma subdermal coagulation in 68 patients and evaluates the outcomes. Methods/Technique A retrospective chart review of 68 patients undergoing differential liposuction with abdominal etching and Renuvion helium plasma subdermal coagulation between 2021 to 2023 by the senior author. The preoperative evaluation, markings, surgical technique and postoperative care are discussed. Clinical parameters assessed include age, gender, body mass index, combination of procedures, volume of lipoaspirate, degree of etching (light, moderate, deep), postoperative changes in weight, and complications such as contour irregularity, wound dehiscence, seroma, surgical site infection, patient dissatisfaction and operative revision. Results/Complications 68 consecutive patients who underwent abdominal etching with Renuvion by the senior author between July 2021 and August 2023 were included in this case series. There were 29 males (43%) and 39 females (57%). The average age of the patients was 39.11 (range, 22 to 64 years), with a non obese, average body mass index of 27.65 kg/m2 (range, 20.8 to 33.9 kg/m2). The average estimated intraoperative blood loss of patients was 104.68 ml (range, 75 to 150 ml); with an average tumescence of 4600 ml (range, 1400 to 8000 ml). The average lipoaspirate was 3920 ml (range, 500 to 9000 ml). In addition to the abdominal region, other areas liposuctioned at the time of etching included flanks (68, 100%), back (66, 97.05%), thighs (14, 20.58%), arms (9, 13.23%), neck (9, 13.23%), chest (8, 11.76%), axilla (3, 4.41%), calves (1, 1.47%). Use of ultrasound was used in 6 cases (8.82%), which were revisionary liposuction. Of our 68 abdominal etching with Renuvion cases the most common combined procedure was autologous fat transfer (20, 29.41%), platysmaplasty (4, 5.88%), mastopexy (5, 8%), breast augmentation (4, 5.88%), buccal fat pad excision (3, 4.41%), umbilical hernia repair (1, 1.47%) and rhytidectomy (1, 1.47%). There were 5 cases of seroma (7.35%) and 4 cases of contour irregularity (5.88%). There were 3 cases of surgical site infection (4.41%), but all in the area of fat grafting and not in the area of liposculpture. No cases of hyperpigmentation were identified. No major complications occurred including skin burns, skin necrosis, visceral injury, deep vein thrombosis, or pulmonary embolism. Overall 66 patients (97.05%) were satisfied following their procedure. Operative revision occurred in two patients (2.94%), who had residual skin laxity following Renuvion and desired skin excision. Conclusion Differential liposuction with abdominal etching and Renuvion helium plasma are safe and effective in combination to synergistically achieve an athletic physique and enhance abdominal aesthetics. Complication rates are low with appropriate surgical technique. Almost all patients reviewed were satisfied with the procedure and maintained long-term results.

Evaluation of the Aesthetic Outcome of Glandular Liposculpture Using V - Dissector Liposuction Cannula for Grades I and II Gynecomastia Combined with the Sealing Effect of Autologous Platelet Gel

Evaluation of the Aesthetic Outcome of Glandular Liposculpture Using V - Dissector Liposuction Cannula for Grades I and II Gynecomastia Combined with the Sealing Effect of Autologous Platelet Gel

Surgical treatment of breast cancer related lymphedema-the combined approach: a literature review.

Breast cancer therapy is a common cause of lymphedema, a chronic condition resulting from impaired fluid drainage through the lymphatic system. The accumulation of fluid in the affected limb leads to swelling, inflammation, and fibrosis, causing irreversible changes. While conservative therapy is the initial treatment for lymphedema, it may prove ineffective for advanced-stage cases that require surgical intervention. Physiological approaches such as lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) aim to restore lymphatic circulation, while reductive approaches such as excision of excess tissue and liposuction (LS) aim to eliminate fibrofatty tissue. In advanced stages of breast cancer-related lymphedema, a treatment that incorporates both physiological and reductive methods is advantageous. The timing of these approaches varies, and recent simultaneous procedures have been introduced to address both aspects in one surgery. Additionally, lymphedema treatment can be combined with breast reconstruction. Current imaging techniques provide a better assessment of the lymphedematous limb, aiding in the tailoring of a personalized combined approach within a single surgery. This study aims to review the combined approach for breast cancer-related lymphedema treatment and propose a new therapeutic algorithm based on recent literature. The research aims to optimize the management of breast cancer-related lymphedema and improve patient outcomes. PubMed/MEDLINE was used as the database to conduct a review of the currently available literature concerning combined surgical techniques for treating breast cancer related lymphedema (BCRL). In our review, we discuss imaging methods for assessing lymphatic system anatomy and function in surgical preparation and decision-making. Simultaneously, we examine a range of combined surgical techniques for treating BCRL, encompassing the combined physiologic approach, breast reconstruction with physiologic surgery, and the combination of reductive and physiologic procedures. Our emphasis remains on key parameters, including patient demographics, lymphedema staging, procedure types, follow-up duration, and objective limb measurements. Surgical treatment of BCRL can include several surgical modalities that can be performed simultaneously. Current imaging techniques enable the tailoring of a personalized combined one-stage surgery for BCRL patients.

Evaluation of The Aesthetic Outcome of Glandular Liposculpture Using V - Dissector Liposuction Cannula for Grades I and II Gynecomastia Combined with The Sealing Effect of Autologous Platelet Gel

Evaluation of The Aesthetic Outcome of Glandular Liposculpture Using V - Dissector Liposuction Cannula for Grades I and II Gynecomastia Combined with The Sealing Effect of Autologous Platelet Gel

Cosmetic augmentation of lower-lid pretarsal roll with injection of autologous fat for Asians

Autologous fat has the advantages of regeneration, rejuvenation, homology, and support. There are currently no reports indicating that injecting autologous fat enhances the fullness of the lower-lid pretarsal roll. In this retrospective, non-randomized study, the effects of injecting autologous fat to cosmetically enlarge the lower-lid pretarsal roll were evaluated by comparison of preoperative and postoperative photographs and patient satisfaction during the follow-up. First, fat tissues were manually sucked with a 20-ml syringe connected to a 2.5-mm three-hole liposuction cannula. The treated fat tissues were transferred to a 10-ml syringe and centrifuged at 2000rpm for 2min, and then the fibrous tissues were manually removed. Finally, autologous fat was injected using a 1-ml syringe linked to a sharp needle. Forty-seven patients who underwent surgery between 2018 and 2021 were retrospectively evaluated. Only three patients showed obvious asymmetry or uneven outlines after surgery and underwent a second fat injection. During recovery, bruising and minor contouring irregularities obviously improved after 1 or 2 weeks. Eight patients, who had severe bruising, were able to make a full recovery in more than 2 weeks. No patients experienced serious complications. All patients ultimately displayed pretarsal fullness in their lower eyelids and were satisfied with their outcomes. The effects of injecting autologous fat to cosmetically enlarge the lower-lid pretarsal roll are long-lasting, esthetic, and safe.

Closed-chamber Suction-assisted Fat Harvest: An Innovative Technique in Resource-limited Settings.

Autologous fat grafting is one of the most commonly performed procedures, not only for cosmetic reasons, but in a variety of reconstructive procedures like correction of contour deformities and treatment of scars. The Coleman technique has been traditionally described as one of the efficient methods of fat harvest, where 10 mL syringes connected with a liposuction cannula are used for the manual harvest of fat; although it is a widely used technique, it becomes time-consuming and tiring when a large amount of fat has to be harvested. To overcome this issue, we have devised a simple, cost-effective, quicker method in resource-limited settings by using a 500-mL normal saline bottle as a closed chamber, which is in turn connected to a suction tube. The liposuction cannula is connected to a tube that is inserted into this closed chamber, where fat is aspirated and collected. Using this technique, a large amount of fat can be easily harvested in less time and with less effort, without damaging the adipocytes.

Submandibular suction lipectomy and single-hole inflator-free endoscopic thyroidectomy with a submental approach: a new surgical technique.

We have successfully carried out single-hole inflator-free endoscopic thyroidectomy through a submental approach, which has the advantages of less trauma, fewer complications, and hidden incisions. However, for patients with submandibular fat accumulation, submental incisions are not easy to hide, which directly affects the cosmetic effect. We developed a new surgical strategy "submandibular suction lipectomy and single-hole inflator-free endoscopic thyroidectomy with a submental approach" for these patients. We initially used submandibular suction lipectomy to reduce the accumulation of submandibular fat and obvious fat protrusion and, thus, restore the normal depression, placing the submental incision back where it is hidden in the submental shadow. Subsequentially, we began to use single-hole inflator-free endoscopic thyroidectomy with a submental approach. We aimed to explore the feasibility and cosmetic effect of this method for the treatment of thyroid disease patients with submandibular fat accumulation. The average operation time was 4.2 hours; and the average hospitalization time was 4.75 days. There were no postoperative complications, such as hoarseness, low calcium, hand and foot numbness, etc., and no special complications and no recurrence or metastasis seen in the 6-month follow-up examination. The aesthetic satisfaction survey results of patients half a year after surgery were satisfactory and above. For thyroid cancer patients with submandibular fat accumulation, this method not only hides the surgical incision in the neck but also meets the patient's requirement for "submental aesthetics"; thus it has good application prospects. It should be pointed out that the current findings are preliminary results, based on data from only four patients.

Modified Colson flap with subcutaneous liposuction for one-stage donor site removal: A case series

The aim of this study was to evaluate the functional and cosmetic results of an innovative procedure for modified Colson flap-graft consisting of immediate defatting of the flap by a liposuction cannula. A cross-sectional study was performed among patients with deep hand burns requiring a modified Colson flap between 2018 and 2021. Outcomes included functional and cosmetic assessment of the hand through a quality-of-life questionnaire, a sensitivity scale and a scar assessment scale. During this period, 7 patients were operated on using our technique. One patient was lost to follow-up; 7 patients with a median age of 44 years were included, with a total of 10 burned hands. The burns were thermal in 5 out of 7 cases and the coverage concerned the whole hand in 50% of the cases. The flaps all received cannula defatting. The median time to flap weaning was 23 days (20 to 30 days). The median follow-up was 16 months. One case required remote flap weaning. The median POSAS (Patient and Observer Scar Assessment Scale) per patient was 4 and 2 per observer. The median BMRCSS (British Medical Research Council Sensory Scale) was 122. One case had recovered S2 sensitivity, the other cases had S3 or S4 sensitivity. Immediate defatting is one of the factors in tegumental quality allowing rapid functional recovery of the hand. The cannula defatting technique does not appear to require additional defatting time. The use of the liposuction cannula allows a one-step, homogeneous, and easier defatting, with a lower risk of devascularization.

Evaluation of cleaning and sterilization of liposuction cannulas after intentional contamination with human fat, Mycobacterium abscessus subspecies bolletii, and Geobacillusstearothermophilus

The complex design of cannulas is a major challenge for reprocessing due to the retention and accumulation of fat residues. To evaluate the cleaning of liposuction cannulas and the protective effects of the remaining fat residues on Mycobacterium abscessus subspecies bolletii (MASB) and Geobacillus stearothermophilus inactivation during steam sterilization. In phase 1, six standard operating procedures were evaluated for cleaning of liposuction cannulas. In phase 2, the sectioned lumens of the liposuction cannulas were contaminated with the largest and smallest volume of human fat found in phase 1, with the addition of MASB. In phase 3, the same volumes of human fat from phase 2 were used to contaminate paper strips containing G.stearothermophilus. In phase 1 the residual amount of fat ranged from 6 to 52mg. In phases 2 and 3, the minimum and maximum amounts of fat (6 and 50mg) protected micro-organisms during steam sterilization at 134°C for 1.5 and 3min. Effective cleaning and sterilization of liposuction cannulas intentionally contaminated with human fat, MASB and G.stearothermophilus could not be performed.

Pain Reduction Using Ropivacaine in Tumescent Solution following Lipoaspiration.

Tumescent solution utilizing dilute epinephrine and a local anesthetic agent injected into a fat compartment has been shown to effectively minimize blood loss and postoperative pain in liposuction. Ropivacaine has a longer duration of action compared to lidocaine and is a potential analgesic in tumescent solution. We sought to explore the effect of using ropivacaine in a tumescent technique with a focus on its efficacy for pain control postoperatively. The formula for the tumescent technique used combined 1 mL of epinephrine with 30 mL of ropivacaine into 500 mL of injectable saline. Tumescent solution was injected manually into fat donor sites of 10 consecutive patients followed by a 20-minute waiting period before beginning fat aspiration with liposuction cannula. Patients were seen immediately following their surgery and on postoperative day 1 and reported their pain using a numerical scale. Data gathered included the amount of ropivacaine used, average pain rating, and the average amount of fat removed. On average, participants reported little to no pain at the donor sites immediately following surgery and on postoperative day 1. Based on the low need for pain medication, we believe that ropivacaine may be successfully used in tumescent solution to reduce postoperative pain.

Evolution of the Push-2-Spin Fat Graft Processing Device: Enhancing Efficiency and Reducing Risk of Contamination.

Small-volume fat graft efficiency is a critical determinant of the cost and material effectiveness of aesthetic fat grafting in the clinical space. Recent development of devices, such as the Push-2-Spin (P2S) system (Pittsburgh, PA), has improved upon the process by yielding a rapid, handheld, multi-use system to minimize operative time and mess. In this study, the authors describe further technical innovations on the P2S prototype that improve operative ease of use, time, and safety. Abdominoplasty samples were obtained as discarded tissue. Lipoaspirate was collected utilizing a 3.0 mm liposuction cannula and processed through centrifugation (Coleman technique), gauze (telfa) rolling, mesh straining, the tabletop P2S device (prototype), or the P2S handheld (P2S-H) device. Operative processing time, spin time, oil fraction, stromal vascular fraction (SVF) yield and viability, and adipocyte viability were assessed to compare the efficacy and viability of each device/technique. Blood agar smears of lipoaspirate were performed to assess for risk of contamination. The P2S-H device outperformed its prior iteration in rotary and processing speed and was significantly faster than each other technique assessed. Furthermore, the use of an inline system offered significant advantages over open-air techniques in terms of resistance to contamination. Serial use characteristics were assessed; under these conditions, oil yield as well as adipocyte and SVF number and viability was similar between all techniques. The technical advancements to the P2S system which enable single-unit, handheld operation significantly improve operative time and minimize space requirements. This operative quality of life improvement comes at no cost to the efficacy of oil extraction, cellular yield, or cell viability.

Invited Commentary on Laser-Assisted Suction Lipectomy in Mastopexy and Breast Reduction

Thank you for this opportunity to comment on the above paper, which I published jointly with Jeffrey Marvel MD, four years ago. I particularly appreciate the opportunity to comment on this publication because both Dr. Marvel (the paper’s senior author) and I have essentially ceased offering this procedure despite the benefits described in the original publication (which include reduced scarring, reduced operative complexity, lower complication rate, reduced surgical time), due – as seen below – to patient preference.

Photobiomodulation Therapy as an Adjuvant Treatment of Cervicofacial Liposuction Complications

Introduction: Cervical suction lipectomy (CSL) procedures result in practically inevitable complications after the operation, such as facial edema and bruise. Photobiomodulation therapy (PBMT) can be used for analgesia, modulation of inflammatory processes, and improved tissue healing. Case Report: We have reported two cases of patients in which this therapy was used to manage complications-related CSL. As they had already been medicated and still had these side effects, the PBMT was proposed for local analgesia, nerve repair, and modulation of the inflammatory process. Within 72 hours after a single PBMT session, there was an important reduction in the severity of all situations. Conclusion: PBMT seems safe and effective in managing pain and edema-related CSL.

CANNULA TIP BREAKAGE INSIDE ADIPOSE TISSUE DURING LIPOSUCTION – A RARE CASE REPORT

Introduction. Liposuction is a popular procedure worldwide and when done by a trained plastic surgeon it is very safe. We report a case of iatrogenic breakage of infiltration cannula during liposuction – a rare complication to liposuction. It poses no immediate harmful complications only discomfort for the patient until removal. Case report. In this case report we conceded a 44-year-old female referred from a private clinic with a broken infiltration cannula from liposuction to the thigh. The localization of the broken cannula was confirmed with x-ray prior to surgery and reconfirmed using a c-arm peri-operatively. Gentle retrieval of the cannula was performed. Discussion. Iatrogenic breakage of a cannula is a rare complication. The liposuction cannula was situated in the subcutaneous tissue and will pose no immediate harm to the patient compared to peripheral and central cannulas – that can have lethal complications. Conclusions. When performed properly by a trained plastic surgeon liposuction is very safe procedure with little serious risks. Iatrogenic breakage of the infiltration is a rare occurrence and can be safely removed using x-ray imaging prior to and during surgery.

Ultrasound-Assisted Abdominal Etching Preoperative Planning.

Ultrasound-Assisted Abdominal Etching Preoperative Planning.

Major clinical evidence of cervicofacial liposculpture: a concise systematic review

Introduction: Liposculpture (LS) can complement cervicofacial aging surgery. Modern trends in face sculpting are expanding and adipose tissue transfer can result in optimal esthetic effects with minimally invasive techniques. Facial LS focuses on repositioning adipose tissue and increasing facial transition zones. This is accomplished using internal suspension sutures as well as with autologous fat grafting. Objective: To carry out a concise systematic review of the main clinical considerations and advances in facial and cervical liposculpture as an important aesthetic tool for dental surgeons. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The search was carried out from November 2021 to February 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: Fifty articles were found involving facial liposculpture. A total of 30 articles were fully evaluated and 16 were included and developed in the present study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies at high risk of bias and 4 studies that did not meet the GRADE. Most patients who were involved in the studies showed improvements in facial augmentation and contouring. In patients with loss of facial volume, high-density fat transfer with SVF-gel facial injection resulted in significantly higher improvement scores and better patient satisfaction, with an improved/much improved esthetic appearance being observed. As a follow-up analysis of the studies, at an average of six months after completion, most patients were satisfied with the results. All procedures were well tolerated. Conclusion: According to the main clinical studies selected in the present study, cervicofacial liposculpture proved to be advantageous, with safety and efficacy.