Conventional Liposuction Research Articles

A systematic approach to the surgical treatment of gynaecomastia

Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is faced with a wide range of excisional and liposuction procedures. There is a paucity of literature describing an integrated approach to the management of this condition and the roles of the different treatment modalities. A review of all gynaecomastia patients operated on by one surgeon over a 2-year period was undertaken. Patient satisfaction was assessed using a linear analogue scale with a maximum score of 10. In total, 48 breasts in 29 patients were treated—31 breasts by liposuction alone (19 by conventional liposuction, 12 by ultrasound-assisted liposuction), eight breasts by liposuction and open excision, and nine breasts by liposuction, open excision and skin reduction (concentric or Lejour mastopexy). There were no early postoperative complications, such as haematoma, seroma or infection, and 91% of patients were very satisfied (score: 8–10) with their cosmetic outcome. The most frequently encountered complication was a residual subareolar lump (five breasts), all in patients treated by conventional liposuction alone. In order to avoid the common complication of an uncomfortable residual subareolar nodule, the threshold for open excision in patients undergoing conventional liposuction should be low. Ultrasound-assisted liposuction extends the role of liposuction in gynaecomastia patients. Although skin excess remains a challenge, it can be satisfactorily managed without excessive scarring. A practical approach to the surgical management of gynaecomastia, which takes into account breast size, consistency, skin excess and skin quality, is proposed.

The effect of ultrasound-assisted liposuction and conventional liposuction on the perforator vessels in the lower abdominal wall

Scientific reports of clinical in vivo research into the effects and side-effects of ultrasonic-assisted liposuction (UAL) are scarce. Advocates of UAL claim that the damage to vascular and nervous structures is limited and even less than with conventional and/or tumescent liposuction (CL). The effect of tumescent infiltration alone and combined with either CL or UAL was assessed by performing injection studies of the panniculus adiposus of the lower abdominal wall of 20 fresh cadavers and five abdominoplasty specimens. Besides the control and infiltration groups (n=5 in each), there was an additional group of ten cadaver flaps and five abdominoplasty flaps that underwent infiltration followed by UAL in the right half of the flap and infiltration followed by CL in the left half of the flap. Radiographs of these flaps were shown to a blinded panel of ten plastic surgeons, who were asked to evaluate and compare the damage on the basis of the number and magnitude of contrast-medium extravasations in the flap. Vascular damage to the perforating vessels was seen even after infiltration alone, although it was very limited. A variable amount of damage (ranging from little to extensive) was observed in the CL and UAL groups. Statistical analysis of the judgments of the observers could not show that either technique was less damaging than the other. UAL is, therefore, probably more beneficial to the surgeon than to the patient. The financial investment in the device is justified for surgeons with large liposuction practices, mainly, and probably solely, because of the reduced physical strain for the surgeon.

Is there evidence for excessive free radical production in vivo during ultrasound-assisted liposuction?

The surgical technique of ultrasound-assisted liposuction has become a standard procedure for the treatment of lipodystrophy. However, little is known about the impact of this therapy on fatty tissue on the molecular level. There are concerns about possible adverse effects related to the high-intensity ultrasound energy, because in vitro studies have shown a substantial generation of free radicals. In this study, the authors investigated whether ultrasound waves can create an excessive free radical production in vivo by measuring lipid peroxidation products in the form of malondialdehyde equivalents. For this purpose, the thiobarbituric acid-reactive substances (TBARS) assay was chosen. In this test, malondialdehyde, a major product of lipid peroxidation, reacts with thiobarbituric acid to produce a pink adduct that can be measured spectrophotometrically. The authors determined oxidation products in 28 aspirates of 17 treated patients before ultrasound-assisted liposuction (0 minutes) to establish a baseline concentration and at 2, 5, and 10 minutes after the treatment was begun. Median malondialdehyde concentration of the control group (conventional liposuction, 0 minutes) was 3.40 nmol of malondialdehyde per gram of adipose tissue. Median concentrations after 2, 5, and 10 minutes of ultrasound-assisted liposuction were 7.45 (n = 28), 8.84 (n = 21), and 4.07 (n = 8) nmol malondialdehyde per gram adipose tissue, respectively. The differences were not statistically significant. The data suggest that there is no excessive formation of lipid oxidation products in response to free radicals. The antioxidative capacity of adipose tissue does not seem to be overwhelmed by the standard application regimen of ultrasound-assisted liposuction.

External Ultrasonic Tumescent Liposuction vs. Conventional Tumescent Liposuction: A Gross and Microscopic Study

When compared to conventional tumescent liposuction (CTL), external ultrasonic tumescent liposuction (EUTL) has been presented as provoking less bleeding, giving improved aesthetic results, faster recovery of the patient, and less effort by the surgeon. CTL and EUTL were compared, with special attention to clinical, physical, chemical, and microscopic results. EUTL demonstrated higher amount of triglycerides in the aspirated fluid but lower amount of proteins than CTL. The percentage of damaged adipocytes was higher in EUTL, while in CTL the connective tissue and vessels were higher. Cosmetic results, recovery time, and complications were similar at both sides. The changes, observed were more microscopic, physical, and chemical than related to patients' cosmetic outcome. If the correct tumescence is used, EUTL is not better than CTL alone.

Endoscopic liposhaving for neck recontouring.

To describe a modified technique of liposuction that combines endoscopic techniques and a soft tissue shaver for neck recontouring. Nonrandomized, nonblinded, retrospective evaluation of endoscopic liposhaving for patients requiring neck recontouring in a facial plastic surgery practice. Endoscopic liposhaving was performed on 5 patients undergoing neck recontouring with platysma plication using a small submental incision. Subjective evaluation by the surgeon. Direct visualization with the endoscope ensures complete removal of excess fat while maintaining a small amount of fat over the platysma muscle and on the skin flap. The fat was easily and precisely removed with minimal trauma and edema. There were no resulting facial nerve injuries, dimpling, hematomas, or significant asymmetries. Endoscopic liposhaving for neck recontouring is a precise and less traumatic method of lipectomy than the current techniques. Direct fat visualization with an endoscope allows more accuracy than the external visualization and palpation relied on in conventional liposuction or direct liposhaving. Using these 2 newer modalities can lead to quicker recovery time. There are no known previous reports of use of these 2 techniques together. Arch Facial Plast Surg. 2000;2:264-268

External ultrasound-assisted lipoplasty from our own experience.

External ultrasound-assisted liposuction (XUAL) is a new technique that requires traditional aspirative liposuction after the application of high frequency ultrasonic fields delivered through the skin into a wetted tissue. Initial data suggest that it has some advantages over the traditional procedure, especially regarding the achievement of less traumatic surgery with superior clinical outcome. This preliminary report describes a comparative study between conventional liposuction and the external ultrasound-assisted technique as the modality of treatment for fat deposits in 65 bilateral anatomical areas. The results showed considerable superiority of the ultrasound-assisted series. We found less resistance to the canulla with more rapid removal of fat and the aspirated tissue showed less blood content with intact viable fat cells. Patients report less pain and discomfort on the ultrasound-treated sides and we found less swelling and bruising, with superior skin shrinkage. Clinical recovery was also enhanced by the external ultrasound and no complications were reported with the technique.

Systematic procedure for ultrasonically assisted lipoplasty.

It is well known that liposuction is the extraction of fat tissue from localized areas through small incisions with the use of a cannula and a vacuum pump. Since we began liposuction 18 years ago in our Department of Plastic and Reconstructive Surgery at the Clinica RUBER of Madrid, more than 1,300 patients have been treated with this procedure. During this time, instruments and techniques have been dramatically improved: there have been changes in methods (from the dry method to the wet and super-wet ones), in instruments (from the large caliber cannulae to the small caliber ones), and in application (from the deep aspiration plane to the superficial one) [1-5]. We presently have completely developed a systematic procedure for conventional liposuction (CL) which produces excellent results and provides a foreseen evolution in all patients, and that we have combined with the new ultrasonically assisted lipoplasty (UAL) to get very satisfactory results.

A 3-Year Multi-institutional Experience With the Liposhaver

To report a 3-year multi-institutional clinical experience with the liposhaver in facial plastic surgery. Nonrandomized, nonblinded, multi-institutional evaluation of the liposhaver in a clinical setting. Seventy-two patients who presented for facial plastic surgical procedures underwent surgery with the liposhaver. Seventy-six liposhaving procedures and 74 concomitant procedures were performed. Standardized preoperative and postoperative photographs were obtained. Subjective evaluation by the surgeons who performed the procedures. The liposhaver was used successfully in all cases. The fat was cleanly shaved and the contour results were even, without dimpling or significant asymmetry. Operative time was comparable to that of conventional liposuction. There were no cases of facial nerve injury and no evidence of increased bleeding intraoperatively. Two male patients had small postoperative hematomas in the immediate postoperative period that were successfully treated with conservative measures. An additional patient developed a small hematoma on postoperative day 5 that was effectively treated with needle aspiration and a pressure dressing. This 3-year multi-institutional report suggests that the liposhaver continues to offer a precise alternative to conventional liposuction.

Liposuction technique and lymphatic lesions in lower legs: anatomic study to reduce risks.

Liposuction is a standard procedure in plastic surgery. Especially, lipectomy with suction of the lower extremities has been of greater interest in recent years. Until now, however, there was no definite information about the integrity of epifascial lymph collectors during this procedure. To study the effect of liposuction devices on lymph vessel injury, postmortem lymphatic preparations were done in five human cadavers (10 lower extremities). Conventional liposuction with a blunt 4-mm cannula and a dry technique was used. Adiposuction was performed either in parallel to the extremity axis and, therefore, in parallel to the superfascial lymph vessels or transversally in an 80- to 90-degree angle to the extremity. Careful surgical preparation of the regions followed. A specific macroscopic lymph vessel injury score was applied to differentiate 3 degrees of lymph vessel lesions according to the extravasation of patent blue. In all lower extremities, postmortem lymph flow occurred as indicated by patent blue staining of the lymph vessels. Lymph vessel injury was more severe in areas where liposuction was performed transversally, vertical to the extremity's axis, than in those after a longitudinal procedure. The difference was statistically significant (p < 0.01). The volumes of adipoaspirate and of the compared regions were comparable between both groups, verified by circumference measurements. Longitudinal liposuction of the lower extremities is unlikely to cause major lesions of epifascial lymph vessels and, therefore, should be preferred in comparison to liposuction vertical to the extremity.

Breast reduction by suction mammaplasty

Suction mammaplasty as a sole method of breast reduction has proven to be a safe and effective method of reduction mammaplasty. It is applicable to a select subset of patients who present with breast enlargment caused primarily by fibro-fatty tissue, and whose nipple-areolar complex is welllocated and is not excessively enlarged. the procedure is done using superwet infilatration of the breast and conventional liposuction. The specimens are kept separate and are examined by a pathologist. Suction mammaplasty offers an additional method of breast reduction in appropriate candidates.

Staff Education And Training For Ultrasound-Assisted Lipoplasty

Although ultrasound-assisted lipoplasty (UAL) has many similarities to conventional liposuction, it is a new technology, and it is important that not only operating room (OR) staff but also office personnel be familiar with the technique, the machinery, and the important safety considerations for appropriate implementation of UAL. UAL is a safe procedure when performed properly. The better the OR personnel understand the necessary safeguards and the reasons for them, the better they can function with the surgeon as a team to provide a system of double checking and vigilance and maintain an efficient environment with a perfect safety record.

Conventional and Ultrasonic Liposuction

Conventional and Ultrasonic Liposuction

Investigation of the effect of liposuction on the perforator vessels using color Doppler ultrasonography

In this clinical study, the effect of conventional liposuction on musculocutaneous and fasciocutaneous perforator vessels was investigated. The perforator vessels in the abdominal and lateral and medial thigh regions in 7 patients and in the abdominal region in 3 patients (a total of 38 anatomic regions in 10 patients) were marked preoperatively by color Doppler ultrasonography. Following a standard liposuction procedure, the changes in the number of the perforators in those regions were detected by the same method postoperatively at 2 weeks and 3 months. The number of cannula passes employed and total volume of the aspirate for each region were also recorded. The results of the Doppler examinations showed that 57.8% of abdominal, 50.0% of lateral thigh and 53.8% of medial thigh perforators could not be detected at 2 weeks and 3 months (p<0.01) postoperatively. Both the number and the locations of the perforators were found to be identical for each anatomic region at the two postoperative Doppler examinations at 2 weeks and 3 months. The changes in the number of the perforators did not show any type of correlation with the number of cannula passes and the aspirate volume. The results of this study have shown that conventional liposuction may have a traumatic effect on the perforator vessels passing from the deep fascia towards the overlying skin. This observation has led us to suggest that a history of previous liposuction should be an indication for preoperative evaluation of the perforators when a musculocutaneous or fasciocutaneous flap is planned in the suctioned regions. This may prevent problems related with flap viability.

Ultrasound-assisted lipoplasty and suction-assisted lipoplasty

Franklin L. DiSpaltro, MD Charles E. Hughes, III, MD Mary K. Gingrass, MD Gerald H. Pitman, MD Rod J. Rohrich, MD Dr. DiSpaltro: The first patient (Figure 1) is a 25-year-old woman who is in good physical condition. She is a weight trainer and wears skimpy swimwear. She is bothered most by her trochanteric and posterior thighs. Dr. Gingrass, how would you manage her problems? Figure 1 This 25-year-old, physically fit woman seeks improvement in her trochanteric and posterior thigh areas. Dr. Gingrass: I would manage the posterior hips with suction-assisted lipoplasty (SAL) alone, mainly because she has extremely minor fat deposits in that area, so I could not justify making the large excision needed for ultrasound-assisted lipoplasty (UAL), especially because she wears very skimpy swimwear. I would treat the saddlebags and posterior thighs with UAL because I could hide the incision in the gluteal crease and believe that UAL would give me more control. However, I would never argue against treating this area with SAL only; UAL is just my preferred tool. Dr. DiSpaltro: How much longer would it take you to treat this patient with UAL as opposed to with SAL? Dr. Gingrass: It wouldn't take me any longer to treat a case of minor fat deposits like this with UAL versus with conventional liposuction. On a larger case, I would treat each trochanteric area with UAL for 6 to 8 minutes, and then evacuate the remaining fatty emulsion, which would take another 2 minutes or less. The average UAL case takes me 10% to 15% longer. Dr. DiSpaltro: How do you determine the contour that you want to create in the lateral femoral trochanteric area? Dr. Gingrass: In the preoperative period on the day of surgery, I take a Polaroid photograph of the patient. I draw the contour that …

Circumferential liposuction of the thighs

The extension of the traditional “bulge”-only treatment to circumferential liposuction of the thighs has significantly improved the results. The circumferential treatment is done by suctioning at an intermediate level in between the original deep and the newer very superficial sunctioning. There is very little difference in the morbility from conventional liposuction and no significant disadvantages.

Liposuction With “Sonic Sculpture”: Six Years’ Experience With More Than 600 Patients

I have used ultrasound-assisted lipoplasty for more than 6 years on more than 600 patients, using first the Ultravac Series 3 and now the Surgitron Series 2000 and 3000 prototypes. Ultrasonic energy for liquefaction of body fat evolved from the use of such energy in phacoemulsification of cataracts. I have all but completely abandoned conventional liposuction techniques in favor of ultrasound-assisted lipoplasty for the reduction of excess fatty deposits in both minimal and large volume cases. This clinical review outlines the method of outpatient treatment of 600 cases of trunk ultrasound-assisted lipoplasty, with or without thigh reduction, 174 chin and neck suctions, 12 upper arm sculptings, 30 breast reductions with soft tissue excision, 17 calf reductions, and 40 gynecomastia reductions, most of which involved soft tissue subareolar resection. Many of the patients underwent multiple area reductions simultaneously. Advantages of this technology to both patient and surgeon, include greater postoperative patient comfort, better refinement in body sculpting, diminished blood loss, an opportunity to provide the larger patient lipoplasty, greater speed of execution in liposuction, and, finally, reduced physical effort by the surgeon. A low complication rate (3% overall), mainly small surface irregularities, lends more to the attractiveness of this modality as being worthy of further study for widespread surgical use.

The Soft-Tissue Shaving Procedure for Removal of Adipose Tissue: A New, Less Traumatic Approach Than Liposuction

To introduce the soft-tissue shaving cannula, a new, precise alternative to conventional liposuction that embodies an entirely different method of soft-tissue extraction and that appears to be less traumatic and more precise than methods currently used in liposuction. Nonrandomized, nonblinded comparison of the soft-tissue shaver and conventional liposuction devices in fresh cadavers, followed by clinical use of the liposhaver in selected patients undergoing cosmetic facial liposuction. Conventional liposuction devices and the soft-tissue shaving cannulas in fresh cadavers (< 8 hours old). A submental lipectomy and a melolabial fold liposhaving were performed in a clinical setting. Subjective evaluation by the operating surgeons. The fat was cleanly shaved and the contour result was even, without dimpling or asymmetry. Our early experiences suggest that this new liposhaving technique may offer a precise, less traumatic alternative to conventional liposuction. Fat can be shaved in an open fashion under direct vision. It does not rely on a vacuum seal. The soft-tissue shaving cannula shaves fat one layer at a time. The depth of each layer removed, the depth of soft-tissue injury, and the optimal settings and sizes for various procedures remain to be reported.

Comparison of the Conventional and the Ultrasound Methods of Liposuction

This article compares the results of the ultrasound and the conventional methods of liposuction and tries to determine the advantages of the ultrasound method. In comparison to the conventional method, ultrasound liposuction shows much better results in saddlebags, the abdominal wall, and the buttocks. The treatment of cellulite with ultrasound liposuction has proved to be more successful and the lift effect of the skin remains 4–6 months longer than with conventional liposuction. On the other hand, the long-term results do not show any significant differences between the two methods; we have observed equal results from both techniques after six months. Ultrasound liposuction at the knees, inner thighs, arms, and ankles has proven not to be very successful. The advantages of the ultrasound method are less pain, less bruising, less blood in the aspirate, and a short recovery time. The disadvantages are the very high expenses and the impossibility of using the aspirated fat again.