Liposuction Methods Research Articles

Assessing Adipocyte Viability and Surgeons' Work Efficiency by Comparing Different Liposuction Methods.

Autologous fat grafting is widely used in plastic and reconstructive surgery. Liposuction methods play a key role in surgeons' work efficiency, adipocyte viability, graft survival, and outcomes. We investigated the effect of four liposuction methods on adipocyte viability, debris, and surgeons' work efficiency by measuring the active energy expenditure and changes in heart rate. Human lipoaspirate was harvested from patients' removed abdominal flaps using four different liposuction methods, and we counted calories per aspirated volume and surgeons' heart rate. Adipocytes were separated from the lipoaspirate immediately by digestion with 0.1% type I collagenase. After digestion, parts of the cells and debris were measured. Adipocytes were plated in an adipocyte maintenance medium containing Alamar blue reagent. The adipocyte metabolic activity was measured using a spectrophotometer. After evaluating the active energy expenditure and changes in surgeons' heart rate, the ultrasonic-assisted liposuction (UAL) method was determined to be the most ergonomic liposuction device for surgeons. In addition, adipocyte viability was higher in the UAL group than in the other groups, and debris was the lowest in the power-assisted liposuction 1 group (PAL1). Adipocyte viability is crucial for improving fat grafting outcomes. This study revealed that the viability of adipocytes is best preserved using the UAL and PAL1 liposuction methods. The UAL and PAL1 methods caused the least damage to the cells. The UAL method yielded the best results for surgeons' work efficiency.

Injectable pulverized electrospun poly(lactic-co-glycolic acid) fibers improve human adipose tissue engraftment and volume retention.

Autologous adipose tissue is commonly used for tissue engraftment for the purposes of soft tissue reconstruction due to its relative abundance in the human body and ease of acquisition using liposuction methods. This has led to the adoption of autologous adipose engraftment procedures that allow for the injection of adipose tissues to be used as a "filler" for correcting cosmetic defects and deformities in soft tissues. However, the clinical use of such methods has several limitations, including high resorption rates and poor cell survivability, which lead to low graft volume retention and inconsistent outcomes. Here, we describe a novel application of milled electrospun poly(lactic-co-glycolic acid) (PLGA) fibers, which can be co-injected with adipose tissue to improve engraftment outcomes. These PLGA fibers had no significant negative impact on the viability of adipocytes in vitro and did not elicit long-term proinflammatory responses in vivo. Furthermore, co-delivery of human adipose tissue with pulverized electrospun PLGA fibers led to significant improvements in reperfusion, vascularity, and retention of graft volume compared to injections of adipose tissue alone. Taken together, the use of milled electrospun fibers to enhance autologous adipose engraftment techniques represents a novel approach for improving upon the shortcomings of such methods.

Gluteal Fold: Cadaveric Dissection of the Superficial Fascial System in the Buttock and Anatomy-Based Gluteal Liposculpture.

The anatomy and formation mechanism of the gluteal fold (GF) remain unclear. Given that understanding the anatomy of the superficial fascial system (SFS) may facilitate the improvement of liposuction techniques, this study aimed to clarify and define the anatomical components of the GF. A total of 20 fresh female buttocks and thighs were dissected sagittally to observe the changes of the SFS along the GF and were dissected horizontally to observe the SFS on the upper, middle, and lower levels of the buttock. Through these dissections, 2 patterns of the SFS in the GF region were identified. The retinaculum cutis (RC)-dominant SFS, named the fascial condensation zone, features an extremely dense and tough RC, originating from the bony structures (eg, the ischium) and radially anchored by the dermis. The fat-dominant SFS features a classic double-layered SFS structure. The RC-dominant SFS is mainly distributed at the medial GF, thus forming the depressed fold. It gradually disappears along the GF and the SFS becomes fat-dominant, making the fold increasingly less visible. At the lateral buttock, the SFS of the buttock and thigh reach an identical status in terms of morphologic features, showing a smooth curve between the buttock and the thigh instead of a fold. Thus, based on these findings, different liposuction methods were formulated to manage GF contouring. The SFS of the GF region shows a regional variation pattern. Topographic anatomy of the SFS in the GF region helps us understand GF contour deformities and provide an anatomical basis for surgical correction.

Liposuction, the epoch procedure

Liposuction is considered to be one of the most popular surgical procedures in the world. It consists of removing subcutaneous fat from specific parts of the body using a medical pump that creates negative pressure and a special thin cannula inserted into the fat tissue. Nowadays, it is a relatively safe procedure, but it was not always this way. Improving liposuction methods, their effectiveness, and reducing the risk of posttreatment complications are the result of aquired experience and knowledge based on practical activities over the years. The aim of this paper is to present the history of liposuction, the diversity of treatment techniques, and their modifications over the years.

Anatomical Guidelines for Thigh Lipoplasty Based on Cadaveric Dissection of the Superficial Fascial System in the Thigh.

Although widely accepted as an optimal procedure in thigh contouring, liposuction can result in complications, such as skin irregularity or aspiration inadequacy. A main cause might be insufficient knowledge of the superficial fascial system (SFS). The authors aimed to explore the characteristics of the SFS in the thigh and propose anatomical guidelines and new zoning for liposuction-assisted thigh contouring. A total of 20 fresh female thighs were dissected from the skin to deep fascia to observe and compare changes in the SFS from the medial to the lateral side and from the proximal to the distal end. The thigh was divided into four units, namely, the medial (three subunits: upper, middle, and lower), anterior, posterior (three subunits: upper medial, upper lateral, and middle lower parts), and lateral thigh. The authors found that the form of the SFS has regional variations. Therefore, based on these varied features, four anatomical scenarios (degrees I to IV) and one functional section (hip-contour support) were devised from the eight subunits. Five different liposuction methods were formulated to manage these subunits: all-layer mass liposuction, normal aspiration, border feather-out, restricted lipoplasty, and anchor. The SFS of the thigh showed a regional variation pattern, based on which the authors proposed a series of new anatomy-based liposuction approaches. A well-sculpted thigh with its different sections presented in harmony can be safely obtained using these approaches.

Current status and prospects of clinical application of liposuction

To review the characteristics and deficiencies of various liposuction methods to provide reference for choosing more suitable liposuction in clinic and ideas for the improvement and development of liposuction equipment. The literature related to liposuction in recent years was consulted, and the principle, indications as well as existing problems were reviewed. Liposuction can be divided into two categories according to the principles of fat separation. The first type relies on physical cutting to separate fat, including suction-assisted liposuction (SAL), power-assisted liposuction (PAL), and water-assisted liposuction (WAL). SAL and PAL are simple to operate and low in price, but the effect of liposuction mainly depends on the experience of the surgeon, and complications such as uneven appearance, hematoma, and ecchymosis may occur. WAL saves time and effort, but has lower cost performance. The second type relies on energy destruction to separate fat, including ultrasound-assisted liposuction, laser-assisted liposuction, and radiofrequency-assisted liposuction. This type of surgery has the advantages of less trauma, fast postoperative recovery, and skin tightening. However, the equipment is more expensive, and has a risk of skin burns. Liposuction can effectively reduce local fat accumulation, but it still has limitations. Equipment improvement and fat transplantation are important directions for liposuction's future development.

Lipoma versus benign symmetric lipomatosis with localization in oral and maxillofacia region

Benign tumors of fat tissue with localization in oral and maxillofacial region are an ongoing problem, with a high frequency and various manifestation causing morphofunctional and aesthetic discomfort for the patient. The article is based on comparative analysis of 2 patients that have benign tumors of the adipose tissue in the OMF region, one patient diagnosed with solitary lipoma and over patient with benign symmetric lipomatosis with anterior cervical localization. The specialized literature offers 2 methods of lipomatous tumor removal Liposuction and Lipectomy, in the article we describe the effectivity of the 2 methods. This study proved that benign tumors of fat tissue can have common morphological origin but different progression and clinical features. Early addressing of the patients and early detection diminishes the duration of the surgery, morbidity and rehabilitation of the patient.

Fate of Fat Grafting In Vivo and In Vitro: Does the Suction-Assisted Lipectomy Device Matter?

Recently, there has been increasing research interest in identifying the effect of liposuction procedures on fat graft survival in order to clarify whether different harvest techniques affect the quality of fat grafts. The aim of this study was to investigate the effect of 2 liposuction methods on the survival and regeneration potential of grafted fat tissue. The proliferation and differentiation potentials of adipose-derived stem cells (ASCs) isolated by both methods was also investigated. Fat grafts were collected from patients who underwent liposuction procedures by 2 different methods: traditional suction-assisted liposuction (TSAL) and vibration amplification of sound energy at resonance (VASER). One portion of the lipoaspirates was implanted into the subcutaneous layer of nu mice for 4 and 12 weeks. ASCs were isolated from the other portion of the lipoaspirate and subjected to proliferation and differentiation assays. Although in vivo fat grafting presented similar adipose tissue survival for the 2 different liposuction methods, more angiogenesis and less fibrosis was observed in the VASER group based on histologic evaluation. Furthermore, VASER-derived ASCs presented better quality in terms of cell differentiation capacity. The in vivo study confirmed better graft angiogenesis with less inflammation, apoptosis, and scar formation in the VASER group. ASCs harvested with VASER exhibited increased differentiation capacity compared with those obtained by TSAL, and represent an excellent source for fat grafting and regenerative medicine.

Assisted liposuction (ultrasound‐assisted, power‐assisted, and laser‐assisted)

AbstractLiposuction is currently the most popular surgical procedure for body contouring requested by patients in many parts of the world. Since its first published description in 1976, continuous evolution in concepts, techniques, and instrumentation has occurred, enhancing its safety and efficacy. Tumescent anesthesia, microcannulas, and good patient selection have enhanced safety. Assisted liposuction techniques utilizing innovative devices as adjuncts to traditional suction‐assisted lipectomy have enhanced efficacy. Three assisted liposuction techniques, which the author has adopted in her practice, namely, ultrasound‐assisted liposuction, power‐assisted liposuction, and laser‐assisted liposuction are reviewed. Methodology for this review consists of literature search from available liposuction textbooks and journal publications in English language, personal communication with liposuction surgeon colleagues, as well as the author's personal experience. This review aims to help dermatologic surgeons make intelligent equipment choices by presenting the evolution of liposuction concepts, instrumentation, and techniques and allow a better understanding of three methods of assisted liposuction.

Invited Discussion on: Application of a Proposed Multi-positional Circumferential Arm Liposuction Method and Quantification of its Clinical Efficacy Evaluation

Invited Discussion on: Application of a Proposed Multi-positional Circumferential Arm Liposuction Method and Quantification of its Clinical Efficacy Evaluation

Application of a Proposed Multi-Positional Circumferential Arm Liposuction Method and Quantification of its Clinical Efficacy Evaluation

BackgroundUpper arm liposuction mainly focuses on the posterolateral region, which may lead to a lack of harmony between the aspirated and unaspirated areas. In addition, the treatment effect of arm liposuction is often evaluated only by preoperative and postoperative photograph comparison and simple measurement; quantitative research on this topic is still lacking.MethodsThe multi-positional circumferential arm liposuction (MCAL) technique was proposed and applied to a total of 34 females in our hospital from 2017 to 2019. Three-dimensional data of 12 patients before the operation and after 2–3 months were collected and processed by 3D imaging, and the volume reduction rate was evaluated quantitatively.ResultsThe MCAL method was successfully applied in the clinic, and its surgical effect was quantitatively studied. The mean follow-up time of 12 patients was (75.2 ±13.1) days, and the postoperative volume was significantly reduced. The postoperative volume of patients with type I, type II and type III decreased by (10.79 ±2.55)%, (17.25 ±3.02)% and (22.76 ±3.51)%, respectively.ConclusionOur new MCAL technique was successful, maximizing the esthetic results in upper limb contour refinements in the superficial fascial layer. The clinical efficacy of this proposed MCAL method was evaluated by CT and 3D digital technology, which provided further accuracy in demonstrating its effect on the shape of the arm.Level of evidence IVThis 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 https://www.springer.com.

Influence of various liposuction methods on cultural properties of adipose-derived stem cells

Influence of various liposuction methods on cultural properties of adipose-derived stem cells

Therapeutic angiogenesis using autologous adipose-derived regenerative cells in patients with critical limb ischaemia in Japan: a clinical pilot study

Adipose-derived regenerative cell (ADRC) is a promising alternative source of autologous somatic stem cells for the repair of damaged tissue. This study aimed to assess the safety and feasibility of autologous ADRC implantation for therapeutic angiogenesis in patients with critical limb ischaemia (CLI). A clinical pilot study—Therapeutic Angiogenesis by Cell Transplantation using ADRCs (TACT-ADRC) study—was initiated in Japan. Adipose tissue was obtained by ordinary liposuction method. Isolated ADRCs were injected into the ischaemic limb. We performed TACT-ADRC procedure in five patients with CLI. At 6 months, no adverse events related to the TACT-ADRC were observed. No patients required major limb amputation, and ischaemic ulcers were partly or completely healed during the 6-month follow-up. In all cases, significant clinical improvements were seen in terms of rest pain and 6-min walking distance. Numbers of circulating CD34+ and CD133+ cells markers of progenitor cell persistently increased after ADRC implantation. The ratio of VEGF-A165b (an anti-angiogenic isoform of VEGF) to total VEGF-A in plasma significantly decreased after ADRC implantation. In vitro experiments, cultured with ADRC-conditioned media (CM) resulted in increased total VEGF-A and decreased VEGF-A165b in C2C12 cells, but not in macrophages. ADRC-CM also increased CD206+ cells expression and decreased TNF-α in macrophages. Autologous ADRC implantation was safe and effective in patients with CLI and could repair damaged tissue via its ability to promote angiogenesis and suppress tissue inflammation.

MEKANİK VE ENZİMATİK YÖNTEM İLE İZOLE EDİLEN STROMAL VASKÜLER FRAKSİYON’UN YARA İYİLEŞMESİ ÜZERİNDEKİ ETKİSİNİN IN VİTRO İNCELENMESİ

Objective: The role of Stromal Vascular Fraction (SVF) cell suspension obtained from adipose tissue in wound healing is gaining importance day by day. In this study, the role of SVF cell population, isolated by enzymatic and mechanical methods in wound healing, will be examined in vitro. Material and Method: An SVF cell cocktail was isolated by mechanical and enzymatic methods after adipose tissue was obtained from 10 different patients by the liposuction method (the adipose tissue was divided into two equal groups for enzymatic and mechanical methods). After the isolation process is done, cell viability and cell number were counted using flow cytometry, and cell proliferation rates were measured by WST-1 assay. The Wound Healing Scratch Assay test, which is used as an in vitro model for wound healing, was performed with cell cocktails obtained from both groups. After isolation, the level of expression of the collagen type 1 gene, known to be involved in wound healing, was measured in both groups. Results: While the SVF (E-SVF) cell cocktail obtained bythe enzymatic method was 1,52x106 /ml (±3,63, n=10, p=0,015), the number of SVF (M-SVF) cell cocktails obtained by mechanical method was 0,67x106 /ml (±1,69, n=10, p=0,015). No significant difference was observed between cell viability of SVF cell cocktails isolated by two different methods. The M-SVF cell cocktail had a 10% higher cell proliferation rate compared to E-SVF. Furthermore, M-SVF cell migration rates and Col1 gene levels were found to be higher than E-SVF cells. Conclusion: Although the cell number of the M-SVF cell cocktail was less than the cell number of the E-SVF cell cocktail, the collagen type 1 gene level of the M-SVF cell cocktail was found to be higher, so the M-SVF cell cocktail had higher wound healing properties. 

Prospective Analysis and Comparison of Periareolar Excision (Delivery) Technique and Pull-Through Technique for the Treatment of Gynecomastia.

Gynecomastia is one of the most common disorders affecting adolescent and adult males. It is a benign disorder but has severe psychological manifestations like low self-confidence, depression, anxiety and social phobia in patients suffering from gynecomastia. Different surgical techniques have been described utilizing a variety of incisions, excisions, lipectomy and liposuction methods. Very frequently, these methods are combined for the gynecomastia treatment with variable reported results. However, there is a lack of studies comparing these techniques. The present study was planned to compare cases of gynecomastia treated by liposuction with periareolar excision (delivery technique) and liposuction with a pull-through technique. A prospective randomized control study was conducted at a tertiary care hospital on 20 patients with gynecomastia. The patients were assigned to either liposuction with periareolar excision (delivery technique) or liposuction with pull-through technique. Anthropometric analysis and breast evaluation questionnaire (BEQ) scores were analyzed and compared before and after the surgery. The majority of the study subjects were between 21 and 30years of age. Low self-confidence was the main reason for surgery in most of the cases. Twelve patients had gynecomastia grade IIa and eight had grade IIb. Both groups had similar responses to BEQ scores before and after the surgery with no statistically significant difference. A statistically insignificant difference was observed between the groups on comparison of anthropometric analysis preoperatively and postoperatively. The mean lipoaspirate volume was 280ml for the pull-through technique and 367ml for the periareolar excision technique. No complications were observed in cases operated on by the pull-through technique, while two cases (10%) operated on by the periareolar excision had hematomas. Both techniques provide excellent cosmetic results with low risk of complications in both small and moderate breast enlargement with skin excess. The pull-through technique combines the benefits of direct excision of glandular tissues along with the minimally invasive nature of liposuction. Thus, performing the procedure via a single incision without the use of drains is a safer alternative to traditional liposuction with the periareolar excision technique. 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.

Novel Method of Liposuction in Primary Lymphedema

Chronic lymphedema is a devastating problem for the patient and major financial and social burden. There are various medical and surgical management options available. One of the methods of treatment of chronic lymphedema is liposuction. We have used a novel modification of liposuction adhering to the principles to help in better aspiration of fat and fluid.

Novel Method of Liposuction in Primary Lymphedema

Chronic lymphedema is a devastating problem for the patient and major financial and social burden. There are various medical and surgical management options available. One of the methods of treatment of chronic lymphedema is liposuction. We have used a novel modification of liposuction adhering to the principles to help in better aspiration of fat and fluid.

Adipose-derived stem/progenitor cells from lipoaspirates: A comparison between the Lipivage200-5 liposuction system and the Body-Jet liposuction system

Adipose-derived stem/progenitor cells (ADSPCs) are under investigation in many clinical applications for their regenerative potential in a variety of autoimmune, degenerative, and inflammatory diseases. Adipose tissue, which is mainly harvested by manual liposuction, is the main source of these ADSPCs. In the past years, a variety of different liposuction devices have been commercialized. To ensure a high quality of obtained ADSPCs, it is crucial to show the advantages and disadvantages of frequently used liposuction methods. For this reason, the objective of this study was to compare ADSPCs harvested by either the suction-assisted LipiVage200-5 or the water-assisted Body-Jet system. The proliferation potential of ADSPCs, harvested from 20patients, was assessed by cumulative population doublings (cumPD), population doubling time (PDT), colony-forming units (CFU), and cell metabolism assays. To prove the multipotency of the primary isolated cells, ADSPCs were induced to differentiate into adipogenic, osteogenic, and chondrogenic lineages. Our data show a significantly higher cumPD, as well as a significantly lower PDT for cells obtained by the Body-Jet system. No significant differences were found regarding the CFU efficiency and the cell metabolism. Furthermore, we showed that the adipogenic, osteogenic, and chondrogenic potential of ADSPCs is similar in both groups. In our study, we provide evidence that the cell characteristics and the functional properties of ADSPCs isolated after liposuction with different techniques are largely similar. However, we observed a significantly higher cumPD and a slightly higher adipogenic potential in cells isolated after liposuction with the Body-Jet system. Different cannula sizes and sheer stresses in the used methods might play a role here.

Clinical application and effects of two different liposuction methods in breast augmentation by autologous fat grafting

Objective To explore the effect of different harvest methods of liposuction on the autologous fat grafting. Methods The clinical data of 60 patients with fat grafting for breast augmentation from January 2014 to January 2017 were analyzed retrospectively. According to the method of liposuction, 60 patients were divided into the water-jet assisted liposuction group (30 cases) and negative-pressure machine liposuction group (30 cases). The surgical time of different liposuctions and the fat survival were compared after breast augmentation. The clinical effect of different liposuction methods was analyzed by follow-up one year after operation. Results Sixty patients completed the surgery. The fat survival rate of water-jet assisted liposuction was (66.71±2.68)%, and the fat survival rate of the negative-pressure machine liposuction was (51.44±1.16)%. There were statistically significant difference between the two groups (P 0.05). Conclusions Compared with negative pressure liposuction, water-jet assisted liposuction using autologous fat grafting in breast augmentation can improve the survival rate of fat transplantation. This technique has good clinical application value. Key words: Transplantation, autologous; Fats; Breast; Negative-pressure liposuction; Water-jet assisted liposuction

Effects of aspiration time on immediate viability of adipocyte cell in ultrasound-assisted liposuction (UAL) and in traditional suction-assisted lipectomy (SAL)

We aimed to determine the effect of aspiration periods following liposuction procedure on vascular structures, fibrocollagenous tissues and viability of adipose cells at different minutes, respectively in UAL and SAL. Abdominoplasty materials were divided into two equal parts from middle following excusion during the operations. Traditional SAL was performed to the right part of the abdominoplasty materials therewithal. Each side of the material was then divided into five parts enumarated from one to five and aspiration procedure time for each area was defined according to this ranking. The aspiration periods for each area were as follows: the transition intervals of 30 seconds between each zone were calculated as preoperative preparation time for surgical equipment in every area, and for discharging the lipoaspirates from collecting container. Red blood cell amount, a rate of degeneration in vasculary tissues, adipocyte cell amount with nuclear conformation, a rate of septal structure loss in fibroblast cells and septal fibroblast amount were the histopatological parametres of the study which observed and analysed by the pathologists. Based on the results of statistically analysis we proved that obtaining more surviving fat graft is possible by keeping aspiration period less than 2 minute in operation zone. In case of elongation of stated period clinical accomplishment of fat graft application reduces due to the downward of viable adipocyte cell amount and accelerating injury on tissues. Consequently, keeping the aspiration duration less than two minutes in planned liposuction area in both liposuction methods is favourable for providing maximum viable autologous fat graft.