Power-assisted Liposuction Research Articles

Safety and Satisfaction in High-Definition Power-Assisted Liposculpture in Men Under Local Anesthesia

In high-definition liposculpture (HDL), the body is shaped in such a way that an athletic appearance and a defined, contoured look is created. Typical areas in the male patient include arms, pectoralis region, the area over the serratus muscle, lower back, as well as medial and lateral abdomen. This procedure is sometimes combined with fat grafting to areas over the deltoid muscle and/or pectorals. The objective was to evaluate the safety and satisfaction of HDL in a large series of patients using reciprocating power-assisted liposuction under local anesthesia. In this bicenter study, we performed HDL on 82 male patients using reciprocating power-assisted liposuction under tumescent local anesthesia with both lidocaine and prilocaine. No drains were used. Intraoperative and postoperative data were collected, and complication and satisfaction rates were evaluated after 6 months. All overall patients’ satisfaction was high. There were no major complications. Minor complications included seroma (n = 4), and 3 patients required touch-up surgery. There were no side-effects from the anesthesia, and there was no fluid overload. High-definition liposculpture using reciprocating power-assisted liposuction in local anesthesia is a safe procedure with a high satisfaction rate.

Cosmetic Breast Augmentation Using Power-Assisted Liposuction and Lipofilling: A Prospective Study.

Autologous fat transfer is becoming a more and more widespread procedure in aesthetic breast surgery. Power-assisted technology produces oscillating reciprocal movements of cannula tip, which reproduce the motion of the operator's arm with lower amplitude. The power-assisted mechanism can be applied to the fat liposuction and injection phases. The aim of this study is to report our experience on autologous fat transfer in primary cosmetic breast augmentation using power-assisted liposuction and lipofilling (PALL), our surgical technique and on long-term cosmetic results, and patient-reported outcomes. A prospective observational study was performed including all patients who underwent PALL cosmetic breast augmentation. Collected data included patient's age, BMI, mean liposuction and fat injection volume, mean operating time, postoperative complications, mean number of grafting procedures required to achieve the desired outcome, cosmetic results and patient satisfaction. A total of 43 patients were included with a mean follow-up of 13.32 months. Mean liposuction and injection volumes were 1884.54 mL and 399.03 mL, respectively. Mean number of grafting procedures was 1.27. With respect to aesthetic outcomes, the mean score for breast volume, shape, symmetry and donor site shape was 4.38, 4.22, 4.27 and 4.42, respectively. Regarding patient satisfaction, the mean score for breast volume, shape, symmetry and donor site shape was 4.22, 5, 5 and 4.77, respectively. The current study is the first prospective report on primary cosmetic breast augmentation using PALL. Although our sample of patients is limited, our results showed that PALL primary breast augmentation is an efficient procedure, which leads to satisfactory results for both patients and surgeons. 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 .

Commentary on: No-Scar Breast Reduction Utilizing Power-Assisted Liposuction Mammaplasty, Loops, and Lipofilling.

Commentary on: No-Scar Breast Reduction Utilizing Power-Assisted Liposuction Mammaplasty, Loops, and Lipofilling.

Commentary on: Vibration Exposure Safety Guidelines for Surgeons Using Power-Assisted Liposuction (PAL).

Commentary on: Vibration Exposure Safety Guidelines for Surgeons Using Power-Assisted Liposuction (PAL).

Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation With Power-Assisted Liposuction and Lipofilling (PALLL).

An increasing number of women wish breast implant removal whilst maintaining an acceptable projection and form were possible. The authors propose a technique to remodel the breast after implant removal utilizing internal suture loops to project the breast, recruit abdominal and axillary tissue cranially and medially, and provide a matrix for lipofilling. A prospective analysis was performed of consecutive patients undergoing implant extraction followed by power-assisted liposuction loops and lipofilling. Patient characteristics were measured. The aesthetic results were evaluated by 2 independent raters. Patient-reported satisfaction was measured by standardized questionnaires. Implants in 52 patients with an average age of 55 and body mass index of 23.7 were extracted followed by breast remodeling. A total of 73% of patients had implants for aesthetic reasons, 41% were smokers, and 43% of the reconstruction cases received radiotherapy. A total of 28% had implant extraction for rupture, 58% for capsular contracture, and 14% due to pain and migration. The average volume of the implants removed was 292 cc, followed by an average lipofilling of 223 cc, yielding a ratio of 0.76 to 1. The average tissue recruited by loops was 82.5 cc. Independent raters measured 79% of results as good, 13% as acceptable, and 8% as requiring improvement; 80% of patients were satisfied to very satisfied. The authors propose implant extraction followed by power-assisted liposuction loops and lipofilling can provide footprint definition, sustained projection, and high patient satisfaction. Moreover, the recruitment of a vascularized adipo-cutaneous flap by loops allows a reduced ratio of fat grafting to implant volume.

High Volume Liposuction in Tumescence Anesthesia in Lipedema Patients: A Retrospective Analysis.

Lipedema is a chronic, progressive disease that occurs almost exclusively in women and leads to pathological, painful fat growths at the extremities. Only symptomatic therapy can be offered since the etiology of the disease has not yet been clarified. Liposuction in tumescent anesthesia has established itself as a surgical treatment method of choice. The complication rate associated with the procedure and the pharmacological course and safety of treatment in patients with lipedema has not yet been sufficiently studied. The aim of the study was to broaden the evidence on the safety of ambulatory high-volume liposuction in tumescent anesthesia in lipedema patients. Influencing factors of patients (weight, fat content, comorbidities) or the process technique (drug administration, volume of aspirates) should be investigated on the safety and risks of tumescent anesthesia. This was a retrospective data analysis in which data from 27 patients (40 liposuction procedures) treated at the Sandhofer and Barsch lipedema center between 2016 and 2018 were evaluated. The liposuctions were carried out in tumescent anesthesia and using a Power-Assisted Liposuction system. Clinical examinations and regular blood samples were carried out before the procedure, intra- and postoperatively. The procedures lasted an average of 118 minutes and an average of 6111 ml of aspirate was removed. For tumescent anesthesia, patients were given an average lidocaine dose of 34.23 mg/kg body weight and an epinephrine dose of 0.11 mg/kg body weight. No relevant complications associated with drug side effects, hypovolemia or hypervolemia or blood loss were detected. Liposuction under high volume tumescent anesthesia for the treatment of lipedema patients is, even for major intervention, a safe procedure. J Drugs Dermatol. 2021;20(3):326-334. doi:10.36849/JDD.5828.

Scarless Composite Breast Reconstruction Utilizing an Advancement Skin Flap, Loops, and Lipofilling

Autologous fat grafting has gained popularity in breast reconstructive surgery. To further increase the breast volume and provide a reliable breast shape, a skin flap can be advanced from the upper abdomen and lateral thorax to the breast. The aim of this study was to propose a method of breast reconstruction utilizing the principles of power-assisted liposuction and lipofilling (PALL) for breast matrix dissociation applied through infiltration, tunnelization, extensive undermining and lipofilling, in combination with loops (PALLL) to recruit a vascularized flap to reshape the breast. A prospective study was performed from January 2014 to January 2019. Demographic data, surgical procedure information (including volumes of the recruited advancement flap and lipofilling, and stages of lipofilling), and complication data were collected. Patient-reported outcomes, including satisfaction and well-being, were measured by a questionnaire. In total, 37 women (41 breasts) underwent breast reconstruction by PALLL with an average follow-up of 26 months. The mean age of the patients was 54 years, and their mean BMI was 29 kg/m2. The mean recruited flap volume was 197 mL, and the mean lipofilling volumes were 153 mL for the first session, 190 mL for the second session, and 110 mL for the third session. Nine patients needed 3 sessions, 27 patients 2 sessions, and 1 patient only 1 session. Overall, 94% of patients were satisfied with their breast shape. All patients reported sensitive breasts. There were minimal complications. Breast reconstruction with PALLL is a minimally invasive alternative to reconstructing and reshaping sensate breasts in which a vascularized skin flap recruited by loops from breast surroundings is combined with fat grafting. This approach provides long-term shape stability with minimal scarring and low complication rates.

Power-Assisted Liposuction: An Important Tool in the Surgical Management of Lymphedema Patients.

Background: Debulking via power-assisted liposuction has been established internationally as the gold standard for patients with chronic fat-dominant lymphedema. In this study we share our experience implementing a debulking surgery program in the United States. Methods and Results: A retrospective review was performed of patients who underwent debulking surgery using power-assisted liposuction at a single institution. Between December 2017 and January 2020, 39 patients with lymphedema underwent 41 extremity debulking procedures. In patients with lymphedema of the upper extremity, median excess volume reduction was 111% at 6 months and 116% at 12 months post-operatively. In patients with lymphedema of the lower extremity, excess volume reduction was 82% at 6 months and 115% at 12 months post-operatively. L-Dex and quality of life improved across all domains in upper and lower extremity patients as well. Conclusion: Debulking with power-assisted liposuction is an effective treatment for chronic lymphedema, supported by improvement in both objective and subjective metrics.

Liposuction of the Neck Using Reciprocating Power Assisted Liposuction

Neck liposuction in local anesthesia is a minimally invasive technique for fat reduction and skin tightening. The purpose of this study was to evaluate the clinical safety of reciprocating power assisted liposuction (PAL) of the neck. Neck liposuction with PAL was performed on 104 consecutive patients (male = 39, female = 65), and the occurrence of side effects were noted. There were no hematomas and no marginal mandibular nerve dysfunction. Transient alopecia at the site of liposuction was found in 3 out of the 39 male patients. In the hands of an experienced surgeon, reciprocating PAL of the neck is a safe method with a very low complication rate.

Power-Assisted Liposculpture in Male Patients: A Spectrum of Definitions.

Liposculpture procedures have gained popularity over the last 2 decades with the evolution of surgeons' skills and technological advancement. According to the 2018 The Aesthetic Society report, liposuction is the second-most popular aesthetic procedure in the United States. The authors aimed to demonstrate that a spectrum of liposculpture definitions can be achieved utilizing power-assisted liposuction (PAL). Also, the authors sought to describe the satisfaction and complication rates in mild-, moderate-, and high-definition groups utilizing the PAL technology. The authors designed a single-center retrospective study, including male patients who underwent PAL liposculpture of the chest, abdomen, back, and arms. Inclusion criteria were male patients >18 years of age and body mass index <30 kg/m2. Measured outcomes included extent of definition, complication rates, and levels of satisfaction. Fifty male patients were included in this study between January 2018 and November 2019. The average age was 37.34 years (range = 25-56 years). The average body mass index was 26.4 kg/m2 (range = 24-30 years). A total of 54.3% of patients opted for high definition (HD), 36.4% for moderate definition, and 9.2% for mild definition. There were no major complications. The HD subgroup registered the highest incidence of minor complications (21%). Patient satisfaction levels were high in all 3 subgroups, with the highest scores in the HD subgroup (9.3/10). A spectrum of definitions can be safely achieved utilizing the PAL technology, with high patient satisfaction in mild-, moderate-, and high-definition liposculpture subgroups and low complication rates.

The Combined Effect of Intravenous and Topical Tranexamic Acid in Liposuction: A Randomized Double-Blinded Controlled Trial.

BackgroundTranexamic acid (TXA) use in surgical procedures due to its hemostatic effects has been gaining an increased interest. In plastic surgery, the effects of TXA have been studied intravenously (IV), and there have been some reports regarding local use.ObjectivesA comparative study examining the combined effect of IV and local TXA was conducted.MethodsA randomized double-blinded controlled trial was performed for patients undergoing breast reduction treatment with liposuction and resection following the power-assisted liposuction mammaplasty (PALM) technique. All patients received 5 mL IV of 0.5 g/5 mL TXA on induction. Before installation, one researcher prepared two solutions of 1 L normal saline: one with 5 mL of 0.5 g/5 mL TXA associated with epinephrine 1:100,000 and the other with only epinephrine 1:100,000. These were randomly infiltrated in either the left or right breast. Clinical dermal bleeding was assessed for both breasts after deepithelialization. The lipoaspirate from these breasts was then compared with each other. A postoperative evaluation at 24 hours was performed to compare the ecchymosis rate.ResultsRatios of decanted volume to total lipoaspirate was measured in bottles and compared between breasts. There was a statistical difference (P = 0.0002) in the ratio of decanted to lipoaspirated volume when comparing the control group (ratio: 0.21) with the treatment group (0.13). Video analysis revealed decreased dermal bleeding in the TXA group and postoperative evaluation less ecchymosis.ConclusionsThe combined use of IV and local TXA can help reducing blood loss in liposuction as measured by decantation in separate drain bottles and as assessed clinically preoperatively and postoperatively.Level of Evidence: 2

Vibration Exposure Safety Guidelines for Surgeons Using Power-Assisted Liposuction (PAL).

As power-assisted liposuction (PAL) gains in popularity, plastic surgeons operating these devices experience occupational exposure to hand-transmitted vibration, which can result in hand-arm vibration syndrome, a debilitating neurovasculopathy. The objective of the study was to determine vibration exposure from the utilization of a PAL device during surgery to generate recommendations for safe use. Vibration emission of a commonly utilized PAL system (MicroAire-650, Surgical Instruments, Charlottesville, VA) was examined employing a vibration data logger under both controlled laboratory conditions and during 13 typical liposuction cases. Data were analyzed and compared with established safety limits of vibration exposure. The experiments demonstrated a mean vibration magnitude of typical liposuction surgeries to be 5.69 ± 0.77 m/s2 (range, 4.59-6.27 m/s2), which is significantly higher than the manufacturer declared value of 3.77 m/s2. Cannula size was shown to be the most significant contributor to vibration magnitude, with larger cannulas causing more vibration transmission. These results indicate that recommendations must be made to prevent undue occupational exposure to vibration from PAL. The MicroAire-650 can generally be safely utilized for less than 1.5 h/d. At exposure levels >1.5 h/d, there is increased risk of developing vibration-related injuries, and vibration-reducing strategies should be implemented. At exposure levels >6 h/d, the safety limit is exceeded and there is significantly increased risk of developing hand-arm vibration syndrome and vibration exposure should be halted.

A novel approach in breast reconstruction: The extended lateral thoracic flip-over flap combined with loops and lipofilling (ELT FOLL)

The use of the thoracodorsal musculocutaneous flap has been limited to donor site complications, whereas the thoracodorsal fasciocutaneous flap spares the muscle and limits morbidities. Our objective is to describe a new technique of breast reconstruction using an extended lateral thoracic (ELT) flip-over flap combined with loops and lipofilling (ELT FOLL) to achieve better breast remodeling. Between 2013 and 2018, 64 patients underwent breast reconstruction using an ELT FOLL. The flap is designed in an elliptical transverse pattern and extends 2 cm lateral to the back midline up to the breast axis at the level of the inframammary fold. The surgical technique consists of an infiltration and tunnelization of the breast recipient site and surrounding area, deepithelialization of the skin paddle, and additional preparation of the flaps and loops. Liposuction is performed using the power-assisted liposuction and lipofilling technique, and lipofilling is achieved throughout the thoracic cutaneous surface of the reconstructed site, particularly into the lower quadrant of the breast. Among the reconstructions, 73.4% was delayed and 92.2% was unilateral. A fourth of the patients were smokers, and 39.1% received radiotherapy. The total complication rate was 8.7%, the patient's shoulder function was not affected at long term, with the DASH score rising from 6.53 preoperatively to 11.32 at 6 weeks and 7.52 at 6 months. The average operative time was 57 min, and drains were removed at day one after surgery. The ELT FOLL should be considered a simple, safe, and reliable alternative for breast reconstruction.

A Single Institution Multi-disciplinary Approach to Power-assisted Liposuction for the Management of Lymphedema.

To implement and evaluate outcomes from a comprehensive, multi-disciplinary debulking program in the United States. Interest in and access to surgical treatment for chronic lymphedema (LE) in the United States have increased in recent years, yet there remains little attention on liposuction, or debulking, as an effective treatment option. In some other countries, debulking is a common procedure for the surgical treatment of LE, is covered by insurance, and has demonstrated excellent, reproducible outcomes. In this study we describe our experience implementing a debulking technique from Sweden in the United States. Patients who presented with chronic LE followed a systematic multi-disciplinary work-up. For debulking with power assisted liposuction, the surgical protocol was modeled after that developed by Håkan Brorson. A retrospective review of consecutive patients who underwent debulking at our institution was conducted. Between December 2017 and January 2020, 39 patients underwent 41 debulking procedures with power assisted liposuction, including 23 upper and 18 lower extremities. Mean patient age was 58 years and 85% of patients had LE secondary to cancer, the majority of which (64%) was breast cancer. Patients experienced excess volume reductions of 116% and 115% in the upper and lower extremities, respectively, at 1 year postoperatively. Overall quality of life (LYMQOL) improved by a mean of 33%. Finally, patients reported a decreased incidence of cellulitis and decreased reliance on conservative therapy modalities postoperatively. Debulking with power assisted liposuction is an effective treatment for patients with chronic extremity LE. The operation addresses patient goals and improves quality of life, and additionally reduces extremity volumes, infection rates and reliance on outpatient therapy. A comprehensive, multi-disciplinary debulking program can be successfully implemented in the United States healthcare system.

Lipofilling to the Buttocks and Breasts in Local Anesthesia Using VASER and Expansion Vibration Lipofilling in a Closed-Loop System

Large-volume fat transfer to the buttocks and breast has rapidly become popular. Lipofilling using syringes is tedious, time-consuming, and carries the risk of contamination. Most often, systemic anesthesia is being used. This study aims to evaluate the efficacy of large-volume lipofilling in local anesthesia. Local anesthesia was performed with 2 anesthetics: lidocaine and prilocaine. We performed vibration amplification of sound energy at resonance (VASER) and reciprocating power-assisted liposuction (PAL) for fat collection in a closed-loop system using a peristaltic pump. In a reverse pump setting, fat was then used for expansion vibration lipofilling. Pre- and postoperative data were collected. There were no major complications. Liposuction volumes up to 3.100 mL were extracted, and injection volumes ranged from 200 to 1600 mL. Mean operation time was 96 minutes. Satisfaction rate was high. Anesthesia was sufficient in all patients. Using a closed-loop system for fat extraction–purification and transfer is not only time- and cost-effective but also ideal for large-volume fat grafting. Recovery time is 1 to 2 days and satisfaction rate is high.

Millennial-Assisted Liposuction: The Next-Generation/Future Technique.

Over the past 6 decades through innovation, creativity, ingenuity, and hard work, liposuction is now one of the most popular cosmetic procedures around the world. Several different liposuction technologies now exist, which include suction-assisted lipectomy, power-assisted liposuction, and so on. We have devised a new technique geared toward the incoming Generation Y surgeon called millennial-assisted liposuction. With such great advances in current liposuction techniques, one might ponder the need to introduce a new technique. This may become more common as the "Me Generation" sets forth in the working community and takes over for the prior generation of plastic surgeons. This article was written and developed by a millennial and the senior author, a nonmillennial, to help conform to the changing dynamic of incoming plastic surgeons. The technique was developed to solve the problem regarding millennials requiring constant reinforcement, around-the-clock assistance, immediate feedback, work-hour limits, frequent breaks, and lack of trophies.

No-Scar Breast Reduction Utilizing Power-Assisted Liposuction Mammaplasty, Loops, and Lipofilling.

In continued interest to develop and refine minimally invasive procedures, recent publications reported a scarless approach in breast lifting. The authors sought to describe a power-assisted lipomodeling technique combined with surgical loops to achieve breast reduction and reshaping with minimal scars. Between 2014 and 2018, 94 patients underwent breast reduction by combined liposuction and loops. Following infiltration of the breasts, liposuction of the outer quadrants and the lower pole was achieved to reduce the breast footprint and the lateral and inferior heaviness of the breast. After multiaxial multiplanar tunnelization, 3 types of loops were taken around the breast to suspend and elevate the breast skin envelope and parenchyma. Each loop was guided through a 3-mm, 3-hole cannula passed through skin stab incisions. The first loop was designed to reduce the breast footprint and enhance the breast projection, whereas the second loop was designed to achieve breast conus remodeling. The third loop was passed circumferentially around the areola and then cephalad along the breast axis and pulled until the desired nipple-areola complex elevation was reached. Each loop was pulled to achieve the desired breast projection and shape. The authors achieved breast reduction with a mean nipple elevation of 7.3 cm, and 88% of patients were satisfied with their breast shape. The total complication rate was 1%, including mild cellulitis in 1 breast, treated efficiently with oral antibiotics. The proposed technique is a novel, simple, and safe alternative to achieve breast reduction and reshaping without a scar.

Severe and massive necrosis following high definition power-assisted liposuction: a case report

Although liposuction is one of the most sought-after surgical procedures in the world, there are plenty of acknowledged complications associated with it. There are, however, no case reports such as this one regarding severe complications deriving from the high-definition technique. We describe the management of a patient with massive necrosis following a high definition power-assisted liposuction. A 37-year-old woman, who presented an overweight body mass index and no other comorbidities, had a liposuction with abdominoplasty done in 2012. In early 2019, she underwent a high definition liposuction, being transferred 8 days after the procedure into a tertiary and university-related hospital with necrotizing fasciitis and sepsis. The patient received treatment for a life-threatening condition at the ICU and several interventions for debridement and skin replacement. She was discharged 2 months after admission. High definition liposuction is a new technique that has recently become widespread. However, it is not fail-safe, as the present case shows. It should be restricted to selected cases and its technique should be reviewed and trained extensively to reduce its possible risks. Level of evidence: Level V, risk/prognostic study.

Liposuction: Drains, Are They Adequate?

Background:Seroma following liposuction (especially mega-sessions; more than 5 L) is a common complication that causes much distress to the surgeon and the patient. This will eventually affect the overall satisfaction and patient’s experience regarding liposuction. If not detected promptly, seromas can impair the results.Methods:This is a prospective analysis performed by the authors in a private practice. All our patients had mega-liposuction sessions (more than 5 L, range 8–12 L) using Power-assisted Liposuction with Lipomatic by Euromai and VASER. Tumescent infiltration was used. Fifty male patients participated after providing their informed consent. Their mean age was 35 years (range, 21–50) and mean body mass index was 29 (range, 28–33). Patients were divided into 2 groups. Group A consisted of 25 patients with no adjunctive draining procedures done, and group B consisted of 25 patients with drainage procedures done. Patients were followed up every other day for 3 weeks for detection of seroma.Results:Seventeen patients had post-operative seroma: 13 in group A and 4 in group B. The volume of seromas was further subdivided into mild (<50 cc), moderate (50–100 cc), and severe (>100 cc).Conclusions:High definition liposuction is a demanding procedure by both the surgeon and the patient to achieve the best results and contour. Drainage procedures and drains placement are truly effective methods for minimizing seroma formation, enhancing the recovery, and eventually improving the results.

A New Suturing Method for Optimal Wound Healing: Technique and Experience

BackgroundWound closure utilizing barbed sutures has been associated with healing problems, such as thread extrusion, infection, and the increase of an inflammatory response around the scar.ObjectivesIn our study, the senior author described a novel technique of skin incision and wound closure based on de-epithelization and bi-layer tension-free closure that minimizes complications.MethodsIn this retrospective study, the authors reviewed the evolution of wound healing for the novel technique developed by the senior author by analyzing clinical reports of 817 patients who underwent surgery for abdominoplasty or breast reduction utilizing power-assisted liposuction mammaplasty with the new incision and closure technique. In addition, three separate plastic surgeons reviewed the wound characteristics and overall appearance by analyzing photographs that were taken over the course of 12 months to document the healing process.ResultsThe overall complication rate was 14.1%, with 0.4% hematoma, 1.25% infection, 0.8% seroma, 1.5% necrosis, 3.75% erythema, 3.3% delayed wound healing, and 3.1% suture extrusion. The authors reported the rate of step-off border (9%), contour irregularities (6.5%), margin separation (1.25%), edge inversion (3.2%), excessive distortion (0.9%), and bad overall appearance (6.4%) of the cases.ConclusionsThis new technique in wound incision and closure based on de-epithelization and bilayer tension-free closure reduces the complications associated with barbed sutures.