Traditional Lipoplasty Research Articles

A Future for Injection Lipolysis?

Nearly a decade has passed since we first began our audit of clinical outcomes using multiple subcutaneous injections of the lipodissolve agent Lipostabil N (Sanofi-Aventis, Frankfurt, Germany) to reduce adipose deposits in the abdomen and other areas.1 That lipodissolve agent contained phosphatidylcholine (PC) and deoxycholate (DC) as active ingredients. These derivatives of soya bean and bile extracts respectively had regulatory approval for certain applications, but neither had been formally approved for subcutaneous injection. However, this mixture gained early support as an off-label, minimally invasive alternative to traditional lipoplasty techniques.2 By 2006, regulatory agencies such as the US Food and Drug Administration (FDA) and the United Kingdom's Medicines and Healthcare products Regulatory Agency (MHRA) had restricted the import of Lipostabil N for …

Comparative Analysis of Blood Loss in Suction-Assisted Lipoplasty and Third-Generation Internal Ultrasound-Assisted Lipoplasty

Lipoplasty remains the most common cosmetic surgical procedure performed in the United States. In spite of its well documented clinical advantages, ultrasound-assisted lipoplasty (UAL) accounts for less than 20% of all lipoplasty procedures currently performed. The purpose of this study is to determine the blood content of third-generation internal UAL aspirate and compare it to traditional lipoplasty aspirate. The lipoplasty aspirate of 27 consecutive patients who underwent traditional suction-assisted lipoplasty (SAL) of their back and posterior flanks was compared to the aspirate of 30 consecutive patients who underwent third-generation internal UAL of their backs and posterior flanks using the VASER Internal Ultrasound Device (Sound Surgical Technologies; Louisville, CO). The volume and composition of the wetting solution used was the same for both groups. The aspirate analysis was performed by an independent laboratory on a Beckman Coulter LH 750 blood analyzer (Fullerton, CA) and consisted of complete blood counts after separation of the fat. The hemoglobin content of SAL aspirate was 7.5 times greater than in the aspirate. The hematocrit value of SAL aspirate was 6.5 times greater than in the VASER-assisted lipoplasty aspirate. Statistical analysis using an independent t test confirmed that the data was statistically significant with P values of < .0001 for both hemoglobin content and hematocrit values. We conclude that third-generation internal UAL should be considered for patients undergoing large-volume lipoplasty procedures or lipoplasty of tight, fibrous areas, such as the back and posterior flanks, where increased blood loss is expected.

Lipodissolve for subcutaneous fat reduction and skin retraction

According to the authors, Lipodissolve injections reduce the size of localized fat deposits and cause skin retraction in body regions containing small deposits of localized fat, cellulite, or postlipoplasty deformities. It will not replace traditional lipoplasty techniques, but is an excellent adjunct or alternative for those patients seeking minimally invasive treatment. Successful outcomes are highly dependent on the correct formula and injection technique, as well as proper patient selection.

Analysis of Laser Lipolysis Effects on Human Tissue Samples Obtained from Liposuction

The use of the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser as an auxiliary tool for lipoplasty has refined the traditional technique. The primary limitation of the traditional technique-large volume blood loss-is addressed by the use of the Nd:YAG laser. This report describe's the technique of laser- assisted liposuction, then reviews and compares the histologic and morphometric effects with those of the traditional method. The Nd:YAG laser was used to produce the desired injury to the adipose tissue after sufficient contact. Laser lipolysis was performed on the patient's right flank in two different areas, with the application of 1,000 and 3,000 J of accumulated energy (in), respectively. Subsequently, another cannula was introduced to suction the liquid content obtained by laser lipolysis. This tissue product was sent to the pathology laboratory for morphologic and morphometric analysis, and for comparison with material obtained from traditional lipoplasty performed on the left flank of the same patient. The histopathologic examination of adipose tissue after laser lipolysis showed cell swelling and less bleeding, as compared with the traditional method. The morphometric analysis showed that the mean diameter of the major adipocyte was 95.69 microm with laser lipolysis using 1,000 J (in), 82.63 microm using 3,000 J (in), and 84.54 microm with the traditional method The traditional method produced less reversible cellular damage (swelling) than laser lipolysis using 1,000 J (in). The area receiving 3,000 J (in) showed major irreversible damage (cytoplasmatic retraction and disruption of membranes). For this reason, the mean diameter of the adipocyte was less.

Effect of low-level laser therapy on abdominal adipocytes before lipoplasty procedures.

Low-level laser therapy is a new subspecialty for the medical application of lasers that provides therapeutic rather than surgical outcomes for many medical indications. Recently, low-level laser therapy was reported to "liquefy" or release stored fat in adipocytes by the opening of specialized yet not identified cell membrane-associated pores after a brief treatment. Currently, low-level laser therapy is a U.S. Food and Drug Administration-approved technology for improving pain alleviation. To explore these data further, a series of in vitro studies on human preadipocytes and institutional animal care and use committee-approved protocols in a porcine Yucatan model and an institutional review board-approved clinical study were performed. Using a 635-nm low-level laser of 1.0 J/cm supplied to the authors by the vendor, these studies were designed to determine whether alteration in adipocyte structure or function was modulated after low-level laser therapy. Cultured human preadipocytes after 60 minutes of laser therapy did not change appearance compared with nonirradiated control cells. In the porcine model, low-level laser therapy (30 minutes) was compared with traditional lipoplasty (suction-assisted lipoplasty) and ultrasound-assisted lipoplasty. From histologic and scanning electron microscopic evaluations of the lipoaspirates, no differences were observed between low-level laser therapy-derived and suction-assisted lipoplasty-derived specimens. Using exposure times of 0, 15, 30, and 60 minutes in the presence or absence of superwet wetting solution and in the absence of lipoplasty, total energy values of 0.9 mW were delivered to tissue samples at three increasing depths from each experimental site. No histologic tissue changes or specifically in adipocyte structure were observed at any depth with the longest low-level laser therapy (60 minutes with superwet fluid). Three subjects undergoing large-volume lipoplasty were exposed to superwet wetting fluid infiltration 14 minutes before and 12 minutes after, according to vendor instructions. Tissue samples from infiltrated areas were collected before suction-assisted lipoplasty and lipoaspirates from suction-assisted lipoplasty. No consistent observations of adipocyte disruptions were observed in the histologic or scanning electron microscopy photographs. These data do not support the belief that low-level laser therapy treatment before lipoplasty procedures disrupts tissue adipocyte structure.

Power-assisted lipoplasty

Efforts to improve lipoplasty results through the application of focused energy continue to arouse interest. The author's initial experience with power-assisted lipoplasty indicates that this technique is safe, fast, and capable of producing results equal or superior to those achieved through use of traditional lipoplasty.

Microwave-assisted lipoplasty: A new treatment for body contouring

Louis P. Bucky, MD, Philadelphia, PA , is a board-certified plastic surgeon. Lipoplasty is the most popular technique for body contouring in aesthetic surgery today. Advances and innovations in lipoplasty have focused on cannula design, suction techniques, and wetting solutions. Traditional lipoplasty depended on the mechanical disruption of subcutaneous adipose tissue by means of a vacuum-assisted cannula. Advances in cannula design and, more important, the infusion of low-dose epinephrine and lidocaine anesthesia, have allowed removal of greater volumes of fat and have reduced bruising and patient discomfort. The first attempt to use ultrasonic energy to enhance liposuction was in the 1980s. In more recent years, the introduction of ultrasound-assisted lipoplasty (UAL) in this country by Zocchi1 has led to its increasing popularity. Despite careful evaluation, however, the exact mechasisms of UAL are not clearly understood. Although other mechanisms may be at work, there are 3 major tissue effects that probably play a role in UAL: thermal, mechanical, and cavitational. The relative contributions of each of these mechanisms and their side effects on the tissues are …

Power-Assisted Lipoplasty (PAL): A Clinical Pilot Study Comparing PAL to Traditional Lipoplasty (TL)

The subject of this paper is a study designed to compare power-assisted lipoplasty (PAL) to traditional lipoplasty (TL) in 30 patients. PAL was used on one side and TL was used on the matching contralateral body area. In PAL, a cannula powered by medical-grade nitrogen (N(2)) reciprocates between 2000 and 4000 cpm with a 2-mm stroke. The device is commercially offered by MicroAire Surgical Instruments. While there was no difference in the speed of recovery or in the aesthetic quality of the result between the two sides, PAL was found considerably superior as far as ease of fat extraction.

Wetting Solutions In Ultrasound-Assisted Lipoplasty

Wetting solutions play a crucial role in traditional lipoplasty by reducing blood loss in the aspirate and diminishing postoperative ecchymosis and edema. From the inception of ultrasound-assisted lipoplasty a "wet environment" has been considered essential for efficient fat emulsification and for control of thermal side effects. This article reviews the historical role of wetting solutions in lipoplasty and examines the risks of their use in an overzealous manner. The authors provide safety guidelines for maximizing the benefits of wetting solutions in traditional and ultrasound-assisted lipoplasty while minimizing their side effects and complications.

Patient Evaluation And Indications For Ultrasound-Assisted Lipoplasty

Ultrasound-assisted lipoplasty (UAL) is an important adjunctive technique to traditional lipoplasty that permits true circumferential body contouring of the trunk and thighs. Its effectiveness is realized in those patients demonstrating diminished skin tone, skin irregularities, and fibrous areas of lipodystrophy. Patient evaluation and selection, indications for UAL, and operative strategy beginning with the initial consultation are discussed.

Patient Selection, Planning, And Marking In Ultrasound-Assisted Lipoplasty

The ideal ultrasound-assisted lipoplasty candidate differs little from the ideal candidate for traditional lipoplasty. This ideal candidate is within 20% of their ideal body weight (as determined by the insurance company statistics; i.e., 100 lbs for 5 feet in height, and 10 pounds for each inch above 5 feet). These patients were thought to be the only patients acceptable for lipoplasty when liposuction was first begun in the early 1980s. Innovative techniques, improved equipment, advances in superficial liposuction, syringe method, ultrasonic lipoplasty, external ultrasound assist, and other factors have served to expand the potential patient population greatly.

The Treatment of Gynecomastia with Ultrasound-Assisted Lipoplasty

Gynecomastia is a prevelent problem in the male population. Although medical treatment may be an option, patients commonly present to the plastic surgeon for treatment. Surgical options include open excision, lipoplasty, and, more recently, ultrasound-assisted lipoplasty (UAL). UAL offers a number of advantages over traditional lipoplasty, many of which are particularly applicable to the male breast. UAL is a valuable tool for the treatment of genecomastia.

Circumferential "intermediate" lipoplasty of the legs.

Circumferential intermediate lipoplasty of the thighs and lower legs is an expansion of the traditional lipoplasty technique. Rather than limiting the correction to defined bulges, the goal is to thin the thigh or the calves and ankles circumferentially. This procedure is not indicated for all patients. In selected patients with extremely heavy thighs, medial and lateral bulges, full anterior thighs, and a full posterior thigh in the upper third, circumferential liposuction improves the results and produces a slimmer thigh. In the calves and ankles, circumferential lipoplasty reduces the entire lower leg giving a more attractive result rather than just reducing the medial and lateral ankle bulges. The concept of intermediate lipoplasty is introduced. This technique has advantages over the superficial technique and the traditional deep lipoplasty. No special equipment, incisions, drains, or change in technique is needed. Using circumferential intermediate lipoplasty to contour the entire lower leg results in a slimmer looking leg. There has been no increase in complications. The author reviews his experience with this technique.