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    Thanks for shearing this presentation. It is learning doc for vaser liposuction surgery.

    Amelia Aitken
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  • The high frequency vibration of VASER Ultrasonic Probes causes the fat cells to break apart and emulsify into the infusion fluid (most fat cells remain viable).
  • Emulsified fat is more easily removed via specially designed VentX ® Suction Cannulae. VentX Never clogs - has ports in the handle Maximum pressure is never exceeded
  • ultrasound does not cavitate fat cells , it cavitates microbubbles in the tumescent fluid, infiltrated among the fat cells.
  • University of Stampford study shows that almost 80% of cells are still intact after treatment.
  • A recent study exposed bovine fat infused with saline to laser energy (25W, 980 nm) and to VASER ultrasound energy (100% amplitude, 3.7mm, 2-ring probe) LASER: temperature in fat rose above the tissue damage threshold in less than 50 milliseconds; temperatures reached the boiling point within 0.1 seconds. VASER: temperature never rose more than 9ºC. Further, the acoustic streaming from the VASER kept the fluid well mixed, distributing the thermal energy; because the laser has no comparable mechanism, the heat does not dissipate
  • Fast recovery is highly dependant on operator experience Pain generally the same for both groups in my experience Reduce need for re treatment is operator dependant Biggest difference Laser “Flogging the donkey” whereas VASER “Holding back the racehorse”
  • Vaser presentation

    1. 1. Semi Invasive Methods of Fat Reduction (VASER & LaserLipo)
    2. 2. Social Trends in Liposculpture <ul><li>Direct to Consumer Promotion </li></ul><ul><ul><li>Reality TV shows and mainstream exposure (Extreme Makeover, Dr. 90210, Nip/Tuck) </li></ul></ul><ul><ul><li>Physicians advertising branded procedures </li></ul></ul><ul><ul><li>Celebrity patients openly discussing procedures </li></ul></ul><ul><li>Development of non-invasive and minimally invasive procedures </li></ul><ul><ul><li>In-office, “lunchtime procedures” are less intimidating </li></ul></ul><ul><ul><li>Less downtime allows patients to get back to work and family faster </li></ul></ul><ul><li>Baby Boomers reaching middle age </li></ul><ul><ul><li>Recapture youth </li></ul></ul><ul><ul><li>Stay competitive in the job market </li></ul></ul><ul><li>Immediate access to information </li></ul><ul><ul><li>Google/ web research </li></ul></ul><ul><ul><li>Educational programming </li></ul></ul><ul><ul><li>YouTube/ online videos </li></ul></ul><ul><ul><li>Blogs/ Plastic Surgery Chat Rooms </li></ul></ul>
    3. 3. Medical Trends in Liposculpture <ul><ul><li>Move towards minimally invasive (small incisions, less destructive) and non-invasive technologies (no incisions) </li></ul></ul><ul><ul><ul><li>Minimal or no patient downtime – “lunchtime” procedures </li></ul></ul></ul><ul><ul><ul><li>Minimal or no post-procedure side effects (pain, bruising, swelling, etc.) </li></ul></ul></ul><ul><ul><ul><li>Smaller instrumentation </li></ul></ul></ul><ul><ul><li>Expectation for technologies to offer a broader range of applications </li></ul></ul><ul><ul><ul><li>Small to large volume removal (increasingly obese population) </li></ul></ul></ul><ul><ul><ul><li>Sculpting as opposed to debulking </li></ul></ul></ul><ul><ul><ul><li>Improved skin tone/ tightening </li></ul></ul></ul><ul><ul><ul><li>Cellulite reduction </li></ul></ul></ul><ul><ul><li>Growing interest in fat transfer procedures </li></ul></ul><ul><ul><ul><li>Remove fat from one area of the body and use it to enhance another area </li></ul></ul></ul><ul><ul><ul><li>Alternative to fillers in small areas like the face </li></ul></ul></ul><ul><ul><ul><li>More cost effective in large volume transfer cases (buttocks) </li></ul></ul></ul><ul><ul><ul><li>More natural results (breast augmentation) </li></ul></ul></ul><ul><ul><ul><li>Correction of irregularities </li></ul></ul></ul>
    4. 4. Semi Invasive Methods of Fat Reduction <ul><li>Liposuction </li></ul><ul><li>Laser </li></ul><ul><li>VASER </li></ul><ul><li>Radiofrequency </li></ul><ul><li>Water Jet </li></ul>
    5. 5. Liposuction <ul><li>Dujarrier in 1921 : Uterine curette -- Amputation </li></ul><ul><li>Next 50 Years : Dermolipectomies -- Long scars </li></ul><ul><li>Schrudde in 1972 : Delicate curette </li></ul><ul><li>Fischer in 1976 : Guided scalpel (undermining), power blades (mincing) and suction </li></ul><ul><li>Kesselring in 1978 : Sharp curette with suction </li></ul><ul><li>Illouz in 1977 : Blunt cannula with powerful suction </li></ul>
    6. 6. Liposuction <ul><li>1- Blunt cannula (6-10mm.) attached to a high power suction machine </li></ul><ul><li>2- Tunnels (no undermining) </li></ul><ul><li>3- Deep fat </li></ul>
    7. 7. Liposuction <ul><li>MODIFICATIONS & ADVANCES </li></ul><ul><ul><li>Tumescent Liposuction </li></ul></ul><ul><ul><li>Syringes and Fine Cannulas </li></ul></ul><ul><ul><li>Superficial Liposuction </li></ul></ul><ul><ul><li>Liposculpture </li></ul></ul><ul><ul><li>External Ultrasound and External Laser </li></ul></ul><ul><ul><li>Power-Assisted Liposuction (PAL) </li></ul></ul><ul><ul><li>Ultrasonic-Assisted Lipoplasty (UAL) </li></ul></ul><ul><ul><li>Laser Lipolysis </li></ul></ul>
    8. 8. Liposuction <ul><li>Illouz 1983 : Wet technique </li></ul><ul><li>(hyaluronidase in sterile water for hydrodissection) </li></ul><ul><li>Hetter 1984 : Diluted epinephrine </li></ul><ul><li>(for vasoconstriction. Previously prohibited due to fluothane interaction) </li></ul><ul><li>Klein 1987 , Hunstad 1992 : Tumescent </li></ul><ul><ul><li>large volume 1:1 to 3:1 saline or lactated Ringer’s </li></ul></ul><ul><ul><li>diluted lidocaine (800-1600mg/L) </li></ul></ul><ul><ul><li>diluted epinephrine (1ml 1:1000 per litre) </li></ul></ul><ul><ul><li>diluted sodium bicarbonate (5-10mls 8.4% per litre) </li></ul></ul>
    9. 9. Advantages of Tumescent Liposuction <ul><li>ADVANTAGES </li></ul><ul><li>1- Less bleeding </li></ul><ul><li>2- Local anesthesia </li></ul><ul><li>3- Easy aspiration </li></ul><ul><li>DISADVANTAGES </li></ul><ul><li>1- Volume overload </li></ul><ul><li>2- Lidocaine toxicity (over 60 mg/kg) </li></ul><ul><li>3- Epinephrine toxicity </li></ul><ul><li>4- Opened the safety boundaries </li></ul>
    10. 10. Infusion of Tumescent Anaesthesia The fatty layer is infused with tumescent fluid.
    11. 11. Laser Lipolysis <ul><li>“ LASER” </li></ul><ul><li>L light </li></ul><ul><li>A amplification </li></ul><ul><li>S stimulated </li></ul><ul><li>E emission </li></ul><ul><li>R radiation </li></ul>
    12. 12. Laser Lipolysis <ul><li>Mechanisms of Tissue Interaction </li></ul><ul><ul><li>Photothermal </li></ul></ul><ul><ul><li>Photomechanical </li></ul></ul>
    13. 13. Laser Lipolysis <ul><li>Dressel 1990 : introduced the technique – Nd.:YAG </li></ul><ul><li>Apfelberg 1994 : multicenter study – Nd.:YAG </li></ul><ul><li>Cook 1997 : CO2 laser -- submental lipectomy </li></ul><ul><ul><li>(fat vaporization and skin tightening) </li></ul></ul><ul><li>Popularised by DEKA with the introduction of the SmartLipo Nd:YAG 1064nm </li></ul><ul><ul><li>Since then: </li></ul></ul><ul><ul><ul><li>Pharon Osyris (980nm Diode) </li></ul></ul></ul><ul><ul><ul><li>Fotona Nd:YAG (1064nm) </li></ul></ul></ul><ul><ul><ul><li>Cynosure MPX (1064 and 1320nm blended) </li></ul></ul></ul><ul><ul><li>All share same mode of action (photomechanical / photothermal destruction of the adipocytes) </li></ul></ul>
    14. 14. Laser Lipolysis <ul><li>Laser Machine : </li></ul><ul><ul><li>Continuous or Quasi Continuous Nd.:YAG Laser (1064 nm.) </li></ul></ul><ul><ul><li>Train of pulses (100 microsec. Each) and a frequency of 50 Hz </li></ul></ul><ul><ul><li>Power of 10-30 W </li></ul></ul><ul><li>Laser Fiber : 300 - 1000 micron. </li></ul><ul><li>Cannulas : of various lengths (15 – 30 cm.) </li></ul>
    15. 15. Laser Lipolysis - Technique <ul><li>Percutaneous introduction of the cannula and fiber </li></ul><ul><li>Laser is activated and gentle foreword / backward motion in different levels </li></ul><ul><li>Location monitored by the aiming beam, skin temperature by the other hand </li></ul><ul><li>End point --- softening of the area and the total number of joules </li></ul>
    16. 16. Laser Lipolysis - Aspiration <ul><li>Laser assisted liposuction </li></ul><ul><li>Fine cannula (3 - 6 mm.), gentle removal of liquefied fat </li></ul>
    17. 17. Advantages of Laser Lipolysis <ul><ul><li>Destruction of adipocytes </li></ul></ul><ul><ul><li>Haemostasis </li></ul></ul><ul><ul><li>Interruption of fibrous bands </li></ul></ul><ul><ul><li>Collagen regeneration </li></ul></ul>
    18. 18. Disadvantages of Laser Lipolysis <ul><li>LASER : temperature in fat can rise above the tissue damage threshold in less than 50 milliseconds; temperatures can reach boiling point within 0.1 seconds. </li></ul><ul><li>LASER : induces heat which cannot dissipate easily and has the potential to cause burns. </li></ul><ul><ul><li>Latest laser systems such as the Cynosure SmartLipo MPX </li></ul></ul><ul><ul><ul><li>Reduced risk by accelerometer in the handpiece </li></ul></ul></ul><ul><li>LASER : highly operator dependent for anything other than small areas </li></ul>
    19. 19. <ul><li>VASER LIPOLYSIS </li></ul>
    20. 20. The VASER ® Lipolysis <ul><li>Uses ultrasound energy delivered via a titanium probe </li></ul><ul><li>Fat is selectively fragmented while conserving other tissues like nerves, blood vessels and connective tissue </li></ul><ul><li>Proven clinical effectiveness and safety (Over 100,000 procedures performed with an outstanding safety profile) </li></ul>
    21. 21. How VASER ® Lipolipolysis Works
    22. 22. How VASER ® Lipo Works
    23. 23. VASER - Ultrasound and Bubbles <ul><li>CAVITATION the ultrasound energy causes expansion and contraction of the air bubbles in the tumescent liquid. </li></ul><ul><li>The collapse of the bubles produces a thermomechanical disruption of the adipose tissue. </li></ul>
    24. 24. VASER - Ultrasound Effects <ul><li>Photomicrographs of fat cells before and after ultrasound show increasing intra-cellular space, but not cell wall disruption </li></ul>LINA VALERO M.D. Fat Cell Fat Cell
    25. 25. VASER - Emulsifying Fat <ul><li>Loose fat forms and emulsion with the tumescent fluid through acoustic streaming. </li></ul><ul><li>Acoustic streaming around the probe causes powerful mixing of the fat and fluid. </li></ul>
    26. 26. LASER vs VASER <ul><li>Similarities: </li></ul><ul><ul><li>Both are minimally invasive procedure which can be carried out as a day case. </li></ul></ul><ul><ul><li>require tumescent anaesthesia </li></ul></ul><ul><ul><li>require a suction component to the treatment </li></ul></ul><ul><ul><li>require compression garments post operatively </li></ul></ul><ul><li>LASER Advantages: </li></ul><ul><ul><li>Sub dermal collagen stimulation </li></ul></ul><ul><ul><li>Superior haemostasis (claimed!!!) </li></ul></ul><ul><li>VASER Advantages: </li></ul><ul><ul><li>No disruption of the fibrous tissue septae </li></ul></ul><ul><ul><li>High tissue specificity </li></ul></ul>
    27. 27. Tissue Selectivity <ul><li>The VASER ® System spares the tissue matrix, removing primarily the fatty component, producing smooth, predictable results. </li></ul>Post Aspiration Note that connective tissue is left intact after adipose tissue has been removed Post Emulsification Fat is broken apart and emulsified into the infusion fluid
    28. 28. Before & After Photos Paul Loverme, MD Before After
    29. 29. Before & After Photos Onelio Garcia, MD Before After
    30. 30. Before & After Photos Alberto Di Giuseppe, MD Before After
    31. 31. Before & After Photos George Commons, MD Before After
    32. 32. Before & After Photos George Commons, MD Before After
    33. 33. Before & After Photos Before After Newton Moscoe, MD
    34. 34. Before & After Photos Mokhtar Asaadi, MD Before After
    35. 35. Before & After Photos Michael Nagy, MD Before After Before After
    36. 36. VASER ® vs Laser Lipo Results <ul><li>In a recent customer survey, doctors reported the following VASER Technology benefits: </li></ul><ul><ul><li>quicker results than Laser </li></ul></ul><ul><ul><li>fast patient recovery </li></ul></ul><ul><ul><li>less pain medication required </li></ul></ul><ul><ul><li>minimal bruising </li></ul></ul><ul><ul><li>reduced need for re-treatments </li></ul></ul><ul><ul><li>smooth, predictable results </li></ul></ul><ul><ul><li>skin tightening </li></ul></ul><ul><ul><li>increased precision </li></ul></ul><ul><ul><li>reduced physician fatigue </li></ul></ul><ul><li>Numerous clinical studies report high efficacy and safety in a wide array of body contouring applications </li></ul>
    37. 37. Thank You for Listening! (if you have been!)