2. DEFINITION
• Liposuction is the surgical
aspiration of
subcutaneous fat by use
of a cannula attached to
a vacuum pump.
• Lipoplasty, liposculpture,
suction-assisted
lipectomy.
4. SUCTION ASSISTED LIPOSUCTION (SAL)
• Introduced by yves Illouz in 1970s
• 39 % conversion to open excision
• Most common and popular
modality.
• Uses a two-stage technique.
• The site is infiltrated with a
predetermined wetting solution
and then evacuated.
• Patients are marked and incisions
3–4 mm in size are made for
access.
5. SAL
Advantages:
1. Ease of use
2. Malleable cannulas Wide variety of cannulas, and Decades of
experience.
Disadvantages:
1. Difficult to use in fibrous areas and secondary liposuction.
2. More physical work involved to break up and remove fat.
6. POWER-ASSISTED LIPOSUCTION
(PAL)
• Used since 1999.
• The cannula reciprocate 2-mm
magnitude at the rates of 4000– 6000
cycles/ min.
• Best used for large volumes, fibrous
areas, and revision liposuction.
• Both the power source, and the suction
are attached to the proximal end of the
handpiece.
• PAL systems have multiple power
settings; they can be programmed for a
variety of areas, tissue types and
according to the preferences of
7. Advantages:
Breaks up fibrous fat much more readily,
the procedure is significantly faster.
less labor intensive for the surgeon than
traditional SAL.
Disadvantages:
Noise generation
Mechanical vibration experienced by the
operating surgeon.
8. ULTRASOUND-ASSISTED LIPOSUCTION (UAL)
Ultrasound-assisted liposuction
devise consist of handpiece that
convert electrical energy to
ultrasonic energy.
Transmit the energy through a
titanium probe.
The tip of the ultrasound device
reciprocate at 20000- 35000
cycles per second over an
amplitude of 100 micron.
Tip of probe break down fat by
cavitation and facilitate suction-
assisted removal.
9. • The handpiece converts electrical energy
from a generator to kinetic energy, which
is transmitted to a probe as ultrarapid
vibrations.
• The handpiece is connected to a generator
by a flexible cord.
• The probe attaches to the handpiece by a
screw mount.
• Hollow ultrasonic liposuction probe tips.
• Ultrarapid vibration at the probe tip
implodes fat cells.
• Openings at the tip permit suction
evacuation of liquefied fat.
10. UAL
• The treatment is begun at a depth of approximately 1–
2 cm, depending on the body area.
• The plane is treated uniformly, beginning at one side of
the area and moving in a radial fashion to the
contralateral side.
• When the last plane is completed, evacuation begins in
the deeper plane to remove the emulsified fat.
11. UAL
• Advantages:
1.Less surgeon fafatigue
2.Improved results in fibrous areas and in secondary procedures.
3. More uniform treatment of fat layers and improved contour with less
revision.
Disadvantages:
1.Increased equipment cost,
2. slightly larger incisions,
3. longer operative times.
4. possibility of thermal injury
12. VASER ASSISTED LIPOSUCTION
(VIBRATION AMPLIFICATION OF SOUND
ENERGY AT RESONANCE)
• Newer generation of ultrasound- assisted
liposuction device that incorporates less
energy with more efficient, solid probes.
• Continuous or intermitten burst of energy can
be produced.
• The grooves on the end of probes allow better
lateral fragmentation of tissue with lower
energy.
• The probes come in an array of sizes and
grooving, depending on tissues in which they
will be used.
• Advocates the use of VASER in large volume
liposuction to reduce blood loss especially in
13. VASER ASSISTED LIPOSUCTION
• VASER is a 3rd generation ultrasound-assisted liposuction system.
• The 1st generation and 2nd generation ultrasound-assisted liposuction
devices were very powerful so the incidence of burn injuries were very
high.
• The VASER liposuction system is safer and rarely causes burn injuries if
used by an experienced plastic surgeon.
14. • Lipo works by using high-intensity, high-frequency ultrasound
energy to liquefy fat cells so that they can be more easily
aspirated through a suction device.
• By only selecting and melting fat, VASER leaves the surrounding
nerves, blood vessels and connective tissue unaffected.
• Consequently, this procedure leads to a more rapid healing and
smoother results.
• The recovery time needed for VASER Lipo is around 7-9 days,
making it more convenient and appealing to my patients.
• Based on the information you have provided about your height
and weight, your BMI is between the ideal parameters for a
successful VASER lipo procedure
15. LASER-ASSISTED LIPOSUCTION(LAL)
• LAL has been at the forefront of marketing
hype at present.
• The treatment involves insertion of a laser
fiber via a small skin incision.
• Depending on the manufacturer, the fiber may
either be housed within a cannula or as a
separate fiber.
• There are several commercially available
lasers.
• The most common available wavelengths in
the United States are 924/975 nm, 1064 nm,
1319/1320, and 1450 nm.
• Many of these devices utilize more than one
wavelength during treatment.
16. • Four-stage technique:
I. Infiltration
II. Application of energy to the
subcutaneous tissues,
III.Evacuation, and
IV.Subdermal skin stimulation.
The laser fiber purportedly acts to
disrupt fat cell membranes and
emulsify fat.
These devices have been marketed
for purported skin-tightening
effects.
• Surgical endpoints
• Skin pinch, final contour, and volume of
aspirate
• Final contour irregularities can be treated
with autologous fat grafting immediately.
18. BACK
• The anatomy of the subcutaneous fat and skin is unique. very thick
dermis and a dense fibrous.
• UAL and PAL extremely useful for this area.
• Access incisions will depend on the distribution of fat and/or skin.
• suctioning from areas off of the thoracic cage (hip region) towards the
posterior back should not be performed to obviate intra- abdominal
and intra-thoracic penetration of the cannula
19. ABDOMEN
• Amenable to all of the various modalities of liposuction.
• Suctioning the deep two-thirds of the fat is safe and effective.
• The operating surgeon should reserve superficial liposuction for
correction of secondary deformities.
• Access through an umbilical incision, bilateral lower abdominal
incisions, suprapubic incisions.
• Manual palpation, pinch, and symmetry assessment helps decrease the
likelihood of contour irregularities.
20. HIPS/FLANKS
• Prefer prone position, allows for simultaneous treatment of both
sides and for comparison.
• Access through bilateral or single midline paraspinous region
and/or lateral gluteal fold.
• Differ aesthetic consideration of the hips and flanks in males and
females is crucial.
• In general, males tend to have fullness in the superior and lateral
region, while females usually exhibit prominence more inferiorly
and posteriorly.
21. BUTTOCKS
• There are widely varying aesthetically pleasing buttock.
• These change with time and vary across age groups, ethnicity, and
geography.
• Access incisions are placed asymmetrically, to avoid an operated
look.
• Avoiding deep, aggressive suctioning and ensuring the length,
position, and integrity of the inferior gluteal crease is of critical
importance.
• Accessed via paraspinous or gluteal access incisions.
22. THIGHS
• Women tend to accumulate fat either in a diffuse,
circumferential manner or in significant amounts medial
and lateral.
• In general, men tend to accumulate more compact fat in
the proximal thighs.
• saddlebag (a trochanteric bulge lateral to gluteal crease);
banana roll (roll inferior to the gluteal fold), and violin
deformity (female contour of narrow waist, full hips, full
lateral thighs, and depression in the zone of adherence
between the hips and thighs).
• The adherent areas: the gluteal crease; the lateral gluteal
depression; the posterior, inferior, and distal lateral thigh;
and the area of the mid- inner thigh
23. NECK
• Patients with minimal to mild skin laxity and lipodystrophy of the
neck.
• All liposuction devices may be used
• neck hyper-extended with a shoulder roll or pill beneath the
upper back.
• submental access incision for central and lobular incision for
lateral access.
• Direct subdermal suctioning should be avoided.
• key pinch is the critical endpoint allowing for symmetry.
24. POSTOPERATIVE CARE
• At the conclusion of surgery, placed in a compression
garment which is customized based on surgeon preference
and procedure performed.
• Antibiotics and analgesics.
• Large-volume procedure (>5000 mL aspirate), liposuction of
multiple areas, or liposuction in addition to abdominoplasty
are kept overnight for observation.
• Patients are asked to ambulate the day of the surgery.
• Patients are allowed to shower as early as 1 or 2 days
postoperatively.
• Instructed to keep the compression garment on 24hours a
day for 2 weeks.
25. • The patient may remove the compression garments for
bathing.
• Initial postoperative visits are scheduled for 5–7 days
postoperatively.
• Return to activity/work can occur as early as 3–4 days or at
2 weeks, depending on the procedure.
• Walking is encouraged immediately, and light activity is
allowed 2 weeks after surgery, unless the patient has
undergone an associated abdominoplasty or other invasive
procedure.
• Edema tends to peak from 3 to 5 days after surgery.
• Bruising should be minimal and dissipate by 7–10 days
after surgery.
26. • Patients should begin to see contour changes in their waist by 2
weeks and at 6 weeks, be able to appreciate significant changes
in their shape.
• The final aesthetic result can be seen 3–6 months after surgery,
depending on the patient.
• Postoperative lymphatic massage is encouraged to help with
swelling and induration and is often started prior to surgery and
resumed shortly after the procedure.
27. COMPLICATIONS
Complications can vary from mild postoperative nausea and
vomiting to deep venous thrombosis (DVT)/pulmonary embolism
(PE) and even death.
Perioperative period (0–48 h): anesthesia and cardiac complications,
cannula trauma to skin and/or internal organs, and volume
loss/overload from bleeding or excess fluid administration.
Early postoperative period (days 1–7): venous thromboembolism,
infection, and skin necrosis.
Late postoperative period (1 week to 3 months ): delayed seroma
formation, edema and ecchymosis, paresthesias,
hyperpigmentation, and contour irregularities.
