New Advances in Body Contouring

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New Advances in Body Contouring Powered By Docstoc
					New Advances in Body
   Lesley Wong, MD, FACS
         UK Healthcare
   Division of Plastic Surgery
When All You Have Left is Your Pride

                  The New York Times
                     April 6, 2009
A  self-conscious emotion, reflecting how
  you feel about yourself
 Keeping appearances in hard times is a
  survival mechanism
 “Lipstick effect”
 Explains the increase in minimally invasive
  procedures by 5% in 2008
         “Body Contouring”
 Changing  the shape of the body
 Passage of time, weight change, genes
 Surgical procedures can remove skin and
  tighten muscles
 Liposuction removes subcutaneous tissue
  and changes the skin
          The Fat Problem
 An  human body has 40 billion fat cells
 Adult weight gain is due to enlargement of
  existing fat cells when more calories are
  ingested than are metabolized
 Estrogen regulates how much fat is stored
  in different anatomic areas
       History of Liposuction
 Joseph  Schrudde 1972, Germany, used
  uterine currette
 Yves Gerard Illouz 1977, Brazil, blunt tip
  cannulas, wet technique
 1980s - took off in US
 “Lipoplasty”  the surgical procedure to treat
  adipose tissue
 “Liposuction” the surgical procedure to
  aspirate adipose tissue
 “Liposculpture” the surgical procedure to
  improve contours through aspiration +/-
  injection of fat
 Patient’smedical history
 Performed in an accredited facility by an
  experienced physician
 Consider anesthesiologist for > 1 liter
         Tumescent Technique
 Klein, 1987
 Inject a high volume solution with local
  anesthetic and epinephrine
 Wet, super wet, tumescent
     Defined by volume injected vs volume
+    general anesthesia
Suction Assisted Lipoplasty SAL
 Small “stab” incisions
 Cannulas introduced into subcutaneous fat
 Suction applied
 Cannula moved in a fanning motion
  throughout the tissue
 Best results are for isolated “bulges” in an
  otherwise fit person
       Postop Management
 Compression     garments for up to 6 weeks
  to encourage skin tightening and speed up
  edema resolution
 Bruising and swelling can persist
 Restrict activities for the first week but
  don’t stay in bed
       Variations on a Theme
 Ultrasound-assisted   liposuction
 Power-assisted liposuction
 Water jet-assisted liposuction
 Laser-assisted liposuction
Ultrasound-assisted Liposuction
 Fibrous   areas, secondary procedures,
 Skin burns
 Emulsify (separates then aspirate
 VASER – 3rd generation US, pre-treats fat
  to emulsify, then SAL, less complications
  than original US
   Power-assisted Liposuction
 Cannula   moves back and forth within
  subcutaneous tissues
 Faster, less surgeon fatigue
 Water Jet-Assisted Liposuction
 Simultaneous   fluid infiltration and fat
 Promotes less fluid requirements, less
  tissue trauma
        Laser-Assisted Liposuction
   Initially started as external laser therapy
       Thought to decrease inflammation, edema and pain
 Found that adipocytes became “leaky”
 2006 – FDA approved direct placement of laser
  energy into the subcutaneous tissue via optical
       “melts” fat
       Coagulation
       Heats collagen in skin
        Laser Assisted Liposuction
 Less  pain, less bruising
 Easy recovery
 Skin tightening, cellulite improvement
   CoolLipo, SmartLipo, LipoLite, SlimLipo
Electron Microscopy
            Patient Survey
 30  sequential patients surveyed by
  telephone, 20 responses
 0-1 pain pills taken, return to work 1.5 day
 15/20 comfortable during procedure
 Perception of size reduction > skin
 Liposuction  “can thin but not tighten”
 Skin retraction
     Compression garments x 6 weeks
     Laser treatment
 Contour     irregularities
 Cellulite
               Fat Grafting
A   hot topic in fat surgery
 ASPS Fat Graft Task Force – review
  evidence based medicine
 Breast – consider for defects associated
  with medical conditions and previous
  surgery – longevity unknown, infection,
  mammographic considerations
 Little scientific evidence to verify safety
  and efficacy
          Adipose Stem Cells
 Found   in liposuction aspirate
 Capable of differentiation into bone,
  cartilage, muscle, nerve
 Fat is abundant, expendable, easy to
 Adipose tissue-derived stem cells
 Have  the ability to differentiate into both
  osteoblasts (bone) and endothelial cells
  (blood vessels) by culture in specific
 Endothelial cells have the potential to
  populate a matrix and form capillary
Thank You!