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					New Advances in Body
     Contouring
   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
                  Pride
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
              Terminology
 “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
                  Safety
 Patient’s medical history
 Performed in an accredited facility by an
  experienced physician
 Consider anesthesiologist for > 1 liter
  aspirate
         Tumescent Technique
 Klein, 1987
         high volume solution with local
 Inject a
  anesthetic and epinephrine
 Wet, super wet, tumescent
     Defined by volume injected vs volume
      aspirated
+    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,
  males
 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
  aspiration
 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
  fiber
       “melts” fat
       Coagulation
       Heats collagen in skin
        Laser Assisted Liposuction
               ?Benefits?
 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
  awake
 Perception of size reduction > skin
  improvement
                Limitations
 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
  harvest
 Adipose tissue-derived stem cells
              (ASCs)
 Have the ability to differentiate into both
  osteoblasts (bone) and endothelial cells
  (blood vessels) by culture in specific
  media
 Endothelial cells have the potential to
  populate a matrix and form capillary
  networks
Thank You!

				
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