ADVANCED TECHNIQUES IN LIPOSUCTION AND FAT TRANSFER Edited by Nikolay Serdev Advanced Techniques in Liposuction and Fat Transfer Edited by Nikolay Serdev Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Masa Vidovic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Benko Zsolt, 2010. Used under license from Shutterstock.com First published August, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Advanced Techniques in Liposuction and Fat Transfer, Edited by Nikolay Serdev p. cm. ISBN 978-953-307-668-3 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Liposuction – History and Techniques 1 Chapter 1 Application of the Liposuction Techniques and Principles in Specific Body Areas and Pathologies 3 Diego Schavelzon, Louis Habbema, Stefan Rapprich, Peter Lisborg , Guillermo Blugerman, Jorge A. D’Angelo, Andrea Markowsky, Javier Soto, Rodrigo Moreno and Maria Siguen Chapter 2 Liposuction and Fat Graft to Enhance Facial Contour in Reconstructive Surgery - Nine Years Experience with the use of Peridural Cannula 35 Claudia Gutiérrez Gómez, Marcia Pérez Dosal and Alexander Cardenas Mejia Chapter 3 Novel Liposuction Techniques for the Treatment of HIV-Associated Dorsocervical Fat Pad and Parotid Hypertrophy 49 Harvey Abrams and Karen L. Herbst Chapter 4 Lipoplasty of the Back 63 Francisco Agullo, Sadri O. Sozer and Humberto Palladino Chapter 5 Power-Assisted Liposuction (PAL) vs. Traditional Liposuction: Quantification and Comparison of Tissue Shrinkage and Tightening 69 Gordon H. Sasaki, Ana Tevez and Erica Lopez Ulloa Chapter 6 Larger Infiltration/Aspiration Volumes, Plasma/ Subcutaneous Fluid Lidocaine Levels and Quantitative Abdominal Tissue Accommodation After Water-Assisted Liposuction (WAL): Comparative Safety and Efficacy to Traditional Liposuction (TL) 81 Gordon H. Sasaki VI Contents Chapter 7 Gynoid Lipodystrophy Treatment and Other Advances on Laser-Assisted Liposuction 95 Alberto Goldman, Sufan Wu, Yi Sun, Diego Schavelzon and Guillermo Blugerman Chapter 8 Radio-Frequency Assisted Liposuction (RFAL) 115 Guillermo Blugerman, Malcolm D. Paul, Diego Schavelzon, R. Stephen Mulholland, Matthias Sandhoffer, Peter Lisborg, Antonio Rusciani, Mark Divaris and Michael Kreindel Chapter 9 Ultrasound Assisted Liposculpture – UAL: A Simplified Safe Body Sculpturing and Aesthetic Beautification Technique 135 Nikolay P. Serdev Part 2 Lipotransfer and Stem Cell Enriched Fat Transfer 151 Chapter 10 Advanced Lipotransfer Techniques 153 Guillermo Blugerman, Roger Amar, Diego Schavelzon, Marco A. Pelosi II, Marco A. Pelosi III, Javier A. Soto, Anastasia Chomyszyn, Maurizio Podda, Andrea V. Markowsky, Jorge A. D’Angelo and Rodrigo Moreno Chapter 11 Processing of Lipoaspirate Samples for Optimal Mesenchymal Stem Cells Isolation 181 Leandra Baptista, Karina Silva, Carolina Pedrosa and Radovan Borojevic Chapter 12 Stem Cell Enriched Fat Transfer 203 Maurizio Ceccarelli and J. Víctor García Part 3 Complications of Liposuction 219 Chapter 13 Complications of Liposuction 221 Francisco J. Agullo, Humberto Palladino and Sadri O. Sozer Preface Liposuction is the first cosmetic procedure to change beutification surgery from open extensive excision surgery into a more atraumatic closed one. It gave rise to the modern understanding of minimally scarring and minimally invasive surgery and changed the understanding and preferences of both patients and doctors. It also became the most common procedure in cosmetic surgery world-wide, practiced by an increased number of physicians from various specialties. The techniques of fat grafting, closely bound with liposuction, have found widespread application and fat stem cells seem to be changing the future of many areas in medicine. Training became necessary in view of the constantly changing and developing character of medical science, and because of the progress in new devices emerging on the market. Turning the pages, the reader will find a lot of information about advances, tips and tricks, and important milestones in the development of the different methods available, such as classic, power, ultrasound, laser and radio-frequency assisted liposuction etc. Most useful anesthesia techniques are described and discussed, and guidelines have been established for medical indications. Special attention is paid to good patient selection, complications and risks. We have invited renowned specialists from all continents to share their valued expertise and experience. We will never be able to thank every single person or institution who helped in fulfilling our work. The difficult task of writing a comprehensive book about the status and science of the most desired and most practiced procedure in cosmetic surgery, in order to prevent dissatisfaction and misunderstandings, was marked with hard work and continuous improvements. It is a privilege to share our knowledge concerning contemporary advances in this area of medicine, and thus help people change and improve their lives. It is our greatest reward as well. Prof. Dr. Nikolay Serdev National Consultant of the Ministry of Health in the Specialty of "Cosmetic (Aesthetic) Surgery" 2006-2008, Medical Center "Aesthetic Surgery, Aesthetic Medicine" 11, Bulgaria [...]... the patient in standing position Then the marking is done comprising the surrounding tissue of inter-gluteal and sub-gluteal groove thus determining an L-shaped marking This mark is divided into two zones, a vertical one which is parallel to the inter-gluteal groove in which the liposuction is done in both deep and superficial plane, and another horizontal to sub-gluteal groove in which the liposuction. .. measurement using 3D imaging (Image3D, Bauerfeind) and self-assessment, based on a questionnaire with 15 criterias They were assessed by the patient using a visual analogue scale (VAS) of 0 to 10 The survey was completed prior to beginning therapy and again at 6 months after the final liposuction treatment (Figure 15) Fig 15 Questionnaire and results 14 Advanced Techniques in Liposuction and Fat Transfer In. .. position of inframammary fold, P representing lowest projection of breast and T representing projection of the nipple L represents Left, R represents Right Fig 25 Markings guiding the surgeon for areas and planes of fat removal side view with axillary tail 25 26 Advanced Techniques in Liposuction and Fat Transfer Fig 26 Five infiltration needles are used during infiltration Fig 27 A: Before liposuction. .. fat deposits without a significant degree of skin laxity The skin in this particular body area is often thin and inelastic and in most circumstances where skin laxity is present liposuction alone fails To contour and tighten the inner thigh, it is necessary to combine liposuction with skin excision to achieve acceptable cosmetic results (36) Adverse results associated with current inner thigh lifting... in Liposuction and Fat Transfer we determine the degree of redundant skin that needs to be removed and the amount of fat that will be suctioned by liposuction (43) Marking the patient in a resting position may result in over-resection of the inner thigh lower flap The marking of the outer border of the ellipsoid-shaped skin incision is then completed (Figure 20) Fig 20 Marking of the skin to be resected,... 1 Liposuction: History and Techniques 1 Application of the Liposuction Techniques and Principles in Specific Body Areas and Pathologies Diego Schavelzon et al.* Argentina 1 Introduction 1.1 Three dimensional gluteoplasty The buttocks have been a symbol of attraction, sexuality and eroticism since ancient times and therefore, they have an important role in defining the posterior body contour More and. .. Micrografts (EAM) In some cases due to the marked ptosis we use adipose grafting, this theme is explained in “Enriched Adipose Micrografts with Autologous Plasma” (13,14) (Figure 8) Fig 8 View of the fat tissue post -liposuction Lateral view of EAM technique in trochanteric depression 10 Advanced Techniques in Liposuction and Fat Transfer 1.3.3 Liposhifting and deep-superficial subsicion Liposhifting technique... microcannulae and – in a more advanced form – with vibrating cannula under tumescent local anesthesia (Figure 13 and 14) (21, 22, 23, 24, 25, 29, 31, 32, 34) The procedure of the liposuction in lipedema does not differ from aesthetic indications (26, 27, 28) Stringent guidance of the cannula in longitudinal direction and aspects of safety have to be considered in the same way 12 Advanced Techniques in Liposuction. .. body lifting and liposuction procedures is planned at the initial visit Evaluation of the degree of skin laxity and its quality, the overall extent of deformity of the inner thigh and the extent of lipodystrophy is relevant (40) An important aspect of the initial physical examination is the evaluation of the lower Application of the Liposuction Techniques and Principles in Specific Body Areas and Pathologies... the vulva and mons pubis (Figure 18) This technique also avoids the T incision The success in this procedure depends on patient selection, surgical planning and patients' realistic expectations (Figure 23) Application of the Liposuction Techniques and Principles in Specific Body Areas and Pathologies 21 Fig 23 Pre -and postoperative photographs of Medial Thigh Lift combining liposuction and Dermal . ADVANCED TECHNIQUES IN LIPOSUCTION AND FAT TRANSFER Edited by Nikolay Serdev Advanced Techniques in Liposuction and Fat Transfer Edited by. excision surgery into a more atraumatic closed one. It gave rise to the modern understanding of minimally scarring and minimally invasive surgery and changed the understanding and preferences. sexuality and eroticism since ancient times and therefore, they have an important role in defining the posterior body contour. More and more people are talking about and understand the meaning and