๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Introduction
CHAPTER 60 Liposuction
Jason Emer Lucija Kroepfl Vahe Tirakyan
SUMMARY
The demand for a sculpted and defined body over one that is just flat has
required surgeons to make advances in techniques and approaches to surgical body shaping that not only remove large volumes of fat in multiple locations at one time but also use this fat for muscular defining and body revolumization, while also addressing the desire for skin tightening and cellulite reduction.
Patient expectations are significantly higher than in the past, as outstanding
results are now expected in the consumer-driven, competitive aesthetic environment.
Beginner Pearls
Combining traditional liposuction techniques with modern technologies such as
VASER (vibration amplification of sound energy at resonance) ultrasound enables the surgeon to be a sculptor in which multiple steps are used to obtain a contoured and defined body that matches the underlying anatomical landmarks.
Patients with significant loose or lax skin with or without stretch marks, higher BMI
(>10 lb over expected weight), poorly defined or toned underlying musculature, and extreme cellulite are not ideal candidates for HDBC.
Expert Pearls
To treat the superficial fat layer you must have (1) water-assisted (BodyJet)
pressurized tumescence, (2) small (2โ3 mm) rotary cannulas, and (3) VASER ultrasound multi-ringed probes.
One component to the HDBC procedure is fat grafting to areas that require more
muscular definition such as the male chest and shoulders or increased size and projection such as the female buttock and breast.
Donโt Forget!
Traditional power-assisted devices vibrate back-and-forth and extract fat by creating
tunnels, increasing the ability to see irregularities and step-offs. Rotary powerassisted devices vibrate side-to-side in a rotational fashion physically shearing the tissue, allowing the surgeon to physically strip down on the thickness of the fat layerby-layer without any tunnels.
Pitfalls and Cautions
In the past, over-resection of the inner and outer thigh gave a smaller appearance, but
also one that was flat and straight, more masculine, and ultimately unattractive.
It is therefore common for an HDBC surgeon to add fat volume to the lateral buttock
and thigh while removing fat of the upper buttock/lower back and inner thigh.
Patient Education Points
Caucasian and Asian patients often desire a less-defined and curvy thigh, and want it
to be as โstick thinโ as possible, with a much less laterally projected buttock.
In contrast, Latin/Hispanic and African-American patients desire much more
prominent lateral thighs, larger buttocks, and very thin waists, often giving a less proportionate appearance.
CHAPTER 60 Liposuction
INTRODUCTION
The desire for improvement in body shape has increased dramatically in the past few years, mainly due to significant improvements in surgical techniques and reduced downtime as well as advances in nonsurgical approaches that not only reduce body fat but also tighten skin and improve cellulite. The demand for a โsculptedโ and defined body over one that is just โflatโ or โimprovedโ has required surgeons to make advances in techniques and approaches to surgical body shaping that not only remove large volumes of fat in multiple locations at one time but also use this fat for muscular defining and body revolumization, while also addressing the desire for skin tightening and cellulite reduction.
Newer energy-based modalities such as vibration amplification of sound energy at resonance (VASER) ultrasound (as well as lasers/SmartLipo and radiofrequency/BodyTite treatments) allow surgeons to address not only the deep subcutaneous layers to remove bulk, but also work in the superficial layers for etching and muscular shaping, which has long been avoided due to increased complications and risk of irregularities. For a full body transformation, more aggressive high definition body contouring (HDBC) procedures can be combined with surgical implants and/or skin removal in a series of procedures to obtain a significant transformation. Postoperative care such as lymphatic massage and superficial radiofrequency (e.g., Venus Legacy and/or Exilis Ultra), vibration/shock therapies (e.g., Cellutone and/or Z Wave), and follow-up may be helpful to ensure long-term complications are minimal.