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Adipose
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From: http://www.tulipmedical.com
The Tumescent Technique
The Tumescent Technique is simply a method of infusing (infiltrating) a large volume of solution into the subcutaneous space. The technique provides for satisfactory anesthesia to perform subcutaneous soft tissue removal, and adequate vasoconstriction to lessen blood loss associated with this procedure.
The Tulip Syringe System is a complete line of instrumentation for soft tissue removal that includes a blunt-tipped, multi-hole infiltrator, for the infusion of the tumescent solution.
The Tulip Infiltrator is mounted on a syringe allowing the physician to easily and quickly introduce the solution into the surgical site. Precise amounts of solution can be infiltrated using the Tulip Syringe System.
The following are examples of formulas for the tumescent solution:
500cc ringer's lactate
20cc 2% lidocaine
1 cc epinephrine 1:1000
1 OCC 3% sodium bicarbonate
1 liter saline
2mg epinephrine 1:1000
50cc marcaine .5%
1,000 ml normal saline
10 mL 8.4% sodium bicarbonate
50 mL 2% liocaine
1 mL .1% epinephrine 1:1000
1 mL triamcinolone acetonide (Kenalog) in the for of a 1Omg/1 mL suspension
added with the epinephrine just before infusion
The Tulip Syringe Technique combined with the Tumescent Technique are complimentary methods that offer considerable advantages over traditional soft tissue removal techniques. These advantages include reducing the need for general anesthesia, decreased blood loss and post-operative bruising, greater accuracy, precision, and patient satisfaction.
Bibliography
FournierPF: Liposculpture; The SyringeTechnique. Arnette Blackwell, Paris, 1991 Fournier PF: Liposculpture: My Technique. Arnette, Paris, 1989 Foumier PF: Body Sculpturing Through Syringe Liposuction and Autologous Fat Re-lnjection. Samuel Rolf Intemational, Corona Del Mar, CA 1987
From: http://www.pragueaestheticsurgery.com/Liposuction.htm
Classical
Liposuction
Using
small incisions, which are positioned as much as possible in inconspicuous places,
the surgeon inserts the thin cannulas under the skin and removes the excess
fat tissue. In certain cases the surgeon can perform liposuction of several
areas during the same surgery. Not all patients are suitable candidates for
combined liposuctions, however.
Power Assisted
Lipoplasty
(Power
Cannula): This advanced method works similar to the Ultrasonic Liposuction.
Fine vibrations of a frequency of 100 hertz are emitted by the cannula. The
low frequency vibrations liquify the surrounding fat before it’s suctioned from
the body. The Power Assisted Lipoplasty is known as a gentle method, safe for
the surrounding tissues. It is generally recognized as the safest existing method
of liposuction. The risk of hematoma and bruising is minimal. The Power Assisted
Lipoplasty is often defined as a refinement of the Tumescent and Ultrasound
Method. A very safe procedure, the Power Assisted Lipoplasty is also suitable
for extensive fat removal. The method also goes beyond the usual problem zones
and is particularly suitable for application at sensitive areas such as legs,
calves, at the knee, ankle, arms, neck, chin, back, and chest. Although
the Power Cannula Liposuction already represents the most efficient fat dissolving
and suction method existing today, it is possible to combine it with previously
used methods such as injection of pre-dissolving liquid solution, or with
external ultrasound or laser probe.
Fine Cannula
Liposuction
With this
method the specialist uses a smaller cannula than the one used with the usual
liposuction, and so it is more gentle and precise. It enables the specialists
to work slowly and smoothly to carefully reach even very sensitive areas and
achieve exact results. It also reduces the risk of post-operative skin irregularities.
This method is especially suitable for removing medium and smaller amounts of
fat tissue. It is suitable for all areas of the body as well as for Body Liposculpture.
Micro-Cannula
Liposuction
The specialist
uses the smallest existing micro-cannula to remove the fat tissue. This method
is ideal for leg sculpturing; the surgeon is able to remove the thin fat layer
on ankles, knees, calves and inner thighs. This method is also used for
sculpting the chin and upper arms.
Tumescent
Liposuction
This is
the version of fat removal with local tumescent anesthesia. The tumescent liquid
contains a local anesthetic solution (local anesthesia) and other medicines.
This special liquid is infused into the fatty tissue deposits about one hour
before the actual liposuction begins. During one session of Tumescent Liposuction
up to approximately 3-6 liters can be removed, depending upon the area. The
double effect: the concerned area is anaesthetized, and the infused liquid resolves
the fatty tissue in such a way that the removal process becomes facilitated.
Doctors are debating about the possible stress to the body due to the relatively
large quantity of liquids injected into the body by this method.
Ultrasonic
Liposuction
Using
this version the fat is dissolved during the actual liposuction process by means
of the ultrasonic effect. Since the ultrasonic waves loosen only the fatty tissue,
the surrounding tissues remain completely safe. The risks of post-operative
skin unevenness and of postoperative hematoma and bruising are reduced.
External
Ultrasonic Liposuction
The External
Ultrasonic Liposuction represents a technological advancement of the classical
Ultrasonic Liposuction. The fat is removed through an external probe that emits
ultrasound waves from the outside, in a non-invasive way. The actual suction
process begins after the pre-dissolving process. The advantage lies in the fact
that the fat is removed without any mechanical movements that could harm the
tissues. Once the fat is dissolved, it can be easily and quickly suctioned out,
with minimal movements of the cannula. The risk of post-operative skin unevenness
and hematoma is minimized, and healing is faster and easier.
Laser Liposuction
This method
uses basically the same procedure as the External Ultrasound Liposuction, but
instead of using ultrasound waves, the fat is pre-dissolved with Laser waves
using an external probe.
Anesthesia
Only small
Liposuction procedures as around the knee or chin can be carried out under local
anesthesia. Generally all medium and large sized procedures are performed under
general anesthesia. In the Tumescent Liposuction procedure, the special tumescent
solution itself contains the local anesthesia.
Hospital
Stay
Minimal
liposuction, if carried out under local anesthesia, takes place as day surgery.
The patient leaves the hospital the same day. If there is removal of medium
or larger fat quantities under general anesthesia, an overnight stay in the
hospital is required.
Recovery
Swelling
and bruising over the next 2-4 weeks. Compressive garments (mostly elastic pants)
for 3-5 weeks.
From: http://www.drhobar.com/liposuction.htm
Dr. Hobar
combines ultrasonic liposuction and traditional cannula liposuction, using a
fluid that constricts the blood vessels within the fat, so that the material
removed is a purer fat, rather than a mixture of blood and fat. The ultrasonic
form of liposuction liquefies the fat and is best used for the deeper pockets
of fat or where the fat is more fibrous, according to Hobar. The traditional
cannulas allow the liposuction to be performed more superficially and allow
tapering into the surrounding areas so there is not an abrupt separation between
the treated and surrounding areas.
From:
http://www.cosmetic-medicine.jp/list/syringe.htm
Re: The low survival rate of transplanted adipose tissue.
Lipoinjection
with a disposable screw-type syringe for soft-tissue augmentation.
Kotaro Yoshimura, Daisuke Matsumoto, Emiko Aiba, Hisayo Yamaoka, Chiaki Machino,
Takashi Nagase.
Introduction
Autologous fat transplantation is one of the promising treatments for facial
rejuvenation and soft-tissue augmentation due to the lack of incisional scar
and complications associated with foreign materials, though there remain some
problems to be resolved, such as unpredictability and a low survival rate due
to partial necrosis. Lipoinjection can be used for treating aging hollow face,
correcting various kinds of depressed deformities such as hemifacial microsomia
and pectus excavatum, and is also conducted for breast augmentation in some
countries including Japan, although the use of autologous fat for breast augmentation
is not accepted in other countries including the United States, which has the
highest prevalence of breast cancer.
The low survival rate of transplanted adipose tissue is the biggest problem.
Many innovations have been reported in an effort to overcome this problem [1-5]
and reviewed previously [5, 6]. It was concluded that we can harvest fat with
a 2.5 mm cannula or 18-gauge needle at -250 to -500 mmHg vacuum and reinject
it with an 18-gauge needle without significant adipocyte damage [6].
For lipoinjection, the authors used a disposable screw-type syringe, commercially
available in many countries but originally made for angiography and balloon
catheter procedures, and found it very useful for this purpose, especially when
a large amount of adipose tissue was transplanted. With this device, lipoaspirates
can be injected smoothly through an 18-gauge needle without pre-cutting the
harvested tissue, in precise amounts (e.g. 0.3-1.0 ml each), and easily in a
short time.
Surgical Techniques
Adipose tissue was suctioned with a cannula of 2-mm inner diameter and a conventional
suction machine under general anesthesia following an infiltration with saline
solution with diluted epinephrine (0.001%). Collected liposuction tissues were
placed in a funnel-shaped 1-liter vessel with a drain and stopper (liquid separator)
(Fig. 1; left, middle), saline solution was added, and the mixture was left
for a few minutes until good separation was attained. The stopper was released
and the unneeded liquids were drained. This procedure was repeated 6 or 7 times
until the tissues were almost free of blood and look bright yellow in color
(Fig. 1; right).
The washed lipoaspirates were then put into a screw-type syringe (threaded plunger)
with threaded connections for both the connecting tube and needle to allow for
precise control and high pressure injection through an 18-gauge needle (Fig.
2; top), and injected into the recipient site of the body (Fig.2; bottom). This
device (10 cc LeVeen? inflator, Boston Scientific Corp., MA) is originally designed
for angiography and ballon catheter purposes.
For breast augmentation, 200-500 ml lipoaspirates were injected into each breast
with the syringe. To reduce the time of procedure, two syringes were used; the
second syringe was filled with lipoaspirates prepared for the next injection,
while the first one was used for actual injection. A long 18-gauge needle (60
mm long, Nipro Corp., Tokyo, Japan) was used for lipoinjection and inserted
subcutaneously at several points around the edge of the breast mound and in
the areola (Fig. 2B). When the long needle was inserted at the edge of the breast
mound, the operator took great care to insert and place the needle horizontally
(parallel to the body line), in order to avoid damaging the plural and subsequent
iatrogenic pneumothorax. The needle was inserted in various directions, and
was pulled out little by little after each injection of 0.5-1.0 ml of fat, in
order to obtain diffuse distribution of transplanted fatty tissues (Fig. 3).
The fatty tissues were placed into the fatty layers around and under the mammary
glands, and also carefully into the pectoralis muscles. As an assistant rotated
the plunger according to the operator's instruction, the operator rigidly held
the inserted needle and pulled it back a short distance after each injection
of a small amount of adipose tissue, The 18-gauge needle was changed after every
10-20 injections.
For lipoinjection in the face, a short 18-gauge needle was used instead. If
an injection of smaller and more accurate volume is required, a regular disposable
1cc-syringe may be used.
Patients
Lipoinjection was performed with this device on a total of 10 patients. In 8
of the cases, adipose tissues were injected into breasts (220-450 ml on each
side), while the other 2 cases were injected in the face (65-95 ml) for rejuvenation.
Patients' data is summarized in Table 1.
Results
Transplantation of adipose tissue was successfully performed in all cases, and
the time of the injection process ranged from 55 to 70 min for breast augmentation,
and from 15-25 min for facial rejuvenation. Subcutaneous bleeding was usually
seen on some parts of the breasts, and faded away in a week or so.
Transplanted adipose tissues were gradually absorbed during the first 3 months,
and the contour showed minimal change thereafter. Representative cases are shown
in Figures 4 and 5. In bilateral breast augmentation, the circumference difference
(= chest circumference at the nipple - chest circumference under the breasts)
increased in all cases, usually by 3 to 5 cm. The increase of the circumference
difference seems to correspond to 100-150ml increase in the volume of each breast
mound. All cases showed natural softness of the breasts without any palpable
nodules, and all patients were satisfied with the resulting texture, softness,
and absence of foreign materials despite the limited size increase possible
with autologous tissue. Postoperatively, no indurations, such as calcification
or fibrosis, were found in any cases, either clinically or with computed tomography.
Discussion
A number of modifications of lipoinjection techniques have been tried in order
to improve the survival rate of injected fat. Among those, it is well accepted
that adipose tissue should be transplanted as small particles, preferably within
3 mm in diameter [1]. To perform diffuse distribution of suctioned fat more
efficiently, we have used a disposable syringe with a threaded plunge and connections.
Though more than half of the grafted fat seemed to be absorbed, we did not see
any indurations such as calcification or fibrosis, which have been the only
factor against the use of lipoinjection for breast augmentation. No abnormal
signs were detected with postoperative CT scans in our small number of cases.
The results of CT scans showed that transplanted fat tissues survived and formed
a significant thickness of the fatty layer not only subcutaneously around the
mammary glands but also between the mammary glands and the pectoralis muscles,
indicating successful augmentation of the breast mounds. Breast volume was nearly
settled 6 months after transplatation. Maximum breast augmentation with this
technique appeared to be 100-150 ml. However, it is a definite advantage that
we do not have to worry about postoperative complications induced by artificial
materials, which include capsular contracture, hardness, immune response, and
breast deformity in the future.
It has been revealed that adipose tissue contains not only adipogenic progenitor
cells but multipotent stem cells which can differentiate into fat, bone, cartilage,
and others [7-10]. Suctioned fat appears to lose a significant amount of these
precursors during mechanical liposuction process compared to non-suctioned adipose
tissue (in preparation), so this relative deficiency of precursors may contribute
to the low survival rate of transplanted lipoaspirates. It is expected that
a variety of new innovations including stem cell technology will be further
developed and contribute an improved transplanted fat survival rate fat in the
future. Further improvements of the technique could make fat transfer the first
choice for breast augmentation in the future.
Correspondence to: Kotaro Yoshimura, M. D.
Department of Plastic, Reconstructive, and Aesthetic Surgery, University of
Tokyo,
7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
Phone: +81-3-5800-8949
Fax: +81-3-5800-6929
E-mail: yoshimura@cosmetic-medicine.jp
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