Fat Disruption : A Useful Adjunct To Liposuction Surgery by

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Presentation transcript:

Fat Disruption : A Useful Adjunct To Liposuction Surgery by E. Antonio Mangubat, MD Seattle, WA

Fat Disruption Concept Not a new idea Chopped up fat is easier to suck out UAL (Ultrasound Assisted Liposuction) Fat disruption before liposuction Great in tough areas (scar, gynecomastia) Made aspiration easier Cost

Fat Disruption Concept Blugerman liposhifting instrument Introduced in 2002 Liposuction World Congress Designed to create mini fat grafts internally in vivo fat grafts manually shifted to fill defect Solid core cannula 3-4mm diameter Current concept Mechanical disruption of fat infrastructure Not intended for fat grafting Detach the fat from its stroma before suction Uses much larger cannulas: 5-6mm typical

Advantage of Fat Disruption SPEED Rapid volume reduction Aspiration speeds up to 1000ml/min Large cannulas do not cause irregularities Smooth results regardless of cannula size No suction applied during disruption Even superficial passes do not leave divots Especially useful for: Large volume reduction Beginning liposuction surgeons

Prototype Fat Disruptor Instrument and technique Large sizes: 5 & 6mm empirically work the best Hollow cannulas Relieve tumescent pressure Retains leaking aspirate in hose; less mess Fat disruption surface Not designed for fat grafting Longer, larger holes, faster Push and pull disruption more efficient

Fat Disruption Technique Large tumescent volume No suction used in disruption phase No divots, no ridges, no depressions Different than pre-tunneling

Technical Notes Intense “super” tumescence - high hydrostatic pressure Forced fluid dispersion Hydrostatic capillary compression Bloodless Staged tumescence – infuse in staged areas e.g. Front the Back Upper body then lower body Vasoconstriction last only ~90min Speed critical for larger volumes

Tumescent Solutions Compositions Technical Notes Tumescent Solutions Compositions Lidocaine = .048% (50ml 1% lidocaine in 1L) Epinephrine = 1:1,000,000 (1ml 1:1000 epi in 1L) Max dose 40-50mg/Kg Addition tumescence above the max lidocaine dosages had no lidocaine. Only: 1:1,000,000 epi in LRS

Large fat disruption surface Intense tumescence Note firm tissue turgor No suction applied yet Start deep next to muscle 5-6 minutes, loss of resistance

1000ml in 60 seconds! Able to get close to surface No surface defects Begin 60 secs of suction Large 6mm cannula Note free flow of aspirate 1000ml in 60 seconds!

Greater Cosmetic Safety Useful In Defects Prone Areas High Resistance Areas Gynecomastia Epigastrium Upper back Revision liposuction

Greater Cosmetic Safety For Experience Surgeons SPEED! Significantly shorter procedures Greater time for refinement Cost-effectiveness

Greater Cosmetic Safety For Beginning Surgeons Much shorter learning curve Reproducibly smoother results SPEED! Cost effective

Fat Disruption Summary Great Speed & Smoother Results Shorter procedure times Less blood loss Less anesthesia Less expense Greater Patient Safety

E. Antonio Mangubat, MD Seattle, WA Thank You! E. Antonio Mangubat, MD Seattle, WA USA