2011 World Congress Female & Male Genital Cosmetic Surgery
Liposuction & Autologous Fat Transfer
Marco A. Pelosi, III, MD FACOG, FACS, FICS, FAACS
CME Disclosure The Faculty reports no significant financial relationships or other relationships with the manufacturers of any commercial products and/or providers of commercial services discussed in this educational presentation and with any commercial supporters of this activity. Furthermore, no off- label or investigational uses of products will be discussed without explicit notification thereof.
Terminology Lipolysis Lipolysis Lipoplasty Lipoplasty Liposuction Liposuction Liposculpture Liposculpture Suction lipectomy Suction lipectomy Suction-assisted lipectomy (SAL) Suction-assisted lipectomy (SAL)
Terminology Small-volume (<100 mL fat) Small-volume (<100 mL fat) Medium-volume (<1500 mL fat) Medium-volume (<1500 mL fat) Large-volume (<4000 fat mL/ 5000 mL total) Large-volume (<4000 fat mL/ 5000 mL total) Megaliposuction Megaliposuction – CA Speier Bill: >5000 mL “unprofessional” – FL: 4000 mL limit
Terminology Dry = nothing infiltrated Wet= saline/hyaluronidase
Superwet Solution 1,000 ml 10 ml 1 ml 25 ml
Tumescent Local Anesthesia 1,000 ml 10 ml 1 ml 100 ml
Generally Accepted Lidocaine Limits Intravenous: 7 mg/Kg Intravenous: 7 mg/Kg Tumescent w/o liposuction: 25 mg/Kg Tumescent w/o liposuction: 25 mg/Kg Tumescent w/ liposuction: 45 – 55 mg/Kg Tumescent w/ liposuction: 45 – 55 mg/Kg – Thin = 45 – Avg = 50 – Heavy = 55 Florida Law: cannot exceed 50 mg/Kg
Terminology Manual Liposuction Manual Liposuction Power-Assisted Liposuction Power-Assisted Liposuction Ultrasound-Assisted Liposuction (UAL) Ultrasound-Assisted Liposuction (UAL) – Internal – External Laser-Assisted Liposuction Laser-Assisted Liposuction – Internal: “Hot” laser – External: “Cold” laser Disruption-Assisted Liposuction Disruption-Assisted Liposuction
The Tools
Aspiration Equipment Suction pump -100 kPa max Suction pump -100 kPa max Syringe for small volume Syringe for small volume
Liposuction Cannulas
Fat Transfer Cannulas
Lips Type 3
NLF V-Dissector Type 1
Non Lines Type 2
Hands Type 2
Buttocks Type 2
Labia Type 2
Augmentation Labia Majoraplasty
Typical Process Patient is consented, marked & photographed Patient is consented, marked & photographed NIBP, ECG, SpO2 monitors are placed NIBP, ECG, SpO2 monitors are placed Hep-lok is inserted Hep-lok is inserted Knee-high SCDs applied Knee-high SCDs applied
Punch or scalpel
Always Parallel
Reverse Jackknife Postion Abdominal Lipo
Long strokes
Multi-Directional Contouring
Nondominant Hand Control
Blend margins
Avoid superfical layer 5mm No-Suck Zone
EBL = 5mL/liter of total aspirate
Regional Applications
High Definition Liposuction Etching Pectoral Abdominal Manual, Laser, Vaser Ideal < 15% Body Fat
Pectoral Etching
Access
Abdominal Etching
Leaner = Better Result
Flanks & Back Strategies
Arms Liposuction
Access: Post
Medial
Lateral
Legs Liposuction Outer Thighs Outer Thighs Inner Thighs Inner Thighs Posterior Thighs Posterior Thighs Anterior Thighs Anterior Thighs Knees Knees Calves & Ankles Calves & Ankles
Access
Inner Thighs & Knees
Breast Liposuction
9 months F cup D cup
Fat Transfer Techniques
mm
1-2 L
Harvest Setup
From patient Topump
Gravity x 15:00 or centrifuge discard
Light Infiltration of Recipient Site
600 cc
500cc superficial & deep
500cc
200cc
Augmentation Mammaplasty
Peri-glandular
Augmentation Labia Majoraplasty
LVR + Augmentation
Questions
End