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