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

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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!

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

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

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

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

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