• #2-2. Theoretical Knowledge and Technique for Lipoplasty

     

    Figure 2. Injection equipment of tumescent solution.

     

    Equipment and Preparation for Tumescent Liposuction

    First, fat aspiration and graft equipment need to be prepared. Thetumescent solution is made in the following composition; 1 liter of saline solution,1 cc epinephrine, 800mg of 2% lidocaine solution, 40mg triamcinolone, 1 gentamicin ampoule. For smaller amounts of saline solution such as 500ml and 100ml, use ½ and 1/5 of the above amounts, respectively. I’ve most often used 500ml saline solution and use 100ml when only a very small amount of fat is required.

    A 20ml or 50ml syringe and 18G needle can be used to directly inject the tumescent solution. An IV and 3-way connector can be used to inject 20ml at a time. I also use the 1.5mm diameter X 25cm long, multi-hole injection cannula.

    For beginners, I recommend the 2.5mm diameter X 25cm 3-hole cannula for fat harvesting. After becoming sufficiently familiar with the technique, the 3mm diameter X 25cm 3-hole suction cannula can be used. However, I prefer the 2.5mm 3-hole cannula for stem cell harvesting or fat harvesting. For harvesting small amount of fat less than 10cc, I use 100ml tumescent solution and 2mm cannula.

    The following are the equipment needed; tumescent solution 500ml, 1.5mm X 25cm injection cannula, 50ml or 20ml injection syringe, 2.5mm X 25cm aspiration cannula, 10ml aspiration syringe, 18G needle or IV set 3-way connector, number 11 blade for incision, and 5-0 nylonforsuture material. 

     

    Injection Technique for Tumescent Liposuction

    After the harvested site has been identified, have the patient change into a sterilized gown. Sterilize the skin surface with betadine and have the patient lie supinely on the plastic sheet over the bed. To prevent contamination of the surgery bed, I recommend covering it first with a sterilized plastic sheet and then a sterilized sheet. The patient should be in the supine position for fat harvesting in the lower abdomen, medial thigh, or anterior thigh, etc. Have the patient lie in the prone position for harvesting in the flank and posterior thigh.

    To harvest adipocytes and stem cells, it is important to calculate the exact amount of fat to be harvested. Aftercentrifugation, only 50% of the initial volume remains. Fat graft in an extensive area requires harvesting a large amount of fat. I recommend only the experienced surgeons to carry them out. It is advisable that beginners aspirate amounts from50ml to 100ml. If 50ml is needed for extracting stem cells, and 25ml of purified fat is needed, a total amount of 100ml should be harvested.

     

    Figure 3. Before and after donor site complication after facial autologous fat transfer.

    Figure 4. Before and after donor site complication after facial autologous fat transfer.

     

    The lower body is an ideal donor site of fat and stem cells. The superficial fat layer of the lower abdomen, between the skin and Scapa’s fascia, is ideal for extracting adipocytes and stem cells.

    I mark the area for adipocyte harvesting and draw contour lines marking the largest fat deposit. I inject the tumescent solution in an area as twice as large as the aspirated amount. I inject 3 times as much tumescent solution into an area that is twice as large as the aspirated amount (marked with contour lines). For harvesting 100ml of fat, inject 300ml of the solution into an area twice as large as the marked area on the both posterior thigh. For harvesting 50ml of fat, inject 150ml of the solution over an area twice as large as the marked area. Looking only at the marked area, only 75ml of the tumescent solution is injected and 50ml of fat is harvested. In other words, the ratio of the injected solution to the harvested fat is 1.5:1.

    The injection technique is the most important. Slowly insert the needle parallel to the skin at the depth of 5mm or less. The anesthetic solution should be injected not during insertion but while withdrawing the needle. In a fan shape infusion technique, continue injecting the solution adjacent to the previous injection. Inject 1 layer of the solution for 1 cm thickness offat and 2 layers in 2 cm.

     

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    I do not recommend repeatinglarge injections in the same site as it can drastically change the outline of the body. I prefer 1:1 or 1.5:1 ratios between injected solution and aspirated fat. Using an excess amount of the solution may interfere with creating a desirable outline. Therefore, I recommend injecting small amounts of the anesthetic solution. Local anesthetic is preferred as the cannula movement can be more easily detected than with general anesthesia. Be taken 1mg Ativan per oral an hour before surgery to alleviate patient anxiety.

    In the next article, we will discuss donor site selection and fat harvesting techniques.

     

    -To be continued

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