The soft-tissue shaving procedure for removal of adipose tissue. A new, less traumatic approach than liposuction

1997 Guidelines for Liposuction Surgery

A joint Ad Hoc Committee of the American Society of Liposuction Surgery (ASLS) and the American Academy of Cosmetic Surgery (AACS) was formed to create the following guidelines for liposuction surgery. The members of this committee include: Robert Alexander, M.D., D.M.D.; Guillermo Castillo, M.D.; Robert Jackson, M.D.; Jeffrey Klein, M.D.; Melvin Shiffman, M.D.; and Howard Tobin, M.D. These guidelines were presented to and passed by the ASLS and AACS Board of Trustees on October 16, 1997.

Laser-assisted lipolysis for knee remodelling: a prospective study in 30 patients

BACKGROUND

Unsightly fat knees are a frustrating aesthetic deformity exacerbated by genetic predisposition and resistance to diet. This article reports our experience with laser-assisted lipolysis (LAL) in knee remodelling.

METHODS

A total of 30 patients were treated for unsightly fat knees with LAL. The 924/975-nm diode laser used in this study consists of two lasers, one emitting at 924 nm and another at 975 nm. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat, in dual emission mode at 924/975 nm. Patients were asked to fill out a satisfaction questionnaire. Ultrasound was used to measure the fat thickness pre-and post-operatively.

RESULTS

Other than one patient who developed mild hyperpigmentation that disappeared after 2 months, there were no complications in the series. Pain during the anaesthesia and discomfort after the procedure were minimal. Return to normal activities never took longer than 2 days and mean downtime was 0.92 days. Of the 30 patients, 29 would recommend this treatment. Overall satisfaction was high with both patients and investigators and was validated by ultrasound measurements demonstrating a systematic decrease in fat thickness.

CONCLUSION

LAL in knee remodelling is a safe and reproducible technique, particularly appreciated by patients. The procedure allows for a reduction in the amount of adipose deposits while providing concurrent skin contraction.

New advances in liposuction technology

Although suction-assisted liposuction under tumescent anesthesia remains the traditional method for body sculpting, newer technologies promise to increase efficiency, decrease surgeon fatigue, and minimize complication. Power-, ultrasound-, and laser-assisted devices are ideal in large volume cases and in areas of fibrous tissues as an adjunct to traditional liposuction. Although skepticism remains chemical lipolysis, more commonly termed mesotherapy or lipodissolve may be an alternative to surgical treatment of localized fat. This article reviews the recent advancements in the field of liposuction and the current literature which support their use.

Submentoplasty

Aging changes to the anterior neck can produce skin laxity, accumulation of submental fat, platysmal banding, and ptosis of the underlying neck structures. To rejuvenate the cervicomental region, the surgeon must accurately diagnose the anatomic irregularities and make appropriate recommendations for surgical correction. Because there are wide variations of anterior neck anatomy among individuals, it is necessary to "customize" the surgery in this area for each patient by employing single isolated procedures or multiple techniques. A stepwise approach in the management of the submentum can facilitate this goal and guide the surgeon in selecting the appropriate procedures for each individual.

Power Liposuction

Power liposuction seems to be a significant advance in the evolution of the liposuction procedure. It allows for a faster, less painful recovery for the patient and is less of a strain on the surgeon, increasing the precision of the procedure. Complications are less than those seen with traditional liposuction performed under local tumescent anesthesia. Because it is performed under local anesthesia, power liposuction allows for fine tuning of the body contours with the patient in the standing position, reducing the number of postoperative touch-ups.

The Soft-Tissue Shaving Procedure for Deformity Management of Chronic Tophaceous Gout

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. A gouty tophus occasionally mimics an infectious or neoplastic process. However, the conventional enucleating procedure might cause complications. In severe cases, skin necrosis and tendon or joint exposure can occur after debridements. In this series, the soft-tissue shaver is used for deformity management of the chronic tophaceous patients and the results are encouraging. From November 2000 to August 2002, 17 patients with chronic tophaceous gout were treated by the shaver technique. Suction and irrigation were performed simultaneously while the shaver was operating, and chalky deposits of sodium urate could be removed efficiently. Skin necrosis was minimized by means of proper incision planning. Also, bedside debridements and wound wet dressing were helpful for improving the outcomes. The families and patients were satisfied with the results. In conclusion, severe chronic tophaceous gout can be a surgical challenge. The soft-tissue shaving technique can be useful for cosmetic debulking of large tophi in patients with advanced chronic tophaceous gouty arthritis.

Powered liposuction: an evaluation of currently available instrumentation

BACKGROUND

Over the past several years, powered liposuction instruments have become available to the dermatologic surgeon. These instruments all move the cannula forward and backward 2-12 mm with rapidity. This motion simulates the standard human movement of the cannula and facilitates movement through the tissue. Powered liposuction may help to prevent surgeon fatigue and has recently been shown to aid in the efficacy of fat removal.

OBJECTIVE

To compare and contrast currently available powered liposuction instruments, to obtain objective engineering data on the instruments, and to compare the instruments when used on actual liposuction cases.

METHODS

Five currently available powered liposuction systems were evaluated by the author. Each instrument was used with a 3 mm dual side port cannula on patients undergoing tumescent liposuction. An independent engineering firm, who collected objective measurements such as weight, stroke force, temperature, and vibration measurements on the instruments, evaluated the units. Noise measurements were obtained.

RESULTS

Each of the five systems showed advantages and disadvantages. Important issues were the size and weight of the units, as well as whether they were driven electrically or pneumatically. Stroke force is variable (range 9.5-30 pounds). The noise of the units ranged between 60 and 87 dB. Vibration measurements varied from instrument to instrument. Units produced a variable amount of heat ranging from 77 degrees F to 102 degrees F. Most instruments are autoclavable, and one system is disposable. Build quality and reliability varied with the instrument.

CONCLUSION

Instruments for powered liposuction have emerged in the last 2 years, with each instrument having distinct advantages and disadvantages. This article reviews five currently available powered liposuction instruments and presents objective measurements as well as the author's experience using the instruments.

The benefits of powered liposuction versus traditional liposuction: a paired comparison analysis

BACKGROUND

There is much debate about the safety of liposuction as well as the efficacy and risk:benefit ratio of newer devices used in this procedure.

OBJECTIVE

To determine if there are any benefits in terms of safety and efficacy of power reciprocating cannulas compared to traditional manual liposuction cannulas.

METHODS

Patients served as their own controls in a paired comparison analysis of power liposuction cannulas and traditional liposuction cannulas.

RESULTS

Power cannulas significantly reduced procedure times, intraoperative pain, and surgeon fatigue, and increased the amount of fat aspirated per minute. Power cannulas also decreased postoperative pain, ecchymoses, and edema, as well as resulting in higher patient satisfaction scores.

CONCLUSION

Power liposuction cannulas produce significantly faster recovery times for patients, allow faster procedure times, and reduce surgeon fatigue, resulting in safer and more precise surgery. A lower incidence of touch-up procedures is likely due to these benefits.

Endoscopic liposhaving for neck recontouring

OBJECTIVE

To describe a modified technique of liposuction that combines endoscopic techniques and a soft tissue shaver for neck recontouring.

DESIGN

Nonrandomized, nonblinded, retrospective evaluation of endoscopic liposhaving for patients requiring neck recontouring in a facial plastic surgery practice.

INTERVENTIONS

Endoscopic liposhaving was performed on 5 patients undergoing neck recontouring with platysma plication using a small submental incision.

MAIN OUTCOME MEASURES

Subjective evaluation by the surgeon.

RESULTS

Direct visualization with the endoscope ensures complete removal of excess fat while maintaining a small amount of fat over the platysma muscle and on the skin flap. The fat was easily and precisely removed with minimal trauma and edema. There were no resulting facial nerve injuries, dimpling, hematomas, or significant asymmetries.

CONCLUSIONS

Endoscopic liposhaving for neck recontouring is a precise and less traumatic method of lipectomy than the current techniques. Direct fat visualization with an endoscope allows more accuracy than the external visualization and palpation relied on in conventional liposuction or direct liposhaving. Using these 2 newer modalities can lead to quicker recovery time. There are no known previous reports of use of these 2 techniques together. Arch Facial Plast Surg. 2000;2:264-268

Powered liposuction

BACKGROUND

Although Arpad and Giorgio Fischer initially employed blades within cannulas in their early research while inventing liposuction, hollow cannulas have become the standard instrument for this procedure for the last quarter century. Ultrasonic liposuction was developed in the 1990s to facilitate the passage of cannulas through subcutaneous tissue while liquefying fat. However, these instruments had a number of drawbacks including seromas and tissue burns. Powered cannulas were introduced in 1995 by Gross for "liposhaving." This technique was used on the neck with open surgery under direct observation.

OBJECTIVE

Based on these principles, a new powered liposuction device has been designed for body liposuction.

METHOD

An oscillating blade within a cannula facilitates removal of fat, especially in fibrous areas such as male flanks and breasts. This instrument has proven to be safe in numerous body areas. Powered reciprocating cannulas also have been recently introduced. These simulate the "to and fro" motion of manual liposuction and appear to be safe.

CONCLUSION

Powered liposuction may provide the advantages of ultrasonic liposuction with fewer complications.

A 3-year multi-institutional experience with the liposhaver

OBJECTIVE

To report a 3-year multi-institutional clinical experience with the liposhaver in facial plastic surgery.

DESIGN

Nonrandomized, nonblinded, multi-institutional evaluation of the liposhaver in a clinical setting.

INTERVENTIONS

Seventy-two patients who presented for facial plastic surgical procedures underwent surgery with the liposhaver. Seventy-six liposhaving procedures and 74 concomitant procedures were performed. Standardized preoperative and postoperative photographs were obtained.

OUTCOME MEASURE

Subjective evaluation by the surgeons who performed the procedures.

RESULTS

The liposhaver was used successfully in all cases. The fat was cleanly shaved and the contour results were even, without dimpling or significant asymmetry. Operative time was comparable to that of conventional liposuction. There were no cases of facial nerve injury and no evidence of increased bleeding intraoperatively. Two male patients had small postoperative hematomas in the immediate postoperative period that were successfully treated with conservative measures. An additional patient developed a small hematoma on postoperative day 5 that was effectively treated with needle aspiration and a pressure dressing.

CONCLUSION

This 3-year multi-institutional report suggests that the liposhaver continues to offer a precise alternative to conventional liposuction.