Cervicofacial Liposuction.pptx

Liposuction of Specific Regions:
Evidence Based Practice.
2002-2022
11/4/2022 email: askprof@moawadskininstitute.com 1

Dedication
The Journey of Liposuction
• This presentation is dedicated to the memory of my parents, Prof. M. Moawad,
and My mother, Iqbal S. They made me what I am today with encouragement and
sacrifices.
• To my family, my wife Salam. B., and my pride in life, my son Mo and my daughter
Noor with their unflagging support, turned the second part of my life journey into
success.

Acknowledgment
• Special acknowledgment is given
to Dr. Ibrahim El Dousky (M.D.,
IMRCS), not only because he is an
outstanding student but also
because he doomed me into the
life of plastic surgery with his
excellent work and experience.
• Dr. El Dousky is the general
secretary of ESCSL.

Acknowledgment
• Special acknowledgment is given
to Dr. M. Ramadan (MS., Ph.D.), a
brilliant scientist, chief of staff at
MSI and my right hand in all what I
do.
• Dr. Ramadan is on the board of
directors of ESCSL.

Appreciation
• The author would like to express his appreciation to the medical team at
L'institute (Riyadh, KSA) and Moawad Skin Institute (MSI) in Cairo, Egypt, for
taking care of the patient during the procedures.

Appreciation • To “PATIENTS” You’ve always believed in me
KEYWORDS: LIPOSUCTION., LIPOSCULPTURE., FAT GRAFTING, ADIPOSE FATTY TISSUES., BODY
CONTOURING

Introduction
email:
askprof@moawadskininstitute.com
• Concepts of beauty have
been continuously evolving
throughout the history of
humankind.
• Slimmer forms have
substituted the voluptuous
figure idealized by artists in
the past.
• With fashion promoting
body-revealing attire,
outdoor exposure, and the
emphasis on fitness and
good health, people have
sought to reflect these
trends by demonstrating
youthfulness and vitality in
their bodies.
11/4/2022 7

Introduction
email:
• On the other hand, a
sedentary lifestyle and
dietary excesses associated
with factors such as
genetic determination,
pregnancy, and the aging
process contribute to body
alterations that result in
the loss of the individual’s
body image, creating a
solid psychological
motivation for surgical
correction.
11/4/2022 8

Introduction
email:
• Localized fat deposits
may involve one
anatomical region and
extend to multiple body
regions.
• Therefore, it is
understandable that body
contouring surgery
includes most body
regions, including the
face, neck, and breast, in
all populations, be treated
by a one-stage operation
or require more complex
combined procedures.
11/4/2022 9

Introduction
• The current evidence-building
process in the healthcare industry is
riddled with conflicts of interest
regarding education, research, and the
practice of medicine.
• Medical specialists worldwide are
flooded with data they must collect,
process, and analyze.
• Medical images make up around 90%
of the data in healthcare.
• Experts across the globe point to the
harms of pervasive industry influence
on research, practice, and education in
healthcare, noting that it compromises
patient care.

Introduction
• The ESCSL, as an academic, non-profit
organization, is responsible for disseminating
unbiased findings to the industry, medical
health providers, and the public about
liposuction, among others.
• At the same time, it is entirely free of ties with
the industry.
• As the president of ESCSL, I retrospectively
reviewed patients' charts and photos
(thousands) who underwent body contouring
and fat grafting procedures in K.S.A. and Egypt
between 2002 and 2022.
• The unbiased evidence in this study is a way to
ensure that the benefits and harms of
liposuction are accurately reported.

Introduction
• It will guide members of ESCSL in delivering high-quality, evidence-based
practice and cost-effective surgery.
• During the journey, I developed my technique as any other medical provider;
trial and error, reading and seeing experts' techniques, and picking and choosing
what suited me based on science and skills.

Introduction
• As new techniques are introduced, we must temper
our enthusiasm and base treatment on solid scientific
evidence. The journey is ongoing. It is like riding a
bicycle; to keep balance, you should keep moving.
2021
2022

Introduction
• The data collected are given to those who want
to deliver the best care to their patients armed with
the most innovative techniques and the latest
technology in the battle of aging, rejuvenation, and
body contouring, in a reproducible and safe
outcome-driven manner.
• It also is given to novice(s) in professional and
educational standards.
• A compendium of the author’s practice, journal
publications, and books read will put the entire
liposuction process in a volume that surgeons
interested in this topic need to read.

Cervicofacial Liposuction

Cervicofacial
Liposuction
• Liposuction is usually
performed in the fatty layer
superficial to the platysma in
the neck.
• Fat is present in the area that
extends between the
sternocleidomastoid muscles
from the mandibular border to
the thyroid cartilage region.
• More fat is present inside the
anterior cervical triangle at the
submental and submandibular
neck levels.
The extent and distribution of the superficial cervical (SC) fat

Cervicofacial
Liposuction
• Ideal candidates for neck
liposuction are patients with
isolated fat deposits, good skin
tone, and minimal platysmal
laxity.
• In appropriately selected
patients, liposuction of the neck
using TLA can effectively remove
fatty deposits with excellent skin
redraping and contraction.

Cervicofacial
Liposuction
• Although liposuction can produce skin tightening, the
more considerable the amount of skin excess and the older
the patient, the less dramatic the result; the same is
applied to patients with sizeable subplatysmal fat deposits.
• Older patients with significant fatty deposits and lax skin
usually require in addition, to liposuction platysmaplasty
and /or rhytidectomy (lift surgery) to achieve the best
cosmetic results.
• In some patients, a ptotic submandibular salivary gland
may contribute to volume in the lower most jowl below the
mandibular edge.
• Trauma to this gland will be avoided if one keeps the
cannula above the platysma.

Cervicofacial
Liposuction
• The patient clenches his or her teeth to tighten the platysma and aids in
distinguishing pre- or retro-platysmal fat.
• Platysma bands can be identified by having the patient grimace.
• Any contributing factors to the blunted neck angle (aging) are reviewed with the
patient, and additional corrective measures and alternative treatments are discussed.
• Botox injection is better done 2 weeks before liposuction
Botox Neck Injection

The Marginal
Mandibular Nerve
• The marginal mandibular nerve generally
courses inferior to the mandibular border
posterior to the antegonial notch (green
arrow) but crosses the mandible anterior to
the notch and travels along the mandibular
border in the jowl region (dotted circle).
• It is essential to remember that the
marginal mandibular nerve frequently
underlies the jowl region, and caution must
be used
• When liposuction of the inferior jowl is
performed, the skin is manually tented to
avoid rasping the mandible and minimize
the risk of blunt trauma to the marginal
mandibular nerve.

Cervicofacial
Liposuction
• Patients that require submental
liposuction require simultaneous jowl
liposuction
• In older patients, the jowl extends above
and below the mandibular border, and it is
essential to treat both regions for natural
results.
• The jowl region can harbor a
surprising amount of fat resulting from
skin and deep tissue ptosis.
Submental Fat

Cervicofacial
Liposuction
• The intended treatment region must be marked in the upright position before
surgery and tumescent infiltration.
• The neck, mandibular border, and cheeks can be approached through midline
submental, infra-jowl and infra-auricular incisions.
• Liposculpture in these areas should be reserved for experienced surgeons

Cervicofacial
Liposuction
• For minor cases, awake liposuction is
preferred.
• In significant cases, IV sedation is better
used
• The patient is then positioned in a supine
position with a neck roll partially under the
shoulders so that the head rolls back
comfortably in an extended position.
• Head extension and lateral rotation provide
appropriate positioning for suctioning the
cheek, jowl, lateral neck, and jawline.

Cervicofacial
Liposuction
• The anesthetic solution is added to the
subdermal space above the
platysma/SMAS layer using a spinal needle.
• Next, a 2 mm infusion cannula is
introduced through access sites.
• It is moved back and forth in all areas of
fat to be treated to pretunnel, loosen the
fat, and assess the completeness of
anesthesia.
• In most cases,150-300 cc of anesthetic
solution is used
Spinal Needle
Tumescent Anesthesia

Cervicofacial
Liposuction
• Submental liposuction begins with an incision
made 1 mm posterior to the submental crease.
• Proper incision placement is essential to
prevent the deepening of this crease with
subsequent scar contracture; a deformity
likened to a “witch’s chin.”
• Incisions are made using a #11 scalpel blade
to produce a minor stab wound at access sites

Cervicofacial
Liposuction
• I use a microcannula spatula tip with one hole directed
away from the dermis attached to the syringe or, in significant
cases, a power-assisted cannula for pretunneling.
• Afterward, I changed to a 3 mm multiholes powered
cannula for lipoaspiration.
• Initial suctioning is done with the cannula ports “turned
down” away from the skin surface.
• A crisscross technique is essential to treat the area without
leaving residual waviness.
• Tapered suctioning over the belly of the
sternocleidomastoid muscle is done to avoid a visible “drop-
off” particularly in patients with overly fatty necks.

Cervicofacial
Liposuction
• Then, the central neck area is suctioned from the submental
incision with the cannula ports turned up and scraping against the
undersurface of the skin.
• A thin layer of fat, approximately 3–5 mm in thickness, should be
left to prevent surface irregularities
• The cannula may be visible beneath the skin; the cannula can be
lifted to “tent” the skin, assessing the completeness of fat removal
from the neck.
• This step enables complete fat removal in the central neck area
and enhances postoperative skin contraction.
• A forceful side-to-side “windshield wiper” sweeping motion with
the cannula is avoided because this maneuver can result in excessive
postoperative subcutaneous fibrosis.
Pinch Test

Cervicofacial
Liposuction
• Liposuction of one jowl is begun using a 2
mm 15 cm spatula or cannula attached to a 10
cc Luer-lock syringe from the infra-auricular
incision.
• The plunger is withdrawn about one-third
of the syringe length to generate a moderate
vacuum, and the cannula is kept moving
uniformly throughout the jowl area.
• Overzealous treatment of this area may
result in hollowing and skeletonizing of the
neck or potentially affect the marginal
mandibular nerve.
• A slight under-correction is advised.
Tip of the Cannula

Cervicofacial
Liposuction
• After liposuction, the cheeks and neck are massaged to remove excess
anesthetic fluid through the incisions that are left open.
• Patients were instructed not to lie down and to rest in an upright position for at
least 4 hours after surgery to prevent the absorption of tumescent fluid into
deeper tissue layers.
• Significant bruising and swelling can be uncomfortable, and the patient is
encouraged to use a compressive neck garment postoperatively.
First Postoperative Visit

THE END
• This chapter, a unique educational manual, is dedicated to dermatologists
and cosmetic surgeons who want to excel in delivering the best care and
liposuction results to their patients with the most innovative techniques
and latest technology in a safe outcome-driven manner.
• I have assembled my experience and global experts to inform you how
liposuction is done in a simplified, efficient, and reproducible manner.
• Liposuction is more of an art than a surgical procedure.
• It entails a practical application of scientific knowledge with precision and
craftsmanship and is a skill attained with clinical experience.
• It brings as much contentment and joy to the person undergoing it as to
the surgeon practicing.

From Adding (1997) to Removing Fat (2022):
Evidence Based Practice
By
Prof. Osama B. Moawad, M.Sc. M.D.

Cervicofacial Liposuction.pptx

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