 Liposuction is surgical aspiration of subcutaneous fat by use of a cannula attached to a vacuum pump.  one of the most commonly performed cosmetic procedures .  also referred to as liposculpture, lipoplasty, and suction-assisted lipectomy.  Not a Substitute for healthy lifestyle.  Helps to change body proportions.  History  Maliniak- described submental fat removal and neck contouring in early 1930s.  Davis- Curettes.  Schrudde- lipexeresis in 1972.  Illouz- lipolysis with saline & hyaluronidase.  Klein- Tumescent technique.  Procedure  Liposuction is devided in three steps;  1) Infusion  2)Evacuation  3)Post examination.  INFUSION  To achieve even removal of fat – accurate infusion of wetting solution.  Dilute lidocaine with epinephrine solution into fat is performed with infiltration cannulas and pumps.  Cannulas dimentions –  Diameter- from 1 – 3 mm.  Length – from 10- 30 cm.  Blunt tip  EVACUATION  Through Small access incisions fat is removed.  Efficiency of a cannula determined by three features:  Configuration  Diameter  Length.  Configuration of cannula  Shape of distal tip of the cannula and the number , configuration and position of apertures affect the efficacy and speed of liposuction  Multiple openings;  Area from which fat can be removed.  shearing of fat.  speed of evacuation.  Result in less trauma.  Diameter of cannula  Commonly used cannulas range from 1.8 to 5 mm.  Small diameter; 1) minimal tissue resistance 2) slower fat evacuation. - Useful for fine , precise fat removal .  Large diameter; 1) increased efficiency of evacuation 2)increased tissue resistance. - Useful for deeper and larger fatty deposits.  Cannula length  Most commonly used cannulas are 18 to 23 cm.  Shorter cannulas; 1)10 to 14 cm in length - are generally used in the face , neck , calves & ankles.  Longer cannula; - provide access to distant areas with fewer incisions.  SUCTION DEVICES  Syringe system.  Power assisted liposuction.  Ultrasonic assisted liposuction.  Laser assisted liposuction.  Hand held syringe:- 1)good for use in head and neck surgery owing to their low cost, portability, & ease of handling. 2) provide an efficient technique for precise contouring of irregularities secondary to cervicofacial adiposity.  Suction unit:- -Are useful for closed and open liposuction techniques. -Provide continuous vaccum & are most useful for removing large amounts of fat or defating a flap  Patient Evaulation  history is explored in detail mainly - body weight history - exercise patterens - eating disorders  Medication intake; medication allergies.  The patient's goals should be understood.  Explanation of the procedure, its risks, alternatives, benefits, and convalescence should be explained.  Consent is obtained.

1. By
Dr. Punam Nagargoje
1

2.  Introduction
 History
 Procedure
 Instruments
 Cervicofacial liposuction
 Anesthesia
 Technique
 Complication
 Adjunctive Procedure
 Fat grafting 2

3. Introduction
 Liposuction is surgical aspiration of subcutaneous fat
by use of a cannula attached to a vacuum pump.
 one of the most commonly performed cosmetic
procedures .
 also referred to as liposculpture, lipoplasty, and
suction-assisted lipectomy.
 Not a Substitute for healthy lifestyle.
 Helps to change body proportions.
3

4. History
 Maliniak- described submental fat removal and neck
contouring in early 1930s.
 Davis- Curettes.
 Schrudde- lipexeresis in 1972.
 Illouz- lipolysis with saline & hyaluronidase.
 Klein- Tumescent technique.
4

5. Procedure
 Liposuction is devided in three steps;
 1) Infusion
 2)Evacuation
 3)Post examination.
5

6. 6

7. 7

8. INFUSION
 To achieve even removal of fat – accurate infusion of
wetting solution.
 Dilute lidocaine with epinephrine solution into fat is
performed with infiltration cannulas and pumps.
 Cannulas dimentions –
 Diameter- from 1 – 3 mm.
 Length – from 10- 30 cm.
 Blunt tip
8

9. EVACUATION
 Through Small access incisions fat is removed.
 Efficiency of a cannula determined by three features:
 Configuration
 Diameter
 Length.

9

10. Configuration of cannula
 Shape of distal tip of the cannula and
the number , configuration and
position of apertures
affect the efficacy and speed of liposuction.
 Multiple openings;
 Area from which fat can be removed.
 shearing of fat.
 speed of evacuation.
 Result in less trauma.
10

11. Diameter of cannula
 Commonly used cannulas range from 1.8 to 5 mm.
 Small diameter;
1) minimal tissue resistance
2) slower fat evacuation.
- Useful for fine , precise fat removal .
 Large diameter;
1) increased efficiency of evacuation
2)increased tissue resistance.
- Useful for deeper and larger fatty deposits.
11

12. Cannula length
 Most commonly used cannulas are 18 to 23 cm.
 Shorter cannulas;
1)10 to 14 cm in length
- are generally used in the face , neck , calves & ankles.
 Longer cannula;
- provide access to distant areas with fewer incisions.
12

13. SUCTION DEVICES
 Syringe system.
 Power assisted liposuction.
 Ultrasonic assisted liposuction.
 Laser assisted liposuction.
13

14.  Hand held syringe:-
1)good for use in head and neck surgery owing to their
low cost, portability, & ease of handling.
2) provide an efficient technique for precise contouring
of irregularities secondary to cervicofacial adiposity.
 Suction unit:-
-Are useful for closed and open liposuction techniques.
-Provide continuous vaccum & are most useful for
removing large amounts of fat or defating a flap
14

15. Patient Evaulation
 history is explored in detail mainly
- body weight history
- exercise patterens
- eating disorders
 Medication intake; medication allergies.
 The patient's goals should be understood.
 Explanation of the procedure, its risks, alternatives,
benefits, and convalescence should be explained.
 Consent is obtained.
 Photographs are taken. .
15

16.  The patient should be in good physical health.
 A healthy well-balanced diet is important in
maintaining the postoperative results as well as in
ensuring excellent healing.
 BMI (body mass index )should be less than 30.
16

17. OPERATIVE PLANNING
 Marking
 Maintenance of core body temperature
 Anesthesia
 Quantitative operative report
 Draping and preparation of patient
 Infiltration
 Choice of cannula
 Fat aspiration
 Moniter aspirate for blood.
17

18. EVALUATION OF ENDPOINT
-Visual assessment of contour
-Pinch thickness; -in OT before infusion
-after procedure.
-Palpation for smoothness
-Measurment of volume.
 Wound closure.
 Compression garment and aftercare.
18

19. 19

20. Cervicofacial liposuction
20

21. 21

22.  No absolute age limitation but good results are
confirmed in middle age & younger patients.
 Adequate skin elasticity.
 Pts with lax anterior platysma bands benefit from
- ant. Platysma plication with liposuction.
22

23. Indications
 Removal of excess fat from the chin and neck.
 Refinement of the jawline.
 Improvement of neck line.
23

24. Contraindication
 Unrealistic patient expectations
 Poor physical health of patient
 Patient who underwent crash dieting immediately
prior to consultation
 Morbid obesity (megaliposuction controversial due to
higher risk of mortality from fluid shifts)
24

25. 25

26. Markings
 Inferior border of mandible.
 Inferior & lateral extent of excess fat.
 Access incisions are marked
-in submental crease and
-bilateral retrolobular creases
26

27. ANESTHESIA
 The tumescent technique for local anesthesia permits
regional local anesthesia of the skin and subcutaneous
tissues by using direct infiltration rather than a
proximal nerve block.
 By using large volumes of a dilute anesthetic solution
consisting of lidocaine (0.1% or 0.05%) and
epinephrine (1:1,000,000) in physiologic saline, the
tumescent technique produces swelling and firmness,
of targeted fatty area.
27

28. 28

29. TUMESCENT SOLUTION
CONCENTRATION
COMPONANT SOLUTION A SOLUTION B SOLUTION C
LIDOCAINE 50cc,
(500mg)
0.05%
100cc
(1000mg)
0.1%
150cc
(1500mg)
0.15%
EPINEPHRINE
(1:1000)
0.5cc
(0.5mg)
1:2,000,000
1.0cc
(1mg)
1:1,000,000
1.5cc
(1.5mg)
1:666,666
BICARBONATE
(1mEq/ml)
10cc
10mEq/L
10cc
10mEq/L
10cc
10mEq/L
NORMAL SALINE 1000ml 1000ml 1000ml
29

30.  Solution A- used for pts undergoing procedure for the
first time.
 Solution B- used for revision liposculpting procedures.
 Solution C- used for liposuction assisted rhytidectomy
procedures and fat harvesting.
30

31. Advantages of Tumescent
technique
 Minimal Blood Loss
 Rapid Postoperative Recovery
 Prolonged Local Anesthesia
 Improved Aesthetic Results
 Decreased Surgical Risk
 Decreased Anesthetic Risk
31

32. Choice of cannula
 Cannula diameter affects the volume of fat removed.
 Generally a cannula of 2 to 6 mm diemeter is used in
cervicofacial liposuction procedures.
 Cannula should have a smooth tip and aperture
opening .
 Neurovascular structures are pushed aside by a blunt
smooth tip.
 1 atm of negative pressure is ideal for liposuction
procedures.
32

33. Technique
33

34.  The incision is gen-erally 4 to 8 mm long. The incision
should accommodate a 4- or 6-mm cannula.
 A small pocket created between dermis and SMAS.
 Tumescent sol. Infiltrated with in infiltrating
cannula(100 to 150cc).
 The cannula is advanced in a systematic manner.
 Area should remain undisturbed for 10 to 15 min.
 Suction-free pretunneling is begun throughout the
surgical site.
34

35. 35

36.  Pretunneling defines:
 appropriate surgical plane
Break up fat cells
Aids in the extraction of fat cell content.
 Following pretunneling the cannula connected to
suction device.
36

37.  In most cases the surgeon removes between 20 and 100
cc of fat in cervicofacial region.
 The same sequence:
Pretunneling
Inspection
Fat Removal .
Used to optimize the final contour enhancement
37

38. 38

39. 39

40.  Following completion residual blood , tumescent fluid
, and fat particles are expressed from space.
 Incision closed with 5-0 or 6-0 monofilament suture
OR
 Simply covered with adhesive bandages.
 Site covered with antibiotic and light pressure
dressing.
 Ask pt to wear compression garment continuously for
7 days and then only at neight for 7 additional days.
40

41. complications
 Rare with cervicofacial liposuction as it involves
removal of < 100cc of fat from limited area.
 Contour irregularities are most common.
 Possible to injure marginal mandibular branch.
 Hematomas are rare
 Infections .
 In Whole-body liposuction procedure:
-Significant blood loss
-Rapid fluid shifts
-Hypotention, shock.
41

42. As a Adjunctive Procedure
 In orthognathic surgery
 Following mandibular setback, lax submental
tissue seen, this should be treated with liposuction to
better define;
-Inferior border of mandible
-remove unesthetic submental fat deposit.
to achieve an acceptable cervicomental angle.
42

43. In Chin augmentation
43

44. Liposuction assisted Rhytidectomy
44

45. AUTOGENOUS FAT TRANSPLANTATION
 Neuber – first to use free fat autografts.
 Indications;
1) Small to moderate soft tissue defects.
2) Retromolar depression after parotid resection.
3) Acquired or congenital soft tissue depression.
4) Hemifacial atrophy.
45

46. Types of fat graft
 Four categories.
 1) Autogenous free fat graft.
 2) Dermal fat graft.
 3) Free fat flap.
 4) Free fat injection
46

47. Behavior of fat grafts
 Billing and May have described;
 During 1st 3 days- infiltration of inflammatory cells
including plasma cells , lymphocytes .
 By 4th day- graft vessels join local vessels. Giant cells
appear.
 Progressive fat degeneration proceeds- peaks at 2
months.
 Following month –slower fat absorption.
 Fat present at 1 year – appears to remain stable
47

48. Dermal fat graft
 Adipose tissue with a dermal carrier.
 Three functional categories;
1) Augmentation of small contour defects.
2) Provision of a barrier between nerves & skin.
3) Prevention of adhesions around gliding surfaces.
48

49. Sites to harvest
 Lower abdomen
 Suprapubic or periumbilical regions.
 Gluteal or inframammary folds.
 Subiliac crest.
49

50. How to harvest
 Marking
 Epithelium removed with scalpel or dermabrasion.
 Remaining ellipse of dermis and subcutaneous – 2cm
max. thickness.
 Removed as single block of tissue.
 Insert into recipient site as a single block.
 Work of Peer gives a general guideline that dermal fat
grafts should be designed to overcorrect defect by
40%.
50

51. Free fat injections
 Coleman in 1990s recommended that –
fat can be concentrated by centrifuge
and
used in multiple planes throughout the face
51

52. Indications
 Most common for Facial augmentation.
1) Effacements of nasolabial folds,
2) Augmentation of the lips,malar region and cheek.
 To correct depressions or atrophic areas due to
lipodystrophy syndromes .
 To correct Depressions of abdominal wall, flanks,
thighs after liposuction
52

53. How to Harvest
 Strict sterile technique
 Through stab incision ringers lactate with 1:4,00,000
infiltrated.
 10 ml Luer lock syringe attached to 2 holed blunt
cannula used to harvest fat.
 Syringe filled with fat spun in centrifuge at 3000 rpm
for 2 to 3 min.
 Material separates into three layers;
 Middle layer – usable subcutaneous tissue
53

54. 54

55. Fat injection technique
 Small 1 or 2 mm incisions made with no. 11 blade
 Blunt tipped 18-gague cannula used
 Cannula is advanced through the tissues, and the fat is
injected during withdrawal through the tissues.
 Each injection should be placed into a new tunnel at
site of fat implantation.
55

56. 56

57. Outcome
 Prolonged edema seen with fat injections but most of
it resolves in first 2 weeks.
 Swelling and induration – observed up to 1 year.
 Necrosis and migration of grafted tissue can occure.
 Around the specific folds or lines –may result in lumpy
appearing deposits.
 Infections may occur.S
57

58. Thank You
58