Liposuction and Lipofilling

Liposuction and Lipofilling

Fat removal (liposuction) is a technique used to improve the contours of the body. It has been in existence since the end of the 1960s and presents high medical and aesthetic requirements. Patients suitable for fat removal may not be too strongly overweight, because a maximum of three litres of pure fat can be removed. The connective tissue should be reasonably elastic. Basically, it is possible to remove fat from any part of the body. Areas that are easy to remove fat from are: hips and thigh (buttocks), the sides of the waist, the insides of the knee. Areas that are difficult to remove fat from include the back, the insides of the thigh and the crease of the buttocks. Areas that are extremely difficult to remove fat from are: the front and back of the thigh, calves and forearms. Although fat cells once removed never return, it may happen that new deposits of fat are formed at other places on the body.

Manual extraction

The tumescence technique is most commonly used. Here approx. three litres of saline solution are pumped into the tissue to be treated via tiny skin incisions in order to swell the fat cells. This facilitates the subsequent process of removing them. The solution is enriched with locally acting anaesthetics. After allowing approx. 1 hour exposure time, the surgeon removes the loosened fat using a thin cannula by means of quick, vigorous to-and-fro movements (manual method after Coleman).  With his other hand, he controls the course of the process, which can take up to three hours.

Mechanically based extraction

  • PAL - Power assisted liposuction (vibration lipolysis)

For this technique, a special electrically powered cannula is used (= rocking motion technique). The cannula has 24 small suction holes and shakes the fat cells up to 4,000 times a minute. In this procedure, blood vessels and nerves no longer suffer any damage, while fat can even be removed from difficult regions, such as calves and ankle joints – without general anaesthesia.

Lipofilling

Although the removal of fat tissue was particularly popularised in the 1980s, plastic surgeons have since realised that the development of fat tissue is also essential for many parts of the body. The American Dr. Sidney Coleman developed a method to carefully remove fat tissue from one part of the body by liposuction and then insert it at a different part to be replenished. The special form of the cannulae for the extraction, the transplanting and the special way of preparing fat cells create the optimal requirements for a new environment for the living fat cells.

Lipofilling is suitable, say, for:

  • Scar correction
  • Correction of congenital malformations
  • Anti-wrinkle injections
  • Breast augmentation
  • Hand rejuvenation
  • Indentations
  • Cheek asymmetries

Preparing fat cells

A special anaesthetic solution is administered in both the area of removal and of insertion. The fat tissue is carefully removed using a very thin cannula so that no change to the surface of the skin occurs. The tissue samples are then treated in an electric centrifuge for a few minutes to remove destroyed cells and residual blood. The concentrated fat cells so obtained are filled into small syringes and immediately transplanted.

The transplant cannulae are inserted into tiny incisions in (as far as possible) non-visible regions and the fat cells carefully added formatively in several layers. Fine sutures are used to close the incisions. In some cases, it is necessary to somewhat "over-correct" in the operation to counteract any subsequent shrinking. If further corrections are desired after a period of six months, then a lipofilling can be performed again. Each time, however, fresh fat tissue must be taken. Storing fat tissue in a freezer is not a sensible idea because fat tissue is destroyed in the freezing and subsequent thawing process. This has been proven in experimental studies. For this reason, only freshly removed fat tissue should be transplanted.

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