VASER Liposuction: A Good Source for Mesenchymal Stromal Cells

Mesenchymal stromal cells (MSCs) are the spindle shaped plastic-adherent cells isolated from bone marrow, adipose, and other tissue sources, with multipotent differentiation capacity in vitro.  These mesenchymal stromal cells could differentiate to bone in vitro and a subset of the cells that has a high proliferative potential . The notion of a mesenchymal stem cell was popularized by Arnold Caplan proposing that MSCs gave rise to bone, cartilage, tendon, ligament, marrow stroma, adipocytes, dermis, muscle and connective tissue. Adipose-derived mesenchymal stromal cells (ASCs) are concentrated in fat tissue, and the ease of harvest via liposuction makes them a particularly interesting cell source.   Thus, fat has been transferred to the face for facial rejuvenation, as well as to the buttock for buttock augmentation.  It has shown that radiation-induced damage skin are dramatically improved by fat transfer.  

Recently, ultrasound-assisted liposuction using VASER liposuction and Lysosonix were found to harvest viable mesenchymal stromal cells.  "UAL samples demonstrated equivalent ASC yield and viability. VASER Liposuction adipose-derived mesenchymal stem cells showed higher osteogenic and adipogenic marker expression, but a comparable differentiation capacity was observed. Soft tissue healing and neovascularization were significantly enhanced via both UAL-derived ASCs in vivo, and there was no significant difference between the cell therapy groups."

VASER Liposuction allows safe and efficient harvesting of the mesenchymal stromal cellular fraction of adipose tissue and that cells harvested via this approach are suitable for cell therapy and tissue engineering applications.

Recent studies have shown that adipose tissue derived using the VASER liposuction system were viable at harvest and suitable for autologous fat grafts, such as in Brazilian Butt Lifts.   The study had shown that "the lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%. Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%.

Reference:

Duscher, et al. Ultrasound-assisted liposuction provides a source for functional adipose-derived stromal cells. Cytotherapy. 2017 Sep 13. pii: S1465-3249(17)30658-8. doi: 10.1016/j.jcyt.2017.07.013. [Epub ahead of print]

Schafer et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction.  Aesthetic Surgery Journal. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.

Emmanuel De La Cruz MD, PLLC

Houston Plastic Surgeon

Treatment of Biopolymer/Hydrogel Buttock Injections

Recently, there had been numerous cases of the use of industrial grade products injected into the body, such as the buttocks and thighs, performed by unlicensed or unskilled practitioners.  Some of these products range from injectable silicone or high-volume hyaluronic acid or hydrogel. Even though some of these products, such as silicone, may be biologically inert, these materials have been implicated in a variety of adverse reactions including granulomas, disfiguring nodules, and lymphedema, sometimes with latent periods of decades.  Often, they may cause disfiguring chronic infections that may require intravenous antibiotics or extensive surgical debridement.  

There had been a few cases that the chronic infections  resulting from illegally injected industrial grade products into the lower extremities, such as the legs, resulted in amputations as a life-saving procedure.  

Figure 1:  Chronic infection from an Biopolymer injections into the buttocks and thighs performed by an unlicensed and unskilled practitioner. 

Clinical Manifestations & Symptoms

• Chronic infection, such as cellulitis, that are recurrent despite antibiotics
• Firmess or hardening of the area of injections
• Chronic pain, such as buttock pain
• Numbness sensation of the area of injection
• Discoloration of the skin of the area of injection

Clinical Management

• We recommend obtaining an MRI of the area of injection to determine the extent of injection as well as the area where the material has potentially migrated.  The MRI would act as a map to determine where your surgeon would remove the biopolymer.

Treatment

• The treatment varies from patient to patient.  This may range from surgical excision, to hyaluronidase injection followed by VASER liposuction and fat transfer into the area to correct the resultant deformity.  Unfortunately, it is not possible to completely remove the biopolymer and not result in a significant deformity of the area involved.  Complete removal, such as surgical excision, may result in a life-changing deformity.  

Figure 2:  Hydrogel/Biopolymer removal from the buttocks using the VASER Liposuction with fat transfer to the buttocks to correct the resulting deformity from removal of the biopolymer.  Patient had resolution of a chronic buttock pain after surgery.

I recommend seeing a plastic surgeon for evaluation and possible removal of the biopolymer injected into one's body.  An MRI may be necessary to evaluate the location of the injected material.  Every person is different, and each treatment may be different.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon Houston, Texas

Keys to a Long-term Success in Liposuction

After liposuction, patient needs to have a realistic expectation to have a long-term succesful outcome.  There are 4 key elements to have a succesful outcome after liposuction:

1)Exercise - Exercising after liposuction is very important, especially after the initial surgery.  We encourage our patient to start exercising 2 to 4 weeks after their surgery.

2)Proper Diet - It is very important to eat a healthy diet consisting of fruits, vegetables and fish.  We recommend avoiding fatty food, drinking sodas, and eating excessively.  We recommend consulting with a nutritionist if one is having difficulty having a proper healthy diet.

3)Positive Lifestyle Changes

4)Succesful Body Contouring - It is important to choose the right surgeon who would perform your procedure.  Unfortunately, cosmetic surgery is unregulated here in the United States, and we recommend choosing a plastic surgeon who is trained in liposculpture surgery to perform your procedure.

Before & After Photos of VASER Liposuction (6 weeks after surgery) performed by Emmanuel De La Cruz MD, PLLC.

A clinical study conducted by Dr. Rohrich revealed that:

• "Among the 57 percent of patients who did not gain weight, 35 percent report exercising more postoperatively (compared with only 10 percent in the weight gain group, p = 0.002) and 50 percent report eating a healthier diet (22 percent in the weight gain group report eating a healthier diet, p = 0.002). "
• In the weight gain group, 67 percent report no change in their diet regimen and only 17 percent thought their productivity increased (compared with 25 percent among the no weight gain group, p = 0.002). Successful body contouring surgery requires a patient to embrace positive lifestyle habits. "

Thus, the long-term success of a liposuction procedure is dependent on having a healthy proper diet and exercise.  One can still gain weight after your liposuction procedure if one does not exercise and eat a healthy diet.

Reference: Rohrich, et al. The key to long-term success in liposuction: a guide for plastic surgeons and patients. Plast Reconstr Surg. 2004 Dec;114(7):1945-52; discussion 1953.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

SmartLipo versus Traditional Tumescent Liposuction - Houston, Texas

A previous randomized clinical trial comparing traditional tumescent liposuction and SmartLipo was performed, and this showed the following findings:

• Less post-operative pain with SmartLipo.
• Cytologic studies showed more damage of the adipocytes (fat cells) in SmartLipo.  Thus, fat harvested from SmartLipo is not suitable for fat grafting, such as in Brazilian Butt Lift.
• No major clinical differences found between SmartLipo versus Traditional Tumescent liposuction.
• Surgical time was longer with the SmartLipo group.
• Higher concentration of free fatty acids were found in the SmartLipo group.
• Lipocrit is lower in the SmartLipo group.

Lower Lipocrit Volume was obtained with the SmartLipo group as compared to the Traditional Tumescent Liposuction group.

In conclusion:  "No major clinical differences for suction-assisted lipoplasty versus laser-assisted lipoplasty were found. Higher concentrations of free-fatty acids after laser-assisted lipoplasty must alert us to possible hepatic and renal toxicity."

Reference:  Prado, et al. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006 Sep 15;118(4):1032-45.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

Reducing Risk of Contour/Skin Irregularities after Liposuction

Patients with poor skin elasticity should be forewarned about the risk for contour irregularities and suboptimal skin contraction. Similarly, pre-existing cellulite, indentations and scars may be present and will not be corrected with liposuction.  

How to Prevent Skin Contour Irregularities after Liposuction

• Intraoperatively, use of micro-cannulae and careful use of the criss-cross technique of liposuction are recommended to prevent waviness
• Using the VASER Liposuction machine may reduce the risk for contour irregularities

Using a smaller cannulae produces less skin contour irregularity as compared to a larger liposuction cannulae.

Before & After Correction of Skin Contour Irregularities.  Patient previously had traditional liposuction from another plastic surgeon and she developed skin contour irregularity.  Dr. De La Cruz performed the VASER liposuction of the thighs with fat transfer to correct the contour irregularity.

Before & After Correction of Skin Contour Irregularities (Frontal View).  Patient previously had traditional liposuction from another plastic surgeon and she developed skin contour irregularity.  Dr. De La Cruz performed the VASER liposuction of the thighs with fat transfer to correct the contour irregularity.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Tumescent Liposuction - Houston, Texas

What is Tumescent Liposuction?

• The word tumescent refers to anything that is swollen and firm. With tumescent liposuction, a large volume of very dilute solution of local anesthesia (lidocaine, bicarbonate and epinephrine) is injected into the fat beneath the skin, causing the targeted area to become swollen and firm. The local anesthetic lidocaine in the solution used for tumescent liposuction reduces the pain that one would experience after liposuction. The drug epinephrine (adrenalin) provides profound localized vasoconstriction that it reduces surgical bleeding during tumescent liposuction.

• Tumescent liposuction can be combined with other forms of liposuction such as in VASER liposuction.  In fact, the tumescent technique liposuction is essential for VASER liposuction to work since ultrasonic energy used in the VASER liposuction needs "water" to emulsify or liquefy the fat.  The fluid in the tumescent solution also prevents "skin burn injuries" from VASER liposuction.

Before & After Photos:  4D VASER Liposuction 6 weeks after surgery.  Procedure performed by Dr. De La Cruz

Benefits of Tumescent Liposuction

• Less blood is lost.

• Intravenous fluid replacement is not necessary.

• Bacteriostatic lidocaine may decrease the risk of infections.

• Tumescence magnifies defects; therefore, the likelihood of needing a secondary procedure may be less.

• Lipid-soluble lidocaine is somewhat suctioned out with the aspirated fat.

• Vasoconstriction minimizes absorption.

• The epinephrine may increase the cardiac output, which, in turn, hastens the hepatic metabolism of the lidocaine.

• The duration of anesthetic effect may last as long as 24 hours.

• The lidocaine may be given safely up to 45 mg/kg and even higher in certain conditions.

Does VASER Liposuction Employs Tumescent Liposuction Technique?

• It is standard of care to employ the tumescent liposuction technique in most liposuction methods, including the VASER liposelection/liposculpture.
• Infilitrating the area of fat with tumescent solution reduces the risk of burn injuries that may occur in VASER liposuction or Laser-assisted liposuction.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Skin Retraction After VASER Liposuction

A recent randomized clinical trial had shown that the VASER liposuction produced clinical significant skin retraction. 

• "Regarding skin retraction, the VASER-assisted lipoplasty-treated side resulted in a statistically significant improvement in skin retraction of 53 percent relative to suction-assisted lipoplasty (17 percent per liter versus 11 percent per liter, p = 0.003) with 33 paired sites using a two-tailed t test. "

Figure 1:  Before and After Photos (3 months after surgery) after VASER Hi-Definition Liposuction performed by Dr. De La Cruz.  Note that there was significant skin retraction after surgery.

Reference:

Nagy, et al.. A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted Lipoplasty and suction-assisted Lipoplasty. Plast Reconstr Surg. 2012 Apr;129(4):681e-9e. doi: 10.1097/PRS.0b013e3182442274.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Improvement of Diabetes after a VASER Liposuction

Recently, there has been a study conducted to examine the liposuction-induced metabolic changes with regard to release of major adipokines and insulin sensitivity in overweight male patients.

Figure 1:  Before and After Photos (6 weeks after surgery) of 4 D VASER Liposuction performed by Dr. Emmanuel De La Cruz in Houston, Texas.

• "To eliminate the confounding effects of postsurgical inflammation and to evaluate delayed metabolic effects, fasting blood was collected on the day of liposuction, within 1 to 2 months and more than 6 months after surgery."
• "Both treatment groups (diabetic and nondiabetic patients) experienced similar postsurgical weight reduction with concomitant lowering of body mass index value at 1 to 2 months follow-up, which was sustained after 6 months from surgery."
• "Improvement in insulin sensitivity at 1 to 2 months follow-up was observed ( p = .017 and p = .002, for diabetics and nondiabetics, respectively) and this change persisted over the next 4 months."

This study shows that there may be beneficial effects of VASER Liposuction in overweight diabetic and non-diabetic males by improving their insulin sensitivity.

Reference:

Gibas-Dorna, et al.. The Effect of VASER Abdominal Liposuction on Metabolic Profile in Overweight Males.  Am J Mens Health. 2017 Mar;11(2):284-293. doi: 10.1177/1557988316674841. Epub 2016 Oct 22.

Emmanuel De La Cruz MD

Plastic & Reconstructive Surgeon

Fat Graft Harvested via VASER Liposuction is Viable and Suitable for Fat Transfer in Brazilian Butt Lift Patients

Although there's clinical evidence of successful autologous fat transfer (AFT), such as in Brazilian Butt Lift, using VASER liposuction is readily available, no study has quantified adipocyte viability using standardized methods until recently.

• The UAL system (VASER; Sound Surgical Technologies, Inc, Louisville, Colorado) was set at 60% amplitude in pulsed mode with vacuum aspiration of 15 in Hg or less.
• Laboratory analysis included free lipid volume, viability via lipolysis and propidium iodide staining, and cytological analysis, including cell surface protein examination and hematoxylin and eosin staining.
• The lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%
• Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%
• Adipose tissue acquired via VASER liposuction is viable at harvest and isa suitable source for autologous fat grafts, especially for Brazilian Butt Lift.
• Adiposed-derived stem cells (fat for fat transfer) obtained via VASER liposuction were of equal quality when directly compared with the current gold standard harvest method according to a study conducted by Duscher.   "UAL- and SAL-derived samples demonstrated equivalent ASC yield and viability, and UAL ASCs were not impaired in their osteogenic, adipogenic, or chondrogenic differentiation capacity."

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas

Reference:

Duscher, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells.  Stem Cells Transl Med. 2016 Feb;5(2):248-57. doi: 10.5966/sctm.2015-0064. Epub 2015 Dec 23.

Schafer, et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.

Hand Rejuvenation using Fat Grafting

Apart from the most obvious region (face & neck) where aging can be seen and where most aesthetic surgery for rejuvenation are performed,  the dorsum of the hand is the next obvious area where aging can be seen and is continuously visible in daily life.  What they used to say,"If you want to know a woman's age, look at her hands" still holds true.

The region of the hand exhibits laxity of the skin with subcutaneous atrophy and age-related pigmentations in a comparable manner to the face. Fat transfer to the dorsum of the hand enables subcutaneous regeneration by refilling the subcutaneous space and hence reducing some of the age-related degenerative process.

Areas of Concern of the Aging Hand

• Bony-looking hands due to loss of some of the fat beneath the skin that occurs with age
• Prominent veins
• Brown aging spots (liver spots)

Rejuvenation Treatment for the Aging Hand

•    Chemical peels to improve the overall appearance of the skin on the back of the hand
• Fillers or Fat transfer onto the dorsum or back of the hand to make them appear less bony.  Fat transfer is ideal since this may improve the texture of the skin.

Please consult your plastic surgeon regarding hand rejuvenation.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, and Hand Surgeon

References:   

• Coleman SR.  Hand rejuvenation with structural fat grafting. Plast Reconstr Surg. 2002 Dec;110(7):1731-44; discussion 1745-7. 
• Villanueva, et al.  Technical Refinements in Autologous Hand Rejuvenation.  Plast Reconstr Surg. 2015 Dec;136(6):1175-9.

Brazilian Butt Lift | Fat Transfer to Buttock in Houston, Texas

From an evolutionary standpoint, an hourglass figure with a narrow waist and full buttocks is associated with female reproductive potential and has been considered an aesthetic ideal across cultures.  A round, well-projected buttock indicates fertility and youth in a woman and is considered aesthetically pleasing.  With the popularity of several celebrities' derriere such as those of Kim Kardashian, Jennifer Lopez, Beyonce and Sofia Vergara, the plastic surgery procedure called Brazilian Butt Lift has become more popular among women.

What is the Brazilian Butt Lift?

• This plastic surgery procedure involves liposuction and the transfer of fat into the buttock.
• The 4 D VASER Hi-Definition liposcuplture incorporates the transfer of fat into the buttock as part of the procedure.  Not only one will have an athletic figure, the buttock is also enhanced to produce a more aesthetically pleasing body.
• The fat is harvested using the Coleman technique, and the fat is then transferred into the buttock to produce a more rounded and more voluptuous buttock.

Figure1:  Before & After Photos of 4 D VASER Hi-Definition Liposuction with Brazilian Butt Lift (6 DAYS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Figure 2:  Before & After photos of Brazilian Butt Lift  (24 HOURS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, TX | The Woodlands, TX

4D VASER High-Definition Liposuction

Abdominal etching was initially developed by Dr. Mentz in 1993.  It was a liposuction technique defining the rectus abdominis muscle to create the 6-pack in men.   With this technique, the linea alba in the middle of the rectus abdominis muscle is etched with the outline of the muscles.   Horizontal lines are then created to sculpt a 6-pack.

Figure 1: 4-D VASER High Definition Liposculpture by Dr. Alfredo Hoyos from Colombia. www.alfredohoyos.com

4D VASER Liposculpture performed by Colombian Plastic Surgeon Dr. Alfredo Hoyos.  Note that the procedure involves sculpting the chest, abdomen, flanks, back and arms.

This technique was further enhanced and improved by a Colombian plastic surgeon Dr. Alfredo Hoyos using the VASER liposuction technology.  VASER (acronym for Vibration Amplification of Sound Energy at Resonance) is an ultrasound-assisted liposuction that utilizes ultrasound energy to selectively remove fat without harming the surrounding structures of the area being liposuctioned.

Figure 1: Before & After Photos of 4D VASER High Definition Liposculpture (6 weeks after surgery) performed by Houston Plastic Surgeon Dr. Emmanuel De La Cruz MD, PLLC. Note that final definition is typically seen 3-4 months after surgery. Patient went from a size 6 to a size 2. Result may vary individually.

 

Figure 3:  Dr. Alfredo Hoyos, the pioneer of the 4D VASER Liposculpture and other plastic surgeons from all over the world (Slovenia, USA [Dr. De La Cruz], Colombia, Egypt and Spain) who perform the 4D VASER High Definition Liposuction.

How Does the VASER Liposuction Work?

VASER liposuction is a minimally invasive liposuction procedure performed in conjunction with tumescent anesthesia that utilizes advanced ultrasound technology designed to gently reshape the body. The ultrasound energy is transmitted through the small VASER probes that diffuse the ultrasound waves and liquefy the fat for easy removal. The ultrasound energy is gentle enough that it can break apart the fat with minimal damage to surrounding tissues, creating smooth, predictable results with fast patient recovery.

Clinical Study

A multicenter, prospective randomized controlled trial in 2012 recently showed that the VASER-assisted liposuction resulted in a statistically significant improvement in skin retraction of 53 percent relative to the traditional regular liposuction (17 percent per liter versus 11 percent per liter, p = 0.003). Moreover, the VASER-assisted liposuction group also resulted in a statistically significant reduction in blood loss of 26 percent relative to the traditional liposuction (p = 0.019 with n = 20 using a two-tailed t test).

FAST FACTS about VASER LIPOSUCTION

• The VASER-liposuction method demonstrated improved skin retraction compared with traditional/conventional liposuction.
• The VASER-liposuction method demonstrated reduction in blood loss compared with traditional liposuction.
• No serious complications reported in a clinical study involving VASER liposuction in over 70,000 VASER liposuction procedures.
• No burn complications, contour irregularities or prolonged swelling seen in one clinical study.
• No revisions needed after a VASER liposuction found in a multi-center pilot study.

KEY BENEFITS of VASERlipo:

• Single procedure results with speedy recovery times
• Less bleeding & more skin retraction
• Improved body contouring over traditional liposuction
• Refines and accentuates appearance of muscles
• It's the RECOMMENDED type of liposuction for treatment of gynecomastia in men

Recovery after a 4-D VASER High Definition Liposuction

• May return to work 3-5 days after surgery
• May resume exercise or work out 1-2 weeks after surgery

Emmanuel De La Cruz M.D. PLLC

Houston Plastic & Reconstructive Surgeon | Cosmetic Surgeon

Certified 4D VASER High Definition Liposculpture Surgeon

Call NOW at 832-520-1844

Clinic Locations: The Galleria in Houston, TX & The Woodlands, TX

SMART Liposuction vs Traditional Liposuction

Comparison of SmartLipo versus Traditional Liposuction

• A prospective randomized clinical study showed that there's no clinical difference between the traditional liposuction versus laser-assisted liposuction using the SmartLipo machine.

•  There's less pain, lower lipocrits, higher triglycerides, and DNA cellular membrane traces were detected in the laser-assisted lipoplasty sides as compared to the traditional liposuction.

• Higher concentrations of free-fatty acids after laser-assisted lipoplasty was found.  It's recommended that this should alert us to any possible hepatic and renal toxicity.

References:

Pradeo, et al. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006 Sep 15;118(4):1032-45.