Lymphatic Massage Therapy Reduces Fibrosis after Liposuction

Fibrosis is considered as one of the most frequent complications that may interfere negatively and significantly the patient's satisfaction after liposuction surgery.  Fibrosis is the formation of hardened plates in the subcutaneous tissues denoting temporary or definitive irregularities on their surface and affecting affect the body contour.

Studies have shown that in the "Liposuction Group (LG) and Liposuction Abdominoplasty Group (LAG), a gradual decrease of classification levels was observed, specifically in relation to tissue fibrosis. Initially, the LG patients were divided into the highest levels (L2 and L3); and 70% of the LAG patients were classified as L2. After the application of this protocol, 62.5% and 50% of patients from both groups had the fibrosis reduced completely; the remaining ones showed the lowest degree of fibrosis, classified as L1.

Before and After Photo Liposuction (VASER Liposuction with Brazilian Butt Lift)

"The association between manual lymphatic massage drainage and the therapeutic ultrasound reduced the swelling and the tissue fibrosis and made pain disappear in liposuction and lipoabdominoplasty PO period."

Reference:

Igor, et al.  Manual lymphatic drainage and therapeutic ultrasound in liposuction and lipoabdominoplasty post-operative period.  Indian J Plast Surg. 2014 Jan-Apr; 47(1): 70–76.

Kim et al.  Analysis of postoperative complications for superficial liposuction: a review of 2398 cases.  Plast Reconstr Surg. 2011 Feb;127(2):863-71

Lisboa FL, Meyer PF, Alves DK, Wanderley SC. Protocolo para avaliação fisioterapêuticados níveis de fibrose cicatricial em pós-operatório de lipoaspiração associada ou não à abdominoplastia. Reabilitar. 2003;19:11–8.

Soares LM, Soares SM, Soares AK. Estudo comparativo da eficácia da drenagem linfática manual e mecânica no pós-operatório de dermolipectomia. RBPS. 2005;18:199–204.

Tacani RE, Alegrance FC, Assumpção JD, Gimenes RO. Investigação do encaminhamento médico a tratamentos fisioterapêuticos de pacientes submetidos a lipoaspiração. O Mundo da Saúde. 2005;29:192–8.

Large Volume Liposuction: Is it safe?

Numerous studies were published regarding the safety of large volume liposuction.  However, this procedure is safe if performed in the right setting:  performed by a plastic surgeon; anesthesia administered by an anesthesiologist; procedure performed in the hospital; and performed on a patient that is a good surgical candidate,

Before and After Photos of Liposuction performed by Dr. Emmanuel De La Cruz MD.

A retrospective study conducted by Dr. Rohrich revealed "no episodes of pulmonary edema, congestive heart failure exacerbation, or other major complications."

Reference:

Rohrich et al. Fluid resuscitation in liposuction: a retrospective review of 89 consecutive patients. Plastic Reconstrive Surgery. 2006 Feb;117(2):431-5.

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

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

VASER Liposuction may Improve Diabetes in Overweight patients

It has been of significant interest whether liposuction may have an effect on diabetes in overweight patients.  A prospective study was recently performed showing that VASER liposuction may have a potential beneficial effect on diabetes.

• Overweight male patients aged 37.15 ± 9.60 years (6 with diabetes type 2, 11 without comorbidities) and 10 age-matched healthy lean controls were enrolled in the study.
• Using Vibration Amplification of Sound Energy at Resonance System (VASER Liposuction), ultrasound assisted liposuction was applied onto the deep layers of abdominal subcutaneous adipose tissue. The mean volume supranatant fat was 2208 ± 562 ml.
• 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.

VASER Liposuction (Before and After 6 months of Surgery) performed by Dr. Emmanuel De La Cruz

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz, Houston Plastic Surgeon

With this study, VASER liposuction of the abdomen may have beneficial effects 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. 2016 Oct 18. pii: 1557988316674841.

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.