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.

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

Abdominal Exercises to Maintain your 6-Pack after 4D VASER Liposuction

After your surgery, it is critical to maintain your new body with exercise and diet. Your results are optimized if you live a healthy lifestyle which includes exercise at least 3 days a week, and a healthy diet with minimal caloric intake.

Here's a video I recommend to maintain your 6-pack after the 4 D VASER liposuction.  Your results will be optimized when you do this exercise.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

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.

Lymphatic Massage after Liposuction

One may notice a hardness or lumpiness to the areas treated with liposuction and/or with other body contouring procedures (such as fat injections for what is popularly known as the Brazilian Butt Lift).   This post-surgical lymphedema is caused by inflammation and trauma from the cannula (instrument that sucks out the fat) moving under the skin.  Channels are formed by the cannula that can fill up with fluid and the tissue also becomes swollen.  Manual Lymphatic Massage helps to move the fluid by gently pumping it back into the lymph vessels.  Reducing the swelling can reduce discomfort and may reduce contour irregularities after a   liposuction procedure.  Without Lymph Massage (LDT or MLD) the inflammation can evolve into fibrosis (a permanent hardening of the tissue) or a seroma ( pocket of serum) can form.  It is imperative that one should follow the post-operative protocol of your plastic surgeon to achieve the best possible results and avoid developing fibrosis and even possibly contour irreguarities.

Clinical studies have shown that lymphatic massage also improved the clinical outcome after a cryolipolysis procedure.   The study had shown that post-treatment manual massage resulted in a mean fat layer reduction was 68% greater in the massage side than in the non-massage side as measured by ultrasound at 2 months post-treatment.  At 4 months, mean fat layer reduction was 44% greater in the massage side.   Histological results showed no evidence of necrosis or fibrosis resulting from the massage.

I do NOT recommend receiving a general therapeutic, deep tissue or Swedish Massage in lieu of a lymphatic massage therapy after a liposuction procedure.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, Houston Texas

References:

Boey, et al.  Enhanced clinical outcome with manual massage following cryolipolysis treatment: a 4-month study of safety and efficacy.  Lasers Surg Med. 2014 Jan;46(1):20-6.

VASER Liposuction on Gynecomastia for Men

Gynecomastia describes a benign increase of the mammary gland in men.   This could range from a puffiness or localized button of tissue concentrated around the areola to marked, distinct enlargement of the breasts making the breasts looking feminine.  Gynecomastia or the so-called "man-boob" can be secondary to multiple causes such as marijuana usage; certain medications such as Pepcid/Tagamet/cardiac medications; testicular tumors; thyroid abnormalities; pre-pubertal enlargement, etc.  Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance.  However, gynecomastia may cause local pain and tenderness, and this could occasionally be the result of a serious underlying illness or a medication, or be inherited.   Most cases of gynecomastia result from deficient androgen action or excessive estrogen action in the breast tissue.  In  pubertal gynecomastia, the breast enlargement may resolve spontaneously and thus may warrant observation for gynecomastia in children.

Before & After Photos of VASER Liposuction of the Breasts for treatment of Gynecomastia.  Note that the patient also underwent the 4D VASER Hi-Definition Liposuction.  Procedure performed by Dr. De La Cruz

When medical treatment fails, the surgical procedure is the treatment of choice.  Numerous surgical techniques exist for gynecomastia treatment.  This could range from using the VASER liposuction or ultrasonic liposuction to direct excision of gynecomastia.  Recent studies have shown that ultrasonic liposuction for the treatment of mild to moderate gynecomastia showed superior results over conventional liposuction methods.

A total of 219 patients (384 breasts) with a mean age of 29 years (range 12-74) were evaluated. UAL was utilised in 24% of breasts (47 patients, 91 breasts). Compared with conventional liposuction, UAL had significantly lower rates of intraoperative conversion to open excision (25% vs. 39%; p<0.05) and postoperative revision (2% vs. 19%; p<0.001) using Fisher's exact test. The haematoma rate for each technique was 1%.

Recently, subcutaneous mastectomy was compared with ultrasonic-liposuction for the treatment of gynecomastia.  The reoperation rates in the mastectomy group and liposuction group were 1.4% and 0.5%, respectively. There were no nipple/areola necrosis and scars in liposuction group.  The ultrasonic-liposuction treatment was associated with superior esthetic results and fewer complications.

The use of ultrasonic-assisted liposuction (UAL) combined with conventional liposuction and partial gland resection without skin excision is an option for moderate cases.  Although a wide range of surgical techniques have been described, the treatment of gynecomastia requires an individualized approach. 

Reference:

Song et al.  Surgical treatment of gynecomastia:  mastectomy compared to liposuction techniques.  Ann Plast Surg. 2014 Sep;73(3):275-8. doi: 10.1097/SAP.0b013e31827c7949.

Wong, et al.. Conventional versus ultrasound-assisted liposuction in gynecomastia surgery:  a 13-year review. J Plast Reconstr Aesthet Surg. 2014 Jul;67(7):921-6. doi: 10.1016/j.bjps.2014.03.004. Epub 2014 Mar 21. 

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

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