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Table of Contents
LETTER TO THE EDITOR
Year : 2018  |  Volume : 26  |  Issue : 2  |  Page : 84-85

Extracorporeal liposuction technique for lipofilling after standard abdominoplasty procedure


Dokuz Eylül University Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Izmir, Türkiye

Date of Web Publication13-Apr-2018

Correspondence Address:
Dr. Alper Geyik
Dokuz Eylul University, Department of Plastic, Reconstructive and Aesthetic Surgery, Izmir
Türkiye
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.TJPS_6_18

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How to cite this article:
Geyik A, Demirdover C, Vayvada H. Extracorporeal liposuction technique for lipofilling after standard abdominoplasty procedure. Turk J Plast Surg 2018;26:84-5

How to cite this URL:
Geyik A, Demirdover C, Vayvada H. Extracorporeal liposuction technique for lipofilling after standard abdominoplasty procedure. Turk J Plast Surg [serial online] 2018 [cited 2019 Nov 21];26:84-5. Available from: http://www.turkjplastsurg.org/text.asp?2018/26/2/84/230120




  Introduction Top


Modern liposuction techniques have evolved over the last 40 years, first with the Pierre Fournier [1] who described the dry technique in which no fluids are infiltrated before liposuction and then with Illouz who favored the wet technique. With the introduction of tumescent [2] and super-wet technique, removing large amount of excessive fat became possible without significant blood loss or considerable complications. In addition to wetting solutions, blunt-tip small cannulas were appreciated to bypass vital structures such as nerves and blood vessels.[3] Subsequently, ultrasonic liposuction was introduced by Zocchi,[4] and further powered liposuction devices were developed. Because of these developments, the procedure can be considered as safe,[5] but, on the other hand, has also risks such as all-invasive procedures. For instance, volume overload, hypothermia,[6] deep-vein thrombosis, and wound infections can be counted as early complications and prolonged edema and ecchymosis and contour deformity and irregularities as late complications.[7]

The aim of this study is to describe a simple method for avoiding the complications of liposuction. Hereby, we would like to present extracorporeal liposuction as an alternative method for lipofilling procedure that can also be applied to the face.


  Surgical Technique Top


A 52-year-old female patient who had a history of two cesarean sections and an oophorectomy, both performed by Pfannenstiel incision admitted to our clinic. She had history of hypothyroidism. On her physical examination, increased skin laxity and lipodystrophy at lower abdominal region, accompanied with wide striae were noted [Figure 1]. She also wanted to have malar and lip augmentation lipofilling to nasolabial and labiomental sulcus. Under general anesthesia, abdominoplasty and rectus diastasis repair were performed. Excessive skin and fat tissue was reserved at wet and warm gauze for extracorporeal liposuction. Without using wetting solutions or a centrifugation system, we obtained lipoaspirate from the excised tissue with conventional methods. We used small Mercedes-type cannulas and Luer–Lock syringe to generate negative pressure for liposuction. 30 cc lipoaspirate [Figure 2] was given to the face for rejuvenation.
Figure 1: The preoperative view of the patient

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Figure 2: Liposuction from flaps

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  Discussion Top


Autologous fat grafting is one of the most prevalent procedures that are used by plastic surgeons for esthetic, reconstructive, and corrective purposes. In the developmental process of liposuction, however, big differences emerged among clinicians based on their experiences. These wide variations arose from numerous factors such as local or general anesthesia, use of tumescence, the type of cannula used, donor site, harvesting technique, methods of purification, and centrifugation.[8] In our study, we performed the procedure under general anesthesia without using tumescence. Adipose tissue was harvested from abdominoplasty flaps using manual syringe aspiration technique with 3 mm Mercedes-type cannula. The lipoaspirate was directly injected as fat graft, without any process of centrifuging, to the nasolabial folds and the malar areas.

First, in our study, primarily the abdomen was used as donor. Rohrich et al.[9] found no differences in viability among adipocytes harvested from the thigh, knee, flank, or abdomen. However, past surgical operation can alter the viability of adipose tissue. After flaps were excised, there was warm ischemia time for adipocytes. Previous studies revealed that differentiated adipocytes underwent apoptosis and necrosis as early as 24 h. In contrast, most adipose-derived stem/progenitor cells survived under hypoxic condition. We also know that severe ischemia induces degenerative changes in adipose tissue.[9],[10] Even if we inject fat graft in 1 h after excision, before presuming this method as useful or superior to other techniques, we should individually compare each variety such as quality, viability, and composition of adipose tissue. Unfortunately, it is impossible to come to a conclusion with this study.

Second, dry technique was used, and a recent study showed that there was no difference between adipocyte samples harvested with or without tumescent solution,[11] but it is still debatable whether or not there is a decrease of adipocyte-derived stem cells. Only dry technique can be used with this method, so even if there is no hydrodissection effect of wetting solutions, the liposuction procedure can be done easily.

Finally, the aforementioned early and late complications of liposuction are unimportant to consider. Since no wetting solutions are required, it seems to be time saving and cost effective. Avoiding perioperative hypothermia, volume overload, hematoma,[12] and hemodynamic instability with extra blood loss could be beneficial for the patient during reanimation. Furthermore, prolonged edema, ecchymosis, and pain are not significant problems after the operation. When used in abdominoplasty patients, this method is practical in that it does not disrupt the blood circulation in the flaps.[13] The procedure can be performed easily without setting up a centrifugation system and liposuction devices. There is no need to use extra incisions for the cannulas and the risk of infection is eliminated.

With this method, on the other hand, limited lipoaspirate can be obtained depending on the excessive tissue. Also, if liposuction is needed for a liposculpture procedure, this method is unusable. All lipoaspirates except for breast tissue – because of the risk of transferring breast parenchyma cells to another location – can be used, but as mentioned above, the abdomen and gluteal region can be candidates as a donor site.

In conclusion, according to our experience, extracorporeal liposuction can be an alternative method with the benefits it offers to abdominoplasty patients who do not need additive liposuction procedure but do request lipofilling for rejuvenation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fournier PF, Otteni FM. Lipodissection in body sculpturing: The dry procedure. Plast Reconstr Surg 1983;72:598-609.  Back to cited text no. 1
[PUBMED]    
2.
Klein JA. The tumescent technique for liposuction surgery. Am J Cosm Surg 1987;4:263-7.  Back to cited text no. 2
    
3.
Shiffman M, Flynn T, editors. Liposuction Principles and Practice. Ch. 1. Ancona, Italy: Springer; 2016. p. 3-7.  Back to cited text no. 3
    
4.
Zocchi M. Ultrasonic liposculpturing. Aesthet Plast Surg 1992;16:287-98.  Back to cited text no. 4
    
5.
Kenkel JM, Lipschitz AH, Luby M, Kallmeyer I, Sorokin E, Appelt E, et al. Hemodynamic physiology and thermoregulation in liposuction. Plast Reconstr Surg 2004;114:503-13.  Back to cited text no. 5
[PUBMED]    
6.
Neligan P. Liposuction: A comprehensive review of techniques and safety. In: Kenkel J, Stephan P, editors. Plastic Surgery. 3rd ed. London: Elsevier Saunders; 2013. p. 507-28.  Back to cited text no. 6
    
7.
Housman TS, Lawrence N, Mellen BG, George MN, Filippo JS, Cerveny KA, et al. The safety of liposuction: Results of a national survey. Dermatol Surg 2002;28:971-8.  Back to cited text no. 7
    
8.
Suszynski TM, Sieber DA, Van Beek AL, Cunningham BL. Characterization of adipose tissue for autologous fat grafting. Aesthet Surg J 2015;35:194-203.  Back to cited text no. 8
    
9.
Rohrich RJ, Sorokin ES, Brown SA. In search of improved fat transfer viability: A quantitative analysis of the role of centrifugation and harvest site. Plast Reconstr Surg 2004;113:391-5.  Back to cited text no. 9
    
10.
Suga H, Eto H, Aoi N, Kato H, Araki J, Doi K, et al. Adipose tissue remodeling under ischemia: Death of adipocytes and activation of stem/progenitor cells. Plast Reconstr Surg 2010;126:1911-23.  Back to cited text no. 10
    
11.
Agostini T, Lazzeri D, Pini A, Marino G, Li Quattrini A, Bani D, et al. Wet and dry techniques for structural fat graft harvesting: Histomorphometric and cell viability assessments of lipoaspirated samples. Plast Reconstr Surg 2012;130:331e-339e.  Back to cited text no. 11
    
12.
Shiffman M, Flynn T, editors. Liposuction Principles and Practice. Ch. 8. Ancona, Italy: Springer; 2016. p. 61-5.  Back to cited text no. 12
    
13.
Matarasso A. Abdominolipoplasty: A system of classification and treatment for combined abdominoplasty and suction-assisted lipectomy. Aesthetic Plast Surg 1991;15:111-21.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]



 

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