| PREGNANCY AND AESTHETICS | PEER-REVIEW
side-effects, such as fat embolism, which can be potentially fatal. Large cannulae need large incisions which have to be sutured and heal with significant scars12
. The use of large cannulae also causes greater
damage to tissue and, hence, increases the bleeding. This technique is associated with significant blood loss, often needing blood transfusions13
. Recovery time is
slow, as after any procedure under general anaesthesia. Microcannular tumescent liposuction involves
subcutaneous infiltration of large volumes of crystalloid fluid called Klein’s solution, which contains low concentrations of lignocaine and epinephrine, followed by suction-assisted aspiration of fat by using small aspiration cannulae called microcannuale. The term tumescent liposuction specifically excludes the use of any additional anaesthesia, either intravenous or gaseous, and by definition, is a method for performing liposuction surgery with the patient totally under local anaesthesia14,15
. Since the first description by Jeffrey
Klein, dermatologic surgeons have made significant contributions in this field, and tumescent liposuction using microcannuale under local anaesthesia, is regarded as safe and effective. There have been many developments in this field16
, including those mentioned
below. ■ Suction-assisted liposuction (SAL) ■ Ultrasound-assisted liposuction (UAL) ■ Power-assisted liposuction (PAL) ■ Twin-cannula (assisted) liposuction (TCAL or TCL) ■ External ultrasound-assisted liposuction (XUAL or EUAL)
■ Water-assisted liposuction (WAL) ■ Laser Assisted. Liposuction can be combined with other procedures
(i.e. radiofrequency) that involve a level of skin retraction. The level of skin retraction following liposuction is affected by the age of the patient, quality of skin, presence of underlying disease or smoking, and the presence of previous skin damage such as those caused by childbirth and surgery. Surgical lifts are also used post-pregnancy to address massive weight loss when the combination of large amounts of skin and shrunken fat cause significant skin drooping. Large volume Liposuction (SAL) in combination with other surgery is common, but may have higher complication rates.
Non-liposuction alternatives The risks, financial costs, and lengthy downtime associated with surgical procedures for fat reduction have led to the development of a number of non-invasive techniques. Non-invasive body contouring now represents the fastest growing area of aesthetic medicine17
. There are currently
four leading non-invasive techniques for reducing localized subcutaneous adipose tissue: low-level laser therapy (LLLT), cryolipolysis, radiofrequency (RF), and high-intensity focused ultrasound (HIFU). Cryolipolysis is the non-invasive cooling of adipose
tissue to induce lipolysis — the breaking down of fat cells — to reduce body fat without damage to other
tissues. It initially received FDA clearance for fat reduction in the abdomen and flanks, and more recently there has been significant interest in non-surgical fat reduction for other sites, such as the inner and outer thighs. Zelickson and Burns reported results of an inner thigh study that contributed to FDA clearance of cryolipolysis for the treatment of thighs18
. The author believes, without question, the
development of SAL/ultrasound-assisted liposuction (UAL) changed the face of excisional body contouring surgery as many plastic surgeons use it an adjunct to excisional abdominoplasty. Most physicians use this system to remove fat from common areas such as the abdomen, waist, hips, back, buttocks and thighs, as well as more delicate areas such as the arms, calves, ankles, knees, face and neck19
. Some physicians also use
the device to sculpt female breasts. A majority of doctors questioned in a recent survey found that the system offered the following benefits over traditional liposuction19
:
■ Faster patient recovery ■ Less pain medication required ■ Minimal bruising ■ Reduced need for re-treatments ■ Skin tightening ■ Increased precision. Preliminary findings from a multi-centre clinical
study measuring skin retraction in ultrasound-assisted liposuction patients shows 40% to 60% skin tightening. Most doctors agree that the key to good skin retraction is related to treating the layer of fat directly under the skin. This allows the physician to effectively sculpt an area and stimulate the dermal collagen, resulting in skin tightening19
. Another study in the July/August issue of
the Aesthetic Surgery Journal, found that this device significantly limited blood loss during liposuction when compared to traditional liposuction alone. The authors concluded that ultrasound-assisted lipoplasty should be recommended over traditional suction-assisted lipoplasty for patients undergoing large-volume liposuction procedures or treatments in very fibrous areas of the body where increased blood loss is expected20
. Another recent development is the use of Nutational
Infrasonic Liposculpture (NIL) or ‘tickle’ liposculpture. The procedure was originally developed in Europe and was approved by the FDA for use in the US in 2010. It uses low frequency acoustic infrasonic vibration combined with simultaneous suction to loosen and remove unwanted areas of fat from the body. Unlike traditional liposuction, NIL uses air pressure rather than heat, which causes less damage to surrounding tissue and blood vessels. The cannula used to remove the fat is also much narrower, resulting in less bruising and scarring after the procedure. NIL can be used on any area of the body previously treated with traditional liposuction methods. The procedure is quickly gaining
prime-journal.com | March 2015
Cryolipolysis
is the non-invasive cooling of adipose tissue to induce lipolysis — the breaking down of fat cells — to reduce body fat without damage to other tissues.
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