e. antonio mangubat, md seattle, wa fat disruption : a useful adjunct to liposuction surgery by
TRANSCRIPT
E. Antonio Mangubat, MDSeattle, WA
Fat Disruption : A Useful Adjunct To Liposuction Surgery
by
Fat Disruption Concept
Not a new idea Chopped up fat is easier to suck out UAL (Ultrasound Assisted
Liposuction)– Fat disruption before liposuction– Great in tough areas (scar,
gynecomastia)– Made aspiration easier– Cost
Fat Disruption Concept
Blugerman liposhifting instrument– Introduced in 2002 Liposuction World Congress– Designed to create mini fat grafts internally– in vivo fat grafts manually shifted to fill defect– Solid core cannula 3-4mm diameter
Current concept– Mechanical disruption of fat infrastructure– Not intended for fat grafting– Detach the fat from its stroma before suction– Uses much larger cannulas: 5-6mm typical
Advantage of Fat Disruption
SPEED – Rapid volume reduction– Aspiration speeds up to 1000ml/min– Large cannulas do not cause irregularities
Smooth results regardless of cannula size– No suction applied during disruption– Even superficial passes do not leave divots
Especially useful for:– Large volume reduction– Beginning liposuction surgeons
Prototype Fat Disruptor Instrument and technique
Large sizes: 5 & 6mm empirically work the best
Hollow cannulas– Relieve tumescent pressure– Retains leaking aspirate in hose; less mess
Fat disruption surface– Not designed for fat grafting– Longer, larger holes, faster– Push and pull disruption more efficient
Fat Disruption Technique
Large tumescent volume No suction used in disruption
phase No divots, no ridges, no
depressions Different than pre-tunneling
Technical Notes
Intense “super” tumescence - high hydrostatic pressure– Forced fluid dispersion– Hydrostatic capillary compression– Bloodless
Staged tumescence – infuse in staged areas e.g.– Front the Back– Upper body then lower body– Vasoconstriction last only ~90min – Speed critical for larger volumes
Technical Notes
Tumescent Solutions Compositions
Lidocaine = .048% (50ml 1% lidocaine in 1L) Epinephrine = 1:1,000,000 (1ml 1:1000 epi
in 1L) Max dose 40-50mg/Kg Addition tumescence above the max
lidocaine dosages had no lidocaine. Only:1:1,000,000 epi in LRS
Large fat disruption surface Intense tumescence Note firm tissue turgor
No suction applied yet Start deep next to muscle 5-6 minutes, loss of
resistance
Able to get close to surface No surface defects Begin 60 secs of suction
Large 6mm cannula Note free flow of aspirate 1000ml in 60 seconds!
Greater Cosmetic SafetyUseful In Defects Prone Areas
High Resistance Areas
Gynecomastia Epigastrium Upper back Revision liposuction
Greater Cosmetic SafetyFor Experience Surgeons
SPEED! Significantly shorter
procedures Greater time for refinement Cost-effectiveness
Greater Cosmetic SafetyFor Beginning Surgeons
Much shorter learning curve Reproducibly smoother
results SPEED! Cost effective
Fat Disruption Summary
Great Speed & Smoother Results
Shorter procedure times Less blood loss Less anesthesia Less expense
Greater Patient Safety
E. Antonio Mangubat, MDSeattle, WA
USA
Thank You!