Vaser UAL for the Heavy Face

26.2 Technologies

Results with liposuction were generally good, but inconsistent, and with insufficient skin retraction. Earlier generations of ultrasonic devices were potentially too powerful or aggressive for easy, safe, and meticulous head and neck applications. Complications, although minimal, were more threatening.

Vaser technology represents an advanced tool available on the market since 2001, which offers guarantee of safety and quality and allows great results in a simple manner, in expert hands.

Training with Vaser for face and neck is not difficult, but requires technical skills and finesse in working close to the subcutaneous layer with a fine (2.2 mm diameter) titanium probe (Fig. 26.1).

A. Di Giuseppe ( )

Via Simeoni, 6, 60122, Ancona, Italy e-mail: adgplasticsurg@atlavia.it

G. Commons

1515 El Camino Real, Suite C, Palo Alto, California, 94306, USA

e-mail: gwcommons@gmail.com

Fig. 26.1 Vaser probes 2.2 mm 10–15 cm. Skin protectors, and 1.8 mm aspiration cannula

26.3 Technique

The probe is always the 2.2 diameter, utilized with 30% continuous mode for fibrous tissue, or 30% Vaser mode. Generally, between 2 or 3 min of application are sufficient to fully undermine each sector of the head and neck area (jowls, chin, mandible, cheeks, etc.). If the neck is heavy with a lot of local fat to be emulsified for facial debulking and contouring, allow another 1 min minimum for the deeper fat layer.

To remove emulsified fat, or to remove infiltrated solution, gentle aspiration with a 1.8 mm cannula at

low aspiration power is required. Gentle manual shaping and pressure is utilized to help the solution to come out. Tumescence is a temporary status, and in the face and neck fluids are absorbed faster than elsewhere.

Heavy faces occur in many of the potential candidates for Vaser facial contouring. Overweight and obese patients often require a general thinning or softening of the cheeks and lower third of the face (Fig. 26.2).

Figure 26.3 is a patient with an undefined face, fatty cheeks and chin, no mandibular line definition, no orbital cheek sulcus, and no pre-parotid natural depression. This patient underwent a Vaser face contouring of cheeks, jaw line, chin, and nasolabial folds. A total of 400 mL tumescent fluid was infused and 8 min Vaser applied. Seventy five milliliter of fat was aspirated. The result appears natural and well defined.

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a2

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Figure 26.4 is patient with heavy neck and cheeks, mostly obese or overweight, and has no definition at chin and neck due to fat accumulation over platysma muscle. There is a “double” chin and no neck and jaw definition or cheek orbital protrusion. Extensive Vaser emulsification gives a better look, younger and fitter

appearance, and more pleasant face. All areas were softened and redraped.

North American population is a mix of different ethnic races, including Hispanic, Afro-Cuban, Latin, Asian, and others. The patient in Fig. 26.5 is a 44-year-old Hispanic overweight woman, unable to

improve natural appearance of the face with a hypocaloric regime. With Vaser of the neck, chin, and jaw, the areas were reduced in volume of fat. The skin was fully mobilized in order to redrape nicely. Even the orbital nasal area, cheeks, and pre-parotid areas were softened and redefined.

26.4 Complications

In over 500 cases operated on by two surgeons, there were no significant complications such as nerve deficits, burns, or skin necrosis. The results were pleasing to patient and surgeon. No surgical redo was requested.