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28 Renuvion-Assisted Body Contouring Surgery
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(The) Inltration of tumescent solution through 0.04cm incisions in the area of
underwear (on the underwear outline) and skin grooves begins; with 1000 cc of
SSN at 0.9% plus 1 cc of epinephrine, starting in the anterior region of the abdomen,
thighs, and arms, we proceed to x the skin protectors with silk sc24 and allow
15min to pass for vasoconstriction to occur.
Liposuction of the inltrated areas is carried out with ultrasound-assisted technology (UAL) SONOCA, a useful tool for the treatment of lipodystrophy, which can
be benecial in secondary cases due to its ability to break adhesions between the
fascia and the dermis, which, in turn, reduces blood aspiration, emulsies the tissue,
and reduces considerably surgical time. It acts at a frequency of 2–3MHz with the
impulses that vary in terms of repetitions per second depending on the instrument;
we use an intensity of 60MHz and treat each quadrant for 30 s to maximum 1min
(maximum).
Next, power-assisted liposuction (PAL) of the emulsied tissue is performed.
The most important parameter to consider is the cannula diameter. The most commonly used are 4mm cannulas, and among them are the at cannula, the Mercedes
cannula, and the Vásquez cannula, which allow an easier passage through fat tissue
layers and greater control for the surgeon to sculpt with precision small or large
body areas (with precision) leaving no skin irregularities.
After traditional liposuction is performed, giving (creating) the desired contour
to the body, the degree of accidity of the tissues in the treated areas is identied,
followed by skin tightening with RENUVION helium plasma technology. The application protocol is respected: frequency, planes, vectors, and application time with
an intensity of 80/20 for 15–20 min/quadrant. This advanced energy-based technology combines the unique properties of cold helium plasma with radiofrequency
energy (Fig.28.4). Its application must be by planes and vectors so that the energy
is directed mainly to the tissue structures and the dermis (Fig.28.5). Its distribution
must be uniform. The helium plasma temperature should be maintained at 65 °C,
for prolonged periods to maximize efcacy. At a temperature of 85 °C, the treatment time can be reduced. The higher the temperature, the lesser the time of helium
plasma application. The frequency and duration is (are) a (the) surgeon’s choice.
Positioning of the patient in lateral decubitus for 0.4cm incisions to be made in
(the underwear outline area) areas of underwear and skin grooves before repeating the process occurs. We systematically perform the Renuvion-Assisted Body
Contouring Surgery in the following sequence: Inltration, liposuction, and skin
tightening covering the areas of the back, waist, arms, and thighs in the right side
and then on the left side.
Once liposuction is over, we proceed (with the lipo-injection) to fat transfer to
the gluteal region.
First, we position the patient in a prone position, and 0.4cm incisions are made
in (the underwear outline area) areas of underwear and skin folds in the gluteal
region, one incision in the intergluteal region and two on each side of the gluteal region.
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Fig. 28.4 Renuvion
helium plasma technology
J. E. G. Serna et al.
Fig. 28.5 Renuvion
application by planes and
vectors
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1. Tumescent inltration of the gluteal region.
2. UAL is performed at a frequency of 60Hz for 30–45 s per gluteal quadrant.
3. Renuvion technology is applied for 7–10min per gluteal region.
(a) Renuvion application technique:
Application planes
Application vectors
Application frequency
Application time
4. Renuvion technology is applied for repolarization of the gluteal area (Fig.28.6).
5. Fat graft is prepared (gentamicin 160mg + clindamycin 600mg is added to the
previously decanted fat). Fat injection of the gluteal graft is performed at the
level of (over/on) the subcutaneous cellular tissue. The volume will be dened
according to the agreement made during the consultation with the surgeon.
Fig. 28.6 Renuvion
technology is applied for
repolarization of the
gluteal area
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After occlusive dressing, the patient goes to a recovery room and will stay in the
hospital for (one) a night.
J. E. G. Serna et al.
Postoperative Care
Antibiotics, painkillers, and anti-inammatories are prescribed. A cotton garment
will be placed under the surgeon’s orientation (command/instructions), usually
after the rst follow-up (appointment). Drainages and massages may begin the day
after the surgery and must be performed by the recommended professional. We recommend to start the use of a rigid dressing/garment after the rst postoperative week,
and to change positions every 15 minutes; showering is allowed after 24 hours postop;
restrict caloric intake is oriented and specic foods such as dairy, pork, seafood, and
spicy foods; and drink plenty of uids. Explain to the patient that red uid output is
normal and it may even moisten the garment. Orthostatic hypotension may occur,
accompanied by symptoms such as blurred vision, paleness, dizziness, cold sweats,
and palpitations that may resolve by lying down and raising the legs, and early ambulation should be stimulated and warning signs such as fever, abdominal pain, bleeding, vomiting, and excessive or difcult breathing (must be) reported to the surgeon.
Complications
Contour irregularities, seroma, hyperpigmentation, asymmetries, scar hypertrophy,
skin necrosis, skin infection, post-surgical anemia.
Pros andPearls
• UAL: decrease in blood loss, greater postoperative (post-surgical) skin retrac-
tion, and shorter recovery time.
• Correct diameter and cannula style: reduces bleeding due to less subcutane-
ous trauma.
• The use of helium plasma technology tightens the skin to the mold sculpted by
the professional.
• Retraction of the skin in all vectors: minimizes and avoids unwanted scars.
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• Decrease in the need of excision of excess of the skin (skin excess), obtaining
doctor/patient satisfaction (satisfactory) results.
• Better aesthetic results with shorter surgical time, less surgical risk, decreased
patient recovery time, and limited unwanted scarring.
• The use of vitamins, minerals, and supplements should be discontinued, and all
non-essential agents before surgery can reduce the risk of a complication related
to bleeding (Broughton 2nd etal. 2007).
• Informed consent requires that the patient (must) be informed of treatment risks,
prognosis, and alternative treatments before consenting to treatment.
• Inltration of several liters of wetting (moisturizing) solution.
• Always make two incisions in the skin, one for the entrance of the piece of
helium plasma and another for the exit due to physical effect.
• Describe the use of the application of an assisted technology, and it does not
depend on (the) results, but it depends on (but the) means, with a possible surgi-
cal time with a reduced scar.
• (Less than 10% chance of) Possible appearance of pneumothorax less than 10%,
and its treatment is respiratory therapy and early ambulation.
This technique is reproducible with successful results.
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Contraindications
Smoking is an important risk factor for wound healing complications.
Not leaving the patient hospitalized increases the risk of postoperative (post-
surgical) complications.
Admitting patients who wish to undergo cosmetic surgery without meeting all
the medical and psychological prerequisites (pre-requirements) can generate risks
to the patient’s health due to lack of information.
Comparative Photos Before andAfter (Figs.28.7, 28.8, 28.9,
28.10, 28.11, and28.12)
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J. E. G. Serna et al.
Fig. 28.7 Liposuction of the abdomen and retraction of the skin with Renuvion, pre-surgical and
post-surgical 6 months
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Fig. 28.8 Liposuction of
the arms and retraction of
the skin with Renuvion,
pre-surgical and postsurgical 6 months
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Fig. 28.9 Liposuction of the neck and retraction of the skin with Renuvion, pre-surgical and postsurgical 6 months
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J. E. G. Serna et al.
Fig. 28.10 Liposuction of the thighs and retraction of the skin with Renuvion, pre-surgical and
post-surgical 6 months
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Fig. 28.11 Liposuction of the back and retraction of the skin with Renuvion, pre-surgical and
post-surgical 6 months
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J. E. G. Serna et al.
Fig. 28.12 Liposuction of the abdomen and retraction of the skin with Renuvion, post-surgical
6 months
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