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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_577_Библиотеки_им_академика_М_И_Перельмана
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A. Di Giuseppe and F. Giovagnoli
Fig. 18.17 (a, c, e, g) Pre op. (b, d, f, h) 1 year post op
a
b
Fig. 18.18 (a) Areas of fat transfer. (b) Incision lines and direction of cannulas (2–3mm large)
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261
Fig. 18.19 Pectoralis enhancement with 180ml of fat, supercial and deep layers. (a, c) Pre op. (b, d) Post op 6months
Keeping in shape by constant training is essential to maintain the proper nice outcome. It is easy to put on weight if the
patient stops training as well as losing the muscle tone and
strength.
6-month post-op (Fig.18.21).
18.7 Post-op Care
Post op 6months (Fig.18.20).
Post-op care includes:
Case 7
High denition can be accomplished even in the older
patient, with senile elastosis skin appearance. This 58-yearold patient presented with a mild form of gynecomastia, fat
excess on the upper abdomen, in an otherwise well-trained
person. The lower part of the abdomen presents one of the
most tricky points in any loose older skin: a double ply (see
red arrows). Using a good technology (Vaser, supercial
ultrasound emulsication, and thus skin retraction) in expertised hands will give this nice redraping in the body frame,
1. Compressiver garment for 6–8weeks
2. Special foam to further compression of the abdominal
region, for 2–3weeks
3. MLD (manual lymphatic drainage) twice a week, for
4weeks at least, until swollen is settled
4. TED stockings and 14days microheparine cycle
5. Antibiotics, 7days, pain medication is needed (Figs.18.22
and 18.23).
with a nicer look, a more athletic appearance, and a better
aesthetic result.
262
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Fig. 18.20 (a, b) Pre op. (c,
d) Post op 6months after high
denition of trunk and fat
transfer to the chest wall.
Complimentary training
program and diet for
enhancing quality of result
A. Di Giuseppe and F. Giovagnoli
ab
Fig. 18.21 (a, c) Pre op; see red arrows which indicate skin excess with double ply in loose skin in older patient. (b, d) Post op 6months appear-
ance after Vaser body shaping to upper chest, gynecomastia, lower abdomen and anks. Note skin reraction and redraping of the lower abdomen
18 Body Fat Grafting Contouring intheMale Patient
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Fig. 18.22 Special foam for compression
263
Fig. 18.23 Special compression garment for high denition
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A. Di Giuseppe and F. Giovagnoli
References
1. Simblet S.Anatomy of art. In: Anatomy for the artist. NewYork:
DK Publishing; 2001.
2. https://soltapracticeproposal.com/product- information/products/
vaser- system/
3. Cimino WW. Ultrasound-assisted lipoplasty hasic physics, tissue
interactions, and related results/complications. In: Prendergast PM,
editor. Aesthetic medicine. Art and techniques. Berlin/Heidelberg:
Springer; 2011.
4. Hoyos AE, Prendergast PM.High denition body sculpting. Berlin
Heidelberg: Springer; 2014.
5. Hoyos AE, Millard JA.VASER-assisted high denition liposculpture. Aesthet Surg J. 2007;27(6):594–604.
6. Hoyos AE, Prendergast PM.High denition body sculpturing, art
and advanced lipoplasty techniques. Berlin/Heidelberg: Springer;
2014.
7. Williams PL.Gray’s anatomy: the anatomical basis of medicine and
surgery. 38th ed. Edinburgh: Churchill Livingstone; 1995. p.811.
8. Goldnger E. Human anatomy for artists. The elements of form.
Oxford: Oxford University Press; 1991. p.289.
9. Singh D, Young RK.Body weight, waist to hip ratio, breast, and
hips: roles in judgements of female attractiveness and desirability
for relationships. Ethol Sociobiol. 1995;16:483–507.
10. Cornelissen PL, Toveé MJ, Bateson M.Patterns of subcutaneous
fat deposition and the relationship between body mass index and
waist-to-hip ratio: implications for models of physical attractiveness. J Theor Biol. 2009;256(3):343–50.
11. Nahas FX.An aesthetic classication of the abdomen based on the
myoaponeurotic layer. Plast Reconstr Surg. 2001;108(6):1787–95.
12. Shiffman MA, Di Giuseppe A.Liposuction. Principles and practice. Berlin: Springer; 2016.
13. Di Giuseppe A, Giovagnoli F, Di Giuseppe S, Ronconi D.Vaser
body contouring achieving a more dened shape. The art of body
contouring. London: Intechopen; 2019. p.105–122.
Body Fat Grafting Contouring
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intheFemale Patient
AlbertoDi Giuseppe andFedericoGiovagnoli
Contents
19.1 Introduction 265
19.2 Simultaneous Lasing andSuction 266
19.3 Study Evaluation (Table19.1) 267
19.4 Skin Tightening Benets 268
19.5 Face Tightening Lipotight Cannula 268
19.6 Skin-Safe Unique Angel™ Emitting Fiber 269
19.7 Liposense™ Temperature Control 269
19.8 Clinical Cases 269
References 276
19
19.1 Introduction
Fat transfer in body contouring has many indications:
– Banana fold deformity treatment
– Correction of asymmetries secondary to surgery
– Muscle edges denition
– Correction of primary asymmetries
– Treatment of cellulitis
– Post-traumatic defect correction
– Enhance body frame by increasing areas of deciency
Fat transfer is the best solution for all these indications. It
is a unique element to be added to the body to solve, of help
solving, complicate cases, and secondary defects post–previous surgery.
Liposuction, intended as a technique to remove fat, has
evolved in liposculpture, intended as a technique to shape
and add fat if, when and where is necessary.
A. Di Giuseppe (*)
University of Padova, Padova, Italy
F. Giovagnoli
University Vita-Salute San Raffaele, Milan, Italy
Evolution of technique and advancement in materials
have deeply increased the rate of survival of fat, which initially (in the 90’s) was around 20–30% of the initial
inltration.
Nowadays (2010–2020), depending on the technique utilized for fat extraction, fat harvesting, fat decanting, fat
cleaning and nally fat inltration, fat survival rate ranges
from 80% to 95%, depending on the author studies reported.
On top, the discovery of the stem cell, dened as “turbo”
cells which boost the survival rate of the implant and fat, has
made a substantial enhancement in the quantity of fat survival, and in the quality of fat itself.
In my surgical experience, I have mainly utilized
ultrasound- assisted liposuction (VASER™) for fat emulsication and extraction and REVOLVE™ cannister, for fat harvesting and preparation to inltration. I have acquired a
15years of clinical experience with this technique, after having used different tools and devices in the past, with less satisfactory results [1–3].
Recently (2020), I started utilizing BeautiFill™ by
LipoLife, produced by Alma Laser (Israel) (Fig.19.1).
LipoLife streamlines the surgical process by offering a
complete, all-in-one solution covering all stages of liposuction, skin tightening, and fat grafting procedures. It is the
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
A. Di Giuseppe et al. (eds.), Fat Transfer in Plastic Surgery, https://doi.org/10.1007/978-3-031-10881-5_19
265
266
LipoDiode 1470 system
WAVELENGTH
ABSORPTION COEFFICIENT
Water
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A. Di Giuseppe and F. Giovagnoli
LipoFlow 1470 system
100
1320nm
10
1064 nm
1
0.1
0.01
850 1000
Fig. 19.2 Selective absorption of the 1470 wavelength in water compared to fat (Courtesy of Alma Lasers, ©2022 BeautiFillTM by LipoLife,
All Rights Reserved)
1150 1300 1450 1600 1750
1470nm
LipoLife
Fat
Fig. 19.1 BeautiFillTM by LipoLife (Courtesy of Alma Lasers, ©2022
BeautiFillTM by LipoLife, All Rights Reserved)
rst integrated solution of its kind combining multiple
modalities in a compact, portable, and neatly organized system. Simultaneous lasing and suctioning simplify the procedure and signicantly reduce the treatment time, thermal
energy and a unique radial emission ber allow for effective,
homogenous skin tightening, and the collection of high vitality fat permits successful, immediate fat grafting.
This is the third generation of Alma Laser’s liposuction
technology offering better safety and clinical success.
19.2 Simultaneous Lasing andSuction
It features an integrated cannula and ber interface that
allows for simultaneous lasing and suction. This unique
interface allows physicians to pass through the tissue more
easily and remove fat cells more quickly and efciently. As
laser energy is delivered to the tissue, the laser cauterizes
blood vessels, minimizing bleeding, swelling and body
trauma such as hematomas, edema, and bruising as well as
minimizing postoperative pain.
Simultaneous lasing and suction create a one-step process
that signicantly reduces the amount of physical effort
required to perform liposuction procedures, especially in
areas with brous tissue.
LipoLife uses the 1470nm wavelength which specically
targets water in soft tissue and features a higher absorption
rate in water and fat than all other competing devices. This
allows for optimal fat removal with minimal tissue damage.
Laser energy is delivered at a low power density for maximum safety, minimizing the risk of burns (Fig.19.2).
Briey, the LipoLife device is operated with a thin radial
ber laser (400 or 600μm) at 1470nm wavelength that targets water and is integrated into a small suction cannula
using an Angel tip (360° annular probe) for combined gentle
laser treatment and careful suction in a single-in-serial step.
The LipoLife device involves simultaneous work of laser
(CW mode) and suction. Power settings are a function of the
liposuction area: 10–13 W (chin, arms, and knees), 13 W
(abdomen, back), and 15W (thighs, hips, and buttocks). The
laser energy is conveyed into the fat layer using a 3 or 4mm
cannula which incorporates a 400- or 600-μm optical singleuse ber (Angel). Given its water absorption, radial emission, and relatively low irradiance on the fat tissue channeled
via Mercedes perforated-tip cannula, the 1470 nm wave-
Fat cells at Laser Liposuction
Fat cells via Mechanical Liposuction
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Fig. 19.3 Angel radial emission ber (Courtesy of Alma Lasers,
©2022 BeautiFillTM by LipoLife, All Rights Reserved)
267
a
a
length laser ber enables gentle fat tissue as shown in
Fig. 19.2. LipoLife system: integrated LipoDiode (left),
Angel radial emission ber (middle), and selective absorption of the 1470 wavelength in water compared to fat collection/yield and provide increased relative ratios of viable
adipocytes in the harvested tissue [9] (Fig.19.3).
Autologous fat transfer for soft tissue contouring has
become increasingly popular in recent years. The immediate
availability of the patient’s own fat, its natural integration
into host tissues, and its permanent correction potential make
it a highly instrumental application. LipoLife achieves a fat
vitality rate of greater than 95%.
The procedure is quick and convenient with a fully
equipped kit, allowing you to easily restore patient tissue
volume.
With LipoLife’s unique lasing technology, fat cells gently
undergo lysis to a semi-liquid state, generating two distinct
phases: a signicant adipose phase with highly viable and
small uniform fat cells and a negligible blood phase, with no
oil phase present as with mechanical liposuction. The preservation of fat cells with high vitality combined with a ltering
Fig. 19.4 Fat viability. (a) Mechanical liposuction, (b) laser liposuction (Courtesy of Alma Lasers, ©2022 BeautiFillTM by LipoLife, All
Rights Reserved)
mesh allows for quality fat grafting and successful autologous fat injection, with longer term results.
A study conducted in a single center in Israel in the year
2018, at the Assaf Harofeh Medical Center, did analyze
laser-assisted derived fat cell. The main target was fat viability after emulsication with Lipolife laser (Fig.19.4).
19.3 Study Evaluation (Table19.1)
Lipoaspirate sample was analyzed with mechanical method,
enzymatic method, and migration method.
The summary of the cell count and viability result is
shown in the diagram in Table19.2.
268
16000000
Number of SVF
Mechanical Manipulation Enzymatic Manipulation
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Table 19.1 Study evaluation
Method Purpose
Cell viability count analysis
(Tryphan blue staining)
FACS Phenotype analysis of ASC cells will by the following markers:
Immunohistochemistry Histological analysis of harvested lipoaspirate fat
Immunouorescence (optional) Identication of ASC cells with specic markers; the transcription factors Nanog and Oct4
RT-PCR analysis (optional) Gene expression analysis of vascular endothelial growth factor (VEGF-A), CD31, and von-Willebrand
Proliferation assay (XTT) Cell proliferation assessment in ASC cultured cells
Table 19.2 Summary of cell count
Counting the viable SVF cells from the lipoaspirate
CD34, CD73, CD90, CD105—positive cell surface markers, support adipose tissue growth
CD45—negative marker
factor (vWF) in the ASCs to conrm adipose tissue origin
14000000
12000000
10000000
A. Di Giuseppe and F. Giovagnoli
No. of SVF cells 87×10
SVF cell viability (%) 97% 98%
No. of ASC cells 1×10
19.4 Skin Tightening Benets
In addition to achieving effective lipolysis, the thermal
energy generated by the 1470nm diode laser contracts existing collagen and elastin bers and stimulates the formation
of new collagen for rmer, tighter looking skin. This is particularly important for delicate areas such as the face and
neck as well as for areas of cellulite. In effect, LipoLife targets cellulite precisely at its source within the underlying
structural tissue. Laser energy is directed beneath the skin,
separating the skin from adipose tissue, effectively breaking
up pockets of cellulite and restructuring the skin for a
smoother appearance.
cells per 1ml
8000000
6000000
4000000
2000000
0
Mechanical Enzymatic
6
6
9.4×10
1.2×10
6
6
19.5 Face Tightening Lipotight Cannula
In addition to the skin tightening benets, it offers a dedicated cannula with a at multiuse laser ber, designed exclusively for skin tightening of the face and neck. Laser energy
is delivered directly underneath the skin above the hypodermis to treat areas of skin laxity such as nasolabial folds,
jowls, and neck. The skin tightening cannula may also be
used for post-facelift touchups including addressing any
asymmetry or loose skin (Fig.19.5).
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Fig. 19.5 Lipotight™ cannula (Courtesy of Alma Lasers, ©2022
BeautiFillTM by LipoLife, All Rights Reserved)
269
target temperature is reached, achieving precise, uniform
treatment. The sensor provides instant temperature feedback
allowing the system to deliver the appropriate level of laser
energy to the tissue while maximizing procedure safety
Intuitive software allows you to dene a maximum temperature limit for the procedure. If subdermal temperature
exceeds the limit, the system will automatically stop, preventing thermal tissue damage. LipoSenseTM temperature
control enables you to perform precise body contouring with
greater efciency and safer results.
I have utilized this new system in 45 cases in 2020: face
and neck tightening, gynecomastia, abdomen, anks and
buttocks shaping, and fat transfer to breast and buttocks and
secondary correction of post-liposuction defects.
My comments to my initial experience with this new
device are positive as clinical results in terms of skin
tightening (which is superior to any other system tried before,
especially in the neck area).
The second excellent goal achieved by this device is the
high-quality fat ready for transfer, with a fast integrated system, and an excellent long-term survival rate.
Fig. 19.6 Radial ber integrated into a Mercedes perforated-tip cannula which emits energy circumferentially in a 360° pattern (Courtesy
of Alma Lasers, ©2022 BeautiFillTM by LipoLife, All Rights Reserved)
19.6 Skin-Safe Unique Angel™ Emitting
Fiber
It is a radial ber integrated into a Mercedes perforated-tip
cannula that emits energy circumferentially in a 360° pattern. Radial lasing is a low-power density approach with
multiple benets including minimizing the risk of burns, distributing energy evenly throughout the treatment area,
removing fat cells more quickly, and covering greater tissue
area, allowing for faster treatment speed. The ber’s radial
emission pattern allows for safe, homogenous, and more efcient skin tightening during the procedure (Fig.19.6).
19.7 Liposense™ Temperature Control
LipoLife features a temperature-sensing cannula that continuous lymonitors subdermal temperatures during laserassisted lipolysis, body contouring, and small area
procedures. Laser energy is delivered to the tissue until the
19.8 Clinical Cases
19.8.1 Banana Fold Deformity: Treatment
The so-called “banana fold deformity” is a double plication
of the subgluteal fold following an improperly treated outer
thigh and subgluteal areas. It is caused by multiple factors:
breaking the vertical bers of the infragluteal fold, residual
fat of the subgluteal fold, heavy residual trocanter, and heavy
inner buttocks.
Treatment of the area is quite a complicated issue which
rst needs a full understanding of the specic problem of the
area.
In the case presented (Fig.19.7) in Fig.19.7a, it is noticeable the heaviness of the outer trochanter, due to insufcient
removal in the rst stage. Also the subgluteal fold appears
heavy and not smooth enough according to the remaining
thigh-buttock area.
Treatment was performed with VASER 2.9mm probe, 2
rings, after tumescent inltration, with power reduced to
60% of total. Gentle and careful emulsication of fat in the
supercial fat layer was performed with reduced power, in
order to thin the subgluteal ap. Also the outer thigh (trochanter) was treated in a similar way (Fig. 19.7b surgical
plan) [4].
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