Surgical Aesthetics

JAN-FEB 2014

For plastic surgery and cosmetic surgery trends, techniques and equipment, plastic and cosmetic surgeons turn to Surgical Aesthetics for the latest on breast augmentation, liposuction, rhinoplasty and more.

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| Shaping the Future | "Liposuction can be very gentle and graceful," says David Amron, MD, a cosmetic surgeon who specializes in liposuction and medical director of Expert Liposuction in Beverly Hills, California. "It's about creating harmony, balance and proper contours." When it comes to equipment, many surgeons— like Jeffrey Hartog, MD, director of Bougainvillea Clinique and the LaserSkin Institute, Winter Park Florida—work with multiple technologies in their practices. These include: "Traditional, non-energybased liposuction techniques, all of which use some sort of tumescent solution and a device that simply sucks out the fat; energy-based systems, which use laser or ultrasonic energy to destroy or break down the fat in a two-phase process; and water-based systems, which use jets of water to simultaneously dislodge and suck out fat," says Dr. Hartog. Shreveport, Louisiana, puts it this way: "PAL makes SAL easier and quicker." Dr. Wall has developed a technique called SAFELipo that he performs using PAL technology. SAFE stands for fat Separation, fat Aspiration, and Fat Equalization; the procedure is performed with a smaller-sized cannula and involves both fat removal and fat grafting to achieve optimal contour. "I get much better and more dramatic results at minimal risk of creating a contour deformity compared to the other techniques I've used in the past," says Dr. Wall, whose procedure does not generate heat. "SAFELipo allows me to perform a dramatic and smooth liposuction procedure with fat grafting to redistribute as necessary, giving me a truly comprehensive body contouring method." Dr. Wall has found that SAFELipo is "ideal for all patients in all areas. I just can't get the kinds of results my patients are looking for with anything else." New techniques and technologies are making liposuction a gentler procedure for patients and surgeons. Liposuction Basics Suction-assisted liposuction, or SAL, is the traditional technique that relies on a cannula and a suction device to pull fat cells out of the body. Power-assisted liposuction, or PAL, relies upon a vibrating cannula. Also referred to as "tickle" lopsuction because of its back-and-forth movement developed to disrupt fat more efficiently, PAL "results in less bruising and swelling and a more rapid recovery," says Adam Schaffner, MD, a plastic and reconstructive surgeon in New York City. Simeon Wall Jr., MD, a plastic surgeon in 14 Surgical Aesthetics ❘ January/February 2014 While Dr. Wall isn't a fan of thermal techniques, other physicians have embraced them. "Laser lipolysis is commonly used as an adjunct to tumescent liposuction, where the laser is used subcutaneously, first to de-bulk or liquefy adipose tissue," says Jason McBean, MD, a dermatologist in Fairfield, Connecticut. "Subsequently, a suction micro-cannula is used to remove the liquefied fat." One benefit of laser lipolysis is that it can eliminate the need for any suction to remove fat in smaller locations of the body, such as the submental region, according to Dr. McBean. Another benefit is that laser energy can be used after fat removal for additional tissue coagulation, collagen stimulation and skin tightening. "You don't get that benefit with traditional liposuction," says Saul Lahijani, MD, a plastic surgeon based in Beverly Hills, California. "And people who need treatment on small areas can bounce back and return to work within a day or two." There are several laser-assisted systems currently available. Both Dr. Lahijani and Dr. McBean work with the Cynosure SmartLipo ( The downside to laser lipolysis is that it can cause side effects, including increased operative time, modest skin tightening effect, and the potential for heat-related injury—in addition to the side effects associated with the traditional tumescent liposuction technique, according to Dr. McBean. © ISTOCKPHOTO.COM Adding Energy

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