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Advanced techniques in liposuction and fat transfer

Advanced Techniques in Liposuction and Fat Transfer
Edited by Nikolay Serdev

Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia

Copyright © 2011 InTech
All chapters are Open Access articles distributed under the Creative Commons 
Non Commercial Share Alike Attribution 3.0 license, which permits to copy, 
distribute, transmit, and adapt the work in any medium, so long as the original 
work is properly cited. After this work has been published by InTech, authors 
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are the author, and to make other personal use of the work. Any republication,
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Statements and opinions expressed in the chapters are these of the individual contributors
and not necessarily those of the editors or publisher. No responsibility is accepted 
for the accuracy of information contained in the published articles. The publisher 
assumes no responsibility for any damage or injury to persons or property arising out 
of the use of any materials, instructions, methods or ideas contained in the book.

Publishing Process Manager Masa Vidovic
Technical Editor Teodora Smiljanic
Cover Designer Jan Hyrat
Image Copyright Benko Zsolt, 2010. Used under license from Shutterstock.com

First published August, 2011
Printed in Croatia

A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechweb.org 

Advanced Techniques in Liposuction and Fat Transfer, Edited by Nikolay Serdev 
p. cm. 
ISBN 978-953-307-668-3 


Preface IX 
Part 1 Liposuction – History and Techniques 1 
Chapter 1 Application of the Liposuction Techniques
and Principles in Specific Body Areas and Pathologies 3
Diego Schavelzon, Louis Habbema, Stefan Rapprich, 
Peter Lisborg , Guillermo Blugerman, Jorge A. D’Angelo,
Andrea Markowsky, Javier Soto, Rodrigo Moreno and Maria Siguen 
Chapter 2 Liposuction and Fat Graft to Enhance Facial
Contour in Reconstructive Surgery - Nine Years
Experience with the use of Peridural Cannula 35
Claudia Gutiérrez Gómez, Marcia Pérez Dosal
and Alexander Cardenas Mejia 
Chapter 3 Novel Liposuction Techniques for 
the Treatment of HIV-Associated Dorsocervical
Fat Pad and Parotid Hypertrophy 49
Harvey Abrams and Karen L. Herbst 
Chapter 4 Lipoplasty of the Back 63
Francisco Agullo, Sadri O. Sozer
and Humberto Palladino 
Chapter 5 Power-Assisted Liposuction (PAL) vs. Traditional
Liposuction: Quantification and Comparison
of Tissue Shrinkage and Tightening 69
Gordon H. Sasaki, Ana Tevez and Erica Lopez Ulloa 
Chapter 6 Larger Infiltration/Aspiration Volumes,
Plasma/ Subcutaneous Fluid Lidocaine Levels and
Quantitative Abdominal Tissue Accommodation
After Water-Assisted Liposuction (WAL): Comparative
Safety and Efficacy to Traditional Liposuction (TL) 81
Gordon H. Sasaki 

Chapter 7 Gynoid Lipodystrophy Treatment
and Other Advances on Laser-Assisted Liposuction 95
Alberto Goldman, Sufan Wu, Yi Sun,
Diego Schavelzon and Guillermo Blugerman 
Chapter 8 Radio-Frequency Assisted Liposuction (RFAL) 115
Guillermo Blugerman, Malcolm D. Paul, Diego Schavelzon,
R. Stephen Mulholland, Matthias Sandhoffer, Peter Lisborg,
Antonio Rusciani, Mark Divaris and Michael Kreindel 
Chapter 9 Ultrasound Assisted Liposculpture –
UAL: A Simplified Safe Body Sculpturing 
and Aesthetic Beautification Technique 135
Nikolay P. Serdev 
Part 2 Lipotransfer and Stem Cell Enriched Fat Transfer 151 
Chapter 10 Advanced Lipotransfer Techniques 153
Guillermo Blugerman, Roger Amar, Diego Schavelzon,
Marco A. Pelosi II, Marco A. Pelosi III, Javier A. Soto,
Anastasia Chomyszyn, Maurizio Podda, Andrea V. Markowsky,
Jorge A. D’Angelo and Rodrigo Moreno 
Chapter 11 Processing of Lipoaspirate Samples for
Optimal Mesenchymal Stem Cells Isolation 181
Leandra Baptista, Karina Silva,
Carolina Pedrosa and Radovan Borojevic 
Chapter 12 Stem Cell Enriched Fat Transfer 203
Maurizio Ceccarelli and J. Víctor García 
Part 3 Complications of Liposuction 219 

Chapter 13 Complications of Liposuction 221
Francisco J. Agullo, Humberto Palladino
and Sadri O. Sozer 


Liposuction is the first cosmetic procedure to change beutification surgery from open
extensive excision surgery into a more atraumatic closed one. It gave rise to the
modern understanding of minimally scarring and minimally invasive surgery and
changed the understanding and preferences of both patients and doctors. It also
became the most common procedure in cosmetic surgery world-wide, practiced by an
increased number of physicians from various specialties. The techniques of fat
grafting, closely bound with liposuction, have found widespread application and fat
stem cells seem to be changing the future of many areas in medicine. 
Training became necessary in view of the constantly changing and developing
character of medical science, and because of the progress in new devices emerging on
the market. 
Turning the pages, the reader will find a lot of information about advances, tips and
tricks, and important milestones in the development of the different methods
available, such as classic, power, ultrasound, laser and radio-frequency assisted
liposuction etc. Most useful anesthesia techniques are described and discussed, and
guidelines have been established for medical indications. Special attention is paid to
good patient selection, complications and risks. 
We have invited renowned specialists from all continents to share their valued
expertise and experience. We will never be able to thank every single person or
institution who helped in fulfilling our work. The difficult task of writing a
comprehensive book about the status and science of the most desired and most
practiced procedure in cosmetic surgery, in order to prevent dissatisfaction and
misunderstandings, was marked with hard work and continuous improvements. It is a
privilege to share our knowledge concerning contemporary advances in this area of
medicine, and thus help people change and improve their lives. It is our greatest
reward as well. 
Prof. Dr. Nikolay Serdev
National Consultant of the Ministry of Health in the Specialty of 
"Cosmetic (Aesthetic) Surgery" 2006-2008,
Medical Center "Aesthetic Surgery, Aesthetic Medicine" 11, 
1. Introduction 
Application of the Liposuction
Techniques and Principles in 
Specific Body Areas and Pathologies 
Diego Schavelzon et al.
1.1 Three dimensional gluteoplasty 
The buttocks have been a symbol of attraction, sexuality and eroticism since ancient times 
and therefore, they have an important role in defining the posterior body contour.
More and more people are talking about and understand the meaning and the role that
buttocks play in modeling and physical beauty.
The three dimensional gluteoplasty (3-DGP) is an innovative technique that allows us to
change volume, shape and firmness, not only in the buttocks but also in the adjacent regions
such as the thighs and trochanters, becoming an ideal tool to answer the frequent reasons of
consultation of our patients about this particular area of the body: 
I want to reduce the volume of my buttocks
I want to lift my buttocks...
I want to improve the shape of my buttocks.
Numerous factors conspire against an ideal buttock. 
First, the weight of the buttocks and the variations of fatty tissue component in addition to
the presence of a strong lower groove skin adhesion called subgluteal fold or inferior gluteal
groove, which is strongly influenced by the action of gravity, cause the appearance of ptosis
with subsequent buttock deformity and that of the adjacent regions. 
Other factors such as obesity, the lack of muscle activity (gluteal muscles), the aging process,
a significant decrease in weight and extreme thinness play an important role in the
development of gluteal ptosis. 
The word ptosis comes from the Greek word meaning “falling” or “fall”. From a medical
perspective refers to prolapsus or caudal displacement, outside its natural site, of a tissue or
The ophthalmologists were the first to use the term to define the upper eyelid drop, and by
analogy, over time its use became widespread. 

Louis Habbema, Stefan Rapprich, Peter Lisborg, Guillermo Blugerman, Jorge A. D’Angelo,
Andrea Markowsky, Javier Soto, Rodrigo Moreno and Maria Siguen 
Centros B&S “Excelencia en Cirugía Plástica”, Buenos Aires, Argentina
Medisch Centrum ’t Gooi, The Netherlands
Department of Dermatology, Darmstadt Hospital,Germany
PrivatKlinik Lisborg & Parner,Österreich
Universidad Nacional del Nordeste, Corrientes, Argentina, 
1.2 Gluteal Ptosis

What does gluteal ptosis mean? 
Gluteal ptosis refers to the excess skin and/ or adipose tissue of the gluteal region that
exceeds the caudal inferior gluteal groove. The progression of gluteal ptosis is usually from
medial to lateral.
What does pseudo-ptosis mean? 
(Sad or long gluteus). When the buttock support system gradually loses its strength and its
power to lift, the entire gluteus falls, and subgluteal groove descends moving distally. With
the consequent loss of natural contour and shape the buttocks have. 
It is critical to have a classification of gluteal ptosis, which serves to select the most
appropriate technique in each case.
The extension in depth and length of the subgluteal groove is a key indicator of ptosis. 
1.2.1 Gonzalez classification of gluteal ptosis
To determine the degree of ptosis the marking is done with the patient in standing position, 
with straight hips, and facing backwards. We identify the ischial tuberosity by palpation,
and from there we draw a vertical line (Line T) and a second parallel to the first one (line M)
corresponding to the midpoint of the posterior thigh 

(Figure 1). 
Degree 0 

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