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  • Advanced techniques in liposuction and fat transfer
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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 
    have the right to republish it, in whole or part, in any publication of which they 
    are the author, and to make other personal use of the work. Any republication,
    referencing or personal use of the work must explicitly identify the original source.

    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 

    Contents 

    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 


    Preface 

    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, 
    Bulgaria 
    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
    organ.
    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, 
    Argentina 
    *
    1.2 Gluteal Ptosis
    (1)

    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 

    (1) 
    (Figure 1). 
    Degree 0 

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