E. Antonio Mangubat, MD Seattle, WA Fat Disruption : A Useful Adjunct To Liposuction Surgery by.

E. Antonio Mangubat, MDSeattle, WA

Fat Disruption : A Useful Adjunct To Liposuction Surgery

by

Fat Disruption Concept

Not a new idea Chopped up fat is easier to suck out UAL (Ultrasound Assisted

Liposuction)– Fat disruption before liposuction– Great in tough areas (scar,

gynecomastia)– Made aspiration easier– Cost

Fat Disruption Concept

Blugerman liposhifting instrument– Introduced in 2002 Liposuction World Congress– Designed to create mini fat grafts internally– in vivo fat grafts manually shifted to fill defect– Solid core cannula 3-4mm diameter

Current concept– Mechanical disruption of fat infrastructure– Not intended for fat grafting– Detach the fat from its stroma before suction– Uses much larger cannulas: 5-6mm typical

Advantage of Fat Disruption

SPEED – Rapid volume reduction– Aspiration speeds up to 1000ml/min– Large cannulas do not cause irregularities

Smooth results regardless of cannula size– No suction applied during disruption– Even superficial passes do not leave divots

Especially useful for:– Large volume reduction– Beginning liposuction surgeons

Prototype Fat Disruptor Instrument and technique

Large sizes: 5 & 6mm empirically work the best

Hollow cannulas– Relieve tumescent pressure– Retains leaking aspirate in hose; less mess

Fat disruption surface– Not designed for fat grafting– Longer, larger holes, faster– Push and pull disruption more efficient

Fat Disruption Technique

Large tumescent volume No suction used in disruption

phase No divots, no ridges, no

depressions Different than pre-tunneling

Technical Notes

Intense “super” tumescence - high hydrostatic pressure– Forced fluid dispersion– Hydrostatic capillary compression– Bloodless

Staged tumescence – infuse in staged areas e.g.– Front the Back– Upper body then lower body– Vasoconstriction last only ~90min – Speed critical for larger volumes

Technical Notes

Tumescent Solutions Compositions

Lidocaine = .048% (50ml 1% lidocaine in 1L) Epinephrine = 1:1,000,000 (1ml 1:1000 epi

in 1L) Max dose 40-50mg/Kg Addition tumescence above the max

lidocaine dosages had no lidocaine. Only:1:1,000,000 epi in LRS

Large fat disruption surface Intense tumescence Note firm tissue turgor

No suction applied yet Start deep next to muscle 5-6 minutes, loss of

resistance

Able to get close to surface No surface defects Begin 60 secs of suction

Large 6mm cannula Note free flow of aspirate 1000ml in 60 seconds!

Greater Cosmetic SafetyUseful In Defects Prone Areas

High Resistance Areas

Gynecomastia Epigastrium Upper back Revision liposuction

Greater Cosmetic SafetyFor Experience Surgeons

SPEED! Significantly shorter

procedures Greater time for refinement Cost-effectiveness

Greater Cosmetic SafetyFor Beginning Surgeons

Much shorter learning curve Reproducibly smoother

results SPEED! Cost effective

Fat Disruption Summary

Great Speed & Smoother Results

Shorter procedure times Less blood loss Less anesthesia Less expense

Greater Patient Safety

E. Antonio Mangubat, MDSeattle, WA

USA

Thank You!