2011 world congress female & male genital cosmetic surgery

2011 World Congress

Female & MaleGenital Cosmetic Surgery

Liposuction& Autologous Fat Transfer

Marco A. Pelosi, III, MDFACOG, FACS, FICS, FAACS

CME Disclosure The Faculty reports no significant financial

relationships or other relationships with the

manufacturers of any commercial products

and/or providers of commercial services

discussed in this educational presentation and

with any commercial supporters of this activity.

Furthermore, no off-label or investigational uses

of products will be discussed without explicit

notification thereof.

Terminology

• Lipolysis• Lipoplasty• Liposuction• Liposculpture• Suction lipectomy• Suction-assisted lipectomy (SAL)

Terminology

• Small-volume (<100 mL fat)• Medium-volume (<1500 mL fat)• Large-volume (<4000 fat mL/ 5000 mL total)• Megaliposuction– CA Speier Bill: >5000 mL “unprofessional”– FL: 4000 mL limit

Terminology

Dry = nothing infiltratedWet= saline/hyaluronidase

Superwet Solution

1,000 ml

10 ml

1 ml

25 ml

Tumescent Local Anesthesia

1,000 ml

10 ml

1 ml

100 ml

Generally Accepted Lidocaine Limits

• Intravenous: 7 mg/Kg• Tumescent w/o liposuction: 25 mg/Kg• Tumescent w/ liposuction: 45 – 55 mg/Kg– Thin = 45– Avg = 50– Heavy = 55

• Florida Law: cannot exceed 50 mg/Kg

Terminology

• Manual Liposuction• Power-Assisted Liposuction• Ultrasound-Assisted Liposuction (UAL)– Internal– External

• Laser-Assisted Liposuction– Internal: “Hot” laser– External: “Cold” laser

• Disruption-Assisted Liposuction

The Tools

Aspiration Equipment

• Suction pump -100 kPa max• Syringe for small volume

Liposuction Cannulas

Fat Transfer Cannulas

LipsType 3

NLFV-Dissector

Type 1

Non LinesType 2

HandsType 2

ButtocksType 2

LabiaType 2

Augmentation Labia Majoraplasty

Typical Process

• Patient is consented, marked & photographed

• NIBP, ECG, SpO2 monitors are placed• Hep-lok is inserted• Knee-high SCDs applied

Punch or scalpel

Always Parallel

Reverse Jackknife PostionAbdominal Lipo

Long strokes

Multi-Directional Contouring

Nondominant Hand Control

Nondominant Hand Control

Blend margins

Avoid superfical layer

5mm No-Suck Zone

EBL = 5mL/liter of total aspirate

Regional Applications

High Definition Liposuction

Etching• Pectoral• Abdominal• Manual, Laser, Vaser• Ideal < 15% Body Fat

Pectoral Etching

Access

Abdominal Etching

Leaner = Better Result

Flanks & Back Strategies

Arms Liposuction

Access: Post

Medial

Lateral

Legs Liposuction

• Outer Thighs• Inner Thighs• Posterior Thighs• Anterior Thighs• Knees• Calves & Ankles

Access

Inner Thighs & Knees

Breast Liposuction

9 months

F cup D cup

Fat Transfer Techniques

2.5 - 3mm

1-2 L

Harvest Setup

11

2

3 3

45

Frompatient

Topump

Gravity x 15:00or centrifuge

discard

Light Infiltration of Recipient Site

600 cc

500ccsuperficial & deep

500cc

200cc

Augmentation Mammaplasty

Peri-glandular

Augmentation Labia Majoraplasty

LVR + Augmentation

Questions

End

mpelosi3@gmail.com

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