Liposuction, lipofilling and body contouring

Hi, this next section covers liposuction, lipophilling and body contouring, so let's begin. What are the layers of subcutaneous fat? There are three layers of subcutaneous fat, the apical layer, the mantle layer and the deep layer. What is the result of injury to the apical fat layer? The apical fat layer is the layer that surrounds sweat glands and hair follicles. Injury to the slayer will lead to seroma, erythema, pigment changes and possibly even skin the creases. What is the characteristics of the mantle fat layer? Within the mantle fat layer, the fat is columnella fat between vertical fibroestroma, where is the mantle fat layer absent? There are four anatomical sites where there is no mantle fat layer. These include the penis, the eyelids, the nail bed and the dorsum and the nose. Which is the target layer for liposuction? The ideal fat layer to be excised during liposuction is the deep layer. How does male and female fat anatomy vary around the hips and flanks? One of the key differences in anatomy is the difference at the zones of adherence, which connect the superficial facial system to the deeper muscle fascia and this should not be breached during liposuction. In males, the adherence is along the iliac crest. In females, it is inferior to the iliac crest, so there is fat over the crest which can be liposuction. What is the significance about the subcutaneous fat below the knees? Interestingly, there is no deep layer of fat beneath the knees. True or false? Fat cell number is constant from puberty. False, this is a common misconception. The stem cells in fact can actually be recruited to form new adipocytes. What are the key examination findings when assessing a patient for liposuction? The key features to assess are the distribution of the fat, any existing hernias, any skin demonstrating podorange, because liposuction may worsen this appearance and then the skin elasticity because the patient has low elasticity is likely to have more redundancy post liposuction. What are the main reasons for liposuction dissatisfaction? Are you why are patients unhappy with their liposuction? It is usually due to asymmetry or insufficient or excess fat removal. Along with that is possible to get visible ridges or pitting, rippling and troublesome scars and finally skin excess. How long after surgery should patients wear compression garments? Patients should wear compression garments for 6 weeks. How long does it take for the swelling to completely settle down? It can take up to 6 months for the swelling to settle down. How long post up until a patient can return to normal activity? Patients can return to normal activity after liposuction after 4 weeks. What are the early liposuction complications? The early liposuction complications are saroma, infection, contoria regularities, piz and this may be a fat embellish and it can be fatal, liglicane toxicity, perforation of viscera, bleeding, burns and friction injuries, severe infection including neck fascia or toxic shock syndrome and sensory changes. What are the late complications? The late complications include persistent contoriaeularity and pigment change. What's the difference in wet, super wet and tumestant liposuction? Wet, which was originally used in the 80s, uses 2-300 ml of infiltrate infusion per area to be aspirated. Adrenaline is added and it reduced the blood loss by around 30%. Tumessant uses a 3-1 ratio, so 3 ml of infiltrate is used for 1 ml of fat to be removed. This reduced blood loss to less than 1% of the aspirate. And super wet, this is a 1-1 ratio. This is the 1 ml of aspirate for each meal of plant. 1 ml of infiltrate for each meal of plant aspirate. This reduced the fluid need but actually still achieves similar hemostasis. What are the wetting solutions for liposuction? The two commonly used wetting solutions are Klein solution, which is a liter of normal saline, plus 500 to a gram of lignicane, plus 0.65 mlg of adrenaline, plus 10 mechs, so MEQ's per liter of sodium bicarbonate. The other solution is huntstead solution. So this is a liter of ringer's lactate, plus 500 mlg of lignicane, and 1 mlg of adrenaline. So it's Klein's and Huntstead solutions. With dilute local anaesthetic within the wetting solution, how much can be given? 35 mlg per kilogram. How is the harvest of mantle fat different? You plan to take mantle fat, then a smaller cannular is used than deep fat, and it is placed pointing downwards away from the apical layer. What are the advantages of ultrasound-assisted liposuction? Ultrasound-assisted liposuction is more effective in fibres areas, for example the upper back, or in gynecomestia, and it may even lead to more skin contraction. Again, moving on to fat grafting. What is fat grafting dependent on? Fat grafting is dependent on a concept of pre-adapocyte proliferation, which cells can adipose-derived stem cells transform into. Adipose-derived stem cells can transform into bone, muscle, cartilage, blood vessels, and adipose-derived stem cells. Huga describes three zones of blood supply to the abdominal wall skin. In zone 1, it goes from the ziffoid to the pubis between the linear semilunaris, and the blood supply comes from the deep inferior gastric arteries and the superior epigastric vessels. In zone 2, it is a line from asus to asus, and it is the zone below this line. And the blood supply comes from the superficial circumflex aliac, and the superficial external pedundal vessels. And then finally, zone 3, which are lateral to the linear semilunaris, and they are from the intercostal and subcostal and lumbar perforators. Now does a dissection differ for a lipopodomaloplasty. In a lipopodomaloplasty, undermining is limited to the infra-unbilical region, and then narrow strips are also taken either side of the envelope. How is the high lateral tension at abdominal plasty different to the standard abdominal plasty? When the high abdominal plasty, the maximum tension lines are lateral, not central, and this flattens out the abdomen and lifts the thighs. What are markings for an upper back lift? The upper back lift, composed of two transverse lines, centered on the brow line. What are the markings for break-your-plasters? For a break-your-plasty, the patient sits in an upright position with the arms of ducted to 90 degrees, and accesses them marked between the midpoint of the arm and a midpoint between the electron and the medial epiconda. The proximal extent of the incision follows the skin excess and can end up in the arm, exhilar, or even lateral chest, and it tends to follow the line of the posterior axillary fold. Where is the medial cutaneous nerve of the arm? Medial cutaneous nerve of the arm is on the medial side of the deep fascia. What are the markings for a thigh lift? In the standard lipofilling technique, how much dilute local anaesthetic is used? One mill of dilute local anaesthetic with adrenaline for every mill of fat. What size of canola is used? A three millimetre canola is usually used. How long is the fat centrifuge for? The fat is centrifuge for three minutes at 3,000 rpm. How else can the aspirate be refined? The other techniques for refining the aspirate include sedimentation here you leave the aspirate to stand for an hour, filtration, towel pressing and towel pressing the aspirate is placed on a sterile cotton towel which absorbs the blood. The no touch technique where fat is taken from an exaggerated limb and injected straight back in or washing and this is done with 5% glucose, nor will saline or sterile water. Moving on, body contouring. Patients who have had malabsorption need which supplements. Patients who have had malabsorption and by that I mean kind of any pretty much bariatric surgery will need supplements for vitamin B1 which is thymine, vitamin B9 which is folate and vitamin B12 which is cabalamine in addition to iron and calcium. If a patient has a mons pubistosis, where should the lower incision be marked? The lower incision should be 5 to 7 centimeters above the vulval crease or root of the penis. Which nerve is at risk in a standard incision to the asus? So in the standard domnaplasty incision it goes up to the asus, it is the lateral femoral cutaneous nerve. What is the umbilical blood supply? The umbil has 4 blood supplies. The subdomal plexus is usually a direct branch from the DIA which is a deep inferior epigastric artery. The ligamentum terrors of the liver and is usually a median umbilical ligament. What is the blood supply to the abdominal wall skin? For thylif marking the patient stands up. The superior edge is midway point between the labia-majora or scrotum in the thai and the marking is extended posteriorly around the issue of tuberosity into the gluteal crease. The maximum width is decided by a skin pinch with the hip flexed and abducted. In non-massive weight loss it is possible just to do a longitudinal thylift. What is an upper body lift? An upper body lift comprises of 4 operations, a reversible domnaplasty, an upper back lift, reshaping or augmenting the breasts and a brachial plasty. What is a lower body lift? A lower body lift is an abdominal plasty, a medial thylift and a lower back lift.