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Key Points
- Liposuction via device offers possibility of producing standardized negative pressure applied to fat cells upon aspiration.
- There is no scientific data that conclusively supports idea that mixing stem cells with fat aspirate will help aspirated fat cells survive or be an advantage in achieving superior fat grafting results.
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31-year-old female patient before (left photos in panels A, B and C) and nine months following (right photos in panels A, B and C) mastopexy, fat grafting and tummy tuck procedures. All photos credit: Kamran Khoobehi, M.D., F.A.C.S.
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FAT ASPIRATION using a syringe has not only been a long-accepted technique of harvesting autologous fat in fat grafting procedures, but has also been widely viewed as atraumatic to the patient's tissues — including the aspirated fat tissue itself. A recent as-yet unpublished study, presented at the recent 54th Annual Meeting of the Plastic Surgery Research Council, shows that the hand-held syringe technique is not as atraumatic as once believed and that an alternate method using a liposuction device to harvest the fat may, in fact, be more advantageous in maintaining fat tissue viability.
A PREMISE IS 'NEEDLED' "The syringe is the most popular technique used in fat grafting procedures worldwide and most plastic surgeons believe and accept that the technique is gentle and does not cause any fat cell destruction when aspirating," study investigator Kamran Khoobehi, M.D., F.A.C.S., clinical associate professor of surgery, Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, tells
Cosmetic Surgery Times
. "However, the negative pressure produced during aspiration can vary greatly from surgeon to surgeon and the problem is that there is no consistency here, which can make it difficult to guarantee reproducible and constant results."
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Dr. Khoobehi
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Dr. Khoobehi put this long-accepted premise to the test and conducted a study quantifying the negative pressures generated in Luer-Lock syringes and compared them to those generated from a conventional liposuction machine. Negative pressures were measured in vitro and in situ within 1, 3, 5, 10, 30 and 60 cc Luer-Lock syringes, as well as with conventional liposuction machine at -10, -15 and -30 inches of Hg. To evaluate the viability of the adipocytes harvested in both procedures, the lipoaspirate samples from the in situ lipoaspiration were analyzed for LDH, triglyceride and G3PD assays and were stained with fluorescent dyes for imaging using scanning electron and confocal laser electron microscopy.
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Dr. Coleman
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Results showed that the negative pressure generated by the liposuction device at low setting was less than that generated by 10 cc and 60 cc syringes. Furthermore, Dr. Khoobehi found that there was much less LDH and triglycerides in the serum at the lower negative pressures when using the liposuction device, according to the results of the biochemical assays and microscopic analyses. Though these parameters are nonspecific for fat cell damage, Dr. Khoobehi contends that if their levels are elevated in the serum, this is an indication of increased adipocyte damage. He adds that the G3PD assay is the most specific for adult, intact living adipocytes, and assay results showed that the enzyme uptake was higher with the liposuction-assisted aspiration technique, indicating more intact adipocytes.
"We found that, compared to the syringe technique, the liposuction device could not only harvest the fat much faster, but also proved to be the less traumatic and a therefore gentler technique, which is in stark contrast to the current conventional wisdom," Dr. Khoobehi explains.
