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 Dr. Mangubat |
Patients who underwent liposuction alone when they really needed abdominoplasty to remove excess skin account for many of the poor cosmetic outcomes, whereas the presence of contour irregularities (lumps, bumps, divots, ridges) is the most common cosmetic complication seen after liposuction procedures, Dr. Mangubat says.
In all cases, good tumescent anesthesia, attention to detail and adequate experience are critical to minimize poor results. In addition, surgeons who are early in their liposuction experience should focus on treating only smaller anatomic areas and removing smaller volumes of fat using microcannulas. A 37-year-old female patient who had undergone liposuction of the thighs (left) and subsequently presented to Dr. Mangubat with significant cosmetic defects. Repair results are shown (right) six months post-revision liposuction using a fat disruptor in the scarred areas and fat transfer using a closed-syringe technique adding platelet-rich plasma to the fat grafts. (Photos credit: E. Antonio Mangubat, M.D.) |
"I have found the fat-disruption technique to be a valuable adjunct for training young surgeons in our fellowship program, because it shortens the learning curve to achieving good outcomes, and I have received very positive feedback from other surgeons who have used it around the world," Dr. Mangubat says.
COMBATING IRREGULARITIES When contour irregularities occur, their appearance can be improved, although they usually cannot be totally eliminated to achieve a perfectly smooth surface. Intervention involves a multiple-step process.
After marking the depressed areas and injecting tumescent anesthetic, the surgeon can use the fat-disrupter cannula to break up the fat and fibrosis. This will result in an almost-immediate improvement of the defects, but not full correction. Further smoothing is accomplished with fat-shifting and fat-transfer techniques.
For fat shifting, after disrupting the fat in both the elevated and depressed areas, the surgeon can try to relocate the fat by applying mechanical pressure on elevated areas, forcing the freed-up fat to ooze into the depressed regions. However, fat transfer offers greater control for contouring and therefore is a more reliable method for achieving good results, Dr. Mangubat says.
To perform fat transfer, after disrupting the fat and fibrosis into an emulsified layer, the surgeon uses a small fat-harvesting cannula to remove excess fat from the elevated areas. The fat is harvested into a syringe, processed for transfer and injected into the depressed areas.
"If the fat and fibrosis was adequately disrupted, the depressions will rise up nicely in response to the fat injection. Otherwise, it may be necessary to reintroduce the fat disrupter to release more of the scarring, or in some cases to free it by cutting with scissors," Dr. Mangubat says.
He says any intervention to address irregularities should not be attempted for at least three months in order to allow for some healing and scar-tissue maturation. If the patient is willing, he says, waiting six months is even better.
