Semi Invasive Methods of Fat

Reduction(VASER & LaserLipo)

Social Trends in Liposculpture Direct to Consumer Promotion

Reality TV shows and mainstream exposure (Extreme Makeover, Dr. 90210, Nip/Tuck)

Physicians advertising branded procedures Celebrity patients openly discussing procedures

Development of non-invasive and minimally invasive procedures In-office, “lunchtime procedures” are less intimidating Less downtime allows patients to get back to work and family faster

Baby Boomers reaching middle age Recapture youth Stay competitive in the job market

Immediate access to information Google/ web research Educational programming YouTube/ online videos Blogs/ Plastic Surgery Chat Rooms

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Medical Trends in LiposculptureMove towards minimally invasive (small

incisions, less destructive) and non-invasive technologies (no incisions) Minimal or no patient downtime – “lunchtime” procedures Minimal or no post-procedure side effects (pain, bruising,

swelling, etc.) Smaller instrumentation

Expectation for technologies to offer a broader range of applications Small to large volume removal (increasingly obese population) Sculpting as opposed to debulking Improved skin tone/ tightening Cellulite reduction

Growing interest in fat transfer procedures Remove fat from one area of the body and use it to enhance

another area Alternative to fillers in small areas like the face More cost effective in large volume transfer cases (buttocks) More natural results (breast augmentation) Correction of irregularities

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Semi Invasive Methods of Fat Reduction

LiposuctionLaserVASERRadiofrequencyWater Jet

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LiposuctionDujarrier in 1921 : Uterine curette --

AmputationNext 50 Years : Dermolipectomies -- Long

scarsSchrudde in 1972 : Delicate curetteFischer in 1976 : Guided scalpel

(undermining), power blades (mincing) and suction

Kesselring in 1978 : Sharp curette with suction

Illouz in 1977 : Blunt cannula with powerful suction

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Liposuction1- Blunt cannula (6-10mm.)

attached to a high power suction machine

2- Tunnels (no undermining)

3- Deep fat

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Liposuction

MODIFICATIONS & ADVANCESTumescent LiposuctionSyringes and Fine CannulasSuperficial LiposuctionLiposculptureExternal Ultrasound and External Laser Power-Assisted Liposuction (PAL)Ultrasonic-Assisted Lipoplasty (UAL)Laser Lipolysis

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Liposuction

Illouz 1983 : Wet technique (hyaluronidase in sterile water for hydrodissection)

Hetter 1984 : Diluted epinephrine(for vasoconstriction. Previously prohibited due to fluothane interaction)

Klein 1987 , Hunstad 1992 : Tumescent large volume 1:1 to 3:1 saline or lactated Ringer’s diluted lidocaine (800-1600mg/L) diluted epinephrine (1ml 1:1000 per litre) diluted sodium bicarbonate (5-10mls 8.4% per litre)

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Advantages of Tumescent Liposuction

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• ADVANTAGES1- Less bleeding2- Local anesthesia3- Easy aspiration

• DISADVANTAGES1- Volume overload2- Lidocaine toxicity (over 60

mg/kg)3- Epinephrine toxicity4- Opened the safety boundaries

Infusion of Tumescent Anaesthesia

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The fatty layer is infused with tumescent fluid.

Laser Lipolysis“LASER”

L lightA amplification S stimulated E emission R radiation

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Laser LipolysisMechanisms of Tissue Interaction

Photothermal

Photomechanical

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Laser LipolysisDressel 1990 : introduced the technique – Nd.:YAGApfelberg 1994 : multicenter study – Nd.:YAGCook 1997 : CO2 laser -- submental lipectomy

(fat vaporization and skin tightening)

Popularised by DEKA with the introduction of the SmartLipo Nd:YAG 1064nmSince then:

Pharon Osyris (980nm Diode) Fotona Nd:YAG (1064nm) Cynosure MPX (1064 and 1320nm blended)

All share same mode of action (photomechanical / photothermal destruction of the adipocytes)

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Laser LipolysisLaser Machine :

Continuous or Quasi Continuous Nd.:YAG Laser (1064 nm.) Train of pulses (100 microsec. Each) and a frequency of 50 Hz Power of 10-30 W

Laser Fiber : 300 - 1000 micron.Cannulas : of various lengths (15 – 30 cm.)

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Laser Lipolysis - Technique

Percutaneous introduction of the cannula and fiber Laser is activated and gentle foreword / backward motion in different levels Location monitored by the aiming beam, skin temperature by the other hand End point --- softening of the area and the total number of joules

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Laser Lipolysis - Aspiration

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• Laser assisted liposuction• Fine cannula (3 - 6 mm.), gentle removal of liquefied

fat

Advantages of Laser LipolysisDestruction of adipocytesHaemostasisInterruption of fibrous bandsCollagen regeneration

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Disadvantages of Laser LipolysisLASER: temperature in fat can rise above the

tissue damage threshold in less than 50 milliseconds; temperatures can reach boiling point within 0.1 seconds.

LASER: induces heat which cannot dissipate easily and has the potential to cause burns.Latest laser systems such as the Cynosure SmartLipo

MPX Reduced risk by accelerometer in the handpiece

LASER: highly operator dependent for anything other than small areas

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VASER LIPOLYSIS

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The VASER® Lipolysis

Uses ultrasound energy delivered via a titanium probe

Fat is selectively fragmented while conserving other tissues like nerves, blood vessels and connective tissue

Proven clinical effectiveness and safety (Over 100,000 procedures performed with an outstanding safety profile)

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How VASER® Lipolipolysis Works

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How VASER® Lipo Works

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VASER - Ultrasound and BubblesCAVITATION the

ultrasound energy causes expansion and contraction of the air bubbles in the tumescent liquid.

The collapse of the bubles produces a thermomechanical disruption of the adipose tissue.

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VASER - Ultrasound Effects

Photomicrographs of fat cells before and after ultrasound show increasing intra-cellular space, but not cell wall disruption

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LINA VALERO M.D.

Fat Cell

Fat Cell

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VASER - Emulsifying FatLoose fat forms and

emulsion with the tumescent fluid through acoustic streaming.

Acoustic streaming around the probe causes powerful mixing of the fat and fluid.

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LASER vs VASERSimilarities:

Both are minimally invasive procedure which can be carried out as a day case.

require tumescent anaesthesiarequire a suction component to the treatmentrequire compression garments post operatively

LASER Advantages:Sub dermal collagen stimulationSuperior haemostasis (claimed!!!)

VASER Advantages:No disruption of the fibrous tissue septaeHigh tissue specificity

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Tissue SelectivityThe VASER® System spares the tissue matrix, removing primarily the fatty component, producing smooth, predictable results.

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Post Aspiration

Note that connective tissue is left intact after adipose tissue has been removed

Post Emulsification

Fat is broken apart and emulsified into the infusion fluid

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Before & After Photos

Before After

Paul Loverme, MD

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Before After

Before & After Photos

Onelio Garcia, MD

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Before After

Before & After Photos

Alberto Di Giuseppe, MD

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Before & After Photos

Before After

George Commons, MD

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Before After

Before & After Photos

George Commons, MD

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Before & After Photos

Before After

Newton Moscoe, MD

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Before & After Photos

Before After

Mokhtar Asaadi, MD

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Before & After Photos

Michael Nagy, MD

Before After

Before After

VASER® vs Laser Lipo ResultsIn a recent customer survey, doctors reported the

following VASER Technology benefits: quicker results than Laser fast patient recovery less pain medication required minimal bruising reduced need for re-treatments smooth, predictable results skin tightening increased precision reduced physician fatigue

Numerous clinical studies report high efficacy and safety in a wide array of body contouring applications

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Thank You for Listening!(if you have been!)

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