Chicago-based plastic surgeon Gregory Wiener, M.D., still uses traditional liposuction and fat transfer when doing fat transfers to the face. But he says a variation to the traditional approach using the ultrasonic VASER (Valeant Pharmaceuticals) device is a better option for larger fat transfer cases, such as to the buttocks or breasts.
Dr. Wiener, who has no conflicts of interest with Valeant, says there are distinct advantages of using the VASER for specific body parts.
While providers using the VASER will start by injecting tumescent fluid just like they would with traditional liposuction, the second step differs. There’s an added step using ultrasound.
“With the VASER, rather than suctioning right away, you’re basically going to use a type of cannula at that point. And that cannula is an ultrasonic cannula, so it doesn’t suction anything. It’s basically a cannula with a tip that vibrates at a very high frequency,” Dr. Wiener says. “VASER has designed these tips with different numbers of rings on them, so, a single-ring cannula focuses the energy forward, and it’s more for tunneling. As you add more rings, the energy is focused more to the sides. So, it breaks up the fat more than just tunnels.”
You typically start down at the deep plane of fat, just above the muscle fascia, gently moving the cannula back and forth through the fat, according to Dr. Wiener.
“It’s, overall, a much gentler procedure, I believe, than liposuction. We’re just going to gently move the cannula through the tissues. And you can definitely feel the fat breaking up and falling away from the tip of that cannula as it advances through the tissue,” he says.
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The advantage, here, is that you can treat the areas more efficiently.
“I’ve removed naturally more fat this way because the energy gets into all the nooks and crannies. You’re actually not damaging connective tissue. The septae that hold the skin onto the muscle and the small capillaries and small nerves that run through the tissue incur less damage than with traditional liposuction,” he says. “It’s not like your typical liposuction where you’re going back and forth rapidly after the fat.”
Based on their experience and comfort levels, surgeons can use the approach to treat not only the deep tissue, but also the mid fatty level and certain areas closer to the surface.
Now it’s time to suction out the treated fat, he says.
“Once you’ve lost treatment resistance with the VASER cannulas, then you go through with a regular liposuction cannula of your choice. And that’s typically not going to be an aggressive cannula. It doesn’t have to be a multi-holed cannula or anything with real sharp edges,” he says.
While the VASER adds some time to the procedure, it’s less traumatic for the patient and more efficient than regular liposuction, Dr. Wiener says.
“It’s fantastic in areas where there is lots of real fibrous tissue,” he says. “I love it at the lower back and waistline, because I can really contour that area much better than with regular liposuction. Men’s fat in the love handle area tends to be a little tougher — a little more fibrous. And in those areas I think this machine excels.”
Dr. Wiener, however, isn’t convinced about claims that ultrasonic liposuction contracts skin better than traditional lipo. From what he has seen, skin contraction is similar to that from regular liposuction.
NEXT: Tips for Fat transfer
Tips for Fat transfer
Surgeons who transfer fat retrieved with the VASER to the buttocks or breasts should take the power down a notch, according to Dr. Wiener.
“The VASER at traditional power would probably end up destroying a certain percentage of the fat cells because that ultrasonic energy, which is cavitating or breaking up the fat, also is breaking up the cells. What we do with fat transfer is we turn the VASER down to 60% of its full power. We also put the VASER into a pulsed mode, where the energy that’s being delivered isn’t continuous, so it’s a gentler mode,” he says.
Lowering the power and putting the VASER into pulsed mode efficiently breaks up and allows for fat removal, while preserving viability in the majority of fat cells, according to Dr. Wiener. The viability isn’t necessarily greater than what one would achieve with traditional liposuction, but, he says, the VASER has the advantage of separating the fat.
“With regular liposuction, when you look at what’s being suctioned there’s a water layer; then on top of that is the fat layer,” he says. “With the VASER, it’s almost creamy. There’s almost no distinction between the fat and the water. You’ve emulsified it. But the fat cells are still viable.”
NEXT: One Drop at a Time
One Drop at a Time
Surgeons transferring the now-emulsified fat from the VASER procedure to the buttocks or breast should do so one drop at a time, according to Dr. Wiener.
“You’re injecting that droplet of fat into the tissue and you want oxygen to get into that tissue immediately…, so it survives,” he says. “By separating the fat cells, we’re injecting this fat and those fat cells are kind of infiltrating into the tissue a lot easier. I think there’s a higher chance they’re getting more oxygen. Studies were done that show the VASER separates the fat into groups of anywhere from three to 10 cells. With that and because it’s all widely separated, theoretically you’re getting more oxygen to more fat cells. Ten to 12 years ago, we were losing the majority of our fat grafting. Now we know so much more about how to treat it. You’re being gentle with it every step of the way.”
Despite good and predictable results using the VASER to transfer fats to the buttocks and breasts, Dr. Wiener says that he hasn’t had a good reason veer from standard facial fat transfer techniques to the face.
“The main difference with facial fat transfer is you’re taking a cannula basically and harvesting on just syringe pressure. We’re not using a machine. It’s kind of more a gentle process, in and of itself,” he says.