Liposuction Technique Matters for Lipedema: Fact or Fake News?
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1 Liposuction Technique Matters for Lipedema: Fact or Fake News? Karol A Gutowski, MD, FACS Board Certified Plastic Surgeon Associate Clinical Professor, University of Illinois Chicago, Illinois
2 DISCLOSURES Nothing to disclose related to lipedema or liposuction
3 Objectives Introduce Levels of Evidence Explain types of liposuctions Scientific & clinical assessment of techniques Understand limitations of liposuction volumes
4 My Background Chair Quality & Performance Metrics Committee (ASPS) Chair Tracking Operations & Outcomes in Plastic Surgery (ASPS) Patient Safety Committee (ASPS) Over 3000 liposuction cases Over 250 lipedema patients Plastic & Reconstructive Surgery Editorial Board
5 Show me the Evidence Level 1 = High quality RCT or systematic review (SR) Level 2 = Lesser quality RCT, comparative study, or SR Level 3 = Retrospective comparative study or SR Level 4 = Case series Level 5 = Expert opinion
6 Internet Does NOT have Levels of Evidence
7 Deceptive Lipedema Treatment Before & after High Def Vaser liposuction treatment, 3 sessions
8 Deceptive Lipedema Treatment Before & after High Def Vaser liposuction treatment, 3 sessions
9 Deceptive Lipedema Treatment Fake News! This patient had a thigh lift!
10 It s a Process. Before After 2 rounds of liposuction SAL & PAL After liposuction & thigh lift
11 Published Papers in PubMed Lipedema 183 results Lipedema Treatment 114 results Lipedema Surgery 65 results Lipedema Liposuction Primary studies on liposuction Reviews of literature 38 results 9 publications 4 publications Comparative studies 0 Randomized controlled studies 0 Lymphatic Sparing Liposuction 3 results 0 related to Lipedema
12 Liposuction Options Tumescent All liposuction procedures must use some tumescent fluid to prevent bleeding Traditional (SAL) Power Assisted (PAL) Ultrasound Assisted (UAL) VASER Assisted (VAL) Laser Assisted (LAL) Water Assisted BodyJet (WAL) All can be done: Awake Minimal incisions Minimal bruising
13 Liposuction Options Tumescent All liposuction procedures must use some tumescent fluid to prevent bleeding Traditional (SAL) Power Assisted (PAL) Ultrasound Assisted (UAL) VASER Assisted (VAL) Laser Assisted (LAL) Water Assisted BodyJet (WAL) All can be done: Awake Minimal incisions Minimal bruising
14 Traditional Liposuction Dependable & reliable Low cost No energy damage Low risk
15 Power Assisted Liposuction Dependable & reliable Low cost No energy damage Shorter procedure Best for tough tissue
16 Ultrasound & Vaser Assisted Liposuction Dependable & reliable High cost Possible energy damage Longer procedure Requires 2 parts Vaser treatment to break up fat Traditional liposuction to remove fat No evidence of skin tightening
17 Water Assisted Liposuction (BodyJet) Dependable & reliable Moderate cost No energy damage Longer procedure Additional water adds to fat removal limit No evidence of more gentle treatment
18 Laser Assisted Liposuction (SmartLipo) Dependable & reliable Vert high cost Possible energy damage Prolonged swelling Longer procedure Requires 3 parts Laser treatment to break up fat Traditional liposuction to remove fat Laser treatment to tighten skin No evidence of skin tightening in lipedema
19 How Much Fat Can be Removed? cc limit (about 5 quarts) Includes removed fat and fluid Otherwise should be Staged 2 or more outpatient procedures Monitored overnight 1 procedure but higher cost No evidence to support this limit Accepted by most surgery facilities & law in some states
20 Is There a Liposuction Limit? 2015 Liposuction limit should be based on BMI More than 100 cc per BMI increases complications Most common complication: Seroma (fluid collection) Not yet accepted by most surgical facilities or laws
21 Lymphatic System Superficial Lymphatic System Medial vessels follow the great saphenous vein Lateral vessels follow the small saphenous vein Deep Lymphatic System Follows the deep arteries Lymphatic vessles follow the blood vessels If blood vessels are not injured, neither are the lymphatics Lymphatic problems do not happen after normal liposuction
22 Lymphatic Sparing Liposuction Small cadaver study suggesting less damage to lymphatic system when liposuction is done longitudinally vs transversely Nearly all liposuction is done longitudinally (in the same direction as the lymphatic vessels) in the extremities Long-term lymphatic damage is not an issue after liposuction Lymphatic Sparing Technique is actually normal liposuction
23 Lipedema & liposuction clinical studies
24 Small Study: Power Assisted Lipo 2010 Vibration liposuction (PAL) Good results with significant pain and leg volume reduction
25 Good Study: Power Assisted Lipo patients treated with PAL 112 evaluated at more than 1 year with standardized questionnaire Overall significant improvement in volume, QOL, etc
26 Best Study: Power Assisted Lipo 2015 Follow up of previous study Compared to 4 years, improvement in pain, sensitivity to pressure, edema, bruising, restricted movement, patient self-assessment cosmetic appearance, quality of life & overall impairment persisted At 8 years, reduction in amount of conservative treatment similar to 4 years Demonstrates long-lasting positive effects of power assisted liposuction
27 Does Water Liposuction Matter? 2008 False & unsupported claims about tumescent fluid & liposuction Analyzed the removed fat tissue, not what was left behind Did not compare to any other liposuction technique Very low fat removal volumes No clinical results measured
28 What is Removed Matters
29 Liposuction & Skin Tightening Many claims to tighten the skin Mostly unproven Utrasound (UAL) - many claims in the 1990 s but no evidence Vaser (VAL) Split study vs SAL, no patient reported difference at 6 months Laser (LAL) Split study vs SAL, LAL 17% tighter at 3 months
30 Traditional Liposuction Results
31 Traditional Liposuction Results
32 SAL 2 Stages
33 Then Body Lift + Thigh Lift
34 Conclusions Don t fall for marketing and hype Consider the source Many low level publications and meaningless studies It s the surgeon, not the type of liposuction Be prepared for more than one liposuction procedure 2 to 3 staged procedures are common May need skin removal (thigh lift)
35 CONTACT INFOROMATION Karol A Gutowski, MD, FACS Karol@DrGutowski.com DrGutowski.com Presentation at DrGutowski.com FOR PHYSICIANS
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