Surgical Concept
Fats are very special components of the human body and are mainly distributed at the body surface (skin) and inside the body (internal organs). Subcutaneous fats account for approximately30% of total fats and anatomically belong to a part of the skin. Therefore, as long as there is skin coverage, there are adipocytes whose main function is to provide protection for skeletal and muscular tissues, regulate body temperature, prop up the skin, and sustain skin elasticity. Excess subcutaneous fat accumulation is prone to cause regional obesity, cellulite, or even skin drooping, thus resulting in a change of stature or appearance. Such problems can be addressed by liposuction, tummy tuck, or other plastic surgeries. Visceral fats comprise over 70% of total fats and are distributed around cavities and organs to protect and cushion vital organs and store energy. Exceeding deposits manifest as systemic obesity or weight gain and have to be resolved by radical weight management or massive exercises to lose body weight.
All such facts clearly indicate that liposuction or lipodissolve therapy is aimed at the selective reduction of subcutaneous fats at targeted body parts to allow patients achieve a rapid and distinct result within the shortest time; this is a part of body contouring rather than systemic weight loss. Moreover, adipocytes accumulate at specific sites due to the prolonged restoration of nutrients and energy at sites such as the arms, abdomen, back waists, or thighs and are difficult to be controlled by exercises or diet control. Therefore, liposuction or lipodissolve injection is the only way to allow patients to reduce the fats in sites they hope to remove them from. Nevertheless, despite fat accumulation being disturbing, excessive fat removal creates other problems. Dr. Chuang has frequently noticed that numerous women are preoccupied with mild obesity but ignore the fact that without fat cushioning and padding, the stature curvature would become unsmooth and poorly proportionate and that drawbacks in skeletal proportion or muscular texture are exposed due to excessive skinniness. Moreover, without fat support, the skin suffers from accelerated aging or looseness. Thus, evaluating the necessity of liposuction not only focuses on fat volumes at a single site but takes into account the overall stature proportion, body weight, skeleton, and age to allow patients to enjoy balanced esthetics that accommodate health and beauty.
Along with the advance in liposuction machines, the concept and method of modern liposuction have experienced tremendous changes. Traditional liposuctions frequently differentiate fats based on their depth. Superficial fats are distributed all over the body, particularly the cheeks, back, buttocks, or calf. They help support the skin and regulate body temperature, as well as store emergency energy necessary when people are hungry or subjected to physical hazards, but due to their close connection with the skin and hard texture, superficial fats are usually difficult to remove by traditional (mechanical) liposuctions, which otherwise easily cause skin depression or unevenness. Deep fats are widely distributed at the arms, abdomen, waist, or thigh, and despite being easy to accumulate due to excess energy intake or obesity, they can be removed by liposuction within a short time, with the results more distinct than those obtained with superficial fats. However, limited by the difference between superficial and deep fats, mechanical liposuction is certainly unable to achieve optimal results. Dr. Chuang adopts the latest composite liposuction, which breaks the barrier of traditional liposuction in the differentiation of superficial and deep fats. Composite liposuction first utilizes Ultra-Z ultrasonic liposculpture (also called Z-wave golden liposculpting) for the simultaneous ultrasonic vibration, melting, and emulsion of superficial and deep fats and breaks the adipose septa and fibers between various layers and then applies the high-speed vacuum liposuction machine (Swiss Medela Dominant 50) to remove dissolved fats outside the human body. This alternative dissolution and suction of fats achieves the comprehensive results of an effective fat volume reduction (deep fats) and curvature contouring (superficial fats).
Apart from the application of new-generation ultrasonic liposuction to remove excess fats, progress has been made in modern medical studies in adipose reuse, and fat grafting has become a hot subject. Traditional fat centrifuge extraction cannot preserve the integrity of adipocytes and frequently damages adipose cells, thus compromising the survival rate of autologous fat grafting. To enhance the stability and safety of fat grafting, Dr. Chuang employs the closed fat extraction and purification system (Cytori pure graft system) and the combined advanced technology of autologous serum-derived growth factors (commonly called stem cells) to mix with purified adipocytes and then inject them into recipient sites. This closed system not only lowers the incidence of the self-absorption rate after grafting to below 30–40% but also decreases the probability of fat lumping or calcification. Moreover, such a closed system filters out abundant fats within a short time to reduce the surgical time of autologous fat breast augmentation and mitigate the risks of necrosis, inflammation, or infection of fats, thus amounting to this system being one of the safest fat preparation methods in fat grafting surgery.
Dr. Chuang believes that fat surgery is an art on “quantity” and “form” and should be well balanced rather than blindly removing body fats. Therefore, the surgery should proceed from curvature sculpting and relinquish the traditional concept of liposuction for simply fat loss. Only in this way can the surgery better meet the requirements of patients. In addition, numerous new liposuction machines and surgical methods only provide more options of tools for physicians, but the success of the surgery still lies in the exquisiteness and skill of the surgeon rather the device; therefore, Dr. Chuang attaches great importance to the depth, scope, and quantity of liposuction, and combined with his abundant clinical experience and sophisticated devices, he offers safe and effective surgeries to patients undergoing liposuction at WiSH Clinic.
Surgical characteristics
Ultra-Z ultrasonic liposculpting machine
Ultra-Z is the newest third-generation ultrasonic fat-melting machine. Its working mechanism is the concussion and emulsification of full-layer lipocytes by the insertion of a customized-size lipolysis probe into the subcutaneous area and the extraction of the liquefied lipid by a liposuction machine. As its high-frequency oscillation produces a warm temperature of 42–45°C, it effectively destroys the relatively hard superficial fats, so it acts on superficial sites where a traditional liposuction machine fails, such as the cheeks, chin, breasts, waist, abdomen, back, and calf then tightens the regional skin (thermal and adhesion effect). Moreover, Ultra-Z can also be specially applied to sculpt muscular texture, such as six packs, V-line abs (Apollo’s belt), or firm abs, and is 20–30% higher than traditional liposuction in the overall efficiency of lipodissolve. In addition, the thermal effect concurrently shrinks blood vessels and mitigates postoperative hemorrhage and bruising, thus decreasing patient recovery time and pain. Besides properties superior to those of traditional liposuction, Ultra-Z boasts advantages in skin tightening and muscular sculpting compared with water jet liposuction which may also result in a massively postoperative edema or water toxicity (hyponatremia) due to water retention in large-volume liposuction. Compared with VASER ultrasonic liposuction of the same nature, Ultra-Z does not confer concurrent lipodissolve and liposuction so the physician has to spend more time conducting the operation, but Ultra-Z would not result in high temperatures during lipolysis, avoiding the excessive thermal injury that can be induced by VASER high-efficient liposuction and preventing skin burns or overdone result. The features of moderate-efficient lipolysis and separate liposuction amounts Ultra-Z to the most comprehensive and safest liposculpting mechine. Currently, Ultra-Z is widely used in WiSH Clinic for various liposuctions, such as large-area full-layer liposuction over the abdomen, waists, thighs and arms and also superficial liposuction of double jowls, accessory breasts, back, abdominal muscles, calf, and reduction mammoplasty. It can also sculpt muscles at various body sites to homogeneously remove superficial fats of skin, thus achieving the objective of muscle toning.
We use the most advanced ultrasonic liposuction machine for large area fat reduction and muscular contour sculpting.
Hybrid liposuction technique
Subcutaneous fat tissues contain superficial and deep levels, which have different scopes of distribution. Superficial fats are mainly concentrated on the face, chin, back, upper arm, back, buttocks, and calf. They are scarce in abundance but closely adhere to the skin and feel relatively hard, so they are usually difficult to reduce by exercises, diet control, or even surgery like traditional liposuction. Deep fats are primarily associated with obesity and are present at the upper and lower abdomen, waist, and thigh. They are relatively abundant and feel soft and are the main targets to get rid of in weight loss or liposuction. Despite distinct effects against deep fats, traditional “one-machine all the way” liposuction technique frequently results in complications such as depressed or uneven skin surfaces due to an excessively shallow suction or compromises patients’ expectations due to failure in extracting superficial fats. All these are attributed to the fact that the single mechanical liposuction cannot distinguish the plane of deep and superficial fats because its liposuction tube does not provide a special configuration for the melting of superficial fats, thus resulting in insufficient liposuction or overdone results. To mend the defects of traditional liposuction, for patients undergoing large-volume liposuction, Dr. Chuang adopts an advanced hybrid liposuction technique, which employs both liposuction and lipolysis machines to process fats at different depths. The primary surgery model is the emulsification and dissolution of superficial fats as well as penetration to melt and render deep fats into bubbles by the Ultra-Z lipolysis machine and the simultaneous removal of the liquefied or softened fats with the high-speed vacuum liposuction machine Medela Dominant 50. Its advantage is the differentiated processing of superficial and deep fats, which effectively eradicates refractory superficial fats and enhances the efficiency and stability of deep fat removal, that increases the overall volume of the removed fats by 20–30% compared with those by traditional single-machine liposuction to achieve an extreme body sculpting result. Moreover, the incidence of complications such as skin depression or unevenness can be lowered. Furthermore, for patients undergoing liposuction and combined fat transfer, the hybrid liposuction technique not only removes more effective fats but also applies a larger-size liposuction tube to minimize damage to lipocytes, curtail the postoperative incidence of lumping and calcification, and increase the successful rate of autologous fat grafting.
Dr. Chuang chooses Medela vacuum extractor in combination with Ultra-Z lipolysis machine to remove the massive amount of fat.
Closed fat filtration system
Fat extraction and purification are important procedures in fat grafting. Reducing damage to adipocytes during liposuction and maximally preserving their integrity following processing are critical to improve the adipocyte survival rate. Traditional fat extraction or purification methods, such as saline wash or centrifugation, have to squeeze, oscillate, and dehydrate the adipocytes to remove the blood, water, or fiber impurities mixed in the adipocyte population, which may unintentionally damage the structure and form of the cells. This not only elevates the necrotic incidence of adipocytes but also leads to excessive absorption or calcified lumps after fat grafting, with a self-absorption rate of up to over 70% on an average. To improve the overall fat grafting and surgical safety, Dr. Chuang has utilized the Puregraft fat filtration system of Cytori Therapeutics, Inc (USA) after studies, which was found to be most compatible with adipocyte physiological characteristics. Its unique bag with a double-membrane filtration design removes over 90% of adipose impurities and directly connects with the distal liposuction tube, so the adipose tissues can enter into this retention bag for deposition and filtration without exposure to air. Meanwhile, the purified adipocytes can be added into a syringe directly via an opening at the bottom of the collecting bag, allowing them to be injected into recipient sites once taken out immediately. Such a fully closed system can screen adipocytes from the air and environment from extraction to injection, which guarantees that the whole process reaches the standard of non-bacterial or human-induced contamination and elevates the safety of large-volume fat transfer (such as autologous fat breast or buttock augmentation). Moreover, the Puregraft system, which is based on static filtration for fat purification, prevents adipocyte damage from human squeezing or mechanical centrifugation, which increases the survival rate of fat grafts and decreases postoperative lumping, calcifications, and excessive absorption.
Fat preparation with growth factor mixture
Along with the advance in studies on stem cells and cytokines in recent years, stem cells and growth factors have been used for the treatment of numerous congenital diseases, and breakthroughs have been made in plastic surgery medicine. Currently, they are being extensively studied for their application in harnessing the property of “regeneration” and “replication” to enable the autonomous reproduction and proliferation of adipocytes injected into the human body and to lower the proportion of self-absorption and relatively improve the survival rate of the fat graft. Dr. Chuang offers two methods for autologous fat grafting. One method is stromal vascular fraction (SVR), where the least adipose-derived mesenchymal stem cell mixture for abundant fat injection (such as autologous fat breast augmentation) where adipocyte precursors extracted from the patient’s body fluids are mixed with adipocytes to facilitate the survival of adipocytes by the high proportion of stem cells in precursor cells, which is called cell auxiliary lipotransfer (CAL). The other method is to mix platelet growth factors (PRP) extracted from the patient’s plasma with a certain proportion of adipocytes to help emplaced adipocytes adhere to the in situ tissues and reconstruct blood circulation, thus elevating the survival rate of the autologous fat graft. This is also called the growth factor mixture method which is applicable to sites that require the injection of few fats, such as the face or periocular area. By either of these methods, the success rate of fat grafting is remarkably higher than that of a traditional fat injection, with the average fat survival rate improved to approximately 60%–70% and fat calcification or lumping incidence effectively lowered. Therefore, the adipose preparation with growth factor mixture is an important part of fat grafting that should not to be ignored.