by Emmanuel De La Cruz MD, PLLC

Dr. De La Cruz is a Houston plastic surgeon who performs the 4D VASER High Definition liposuction Houston.  Check out our Before and After Liposuction Page.

Defining Your Six-Packs Abs with Hi-Def VASER Liposuction

    Sometimes, regardless of how much workout and strict diets, one can’t succeed on developing the six-pack or rectus abdominis muscles. Pretty often, patients comes to my office searching for a procedure that can make their underlying muscle or six-pack noticeable. High Definition VASER Liposuction would be the right solution for a six-pack body. Colombian plastic surgeon, Alfredo Hoyos, created this revolutionary body contouring technique that enhances the underlying musculature in order to achieve well-defined or ripped six-pack abs, in both men and women (1). He have trained hundreds of plastic surgery physicians in the High Definition and 4D LIPO technique, worldwide.  Several year ago I had the good fortune of traveling to Bogotá, Colombia and got trained and certified by Doctor Hoyos in the latest VASER Hi-Def Liposculpture methods. Since then, I have executed over a hundred procedures in the State of Texas, which delivered some amazing results.

Before and After 4D VASER Hi-Definition Liposuction (8 weeks after surgery) performed by Dr. Emmanuel De La Cruz MD

Before and After 4D VASER Hi-Definition Liposuction (8 weeks after surgery) performed by Dr. Emmanuel De La Cruz MD

    One of the extensive benefits that High Definition VASER liposuction offers is that this procedure can be used on both, athletic patients who work out at the gym, as well as overweight patients who want more definition and muscular look. It works by selectively removing deposits of fat surrounding specific muscle groups to enhance the visibility of the natural muscle contours underneath. Traditional liposuction procedures did not allow surgeons to remove and properly contour the superficial fat layers. However, with the latest innovations of Hi-Def VASER lipo, such as the ultrasonic emulsification of fat and rotating cannula, an experienced aesthetic surgeon can literally rip your abdomen and narrow your waist line like never before.

    Typically, the six-pack abdominal procedure is performed under general anesthesia. Usually, five very small incisions (of less than 1 centimeter in length) are placed on the abdominal wall. Tumescent fluid is injected. This fluid contains anesthetic which helps with pain control during and after the surgery, and epinephrine, which minimizes blood loss. Tumescent fluid is also antibacterial, so there is less chance of infections. The surgeon selects the area to be treated and uses the ultrasound-assisted device to liquefy the fat cells, leaving the surrounding nerves, blood vessels and connective tissue unaffected. By only melting fat, the VASER leads to more rapid healing and smoother results. Since the VASER also creates thermal energy, this generated heat causes further fat to dissolve and causes significant skin contracture. Results from clinical studies presented at the 78th Annual American Society of Plastic Surgeons Meeting in October 2009 demonstrated a 53% improvement in skin contraction relative to the standard liposuction procedures (2). It’s worth noting that thermal skin contracture is not attainable with traditional liposuction. These clinical studies have also shown significantly less blood loss with the use of the VASER. Specifically, an average reduction in blood loss of 26% compared with traditional liposuction methods (3). Altogether, these beneficial factors positively impact the procedure final outcome and recovery process. Therefore, an increasingly large amount of patients now opt for High-Definition VASER sculpting procedures to obtain the rock-hard abs they have always desired.



(1)  “Dr. Alfredo Hoyos’ liposuction gives dramatic and desirable results”. The New Economy 2017. https://www.theneweconomy.com

(2)  Lewis, Linda W. “Taking Shape”. MedEsthetics. https://www.aestheticdoctors.co.za

(3)  Garcia, O., Jr., Nathan N. 2008. “Comparative Analysis of Blood Loss in Suction-Assisted Lipoplasty and Third-Generation Internal Ultrasound-Assisted Lipoplasty”. Aesthetic Surgery Journal, 28(4): 430-435



Factors That Can Affect Fat Grafting Success in Brazilian Butt Lift

Fat grafting is the latest trend in body sculpting. A fat grafting procedure transfer autologous fat (from your own body) from areas in which patients have excess fat, such as arms, abs, flanks and back, and injects it into areas that may need volume-enhancement, such as face, hands, breasts or buttocks. In particular, many of my patients who desire a fuller, more curvaceous derriere opt for a buttocks augmentation with fat grafting (BBL). Since the fat grafted is not a foreign material such as an implant, there is no risk of rejection and very little risk of complications associated with implants such as often reported ruptures or leaks.


After the autologous fat is re-injected, 65% to 85% of the transferred fat will usually take and stay in the area for years to come, providing a permanent solution for the patient’s cosmetic needs. The rest of the transplanted fat will be harmlessly and naturally metabolized by the body.Due to this variable amount of fat graft take patients frequently require more than one session of grafting to attain their desired result. The percentage of the fat that survive will vary depending on many factors, some of which doctors can affect (the method of harvesting, processing and placement) and some others which are under patients’ control.

 The method of harvesting is among the factors that enhance survival of the transferred autologous fats, and surgeons can definitely influence it. Clinical studies have shown that fat transfer procedures success is dependent on factors during the removal of the fat, such as the aspiration pressure used, and the cannula’s size used. The area where the fat comes from per se is not a determinant factor in fat grafting attainment. In this respect, I favor VASER liposuction system for viable fat harvesting. Fat cells treated and removed during VASERlipo procedures are typically of high quality and are viable to re-introduce the body (1). The VASERlipo system was designed to maintain the integrity of fat cells, by using ultrasound energy to selectively target and dislodge fat cells from the fatty tissue matrix. Atraumatic VentX cannulas give you the ability to fine tune suction pressure to remove the treated fat. Typically, 2.9mm to 4.0mm precision cannulas are used, depending on the donor site, and the pressure utilized to extract the fat with VASERlipo system is minimal (around 15 inch Hg) as opposed to the standard 25 inch Hg, which can affect the viability of the fat cells harvested. Two recent, independents studies have confirmed the viability of fat removed with VASERlipo: Cytori Therapeutics conducted a multi-site study that confirmed the viability of VASER-treated fat at 85% and regenerative cells at 87%, and the University of Pittsburgh Medical Center found the viability of VASER-treated fat to be over 80%, six weeks post re-injection (2). Research concluded that breaking apart adipose tissue prior to aspiration allows the use of atraumatic cannula and lower vacuum levels, which prevent the fat from tearing or shearing during aspiration.  

Moreover, the method of processing is the second key factor that surgeons can use to maximize fat survival. The preparation process clears the donor fat of blood, pain killers and other unwanted elements that could cause infections or other undesirable complications. Separation from excess fluid (purification of the fat) ensures that the surgeon is injecting a higher proportion of fat. After the fat selection process is completed, only 500cc to 1500cc of the fat will be injected into each butt cheek. Three primary methods (sedimentation by gravity, filtering technique, and centrifugation) have been used clinically to process fat grafts. In this respect, centrifugation is the more effective method of choice for processing facts, based on numerous clinical studies that concluded: “although may be more aggressive on adipocytes, centrifugation clears the fat from most blood remnants and is able to possibly maintain the highest concentration of stem cells within the processed lipoaspirates” (3). For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, sedimentation by gravity or filtering technique. Research determined that fat grafts processed with centrifugation at 1200 g for 3 minutes have better viability and should be recommend for processing fat grafts.

Third, high success rates of fat survival can be achieved by choosing a proper method of placement. After the harvested fat is purified, the surgeon carefully transfers fat cells into each buttock. To do so successfully, he or she will make small incisions (less than 1cm in diameter) in the butt cheeks and use a hollow tube to insert small quantities of fat cells into each side of the buttocks (micro-fat injections). This process is repeated until the desired correction has been achieved, creating a grid of grafted fat. At the end, the surgeon proceeds to massage the grafted areas to create a satisfactory contour. By all means, fat placement requires slow injection techniques and is time consuming. Clinical studies in patients found that “a slow injection speed of 0.5 to 1.0ml/second resulted in larger fat grafts compared with a fast injection speed of 3.0 to 5.0 ml/second” (4). Increasing injection speeds can result in cellular damage. The studies also reinforce the principle that fat grafts, once placed, should have a maximal amount of contact with the vascularized tissue in the recipient site for better survival.

Lastly, proper BBL post-operative care and healthy lifestyle habits are factors that significantly affect fat survival. Patients can actively contribute a great deal on the success of the procedure and longevity of the results by following their surgeon’s recovery recommendations. In my experience, patients who successfully avoid sitting or putting pressure on their buttocks or stretching for the first eight weeks after their surgery are much more likely to have long-lasting results than patients who fail to follow this advice. The longevity of transplanted fat cells can also be affected by lifestyle factors. In particular, smoking can lead to the degradation of new cells because reduces circulation throughout the body. By eating right and avoiding cigarettes, patients can considerably increase the longevity of their Brazilian Butt Lift.



(1) Schafer, M.E., et al. “Acute Adipocyte Viability After Third-Generation Ultrasound-Assisted Liposuction”. Aesthetic Surgery Journal. 2013 Jul; 33(5):698-704.

(2) Fisher, C., et al. Comparison of Harvest and Processing Techniques for Fat Grafting and Adipose Stem Cell Isolation. Plastic Reconstructive Surgery. 2013 Aug; 132(2):351-61

(3) Lee L.Q. Pu. “Towards more rationalized approach to autologous fat grafting”. Journal of Plastic, Reconstructive & Aesthetic Surgery.pdfs.semanticscholar.org



(4) Strong, Amy L. “The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques”. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov


Recientemente se han reportado numerosos casos del uso de productos de grado industrial inyectados en distintas partes del cuerpo, como en los glúteos y muslos, realizados por profesionales no calificados o que no poseen las licencias reglamentarias. Algunos de estos productos van desde silicona inyectable o ácido hialurónico, hasta el hidrogel de alto volumen. Aunque algunos de estos productos, como la silicona, pueden ser biológicamente inertes, dichos materiales han sido implicados en una variedad de reacciones adversas que incluyen granulomas, nódulos deformantes y linfedema, a veces con períodos latentes de décadas. A menudo, pueden causar infecciones crónicas deformantes que pueden requerir antibióticos por vía intravenosa o extensas intervenciones quirúrgicas. Incluso, han habido algunos casos en que las infecciones crónicas resultantes de productos de grado industrial ilegalmente inyectados en las extremidades inferiores, resultaron en amputaciones como un recurso para salvar vidas.


Figura 1: Infección crónica generada por inyecciones de Biopolímeros en glúteos y muslos, aplicadas por un profesional sin licencia y no calificado.

Síntomas y Manifestaciones Clínicas

• Infección crónica, como la celulitis, que es recurrente a pesar de los antibióticos.

• Rigidez o endurecimiento del área donde las inyecciones fueron aplicadas.

• Dolor crónico, como dolor en los glúteos.

• Sensación de entumecimiento del área tratada.

• Decoloración de la piel en el área de las inyecciones.

Gestión Clínica

• Recomendamos obtener un estudio con imágenes por resonancia magnética (IRM) del área de inyección para determinar el alcance de la inyección y la zona donde el material pudiera haber migrado, potencialmente. La resonancia magnética actuaría como un mapa para estipular dónde su cirujano debería remover los biopolímeros. 


• El tratamiento varía de paciente a paciente. Este puede ir desde la extirpación quirúrgica, a la inyección de hialuronidasa, seguida de la liposucción VASER y la transferencia de grasa en el área tratada, para corregir la deformidad resultante. Desafortunadamente, no es posible eliminar por completo los biopolímeros sin provocar una deformidad significativa del área afectada. La remoción completa, como la extirpación quirúrgica, pudiera provocar una deformación que le cambiaría la vida.


remover los biopolímeros.png

Figura 2: Eliminación de hidrogel/biopolímeros de los glúteos utilizando la liposucción VASER con transferencia de grasa a glúteos, para corregir la deformidad resultante de la eliminación de los biopolímeros. El paciente tuvo la resolución de dolor crónico en glúteos después de la cirugía.


Resulta altamente recomendable visitar a su cirujano plástico para la evaluación y posible eliminación de los biopolímeros inyectados en su cuerpo. Un estudio de imágenes por resonancia magnética puede ser necesaria para medir la ubicación del material inyectado. Es importante recalcar que cada caso médico es diferente, y de igual manera, cada tratamiento puede ser distinto y ajustado a las necesidades particulares de cada paciente.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Potential Complications of a Tummy Tuck Procedure (Abdominoplasty)

One of the most common cosmetic surgeries patients are interested in when they come to my office is the abdominoplasty. This procedure, generally known as tummy tuck, can flatten your abdomen by removing loose, excess fat and skin and tightening muscles in the abdominal wall. One benefit that patients appreciate the most is that it can also remove the stretch marks in your lower abdomen. It is popular following pregnancy, massive weight loss or whenever a saggy abdomen with weak muscles impairs body contour.

            When performed by an experienced board certified plastic surgeon, the abdominoplasty will result in flatter, firmer abdominal contour with narrower waistline that wouldn’t be achieved by liposuction procedures only. All in all, abdominoplasty is a very safe operation. Unfortunately, as with any other cosmetic surgeries, there are post-operative complications that should be addressed by a specialist in a time manner. The most likely possible complications after abdominoplasty are: swelling, infection, wound separation and fluid collections (seromas and hematomas). 

The swelling is manifested in the upper thighs and in some cases in the lower legs. The abdominal skin flap can stay swollen due to lymphatic blockage weeks after surgery. This type of swelling requires compression, because swollen tissues themselves can cause more scarring. To prevent the swelling that can occur following a tummy tuck procedure, I prefer the Lockwood technique because separates less tissues than the standard technique. Moreover, one significant thing you can do to control the swelling after the surgery is to wear the post-op compression garment 24/7 for at least eight weeks. Have in mind that tissues heal better and faster when there is minimal swelling.               

Infection is another possible complication that can occur after abdominoplasty. Usually, I prescribe patients antibiotics during their final pre-operative visit to prevent wound infection. It is important that patients make sure they are not allergic to the antibiotics prescribed by their surgeons. Oral temperature over 100.4 degrees, yellowish or greenish drainage from the incisions and/or foul odor are among the indicators of a possible infection. A suture abscess is typically not dangerous and it’s easily taken care of by lancing the area under a local anesthetic, and packing the small puncture with a medicated gauze. However, infections can also be life threatening, like those of MRSA (Methicillin Resistant Staph Aureus). It’s always best for patients to contact their doctor promptly if they have any sign of infection. Therefore, I facilitate my cell phone number to all of my post-op patients so they can communicate immediately if any problems or concerns arise.  

Wound separation can also be a possible complication after an abdominoplasty. Excess skin tension if too much skin was taking out during the procedure can cause the wound to separate. Small wound separations are easily taken care of by packing the wound with medicated gauze. Slightly larger wound separations can be taken care of by a suction device called a “Vac Dressing”. Large wound separations caused by poor blood supply may need revision and re-approximation of the wound edges in a procedure room.

In any case, I highly recommend patients to schedule an in-person visit to get the wound treated promptly and prevent further complications such as getting the wound infected or extending the recovery period.

Lastly, fluid collections (namely seromas and hematomas) are among the possible complications after a tummy tuck procedure. A seroma is a collection of wound fluid. Sometimes it occurs when patients do not wear the compression garment adequately or he/she has a lot of activity in the post-operative period. For its part, a hematoma is a collection of blood in the dead space. It usually needs to be evacuated because it can be painful, can lead to infection or cause excessive scarring. Although seromas and hematomas can be easily treated with a needle aspiration, the best remedy against fluid collections is prevention. The proper use of compression garments and foam pads (Topifoam pads) over areas of potential fluid accumulation are significantly beneficial to prevent these post-operative complications.   


Many people who desire a fuller, beautiful, curvy backside will opt for a buttocks augmentation with fat grafting (generally known as “Brazilian Butt Lift”). This is a popular cosmetic procedure which uses fat transfer to provide a more curvaceous buttock without the use of an implant. Liposuction is generally used to both sculpt the surrounding area and collect the autologous fat (from your own body) to be injected.

According to the statistics issued by the American Society of Plastic Surgeons, more than 18,000 buttock augmentations with fat grafting were performed in the United States in 2016(1). This figure surpasses in 26% the statistics corresponding to the previous year. Experts say butt augmentation surgery with fat grafting is by far the most popular butt enhancing procedure they perform and many significant advantages are accountable for patients’ preference of this procedure over buttocks implants and dermal fillers, and its steady increasing demand.

Before and After Brazilian Butt Lift performed by Dr. De La Cruz

Before and After Brazilian Butt Lift performed by Dr. De La Cruz

Patients’ welfare is among the main reason why Brazilian Butt Lift’s requests are on the rising. This is proven to be a safer procedure in comparison with butt implants. In fact, patients who have implants can experience pain and infection, and have trouble sitting on their butts for a longer period of time. Moreover, implant patients are more likely to develop seromas (lumps caused by an accumulation of serum within the tissue) and experience dehiscence and capsular contracture(2). Also, since BBL utilizes autologous fat, the chance of allergic reactions to foreign substances, such as dermal fillers and silicone prosthesis (implants) are reduced, and the results are longer lasting. Recovery is also better with butt augmentation with fat grafting. BBL’s patients can typically return to work a week after surgery, as opposed to those who receive butt implants and would need at least two weeks to resume their regular activities.     



(1) “Plastic Surgery Statistics Report 2016”. American Society of Plastic Surgeons. www.plasticsurgery.org

(2) Chugay, Paul. “Buttock Augmentation with Implants and Fat Grafting: A Comparative Study”. The American Journal of Cosmetic Surgery. www.journals.sagepub.com


VASER Liposuction to Treat Lymphedema

Liposuction for Arm Lymphedema Following Breast Cancer Surgery

Fast Facts about Lymphedema and Breast Cancer Surgery

  • Lymphedema is swelling of the limbs caused by abnormal build up of fluids in the body.  This may occur after breast cancer surgery, such as a mastectomy (removal of the breast) and axillary node dissection (surgery to remove the lymph nodes at the arm pit area.) 
  • Extensive surgery of the axilla (arm pit area) increases risk for lymphedema of the arm. 
  • Radiation therapy to the axilla also increases risk for arm lymphedema.
  • Up to 38% of patients who undergo axillary dissection for breast cancer and radiation therapy may develop lymphedema (swelling) of the arm
  • Most patients can be treated with no need for surgery.
  • Patients with lymphedema are at increased risk of developing an infection of the arm, such as cellulitis.

Precautions to take to avoid an infection of the arm when one has lymphedema :

  • Make every attempt to avoid cuts, scratches, hangnails, insect bites and burns.
  • No blood pressures or venipunctures on the arm with the lymphedema.
  • Wear protective garments when gardening or pruning, dishwashing, baking/cooking or sewing.
  • Contact your physician immediately if there are any signs of infection of your arm (more swelling, redness, fever, pus drainage, more pain.)
  • Carry heavy parcels or purses on the unaffected limb (no lymphedema.)
  • Avoid wearing jewelry on the arm with the lymphedema.

Treatment of Severe Lymphedema of the Arm after Breast Cancer Surgery

  • Dr. Brorson, a Swedish Surgeon, had shown the effectiveness of reducing lymphedema in patients who previously had breast cancer surgery by performing liposuction of the arm lymphedema. 
  • According to the study, liposuction of the lymphedema arm reduced the arm edema volume by 115% versus 53% when compared with Controlled Compression Therapy (p=0.008).
  • Circumferential liposuction is currently the preferred method to treat severe lymphedema that is not responsive to conservative therapy.
  • There's an associated 4-fold decrease incidence of infection of the arm with the lymphedema after liposuction treatment.
  • After liposuction of the arm, the patient will need to wear a compression bandage more or less permanently to prevent the lymphedema from coming back.
  • Note that liposuction does not correct the inadequate lymphatic drainage found in lymphedema. 
  • Combined Decongestive Therapy (CDT) may be recommended initially as treatment for lymphedema after breast cancer surgery.
  • CDT is a lymphedema therapy consisting of manual lymph drainage, compression bandaging, skin care, exercise and self care instruction.  


If you or your family has a history of arm lymphedema after breast cancer surgery, I recommend to ask one of your Houston Plastic Surgeons whether liposuction of the arm with lymphedema is right for you. 


Emmanuel De La Cruz MD


National Lymphedema Network. 

Brorson, H. Liposuction in Arm Lymphedema Treatment. Scand J Surg. 2003;92(4):287-95.
Brorson, et al. Liposuction Reduces Arm Lymphedema Without Significantly Altering the Already Impaired Lymph Transport. Lymphology. 1998; 32:156-172
Koul, et al. Efficacy of Complete Decongestive Therapy and Manual Lymphatic Drainage on Treatment-Related Lymphedema in Breast Cancer.  Int. Journal of Radiation Oncology Biol. Phys. 2007: 67 (3):841-846
Williams, et al. A Randomized Controlled Crossover Study of Manual Lymphatic Drainage Therapy in WOmen with Breast Cancer-related lymphoedema. European Journal of Cancer Care. 2002. 11:254–261 


Lymphatic Massage Therapy Reduces Fibrosis after Liposuction

Fibrosis is considered as one of the most frequent complications that may interfere negatively and significantly the patient's satisfaction after liposuction surgery.  Fibrosis is the formation of hardened plates in the subcutaneous tissues denoting temporary or definitive irregularities on their surface and affecting affect the body contour.

Studies have shown that in the "Liposuction Group (LG) and Liposuction Abdominoplasty Group (LAG), a gradual decrease of classification levels was observed, specifically in relation to tissue fibrosis. Initially, the LG patients were divided into the highest levels (L2 and L3); and 70% of the LAG patients were classified as L2. After the application of this protocol, 62.5% and 50% of patients from both groups had the fibrosis reduced completely; the remaining ones showed the lowest degree of fibrosis, classified as L1.

Before and After Photo Liposuction (VASER Liposuction with Brazilian Butt Lift)

Before and After Photo Liposuction (VASER Liposuction with Brazilian Butt Lift)

"The association between manual lymphatic massage drainage and the therapeutic ultrasound reduced the swelling and the tissue fibrosis and made pain disappear in liposuction and lipoabdominoplasty PO period."


Igor, et al.  Manual lymphatic drainage and therapeutic ultrasound in liposuction and lipoabdominoplasty post-operative period.  Indian J Plast Surg. 2014 Jan-Apr; 47(1): 70–76.

Kim et al.  Analysis of postoperative complications for superficial liposuction: a review of 2398 cases.  Plast Reconstr Surg. 2011 Feb;127(2):863-71

Lisboa FL, Meyer PF, Alves DK, Wanderley SC. Protocolo para avaliação fisioterapêuticados níveis de fibrose cicatricial em pós-operatório de lipoaspiração associada ou não à abdominoplastia. Reabilitar. 2003;19:11–8.

Soares LM, Soares SM, Soares AK. Estudo comparativo da eficácia da drenagem linfática manual e mecânica no pós-operatório de dermolipectomia. RBPS. 2005;18:199–204.

Tacani RE, Alegrance FC, Assumpção JD, Gimenes RO. Investigação do encaminhamento médico a tratamentos fisioterapêuticos de pacientes submetidos a lipoaspiração. O Mundo da Saúde. 2005;29:192–8.

VASER Liposuction versus Smart Liposuction - Houston, Texas

After more than a hundred VASER liposuctions I’ve performed in the Houston area, the fundamental questions asked by the patients about this surgery have remained the same. Therefore, I’ve decided to uncover their inquiries in a series of articles, starting by explaining in what this innovative procedure consists and how much it differs from other fat removing techniques such as Smart Liposuction.

VASER Liposuction is an advanced body contouring procedure that “selectively” remove unwanted body fat. This method uses minimally-invasive ultrasound technology to breaks up fat while leaving all other important tissues intact, resulting in significant desirable effects with minimal damage to surrounding tissues. Consequently, patients recover considerably quicker as they suffer reduced bleeding, bruising and swelling in the treated areas(1). The shorter recovery time needed for VASER Liposuction makes it more convenient and appealing to my patients, who may return to their regular lives 1-2 weeks after the surgery and sometimes sooner. Meanwhile, the recovery time expected for Smart Lipo and other liposuction methods exceeds the 2 weeks. Moreover, the major advantage of VASER liposuction as compared to traditional or Smart liposuction would be the significant skin retraction that occurs after this liposculpture procedure.  It’s the only liposuction method that has been proven (based on a randomized clinical trial) to cause skin retraction.  The risk of bleeding and contour irregularities are also significantly lower with the use of the VASER liposuction machine when compared to other liposuction methods.

Another reason why I recommend VASER liposuction over other alternatives is the remarkable advantage of using the extracted excess of fat to transfer it to other specifics areas of the body such as buttocks and/or thighs. This process is called Fat Transfer Procedure or Fat Grafting. It’s important noticing that fat cells treated and removed during VASER Lipo procedures are typically of high quality –in contrast with the ones extracted via Smart Lipo-, and are viable to re-introduce into the body. Unlike short lasting synthetic fillers, re-injecting your own fat may give you natural looking results that last longer, with no risk of rejection(2). This favorable possibility to accentuate and contour your body by using your own fat in a single procedure is definitely one big plus for VASER Lipo in comparison to other liposuction procedures.


Before & After Photos of VASER Hi-Definition Liposuction of the abdomen, back with Biopolymer removal from the buttock and fat transfer to the buttock performed by Dr. De La Cruz 


(1) Garcia, O., Jr., Nathan N. 2008. “Comparative Analysis of Blood Loss in Suction-Assisted Lipoplasty and Third-Generation Internal Ultrasound-Assisted Lipoplasty”. Aesthetic Surgery Journal, 28(4)

(2) Schafer, M.E. et al. “Acute Adipocyte Viability After Thrid-Generation Ulatrsound-Assisted Liposuction”. Aesthetic Surgery Journal.

Large Volume Liposuction: Is it safe?

Numerous studies were published regarding the safety of large volume liposuction.  However, this procedure is safe if performed in the right setting:  performed by a plastic surgeon; anesthesia administered by an anesthesiologist; procedure performed in the hospital; and performed on a patient that is a good surgical candidate,

Before and After Photos of Liposuction performed by Dr. Emmanuel De La Cruz MD.

Before and After Photos of Liposuction performed by Dr. Emmanuel De La Cruz MD.

A retrospective study conducted by Dr. Rohrich revealed "no episodes of pulmonary edema, congestive heart failure exacerbation, or other major complications."


Rohrich et al. Fluid resuscitation in liposuction: a retrospective review of 89 consecutive patients. Plastic Reconstrive Surgery. 2006 Feb;117(2):431-5.

Large Volume Liposuction may Improve Diabetes & Hypertension

Numerous studies have been published recently regarding the benefits of large volume liposuction.  it has been shown that large volume liposuction reduces the total BMI (body mass index) of the patient, as well as improvement of hypertension.  In a recent study investigating the safety of large volume liposuction, they had found that large volume liposuction also improved hypertension by reducing the baseline blood pressure 4 months post-operatively.   The same finding was found by multiple authors who reported that there were significant decreases in pulse rate and systolic blood pressure over the 4-months post-operative period.

Before and After Photos of Large Volume Liposuction performed by Dr. Emmanuel De La Cruz.

Before and After Photos of Large Volume Liposuction performed by Dr. Emmanuel De La Cruz.

The study also has shown that over the 4 month post-operative period after large volume liposuction, the blood glucose level of patients with Diabetes also improved.  The authors "explained this by the fact that subcutaneous abdominal fat, as a component of central adiposity, has as strong an association with insulin resistance as visceral fat, and is an important independent marker of insulin resistance in obesity."

Although large volume liposuction may reduce the blood sugar in diabetic patients, it is not a treatment for diabetes.  Liposuction is also not an alternative treatment for hypertension.    Safety is a major concern for these kind of procedures. Large-volume liposuction should be done in a hospital-setting and a 23-hour observation post-operatively may be needed.  I recommend consulting with your plastic surgeon.

Emmanuel De La Cruz MD, PLLC

Plastic Surgeon, Houston Texas


Commons GW, Halperin B, Chang CC. Large-volume liposuction: A review of 631 consecutive cases over 12 years. Plast Reconstr Surg. 2001;108:1753. doi: 10.1097/00006534-200111000-00050. discussion 1764

Gonzalez-Ortiz M, Robles-Cervantes JA, Cardenas-Camarena L, Bustos-Saldana R, Martinez-Abundis E. The effects of surgically removing subcutaneous fat on metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment. Horm Metab Res. 2002;34:446–9. doi: 10.1055/s-2002-33603.

Perez RA.  Liposuction and diabetes type 2 development risk reduction in the obese patient. Med Hypotheses. 2007;68(2):393-6. Epub 2006 Oct 2.

Saleh et al. Safety and benefits of large-volume liposuction: a single center experience. Int Arch Med. 2009; 2: 4. 

Sharon YG, Erwin JB, George WC, Scott LS, Jack AY. Improvements in cardiovascular risk profile with large-volume liposuction: A pilot study. Plast. Reconstr. Surg. 2001;108:510–9. discussion 520–1



Large Volume Liposuction Improves Cholesterol Level and Diabetes

A recent systematic review was recently published evaluating whether large volume liposuction improves diabetes and decrease cholesterol levels.  Large volume liposuction (defined as liposuction of more than 3.5 L) was found to decrease the total Body Mass Index (BMI), as well as improved cardiovascular risk factors by decreasing the cholesterol levels as well as improved insulin sensitivity.

Before & After Photos of VASER Liposuction performed by Dr. Emmanuel De La Cruz.

Before & After Photos of VASER Liposuction performed by Dr. Emmanuel De La Cruz.

"A total of 364 patients were pooled for analysis. The mean volume of lipoaspirate was 7440 ± 1934.9 mL. The mean body mass index at baseline and postliposuction was 30.7 and 28.4, respectively. Seven studies reported a trend toward decrease in total cholesterol levels with an overall mean reduction of 0.21 ± 0.05 mmol/L from 4.6 ± 0.79 mmol/L to 4.4 ± 0.74 mmol/L. After LVL, leptin was reported to significantly decrease in 4 studies, and TNF-α was reported to significantly decrease in 2. Adiponectin was reported to significantly increase in 2 studies. IL-6 decreased significantly in 2 studies. Two studies included participants with type II diabetes mellitus, whereas 10 studies evaluated insulin sensitivity. Of these, 6 studies reported improvement in insulin sensitivity. Six studies represented level IV and 6 represented level II evidence."

Thus, large volume liposuction may be beneficial in terms of improving cardiovascular risk factors as well as improving diabetes by increasing insulin sensitivity.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon


Sailon, et al.  Influence of Large-Volume Liposuction on Metabolic and Cardiovascular Health: A Systematic ReviewAnnals of Plastic Surgery. 2017 Jul 22. doi: 10.1097/SAP.0000000000001195. [Epub ahead of print]



Buccal Fat Removal | Bichectomia in Houston, Texas

Buccal fat removal is a facial plastic surgery procedure that involves removing fat from your face to create a slimmer appearance of one's face.  This procedure is ideal for patients who typically present with "chubby cheeks" or "chipmunk cheeks" or "baby face."

Buccal Fat Removal Before & After Photos (3 months after surgery) performed by Dr. Emmanuel De La Cruz.

Buccal Fat Removal Before & After Photos (3 months after surgery) performed by Dr. Emmanuel De La Cruz.

Procedure:  Buccal Fat Removal performed in the procedure room/clinic

Incision: ~1.5 cm incision inside the mouth

Anesthesia: Local

Recovery time:  May go back to work the following day.

Results:  Individual results may vary.  May see improvement within 6 weeks.  Results continue to improve up to 6 months.

Emmanuel De La Cruz MD, PLLC

Plastic Surgeon

Houston, TX

VASER Liposuction: A Good Source for Mesenchymal Stromal Cells

Mesenchymal stromal cells (MSCs) are the spindle shaped plastic-adherent cells isolated from bone marrow, adipose, and other tissue sources, with multipotent differentiation capacity in vitro.  These mesenchymal stromal cells could differentiate to bone in vitro and a subset of the cells that has a high proliferative potential . The notion of a mesenchymal stem cell was popularized by Arnold Caplan proposing that MSCs gave rise to bone, cartilage, tendon, ligament, marrow stroma, adipocytes, dermis, muscle and connective tissue. Adipose-derived mesenchymal stromal cells (ASCs) are concentrated in fat tissue, and the ease of harvest via liposuction makes them a particularly interesting cell source.   Thus, fat has been transferred to the face for facial rejuvenation, as well as to the buttock for buttock augmentation.  It has shown that radiation-induced damage skin are dramatically improved by fat transfer.  

brazilian butt lift.jpg

Recently, ultrasound-assisted liposuction using VASER liposuction and Lysosonix were found to harvest viable mesenchymal stromal cells.  "UAL samples demonstrated equivalent ASC yield and viability. VASER Liposuction adipose-derived mesenchymal stem cells showed higher osteogenic and adipogenic marker expression, but a comparable differentiation capacity was observed. Soft tissue healing and neovascularization were significantly enhanced via both UAL-derived ASCs in vivo, and there was no significant difference between the cell therapy groups."

VASER Liposuction allows safe and efficient harvesting of the mesenchymal stromal cellular fraction of adipose tissue and that cells harvested via this approach are suitable for cell therapy and tissue engineering applications.

Recent studies have shown that adipose tissue derived using the VASER liposuction system were viable at harvest and suitable for autologous fat grafts, such as in Brazilian Butt Lifts.   The study had shown that "the lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%. Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%.



Duscher, et al. Ultrasound-assisted liposuction provides a source for functional adipose-derived stromal cells. Cytotherapy. 2017 Sep 13. pii: S1465-3249(17)30658-8. doi: 10.1016/j.jcyt.2017.07.013. [Epub ahead of print]

Schafer et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction.  Aesthetic Surgery Journal. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.

Emmanuel De La Cruz MD, PLLC

Houston Plastic Surgeon

Removal of Silicone Granuloma from the Buttocks using VASER Liposuction

Patients who present with a history of silicone injection to the buttocks or gluteal region may present with debilitating complications, such as chronic pain, chronic infections such as cellulitis and abscesses; skin necrosis and silicone granulomas that may cause deformity of the buttocks.  Unfortunately, silicone toxicosis of the gluteal region (buttock) can be difficult to manage.


Management of Silicone Toxicosis of the Buttock

  • An MRI of the gluteal region will need to be obtained to evaluate the location and extent of the silicone granulomas
  • Treatment may range from surgical excision versus suction-assisted lipectomy with VASER liposuction with concomitant fat transfer to the buttock to correct the resulting deformity from liposuction

Clinical Study using VASER Liposuction for Removal of Silicone Granulomas of the Buttocks

  • "Average patient age was 36 years (range, 25-43 years). All patients initially presented with intense pain as assessed by a visual analog scale; by the 12th week postoperatively, the entire cohort experienced remission in pain. At 1 year postoperatively, no patients had infections (vs 75% preoperatively; P = .028), visited the ER (vs 50% preoperatively; P = .058), or were hospitalized (vs an average of 1.5 hospitalizations per patient preoperatively; P = .066)."

  • "Liposuction with immediate intramuscular fat transfer for buttock augmentation appears to be a safe surgical option that preserves aesthetic appearance for patients with gluteal silicone toxicosis."


Salgado, et al.  Liposuction and lipofilling for treatment of symptomatic silicone toxicosis of the gluteal region. Aesthet Surg J. 2014 May 1;34(4):571-7. doi: 10.1177/1090820X14527107. Epub 2014 Mar 27.


Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas



History of Liposuction

Liposuction has been around since the 1920s when Dr. Dujarrier used a uterine curette to remove fat from the knee of a well-known ballerina.  Unfortunately during that time, the gynecologic surgeon damaged the femoral artery which resulted to amputation of the leg.

Liposuction really began evolving in the late 1960s and became what we know it as in 1974.   Dr. Yves-Gerard Illouz of Paris France created modern liposuction in 1982.  The procedure he created was the "Illouz Method", which was actually Suction Assisted Liposuction (SAL)

History of Liposuction:  Timeline

1921 -  Dujarrier used a uterine curette to remove fat from the knee of a ballerina

1960 -  Schrudde rekindled the interest in liposuction with sharp removal of fat

1978 - Kesselring and Meyer added suction to sharp curretage

1970 - Illouz (Paris, France) used a blunt cannula attached to suction device

1982 - "Illouz Method" of liposuction or Suction Assisted Liposuction

1983 - Hetter used epinephrine and 0.25% lidocaine as a solution to reduce post-operative bleeding

1984 - Hetter described the use of adequate pressure to induce lipolysis

1980 - Klein proposed the tumescent liposuction technique

Figure 1: Before & After Photos of 4D VASER Liposuction with Brazilian Buttlift performed by Dr. Emmanuel De La Cruz (8 weeks after surgery)

Figure 1: Before & After Photos of 4D VASER Liposuction with Brazilian Buttlift performed by Dr. Emmanuel De La Cruz (8 weeks after surgery)

In 1985, "Tumescent Liposuction" was invented by Dr. Klein and Dr. Lillis. Liposuction could all of a sudden be performed in an office-setting with only local anesthesia via IV sedation rather than general anesthesia. The "Super Wet" technique was invented right after tumescent, because of the high volume of fluid and potential toxicity of the fluid used (lidocaine). So this lower volume 'wet' technique, Super Wet, was invented.

With modern technology, plastic surgeons discovered Ultrasound Assisted Liposuction (UAL) in the late 1990s.  It was used to emulsify fat or liquefy fat using ultrasonic energy.   Fat is subsequently removed with lower pressure liposuction.   VASER liposuction, a third-generation ultrasonic-assisted liposuction,  was subsequently invented. It's an improved liposuction machine with lower complication rates and improved skin retraction post-liposuction.


Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgery

Houston, Texas

Treatment of Biopolymer/Hydrogel Buttock Injections

Recently, there had been numerous cases of the use of industrial grade products injected into the body, such as the buttocks and thighs, performed by unlicensed or unskilled practitioners.  Some of these products range from injectable silicone or high-volume hyaluronic acid or hydrogel. Even though some of these products, such as silicone, may be biologically inert, these materials have been implicated in a variety of adverse reactions including granulomas, disfiguring nodules, and lymphedema, sometimes with latent periods of decades.  Often, they may cause disfiguring chronic infections that may require intravenous antibiotics or extensive surgical debridement.  

There had been a few cases that the chronic infections  resulting from illegally injected industrial grade products into the lower extremities, such as the legs, resulted in amputations as a life-saving procedure.  

Figure 1:  Chronic infection from an Biopolymer injections into the buttocks and thighs performed by an unlicensed and unskilled practitioner. 

Figure 1:  Chronic infection from an Biopolymer injections into the buttocks and thighs performed by an unlicensed and unskilled practitioner. 

Clinical Manifestations & Symptoms

  • Chronic infection, such as cellulitis, that are recurrent despite antibiotics
  • Firmess or hardening of the area of injections
  • Chronic pain, such as buttock pain
  • Numbness sensation of the area of injection
  • Discoloration of the skin of the area of injection

Clinical Management

  • We recommend obtaining an MRI of the area of injection to determine the extent of injection as well as the area where the material has potentially migrated.  The MRI would act as a map to determine where your surgeon would remove the biopolymer.


  • The treatment varies from patient to patient.  This may range from surgical excision, to hyaluronidase injection followed by VASER liposuction and fat transfer into the area to correct the resultant deformity.  Unfortunately, it is not possible to completely remove the biopolymer and not result in a significant deformity of the area involved.  Complete removal, such as surgical excision, may result in a life-changing deformity.  
Figure 2:  Hydrogel/Biopolymer removal from the buttocks using the VASER Liposuction with fat transfer to the buttocks to correct the resulting deformity from removal of the biopolymer.  Patient had resolution of a chronic buttock pain after surgery.

Figure 2:  Hydrogel/Biopolymer removal from the buttocks using the VASER Liposuction with fat transfer to the buttocks to correct the resulting deformity from removal of the biopolymer.  Patient had resolution of a chronic buttock pain after surgery.

I recommend seeing a plastic surgeon for evaluation and possible removal of the biopolymer injected into one's body.  An MRI may be necessary to evaluate the location of the injected material.  Every person is different, and each treatment may be different.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon Houston, Texas

Keys to a Long-term Success in Liposuction

After liposuction, patient needs to have a realistic expectation to have a long-term succesful outcome.  There are 4 key elements to have a succesful outcome after liposuction:

1)Exercise - Exercising after liposuction is very important, especially after the initial surgery.  We encourage our patient to start exercising 2 to 4 weeks after their surgery.

2)Proper Diet - It is very important to eat a healthy diet consisting of fruits, vegetables and fish.  We recommend avoiding fatty food, drinking sodas, and eating excessively.  We recommend consulting with a nutritionist if one is having difficulty having a proper healthy diet.

3)Positive Lifestyle Changes

4)Succesful Body Contouring - It is important to choose the right surgeon who would perform your procedure.  Unfortunately, cosmetic surgery is unregulated here in the United States, and we recommend choosing a plastic surgeon who is trained in liposculpture surgery to perform your procedure.

Before & After Photos of VASER Liposuction (6 weeks after surgery) performed by Emmanuel De La Cruz MD, PLLC.

Before & After Photos of VASER Liposuction (6 weeks after surgery) performed by Emmanuel De La Cruz MD, PLLC.

A clinical study conducted by Dr. Rohrich revealed that:

  • "Among the 57 percent of patients who did not gain weight, 35 percent report exercising more postoperatively (compared with only 10 percent in the weight gain group, p = 0.002) and 50 percent report eating a healthier diet (22 percent in the weight gain group report eating a healthier diet, p = 0.002). "
  • In the weight gain group, 67 percent report no change in their diet regimen and only 17 percent thought their productivity increased (compared with 25 percent among the no weight gain group, p = 0.002). Successful body contouring surgery requires a patient to embrace positive lifestyle habits. "

Thus, the long-term success of a liposuction procedure is dependent on having a healthy proper diet and exercise.  One can still gain weight after your liposuction procedure if one does not exercise and eat a healthy diet.

Reference: Rohrich, et al. The key to long-term success in liposuction: a guide for plastic surgeons and patients. Plast Reconstr Surg. 2004 Dec;114(7):1945-52; discussion 1953.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

SmartLipo versus Traditional Tumescent Liposuction - Houston, Texas

A previous randomized clinical trial comparing traditional tumescent liposuction and SmartLipo was performed, and this showed the following findings:

  • Less post-operative pain with SmartLipo.
  • Cytologic studies showed more damage of the adipocytes (fat cells) in SmartLipo.  Thus, fat harvested from SmartLipo is not suitable for fat grafting, such as in Brazilian Butt Lift.
  • No major clinical differences found between SmartLipo versus Traditional Tumescent liposuction.
  • Surgical time was longer with the SmartLipo group.
  • Higher concentration of free fatty acids were found in the SmartLipo group.
  • Lipocrit is lower in the SmartLipo group.
Lower Lipocrit Volume was obtained with the SmartLipo group as compared to the Traditional Tumescent Liposuction group.

Lower Lipocrit Volume was obtained with the SmartLipo group as compared to the Traditional Tumescent Liposuction group.

In conclusion:  "No major clinical differences for suction-assisted lipoplasty versus laser-assisted lipoplasty were found. Higher concentrations of free-fatty acids after laser-assisted lipoplasty must alert us to possible hepatic and renal toxicity."

Reference:  Prado, et al. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006 Sep 15;118(4):1032-45.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

Reducing Risk of Contour/Skin Irregularities after Liposuction

Patients with poor skin elasticity should be forewarned about the risk for contour irregularities and suboptimal skin contraction. Similarly, pre-existing cellulite, indentations and scars may be present and will not be corrected with liposuction.  

How to Prevent Skin Contour Irregularities after Liposuction

  • Intraoperatively, use of micro-cannulae and careful use of the criss-cross technique of liposuction are recommended to prevent waviness
  • Using the VASER Liposuction machine may reduce the risk for contour irregularities
Using a smaller cannulae produces less skin contour irregularity as compared to a larger liposuction cannulae.

Using a smaller cannulae produces less skin contour irregularity as compared to a larger liposuction cannulae.

Before & After Correction of Skin Contour Irregularities.  Patient previously had traditional liposuction from another plastic surgeon and she developed skin contour irregularity.  Dr. De La Cruz performed the VASER liposuction of the thighs with fat transfer to correct the contour irregularity.

Before & After Correction of Skin Contour Irregularities (Frontal View).  Patient previously had traditional liposuction from another plastic surgeon and she developed skin contour irregularity.  Dr. De La Cruz performed the VASER liposuction of the thighs with fat transfer to correct the contour irregularity.

Before & After Correction of Skin Contour Irregularities (Frontal View).  Patient previously had traditional liposuction from another plastic surgeon and she developed skin contour irregularity.  Dr. De La Cruz performed the VASER liposuction of the thighs with fat transfer to correct the contour irregularity.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Tumescent Liposuction - Houston, Texas

What is Tumescent Liposuction?

  • The word tumescent refers to anything that is swollen and firm. With tumescent liposuction, a large volume of very dilute solution of local anesthesia (lidocaine, bicarbonate and epinephrine) is injected into the fat beneath the skin, causing the targeted area to become swollen and firm. The local anesthetic lidocaine in the solution used for tumescent liposuction reduces the pain that one would experience after liposuction. The drug epinephrine (adrenalin) provides profound localized vasoconstriction that it reduces surgical bleeding during tumescent liposuction.
  • Tumescent liposuction can be combined with other forms of liposuction such as in VASER liposuction.  In fact, the tumescent technique liposuction is essential for VASER liposuction to work since ultrasonic energy used in the VASER liposuction needs "water" to emulsify or liquefy the fat.  The fluid in the tumescent solution also prevents "skin burn injuries" from VASER liposuction.
Before & After Photos:  4D VASER Liposuction 6 weeks after surgery.  Procedure performed by Dr. De La Cruz

Before & After Photos:  4D VASER Liposuction 6 weeks after surgery.  Procedure performed by Dr. De La Cruz

Benefits of Tumescent Liposuction

  • Less blood is lost.

  • Intravenous fluid replacement is not necessary.

  • Bacteriostatic lidocaine may decrease the risk of infections.

  • Tumescence magnifies defects; therefore, the likelihood of needing a secondary procedure may be less.

  • Lipid-soluble lidocaine is somewhat suctioned out with the aspirated fat.

  • Vasoconstriction minimizes absorption.

  • The epinephrine may increase the cardiac output, which, in turn, hastens the hepatic metabolism of the lidocaine.

  • The duration of anesthetic effect may last as long as 24 hours.

  • The lidocaine may be given safely up to 45 mg/kg and even higher in certain conditions.

Does VASER Liposuction Employs Tumescent Liposuction Technique?

  • It is standard of care to employ the tumescent liposuction technique in most liposuction methods, including the VASER liposelection/liposculpture.
  • Infilitrating the area of fat with tumescent solution reduces the risk of burn injuries that may occur in VASER liposuction or Laser-assisted liposuction.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

The Galleria Clinic

1700 Post Oak Boulevard

2 BLVD Place Suite 600Houston TX, 77056(Next to Whole Foods, above North Italia Restaurant)

The Woodlands Clinic

2219 Sawdust Road  #1203  The Woodlands, TX 77380

Call us at 832-520-1844