4D VASER High-Definition Liposuction

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.

Filtering by Category: 4D VASER Liposuction

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 VASER lipo 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

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.

Skin Retraction After VASER Liposuction

A recent randomized clinical trial had shown that the VASER liposuction produced clinical significant skin retraction. 

  • "Regarding skin retraction, the VASER-assisted lipoplasty-treated side resulted in a statistically significant improvement in skin retraction of 53 percent relative to suction-assisted lipoplasty (17 percent per liter versus 11 percent per liter, p = 0.003) with 33 paired sites using a two-tailed t test. "
Figure 1:  Before and After Photos (3 months after surgery) after VASER  Hi-Definition Liposuction  performed by Dr. De La Cruz.  Note that there was significant skin retraction after surgery.

Figure 1:  Before and After Photos (3 months after surgery) after VASER Hi-Definition Liposuction performed by Dr. De La Cruz.  Note that there was significant skin retraction after surgery.


Nagy, et al.. A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted Lipoplasty and suction-assisted Lipoplasty. Plast Reconstr Surg. 2012 Apr;129(4):681e-9e. doi: 10.1097/PRS.0b013e3182442274.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Fat Graft Harvested via VASER Liposuction is Viable and Suitable for Fat Transfer in Brazilian Butt Lift Patients

Although there's clinical evidence of successful autologous fat transfer (AFT), such as in Brazilian Butt Lift, using VASER liposuction is readily available, no study has quantified adipocyte viability using standardized methods until recently.

  • The UAL system (VASER; Sound Surgical Technologies, Inc, Louisville, Colorado) was set at 60% amplitude in pulsed mode with vacuum aspiration of 15 in Hg or less.
  • Laboratory analysis included free lipid volume, viability via lipolysis and propidium iodide staining, and cytological analysis, including cell surface protein examination and hematoxylin and eosin staining.
  • 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%
  • Adipose tissue acquired via VASER liposuction is viable at harvest and isa suitable source for autologous fat grafts, especially for Brazilian Butt Lift.
  • Adiposed-derived stem cells (fat for fat transfer) obtained via VASER liposuction were of equal quality when directly compared with the current gold standard harvest method according to a study conducted by Duscher.   "UAL- and SAL-derived samples demonstrated equivalent ASC yield and viability, and UAL ASCs were not impaired in their osteogenic, adipogenic, or chondrogenic differentiation capacity."
4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas


Duscher, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells.  Stem Cells Transl Med. 2016 Feb;5(2):248-57. doi: 10.5966/sctm.2015-0064. Epub 2015 Dec 23.

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

Hand Rejuvenation using Fat Grafting

Apart from the most obvious region (face & neck) where aging can be seen and where most aesthetic surgery for rejuvenation are performed,  the dorsum of the hand is the next obvious area where aging can be seen and is continuously visible in daily life.  What they used to say,"If you want to know a woman's age, look at her hands" still holds true.

The region of the hand exhibits laxity of the skin with subcutaneous atrophy and age-related pigmentations in a comparable manner to the face. Fat transfer to the dorsum of the hand enables subcutaneous regeneration by refilling the subcutaneous space and hence reducing some of the age-related degenerative process.

Areas of Concern of the Aging Hand

  • Bony-looking hands due to loss of some of the fat beneath the skin that occurs with age
  • Prominent veins
  • Brown aging spots (liver spots)

Rejuvenation Treatment for the Aging Hand

  •    Chemical peels to improve the overall appearance of the skin on the back of the hand
  • Fillers or Fat transfer onto the dorsum or back of the hand to make them appear less bony.  Fat transfer is ideal since this may improve the texture of the skin.

Please consult your plastic surgeon regarding hand rejuvenation.


Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, and Hand Surgeon




  • Coleman SR.  Hand rejuvenation with structural fat grafting. Plast Reconstr Surg. 2002 Dec;110(7):1731-44; discussion 1745-7. 
  • Villanueva, et al.  Technical Refinements in Autologous Hand Rejuvenation.  Plast Reconstr Surg. 2015 Dec;136(6):1175-9.

Lymphatic Massage after Liposuction

One may notice a hardness or lumpiness to the areas treated with liposuction and/or with other body contouring procedures (such as fat injections for what is popularly known as the Brazilian Butt Lift).   This post-surgical lymphedema is caused by inflammation and trauma from the cannula (instrument that sucks out the fat) moving under the skin.  Channels are formed by the cannula that can fill up with fluid and the tissue also becomes swollen.  Manual Lymphatic Massage helps to move the fluid by gently pumping it back into the lymph vessels.  Reducing the swelling can reduce discomfort and may reduce contour irregularities after a   liposuction procedure.  Without Lymph Massage (LDT or MLD) the inflammation can evolve into fibrosis (a permanent hardening of the tissue) or a seroma ( pocket of serum) can form.  It is imperative that one should follow the post-operative protocol of your plastic surgeon to achieve the best possible results and avoid developing fibrosis and even possibly contour irreguarities.

Clinical studies have shown that lymphatic massage also improved the clinical outcome after a cryolipolysis procedure.   The study had shown that post-treatment manual massage resulted in a mean fat layer reduction was 68% greater in the massage side than in the non-massage side as measured by ultrasound at 2 months post-treatment.  At 4 months, mean fat layer reduction was 44% greater in the massage side.   Histological results showed no evidence of necrosis or fibrosis resulting from the massage.

I do NOT recommend receiving a general therapeutic, deep tissue or Swedish Massage in lieu of a lymphatic massage therapy after a liposuction procedure.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, Houston Texas



Boey, et al.  Enhanced clinical outcome with manual massage following cryolipolysis treatment: a 4-month study of safety and efficacy.  Lasers Surg Med. 2014 Jan;46(1):20-6.


Brazilian Butt Lift | Fat Transfer to Buttock in Houston, Texas

From an evolutionary standpoint, an hourglass figure with a narrow waist and full buttocks is associated with female reproductive potential and has been considered an aesthetic ideal across cultures.  A round, well-projected buttock indicates fertility and youth in a woman and is considered aesthetically pleasing.  With the popularity of several celebrities' derriere such as those of Kim Kardashian, Jennifer Lopez, Beyonce and Sofia Vergara, the plastic surgery procedure called Brazilian Butt Lift has become more popular among women.

What is the Brazilian Butt Lift?

  • This plastic surgery procedure involves liposuction and the transfer of fat into the buttock.
  • The 4 D VASER Hi-Definition liposcuplture incorporates the transfer of fat into the buttock as part of the procedure.  Not only one will have an athletic figure, the buttock is also enhanced to produce a more aesthetically pleasing body.
  • The fat is harvested using the Coleman technique, and the fat is then transferred into the buttock to produce a more rounded and more voluptuous buttock.
Figure1:  Before & After Photos of  4 D VASER Hi-Definition Liposuction  with  Brazilian Butt Lift  (6 DAYS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Figure1:  Before & After Photos of 4 D VASER Hi-Definition Liposuction with Brazilian Butt Lift (6 DAYS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Figure 2:  Before & After photos of  Brazilian Butt Lift   (24 HOURS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Figure 2:  Before & After photos of Brazilian Butt Lift  (24 HOURS after Surgery.)  Procedure performed by Dr. Emmanuel De La Cruz in Houston, TX.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, TX | The Woodlands, TX

4D VASER High-Definition Liposuction

Abdominal etching was initially developed by Dr. Mentz in 1993.  It was a liposuction technique defining the rectus abdominis muscle to create the 6-pack in men.   With this technique, the linea alba in the middle of the rectus abdominis muscle is etched with the outline of the muscles.   Horizontal lines are then created to sculpt a 6-pack.

Figure 1: 4-D VASER High Definition Liposculpture by Dr. Alfredo Hoyos from Colombia. www.alfredohoyos.com

4D VASER Liposculpture performed by Colombian Plastic Surgeon Dr. Alfredo Hoyos.  Note that the procedure involves sculpting the chest, abdomen, flanks, back and arms.

4D VASER Liposculpture performed by Colombian Plastic Surgeon Dr. Alfredo Hoyos.  Note that the procedure involves sculpting the chest, abdomen, flanks, back and arms.

This technique was further enhanced and improved by a Colombian plastic surgeon Dr. Alfredo Hoyos using the VASER liposuction technology.  VASER (acronym for Vibration Amplification of Sound Energy at Resonance) is an ultrasound-assisted liposuction that utilizes ultrasound energy to selectively remove fat without harming the surrounding structures of the area being liposuctioned.

Figure 1: Before & After Photos of 4D VASER High Definition Liposculpture (6 weeks after surgery) performed by Houston Plastic Surgeon Dr. Emmanuel De La Cruz MD, PLLC. Note that final definition is typically seen 3-4 months after surgery. Patient went from a size 6 to a size 2. Result may vary individually.


Figure 3:  Dr. Alfredo Hoyos, the pioneer of the 4D VASER Liposculpture and other plastic surgeons from all over the world (Slovenia, USA [Dr. De La Cruz], Colombia, Egypt and Spain) who perform the 4D VASER High Definition Liposuction.

How Does the VASER Liposuction Work?

VASER liposuction is a minimally invasive liposuction procedure performed in conjunction with tumescent anesthesia that utilizes advanced ultrasound technology designed to gently reshape the body. The ultrasound energy is transmitted through the small VASER probes that diffuse the ultrasound waves and liquefy the fat for easy removal. The ultrasound energy is gentle enough that it can break apart the fat with minimal damage to surrounding tissues, creating smooth, predictable results with fast patient recovery.


Clinical Study

A multicenter, prospective randomized controlled trial in 2012 recently showed that the VASER-assisted liposuction resulted in a statistically significant improvement in skin retraction of 53 percent relative to the traditional regular liposuction (17 percent per liter versus 11 percent per liter, p = 0.003). Moreover, the VASER-assisted liposuction group also resulted in a statistically significant reduction in blood loss of 26 percent relative to the traditional liposuction (p = 0.019 with n = 20 using a two-tailed t test).


• The VASER-liposuction method demonstrated improved skin retraction compared with traditional/conventional liposuction.
• The VASER-liposuction method demonstrated reduction in blood loss compared with traditional liposuction.
• No serious complications reported in a clinical study involving VASER liposuction in over 70,000 VASER liposuction procedures.
• No burn complications, contour irregularities or prolonged swelling seen in one clinical study.
• No revisions needed after a VASER liposuction found in a multi-center pilot study.


• Single procedure results with speedy recovery times
• Less bleeding & more skin retraction
• Improved body contouring over traditional liposuction
• Refines and accentuates appearance of muscles
• It's the RECOMMENDED type of liposuction for treatment of gynecomastia in men

Recovery after a 4-D VASER High Definition Liposuction

  • May return to work 3-5 days after surgery
  • May resume exercise or work out 1-2 weeks after surgery



Emmanuel De La Cruz M.D. PLLC

Houston Plastic & Reconstructive Surgeon | Cosmetic Surgeon

Certified 4D VASER High Definition Liposculpture Surgeon

Call NOW at 832-520-1844

Clinic Locations: The Galleria in Houston, TX & The Woodlands, TX

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