4D VASER High-Definition LIPOSUCTION

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.

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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.   

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%.

 

Reference:

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

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.

Treatment

  • 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

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

Reference:

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

 

 

References:   

  • 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

 

References:

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.

 

VASER Liposuction on Gynecomastia for Men

Gynecomastia describes a benign increase of the mammary gland in men.   This could range from a puffiness or localized button of tissue concentrated around the areola to marked, distinct enlargement of the breasts making the breasts looking feminine.  Gynecomastia or the so-called "man-boob" can be secondary to multiple causes such as marijuana usage; certain medications such as Pepcid/Tagamet/cardiac medications; testicular tumors; thyroid abnormalities; pre-pubertal enlargement, etc.  Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance.  However, gynecomastia may cause local pain and tenderness, and this could occasionally be the result of a serious underlying illness or a medication, or be inherited.   Most cases of gynecomastia result from deficient androgen action or excessive estrogen action in the breast tissue.  In  pubertal gynecomastia, the breast enlargement may resolve spontaneously and thus may warrant observation for gynecomastia in children.

Before & After Photos of  VASER Liposuction  of the Breasts for treatment of Gynecomastia.  Note that the patient also underwent the 4D VASER Hi-Definition Liposuction.  Procedure performed by Dr. De La Cruz

Before & After Photos of VASER Liposuction of the Breasts for treatment of Gynecomastia.  Note that the patient also underwent the 4D VASER Hi-Definition Liposuction.  Procedure performed by Dr. De La Cruz

When medical treatment fails, the surgical procedure is the treatment of choice.  Numerous surgical techniques exist for gynecomastia treatment.  This could range from using the VASER liposuction or ultrasonic liposuction to direct excision of gynecomastia.  Recent studies have shown that ultrasonic liposuction for the treatment of mild to moderate gynecomastia showed superior results over conventional liposuction methods.

A total of 219 patients (384 breasts) with a mean age of 29 years (range 12-74) were evaluated. UAL was utilised in 24% of breasts (47 patients, 91 breasts). Compared with conventional liposuction, UAL had significantly lower rates of intraoperative conversion to open excision (25% vs. 39%; p<0.05) and postoperative revision (2% vs. 19%; p<0.001) using Fisher's exact test. The haematoma rate for each technique was 1%.

Recently, subcutaneous mastectomy was compared with ultrasonic-liposuction for the treatment of gynecomastia.  The reoperation rates in the mastectomy group and liposuction group were 1.4% and 0.5%, respectively. There were no nipple/areola necrosis and scars in liposuction group.  The ultrasonic-liposuction treatment was associated with superior esthetic results and fewer complications.

The use of ultrasonic-assisted liposuction (UAL) combined with conventional liposuction and partial gland resection without skin excision is an option for moderate cases.  Although a wide range of surgical techniques have been described, the treatment of gynecomastia requires an individualized approach. 

Reference:

Song et al.  Surgical treatment of gynecomastia:  mastectomy compared to liposuction techniques.  Ann Plast Surg. 2014 Sep;73(3):275-8. doi: 10.1097/SAP.0b013e31827c7949.

Wong, et al.. Conventional versus ultrasound-assisted liposuction in gynecomastia surgery:  a 13-year review. J Plast Reconstr Aesthet Surg. 2014 Jul;67(7):921-6. doi: 10.1016/j.bjps.2014.03.004. Epub 2014 Mar 21. 

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

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: &nbsp;Before &amp; After Photos of  4 D VASER Hi-Definition Liposuction  with  Brazilian Butt Lift  (6 DAYS after Surgery.) &nbsp;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: &nbsp;Before &amp; After photos of  Brazilian Butt Lift  &nbsp;(24 HOURS after Surgery.) &nbsp;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. &nbsp;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).

FAST FACTS about VASER LIPOSUCTION

• 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.

KEY BENEFITS of VASERlipo:

• 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

 

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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

SMART Liposuction vs Traditional Liposuction

Comparison of SmartLipo versus Traditional Liposuction

  • A prospective randomized clinical study showed that there's no clinical difference between the traditional liposuction versus laser-assisted liposuction using the SmartLipo machine.

  •  There's less pain, lower lipocrits, higher triglycerides, and DNA cellular membrane traces were detected in the laser-assisted lipoplasty sides as compared to the traditional liposuction.

  • Higher concentrations of free-fatty acids after laser-assisted lipoplasty was found.  It's recommended that this should alert us to any possible hepatic and renal toxicity.

References:

Pradeo, 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.

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