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Fat Liposuction

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Harvesting sites should be convenient for access and should enhance the patient’s contour. The abdomen and medial thighs are the most commonly chosen donor sites.When abdominal or medial thigh fat is in short supply because of prior liposuction or scarcity of body fat, the other potential sites include the suprapubic region, the anterior or lateral thighs, the knees, the lower back, the hips, or the sacrum.

Whenever possible, harvesting sites are accessed through incisions placed in creases, previous scars, stretch marks, or hirsute areas. Meticulous sterile technique is observed with preoperative preparation using antimicrobial scrubs   solutions.

Local anesthesia is most commonly used, but epidural or general anesthesia may be preferred for removal of larger volumes or when multiple sites are used for harvesting. In lo- cal anesthesia cases, a blunt Lamis infiltrator attached to a 10-mL syringe is used to infiltrate 0.5% lidocaine with 1:200,000 epinephrine into the desired sites.To ensure hemostasis in general or epidural cases, lactate Ringer solution with 1:400,000 epinephrine is infiltrated. In all situations, about 1 mL of solution is infiltrated for every milliliter of fat to be harvested. Super wet or tumescent techniques of the harvested tissue can disrupt the parcels of fatty tissue and decrease survival.

A 15- or 23-cm two-hole Coleman harvesting cannula with a blunt tip and dull distal openings placed extremely close to the end of the cannula is twisted onto a 10-mL Luer-Lok sy- ringe. The distal openings of the harvesting cannula are of an appropriate size and shape for harvesting the largest in- tact fatty tissue parcels that can readily pass though the lu-men of a Luer-Lok syringe. If the fatty tissue parcel can pass through the lumen of the Luer-Lok syringe, it will usually pass through the much smaller (17-gauge) lumen oftheinfiltrationcannula.

After inserting the cannula tip into the donor site, the surgeon pulls back on the syringe plunger to create a small amount of negative pressure within the barrel of the syringe. A10-mL syringe is small enough to be manipulated manually without locking devices in order to minimize negativepressure.Thesurgeonpullsbackontheplungerofthesyringetocreateabout1 or 2mL of space in the barrel of the syringe while the attached cannula is pushed through the harvest site. The combination of slight negative pressure and the curetting action of the cannula’s motion through the tissues allows parcels of fatty tissue to move through the cannula, through the Luer-Lok aperture, and into the barrel of the syringe with minimal mechanical damage.

When filled, the syringe is then disconnected from the cannula and replaced with a “dual-function Luer-Lok plug for capping.”After the syringe is sealed at the Luer-Lok end, the plunger is removed from the proximal end of the syringe and the barrel filled with 10mL of harvested material is placed into a centrifuge.

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