Briar L. Dent and B. Aviva Preminger

Abstract

power-assisted liposuction ( PAL ) allows for increased fatty origin with reduce tissue trauma and operator fatigue due to better tissue penetration. The reciprocating motion and device vibration help more rapid adipose tissue aspiration with decrease physical effort particularly in hempen areas and revision procedures. Studies have demonstrated larger volume adipose tissue inhalation and short operative times and potential skin tighten. extra benefits reported include less intraoperative and postoperative annoyance, less postoperative ecchymosis and edema and greater patient gratification when compared to traditional liposuction techniques. The reduced adipocyte damage may besides allow for improved fat graft. PAL has, consequently, become a prove technique with advantages over traditional liposuction .

power-assisted liposuction – liposuction – fat grafting – gynecomastia – fat reap – energy-assisted liposuction – fat inhalation

13 Power-Assisted Liposuction Cannula Types and Technique

“ about all men can stand adversity, but if you want to test a man ’ randomness character, give him ability. ”
—Abraham Lincoln

13.1 History of PAL

liposuction as a procedure has always been a balance between the need to maximize weave penetration and minimize weave damage. PAL was developed in the 1990s in answer to the motivation for better fat penetration and command without the generation of excessive heat and the complications associated with ultrasound-based devices. 1

13.2 Equipment

The foremost power-assisted devices incorporated a blade within a cannula drawing from orthopedic and otolaryngologic instruments and were primarily intended for submental function. 2 Concerns about increased blood passing using cannulas with internal blades led manufacturers away from blades in favor of reciprocating cannulas. 2 These instruments were designed to vibrate at a rate of 800 to 10,000 movements per minute and the oscillation allowed easier weave penetration. 2 The power-assisted devices were besides designed to work with a diverseness of cannula shapes and sizes .
The early powered devices were driven by compressed flatulence and were very noisy. 2, 3 They besides required the expense and troublesomeness of maintaining large tanks of medical-grade compressed accelerator. Byron Surgical ( Mentor, Irvine CA ) developed a disposable power-assisted handle that was driven by the publicize discharged from the aspirator. 2 however, this was fraught with increase noise and cost. Quieter electrical sources were soon developed. 3
A small variable speed motive generates a forth and backward reciprocating motion to produce a 2 millimeter to 12 mm excursion at the tip off. 4, 5, 6 At the weave tied, the reciprocating movements of the power cannula mirror that of the manual movements but the standard stroke distance and limited lateral movements help to reduce weave injury. vigorous movements are replaced by slower manual passes of the powered cannula, maximizing fat extraction with less effort. The mechanism of natural process has not been clearly defined. Two possibilities have been proposed : ( 1 ) a jackhammer-type gesture of the cannula tip breaks up fat or ( 2 ) the adipose tissue is suctioned into the cannula and then avulsed by the reciprocating apparent motion. 4

Studies have demonstrated the largest increase in fat extraction using the PAL system previously produced by Byron Surgical ( Mentor, Irvine CA ). 2 Some systems rely on electricity and others are gasoline driven. 6 Differences in efficacy may be attributable to differences in the rate of oscillation though it is unclear whether slower or faster vibration provides optimum efficiency for removing fatness. 2 The extent of radial movement may besides contribute to efficacy. Choice among competing PAL devices is generally based upon warrantee, preference of electric versus pneumatic, vibration, and make noise. 6 In the United States, the PAL LipoSculptor by MicroAire ( Charlottesville, VA ) is the merely PAL system that is presently being manufactured. The device is electric and operates with a 2 millimeter reciprocating stroke at 4,000 cycles per minute. Per report from the manufacturer in 2016, the system costs approximately uracil $ 20,000. other companies that have previously manufactured PAL systems include Wells-Johnson ( Tucson AZ ), Byron Surgical ( Mentor, Irvine CA ), and Medtronic ( Minneapolis MN ), but these products are no longer on the marketplace .
Powered systems incorporate cannulas of comparable duration and diameter to suction-assisted lipoplasty cannulas, allowing for the use of little incisions. The powered cannulas have been shown to create larger tunnels in the hypodermic tissue than traditional liposuction cannulas. 2, 7 In early words, a 3 millimeter cannula may produce tunnels of 4 millimeter or larger. 2, 7 Therefore, surgeons should consider choosing a smaller size cannula than that to which they are normally accustomed. This besides allows surgeons to make smaller entree incisions than they would typically require for a given tunnel size. When the office is on, the cannula can be held in one stead and however remove adipose tissue. caution must be used for this lapp cause to avoid creating contour irregularities .

13.3 Advantages for the Surgeon

The improved weave penetration of the power-assisted devices reduces operator fatigue duty by allowing for more rapid inhalation and decreased muscle strain. This is particularly helpful in revision cases ampere good as fibrous areas such as the binding, flanks, and male summit. By reducing the physical effort required by the surgeon, longer or more numerous surgeries can potentially be performed in a given school term. Furthermore, decreasing the fatigue and monotony associated with traditional liposuction likely improves surgeon attention and preciseness. 2, 7, 8
A multicenter study performed by Coleman et alabama demonstrated an average increase in fatten origin of 30 % ( range 20 to 45 % ) with PAL, as compared to traditional liposuction. 5 traditional liposuction was simulated in their sketch by using PAL devices in their non-powered modes. The greatest increase in fat extraction was seen in the hip area ( 62 % ), compared to the upper thigh ( 48 % ) and the abdomen ( 36 % ), which supports the observation that PAL is particularly advantageous in hempen areas where traditional liposuction can be more challenge .
Katz et aluminum compared traditional liposuction and PAL in a group of patients who served as their own controls. 7 They found that PAL was associated with 35 % short surgical times, 31 % greater adipose tissue aspiration per moment, and 49 % less surgeon fatigue duty than traditional liposuction. 7 The authors besides reported that, because of the greater relief with which the power cannula moves within the hypodermic weave, together with the increased patient comfort associated with PAL ( see segment 13.4 ), they were able to polish unmanageable areas at the end of the encase with the affected role digest. 2, 7 They believe that this opportunity allows for a degree of final symmetry and shape that could not differently be achieved with traditional liposuction and a lower incidence of revision procedures. 7
In an undertake to assess peel tightening following PAL, Sasaki et aluminum measured surface area changes in three patients who underwent both PAL and traditional liposuction of their abdomen. 9 While their results did not reach statistical significance, they reported a greater reduction in clamber surface sphere with PAL ( average 5.8 % ) than with traditional liposuction ( modal 4.2 % ) six months postoperatively. 9 Their survey was limited by its humble sample size, but should encourage further research into the likely skin tightening advantages of PAL over traditional liposuction .
The overall increase in adipose tissue extraction reported by Coleman et alabama, as discussed above, was only significant for surgeons who had performed eight or more buddy cases. 5 For surgeons who had performed seven or fewer PAL cases, there was no meaning deviation in fat extraction between powered and non-powered liposuction. The learn draws attention to the short but real learn curve associated with the powered devices. Surgeons must become habituate to moving the cannula more slowly than in traditional liposuction in order to maximize the fat origin benefits of PAL. While irregular, this learning curvature may be considered a small disadvantage of PAL.

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