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.  

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

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.

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.

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.

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

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