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Ocean Plastic Surgery - Smart Lipo Case Study - Los Alamitos, CA

Smart Liposuction Case Study by Dr. William Aiello


Dr. Aiello: We're here today to do Smartlipo on thighs. This is on the outer thighs, and I'm just going to go over some of the markings. This procedure is done under local with oral sedation. It means the medication is by mouth, we inject the patient with a solution of lidocaine, otherwise known as adrenaline, and saline and some bicarbonate which helps the injections. Once this is done, the patient then has the Smartlipo performed, but at this time I'm going to go over the markings.

We have fullness in this area which is known as lipodystrophy, which is diet and exercise-resistant fat. We're going to suction out this first and do a laser. This is kind of a three-part procedure where we inject them first and then we do the lasering. Actually it's four parts. We do the lasering. Then we suction out the excess fat and then we go back in and tighten up the skin by lasering the skin a little bit from the undersurface.

This is going to be an access point and an access point to go in to do this. What we've made is a grid red with little boxes, and these tell us how much energy we can deliver to each box area from the laser. Then green is just the numbering of the boxes and lets us know how many boxes we're doing so we can calculate on the medications and the amount of laser joules that we're putting in for energy. Then the blue is just boxes for us to do six boxes at a time, generally on both sides. We're going to lip down this area and in here and in here to kind of get this all contoured nicely.

Now I'm going to make two access incisions right here and then we're going to inject this area about 50 cc of fluid in each one of the boxes. Okay, now what we're going to be doing is injecting one box roughly at a time with about 50 cc of tumescent fluid. All right, we injected some of the lower half down here and coming through this other access point now to inject other areas.

Now we've infiltrated both thighs, and this was done under just straight local with a little oral medication. We're going to let this sit for about 10, 15 minutes. That will let the anesthetic work a little bit better and help with venous constriction. You can see there's some venous constriction here. Vascular blood supply is minimized and it's turning white. These areas will turn white, which will help reduce the amount of blood loss from the procedure. Okay. We'll come back in a little while and start the laser.

Dr. Aiello at Ocean Plastic Surgery. We're in the process of doing Smartlipo to the outer thighs. We've already done the markings and injection of the tumescent fluid for the numbing. The patient is under local with local anesthesia. She had a little sedation orally. She is very comfortable. We've already done all of these boxes here. We're now doing some more.

Take a picture of the machine there. This is the Smartlipo Cynosure machine. We've already given her 19,418 joules of energy, and we're going to be doing some more right now. We're working on this box. We delivery about 1000 joules per box. It's not a lot to see, but we just go over there area, and we're limited on what we can give by the temperature of this little alarm. It shuts off the machine if the temperature underneath the skin gets too hot. I delivery about 1000 joules per box. We're almost at 1000. Ten thousand now means that we did 10 boxes. You can see over there.

We're going to move onto our next box. As you can see, the patient is very comfortable. After this procedure, this process, then we're going to use a small liposuction cannula and take out the melted, liquified fat from what the laser had done to the fatty tissue.

Excellent laser lipo with the Smartlipo by Cynosure. All the little purple marks is all the boxes that we've already finished so far. We have a few more to do. We give about 1000 joules to each one of the boxes of energy, and then we're going to liposuction her, so we'll do these last few. Then you can look over here. You can see we've already done 18,000 joules, which means we did 18 boxes. Okay.

We'll start now. If you get close enough, you can see the little red light that's kind of an indicator light for the laser. Lets us know where we are and how deep we are. If it's dimmer, it means we're deeper. Like I said, we're trying to deliver 1000 joules to each box. We already did this box. Working on this box now.

That beeping sound that goes beep, beep, beep, beep means that it's already reached its temperature and it's shutting off the unit so that you can't overheat the skin and cause any tissue damage. That's this little device here that has a sensor on the end of the probe, this little metal collar that measures the temperature underneath the skin, preventing any thermal burns.

Five hundred.

You can see the little light. That's the laser aiming beam.

You can see the contour difference between the side that we liposuctioned and lasered and the side we just lasered. I'm going to liposuction that side. We've contoured this, gave her a nice buttocks crease, nice contour on the side. On the other side, we haven't done that yet.

If you look in the canister, we've taken out about 750 cc, roughly, of just aspirate. Very little blood. All of that is fat.

... liposuction. Remember this is the third phase. We've injected her first with the tumescent fluid, then the lasered her deeply for the fat, emulsify the fat. Now we're liposuctioning.

Last phase is to do another lasering to tighten up the skin. Show a picture of the hose. You can see all the fat in the hose is basically just emulsified fat. No big clumps and not a lot of blood. We've liposuctioned both sides. We got out in the canister here about 1300 cc of emulsified fat.

We're going to do the last stage, which is stage four. We're going to superficially laser underneath the skin to tighten up the skin with the laser. This is that little red light I showed before that was under the skin, and that will help tighten her, and then we'll be done. Okay.

You can see the little red light moving around this box 19. Up until now we've done injection for the tumescent fluid for numbing. Then we lasered her deeply and we liposuctioned it. We then are doing superficial lasering to help tighten the skin. Then the last couple things we're going to do is we're going to roll the skin a little bit and get out any access fluid from the incision holes and then put her in a garment. As soon as I finish doing this last box, we're going to squeeze out some bloody fluid from the holes.

We're rolling out whatever emulsified blood and fat see in the skin, get out as much fluid as possible. We'll leave the little holes open to drain. Usually they'll drain for a day, maybe two at the most. That helps get the swelling down quicker. It gets out all of the excess fluid and any kind of liquified, emulsified fat from the laser. We will be putting a garment on her.

The little X boxes shows us that we lasered her deep and superficial. It's going to take about four months for her end result, but she'll notice a nice improvement after about a month. As far as activity, she's going to go home today. We'll give her some pain medicine. Obviously, she's not hurting right at the moment from the surgery, but she still has a local on board. that will wear off eventually, later on today. Then she can be moving around and about in the next couple of days, but no sports or anything like that. Just normal daily activity is fine. She can take a shower tonight or tomorrow morning and put some antibiotic ointment on those incision sites.