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E. Antonio Mangubat, MD Seattle, WA

Fat Disruption : A Useful Adjunct To Liposuction Surgery by. E. Antonio Mangubat, MD Seattle, WA. Fat Disruption Concept. Not a new idea Chopped up fat is easier to suck out UAL (Ultrasound Assisted Liposuction) Fat disruption before liposuction Great in tough areas (scar, gynecomastia)

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E. Antonio Mangubat, MD Seattle, WA

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  1. Fat Disruption : A Useful Adjunct To Liposuction Surgeryby E. Antonio Mangubat, MD Seattle, WA

  2. Fat Disruption Concept • Not a new idea • Chopped up fat is easier to suck out • UAL (Ultrasound Assisted Liposuction) • Fat disruption before liposuction • Great in tough areas (scar, gynecomastia) • Made aspiration easier • Cost

  3. Fat Disruption Concept • Blugerman liposhifting instrument • Introduced in 2002 Liposuction World Congress • Designed to create mini fat grafts internally • in vivo fat grafts manually shifted to fill defect • Solid core cannula 3-4mm diameter • Current concept • Mechanical disruption of fat infrastructure • Not intended for fat grafting • Detach the fat from its stroma before suction • Uses much larger cannulas: 5-6mm typical

  4. Advantage of Fat Disruption • SPEED • Rapid volume reduction • Aspiration speeds up to 1000ml/min • Large cannulas do not cause irregularities • Smooth results regardless of cannula size • No suction applied during disruption • Even superficial passes do not leave divots • Especially useful for: • Large volume reduction • Beginning liposuction surgeons

  5. Prototype Fat Disruptor Instrument and technique • Large sizes: 5 & 6mm empirically work the best • Hollow cannulas • Relieve tumescent pressure • Retains leaking aspirate in hose; less mess • Fat disruption surface • Not designed for fat grafting • Longer, larger holes, faster • Push and pull disruption more efficient

  6. Fat Disruption Technique • Large tumescent volume • No suction used in disruption phase • No divots, no ridges, no depressions • Different than pre-tunneling

  7. Technical Notes • Intense “super” tumescence - high hydrostatic pressure • Forced fluid dispersion • Hydrostatic capillary compression • Bloodless • Staged tumescence – infuse in staged areas e.g. • Front the Back • Upper body then lower body • Vasoconstriction last only ~90min • Speed critical for larger volumes

  8. Technical Notes Tumescent Solutions Compositions • Lidocaine = .048% (50ml 1% lidocaine in 1L) • Epinephrine = 1:1,000,000 (1ml 1:1000 epi in 1L) • Max dose 40-50mg/Kg • Addition tumescence above the max lidocaine dosages had no lidocaine. Only: 1:1,000,000 epi in LRS

  9. Large fat disruption surface Intense tumescence Note firm tissue turgor No suction applied yet Start deep next to muscle 5-6 minutes, loss of resistance

  10. Able to get close to surface No surface defects Begin 60 secs of suction Large 6mm cannula Note free flow of aspirate 1000ml in 60 seconds!

  11. Greater Cosmetic SafetyUseful In Defects Prone Areas High Resistance Areas • Gynecomastia • Epigastrium • Upper back • Revision liposuction

  12. Greater Cosmetic Safety For Experience Surgeons • SPEED! • Significantly shorter procedures • Greater time for refinement • Cost-effectiveness

  13. Greater Cosmetic Safety For Beginning Surgeons • Much shorter learning curve • Reproducibly smoother results • SPEED! • Cost effective

  14. Fat Disruption Summary Great Speed & Smoother Results • Shorter procedure times • Less blood loss • Less anesthesia • Less expense Greater Patient Safety

  15. Thank You! E. Antonio Mangubat, MDSeattle, WA USA

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