Instrumentation for liposuction of the face and neck

Successful performance of any operation requires not only skill, but also the availability of appropriate equipment. There are few basic instruments for liposuction, but they have continued to improve since their introduction in the early 1970s. The physiological basis of liposuction, with the exception of the liposhaver, remains the same: subcutaneous fat is sucked in by negative pressure and torn off by the reciprocating movements of the cannula. Currently, the advent of blunt-ended liposuction cannulas with a diameter of 1 mm, 2 mm and 3 mm, as well as the liposhaver, allows for more controlled and precise work, forming the art of "liposculpture".

Improvements in cannula design include the use of lightweight metals and a variety of handle sizes. Cannulas have different numbers of suction holes. Tips come in sharp, blunt, and spatula-shaped configurations. As will be discussed in the section on technique, different cannulas should be used at different stages of liposuction. These stages include active fat removal, shaping, and smoothing. Some cannulas have more than one hole, each with a different shape. The larger the hole, the greater the suction force. In addition, the end of the cannula should be blunt to avoid damaging the skin.

Physicians who advocate fat injection for soft tissue augmentation often use a Luer-lock aspiration cannula to remove small fat deposits. It is then washed and injected elsewhere. This method can be used for primary liposuction on the face and neck with minimal equipment costs. The technique is similar to standard liposuction, except that the suction force is created manually, using a 10-20 ml syringe that collects a small amount of fat. Fat aspiration with lower suction force is used when the fat will be injected into areas of tissue augmentation. This force preserves the adipocyte structure and increases the likelihood of transplant engraftment. The cannula for syringe liposuction is structurally smaller - 14-17 G.

Hypotonic infiltration technique, ultrasound energy is used less frequently in the face and neck area, but it certainly has its supporters. The cannulas used for this purpose are thin and blunt; they serve to quickly pump a hypotonic/anesthetic solution.

Ultrasound equipment consists of either a handheld cutaneous ultrasound emitter or a cannula (hollow or solid) with an integrated ultrasound system. A hollow cannula can perform lipoextraction, while a solid cannula (preferred by most) requires standard lipoextraction after ultrasound exposure. These cannulas are manufactured industrially and are similar to standard liposuction cannulas. They are slightly larger and slightly heavier.

When ultrasound procedures are used to restore contours, the amount of equipment used and its cost increase significantly. The long-term results of internal ultrasound liposuction have not yet been determined, and the practitioner must weigh the cost/quality ratio against the risk of potential complications associated with internal and external ultrasound exposure of the facial and neck tissues. The use of ultrasound cannulas in combination with an integrated cooling irrigation system reduces the risk of burns at the incision site and elsewhere. Inexpensive polyethylene sleeves are available that reduce the risk of burns at the incision site, but do not provide distal protection.

One of the latest advances in liposuction is the introduction of the liposhaver. It is similar to the shaver used for endoscopic removal of nasal polyps, as well as the arthroscopic shaver designed to work on the soft tissues of the joint. The liposhaver works similarly to these devices. Its operation is based on the rapid excision of fatty tissue with a safe oscillating motion. Conventional liposuction devices tear away fat, but this instrument excises it sharply and requires minimal pressure for aspiration. The liposhaver also creates a network of subcutaneous tunnels to protect the vascular system. It is believed that its use with a large set of replaceable and disposable blades allows for a more precise contour of the subcutaneous fat layer. The liposhaver can be used in a closed or open manner with the risk of complications inherent to it, which will be briefly discussed below.

The main equipment for liposuction is a suction device capable of creating negative pressure sufficient to tear and aspirate fat. When using a lipo shaver, according to Gross and Becker, suction is not as important in terms of fat extraction, but is still necessary to remove it from the surgical field.

Negative pressure during liposuction can be created either by surgical suction or by a special syringe. Electric suction can provide negative pressure of about 1 atm (960 mm Hg), while a syringe can initially provide about 700 mm Hg, with a subsequent decrease to a stable value of about 600 mm Hg. Large areas are easier to treat with electric suction, although the same task can be performed with a syringe. Before the procedure, it is necessary to check the degree of vacuum created by the suction to prevent it from exceeding the required values. Theoretically, this increases the risk of damage to the vascular-nerve structures.