Tools for liposuction on the face and neck

Successful execution of any operation requires not only the skill, but also the availability of appropriate equipment. The basic tools for liposuction are few, but they continue to be improved from the time of their introduction in the early 70s of the XX century. The physiological basis of liposuction, with the exception of the liposweaver, remains the same: subcutaneous fat is absorbed by negative pressure and detached by the reciprocating movements of the cannula. At present, the appearance of blunt cannulae for liposuction with a diameter of 1 mm, 2 mm and 3 mm, as well as a liposcope, allows for more controlled and precise work, forming the art of "liposculpture".

Improvements in cannula design include the use of light metals and a variety of handle sizes. Cannulas have a different number of suction holes. Tips on the configuration are sharp, blunt and spatula-like. As will be shown in the section on the technique of execution, different cannulas should be used at different stages of liposuction. These stages include active fat removal, shape creation and smoothing. Some cannulas have more than one hole with a different shape. The larger the opening, the higher the suction force. In addition, the end of the cannula should be blunt, so as not to damage the skin.

Doctors who support the introduction of fat to fill soft tissue, often to remove small accumulations of fat use aspirating cannula with a Luer connector. Then it is washed and injected into another place. This method can be used for primary liposuction on the face and neck with minimal expenditure on equipment. The procedure 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. Aspiration of fat at a lower suction force is used when the fat is used to introduce tissue expansion into the sites. This effort preserves the structure of the adipocytes and increases the chance of engraftment of the graft. The cannula for syringe liposuction is structurally less - 14-17 G.

The technique of hypotonic infiltration, ultrasonic energy is applied in the face and neck less often, but they definitely have supporters. Cannulas used for this purpose are thin and blunt; they serve to quickly inject hypotonic / anesthetic solution.

The ultrasound equipment consists of either a hand-held ultrasonic radiator or a cannula (hollow or solid) with a built-in ultrasound system. A cannula can be used to perform lipoextraction, and the use of a continuous cannula (preferred by the majority) requires standard lipoextraction after ultrasound. Such cannulas are manufactured industrially and are similar to standard cannulas for liposuction. They are somewhat larger and slightly heavier.

When ultrasonic procedures are used to reconstruct contours, the amount of equipment used and its cost significantly increase. Long-term results of internal ultrasonic li-planting have not yet been determined, and the physician must weigh the price / quality ratio, as well as the risk of potential complications associated with internal and external ultrasound effects on the face and neck tissues. The use of ultrasonic cannula in combination with the built-in cooling washing system reduces the likelihood of burns in the area of the incision and other places. Low-cost polyethylene hoses are produced, which reduce the risk of burns in places of incisions, but in no way contribute to distal protection.

One of the latest advances in liposuction is the introduction of liposheaver. It is similar to a shaver used for the endoscopic removal of nasal polyps, as well as an arthroscopic shiver designed to work on the soft tissues of the joint. Liposheyver works like the mentioned devices. Its functioning is based on rapid excision of adipose tissue with a safe oscillating one. Conventional devices for liposuction tear off fat, and this tool severely excludes it and requires a minimum pressure for aspiration. Liposheiver 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 makes it possible to create a more accurate contour of the subcutaneous fat layer. The liposcaver can be used in a closed and open way with the risk of its inherent complications, which will be briefly discussed below.

The main equipment for liposuction is a suction device capable of producing a negative pressure sufficient to tear off and aspirate fat. When using a liposcope, according to the opinion of Gross and Becker, suction is not so important, in terms of fat extraction, but still necessary for its removal from the operating field.

Negative pressure with liposuction can be created either by surgical suction or using a special syringe. Electric suction can provide a negative pressure of about 1 atm. (960 mm Hg), and the syringe - at the beginning of about 700 mm Hg. With a subsequent reduction to a stable value of about 600 mm Hg. Art. Areas of large dimensions are easier to handle by electric suction, although the same task can be performed with a syringe. Before starting 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 neurovascular structures.