Liposhifting: Treatment of the Post-Liposuction Irregularities
International Journal of Cosmetic Surgery,
Abstract: According to
the German Liposuction Society1 many unsatisfactory results were reported
due to the rapid growing popularity of liposuction. According to their
statistics almost 20% of liposuctions needed to be corrected again.
Pittmann2 claimed 15% to be minor touch ups or lipofillings as a local
treatment in the office, the other 9% needed to undergo a proper liposuction
using lipofilling or re-liposuction. The lipofilling in large quantities as
we have performed up to now didn't last and were not a good solution to this
particular problem. The Author proceeds to shift the fatty tissue under the
skin without incorporating any liposuction and he doesn't remove the loose
fat out of the body during this procedure. A special type of taping and
fixation is necessary directly afterwards.
Keywords: , shifting under the skin, fat damage survival, Post - Liposuction
Iin Europe approximately 200.000 liposuctions are performed annually, and
this number is rapidly increasing. Due to the amount of increased
Liposuctions, the number of unsatisfactory results are also rising. Cosmetic
surgeons are not being trained to the proper standards required of
liposuction . Untrained physicians, after reading a few articles and
visiting one or two congresses (not even workshops), are beginning to
practice liposuction and cause the majority of unsatisfactory results.
My personal experience
up to now is that the lipofilling of small post liposuction irregularities
may be helpful, but lipofilling of larger irregularities has not been
satisfactory enough forcing me to develop a new method. After studying fat
transfer and damage over the years, I came up with the idea of shifting fat
under the skin without suctioning (damaging) and without removing it from
the body (no pressure, and no air contact). This is safest way not to damage
fatty tissue and enable it to survive.
This new technique which I developed has been applied on 27 patients since
August 1996. The results have so satisfactory that I want to introduce and
share this method with my colleagues for further development.
The procedure consists of the following stages:
1. Marking the skin while standing
2. Local anesthesia
3. Tumescent technique
4. Loosening the fat (Becker cannula)
6. Fixation (taping and Reston Foam fixation)
Marking the skin:
The marking of the skin is extremely important. The marking has to be done
while the patient is standing allowing the physician to localize the correct
places for liposhifting and giving him the possibility of controlling his
results. An Orthostatic table like Dr. Giorgio Fischer's is not necessary
because the patient needs to stand many times during this procedure. The
molds on the skin should be marked with different colors so that the sites
can be recognized during the shifting. Before starting the procedure the
amount of fat to be shifted has to be decided. The places where large
amounts are required should be marked with a third color or it has to be
written on the skin which makes the whole procedure easier. A form of
documentation by means of photographing the area is very important for
future comparison. We also make a drawing on a piece of paper to give us
If the patient wishes to have a total sedation it is done with general
anesthesia. Normally iv sedation with a local anesthesia (tumescent
technique) or a tumescent local anesthesia without any iv sedation is all
that is required. The sites of the incisions are infiltrated with local
anesthesia (we generally prefer lidocaine because of it's known safety).
To loosen the fatty tissue and to also provide an anesthesia a tumescent
solution is used . After infiltration of the tumescent solution some time is
required to allow it to work and achieve an optimal fat loosening and
vasoconstriction. A molding of the tissue (as described by Dr. Giorgio
Fischer) is in my opinion very helpful in obtaining better results. In our
study we have seen very good results after molding the place to be treated.
I believe that the fatty tissue is set free by means of molding so that a
larger amount of fat can be shifted.
Tumescent technique has now diluted the fatty tissue and loosened it a
little bit, but now something has to be done in order to free the fatty
tissue from the connective tissue. For this purpose I'm using a 26 cm long
3mm Becker cannula from Byron medical Co. which will be pushed under the
skin and has to be moved in criss-cross technique (figure 1) in order to set
the fat free. Many incisions are required to achieve better results,
windshieldwiper movements has to be avoided, otherwise the subcutaneous
connective tissue will be damaged and skin will also be loosened which is
not our goal.
Pushing or shifting the fat under the skin can now be done. An old thick
cannula (6-9 mm) which is not used any more can be helpful for this purpose
(figure 2). The cannula is held in both hands and the fatty tissue under the
skin will be shifted towards the defect which has to be filled (abbr. 1).
The place to be filled has to be observed very closely and when the dent is
filled and has the same level as the surrounding skin further shifting is
required to obtain an overcorrection of 20-30%, which is the amount of the
tumescent solution that will be absorbed in a few hours.
After shifting the fatty tissue and placing it in the dent a tape dressing
(same technique as the orthopedic surgeons) is required in order to keep the
fat in situ. This kind of taping is called water melon slice formed taping
which applies pressure from upper and lower parts in direction to the middle
of the tape dressing (abbr. 2, figure 3). We usually apply a Reston® Foam
(3M Company) dressing over the tape in order to stabilize the whole
dressing. This foam applies a kind of massage to the tissue as the patient
moves which will reduce the bruising and oedema4. The taping and fixation
has to be taken off and renewed after 3 or 4 days which enables a control of
the operation site ( looking for hematoma and infection) and gets rid of the
loosened dressing. The fixation is removed after 7 days.
I have applied this technique on 17 patients in a time of one year. All
patients were female with an average age of 34. The rate of satisfaction was
88% (15 patients). Some cases with huge defects had to be liposhifted more
than once (5 cases, 24%). This will be explained to the patient before the
Surgery so that we plan a strategy and a schedule with them before the
treatment. A time of 3-4 months is needed between two treatments. If they
know that they need 2 or 3 sessions, they are more cooperative and satisfied
with the result. In 3 cases (18%) the result was not that satisfactory even
if it was a small lesion and 2 cases (12%) didn't answer to this treatment.
The most common complication was the hematoma due to fat loosening. This
problem was reduced after using the taping and the Reston Foam and also
leaving the incisions unsutured. There were no infections. A
hypersensibility of the liposhifted part of the body is longer than the
liposuctioned parts of the body. Also the hyposensibility is seen more often
but disappears after a few weeks. A hemosiderin pigmentation ( pigmentation
of the skin due to iron in the blood) was seen in 2 cases who had hematomas
and which was still there after 6 and 9 months.
Liposhifting is the only method to eliminate larger irregularities of the
skin and the underlying tissue caused by liposuction. It is only helpful in
the extremities and in the abdominal wall. It is almost safe because a
contamination of the fat transplant via air contact is not possible and
needs no training or special instruments. The fixation of the liposhifted
part of the body for one week is very important which stabilizes the shifted
fat and makes it possible for the fat to survive. More research has to be
done to study my technique which would also make it possible to compare the
results of other surgeons. The irregularities due to liposuction are still a
1. German Liposuction Society, Annual Meeting 1996 in Düsseldorf. Saylan,
Ziya, MD. Presentation on Liposuction Complications about a questionary of
2. Pittman, Gerald, MD; Liposuction and Aesthetic Medicine, QMP Inc. St.
Louis, Missouri, 1993
3. Fischer Giorgio, Personal Conversation, April 1997 Annual Meeting of the
European Academy of Cosmetic Surgery.
4. Saylan, Personal Conversation with 3M "Reston Foam"