Laser-Assisted Liposuction versus Mechanical Liposuction by Medical fibers

Keywords:laser, medical, fibers, surgical, fiber,  Time:05-01-2016

The dramatic evolution of contemporary plastic surgery has brought liposuction to become the fifth-most popular aesthetic procedure performed in Britain in 2014, with a 7% rise in prevalence from the preceding year [1]. The procedure is performed to recontour defects of a spectrum of severities and, when harnessed toward autologous fat transfer applications, supports tissue reconstruction, radiation-induced necrosis of the chest wall, breast augmentation, volume enhancement in the facial area and wrinkle repair [2]. Autologous fat transfer circumvents complications associated with allogenic fillers and implants, is more readily available, more cost-ef- fective, incurs minimal donor-site morbidity and provides a more durable outcome [3]. The constantly improving fat injection techniques have transformed autologous fat transfer into a minimally invasive, outpatient procedure.
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However, highly variable resorption rates have been reported, averaging 45% graft weight retention within one year of transplantation [4] [5], where volume loss as high as 70% has also been reported [6] [7], lending to overcorrection and reinjection sessions, and subsequent fat necrosis and calcification. Peer et al. established that the viable adipocyte content is the key determinant of fat transfer longevity [8]. Thus, minimization of the liquefied fat and serosanguinous fluid in the fat sample, increases the relative ratio of viable adipocytes, preventing early resorption as well as inflammatory reactions [9] [10]. Furthermore, while injection of fat specimens with high fibrous tissue content provides an immediate volumizing effect, postsurgical fibrosis positively correlates with adipocyte absorption and a short-lived clinical effect [11] [12]. Moreover, traces of blood, free oil fat and fibrotic tissue in transferred fat are said to accelerate adipocyte degradation [11], via increased inflammatory responses to the graft [13]. Thus, the ideal fat graft, containing a high adipocyte count and low contaminant content, has been the focus of harvesting optimization efforts for decades. Isolation solutions designed to maximize cell yield and viability, will inevitably ensure more durable clinical results and reduce the need for correction procedures.

As laser-assisted liposuction has often been charged with detrimental effects on cell viability, continuous efforts are being invested in design of a device that can maximize viable adipocyte yields. This study presents experience with a novel laser liposuction device featuring a 1470 nm diode laser and a radial emitting fiber. Specimen content and preadipocyte cell viability when harvested via laser-assisted lipolysis versus mechanical liposuctioning were compared. Medical fibers liposuction proved more effective in preserving preadipocyte viability, while ensuring as fewer blood and connective tissue contaminations in the collected adipose tissue.

2. Materials and Methods

Donors: Human subcutaneous adipose tissue samples were obtained from the abdomen, thighs and inner thighs of 10 female subjects who had provided informed consent. All procedures were performed under general anesthesia and the average volume aspirated was 1.5 liters. Maximum aspired material was 3.5 liters. Minimum was 600 cc.

Surgical procedure: Patients were prepped with betadine. Saline, supplemented with lidocaine 20% (30 cc per liter saline) and adrenaline (0.5 ml per liter saline) was introduced to the treated area via mechanical infusion (Byron Medical Inc.). Standard puncture holes were made at the treated areas with medical fibers surgical blade, to allow fat laser aspiration. The ratio of injected liquid (Tumescent) to aspirated material was 2:1. For fat aspiration, Mercedes 3 mm and 4 mm cannulas specially designed with a swivel handle (LipoLife, Alma Lasers) were used. The 1470 nm, 600 micron, radial emitting laser fiber (Alma Lasers, Ltd.) was advanced through the cannula and positioned in the center of the distal opening of the cannula. Mechanical aspiration was then performed on the opposite side and by the same physician using 3 mm - 4 mm Mercedes liposuction cannulas (Byron Medical Inc.). Temperature in the treated area was measured throughout the procedure and was maintained below 40˚C.

Adipose tissue harvesting: Fat samples were collected with a laser-assisted liposuction device (LipoLife, Alma) from one side of the patient and with a mechanical liposuction device (Byron) from the other side of the patient. Samples were not manipulated or washed in any way and were allowed to stand at room temperature to allow for phase separation. Samples were analyzed within 12 hours of collection.

Calculation of fat:blood phase ratios: The following formulation was applied to calculate the ratios between the phases into which specimens separated following liposuction:

Cell yield, viability and morphology: Viable cell yield after isolation was determined using the trypan blue staining test. To assess the number of stem cells, the adherent cells were removed by proteolysis with trypsin C (Biological Industries, Israel). Cells were then stained with 0.4% trypan blue solution (10 μl cells: 10 μl dye) and counted in a hemocytometer, viewed under a phase contrast microscope (Nikon). Duplicates samples from each specimen were evaluated. In addition, cell diameter, and connective tissue content were visually estimated.

Preadipocyte isolation: Preadipocytes were isolated after tissue harvesting. Fibrous structures and visible vessels were removed, and then washed up to seven times in phosphate-buffered saline (PBS) (Biological industries, Israel). After centrifugation (300 g, 10 min) the tissue pellet was enzymatically digested with 2 mg/mL collagenase Type I (Sigma-Aldrich) dissolved in an equal volume of PBS solution (37˚C, 60 min). Collagenase was inactivated with 10% fetal bovine serum (FBS) (Biological Industries, Israel), followed by redistribution of the mixture into 50 ml conicals and centrifugation (1000 g, 10 min) to separate the oil and remaining fat lobules from the stromal vascular fraction (SVF). The red blood cells in the SVF pellet were then lysed in 160 mM NH4Cl (room temperature (RT), 10 min). The sample was then washed twice in PBS and centrifuged (300 g, 5 min, RT). The adherent cell population was then isolated by culturing the cells overnight in flasks (DMEM F-12, 10% fetal calf serum, 2 mM L-Glutamine, 0.1% penicillin/streptomycin (Biological Industries, Israel)). The non-adherent cells and debris were washed away with PBS and the adipose stem cells were grown and expanded as monolayers. Cell viability was determined using trypan blue.

Statistical analysis: Comparative analyses between mechanical liposuction samples and laser liposuctioned samples were performed. Mean values and standard deviations are presented. Significance was determined using a one-sided Student’s T-test.