The Magic Wand: A Liposuction Cannula

Cannulas used for Infiltration, Liposuction and Fat Transfer.

Advances in instrumentation, techniques and devices have taken liposuction into a new era.

Ives-Gerard Illouz

What is a liposuction cannula?  What is it used for?  Why is it important to understand the difference between a cannula and a needle?  Why is it important to refer to a cannula as a cannula, specially during a surgery with a patient awake?  

Pearls of history: The origin of liposuction can be traced to 1921 when Dujarrier used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery.  The history of liposuction since then has been one of avoiding complications and optimizing outcomes.  In the 1960’s, Schrudde revived the practice using small stab incisions and sharp curettage with secondary suction to aspirate the freed tissue.  This technique was associated with a high incidence of complications especially seroma and skin necrosis.  Illouz then replaced the curette with a blunt cannula connected to a vacuum pump thus avoiding the complications of a sharp curette.  The blunt cannula liposuction technique then became the global standard of care for liposuction.  Liposuction is generally a safe procedure with reproducible outcome and just like any surgical procedure, it should be treated with the utmost care. (Illouz 2014)  

Nomenclature of a liposuction cannula:  A liposuction cannula is a blunt tip instrument used during a liposuction procedure.  There is a wide variety of liposuction cannulas with different designs, sizes, lengths, and indication of use.  Liposuction cannulas include: infiltration cannulas, suction or fat harvesting cannulas and injection or fat transfer cannulas.

An infiltration cannula is used during the initial tumescent anesthesia part of a liposuction surgery;  it’s usually thin and with multiple openings at the tip allowing for the liquid tumescent anesthesia to be infiltrated by evenly spraying the solution into the tissue.

A suction or fat harvesting cannula is used to extract the fat from the tissue.  There is a variety of designs, lengths and gauges and the choice of use will depend on several factors such as the end purpose of the surgery and the anatomical areas to be treated, among others.  In other words, as an example, the cannula used for harvesting fat from the inner thighs to transfer to the face in a patient awake will be different from the cannula used for liposculpting with etching of a full abdomen in an awake patient.

An injection or fat transfer cannula is used to transfer fat after suctioning.  These cannulas tend to have one opening at the tip and the length and gauge will depend on the area to be treated by fat.  Other factors to consider in the selection of the appropriate fat transfer cannula are: the cannula used for fat harvesting, the anatomical area of the body from where the fat was extracted and the use of laser technology, among others.

The importance of understanding the difference between a cannula and a needle is based on patient safety and tissue preservation.  A cannula is a blunt tip instrument which usually causes less damage to the tissue; a needle is usually a sharp, cutting tip instrument which is more aggressive to the integrity of the tissue.  There is a learning curve for the use of a blunt cannula but with appropriate training and experience of use, one can acquire a high level of confidence in its use, contributing to the patient’s safety. 

It is of critical importance for the cosmetic specialist to understand the type of instrument he/she is working with and to refer to it in the correct way.  During surgery with an awake patient, it is not unusual for the patient to somewhat panic at the site of a long instrument and refer to it as a “huge needle”, but by quickly reassuring her/him that it is a cannula with a blunt tip and not a needle, the patient’s anxiety can quickly decrease, as safety and comfort will remain the cosmetic specialist’s priority.  A liposuction cannula is a magic wand in the hands of the cosmetic specialist, an instrument designed and intended to cause minimal tissue damage maintaining patient safety, while providing the patient with beautiful and acceptable results that will make her/him feel more secure and beautiful with her/himself and increasing her/his self-esteem.  Connect with us at dravellanet.com. 

The Direction of the Cannula during Abdominal, Waist and Back Liposuction

As previously discussed in my blog “Pearls of Wisdom: Abdominal, Waist and Back Lipo Incisions”, the planning of a liposuction surgery, including the placement of incisions, is a critical step for it’s success.  The placement of the incisions is part of the mapping of the surgery and will depend on the areas to be treated.  These incisions are strategically placed so the direction of the cannula during surgery can reach and cover as much of the area to be treated as possible.  The appropriate placement of the suction cannula in the fat layer and the direction of the cannula during suction, will ensure the most efficiency during the procedure. 

A suction cannula is inserted into the adipose tissue at an angle to the skin, and once in the correct fat plane, it is advanced parallel to the surface of the skin.  The movements are performed in parallel, in and out, along a straight line, using a “fanning or fan-shaped” pattern to aspirate the fat. This fat aspiration technique creates a number of tunnels in different directions that, once they collapse and the skin retracts, will give the body its new shape. The best results will be achieved by using multiple incision sites while overlapping adjacent fan-like tunnels with each movement in different directions.

Enclosed various images that show the direction of the cannula (pink arrows) from various incisions sites (green Xs) to treat the abdomen, waist and back areas.

Abdomen and Waist Area
Back Area
Waist and Back Area

 

Although this fat aspiration technique is a simple procedure with good and acceptable cosmetic results, it requires practice and experience; the more it is practiced, the more consistent better results can be achieved.  Liposuction is a very tactile procedure, the more you do it, the better the results will be.  Contact us at dravellanet.com for more information about our trainings.

My Unforgettable Experience at the First Launch of Beautifill in Latinamerica


A few months ago, at the end of 2020, while doing a training in the United States, I received an international call with an invitation to participate in a Beautifill Training in Central America.  Beautifill is a diode laser from Alma Lasers used for liposuction and fat transfer.  I have been a Beautifill trainer in the US for many years training doctors around the country on the operation and advantages on this equipment.  I had already been in conversation with Alma Lasers since the end of 2019 about collaborating with the international market offering Beautifill Trainings.  The delays that occurred due to the pandemic in 2020, forced face-to-face surgical trainings to be postponed to 2021.  Upon receiving this call, I accepted immediately, as my interest was to enter the Spanish-speaking market as a trainer for this laser equipment.  We immediately began planning for the first Beautifill launch in Latin America to be carried out in Costa Rica, with the local distributor, H&B. 

I had the opportunity to participate in three days of face-to-face training with live surgeries, demonstrating Beautifill for the use in laser liposuction and skin tightening and fat transfer.  On the first day, we trained the clinic SKN, owners of the first Beautifill laser in San José, Costa Rica.  We were able to complete three cases of laser liposuction and fat transfer, including liposculpting of the abdomen and flanks and fat transfer to buttocks, breasts and face.  On the second day, we trained specialists, plastic surgeons and dermatologists, and on the third day we trained aesthetic doctors, offering them, on both days, a talk to discuss the equipment, the operation and advantages, as well as the opportunity to participate in live operations.  All specialists, experts in the technique of liposuction and fat transfer, were completely satisfied with the quality of the laser and its ease of operation and the advantage of offering their patients optimal results using state-of-the-art equipment.  

My experience was enriching as I had the opportunity for the first time, in my native Spanish language, to offer face-to-face Beautifill trainings and share my knowledge with Spanish-speaking colleagues.  Additionally, being able to share state-of-the-art technology with highly skilled and specialized colleagues in the field of liposuction and fat transfer surgery resulted in enriching professional discussions for everyone in attendance, including myself.  The kindness and hospitality of the H&B team was excellent.

Here I share a video of this experience and the participants of the first launch of Beautifill in Latin America, San José, Costa Rica.

Pearls of Wisdom: Abdominal, Waist and Back Lipo Incisions

We blogged about Surgical Aesthetic Photography and the importance of measuring and weighing the patient prior to surgery, now we need to address how surgical planning is imperative for the success of any surgery.  The size, placement and number of incisions is a critical initial step in the planning of any aesthetic surgery.  Liposuction and fat transfer procedures include multiple small incisions placed in key areas ensuring precision and optimization of technique and results.  Enclosed some pearls of wisdom when doing liposuction of the abdomen, waist and back.

  • Incisions are the access points of liposuction cannulas into the subcutaneous fat.
  • Incisions allow post-operative drainage of blood-tinged anesthetic solution, minimizing tenderness, swelling, and edema.
  • The size of an incision will depend on the size of the cannula(s) to be used: an incision should be sufficiently large to permit easy access and avoid friction with the skin that could potentially cause post-traumatic hyperpigmentation.
  • Incision placement will depend mainly on accessibility and aesthetics: the need to minimize the visibility of potential scars and maximize results.
  • Accessibility of placement is crucial as the idea is to have an incision placed in a location that has the most access to the areas to be treated.  
  • The aesthetics of placement is mostly for the patient as most patients prefer to have very small, imperceptible, hidden scars.
  • The number of incisions required will depend on the size of the areas to be treated.  
  • Not all patients will have the same number of incisions in the same location; this will vary depending on the size of the patient and the areas to be treated.  Patients will ALWAYS ask about the incisions.
  • The average incisions per area is:  abdomen: 3-6; waist: 1-2; love handles: 1-2; bra-line: 1-2; upper back: 1-2.  If the entire abdomen, waist and back are to be treated, a strategic placement of the incisions will cover multiple areas.
  • The more versatility of access, the more areas than can be treated, and the less incisions needed.
The green “X”s shown in the vectors refer to approximate locations of incision placement.
The green “X”s shown in the vectors refer to approximate locations of incision placement.
The green “X”s shown in the vectors refer to approximate locations of incision placement.

We all want to have good, acceptable and beautiful results for all our patients.  But before we achieve this goal, we need to PLAN, PLAN, PLAN.  Start by planning the number and placement of incisions!  For more information connect with us at dravellanet.com.

The Inches vs Weight Question Explained

“Doctor, will I lose weight with Liposuction?”

“Will I lose weight with liposuction?  No, the answer is NO.  Liposuction is not a weight loss procedure.”  This is a common question asked by almost all patients.  It is important to explain to patients what is the end-point of liposuction: removing unwanted fat deposits from certain areas; sculpt the body, enhancing its shape.

“How many inches will I lose with liposuction?”  This is another common question asked by patients and it is important to explain that results vary from person to person but that this is a realistic and objective measure that can be measured after liposuction surgery.   

The areas of the body to be treated should always be measured as to have a pre and post-operative comparison, as loss in inches, NOT loss in weight, is an accurate way of assessing final results.  Some examples are:

Abdomen: at the umbilicus and at the patient’s true waist, if different from the umbilicus.

 

Inner thighs: at the upper, widest point of the inner thigh, usually mid-point from the groin to the mid-thigh. Outer thighs: at the widest point of the outer thigh.

 

Arms: at the widest point, usually mid-point from the axilla to the elbow.

 

Do not compress any of the areas measured with the tape measurement while measuring.  

All measurements should be taken prior to surgery and at each post-op visit.  Patients will be delighted to see how many inches they have lost and how much better clothes fit in their new sculpted body.

Should the patient’s weight be taken before and after a liposuction surgery?  ABSOLUTELY!  Weight should be documented at the time of the cosmetic consultation, pre-operatively and at each post-operative visit.  Although weight is not an accurate measure of assessing final results, it is a tool for assessing any significant change in gain and/or loss that could influence the assessment of final results. 

In conclusion, measurements and weight are both essential tools in the pre-operative evaluation and the post-operative healing process.

Connect with us at dravellanet.com for more information about our trainings.

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