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E. Antonio Mangubat, MD Seattle, WA - PowerPoint PPT Presentation

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Fat Disruption : A Useful Adjunct To Liposuction Surgery by. E. Antonio Mangubat, MD Seattle, WA. Fat Disruption Concept. Not a new idea Chopped up fat is easier to suck out UAL (Ultrasound Assisted Liposuction) Fat disruption before liposuction Great in tough areas (scar, gynecomastia)

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Fat Disruption : A Useful Adjunct To Liposuction Surgeryby

E. Antonio Mangubat, MD

Seattle, WA

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Fat Disruption Concept

  • Not a new idea

  • Chopped up fat is easier to suck out

  • UAL (Ultrasound Assisted Liposuction)

    • Fat disruption before liposuction

    • Great in tough areas (scar, gynecomastia)

    • Made aspiration easier

    • Cost

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Fat Disruption Concept

  • Blugerman liposhifting instrument

    • Introduced in 2002 Liposuction World Congress

    • Designed to create mini fat grafts internally

    • in vivo fat grafts manually shifted to fill defect

    • Solid core cannula 3-4mm diameter

  • Current concept

    • Mechanical disruption of fat infrastructure

    • Not intended for fat grafting

    • Detach the fat from its stroma before suction

    • Uses much larger cannulas: 5-6mm typical

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Advantage of Fat Disruption


    • Rapid volume reduction

    • Aspiration speeds up to 1000ml/min

    • Large cannulas do not cause irregularities

  • Smooth results regardless of cannula size

    • No suction applied during disruption

    • Even superficial passes do not leave divots

  • Especially useful for:

    • Large volume reduction

    • Beginning liposuction surgeons

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Prototype Fat Disruptor Instrument and technique

  • Large sizes: 5 & 6mm empirically work the best

  • Hollow cannulas

    • Relieve tumescent pressure

    • Retains leaking aspirate in hose; less mess

  • Fat disruption surface

    • Not designed for fat grafting

    • Longer, larger holes, faster

    • Push and pull disruption more efficient

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Fat Disruption Technique

  • Large tumescent volume

  • No suction used in disruption phase

  • No divots, no ridges, no depressions

  • Different than pre-tunneling

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Technical Notes

  • Intense “super” tumescence - high hydrostatic pressure

    • Forced fluid dispersion

    • Hydrostatic capillary compression

    • Bloodless

  • Staged tumescence – infuse in staged areas e.g.

    • Front the Back

    • Upper body then lower body

    • Vasoconstriction last only ~90min

    • Speed critical for larger volumes

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Technical Notes

Tumescent Solutions Compositions

  • Lidocaine = .048% (50ml 1% lidocaine in 1L)

  • Epinephrine = 1:1,000,000 (1ml 1:1000 epi in 1L)

  • Max dose 40-50mg/Kg

  • Addition tumescence above the max lidocaine dosages had no lidocaine. Only:

    1:1,000,000 epi in LRS

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Large fat disruption surface

Intense tumescence

Note firm tissue turgor

No suction applied yet

Start deep next to muscle

5-6 minutes, loss of resistance

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Able to get close to surface

No surface defects

Begin 60 secs of suction

Large 6mm cannula

Note free flow of aspirate

1000ml in 60 seconds!

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Greater Cosmetic SafetyUseful In Defects Prone Areas

High Resistance Areas

  • Gynecomastia

  • Epigastrium

  • Upper back

  • Revision liposuction

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Greater Cosmetic Safety

For Experience Surgeons

  • SPEED!

  • Significantly shorter procedures

  • Greater time for refinement

  • Cost-effectiveness

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Greater Cosmetic Safety

For Beginning Surgeons

  • Much shorter learning curve

  • Reproducibly smoother results

  • SPEED!

  • Cost effective

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Fat Disruption Summary

Great Speed & Smoother Results

  • Shorter procedure times

  • Less blood loss

  • Less anesthesia

  • Less expense

    Greater Patient Safety

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Thank You!

E. Antonio Mangubat, MDSeattle, WA