33-year-old female patient following her modified tummy tuck and high definition liposuction.
Introduction: What is ex vivo liposuction?
Ex-Vivo liposuction is a novel technique wherein tissues that are preoperatively planned for excision can be liposuctioned in a sterile manner after removal from the patient. Excised tissues are routinely obtained during a tummy tuck, lateral thigh tuck, buttock tuck, brachioplasty, upper body tuck, and even medial thigh tuck. These tucking procedures are performed when moderate to severe skin redundancy is present in patients undergoing body contouring. Traditionally, these tissues were first liposuctioned while attached to the patient before being excised, termed in-vivo liposuction. However, we have developed ex-vivo liposuction protocols wherein the tissues are liposuctioned only after they have been excised from the patient. There are multiple advantages to performing ex-vivo liposuction. First, ex-vivo, liposuction saves operative time. Second ex-vivo liposuction is safer. In addition, the maximum volume of fat for transfer can be harvested. Finally, the fat that is harvested demonstrates improved quality.
Ex-Vivo liposuction saves operative time
Ex-vivo liposuction saves operative time since any excised tissues can be liposuctioned simultaneously while the excised defects are repaired. When performing excision of multiple areas such as a total body lift, the length of operation can be a detriment to patient safety. We strive to limit operative times to less than six hours in an outpatient setting. We routinely save 1 to 2 hours of surgical time when performing ex-vivo liposuction in our total body lifts. For example, when we perform liposuction of the flanks, the fat can be laden in dense connective tissue requiring at least one hour of liposuction to remove fat comprehensively.
Ex-vivo liposuction is safer because the process of liposuction can cause inadvertent harm to vital structures. This is especially true when performing liposuction of areas that possess a higher density of connective tissues. Specifically, the lower back and flanks is an area that possesses superficial, mid, and deep fat that is laden with connective tissues. When performing the act of liposuction with the back-and-forth motion of the cannula, the lower back and flanks can experience unnecessary trauma that can be avoided by removing the fat in an ex-vivo manner following the excision of the tissues.
Ex-Vivo liposuction maximizes fat harvest
Ex-vivo liposuction maximizes fat harvest by allotting more time to harvest the fat. When in-vivo liposuction is being performed during excision of tissues, the time for harvesting the fat maximally may be limited by the scope of surgical time required to complete the surgery. Thus, the luxury of time for maximal removal of fat may not be available during a surgical procedure. Furthermore, maximal fat removal volume is just not as feasible with in-vivo liposuction as it is with ex-vivo liposuction where more aggressive removal of fat may be performed.
We have consistently observed that the fat harvested is cleaner and less blood-tinged following ex-vivo versus in-vivo liposuction. Blood-tinged fat is felt to possess pro-inflammatory blood products that can compromise fat graft take. One of the steps of processing fat before injection involves washing the fat cells with antibiotic irrigation to remove proinflammatory blood products. Why in-vivo fat is more likely to be blood-tinged, is that when you liposuction the fat in-vivo, there are actively circulating blood cells whereas ex-vivo fat has no blood flow as it has been removed from the patient.
Better Graft Viability
In summary, ex-vivo liposuction provides several advantages to patients undergoing excisional surgery to achieve their body contouring results. These advantages provide both safety and efficacy to patients undergoing total body transformations..
