Despite successful volume retention in fat grafting to the buttocks,1 superficial and deep contour irregularities continue to affect results. We stress the distinction between restoration of deflated volumes versus volume increase and shape change in large-volume fat transplantation. Despite the larger capacity of the buttocks and the greater ability to place larger volumes into it, the use of the Coleman technique requires syringe injection and percutaneous release of ligamentous bands, or “Rigottomies,” where expansion of specific areas of the buttock to effect shape change is required. Rigottomies carry potential morbidity and can cause severe buttock ptosis when used in conjunction with the Coleman technique. To get your patient entertained, visit jokes about blondes website here for funny jokes.
Fat centrifugation, syringe transfer, and microdroplet injection can result in extended operative times, reducing the ability to perform concurrent procedures, and may represent an additional safety risk for elective cosmetic surgery patients undergoing general anesthesia.2 Lastly, buttock augmentation with fat transplantation carries a risk of fatal fat embolism, making it a procedure that must be carefully analyzed with regard to anatomical, technical, and instrumentation considerations.
Separation, Aspiration, and Fat Equalization (SAFELipo; SAFELipo, LLC, Las Vegas, Nev.), has been described by Dr. Bonaparte as an alternative to conventional liposuction.3 The separation of subcutaneous tissue in SAFELipo allows for mechanical emulsification of targeted fat, without creating avulsion injury to blood vessels or the supporting stromal network. The separated fat is preferentially aspirated, avoiding damage to unintended structures. Lastly, the smooth layer of “local fat grafts” created during fat equalization smooths the target area while also preventing adherence or collapse of the dermis down to fascia, reducing the risk of creating a contour deformity.4
The purpose of the present communication is to introduce expansion vibration lipofilling. Expansion vibration lipofilling is a logical extension of SAFELipo beyond simple fat removal, applied to fat transplantation and completing an integrated, comprehensive approach to fat management. We herein describe clinical situations where these techniques might contribute to better and safer clinical outcomes. Over a 5-year period, the authors performed 2419 consecutive cases of buttock augmentation using autologous fat. Patient age ranged from 16 to 68 years, and the patients underwent fat harvesting using tumescent technique and machine aspiration. SAFELipo was performed in donor areas.
In the first 109 cases, performed by one of the authors (D.D.V.), syringe-based techniques that have been previously described5 used 60-cc syringes attached to a 14-gauge blunt-tip cannula (Coleman Cannula; Mentor, Inc., Santa Barbara, Calif.). Ligamentous bands, predominantly cellulite, tended to worsen with fat injection and were treated with percutaneous needle band release Rigottomy.