MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
Issue link: https://medesthetics.epubxp.com/i/468544
CANNULA SELECTION 70 MARCH 2015 | Surgical Aesthetics SURGICAL AESTHETICS cannula, the less discomfort there is," he says. "Once you've made the small tunnels, you can increase the size of the cannula in a step-wise fashion; and there's mini- mal resistance, therefore it's more comfortable for the patient. Surgeons who use larger cannulas or just start with larger cannulas often fi nd it diffi cult to do liposuc- tion totally by local anesthesia." For the abdomen, Dr. Klein starts with a 16-gauge Capistrano working around the umbilicus. "Because that's fi brous, we want to create a lot of fi ne, little tunnels around the umbilicus so we can remove the fat later on with ease," he says. "Similarly on the upper abdomen along the costal margin and any other fi brous areas, we go through with the 16-gauge cannula. Then, if the fat is not too fi brous we'll go right to a 14-gauge Capistrano cannula, then a 12-gauge Capistrano cannula. And then we fi nish up with either a 12-gauge Finesse or a 10-gauge Finesse cannula." To reduce the risk of irregularities, Dr. Klein gradually removes fat throughout the treatment area. "When we insert the cannulas, we don't try to take all the fat out from one area and then march onto the next area," he says. "We treat the whole abdomen and take out 15% to 20% at a pass going all around the different holes in the skin, and then come back and do it again and again until we've taken out as much fat as we need to." The benefi t to this approach is that "the area is always smooth. We can stop at any point in time and be assured that there are not going to be any irregularities," says Dr. Klein. "That's the main objection of patients who have had liposuction—they have lumps or irregularities be- cause too much has been taken out focally or not enough fat has been removed in the upper abdomen—so that is how we avoid those pitfalls." Protecting the Dermal Interface The benefi t of using the Finesse cannula for fi nal sculpt- ing is that the ports on these cannulas are only on one side, so they can be positioned away from the skin to protect the dermal-vascular plexus. "When we get to the end of the procedure, where we have taken out most of the fat, we don't want the apertures pointing toward the skin where they can damage the dermal interface," says Dr. Klein. "There are some surgeons who advocate actually rasping the skin with the belief that they will get better dermal contraction; this causes problems. From my perspective, there is no dermal