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surgicalaestheticsmagazine.com | MARCH 2015 71 contracture other than normal elasticity. The contraction comes when the subcutaneous tissue contracts." Dr. Stevens agrees that the key to reducing complica- tions is working slowly and keeping the fat layer under the skin untouched. "That's really the secret to avoiding com- plications such as dimples, irregularities and discoloration of the skin," he says. "So start deep and then work more superfi cially. If there's a large margin of error, such as in a large abdomen or wide thigh, then I start with a wide can- nula fi rst to take it down—this will save time—then switch to a smaller cannula where you have more control." For lean patients, "you have to be more judicious in the cannula that you choose," says Dr. Stevens. Removing Fat for Transfer If the fat removed during liposuction is going to be har- vested for transfer, the surgeons we spoke with prefer cannulas with larger port sizes that keep fat tissue more intact. Dr. Klein uses the Finesse cannula rather than the Capistrano when harvesting adipose tissue. "With the Capistrano, the fat comes out sort of morselized or chumped up," he says. "With the Finesse, it comes out in bigger pearls." Some companies have introduced fat harvesting cannulas with multiple small holes. "The theory behind this is that the fat globules going into the cannula are the same as what you are injecting," says Dr. Stevens. "I tried them and found that they made the fat too foamy. I never have a problem when I inject fat using my usual cannulas." Regardless of the specifi c cannula surgeons use, the key is to work slowly and consistently to avoid overcor- rection and irregularities. "The cardinal rule of liposuction in the body is: It's not what you take away, it's what you leave behind," says Dr. Rohrich. "Be very careful and conservative. If you do get a contour depression, you've probably taken out too much fat. The key at that point is not to suction more, it's to add fat back in." Inga Hansen is the executive editor of MedEsthetics. Port size and the number of ports can affect the aggressiveness of aspiration almost as much as diameter size. PHOTOS COURTESY OF HK SURGICAL