48 March 2016 March 2016 49 Expert guide: Aesthetics & Cosmetology 2016 bosis rate in a retrospective series of patients who underwent large-volume liposuction and received chemoprophylaxis with low-molecu-lar-weight heparin.19 In 2011 the ASPS Venous Thromboembolism Task Force recommended risk stratification based on the 2005 Caprini scale for patients undergoing liposuction and the need for low molecular weight prophylax-is.20 These guidelines should be incorporated by all plastic surgeons in their practice. Although indirectly related to liposuction, the topic of fat transfer is among the most current and still debated topics in plastic surgery, de-spite initial investigations going back more than 25 years. Fat transfer may be performed as a primary procedure (e.g., breast or buttock augmentation), as an adjunct (e.g., face-lift sur-gery or breast reconstruction), or for the po-tential of “stem cell” therapy.22 Adipose stem cell pluripotentiality and unlimited capacity for self-renewal, represents a great promise for tissue engineering. Cell-assisted lipotransfer is a novel approach to autologous fat transplan-tation in which adipose-derived stem cells are attached to the aspirated fat.24 The “holy grail” for body-sculpting technol-ogy is non-invasive technologies that minimise tissue morbidity, decrease downtime, and in-crease skin contraction/tightening, which less-ens the need for skin excision by way of surgi-cal intervention. This has led to a new industry: non-invasive body contouring.21 In this regard are non-invasive technologies as cryolipolysis (e.g ZeronaTM, Coolsculpt ™), high-intensity fo-cused ultrasound – HIFU (e.g Liposonix ™) and radiofrequency devices (e.g BodyFXTM) for fat cell disruption and lysis. The proven benefit of liposuction as an adjunct in procedures such as abdominoplasty, breast 5. Haeck PC, Swanson JA, Gutowski KA, et al. Evidence-based patient safety advisory: Liposuction. Plast Reconstr Surg.2009;124:28S–44S 6. Iverson RE, Lynch DJ; American Society of Plastic Surgeons Committee on Patient Safety. Practice advisory on liposuction. Plast Reconstr Surg. 2004;113:1478–1490 7. Ostad A, Kageyama N, Moy RL. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996;22:921–927 8. Matarasso A. Lidocaine in ultrasound-assisted lipoplasty. Clin Plast Surg. 1999;26:431–439, viii.9. Hatef DA, Brown SA, Lipschitz AH, Kenkel JE. Efficacy of lidocaine for pain control in subcutaneous infiltration during liposuction. Aesthetic Surg J 2009;29:122-127 10. Perry AW, Petti C, Rankin M. Lidocaine is not necessary in liposuction. Plast Reconstr Surg 1999;104:1900-1902.11. Hunstad JP, Aitken ME. Liposuction: techniques and guidelines. Clin Plast Surg 2006;33:13-25 12. DiBernardo BE. Treatment of cellulite using a 1440-nm pulsed laser with one-year follow-up. Aesthet Surg J. 2011;31:328–341 13. Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006;118:1032–1045 14. Scuderi N, Paolini G, Grippaudo FR, et al. Comparative evaluation of traditional, ultrasonic and pneumatic-assisted lipoplasty: analysis of local and systemic effects, efficacy and costs of these methods. Aesthetic Plast Surg 2000;24:395-400 15. Scuderi N, Tenna S, Spalvieri C, et al. Power-assisted lipoplasty reduction, face-neck lifting and body lifts can-not be stressed enough. It is an essential tool for the three dimensional composite sculpting/remodelling of body structures. When liposuction was first introduced and popularised in the early 1980s, it indelibly al-tered the field of body contouring surgery and redefined plastic surgery for future generations of surgeons. Unless a “cure” for obesity is dis-covered, or a tectonic shift in human nature, lifestyle, or fashion trends occurs, it is likely than our concerns with lipodystrophy will per-sist unabated. Moreover, as more practitioners and manufacturers become involved in this area and research continues into the understanding of adipocyte physiology, the fields of liposuc-tion, lipolysis, obesity, and fat cell metabolism will continue to gain more interest and realize more advancement.22 Dr. Salil Bharadwaj is a board certified Consul-tant Plastic, Reconstructive and Aesthetic Sur-geon. He is a member of the International So-ciety of Aesthetic Plastic Surgery, Association of Plastic Surgeons of India and European College of Aesthetic Medicine and Surgery. He has more than 10 years’ experience in the field of Plastic Surgery. He has been actively involved in the training of plastic and general surgery postgradu-ates. After practising in several leading corporate hospitals in Bangalore, India, he now works at one of the Gulf ’s top hospitals, the Bahrain Spe-cialist Hospital, Bahrain. He is a regular speaker in International conferences and has published several articles in reputed journals.1. International Society of Aesthetic Plastic Surgery (ISAPS) Global statistics 2014 2. American Society of Plastic Surgery (ASPS) 2015 Plastic Surgery Procedural Statistics.3. Lewis CM. Early history of lipoplasty in the United States. Aesthet Plast Surg. 1990;14:123–126.4. Rohrich RJ, Broughton G, Horton B, et al. The key to longterm success in liposuction: A guide for plastic surgeons and patients. Plast Reconstr Surg. 2004;114:1945–1952.versus traditional suction-assisted lipoplasty: comparative evaluation and analysis of output. Aesthetic Plast Surg 2005;29:49-52 16. Rebelo A. Power-assisted liposuction. Clin Plast Surg 2006;33: 91e105 17. Paul M, Mulholland RS. A new approach for adipose tissue treatment and body contouring using radiofrequency-assisted liposuction. Aesthetic Plast Surg 2009;33:687- 94 18. Stephan PJ, Kenkel JM. Updates and advances in liposuction. Aesthet Surg J. 2010;30:83–97; quiz 98 19. Newall G, Ruiz-Razura A, Mentz HA, Patronella CK, Ibarra FR, Zarak A. A retrospective study on the use of a low-molecular-weight heparin for thromboembolism prophylaxis in large-volume liposuction and body contouring procedures. Aesthetic Plast Surg. 2006;30:86–95 20. Murphy RJ, Alderman A, Gutowski K, Kerrigan C, Schechter L, Wilkins E. Evidence-Based Practices for Thromboembolism Prevention: A Report from the ASPS Venous Thromboembolism Task Force Approved by ASPS Executive Committee: July 2011. Arlington Heights, Ill: American Society of Plastic Surgeons; 2011 21. Shridharani SM, Broyles JM, Matarasso A. Liposuction devices: technology update Medical Devices: Evidence and Research 2014:7 241–251 22. Matarasso A, Levine SM. Evidence-based medicine: liposuction. Plast Reconstr Surg. 2013 Dec;132(6):1697-705 23. Ahmad J, Eaves FF, Rohrich RJ, Kenkel JM. The American Society for Aesthetic Plastic Surgery (ASAPS) survey: current trends in liposuction. Aesthet Surg J. 2011; 31:214–224.24. Steridomas A, De Faria J, Nicaretta B, Papadopoulos O, Papalambros E, Illouz YG. Cell-assisted lipotransfer. Aesthet Surg J 2010; 30: 78-81.Bahrain