*2.7.1 Fat shifting*

Guillermo Blugerman, MD designed a multi holed tip on a solid cannula that is used in cheese grater fashion to blend and shift fat under the skin. Useful diameters range from 3 mm for fine tuning HiDef procedures and sculpting faces and necks, to 4 to 6 mm cannulas used for the rest of the body. This cannula can be used to grossly define a surgical/suction-able plane and elegantly adjust variations in skin pinch to improve surface contours. The fat morsels liberated by the distal holes are release from the proximal holes and vice versa, with each stroke, literally leveling the "playing field" and allowing the skin to drape more smoothly. I use this cannula to define the thickness of the fat and make a plane that is easy for the suctioning cannula to pass when starting the procedure, adjust for fine symmetry during a case, and fine tune every liposculpting case after sitting the patient up and marking remaining contour and symmetry issues. Depending on the tightness or pressure of the "smart" hand pressing the tissue into the holes of the cannula as the cannula is moved by the

"dumb" hand, macro or micro effects can be achieved. Manual skin manipulation is useful for massaging and blending the emulsified fat to the desired locations.
