13. Risk reduction in energy-assisted lipocontouring

Side effects can be seen when using any energy-based device. With radiofrequency, most of these are thermal. There is a difference between expected sequelae and adverse sequelae.

Figure 11.

A 65-year-old woman with pendulosity of the volar upper arm (above). Below, a patient 3 months after circumferential liposuction and treatment with Renuvion. Pendulosity measurement decreased by 40%.

#### Figure 12.

This 38-year-old man had gynecomastia, abdominal lipodystrophy with pendulosity, and flank and waist fatty hyperplasia and tissue contraction at 6 weeks. (a) A patient before treatment and (b) a patient 6 weeks after liposuction plus Renuvion.

#### Figure 13.

(a) Postoperative analysis of directional lift following liposuction and Renuvion RF assisted tissue tightening. (b) Compressive tissue analysis of the same patient following treatment with abdominal liposuction and Renuvion tissue tightening.

Expected sequelae include erythema, swelling, and redness and small scar at the access port sites. Bruising may be prolonged, and a temporarily modest improvement due to post-op swelling is expected. Patients may note they cannot fit into their regular size of clothing for a few weeks. Less than hoped for improvement in the early weeks is expected. Tissue contraction really becomes noticeable about 3 months post-op and continues for a year or more. Pre-existing asymmetry will not be totally corrected. Crepitus or air in the tissue due to residual helium is common, even if gas is expressed or suctioned at case end.

Adverse sequelae can include persistent tissue pendulosity if present preoperatively. Creases or folds in the skin can occur if the patient is not careful about compression garment application. Small burns or blistering can occur but this is rare. If heat or ice is applied to the treatment region postoperatively, an area of full-thickness skin loss can occur. Unsatisfactory scarring at the access port sites may occur. Rarely, fibrosis can occur in overtreated regions. Undertreatment may result in residual lipodystrophy, a hooded umbilicus, or focal skin contour irregularities.

These irregularities can also occur if fat pad thickness is not checked for uniformity prior to closure. Overly aggressive liposuction, especially if superficial, can leave an unattractive skin surface.

Top 10 technical tips for achieving good outcomes:


10.Dr. Gerhard Sattler likes to use a bit more tumescent fluid in a secondary treatment, as well as the PAL handpiece. This approach optimizes tunneling though fibrous tissue and allows for more thorough liposuction, tissue protection from overtreatment, and creation of regions of low impedance recipient tissue.
