Separation, Aspiration, and Fat Equalization: SAFE Liposuction Concepts for Comprehensive Body Contouring

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When we want to innovate a concept or technique, we must use scientific concepts and methods that can support our affirmations or conclusions and not be left with mere clinical observations. Liposuction is the most frequently performed cosmetic surgery procedure. It was designed to correct subcutaneous fat deposits and to produce a satisfactory silhouette contour in well-selected patients and areas. Any new liposuction concept must first be compared with the conventional liposuction technique that is applied worldwide. If benefits are proven, we would be responsible for important changes that will benefit our patients.
Wall and Lee mentioned that if the amount of fat removed in an area increases, the potential for skin irregularities also increases.1 Skin irregularities are created by the superwet or tumescent infiltration technique used that modified the histologic architecture of the subcutaneous tissue, especially when the infiltration solution is infiltrated under high pressure. This mechanism is traumatic hydraulic dissection. Tunneling the subcutaneous tissue with a high volume of saline solution results in an important deformity and irregularities.
Another point is when they mention that thermal energy introduced with different techniques such as ultrasound-assisted, laser-assisted, and radiofrequency-assisted liposuction creates injury to fat cells. We published our experience with a new concept of fat preservation by laser, using an adequate wavelength (1210 nm) of laser that offers absorption/affinity for fat rather than for water.2 Thermal damage precludes use of the aspirated tissue for graft. The most important concept is the “preservation of the fat” through a photochemical property; thus, we describe a selective photostimulation on adipose stem cells and adipocytes, making the aspirated fat adequate for grafting.3 SAFE liposuction changes a “mechanical disruption” by a “hydraulic high-pressure disruption”; in both cases, it is a blunt traumatic dissection.
The lasers have more properties than only the photothermal property that produces the lipolysis. We describe and demonstrated a “one-step technique” as an ideal technique for adipocyte and stem cell harvesting, using a laser with a novel wavelength (1210 nm). We present our histopathologic, biomolecular, and phenotypic studies, and then we concluded that our technique shows a better quantity and quality of adipocytes and stem cells compared with the conventional liposuction technique.4–7
The authors did not perform any histologic tests confirming that the treated area remains vascularized, so how can they assert this concept? In our experience, we have performed histologic studies 2 months and 1 year after fat grafting using our technique. These studies show a residual inflammatory response and mature viable fat tissue, respectively.7 In our consideration, the SAFE technique did not differ from the conventional liposuction technique because they both use the same basic principle of curettage, which is just a mechanical disruption.
In conventional liposuction, the connective tissue (fibrous septa) is aspirated as a result of mechanical disruption created by the cannula. If the authors did not study the aspirated tissue, how can they ensure that the separation of fat from the fibrous septae is without damage of this structure?
In contrast, we observed that a 1210-nm laser denaturalized the connective tissue, and liberated the adipocytes (preserved) and the stem cells (stimulated). Our histologic studies show no connective tissue in the aspirated fat; this material is homogeneous and, when minced, is easy to aspirate and easy to inject through small microannulas.2,8,9
Finally, the authors concluded that the process of SAFE liposuction fulfills the principles of advanced body contouring. Personally, we consider that this technique does not innovate but only improves lipocurettage technique that already exists.
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