Doctor Mountcastle Performs Liposuction Explained In English And Spanish

Doctor Mountcastle walks us through a liposuction in both English and Spanish. He first explains the laser lipo portion of the procedure where fat is essentially "liquefied" before it will be removed through the cannula. He then walks us through the second portion, first explaining the cannula and how it works and suctions the fatty tissue. Doctor Mountcastle utilizes a fan-like technique throughout the procedure to methodically remove fat in an even and cosmetically appealing way.

Transcription

Dr. Mountcastle:    What we're doing now is our laser lipo portion of the smart lipo, and you can see the laser tip being guided through the tissue. What we're doing is we're passing the laser fiber in between the skin and the muscle tissue layer. All her tissue's numbed up, so we're working in the space between the skin and her muscle. And as you can see, the patient's under local anesthesia. They're completely awake, and they're not having any pain whatsoever. The patient is extremely comfortable, just sitting here listening to beautiful kumbaya music. Okay? 5,000. Okay. So we got 2,000, 1,000, 2,000, that's five. Now we're gonna go to the upper side, so we're gonna get 2,000 more over here. So I'm measuring out the amount of joules that I'm using. One famous plastic surgeon said liposuctioning is like vacuuming under a couch. You have to methodically plan. And as you can see, I'm fanning out. I'm trying to add the exact same amount and just working back and forth in a fan-like technique to try and apply the exact same amount of heat energy, joules, to each and every area. You can also see there's some fibrous bands that we're also trying to kind of break through as well. Those fibrous bands create cellulite, and we're trying to cut down on the amount of cellulite in her abdomen to smooth out her abdomen postoperatively. 

Dr. Mountcastle:    Flip the pedal.

Dr. Mountcastle:    We have two different cannulas here. We have the tissue breakup cannula on my right, and the suction cannula on the left. Turned upside down, you can see the three little holes that are ... So the suctioning is when you are passing it through the tissue, it's facing down. So you're suctioning down, so you're not suctioning up towards the skin. This is totally done off of suction, completely off of suction, because otherwise you'd be sucking way too much. You have to suck under controlled lower pressure. If you look over at our vacuum pressure over here, we're going to see a 195. When we go into the tissue, it's going to go up to around 230, between 230 and 250 millimeters of mercury. If you look at our canister over there, you're gonna to seeing the tissue start coming out. We're gonna start working in our right lower quadrant in the same technique, and you will start to see the tissue come through the tubing over here. When you start seeing it come through the tubing ... See that right there? It's coming through the tubing. Beautiful yellow fatty tissue, and it just comes on through. And we're sucking at negative 236 millimeters of mercury, which is a nice, low, controlled pressure, not too high.

If you turn your attention back to the abdomen, you can see how I have my left hand pressed on the abdomen for bimanual palpation as we go in a same fan-like technique going from top to bottom and then working back. And I'm turning the cannulas suction from facing downwards to facing to, at a 90 angles to the side and going back and forth. But you can see all the tissue coming out. And this is just out of the right lower quadrant. And occasionally we take it out of the abdomen to clear the tubing. But you can already see, we're already up to 200 CC's of fat removed. And doing that pre-step of going in and doing tissue breakup before, this tissue comes out a lot easier. Okay.

So we just do this for a while. We go back and forth, back and forth. And then I'm gonna come in from the other side as well. But we try to do it from multiple different angles. We call it a lattice work technique, and that allows us ... I can take out all the fat from this angle and not be able to get anymore out. And then I move to the other side of the table, get it from the other side, and I'll get a bunch more tissue out. And once again, you can see that there's a lot of pressure here, but the patient's really not feeling anything. Okay. 

Speaker 2:          Okay.

Dr. Mountcastle:    And this will continue. So we work in the right lower quadrant, then we'll do the left lower quadrant. Then we'll do the right upper quadrant, then we'll do the left upper quadrant. So we do everything in a methodical fashion. Okay. So this patient will be seen one week postoperatively for a quick check. Then we'll see them in about two to three months postoperatively. Typically, the pain only lasts a couple of days, sometimes even a day. Sometimes patients take pain pill for a day, sometimes they take it for about three days. That's on average. 
                    Patients do very well. She'll be able to walk out of the office, get in her car, and obviously have someone to keep an eye on her tonight of surgery. But the patient's completely awake and very comfortable. And it's just going back and forth and back and forth and back and forth. Okay. It's a little bit harder there, wouldn't you say than the rest?

Speaker 3:          Mm-hmm (affirmative).

Dr. Mountcastle:    So I'm gonna try to smooth that out. So now I'm kind of coming through and trying to contour a little bit. As you can see, I'm gonna come try to work up here. Trying to work on that one spot there. Okay. Now you can come from the top and look at this side versus that side. Okay. The angle right there, you can see how this side is bulging up, and this side is nice and flat. This side I pinched that little bit. That side is a lot of extra tissue. You see the difference? That's after just, I still have some more applications to do, but that's kind of the beginning phase. Okay?  You can see I'm wearing some purple latex-free gloves. I try to use these on quite a bit of patients, because then we don't have to worry about whether they have a latex allergy or not. Just the safest thing to do. And you can see this patient has a bunch of stretch marks here. Those will tighten up with the laser. If we didn't use the laser, they wouldn't tighten up as much. Okay. So you really gotta add some heat energy when you have stretch marks to get that skin tightening. So this is critical to this process is having that Smart Lipo laser added to the tissue.

Speaker 2:          Okay. So we're all finished up here on this Smart Lipo of the abdomen. This is the results. It's a little swollen because of the anesthesia, but it looks really, really good, as you can see. Very minimal. The next part is we're just going to go ahead and help this patient just kind of drain a lot of the liquid out, the solution, so that she can expect very less at her house. She'll return next week, and we'll wrap her up, compression, and she looks great, and she's feeling great.