Medical Corporation Mizunomori Plastic Surgery Approach to liposuction based on scientific evidence for safer and more effective liposuction

Medical Corporation Mizunomori Plastic Surgery
Approach to liposuction based on scientific evidence for safer and more effective liposuction
We also consider Mizunomori’s commitment to liposuction and VASER liposuction
In recent years, liposuction has seen an increase in demand and diversification of needs throughout the year.
Based on your own knowledge, scientific evidence, and Mizumori’s surgery method, what is important for safe, secure and effective liposuction?
Director Takemura of Mizunomori Beauty Clinic Tokyo Ginza explained.

Liposuction is now a common surgery. But the risks are also increasing. [Image 1

Liposuction is a very popular surgery in Japan.
According to statistics from the Japan Society of Aesthetic Surgery (JSAPS), liposuction ranks seventh among major cosmetic surgery procedures (Fig. 1).
[Image 2

However, it is also true that while the number of treatments is increasing, the risks of liposuction and other treatments are also increasing.
That is to say, aesthetic medicine in Japan is free medical treatment. Since there are no regulations like the US FDA (US Food and Drug Administration), unapproved devices are easily introduced overseas, and hyaluronic acid breast augmentation is prohibited overseas due to the high risk. Treatment methods such as 1) are prevalent in Japan. Before I became a cosmetic surgeon, the cardiology department that I belonged to had the concept of EBM (Evidence Based Medicine) deeply ingrained among medical departments.
When prescribing a drug, it was basic to prescribe it with reference to numerous clinical studies and papers.
Based on such experience, I feel uncomfortable with the signs of the current aesthetic medicine industry.
Commitment to liposuction based on EBM (Evidence-Based Medicine) [Image 3

For those of you reading this article and those who are considering liposuction right now, we would like to introduce the liposuction surgery method and pre- and post-surgery care that Mizunomori does based on scientific evidence.
In addition, clinical trial results are also available on the differences and effects of liposuction methods such as VASER (internal ultrasound) liposuction and laser liposuction, which have recently become a hot topic, and syringe-type liposuction. I would like to explain from a flat point of view for reference.
As a premise, liposuction is a surgery that has the risk of causing serious complications, but it can be safely performed and the risk of complications can be eliminated with proper treatment and technique and thorough postoperative care.
For this reason, we attach great importance to preoperative diagnosis. Specifically, those with a BMI of 30 or higher should be managed by the anesthesiologist, and the amount of liposuction should be up to 5L2), and for patients who are likely to exceed 5L, the operation should be divided into two or the amount of liposuction should be reduced to one site. We are responding to such as.
In addition, for those who have diabetes in the preoperative blood sample or who have severe hepatic and renal dysfunction, we propose treatment after prioritizing the treatment of the underlying disease 3).
Anesthesia that reduces the burden on the body and a safe and reliable suction procedure
[Image 4

Intravenous anesthesia is administered during the operation to ensure a painless operation.
The safety of liposuction with intravenous anesthesia, which is properly monitored at our hospital, has been established, and the risk of serious complications such as pulmonary embolism is well
controlled.
In addition to intravenous anesthesia, we also use a local anesthetic called “tumescent anesthesia”, which contains diluted epinephrine (which has the effect of constricting blood vessels and suppressing bleeding)5).
By using this anesthetic, the fat becomes soft and “soggy”, so there is little bleeding and it is possible to suction the fat safely and efficiently.
Furthermore, in addition to reducing pain during and after surgery, it also contributes to early recovery of skin sensation 6), 7). In addition, the amount of intravenous anesthesia used can be reduced, making it possible to safely perform liposuction on the same day. [Image 5

At our clinic, we mainly perform the most common manual liposuction. (At Mizunomori, we use the criss-cross method and the resurfacing method.) Even in the United States, where liposuction is the most popular and patients are larger than Japanese, 51% of doctors perform manual liposuction8).
Devices using new methods such as laser liposuction 9) and
power-assisted liposuction have also appeared, but none of them have been able to produce an effect superior to conventional liposuction, and burns, postoperative scars, etc. complications have also been frequently reported.
The risk of complications and infections is almost zero
First, it has been reported that the frequency of complications due to liposuction itself is very low, and the mortality rate is less than 0.02%13).
In addition, we have never had a fatal accident since our hospital opened, so I think this is a point that everyone can rest assured about.
On the other hand, specific causes of fatal accidents due to liposuction have been reported: abdominal organ injury, pulmonary embolism, fat embolism, lidocaine poisoning, and infection
(necrotizing fasciitis).
Of these, abdominal visceral injuries are caused by preoperative oversight of hernias and abdominal surgery history, as well as the skill of doctors.
At our hospital, we prevent oversights by ensuring preoperative counseling and examinations. In addition, we can achieve safe liposuction because we are in charge of the treatment after the doctor’s technique is sufficiently established through the monitor system.
[Image 6

Other complications that require attention include deep vein thrombosis, pulmonary embolism (economy class syndrome), and fat embolism.
Pulmonary embolism is not a complication specific to liposuction, but a complication common to all surgeries performed under general anesthesia.
As a countermeasure against such complications, in addition to wearing elastic stockings at our hospital, for high-risk patients before surgery, if necessary, the surgery is canceled and the
anesthesiologist manages it. .
In addition, for fat embolism, a large amount of liposuction and the length of the operation time are risk factors, so for patients who are predicted to have liposuction in excess of 5L in advance, the procedure is performed twice. We can handle this by dividing it into separate sessions and reducing the amount of suction in one area2). Furthermore, with regard to local lidocaine poisoning, we are working to maintain an appropriate amount of anesthetic concentration by performing the “tumescent anesthesia”5) introduced earlier, so the possibility of it occurring is extremely low.
It’s difficult to completely reduce risk to 0, but we are thoroughly implementing measures and risk management throughout Mizunomori to bring it as close to 0 as possible.
In addition, preoperative administration of antibiotics, which has been reported to suppress the onset of postoperative infections13), is performed as a countermeasure against infections.
We ask you to wear a compression garment to prevent postoperative lumpy feeling14). In addition, immediately after the operation, the wound is not sutured, but a device called a drain is inserted to drain the fluid from the suctioned area, and the drain is removed and the wound is sutured the next day.
Therefore, reduction of swelling and enhancement of compression effect can be expected. 15)
During downtime, water may accumulate at the suction site, so puncture suction is performed to prevent unevenness on the surface.
Vaser liposuction remains questionable as to its cost-effectiveness [Image 7

In recent years, the popularity of liposuction using VASER (internal ultrasound) has increased and it can be said that it is in fashion. However, at present, the conventional manual liposuction method (which is performed at our hospital) has accumulated sufficient evidence compared to newer liposuction methods such as VASER, and it is considered cost-effective. I think it is one of the most comprehensive liposuction methods.
With that in mind, I am paying attention to the results and papers of a “single-blind controlled trial (patients are not allowed to have surgery)” sponsored by a Vaser company. .
In this paper, although superiority of VASER liposuction was recognized in terms of skin tightening effect and bleeding amount, the postoperative course such as pain, swelling, etc. No significant difference was observed10).
Vaser liposuction has been proven to be effective to some extent, but there are still doubts about its cost-effectiveness (whether it is worth paying a high price)11),12 ).
Evidence-based treatment for liposuction
[Image 8

A clinical trial of Vaser liposuction. There is a comparative study with conventional liposuction by Nagy et al. 10). In this study, 20 patients underwent liposuction on 33 sites on the arms, back, flanks and thighs.
A clinical study in which conventional liposuction was performed on one side and VASER liposuction was performed on the other side without telling the patients who had undergone the procedure which was performed by VASER liposuction (single-blind comparison). test). The results of this study showed that VASER liposuction was superior in terms of skin tightening and blood loss.
Regarding the skin tightening effect, an isosceles triangle with a side of 5 cm was applied to the treatment site before surgery, and the size of the circumference of the triangle was compared.
Details are unknown without detailed individual data, but 6 months after surgery, Vaser liposuction has a tightening effect of 17%, while conventional liposuction has a tightening effect of 11% (p = 0.003 )* (Figures 2 and 3).
Also, regarding the amount of blood loss, Vaser liposuction is 11.2cc per 100cc of suction volume, while conventional liposuction is 14cc, showing a difference (p = 0.019)* (Fig. 2).
On the other hand, there was no difference in satisfaction between the postoperative patients and the doctors who performed the surgery, and there was no difference in the postoperative course (pain, dull pain, paresthesia, swelling, etc.). .
*In terms of statistical significance, p=0.05 or less is considered significant. [Image 9

[Image 10

I think Vaser liposuction itself is one of the good treatments, but as you say, I think it is necessary to think carefully about
cost-effectiveness.
In summary, VASER liposuction is currently superior to conventional liposuction in terms of skin tightening effect and bleeding volume. However, although the difference is slight and there is a statistical difference, it is also true that there is no difference at all in the postoperative effect and progress that the patient himself perceives. (Although there is a statistical difference, the difference is almost meaningless in clinical practice)
In fact, even the letter (which describes a constructive opinion to the author) for the paper introduced this time mentions that Vaser liposuction cannot be said to be superior to conventional liposuction at this time.
Vaser liposuction is also a good treatment for removing fat. But I wouldn’t say it’s a better treatment than traditional liposuction. I hope you can understand that.
When patients are considering liposuction, I think it is necessary for them to judge for themselves whether the slight difference is worth the high cost.
Based on more accurate knowledge, I always have the desire to spread aesthetic medicine, collect various information, and conduct daily medical treatment.
Unfortunately, doctors are humans too, and when new equipment comes out, we want to try it out of curiosity.
However, as a person involved in medical care, it is necessary to make objective judgments based on various data.
After properly assessing the cost-effectiveness, we propose the most suitable treatment for the patient.
At Mizumori Plastic Surgery, in order to deliver liposuction safely, securely, and effectively to our patients, we strive daily to improve our procedures and create protocols based on scientific evidence (EBM). increase.
References
1) US Food and Drug Administration, Dermal Fillers (Soft Tissue Fillers) 2) Haeck PC, Swanson JA, Gutowski KA, et al. Evidence-based patient safety advisory: liposuction. Plast Reconstr Surg. 2009 Oct;124(4 Suppl):28S-44S.
3) Liu J, Ludwig T, Ebraheim NA. Effect of the blood HbA1c level on surgical treatment outcomes of diabetics with ankle fractures. Orthop Surg. 2013 Aug;5(3):203-8.
4) Bitar G, Mullis W, Jacobs W, et al. Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures. Plast Reconstr Surg. 2003 Jan;111(1):150-6 discussion 157-8.
5) Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990 Mar;16(3):248-63.
6) Perry AW, Petti C, Rankin M. Lidocaine is not necessary in liposuction. Plast Reconstr Surg. 1999 Nov;104(6):1900-2.
7) Matarasso A. Lidocaine in ultrasound-assisted lipoplasty. Clin Plast Surg. 1999 Jul;26(3):431-9
8) Matarasso A, Levine SM. Evidence-based medicine: liposuction. Plast Reconstr Surg. 2013 Dec;132(6):1697-1705.
9) Prado A, Andrades P, Danilla S, et al. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006 Sep 15;118(4): 1032-1045.
10) Nagy MW, Vanek PF Jr. A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted Lipoplasty and suction-assisted Lipoplasty. Plast Reconstr Surg. 2012 Apr;129(4):681e-689e.
11) Matarasso A. Discussion: a multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted lipoplasty and suction-assisted lipoplasty. Plast Reconstr Surg. 2012 Apr;129(4):690e-691e.
12) Swanson E. Improved skin contraction after VASER-assisted lipoplasty: is it a change we can believe in? Plast Reconstr Surg. 2012 Nov;130(5):754e-756e.
13) Robert Kure, Katsuhiro. Complications, sequelae and treatment of liposuction. PEPARS 2015 No.99: 162-167.
14) Chia CT, Neinstein RM, Theodorou SJ. Evidence-Based Medicine: Liposuction. Plast Reconstr Surg. 2017 Jan;139(1):267e-274e. 15) Toledo LS, Mauad R. Complications of body sculpture: prevention and treatment. Clin Plast Surg. 2006 Jan;33(1):1-11, v.
About Mizunomori Beauty Clinic
[Image 12

Mizunomori Beauty Clinic is a beauty clinic that operates five clinics nationwide: Nagoya, Osaka, Tokyo Ginza, Tokyo Shinjuku, and Fukuoka. Based on the philosophy of “patient-centric principle”, we will provide optimal treatment and satisfaction from the patient’s point of view, not profit, based on the realization of high medical technology and the establishment of technical unification among doctors. We will create a highly complete surgery throughout the clinic that does not change even if you undergo surgery at any clinic nationwide. ▽ Clinic name: Medical Corporation Mizunomori Beauty Clinic
▽ General Director: Wataru Takee
▽ Number of clinics: 5 nationwide
▽ Location (representative): Mizunomori Beauty Clinic Nagoya Clinic ▽Address: 3-6-20 Sakae, Naka Ward, Nagoya City, Aichi Prefecture Shinko Building 5F
▽ Clinic hours: 10:00-19:00
▽Access: Subway Higashiyama Line, Meijo Line Sakae Station, Meitetsu Seto Line Sakaemachi Station Exit 16, 5 minutes on foot
・Mizunomori Beauty Clinic Comprehensive Site
https://www.mizunomori.com/
・General Director of Mizunomori Beauty Clinic
Wataru Takee Official YouTube Channel
“True cosmetic surgeon Wataru Takee”
https://www.youtube.com/channel/UCo3qCN17xUuS-bTHxFhiEuA
General director Wataru Takee himself sends out various information about cosmetic surgery, including liposuction!
[Inquiries from the press regarding this matter]
Medical Corporation Mizunomori Beauty Clinic Public Relations: Ito Phone: 03-6893-2755
Email address: media@mizunomori.com
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Our school has acquired YMAA group certification.
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Details about this release:
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