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Video Transcrition

Dr. Katzen:

Today we're doing a liposuction the chest, this patient has gynecomastia. Now we are going to flatten his chest by taking out the fat and then we're also going to be doing a tummy tuck. He'd lost about maybe 150 pounds and has excess skin and fat of his tummy and he also wants his incision as low as possible. He wants to be able to wear a reasonable shorts and to have that incision covered. So we are going to keep the incision nice and low on his tummy tuck.

Made a little incision here and now we're going to put it in our tumescent fluid. Key ingredients are lidocaine, which minimizes the pain during the procedure as well as after the procedure and it's got this element in it that we add to it called epinephrine. Epinephrin causes vasoconstriction and that minimizes the bleeding during the procedure. It also our floats the fat in here and allows the vaser to be a lot more effective.

These are the port sites that protect the skin from friction and burns. This is the vaser probe. It's got two rings on it and emits sound energy from the side. I'm going to turn it on here and you can see that little puff of a vapor that goes. So I'm going to put it in water and this is what it does to the fat cells in the tissue. You can see that? This is sound energy and you can see it just basically emitting sound to break up all the fat cells. As I get closer to the wall of the bin here, you can see it get louder and louder because it's, again, sound energy.

Good. If I put that in a glass it would probably shatter, but we won't do that here today. That'd be really cool to after surgery.

This is the vaser. This is a probe that is really good on the chest and it's really good on patients that need revision or secondary liposuction.

So this patient had liposuction done twice before by two other plastic surgeons and really didn't like his results, but you know, they didn't use the vaser. So this really helps to break up the scar tissue in the chest.

Con. Probably related.

So when I do this, it's like a sprinkler. You just kind of go chik, chik, chik, chik.

So now you can see we've defatted the chest, we've gotten out a lot of the fat of the chest. Nice flat chest for our garment for about six weeks and it should all be all nice and flat when we're done.

Thank you.

Speaker 2:

How do those patients work out when you use fat instead of implants?

Dr. Katzen:

It's okay.

Speaker 2:

I can't imagine it working out well.

Dr. Katzen:

Basically I'm making an incision around the belly button now and the analogy that I use, it's like a button on a shirt. So I'm basically unbuttoning the button and I'm going to push it back into the belly. And then after I bring the belly down, then we're going to pull the belly button out. So there is the belly button. I do this to preserve the blood supply and if you do it any other way, you know when you take out the specimen, the belly button is going to be in the trash.

So you sort of have to do it like this. I check the tension in my flap to be sure I can get this out before I commit to the resection. I'm very confident I can get that out. So now I can go on to this step where we cut up to the belly button and it makes our dissection a lot easier.

We watch our fingers, watch your hand there. Caught on live film. How I cut all of Justin's fingers. Exactly. Let's look at that in slow motion.

Speaker 2:

You might want to find another profession.

Dr. Katzen:

Exactly. How about professional plaintiff?

And then you can see the six pack outline right in here. You can also see how the muscle twitches and I can get an idea of where the muscle ends. There's a lot of water right in here.

Speaker 2:

How long is recovery-

Dr. Katzen:

To give you an idea of scale, this is six inches. [inaudible] it's probably about three inches thick for a fat. So, there we go.

Yeah. Ooh, this is good. So I can go right up to his sternum, his xiphoid. So I draw a line from the midline here to the xiphoid and the sternum there, and another line perpendicular here to the top of the iliac crest or the hip bones and that's where everyone's belly button should be. Right there.

So on him I think the belly button would be good right there. Let's wait. Let's get the well right there. Good.? Better?

Speaker 2:


Dr. Katzen:

Now males should get a round belly button as opposed to a vertical belly button. This blood is a good sign because it means my flap has a lot of blood. It means that our dissection is a good one and it's so good that it's oozing here because that means we have really good blood supply to this whole flap. The point that's further aways from the heart is right here, for blood supply, and that spot looks really good. So now we're just going to go find this belly button. And just as I predicted, there is the belly button. All right?

So there's that tag at six o'clock that you remember from the beginning of the case, and that helps me orient where the belly button goes. So that's six o'clock. It doesn't go over here, it doesn't go over there. It goes at six o'clock. So I'm just going to inset that belly button with some three [omonicurls] and finish up our runner here. And we're done with the male tummy tuck.