Ex Vivo Versus In Vivo Liposuction Hemolysis Index in High-Definition Liposuction and Body Contouring

Abstract

Ex vivo liposuction is a novel technique wherein tissues that are preoperatively planned for excision can be liposuctioned in a sterile manner after removal from the patient. Excised tissues are routinely obtained during a tummy tuck or variant, lateral thigh tuck, buttock tuck, brachioplasty, upper body tuck, and medial thigh tuck. These tucking procedures are performed when moderate to severe skin redundancy is present in patients undergoing body contouring. Traditionally, these tissues were first liposuctioned prior to being excised, termed in vivo liposuction. However, we have developed ex vivo liposuction protocols wherein the tissues are liposuctioned after they have been excised off the patient. Routine processing of harvested fat focuses on minimizing blood products in the aspirate prior to injection. This is because blood products are felt to contain pro-inflammatory products that negatively affect fat graft take. We hypothesized that fat collected by ex vivo technique provides a less bloody harvest than fat collected by in vivo technique. We quantitated blood concentrate of ex vivo versus in vivo fat aspirate by comparing the hemolysis index in 14 consecutive patients undergoing high-definition liposuction and body contouring. Comparison of hemolysis index demonstrated significant reduction in blood concentrate in ex vivo versus in vivo fat aspirate. In vivo hemolysis index demonstrated a larger median than ex vivo hemolysis index. These results confirm our clinical observation that fat harvested by ex vivo liposuction is cleaner and less blood-tinged than fat harvested by in vivo liposuction. No patients experienced complications related to fat graft infection nor fat emboli. Ex vivo liposuction has proven a safe and less blood-tinged technique for harvesting fat in patients who require excisional procedures.