Expansion Vibration Lipofilling — EVL — A New Technique in Large Volume Fat Transplantation

Introduction: Despite rapid growth, gluteal fat transplantation is an operation in search of science and a teachable technique. Long operating times, tedious syringe transfers, inability to shape the recipient site and the risk of fat embolism all headline as impediments to clinical adoption of the procedure. Expansion Vibration Lipofilling - EVL - is a syringe-free surgical strategy which is a logical extension of SAFE® liposuction. In EVL, there is simultaneous disruption of recipient site connective tissue, internal expansion using exploded-tip cannulas and backfilling of these spaces with roller pump-propelled fat. Materials and Methods: 2419 consecutive cases of EVL fat transplantation to the buttocks were reviewed. Average follow-up was 12 months. The technique of EVL is dependent on the use of larger caliber cannulas attached to a roller pump and to an oscillatory PAL device, which is less labor-intensive, potentially allowing for better knowledge of cannula-tip location at all times during the procedure. Results: Operating times averaged one hour and 40 minutes. The average volume of fat inserted was 1003cc. Complications included donor site seroma, infection and one pulmonary embolism treated with anticoagulation. There were no cases of fat embolism or death. Conclusions: EVL is a new method for large-volume fat transplantation. Avoidance of fatal fat emboli demands a surgeon's complete knowledge of cannula tip location at all times during the procedure. Syringe free, larger caliber and less flexible cannulas, combined with techniques requiring less operator upper extremity effort resulting in less fatigue may contribute to avoidance of this dreadful complication. As listed in the submission, Dr. Del Vecchio is the corresponding author for the review and the pre-publication acceptance period. If/once necessary revisions and explanations are made and the paper is accepted for publication, Dr. Wall will become the corresponding author for questions, comments and reprints post publication. Dr. Wall's address: Corresponding author address: 8600 Fern Avenue, Shreveport, LA 71105, swalljr@wallcenter.com Dr. Del Vecchio and Dr. Wall both own equity in Surgistem Technologies, a developer of surgical instruments used in liposuction and fat transfer. Dr. Del Vecchio and Dr. Wall auto-declare this body of work constitutes a level of Evidence V. ©2018American Society of Plastic Surgeons

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