After liposuction was first described, different techniques and technologies have been invented to assist us during this procedure.
First, the use of tumescent solution was described, which considerably decreased bleeding and the need for transfusions, but still the aim was to decrease fat deposits.
Then an Italian ultrasound device was produced with the intention of liquefying the fat so that it would be easier to extract, but with this technology, complications also started to appear. As this was a power-assisted device, the occurrence of burns in the skin increased. Owing to these complications, the use of this first ultrasound machine was discontinued.
Afterwards, the concept of superficial liposuction was introduced, claiming that better body contours could be achieved, and the term “liposculpture” was first used so that body contouring surgery with liposuction could remove excess fat and put it back where it was missing, so we could truly sculpt the human body.
With this liposculpture technique, skin looseness and irregularities were more commonly seen after the procedure, so there was a need to improve these results and the industry started to work on what options could be available.
We were soon invaded with different power-assisted devices, such as a new ultrasound technology named VASER (vibration amplification by sound energy at resonance) and also different types of lasers, vibro liposuction, and others that would facilitate the surgeon with fat extraction. As many used energy sources that produced heat, this heat could also help with skin tightening.
Today we have a new power-assisted machine that can be used with liposuction called Renuvion powered by J-Plasma. Although not new, use of the J-Plasma technology for liposuction is a new concept. The manufacturer claims that because the technology was conceived as a cutting device that produced less heat in its surroundings, thereby decreasing burn risks in nearby tissues, this same concept could be extended to liposuction, producing less heat but with much more skin contraction. The manufacturers advertise that the device stating will produce up to 65% more skin contraction.
Why is it Important as Doctors to Offer These Types of Treatments?
Since the invention of liposuction, it has been (together with breast augmentation) the most popular surgical a esthetic procedure done worldwide. As plastic surgeons, we currently all use liposuction and lipoinjection techniques and because we need to be up to date with new scientific advances and innovations, we need to follow and catch up with what technology offers us. However, we can never forget that with liposuction, we are sculpting the human body and by saying so, we are stating that we are sculpting our piece of art in this human body. Although technology will certainly help us improve results or decrease surgery risk, it will never replace the surgeon’s artistic taste.
We must not presume that because we buy the newest machine, this will guarantee that we will achieve incredible results, as the end is in the surgeon’s hand and the feel of the sculpture being desired as to how successful they will be in delivering the results the patient expects. Therefore, we must stay out of the industry trap that the newest machine will provide better results, as this is not necessarily true. Actually, all these machines that produce heat can increase our surgery risks for complications, especially skin necrosis.
If you have been doing something for, long time and have good and consistent results, why would you want to change it? Many times, we do it because these new technologies can be good for marketing ourselves, making us different from our colleagues, and showing that we are up to date.
In our surgery center, this was the case when we started using laser liposuction, being pioneers in the region in offering this laser-assisted liposuction procedure, Today, we are doing the same by using the J-Plasma technology in our liposuctions. Different technologies can certainly give us more skin retraction, but we cannot claim it to be consistent with every single case.
J-Plasma technology is a technology that, although new for liposuction, has long been used as a cutting device that claims to produce less heat expansion when used for cutting in surgery. It has very good cutting qualities, similar to those achieved by electrocautery devices, but produces less heat and this is why it was initially thought to be a good option for assisting liposuction. Although it produces heat for skin contraction, because it has a lower heat expansion effect, it would have a lower risk of burning skin.
It is important to know when using J-Plasma technology that helium gas must be infused inside the patient’s body so that the J-Plasma can be produced during the procedure. Helium gas does not have any crucial side effects in our body (when used in large quantities it can decrease the percentage of oxygen in the air we breathe), but it is important to prevent its accumulation after the procedure. Therefore, often more incisions for evacuation of the gas are needed, and also it is a good idea to leave incisions open so the gas can leave the body easily after the procedure is finished. Excess gas must also be extracted from the body by “milking” the area towards the incision where the gas was infused, which decreases the excess gas remaining in the body once the procedure is finished.
Currently, I use the Renuvion J-Plasma technology because it can give us a better skin tightening effect, although this is never promised to the patient. Also, we use it because it is a very efficient marketing tool that differentiates us from other plastic surgery practices.
Dr. Wafaa Mradmi is a surgeon who is sharing with us her experience in using this J-Plasma technology.
Expert Approach: J-Plasma Liposuction
Wafaa Mradmi
Plastic Surgeon
Casablanca, Morocco
When did you learn it? how did you end up doing it?
I decided to use this technique because I needed a tool that could improve my results, especially regarding the skin tightening after liposuction. I was hesitating between various devices such as laser, VASER, etc., but this one was presented to me as being the best on the market so far, giving the best security and safety in the matter of complications (such as burns).
I started to do the procedure after receiving training by the company that sells the J-Plasma machine – Renuvion – in Morocco, training from a specialist nurse who came from Spain and gave me the basic knowledge on how to operate the machine but was not able to answer many of my questions. As this is a new technology, I knew I would have to learn the details by myself doing my own work while using the device. The one thing that convinced me to buy the technology was that I really “felt” a real retraction of the skin after using the machine during the surgery after having performed liposuction.
Can this technique be compared with others and why?
As the main purpose of this technique is to improve the skin tightening after procedures such as liposuction or for any loose skin all over the body (face, neck, arms, abdomen, thighs, etc.), yes it can be compared with other technologies that are supposed to give the same results, such as VASER or laser. Although I do not have experience with these other technologies, Dr. Lina Triana, who is familiar with ultrasound liposuction-assisted technology and liposuction laser-assisted technology, says anecdotally that more skin contraction can be seen with this J-Plasma device, although no scientific studies have been done to prove it. All I can say is that you can just see the skin contraction on the operating table.
What do you consider to be important landmarks and anatomy to be able to better perform this technique?
The target of this energy is all the fibers that exist between the skin and the muscles that pass through the fat tissue.
It is a blind technique like the liposuction itself and as surgeons, we need to really understand what liposuction is about so in the end, we can proceed to perform the J-Plasma procedure correctly.
As far as I am concerned, I try to do a very safe liposuction (not using the basket cannulas, for example, that really damage the fibers) when I plan to use the J-Plasma technology.
Can you explain to us how do you do the assessment on a patient asking for this procedure?
We are – unfortunately – working in a new era of plastic surgery where patients come into our office asking for new technologies, not just for a technique or even to resolve a physical problem. They just want to solve a problem and because often new technologies are said to give less downtime with good results, this is what people seek more and more today and why they ask for it initially. Here, it is important to tell patients that it is a new device and has only been a few years on the market and not enough data has been collected on its usage.
Because of advertising that we find on Instagram, Facebook, Snapchat, etc., people are aware of a lot of technologies and often presume that they will produce better outcomes. They come to us thinking that the J-Plasma is the solution for their excess skin when the solution is sometimes a good abdominoplasty or facelift.
It is our duty as physicians to explain to them that there are specific indications for this technology, such as moderate loose skin or moderate skin excess, but otherwise, if too much excess skin is present, they will end up with bad results from its technology alone, so when choosing incorrectly by the patient, the device itself will end up having bad advertising.
Can you describe your technique?
First, I will do the traditional liposuction and then at the end of the liposuction procedure, I will proceed to use the J-Plasma.
Before starting the J-Plasma procedure, with the cannula under the skin, incisions are interconnected to facilitate gas leaving the body after the procedure. It is important to stop the pass of J-Plasma at least 1 cm from the entrance of the device where the incision is to prevent overpassing it in this area.
