The Proximal Superiorly Angled Liposuction Cannula

We would like to describe a novel, simple modification to liposuction cannulas that can improve the safety and ergonomics of liposuction and fat grafting. Liposuction cannulas that have an inferiorly angled bend at the distal end have been well described in the literature.1 We describe the opposite, a reproducible modification that utilizes superior angulation at the proximal portion of the liposuction cannula (Fig. 1).Fig. 1.: Difference between the proximal superiorly angled liposuction cannula and the distal inferiorly angled cannula.The proximal superiorly angled liposuction cannula (PSALC) has a 30-degree to 45-degree angulation at the junction of the proximal and middle third of the cannula. When modifying the cannula, it should be bent once and never again straightened. After using 4-mm and 5-mm cannulas with a proximal superior angulation for more than a year, we can attest that the modified cannulas are intuitive and comfortable to use and remain stable. PSALC have several benefits. During liposuction, it enters the subcutaneous tissues of the abdominal wall without the handpiece or liposuction tubing catching on the anterior surface of the lower abdomen or thighs. [See Video (online), which demonstrates differences between use of the proximal superiorly angled liposuction cannula versus the straight cannula.] This superior angulation improves the ergonomics of liposuction by allowing the surgeon to always maintain the cannula tip above the deep fascia of the abdominal wall with the surgeon’s wrist and forearm in a natural position. When the surgeon lowers the handpiece of a proximal superior cannula, the cannula tip moves superiorly, toward the dermis and away from the deep fascia of the abdomen. In this way, PSALC can accomplish what has been previously described as one of the most important tasks in liposuction: keeping the cannula tip parallel to the deep fascia of the abdominal wall to prevent inadvertent abdominal wall perforations.2 {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"Differences between use of the proximal superiorly angled liposuction cannula versus the straight cannula.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_m7a984ni"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Use of the PSALC also improves the safety of gluteal fat grafting by helping the cannula stay above the deep gluteal fascia and avoiding the downward angulation of the cannula, thus diminishing the risk of gluteal muscle penetration and microscopic or macroscopic fat embolism,3 as recommended by the Aesthetic Surgery Education and Research Foundation and the Multi-Society Gluteal Fat Grafting Safety Task Force.4 When performing gluteal fat grafting, surgeons can push the cannula handle down to keep the cannula tip up toward the dermis and away from the deep gluteal fascia. Proximal superior cannulas make penetration of the deep gluteal fascia difficult and an unnatural maneuver. The PSALC also improves the ergonomics of liposuction and fat grafting. With straight cannulas, surgeons would often abduct their wrist to keep the tip parallel and superficial to the deep fascial planes of the abdomen or gluteal region. This is no longer necessary with the PSALC. By preventing excess wrist motions, the PSALC avoids wrist tension and wrist articulation fatigue and minimizes the possibility of the repetitive stress injuries that are common among plastic surgeons.5 The novel PSALC offers an ergonomic alternative whose angulation facilitates keeping the cannula tip parallel and superficial to the deep fascial planes of the abdomen and buttock. It thus improves the safety of liposuction and gluteal fat grafting. DISCLOSURE Dr. Durán is a consultant for Establishment Labs KOL 2. Dr. Pazmiño is a consultant for Clarius Ultrasound.