Musculoskeletal Ultrasound in Orthobiologic Care—From Harvest to Injection: A Cadaveric Validation of Ultrasound-Guided Lipoaspiration for Orthobiologic Applications
Main Article Content
Abstract
Background: Musculoskeletal (MSK) ultrasound is increasingly used for point-of-care diagnosis, delivery of therapeutics like orthobiologics, and follow-up evaluations. However, it is underutilized for the harvest of orthobiologic tissue such as adipose, leading to concerns about safety and procedure accuracy. Adipose tissue is a valuable orthobiologic source due to its regenerative potential, high progenitor cell content, and resistance to age-related decline. Safe, targeted harvesting is critical to maintain graft integrity.
Objective: To describe and validate a novel, ultrasound-guided manual lipoaspiration technique for precise and safe harvest of abdominal adipose tissue for orthobiologic use.
Methods: High-frequency (4–13 MHz) interventional ultrasound was used to identify the mantle and deep layers of the anterior abdominal subcutaneous compartment in three cadaveric models. Manual lipoaspiration was performed using a blunt-tip cannula under real-time ultrasound guidance. Procedural validation included colored latex injections to the harvest sites to assess for anatomical accuracy, as well as dissection and microscopic evaluation of the aspirated tissue to confirm adipose identity.
Results: All six aspiration sites yielded adipose tissue without evidence of muscle or peritoneal involvement. Microscopy revealed classic adipocyte morphology, and density centrifugation confirmed low-density tissue, consistent with adipose. Colored latex remained confined to the intended adipose compartments on dissection, confirming harvest precision.
Conclusion: This cadaveric study demonstrates that manual lipoaspiration performed under ultrasound guidance allows for safe and anatomically accurate adipose harvesting, preserving adjacent structures and tissue integrity. MSK ultrasound supports a full orthobiologic workflow—from harvest to injection and post-treatment monitoring—enhancing procedural safety, biologic effectiveness, and standardization in regenerative care. Further clinical research is needed to assess graft viability and therapeutic outcomes in live patients.
Keywords:
Ultrasound-Guided Lipoaspiration, Adipose Tissue Harvest, Orthobiologics, Regenerative Medicine, Musculoskeletal Ultrasound, Image-Guided Procedures
Article Details
How to Cite
PANERO, Alberto et al.
Musculoskeletal Ultrasound in Orthobiologic Care—From Harvest to Injection: A Cadaveric Validation of Ultrasound-Guided Lipoaspiration for Orthobiologic Applications.
Medical Research Archives, [S.l.], v. 13, n. 6, june 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6606>. Date accessed: 15 july 2025.
doi: https://doi.org/10.18103/mra.v13i6.6606.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Sivan M, Brown J, Brennan S, Bhakta B. A one-stop approach to the management of soft tissue and degenerative musculoskeletal conditions using clinic-based ultrasonography. Musculoskeletal Care. 2011;9(2):63-68.
2. Howard ZD, Noble VE, Marill KA, Sajed D, Rodrigues M, Bertuzzi B, Liteplo AS. Bedside ultrasound maximizes patient satisfaction. J Emerg Med. 2014 Jan;46(1):46-53. doi: 10.1016/j.jemermed.2013.05.044. Epub 2013 Aug 12. PMID: 23942153.
3. Panero AJ, Hirahara AM. A guide to ultrasound of the shoulder, Part 2: The diagnostic evaluation. Am J Orthop. 2015; 45(4):233-238.
4. Hirahara AM, Panero AJ. A guide to ultrasound of the shoulder, part 3: interventional and procedural uses. Am J Orthop. 2016;45(7):440-445.
5. Finnoff JT, Hall MM, Adams E, et al. American Medical Society for Sports Medicine (AMSSM) position statement: Interventional musculoskeletal ultrasound in sports medicine. Br J Sports Med. 2015;49(3):145-150.
6. Partington P, Broome G. Diagnostic injection around the shoulder: Hit and miss? A cadaveric study of injection accuracy. J Shoulder Elbow Surg. 1998;7(2):147-150.
7. Rutten M, Maresch B, Jager G, de Waal Malefijt M. Injection of the subacromial-subdeltoid bursa: Blind or ultrasound-guided? Acta Orthop. 2007; 78(2):254-257.
7. Kang M, Rizio L, Prybicien M, Middlemas D, Blacksin M. The accuracy of subacromial corticosteroid injections: A comparison of multiple methods. J Shoulder Elbow Surg. 2008;17(1 Suppl):61S-66S.
9. Yamakado K. The targeting accuracy of subacromial injection to the shoulder: An arthrographic evaluation. Arthroscopy. 2002; 19(8):887-891.
10. Henkus HE, Cobben M, Coerkamp E, Nelissen R, van Arkel E. The accuracy of subacromial injections: A prospective randomized magnetic resonance imaging study. Arthroscopy. 2006; 22(3):277-282.
11. Sethi P, El Attrache N. Accuracy of intra-articular injection of the glenohumeral joint: A cadaveric study. Orthopedics. 2006;29(2):149-152.
12. Naredo E, Cabero F, Beneyto P, et al. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004; 31(2):308-314.
13. Royall NA, Farrin E, Bahner DP, Stanislaw PA. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop. 2011;2(7):57-66.
14. Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1042-1049.
15. Hirahara AM, Panero A, Andersen WJ. An MRI Analysis of the Pelvis to Determine the Ideal Method for Ultrasound-Guided Bone Marrow Aspiration from the Iliac Crest. Am J Orthop (Belle Mead NJ). 2018;47(5):10.12788/ajo.2018.0038. doi:10.12788/ajo.2018.0038
16. Asakura Y, Kinoshita M, Kasuya Y, Sakuma S, Ozaki M. Ultrasound-guided sternal bone marrow aspiration. Blood Res. 2017 Jun;52(2):148-150. doi: 10.5045/br.2017.52.2.148. Epub 2017 Jun 22. PMID: 28698857; PMCID: PMC5503898.
17. Hirahara AM, Andersen WJ. Ultrasound-Guided Percutaneous Reconstruction of the anterolateral Ligament: Surgical Technique and Case Report. Am J Orthop. 2016;45(7):418-460.
18. Hirahara AM, Andersen WJ. Ultrasound-Guided Percutaneous Repair of Medial Patellofemoral Ligament: Surgical Technique and Outcomes. Am J Orthop. 2017;46(3):152-157.
19. Hirahara AM, Andersen WJ, Panero AJ. Superior Capsular Reconstruction: Clinical Outcomes After Minimum 2-Year Follow-Up. Am J Orthop. 2017;46(6):266-278.
20. Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017 Aug 28;21(1):225. doi: 10.1186/s13054-017-1814-y. PMID: 28844205; PMCID: PMC5572160.
21. Lawver J, Thaler R. Ultrasound-Guided Lipoaspiration for Mesenchymal Stromal Cell Harvest in the Horse. Equine Vet Educ (2016) 28 (1) 23-29. Doi: 10.1111/eve.12398
22. Cs Nagy G, Verwiebe R, Wunsch M. Staged ultrasound-guided liposuction for hidden arteriovenous fistulas in obese patients. Vasa. 2018 Aug;47(5):403-407. doi:10.1024/0301-1526/a000719. Epub 2018 Jul 19. PMID: 30022718.
23. Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. 1st ed. Mosby; 2000.
24. Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 2nd ed. Elsevier Saunders; 2013.
25. Enriquez JL, Wu TS. An introduction to ultrasound equipment and knobology. Crit Care Clin. 2014; 30(1):25-45, v. doi:10.1016/j.ccc.2013.08.006
26. Viaro MSS, Danilla S, Cansanção AL, Viaro PS. Ultra HD Liposuction: Enhancing Abdominal Etching Using Ultrasound-Guided Rectus Abdominis Fat Transfer (UGRAFT). Plast Reconstr Surg Glob Open. 2020;8(5):e2818. doi:10.1097/GOX.0000000000002818
27. Duscher D, Atashroo D, Maan ZN, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells. Stem Cells Transl Med. 2016;5(2):248-257. doi:10.5966/sctm.2015-0064
28. Shridharani SM, Broyles JM, Matarasso A. Liposuction devices: technology update. Med Devices (Auckl). 2014;7:241-251. doi:10.2147/MDER.S47322
29. Collins PS, Moyer KE. Evidence-Based Practice in Liposuction. Ann Plast Surg. 2018;80(6S Suppl 6):S403-S405. doi:10.1097/SAP.0000000000001325
30. Simonacci F, Bertozzi N, Grieco MP, Raposio E. From liposuction to adipose-derived stem cells: indications and technique. Acta Biomed. 2019; 90(2):197-208. doi:10.23750/abm.v90i2.6619
31. Graf R, Auersvald A, Damasio RCC, et al. Ultrasound-assisted liposuction: an analysis of 348 cases. Aesthetic Plast Surg. 2003;27(2):146-153. doi:10.1007/s00266-002-1516-x
32. Chia CT, Neinstein RM, Theodorou SJ. Evidence-Based Medicine: Liposuction. Plast Reconstr Surg. 2017;139(1):267e-274e. doi:10.1097/PRS.0000000000002859
33. Habbema L. Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases. Dermatol Surg. 2009;35(11):1728-1735. doi:10.1111/j.1524-4725.2009.01284.x
34. Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15,336 patients. National survey results. Dermatol Surg. 1995;21(5):459-462. doi:10.1111/j.1524-4725.1995.tb00213.x
35. Estes BT, Diekman BO, Gimble JM, Guilak F. Isolation of adipose-derived stem cells and their induction to a chondrogenic phenotype. Nat Protoc. 2010;5(7):1294-1311. doi:10.1038/nprot.2010.81
36. Tordjman J. Histology of Adipose Tissue. In: Bastard J-P, Bruno F, eds. Physiology and Physiopathology of Adipose Tissue. Springer; 2012.
37. Berry R, Church CD, Gericke MT, Jeffery E, Colman L, Rodeheffer MS. Imaging of adipose tissue. Meth Enzymol. 2014;537:47-73. doi:10.1016/B978-0-12-411619-1.00004-5
38. Martin AD, Daniel MZ, Drinkwater DT, Clarys JP. Adipose tissue density, estimated adipose lipid fraction and whole body adiposity in male cadavers. Int J Obes Relat Metab Disord. 1994;18(2):79-83.
39. Choi JS, Yang H-J, Kim BS, et al. Fabrication of porous extracellular matrix scaffolds from human adipose tissue. Tissue Eng Part C Methods. 2010; 16(3):387-396. doi:10.1089/ten.TEC.2009.0276
40. Choi JS, Kim BS, Kim JY, et al. Decellularized extracellular matrix derived from human adipose tissue as a potential scaffold for allograft tissue engineering. J Biomed Mater Res A. 2011; 97(3):292-299. doi:10.1002/jbm.a.33056
41. Aust L, Devlin B, Foster SJ, et al. Yield of human adipose-derived adult stem cells from liposuction aspirates. Cytotherapy. 2004;6(1):7-14. doi:10.1080/14653240310004539
42. Bunnell BA, Flaat M, Gagliardi C, Patel B, Ripoll C. Adipose-derived stem cells: isolation, expansion and differentiation. Methods. 2008; 45(2):115-120. doi:10.1016/j.ymeth.2008.03.006
43. Jang Y, Koh YG, Choi Y-J, et al. Characterization of adipose tissue-derived stromal vascular fraction for clinical application to cartilage regeneration. In Vitro Cell Dev Biol Anim. 2015; 51(2):142-150. doi:10.1007/s11626-014-9814-6
44. Jurgens WJFM, Oedayrajsingh-Varma MJ, Helder MN, et al. Effect of tissue-harvesting site on yield of stem cells derived from adipose tissue: implications for cell-based therapies. Cell Tissue Res. 2008;332(3):415-426. doi:10.1007/s00441-007-0555-7
45. Pittenger MF, Mackay AM, Beck SC, et al. Multilineage potential of adult human mesenchymal stem cells. Science. 1999;284(5411):143-147. doi:10.1126/science.284.5411.143
46. Roato I, Alotto D, Belisario DC, et al. Adipose Derived-Mesenchymal Stem Cells Viability and Differentiating Features for Orthopaedic Reparative Applications: Banking of Adipose Tissue. Stem Cells Int. 2016;2016:4968724. doi:10.1155/2016/4968724
47. Schneider S, Unger M, van Griensven M, Balmayor ER. Adipose-derived mesenchymal stem cells from liposuction and resected fat are feasible sources for regenerative medicine. Eur J Med Res. 2017;22(1):17. doi:10.1186/s40001-017-0258-9
48. Yoshimura K, Shigeura T, Matsumoto D, et al. Characterization of freshly isolated and cultured cells derived from the fatty and fluid portions of liposuction aspirates. J Cell Physiol. 2006; 208(1):64-76. doi:10.1002/jcp.20636
49. Zhu Y, Liu T, Song K, Fan X, Ma X, Cui Z. Adipose-derived stem cell: a better stem cell than BMSC. Cell Biochem Funct. 2008;26(6):664-675. doi:10.1002/cbf.1488
50. Zuk PA, Zhu M, Ashjian P, et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell. 2002;13(12):4279-4295. doi:10.1091/mbc.E02-02-0105
51. Durán Vega HC, Manzaneda R, Flores E, Manfrim C, Morelli H. Deep Back Liposuction: Ultrasound-Guided Deep Fat Liposuction of the Subiliac Crest. Aesthet Surg J. 2023 Jul 20:sjad236. doi: 10.1093/asj/sjad236. Epub ahead of print. PMID: 37474316.
52. Harutyunyan R, Gilardino MS, Papanastasiou VW, Jeffries SD, Hemmerling TM. Ultrasound Calculation of Fat Volume for Liposuction: A Clinical Software Validation. Aesthet Surg J. 2023 Sep 14;43(10):1150-1158. doi: 10.1093/asj/sjad121. PMID: 37099036.
53. Duscher D, Atashroo D, Maan ZN, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells. Stem Cells Transl Med. 2016;5(2):248-257. doi:10.5966/sctm.2015-0064
54. Shridharani SM, Broyles JM, Matarasso A. Liposuction devices: technology update. Med Devices (Auckl). 2014;7:241-251. doi:10.2147/MDER.S47322
55. Collins PS, Moyer KE. Evidence-Based Practice in Liposuction. Ann Plast Surg. 2018;80(6S Suppl 6):S403-S405. doi:10.1097/SAP.0000000000001325
56. Chia CT, Neinstein RM, Theodorou SJ. Evidence-Based Medicine: Liposuction. Plast Reconstr Surg. 2017;139(1):267e-274e. doi:10.1097/PRS.0000000000002859
57. Chung MT, Zimmermann AS, Paik KJ, et al. Isolation of human adipose-derived stromal cells using laser-assisted liposuction and their therapeutic potential in regenerative medicine. Stem Cells Transl Med. 2013;2(10):808-817. doi:10.5966/sctm.2012-0183
58. Duscher D, Luan A, Rennert RC, et al. Suction assisted liposuction does not impair the regenerative potential of adipose derived stem cells. J Transl Med. 2016;14(1):126. doi:10.1186/s12967-016-0881-1
59. Mordon S, Eymard-Maurin AF, Wassmer B, Ringot J. Histologic evaluation of laser lipolysis: pulsed 1064-nm Nd:YAG laser versus cw 980-nm diode laser. Aesthet Surg J. 2007;27(3):263-268. doi:10.1016/j.asj.2007.03.005
60. Taha S, Saller MM, Haas E, et al. Adipose-derived stem/progenitor cells from lipoaspirates: A comparison between the Lipivage200-5 liposuction system and the Body-Jet liposuction system. J Plast Reconstr Aesthet Surg. 2020;73(1):166-175. doi:10.1016/j.bjps.2019.06.025
61. Qu Y, Luan J, Mu D, et al. Does Water-Jet Force Affect Cryopreserved Adipose-Derived Stem Cells? Evidence of Improved Cell Viability and Fat Graft Survival. Ann Plast Surg. 2021;87(2):199-205. doi:10.1097/SAP.0000000000002584
62. Ince B, Oltulu P, Yildirim MEC, Ismayilzade M, Dadaci M. Effects of aspiration time on immediate viability of adipocyte cell in ultrasound-assisted liposuction (UAL) and in traditional suction-assisted lipectomy (SAL). J Plast Surg Hand Surg. 2019; 53(1):14-19. doi:10.1080/2000656X.2018.1515770
63. Pereira-Netto D, Montano-Pedroso JC, Aidar ALES, Marson WL, Ferreira LM. Laser-Assisted Liposuction (LAL) Versus Traditional Liposuction: Systematic Review. Aesthetic Plast Surg. 2018; 42(2):376-383. doi:10.1007/s00266-018-1085-2
64. Lauvrud AT, Gümüscü R, Wiberg R, et al. Water jet-assisted lipoaspiration and Sepax cell separation system for the isolation of adipose stem cells with high adipogenic potential. J Plast Reconstr Aesthet Surg. Published online March 29, 2021. doi:10.1016/j.bjps.2021.03.025
2. Howard ZD, Noble VE, Marill KA, Sajed D, Rodrigues M, Bertuzzi B, Liteplo AS. Bedside ultrasound maximizes patient satisfaction. J Emerg Med. 2014 Jan;46(1):46-53. doi: 10.1016/j.jemermed.2013.05.044. Epub 2013 Aug 12. PMID: 23942153.
3. Panero AJ, Hirahara AM. A guide to ultrasound of the shoulder, Part 2: The diagnostic evaluation. Am J Orthop. 2015; 45(4):233-238.
4. Hirahara AM, Panero AJ. A guide to ultrasound of the shoulder, part 3: interventional and procedural uses. Am J Orthop. 2016;45(7):440-445.
5. Finnoff JT, Hall MM, Adams E, et al. American Medical Society for Sports Medicine (AMSSM) position statement: Interventional musculoskeletal ultrasound in sports medicine. Br J Sports Med. 2015;49(3):145-150.
6. Partington P, Broome G. Diagnostic injection around the shoulder: Hit and miss? A cadaveric study of injection accuracy. J Shoulder Elbow Surg. 1998;7(2):147-150.
7. Rutten M, Maresch B, Jager G, de Waal Malefijt M. Injection of the subacromial-subdeltoid bursa: Blind or ultrasound-guided? Acta Orthop. 2007; 78(2):254-257.
7. Kang M, Rizio L, Prybicien M, Middlemas D, Blacksin M. The accuracy of subacromial corticosteroid injections: A comparison of multiple methods. J Shoulder Elbow Surg. 2008;17(1 Suppl):61S-66S.
9. Yamakado K. The targeting accuracy of subacromial injection to the shoulder: An arthrographic evaluation. Arthroscopy. 2002; 19(8):887-891.
10. Henkus HE, Cobben M, Coerkamp E, Nelissen R, van Arkel E. The accuracy of subacromial injections: A prospective randomized magnetic resonance imaging study. Arthroscopy. 2006; 22(3):277-282.
11. Sethi P, El Attrache N. Accuracy of intra-articular injection of the glenohumeral joint: A cadaveric study. Orthopedics. 2006;29(2):149-152.
12. Naredo E, Cabero F, Beneyto P, et al. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004; 31(2):308-314.
13. Royall NA, Farrin E, Bahner DP, Stanislaw PA. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop. 2011;2(7):57-66.
14. Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1042-1049.
15. Hirahara AM, Panero A, Andersen WJ. An MRI Analysis of the Pelvis to Determine the Ideal Method for Ultrasound-Guided Bone Marrow Aspiration from the Iliac Crest. Am J Orthop (Belle Mead NJ). 2018;47(5):10.12788/ajo.2018.0038. doi:10.12788/ajo.2018.0038
16. Asakura Y, Kinoshita M, Kasuya Y, Sakuma S, Ozaki M. Ultrasound-guided sternal bone marrow aspiration. Blood Res. 2017 Jun;52(2):148-150. doi: 10.5045/br.2017.52.2.148. Epub 2017 Jun 22. PMID: 28698857; PMCID: PMC5503898.
17. Hirahara AM, Andersen WJ. Ultrasound-Guided Percutaneous Reconstruction of the anterolateral Ligament: Surgical Technique and Case Report. Am J Orthop. 2016;45(7):418-460.
18. Hirahara AM, Andersen WJ. Ultrasound-Guided Percutaneous Repair of Medial Patellofemoral Ligament: Surgical Technique and Outcomes. Am J Orthop. 2017;46(3):152-157.
19. Hirahara AM, Andersen WJ, Panero AJ. Superior Capsular Reconstruction: Clinical Outcomes After Minimum 2-Year Follow-Up. Am J Orthop. 2017;46(6):266-278.
20. Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017 Aug 28;21(1):225. doi: 10.1186/s13054-017-1814-y. PMID: 28844205; PMCID: PMC5572160.
21. Lawver J, Thaler R. Ultrasound-Guided Lipoaspiration for Mesenchymal Stromal Cell Harvest in the Horse. Equine Vet Educ (2016) 28 (1) 23-29. Doi: 10.1111/eve.12398
22. Cs Nagy G, Verwiebe R, Wunsch M. Staged ultrasound-guided liposuction for hidden arteriovenous fistulas in obese patients. Vasa. 2018 Aug;47(5):403-407. doi:10.1024/0301-1526/a000719. Epub 2018 Jul 19. PMID: 30022718.
23. Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. 1st ed. Mosby; 2000.
24. Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 2nd ed. Elsevier Saunders; 2013.
25. Enriquez JL, Wu TS. An introduction to ultrasound equipment and knobology. Crit Care Clin. 2014; 30(1):25-45, v. doi:10.1016/j.ccc.2013.08.006
26. Viaro MSS, Danilla S, Cansanção AL, Viaro PS. Ultra HD Liposuction: Enhancing Abdominal Etching Using Ultrasound-Guided Rectus Abdominis Fat Transfer (UGRAFT). Plast Reconstr Surg Glob Open. 2020;8(5):e2818. doi:10.1097/GOX.0000000000002818
27. Duscher D, Atashroo D, Maan ZN, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells. Stem Cells Transl Med. 2016;5(2):248-257. doi:10.5966/sctm.2015-0064
28. Shridharani SM, Broyles JM, Matarasso A. Liposuction devices: technology update. Med Devices (Auckl). 2014;7:241-251. doi:10.2147/MDER.S47322
29. Collins PS, Moyer KE. Evidence-Based Practice in Liposuction. Ann Plast Surg. 2018;80(6S Suppl 6):S403-S405. doi:10.1097/SAP.0000000000001325
30. Simonacci F, Bertozzi N, Grieco MP, Raposio E. From liposuction to adipose-derived stem cells: indications and technique. Acta Biomed. 2019; 90(2):197-208. doi:10.23750/abm.v90i2.6619
31. Graf R, Auersvald A, Damasio RCC, et al. Ultrasound-assisted liposuction: an analysis of 348 cases. Aesthetic Plast Surg. 2003;27(2):146-153. doi:10.1007/s00266-002-1516-x
32. Chia CT, Neinstein RM, Theodorou SJ. Evidence-Based Medicine: Liposuction. Plast Reconstr Surg. 2017;139(1):267e-274e. doi:10.1097/PRS.0000000000002859
33. Habbema L. Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases. Dermatol Surg. 2009;35(11):1728-1735. doi:10.1111/j.1524-4725.2009.01284.x
34. Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15,336 patients. National survey results. Dermatol Surg. 1995;21(5):459-462. doi:10.1111/j.1524-4725.1995.tb00213.x
35. Estes BT, Diekman BO, Gimble JM, Guilak F. Isolation of adipose-derived stem cells and their induction to a chondrogenic phenotype. Nat Protoc. 2010;5(7):1294-1311. doi:10.1038/nprot.2010.81
36. Tordjman J. Histology of Adipose Tissue. In: Bastard J-P, Bruno F, eds. Physiology and Physiopathology of Adipose Tissue. Springer; 2012.
37. Berry R, Church CD, Gericke MT, Jeffery E, Colman L, Rodeheffer MS. Imaging of adipose tissue. Meth Enzymol. 2014;537:47-73. doi:10.1016/B978-0-12-411619-1.00004-5
38. Martin AD, Daniel MZ, Drinkwater DT, Clarys JP. Adipose tissue density, estimated adipose lipid fraction and whole body adiposity in male cadavers. Int J Obes Relat Metab Disord. 1994;18(2):79-83.
39. Choi JS, Yang H-J, Kim BS, et al. Fabrication of porous extracellular matrix scaffolds from human adipose tissue. Tissue Eng Part C Methods. 2010; 16(3):387-396. doi:10.1089/ten.TEC.2009.0276
40. Choi JS, Kim BS, Kim JY, et al. Decellularized extracellular matrix derived from human adipose tissue as a potential scaffold for allograft tissue engineering. J Biomed Mater Res A. 2011; 97(3):292-299. doi:10.1002/jbm.a.33056
41. Aust L, Devlin B, Foster SJ, et al. Yield of human adipose-derived adult stem cells from liposuction aspirates. Cytotherapy. 2004;6(1):7-14. doi:10.1080/14653240310004539
42. Bunnell BA, Flaat M, Gagliardi C, Patel B, Ripoll C. Adipose-derived stem cells: isolation, expansion and differentiation. Methods. 2008; 45(2):115-120. doi:10.1016/j.ymeth.2008.03.006
43. Jang Y, Koh YG, Choi Y-J, et al. Characterization of adipose tissue-derived stromal vascular fraction for clinical application to cartilage regeneration. In Vitro Cell Dev Biol Anim. 2015; 51(2):142-150. doi:10.1007/s11626-014-9814-6
44. Jurgens WJFM, Oedayrajsingh-Varma MJ, Helder MN, et al. Effect of tissue-harvesting site on yield of stem cells derived from adipose tissue: implications for cell-based therapies. Cell Tissue Res. 2008;332(3):415-426. doi:10.1007/s00441-007-0555-7
45. Pittenger MF, Mackay AM, Beck SC, et al. Multilineage potential of adult human mesenchymal stem cells. Science. 1999;284(5411):143-147. doi:10.1126/science.284.5411.143
46. Roato I, Alotto D, Belisario DC, et al. Adipose Derived-Mesenchymal Stem Cells Viability and Differentiating Features for Orthopaedic Reparative Applications: Banking of Adipose Tissue. Stem Cells Int. 2016;2016:4968724. doi:10.1155/2016/4968724
47. Schneider S, Unger M, van Griensven M, Balmayor ER. Adipose-derived mesenchymal stem cells from liposuction and resected fat are feasible sources for regenerative medicine. Eur J Med Res. 2017;22(1):17. doi:10.1186/s40001-017-0258-9
48. Yoshimura K, Shigeura T, Matsumoto D, et al. Characterization of freshly isolated and cultured cells derived from the fatty and fluid portions of liposuction aspirates. J Cell Physiol. 2006; 208(1):64-76. doi:10.1002/jcp.20636
49. Zhu Y, Liu T, Song K, Fan X, Ma X, Cui Z. Adipose-derived stem cell: a better stem cell than BMSC. Cell Biochem Funct. 2008;26(6):664-675. doi:10.1002/cbf.1488
50. Zuk PA, Zhu M, Ashjian P, et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell. 2002;13(12):4279-4295. doi:10.1091/mbc.E02-02-0105
51. Durán Vega HC, Manzaneda R, Flores E, Manfrim C, Morelli H. Deep Back Liposuction: Ultrasound-Guided Deep Fat Liposuction of the Subiliac Crest. Aesthet Surg J. 2023 Jul 20:sjad236. doi: 10.1093/asj/sjad236. Epub ahead of print. PMID: 37474316.
52. Harutyunyan R, Gilardino MS, Papanastasiou VW, Jeffries SD, Hemmerling TM. Ultrasound Calculation of Fat Volume for Liposuction: A Clinical Software Validation. Aesthet Surg J. 2023 Sep 14;43(10):1150-1158. doi: 10.1093/asj/sjad121. PMID: 37099036.
53. Duscher D, Atashroo D, Maan ZN, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells. Stem Cells Transl Med. 2016;5(2):248-257. doi:10.5966/sctm.2015-0064
54. Shridharani SM, Broyles JM, Matarasso A. Liposuction devices: technology update. Med Devices (Auckl). 2014;7:241-251. doi:10.2147/MDER.S47322
55. Collins PS, Moyer KE. Evidence-Based Practice in Liposuction. Ann Plast Surg. 2018;80(6S Suppl 6):S403-S405. doi:10.1097/SAP.0000000000001325
56. Chia CT, Neinstein RM, Theodorou SJ. Evidence-Based Medicine: Liposuction. Plast Reconstr Surg. 2017;139(1):267e-274e. doi:10.1097/PRS.0000000000002859
57. Chung MT, Zimmermann AS, Paik KJ, et al. Isolation of human adipose-derived stromal cells using laser-assisted liposuction and their therapeutic potential in regenerative medicine. Stem Cells Transl Med. 2013;2(10):808-817. doi:10.5966/sctm.2012-0183
58. Duscher D, Luan A, Rennert RC, et al. Suction assisted liposuction does not impair the regenerative potential of adipose derived stem cells. J Transl Med. 2016;14(1):126. doi:10.1186/s12967-016-0881-1
59. Mordon S, Eymard-Maurin AF, Wassmer B, Ringot J. Histologic evaluation of laser lipolysis: pulsed 1064-nm Nd:YAG laser versus cw 980-nm diode laser. Aesthet Surg J. 2007;27(3):263-268. doi:10.1016/j.asj.2007.03.005
60. Taha S, Saller MM, Haas E, et al. Adipose-derived stem/progenitor cells from lipoaspirates: A comparison between the Lipivage200-5 liposuction system and the Body-Jet liposuction system. J Plast Reconstr Aesthet Surg. 2020;73(1):166-175. doi:10.1016/j.bjps.2019.06.025
61. Qu Y, Luan J, Mu D, et al. Does Water-Jet Force Affect Cryopreserved Adipose-Derived Stem Cells? Evidence of Improved Cell Viability and Fat Graft Survival. Ann Plast Surg. 2021;87(2):199-205. doi:10.1097/SAP.0000000000002584
62. Ince B, Oltulu P, Yildirim MEC, Ismayilzade M, Dadaci M. Effects of aspiration time on immediate viability of adipocyte cell in ultrasound-assisted liposuction (UAL) and in traditional suction-assisted lipectomy (SAL). J Plast Surg Hand Surg. 2019; 53(1):14-19. doi:10.1080/2000656X.2018.1515770
63. Pereira-Netto D, Montano-Pedroso JC, Aidar ALES, Marson WL, Ferreira LM. Laser-Assisted Liposuction (LAL) Versus Traditional Liposuction: Systematic Review. Aesthetic Plast Surg. 2018; 42(2):376-383. doi:10.1007/s00266-018-1085-2
64. Lauvrud AT, Gümüscü R, Wiberg R, et al. Water jet-assisted lipoaspiration and Sepax cell separation system for the isolation of adipose stem cells with high adipogenic potential. J Plast Reconstr Aesthet Surg. Published online March 29, 2021. doi:10.1016/j.bjps.2021.03.025