Continuous Release-Assisted Sharp-Tip Aspiration for Fibrotic Dorsocervical Fat Pads: A Phase-Adapted Cannula Protocol.

backgroundFibrotic dorsocervical fat pads ("buffalo humps") are challenging to treat with conventional blunt-tip liposuction because dense fibrofatty septa may limit cannula passage, aspiration efficiency, and contour refinement. Although sharp-cannula release has been introduced to address fibrotic resistance, existing approaches generally separate release from subsequent debulking and refinement.

objectivesTo describe a continuous release-assisted sharp-tip aspiration protocol using custom-designed cannulas throughout penetration, debulking, and refinement, and to evaluate its early clinical outcomes and safety.

methodsThirty patients with clinically evident fibrotic dorsocervical fat pads underwent a phase-adapted sharp-tip aspiration protocol using a 2.5 mm 2-port cannula and 3.0 mm 3- or 4-port cannulas. The protocol incorporated lesion-centered dual-circle marking, phase-adapted cannula selection, bimanual tactile control, and staged aspiration. Immediate postoperative B-mode ultrasonography was performed in representative cases. Twelve-month outcomes were assessed using a standardized 4-point photographic scale by two independent plastic surgeons, with inter-rater reliability evaluated using quadratic weighted Cohen's kappa. Patient satisfaction was also assessed at 12 months using a 5-point Likert scale.

resultsThe mean aspirated volume was 260.7 mL. At 12 months, both raters classified 93.3% of cases as good or excellent, and 80.0% of patients were satisfied or very satisfied. Exact inter-rater agreement was 73.3%, and quadratic weighted Cohen's κ was 0.63. Representative ultrasound showed residual treated subcutaneous tissue thickness of 0.55-0.74 cm, preserved layer continuity, and no obvious fluid collection or fascial disruption. No major complications or revision procedures occurred; minor complications resolved spontaneously or were managed conservatively.

conclusionsContinuous release-assisted sharp-tip aspiration appears feasible for selected fibrotic dorsocervical fat pads. By coupling septal disruption and aspiration throughout the procedure, this protocol may improve procedural consistency while preserving a minimally invasive approach. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.