Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer.

Background: The rejuvenation and restoration of a well-defined jawline contour are crucial for enhancing facial aesthetics in both men and women. Within the jawline aesthetic unit (mandibular angle), the masseter muscle plays a significant role, as it is responsible for mandibular masticatory movements. We propose a new approach using ultrasound-guided intramuscular fat transfer to enhance the mandibular angle and jawline. Methods: The multicenter study included 20 patients from three countries (Peru, Brazil, and Mexico). After fat harvesting, the ultrasound-guided masseteric fat transfer was performed with a 1.5-mm Viaro cannula from an incision beneath the ear lobule. The fat was then injected intramuscularly into the masseter at each side of the mandibular angle. Results: Masseter ultrasound-guided fat transfer was performed on 10 men and 10 women between 2021 and 2022. The patients had a mean age of 34.4 ±â€…6.39 years and a mean body mass index of 22.39 ±â€…2.59 kg per m2. The mean injected volume was 5.83 mL and 5.58 mL on the right and left sides, respectively. Muscle thickness increased in patients immediately postsurgery, but decreased after 1 month. The muscle remained significantly thicker on each side than the presurgery measurements in patients regardless of gender (both P < 0.0001). Conclusions: Ultrasound-guided intramuscular fat transfer is a safe and reproducible technique for enhancing the jawline contour at the mandibular angle. We believe that it could be a more durable solution than other procedures, although further evaluation of long-term results is necessary.

Deep Back Liposuction: Ultrasound-Guided Deep Fat Liposuction of the Subiliac Crest.

In the past 5 years, aesthetic surgery of the buttock has changed a lot with the use of technologies like imaging ultrasound to get safer and more beautiful results. These techniques are not only used to make a safer fat infiltration in the buttock, but also for modeling it. The aim of this study was to describe ultrasound-guided subiliac crest deep fat liposuction for contouring the buttock-back region. This area is often overlooked in gluteal frame management because of the depth at which it is located. Healthy patients were chosen for whom this deep back ultrasound technique was performed to improve the gluteal frame. The technique involved making a small incision in the iliac crest of the ilium, followed by identification of the area of deep posterior fat below the iliac crest under ultrasonographic control. A cannula was positioned to deliver static tumescent infiltration and liposuction was performed. This study included 16 female patients aged 20 to 45 years old who underwent this procedure. The area was infiltrated with 150 to 200 mL of tumescent solution per side, and 175 to 200 mL of fat was obtained. The depth of the study area varied but was observed to be generally located between 3 and 5 cm from the skin. This study indicates that this technique is safe and effective in achieving aspiration of the subiliac crest deep fat, which enhances the frame for buttock-back contouring. Ultrasound was indispensable for locating the fat and infiltrating the area for subsequent liposuction.See the abstract translated into Hindi, Portuguese, Korean, German, Italian, Arabic, Chinese, and Taiwanese online here: https://doi.org/10.1093/asj/sjad236.

Waist Remodeling without Incision, with Ultrasound-guided Monocortical Fracture.

Background: Rib remodeling is a surgical technique for waist shaping in women and men. However, one of the main patient complaints is the scar. We aimed to describe a scarless, ultrasound-guided rib remodeling (RibXcar) technique that assessed the degree of angular variation of the fracture by ultrasound and the variation in waist measurement and patient satisfaction through a survey. Methods: The RibXcar technique was performed in 30 women aged 18-35 years in Peru, Colombia, and Mexico between October and December 2022 by three board-certified plastic surgeons trained in ultrasound and in this technique. The plastic surgeons measured costal angles before and immediately, 1 month, and 3 months after the surgery by ultrasound, as well as the waist in the same site and at these time points. Similarly, patient satisfaction was surveyed 3 months after the surgery, in which questions were asked about body aesthetics and the puncture site. Results: Ultrasound angular measurements before and immediately, 1 month, and 3 months after the surgical procedure were 168.00, 158.00, 160.00, and 160.43 degrees in the 10th rib, 170.50, 160.50, 152.50, and 163.50 degrees in the 11th rib, and 172.00, 162.00, 154.00, and 165.00 degrees in the 12th rib, respectively. The satisfaction survey showed that patients were satisfied with the aesthetic results of both the shape of the waist and the puncture site. Conclusions: RibXcar surgery maintains the angular variation over time. Similarly, waist measurements show a sustained reduction. Three months postoperatively, the patients were satisfied with the aesthetic results of the waist and the puncture site.

Ultrasound-guided Fat Graft of the Obliques-Serratus Complex.

Background: The idea of the anterolateral thoracic musculature in men during the contour procedure is very limited, particularly in terms of surgical techniques that improve its appearance and aesthetics. Therefore, this study aimed to describe a technique of deep definition liposuction with intramuscular grafting of the serratus external oblique muscle complex. Methods: A retrospective case series of a total of 11 cases of male patients aged between 29 and 60 years in the year 2022 is presented. These patients underwent body contouring surgery and subsequently underwent ultrasound-guided intramuscular fat grafting in the serratus external oblique complex. As part of the study, measurements were taken before and immediately after surgery. The data were stored in a database and analyzed with the statistical software SPSS, v23.0. Results: The patients were aged between 29 and 60 years, with a mean age of 38.3 years (±8.5). All cases had a body mass index of 30. Results were matched preinfiltration and postinfiltration; These results were subjected to statistical validation using the Student t test for related samples, and statistically significant differences were obtained in all the measures tested. Conclusions: The technique of fat grafting in the oblique-serratus complex allows for increasing muscle thickness. The measurements were made only immediately after the infiltration; it is important in the future to show the long-term follow-up. No adverse events occurred during the study.

Ultrasonography as a Tool to Improve Preoperative Marking in Body Contour Surgery.

Background: Body contouring surgery and surgical drawings are usually performed based on the surgeon's experience without considering the nature of the unique anatomical structures of each patient. Thus, we propose a more reliable surgical design approach that considers the anatomical structures of each patient. Ultrasonography is increasingly used in plastic surgery and helps plastic surgeons to highlight anatomical features representing results in their interventions by providing a better understanding of the patients' unique structures. Methods: This study presents a series of cases involving 100 recruited patients (36 men and 64 women) between 18 and 60 years of age. Five surgeons examined the patients and created a presurgical design based on palpation, which was validated later by a physician skilled in evaluating the anterior wall of the abdomen using ultrasonography. The concordance between the findings of the palpation and ultrasonography was assessed for each patient. Results: The concordance rate for each structure in both evaluations was midline (49%) (P > 0.92), diastasis recti (15%), semilunar line (23%), upper edge of rectus abdominis muscles (12%), lower edge of pectoral muscles (16%), border of oblique muscle (13%), number of tendinous intersections (12%), shape of tendinous intersections (11%), serratus anterior muscle (15%), subcostal triangle (15%), and oblique triangle (26%) (P < 0.0001). Conclusion: All the structures evaluated by palpation in comparison with ultrasound show discordance, except the midline where agreement is evident, with a very good level of statistical significance.

Buttock and Full Body Contouring Harmony.

The concept of the gluteal framework has significantly enhanced our understanding of the gluteal anatomy. The buttock does not constitute a bulging area in the human body. To be attractive, it must harmonize with all elements of the human body around it. Nevertheless, the changes in patient desires and demands, in addition to innovations in surgical technique open a field of opportunity to achieve more beautiful and natural results. In this work, the main updates in the management of body contouring are condensed, including new safe and aesthetic fat infilration techniques.

The Energy a Plastic Surgeon Expends during Liposuction.

It is generally accepted that liposuction requires a significant amount of energy from surgeons. This procedure involves the use of specialized equipment and techniques to remove fat cells from the body, which can be physically demanding for surgeons. The amount of effort required for liposuction must be evaluated in terms of energy consumption. Our goal was to conduct a study to record the energy that the surgeon uses during liposuction and correlate these results with the volume of fat obtained as well as other variables. Methods: A series of cases was carried out from April 2022 to November 1, 2022, in three different plastic surgery centers. Three plastic surgeons recorded the procedures using an Apple Watch, choosing from among Apple Watch training options and free indoor walking. The surgeon then concluded the registration at the time of finishing the surgery and removed the surgical gloves and gowns. Results: Complete data were obtained for 63 patients. The average fat obtained per 1 kcal of energy was 6.14 cm3 of fat, and 160 cal to obtain 1 cm3 of fat by liposuction. Other data that demonstrated statistically significant correlations were fat volume versus average pace (km), total fat volume versus average heart rate, fat volume versus surgical time, and fat volume versus distance. Conclusions: Liposuction is a surgical procedure that requires considerable effort. This study demonstrates the amount of energy required for regular liposuction. Compared with other single procedures, three times more energy is required to complete liposuction.

Incorporation of the UGRAFT Technique to High-definition Liposuction.

High-definition liposuction is now a reliable procedure that provides more athletic results. It is a trend among plastic surgeons and patients. The ultrasound-guided rectus abdominis fat transfer (UGRAFT) technique has expanded the range of patients who can benefit from rectus abdominis fat grafting, including those without skin laxity. Its advantage over isolated high-definition liposuction is a more natural-looking result because it increases muscle volume and provides a contoured abdomen even during movement, regardless of the patient's position. In this article, we describe one patient undergoing the UGRAFT technique after high-definition liposuction, versus one patient undergoing only high-definition liposuction. We determined that the use of the UGRAFT technique provides greater muscle definition over those in which this technique has not been performed. The UGRAFT technique opens the possibility of developing more complete body structures regarding definition, providing volume to muscular areas. The more muscle mass and less body fat, the greater the body definition in a liposuction. The less muscle mass and more body fat, the less definition a patient will have in a liposuction. Under these principles, we improve the result by increasing the volume of muscle mass.

Influence of Age, Sex, and Body Mass Index on the Thickness of the Gluteal Subcutaneous Fat: Implications for Safe Buttock Augmentation Procedures.

BACKGROUND: The deep intramuscular approach during buttock augmentation with fat grafting has been associated with a significantly increased risk for pulmonary fat embolism. This study was designed to provide guidance for injection into the subcutaneous fat. METHODS: The authors investigated 150 Caucasian individuals with an equal distribution of men and women (n = 75 each) and a balanced distribution of age (n = 30 per decade: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 69 years) and body mass index (n = 50 per group: ≤24.9 kg/m, between 25.0 and 29.9kg/m, and ≥30 kg/m). Ultrasound-based measurements were conducted of the thickness of the total, superficial, and deep gluteal fatty layers. RESULTS: An increase in body mass index of 1.0 kg/m corresponded to an increase of 3 mm of the total gluteal subcutaneous fat of men and a 4-mm increase of the total gluteal subcutaneous fat in women. With increasing age, the thickness of the deep fatty layer increased, whereas with increasing body mass index the thickness of the superficial layer primarily increased. Formulas were generated to estimate the total thickness of the gluteal subcutaneous fatty layer for men [total thickness (in millimeters) = -33.56 + (age × 0.078) + (body mass index × 3.042)] and women [total thickness (in millimeters) = -56.997 + (age × 0.1) + (body mass index × 3.86)]. CONCLUSIONS: Knowing the total thickness of the gluteal subcutaneous fat (i.e., the safe space) allows surgeons to estimate their operating range for cannula motion even if no ultrasound machine is available during buttock augmentation with fat grafting. This can increase safety, potentially reducing the number of adverse events.

Spreader Graft Easy and Stable Fixation.

The original spreader graft described by Sheen was dissecting a sub perichondrial flap along the anterior edge of the septum and inserting the grafts in place and occasionally, fixing them with a mattress suture. Although it has been done usually with mattress suture, it has some disadvantages as the instability of the graft while it is being fixated and others. We present a different fixation method with a simple running suture instead.

Where Does the Transplanted Fat is Located in the Gluteal Region? Research Letter.

INTRODUCTION: Liposuction is one of the most popular plastic surgery procedures. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have been reported. A possible explanation is the puncture and tearing of gluteal vessels during the procedure, especially when a deep injection is planned. OBJECTIVE: To identify the places where fat can be located after injection during a fat graft in the gluteus. METHODS: An experimental study was done in which colorant was injected in four directions using four different quadrants of the gluteus. We Injected 10 cc six times following clock hands until 60 cc were injected, and the cutaneous flap and the muscles were then elevated. Our main purpose was to describe where the colorant went and if it was in contact with the vessels (superior and inferior gluteal vessels). In total, four gluteus muscles were injected and dissected. RESULTS: Injection in the lower lateral quadrant was mainly into the muscle, and colorant was observed in the hypogastric vessels. The injection in the upper quadrants stayed mainly in the subcutaneous tissue. CONCLUSIONS: During surgery, it is important to identify the location of the perforators and to avoid a deep injection, especially from the lower lateral quadrant to the superior medial quadrant (Q4 to Q1), as the probability of puncturing and injecting fat into the main vessels from this direction is higher.

Ropivacaine in Breast Augmentation Surgery.

BACKGROUND: Breast augmentation surgery is still 1 of the most popular procedures in plastic surgery. Like other surgical procedures, it has been traditionally handled with nonsteroidal anti-inflammatory drugs and narcotics, which had many adverse effects; therefore, alternatives with the same effectiveness are being researched. The aim of this study was to investigate the efficacy of ropivacaine breast pocket irrigation during primary breast augmentation surgery to control pain during the first postoperative hours. METHODS: A multicenter, prospective, double-blind, randomized trial was performed on 52 primary breast augmentation procedures in which patients served as their own control: One breast received ropivacaine pocket irrigation and the other placebo. All patients received an oral analgesic. Pain was evaluated with a visual analogue scale at 30, 60, 90, and 120 minutes postoperatively. RESULTS: Pain was significantly less in ropivacaine breast at 90 and 120 minutes postoperatively (P = 0.027 and 0.022, respectively). There was no statistical significance when the type of anesthesia used, general or epidural, was compared (P = 0.33 and P = 0.37 at 90 and 120 minutes, respectively). CONCLUSIONS: Ropivacaine irrigation in breast pocket is able to diminish early postoperative pain safely, being an alternative to other analgesic methods.

Is Latin America Ready to Identify Anaplastic Large Cell Lymphoma in Breast Implants Patients? Regional Encounter During the National Plastic Surgery Meeting in Cancun, Mexico.

INTRODUCTION: Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS: This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS: Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION: A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION: Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. 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 .

[Evidence based surgery. A necessary tool]. / Cirugía basada en la evidencia. Una herramienta necesaria.

BACKGROUND: Evidence-based surgery is a tool that has been adopted worldwide by surgeons. As all decisions must be current and have a scientific basis, the approach for performing it must be standardised. Five important steps are required to perform surgery based on evidence. Convert the need for information into a question that can be answered, finding the best information to answer that question, critical evaluation of the evidence, and its validity, impact and applicability, integrating the evidence with your own experience, and with the evaluation of the patients. This should take into account their biology, values and specific circumstances, as well as to evaluate the effectiveness and efficiency of the execution of steps 1-4 and propose how to improve them. CONCLUSION: This article presents the main tools to perform surgery properly based on evidence.

Factores de riesgo para el desarrollo de hipomagnesemia en el paciente quemado / Risk Factors for Development of Hypomagnesemia in the Burn Patient

Las alteraciones electrolíticas son frecuentes en el paciente quemado, y en general se presentan enpacientes con quemaduras de mayor gravedad. Es poco conocida la frecuencia y magnitud de la hipomagnesemia, asicomo los factores de riesgo para presentarla en esta situación clínica. Se realizó un estudio retrospectivo observacional de revisión de casos, en 35 pacientes con quemaduras, manejados en el servicio de Cirugía Plástica Reconstructiva del Hospital Central Sur de PEMEX. Se determinó el comportamiento del magnesio sérico y se formaron dos grupos, un grupo de estudio que incluyó a 11 pacientes con quemaduras e hipomagnesemia, y un segundo grupo de 24 pacientes, con quemaduras y sin hipomagnesemia. Se determinaron los principales factores de riesgo relacionados con los episodios de hipomagnesemia. Se encontró que el paciente de mayor riesgo es aquel con quemaduras mayores de 40%de superficie corporal, de segundo y tercer grado, que se encuentra en el cuarto y el décimo día después de la quemadura, y que presenta hipocalemia, hipocalcemia o las dos y que además no ha recibido aporte por vía intravenosa este catión. La mejor manera de prevenirlo es identificar al paciente de alto riesgo o diagnosticar de manera oportuna para evitar mayores complicaciones.

Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at riskwas the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier.

[Risk factors for development of hypomagnesemia in the burned patient]. / Factores de riesgo para el desarrollo de hipomagnesemia en el paciente quemado.

Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at risk was the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier.

[Desmoid fibroma of the mandible in a child and one-stage reconstruction]. / Fibroma desmoide de la mandíbula de un niño y reconstrucción en un tiempo.

A 12-year-old patient case is reported, presented with a desmoid fibroma of the left pterygoid region, extended to the cortical and endosteal regions of the mandible, reconstructed immediately with a free peroneal flap, recovering with this both form and function. To date, 3 years from surgery, he has no complications. Evolution of this case and a brief review of the literature is reported. It is concluded that free peroneal graft for mandible reconstruction is safe and has excellent results, both aestethic and functional.

Fibroma desmoide de la mandíbula de un niño y reconstrucción en un tiempo / Desmoid fibroma of the mandible in a child and one-stage reconstruction

A 12-year-old patient case is reported, presented with a desmoid fibroma of the left pterygoid region, extended to the cortical and endosteal regions of the mandible, reconstructed immediately with a free peroneal flap, recovering with this both form and function. To date, 3 years from surgery, he has no complications. Evolution of this case and a brief review of the literature is reported. It is concluded that free peroneal graft for mandible reconstruction is safe and has excellent results, both aestethic and functional.