Viability of Fat Cells in Frozen Fat Tissue in Relation to Thawing Technique.

Damage of frozen fat, which will be used for retransplantation, is inevitable. Reuse of frozen fat requires a thawing process. No standardized method has yet been established for thawing frozen fat. Methods: Microscopic analysis of count and viability of frozen fat of 21 patients. Two fat samples from each patient were harvested and frozen at -20°C in a common commercial refrigerator for different freezing durations. Thawing of fat samples was done. There was one (3 mL) sample for each thawing technique; technique A included natural thawing at 25°C for 15 minutes, while rapid thawing at 37°C for 10 minutes in a water bath was included in technique B. Survival rates of adipocytes were assessed with trypan blue staining. Culturing of adipose-derived stem cells to assess their ability to divide was done. Relating survival rate of frozen fat to patients' age and to duration of freezing was done. Results were statistically analyzed. Results: The count of viable adipocytes is higher in technique A. Adipose-derived stem cells of frozen fat do not have the ability to divide in culture media. Viable adipocytes were higher in younger ages and in shorter freezing duration. Conclusion: Natural thawing is better in maintaining frozen adipocyte viability. Younger patients will benefit from frozen fat more than older ones. Duration of freezing should not exceed 7 months.

Nasal Tip Depressor Manipulation through Upper Buccal Sulcus Approach in Selected Open Primary Rhinoplasties.

During smiling, the prominent action of nasal tip depressors (NTDs) antagonizes the rhinoplasty nasal tip support maneuvers and favors scarring forces' pulling the nasal tip in a less projecting vector. The NTDs' disinsertion is feasible through the open rhinoplasty approach. Yet, the reliability of the open approach to manipulate all NTD attachments is still questionable. The upper buccal sulcus approach (UBSA) is a reliable approach to manipulate variable anatomy of the NTDs. Methods: Thirty-two patients had primary open rhinoplasty between 2016 and 2020. All patients showed hyperactive NTDs during smile preoperatively. Through UBSA, disruption of NTDs was done. Aesthetic outcome was evaluated by comparing the pre/postoperative nasal tip projection (NTP) and nasolabial angle (NLA) in lateral views. Results: The sample included 28 women and four men, and the mean age was 30.7 years. The mean follow-up period was 23.8 months. Preoperatively, 53% (n = 17) of patients showed normal NTP measurements; this percentage increased to 87.5% (n = 28) postoperatively. The mean NLA for the 32 patients was 91.0 degrees preoperatively' which was increased to 102.5 degrees postoperatively. These aesthetic results were maintained throughout the follow-up period' with no significant increase in the incidence of complications. Conclusions: The combination of the UBSA with open rhinoplasty resulted in objective visualization and manipulation of the NTDs. This was proven by the maintained NTP and NLA in aesthetic optimum values throughout the follow-up period. We believe that UBSA can be safely combined with open rhinoplasty as a reliable hidden approach to manipulate hyperactive NTD cases.

A Staged Approach for Contouring of Temporal Deformities Using Porous Polyethylene and Lipofilling.

ABSTRACT: Many studies evaluated the effectiveness of a single reconstructive material during temporal cranioplasty, or in comparison to the outcome of another material. To our knowledge, no previous study evaluated a staged combination of reconstruction modalities during temporal cranioplasty. In a prospective interventional study, the authors combined high-density porous polyethylene (HDPP) implant insertion (stage I) with a following lipofilling session (stage II) in 8 patients scheduled for temporal cranioplasties. This two-staged approach was evaluated 6 months after each stage independently. The patients' satisfaction as regards the aesthetic outcome was evaluated through a 5-points Likert scale by the patients themselves. For every individual patient, this psychometric analysis was repeated by medical staff from other departments. Statistical analysis of the patients and medical staff satisfaction scores showed a statistically significant increase after the addition of lipofilling session (stage II) if compared to implant insertion only (stage I). Clinically, this outcome was maintained in a long-term follow-up ranged from 1 - 8 years. Nevertheless, 2 patients needed one more lipofilling session to obtain their satisfaction as regards the final aesthetic outcome. No other complications were recorded in this study. In conclusion, combining alloplastic and autogenous reconstruction modalities in a staged approach can suffice the reconstruction requirements for such temporal defects. After a long follow-up period, the insertion of high-density porous polyethylene implant with the addition of a following lipofilling session showed more evaluators' satisfaction in terms of the final aesthetic outcome.

Autoaugmentation Brachioplasty: An Arm Contouring Method in Women with Massive Weight Loss.

BACKGROUND: Brachioplasty of deflated arms following massive weight loss (MWL) often results in too slim arms. These slimmer arms lack the natural proportion and contour. This study presents a novel method for such arms through standard skin excision and autoaugmentation by dermofat flap. PATIENTS: During a period of 2 years, 21 women complaining of severe deflation deformity of upper arms following MWL were operated. At time of surgery, the BMI ranged from 20.5 to 33. 4 with a mean of 26.2 kg/m2. The mean value of weight loss was 47.8 kg over a mean period of 18 months. METHODS: A de-epithelialized dermofat flap was preserved underneath the dissected and advanced anterior and posterior arm skin flaps. The bulk of the flap was tailored as to give an appropriate girth with balanced proportion and contour of the upper arm. RESULTS: During 14 months of follow-up, all patients reported a high satisfaction. Objective evaluation was based on measurement of the mid-upper arm circumferences (MUAC) and its ratio with the mid-forearm circumferences (MFAC) which was compared with those of arms of healthy volunteers with normal BMIs. CONCLUSION: Augmentation of the upper arm by autologous dermofat flap provides a well arm contour in appropriate balance with the forearm in women having severe arm deflation deformity following MWL. The findings were supported by the objective anthropometric measurements of the MUAC/MFAC of a normal weight healthy women which reached to a mean value of 1.366. The normal girth of upper arm should equal 1[Formula: see text] that of the forearm. LEVEL OF EVIDENCE IV: 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 .

A Simple Method for Proper Placement of the Inframammary Fold Incision in Primary Breast Augmentation.

BACKGROUND: The inframammary incision is a very common access in breast augmentation. The incision must be positioned well to place the resulting scar in the new inframammary fold. AIM: This article presents a simple marking on patients for proper localization of the inframammary incision. MATERIALS AND METHODS: Ninety-six patients who underwent primary breast augmentation were divided into 3 groups according to the volume of the used implants. RESULTS: A total of 90.6% of the patients had excellent postoperative scar location, and 9.4% had good results, with overall 100% patient satisfaction. CONCLUSIONS: Our preoperative markings offer simple, easy, and fixed measurements that facilitate proper postoperative location of the inframammary incision and hide the scar significantly.