M1 Polarized Macrophages Persist in Skin of Post-Bariatric Patients after 2 Years.

BACKGROUND: Obesity is considered a condition of systemic chronic inflammation. Under this condition, adipose tissue macrophages switch from an M2 (anti-inflammatory) activation pattern to an M1 (proinflammatory) activation pattern. OBJECTIVE: The study aimed to verify the profile of skin macrophage activation after bariatric surgery as well as the role of MMP-1 in extracellular tissue remodeling. METHODS: This is a prospective, controlled and comparative study with 20 individuals split into two groups according to their skin condition: post-bariatric and eutrophic patients. Histological and morphometric analyses based on hematoxylin-eosin, picrosirius red (collagen), orcein (elastic fiber systems), and alcian blue (mast cells)-stained sections and immunohistochemical analysis (CD68, iNOS, and mannose receptor) for macrophages and metalloproteinase-1 were performed. RESULTS: Post-bariatric skin showed an increase in inflammation, angiogenesis, CD68, M1 macrophages (P< 0.001), and mast cells (P< 0.01); a decrease in M2 macrophages (P< 0.01); and a significant decrease in the collagen fiber network (P< 0.001). MMP-1 was increased in the papillary dermis of post-bariatric skin and decreased in the epidermis compared to eutrophic skin (P< 0.05). CONCLUSION: This study shows that post-bariatric skin maintains inflammatory characteristics for two years. Mast cells and M1 macrophages maintain and enhance the remodeling of the dermal extracellular matrix initiated during obesity in part due to the presence of MMP-1 in the papillary dermis. EBM LEVEL 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 .

Does the Approach of the Lateral Platysmal Bands Widen the Gap between the Medial Bands?

BACKGROUND: The first visible change in an aging face and neck is the loss of neck contour, which can be corrected by treating the platysmal bands; however, it remains unclear as to which is the best strategy to approach these bands. The aim of the present study is to verify whether the lateral platysmal bands approaches, before the medial ones, cause widening of the gap between them. METHODS: This is a prospective, randomized, comparative study involving 30 individuals presenting various stages of neck and facial flaccidity and sagging. The patients were split into 2 groups according to the lateral platysmal approach (group A: lateral platysmal traction/plication; group B: lateral platysmal undermined/traction). A protocol was established to measure the gap between the medial bands, 3 and 5 cm away from the chin, before and after superficial musculoaponeurotic system/platysma lateral suspension. Measurements were taken using a compass and a ruler. The endpoint was to determine whether the gap between the medial platysmal bands widens after the lateral procedure. RESULTS: Group A, first measure (1-M): the gap ranged between 1.0 and 1.6 cm in point M3 (3 cm away from chin) and between 1.8 and 3.0 cm in point M5 (5 cm away from chin) (mean in M3 = 1.2; SD, 0.22 and mean in M5 =2.3; SD, 0.52). Group A, second measure (2-M): the measure ranged between 1.0 and 1.7 cm in point M3 and between 1.8 and 3.2 cm in point M5 (mean = 1.28; SD, 0.25 and mean = 2.42; SD, 0.63, respectively). Group B, first measure (1-M): the gap ranged between 1.1 and 1.7 cm in M3 (mean = 1.32; SD, 0.21) and between 1.8 and 3.2 cm in M5 (mean = 2.38; SD, 0.57). Group B, second measure (2-M): the measure ranged between 1.2 and 1.7 cm in M3 (mean = 1.4; SD, 0.18) and between 2.0 and 3.2 cm in M5 (mean = 2.5; SD, 0.55). Group A: P = 0.07 (M3) and 0.10 (M5); Group B: P = 0.09 (M3) and 0.07 (M5). CONCLUSION: The lateral platysmal approach, plication or undermined, does not lead to a widening of the gap between the medial platysmal bands.

Influence of negative pressure on the viability of adipocytes and mesenchymal stem cell, considering the device method used to harvest fat tissue.

BACKGROUND: Transplanted adipose tissue has many applications in regenerative medicine. However, fat grafting yields unpredictable results because the fat that is transferred can suffer variable degrees of fat reabsorption. It is necessary to identify methods and maneuvers to minimize reabsorption rates and provide predictable long-term results. OBJECTIVES: Our study aimed to identify the optimal method of harvesting, as well as the optimal pressure regime for fat aspiration. The primary objective was to assess the degree of adipocyte and mesenchymal stem cell death that occurred with the various devices and pressure levels used to harvest fat. METHODS: This study was a prospective, randomized, comparative study in 15 healthy male and female subjects aged 25 to 60 who were undergoing abdominal cosmetic surgery. Various apparatuses and pressure regimens were used to harvest 8 samples of fat tissue. These samples (R1 = R8) underwent histological analysis in order to verify the integrity and functionality of the adipocytes and mesenchymal stem cells that had been harvested. RESULTS: A total of 14 females and 1 male underwent abdominal cosmetic surgery. Quantitative analysis revealed that the adipocytes in all 8 samples had homogeneous quantitative profiles. The adipose mesenchymal stem cell (AMSC) analysis, according to Friedman ANOVA, revealed no significant variation in the percentage of mesenchymal stem cells (P = .045) between the various samples. CONCLUSIONS: The type of device, nozzle diameter tip, and pressure regimen used in this study for harvesting fat tissue did not significantly affect the number of the adipocytes or viable AMSC harvested. LEVEL OF EVIDENCE: 3 Therapeutic.

Island technique for prominent ears: an update of the Ivo Pitanguy clinic experience.

BACKGROUND: Prominent ears are a relatively common and instantly-recognizable condition. Numerous studies have reported psychological distress, emotional trauma, and behavioral problems associated with this deformity in childhood. The multitude of approaches clearly indicates the lack of a definitive technique to correct this issue in all patients. OBJECTIVES: The authors describe the "island technique," originated by the senior author (IP), which involves dissecting a cartilaginous island to reconstruct the antihelix and the triangular fossa and correct the conchascaphal angle. METHODS: The authors retrospectively reviewed the charts of all patients (n = 111) who underwent otoplasty with the island technique at the senior author's private clinic between July 1990 and July 2008. Patients who underwent treatment with a modified island technique or any other approach were excluded. Charts were examined for patient history and demographics, etiology, concurrent procedures, and complications. RESULTS: Eighty patients were female (72%); 31 were male (28%). The average age was 28.2 years (range, five to 65). The most common etiology was a combination of overdeveloped concha and an underdeveloped antihelical fold (n = 76, 69%). Other facial aesthetic procedures were simultaneously performed in 54 patients (49%). Early complications occurred in two patients (1.8%), including hematoma and wound dehiscence. Late complications were observed in 12 patients (10.8%). All complications were addressed without consequence to the surgical outcome. No recurrence was observed. CONCLUSIONS: The island technique is an effective, simple, and reliable surgical option to correct prominent ears. Its greatest advantages are the absence of recurrence and the minimal incidence of complications.