Is "Clack" Enough? Rib Remodeling Guided by Ultrasound.

Rib remodeling is a surgical technique that allows waist contouring in women and men. This study proposes that the "clack" sound heard in ultrasound-guided scarless rib remodeling (RibXcar technique) is not evidence of the completion of the surgery, but rather, the use of ultrasound is necessary to identify angulations, loss of bone strength, and ultrasound visualization of the loss of bone continuity, and thus consider cosmetic rib surgery to be complete. This study was performed on 100 Peruvian women aged 18-40 years who voluntarily agreed to a rib remodeling procedure. The RibXcar technique was used, and intraoperative ultrasound was performed to obtain objective information during each patient's procedure. Of the total number of patients who underwent surgery with the RibXcar technique, the "clack" sound was detected in 90% of patients, and no "clack" sound was detected in the remaining 10% of patients. However, the use of ultrasound revealed monocortical fractures in 100% of patients. It is observed that of the total number of patients, only in 90% was the "clack" heard; however, in 100% there was a monocortical fracture evaluated in the immediate postoperative period. We suggest not considering the "clack" as the end point of the surgery; instead, define the end point after the use of the ultrasound examination, which provides information on angulations, the loss of bone resistance, and ultrasound visualization of the loss of bone continuity.

Depression, Anxiety, Body Dissatisfaction, and Eating Disorders in Plastic Surgery Patients.

Background: This study aimed to identify and describe indicators of depression, anxiety, body dissatisfaction, and risk of an eating disorder in patients who undergo plastic surgery. Methods: The sample was made up of 90 patients from a private clinic in Lima, Peru, with ages between 20 and 50 years. The participants were asked to answer the Aaron Beck Depression Inventory (BDI-II), the Aaron Beck Anxiety Inventory, the Body Shape Questionnaire, and the Abbreviated and Modified Eating Attitudes Scale (EAT - 26M). Results: Through data analysis with the SPSS statistical program, it was found that 80% of patients who access plastic surgery are women, and the average age is 32.4 years. Likewise, of the total sample, no anxiety traits have been identified; however, 3.3% present traits of moderate depression, pathological body discomfort, and risk of an eating disorder. Conclusion: The presurgical psychological evaluation in plastic surgery patients is crucial because it allows for the identification of predisposing factors to mental health problems and proposes support if needed.

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.

Intramuscular Posterior Thigh Volumization: An Aesthetic and Harmonious Transition to the Gluteal Region (Hv-FAT).

The gluteal region remains the preferred site for fat grafting. However, the transition from the gluteal region to the thighs has not been well studied. This study aimed to describe an echographic guidance hamstring volumization procedure (Hv-FAT) as a complement to body contouring surgery. Methods: Hv-FAT was performed in 19 patients from four countries (Peru, Argentina, Brazil, and Mexico) from May to June 2022 by four surgeons trained in soft-tissue ultrasound and in the aforementioned technique. All the patients met the following criteria: age older than 18 years and younger than 60 years; a body mass index of 30 kg/m² or less, and a surgical risk score of 2 or less, according to the Goldman index. Results: A total of four men and 15 women were included in this study, whose ages ranged from 22 to 58 years (mean: 36.37 years). After fat grafting, on average, the thickness of the right biceps femoris increased by 54.07%, maintaining 95.02% of this thickness one month postoperatively, whereas the thickness of the left biceps femoris increased by 46.57%, maintaining 94.86% of this thickness in the same postoperative period. In turn, the right semitendinosus muscle thickness increased by 181.90%, maintaining 97.42% of this thickness, whereas the left semitendinosus muscle increased by 111.90%, maintaining 95.29% of this thickness 1 month postoperatively (P < 0.0001). Conclusion: Hv-FAT is an effective and reproducible procedure for volumizing the biceps femoris and semitendinosus muscles, maintaining significant results one month postoperatively.

Echo-guided Lower-back Sculpture and Volumization as a Complement to High-definition Liposuction (XPINE-FAT).

Background: Knowledge about lower-back aesthetics is very limited, especially regarding surgical techniques that improve its appearance. Thus, this study aimed to describe a high-definition liposuction technique with intramuscular grafting of erector spinae muscles (longissimus). Methods: A total of 15 female patients 25-48 years of age were recruited between November 2021 and January 2022, who underwent body contouring surgery and subsequently underwent a low-back lipodefinition and echo-guided intramuscular erector spinae (longissimus) fat graft to complement the procedure. As part of the study, measurements were performed before surgery and in the immediate postoperative period. The data were stored in a database and analyzed with the SPSS Version 25 statistical software. Results: The patients' ages ranged from 25 to 48 years (mean: 37 years), with a body mass index of 18.6-29.3 (mean: 25.5). The surgical times ranged between 1 and 8 hours (mean: 3.73 hours); hospitalization times were 0.7-1 days (mean: 0.940 days). Lipograft was performed on the erector spinae muscles (longissimus), the right one with a range of 20-60 cm3 (mean: 43.33 cm3) and percentage increase of 65.3% (P < 0.0001). Regarding the left erector, similar volumes between 20 and 60 cm3 (mean: 44.67 cm3) were grafted with a percentage increase of 66.4% (P < 0.0001). Conclusions: XPINE-FAT is a safe technique that allows an increase in the immediate intramuscular thickness of the erector spinae muscles (longissimus). We observed no adverse events during the study.

Aesthetic Preferences of the Anterior Thigh as a Beauty Factor in Women.

BACKGROUND: In body contouring surgery, some regions, such as the abdomen, thorax, upper limbs, and glutes, are prioritized over others, including the lower limbs, particularly the anterior thighs. This study aimed to identify anterior thigh preferences by age, sex, ethnicity, and region and assess their importance as a factor of female beauty by conducting an online survey. METHODS: Photographs of a 24-year-old female model were modified in two front-view and side-view panels. Through a survey on the Amazon Mechanical Turk platform, participants were asked to order the images from the most beautiful to the least beautiful, and the results were broken down by age, sex, ethnicity, and region. RESULTS: A total of 1000 respondents were surveyed, all of whom answered the survey without error; therefore, no one was excluded. Of the 1000 respondents, 504 were men (50.4%) and 496 were women (49.6%). The predominant age group was 26-35 years, with 443 people (44.3%), the region with the highest number of participants was North America, with 484 respondents (48.4%), and the predominant ethnicity was White, with 555 respondents (55.5%). The survey showed that the most beautiful images were image A on the side-view panel (25.9%) and image I on the front-view panel (28.5%)(P < 0.001). CONCLUSIONS: In the side view, the aesthetic preferences of the anterior thigh do not appear to be associated with the anterior projection. However, in the front view, the increase in width generates a beauty trend, but only up to an intermediate level, quantified in the ratio (0.44).