Revision Abdominoplasty with Truncal Liposculpting: A 10-Year Experience.

INTRODUCTION: Abdominoplasty is one of the most popular body-contouring procedures. Despite its popularity, classic abdominoplasty is still associated with a significant rate of complaints from patients such as: fullness of flanks and epigastric areas, lack of a posterior lumbar curve, hanging skin over the incision line, and visible scars over the flanks and beyond underwear or swimming suit coverage. This study reviews the authors' experience in redo abdominoplasty when the patient is not or partially satisfied with the primary procedure. PATIENTS AND METHODS: A total of 115 female and 32 male patients underwent revision abdominoplasty with truncal liposculpting between 2007 and 2016. The age distribution of patients ranged from 33 to 73 years, with a mean of 43.1 years. All the patients included in the study had undergone classic abdominoplasty in a different institution. Overall satisfaction with the body appearance after the combined procedure was rated on a scale of 1-5, where 1 is 'poor,' 2 is 'fair,' 3 is 'good,' 4 is 'very good,' and 5 is 'excellent.' The evaluation was made 12 months after the composite body-contouring procedure. RESULTS: Four hundred to 1500 ml of fat were obtained with liposuction (mean 840 ml). The amount of clean, adipose tissue transplanted to the buttocks varied from 95 to 425 (mean 286 ml) and to the lower limbs from 75 to 270 ml (mean 195 ml). The stromal-enriched lipograft technique was used in all the cases to enrich the fat transplantation. There was no hematoma, infection or deep vein thrombosis. Seventy-five percent reported that their appearance after composite body contouring was 'very good' to 'excellent' (30% 'excellent' and 45% 'very good') and 20% responded that their appearance was 'good.' Only 5% of patients thought their appearance was less than good ('fair'). The average follow-up time for this group of patients has been 6.3 years (range 1-10 years). CONCLUSION: Truncal liposculpting with modified abdominoplasty accomplishes very good aesthetic results in a single surgical procedure with a low rate of complications and high patient satisfaction in cases of revision abdominoplasties. LEVEL OF EVIDENCE V: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Bilateral calf augmentation for aesthetic purposes.

BACKGROUND: The shape of the calf is determined by the development of the soleus and gastrocnemius muscles, the length and orientation of the crural bones, and the distribution of subcutaneous fat. Some people have a naturally thin or underdeveloped calf that remains small despite exercise. Calf augmentation is indicated for cosmetic reasons or for reconstruction of a shrunken lower leg resulting from injury, illness, or congenital disability. METHODS: A total of 53 consecutive patients (40 women and 13 men) had surgery for calf augmentation between January 2004 and January 2007. The patients ranged in age from 25 to 51 years (mean, 29.5 years). All the patients included in the study requested calf augmentation for aesthetic purposes. Asymmetric-base silicone elastomer smooth-surface implants were used. Overall satisfaction after silicone calf augmentation was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). All the patients had surgery by the same team of surgeons (L.H.P., A.S., B.N.). The evaluation was made at follow-up office consultations after 1 year. The total mean follow-up time was 4.4 years. RESULTS: In this study, 53 bilateral calf augmentations were performed, for a total of 106 procedures. The 125-ml implant was used in 37 bilateral cases, the 70-ml implant in 10 cases; and the 175-ml implant in 6 cases. In three cases, unilateral seroma formation needed to be drained by a partial skin incision opening. There were no cases of infection or hematoma. Hypertrophic scar was observed in four patients bilaterally. One patient requested removal of the implants, and the procedure was performed on an outpatient basis. There were no cases of compartment syndrome or deep vein thrombosis, and no pulmonary embolisms occurred. There were no cases of rotation or displacement of the implant. At 12 months, 73% of the patients rated their appearance after calf augmentation as "very good" to "excellent," and 19% responded that their appearance was "good." Only 8% of the patients thought their appearance was less than good. At this writing, the average follow-up time for this group of patients has been 3.4 years. CONCLUSION: Calf augmentation by silicone-filled implants for cosmetic purposes appears to be effective, safe, and aesthetically pleasing, with minor side effects.

Correction of liposuction sequelae by autologous fat transplantation.

BACKGROUND: In many countries, liposuction is the most frequently performed aesthetic procedure. Although liposuction has been considered a safe surgical procedure, reports indicate that it can have significant sequelae. Irregularities ranging from "oversuctioning" to bumpy skin and asymmetries result from inadequate experience of the surgeon. METHODS: A total of 57 consecutive female patients were operated on from June 2005 to June 2007. The age distribution of the patients ranged from 22 to 53 years, with a mean of 34.2 years. All the patients that were included in the study had undergone from one to three liposuction procedures. Overall satisfaction with the body appearance after autologous fat transplantation for correction of postliposuction irregularities was rated on a scale of 1-5, where 1 is poor, 2 is fair, 3 is good, 4 is very good, and 5 is excellent. RESULTS: The total amount of clean adipose tissue transplanted varied from 14 to 120 ml. There were no cases of liponecrosis, which developed in the grafted area, and no liponecrotic lumps were palpated on postoperative evaluation on any operated cases. There were no cases of cellulitis at the donor or grafted area, no deep vein thrombosis, and no pulmonary embolism. There were nine cases that needed one additional session of fat grafting of 5-35 ml. Seven of those cases needed further fat grafting on the abdominal area and the remaining two needed further grafting of the infragluteal depressions. At 12 months, 68% reported that their appearance after autologous fat grafting was "very good" to "excellent" and 23% responded that their appearance was "good." Only 9% of patients thought their appearance was less than good. CONCLUSION: With the overall acceptance of aesthetic surgery increasing and the number of patients undergoing liposuction increasing, it is likely that plastic surgeons will see more patients requesting secondary contour surgery in the future. The key to successful autologous fat grafting is familiarity with the technique, recognizing its limitations, and understanding the goals of the patient. This study has shown that the patient satisfaction rate observed after autologous fat transplantation produces aesthetically acceptable results in correcting post liposuction deformities.

Autologous gluteal lipograft.

In the past 25 years, several different techniques of lipoinjection have been developed. The authors performed a prospective study to evaluate the patient satisfaction and the rate of complications after an autologous gluteal lipograft among 351 patients during January 2002 and January 2008. All the patients included in the study requested gluteal augmentation and were candidates for the procedure. Overall satisfaction with body appearance after gluteal fat augmentation was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). The evaluation was made at follow-up times of 12 and 24 months. The total amount of clean adipose tissue transplanted to the buttocks varied from 100 to 900 ml. In nine cases, liponecrosis was treated by aspiration with a large-bore needle connected to a 20-ml syringe, performed as an outpatient procedure. Infection of the grafted area also occurred for four patients and was treated by incision drainage and use of antibiotics. Of the 21 patients who expressed the desire of further gluteal augmentation, 16 had one more session of gluteal fat grafting. The remaining five patients did not have enough donor area and instead received gluteal silicone implants. At 12 months, 70% reported that their appearance after gluteal fat augmentation was "very good" to "excellent," and 23% responded that their appearance was "good." Only 7% of the patients thought their appearance was less than good. At 24 months, 66% reported that their appearance after gluteal fat augmentation was "very good" (36%) to "excellent" (30%), and 27% responded that their appearance was "good." However, 7% of the patients continued to think that their appearance was less than good. At this writing, the average follow-up time for this group of patients has been 4.9 years. The key to successful gluteal fat grafting is familiarity with the technique, knowledge of the gluteal topography, and understanding of the patient's goals. With experience, the surgeon can predict the amount of volume needing to be grafted to produce the desired result. Although the aim of every surgeon is to produce the desired augmentation of the gluteal region by autologous fat grafting in one stage, the patient should be advised that a secondary procedure may be needed to accomplish the desired result.

Autologous fat transplantation and delayed silicone implant insertion in a case of Mycobacterium avium breast infection.

BACKGROUND: Infection after breast augmentation is uncommon, occurring in 1-3% of cases. They are typically caused by bacterial skin flora, specifically Staphylococcus aureus and the coagulase-negative staphylococci. There have been infrequent reports of breast implant infection caused by the atypical mycobacteria. METHODS: This report summarizes the case of a female patient who was infected by Mycobacterium avium after undergoing augmentation mammoplasty. This is the second case reported in the literature. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until healing of the wound. Salvage methods include one or more of the following: antibiotic therapy, debridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage. RESULTS: After removal of the implant and antibiotic therapy, autologous fat transplantation for correction of breast tissue depressions caused by the mycobacterium infection was done. Delayed bilateral breast augmentation by inserting polyurethane-covered silicone implants in subpectoral position and round block mastopexy to resect the periareolar scars were performed. CONCLUSION: Although this kind of complication has significantly compromised the aimed result and has caused frustration to both the patient and the physicians involved, we believe that the combination of autologous fat transplantation and delayed silicone implant insertion can be a safe strategy and can produce an acceptable aesthetic result.

Treatment of iatrogenic abdominal contour irregularities.

In many countries, liposuction is the most frequently performed aesthetic procedure. The procedure is promoted as a safe, easy-to-learn, outpatient procedure. The increasing number of liposuction procedures, often performed by inadequately trained physicians, has led to a growing number of iatrogenic postliposuction contour deformities and skin irregularities. This report describes a treatment protocol for iatrogenic abdominal contouring deformities. For patients who present with contour deformities but no skin flaccidity, the type 1 treatment plan (syringe-assisted lipectomy and lipografting) is the suggested approach. In cases of contour deformities and infraumbilical skin flaccidity, the type 2 treatment plan (mini-lipoabdominoplasty and lipografting procedures) is used. Finally, in the case of contour deformities as well as supra- and infraumbilical flaccidity, the type 3 treatment plan (lipoabdominoplasty and lipografting procedures) is indicated.

Transaxillary breast augmentation: a prospective comparison of subglandular, subfascial, and submuscular implant insertion.

BACKGROUND: During the last decades transaxillary breast augmentation (TBA) has gained worldwide acceptance. Breast augmentation via transaxillary access endoscopically assisted in the subglandular, subfascial, and submuscular planes has been previously described. Although TBA is a well-studied procedure, few reports exist concerning the subfascial plane of implant insertion and none exist comparing the three different planes of insertion by TBA. METHODS: A perspective study to evaluate the outcomes, complications, and patient satisfaction of TBA using the three different planes of implant insertion was performed during 2004-2005. Fifty-three patients fulfilled the inclusion criteria. They were randomly divided into three groups corresponding to the three planes of silicone insertion. All patients had a silicone texturized implant that ranged from 190 to 300 cc. Overall satisfaction with the breast appearance after TBA was rated on a scale of 1-5, where 1 is poor, 2 is fair, 3 is good, 4 is very good, and 5 is excellent. The evaluation was made at the follow-up times of 6 months and 3 years. RESULTS: There were 18 patients enrolled for the subcutaneous TBA (Group A), 18 for the subfascial TBA (Group B), and 17 for the submuscular TBA (Group C). Axillary incision-related complications occurred in 9% of the patients and included formation of a hypertrophic scar and small-wound dehiscence. There was no hematoma formation and no case of infection. There was one patient from Group A who developed seroma and was treated conservatively. Twenty-seven months postoperatively the same patient developed Baker III capsule contracture, which required silicone implant replacement in the subfascial plane. One case of stretch marks in a young nulliparous woman from Group B did not need treatment. One patient from Group A underwent implant exchange because of implant size dissatisfaction. Three patients in Group C had mild distortion of the implant during pectoral contracture. A meta-analysis of patient satisfaction 6 months and 3 years after TBA is presented. CONCLUSION: Transaxillary breast augmentation provides consistent, satisfactory results with ease of dissection, when properly indicated. Although the subfascial augmentation mammaplasty has all the advantages of the subpectoral and subglandular augmentation mammaplasties and eliminates the disadvantages of increased postoperative discomfort, implant visibility, and distortion, patients of all three groups had similar rates of satisfaction. Further follow-up is needed in order to compare the long-term effects of the three different planes of insertion.

Composite body contouring.

BACKGROUND: Aesthetic surgery of the thoracoabdominal region is one of the most frequently performed surgical procedures in plastic surgery. The combination of circumferential liposuction, autologous fat grafting of the buttocks and/or lower limbs, and the modified transverse abdominoplasty as an adjuvant procedure all done in a single surgical procedure is not very common. The authors present a prospective study of the surgical technique of composite body contouring, emphasizing the low rate of complications and the high overall patient satisfaction. METHODS: A total of 64 consecutive female patients were operated on between January 2004 and January 2007. All the patients who were included in the study were candidates for a classical abdominoplasty. Posterior and lateral syringe-assisted liposuction combined with fat insertion into the buttocks and/or lower limbs was performed. Autologous fat grafting was done in the gluteal area for buttocks enhancement and in the lower limbs to correct contour deformities. Anterolateral liposuction with modified transverse abdominoplasty was done as an adjuvant procedure. Overall satisfaction with body appearance after composite body contouring was rated on a scale of 1-5. RESULTS: From 1,500 to 4,600 ml of fat was obtained with liposuction (mean = 2,478 ml). Forty-five patients had fat grafting only to the buttocks area. Six patients had fat insertion into the lower limbs and 13 had fat injection into the buttocks and lower limbs. The amount of fat transplanted to the buttocks varied from 165 to 625 ml (mean = 346 ml) and to the lower limbs it varied from 75 to 270 ml (mean = 195 ml). Three patients (5%) suffered from early complications, including infection (3%) and hematoma formation (2%). Nine patients (14%) had late complications, including hypertophic scars (7.5%), dog ears (4.5%), and localized fat excess (2%). Nine patients (14%) underwent revision surgery. Sixty-three percent reported that their appearance after composite body contouring was "very good" (42%) or "excellent" (21%) and 27% responded that their appearance was "good." Only 10% thought their appearance was less than good, (7% "fair" and 3% "poor").The average follow-up time has been 3.2 years (range = 2-5 years). CONCLUSION: Composite body contouring combines circumferential liposuction, fat grafting of the buttocks and lower limbs, and modified transverse abdominoplasty to accomplish very good aesthetic results in a single surgical procedure with a low rate of complications and high patient satisfaction.

Correction for the iatrogenic form of banana fold and sensuous triangle deformity.

The "banana fold," or the infragluteal fold, is a fat deposit on the posterior thigh near the gluteal crease and parallel to it. The "sensuous triangle" is found at the junction of the lateral buttocks, the lateral thigh, and the posterior thigh. The iatrogenic forms of banana fold and sensuous triangle deformity are produced by excessive liposuction. The authors' experience using autologous fat transplantation to treat tissue defects led them to use this technique for correcting iatrogenic forms of banana fold and sensuous triangle deformity. The simplicity of the procedure, the low incidence of complications, and the high satisfaction rate makes autologous fat transplantation an attractive option for correcting iatrogenic complications of liposuction.

Surgical correction of Poland's syndrome in males - a purposely designed implant.

OBJECTIVE: To present a type of silicone implant for the treatment of Poland's syndrome chest wall deformity. METHODS: An axillary surgical approach was used in order to introduce the textured, rectangular-shaped silicone implant that was fabricated in three different sizes. RESULTS: Since 2001, eight male patients have received silicone implants. Implant displacement occurred in only one patient, who later underwent a second operation. The remaining seven patients did not have any complications. CONCLUSION: The safety of the technique, the overall satisfaction of the patients with this type of silicone implant and the lack of significant complications make this procedure an interesting option for the correction of chest deformities of Poland's syndrome male patients.

Pectoral muscle implant: approach and procedure.

The authors present their 4-year experience with the pectoral muscle implant for aesthetic purposes in 16 male patients. The significant enhancement of the chest contour achieved and the satisfying results obtained with no major complications makes this procedure an interesting advancement in male body contour surgery.

Discussão de caso

Sixty year-old patient presenting a depression in themedium third of the face (cheek subsidence). The patient had had a face-lift 15 years before. Presently wants to correct the changes

Mastoplastia e reduçäo de cicatrizes / Mammaplasty and scars reduction

Os autores apresentam sua experiência, utilizando táticas anexadas a técnica de Arié-Pitanguy, com o objetivo primário de se diminuir a cicatriz do sulco submamário, mesmo em pacientes portadoras de hipertrofia, sem contudo haver prejuízo na forma, principal objetivo a ser almejado ao final da cirurgia

Blefaroplastia conjuntival: técnica cirúrgica / Conjunctival blefaroplasty: surgical techinic

O autor apresenta sua experiência em uma série de casos operados pela técnica de blefaroplastia conjuntival, comparando as vantagens e desvantagens deste método, em relaçäo aos descritos anteriormente. Bem assim, promove um relato sucinto da descriçäo da tática operatória por ele empregada para a resoluçäo das bolsas de gordura conjuntival sem necessidade de ressecçäo tegumentar