The effect of hypothermia on coagulation and its implications for infiltration in lipoplasty: a review.

Guidelines issued by the American Society for Aesthetic Plastic Surgery and other professional organizations have helped to reduce complications associated with lipoplasty. However, current guidelines for lipoplasty do not address the issue of hypothermia, which can be aggravated by infiltration of large amounts of anesthetic vasoconstrictive solution. In this article, we review the mechanisms of hemostasis and the pathophysiology of hypothermia and suggest measures by which to minimize the effect of hypothermia on coagulation during and after lipoplasty.

Augmentation of the buttocks by micro fat grafting.

BACKGROUND: Requests for buttock augmentation are increasing in the United States because of changes in lifestyle and fashion that emphasize the "gluteal aesthetic unit." OBJECTIVES: We review the use of micro fat grafting for enhancing the buttocks in a series of 566 patients. METHODS: Tumescent solution (1 mg epinephrine per 1000 mL saline solution) was infiltrated; for small cases the volume used was less than half the amount of expected fat to be harvested. Harvesting was accomplished either manually with a syringe or with a liposuction pump that allowed precise control of the vacuum. The fat was injected both intramuscularly and subcutaneously into all levels of the desired area for augmentation of the buttocks. The typical augmentation averaged 300 to 400 mL per side but ranged from 175 mL to about 800 mL, depending on the patient's desires and the amount of donor fat available. RESULTS: Patient and physician satisfaction with the results was high. Approximately 50% to 75% of the fat grafted remains in the long term. Complications included cellulitis (1.9% of cases), which responded promptly to treatment with cephalosporin, and infrequent seromas and hematomas (0.8% of cases). CONCLUSIONS: Buttock augmentation by micro fat grafting is a safe, simple procedure. Compared with implant placement, the advantages of micro fat grafting include greater flexibility in the size and placement of augmentations, less pain and faster recovery for the patient, and less risk of complications. The technique is limited only by the amount of donor fat available. (Aesthetic Surg J 2001;21:311-319.).

Standardization in photography for body contour surgery and suction-assisted lipectomy.

Despite the existence of basic clinical standards in plastic surgery, specific guidelines for body contour photography have not been detailed previously. In this report we propose standard and supplemental views for positioning of the subject for suction-assisted lipectomy and body contour surgery. Also demonstrated are specialty views for the face, where liposuction has become an integral component of the procedures. Finally, recommendations for photographic documentation of skin "textural" changes and "cellulite" improvement with liposuction, as well as regions requiring lipectomy, are discussed. A professional photographic studio and a model were utilized. Proper lighting, equipment, and backgrounds are described to achieve such standards. General principles for clinical photography are reviewed. We present standard and supplemental views for suction-assisted lipectomy and body contour surgery, with an emphasis on methods to address advanced liposuction techniques (i.e., superficial suction lipectomy) that may affect texture and contour of the skin. These techniques provide consistency for all practitioners, allowing comparison of results and techniques.

Syringe liposculpture.

This article presents syringe liposculpture, a technique for the treatment of localized fat deposits, to remodel the body and the face, using disposable syringes and fine-tip cannulas. In March 1989, the author started working on a combination of syringe liposculpture and superficial liposuction to treat the superficial layer of fat, resulting in "superficial liposculpture." Syringe liposculpture of the face can offer an alternative to rhytidoplasty. This is a gentle facial recontouring procedure and a complement to other techniques to improve the appearance with minimal morbidity through a simple, fast procedure with the patient under local anesthesia and no need for hospitalization.

Doppler-duplex ultrasound in renal colic.

OBJECTIVE: To determine the role of intrarenal Doppler ultrasound (US) in patients with renal colic and to establish the usefulness of this diagnostic method. MATERIALS AND METHODS: In 121 patients with renal colic and 70 healthy individuals, 382 kidneys were examined with color duplex US. Mean intrarenal-arterial resistive index (RI), and the difference of mean RIs (dRI) between both kidneys were determined. In 64 patients, RI and dRI were compared with urographic findings (time of delay pyelogram between both kidneys). RESULTS: In the 70 healthy individuals, RI was 0.62 +/- 0.045 and dRI 0.018 +/- 0.01. In the 121 patients with renal colic, RI (0.71 +/- 0.06) was significantly superior (P < 0.001) with respect to the opposite kidney, with a dRI of 0.09 +/- 0.055. In a correlation performed in 64 patients with urographic findings among color doppler US, with a RI > or = 0.70 and/or dRI > or = 0.06 as an indicative value of obstruction, sensitivity and specificity were 91.8% for patients with delayed pyelogram (n = 37 patients), and 48.1% for patients with nondelayed pyelogram (n = 27 patients) with a specificity of 92.8% with respect to the group of normal patients. In the group of patients with delayed pyelogram, RI was significantly superior (P < 0.05) in patients with an evolution time greater than 24 hours, in patients with proximal ureteral obstruction and in patients who had signs of pyelonephritis. There were no significant differences in the group of patients with nondelayed pyelograms. CONCLUSION: Color Doppler US is useful to fundamentally evaluate the consequences of the obstruction on renal function. Other factors such as evolution time of the symptomology, obstruction level, or existence of pyelonephritis can alter the US-Doppler values.

[Complicated spermatocele as a cause of scrotal mass with solid appearance. Ultrasonographic findings]. / Espermatocele complicado como causa de masa escrotal de aspecto solido. Hallazgos ecográficos.

We report an atypical case of spermatocele in which sonographic findings demonstrated an intraescrotal mass fixed to the testicle, apparently solid and with important vascularity, being these findings suspicious of malignant tumor. We recommend to include complicated spermatocele in the differential diagnosis of ecographically solid masses.

Video-endoscopic facelift.

We report on our experience with 22 video-endoscopic facelift cases. We prefer the term facelift to rhytidoplasty because with the endoscopic facelift facial wrinkles are not eliminated by resecting skin but by elevating facial structures, treating the facial muscles, and improving facial contour. We treat the frontal region subperiosteally by elevating the eyebrows, minimizing wrinkles, and avoiding the coronal incision. The midthird of the face is treated subcutaneously by dissecting the skin from the SMAS, from the ear to the nasolabial fold. The endoscope is inserted through one incision and a cautery through the other. Blood vessels are cauterized. Plicating the SMAS and premalar fat pads to the temporal fascia treats the nasolabial fold and the "jowl." In the cervical region we treat the plastysma, and, with superficial liposculpture, remove excess fat and provoke skin retraction, which allows us to treat older patients who have a more flaccid skin tone. The endoscope is used to help the cauterizing and the suturing. The platysma can be sutured in the midline, if necessary. The cervical mental angle can be redefined with a Goretex 0 suture that passes from mastoid to mastoid. Modified instruments and different approaches to this technique can be expected, but we believe video endoscopy is going to have an important impact on the future of plastic surgery.

Syringe liposculpture: a two-year experience.

Syringe liposculpture is a method that combines two relatively new techniques of plastic surgery: syringe liposuction and fat grafting. We can reshape the face and the body by removing localized fat deposits and reinjecting this fat where needed. When we do not reinject, we call the technique reduction liposculpture. In 1989 we introduced a new technique--superficial syringe liposculpture--to treat patients with flaccid skin, superficial irregularities or depressions, "cellulite," and liposuction sequelae. The technique combines syringe liposculpture, superficial liposuction, and our method of treating skin irregularities by breaking the fibrous adherences and injecting fat superficially.

Mammoplasty using liposuction and the periareolar incision.

The major dilemma of reduction mammoplasty and mastopexy has been the difficult choice between a procedure that yields an ideal shape of the breast versus the size of the scar. With our technique, selected breasts can now be reduced through liposuction and the mastopexy performed through a periareolar incision, resulting in virtually imperceptible scarring.

Experience of injected fat grafting.

Eighteen months' experience with the injected fat grafting technique used in 208 patients to correct various problems such as buttocks (augmentation and reshaping), trochanteric depressions, breast augmentation, scar depressions, thighs and legs (calf and ankle augmentation), small wrinkles and depressions of the face (Romberg's disease), nasolabial fold, upper outer breast quadrant, liposuction sequela, fingers and hands is presented. This method shows major advantages with few complications. Some technical details and recommendations for successful fat grafting are also presented.