Superficial Intramuscular Gluteal Lipograft by Doppler Ultrasound: A Report of 24 Patients.

Background: Gluteal fat grafting is a common procedure in liposculpture. This study proposes a Doppler ultrasound-guided intramuscular and subcutaneous gluteal lipotransfer technique that allows for visualization of the location of the gluteal vessels, avoiding approaching them during lipotransfer by having the cannula localized during fat infiltration. Methods: This new technique was applied to 24 women after obtaining informed consent and providing them with a clear explanation of potential risks and complications. Doppler ultrasound was used to locate the site and depth of blood vessels, and for quadrant scanning of vessels and superficial intramuscular visualization of the cannula's location. Intramuscular lipotransfer was performed with a volume of 400 mL per gluteus (or less), and 12 patients underwent magnetic resonance imaging before and 3 months after surgery. Results: This technique allowed for visualizing the location of the gluteal vessels, and infiltration could be easily performed in patients. In the 24 glutei reviewed postsurgery, from 12 patients who underwent pre- and postsurgery magnetic resonance imaging, intramuscular fat was found; however, there was no migration outside the gluteus maximus muscle. Conclusions: No local or systemic complications were observed. The results of our report show that fat filtration did not migrate outside the gluteus maximus muscle. This finding seeks to promote new research to create theoretical/practical precedents for the intervention of plastic surgeons and, from there, promote the standardization of a new and safe technique.

Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer.

Background: The rejuvenation and restoration of a well-defined jawline contour are crucial for enhancing facial aesthetics in both men and women. Within the jawline aesthetic unit (mandibular angle), the masseter muscle plays a significant role, as it is responsible for mandibular masticatory movements. We propose a new approach using ultrasound-guided intramuscular fat transfer to enhance the mandibular angle and jawline. Methods: The multicenter study included 20 patients from three countries (Peru, Brazil, and Mexico). After fat harvesting, the ultrasound-guided masseteric fat transfer was performed with a 1.5-mm Viaro cannula from an incision beneath the ear lobule. The fat was then injected intramuscularly into the masseter at each side of the mandibular angle. Results: Masseter ultrasound-guided fat transfer was performed on 10 men and 10 women between 2021 and 2022. The patients had a mean age of 34.4 ±â€…6.39 years and a mean body mass index of 22.39 ±â€…2.59 kg per m2. The mean injected volume was 5.83 mL and 5.58 mL on the right and left sides, respectively. Muscle thickness increased in patients immediately postsurgery, but decreased after 1 month. The muscle remained significantly thicker on each side than the presurgery measurements in patients regardless of gender (both P < 0.0001). Conclusions: Ultrasound-guided intramuscular fat transfer is a safe and reproducible technique for enhancing the jawline contour at the mandibular angle. We believe that it could be a more durable solution than other procedures, although further evaluation of long-term results is necessary.

Waist Remodeling without Incision, with Ultrasound-guided Monocortical Fracture.

Background: Rib remodeling is a surgical technique for waist shaping in women and men. However, one of the main patient complaints is the scar. We aimed to describe a scarless, ultrasound-guided rib remodeling (RibXcar) technique that assessed the degree of angular variation of the fracture by ultrasound and the variation in waist measurement and patient satisfaction through a survey. Methods: The RibXcar technique was performed in 30 women aged 18-35 years in Peru, Colombia, and Mexico between October and December 2022 by three board-certified plastic surgeons trained in ultrasound and in this technique. The plastic surgeons measured costal angles before and immediately, 1 month, and 3 months after the surgery by ultrasound, as well as the waist in the same site and at these time points. Similarly, patient satisfaction was surveyed 3 months after the surgery, in which questions were asked about body aesthetics and the puncture site. Results: Ultrasound angular measurements before and immediately, 1 month, and 3 months after the surgical procedure were 168.00, 158.00, 160.00, and 160.43 degrees in the 10th rib, 170.50, 160.50, 152.50, and 163.50 degrees in the 11th rib, and 172.00, 162.00, 154.00, and 165.00 degrees in the 12th rib, respectively. The satisfaction survey showed that patients were satisfied with the aesthetic results of both the shape of the waist and the puncture site. Conclusions: RibXcar surgery maintains the angular variation over time. Similarly, waist measurements show a sustained reduction. Three months postoperatively, the patients were satisfied with the aesthetic results of the waist and the puncture site.

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.

Anatomical Bases for Aesthetic Costal Surgery: Assessing the Thoracoabdominal Limits.

Background: Knowing the anatomy of the ribs is crucial for understanding various rib procedures. The present study is aimed at describing radiological measurements and ratios of 83 Latin American patients undergoing thoracoabdominal computed tomography (CT). Methods: A total of 83 thoracoabdominal computed tomography scans of women aged 18-35 conducted at a medical center in Lima, Peru, were reviewed from January 2022 to January 2023. The resulting measurements and ratios were used to calculate frequency distributions. All data were stored in a Microsoft Excel database and analyzed using statistical analysis software SPSS version 28. Results: Ratios and measures of the tenth, eleventh, and twelfth ribs are shown in the different tables, and costal characteristics with an adequate statistical significance are defined. Conclusions: Using radiological measurements and rib ratios, we were able to find key anatomical relationships with an adequate level of significance, which could help establish objective results in rib procedures.

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.

Incorporation of the UGRAFT Technique to High-definition Liposuction.

High-definition liposuction is now a reliable procedure that provides more athletic results. It is a trend among plastic surgeons and patients. The ultrasound-guided rectus abdominis fat transfer (UGRAFT) technique has expanded the range of patients who can benefit from rectus abdominis fat grafting, including those without skin laxity. Its advantage over isolated high-definition liposuction is a more natural-looking result because it increases muscle volume and provides a contoured abdomen even during movement, regardless of the patient's position. In this article, we describe one patient undergoing the UGRAFT technique after high-definition liposuction, versus one patient undergoing only high-definition liposuction. We determined that the use of the UGRAFT technique provides greater muscle definition over those in which this technique has not been performed. The UGRAFT technique opens the possibility of developing more complete body structures regarding definition, providing volume to muscular areas. The more muscle mass and less body fat, the greater the body definition in a liposuction. The less muscle mass and more body fat, the less definition a patient will have in a liposuction. Under these principles, we improve the result by increasing the volume of muscle mass.

Ultra HD Liposuction: Enhancing Abdominal Etching Using Ultrasound-Guided Rectus Abdominis Fat Transfer (UGRAFT).

High-definition (HD) liposuction has allowed surgeons to sculpt the abdomen, enhancing abdominal etching. To create a more athletic abdomen, fat grafting has been used subcutaneously, and rectus abdominis fat grafting has been performed in patients undergoing lipoabdominoplasty. With the objective of increasing muscle volume to obtain a natural-looking abdomen in patients who are not suitable for abdominoplasty, we propose the use of ultrasound-guided rectus abdominis fat grafting (UGRAFT) in association with HD liposuction. PATIENTS: A prospective study with 10 consecutive patients undergoing UGRAFT was conducted. After HD liposuction, UGRAFT was performed from an incision in the umbilical region, using a blunt 2.5-mm cannula assisted by ultrasound. Fat injection was done closer to the anterior rectus sheath in the lower and middle muscle bellies. RESULTS: UGRAFT was performed in 10 patients. The mean age was 34.8 years (range, 24-51 years). The mean body mass index was 23.83 kg/m2 (range, 20.58-28.39 kg/m2). The mean volume of fat injected per "pack" was 34 cm3 (range, 20-40 cm3). UGRAFT added a mean time of 20 minutes (range, 15-30 minutes) to HD liposuction. Comparing the rectus abdominis muscle thickness pre-UGRAFT and post-UGRAFT, average muscle thickness increase was 5.1 mm (55.7% ± 37%), with P < 0.0001. CONCLUSION: UGRAFT showed to be helpful for obtaining muscle expansion and a more natural abdominal contour, avoiding that unnatural appearance that HD liposuction may provide in patients who gain weight or have skin laxity.

Lipoaspiração de definição abdominal / Abdominal etching

Introdução: A lipoaspiração de definição abdominal consiste na criação de sulcos em locais específicos do abdome através da retirada de gordura em toda sua espessura, incluindo a camada superficial, permitindo um maior detalhamento da musculatura. O objetivo deste estudo foi avaliar os resultados da técnica de lipoaspiração na definição abdominal. Métodos: Foram avaliadas 80 pacientes do sexo feminino no período de 2017 a 2018. O grau de definição e as complicações relacionadas ao procedimento foram avaliadas pelo autor. Todas as pacientes responderam um questionário padrão sobre grau de definição abdominal, satisfação, naturalidade do resultado, aumento da atividade física e melhora da alimentação. Resultados: A média de idade das pacientes foi de 38,97 anos e a média de índice de massa corporal, 24,01. Gestação prévia foi observada em 75% dos casos, cirurgia abdominal pregressa em 25% e tabagismo em 2,5%. Cirurgias simultâneas foram realizadas em 90%. Em relação ao tipo de cirurgia realizada, ocorreu a seguinte distribuição: 40% lipoaspiração isolada, 36,25% lipoabdominoplastia, 12,5% minilipoabdominoplastia, 10% lipoaspiração pós-abdominoplastia e 1,25% lipoabdominoplastia reversa. Grau 2 de definição abdominal foi observado em 86,25% e complicações ocorreram em 8 pacientes. O índice de satisfação foi de 91,7% e o resultado foi classificado como natural por 97,5% das pacientes. Conclusão: A lipoaspiração de definição abdominal promoveu um alto índice de satisfação e naturalidade à região abdominal. Esse resultado pode ser atingido através da técnica de lipoaspiração convencional, sem nenhum dispositivo tecnológico adicional. Contudo, são necessários novos estudos para avaliação dos resultados em longo prazo.

Introduction: Abdominal etching involves improvement of the appearance of the abdominal musculature by removing fat from several skin layers, including the superficial layer. This study evaluated the aesthetic results of abdominal etching using liposuction. Methods: The aesthetic results and surgical complications of female patients were evaluated between 2017 and 2018. All study patients answered a standard questionnaire about the extent of improvement in body image, overall satisfaction level, naturalness of the result, and changes in exercise and dietary habits. Results: The mean patient age was 38.97 years, while the mean body mass index was 24.01. In our sample, 75% of the subjects had previous pregnancies, 25% had previous abdominal surgeries, and 2.5% had a history of smoking. Simultaneous surgeries were performed in 90% of cases. The following surgery types were performed: liposuction alone (40.00%), liposuction + abdominoplasty (36.25%), miniabdominoplasty (12.50%), abdominoplasty + liposuction (10.00%), and reverse abdominoplasty (1.25%). Moderate aesthetic improvement was observed in 86.25% of the patients, and surgical complications occurred in eight patients. The satisfaction rate was 91.7%, and the result was classified as natural by 97.5% of the patients. Conclusion: Abdominal etching promoted high patient satisfaction and achieved a natural appearance of the abdomen. This surgical outcome was achieved using conventional liposuction without the need for additional techniques. However, further studies are needed to evaluate long-term outcomes.

Tradução para o português da Patient and Observer Scar Assessment Scale (POSAS) / Portuguese translation of Patient and Observer Scar Assessment Scale (POSAS)

INTRODUÇÃO: A avaliação de cicatrizes é uma ferramenta útil na análise de intervenções cirúrgicas e outros tratamentos, ao documentar sua eficácia e possibilitar avanços. Não há registro de escala padrão em português para avaliação de cicatrizes, e a Patient and Observer Scar Assessment Scale (POSAS) foi escolhida para tradução e validação por ter recebido as melhores avaliações em revisões e por contemplar também a percepção do paciente. MÉTODOS: Foi realizada a tradução da escala POSAS do inglês para o português. A tradução foi baseada em orientações da Organização Mundial da Saúde com permissão do autor principal da escala original. Antes de realizar o pré-teste, a escala traduzida foi enviada aos autores da escala original para análise, e ajustes foram realizados. RESULTADOS: A versão para pré-teste foi aplicada por três examinadores em cinco pacientes cada (n = 15), e dificuldades foram relatadas aos autores. Nenhuma alteração foi necessária durante o pré-teste. CONCLUSÃO: Apresentamos neste artigo o processo de tradução da POSAS, e sua validação está em andamento.

INTRODUCTION: The scar assessment is a useful tool in surgical intervention and other treatments by documenting efficacy and making possible to improve them. There is no record of a standard scale in Portuguese to scar evaluation, and the Patient and Observer Scar Assessment Scale (POSAS) was chosen to translation and validation for having received the best evaluations in reviews, and because it contemplates the patients' perception. METHODS:We translated the POSAS scale from English to Portuguese. The translation was based on orientations from the World Health Organization, with permission from the main author of the original scale. Before the pre-testing, the translated scale was sent to the authors of the original scale for analysis, and adjusts were made. RESULTS: The pre-testing version was applied by three examiners in five patients each (n = 15), and difficulties were reported to the authors. No alterations were necessary during the pre-test. CONCLUSION: In this manuscript, we present the translation process of POSAS, and its validation is now in progress.

Galactocele medicamentosa pós-mamoplastia de aumento: relato de caso e revisão da literatura / Galactocele due to drugs prescribed after augmentation mammoplasty: a case report and literature review

A mamoplastia de aumento é um procedimento cirúrgico muito comum e seguro na cirurgia plástica, mas o mesmo não está isento de complicações. A galactocele após mamoplastia de aumento é raramente descrita na literatura. Este relato de caso refere-se a uma paciente de 34 anos de idade, que fazia uso de sulpirida há 2 anos e 4 meses e desenvolveu galactocele cerca de 100 dias após mamoplastia de aumento. O diagnóstico deve ser suspeitado quando se observar uma mama aumentada de volume, associada a calor local, dor ou desconforto mamário no pós-operatório. Acredita-se que a melhor conduta seja a drenagem cirúrgica, a fim de confirmar o diagnóstico de galactocele e excluir a presença de abscesso mamário.

Augmentation mammaplasty is a common and safe plastic surgery procedure, but it is not free from complications. Galactocele after augmentation mammaplasty is rarely described in the literature. We discuss the case of a 34-year-old woman who had been taking sulpiride for 2 years and 4 months and developed galactocele approximately 100 days after augmentation mammaplasty. However, diagnosis should be suspected if breast size increases and it is associated with postoperative local heat, pain or breast discomfort. We believe that the surgeon must surgically drain galactocele to confirm diagnosis, especially to exclude the presence of breast abscess.

Tratamento cirúrgico de macroglossia na síndrome de beckwith-wiedemann: relato de caso / Surgical treatment of macroglossia in beckwith-wiedemann syndrome: case report

Introdução: a macroglossia está associada a uma variedade de síndromes congênitas podendo ser do tipo verdadeira ou relativa. Reportamos o caso de Síndrome de Beckwith-Wiedemann (BWS) cuja prevalência é 1: 17.000 nascimentos 1 e, apresentado macroglossia verdadeira. Clinicamente, pode acarretar comprometimentos na respiração, deglutição, articulação da fala e ou, também, no aspecto estético 2. Objetivos: relatar caso raro de síndrome congênita apresentando macroglossia verdadeira cujo tratamento cirúrgico é o de eleição. Métodos: paciente feminina, seis meses de vida, portadora de BWS e macroglossia verdadeira com dificuldade para deglutição, submetida a glossectomia parcial. Resultados: os resultados estético e funcional foram satisfatórios, com recuperação completa e adequada da função alimentar. Reforça-se, portanto, os achados da literatura, sobre a indicação imperiosa do tratamento cirúrgico da língua quando diagnosticada a macroglossia verdadeira, como ocorre em 97,5% dos casos de BWS (1). Discussão: deve-se ter o diagnóstico de macroglossia verdadeira para que se obtenha sucesso com a terapêutica cirúrgica na língua. Em casos de macroglossia relativa, como o da Sídrome de Down, a glossectomia não estaria indicada 3. Conclusão: o tratamento cirúrgico da macroglossia verdadeira é fundamental, tendo em vista a morbidade elevada e a efetividade do resultado da cirurgia.

Background: macroglossia is associated with several inhirited syndromes. It may be either true or relative. We have reported a true case of Beckwith- Wiedemann Syndrome (BWS), with a prevalence of 1:17,000 births. Clinically, it may compromise breath, swallowing, speech, and morphology. Objectives: to report a rare case of an inhirited syndrome with true macroglossia, for which surgery is the treatment of choice. Methods: a six-month-year-old female patient presented in our office. She had the diagnosis of BWS with true macroglossia. She had difficulty to swallow, and underwent partial glossectomy. Results: aesthetic and functional results were satisfactory; normal feeding was restablished. We emphasize the already reported indication of glossectomy for true cases. Their occur in 97.5% of BWS cases. Discussion: one should precisely diagnose true macroglossia, in order to obtain success in intervention. Relative macroglossia patients, as seen in Down Syndrome, will not have such indication. Conclusion: surgical treatment is an important indication fo true macroglossia, once morbidity is high and such treatment is usually very effective.