Women in dire need: the far-reaching impact of lipoedema on women's lives.

Lipoedema, an adipose tissue disorder, is a poorly visible, often unrecognised condition. To foster a greater understanding of the significant and debilitating impacts faced by women living with lipoedema, the charity Lipoedema UK conducted four focus group interviews, the findings of which were published in a series of reports under the umbrella title 'Women in dire need'. The reports identified the substantial and numerous negative effects of lipoedema on the women's everyday lives, including the patients' experiences with compression garments, the effects of liposuction surgery (many of which were not positive), the everyday impacts ranging from pain and reduced mobility to poor self-esteem and working prospects, and the considerable challenges faced by women with late-stage lipoedema which can render them immobile.

Quality of life following aesthetic liposuction: A prospective outcome study.

BACKGROUND: The authors' previous research suggested the hypothesis that aesthetic surgery in general has a positive impact on quality of life (QoL). This prospective study aimed to investigate the indication-specific effect on QoL in patients undergoing aesthetic liposuction. To our knowledge, no other prospective study has been conducted using standardised and validated questionnaires with a comparable return rate and sample size. METHODS: Sixty-four patients underwent aesthetic liposuction. Forty-two patients met the inclusion criteria, and 38 of them answered one set of questionnaires preoperatively and the follow-up set at six months post-operatively. The testing instrument included a self-developed, indication-specific questionnaire and four standardised and validated questionnaires with German norm data available: Questions on Life Satisfaction, Modules (FLZM, German version), the Freiburg Personality Inventory-Revised (FPI-R), the Rosenberg Self-Esteem Scale (RSES) and the Patient Health Questionnaire (PHQ-4). RESULTS: Our self-developed indication-specific questionnaire showed high satisfaction with the postoperative results. The FLZM demonstrated significant improvements for all modules, concerning life in general (p = 0.02), health (p = 0.04) and body image (p = 0.02). Moreover, the FPI-R revealed a significant improvement in emotional stability (p < 0.01). Moreover, the PHQ-4 showed a significant reduction in overall psychological distress (p = 0.03) and anxiety (p = 0.01). CONCLUSION: Liposuction had significant impact on QoL. The surgery led to a higher satisfaction not only with the result of intervention and the outer appearance specifically but also with life and the state of health generally. It improved emotional stability and reduced anxiety. Therefore, the authors' hypothesis in a previous research was confirmed for this specific indication prospectively.

Body Image & Quality of Life: Changes With Gastric Bypass and Body Contouring.

INTRODUCTION: Bariatric surgery has emerged as an effective method of combating the morbid obesity epidemic. However, the massive weight loss that follows may result in contour changes that can affect body image and quality of life. Our study examines the effects and consequences of bariatric surgery and subsequent body contouring on body image and quality of life. METHODS: Patients were prospectively followed up through their experience with bariatric surgery and subsequent body contouring surgery. Using 2 validated survey instruments, the Multidimensional Body-Self Relations Questionnaire and the Short Form 36 (SF-36), patients completed questionnaires preoperatively and at 6, 12, and 24 months postoperatively. Mean scores were determined by repeated measures analyses of variance F tests. RESULTS: One hundred seventy-five patients were surveyed before bariatric surgery, with noted declines in survey completion at 6, 12, and 24 months. Appearance Evaluation scores improved significantly at all intervals (P = 0.0033), as did Body Area Satisfaction Scale and Appearance Orientation scores (P = 0.0079 and P = 0.044, respectively). While Overweight Preoccupation and Self-Classified Weight scores decreased over time, only the latter was significant (P < 0.0001). The composite SF-36 score for patients awaiting bariatric surgery (54.1%) with postoperative scores at 6 (67.6%,), 12 (at 74.0%), and 24 (76.7%) months being significantly higher (P < 0.0001). The body contouring group consisted of 41 patients who primarily had lower body procedures, with 31 patients surveyed at 6 months and 27 patients at 12 months. For this cohort, Appearance Evaluation and Body Area Satisfaction Scale scores both improved significantly (P = 0.0001 and P = 0.0005, respectively) whereas Appearance Orientation scores declined significantly (P = 0.0055). Both Overweight Preoccupation and Self-Classified Weight scores decreased with only the latter being statistically significant (P = 0.0286). Postoperative SF-36 scores at 6 (72.9%) and 12 (64.5%) months were no different than patients awaiting body contouring (71.3%). CONCLUSIONS: Using 2 validated survey instruments, we show that patients undergoing bariatric surgery have improvements in body image and quality of life. Subsequent postbariatric body contouring surgery results in further improvements in body image. Our findings provide measurable evidence for the value of body contouring after significant weight loss, which may favor greater insurance coverage for this patient population.

Análise da lipoenxertia estruturada na redefinição do contorno facial / Analysis of structured fat grafting for redefining facial contours

INTRODUÇÃO: A enxertia de gordura como preenchimento no rejuvenescimento e melhoria do contorno facial vem sendo usada por alguns autores e demonstra um potencial excelente como método de escolha para essa finalidade, uma vez que tem como premissa o princípio básico de corrigir as deformidades com o tecido mais semelhante possível. O objetivo deste trabalho foi avaliar clinicamente a eficiência da enxertia de gordura estruturada na redefinição do contorno facial. MÉTODO: Foi realizada análise retrospectiva de 39 pacientes submetidos a lipoenxertia estruturada para a redefinição do contorno facial, entre 2002 e 2012. A seleção de pacientes incluiu correção de deformidades, assimetrias, harmonização do contorno e aumento da projeção óssea, mas excluiu o rejuvenescimento per se. A avaliação do resultado clínico foi realizada pelo paciente e pelo cirurgião, com auxílio de documentação fotográfica pré e pós-operatória. O resultado clínico foi classificado pelo paciente e cirurgião, empregando escala que variava de 1 a 3: (1) o objetivo não foi alcançado de forma alguma; (2) o objetivo foi alcançado parcialmente; ou (3) o objetivo foi alcançado totalmente. Foi realizado, também, levantamento de prontuários para obtenção dos seguintes dados: idade, alteração ponderal, volume enxertado por área, número de sessões de enxertia realizadas, história de tabagismo e complicações. RESULTADOS: As médias das avaliações do cirurgião e paciente foram, respectivamente, 2,6 ± 0,6 e 2,7 ± 0,5, havendo correlação estatisticamente significante (P < 0,0001). Não foi encontrada relação significativa entre as avaliações e idade, alteração ponderal, volume de enxertia ou tabagismo, com uma única exceção. CONCLUSÕES: A lipoenxertia estruturada demonstrou ser eficiente adjuvante na redefinição do contorno facial e sua eficiência não foi prejudicada por idade, alteração ponderal ou tabagismo. O volume a ser enxertado deve ser adequado às necessidades específicas de cada área.

INTRODUCTION: Fat grafting as a filling method for the rejuvenation and enhancement of facial contours was demonstrated by some authors to be an excellent alternative method for redefining facial contours, based on the premise that the donor tissue used in the correction of the deformities has similar characteristics as the recipient tissue. The objective of the present study was to clinically evaluate the efficiency of structured fat grafting when redefining facial contours. METHODS: A retrospective evaluation was performed in 39 patients who underwent structured fat grafting to redefine their facial contours between 2002 and 2012. The patients selected included those who underwent corrections of deformities, asymmetrical features, contour smoothing, and increased bone projection. Patients who underwent facial contour rejuvenation were excluded. The clinical outcome assessment was performed by the patient and surgeon, with the aid of preoperative and postoperative photographic documentation. The clinical outcome was rated by the patient and surgeon, using a scale ranging from 1 to 3, defined as follows: 1, the objective has not been achieved in any way; 2, the objective was partially achieved; or 3, the objective was fully achieved. In addition, a survey was conducted using the patients' medical charts to obtain the following data: age, weight change, volume grafted by area, number of grafting sessions performed, history of smoking, and complications. RESULTS: The mean surgeon and patient assessment scores were 2.6 ± 0.6 and 2.7 ± 0.5, respectively, with a statistically significant correlation (P < 0.0001). No significant relationship was found between the assessments and age, weight change, graft volume, or smoking habit, with the exception of the cheekbone area. CONCLUSIONS: Structured fat grafting proved to be an efficient adjuvant technique for redefining facial contours, and its efficiency was not affected by age, weight change, or smoking habit. However, the fat volume to be grafted should be adequate for the specific needs of each area.

Overweight/obese patients referring to plastic surgery: temperament and personality traits.

BACKGROUND: Correlations between psychiatric disorders and overweight/obesity are reported in the literature. However, temperament/personality traits have been less frequently studied even though the correlation with Axis-1 diseases is well defined. The present study aims to detect correlations between psychiatric disorders, temperament traits and body image perception in overweight and obese patients who seek surgical lipostructuring treatment. METHODS: Seventy overweight/obese patients (age 18-60 years, BMI 25-34.9 at recruitment) referring to the outpatient service for obesity-related lipodystrophism were enrolled in the period March 2008-March 2012. Psychiatric disorders, temperament traits, and body image perception were evaluated and compared with a control group (N = 33) from the general population sharing clinical/demographic features. RESULTS: Patients had higher scores in lifetime depression, with moderate/mild concern with body shape. Regarding personality traits, tests revealed higher scores on subscale RD4 (dependence/independence) in patients, whereas controls scored higher on the "openness to experience" NEO Five Factory Inventory sub-scale. Obese patients had a higher prevalence of obsessive characteristics. CONCLUSIONS: The affective sphere is an important feature in obese patients, as are obsessive traits, since negative body shape perception and temperament and personality characteristics appear to be involved in leading patients to seek surgical advice. These aspects should be involved in medical/surgical outcomes and compliance with treatment. The future possibility of identifying patients who show alterations in these traits or psychic characteristics may represent a possible instrument to avoid early post-treatment relapse and to implement the service offered to patients, with appropriate psychiatric care before and after surgery.

A lipofobia nos discursos de mulheres praticantes de exercício físico / Lipophobia in the speeches of physical exercise female practitioners

Atualmente a valorização da magreza tem contribuído para a formação de sujeitos lipofóbicos pautados num regime de verdade sobre o corpo que expressa ideais biopolíticos de maximização econômica. Recorremos à teoria de Foucault para analisar as formas de problematização produzidas e reproduzidas pelos sujeitos lipofóbicos acerca do corpo gordo, a partir das falas de 30 mulheres praticantes de exercício físico em academias de ginástica da cidade do Recife. Para coletar os discursos utilizamos um roteiro de entrevista composto por imagens (photo elicitation). A análise seguiu a proposta arqueológica foucaultiana. Os pensamentos sobre o corpo gordo revelaram três manifestações da lipofobia (medo da gordura, medo de engordar e medo de ser improdutivo). O discurso médico, a mídia e a moda produzem discursos e práticas que desencadeiam efeitos sociais de lipofobia. Os resultados demonstram a necessidade de expandir as investigações sobre a produção de verdades acerca do corpo e seus possíveis regimes de existência.

Currently, the valuation of thinness has contributed to the formation of lipophobic subjects oriented in a regimen of truth that expresses biopolitical ideals. In this study we used Foucault's theory to analyze how lipophobic subjects produced and reproduced thoughts about body fat, from the speech of 30 women-exercising in gym clubs of the city of Recife. To collect the discourses we used an interview guide composed of images (photo elicitation). The analysis followed Foucault's archaeological proposal. Thoughts on the fat body showed three manifestations of lipophobic attitudes (fear of fat, fear of fat and fear of being unproductive). The medical discourse, media and fashion produces discourses and practices that triggers social lipophobic effects. The results demonstrate the need to expand investigations into the production of truths about the body and their possible systems of existence.

Predicting interest in liposuction among women with eating problems: a population-based study.

The purpose of this paper was to examine predictors of an interest in liposuction among women with eating problems. A questionnaire was sent to 3500 women aged 18-35 years, whereof 378 of 1861 responders screened positively on eating problems. Assessments included sociodemographic status, social network, physical exercise, attitudes towards cosmetic surgery, teasing history, body dysmorphic disorder-like symptoms, body image, self-esteem, personality, interpersonal attachment and emotional distress. Fifty-two percent reported an interest in liposuction, which was independently predicted by appearance orientation, appearance evaluation, being critical/quarrelsome, teasing history, wish for a better relationship with father, low education and being unmarried. Predictors differed somewhat from those previously found in the general population. Considering that our sample consisted of women with self-reported eating problems, the association between liposuction and eating behaviors should be further examined in a sample of patients with a formal eating disorder diagnosis.

Psychosocial predictors of an interest in cosmetic surgery among young Norwegian women: a population-based study.

BACKGROUND: The present study investigated psychosocial factors expected to predict an interest in cosmetic surgery. It was hypothesized that body dysmorphic disorder-like symptoms, personality, interpersonal attachment insecurity, low self-esteem, poor body image, dissatisfaction with sexual life, distorted eating behavior, emotional distress, low education, poor relationship with parents and friends, teasing history, social acceptance of cosmetic surgery, and low level of physical activity would relate to an interest in cosmetic surgery. METHODS: Questionnaire data were obtained from 1880 participants who responded to a survey distributed to a representative sample of 3500 Norwegian women between 18 and 35 years of age living in the two northernmost counties. Data were analyzed by univariate and multiple logistic regression analyses. RESULTS: Multiple regression analyses showed that an interest in cosmetic surgery was positively related to body dysmorphic disorder-like symptoms, body image orientation, having children, been teased for appearance, knowing someone who has had cosmetic surgery, and being recommended cosmetic surgery. Agreeability, body image evaluation, education, and quality of relationship with parents were negatively related to an interest in cosmetic surgery. CONCLUSIONS: The study gives new insights into psychosocial factors predicting an interest in cosmetic surgery. In addition to previously known predictors, having been teased for appearance and having children were positive predictors, whereas education and quality of relationship with parents were negative predictors of an interest in cosmetic surgery. The results may contribute to a better understanding of the various factors that may motivate an individual to undergo cosmetic surgery.

Psychosocial characteristics of young Norwegian women interested in liposuction, breast augmentation, rhinoplasty, and abdominoplasty: a population-based study.

BACKGROUND: The present study investigated various psychosocial factors expected to predict an interest in liposuction, breast augmentation, rhinoplasty, and abdominoplasty. METHODS: Questionnaire data were obtained from 1862 participants who responded to a survey distributed to a representative sample of 3500 women from northern Norway aged 18 to 35 years. RESULTS: Liposuction was the most popular procedure (25 percent), followed by breast augmentation (15 percent), rhinoplasty (7.0 percent), and abdominoplasty (5.6 percent). Most of the women interested in rhinoplasty and breast augmentation reported interest in more than one procedure, whereas the vast majority of women interested in abdominoplasty were not interested in any other procedure. Multiple regression analyses showed that a low level of education, indicators of social acceptance of cosmetic surgery, and negative appearance evaluation were predictors of an interest in all procedures. Body dysmorphic disorder-like symptoms, appearance orientation, and teasing history were predictors of an interest in all procedures except for abdominoplasty, whereas having children was a predictor of all procedures except for rhinoplasty. Divorce rate and eating disorder were predictors of an interest in liposuction only. Univariate regression analyses showed that the Big-Five personality traits were associated with all procedures except abdominoplasty. CONCLUSIONS: It appears that women interested in abdominoplasty may be motivated by a desire to repair the bodily changes occurring after childbirth, whereas women interested in liposuction, breast augmentation, and rhinoplasty may have more complex psychological factors associated with their interest in cosmetic surgery. The findings of this study provide increased knowledge about psychosocial factors characterizing women interested in liposuction, breast augmentation, rhinoplasty, and abdominoplasty.

Bioelectric impedance analysis and quality of life after body-contouring procedures in plastic surgery.

BACKGROUND: This study dealt with the assessment of two body-contouring patient groups, the first having undergone abdominoplasty and the second liposuction. The focus of inquiry was the change in body mass index (BMI) values and the correlation of these with health-related quality of life (HRQoL). METHODS: Fat and BMI values for 98 consecutive patients were determined 1 h preoperatively, and 1 day, 3 weeks, and 3, 6, and 12 months postoperatively. Operative results and quality of life were evaluated using an individual patient questionnaire and the 'Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being' (FACIT-SP), which were completed preoperatively and 12 months postoperatively. RESULTS: The liposuction group showed a significant reduction in fat and BMI values, and liposuction as well as abdominoplasty patients exhibited an increase in HRQoL 1 year after surgery (P<0.001). The liposuction patients showed an average decrease of 1.98 kg body fat and a decrease in BMI values of 0.94 kg/m(2) 1 year following surgery. The abdominoplasty patients showed an average decrease of 2.97 kg in body fat, and a BMI reduction of 0.11 kg/m(2) after 12 months. The FACIT-questionnaire score increased from 91.57 preoperatively to 136.16 points postoperatively for liposuction patients, and from 89.12 to 132.43 points for the abdominoplasty patients. On the individual questionnaire, liposuction patients improved from 14.83 to 24.77 points, whereas abdominoplasty patients showed an increase from 16.84 to 25.21 points. CONCLUSIONS: These findings indicate an overall improvement in HRQoL of the abdominoplasty as well as the liposuction patients, in the latter group accompanied by long-term success in reduction of fat and BMI values.

Interest in cosmetic surgery and body image: views of men and women across the lifespan.

BACKGROUND: Little is known about interest in cosmetic surgery among the general public or how this interest is related to gender, age, relationship status, body mass index, or body image satisfaction. METHODS: The present study tested these associations among a sample of 52,677 heterosexual men and women aged 18 to 65 years who completed the online "ELLE/MSBNC.com Sex and Body Image Survey" in 2003. RESULTS: Many women were interested (48 percent) or possibly interested (23 percent) in cosmetic surgery. A substantial minority of men were also interested (23 percent) or possibly interested (17 percent) in cosmetic surgery. Individuals interested in cosmetic surgery did not report poorer global body image than individuals not interested in cosmetic surgery. Individuals specifically interested in liposuction, however, tended to have poorer body image, and interest in liposuction was greater among heavier individuals. CONCLUSIONS: The finding that many women and men are interested in cosmetic surgery has implications for research comparing cosmetic surgery patients to individuals drawn from the general population. Specifically, researchers conducting comparative studies should recognize that many individuals in their control group may be strongly interested in cosmetic surgery, even if they have not yet had any. Furthermore, individuals interested in different types of cosmetic surgery may differ from each other on such attributes as body mass index and body image.

Cultural and ethnic differences in the acceptance or rejection of liposuction instrumentation entrance marks.

The acceptance of visible marks on the skin as a result of surgical procedures varies by the necessity of the procedure (ie, cosmetic or not) and by the cultural interpretation of those sequelae. As liposuction has become the most commonly performed major cosmetic procedure in the US, and perhaps throughout the world, the visible stigmata resulting from the surgical invasion may be of major consequence to some while they remain of little or no consequence to others. This article explores the national, cultural, racial, and ethnic variations in the acceptance or rejection of visible marks on the skin in several parts of world.

Lifestyle outcomes, satisfaction, and attitudes of patients after liposuction: a Dallas experience.

BACKGROUND: Liposuction is the most common cosmetic operation performed. To the authors' knowledge, no report has examined patients' attitudes and postoperative opinions, lifestyle changes, weight gain changes, and satisfaction with their liposuction procedure in general and by specific site. The authors report on data from a survey provided to patients by two plastic surgeons at the University of Texas Southwestern Medical Center at Dallas. METHODS: Six hundred questionnaires were mailed to all patients who had liposuction surgery performed between 1999 and 2003. There were 108 undeliverable surveys; 209 completed surveys were returned (34.8 percent of 600 and 42.5 percent of 492 surveys). Data were analyzed using the chi-square test. A p value of less than 0.05 was considered significant. RESULTS: The majority of patients (80 percent) were satisfied with their results. Fifty-three percent thought that their appearance was either "excellent" or "very good." With regard to satisfaction by site treated, 60 percent or more of the responders were "very satisfied" or "satisfied" with their results. Weight gain was reported in 43 percent of the responders, with 56 percent of them gaining between 5 and 10 pounds 6 months after their surgery. Fat return was reported in 65 percent of the responders. The abdomen was the most common location for fat return. As a group, 79.7 percent would have the procedure again and 86 percent would recommend the procedure to family or friends. Approximately 75 percent of responders described their postoperative discomfort as mild to moderate, with 60 percent indicating that their discomfort lasted less than 7 days (39.8 percent indicated their pain lasted longer than 7 days); 83 percent indicated that they only needed to use narcotics for 7 days of less. When responders were divided into groups, the great majority of patients were satisfied with the surgery and their results. CONCLUSIONS: Despite postoperative pain, fat return, and weight gain, patients were willing to have the procedure again and recommend it to others. Those patients who were unsatisfied and were less likely to refer patients were those who had the lowest opinion of their appearance.

Psychosocial factors predicting the motivation to undergo cosmetic surgery.

BACKGROUND: The present study investigates psychological factors expected to predict the motivation to undergo cosmetic surgery. It is hypothesized that body image, self-esteem, teasing history, acceptance of cosmetic surgery in the individual's environment, and self-monitoring relate to motivation to have cosmetic surgery. METHODS: Questionnaire data were obtained from 907 participants who responded to a survey distributed to a representative sample of Norwegian women aged 22 to 55 years. A second sample of 195 female prospective cosmetic surgery patients was recruited from a plastic surgery clinic. Measures of the hypothesized predictor variables were obtained from both samples. Surgery motivation was operationalized in two different ways. First, the women in the first sample were asked to indicate whether they wished to undergo cosmetic surgery, such that women who wished to have surgery could be compared with those who did not. Second, prospective patients were compared with women from the first sample who indicated that they did not wish to have cosmetic surgery. RESULTS: Analyses revealed all predictor variables but self-esteem to be related to either the wish or the decision to undergo surgery, or to both. Social acceptance of cosmetic surgery and body image were the strongest predictors of cosmetic surgery motivation. CONCLUSIONS: The study gives new insights into psychological factors predicting cosmetic surgery motivation. Furthermore, the influence of social factors on cosmetic surgery motivation is emphasized, and it is suggested that these factors be included in future research designs.

Body contouring after massive weight loss.

As the results of bariatric surgery become increasingly successful, the demand for dy contouring following significant weight loss is rapidly growing. Persons who have lost weight are often unpleasantly surprised with the hanging folds of tissue and loose skin that may be present. The following article is a review of the surgical treatment currently available to provide a more pleasing body contour after successful weight loss.

[The role of plastic surgery in remodeling the body image]. / Zwischen plastisch-rekonstruktiver und asthetischer Chirurgie. Das Skalpell ist kein Ersatz für eine Psychotherapie.

On the basis of comprehensive information on the realistic possibilities and outcomes of esthetic corrective surgery, such operations can contribute to an effective and lasting improvement in the patient's quality of life and self-esteem. However, the esthetic surgeon's scalpel must never be considered an alternative to necessary psychotherapy. Exaggerated expectations, obsessions, and an absent sense of reality coupled with the projection of psychological and social problems on a certain part of the body must be interpreted as dysmorphophobia with a disordered personality structure. For a reputable plastic surgeon they must be considered a contraindication to esthetic surgery. Against a background of constantly changing social conditions and attitudes, too, surgical body sculpting should no longer be uncritically accepted as a legitimate field for esthetic surgery. Currently, the question as to where the lines are to be drawn for the performance of body-modeling surgical interventions remains unanswered.