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Liposuction: Concepts, safety, and techniques in body-contouring surgery.

Liposuction is the second most commonly performed cosmetic surgery in the United States and the most common surgical procedure in patients between the ages of 35 and 64; practitioners of medicine and surgery will undoubtedly encounter these patients in their practice. This brief review discusses the role of liposuction and fat transfer in aesthetic and reconstructive surgery, as well as key considerations, indications, and safety concerns.

[Research progress of abdominoplasty].

Objective: To summarize the research progress of abdominoplasty. Methods: The literature related to abdominoplasty in recent years was reviewed and the evolution of this surgical method and related surgical techniques were summarized. Results: By removing excess skin adipose tissue from abdominal wall and strengthening loosening muscle fascia system, the abdominal wall contour can be improved by abdominoplasty. With the development of liposuction, selective flaps undermining, progressive tension sutures, and Scarpa fascia retention, the trauma and complications of abdominoplasty are significantly reduced, and better aesthetic result is achieved. Conclusion: At present, the incidence of abdominoplasty complication is still the highest among cosmetic surgeries, and further exploration is needed to reduce complications and improve aesthetic effects.

Lipoaspiração abdominal de alta definição e tubos de silicone / High-definition abdominal liposuction with silicone tubing

Introdução: Recentemente, alguns autores têm descrito a lipoaspiração de alta definição, na qual, na região abdominal, é alcançada pela marcação vigorosa dos sulcos das linhas alba, semilunar e interseções tendíneas transversais do músculo reto abdominal. O objetivo é apresentar estudo piloto de técnica de lipoaspiração de alta definição abdominal utilizando material convencional e tubos de silicone nos curativos. Métodos: Foram descritos 20 casos, submetidos à lipoaspiração convencional e em seguida lipoaspiração superficial sob as linhas alba, semilunar e interseções tendíneas, até que se obtivesse a formação de um sulco nestes locais. Utilizamos tubos de silicone maleáveis nas linhas alba, semilunar bilateral e interseções tendíneas, fixados externamente com micropore, os quais foram removidos após 5 dias. Resultados: Houve um acréscimo médio de 20 minutos para realização destas etapas. As marcas dos tubos de silicone apresentaram-se muito evidentes no primeiro retorno, estando mais discretas no segundo retorno. Não foram observadas alterações de coloração, isquemia ou dor maior pela técnica empregada. Após 3 meses, não houve nenhum caso de dermatite, cútis marmorata, seroma, infecção, irregularidade de contorno ou necessidade de procedimentos adicionais. Conclusão: Foi realizada lipoaspiração de alta definição abdominal, com material convencional e uso de tubos de silicone temporários fixados externamente.

Introduction: Recently, some authors have described high definition liposuction in the abdominal region, achieved by the vigorous marking of the grooves of the linea alba, linea semilunaris, and transverse tendinous intersections within the rectus abdominis muscle. The aim is to present a pilot study of high-definition abdominal liposuction technique using conventional material and silicone tubing in the dressings . Methods: Twenty cases were submitted to conventional liposuction, followed by superficial liposuction under the linea alba, linea semilunaris, and tendinous intersections, until a groove was formed at these sites. Flexible silicone tubing was externally fixed with Micropore tape in the linea alba, bilateral linea semilunaris, and tendinous intersections, and removed after 5 days. Results: A mean increase of 20 minutes was required to perform these steps. The marks of the silicone tubing were evident at the first follow-up, and less prominent at the second follow-up. No color change, ischemia, or significant pain was observed using this technique. After 3 months, there were no cases of dermatitis, cutis marmorata, seroma, infection, contour irregularity or need for additional procedures. Conclusion: High-definition abdominal liposuction was performed using conventional materials and externally fixed temporary silicone tubing.

Arm Contouring: Review and Current Concepts.

Arm contour improvement is a desired goal of the massive weight loss and the aging population who want to maintain the arm aesthetics. Brachioplasty is a growing and safe procedure to improve the arm contour and different approaches and innovative treatment options have been described since the 1930s. This paper reviews the relevant literature in arm contouring including surgical and nonsurgical procedures used to aesthetically improve the arm. A comprehensive literature review was performed using the words "brachioplasty," "arm lift," "arm contouring," "arm liposuction," "noninvasive arm lift," "minimally invasive arm lift." Commonly used techniques, classification systems, and procedure outcomes are described. The review demonstrated that there are several methods to accomplish good arm contouring. There is no consensus about the best incision type and location, but the classification systems help guide treatment. Assessment of fat excess, skin excess, and location of the deformity (proximal, entire arm, arm and chest) help determine the best approach including liposuction only, skin resection only, a combination of liposuction and excision, or even the use of nonsurgical devices. Infection, hematoma, and unsatisfactory scars are the most commonly reported complications. Brachioplasty is a growing procedure and can be performed with low complication rates and good patient satisfaction. Classification systems stratify deformities to the ideal treatment but no studies have shown the superiority of any technique. Nonsurgical fat removal and skin tightening of the arms are promising procedures for selected patients and higher levels of evidence are needed to show clear indication for different technologies and devices.

Current Trends in Management of Submental Liposis: A Pooled Analysis and Survey.

IMPORTANCE: Since its approval by the US Food and Drug Administration for treatment of moderate to severe submental liposis in April 2015, deoxycholic acid (Kybella) has received significant media attention as a novel aesthetic treatment. Four phase 3 clinical trials have published data demonstrating the safety and efficacy of the drug compared with placebo; however, no study has juxtaposed the product with submental liposuction. OBJECTIVE: To evaluate the efficacy of injectable deoxycholic acid in the treatment of isolated submental liposis. EVIDENCE REVIEW: A pooled analysis of the data from the 2 European and 2 North American phase 3 clinical trials was performed by grouping the study participants by treatment arm to analyze efficacy, adverse effects, and treatment variables. Members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) were also surveyed regarding their clinical use of deoxycholic acid, fees, and adverse events. FINDINGS: The pooled analysis included 1738 unique patients (348 men [20.0%] and 1390 women [80.0%]; mean [SD] age, 47.7 [1.6] years) and revealed that all studies demonstrated efficacy compared with placebo. However, a significant number of patients experienced pain, edema, and numbness after injection. The clinical trial population was injected with a mean (SD) of 186.0 (106.6) mg of drug per patient during the course of treatment. A total of 102 members responded to the survey, representing 4% of AAFPRS membership. Based on the results of the survey, clinicians reported charging a mean (SD) of $691.04 ($168.68) per 20-mg vial of deoxycholic acid, resulting in a cost of $6426.35 per study participant. The survey revealed a mean (SD) total cost to the patient for submental liposuction to be $2976.56 ($1041.62). CONCLUSIONS AND RELEVANCE: Although the clinical trials demonstrated functional drug efficacy, the large volume of drug used precluded cost-effectiveness. The survey found clinical practice to differ from the protocols used in the trials. Deoxycholic acid may be only fiscally efficacious for patients with mild to moderate submental liposis who require only 20 to 30 mg of drug per treatment for 3 treatment sessions. LEVEL OF EVIDENCE: 1.

Personal Evolution in Thighplasty Techniques for Patients Following Massive Weight Loss.

BACKGROUND: Lockwood described the importance of Colles' fascia anchoring in medial thighplasty to reduce morbidity associated with the procedure. However, this maneuver may still have complications including traumatic dissection, prolonged edema, and potential wound healing ramifications form increased tension. Alternatively, we suggest orienting tension in medial thighplasty for massive weight loss (MWL) patients in the horizontal vector rather than a vertical direction, negating the need for Colles' fascia anchoring. OBJECTIVES: To compare the morbidities, complications, and outcomes between Colles' fascia suture fixation (CFSF) and horizontal vector fixation (HVF) in medial thighplasties in MWL patients. METHODS: A retrospective chart review was conducted on an Institutional Review Board approved database of MWL patients who had medial thighplasty between October 2004 and March 2014. Patient demographics and surgical outcomes were reviewed between those MWL patients with CFSF and HVF. RESULTS: Of 65 post-MWL patients, 26 (40.0%) patients were in the CFSF group, and 39 (60.0%) patients were in the HVF group. The 2 groups had statistically equivocal preoperative characteristics and comorbidities. Intraoperatively, the HVF group had increased use of barbed suture (92.3% vs 30.6%, P < 0.0001) and liposuction (71.8% vs 26.9%, P < 0.0001). Postoperatively, the HVF group had decreased incidence of infection (5.1% vs 23.0%, P = 0.051) and lymphocele/seroma (10.3% vs 34.6%, P = 0.0257). No statistical differences were observed for dehiscence, necrosis, or hematoma. CONCLUSIONS: HVF for medial thighplasty in MWL patients is a safe and effective procedure, with a lower complication profile than CFSF. Furthermore, the incorporation of barbed sutures and/or liposuction may help to achieve optimal results. LEVEL OF EVIDENCE: 3.

Thirtyfour years of liposuction: past, present and future.

Initial, variably successful attempts of fat sculpting date back to the beginning of the 20th Century, but Gerard Illouz was the first to introduce the modern, safe, widespread method of liposuction. Preoperative injection of local anaesthesia, saline, distilled water, adrenaline and hyaluronidase, defined wet technique, established as a safe and effective adjunct to lipoaspiration. This procedure was initially based on an automatic pump system, but then the accuracy of syringe aspiration was popularized by Toledo in the eighties. Liposuction in the subcutaneous tissue, just 3-4 mm deep to dermis, also called superficial liposuction, is a modern effective evolution of the technique, but requires a good mastery in order to avoid disfiguring outcomes. Ultrasound and laser lipoplasty methods have provided further advancement in the range of technical choices offered to the plastic surgeon. Liposuction is a purely surgical procedure, and as such, carries risks of minor and major complications. In the nineties, an interplay between abdominoplasty and abdominal liposuction as simultaneous procedures, also called lipoabdominoplasty, has become more and more popular. Reinjection of the harvested fat with the purpose of liposculpture for both reconstructive and cosmetic indications is a relatively recent development which has established as a successful, world-wide accepted procedure. Adipose stem cells, extracted from the unlimited source represented by human adipose tissue, are a great promise for future tissue-engineering. Liposuction has nowadays become a safe, effective, popular procedure for contouring adipose tissue and human body in general, in many reconstructive and cosmetic indications.

Liposuction - a surgical procedure in dermatology.

Liposuction is an integral part of the wide range of surgical procedures in dermatology. Dermatologists established tumescent local anesthesia in combination with the use of micro-cannulas; especially dermatologists from Germany and Austria actively designed and developed these new techniques. In this position paper, we discuss the history, various interdisciplinary aspects, the significance, and the treatment indications for this procedure as well as its role within dermatologic training programs and research. For quality reasons, members of the Germany Society of Dermatologic Surgery and the Austrian Society of Dermatologic Surgery discuss several fundamental professional aspects as well as the historical development of liposuction.

Updates and advances in liposuction.

Liposuction has evolved tremendously over the past three decades. Since its introduction by Illouz it has progressed into one of the most popular procedures in plastic surgery. The objective of this CME is to provide a foundation of knowledge with respect to anatomy, physiology, preoperative, intraoperative, and postoperative management of patients scheduled to undergo liposuction. A review of both the immediate and delayed complications related to liposuction is addressed, as well as relevant surgical site-specific pearls for patients undergoing liposuction. Finally a summary of the various operative techniques available for surgeons is discussed along with information related to relevant emerging technology in body contouring.

Discussion of laser-assisted liposuction.

UNLABELLED: There has been a significant advancement in the use of lasers for body contouring over the past several years. This article will review the recent past and discuss the future of this trend. INTRODUCTION: There is much confusion over the definition of procedures using lasers for lipolysis and liposuction. This review article discusses the definitions of suction-assisted liposuction, laser lipolysis, and laser-assisted liposuction in detail. The development of these procedures is then discussed and pertinent articles are reviewed. MATERIALS AND METHODS: Pubmed and FDA.gov web sites were searched for published articles and FDA approved devices employing lasers for targeting fat for body contouring. This information along with the authors' personal experience was used to review and discuss this topic. DISCUSSION: There is a specific difference between suction-assisted liposuction, laser-assisted liposuction, and laser lipolysis. This review article clarifies these definitions and highlights the recent articles employing lasers for minimally invasive fat reduction.

Laser lipolysis: current practices.

Laser-assisted liposuction (LAL) is a recent innovation within the field of liposculpture. In addition to body contouring, the indications of LAL are skin retraction in areas of flaccidity and fat melting for challenging surgical cases including revisions, areas of dense fibrosity, and large-volume cases. A photothermal effect explains the effects of LAL on tissue, regardless of the wavelength used. Advantages of LAL include reduced bruising, edema, pain, and recovery time. Disadvantages are most often related to thermal effects on tissue, such as skin blistering. Currently, 3 wavelengths, 980, 1064, and 1320 nm, are Food and Drug Administration-approved for LAL. Comparative studies examining the safety and efficacy of LAL have appeared in the medical literature. Technical considerations, emerging technology, and future indications are important to the success and continued development of this procedure.

Reposición volémica mediante cristaloides o cristaloides e hidroxietilalmidón en cirugía de liposucción / No disponible

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Análisis de controversias en reconstrucción mamaria con colgajo DIEP / Analysis of debated uses in mammary reconstruction with DIEP flap

La reconstrucción mamaria mediante colgajo DIEP (DeepInferior Epigastric Perforator) se encuentra condicionada en muchas ocasiones por características de la paciente o del tratamiento oncológico recibido, de tal forma que diversos grupos de trabajo contraindican este método en caso de existir alguno de esos factores. Nosotros hemos realizado un estudio de los mismos, analizando su impacto sobre la viabilidad del colgajo y su correlación con las complicaciones postoperatorias, para optimizar así su indicación. Los condicionantes analizados son el tabaco, las intervenciones quirúrgicas previas que afecten en alguna medida la pared abdominal, el sobrepeso u obesidad de la paciente, el volumen dela mama contralateral, el tratamiento radioterápico anterior o posterior a la reconstrucción, y finalmente el gasto sanitario que supone. Estas controversias son a su vez las más discutidas en la literatura al respecto. Se valoran los resultados obtenidos tras 55 reconstrucciones mamarias mediante colgajo DIEP entre enero de 2000 y noviembre de 2005, así como los estudios y publicaciones más recientes existentes sobre esta materia. Hemos encontrado una pobre correlación entre los índices de fracaso del colgajo y las controversias estudiadas, determinando así dos contraindicaciones absolutas para que una paciente pudiese beneficiarse de un colgajo DIEP: abdomino plastia previa y radioterapia adyuvante tras reconstrucción inmediata. Los excelentes resultados que se obtienen globalmente, nos llevan a recomendar este colgajo por encima de otras opciones terapéuticas (AU)

The use of DIEP (Deep Inferior Epigastric Perforator) flap surgery in breast reconstruction is often conditioned by the patient and the oncologic treatment characteristics to such an extent that several working groups advise against this surgical procedure when any of these factors is present. In the study of this interaction, an analysis of its impact on the flap feasibility and its correlation with postoperative complications was carried out as an attempt to gain accuracy in the prescription of this technique. The factors under assessment were smoking habits, previous surgical interventions involving the abdominal wall to any extent, patient obesity, contralateral breast size, pre- and post-reconstruction radiotherapy, and lastly the medical costs. These factors coincide with the most debated issues in the related literature. The results of 55 breast reconstructions by DIEP flap surgery performed between january 2000 and november 2005 were evaluated, together with the latest studies and publications on the subject. The study revealed a poor correlation between DIEP flap surgery failure rates and the conditioning factors analyzed, while two scenarios proved to be absolutely incompatible with successful DIEP flap surgery: previous abdominoplasty and adjuvant radiotherapy after immediate reconstruction. In light of the excellent global results obtained, DIEP flap surgery is recommended over other therapeutic options (AU)

Breast reduction trend among plastic surgeons: a national survey.

BACKGROUND: A number of breast reduction techniques have been developed over the years, but debate over which technique is better for patients continues to grow. The authors' goal was to survey members of the American Society of Plastic Surgeons to identify their preferences and practices and report their opinion regarding issues related to the various breast reduction techniques. METHODS: In the fall of 2006, a one-page anonymous survey was sent to 5112 plastic surgeons who were members of the American Society of Plastic Surgeons. A follow-up survey was sent 2 weeks after the first mailing as a friendly reminder. The questionnaires were then collected over a 6-week period. RESULTS: Of the 5112 plastic surgeons surveyed, 2665 (52 percent) responded to the survey. The majority of the respondents (69 percent) use the inferior pedicle breast reduction technique. Ninety-two percent of the respondents use intraoperative deep venous thrombosis prophylaxis. Sixty-one percent of respondents performed over 75 percent of their cases on an outpatient basis and 97 percent of respondents use general anesthesia. Ninety-three percent of the respondents use preoperative antibiotics. Over 70 percent of the respondents do not think breast reduction should be a cosmetic procedure. CONCLUSIONS: In conclusion, the inferior pedicle technique has traditionally been the procedure of choice and remains so today. However, there has been an increase in the use of the newer techniques. Plastic surgeons are becoming more cognizant of the risk of deep venous thrombosis among their patients. The majority of breast reductions are now performed as outpatient procedures.

New advances in liposuction technology.

Although suction-assisted liposuction under tumescent anesthesia remains the traditional method for body sculpting, newer technologies promise to increase efficiency, decrease surgeon fatigue, and minimize complication. Power-, ultrasound-, and laser-assisted devices are ideal in large volume cases and in areas of fibrous tissues as an adjunct to traditional liposuction. Although skepticism remains chemical lipolysis, more commonly termed mesotherapy or lipodissolve may be an alternative to surgical treatment of localized fat. This article reviews the recent advancements in the field of liposuction and the current literature which support their use.

Fracción vascular estromal de tejido adiposo: cómo obtener células madre y su rendimiento de acuerdo a la topografía de las áreas donantes: estudio preliminar / Stromal vascular fraction from fat tissue: obtaining stem cells and their yield according to the topography of the donor areas: previous note

La obtención de tejido adiposo supone un nuevo y prometedor mercado de trabajo para los cirujanos plásticos, ya que los bancos de tejidos escogerán de forma acertada la grasa como el medio más fácil para obtener fuentes de células madre de alto rendimiento, en la medida en que este tejido es capaz de producir al menos cinco veces más unidades formadores de colonias (UFCs) que la médula ósea. El objetivo del presente trabajo es mostrar lo que se puede esperar del tejido adiposo como origen de células adultas de fracción vacularestromal (FVE), y señalar las mejores áreas del cuerpo humano para ser elegidas como donantes de tejido adiposo, extraído mediante liposucción. Describimos la rutina seguida para la obtención de células de FVE mediante la digestión de las muestras de tejido adiposo humano con colagenasa. En el momento de su recolección, esas células presentaban una viabilidad de 92+/- 1% basada en exclusión por Azul de Trypan. Las células de FVE recontadas después de permanecer48 horas en medio de cultivo de Eagle modificado por Dulbecco(DMEM), dentro de una cámara de Neubauer, tras lo cual el rendimiento medio de las células de FVE fue de 7,2 +/- 1,3 x 103células por mililitro de tejido lipoaspirado. En conclusión, pensamos que supone un desafío en la actualida del mejorar las estrategias para la obtención de células de FVE. Este trabajo, por ahora preliminar, muestra que las células de FVE pueden ser fácilmente obtenidas por medio de lipoaspiración. La comparación entre las diferentes áreas donantes, mostró un rendimiento22% más alto para las células de FVE cuando el tejido adiposo había sido obtenido del tronco, en comparación a cuando lo había sido delos miembros (AU)

The harvest of adipose tissue will be a promising labor marketing for plastic surgeons, since tissue banks will certainly choose fat as the easiest way to obtain a high-yield source of stem cells, as this type of tissue can produce at least five times more colony-forming units (CFUs) than bone marrow extracts. The aim of this study is to show what can be expected from fat tissues as an origin of adult stromal vascular fraction (SVF) cells, and to evaluate the best areas to be elected as donor sites within the human body, all obtained by liposuction. The routine to obtain SVF cells by collagenase digestion of human adipose tissue samples was described. At the time of harvest, these cells displayed a viability of 92+/- 1% based on Try pan Blue exclusion, SVF cells were counted after 48 hours culture in Dulbecco´s modified Eagle medium (DMEM) in a Neuberger counting chamber. The average yield of SVF cells was 7,2 +/- 1,3 x 103 cells per millilitre of liposuctioned tissue. As a conclusion, best strategies to obtain SVF cells are an important challenge nowadays. This study, although preliminary, showed that SVF may be easily obtained From liposuction. Comparison among different donor sites showed a 22% higher yield of SVF cells when fat tissue had been obtained from the trunk regions, when confronted with limbs (AU)

Supervivencia a largo plazo de los injertos grasos / Long-term survival with fat grafting

Presentamos varios casos de pérdida de volumen de diferentes etiologías y en distintas regiones corporales y faciales tratadas mediante injertos de tejido graso autólogo según la técnica de lipoestructura. En ningún caso se realizó sobrecorrección del defecto en ningún caso. La evolución con un seguimiento máximo de 7 años y mínimo de 1 año no mostró disminución del volumen obtenido en el acto quirúrgico en la gran mayoría de los casos. Debido a los resultados obtenidos creemos que el injerto de grasa autólogo es el método de elección para restaurar volúmenes con fines estéticos o reconstructivos (AU)

Volume loss in several facial and body areas was treated by means of autologous fatty tissue grafts with lipostructure technique. There were no cases of overcorrection. The patients’ course, with a maximum follow-up of 7 years and a minimum of 1 year did not evidence any loss of the surgically restored tissue volume in the majority of cases. The above results suggest that autologous fat grafts are the method of choice to restore volume for both cosmetic and reconstructive purposes (AU)