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PubMed2005

[Orbital decompression for Graves' ophthalmopathy].

Graves' ophthalmopathy is a complex orbital condition with a controversial pathogenesis. It is the clinical expression of a discordance between the inextensible orbit and hypertrophic muscular and fatty elements within the orbit responding to immunological stimulation. The relationship between the orbital and its content can be improved by surgical expansion which increases the useful volume of the orbit. This procedure can be combined with lipectomy to decrease the volume of the orbital contents. We briefly recall the history of surgical decompression techniques and present our experience with Graves' ophthalmopathy patients.

Decompression, Surgical↗
PubMed2001

Surgical treatment of the aging neck.

To obtain consistently successful results, surgical treatment of the aging neck must be based upon a comprehensive anatomic diagnosis, using an appropriate sense of cervicofacial aesthetics and taking into account the relative contributions of each structural component of the deformity. The degree to which the projection and contour of the anterior mandible, redundancy of cervical skin, presence of excess submental fat, hyoid bone position, and configuration of the platysma muscles affect the appearance of the neck should be determined preoperatively to develop an effective surgical plan. Experience has shown that extensive incisions in the region of the anterior neck and transection of the platysma should be avoided. Depending upon the specific findings, any combination of a group of procedures may be required, including cervical rhytidectomy, submental suction-assisted lipectomy, chin augmentation, and midline imbrication of the platysma muscles. The indications, limitations, and possible complications of each procedure are described, and some technical considerations are discussed.

Aging↗
PubMed2005

An aesthetic deformity: Madelung's disease.

Madelung's disease, also known as benign symmetric lipomatosis, multiple symmetrical lipomatosis or Lanois-Bensaude syndrome, consists of growth of fatty masses predominantly on the face, neck, shoulders, upper thorax and arms. These painless and symmetrical fatty deposits can cause important aesthetic changes in these patients. Middle-aged males are more commonly affected, with an increased prevalence in the Mediterranean area. Currently, the incidence in Italy is 1 in 25,000 males. The aetiology of Madelung's disease remains unknown, although approximately = 60% of affected patients are clinically overweight and there is an intimate association with chronic alcohol abuse. We report an unusual case of Madelung's disease in a 52-year-old male. The fatty deposits were completely resected by means of surgical lipectomy. The patient remains well and disease-free after 12 months of postoperative follow-up.

Esthetics↗
PubMed1997

Comparison of the enzyme activities between the thickest and the thinnest parts of the abdominal pannus.

OBJECTIVE: According to some reports, there are variations in metabolism in adipocytes from different areas of the body. The purpose of this study was to determine if there are differences in some of the lipid assimilating enzyme activities between the thickest (overhang) and the thinnest (upper margin) parts of the abdominal pannus. METHODS: The abdominal panniculectomy activities of sn-glycerol-3-phosphate dehydrogenase (31 subjects, spectrophotometric method), fatty acid synthetase (14 subjects, spectrophotometric method) and lipoprotein lipase (18 subjects, radioactive method) were determined in the thickest and the thinnest parts of the pannus of lipectomy patients. RESULTS: The enzyme activities were as follows: sn-glycerol-3-phosphate dehydrogenase: thickest: 2083 +/- 227.7 nm/mg/min; thinnest: 2084 +/- 208.3 nm/mg/min (p < 0.098, T = 0.02). Fatty acid synthetase: thickest: 22.0 +/- 3.9 microns/mg/min; thinnest 25.9 +/- 6.9 microns/mg/min (p < 0.36, T = 0.94). Lipoprotein lipase: thickest: 0.70 +/- 0.11% of control; thinnest: 0.61 +/- 0.14% of control (p < 0.47, T = 0.75). Thus no differences in specific enzyme activities were found between the two sites studied. CONCLUSIONS: There was no difference in the activity of the enzymes studied at the thickest and the thinnest part of the pannus.

Abdomen↗
PubMed2001

Multilineage cells from human adipose tissue: implications for cell-based therapies.

Future cell-based therapies such as tissue engineering will benefit from a source of autologous pluripotent stem cells. For mesodermal tissue engineering, one such source of cells is the bone marrow stroma. The bone marrow compartment contains several cell populations, including mesenchymal stem cells (MSCs) that are capable of differentiating into adipogenic, osteogenic, chondrogenic, and myogenic cells. However, autologous bone marrow procurement has potential limitations. An alternate source of autologous adult stem cells that is obtainable in large quantities, under local anesthesia, with minimal discomfort would be advantageous. In this study, we determined if a population of stem cells could be isolated from human adipose tissue. Human adipose tissue, obtained by suction-assisted lipectomy (i.e., liposuction), was processed to obtain a fibroblast-like population of cells or a processed lipoaspirate (PLA). These PLA cells can be maintained in vitro for extended periods with stable population doubling and low levels of senescence. Immunofluorescence and flow cytometry show that the majority of PLA cells are of mesodermal or mesenchymal origin with low levels of contaminating pericytes, endothelial cells, and smooth muscle cells. Finally, PLA cells differentiate in vitro into adipogenic, chondrogenic, myogenic, and osteogenic cells in the presence of lineage-specific induction factors. In conclusion, the data support the hypothesis that a human lipoaspirate contains multipotent cells and may represent an alternative stem cell source to bone marrow-derived MSCs.

Adipocytes↗
PubMed1994

Appetite and the regulation of body composition.

Stability of body composition requires that energy intake equals energy expenditure when integrated over prolonged periods. As recent human studies have failed to demonstrate active changes in energy expenditure with changes in body composition, it is likely that energy intake is continually adjusted to preserve a constant total adipose tissue mass. If adipose tissue mass is regulated directly, then there must be some input reflecting this quantity to the central nervous system for the purpose of making corrective changes in appetite when total body fat content fluctuates. The nature of this input has been examined in a variety of animal experiments involving induced weight change, lipectomy, plasma transfer from obese or satiated animals to hungry animals, and parabiosis between obese and lean animals. The bulk of evidence suggests that the plasma level of one or more currently unidentified stable circulating molecules increases in proportion to total body fat content and augments the effect of meal-related satiety signals in the central nervous system. The implications of this adipose tissue-related satiety factor for the pathogenesis of obesity, and the possible nature of the factor are discussed.

Animals↗
PubMed1986

Aesthetic surgery of the medial thigh.

Aesthetic surgery of the medial thigh is indicated in three instances: excess of skin, localized steatomery, and diffuse obesity after loss of weight. In the first two cases it is possible to limit scarring to the gluteal fold. In obese patients the functional benefits of a combination excision-suction lipectomy outweigh the disadvantages of the scarring over the medial thigh.

Dermatologic Surgical Procedures↗
PubMed1986

Alternatives to the classic abdominoplasty.

Prior to designing and performing an abdominoplasty, we use a simple test that allows us to predict, within 1 cm, the location of the suprapubic scar after a standard abdominoplasty. When the distance from the umbilicus to the suprapubic scar is less than 10 cm, we recommend using different techniques, such as an abdominoplasty with a short vertical scar, a midabdominoplasty, or an abdominal up-and-down lift. We suggest that only a belt lipectomy can improve the silhouette appearance after a substantial weight loss.

Abdominal Muscles↗
PubMed1988

Liposuction on a lymphedematous arm.

Suction lipectomy is a technique that is being used more and more frequently for both aesthetic and reconstructive purposes. One area in which this technique has only seen limited use heretofore is in the treatment of acquired lymphedema. A patient with longstanding postmastectomy lymphedema recently presented with a large squamous cell carcinoma and multiple smaller suspicious lesions on the lymphedematous forearm. After resection of these lesions, the remaining forearm skin was treated with liposuction to debulk the arm and facilitate wound closure. Most of the forearm wound could be closed after this treatment. The upper arm was then debulked with liposuction as well. Redundant skin from the upper arm was resected and used as a skin graft to the residual defect on the forearm. All wounds healed primarily. The patient has shown no sign of recurrence and has greatly improved function of the arm at 10 months follow-up. Although its exact indications and limitations need to be defined, liposuction can be a useful treatment modality for at least some patients with acquired lymphedema.

Aged↗
PubMed1989

Hereditary progressive nodular lipomatosis: a report and selective review of a new syndrome.

Multiple hereditary lipomatosis has been reported very rarely in the literature. The largest number of lipomas previously reported in a single patient was 160. We report on a 45-year-old man who began to experience multiple lipomas at about age 26. The lipomas multiplied until they severely disfigured his entire torso, arms, and upper legs. Both sides of his body were affected to approximately equal degrees. A family history revealed that the patient's father, two brothers, and two nephews have all experienced multiple subcutaneous lipomas, although to a lesser degree. In treating the patient, what appeared to be very large lipomas were in fact found to be subcutaneous clusters of hundreds of small encapsulated lipomas. Lipomas were excised using suction lipectomy to treat different involved areas on eleven separate occasions. A total of 8,475 cc was removed over a two-year period. A modified, slightly less blunt cannula was developed to aspirate the clustered lipomas individually.

Humans↗
PubMed1990

Fat embolism syndrome after liposuction: a case report and review of the literature.

There have been three previous case reports of fat embolism syndrome (FES) after lipectomy. We present a case of FES diagnosed by pulmonary angiography. It seems likely that there is an incidence of subclinical fat embolization after liposuction, but conservative patient selection and aggressive postoperative management can lessen the morbidity and mortality of FES.

Embolism, Fat↗
PubMed1991

Buccal fat pad excision: aesthetic improvement of the midface.

Visual criteria for a harmonious midface depends on (1) a distinction between the anterior border of the parotid gland and cheek hollow, (2) a visible posterior border of the nasolabial fold (this signifying the most variable criterion), (3) an intervening cheek soft-tissue convexity that does not exceed the plane of a perpendicular from the midzygoma to the mandible (subtle submalar depression), (4) prominent zygomatic eminences, and (5) a well-defined mandible, particularly the angle. The space within the zygomatic arch and the mandible that defines the ideal midfacial "cheek hollow" has been established. This can be achieved through a combination of: aesthetic contouring of the facial skeleton, facial liposculpture, and cervicofacialplasty. A series of 25 consecutive patients undergoing submuscular fat removal by buccal fat pad excision to improve aesthetic midface were treated and are presented. To preserve the subcutaneous fat commonly lost with aging and to avoid late secondary deformities, only submuscular buccal fat excision is recommended in a carefully selected group of patients. The anatomy, indications, and technique for buccal lipectomy in midface contouring are discussed.

Adipose Tissue↗
PubMed1995

Endoscope-assisted suction extraction of lipomas.

The blunt technique of suction-assisted lipectomy partially evolved while proving to be an efficient, albeit blind, method for the removal of lipomas. Larger or poorly encapsulated tumors were acknowledged to be at a greater risk for recurrence probably because of an unrecognized residua. Just as liposuction has enhanced body-contour surgery because of the potential for smaller and fewer scars hidden in strategically camouflaged locations, the identical advantages are possible for liposuction extraction of lipomas, with a greater assurance for their entire removal via direct visualization using a surgical endoscope.

Endoscopy↗
PubMed1995

Minimal-access variations in abdominoplasty.

The use of liposuction began a trend toward less invasive abdominal contour surgery and resulted in a variety of techniques based on individual anatomy. An analysis of 170 patients was undertaken to determine which patients benefited from even less invasive techniques that evolved from these concepts. The selection criteria used were based on the physical examination of the skin, fat and muscle layers, and patients' goals, willingness to accept incisions, and tolerance for the recovery period. The options used for this new category of treatment were subtypes of the abdominolipoplasty system (type 1, suction-assisted lipectomy; type 2, miniabdominoplasty; type 3, modified abdominoplasty; type 4, full abdominoplasty) and included extended liposuction (type 1a); "open" miniabdominoplasty (type 2a); and endoscopically assisted or muscle access abdominoplasty (type 3a). Also included in this series were patients whose procedures were downstaged to a less extensive alternative and cases during which the abdominoplasty incision was used for access for another operation. All procedures resulted in smaller or fewer incisions. Results suggested that the current period (1991-present) is marked by less invasive treatment options, characterized by a preponderance of "closed" techniques (60% vs. 40%: 1986-1991). With the availability of technology to treat muscle and adipose tissue through inconspicuous incisions, judgment regarding the capability of the skin to recontour becomes the overriding physical factor in the decision-making process. The outcomes support the conclusion that minimal-access variations in abdominoplasty are appropriate alternatives, reflecting a philosophical alteration in the approach to patients.

Abdominal Muscles↗
PubMed1996

Effect of electrosurgical technique on wound healing and early complication rate following abdominal dermolipectomy.

Thirty-eight patients with significant weight loss after vertical banded gastroplasty were studied prospectively while undergoing abdominal dermolipectomy to determine if the current intensity used during electrosurgical dissection influenced wound complication rates after this surgery. Patients were assigned randomly to one of two groups: (1) a HI group, in which the electrosurgical current intensity was set at a level that easily allowed coagulation of all vessels smaller than 0.5 mm in diameter or (2) a LO group, in which the current intensity was set at a much lower level that allowed dissection, but required that nearly all visible vessels be ligated separately. A standardized procedure was employed for all patients. The patients in the LO (N = 14) and HI (N = 24) groups were well matched for age, weight history, nutritional parameters, operative times, surgical blood loss, and postoperative hospital stay. The overall complication rates of 36% and 21%, and wound complication rates of 36% and 13% for the LO and HI groups, respectively, were not significantly different. These data indicate that using a relatively high electrosurgical current intensity for dissection during abdominal lipectomy does not result in a higher wound complication rate.

Abdomen↗
PubMed1996

Insulin-induced lipohypertrophy treated by liposuction.

Lipohypertrophy is one of the local side effects of repeated subcutaneous insulin injections. This case report demonstrates the successful cosmetic and therapeutic treatment of two lipohypertrophic masses in the lower abdomen of a young diabetic patient by suction-assisted lipectomy.

Adipose Tissue↗
PubMed1998

Benign symmetric lipomatosis (Madelung's disease).

Benign symmetric lipomatosis, also known as Madelung's disease, is a rare condition characterized by massive fatty deposits arranged symmetrically around the neck, shoulders, and arms. These patients might present for liposuction and body contouring. Although infrequently encountered in the average plastic surgeon's practice, this condition should be considered when evaluating candidates for these procedures. The deformity is associated with chronic alcohol use and also with malignant tumors of the upper airways. The deformity is prone to recurrence and its surgical treatment often results in less than optimal aesthetic outcomes. Despite this fact, surgical removal via either direct excision or suction-assisted lipectomy provides the only real hope of palliation. This report describes a patient with this deformity and a review of the literature.

Female↗
PubMed2001

Liposuction as an adjunct procedure in reduction mammaplasty.

Liposuction has been recognized as a useful adjunct to breast reduction surgery for fine contouring of adjacent areas to achieve aesthetic balance and preservation of nipple sensation. In particular, the liposuction technique has provided an acceptable way of treating the "fat roll" of the lateral portion of the breast, which extends to the axilla and lateral chest. The purpose of this study was to review the authors' approach to adjunctive lipoplasty with breast reduction surgery and to review their experience. Examination of their own results in 70 consecutive women who underwent reduction mammaplasty in 1998 by the senior surgeon did not reveal any substantial difference in the complication rate of those women who had adjunctive liposuction with their breast reduction surgery vs. those who did not. All complications such as fat necrosis, cellulitis, and seromas were confined to the breast and were not related to the liposuction. Furthermore, there was no additional morbidity associated with ultrasonic liposuction compared with traditional suction-assisted lipectomy. Their experience indicates that patients undergoing reduction mammaplasty may benefit aesthetically from adjunct lateral chest wall liposuction without additional morbidity.

Adolescent↗