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Multiple symmetric lipomatosis (MSL) is a rare disorder only mentioned in about 200 cases in the medical literature. It manifests as massive lipomatous deposits in specific areas of the body. The cause is unknown, although there frequently is a history of alcoholism. Surgical lipectomy has so far been the choice of treatment. We present a review of the disease and report one case successfully treated with liposuction.
One may accomplish certain closures without tension or distortion using blunt liposuction cannula dissection with or without suction-assisted lipectomy. If closure cannot be accomplished with adequate undermining and an appropriate flap design, the surgeon may first aspirate fat to allow use of the focally expanded skin over the fat. If still unsuccessful, fibrous neurovascular septae are progressively sacrificed as necessary to allow adequate movement and closure. Preservation of the maximal number of blood vessels and nerves within the flap is a given fact. These techniques provide more rapid and safe methods for elevating flaps with significantly less morbidity than sharp dissection methods alone.
This study was performed in 15 female patients submitted to suction lipectomy as an isolated procedure, to establish blood loss in the procedure. A wide variation of blood-to-fat ratios was observed (17 to 59%) with a mean blood loss in lipoaspirates of 34 +/- 3%. Internal blood losses occurring in the first 72 post-operative hours were as important as or more important than external losses, and responsible for a mean 7% fall in the level of hemoglobin. Internal blood losses occurred between 72 hours and the 7th to the 10th post-operative days and were responsible for a mean 3% fall in the level of hemoglobin. Blood losses occurring in this study were demonstrated to be greater than usually assumed. Some prophylactic measures are recommended to provide for a safer treatment of these patients: an iron supplementation during the pre-operative period; careful clinical and laboratorial screening for bleeding disorders and for the intake of drugs that can interfere with coagulation; use of smaller-diameter cannulas for aspiration, auto-transfusion when aspirating in excess of 1,000 ml, and limiting the aspiration to 1,500 ml.
In summary, the increasing frequency with which we perform lipectomy prompts us to investigate the risks and benefits to which we may be subjecting our patients. It is hoped that this article has shed some light on the biology and anatomy of adipose tissue so that we can make educated guesses as to the effects of its removal.
Endoscopically assisted rectus abdominis plication is a safe and effective method of repair in patients with mild to moderate central abdominal wall flaccidity. A procedure was developed in animals and in a human cadaver using a single umbilical incision, gasless dissection of the anterior rectus abdominis fascia, and suture plication under endoscopic guidance. This procedure was performed successfully in three patients. Early postoperative results were comparable to those obtained by standard rectus abdominis plication. Moreover, adjunctive suction lipectomy or a limited abdominal skin resection can be used to expand the contouring capability of this technique.
The original consulting microsurgeon should be present to assist in the identification and protection of the vascular pedicle during secondary procedures on microvascular transplants. Flap elevation, trimming, and bone graft placement should be completed during a single tourniquet time, whenever possible. Flaps can easily be resutured on the original bed while the tourniquet is still inflated. Although proximal pedicle transection is possible, it should be avoided by careful planning, because the transplanted tissue cannot be predictably expected to survive, especially with muscle transplants. The distal muscle should be transected only in situations in which the muscle inset is extremely complex. Transection in the extramuscular portion of the main pedicle may require prompt microsurgical repair in immature muscle transplants. The safest approach is to avoid the pedicle whenever additional secondary procedures are necessary following free microvascular tissue transplantation. Placement of vascular pedicles such that the anterior crest of the tibia is avoided if the Ilizarov technique is required permit uncomplicated distraction osteosynthesis. Simultaneous Ilizarov fixation and microvascular tissue transfer are safe, practical procedures for limb salvage. Placement of the Ilizarov fixator at the time of microvascular transplantation provides stable fixation and eliminates the need for a subsequent anesthetic for fixator placement. This form of stabilization, when performed at the time of microvascular tissue transfer, allows the orthopedic surgeon direct visualization of the fracture site as the fixator is placed and eliminates the need for placement of the fixation device through the transplanted tissue. Tissue expansion or suction lipectomy are sometimes needed to optimize the clinical result.
As we age, a number of factors distort the contour of the cervicomental angle. Submental adipose deposits, anterior laxity of the platysma muscle, and relaxation of cervical skin contribute to this undesirable result. Comprehensive rhytidectomy will frequently involve enhancement of the cervicomental angle as an adjunctive procedure. Facial aesthetic surgeons have devised numerous techniques to deal with the aging neck. Commonly, the approach combines submental adipose tissue excision with posterosuperior-based support, either by preauricular or postauricular incision. Herein, we describe a technique incorporating standard submental suction lipectomy with a novel method of contralateral midline platysma suspension that creates a dynamic support system involving both rigid suture-based and flexible muscle-based components. This technique delivers quality aesthetic results and superior postoperative patient satisfaction.
Cervical and submental deformities are the major complaints of many patients who have had rhytidectomies. Unfortunately, traditional rhytidectomy techniques have failed to provide satisfactory and lasting results in this region. During recent years, the superficial muscular aponeurotic system has been described and multiple platysma surgical techniques introduced. Our technique emphasizes a youthful cervical and submental region. It involves an anterior submental incision, total surgical excision of the anterior platysma bands, conservative submental lipectomy, routine rhytidectomy dissection, submandibular and mandibular fat contouring, and division and rotation of platysma flaps. This technique has been used for two years on 94 patients. There have been no complications specifically related to this technique.
Restoration of a well-defined, youthful-looking, cervicomental angle is not easily achieved. The classic rhytidectomy is now often supplemented by lipectomy and platysmamodifying procedures. Still, irregularities of neck contour are bothersome, and for the short, stocky neck, results at times fall short of a patient's and surgeon's expectation. Insertion of an E-PTFE (expanded polytetrafluorethylene [E-PTFE]; tradename, Gore-Tex, W. L. Gore Associates Inc, Flagstaff, Ariz) soft-tissue patch as a sling to support the floor of the mouth and redefine the cervicomental angle for a smoother neck contour is described. This method was used in seven patients presenting with problematic aging neck. The first three patients needed readjustment of the E-PTFE membrane. This evolving method seems to offer a superior, more lasting result for the correction of an obtuse cervicomental angle.
The experimental obesity by high-fat feeding of rats, introduced after weaning, was found to be a suitable model for evaluation of the biological value of nutritional fats with different fatty acid composition: butter (group B), lard (L), partially hydrogenated oil (H), lard + sunflower oil 2:1 (LS). The differences in the fatty acid composition of these regimens affect: the efficiency in creating the model of obesity; the hormonal pattern of blood plasma; some metabolic pathways in liver and adipose tissue (especially in group H); the fatty acid composition of some structural, reserve and transport lipids; some biological tests indicative of membrane's phospholipid and fatty acid composition, i.e. the rate of platelets aggregation. A special attention should be paid to the striking differences in the cellularity and morphogenesis of adipose tissue in group B (hyperplastic obesity) in comparison with all other high-fat groups (hypertrophic obesity), irrespective of the identical energy and protein content of the diets. Thus, the early administration of a diet with butterfat (50% of energy) promoted a model of hyperplastic obesity, while the isocaloric diet with lard + sunflower oil caused a hypertrophic type of obesity. The authors have proved the regenerating capacity of the periepididymal fat pad in adult rats after partial lipectomy. The relative contribution of endogenic and exogenic (nutritional) factors in this process is discussed and the modifications in the cellularity of adipose tissue on these conditions are evaluated.
We describe the technical details used in applying nonabsorbable sutures running from the anterior platysma muscles and/or adjacent fascia back to the fascia just in front of or covering the sternocleidomastoid muscles. These sutures usually pass 1.5-2 cm below the angle of the mandible. Anteriorly, they cover or are attached to the platysma muscles at the level of the cervical concavity or angle. The sutures suspend or draw back the superficial musculoaponeurotic system (SMAS) at this level, preventing some of the anterior displacement of the platysma when it is contracted in normal use. We believe that the sutures have relatively long-lasting effects and that they delay the early return of "platysma cording" after cheek-neck lifting. Their application using Reverdin and Keith needles is demonstrated. Differences in technique when submental lipectomy is and is not performed with the lift are shown.
This study reports the initial observation of the novel estrogen receptor, ER beta, in human subcutaneous adipose tissue. Human adipose tissue was obtained from various anatomic sites including the subcutaneous depots of lipectomy patients (healthy controls), and from subcutaneous abdominal and breast depots of lean and obese women with breast cancer. ER beta mRNA expression, determined by reverse transcription and polymerase chain reaction (RT-PCR), was present in each adipose tissue sample examined. Cloning and sequencing of the PCR product confirmed its identity as ER beta. Separation of adipose tissue into component fractions indicated that ER beta was expressed in both adipocytes and the stroma-vasculature. Primary culture of human preadipocytes indicated that ER beta mRNA was present only after differentiation to the adipocyte phenotype. This novel observation of ER beta mRNA indicates that this receptor subtype may have a role in ER-mediated responses in human adipose tissue.
The author presents a clinical classification of fat-suction cases in which treatment of excessive adiposity of the face and neck is discussed. Selection of the patient is a very important preoperative procedure. Fat suction is performed only on the adipose tissue lying between the skin and the platysma muscle and is not indicated for fat lying below the muscle structures. The author presents several improvements on the Illouz technique in comparison with more conventional lipectomy surgical procedures.
Excision of moderate to large amounts of adipose tissue in male breasts has been unsatisfactory because of frequent complications and unacceptable cosmetic results. Essentially, one deformity was traded for another. Lipoplasty (blunt suction lipectomy) provides a new means to acquire a better contour without a need for incisions outside the areola with reduced morbidity and complications. The operative technique is discussed in detail and a representative result shown.
The large drops in hematocrit levels that frequently follow blunt suction lipectomy can be lessened by the preparation of the localized operative area with subcutaneous injections of a solution containing a weak concentration of epinephrine.
Classical open surgical contouring and sculpturing of the body has required significant scarring with long incisions and wide depressed scars. During the last decade, a small number of European surgeons have pioneered techniques for suction lipectomy. Illouz introduced the concept of lipolysis and blunt cannula extraction. The method described herein, which is termed lipo-suction, is a dry technique. No lipolytic solutions or local anesthetic solutions are injected. The technique relies on mechanical disruption and suction extraction of adipose tissue. The instrument is a rigid blunt-ended extractor with dull apertures. Postoperative care is a significant factor in reducing the rate of seroma formation to less than 1%.
Subjects with localized fat deposits commonly receive suction lipectomy as a cosmetic procedure. A new office procedure for correction of those superficial fat deposits was applied in 50 patients by injection of phosphatidylcholine. The method itself consists of using a 3OG1/2 insulin needle to inject about 5 ml (250 mg/5 ml) of phosphatidylcholine into the fat, distributing it evenly in an 80 cm2 area. Pre- and posttreatment photographs were taken for technical planning and analysis of the results over the long term. A clear improvement occurred in all, with a marked reduction of the fat deposits without recurrence over a 2-year follow-up period and no weight gain. The injection of phosphatidylcholine into the fat deposits is a simple office procedure that can sometimes postpone or even replace surgery and liposuction.
BACKGROUND: The suture suspension platysmaplasty technique for neck rejuvenation was introduced more than 13 years ago. Over the years and after a large number of procedures performed for all classes of neck deformities, a number of technical fine points evolved that resulted in even more aesthetically pleasing and predictable results. These technical fine points are presented in detail, and their direct anatomic effects are analyzed. Finally, the points that constitute the youthful neck are redefined with detailed schematic presentation. ANATOMIC CONSIDERATIONS: All aspects of neck rejuvenation with the suture suspension platysmaplasty are analyzed, with a focus on the changes that occur in terms of the following six key anatomic points: cervicomental angle depth, mandibular border definition, mandibular angle definition, labiomandibular fold prominence (jowling), mental prominence, and neck width. TECHNICAL FINE POINTS: Additional technical fine points have evolved over the past 13 years to optimize the results and produce a more natural appearing and aesthetically pleasing neck: the "angle loop" of the suspension sutures, anatomic suction-assisted lipectomy using appropriate cannulas, application of moderate tension to the interlocking suspension suture to avoid the "overcorrected neck," imbrication of the midline platysma, conservative skin excision, and augmentation of the chin to increase the depth of the cervicomental angle. CONCLUSION: The interlocking suture technique, by creating an artificial permanent "ligament" under the mandible, corrects the anatomic components of the neck (points 1 to 6) with excellent long-term outcomes and patient satisfaction rates. The additional technical fine points have made the aesthetic results more natural and pleasing, while making the technique more simple, safe, and reproducible.