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PubMed1991

Surgical management of primary hyperhidrosis.

Primary hyperhidrosis, although lacking a precise definition and of unknown aetiology, disrupts professional and social life and may lead to emotional problems. A variety of treatment methods are used to control or reduce the profuse sweating which involves mainly the palms, soles and axillae. The simplest method, the application of topical agents, is usually attempted first for axillary and plantar sweating. Iontophoresis may provide relief especially in patients with plantar or palmar involvement. In severe cases operative intervention is necessary. Excision of sweat glands is successful in patients with axillary hyperhidrosis but the role of suction-assisted removal of axillary sweat glands remains to be determined. Sympathectomy remains the standard by which other treatments must be judged. For upper thoracic sympathectomy a variety of surgical approaches are used with satisfactory relief of hyperhidrosis. Complications related to the surgical approach, such as Horner's syndrome, brachial plexus injuries, pneumothorax and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur. Plantar hyperhidrosis which may be exacerbated or ameliorated by upper thoracic sympathectomy and which fails to respond to non-operative intervention is relieved by lumbar sympathectomy.

Administration, Topical↗
PubMed2006

Characterization of freshly isolated and cultured cells derived from the fatty and fluid portions of liposuction aspirates.

Liposuction aspirates (primarily saline solution, blood, and adipose tissue fragments) separate into fatty and fluid portions. Cells isolated from the fatty portion are termed processed lipoaspirate (PLA) cells and contain adipose-derived adherent stromal cells (ASCs). Here we define cells isolated from the fluid portion of liposuction aspirates as liposuction aspirate fluid (LAF) cells. Stromal vascular fractions (SVF) were isolated separately from both portions and characterized under cultured and non-cultured conditions. A comparable number of LAF and PLA cells were freshly isolated, but fewer LAF cells were adherent. CD34+ CD45- cells from fresh LAF isolates were expanded by adherent culture, suggesting that LAF cells contain ASCs. Although freshly isolated PLA and LAF cells have distinct cell surface marker profiles, adherent PLA and LAF cells have quite similar characteristics with regard to growth kinetics, morphology, capacity for differentiation, and surface marker profiles. After plating, both PLA and LAF cells showed significant increased expression of CD29, CD44, CD49d, CD73, CD90, CD105, and CD151 and decreased expression of CD31 and CD45. Multicolor FACS analysis revealed that SVF are composed of heterogeneous cell populations including blood-derived cells (CD45+), ASCs (CD31- CD34+ CD45- CD90+ CD105- CD146-), endothelial (progenitor) cells (CD31+ CD34+ CD45- CD90+ CD105low CD146+), pericytes (CD31- CD34- CD45- CD90+ CD105- CD146+), and other cells. After plating, ASCs showed a dramatic increase in CD105 expression. Although some adherent ASCs lost CD34 expression with increasing culture time, our culture method maintained CD34 expression in ASCs for at least 10-20 weeks. These results suggest that liposuction-derived cells may be useful and valuable for cell-based therapies.

Adipocytes↗
PubMed2003

Rupture of fat cells using laser-generated ultra short stress waves.

BACKGROUND AND OBJECTIVES: Ultrasound-assisted liposuction has been investigated as an aid to breakup fat for its less traumatic removal, and minimizing the post-operative recovery period. This research focused on understanding the mechanism of fat interaction with laser-generated ultra short stress waves with high amplitudes. STUDY DESIGN/MATERIALS AND METHODS: Freshly extracted human fat was secured in an Aluminum (Al) cavity. Sixteen nanoseconds duration stress waves were generated by exfoliating the bottom surface of the Al cavity by focusing 3 nanoseconds-long YAG laser pulses over a 2 mm diameter area at 10 Hz with a maximum pulse energy of 0.95 J. The lipids released due to cell rupture were extracted and measured RESULTS: Four minutes of pulsing released about 0.005 g, which was over 1% of the initial weight of the tissue. In situ temperature rise of only 5 degrees C was measured at the maximum stress wave loading duration of 5 minutes. This was evidenced by histological sections, which showed no burn artifacts. CONCLUSIONS: This research shows that ultra short stress waves can mechanically cavitate fat in vitro without significant damage to adjacent structures, and forms the basis for future clinical work.

Adipose Tissue↗
PubMed2005

Histologic evaluation of the pulsed Nd:YAG laser for laser lipolysis.

BACKGROUND AND OBJECTIVES: Laser lipoplasty with pulsed Nd:YAG laser, widely used in Europe and Latin America, has recently been introduced in Japan and the USA. We report histologic analyses of the effects of the laser on human fat tissue. STUDY DESIGN/MATERIALS AND METHODS: Freshly excised human skin and subcutaneous fat were irradiated with the pulsed Nd:YAG laser (SmartLipo, DEKA, Italy). A 1,064 nm laser at 40 Hz and 150 mJ and 100 microseconds-long pulses were used. Methods of exposure were the same as in the clinical application. In the control group, the specimens were cannulated by the handpiece without irradiation. The tissue was studied by scanning electron microscopy and hematoxylin eosin staining. RESULTS: Scanning electron microscopy after irradiation showed greater destruction of human adipocytes than in the control. Degenerated cell membrane, vaporization, liquefaction, carbonization, and heat-coagulated collagen fibers were observed. CONCLUSIONS: Our study showed that the SmartLipo appeared to be histologically effective for destruction of human fat tissue.

Adipocytes↗
PubMed2006

Submental Nd:Yag laser-assisted liposuction.

BACKGROUND: Liposuction of the neck is currently one of the most common cosmetic surgical procedures. In the present study, the author describes his experience with neck and jowl laser-assisted liposuction. STUDY DESIGN/MATERIALS AND METHODS: In this procedure, submental lipodystrophy is treated with an Nd:YAG laser, at a 1,064 nm wavelength. Over a 5-year-period, 82 subjects were treated using 6-W power, 40-Hz frequency, 150-mJ energy, and 100-microsecond pulse width parameters. Histology was performed on fatty tissue samples. RESULTS: Submental laser-assisted liposuction resulted in significant cosmetic improvement. Histology revealed a rupture of the adipocyte membrane as well as collagen coagulation and channels along the fatty tissue. Additionally, small blood vessels were coagulated. An adequate skin contraction was observed with an improvement of the cervicofacial region. CONCLUSIONS: The Nd:YAG laser is a useful tool for the treatment of local lipodistrophy. The laser proved to be effective for cellular lysis and collagen neoformation.

Adipose Tissue↗
PubMed2001

Panniculectomy with simultaneous gynecologic oncology surgery.

OBJECTIVE: The objective was to report the utility and morbidity of panniculectomy in obese gynecologic oncology patients undergoing exploratory laparotomy. METHODS: A retrospective chart review of 41 consecutive women who had a panniculectomy as part of an abdominal gynecologic oncology procedure between July 1996 and May 2000 was performed. Obese patients possessing a large pannus, the majority with a BMI > or = 30 kg/m(2), were included. Demographic, preoperative, operative, and postoperative data were obtained. Statistical analyses were performed using Statistical Analysis System (SAS) Version 6.13. RESULTS: Panniculectomy was performed on 41 patients with a mean age of 55, weight of 126 kg, and BMI of 48 kg/m(2). The most common comorbidities in this population were hypertension, diabetes, and osteoarthritis. Wound infection occurred in 4 (9.8%) patients; 88% of the patients received a hysterectomy. The average EBL was 358 cc. Operative time and length of hospital stay were on average 203 min and 5.5 days, respectively. A prior history of diabetes increased the risk of early complications (P = 0.03). Late complications were more likely to occur in older women (P = 0.05). Wound complications were increased in patients with larger BMI's (P = 0.05). CONCLUSIONS: This study supports the safety of the panniculectomy procedure in this high-risk group of morbidly obese patients for whom a technical advantage may be achieved by improved operative exposure.

Adult↗
PubMed1992

Correction of deep gluteal depression by autologous fat grafting.

In the past, the traditional method of contouring the iliac crest and lateral femoral areas has been liposuction or the surgical removal of the bulges. Unfortunately, this method fails to correct the deep gluteal depression juxtaposed at these two sites. Since we use autologous fat grafts to correct contouring deficiencies elsewhere, it seems logical to investigate whether this technique is applicable to correcting this deformity. We have performed autologous fat grafting to the gluteal depression on 12 patients who underwent lipoplasty of the iliac crest and lateral femoral sites. The longest followup was one year. We have found that this method corrects the deep gluteal depression and yields an improved aesthetic contour. This article describes the technique, addresses the problems encountered, and shows postoperative results.

Adipose Tissue↗
PubMedDate not supplied

Rationale of subdermal superficial liposuction related to the anatomy of subcutaneous fat and the superficial fascial system.

The liposuction technique has changed greatly over the years. In 1989, the authors presented subdermal superficial liposuction which treats the superficial fat layer and yields better skin retraction. With this technique the surgeon can treat thin adipose layers to obtain better results in more cases than the traditional liposuction technique. The technique can be used in cases with difficult skin adjustment and in secondary cases when "deep only" liposuction has been performed and there were residual adiposities. Subdermal superficial liposuction evolved so that one could obtain good skin retraction by performing massive liposuction of all the fat layers. The authors named this technique MALL (Massive All Layer Liposuction). The technique is applied in body areas where the fat layer is very thick and stretches the skin because of its volume and weight such as in the abdomen, posterior arms, and internal surface of the upper third of the thighs. MALL liposuction drastically reduces the indications for abdominoplasty and inner thigh and arm dermolipectomies. Knowledge of the anatomy of the subcutaneous fat and the superficial fascial system allows one to explain the subdermal superficial liposuction from an anatomical point of view, to perform a more rational and effective procedure, and to differentiate the technique depending on the area of the body.

Abdomen↗
PubMedDate not supplied

Lipocontouring in breast reconstructive surgery.

The increasing popularity of the TRAM Flap for breast reconstruction has created a much greater request by many patients for further aesthetic improvement in the appearance of the new breast and of the abdominal donor site as well. This can be provided by greater use of a second-stage liposuction sculpturing of both the breast mound and the abdominal contours.

Breast↗
PubMed1993

Abdominal etching: differential liposuction to detail abdominal musculature.

Male athletes seeking improvement in the detail of their abdominal musculature have traditionally utilized vigorous exercise and a tightly controlled diet. Abdominal etching is a technique devised to enhance the appearance of the abdominal musculature by removing fat with liposuction at variable levels. The abdominal musculature is topographically visualized as the linea alba, linea semilunaris, and the transverse tendinous intersections within the rectus abdominous muscle. These landmarks are enhanced with localized superficial liposuction to deepen the natural grooves or furrows in these areas. We have performed abdominal etching on eight male patients with good to excellent results and minimal risks.

Abdominal Muscles↗
PubMedDate not supplied

Body sculpture: the words become reality.

The last decade has been marked by the development of liposuction. A better knowledge of the anatomy of fat tissue, together with an improvement in different devices, has made our results more predictable. However, such areas as the chin, anterior and inner thigh, and knee have remained "difficult." This is especially true when large volumes of fat need to be removed. Blood loss has remained a problem as well. The development of ultrasound (U.S.) liposuction is a big step toward even more predictable results and to where blood loss can be negligible.

Abdomen↗
PubMedDate not supplied

Equatorial breast reduction: a new technique for the correction of moderate-to-large mammary hypertrophy.

The author describes a personal technique for moderate-to-large breast hypertrophy, regardless of the degree of ptosis, based upon a personal experience of more than 200 breast reductions. It is a superior monopedicle nipple-areola flap procedure, which leaves an inverted-T scar. It was used in 35 cases over the last 3 years involving tissue reductions ranging from 500 to 1950 g per gland. All patients underwent follow-up evaluations 1, 3, 6, and 12 months after surgery. No complications were observed, and areolar sensation was preserved in all cases. Apart from its effectiveness in cases of massive hypertrophy and the absence of difficulties related to elevation of the nipple-areola complex, the equatorial technique offers the significant advantages of a simple preoperative marking phase and well-defined, reproducible parameters for reduction and reshaping. These characteristics reduce the need for subjective judgment and, therefore, the risk of error. The results obtained are highly satisfactory in terms of volume reduction, form, and symmetry.

Adolescent↗
PubMed1994

MALL liposuction: the natural evolution of subdermal superficial liposuction.

Subdermal superficial liposuction, first presented by the authors at the ISAPS Congress at Zurich in 1989, is performed with thin three-hole Mercedes cannulas (diameter ranges from 1.8 to 2 mm) to treat small and secondary adiposities and to allow better skin retraction. Suction of the subdermal layer of fat reduces the thickness and consistency of the superficial fat and enhances the possibility of skin retraction. In cases where there is a large adiposity of the abdomen, arms, or inner thighs, there is a conspicuous volume of fat whose weight tends to overstretch and to carry the overlying skin downward. In these cases we need to reduce the large fat volume to permit effective skin retraction. Therefore, we apply the principles of traditional liposuction with those of subdermal superficial liposuction to aspirate large amounts of fat from all the adipose layers. We call this technique Massive All Layer Liposuction (MALL). The amount of skin shrinkage after this "defatting" procedure is remarkable and the clinical results are very good. The MALL technique can be applied to other areas as well. In our experience this new liposuction technique has dramatically reduced the indications of abdominoplasties and dermolipectomies of inner thighs and arms.

Abdomen↗
PubMed1994

Progress report on multicenter study of laser-assisted liposuction.

Fifty-one patients underwent an FDA-approved study of laser-assisted liposuction in five plastic surgery centers. The YAG laser fiber is contained within the cannula and shears off the fat cleanly and coagulates blood vessels as the fat is drawn into the cannula. The drop in hemoglobin was relatively modest after surgery. Patients were able to return to work at six days and to light exercise at seven days. Contralateral studies showed a slight benefit for the laser side at both one and eight weeks for ecchymosis, pain/discomfort, and edema. Lipocrit studies were inconsistent.

Adult↗
PubMed1994

Axillary approach for gynecomastia liposuction.

Liposuction through an axillary incision is used to treat pseudogynecomastia and true gynecomastia. It avoids the large undermining between the skin and the muscular plane that frequently occurs with usual procedures. When true gynecomastia is present, liposuction can be combined with an inferior periareolar incision for resection of the remaining glandular tissue. Unlike usual procedures that can lead to deep skin adherence, depression in the mammary area, or nipple-areola complex deformity, liposuction provides a well-defined contour for the male breast.

Adolescent↗