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PubMed1994

Serial and superficial suction for steatopygia (Hottentot bustle).

Steatopygia, from the Greek "steato" meaning "fat" and pygia meaning "buttocks," is defined as excessive fat of the buttocks, usually seen in women and sometimes called Hottentot bustle because it was commonly seen in the Hottentot people of southern Africa. This affliction is characterized by protrusion and excessive fatness of just the buttocks region. Our patient was not particularly overweight (166 lb) and had a reasonably thin waist and legs. However, her buttocks were so protruding as to appear to have been from a completely different person. She wore only full skirts and could never wear jeans or pants of any kind. By using both superficial and deep serial suction techniques we were able to remove 12.5 L of subcutaneous fat over a two-year period without hospitalization or exogenous transfusion. The superficial technique improved skin retraction.

Adult↗
PubMedDate not supplied

Effect of large-volume liposuction on sex hormones and glucose- and lipid metabolism in females.

Nine consecutive patients who underwent syringe-assisted liposuction with a mean aspirate volume of 3633 mL (range: 1800-5500) had their lipids, lipoproteins, and sex hormones measured pre- and postoperatively. Seven of the patients also underwent an oral glucose tolerance test with measurements of insulin and C-peptide. The major finding was a significant increase in HDL cholesterol and apolipoprotein A1, while there was no significant change in sex hormones or glucose levels 9-12 months after the liposuction procedure. The results indicate that large-volume liposuction might decrease the risk of cardiovascular disease in these patients.

Adult↗
PubMed1992

Superficial liposuction: a new application of the technique for aged and flaccid skin.

From 1982 to 1991, 2500 patients underwent liposuction to thin the superficial areolar layer of fat. The patients were of all ages and had different types of skin. From the results the author concludes that the new superficial liposculpting, based on the controlled scar retraction of the thin cutaneous adipose flap remaining after the treatment, allows for very good results even in very flaccid and aged skin. A digital molding of the residual fat also improves the contouring. So-called "cellulite" is finally meliorated.

Adolescent↗
PubMed1992

Felman double-liposuction cannula.

This article presents the design of a new double-liposuction cannula that can be used in major lipodystrophy. The new cannula enables constant flow of sterile solution during liposuction to wash out the remaining destroyed fat tissue and blood clots in "tunnels."

Catheterization↗
PubMedDate not supplied

Neck recontouring with suture suspension and liposuction: an alternative for the early rhytidectomy candidate.

The authors present a new technique that uses liposuction of the submental and submandibular areas to remove fat and initiate skin contracture. The technique also includes platysmal resection and the use of interlocking sutures running through a subcutaneous tunnel immediately below the submandibular border. The results of the procedure are a recontoured neck and highlighted mandibular border.

Adult↗
PubMed1994

Endoscopic full facelift.

This article demonstrates the efficacy of endoscopic techniques in total facial rejuvenation. The author has introduced the total subperiosteal dissection to the endoscopic forehead lift. This concept has been extended to the rejuvenation of the central and lower third of the face. Patients up to the late 40s can have a total facelift without skin excisions. In older patients, the introduction of endoscopic techniques helps to minimize some of the undesirable sequelae of the traditional open procedures such as alopecia, scalp paresthesias, and facial edema of the subperiosteal lift. The author also introduces a new, more efficacious method of midface suspension.

Adult↗
PubMed1994

Liponecrotic cysts after augmentation mammaplasty with fat injections.

A 26-year-old woman underwent breast augmentation with fat injections from trochanteric liposuction. After one year firm lumps developed in both breasts. Surgical treatment included excising the cysts through an inframammary approach. Volume replacement consisted of a silicone gel prosthesis inserted through an axillary retropectoral approach. In a second stage, a supra-areolar dermopexy was done to centralize the nipple-areola complex.

Adipose Tissue↗
PubMedDate not supplied

A "bicycle-handlebar" type of incision for primary and secondary abdominoplasty.

The authors register a revision of the literature regarding the types of low transversal pubic incisions used in abdominoplasty. Since 1987, the traditional open W-type incision changed to a new type called the bicycle handlebar. In this procedure, the pubic segment remains in a lower line at the level of the pubic hair, while the lateral limbs are in a high position. The anterior superior iliac spine is used as reference. Different types of procedures where the umbilical skin hole reaches the pubic incision are described and illustrated. This procedure is also used in secondary abdominoplasty. In all cases, the incision's new position should remain hidden under a bathing suit.

Abdomen↗
PubMedDate not supplied

Tumescent and syringe liposculpture: a logical partnership.

Liposuction has been traditionally performed under general anesthesia. Standard instrumentation for the procedure has included blunt-tipped suction cannulae connected to an electric vacuum pump by noncollapsible tubing. A subcutaneous injection of Lidocaine with Epinephrine is routinely employed to minimize blood loss during the procedure. This infiltration has been described as the "wet technique," but it is not a method to supplant general anesthesia. The tumescent technique, a method of infusing very large volumes of dilute lidocaine with epinephrine solutions, has been advocated as a satisfactory means for providing conscious anesthesia for liposuction procedures, avoiding the need for general anesthesia. The syringe technique employs blunt-tipped suction cannulae connected to a syringe. Drawing back the syringe plunger generates the negative pressures needed to remove fat during liposuction and replaces the electric vacuum pump and connecting tubing traditionally used for this procedure. This study evaluates the combined tumescent and syringe techniques for liposuction. One hundred consecutive patients were treated with the tumescent technique as the sole means of anesthesia and the syringe technique as the sole means of performing liposuction. A modified tumescent formula is presented. A comparison of liposuction aspirates using this modified tumescent technique is compared and contrasted to liposuction aspirates obtained using the "dry technique" and the "wet technique." A historical review of the syringe technique and its perceived attributes is also presented. Technical descriptions of the tumescent infusion method, tumescent fluid formulation, and suggested patient sedation and monitoring is presented. Photographic documentation of patients who underwent the combined tumescent and syringe liposculpture treating various body areas is shown. A critical analysis of the limitations of this combined technique is also described noting added time requirements, difficulties with under-correction of deformities, and need for reoperation, methods for determining the "end-point" for the procedure, as well as addressing large-volume liposuction problems. The conclusion reached by this study is that combining the tumescent technique and the syringe technique is a logical partnership. Each method complements the other, allowing liposuction to be performed with considerable advantage over traditional methods. These advantages include eliminating the need for general anesthesia, lessening blood loss and postoperative bruising, greater accuracy, precision, and overall high patient satisfaction.

Adolescent↗
PubMedDate not supplied

The saddle lift for tight thighs.

Efforts to tighten the lateral thigh skin and subcutaneous tissue after liposuction may result in conspicuous scars on the hips, groin crease, or medial thighs. We have developed a technique that enables the excision of skin and subcutaneous tissue, measuring about 20 x 10 cm2, from the inner thigh and central buttocks crease where the scar can be completely hidden. We present a patient who, after appropriate liposuction, had a nearly perfect silhouette but who continually complained about the looseness of the skin on her lateral and posterior hips. The patient suggested that we remove the skin and subcutaneous tissue from the middle portion. We did so and the results were surprisingly good. We recommend this procedure for those patients in whom no external scar is acceptable and who require tightening of the skin of the upper thighs and buttocks.

Adult↗
PubMedDate not supplied

Liposuction fat-fillant implant for breast augmentation and reconstruction.

The perfect breast implant fillant material would have higher viscosity than water and would be autologous and harmless. We describe the confinement of liposuction fat in implants using the Lipovacutainer during a routine liposuction procedure. This collected fat is prepared inside the Lipovacutainer and is reinjected through a Lipomedia filling cannula into a leaf valve implant as the fillant in place of saline. The implants are used for bilateral augmentation mammoplasty and breast reconstruction procedures. Our six clinical cases have been monitored closely using mammography and MRI. These cases showed slow liquefaction without interference with mammography studies. We obtained excellent overall body contours. All complications were correctable and non-life-threatening and there was no capsule formation.

Adipose Tissue↗
PubMedDate not supplied

Musculoaponeurotic plication in abdominoplasty: how durable are its effects?

Abdominal myofascial plication has become an integral part of aesthetic abdominoplasty in an effort to narrow the waistline. Out of concern for the durability of this procedure, we performed a study using standard radiographs and clinical photographs to determine if there was long-term separation of the plication. Nine patients were entered into the study. In one patient immediate total separation of the plication occurred, and in another no separation occurred at all. The remaining patients' plication separated over only a 1-3-cm distance in the central part of the abdomen (original maximum width of plication was 12-16 cm). Aesthetic appearance was not compromised by this minor degree of separation. We conclude that the effects of musculoaponeurotic plication are durable.

Abdomen↗
PubMed1994

Blood loss during liposuction using the tumescent technique.

Blood loss during liposuction has been a concern when more than 1500 mL of material are removed during one session. Several authors have claimed that blood loss is dramatically reduced when the targeted area is infiltrated with large amounts of dilute lidocaine with epinephrine ("tumescent" or "superwet" technique). Using this technique, 25 consecutive cases in which the liposuction aspirate was expected to be 1000 mL or more were investigated with pre- and postoperative measurements of hemoglobin. In addition, hemoglobin was also measured in the fluid fraction of the aspirate. The mean +/- SD aspirated volume was 1658 +/- 518 mL and the mean +/- SD fall in postoperative hemoglobin was 0.7 +/- 0.6 g/100 mL (5.4% +/- 4.9%). The mean amount of blood per liter of aspirate was calculated to be 10.5 +/- 5.2 mL. These results clearly demonstrate that the blood loss when using the tumescent or superwet technique is dramatically reduced compared with the dry or classical "wet" technique.

Adult↗
PubMed1994

Circumferential "intermediate" lipoplasty of the legs.

Circumferential intermediate lipoplasty of the thighs and lower legs is an expansion of the traditional lipoplasty technique. Rather than limiting the correction to defined bulges, the goal is to thin the thigh or the calves and ankles circumferentially. This procedure is not indicated for all patients. In selected patients with extremely heavy thighs, medial and lateral bulges, full anterior thighs, and a full posterior thigh in the upper third, circumferential liposuction improves the results and produces a slimmer thigh. In the calves and ankles, circumferential lipoplasty reduces the entire lower leg giving a more attractive result rather than just reducing the medial and lateral ankle bulges. The concept of intermediate lipoplasty is introduced. This technique has advantages over the superficial technique and the traditional deep lipoplasty. No special equipment, incisions, drains, or change in technique is needed. Using circumferential intermediate lipoplasty to contour the entire lower leg results in a slimmer looking leg. There has been no increase in complications. The author reviews his experience with this technique.

Adult↗
PubMed1993

Use of Reston foam in liposuction.

Use of Reston foam along with a pressure garment after liposuction results in three salutary effects: less waviness in the skin surface, a more comfortable recovery, and less blood loss and ecchymoses. Free fat cells are thought to be redistributed evenly by the pressure of the foam plus the pressure garment. The result is a smoother skin surface with less waviness. Reston foam is also comfortable under the pressure garment and there is less immediate postoperative tenderness. In addition, the use of the foam, in conjunction with the pressure garment, results in less postoperative bleeding and bruising. Consequently, there is also a decrease in the amount of postoperative fall in hematocrit. Since there is less of a drop in hematocrit and hemoglobin, there is also less postoperative anemia. The mechanism involved in the reduction in blood loss is thought to be a combination of overcoming capillary pressure and stabilization of the skin and subsurface blood vessels.

Adipose Tissue↗
PubMed1993

Syringe liposculpture revisited.

Syringe liposculpture was introduced by Fournier almost a decade ago. Recent advances have improved the technique, making it easier for the surgeon to use. To determine the efficacy of the syringe in reducing morbidity, groups of patients who had between 1200 and 1500 mL of adipose tissue removed were evaluated using different infiltration and power source (syringe vs machine) regimens. There was less blood lost when the syringe was used. In addition, syringe-treated patients appeared to heal faster, return to work in a shorter period of time, and have less pain. The advantages of the syringe technique are considerable and increase the safety factor of the liposculpture procedure.

Blood Loss, Surgical↗