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PubMedDate not supplied

A new, T-shaped adaptor for easy, quick and efficient fat harvesting during liposuction.

Although there is a controversy about success and failure of autologous fat tissue transfers, it is a widely accepted method for soft tissue augmentation and is performed by many plastic surgeons as well as dermatologists all around the world. Its advantages are that it does not cause reactions, its absorption rates have been reduced by increased knowledge, experience, and techniques, it can yield good, long-term results, and there are now preservation techniques that allow reinjections when necessary. However, no single ideal technique has been determined. In this paper a new, simple, T-shaped adaptor for easy, quick, and efficient fat harvesting during liposuction is described. This study not only describes the clinical use of the adaptor, but also histologically examines its effects on fat cells under various vacuum pressures (-250 mmHg, -500 mmHg, -700 mmHg). The study shows that the cell structure of fat tissue harvested under medium power (with vacuum pressures of -250 mmHg and -500 mmHg) is not disrupted, while that of tissue harvested with a vacuum pressure of -700 mmHg was traumatized and occasional cell wall fragmentation occurred. In conclusion, it is shown that the T-shaped adaptor allows harvesting of the desired amount of fat tissue without causing trauma to fat cells when it is used with medium-power suction.

Adipose Tissue↗
PubMedDate not supplied

If you continue to smoke, we may have a problem: smoking's effects on plastic surgery.

Smoking causes various aero-digestive neoplasms, some cardiovascular diseases, respiratory pathologies, and cardiovascular disorders. Surgeons have observed an association between impaired wound healing and smoking. In plastic surgery, cigarette smoking should be forbidden before and after surgery to prevent poor surgical results. In this retrospective study, we presented four major complications related with continuous smoking immediately after surgery. Although we have strongly forbidden smoking for every patient, 4 patients did not follow our advice and continued to smoke. One of them had a breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap. Another patient had an abdominoplasty. The third and fourth patients had digital replantation and they were chronic smokers. After their poor surgical outcomes, these heavy smokers received close supervision, but managed to smoke, anyway. Education, psychologic consultation, and sometimes refusing to perform aesthetic or reconstructive surgery are required to minimize postoperative complications.

Adult↗
PubMedDate not supplied

An efficient way to correct recurrent rectus diastasis.

BACKGROUND: Recurrent rectus diastasis is a troublesome complication because its correction requires an extensive procedure. CASE REPORTS: Two patients with recurrent rectus diastasis secondary to abdominoplasty corrected by plication of the anterior rectus sheath are presented. These patients had lateral insertion of the rectus muscles. They were treated by the advancement of the rectus muscles after undermining of the posterior rectus sheath and a two-layer closure to correct the rectus diastasis. Good cosmetic results and postoperative pain control were achieved in both cases. DISCUSSION: The causes, prevention, and treatment for this type of rectus diastasis are described. The main reason for recurrence of this deformity in these patients was lateral insertion of the rectus muscles on the costal margins. On the basis principle, an efficient technique to correct this deformity is described. A postoperative compute tomography scan with slices made at the same bony level as the preoperative control examination demonstrated total correction of rectus diastasis over a long-term follow-up evaluation. CONCLUSION: Advancement of the recti muscles seems to be a reliable method for correcting recurrent rectus diastasis in patients with lateral insertion of the recti muscles.

Abdomen↗
PubMedDate not supplied

Lipoabdominoplasty with selective and safe undermining.

Our objective is to present a new surgical concept for the aesthetic treatment of the abdominal region using the principles of liposuction associated with the traditional abdominoplasty. Lipoabdominoplasty is different from other techniques because it has the advantages of conserving perforator vessels of the abdominal wall, it preserves suprapubic sensibility, results in better abdominal contouring, has a low rate of complications, and a faster recuperation after surgery. The traditional abdominoplasty has been used for many years with several modifications intending to achieve better aesthetic contouring and to reduce complications. However, each modification solves problems only partially. The authors perform the surgery beginning with wet lipoplasty in superficial and deep fat layers. The skin below the umbilical scar is excised as in classical abdominoplasty. After that, selective and safe undermining of the dermocutaneous flap is done in the middle section of the upper abdomen between the borders of the rectus abdominis muscle, preserving mainly supply vessels of the abdominal wall.

Abdominal Wall↗
PubMed2004

Experience with more than 5,000 cases in which monitored anesthesia care was used for liposuction surgery.

BACKGROUND: Conscious sedation using monitored anesthesia care can provide a clinical spectrum from relaxation to moderate anesthesia. This middle ground between general anesthesia and "pure" tumescent liposuction can help facilitate patient comfort and surgical proficiency during the procedure. OBJECTIVE: To describe a method of liposuction surgery with monitored anesthesia care in which a designated licensed and qualified individual is responsible for administration of supplemental intravenous conscious sedation as well as continuous monitoring of the patient. METHODS: Conscious sedation is induced with midazolam, and the patient is titrated to level II-V on the Ramsey sedation scale with propofol. The basic surgical technique is that of tumescent liposuction. However, the supplemental conscious sedation allows the tumescent fluid to be infiltrated at higher rates and fat extraction to be completed in a shorter period with minimal or no discomfort. RESULTS: In the authors' experience with more than 5,000 cases of liposuction surgery using this method, safety and efficacy have been proved. No patients have experienced significant adverse effects. CONCLUSION: Tumescent liposuction surgery with monitored anesthesia care provides a middle ground between general anesthesia and purely tumescent liposuction.

Anesthesia, Local↗
PubMed2004

Metabolic modulation by lipoplasty: a case report and invitation for investigators.

Metabolic modulation refers to the change in glucose metabolism that may be caused by the reduction in body fat after large-volume liposuction. Since the authors began doing liposuction in 1989, they have had several diabetic patients whose insulin or oral diabetic needs have been substantially reduced after liposuction. When the charts for these patients were reviewed, it was found that they had improved diets, increased exercise, and decreased weight. The authors were uncertain about the relation between fat removal and metabolic modulation. They recently had a patient whose fasting blood sugar went from 200 to 100 mg after large-volume liposuction, and has stayed that way for more than 1 year. In addition, this patient lost 60 more pounds in the year after liposuction. It appears that removal of fat may improve several metabolic parameters, so the authors have started a multicenter study to evaluate this finding.

Adult↗
PubMed2004

The concentric medial thigh lift.

Plastic surgeons often are asked to perform horizontal medial thigh lifts because the skin of this area has poor elasticity, inducing excess skin, and also because there is upper fat deposit. This excess skin and fat lead to irritation and even functional problems. But surgeons dislike this operation because of its justified bad reputation. Obviously, this area is difficult to manage because of the many possible side effects (e.g., healing difficulty, scar migration, necrosis, effusions, pain) and unreliable results. A new way of thinking is proposed to lighten this operation and make its more frequent use possible. This horizontal technique presents several innovating points: -A new incision line located along the labia major in the perineal crease remains at the same height backward. The incision never descends into the buttock fold. -No undermining whatsoever occurs even in the resection area. Liposuction is the key to avoidance of any undermining. It is performed everywhere in the thigh, but most importantly under the resection area where all the fat must be eliminated to lighten the flap and favor its lifting. -The resection removes only the skin layers (epidermis and dermis) and not the liposucted tissue, which is very thin. Consequently, all lymphatic and other vessels are preserved, and the healing process is much easier. Moreover, there is no dead space after ascension of the flap and no risk of effusion. -The resection is realized on demand, depending on the excess of skin brought on the incision line by each anchor suture. Therefore, any tension on the skin closure is avoided. -The direction of the skin stretching is concentric toward the labia minor. Consequently, the length of the scar is shortened at both the front and the rear. -Anchor sutures pull a nonundermined skin, thus drastically decreasing the risk of necrosis. In the past 2 years, 25 patients, most of them as outpatients, have undergone surgery using this technique, with a real improvement in the quality of the result, as compared with the results from the standard technique.

Adipose Tissue↗
PubMed2005

Power-assisted lipoplasty versus traditional suction-assisted lipoplasty: comparative evaluation and analysis of output.

Power-Assisted lipoplasty (PAL) is a new method introduced to simplify and standardize surgical results of traditional suction-assisted lipoplasty (SAL). Comparative studies already have demonstrated PAL to be a handy, atraumatic, time- and fatigue-sparing technique. The authors performed a pilot study to compare the output capacity of PAL and SAL in 15 healthy female patients. The general and the specific per area outputs over 1 min from symmetrical areas were assessed. The results confirmed the efficiency of PAL (17.41% increase in average specific area output, as compared to SAL) and the distribution of fat in major "fat storage" areas such as the abdomen and the anterior thigh. Specific per area output indicated a higher suction capacity for PAL in all areas except the inner thigh. The efficiency of PAL seemed to be less influenced than that SAL by fat distribution.

Adipose Tissue↗
PubMed2004

Prilocaine plasma levels and methemoglobinemia in patients undergoing tumescent liposuction involving less than 2,000 ml.

BACKGROUND: As a reaction to reported adverse outcomes after lidocaine infiltration in tumescent liposuction, prilocaine has gained increasing popularity. Previous studies investigating large-volume liposuction procedures found maximum prilocaine levels and methemoglobinemia up to 12 h postoperatively, suggesting that liposuction should be performed as a hospital procedure only. The aim of this study was to determine prilocaine plasma levels and methemoglobinemia in patients after low- to average-volume liposuction for the purpose of defining the required postoperative surveillance period. METHODS: In 25 patients undergoing liposuction involving less than 2,000 ml prilocaine levels and methemoglobinemia were measured over 4 h postoperatively. Liposuction was conducted after the tumescent technique using a 0.05% hypotonic prilocaine solution with epinephrine. RESULTS: The average prilocaine dose was 6.8 + 0.8 mg/kg, with a maximum dose of 15 mg/kg. The peak prilocaine plasma level of 0.34 mug/ml occurred 3 h after the infiltration. The mean methemoglobinemia at this time point was 0.65%. Only one patient demonstrated a slightly elevated methemoglobin level of 1.4%, but lacked any clinical signs of methemoglobinemia. The prilocaine recovery in the aspirate averaged 36 +/- 4%, indicating that a large amount is removed by suctioning. CONCLUSIONS: The patients did not experience high plasma levels of prilocaine or methemoglobinemia undergoing liposuction involving less than 2,000 ml using a 0.05% hypotonic prilocaine solution. The authors therefore conclude that this procedure can be performed safely with a monitoring period of 12 h.

Adult↗
PubMedDate not supplied

Quantitative analysis of liposuction with B mode ultrasound.

BACKGROUND: The objective of this study was to determine whether ultrasonography is a reliable method for monitoring subcutaneous fat thickness in the quantitative analysis of liposuction results. METHODS: Subcutaneous fat thicknesses before and 2 months after liposuction in prespecified areas were measured in 14 patients using a 7.5-MHz ultrasound scanner. Pre- and postoperative subcutaneous fat thicknesses were compared statistically. RESULTS: The thicknesses of pre- and postoperative subcutaneous fat layers were statistically different. CONCLUSION: Ultrasound is a valuable tool for perioperative guidance, preoperative planning, and quantitative analysis of the procedure results.

Adipose Tissue↗
PubMed2005

New observations in liposuction-only breast reduction.

BACKGROUND: Breast reduction surgery is known to be more effective than medications, diet, or support bras in relieving the suffering from excessively large breasts. Liposuction-only breast reduction, without surgery, is effective for eliminating symptoms and significantly reduces scarring and complications. The procedure allows women to maintain nipple sensation and the ability to breast-feed. The author describes his technique, results, and new observations over a 2-year period. METHODS: The results from the charts and photos of all patients in the study group were retrospectively reviewed. RESULTS: The patients were very satisfied with the results of their treatment. New observations are detailed. Complications were minimal. No cases of increased ptosis resulted from suction. CONCLUSIONS: Breast liposuction is an excellent technique that reduces scars, complications, recovery, and costs. It is a technique that should be readily available to women in every society.

Adolescent↗
PubMedDate not supplied

Lipoabdominoplasty: liposuction with reduced undermining and traditional abdominal skin flap resection.

Abdominoplasty surgery has spread universally, as both an aesthetic and a reconstructive procedure, and new techniques are appearing with the goal of minimizing ischemic complications of the flap and bettering body contour. The purpose of this article is to demonstrate that an abdominoplasty technique with limited undermining and preservation of the flap perforator vessels makes it possible to reduce the complication rate attributable to flap necrosis and seroma in abdominoplasty. Doppler flowmetry color study of the abdominal wall was performed before the surgical procedure and on postoperative day 15 after lipoabdominoplasty for a series of 20 patients to evaluate the blood supply of the abdominal wall. This study confirmed the preservation of perforator arteries in the periumbilicus area and right upper quadrant after abdominoplasty with liposuction and reduced undermining.

Abdominal Wall↗
PubMed2005

Analysis of laser lipolysis effects on human tissue samples obtained from liposuction.

BACKGROUND: The use of the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser as an auxiliary tool for lipoplasty has refined the traditional technique. The primary limitation of the traditional technique-large volume blood loss-is addressed by the use of the Nd:YAG laser. This report describe's the technique of laser- assisted liposuction, then reviews and compares the histologic and morphometric effects with those of the traditional method. METHODS: The Nd:YAG laser was used to produce the desired injury to the adipose tissue after sufficient contact. Laser lipolysis was performed on the patient's right flank in two different areas, with the application of 1,000 and 3,000 J of accumulated energy (in), respectively. Subsequently, another cannula was introduced to suction the liquid content obtained by laser lipolysis. This tissue product was sent to the pathology laboratory for morphologic and morphometric analysis, and for comparison with material obtained from traditional lipoplasty performed on the left flank of the same patient. RESULTS: The histopathologic examination of adipose tissue after laser lipolysis showed cell swelling and less bleeding, as compared with the traditional method. The morphometric analysis showed that the mean diameter of the major adipocyte was 95.69 microm with laser lipolysis using 1,000 J (in), 82.63 microm using 3,000 J (in), and 84.54 microm with the traditional method CONCLUSIONS: The traditional method produced less reversible cellular damage (swelling) than laser lipolysis using 1,000 J (in). The area receiving 3,000 J (in) showed major irreversible damage (cytoplasmatic retraction and disruption of membranes). For this reason, the mean diameter of the adipocyte was less.

Adipose Tissue↗
PubMedDate not supplied

Treating the banana fold with the dermotuberal anchorage technique: case report.

The banana fold, or the infragluteal fold, is a fat deposit on the posterior thigh close to the gluteal crease and parallel to it. A banana fold may form for different reasons, among which an iatrogenic cause is recurrent. Although banana fold is a common problem, unrelished by most women, few procedures are targeted specifically to fight it. This report presents a severe case of iatrogenic banana fold corrected by a modification of the dermotuberal anchorage buttock-lifting technique, as reported by the author for gluteal ptosis. The operation is performed by tucking in part of the banana fold tissue caudal to the gluteal crease, sliding that tissue, after depithelization, under the buttock, and pulling it up toward the ischial tuberosity until the redundant skin on the posterior thigh is tight and the banana fold is reduced. Assessment of the results 1 year after surgery showed that the technique provided a good scar kept within the subgluteal crease, and that it satisfactorily corrected the patient's major complaint: the banana-shaped fold.

Adipose Tissue↗