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The waist and abdominoplasty.

Basing our work on ideal aesthetic features of the feminine figure and focusing our attention on the waist, we add several points to the abdominoplasty classification. We have carried out 150 abdomino plasties in the last 5 years: 60% of the patients presented with musculoponeurosis alterations, for whom plicature of the rectus abdominis and obliques with wide dissection was accomplished, and 40% with mainly fat excess at the flanks, on whom limited dissection and liposuction were performed. Our objective was to achieve an ideal waist for each patient.

Abdomen↗
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Medial thigh lift and DE.C.LI.VE.

Vertical dermocrurolipectomy is a technique that in Italy has been named "DECLIVE," (which in Latin means something that moves downward). The first medial thigh lift with the DECLIVE technique was done in 1993. Since then, based on its excellent results 50 patients have been operated on, following DECLIVE. Therefore, DECLIVE should be considered just a variant in the medial thigh lift, because resecting a triangular portion from the perivulvar skin, it stops the displacement of the scar downward. Special acknowledgment goes to Ted Lockwood's studies for his role in the development of this technique.

Cicatrix↗
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Midiabdominoplasty: indications and technique.

In the treatment of aesthetic deformities of the abdomen there are three points we should analyze: the skin, the fat tissue, and the muscles. Based on these points we can classify it into six groups. Midiabdominoplasty is indicated in the correction of deformities of groups 2, 3, and 4. A small fusiform resection of skin is done in the lower abdomen, undermining of the skin up to the umbilicus (or to the xiphoid appendix if necessary to treat diastasis of the rectus muscles in the supraumbilical region), and desinsertion of the umbilicus, with no external scar, are the main points in this technique. The main complication was the formation of seroma. No necrosis of the flap or unsightly scars were observed. The results were good, with the patients satisfied with their new abdomens.

Abdomen↗
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Liposculpture with ultrasound: biomedical considerations.

The authors, after a careful review of the scientific literature and on the basis of biophysical concepts with their own experience, conclude that high-intensity ultrasounds (US) are responsible for some biological lesions, which are partly unknown. US can cause burns and skin necrosis; thus, our employment of this technique must be correct, justified, and practiced very carefully and shrewdly and its advantages versus traditional liposuction must be reviewed.

Humans↗
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Liposuction of the kneecap area under tourniquet: a superdry procedure.

In this paper, we report our experience and describe the technique of liposuction under tourniquet. This technique facilitates liposuction in the kneecap area and makes it bloodless. The approach described is effective and necessitates a relatively brief intraoperative and postoperative period, with inherently less morbidity. We obtained satisfactory results using this simple procedure.

Humans↗
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Large-volume liposuction in 181 patients.

Liposuction is a commonly performed cosmetic surgery procedure that is associated with complications, including fatalities. Many of these have been associated with large-volume liposuction. During 1998 the American Society of Plastic Surgery Task Force on Lipoplasty and the Plastic/Cosmetic Surgery Committee of the Medical Board of California have both arbitrarily defined large-volume liposuction as greater than 5000 cc and asked that surgeons not remove any more than this volume except in specific circumstances such as a hospital-type setting [1]. This study includes 181 patients who have had greater than this amount of total aspirate removed in a single procedure. From January 1, 1996, to February 11, 1997, we used tumescent liposuction only (31 patients). From February 12, 1997, to June 30, 1998, we used a combination of ultrasonic liposuction using the Lysonix 2000 Ultrasonic Liposuction Unit and tumescent liposuction (150 patients). During the last part of the latter series we calculated the blood loss of 45 patients derived from preop and 5-day postop hematocrits. The results show that (1) there is no correlation between the aspirate volume and the calculated blood loss; (2) the majority of the calculated blood loss is not in the cannister; and (3) no deaths occurred, but one patient suffered a deep venous thrombosis and two patients suffered pulmonary emboli. As others have pointed out [2-6] large-volume liposuction can be performed relatively safely if this procedure is treated with the respect it deserves and the practitioner exercises sound surgical judgment, uses appropriate technique, and does not try to cut corners to save money for the patient by performing this surgery in minimal settings.

Adult↗
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Mega-liposuction: analysis of 1520 patients.

Fifteen hundred and twenty cases of liposuction/liposculpture were performed at Dr. M. Erfan & Bagedo Hospitals and King Abdulaziz University Hospital in Jeddah from January 1983 to December 1994. These cases were mostly females. The age group was from 16-65 years. Multiple procedures were performed in 11.68% of these cases. The change in hemoglobin and the hematocrit ratio pre- and post-operatively, and the incidence of complications, were studied. The percentage of surface area operated upon rather than the amount of fat removed was the most important relevant factor.

Adolescent↗
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Total corporal contouring with megaliposuction (120 consecutive cases).

The purpose of this study is to present the authors' long-term experience with total corporal contouring with megaliposuction. The evolution of body reshaping in one operative setting including simultaneous head and neck contouring, upper and lower extremity recontouring, and creation of an aesthetic trunk and abdominal form is discussed. Patient evaluation, operative techniques, postoperative management, and long-term results are emphasized. From February 1994 to February 1997, 120 consecutive patients underwent total corporal contouring with tumescent (Hunstad formula)-technique, classic liposuction. There were 10 males and 110 females. The average age of all patients was 28 years. Preoperative evaluation emphasized corporal shape and proportions. No other open procedures were performed simultaneously in these patients. The authors' postoperative regimen is discussed. The average amount of aspirated material in these series was 14,000 ml (range, 8000-20,000 ml). No blood transfusions were required. Complications included only hypopigmentation (N = 2) and postoperative seromas requiring aspiration (N = 12). Follow-up examination took place at 3 months to 3 years, with an average of 14 months. All patients underwent a metamorphosis from an amorphic shape to one that follows the normal body contours and profiles. The goals of megaliposuction are no longer just to reduce body fat and body mass. Individually planned surgery for these patients should be based upon obtaining normal symmetrical body proportions. Total corporal contouring and reshaping can now be safely performed, offering hope and predictable outcomes to this patient population. Patient evaluation, operative technique, postoperative care, and long-term results are presented.

Adolescent↗
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H-Shaped, double-contour plication in abdominoplasty.

H-shaped, double-contour plication, by reducing the longitudinal and transverse abdominal diameters, improves the waistline and reinforces the entire anterior abdominal wall, with better accommodation of the cutaneous flap. The decrease in the longitudinal diameter allows lowering and fixation of the cutaneous flap without tension.

Abdominal Muscles↗
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New indications in the approach to the pendulous abdomen.

The appearance of the superficial liposuction technique has permitted the surgeon to advance in his indications for treating localized lipodystrophy, without skin resection. With the cutaneous retraction phenomenon that follows superficial liposuction, pendulous abdomen, which was once treated by classical dermolipectomies, can now be treated with liposuction alone, obtaining satisfactory results. The authors recommend this form of treatment for patients with pendulous abdomen and with good skin quality, with few or no stretch marks, and with little or no diastasis of the rectoabdominal musculature.

Abdominal Muscles↗
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Analysis of methods for reporting severe and mortal lipoplasty complications.

During the past 2 years, media attention has focused on catastrophic outcomes associated with liposuction. A critical review of the lipoplasty literature was undertaken to determine the incidence of severe and mortal complications. Reported lipoplasty complications and patient outcome studies published in the English literature through January 1, 1999, were reviewed. From these and from ASPRS questionnaire surveys of experienced, board-certified plastic surgeons, it is apparent that (1) plastic surgeons do not often voluntarily report severe and mortal complications (either as case reports or in self-reported series), and (2) while survey studies provide the most accurate estimate of complications due to lipoplasty, they are subject to an underreporting bias because they exclude complications occurring in the hands of residents and junior attendings. The mortality from lipoplasty procedures is higher than the 0.003 to 0.02% reported in the literature and may be as high as 0.1%.

Humans↗
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Ultrasound-assisted lipoplasty: is It really safe?

During the last decade liposuction has become the most common aesthetic procedure. It has also become the most common aesthetic procedure performed by physicians not trained in plastic surgery. New developments such as the tumescent technique, finer cannulas, and, finally, the technique of ultrasound-assisted lipoplasty (UAL) have been paralleled by reports of larger amounts of extracted fat. At the same time we see an increasing number of fatal complications. I have undertaken an investigation of 28 patients during 16 months, undergoing liposuction with UAL, to find out how the procedure affected them in terms of blood loss. I found that, while undergoing UAL, our patients lost up to 53% of their blood volume on postoperative day 1, and the average patient still had a loss of 20% of the blood volume 1 week postoperatively.

Adult↗
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Umbilical restoration in abdominal dermolipectomy: A simple double-Y, double-M technique.

The authors present a simple technique for restoration of the umbilicus in abdominal dermolipectomy. This procedure is represented by a double-Y cutaneous incision on the abdominal skin and by a double-M cutaneous incision on the umbilical skin. This technique restores a neoumbilicus with multiple small skin flaps and conceals the periumbilical scar at the bottom of the umbilicus. Different designs and figures are proposed to explain the procedure.

Abdomen↗
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Power-assisted lipoplasty (PAL): A clinical pilot study comparing PAL to traditional lipoplasty (TL).

The subject of this paper is a study designed to compare power-assisted lipoplasty (PAL) to traditional lipoplasty (TL) in 30 patients. PAL was used on one side and TL was used on the matching contralateral body area. In PAL, a cannula powered by medical-grade nitrogen (N(2)) reciprocates between 2000 and 4000 cpm with a 2-mm stroke. The device is commercially offered by MicroAire Surgical Instruments. While there was no difference in the speed of recovery or in the aesthetic quality of the result between the two sides, PAL was found considerably superior as far as ease of fat extraction.

Adult↗
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Preoperative normovolemic hemodilution in aesthetic plastic surgery.

Normovolemic autotransfusion was used with 11 healthy females who were about to undergo multiple aesthetic plastic surgeries. After collecting a unit of blood immediately prior to surgery, a quick infusion of isotonic saline solution is made, at a 4-to-1 ratio, until reaching a hematocrit equal to or lower than 30%, thus inducing olighemia. The intended consequence is that blood lost during surgery be poor in red cell mass, which means reduced blood loss, leading to improved tissue oxygenation and decreased risk of thromboembolism. The blood thus collected is reinstilled at the end of the intervention. Results indicate that the technique can be prescribed and bring benefits to any patient entering surgery for which the surgeon anticipates heavy blood loss. The method proposed herein is presented as an alternative to homologous and autologous programmed transfusions and as equivalent to these in terms of volume replenishment.

Adult↗
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Liposuction in atypical cases.

Liposuction has become the most frequent aesthetic procedure, and its indications continue to expand to different areas of plastic surgery. In this article the authors present their experience with liposuction in the treatment of nine cases termed "atypical," for not being purely aesthetic. Included are four congenital lipodystrophies-occult spinal disraphism, osteogenesis imperfecta, congenital lipomatosis difusa, and Klinefelter syndrome-and five acquired ones-posttraumatic lipoma, posttraumatic asymmetry, insulinic hypertrophic lipodystrophy, adiposis dolorosa, and TRAM flap. Particular features of each lipodystrophy are reviewed and details of fat distribution and density are described. We also review some specific details of the technique. On the other hand, we wish to point out the importance of recognizing and correctly diagnosing some specific lipodystrophies that are part of defined clinical patterns and that require an integral therapeutic approach.

Adolescent↗