Unfavourable outcomes of liposuction and their management

Innovative Glove Drains for Seroma Prevention in Body-Contouring Surgery: Retrospective Findings

OBJECTIVE

The purpose of this study is to present an innovative and efficient alternative to conventional silicone drains for seroma prevention, aiming to enhance patient outcomes and satisfaction post-liposuction.

PATIENTS AND METHOD

In this retrospective, comparative study, we evaluated a total of 300 patients, divided into two groups. All patients underwent liposculpture of the back and hips, either as a standalone procedure or as part of lipoabdominoplasty or Mommy Makeover interventions: Group I (n = 150) patients without drain placement and Group II (n = 150) patients with drain placement. We assessed seroma formation in each group over a 2-week postoperative period, along with other complications.

RESULTS

Seroma formation represented the second most frequent complication (n = 14, 4,6 %). In the "no-drain" group the incidence was 8% (12 patients), and in the "drain" group seroma was recorded in 1.3% (2 patients), supporting a statistically significant reduction in seroma formation (p < 0.05). All cases responded to percutaneous aspiration with more punctures needed in the "no-drain" group. No systemic complications were recorded.

CONCLUSION

The addition of liposuction during surgical body-contouring procedures does not significantly increase the rate of complications, while achieving excellent aesthetic results. The innovative drain used in our study provided results comparable to traditional tube drains but with less patient discomfort, better compliance, and enhanced postoperative healing quality.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effect of Tranexamic Acid Administration During Liposuction on Bleeding Complications and Ecchymosis: A Systematic Review

Liposuction is the most frequently performed cosmetic procedure. Tranexamic acid (TXA) has emerged as a promising blood loss reducing agent in plastic surgery, but its value in liposuction is still being studied. This systematic review investigates the safety and efficacy of TXA in reducing blood loss during liposuction procedures. A systematic review of PubMed, EMBASE, and Cochrane databases from inception to June 2023 was performed. The primary objective was to compare blood loss, hematoma rate, and ecchymosis from liposuction procedures in patients who received TXA with those who did not. The secondary objective was to assess the incidence of TXA-related complications. A total of 9 studies were included, published between 2018 and 2023, of which 8 were prospective and 1 was retrospective. A total of 345 intervention vs 268 control arms were compared. Follow-up time ranged from 1 to 14 days. Mean age and mean BMI ranged from 33 to 50 years and 23 to 30 kg/m2, respectively. Blood loss in aspirate was significantly less with TXA administration as assessed in 5 studies (P < .05). Of the 5 studies that described assessment of the incidence of ecchymosis, all reported less bruising with TXA use. Among all the studies, only 1 reported postoperative complications in 5 patients requiring transfusion in the control group (without TXA). The evidence provided in the literature suggests that TXA administration in liposuction is safe and effective for reducing blood loss and ecchymosis by both intravenous and local administration.

LEVEL OF EVIDENCE: 3 (THERAPEUTIC)

Lipedema: Complications in High-Volume Liposuction Are Linked to Preoperative Anemia

Background: Lipedema is a subcutaneous adipose tissue disorder mainly affecting women. Its progressive nature often requires high-volume liposuction for efficient pain reduction. However, aspiration volumes of more than 5 L within a single session may lead to a variety of complications. Thus, we examined the effect of high-volume liposuctions on lipedema patients and the incidence of associated complications. Methods: We analyzed perioperative differences in lipedema patients undergoing low- or high-volume liposuctions. Statistical analyses were performed, investigating postoperative complications and the correlation of patients' BMI, total amount of aspiration, duration of surgery, hospital stay and hemoglobin alterations. Complications were investigated according to the Clavien-Dindo Classification. Patients were divided in two groups based on the volume aspirated at liposuction (low-volume vs. high-volume liposuction). Results: Overall, 121 sessions were investigated. Mean total volume of aspiration was 8227.851 mL ± 3643.891. Mean preoperative hemoglobin levels were 13.646 g/dL ± 1.075 g/dL. Preoperatively, 7.44% of patients were anemic (Hb < 12 g/dL). Mean postoperative hemoglobin was 10.563 g/dL ± 1.230 g/dL. Postoperatively, 90.10% of patients showed Hb levels below 12 g/dL. Hemoglobin loss differed significantly between the two groups (p = 0.001). Significant correlations between pre- (p = 0.015) and postoperative (p < 0.001) hemoglobin levels and pre- (p < 0.001) and postoperative (p < 0.001) anemia with Class II complications were also seen. The total volume of aspiration did not correlate with complication rates (p = 0.176). Conclusions: Complication rates in high-volume liposuctions are hemoglobin-dependent rather than volume-associated. Preoperative anemia was the most influential for the occurrence of postoperative complications. To safely conduct high-volume liposuctions in lipedema patients, adequate patient selection and preoperative patient preparation are imperative.

Exosomes derived from minor salivary gland mesenchymal stem cells: a promising novel exosome exhibiting pro-angiogenic and wound healing effects similar to those of adipose-derived stem cell exosomes

BACKGROUNDS

Minor salivary gland mesenchymal stem cells (MSGMSCs) can be easily extracted and have a broad range of sources. Applying exosomes to wounds is a highly promising method for promoting wound healing. Exosomes derived from different stem cell types have been proven to enhance wound healing, with adipose-derived stem cell (ADSC)-derived exosomes being the most extensively researched. Considering that MSGMSCs have advantages such as easier extraction compared to ADSCs, MSGMSCs should also be a very promising type of stem cell in exosome therapy. However, whether MSGMSC-derived exosomes (MSGMSC-exos) can promote wound healing and how they compare to ADSC-derived exosomes (ADSC-exos) in the wound healing process remain unclear.

MATERIALS

The effects of MSGMSC-exos and ADSC-exos on angiogenesis in wound healing were investigated in vitro using CCK-8, scratch assays, and tube formation assays. Subsequently, the promotion of wound healing by MSGMSC-exos and ADSC-exos was evaluated in vivo using a full-thickness wound defect model in mice. Immunohistochemistry was used to verify the effects of MSGMSC-exos and ADSC-exos on promoting collagen deposition, angiogenesis, and cell proliferation in the wound. Immunofluorescence staining was performed to investigate the role of MSGMSC-exos and ADSC-exos in modulating the inflammatory response in the wound. Furthermore, proteomic sequencing was conducted to investigate the functional similarities and differences between the proteomes of MSGMSC-exos and ADSC-exos, with key protein contents verified by ELISA.

RESULTS

MSGMSC-exos exhibited similar effects as ADSC-exos in promoting the migration, proliferation, and tube formation of human umbilical vein endothelial cells (HUVECs) in vitro, with a comparable dose-dependent effect. In vivo experiments confirmed that MSGMSC-exos have similar wound healing-promoting functions as ADSC-exos. MSGMSC-exos promoted the neovascularization and maturation of blood vessels in vivo at a level comparable to ADSC-exos. Despite MSGMSC-exos showing less collagen deposition than ADSC-exos, they exhibited stronger anti-scar formation and anti-inflammatory effects. Proteomic analysis revealed that the proteins promoting wound healing in both MSGMSC-exos and ADSC-exos were relatively conserved, with ITGB1 identified as a critical protein for angiogenesis. Further differential analysis revealed that the functions specifically enriched in MSGMSC-exos and ADSC-exos reflected the functions of their source tissue.

CONCLUSIONS

Our study confirms that MSGMSC-exos exhibit highly similar wound healing and angiogenesis-promoting functions compared to ADSC-exos, and the proteins involved in promoting wound healing in both are relatively conserved. Moreover, MSGMSC-exos show stronger anti-scar formation and anti-inflammatory effects than ADSC-exos. This suggests that MSGMSCs are a promising stem cell source with broad applications in wound healing treatment.

Long-Term Outcome of Surgery for Grade 4 Gynecomastia: A Single-Center Experience

Background  Gynecomastia results in a feminine appearance of the male chest, leading to social embarrassment and loss of self-esteem in the afflicted males. Grade 4 gynecomastia is expected to have less than perfect results with liposuction and gland excision alone. This study was done to assess the long-term outcome of this surgery for grade 4 gynecomastia. Materials and Methods  From January 2021 to December 2022, 81 patients with grade 4 gynecomastia were treated by us. All the patients underwent vibration amplification of sound energy at resonance (VASER) and suction-assisted liposuction of the chest and side rolls with excision of the gland with crescentic lift in the cases with ptosis. A retrospective study was done to analyze the long-term surgical outcomes in these patients by review of clinical records. Results  Symmetry was achieved in 37/39 patients with grade 4a gynecomastia but only in 33/42 patients with grade 4b gynecomastia. The inframammary fold disappeared in 35/39 patients with grade 4a gynecomastia but only in 25/42 of grade 4b gynecomastia patients. Ptosis was corrected in 35/42 grade 4b gynecomastia patients. The mean follow-up was 15 months (range: 12-24 months). Only seven patients desired a second stage to correct the remaining deformity. Conclusion  Liposuction with gland removal alone in grade 4a gynecomastia and with liposuction with crescentic nipple-areola complex (NAC) lift in patients of grade 4b gynecomastia give satisfactory results in patients with massively enlarged breasts. While grade 4a gynecomastia has overall better results and lesser complications as compared with grade 4b gynecomastia, the latter also has acceptable outcomes. Realistic prognosis needs to be explained to the patient preoperatively.

Deep Tissue Sculpture in Neck Rejuvenation: Review of 641 Consecutive Cases

Background

Enhancing neck contour is a primary goal for individuals seeking facial and neck rejuvenation. However, the literature on deep neck sculpture and its potential complications is scarce.

Methods

The records of 641 patients with deep plane neck lift and deep tissue sculpture were reviewed retrospectively between 2014 and 2023. The surgical techniques used by the author were addressed comprehensively and supplemented with videos. The outcomes and complications were reported.

Results

A total of 1861 consecutive patients underwent deep plane facelift. Of these, 641 patients (34.4%) underwent deep neck surgery, with an average age of 52 years; 14.6% were men, and 29% were smokers. A total of 12.3% experienced complications after deep neck sculpture. The most common complications were subcutaneous serous collection (4.3%), followed by marginal mandibular neuropraxia (3.3%) and hematomas (2.96%). Parotid sialocele was the least frequent complication among enrolled patients (0.3%).

Conclusions

Deep neck sculpture presents an effective and safe technique for patients seeking neck rejuvenation.

Liposuction Port-Site Protection: Necessity or Needless Expense?

Background

Liposuction is the most common cosmetic plastic surgery procedure in the United States, and lipo-aspiration for fat grafting is gaining in popularity. The results are effective, but complications include seroma, contour irregularities, skin necrosis, and even death. Scarring, dehiscence, and infection at the port site, although minor, are a common and less-discussed problem. To date, no study has examined the local complication profile of patients treated with and without port-site protection.

Objectives

To evaluate the efficacy of silicone port protectors to decrease local complications after liposuction.

Methods

A retrospective review was performed on 60 consecutive patients treated for cosmetic liposuction or autologous fat transfer between August 2022 and March 2024. The first 30 patients underwent tumescent-based lipo-aspiration without port-site protectors and the following 30 with placement of a segment of suction tubing to protect the skin. Records were reviewed to determine patient demographics, amount of tumescent and aspirate, and complications at the port site.

Results

Sixty patients completed the study. There were no significant differences in patient demographics and surgical data between groups. Ten patients in the unprotected group and 2 in the protected group experienced port-site complications (33.3% vs 6.7%, P = .0093). Significantly more patients in the unprotected group experienced wound dehiscence (P = .0095), and there was a trend toward more patients requiring steroid injections and excisions and reclosures (P = .088 and .167, respectively).

Conclusions

In this cohort, patients treated with a port protection device suffered fewer local complications, requiring less wound management, steroid injections, and revisions.

Level of Evidence 3 Therapeutic

Comparing the safety and effectiveness of different liposuction techniques for lipedema

INTRODUCTION

Lipedema is a relatively common, frequently misdiagnosed, chronic condition that is often treated using liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL) are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aimed to assess the efficacy and safety of liposuction in patients with lipedema.

METHODS

Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with post-operative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, and 2 articles used PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity.

RESULTS

A total of 2542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). TTL, PAL, and WAL led to significant improvements in pain reduction P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). However, WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for the studies that used TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%).

CONCLUSION

Liposuction techniques, including TTL, PAL, and WAL, resulted in significant symptom improvement in patients with lipedema with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. To the best of our knowledge, this is the first meta-analysis investigating liposuction data in lipedema treatment.

Fibrosis Management Algorithm in Secondary Liposculpture

BACKGROUND

Liposuction is considered one of the most common procedures in plastic surgery. However, major postoperative complications such as visceral injury, fluid overload, and necrotizing fasciitis still occur. Likewise, minor complications such as ecchymosis, seromas, infections, and contour irregularities that do not threaten the life of the patient do generate significant dissatisfaction. Current evidence regarding the management of fibrosis after previous liposuction remains limited.

OBJECTIVES

The objective of this article is to standardize a management algorithm based on the extensive experience and successful results of the primary author (G.M.).

METHODS

Patients who underwent secondary liposculpture between August 2022 and May 2023 were evaluated prospectively. Inclusion criteria comprised females between 18 and 60 years old, nonsmokers, with a BMI < 35 kg/m2 and a history of previous body contouring surgeries. Identification of the patient's skin condition and subcutaneous lesions in the adipose tissue were obtained in detail. Statistical analysis of preoperative and postoperative medical photographs was also performed with the Fiji Biological image analyzer.

RESULTS

Photographic analysis of preoperative and postoperative photographs showed a statistically significant difference between the areas affected by fibrosis (P < .001). The most frequent clinical findings were depressions in 99% of the females (74), followed by soft nodules in 95% (70), hard nodules in 81% (61), adhesions in 47% (35), and finally cutaneous bursas in 4%.

CONCLUSIONS

Our classification system and management algorithm for fibrosis and contour irregularities is a safe and reliable tool. Results were objectively verified, yielding statistically significant outcomes.

LEVEL OF EVIDENCE: 3

Surgical Correction of Abdomen Irregularities after Liposuction: Case Series

Background

The occurrence of surface irregularities in the abdomen after liposuction is frequent and can be due to the fact that more liposuctions are being done nowadays, and perhaps, the fact that more noncore surgeons are doing it could be an important factor. These superficial changes compromise the aesthetic results of surgery, and their correction is a major technical challenge.

Methods

The author presents a systematized approach for surgical treatment of fibrosis and post liposuction irregularities. Twenty-three patients underwent liposuction and abdominoplasty or mini abdominoplasty by a single surgeon (G.B.B.) over a period of 24 months to correct superficial abdominal wall irregularities after previous liposuction. All patients underwent evaluation through digital photography by two independent senior plastic surgeons according to an objective aesthetic outcome scale, 12 months after the operation.

Results

All 23 patients showed an improvement in the appearance of the abdominal wall according to the aesthetic outcome scale used. Eighty-seven percent of the patients operated on in this series had previously undergone liposuction using technologies and 4.3% underwent liposuction alone. The overall minor complication rate was 26%. No major complications were noted.

Conclusions

The combination of liposuction, direct fibrosis removal, and flap tensioning (abdominoplasty or mini abdominoplasty) could correct in this series the multiple factors (fibrosis, skin laxity, residual fat deposits post liposuction) related to abdominal wall surface irregularities in a safe, effective, and reproducible manner.

Complicated Surgical Site Infection with Mycobacterium Abscessus After Liposuction and Affections of Corticosteroids in the Treatment Regimen: Three Cases Report and a Systematic Review

INTRODUCTION

Mycobacterium abscessus infection after liposuction/fat grafting is a rare complication that is hard to diagnose and treat. Misdiagnosis could result in treatment failure and prolonged hospital stays. The paradoxical reaction is another complication that rarely occurs in non-HIV patients infected with nontuberculosis mycobacteria. This study reported 3 cases infected with M. abscessus complicated by the paradoxical reaction after liposuction and fat grafting. It highlighted characteristics giving clues of the paradoxical reaction and a successful strategy. Also, a systematic review was conducted to comprehensively provide varied aspects of M. abscessus infection after liposuction and/or fat grafting.

METHODS

Three cases were retrospectively included reporting data characteristics of patients, cosmetic procedures, and treatment strategy. PubMed, Scopus, Virtual Health Library (VHL), and Global Health Library (GHL) were searched to find and include cases with M. abscessus infection after liposuction and/or fat grafting based on defined selection criteria. Relevant data were extracted and summarized. The risk of bias in included studies was assessed using JBI critical appraisal checklists.

RESULTS

Twenty-four articles were included in the systematic review. Symptoms often developed approximately 1 month after the cosmetic surgery. Culture, AFB, and PCR were common methods of diagnosis of M. abscessus after liposuction and/or fat grafting. It took about 33 days on average from the presentation to isolate and detect the pathogens. Antibiotics based on susceptibility testing results along with surgical interventions were effective methods of treatment. Our three cases which were complicated by the paradox were addressed by adding methylprednisolone for 2 weeks to the macrolide-based therapy.

CONCLUSIONS

Awareness of this disease should be widely raised among physicians for early diagnosis and proper treatments. Cultures of specimens and AFB should be repeated many times before excluding the possibility of Mycobacterium spp. A paradoxical reaction should be suspected if the symptoms were worse after the antibiotic therapy based on susceptibility testing results and proper surgical interventions, especially if patients had taken corticosteroids before being admitted.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Small Intestinal Perforation after 360-Degree Liposuction: A Case Report

OBJECTIVE

As one of the most commonly performed cosmetic procedures, liposuction is relatively safe. Bowel injury following liposuction is a rare but devastating complication, which necessitates hospital admission and surgical intervention. The authors highlight a case report describing the presentation, diagnosis, and management of a patient with bowel injury following liposuction.

CASE

A 58-year-old woman presented with abdominal pain, erythema, and discharge three days after 360-degree abdominal liposuction with concomitant fat grafting to bilateral buttocks at an outpatient surgery center. Bowel perforation was suspected after CT-scan revealed extraluminal gas in the abdomen and communication that traversed the peritoneum. Exploratory laparotomy was performed which demonstrated at least one site of distinct perforation of the small bowel and an area omentum noted to be inflamed, thickened and with a purulent rind. The patient underwent 20-cm small bowel resection and partial omentectomy temporarily closed with negative pressure wound therapy. After subsequent abdominal wall debridements the patient received ventral hernia repair with bridging mesh and abdominal closure.

CONCLUSIONS

While safe, elective cosmetic procedures are not without risk of serious and even fatal complications. Providers must be familiar with the presentation of bowel injury following abdominal liposuction to prevent delays in appropriate surgical and medical care.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Weight Loss After VASER-Assisted Liposuction

BACKGROUND

Liposuction is one of the most common procedures used for body contouring. In this study, we aimed to determine whether there is a weight change with VASER-assisted liposuction (VAL) procedure and the demographic factors affecting it.

METHODS

A total of 51 patients (30 females and 21 males) who underwent VAL between the years of 2020 and 2022 were included in the study. Participants' weights before VAL, body mass indexes (BMI), aspiration volumes, demographic data, and weights and BMIs one month after VAL were recorded and analyzed. In addition, the fat ratio in the aspirate was determined in ten patients.

RESULTS

The mean aspiration volume with VAL was 4832.50 ± 2373.26 ml in females and 5176.90 ± 1602.61 ml in males. Body weights (baseline, 90.34 ± 9.17 vs. 71.01 ± 8.87; one month later, 86.95 ± 8.34 vs. 66.28 ± 10.04: p < 0.001) and BMIs (baseline, 28.59 ± 2.97 vs. 26.40 ± 3.69; one month later, 27.54 ± 2.92 vs. 24.59 ± 3.76: p = 0.009) were higher in males than females, both at baseline and after VAL. There was a significant decrease in body weights and BMIs after VAL in both females (4.73 ± 4.73 kg) and males (3.39 ± 4.27 kg) (p < 0.001). However, no correlation was observed between the decrease in body weights and BMIs after VAL and gender, age, aspirate volume, and fat volume.

CONCLUSION

Although there was a decrease in mean body weight and mean BMI in both males and females one month after VAL, no associations were observed between weight drop after VAL and gender, age, aspiration volume, and fat volume. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Induction of fat apoptosis by a combination of synchronized radiofrequency and HIFEM technology: Human histology study

PURPOSE

With the growing demand for more effective fat reduction techniques, a combination of synchronized radiofrequency (RF) and HIFEM has been introduced. Preceding studies evidenced the ability of RF+HIFEM to maintain the fat tissue temperature at the levels necessary for adipocyte apoptosis while documenting the induced changes to the fat tissue during the several weeks after the treatment. This study aims to demonstrate the induction of apoptosis by RF+HIFEM technology in the early stages through the assessment of caspase-3 protein, one of the apoptosis-executing proteases.

DESIGN

In this two-arm, single-center, randomized trial, nine human subjects were enrolled and assigned into two groups, either the active group (N = 6) treated with both RF+HIFEM set at the highest tolerated levels or the sham group (N = 3) treated with 5% of the maximum RF+HIFEM power, serving as a control. All patients were scheduled to undergo one treatment visit of the abdominal area, two follow-up visits at 8 and 24 h, and one safety visit 7 days after the treatment. A punch biopsy (5 mm in diameter, approximately 10 mm in depth) was obtained from the abdominal area at the baseline and consecutive follow-up visits. Samples were fixed, and cut into 5 μm thick slices, and immunohistochemical staining was used to visualize the Caspase-3, revealing the adipocyte nuclei where apoptosis processes are in progress.

FINDINGS

Documented findings suggest that the temperature threshold of 43-45°C is required to initiate fat apoptosis and consequent reduction in adipocyte number was achieved during the combined treatment with RF+HIFEM. The active group showed an elevated ratio of positively stained nuclei versus all adipocyte nuclei found on the evaluated slices-referred to as the apoptotic index (AI). The AI significantly (p < 0.001) increased at both 8 h (47.01 ± 10.56%) and 24 h (43.58 ± 6.35%) posttreatment. The Sham group showed no significant change in the AI (p > 0.05). No adverse events or side effects related to the treatments were observed.

SUMMARY

This study supports previously published evidence on fat reduction after RF+HIFEM treatment, documenting the safe initiation of adipocyte programmed cell death posttreatment.

Evaluation of Kinesio Taping for Edema, Ecchymosis, and Pain After Liposuction: A Prospective Pilot Study

BACKGROUND

Liposuction is a safe, simple, and effective method of body contouring. Pain, ecchymosis, and edema are often local complications at the removal site, especially in the first weeks after surgery. Several studies have shown that kinesiology (kinesio) taping improves blood and lymphatic flow, removing congestions of lymphatic fluid and alleviating hemorrhage. However, there are limited data on the effect of kinesio taping in mitigating local complications at fat grafting donor sites.

OBJECTIVES

The aim of this pilot study was to evaluate the impact of kinesio taping in reducing postoperative edema, pain, and ecchymosis in the liposuction area.

METHODS

Over a period of 18 months (January 2021-June 2022), 52 patients underwent liposuction of both flanks with subsequent breast fat grafting. Immediately after the surgery, kinesio taping was used on the right abdomen flank in all patients. Degree of edema as well as ecchymosis and pain were quantified at 7, 14, and 21 days after surgery.

RESULTS

There were statistically significant differences in the taping area for ecchymosis at 7 days after surgery, edema at 14 and 21 days after surgery, and in pain, rated on a visual analog scale, at 7, 14 and 21 days after surgery.

CONCLUSIONS

Kinesio taping, as used in this study, is beneficial in the reduction of edema and pain and the resolution of ecchymosis after liposuction.

LEVEL OF EVIDENCE: 3

The Safety of Large-Amount Liposuction: A Retrospective Analysis of 28 Cases

Aim

Our study aims to assess the safety of large amounts of liposuction in a new light.

Materials and Methods

This is a retrospective review of patients who underwent large-volume liposuction from August 2020 to April 2021. Patient demographics, liposuction areas, the amount of infiltrate and aspirate, the surface area of liposuction areas, anesthesia duration, pain score after surgery, preoperative and 4-h postoperative hemoglobin, and basic metabolic panel (sodium, potassium, creatinine, urea) were measured.

Results

Out of the 28 patients, 26 (92.85%) were females. The mean age was 37.1 years old. The mean preoperative hemoglobin was 13.73 g/dL. The average anesthesia time was 220.39 min. The average amount of liposuction infiltrated was 7.55 L, and the average amount of liposuction aspirate was 6.83 L. The mean hemoglobin 4 h postoperatively was 13.7 g/dL.

Conclusions

With proper patient selection and a comprehensive physical exam with preoperative blood workup performed in an accredited facility with a highly experienced plastic surgeon and anesthesiologist, mega liposuction can be safely performed as a day surgery procedure.

Aesthetic Surgery Gone Wrong: A Case Report and Literature Review of Acute Kidney Injury Secondary to Hematoma After Liposuction

Liposuction is a widely used cosmetic surgery that involves the removal of excess fatty tissue. Although it is generally considered a safe and effective procedure, complications can arise. Acute kidney injury (AKI) is a serious complication, which can be caused by various factors. Extravasation of blood from vessels damaged by the cosmetic liposuction procedure cause hypovolemia and intravascular depletion, significant factors leading to pre-renal acute kidney injury. In this case report, we present the case of a 29-year-old female patient who developed AKI after undergoing a liposuction and "Brazilian Butt Lift (BBL)" procedure. The patient experienced persistent nausea, vomiting, and abdominal pain postoperatively and was admitted to the ICU. The patient's condition gradually worsened over the next few days, and imaging of the abdomen revealed a complex, clotted hematoma in abdominal and pelvic cavities that required surgical intervention. Her care involved a collaborative effort from critical care, plastic surgery, and nephrology specialists. This case highlights the potential complications of cosmetic surgery and the need for comprehensive postoperative care to manage these complications effectively. It also emphasizes the importance of identifying and managing risk factors for AKI during liposuction to minimize the risk of this serious complication.

The Incident of Multiple Skin Necrosis and Unilateral Vision Loss Post Liposuction: A Case Report

For many years, people with excess weight around specific body parts who wanted to improve their shape or establish symmetry to achieve their ideal body image chose liposuction. As with any intervention, there is a chance of complications and unfavorable outcomes with liposuction. As a late result of the procedure, skin necrosis, infection, and hematoma are some of the known complications of such a procedure. Other known complications include damage to surrounding structures like nerves, vasculature, or perforating body viscera. This study aimed to report an eventful and unwanted result of a common and relatively safe cosmetic procedure. A 31-year-old Saudi female presented to the emergency room (ER) with right unilateral vision loss, bruises, and burning pain involving the upper limbs, thighs, abdomen, back, and flanks after having liposuction and rhinoplasty two weeks ago in a private clinic overseas. Multiple investigations were obtained to investigate her blindness, which showed a right upper branch of retinal vein occlusion. She was treated conservatively with daily wound dressings and analgesics. After five days, the patient returned with infected wounds and clinical deterioration, necessitating multiple excisions, debridement, and grafting. She eventually recovered and was discharged in good health. Herein, we report a rare case of unilateral blindness and multiple skin necrosis following liposuction of the abdomen and thigh. Debridement and skin grafting were the ideal treatment strategies.

Potential Lipolytic Effect of Panduratin A Loaded Microspicule Serum as a Transdermal Delivery Approach for Subcutaneous Fat Reduction

Boesenbergia rotunda (L.) Mansf contained a potent anti-obesity agent. The objectives of this study were to investigate the anti-adipogenesis and lipolysis effects of panduratin A from B. rotunda extract and develop extract-loaded lipolytic body microspicule (MS) serum. Panduratin A that was separated from the ethanolic extract of B. rotunda in fraction 3 (BP-3) were studied the bioactivity of 3T3-L1 preadipocyte cells. The extract-loaded MS serum was formulated and evaluated for safety and efficacy. The BP-3 extract containing panduratin A at 0.29 g per g of the extract was not toxic to the cells at concentrations lower than 10 µg/mL, and the antiadipogenesis and lipolysis effects of the BP-3 extract were strong at 10 µg/mL. To deliver bioactive panduratin A into and through the skin, MS serum was successfully formulated. Application of BP-3 extract-loaded MS serum to the human thigh for 14 d reduced the thigh circumference and increased skin hydration and firmness. Although the skin erythema was increased, no severe redness or pain was found. In conclusion, BP-3 extract acts as a potent bioactive compound to inhibit adipocyte cells, and the antiadipogenesis and lipolysis effects of BP-3 extract in MS serum might play an important role as a potential lipolytic body product for reducing human subcutaneous fat mass.

Combining reconstructive and ablative surgical treatment of chronic breast cancer-related lymphedema (BCRL): safe and effective

PURPOSE

We investigated whether a one-stage combination of vascularized lymph node transfer (VLNT) with water jet-assisted liposuction (WAL) can be safely performed and results in improved patient outcomes such as a greater reduction in arm volume when treating chronic breast cancer-related lymphedema (BCRL).

METHODS

In this retrospective cohort study, we included all patients from our encrypted lymphedema database treated for chronic BCRL with VLNT or VLNT + WAL who had a minimum follow-up of two years. We analyzed patient-specific variables including arm circumferences as well as patient-reported outcomes before and after surgery as well as surgery time, surgery-related complications and patient satisfaction.

RESULTS

Only the mean preoperative differences of the circumferences between the lymphedematous and the unaffected arm in individual patients showed a statistically significant difference between treatment groups (p < 0.05). Indeed, patients treated with VLNT + WAL had consistently larger differences in individual sets of arms and therefore more pronounced chronic BCRL. The mean surgery time was significantly longer in the VLNT + WAL group (p < 0.05). Complications were seldom and similar in both groups. Using a numeric rating scale, the level of patient satisfaction following treatment did not differ significantly between groups (p = 0.323).

CONCLUSIONS

Our findings suggest that a one-stage combination of VLNT with WAL does not result in more complications even though it also entails a longer surgery time. This is acceptable as secondary interventions resulting in overall longer surgery times and higher costs can be avoided. A one-stage combination might be especially favourable for patients suffering from more severe chronic BCRL.

An explainable machine learning method for assessing surgical skill in liposuction surgery

PURPOSE

Surgical skill assessment has received growing interest in surgery training and quality control due to its essential role in competency assessment and trainee feedback. However, the current assessment methods rarely provide corresponding feedback guidance while giving ability evaluation. We aim to validate an explainable surgical skill assessment method that automatically evaluates the trainee performance of liposuction surgery and provides visual postoperative and real-time feedback.

METHODS

In this study, machine learning using a model-agnostic interpretable method based on stroke segmentation was introduced to objectively evaluate surgical skills. We evaluated the method on liposuction surgery datasets that consisted of motion and force data for classification tasks.

RESULTS

Our classifier achieved optimistic accuracy in clinical and imitation liposuction surgery models, ranging from 89 to 94%. With the help of SHapley Additive exPlanations (SHAP), we deeply explore the potential rules of liposuction operation between surgeons with variant experiences and provide real-time feedback based on the ML model to surgeons with undesirable skills.

CONCLUSION

Our results demonstrate the strong abilities of explainable machine learning methods in objective surgical skill assessment. We believe that the machine learning model based on interpretive methods proposed in this article can improve the evaluation and training of liposuction surgery and provide objective assessment and training guidance for other surgeries.

Infectious shock after liposuction

Background

Liposuction has become one of the most popular cosmetic surgeries in China. However, few studies have discussed infectious shock caused by C. perfringens as one of the causes of death after liposuction.

Case presentation

A 24-year-old woman was brought to the emergency department (ED) of Guangzhou Chinese Overseas Hospital for treatment. The patient had undergone liposuction in her bilateral lower limbs two days prior. At the ED, the patient was unconscious, and had bilateral equal-sized (diameter, 6 mm) round pupils, no light reflex, a blood pressure (BP) of 71/33 mmHg, a heart rate of 133 bpm, and an SpO2 of 70%. She had bilateral limb swelling, extensive ecchymoses in her lower abdomen and bilateral thighs, local crepitus, blisters, weak pulses on her femoral artery and dorsalis pedis, high skin tension, and hemoglobin of 32 g/L. The patient was diagnosed with Clostridium perfringens infection, and she underwent debridement surgery and supportive treatment. But the patient’s BP could not improve. At 8:28 pm on the day of admission, the patient was declared clinically dead after the electrocardiograph showed a horizontal line and spontaneous respiration ceased.

Conclusions

Failure to meet surgical disinfection and environmental standards may be the cause of infection of C. perfringens through wounds. Therefore, it is necessary to strengthen the environmental disinfection of the operating room, and standardize the sterile conditions of the operation staff and patients before and during operation. Liposuction surgery necrotizing fasciitis is a rare but fatal complications, especially if diagnosis delay, therefore it is critical for early diagnosis and treatment of gas gangrene.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07574-1.

Evolution of the Coleman Technique

Fat grafting is one of the most revolutionary surgical techniques of our century, which has changed the field of plastic surgery and regenerative medicine. Early reports of fat grafting date back to the late 19th century, but the results were unsatisfactory due to minimal graft retention. It wasn't until Sydney R. Coleman challenged the dogma and introduced a standardized approach to fat grafting after years of research and learning from experts across the world. The Coleman technique represents an evolutionary approach to fat grafting, with three main components: harvesting, refinement, and placement. The Coleman technique has been adopted and modified by surgeons around the world because it has allowed a reliable increase in fat graft survival through a standardized process. This article discusses the influencing factors and milestones that led to this world known technique, as well as Dr. Coleman's current practices, pearls, pitfalls, and lessons learned over the years. The knowledge of the true potential and usefulness of fat is in its infancy, with its regenerative potential becoming increasingly recognized. Current and future research will likely prove that autologous fat has many clinical applications beyond its well-known aesthetic and reconstructive benefits, and extending beyond the regenerative realm.

Perforation of Abdominal Viscera Following Liposuction: A Systemic Literature Review

BACKGROUND

Liposuction is among the most popular esthetic procedures worldwide. With growing demand and popularity, reports of serious complications accumulate. Despite being a rare complication of the procedure, visceral perforation is associated with morbidity and severe debilitation.

METHODS

The authors conducted a literature search for reported cases of perforation of abdominal viscera following liposuction procedures in the electronic databases of PubMed, Scopus and Cochrane Library databases.

RESULTS

The authors found 22 publications; 19 cases case reports and three studies, reporting a total of 49 cases of visceral perforation following abdominal liposuction procedures. Average age of patients was 50 years (range 24-72). Twenty-seven patients (73%) were female, and 10 were male (27%). Forty (81%) patients underwent isolated liposuction, and nine (19%) had multiple procedures carried out in a single surgery. Twenty patients (42%) had undergone previous abdominal surgery, 13 (27%) suffered abdominal wall weakness or deformities, and 7 (14%) suffered from obesity. 25 (52%) ileal perforations occurred, 6 jejunal (12.5%), 5 colic (10%) and 2 (4%) each of splenic and hepatic. Seven patients (14%) died during their hospitalization, 20 (41%) were discharged with no sequelae complications, and 22 (45%) developed complications after discharge.

CONCLUSIONS

Liposuction is a popular esthetic procedure that underwent numerous changes over the past century since its introduction. Despite its widely accepted reputation of a safe procedure with minimal complications, a growing number of reports on visceral perforation following liposuction have emerged. Scrupulous pre-operative evaluation and high index of suspicion are crucial for avoiding complications and unfavorable outcomes.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Short-Term High-Fat Diet Improved the Survival of Fat Grafts in Mice by Promoting Macrophage Infiltration and Angiogenesis

Background: Adipose tissue is an ideal filler material that is widely used for soft tissue defects. But the low survival rate and complications associated with such grafts pose a serious challenge, which limits their clinical application. Adipose tissue is a metabolic diet-responsive tissue; however, the influence of diets on fat grafting remains ambiguous.

Methods: We extracted inguinal fat pads from C57/BL6 male mice, and transplanted them into the dorsal region of recipient mice (0.3 ml). Post-fat-grafting, mice (n = 54) were randomized into three groups, namely normal diet (ND), high carbohydrate diet (HC), and high-fat diet (HF). Structural changes were assessed by histological staining. Lipolysis activity and vascular regeneration of grafts on day 30 were analyzed using real-time polymerase chain reaction, immunofluorescence, and western blotting.

Results: The grafts of mice on HC and HF diets exhibited significantly fewer oil cysts and larger volume retention (0.18 ± 0.01, 0.21 ± 0.01, and 0.25 ± 0.01 ml, for ND, HC, and HF group, respectively, p < 0.05) on day 90. In comparison, grafts for the mice belonging to the HF groups exhibited higher expression of lipolysis-related genes, including adipose triglyceride lipase (ATGL), hormone-sensitive lipase (HSL), and carnitine palmitoyltransferase 1 (CPT1), on day 30. Furthermore, increased infiltration of macrophages (F4/80+) and the higher expression of angiogenesis genes were reported in the HF groups.

Conclusion: Altogether, the administration of short-term HF diet remarkably enhanced angiogenesis and improved the quality of fat grafts, which was characterized by fewer oil cysts and higher long-term volume retention. The possible mechanisms may be due to the increased macrophage infiltration, and the promoted angiogenesis in HF grafts.

Do Websites Serve Our Patients Well? A Comparative Analysis of Online Information on Cosmetic Injectables

BACKGROUND

Patients access online cosmetic health information to help with decision making. This information is unregulated, variable in quality, and may be biased. This study compared the most popular cosmetic injectables websites to assess their readability, quality, and technical performance.

METHODS

A Google search for "Botox" (botulinum toxin type A) and "fillers" was performed in July of 2020, identifying the most popular health information websites. Sites were analyzed for their readability and quality of health information using the validated DISCERN criteria and the Health on the Net Foundation Code of Conduct principles. Technical qualities were evaluated using two website performance algorithms, WooRank and WebsiteGrader.

RESULTS

Eighty-five websites were analyzed (13 academic/hospital websites, seven commercial websites, 25 private practice board-certified websites, seven private practice not-board-certified websites, 16 online health reference websites, and 17 other websites). The mean readability consensus score was 11 (eleventh grade reading level). The mean DISCERN quality scores were higher for online health reference websites compared to academic/hospital websites (p = 0.045), commercial websites (p = 0.045), private practice board-certified websites (p < 0.001), and private practice not-board-certified websites (p = .002). No correlation between a website's rank and its DISCERN score was found (ρ = -0.07; p = 0.49).

CONCLUSIONS

Cosmetic injectable websites are too difficult to read by the sixth grade standard recommended by the National Institutes of Health and the American Medical Association. Online health reference sites are higher in quality than physician sites. This has implications for the ability of many patients to be fully informed consumers. The readability, quality, and technical aspects of websites may affect the overall accessibility of patient health information.

1470-nm Radial fiber-assisted liposuction for body contouring and facial fat grafting

Background

Laser‐assisted liposuction using 1470‐nm radial fiber emits light energy preferentially absorbed by water, yielding a rapid and localized contouring and tightening effect, with minimal scarring. When collected under appropriate conditions, extracted fat samples can be exploited as autologous filling material in liposculpturing procedures.

Objectives

To assess the 6‐month contouring efficacy of 1470 radial fiber‐assisted liposuction and the volumetric enhancement effect of the harvested tissue in facial fat grafting.

Methods

Twenty subjects underwent liposuction (BeautiFill, Alma Lasers, Inc.) of lower abdominal or outer thigh fat. In seven subjects, harvested samples were grafted into facial regions. Treatment safety, body weight, blinded evaluator‐assessed aesthetic improvements, and subject‐rated satisfaction were monitored for 6 months. Abdominal and facial fat thickness were assessed by magnetic resonance imaging (n = 5) within 3 months of treatment.

Results

One‐month posttreatment, most subjects ranked improvements good/excellent (88%) and skin tightening satisfactory/very satisfactory (92%), with >70% of subjects providing similar scores 6‐month posttreatment. Blinded evaluators noted improved/very much improved aesthetic appearance (87%). Harvested tissue injected as a facial filler (21.0 ± 5.2 ml) led to a 0.63 ± 0.12 mm increase in facial fat thickness, observed by MRI, within 3 months. Six months postfilling, the majority of subjects (83%) were satisfied with the outcome. All procedures were well‐tolerated.

Conclusions

A single 1470 nm radial fiber‐assisted abdominal and thigh liposuction session provided for effective and durable reduction of adipose tissue deposits, with appreciable skin tightening and aesthetic improvements. The gentle harvesting method yielded viable filler material, which was well‐retained in facial regions for up to 6 months.

Avoidance and Correction of Deformities in Body Contouring

Body contouring procedures are highly impactful because of their potential to improve a patient's quality of life. These procedures, particularly when performed on patients following massive weight loss, may require secondary intervention to treat residual contour abnormalities. Presently, there is a paucity of information in the literature detailing the avoidance and correction of body contouring deformities. Herein, we will discuss the management of patients seeking revisional body contouring procedures.

Standard of care for lipedema in the United States

Background

Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips and limbs that develops at times of hormone, weight and shape change including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce by diet, exercise, or bariatric surgery.

Methods

This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system.

Results

Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested.

Conclusion

These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.

Necrotizing soft tissue infection after liposculpture; Case report

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Infections in isolated liposuction procedures are reported as only 0.1 % of cases

•

One of the most serious complications of liposuction is necrotizing soft tissue infection (NSTI).

•

Rapid recognition of NSTI is life saving; with urgent extensive debridement and prophylactic antibiotics as the mainstay of treatment for this condition

Introduction

Liposculpture procedures have a complication rate of 5%, with the majority being minor complications. Infections in isolated liposuction procedures are as low as 0.1 % of cases. Necrotizing infections can occur after major traumatic injuries, as well as after minor breaches of the skin or mucosa. Here we present a case of a 53-year-old female patient who underwent cosmetic surgery and developed a necrotizing soft tissue infection and we will discuss the importance of early diagnosis, risk factors and preventive measures, treatment options and our management of this particular case.

Presentation of Case

53-year-old female patient with a history of multiple cosmetic surgeries, with no significant past medical history, she presented fever and disabling pain at the surgical site with extensive bullae formation; during her fourth post operative day, she presented septic shock that required vasopressor support and mechanical ventilation, accompanied by acute renal failure which required admission to the intensive care unit.

The patient’s relatives requested air transportation to bring the patient to our center.

The patient remained hospitalized for 42 days in which 15 surgical interventions were performed including multiple surgical wound cleansing and debridement as well as placement of a negative pressure wound therapy system, flaps advancement, lesions reconstruction, graft procurements and insertions.

Discussion

Antibiotic prophylaxis is recommended preferably with a second-generation cephalosporin, one hour prior to surgery and should be continued for 5–6 days afterwards. Likewise, prophylaxis with Flucloxacillin or gentamicin is recommended in the case of liposuction and or abdominoplasty. The microorganisms most frequently isolated in post-liposuction infections are Staphylococcus aureus, Streptococcus group A, Streptococcous pyogenes, and synergistic infections with anaerobes and facultative pathogens.

Among the most severe complications of liposuction is necrotizing soft tissue infection (NSTI), which is an infection of the subcutaneous tissue that spreads to the underlying dermis and sometimes beyond including the fascia and muscle.

Conclusion

Rapid recognition of NSTI is life-saving and urgent, extensive debridement and prophylactic antibiotics are the mainstay treatment for this condition, multiple debridement procedures may be necessary for successful treatment.

Iatrogenic sciatic nerve injury during liposuction and fat tissue grafting: a preventable surgical complication with devastating patient outcomes

Background

Liposuction and autologous fat transplantation represent widely used techniques in plastic surgery to correct or enhance contour irregularities in the face and body. While these techniques are assumed to be safe, liposuction and fat grafting impose a hidden risk for serious preventable surgical complications and adverse patient outcomes. We hereby report two cases of iatrogenic sciatic nerve injury and provide recommendations on how to prevent this serious surgical complication.

Case presentation

We present two cases of sciatic nerve injury - one related to liposuction and the other related to gluteal lipo-augmentation. The first case is a 20-year-old female who presented to our institution with right leg weakness one week after undergoing scar revision and fat grafting in the left peri-oral region to correct peri-oral cicatricial banding and tissue atrophy. Fat was harvested from the medial thigh using a 3-mm cannula with low-pressure manual suction, utilizing minimal tumescent solution. Nerve conduction velocity and electromyography testing suggested a right-sided sciatic nerve lesion as a result of direct trauma. The patient was observed for a period of 4 months during which time she underwent physical therapy. At four months post-operatively, she had recovered completely. The second case is that of a 39-year-old female who presented to our institution with left-sided weakness of foot eversion and dorsiflexion five days after she had undergone liposuction of the thighs, flanks, and abdomen in addition to gluteal lipo-augmentation at an outside facility. The patient had undergone super wet liposuction in the areas of the abdomen, flanks and thighs. 200 mL of collected fat was then transplanted into each buttock at multiple levels. Post-operative computed tomography and electroneurography revealed acute left sided sciatic injury consistent with direct trauma to or compression of the sciatic nerve. The patient underwent an extensive regimen of physical therapy. Three months post-operatively, the patient had regained some motor function, but was lost to follow-up thereafter.

Conclusion

The sciatic nerve is relatively superficial and vulnerable to injury in the upper thigh and lower buttock regions. Therefore, extreme care should be taken when working in these areas to avoid direct or indirect injury to the sciatic nerve by compression or traction.

Plastic Surgery Complications: A Review for Emergency Clinicians

The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.

Pneumothorax with Liposuction: Spreading Awareness

Complications with liposuction are not uncommon; some of these are very serious and can be life-threatening. In this case report we present a case of pneumothorax following liposuction.

High-Definition Liposculpture: What are the Complications and How to Manage Them?

BACKGROUND

High-definition liposculpture is a novel surgical technique widely accepted among plastic surgeons. The aim of this article is to describe surgical outcomes with a special emphasis on complications in high-definition liposculpture patients.

METHODS

An historical cohort of patients who underwent high-definition liposculpture from two senior surgeons was reviewed. Technique, patient selection criteria, preoperative marks and surgical outcomes are described. Postoperative complications are discussed.

RESULTS

A total of 417 patients underwent high-definition liposculpture between 2015 and 2018. Primary liposuction and secondary liposuction were performed in 308 (74%) and 109 (26%), respectively. Combined surgeries were performed in 121 cases (29%). There were no systemic complications. Local complications included hyperpigmentation (n = 276), seroma (n = 125), nodular fibrosis (n = 83), unsatisfactory definition in superficial liposuction areas (n = 16), unnatural appearance of body contour (n = 17), VASER-related burns (n = 3) and Mondor's syndrome (n = 2). Most patients (94%) were satisfied with the results.

CONCLUSION

High-definition liposculpture is a body contouring technique that has shown excellent results. Despite non-serious complications were frequent, most complications were local and safely treated without affecting surgical outcome. To know these complications will help to recognize them earlier and to adjust patient expectation about the postoperative period.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Influences of Age, Gender, and Body Mass Index on the Thickness of the Abdominal Fatty Layers and its Relevance for Abdominal Liposuction and Abdominoplasty

BACKGROUND

Liposuction and lipoabdominoplasty procedures frequently involve the treatment of the superficial and deep fatty layers of the abdomen.

OBJECTIVES

The aim of the present investigation was to provide comprehensive data on the thickness of the abdominal fatty layers in relation to age, gender, and body mass index (BMI).

METHODS

The study investigated 150 Caucasian individuals; there was an equal distribution of males and females (each n = 75) and a balanced distribution of age (n = 30 per decade: 20-29, 30-39, 40-49, 50-59, and 60-69 years) and BMI (n = 50 per group: BMI ≤24.9, 25.0-29.9, and ≥30 kg/m2). Ultrasound-based measurements of the superficial and deep abdominal fatty layers were performed.

RESULTS

An increase in BMI was associated with an increase in total abdominal wall fat thickness. The measured increase was related more to the thickness of the deep fatty layer than to the thickness of the superficial fatty layer (Z = 1.80, P = 0.036). An increase in age was associated with a decrease in thickness of the superficial fatty layer (rp = -0.104, P = 0.071) but with an increase in thickness of the deep fatty layer (rp = 0.197, P = 0.001).

CONCLUSIONS

Age and BMI can change the thickness of both the superficial and deep fatty layers of the anterior abdominal wall, thus influencing the plan and conduct of cosmetic surgical procedures. Knowledge of the layered anatomy of the anterior abdominal wall, as well as its associated blood supply, is important for surgeons performing procedures in this area.

Successful Outcome of Post Liposuction Extensive Necrotizing Soft Tissue Infection of Abdomen and Concomitant Jejunal Perforation-A Case Report

Introduction Liposuction is one of the common cosmetic surgery procedures performed. Although rare, the complications associated with it are necrotizing soft tissue infection and bowel perforation. We would like to share our experience of such a complication that was managed successfully. Case Report We were referred a 65-year-old male patient with signs and symptoms of intestinal obstruction who had undergone liposuction of abdomen 1 week before and now had discoloration of the abdominal skin. The discoloration was present from just below the costal margin and was extending up to bilateral inguinal regions. Laterally the discoloration extended up to the mid axillary line on both sides. Imaging studies showed dilated small bowel. During laparotomy, he underwent debridement of all discolored skin and repair of the single jejunal perforation. Postoperatively patient was first managed on intravenous fluids, nasogastric aspiration and total parenteral nutrition for 10 days. The wound was managed with silver dressings that led to healthy granulations. The patient was at high risk for anesthesia for skin grafting; hence, he was managed with allograft for 10 days. The patient then underwent skin grafting once he was fit. The graft took up well and he resumed regular activities. Conclusion This is unique as the patient had extensive necrotizing soft tissue infection of the abdominal skin after liposuction along with intestinal perforation and obstruction that was managed successfully due to aggressive surgical intervention, allograft, and good supportive care both in the intensive care unit and in ward.

Clinical Study to Assess the 1,060 nm Diode Laser for the Treatment of Post-Liposuction Deformities

BACKGROUND AND OBJECTIVES

Liposuction has become increasingly popular in the past decade due to advances in technique and technology. Despite the demand, there exists a significant population of patients who have contour deformities post-liposuction. The 1,060 nm diode laser has been Food and Drug Administration cleared for the removal of unwanted fat, so it was theorized that this noninvasive laser system could be efficacious to smooth these areas of post-liposuction contour deformities. This study was designed to retrospectively study the clinical changes induced by a 1,060 nm diode laser system to treat contour deformities in tissue post-liposuction.

STUDY DESIGN/MATERIALS AND METHODS

Fifteen patients with contour deformities post-liposuction (minimally six months post-surgery) were treated in the area of the deformity with the noninvasive hyperthermic 1,060 nm diode laser system. Each patient received two treatments at a 6-week interval in the anatomical area of their contour deformity.

RESULTS

Fifteen subjects had completed two treatments and the necessary follow-up needs to be included in these results. Two blinded evaluators could correctly identify the pre-treatment image compared to the post-treatment image in an average of 85% of subjects. So, 100% of the patients were graded to be at least "Improved" with an average of 40% of subjects being "Very Much Improved". Patient satisfaction was "High" in all subjects who have completed the treatment protocol. The physician satisfaction was rated as "Much Improved" in 33% of the patient results and "Improved" in 66% of the patient results.

CONCLUSIONS

The noninvasive hyperthermic 1,060 nm diode system is highly effective and safe for the treatment of contour deformities post-liposuction. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

3D Mammometric Changes in the Treatment of Idiopathic Gynecomastia

BACKGROUND

Three-dimensional surface imaging (3DSI) has shown promise for plastic surgeons to objectively assess changes in body contour and breast volume.

OBJECTIVES

To assess the surgical outcome after bilateral subcutaneous mastectomy (BSM) and water jet-assisted liposuction (WAL) as treatment for idiopathic gynecomastia, using 3DSI to document changes regarding nipple-areolar complex (NAC) and breast volume.

METHODS

Thirty male patients (Simon II A to B) receiving BSM and WAL were enrolled. Eight subjects received additional mastopexy and NAC reduction. Use of a Vectra 3D Imaging System^® before and 6 months after surgery provided data regarding changes of NAC placement and NAC and breast dimensions. The sum volume of intraoperatively approximated lipoaspirate before and after centrifugation and mastectomy specimens quantified using water displacement were compared with 3D-assessed differences in volume.

RESULTS

When compared to the NAC dimensions defined during surgery, patients receiving NAC reductions showed nonsignificant postoperative changes in NAC dimensions. Patients without additional mastopexy showed a significant (p < 0.001) vertical (15.7 ± 14.3%) and horizontal (17.1 ± 15.0%) reduction in NAC diameter. 3D volume changes (92.8 ± 26.4 mL) showed significant differences (p < 0.001) 6 months after surgery compared to the intraoperatively measured lipoaspirate before (182 ± 54.5 mL) and after (120 ± 34.6 mL) centrifugation.

CONCLUSION

Although it is clear that patient satisfaction must remain the prime focus of surgical body contouring, 3DSI has proven valuable to objectively demonstrate both the anticipated outcome and further findings regarding treatment of idiopathic gynecomastia.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

INFLUENCE OF LOCAL INFILTRATION ANALGESIA ON POSTOPERATIVE PAIN IN ABDOMINOPLASTY PATIENTS

The aim of this study was the influence of local infiltrating analgesia with levobupivacaine on acute postoperative pain in patients that underwent abdominoplasty in day surgery. Local infiltration anesthesia is an injection of local anesthetic solution in painful areas. General anesthesia and tumescent fluid solution were performed in all patients. The study included 55 patients within age range from 20 to 72 years old. Study was conducted from January 2016 to February 2019.Postoperative pain after abdominoplasty was evaluated. LIA were performed before closure of abdominal wall after resection of skin and subcutaneous fat in lower part of abdominal wall. Infiltration was performed after plication of rectus abdominis muscles with single shot of 40 ml 0.25% Bupivacaine. Postoperative pain was reduced in the abdominal wall and in the wound area around umbilicus and in lower abdomen scar after waking from general anesthesia. Occurrence of acute postoperative was noticed in all participants. 85% of patients required an additional dose of analgesics and only in 3% of patients was required during the first postoperative day discharged during 48 hours. The research has shown that the appearance of acute postoperative pain did not lead to prolonged stay in the facility for day surgery.

A Single-Blind Study Evaluating the Efficacy of Gold Nanoparticle Photothermal-Assisted Liposuction in an Ex Vivo Human Tissue Model

BACKGROUND

Liposuction is one of the most performed cosmetic surgery procedures. In a previously reported study, gold-nanoparticle (GNP) laser-assisted liposuction (NanoLipo) was shown to improve procedure parameters and outcomes in a porcine model.

OBJECTIVES

An ex vivo human liposuction model was developed to assess the ease, efficacy, and outcomes of NanoLipo, and to further explore its mechanism of action in facilitating liposuction.

METHODS

NanoLipo was compared to a control without GNPs in sets of fresh, nonperfused, anatomically symmetric, matched tissue specimens from 12 patients. A subset of three experiments was performed under single-blinded conditions. Intraoperative assessments included lipoaspirate volume, percentage of free oil, ease of removal, and temperature rise. Specimens were palpated, visualized for evenness, and graded with and without skin. Postoperative assessment included viability staining of the lipoaspirate and remaining tissues. Microcomputed tomography was used to assess the distribution of infused GNPs within the tissues.

RESULTS

NanoLipo consistently removed more adipose tissue with more liberated triglycerides compared to control. NanoLipo specimens were smoother, thinner, and had fewer and smaller irregularities. Infused solutions preferentially distributed between fibrous membranes and fat pearls. After NanoLipo, selective structural-tissue disruptions, indicated by loss of metabolic activity, were observed. Thus, NanoLipo likely creates a bimodal mechanism of action whereby fat lobules are dislodged from surrounding fibro-connective tissue, while lipolysis is simultaneously induced.

CONCLUSIONS

NanoLipo showed many advantages compared to control under blinded and nonblinded conditions. This technology may be promising in facilitating fat removal.

LEVEL OF EVIDENCE 5

Clinical Protocol of Producing Adipose Tissue-Derived Stromal Vascular Fraction for Potential Cartilage Regeneration

Osteoarthritis (OA) is one of the most common debilitating disorders. Recently, numerous attempts have been made to improve the functions of the knees by using different forms of mesenchymal stem cells (MSCs). In Korea, bone marrow concentrates and cord blood-derived stem cells have been approved by the Korean Food and Drug Administration (KFDA) for cartilage regeneration. In addition, an adipose tissue-derived stromal vascular fraction (SVF) has been allowed by the KFDA for joint injections in human patients. Autologous adipose tissue-derived SVF contains extracellular matrix (ECM) in addition to mesenchymal stem cells. ECM excretes various cytokines that, along with hyaluronic acid (HA) and platelet-rich plasma (PRP) activated by calcium chloride, may help MSCs to regenerate cartilage and improve knee functions. In this article, we presented a protocol to improve knee functions by regenerating cartilage-like tissue in human patients with OA. The result of the protocol was first reported in 2011 followed by a few additional publications. The protocol involves liposuction to obtain autologous lipoaspirates that are mixed with collagenase. This lipoaspirates-collagenase mixture is then cut and homogenized to remove large fibrous tissue that may clog up the needle during the injection. Afterwards, the mixture is incubated to obtain adipose tissue-derived SVF. The resulting adipose tissue-derived SVF, containing both adipose tissue-derived MSCs and remnants of ECM, is injected into knees of patients, combined with HA and calcium chloride activated PRP. Included are three cases of patients who were treated with our protocol resulting in improvement of knee pain, swelling, and range of motion along with MRI evidence of hyaline cartilage-like tissue.

Gender difference in requesting abdominoplasty, after bariatric surgery: Based on five years of experience in two centers in Sulaimani Governorate, Kurdistan Region/Iraq

BACKGROUND

The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to multiply each year, many patients who have experienced massive weight loss are left with the dissatisfying consequences of loose and redundant skin, resulting in contour irregularities, an aesthetic and functional problem, and profound dissatisfaction with appearance, residual body image dissatisfaction, There is a subsequent increase in the number of patients seeking additional corrective procedures including abdominoplasty which considered as one of the most popular body-contouring procedures. Correcting skin excess, could improve all the corollaries, including body, and functional problems and gives profound satisfaction with appearance, it has shown to improve both psychological and social aspects of the patients' lives.

OBJECTIVES

Is there a gender difference in seeking body countering after bariatric surgery for weight loss?

PATIENTS AND METHODS

A longitudinal observational study includes 209 obese patients with mean age of 31 ± 8.6 years; (31 ± 9, 31 ± 7 years for female and male patients respectively). Gender ratio M/F = 1.94/1, mean BMI 40 ± 9 kg/m2sin (n = 138 female) and 45±8m2s in (n = 71 male) patients, and Waist circumference 109 ± 7 cm in female and 118 ± 4 cm in males.

RESULTS

Some female (n = 10, 7.25%) patients were seeking abdominoplasty from the third month after the operations were they have lost (21 ± 2 kg) of their excess weight, fourteen patients (10.14%), at 6 months and 27 patients (19.56%) at 12 months, but most of male patients were requesting abdominoplasty (n = 7, 09.86%) at 12 months after the operations. Male patients have shifted their ideal from weight loss to abdominoplasty after losing (50-70) of their excess weight 12 months after the operations. The main motivation of requesting abdominoplasty in female and male patients was physical difficulty because of redundant skin, and a smaller number in both genders were motivated by a friend or by a doctor.

CONCLUSION

The motivation for abdominoplasty in females is parallel to the amount of EWL or waist circumference. Female patients are looking for body countering three months after surgery, while male patients more often than not request body shaping following one year after surgery, the age groups are invert in genders; female patients asking for body contouring in younger age group while male patients in older age group.

Buried umbilicus with inflammation due to retained rubber foreign body after liposuction: A case report

INTRODUCTION

Liposuction is one of the most widely performed aesthetic surgeries. It is mainly used for the correction of deep and superficial fat accumulations and remodeling of the body contour.

CASE PRESENTATION

We present a rare case of unusual rubber foreign body found within the periumbilical area during the reconstruction of buried umbilicus after liposuction.A 61-year-old female had undergone a liposuction surgery 10 years ago. Last year, she experienced signs of inflammation around the periumbilical area. The patient was treated with antibiotics and daily dressing at a local clinic. However, her symptoms did not improve with treatment.After admission, we decided to reconstruct the umbilicus and explore the previous operative site. During reconstruction of umbilicus, we finally discovered a rubber foreign body in the periumbilical area and buried umbilicus.

CONCLUSION

Retained surgical foreign body can clinically manifest as acute reaction, such as an inflammatory response, infection, or abscess within days or weeks after the operation. Patients may complain of pain and discomfort, even months or years after the procedure.Our patient had suffered from delayed inflammation due to retained surgical foreign body after liposuction surgery. We emphasize the need for excellent communication within the surgical team to prevent the incidence of retained surgical bodies.

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several studies have focused their attention on mesenchymal stem cells derived from adipose tissue. Adipose-derived stem cells (ADSCs) exhibit morphological characteristics and properties similar to other mesenchymal cells, and are able to differentiate into several cellular lines. Moreover, these cells are also widely available in the subcutaneous tissue, representing 10 - 30% of the normal body weight, with a concentration of 5,000 cells per gram of tissue. In the presented technique, the first step involves harvesting ADSCs from the abdomen and a process of microfracture and purification; next, the surgical procedure is performed entirely arthroscopically, with less soft tissue dissection, better joint visualization, and a faster recovery compared with standard open procedures. Arthroscopy is characterized by a first phase in which the lesion is identified, isolated, and prepared with microperforations; the second step, performed dry, involves injection of adipose tissue at the level of the lesion. Between January 2016 and September 2016, four patients underwent arthroscopic treatment of osteochondral lesion of the talus with microfractured and purified adipose tissue. All patients reported clinical improvement six months after surgery with no reported complications. Functional scores at the latest follow-up are encouraging and confirm that the technique provides reliable pain relief and improvements in patients with osteochondral lesion of the talus.