Lower Gluteal Liposuction Combined With Upper Gluteal and Infragluteal Region Fat Grafting: A Novel Concept to Improve Gluteal Ptosis

BACKGROUND

Gluteal ptosis results in a severe disturbance of gluteal aesthetics. Currently, satisfactory procedures for improving gluteal ptosis are lacking.

OBJECTIVES

To improve gluteal ptosis, the authors propose a novel concept of combined liposuction of the lower gluteal region and fat grafting to the upper gluteal and infragluteal regions, and verify its efficacy and safety.

METHODS

Patients who underwent liposuction of the lower gluteal region combined with fat grafting to the upper gluteal and infragluteal regions between January 2020 and July 2023 were retrospectively reviewed. Postoperative changes in the gluteal ptosis grade, complications, and patient satisfaction were evaluated.

RESULTS

A total of 28 patients were enrolled in this study; 21 (75.0%) patients had gluteal ptosis grade 4 and 7 (25.0%) patients had gluteal ptosis grade 5. The median fat removal volume was 210 mL, and the median fat graft injected volume was 355 mL in the gluteal region and 180 mL in the infragluteal region. All patients showed improvement in gluteal ptosis; 16 (57.1%) patients improved by 1 grade and 12 (42.9%) patients showed a 2-grade improvement. All patients were satisfied with their posttreatment outcomes. Only 1 patient showed lateral translocation of the fat graft. No other complications were observed.

CONCLUSIONS

Liposuction of the lower gluteal region combined with fat grafting to the upper gluteal and infragluteal regions is effective in improving gluteal ptosis, with a low risk of complications and high patient satisfaction.

LEVEL OF EVIDENCE: 3

Delayed-Onset Idiopathic Intracranial Hypertension After Liposuction: A Case Report and Review

ABSTRACT

Although systemic complications following liposuction are rare, visual impairment has been reported in a few cases and may occur for a variety of reasons. Here we present the case of a 31-year-old woman who underwent 360° liposuction and subsequently developed headaches and delayed partial visual disturbance 10 days after the procedure. She had symptoms suggestive of idiopathic intracranial hypertension, which was confirmed by lumbar puncture. A literature search revealed other case reports of visual changes or headaches following high-volume liposuction. Our case provides further evidence of a rare association between liposuction and idiopathic intracranial hypertension, emphasizing the need for thorough preoperative evaluations and the consideration of possible risks.

[Treatment of abdominal lipocutaneous excess in massive weight loss patients]

In massive weight loss patients, abdominal lipocutaneous excess is a frequently encountered complication with major psychological, medical and functional consequences. A wide variety of corrective techniques exists, each with its advantages and side effects, and the choice of the technique must be made in conjunction with the patient, taking into account his unique anatomy, his wishes and his risk factors, in order to obtain the best aesthetic result while minimising the per- and post-operative complications. Liposuction, if prudently executed with the correct technique, permits a further harmonisation of the body contour in zones not reached by the surgical correction, representing a very useful and efficient additional tool.

A Retrospective Analysis of Upper Arm Rejuvenation Surgery in 50 Patients

BACKGROUND

Upper arm aesthetics often suffer from aging effects such as skin laxity and sagging due to collagen and elastin depletion. Fat loss, obesity, and weight fluctuations further exacerbate these issues. Existing classification systems for upper arm excess are complex and have practical limitations.

OBJECTIVES

The aim of this study was to develop a more concise and clearer classification of upper arm excess that can guide surgical interventions effectively and assess clinical outcomes.

METHODS

Patients undergoing upper arm rejuvenation surgery from January 2020 to January 2023 were categorized as mild, moderate, or severe. Mild cases underwent suction-assisted liposuction (SAL), moderate cases underwent radiofrequency-assisted liposuction combined with SAL, and severe cases underwent brachioplasty combined with SAL. Arm circumferences and BODY-Q questionnaires were collected pre- and postoperatively.

RESULTS

The study included 50 female patients, aged 21 to 49 years. The average follow-up time was 7.5 [2.2] months. Arm circumference reduction rates were 6.8% in mild cases, 15.1% in moderate cases, and 17.3% in severe cases. Regarding the BODY-Q questionnaire for upper arms, the average score increased by 0.9 for mild, 2.1 for moderate, and 2.9 for severe cases. Complications were minimal, including 1 seroma and 2 cases of scar widening.

CONCLUSIONS

The revised classification system for upper arm excess proved effective in guiding surgical decisions. Selecting the surgical approach based on severity resulted in satisfactory outcomes based on BODY-Q scores. This system offers a concise, objective, and practical tool for plastic surgeons.

LEVEL OF EVIDENCE: 3

Gluteoplasty With Lumbar Gluteal Flap Associated With Liposuction and Fat Grafting: A Safe Technique for Massive Weight Loss Patients

BACKGROUND

Weight loss leads to excessive flaccidity, volume loss, and tissue descent in the gluteal region. Translated autologous flaps during lower body lifting have been utilized in patients; they address sagging tissue and the lack of volume. However, sometimes use of these autologous flaps does not provide adequate gluteal projection, and a second procedure with fat injection may be required.

OBJECTIVES

The authors describe their technique of a lower body lift with a lumbosacral flap in association with liposuction and lipofilling for gluteoplasty.

METHODS

A prospective series of 23 post-bariatric surgery individuals who underwent a lower body lift with lumbosacral flap gluteal augmentation, liposuction, and lipofilling between January 2021 and September 2022 were described. The satisfaction rate and complications were assessed 6 months postoperatively with a validated questionnaire (BODY-Q scale).

RESULTS

The patients had a mean age of 38.18 (range, 28-56 years) and median body mass index of 26. Four patients with dehiscence were diagnosed and treated conservatively. All wound breakdowns were observed in the paramedian plane of the torsoplasty. No reoperations were performed. The mean satisfaction percentage of the BODY-Q scale transformed score was 97.5.

CONCLUSIONS

A technique for a lower body lift with buttock augmentation combined with liposuction and fat grafting was presented. In future studies other techniques to maximize gluteal contouring should be investigated.

Augmented Safety Profile of Ultrasound-Guided Gluteal Fat Transfer: Retrospective Study With 1815 Patients

BACKGROUND

Gluteal augmentation with autologous fat transfer is one of the fastest growing aesthetic surgical procedures worldwide over the past decade. However, this procedure can be associated with high mortality from fatal pulmonary fat embolism events caused by intramuscular injection of fat. Ultrasound-guided fat grafting allows visualization of the transfer in the subcutaneous space, avoiding intramuscular injection.

OBJECTIVES

The aim of this study was to assess the safety and efficacy of gluteal fat grafting performed with ultrasound-guided cannulation.

METHODS

A retrospective chart review of all patients undergoing ultrasound-guided gluteal fat grafting at the authors' center between 2019 and 2022 was performed. All cases were performed by board-certified and board-eligible plastic surgeons under general anesthesia in ASA Class I or II patients. Fat was only transferred to the subcutaneous plane when over the gluteal muscle. Patients underwent postoperative follow-up from a minimum of 3 months up to 2 years. Results were analyzed with standard statistical tests.

RESULTS

The study encompassed 1815 female patients with a median age of 34 years. Controlled medical comorbidities were present in 14%, with the most frequent being hypothyroidism (0.7%), polycystic ovarian syndrome (0.7%), anxiety (0.6%), and asthma (0.6%). Postoperative complications occurred in 4% of the total cohort, with the most common being seroma (1.2%), local skin ischemia (1.2%), and surgical site infection (0.8%). There were no macroscopic fat emboli complications or mortalities.

CONCLUSIONS

These data suggest that direct visualization of anatomic plane injection through ultrasound guidance is associated with a low rate of complications. Ultrasound guidance is an efficacious adjunct to gluteal fat grafting and is associated with an improved safety profile that should be considered by every surgeon performing this procedure.

LEVEL OF EVIDENCE: 3

Aesthetic Improvement of Body Proportion Through Trunk Liposculpture: A Waistline-based Strategy

BACKGROUND

Abdominal contouring through liposuction has been practiced for decades. However, few studies have focused on describing the definition and enhancement of the waistline in torso contouring procedures.

OBJECTIVES

In the present study, the authors proposed a waistline-based strategy for abdominal liposculpture to achieve a better aesthetic outcome and emphasize high overall patient satisfaction.

METHODS

The data of patients who underwent the waistline-based liposculpture procedure from 2020 to 2023 were retrospectively reviewed. Aesthetic improvement of the central trunk contour was evaluated and analyzed by comparing preoperative and postoperative photogrammetric measurements. Satisfaction with the outcome was assessed with a patient satisfaction questionnaire.

RESULTS

A total of 70 patients were enrolled in this study. During 6 months of postoperative evaluation, the shape of the central trunk contour improved significantly (both waist concavity and hip convexity increased quantitatively, P < .05), while the position of the waist did not differ significantly postoperatively (P > .05). All patients were satisfied with their postoperative outcomes, including their overall aesthetic appearance, waistline position, and waist-to-hip ratio. There were no intraoperative complications or rare postoperative complications.

CONCLUSIONS

Waistline-based liposculpture is a simple and effective procedure to improve the aesthetic outcomes of trunk contouring and has highly satisfactory results after long-term follow-up.

LEVEL OF EVIDENCE: 5

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.

Unraveling the Enigma: A Rare Case of Recurrent Idiopathic Gynecomastia in an Adolescent

Gynecomastia presents as abnormal hypertrophy of mammary tissue in males that is typically asymptomatic and usually does not require intervention. Gynecomastia responds well to medical and surgical treatment, when necessary, with low recurrence rates. The authors report an atypical case of recurrent idiopathic unilateral gynecomastia first presenting in an adolescent male. Physical examination, hormonal, and oncologic evaluations were normal. After subcutaneous mastectomy with liposuction and treatment with Tamoxifen at 19 years old, his unilateral gynecomastia recurred over the course of 3 years, requiring a second surgery. Furthermore, we review the literature for recurrent gynecomastia after surgical management to examine prevalence and risk factors.

Update on Oblique Flankplasty: Easily Executed, Long-Lasting, Integral Component of Total Body Lift Surgery

BACKGROUND

Twenty years ago, coordinated aesthetic surgery for laxity and lipodystrophy after massive weight loss (MWL), so-called total body lift surgery (TBL), encompassed circumferential hip hugging transverse lower body lift (LBL) with possible buttock auto-augmentation, and a transverse bra line upper body lift (UBL) with breast reshaping. Brachioplasty and vertical thighplasty were often included. Disappointing aesthetics of the posterior torso led to innovation with J-torsoplasty and oblique flankplasty.

OBJECTIVES

The goal of this study was to demonstrate in a large clinical series and in a range of case presentations from 2 plastic surgeons that oblique flankplasty with lipoabdominoplasty (OFLA) optimally narrows the waist, suspends lateral buttocks and thighs, and integrates with J-torsoplasty and vertical thighplasty to tighten skin and aesthetically contour the torso and thighs with an acceptable rate of complications.

METHODS

Retrospective chart review of 151 consecutive flankplasties between June 2010 and April 2023, including sex, age, BMI, associated operations, complications, and revisions was performed. Five case presentations were accompanied by limited photographs and a marking video.

RESULTS

Across a broad clinical spectrum, malleable oblique flankplasty resected bulging flanks and, facilitated by neighboring liposuction and/or J-torsoplasty, consistently pulled in lax skin and anchored through cadaver-proven dense dermal adherences lax tissues to create a long-lasting skintight shapely torso and upper thighs, with only 3.3% problematic wounds. Five diverse cases showed broad applicability.

CONCLUSIONS

OFLA, often with J-torsoplasty and neighboring liposuction, aesthetically recontours torso skin laxity in a variety of presentations with a low rate of complications in a high-risk population.

LEVEL OF EVIDENCE: 3

Pneumothorax with liposuction, awareness of rare complication: a case report

BACKGROUND

Liposuction is the most commonly performed procedure in aesthetic plastic surgery worldwide, the complications and morbidity are under evaluated. Pneumothorax is thought to be a rare complication after liposuction but the exact rate still unknown.

CASE PRESENTATION

We presented to you a 45-year-old Arabian female with history of hypertension underwent lipoabdominoplasty, back liposuction and gluteal lipofilling. On the first postoperative day, the patient was complaining of chest pain accompanied with tachypnea and tachycardia, oxygen saturation was maintained on room air. Upon chest auscultation, diminished air entry was markedly noted on her left side, immediate chest x-ray and electrocardiogram (ECG) was done, which showed unremarkable x-ray and ECG shows sinus tachycardia. Computed tomography (CT) carried out and showed left side pneumothorax. An urgent thoracic surgery consultation was done and chest tube was inserted. The patient reported immediate improvement of her symptoms and the vital signs retain to normal range. On day 3, air leak stopped, chest tube was clipped by thoracic surgery, and the chest tube was removed 24 h later. The patient had a relatively smooth recovery with no other complications.

CONCLUSION

Pneumothorax have possibility to happen with liposuction, awareness of possible risk factors should detect by plastic surgeon, to manage earlier as soon as possible.

Radiofrequency and pulsed electromagnetic field application following liposuction-Clinical evaluation of performance and safety

OBJECTIVE

With more than 1.5 million performed procedures, liposuction was the second most performed esthetic surgical procedure all over the world in males and in females in the year 2020. The objective of this open-label, evaluator-blinded study was to assess the efficacy and safety of an energy-based device that combines multipolar radiofrequency with pulsed electromagnetic field (PEMF) in patients that underwent liposuction.

MATERIALS AND METHODS

A total of 30 subjects, of whom 24 were females (80%), with a mean age of 48.4 ± 11.0 years (range: 27-69 years) and a mean weight of 69.5 ± 11.7 kg underwent unilateral treatment with radiofrequency and application of PEMF after bilateral liposuction. One month after the last of a total of six weekly treatments, skin elasticity, visco-elasticity and net elasticity, as well as subject reported satisfaction on a 5-point scale ranging from -1 (worse) to 3 (very much improved) and esthetic improvement ranging from 0 (very unsatisfied) to 4 (very satisfied) rated by three independent reviewers were assessed.

RESULTS

Three independent and blinded reviewers rated the improvement of the treated side on average as 1.17 + 0.07 compared with baseline. Subjects were very satisfied with their treatment, with a mean score of 3.24 (0.03) out of 4 at the 1-month follow-up visit. Cutometer measurements showed no significant changes.

CONCLUSION

This study revealed that the subjective satisfaction with the results of the application of RF and PEMF after liposuction is high, while at the same time the esthetic appearance as rated by independent raters improved on the treated side.

Active Heating following Cryolipolysis Reduces Efficacy and Side Effects: A Randomized Split-Body Trial

BACKGROUND

Cryolipolysis-a popular noninvasive technique for body contouring-has fewer side effects compared with liposuction; however, its effectiveness in terms of reducing local adipose tissue is also lower. This study is, to the authors' knowledge, the first prospective, controlled, investigator-blinded split-body trial to evaluate whether postcryolipolytic heating can increase the efficacy.

METHODS

Twenty-five subjects were treated with one session of cryolipolysis on the lower abdomen and a subsequent heating with a mud pack of a randomized side of the treated region (left or right). Epidemiologic, temperature, edema, erythema, hypesthesia, and pain level data were obtained. Photographs, fat layer thickness (on ultrasound, caliper, and abdominal girth), satisfaction, and side effects were documented over a follow-up period of 12 weeks.

RESULTS

The side effects-edema, erythema, and hypesthesia-faded almost completely with heating, whereas they remained on the nonheated site. However, the mean sonographic reduction of local adipose tissue after 12 weeks was significantly lower on the heated sites than on the control sites (9.6% versus 14.1%; P = 0.0003). The overall satisfaction was high (9.2 of 10 points), even though only 44% of participants had a subjective recognition of fat loss without difference between the sites.

CONCLUSIONS

Active heating following cryolipolysis increases bodily well-being by reducing common side effects, but it reduces the effectiveness of cryolipolysis significantly and should therefore be avoided. Further improvements are necessary to enhance the efficacy of cryolipolysis.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, I.

Cryolipolysis: A promising nonsurgical technique for localized fat reduction

BACKGROUND

Cryolipolysis, also known as fat freezing, is a nonsurgical technique specialized for localized fat reduction. Utilizing targeted cold exposure to adipose tissue, cryolipolysis devices induce cellular apoptosis in adipocytes while sparing surrounding tissues, resulting in the selective disruption of fat cells and subsequent removal of damaged cells by macrophages. A reduction of the fat layer produces a noninvasive cosmetic benefit that provides an accessible alternative to liposuction. Objective and subjective measurements have demonstrated significant reduction in fat volume and high patient satisfaction rates. Cryolipolysis has been proven to be safe with minimal adverse effects. However, further research is needed to fully understand the mechanism of cryolipolysis and its efficacy in different treatment areas. This paper aims to provide a comprehensive overview of cryolipolysis, including its mechanism of action, indications, contraindications, adverse effects, results and outcomes, safety profile, and areas requiring further research.

METHODS

Our primary phase of literature review consisted of a PubMed search looking for all published literature around cryolipolysis. We employed a review approach that examined over 30 papers with the key search terms of "cryolipolysis," "fat-freezing," "cosmetic dermatology," "body contouring," "adverse effects," "adipocyte apoptosis," "Coolsculpting®," "cold panniculitis," and "localized fat reduction." We then analyzed each paper, extracting relevant information to gain a multidimensional understanding of cryolipolysis to provide a comprehensive review.

CONCLUSION

Cryolipolysis, with its ability to target and reduce localized adipose tissue, has emerged as a promising nonsurgical technique in the field of body contouring. It offers patients a valuable option for achieving their desired fat reduction without the need for a lengthy recovery period or major surgery. Cryolipolysis has shown to reduce the number of adipocytes in the treated area, a phenomenon that can be objectively quantified through various means, including fat caliper measurements, ultrasound assessments, and 3D imaging, or subjectively observed through patient satisfaction rates, clinical observations, and investigator assessments. In addition to its effectiveness in reducing localized adipose tissue, cryolipolysis also holds potential in the area of skin tightening. Preliminary studies suggest that cryolipolysis may have a positive impact on skin elasticity and tightening. Further investigation of this mechanism is needed to provide a better understanding of its potential in achieving optimal cosmetic outcomes for patients. By combining the benefits of fat reduction and skin tightening, cryolipolysis has the potential to offer a comprehensive nonsurgical solution for body contouring.

A review of research for a cryolipolysis technology

BACKGROUND

Obesity and excess body fat are known health issues and a major aesthetic concern. Numerous modalities have been developed to address unwanted deposits of adiposity, including the development of various noninvasive methods overcoming the limitations and risks of invasive alternatives. Cryoadipolysis, also known commonly as cryolipolysis, involves the harnessing of selective cryolysis, the selective cold-based damaging of subcutaneous fat cells which die via apoptosis, and are removed naturally by the body over time.

AIMS

To provide a brief but comprehensive summary of the literature supporting two related cryoadipolysis devices that are only available outside of North America, Cooltech and Cooltech Define (Sinclair).

RESULTS/DISCUSSION

Review of 10 available clinical studies evaluating the two devices, specifically, showed both devices to be safe, with side effects profiles comparable to those of similar platforms in the armamentarium. Both operate by non-invasively lowering the temperature of localized subcutaneous fat and maintaining it at or below a threshold that causes disruption of adipocytes via crystallization, inducing apoptosis (programmed cell death). Over time, clinically significant reductions in fat thickness and circumference of the treated area were noted. Patient satisfaction is high. The literature also highlights the necessity of adherence to patient selection and device use guidelines to minimize potential for rare paradoxical adipose hyperplasia and maximize patient satisfaction.

Cryolipolysis in the United States-Review of the clinical data

BACKGROUND

Noninvasive body contouring is becoming more popular in the United States as an alternative to liposuction. The most popular of these methods, cryolipolysis, uses precisely controlled cooling to reduce focal adiposities. The number of cryolipolysis procedures performed annually has experienced rampant growth in United States markets, and the indications have likewise diversified. In light of this change, it is imperative to perform an updated review of available US safety and efficacy data on cryolipolysis.

AIMS

To examine the safety and efficacy of cryolipolysis treatments in the United States using data extracted from research performed exclusively at US-based sites.

METHODS

In order to identify relevant studies, a literature search was conducted on PubMed using the terms "CoolSculpting" OR "cryolipolysis" OR "lipocryolysis." Articles were manually reviewed to exclude literature reviews, research not performed on humans, studies on experimental combinations of techniques, and any studies not performed in the United States.

RESULTS

The initial literature search returned 246 results. Following manual review, a total of 18 studies were selected for data extraction. Mean reduction in fat thickness by ultrasound was 2.0-5.1 mm or 19.6%-32.3%; mean reduction by body caliper was 2.3-7 mm or 14.9%-21.5%. Side effects were mild and transient. Four instances of PAH were documented in 3453 treatment cycles.

CONCLUSIONS

Cryolipolysis is a safe, modestly effective method for reducing focal adiposity. Complications are rare and treatable. However, US-based studies are few in number and often of low power and/or quality. More high-quality research is needed for all aspects of cryolipolysis.

HTLV-1 Presenting as an Incidental Finding after a Cosmetic Procedure

A 44-year-old woman presented to a plastic surgeon for liposuction of the abdomen, back, and flanks, a gluteal fat transfer, and a vertical pattern breast lift and small reduction. The patient had a medical history of significantly well-controlled hypertension for 4 years treated with hydrochlorothiazide and amlodipine. She had been pregnant four times and delivered six children with two sets of twins. She was allergic to latex and denied a history of smoking. Her physical examination was unremarkable and her body mass index (BMI) was 26.1. No skin lesions were evident (Figure 1). Her preoperative laboratory findings were within normal limits, with unremarkable electrocardiogram (EKG), chest x-ray, and mammogram. The patient underwent a successful surgical procedure, and the excised breast tissue and skin were sent to pathology for routine evaluation. Surgery removed 220 g of breast tissue from the left breast and 45 g was excised from the right one. The histopathology depicted atypical T-cells in the epidermis and superficial dermis of both left and right breasts. Physical examination failed to evidence lymph-adenopathy or masses. The patient denied weight loss, night sweats, or fever; however, due to her Caribbean heritage, adult T-cell leukemia/ lymphoma was considered and submitted for further histologic workup.

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

A Case of Acute Opioid Withdrawal after Liposuction Surgery in a Patient on Extended-release Buprenorphine

BACKGROUND

The US Food and Drug Administration approved the once-monthly injectable extended-release buprenorphine product to treat moderate-to-severe opioid use disorders. The patient in our case report had a liposuction procedure and immediately started having opioid withdrawal symptoms after the procedure.

CASE DESCRIPTION

The patient is a 27-year-old African-American woman who injects drugs and has morbid obesity. She enrolled in a medications for addiction treatment program and opted to get treated with extended-release buprenorphine monthly injections. She tolerated them well for a span of 6 months. In one clinic visit, she reported opioid withdrawal symptoms and started purchasing and using sublingual buprenorphine from her acquaintances. On review of history, she underwent liposuction surgery and this triggered the opioid withdrawal symptoms. Examining her abdomen revealed surgical scars at the site of the buprenorphine injection and the residual buprenorphine depot was not palpable.A subcutaneous injection of 300-mg extended release buprenorphine was administered in the right periumbilical area in this clinic visit. The following week, she was doing well and denied any withdrawal symptoms.

DISCUSSION

This is a unique case of "iatrogenic opioid withdrawal" after a fairly common surgical procedure. The extended-release buprenorphine formulation solidifies when it comes into contact with bodily fluids forming a depot. The depot and surrounding adipose tissue may have been removed during the patient's liposuction procedure, causing an immediate drop in buprenorphine levels leading to acute opioid withdrawal.This case report highlights the precautions that need to be taken before patients go for a surgical procedure like liposuction.

[Lipedema pain-the neglected symptom]

Pain, which is a central characteristic of lipedema, allows differentiation from other fat tissue diseases. The analysis of the multiple aspects of pain beyond a quantification of pain scale scores could make molecular disease and therapy mechanisms accessible. Lipedema pain is causally linked to lipedema fat. First robust data show peripheral sensory changes. Tissue weight and systemic inflammation are becoming less likely as causes for the experianced pain. Furthermore, genetics and hormonal influences need to be investigated. Lipedema pain cannot currently be treated with drugs. Physical therapy shows transient relief. Liposuction has been shown to have a long-term effect on pain. The potential of modulating the perception of pain with psychotherapeutic approaches is emerging as a potentially effective new therapeutic approach.

Efficacy of Cold Tumescent for Prevention of Intraoperative Bleeding in Patients Undergoing Liposuction: A Double-Blind Randomized Controlled Trial-Half-Side Comparison

BACKGROUND

Bleeding, a common intraoperative complication of liposuction, often causes pain and discomfort during recovery. Because of the vasoconstrictive effect of adrenaline in the tumescent solution, bleeding can be reduced; however, reports of postoperative bleeding persist. Cold temperatures also have a vasoconstrictive effect.

OBJECTIVES

This study aimed to determine the efficacy of cold tumescent solution in preventing and reducing intraoperative bleeding.

METHODS

This prospective randomized controlled trial was conducted between June 2018 and June 2019. The liposuction areas in each participant were divided into left and right sides; one side received operative room temperature tumescent solution (25 °C), and the other side received low-temperature tumescent solution (4 °C). The areas of ecchymosis, pain scores, and patient and surgeon satisfaction scores were compared and analyzed.

RESULTS

Ten patients with 36 pairs of liposuction areas were enrolled in the study. Cold tumescent liposuction resulted in a significantly lower lipocrit than was obtained on the standard tumescent side (1.56 ± 0.69 vs 2.92 ± 0.94; P < .001). The ecchymosis area and pain score were significantly lower in the cold tumescent group on days 2, 4, 7, and 14. The satisfaction evaluation scores did not differ between patients and surgeons at 12 months postoperatively.

CONCLUSIONS

The use of cold tumescent anesthesia significantly improved liposuction outcomes by reducing the intraoperative blood loss and the postoperative ecchymosis and pain, with no immediate or short-term complications in low-volume liposuction (<1000 mL) procedures. Furthermore, it generated a standard outcome and good patient satisfaction scores.

LEVEL OF EVIDENCE: 2

Brazilian Butt Lift-Associated Mortality: The South Florida Experience

BACKGROUND

Brazilian butt lift (BBL) surgery has been the fastest growing aesthetic surgical procedure over the past decade. By 2017, the risk of death from pulmonary fat (PFE) was identified, earning the BBL the highest mortality rate of any aesthetic surgical procedure. South Florida carries the highest BBL mortality by far in the nation.

OBJECTIVES

The purpose of this study was to explore the factors involved in making South Florida an outlier in terms of BBL mortality.

METHODS

The anatomic findings of the gluteal dissections from 11 post-BBL surgery autopsies (22 hemibuttocks) were assessed for commonalities. The public records of patients who died from BBL-related fat emboli were examined to determine commonalities.

RESULTS

All BBL PFE cases had fat grafts injected into the gluteal musculature in multiple different levels. Another commonality involved the location where the surgery took place, with the great majority of patients (92%) undergoing surgery at high-volume, budget clinics located in South Florida. Short surgical times of approximately 90 minutes appeared to be the norm for these cases.

CONCLUSIONS

South Florida has experienced 25 BBL-related fat emboli deaths between 2010 and 2022; however, 14 of these occurred after publication of the Aesthetic Surgery Education and Research Foundation's 2018 guidelines and the 2019 Florida Board of Medicine's BBL "subcutaneous-only" rule. The working environment at the clinics, and the short surgical times for these cases, may be the most important contributors to the BBL mortality in South Florida.

Does Liposuction for Lymphedema Worsen Lymphatic Injury?

Liposuction for treatment of lymphedema is an effective and time-tested treatment. However, as there is a fear regarding further lymphatic damage caused by liposuction, we objectively compared lymphatic function pre- and post-liposuction. All patients with solid-predominant lymphedema who were treated during the study period of June 2014 and November 2018 were included. Patients were assessed using patient-reported baselines/outcomes, lymphedema- specific quality of life scale (LYMQOL), limb circumference/volume measurements, and indocyanine green lymphography (ICGL) preoperatively and at predefined postoperative time intervals. Fifty-seven limbs from 41 patients were included. Mean lipoaspirate volumes were 2035 mL, 5385 mL, and 3106 mL for the arm, thigh, and leg, respectively with a mean adipose fraction of the lipoaspirate of 71%. All patients underwent redundant skin excision with the "flying squirrel" technique. The mean follow-up was 10.7 months (range 3 - 48 months) with a mean limb volume reduction of 32.2% and all patients reporting satisfactory relief of symptoms. All showed statistically significant improvement in LYMQOL in symptoms, appearance, and function. On ICGL, none showed worsened lymphatic drainage, rather, all showed improved lymph drainage. Furthermore, the improved lymph drainage was found to be progressive during the study period in all patients. Our study results demonstrate that treating extremity lymphedema with liposuction does not worsen lymphatic function and in fact, paradoxically, it induces progressive improvement in lymph drainage.

Morphea After Liposuction Ultrasonography

Liposuction is a common aesthetic procedure; however, to date, liposuction has not been linked to morphea. The aim was to review cases with a history of liposuction that presented active morphea lesions in the same surgery regions and were confirmed by ultrasound and histology. A retrospective descriptive analysis of the clinical, ultrasonographic, and pathology database took place (2014-2020). Eleven patients met the criteria. Ultrasound supported the diagnosis, and the ultrasonographic signs of activity in these cases matched the features described in the literature in 100% of cases. In summary, morphea may appear after liposuction and ultrasound can support its early detection.

Isolated axillary nerve palsy after liposuction, an exceptional complication

Isolated injury to the axillary nerve associated with the patient's surgical position is a very rare complication, and in most cases it is associated with the prone during spinal surgery. The presentation of this pathology in relation to surgeries of another nature is exceptional, with only a few cases in the scientific literature. We present the case of a patient who developed symptoms of isolated left axillary nerve palsy after undergoing lipoabdominoplasty and breast reduction, in which the prone and supine positions were alternated. The use of an infiltration solution with lidocaine and epinephrine could have contributed to the appearance of the lesion in this unique case. Finally, the clinical picture was fully resolved thanks to conservative treatment.

Key Moments in the History of Liposuction by Dermatologists

Dermatologists have been pioneers in the development and refinement of liposuction using local anesthesia. Although other specialties routinely use general anesthesia for liposuction, the safety profile of liposuction using local anesthesia is impressive. This article traces the history and development of liposuction by dermatologists in the United States. J Drugs Dermatol. 2022;21(9):997-1000. doi:10.36849/JDD.6952.

Functional panniculectomy vs cosmetic abdominoplasty: Multicenter analysis of risk factors and complications

BACKGROUND

Amidst the rising trend of bariatric surgical procedures being performed across the country and around the world, patients seeking functional panniculectomy after massive weight loss represent a different population than those seeking cosmetic abdominoplasty. The purpose of this study was to determine whether certain complications are more likely to occur in patients undergoing functional panniculectomy, as well as identify risk factors that are implicated in the occurrence of adverse events.

METHODS

Retrospective cohort study was conducted of patients undergoing cosmetic abdominoplasty and functional panniculectomy in North America between 2015 and 2019 using the National Surgical Quality Improvement Program database sponsored by the American College of Surgeons. Comorbidities and postoperative complications between these two cohorts were analyzed with appropriate statistics.

RESULTS

During the study interval, 11,137 patients underwent excision of excessive infraumbilical abdominal skin, including 57.4% (n = 6397) patients undergoing functional panniculectomy and 42.6% (n = 4740) patients undergoing cosmetic abdominoplasty. Patients undergoing functional panniculectomy were significantly more likely to have comorbidities than those undergoing cosmetic abdominoplasty (p < .001). Overall adverse events (p < .001), medical complications (p = .047), surgical complications (p < .001), related readmission (p < .001), and related reoperation (p < .001) were significantly higher in patients undergoing functional panniculectomy. Surgical complications significantly higher in functional panniculectomy included superficial incisional infection (p < .001), deep incisional infection (p < .001), organ/space infection (p < .001), dehiscence (p = .003), and bleeding requiring transfusion (p = .003).

CONCLUSIONS

Patients undergoing functional panniculectomy are significantly more likely to have comorbidities and experience postoperative wound infection, dehiscence, sepsis, bleeding, related readmission, and related reoperation.

High Volume Liposuction in Tumescence Anesthesia in Lipedema Patients: A Retrospective Analysis

BACKGROUND

Lipedema is a chronic, progressive disease that occurs almost exclusively in women and leads to pathological, painful fat growths at the extremities. Only symptomatic therapy can be offered since the etiology of the disease has not yet been clarified. Liposuction in tumescent anesthesia has established itself as a surgical treatment method of choice. The complication rate associated with the procedure and the pharmacological course and safety of treatment in patients with lipedema has not yet been sufficiently studied. The aim of the study was to broaden the evidence on the safety of ambulatory high-volume liposuction in tumescent anesthesia in lipedema patients. Influencing factors of patients (weight, fat content, comorbidities) or the process technique (drug administration, volume of aspirates) should be investigated on the safety and risks of tumescent anesthesia. This was a retrospective data analysis in which data from 27 patients (40 liposuction procedures) treated at the Sandhofer and Barsch lipedema center between 2016 and 2018 were evaluated. The liposuctions were carried out in tumescent anesthesia and using a Power-Assisted Liposuction system. Clinical examinations and regular blood samples were carried out before the procedure, intra- and postoperatively. The procedures lasted an average of 118 minutes and an average of 6111 ml of aspirate was removed. For tumescent anesthesia, patients were given an average lidocaine dose of 34.23 mg/kg body weight and an epinephrine dose of 0.11 mg/kg body weight. No relevant complications associated with drug side effects, hypovolemia or hypervolemia or blood loss were detected. Liposuction under high volume tumescent anesthesia for the treatment of lipedema patients is, even for major intervention, a safe procedure. J Drugs Dermatol. 2021;20(3):326-334. doi:10.36849/JDD.5828.

[Fat embolism syndrome after liposuction and lipoinjection]

Fat embolism syndrome (FES) after liposuction and lipoinjection especially gluteal augmentation is a rare, but potentially life-threatening complication. Plastic surgeons should only inject fat into the superficial planes and stay away from the gluteal veins. The three main symptoms include respiratory distress, neurological symptoms and petechial rash, but many patients fail to develop the classic triad, and there are no specific laboratory findings. As argued in this review, there is currently no specific therapy, so prevention, early detection and supportive care are the main strategies to prevent and treat FES.

Vibration Exposure Safety Guidelines for Surgeons Using Power-Assisted Liposuction (PAL)

BACKGROUND

As power-assisted liposuction (PAL) gains in popularity, plastic surgeons operating these devices experience occupational exposure to hand-transmitted vibration, which can result in hand-arm vibration syndrome, a debilitating neurovasculopathy.

OBJECTIVES

The objective of the study was to determine vibration exposure from the utilization of a PAL device during surgery to generate recommendations for safe use.

METHODS

Vibration emission of a commonly utilized PAL system (MicroAire-650, Surgical Instruments, Charlottesville, VA) was examined employing a vibration data logger under both controlled laboratory conditions and during 13 typical liposuction cases. Data were analyzed and compared with established safety limits of vibration exposure.

RESULTS

The experiments demonstrated a mean vibration magnitude of typical liposuction surgeries to be 5.69 ± 0.77 m/s2 (range, 4.59-6.27 m/s2), which is significantly higher than the manufacturer declared value of 3.77 m/s2. Cannula size was shown to be the most significant contributor to vibration magnitude, with larger cannulas causing more vibration transmission.

CONCLUSIONS

These results indicate that recommendations must be made to prevent undue occupational exposure to vibration from PAL. The MicroAire-650 can generally be safely utilized for less than 1.5 h/d. At exposure levels >1.5 h/d, there is increased risk of developing vibration-related injuries, and vibration-reducing strategies should be implemented. At exposure levels >6 h/d, the safety limit is exceeded and there is significantly increased risk of developing hand-arm vibration syndrome and vibration exposure should be halted.

LEVEL OF EVIDENCE: 4

Conceptual Paper: Abdominoplasty and Liposuction in Systemic Sclerosis

Surgical interventions in patients with systemic sclerosis (SSc), in particular plastic procedures, might cause undesired consequences. Notably, liposuction seems to possess greater risk as adipose tissue has been shown to play an important role in treating wounds and ulcers in patients with SSc. While anticentromere antibodies were found to be correlated with vasculopathy in SSc, patients with SSc and anticentromere antibodies might be more vulnerable to surgical wound complications following liposuction. A 46-year-old female patient, who had been diagnosed with SSc at the age of 31 years, had antinuclear as well as anticentromere antibodies. She underwent abdominoplasty with liposuction and developed severe skin necrosis of the abdomen following the procedure and at the site of liposuction. The correlation with anticentromere and the role of liposuction in skin necrosis in SSc are presented.

Bipolar Radiofrequency as an Adjunct to Face and Body Contouring: A 745-Patient Clinical Experience

BACKGROUND

Radiofrequency (RF) technology has ushered in a new paradigm in body contouring for patients with mild to moderate skin laxity who desire fat removal without exacerbating skin laxity issues. A bipolar internal RF device, used as an adjunct to liposuction, has been found to be simpler and more accurate than previous technologies.

OBJECTIVES

The aim of this study was to review the authors' clinical experience with bipolar RF-assisted liposuction (RFAL).

METHODS

We conducted a review of our large experience with bipolar RFAL, evaluating the nuances from appropriate patient selection and specific treatment areas. The review covered 745 patients treated from January 2017 to January 2020 at 2 centers. A retrospective chart review was performed of the first and last 50 patients treated at each center (for a total of 100 patients in each group) to assess trends in outcomes and adverse events.

RESULTS

Results were generally excellent from physician evaluation, and overall patient satisfaction was high (96%). The two most common adverse events were temporary swelling (9%) and nodules (8.5%). Selected examples of a variety of cases are reviewed.

CONCLUSIONS

The ability to tighten skin with a minimally invasive tool adds much to the contemporary approach to the body-contouring patient with skin laxity. Adverse events were minimal and greatly decreased after an initial short learning curve. Bipolar RFAL is a strong addition to our surgical armamentarium and has become an essential tool for our practices.

LEVEL OF EVIDENCE: 4

Variable Sculpting in Dynamic Definition Body Contouring: Procedure Selection and Management Algorithm

BACKGROUND

Currently, corporal perception has evolved among different ethnic groups and a tendency to change from a slim to an athletic shape has been influenced by geography, culture, race, gender, and social media. Although exercise improves health status, physical appearance does as well in the long term. Patients often opt for an immediate solution for which high-definition (HD) liposculpture has been the best choice. However, they differ on their preference regarding muscular definition.

OBJECTIVES

The authors presented a new therapeutic algorithm for HD liposculpture in harmony with body biotypes and patients' preferences.

METHODS

The authors reported their experience with 1772 consecutive patients, classified according to their body type in endomorph (217), ectomorph (195), and mesomorph (1360), and treated according to our new algorithm. Patients in general good health requesting HD liposculpture were included from June 2013 to September 2019. Pre- and postoperative photographs were taken to evaluate results.

RESULTS

A total of 479 men and 1293 women were analyzed. Age ranged from 23 to 69 years in men and 18 to 57 years in women. Variable-degree HD liposculpture was successfully performed in all cases. Minor complications included port wound dehiscence (1.2%), seroma (4.1%), prolonged bruising (1.5%), and hyperchromia (10.4%). Superficial burns (0.7%), localized infection (0.4%), erratic skin adhesion (1%), and flap necrosis (0.4%) were also reported. A high-satisfaction index was reported in a nonstandardized patient survey.

CONCLUSIONS

The authors' new algorithm helps in the decision-making for HD liposculpture according to variable degrees of muscle definition due to patients' preferences.

LEVEL OF EVIDENCE: 4

Blood Impairs Viability of Fat Grafts and Adipose Stem Cells: Importance of Washing in Fat Processing

BACKGROUND

Fat processing plays a pivotal role in graft survival. Each component of the blood in lipoaspirate affects fat survival in different ways, but the mechanisms are not clear.

OBJECTIVES

The aim of this study was to investigate, by various experimental methods, the effect of blood on the viability of fat grafts and adipose stem cells (ASCs).

METHODS

Blood and fat samples were obtained from 6 female patients undergoing aesthetic liposuction. For the in vivo experiment, we compared fat mixed with normal saline or various ratios of blood in nude mice. The samples were explanted at 2 and 8 weeks to evaluate the gross volume retention and histologic and immunohistochemical characteristics. For in vitro experiments, ASCs were pretreated with hemoglobin at different concentrations and for different times. We then assessed the proliferation, migration, adipogenesis, and reactive oxygen species production of ASCs.

RESULTS

Blood in the graft led to a decrease in graft viability, as evaluated by general observation and histologic and immunohistochemical morphology in vivo. In vitro experiments showed inhibited proliferation, migration, and adipogenesis, and increased reactive oxygen species production in ACSs, after hemoglobin treatment, suggesting impaired ASC viability.

CONCLUSIONS

This study suggests that blood impairs the viability of fat grafts and ASCs and provides evidence that washing to remove blood is important in fat processing.

Brachioplasty Refinements

With a growing massive weight loss population, upper arm contouring continues to rise in popularity. Refinements in technique, such as modification of skin excision patterns and the adjunct use of liposuction, have allowed for safe and reproducible results. This article helps to understand the evolution of upper arm contouring and provides an update on the limited-incision medial brachioplasty. Details of preoperative markings and operative technique are clearly illustrated in the video included.

Lower Body Lift After Bariatric Surgery: 323 Consecutive Cases Over 10-Year Experience

BACKGROUND

Lower body lift is a widespread procedure for massive weight loss patients aimed to improve the contour of the lower trunk, gluteal region and proximal lower extremity. The data about complications are confusing, and there is a lack of uniform studies for massive weight loss patients. A simple formula to carry out a reliable procedure in a short time with a low complication rate should be advocated.

METHODS

This retrospective study analyzed data of 323 patients undergoing lower body lift after bariatric surgery over a 10-year period. Selection criteria, careful preoperative marking, reliable intra- and postoperative care and a few surgical tips are discussed. All the complications (both major and minor) and the aesthetic satisfaction were evaluated. Risk factors assessed were patient age, tobacco consumption, current BMI, operative time and combined surgery.

RESULTS

The overall complication rate was 42%. We recorded a lower rate of major complications and skin dehiscence; no infection and no skin necrosis were observed. The most frequent complication was seroma (35%). A complication development was straight related to age (p = 0.0177) and tobacco use (p = 0.0336). Patients' satisfaction about overall aesthetic was high.

CONCLUSIONS

We present our case load and describe an easy recipe to perform a safe surgery without undermining and liposuction in short operative times. The reasonable overall complication rate and the surprisingly lower rate of dehiscence and skin necrosis combined with a pleasant aesthetic result make the lower body lift an easy and safe procedure, when applied to the appropriate patient population.

LEVEL OF EVIDENCE IV

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