Principles of liposuction

A Three-Dimensional Approach To Male Chest Enhancement: A Surgical Algorithm Based On 300 Cases

Gynecomastia is defined as a benign condition of the male caused by tissue overgrowth (Blau and Hazani in Plast Reconstruct Surg 135(2): 425-432, 2015). Its incidence ranges widely in the world population, ranging from 32 to 65% (Innocenti et al. in Ann Plast Surg 78(5):492-496, 2017). Pseudogynecomastia is a condition characterized by deposits of adipose tissue with alteration of the profile of the male thorax. It appears clinically similar to gynecomastia (Hoyos et al. in Plast Reconstr Surg 147:1072-1083, 2021). Several classification systems that characterize the severity of male breast hypertrophy have been described in the literature, and many surgical algorithms have been formulated for its treatment (Holzmer et al. in Plast Reconstruct Surg-Global Open 8:e3161, 2020). The purpose of this original article is to provide a comprehensive surgical algorithm for the management of male chest enhancement based on severity, as defined by the Moschella scale (Tambasco et al. in J Plast Reconstruct Aesthet Surg 90:99-100, 2024). A total of 300 patients treated for bilateral breast hypertrophy are included and reviewed in this retrospective study. Patients have been diversified according to the Moschella scale. For each grade up to grade III, two subgroups were distinguished: A) pinch test less than 0.7 cm and B) pinch test greater than 0.7 cm. For Grade IV, we distinguished: subgroup A) where the distance between the inframammary fold and the nipple was < 3 cm; and subgroup B) where the distance between the inframammary fold and the nipple was > 3 cm. We developed an algorithm, based on this experience, to help to choose the best surgical techniques to perform a three-dimensional result. All patients were treated using multiple surgical techniques. In all cases, we made a reduction in the hypertrophy of the chest, obtaining the three dimensionality. Associate techniques include ultrasound-assisted liposuction (UAL) and helium plasma radiofrequency technology (HPRF). A round block mastectomy (RBm) or skin-reducing mastectomy T inverted (SRM Tinv) is reserved only in limited cases.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 .

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

Safety and efficacy of treating symptomatic, partial-thickness rotator cuff tears with fresh, uncultured, unmodified, autologous adipose-derived regenerative cells (UA-ADRCs) isolated at the point of care: a prospective, randomized, controlled first-in-human pilot study

Background

This study tested the hypothesis that treatment of symptomatic, partial-thickness rotator cuff tears (sPTRCT) with fresh, uncultured, unmodified, autologous adipose-derived regenerative cells (UA-ADRCs) isolated from lipoaspirate at the point of care is safe and more effective than corticosteroid injection.

Methods

Subjects aged between 30 and 75 years with sPTRCT who did not respond to physical therapy treatments for at least 6 weeks were randomly assigned to receive a single injection of an average 11.4 × 10⁶ UA-ADRCs (in 5 mL liquid; mean cell viability: 88%) (n = 11; modified intention-to-treat (mITT) population) or a single injection of 80 mg of methylprednisolone (40 mg/mL; 2 mL) plus 3 mL of 0.25% bupivacaine (n = 5; mITT population), respectively. Safety and efficacy were assessed using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), RAND Short Form-36 Health Survey, and pain visual analogue scale (VAS) at baseline (BL) as well as 3 weeks (W3), W6, W9, W12, W24, W32, W40, and W52 post treatment. Fat-saturated T2-weighted magnetic resonance imaging of the shoulder was performed at BL as well as at W24 and W52 post treatment.

Results

No severe adverse events related to the injection of UA-ADRCs were observed in the 12 months post treatment. The risks connected with treatment of sPTRCT with UA-ADRCs were not greater than those connected with treatment of sPTRCT with corticosteroid injection. However, one subject in the corticosteroid group developed a full rotator cuff tear during the course of this pilot study. Despite the small number of subjects in this pilot study, those in the UA-ADRCs group showed statistically significantly higher mean ASES total scores at W24 and W52 post treatment than those in the corticosteroid group (p < 0.05).

Discussion

This pilot study suggests that the use of UA-ADRCs in subjects with sPTRCT is safe and leads to improved shoulder function without adverse effects. To verify the results of this initial safety and feasibility pilot study in a larger patient population, a randomized controlled trial on 246 patients suffering from sPTRCT is currently ongoing.

Trial registration

Clinicaltrials.gov ID NCT02918136. Registered September 28, 2016, https://clinicaltrials.gov/ct2/show/NCT02918136.

Level of evidence

Level I; prospective, randomized, controlled trial.

Improved guided bone regeneration by combined application of unmodified, fresh autologous adipose derived regenerative cells and plasma rich in growth factors: A first-in-human case report and literature review

BACKGROUND

Novel strategies are needed for improving guided bone regeneration (GBR) in oral surgery prior to implant placement, particularly in maxillary sinus augmentation (GBR-MSA) and in lateral alveolar ridge augmentation (LRA). This study tested the hypothesis that the combination of freshly isolated, unmodified autologous adipose-derived regenerative cells (UA-ADRCs), fraction 2 of plasma rich in growth factors (PRGF-2) and an osteoinductive scaffold (OIS) (UA-ADRC/PRGF-2/OIS) is superior to the combination of PRGF-2 and the same OIS alone (PRGF-2/OIS) in GBR-MSA/LRA.

CASE SUMMARY

A 79-year-old patient was treated with a bilateral external sinus lift procedure as well as a bilateral lateral alveolar ridge augmentation. GBR-MSA/LRA was performed with UA-ADRC/PRGF-2/OIS on the right side, and with PRGF-2/OIS on the left side. Biopsies were collected at 6 wk and 34 wk after GBR-MSA/LRA. At the latter time point implants were placed. Radiographs (32 mo follow-up time) demonstrated excellent bone healing. No radiological or histological signs of inflammation were observed. Detailed histologic, histomorphometric, and immunohistochemical analysis of the biopsies evidenced that UA-ADRC/PRGF-2/OIS resulted in better and faster bone regeneration than PRGF-2/OIS.

CONCLUSION

GBR-MSA with UA-ADRCs, PRGF-2, and an OIS shows effectiveness without adverse effects.

[Liposuction]

Liposuction began in the 1920s when the Parisian surgeon Charles Dujarier became interested in body shaping and fat removal. Today, it is estimated that 1,453,000 liposuctions are annually performed worldwide. In Germany, 45,000 liposuctions are performed annually. The majority of liposuctions are performed as self-pay services. The aim of this article is to outline the development of liposuction, to explain the various liposuction procedures and methods, to clarify the indications for treatment, and point out the complications and pitfalls described in the literature.

Occurrence and severity of upper eyelid skin contracture in facial nerve palsy

PurposeTo describe the occurrence and severity of upper eyelid skin contracture in facial nerve palsy (FNP).MethodsWe enroled consecutive patients with unilateral FNP into this study. Patients with previous upper eyelid surgery for either side were excluded. We developed a standardised technique to measure the distance between the upper eyelid margin and the lower border of brow (LMBD). FNP was graded using the Sunnybrook grading scale. Its aetiology, duration, and treatment were noted. Upper and lower marginal reflex distance and lagophthalmos were also noted.ResultsSixty-six patients (mean age 51 years) were included. FNP was owing to a variety of aetiologies. LMBD on the paralytic side was shorter than the normal contralateral side in 47 (71%), equal in 15 (23%), and larger in four (6%) patients. The mean contracture was 3.4 mm (median: 3, range: 1-12) with 11 (17%) patients showing 5 mm or more of skin contracture. The mean LMBD on the paralytic side in all patients was significantly smaller than the contralateral side; 30±3.7 (median: 30; 95% CI 29-31) compared with 32±3.7 (median: 32; 95% CI 32-33), respectively, P<0.0001, two-tailed paired t-test.ConclusionTo our knowledge, this is the first study that quantitatively demonstrates contraction of the upper eyelid skin in FNP. This finding is valuable in directing optimal early management to minimise skin contracture and to caution surgeons against unnecessary upper eyelid skin excision.

Intradermal injection of human adipose-derived stem cells accelerates skin wound healing in nude mice

Background

The use of stem cells from adipose tissue or adipose-derived stem cells (ASCs) in regenerative medicine could be an interesting alternative to bone marrow stem cells because they are easily accessible and available in large quantities. The aim of this study was to evaluate the potential effect of ASCs on the healing of 12 mm diameter-excisional wounds (around 110 mm²) in nude mice.

Methods

Thirty nude mice underwent surgery to create one 12-mm excisional wound per mouse (spontaneous healing, n = 6; Cytocare® 532, n = 12; ASCs, n = 12). The Galiano wound model was chosen to avoid shrinkage and thus slow the spontaneous healing (SH) of mouse skin, making it closer to the physiology of human skin healing. Transparent dressings were used to enable daily healing time measurements to be taken. Immunohistochemistry, histological and blood perfusion analysis were carried out on the healed skin.

Results

The in vivo results showed the effectiveness of using ASCs on reducing the time needed for complete healing to 21.2 days for SH, 17.4 days for vehicle alone (Cytocare® 532) and 14.6 days with the addition of ASCs (p < 0.001). Moreover, cutaneous perfusion of the healed wound was significantly improved in ASC-treated mice compared to SH group, as shown by laser Doppler flowmetry and the quantitation of blood vessels using immunohistochemistry of αsmooth muscle actin.

Conclusions

The tolerance and efficacy of cryopreserved ASCs to accelerate the complete closure of the wound by increasing the maturation of the skin and its blood perfusion, shows their therapeutic benefit in the wound healing context.

Transcutaneous electrical nerve stimulation for pain relief after liposuction: a randomized controlled trial

BACKGROUND

Liposuction is a common cosmetic surgical procedure, which requires analgesia for postoperative pain. Transcutaneous electrical nerve stimulation (TENS) has been used for postoperative pain relief; however, there is no evidence of its effectiveness in liposuction patients and this is the focus of this paper.

METHODS

A prospective, randomized, double-blind, controlled trial was conducted with 42 adult patients who underwent liposuction. Patients were randomly allocated to either the TENS group (active TENS) or control group (sham TENS). All patients received morphine (0.1 mg/kg) and dipyrone 1 g immediately after surgery; TENS was delivered 2 h later. The primary outcome was pain intensity. Secondary outcomes were analgesic requirement, number and types of adverse effects of TENS, quality of pain, treatment success, and patient satisfaction. Postoperative pain was measured using a visual analog scale (VAS) and the Brazilian version of the McGill Pain Questionnaire (Br-MPQ).

RESULTS

Patients in the TENS group reported significantly lower pain intensity (P < 0.001, effect size = 0.92) compared with those in the control group. TENS significantly decreased the consumption of analgesics in the postoperative period (P < 0.001). No withdrawals or adverse effects were observed in the TENS group, but 33.3% of patients in the control group reported drowsiness and nausea. About 95 and 38% of patients in the TENS and control groups, respectively, were satisfied with the analgesic treatment.

CONCLUSION

The results indicate that TENS is effective as an adjunct to analgesics for pain relief after liposuction.

LEVEL OF EVIDENCE I

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.

An evaluation of the patient population for aesthetic treatments targeting abdominal subcutaneous adipose tissue

A large and growing population of patients currently seeks minimally invasive therapeutic options for the aesthetic treatment of localized, central abdominal subcutaneous adipose tissue (SAT). We sought to evaluate the ideal population for aesthetic treatment of central abdominal SAT, highlight the existing disparities between SAT in obese (body mass index [BMI] ≥ 30; BMI) and nonobese (BMI < 30) patients, and review the available FDA-cleared, minimally invasive treatment options for central abdominal adiposity. The cosmetic issue of localized, central (periumbilical) abdominal adiposity in nonobese individuals is quite distinct from abdominal bulging secondary to obesity. Given the recognized clinical and physiologic differences between obese and nonobese counterparts, the exclusion of obese patients from clinical study by currently available FDA-cleared devices targeting abdominal fat, and the status of obesity as a chronic, systemic disease requiring medical, surgical, and/or lifestyle-altering therapies, minimally invasive therapeutic options for aesthetic reductions in central abdominal SAT must be limited to the nonobese population.

Randomized, blinded split abdomen study evaluating skin shrinkage and skin tightening in laser-assisted liposuction versus liposuction control

BACKGROUND

Laser-assisted liposuction has shown great potential in facilitating fat removal, improving patient recovery time, and decreasing postoperative side effects. Clinical experience has indicated superior skin tightening after laser-assisted liposuction than with liposuction alone.

OBJECTIVES

The aim of the present study was to obtain quantitative, objective data for comparing tissue shrinkage and skin tightening achieved by laser-assisted liposuction versus liposuction alone.

METHODS

Ten female subjects from the author's private practice with unwanted abdominal adiposity and mild to moderate skin laxity were enrolled. On the abdominal skin of each patient, the corners of four rectangular regions (approximately 5 × 5 cm each) were tattooed with India ink and randomly assigned to treatment with laser-assisted liposuction (Smartly MPX laser, Cynosure, Inc., Westford, Massachusetts) or with liposuction alone. The laser system permits individual as well as sequential emission of 1064-nm and 1320-nm wavelengths. Skin shrinkage was quantified by calculating the changes in surface area of the regions. Skin tightening was quantified by changes in the skin stiffness index measured in the treated regions.

RESULTS

One month and three months after treatment, the mean skin shrinkage ratios were significantly higher on the laser-treated side than on the suction side. One month after treatment with or without laser, the mean skin stiffness and skin tightening showed no statistically significant difference from baseline. Three months after treatment, the mean skin stiffness and skin tightening were significantly higher on the laser-treated side.

CONCLUSIONS

Laser-assisted liposuction has a statistically significant effect on skin shrinkage and tightening of the skin in the abdominal area when compared to liposuction alone.

New advances in liposuction technology

Although suction-assisted liposuction under tumescent anesthesia remains the traditional method for body sculpting, newer technologies promise to increase efficiency, decrease surgeon fatigue, and minimize complication. Power-, ultrasound-, and laser-assisted devices are ideal in large volume cases and in areas of fibrous tissues as an adjunct to traditional liposuction. Although skepticism remains chemical lipolysis, more commonly termed mesotherapy or lipodissolve may be an alternative to surgical treatment of localized fat. This article reviews the recent advancements in the field of liposuction and the current literature which support their use.

Lipoplasty of the face and neck

PURPOSE OF REVIEW

Facial aesthetic surgery has gained wider acceptance and demand for it is increasing. Patients seeking a more youthful facial look often request lipoplasty. This article reviews the recent advances in lipoplasty and related fat contouring for the face and neck.

RECENT FINDINGS

Lipoplasty of the face and neck continues to be popular. There have been improvements in instrumentation, with laser and powered lipoplasty improving the efficiency of fat removal. Lipoplasty indications for neck lipodystrophy have been extended to patients previously only offered neck lifting. Additionally, limited procedures for patients with isolated anterior neck deformities, including direct lipectomy and skin excision, are gaining in popularity. Considerable attention in the lay and professional literature has been paid to mesotherapy for dissolving unwanted fat. Evidence supporting its efficacy is elusive. Finally, there remains enthusiasm for injection fat transfer for facial volume restoration as a component of rejuvenation.

SUMMARY

The treatment of lipodystrophy of the face and neck involves the removal of undesirable fat and the transfer of fat to other areas to produce improved aesthetic results. With the current emphasis on restoring volume, lipoplasty and fat transfer will continue to be important in facial plastic surgery.