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Seranio N, Muncey W, Cox S, Belladelli F, Del Giudice F, Glover F, Eisenberg ML. Size matters: characterizing penile augmentation content from the 100 most popular YouTube videos. Int J Impot Res 2024; 36:493-497. [PMID: 37380757 DOI: 10.1038/s41443-023-00728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/21/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
Aesthetic penile augmentation is considered investigational and not shown to be safe or efficacious. This study sought to characterize the quality and reliability of YouTube videos on the topic of penile augmentation. A systematic search identifying the 100 most viewed YouTube videos on penile augmentation was conducted. The videos were then evaluated by two independent urologists for reliability and quality using a modified DISCERN scoring system and Global Quality Scale (GQS). The median total views were 530,612 (range 123,478-32,914,713). The median DISCERN and GQS scores for all 100 videos were generally poor at 1.75 (IQR 1-2.63) and 2.5 (IQR 1.5-3.5), respectively. A little under half of the videos had a physician present (44.7%). DISCERN and GQS scores were significantly higher in videos with physicians compared to those without one (p < 0.001 for both). The majority of videos discussed nonsurgical methods of penile augmentation (65.1%) with penile traction devices being the most frequently discussed (19.2%). Urologists and medical organizations should strive to have more of a presence in this space to ensure patients are appropriately educated and counseled before pursuing potentially ineffective or harmful treatments.
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Affiliation(s)
- Nicolas Seranio
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA.
| | - Wade Muncey
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Federico Belladelli
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Frank Glover
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael L Eisenberg
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
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2
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Agullo FJ, Castro-Garcia JA, Mohan VC. Multidisciplinary Experience for Gluteal Fat Grafting. Aesthetic Plast Surg 2024:10.1007/s00266-024-04163-2. [PMID: 39009870 DOI: 10.1007/s00266-024-04163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Gluteal fat grafting, colloquially known as Brazilian Butt Lift, has experienced a significant rise in popularity in recent years. Despite this increase, potential complications associated with the procedure have also been observed, necessitating a thorough examination of the current practices and outcomes. METHODS This study collected experiences of a multidisciplinary group of surgeons through a detailed survey sent in April 2022. This study aimed to shed light on the practices employed by these surgeons, the frequency and types of complications they encounter, and the overall outcomes of their procedures. RESULTS Of the 100 surgeons surveyed, 86 responded. The study identified that pulmonary fat embolism (PFE) was the most serious complication, with fatality due to PFE recorded at a rate of 1:23,878. Liposuction site seromas were the most common complications, with an overall rate of 2.45%. Although there were no overall differences in complications between plastic and non-plastic surgeons, plastic surgeons were found to have a sixfold increase in the odds of experiencing a liposuction seroma. The survey also revealed substantial practice variations, particularly regarding fat preparation methods, recipient-site preparation, antibiotic use, and postoperative care protocols. CONCLUSION Despite known complications, a strong tendency to continue performing these procedures was observed among surgeons, demonstrating the sustained demand and acceptance of the procedure. This study underscores the need for continued surveillance and research to enhance the safety and effectiveness of gluteal fat grafts. The experiences and data gathered from practicing surgeons provide valuable insights, paving the way for refining techniques, building consensus, and facilitating informed discussions with patients about the risks and benefits of the procedure. 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 .
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Affiliation(s)
- Francisco J Agullo
- Division of Plastic Surgery, Department of Surgery, Texas Tech University Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX, 79905, USA.
| | - Jose A Castro-Garcia
- Division of Plastic Surgery, Department of Surgery, Texas Tech University Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX, 79905, USA
| | - Vamsi C Mohan
- Division of Plastic Surgery, Department of Surgery, Texas Tech University Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX, 79905, USA
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3
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Weidman AA, Foppiani J, Valentine L, Hernandez Alvarez A, Elmer N, Hassell N, Seyidova N, Hwang P, Paul M, Arguello A, Lin SJ. Complications From Fat Grafting and Gluteal Augmentation in Outpatient Plastic Surgery: An Analysis of American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, QUAD A) Data. Aesthet Surg J 2024; 44:722-730. [PMID: 37996070 DOI: 10.1093/asj/sjad345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Gluteal augmentation with autologous fat grafting, colloquially referred to as Brazilian butt lift (BBL), is an increasingly common procedure with a highly reported complication profile. OBJECTIVES In this study we aimed to analyze the prevalence and characteristics of complications that accompanied these surgeries at ambulatory surgery facilities. METHODS Adults patients who experienced fat grafting complications from 2019 to 2021 were identified in QUAD A, formerly known as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF, Highland Park, IL, USA), database. Patients and complications were analyzed based on sociodemographic, surgery-, and facility-specific variables with descriptive statistics and logistic regression. RESULTS Overall, 436 fat grafting procedures with complications were reported to QUAD A, with an overall complication rate of 0.94%. Of these complications, 164 (37.6%) were confirmed to be from gluteal augmentation procedures. Notably, the number of gluteal augmentation with fat grafting complications decreased from the year 2019 (48) to 2020 (36), then nearly doubled from 2020 to 2021 (69). The majority of patients were female (96.7%), with a mean age of 42.0 years and a mean BMI of 28.3 kg/m2. Wound infection was the most commonly documented complication (22.3%). Of the patients who experienced complications, 35.9% presented to a hospital for their complications and 12.6% required reoperation. Four deaths were described. There was no association between sociodemographic or surgical variables and increased odds of readmission or reoperation (P > .05), except for increasing surgeon number and reoperation (P = .02). CONCLUSIONS Gluteal augmentation accounts for a large proportion of complications from fat grafting procedures. Increased reporting requirements may aid in future determination of incidences of complications and improve patient safety. LEVEL OF EVIDENCE: 3
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Hegde S, Carroll EF, Doo FX, Drzewiecki B, Jensen KK, Sertic M, Pierce TT. Imaging the acute complications of gender-affirming surgeries: a primer for radiologists in the emergency setting. Abdom Radiol (NY) 2024:10.1007/s00261-024-04385-7. [PMID: 38832942 DOI: 10.1007/s00261-024-04385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
Gender-affirming surgery (GAS) is increasingly being performed. GAS is tailored to the patient leading to a diverse spectrum of radiologic post-operative findings. Radiologists who are unfamiliar with expected anatomic alterations after GAS may misdiagnose important complications leading to adverse patient outcomes. This collaborative multi-institutional review aims to: Describe relevant embryology and native anatomy. Describe relevant Gender-Affirming Surgery (GAS) techniques and expected neo-anatomy with associated complications, including common terminology. Review expected imaging appearance of neo-anatomy/postoperative findings. Review multi-modality [ultrasound, plain film, retrograde urethrogram, computed tomography] emergent imaging findings. Understand unique patient evaluation and imaging protocol considerations in the GAS population. Discuss pearls and pitfalls of imaging in the acute post-GAS setting.
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Affiliation(s)
- Siddhi Hegde
- Department of Radiology, Center for Ultrasound Research and Translation (CURT), Massachusetts General Hospital, 101 Merrimac St, Boston, MA, 02114, USA.
| | - Evelyn F Carroll
- Breast Imaging/Hospital and Emergency Radiology Divisions, Mayo Clinic, Rochester, MN, USA
| | - Florence X Doo
- Body/Abdominal Imaging Division, University of Maryland Medical Center, Baltimore, MD, USA
| | - Beth Drzewiecki
- Pediatric Surgical Services (MGfC), Massachusetts General Hospital, Boston, MA, USA
| | - Kyle K Jensen
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Madeleine Sertic
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Theodore T Pierce
- Department of Radiology, Center for Ultrasound Research and Translation (CURT), Massachusetts General Hospital, 101 Merrimac St, Boston, MA, 02114, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
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Ibarra-Hurtado TR, Nuño-Guzmán CM, Ambriz-Plascencia AR, Ibarra-Tapia ME. Minimally Invasive Video-Assisted Submuscular Gluteal Augmentation with Implants: An Innovative Technique. Plast Reconstr Surg 2024; 153:1302-1305. [PMID: 37220272 DOI: 10.1097/prs.0000000000010732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
SUMMARY Gluteal augmentation is one of the most requested cosmetic procedures. This article describes the surgical technique and early results of an innovative minimally invasive video-assisted submuscular gluteal augmentation with implants. The authors aimed to perform a technique that would reduce complications and surgical time. Fourteen healthy women without obesity or relevant pathologic background who requested gluteal augmentation with implants as a single procedure were included. The procedure was performed through bilateral parasacral 5-cm incisions at cutaneous and subcutaneous planes as far as the gluteus maximus muscle fascia. Through a 1-cm incision in the fascia and muscle, the index finger was introduced under the gluteus maximus, and a submuscular space was created by blunt dissection toward the greater trochanter to avoid a sciatic nerve injury, until the middle gluteus level was reached. Next, the balloon shaft of a Herloon trocar was introduced in the dissected space. Balloon dilatation in this submuscular space was performed as required. The balloon shaft was replaced by the trocar, through which a 30-degree 10-mm laparoscope was introduced. Submuscular pocket anatomic structures were observed, and while the laparoscope was being retrieved, hemostasis was verified. The submuscular plane collapsed, leaving the pocket for the implant to be placed. There were no intraoperative complications. The only postoperative complication was a self-limited seroma in one patient (7.1%). This innovative technique was simple to perform and safe, allowing direct visualization and hemostasis, with a short surgical time, low complication rate, and high degree of satisfaction.
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Affiliation(s)
| | - Carlos M Nuño-Guzmán
- General Surgery, Hospital Civil de Guadalajara Fray Antonio Alcalde
- Department of Surgical Clinics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
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Antezana LA, Kreutz-Rodrigues L, Shapiro D, Chen A, Sharaf B, Martinez-Jorge J, Bakri K. Most Cited Articles in Body Contouring: A Bibliometric Analysis of the Past 45 Years. Plast Surg (Oakv) 2024; 32:265-275. [PMID: 38681248 PMCID: PMC11046267 DOI: 10.1177/22925503221120574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 05/01/2024] Open
Abstract
Introduction: The purpose of this study is to produce a bibliometric review of the 30 most cited articles related to 6 major domains of body contouring-abdominoplasty, thighplasty, brachioplasty, gluteoplasty, body lift, and liposuction-for resident and fellow education. Methods: The authors utilized the Web of Science Citation Index to identify the 30 most cited articles related to surgery for body contouring published from 1975 to 2020. Articles were classified according to their level of evidence, type of study, and country of publication. Results: A total of 336 articles were reviewed to compile our list. The mean number of citations across the articles was 114.7 ± SD 86.1. The highest prevalence of the papers was published between 2000 and 2009 (n = 15, 50%). The country with the highest number of contributions was the United States (n = 22, 73%). Plastic and Reconstructive Surgery served as the main journal of publication for these papers (n = 22, 73.3%). The majority of articles were designated for clinical-type studies (n = 26, 86.7%). No basic science or prevalence study design papers were listed. In terms of level of evidence (LoE), most papers were assigned IV (n = 11, 36.7%) and III (n = 7, 23.3%). Conclusions: Our study reveals that the most cited papers in body contouring are of LoE III and IV. Although the LoE of plastic surgery research, in general, has improved, in the past decade, a call for higher quality papers remains. Overall, this analysis provides an easy, electronic starting point for residents and fellows interested in understanding the field's evolution.
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Affiliation(s)
| | | | - Daniel Shapiro
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Austin Chen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Basel Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Güzey S, Ergan Şahin A. Brazilian Butt Lift: An Experience Over 3000 Patients. Aesthetic Plast Surg 2024:10.1007/s00266-024-03965-8. [PMID: 38580866 DOI: 10.1007/s00266-024-03965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/23/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer. METHOD Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure. RESULTS Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures. CONCLUSION BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. LEVEL OF EVIDENCE 3: 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 .
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8
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Yang M, Li J, Dong W, Lv Q, Qi Y, Han X, Qi Z, Ma GE, Gu Y. Lower Gluteal Liposuction Combined With Upper Gluteal and Infragluteal Region Fat Grafting: A Novel Concept to Improve Gluteal Ptosis. Aesthet Surg J 2024; 44:NP329-NP336. [PMID: 38324894 DOI: 10.1093/asj/sjae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024] Open
Abstract
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
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Seabra Robalo Gomes Jorge AC, Feng YS, Santos Stahl A, Grözinger G, Nikolaou K, Glanemann M, Daigeler A, Stahl S. Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting. Aesthetic Plast Surg 2024; 48:1597-1605. [PMID: 38302712 PMCID: PMC11058931 DOI: 10.1007/s00266-023-03824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Knowledge of the vascular anatomy is critical to performing safe gluteal surgery. To date, only the course of the main blood vessels within the muscles has been outlined. These findings are based on MRI and CTA images that do not conform to a topographically standardized and normalized probability distribution. OBJECTIVES The aim of this study was to develop a three-dimensional mapping of the gluteal zones of high vascular density in relation to anatomical landmarks. MATERIALS AND METHODS This single-center retrospective cohort analysis comprised all consecutive patients who underwent cone-beam computed tomography (CBCT) scans between January 2016 and October 2021. The location of blood vessels in the gluteal region was allometrically normalized in relation to anatomical landmarks. Moreover, the caliber and area of the blood vessels were assessed. RESULTS CBCT scans of 32 patients with an average age of 64 ± 12 years (range 34-87 years) were included. Fifty-three percent were female. The median [IQR] caliber of the intramuscular gluteal vessels was 1.47 [1.15-1.88] mm, significantly greater than that of the subcutaneous vessels 1.09 [0.72-1.44] mm (p < 0.001). Vascular density was higher intramuscularly, as 4.5% of the area of the muscle was occupied by blood vessels, as opposed to 0.3% in the adipose tissue. CONCLUSION The analysis of the CBCT scans showed a higher vascular density and larger vessels intramuscularly. We, therefore, recommend the injection of autologous fat merely to the subcutaneous plane. 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 .
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Affiliation(s)
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | | | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Matthias Glanemann
- Department of General, Visceral, Vascular, and Pediatric Surgery, Saarland University Hospital, Kirrberger Straße, 66421, Homburg, Saarland, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Clinic Tübingen, Tübingen, Germany
| | - Stéphane Stahl
- CenterPlast private practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany
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Roblero Rivera CA, Manzaneda Cipriani R, Flores Gonzáles EA, Scheneider Salomone Viaro M. Superficial Intramuscular Gluteal Lipograft by Doppler Ultrasound: A Report of 24 Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5743. [PMID: 38623442 PMCID: PMC11018222 DOI: 10.1097/gox.0000000000005743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/28/2024] [Indexed: 04/17/2024]
Abstract
Background Gluteal fat grafting is a common procedure in liposculpture. This study proposes a Doppler ultrasound-guided intramuscular and subcutaneous gluteal lipotransfer technique that allows for visualization of the location of the gluteal vessels, avoiding approaching them during lipotransfer by having the cannula localized during fat infiltration. Methods This new technique was applied to 24 women after obtaining informed consent and providing them with a clear explanation of potential risks and complications. Doppler ultrasound was used to locate the site and depth of blood vessels, and for quadrant scanning of vessels and superficial intramuscular visualization of the cannula's location. Intramuscular lipotransfer was performed with a volume of 400 mL per gluteus (or less), and 12 patients underwent magnetic resonance imaging before and 3 months after surgery. Results This technique allowed for visualizing the location of the gluteal vessels, and infiltration could be easily performed in patients. In the 24 glutei reviewed postsurgery, from 12 patients who underwent pre- and postsurgery magnetic resonance imaging, intramuscular fat was found; however, there was no migration outside the gluteus maximus muscle. Conclusions No local or systemic complications were observed. The results of our report show that fat filtration did not migrate outside the gluteus maximus muscle. This finding seeks to promote new research to create theoretical/practical precedents for the intervention of plastic surgeons and, from there, promote the standardization of a new and safe technique.
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Vidal-Laureano N, Huerta CT, Perez EA, Earle SA. Augmented Safety Profile of Ultrasound-Guided Gluteal Fat Transfer: Retrospective Study With 1815 Patients. Aesthet Surg J 2024; 44:NP263-NP270. [PMID: 38124368 DOI: 10.1093/asj/sjad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
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
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12
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Kelishadi SS, Chiemi JA, Chowdhry S, Colorado A, Herring NR, Kinney B, Wilhelmi BJ. Accurate Plane Fat Grafting in Gluteal Augmentation: An Anatomic Study. Aesthet Surg J 2024; 44:311-316. [PMID: 37707558 DOI: 10.1093/asj/sjad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The safety of gluteal fat grafting is a global concern in plastic surgery. OBJECTIVE The goal of this study was to test whether fat grafting to the buttocks with Auto Stop Reach (ASR) technology prevents penetration from the subcutaneous space into the fascia and muscle layers of the buttocks. METHODS Fat transfer simulation was performed with blue dye on 8 fresh tissue cadaver buttocks by 3 board-certified plastic surgeons (S.S.K., S.C., B.W.). An open control was utilized to visualize the process in the different anatomic layers, and all of the other procedures were performed blindly, akin to live surgery. After blue dye transfer reached maximum capacity (ranging from 400-800 mL per buttock), dissection of the anatomical layers of the buttocks was performed to determine the plane(s) of injection. RESULTS Blue dye fat transfer injection to the buttocks did not penetrate the gluteal fascia or muscle layers from the subcutaneous space while using ASR. CONCLUSIONS Auto Stop Reach technology supports the safety of gluteal fat transfer in the subcutaneous space by board-certified plastic surgeons. LEVEL OF EVIDENCE: 4
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Khoobehi K. Commentary on: The Optimal Layer for Breast Augmentation in an Autologous Fat Grafting Murine Model. Aesthet Surg J 2024; 44:226-227. [PMID: 37935038 DOI: 10.1093/asj/sjad343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023] Open
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Rohrig A, Morrison J, Kleinwaks G, Pugh J, McShane H, Savulescu J. Exploring the ethics of tuberculosis human challenge models. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109234. [PMID: 38159935 DOI: 10.1136/jme-2023-109234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/28/2023] [Indexed: 01/03/2024]
Abstract
We extend recent conversation about the ethics of human challenge trials to tuberculosis (TB). TB challenge studies could accelerate vaccine development, but ethical concerns regarding risks to trial participants and third parties have been a limiting factor. We analyse the expected social value and risks of different challenge models, concluding that if a TB challenge trial has between a 10% and a 50% chance of leading to the authorisation and near-universal delivery of a more effective vaccine 3-5 years earlier, then the trial would save between 26 400 and 1 100 000 lives over the next 10 years. We also identify five important ethical considerations that differentiate TB from recent human challenge trials: an exceptionally high disease burden with no highly effective vaccine; heightened third party risk following the trial, and, partly for that reason, uniquely stringent biosafety requirements for the trial; risks associated with best available TB treatments; and difficulties with TB disease detection. We argue that there is good reason to consider conducting challenge trials with attenuated strains like Bacillus Calmette-Guérin or attenuated Mycobacterium tuberculosis.
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Affiliation(s)
- Abie Rohrig
- Columbia University, New York, New York, USA
- 1Day Sooner, Baltimore, Maryland, USA
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | | | | | - Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Helen McShane
- Jenner Institute, University of Oxford Nuffield Department of Medicine, Oxford, Oxfordshire, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Biomedical Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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15
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Finkelstein ER, Wo L, Garcia O, Kassira W. The Brazilian Butt Lift Remains the Deadliest Aesthetic Surgery Procedure: Are Plastic Surgeons Adjusting Their Surgical Practice to Promote Safety? Aesthet Surg J 2023; 44:NP69-NP76. [PMID: 37738429 DOI: 10.1093/asj/sjad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The number of Brazilian butt lift (BBL) fatalities remains high in the United States despite numerous practice advisories geared towards patient safety and reducing the incidence of fatal pulmonary fat emboli. OBJECTIVES This study aimed to evaluate US board-certified plastic surgeons' opinions, understanding of BBL-related mortality, and current risk-reducing surgical practices for BBL procedures. METHODS An online 18-question survey was distributed via email by the Aesthetic Surgery Education and Research Foundation to national board-certified plastic surgeon members of the The Aesthetic Society. Survey responses were collected over 21 days on the Qualtrics platform. RESULTS The survey response rate was 10% (n = 178). Of the 77% who performed BBL procedures, 48% (n = 80) did not use ultrasound. Approximately 60% (n = 102) of all respondents disagreed with imposing regulations to require ultrasound, with the most frequent reason being that it was unnecessary with adequate surgeon experience (45%). Plastic surgeons thought that high-volume budget clinics (n = 64) and a lack of regulations imposed on individual surgeons by boards of medicine (n = 31) were the greatest contributors to BBL mortality. CONCLUSIONS Most US plastic surgeons did not use ultrasound for BBL procedures and did not agree that ultrasound should be required, which may partially be the result of unsuccessful educational outreach for risk-reducing practices and training for ultrasound. Regulations by the boards of medicine imposed on individual surgeons, in combination with new legislation targeted at ownership of high-volume clinics, are strongly backed by surgeon respondents as measures that may improve patient safety. LEVEL OF EVIDENCE: 5
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16
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Kalaaji A. Commentary on: Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better. Aesthet Surg J 2023; 43:1307-1309. [PMID: 37392429 DOI: 10.1093/asj/sjad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023] Open
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17
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Pazmiño P, Del Vecchio D. Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better. Aesthet Surg J 2023; 43:1295-1306. [PMID: 37158159 DOI: 10.1093/asj/sjad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Although the Brazilian butt lift (BBL) is one of the most popular procedures in body contouring, it has been associated with the risk of pulmonary fat embolism when fat graft is injected into the gluteal muscles. The subcutaneous plane has been identified as a safe site for fat graft injection, but deaths from fat embolism continue to occur because there is no mechanism to confirm consistent subcutaneous placement. OBJECTIVES The aim of this paper was to determine if real-time intraoperative ultrasound could accurately identify the subcutaneous gluteal anatomic landmarks and permit a single surgeon to consistently target fat graft placement in the subcutaneous space. METHODS In total, 4150 BBLs were performed with real-time intraoperative ultrasound being used to confirm the subcutaneous position of a static cannula during fat graft injection. Serial deposits of fat graft were performed in each buttock. Ultrasound confirmed that fat graft consistently remained above the deep gluteal fascia and migrated through the deep subcutaneous space. These fat graft deposits were then equalized with a moving cannula to correct any contour deformities. Operative times were recorded and compared with BBL performed by expansion vibration lipofilling without ultrasound. RESULTS Real-time intraoperative ultrasound allowed for the visual confirmation of consistent subcutaneous fat graft deposition and the targeting of fat graft into specific gluteal subcutaneous compartments. CONCLUSIONS Real-time intraoperative ultrasound allows the surgeon to confirm a subcutaneous-only fat graft injection, target specific gluteal subcutaneous compartments, and take advantage of the unique architecture of the deep subcutaneous space to create gluteal projection and correct contour deformities.
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18
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Cress PE. The ASJ Impact Factor: What You Need to Know. Aesthet Surg J 2023; 43:1405-1407. [PMID: 37606300 DOI: 10.1093/asj/sjad273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/23/2023] Open
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19
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Shaheen S, Al-Habbaa A, Riad MS, Mandour AS, Elzeny MA, Alnady K. Fatal pulmonary embolism following injectable gluteal filler usage: a case report. Egypt Heart J 2023; 75:83. [PMID: 37816906 PMCID: PMC10564681 DOI: 10.1186/s43044-023-00415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Despite the fact that injectable filler usage in the gluteal region has not been recommended in formal medical institutions, illegal procedures are performed in many clinics and beauty centers across Egypt. This case report illustrates the illegal practice culminating in a fatal complication. CASE PRESENTATION A 26-year-old female with no relevant medical history presented to the ER with acute onset shortness of breath. The complaint started 16 h before, with a rapidly progressive course, shortly after undergoing a gluteal filler injection at a center in Cairo. At ER, the patient was severely distressed, yet fully conscious and oriented. She was shocked (BP 70/40 mmHg), tachycardic (130 BPM), and tachypneic (30/min) with normal temperature. She had congested pulsating neck veins with positive Kussmaul sign. Chest auscultation revealed normal vesicular breathing with equal air entry and no adventitious sounds. Her O2 saturation was 60% on room air that improved to 85% on O2 mask. ECG showed sinus tachycardia. Echocardiography showed dilated right side, D-shaped septum with systolic flattening, dilated IVC, mild tricuspid regurgitation and estimated RV systolic pressure 53 mmHg. Her ABG showed compensated metabolic acidosis with elevated lactate level. At the ICU, CVP was 18 mmHg. Saline infusion was continued along with noradrenaline infusion initiation. A provisional diagnosis of high-risk pulmonary embolism was made, though CT pulmonary angiography was not available. Accordingly, thrombolytic therapy was initiated with alteplase (100 mg) over 2 h. Also, a dose of pulse steroids (methylprednisolone 200 mg) was given. Chest X-ray showed bilateral heterogenous opacity and ABG showed deteriorating hypoxia and combined metabolic and respiratory acidosis. The patient was intubated upon deterioration of conscious level and was put on mechanical ventilation. Her ET tube showed frequent blood-tinged secretions. Echocardiography showed more right-side dilatation that was consistent with deterioration of clinical status. Three hours after admission the patient developed cardiac arrest and died 2 h later. CONCLUSIONS This case report highlights the dangers associated with injectable filler usage in the gluteal region. Physicians and patients should be aware of the possible complications and how to avoid it.
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Affiliation(s)
- Sameh Shaheen
- Ain-Shams University, Faculty of medicine, Cairo, Egypt.
- Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt.
| | - Ahmed Al-Habbaa
- Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt
- Al-Azhar University, Faculty of medicine, Cairo, Egypt
| | - Mohamed Saeid Riad
- Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt
- Kobri El-Kobba Military Hospital, Cairo, Egypt
| | | | | | - Khaled Alnady
- Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt
- Military Medical Academy, Cairo, Egypt
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20
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Triana L, Reddy CL, Liscano E. Complications of Fat Grafting Versus Implants in Gluteal Augmentation: A Retrospective Review and Lessons Learnt. Aesthetic Plast Surg 2023; 47:1939-1944. [PMID: 37407707 DOI: 10.1007/s00266-023-03431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/11/2023] [Indexed: 07/07/2023]
Abstract
There have been various studies and literature reviews about gluteal augmentation, possibly due to the high complication rates associated with the procedure. But in the recent past, there has been extensive work in an effort to reduce the complications and various different methods have been developed for this purpose. This article brings to view the procedure followed in our surgery centre for fat grafting and implants for gluteal augmentation. We have compiled the complications we encountered with these procedures and the lessons we learnt to prevent them. 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 .
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21
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Young S, Osman B, Shapiro FE. Safety considerations with the current ambulatory trends: more complicated procedures and more complicated patients. Korean J Anesthesiol 2023; 76:400-412. [PMID: 36912006 PMCID: PMC10562071 DOI: 10.4097/kja.23078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
In the last quarter of a century, the backdrop of appropriate ambulatory and office-based surgeries has changed dramatically. Procedures that were traditionally done in hospitals or patients being admitted after surgery are migrating to the outpatient setting and being discharged on the same day, respectively, at a remarkable rate. In the face of this exponential growth, anesthesiologists are constantly being challenged to maintain patient safety by understanding the appropriate patient selection, procedure, and surgical location. Recently published literature supports the trend of higher, more medically complex patients, and more complicated procedures shifting towards the outpatient arena. Several reasons that may account for this include cost incentives, advancement in anesthesia techniques, enhanced recovery after surgery (ERAS) protocols, and increased patient satisfaction. Anesthesiologists must understand that there is a lack of standardized state regulations regarding ambulatory surgery centers (ASCs) and office-based surgery (OBS) centers. Current and recently graduated anesthesiologists should be aware of the safety concerns related to the various non-hospital-based locations, the sustained growth and demand for anesthesia in the office, and the expansion of mobile anesthesia practices in the US in order to keep up and practice safely with the professional trends. Continuing procedural ambulatory shifts will require ongoing outcomes research, likely prospective in nature, on these novel outpatient procedures, in order to develop risk stratification and prediction models for the selection of the proper patient, procedure, and surgery location.
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Affiliation(s)
- Steven Young
- Department of Anesthesiology, 1Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Brian Osman
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Fred E. Shapiro
- Department of Anesthesiology, 1Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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22
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Stepien DM, Ghavami A. Art and Safety of Gluteal Augmentation: Future Directions. Clin Plast Surg 2023; 50:629-633. [PMID: 37704329 DOI: 10.1016/j.cps.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Gluteal augmentation is a quickly evolving field that continues to grow in the realms of patient safety, surgical education, and technological advancement. This article discusses innovation in gluteal augmentation and suggests potential new pathways for developing the practice of gluteal augmentation.
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Affiliation(s)
- David M Stepien
- Duke Plastic Surgery, 2301 Erwin Road, Durham, NC 27710, USA
| | - Ashkan Ghavami
- Division of Plastic Surgery, David Geffen UCLA School of Medicine, UCLA Plastic Surgery, 200 Medcal Plaza Driveway, Suite 460, Los Angeles, CA 90095, USA; Private Practice, Ghavami Plastic Surgery, Inc., 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA.
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23
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Hoyos Ariza AE, Perez Pachon M. Combining Gluteal Shaping with High-Definition Liposuction: New Concepts and Techniques. Clin Plast Surg 2023; 50:541-552. [PMID: 37704322 DOI: 10.1016/j.cps.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Gluteal contouring has been subject to numerous publications in aesthetic plastic surgery. Not only the female but also the male features that govern such procedures have been thoroughly described by different authors. In this article, we will provide the reader with an updated account of how gluteal contouring blends with High Definition Liposculpture (HDL). We discuss the most current techniques for buttocks reshaping through a holistic approach of new anatomical and artistic concepts. We will dive into new techniques to perform multiplanar and 4-dimensional Fat Grafting and equalization of the buttocks and surrounding areas, which we believe might help plastic surgeons to improve the quality of their patient outcomes. In effect, a proper understanding of the anatomical structures and its variations among different gender and ethnicities, will both help the surgeon to individualize the procedure based on patient preferences.
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24
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Pazmiño P, Del Vecchio D. Static Injection, Migration, and Equalization: A New Paradigm for Safe Ultrasound-Guided BBL: Safer, Faster, Better. Clin Plast Surg 2023; 50:603-614. [PMID: 37704327 DOI: 10.1016/j.cps.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Static injection, migration, and equalization allows for always subcutaneous-targeted fat grafting to either the deep or the superficial subcutaneous spaces.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami, 848 Brickell Avenue, Suite 820, Miami, FL 33131, USA.
| | - Daniel Del Vecchio
- Department of Plastic Surgery, Massachusetts General Hospital, 38 Newbury Street, Suite 502, Boston, MA 02116, USA
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25
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César Durán Vega H. Buttock and Full Body Contouring Harmony. Clin Plast Surg 2023; 50:573-585. [PMID: 37704325 DOI: 10.1016/j.cps.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The concept of the gluteal framework has significantly enhanced our understanding of the gluteal anatomy. The buttock does not constitute a bulging area in the human body. To be attractive, it must harmonize with all elements of the human body around it. Nevertheless, the changes in patient desires and demands, in addition to innovations in surgical technique open a field of opportunity to achieve more beautiful and natural results. In this work, the main updates in the management of body contouring are condensed, including new safe and aesthetic fat infilration techniques.
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Affiliation(s)
- Héctor César Durán Vega
- ASAPS, ASPS, AMCPER, FILACP, Centro Medico de Las Americas CMA, Consultorio#317 Calle 54 #365 x 33-a y Av. perez Ponce Colonia Centro, Merida, Yucatán CP 97000, Mexico; Hospital Eme Red hospitalaria, Calle 33 Número 496, Consultorio 229, Entre 56 y 56 A, Centro, 97000 Mérida, Yucatán, México.
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26
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Pazmiño P. Ultrasound-Guided Gluteal Fat Grafting: A to Z. Clin Plast Surg 2023; 50:587-601. [PMID: 37704326 DOI: 10.1016/j.cps.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Low-cost, high-resolution ultrasound systems allow surgeons to visualize and manipulate the subcutaneous space and inject fat graft with millimeter accuracy.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami.
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27
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Seranio N, Muncey W, Eisenberg ML. A Call for Action in Penile Augmentation: Lessons From Plastic Surgery. Urology 2023; 180:304-305. [PMID: 37482103 DOI: 10.1016/j.urology.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Nicolas Seranio
- Department of Urology, School of Medicine, Stanford University, Stanford, CA.
| | - Wade Muncey
- Department of Urology, School of Medicine, Stanford University, Stanford, CA
| | - Michael L Eisenberg
- Department of Urology, School of Medicine, Stanford University, Stanford, CA
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28
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Kenkel JM, Polo M, Pazmiño P, Garcia O. Brazilian Butt Lift Safety and Florida Legislature: What You Should Know, How You Can Help. Aesthet Surg J Open Forum 2023; 5:ojad041. [PMID: 37325788 PMCID: PMC10265438 DOI: 10.1093/asjof/ojad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Affiliation(s)
- Jeffrey M Kenkel
- Corresponding Author: Dr Jeffrey M. Kenkel, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-9132, USA. E-mail:
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29
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Oregi P, Khatib M, Cavale N, Rahman SM. Comparing the safety profiles of implants and autologous fat grafting in gluteal augmentation: A systematic review. J Plast Reconstr Aesthet Surg 2023; 83:463-474. [PMID: 37320936 DOI: 10.1016/j.bjps.2023.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 06/17/2023]
Abstract
Gluteal augmentation has become a popular esthetic procedure since its inception. The main methods are augmentation using implants or autologous fat grafting, which is the harvesting and grafting of patients' own fat tissue. The last review comparing the safety of these methods was written 7 years ago, which warrants the writing of a new one. PubMed, Cochrane, and Medline were searched for studies focusing on the methods of gluteal augmentation listed previously. Five search terms were used and 15 studies fulfilled the criteria. The data were cataloged according to the method described and outcomes compared. Seven articles focused on gluteal implants and another seven assessed autologous fat grafting, whereas one detailed both. The most common complications in 524 implant procedures were wound dehiscence (9.16%), excessive implant palpability (5.92%), and seroma (3.82%), with an overall complication rate of 25%. The most common complications in 1788 gluteal fat augmentation procedures were seroma (6.9%), infection (3.0%), and transient sciatic paresthesia (1.0%), with an overall complication rate of 13%. Several articles listed satisfaction figures, but these were not assessed because this article was not powered to assess this outcome. Overall, gluteal augmentation using autologous fat grafting leads to fewer postoperative complications than implants and allows greater contouring of the buttocks and the surrounding areas. However, it can also be a far more dangerous procedure if certain recommendations are not followed.
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Affiliation(s)
- Paul Oregi
- GKT School of Medical Education, King's College London, United Kingdom.
| | - Manaf Khatib
- Lister Hospital - East and North Hertfordshire NHS Trust, United Kingdom
| | - Naveen Cavale
- King's College Hospital and Guy's & St.Thomas' Hospitals, United Kingdom
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30
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Marallo M, Staudinger-Knoll A, Rubin JP. Medical Tourism and Budget Brazilian Butt Lifts: A High Cost to US Healthcare Systems and a Danger to Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4913. [PMID: 37020988 PMCID: PMC10069829 DOI: 10.1097/gox.0000000000004913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Michael Marallo
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - J. Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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31
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Rubin JP, Walden JL, Lee BT, Van Natta BW, Piccolo N, Blunk T, Fontbona M, Triana L. Statement on Patient Safety During Gluteal Fat Grafting Endorsed by the International Society for Aesthetic Plastic Surgery (ISAPS), American Society of Plastic Surgeons (ASPS), the Aesthetic Society, the Plastic Surgery Foundation (PSF), the Aesthetic Surgery Education and Research Foundation (ASERF), the International Society of Plastic Regenerative Surgeons (ISPRES), the International Federation for Adipose Therapeutics and Science (IFATS) and. Aesthetic Plast Surg 2023; 47:894-896. [PMID: 36786918 DOI: 10.1007/s00266-023-03282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- J Peter Rubin
- American Society of Plastic Surgeons, Arlington Heights, USA.
| | - Jennifer L Walden
- The Aesthetic Society (American Society for Aesthetic Plastic Surgery), Garden Grove, USA
| | - Bernard T Lee
- The Plastic Surgery Foundation, Arlington Heights, USA
| | - Bruce W Van Natta
- The Aesthetic Surgery Education and Research Foundation, Garden Grove, USA
| | - Nelson Piccolo
- International Society of Plastic Regenerative Surgeons, Vancouver, USA
| | - Torsten Blunk
- International Federation for Adipose Therapeutics and Science, Hanover, USA
| | - Montserrat Fontbona
- International Society of Aesthetic Plastic Surgery (ISAPS), Mount Royal, USA
| | - Lina Triana
- International Society of Aesthetic Plastic Surgery (ISAPS), Mount Royal, USA
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32
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Pazmiño P, Garcia O. Brazilian Butt Lift-Associated Mortality: The South Florida Experience. Aesthet Surg J 2023; 43:162-178. [PMID: 35959568 PMCID: PMC9896146 DOI: 10.1093/asj/sjac224] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Onelio Garcia
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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33
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Li B, Ri C, Mao J, Zhao M. A Bibliometric and Visualization Analysis on the Research of Fat Grafting from 1945 to 2021. Aesthetic Plast Surg 2023; 47:397-411. [PMID: 36261744 DOI: 10.1007/s00266-022-03137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND It is very important to generate a comprehensive assessment of the fat grafting field due to the rapid growth of scientific literature. The current study aimed to use bibliometric analysis to evaluate fat grafting research qualitatively and quantitatively and determine the research hotspots and trends in this field. METHODS Publications on fat grafting research were extracted from the Web of Science core collection database. VOSviewer 1.6.18 was applied to perform the bibliometric analysis of these articles. RESULTS A total of 2558 studies published by 594 different journals authored by 9097 researchers were contained in this study. In the co-authorship analysis, the bulk of the retrieved studies was conducted by the USA, followed by China, Italy and Japan, while the most productive institution, journal and author were Chinese Academy of Medicine Sciences, Plastic and Reconstruction Surgery and Klinger M, respectively. In the co-cited analysis, the most top cited author, journal, organization and country were Coleman Sr, Plastic and Reconstruction Surgery, New York University and the USA, respectively. The map of keywords occurrence revealed the most active research aspects were focused on "surgery," "cell," "breast reconstruction" and "survival" and the time overlay mapping showed that the most active research hotspots were "breast reconstruction" and "retention". CONCLUSIONS The research hotspots include the following four aspects: aesthetic surgeries, cell-assisted lipotransfer, breast reconstruction and grafted fat survival. Breast fat grafting and volume retention may be trends in the future. We are willing to provide more beneficial data to contribute valuable research for the fat grafting through this study. 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 .
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Affiliation(s)
- Bo Li
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China
| | - CholSik Ri
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China.,The Pyongyang Medical University in D.P.R of Korea, Pyongyang, Korea
| | - JiaXin Mao
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China
| | - MuXin Zhao
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China.
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34
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Atiyeh B, Ghieh F, Oneisi A. Safety and Efficiency of Minimally Invasive Buttock Augmentation: A Review. Aesthetic Plast Surg 2023; 47:245-259. [PMID: 35999464 DOI: 10.1007/s00266-022-03049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Volume restoration and enhancement of the gluteal region appearance has become nowadays a popular concern in particular for many women. Several options are available, none however are without complications and side effects. Volume enhancement with soft tissue fillers of the gluteal region is emerging as a highly attractive minimally invasive modality. It has led unfortunately to more unlicensed, nonmedical practitioners administering illicitly injections for buttock augmentation at relatively low costs. MATERIALS AND METHODS To determine safety, efficacy, and cost effectiveness of mostly used soft-tissue fillers for buttock augmentation, a systematic literature search of PubMed, Medline, and Embase was conducted to identify the mostly used fillers for gluteal augmentation. It was complemented by searching for each of the identified filler material separately to retrieve any missed reports. References of clinical studies and trials, reviews, and consensus reports were reviewed as well for the same objective. RESULTS In the final analysis 12, mostly strongly biased clinical reports providing a low level of evidence, were identified for inclusion in the review. Two studies involved Polymethylmethacrylate (PMMA), 5 Poly-L-lactic acid, 1 Calcium hydroxyapatite and 4 hyaluronic acid filler injection. No studies were identified involving liquid silicone or Polyacrylamide hydrogel. The little available evidence provided by this review indicates that a specific brand of PMMA in Brazil has a demonstrable relatively good safety, efficiency, and cost-effectiveness record superior to surgical alloplastic gluteal augmentation or to lipofilling only when injected by experts. CONCLUSION Gluteal augmentation with soft tissue fillers is not as simple and innocuous as advertised. Serious complications may occur. Moreover, optimal buttock contouring entails not only volume augmentation but also volume removal; thus, volume augmentation with soft tissue fillers may not be ideal. Popularizing this modality must also be approached with great care. Serious complications do occur; they become inevitable when performed illegally by non-specialized, non-authorized, and unscrupulous practitioners in non-accredited facilities. Patients must be warned that adherence to regulations is critical and that only well-trained certified experts practicing legally in accredited facilities can address safely and efficiently their concerns. 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 .
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Affiliation(s)
- Bishara Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneisi
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us. Plast Reconstr Surg 2023; 151:342e-343e. [PMID: 36374287 DOI: 10.1097/prs.0000000000009867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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36
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Knoedler L, Odenthal J, Prantl L, Oezdemir B, Kehrer A, Kauke-Navarro M, Matar DY, Obed D, Panayi AC, Broer PN, Chartier C, Knoedler S. Artificial Intelligence-Enabled Simulation of Gluteal Augmentation: A Helpful Tool in Preoperative Outcome Simulation? J Plast Reconstr Aesthet Surg 2023; 80:94-101. [PMID: 37001299 DOI: 10.1016/j.bjps.2023.01.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/14/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND While the buttock region is considered an esthetic hallmark, the Brazilian butt lift (BBL) remains controversially discussed in the plastic surgery community. This is due to its contentious safety profile. Thus, informed consent and patient education play a key role in preoperative planning. To this end, we aimed to program an easy-to-use, widely accessible, and low-budget algorithm that produces reliable outcome simulations. METHODS The conditional generative adversarial network (GAN) was trained using pre- and postoperative images from 1628 BBL patients. To validate outcome simulation, 25 GAN-generated images were assessed deploying 67 Amazon Mechanical Turk Workers (Mturks). RESULTS Mturks could not differentiate between GAN-generated and real patient images in approximately 49.4% of all trials. CONCLUSION This study presents a free-to-use, widely accessible, and reliable algorithm to visualize potential surgical outcomes that could potentially be applied in other fields of plastic surgery.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Jan Odenthal
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Berkin Oezdemir
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Dany Y Matar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Doha Obed
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Adriana C Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Munich, Munich, Germany
| | | | - Samuel Knoedler
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
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Ramírez-Montañana A. Commentary on: Deep Subcutaneous Gluteal Fat Compartments: Anatomy and Clinical Implications. Aesthet Surg J 2023; 43:84-85. [PMID: 36053902 DOI: 10.1093/asj/sjac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 01/18/2023] Open
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Frojo G, Halani SH, Pessa JE, Pazmiño P, Wall S, Kenkel JM, Del Vecchio DA. Deep Subcutaneous Gluteal Fat Compartments: Anatomy and Clinical Implications. Aesthet Surg J 2023; 43:76-83. [PMID: 35977084 DOI: 10.1093/asj/sjac230] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Advances in gluteal fat grafting have resulted in diminished risks through improved understanding of regional anatomy and technical nuances. No anatomic studies identifying the presence or absence of buttock fat compartments have yet been reported. OBJECTIVES The aim of this cadaveric study was to identify and characterize the deep subcutaneous gluteal fat compartments to further understand the nuanced differences between deep and superficial subcutaneous fat layers. METHODS A cadaveric study was performed to identify the fat compartments. Latex injection into the iliac artery and vein was used to prepare 4 fresh (N = 8 hemibuttocks) hydrated cadavers for dissection. Preliminary work identified the likely position of deep gluteal fat compartments. The cannula was positioned under ultrasound guidance in between the superficial and deep gluteal layers. Cadaveric buttocks were infiltrated by the static technique with dyed human fat, dyed applesauce, and dyed saline in an attempt to identify the gluteal deep subcutaneous fat compartments. RESULTS Dissection identified and characterized 7 discrete deep gluteal fat compartments. These comprise 3 medial fat compartments (superior, middle, and inferior); a central fat compartment; and 3 lateral (superior, middle, and inferior) deep fat compartments. CONCLUSIONS Seven deep gluteal fat compartments have been identified that have distinct boundaries and maintain injected contents separate from each other above the gluteal muscle fascia. These compartments can be selectively expanded for buttock augmentation. Knowledge of these compartments enables surgeons to perform gluteal augmentation by static infiltration, injecting autologous fat under ultrasound guidance in the deep subcutaneous fat layer, while optimizing aesthetic considerations. RESUMEN
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Commentary on: Gluteal Augmentation with Hyaluronic Acid Filler: A Retrospective Analysis Using the BODY-Q Scale. Aesthetic Plast Surg 2023; 47:1182-1184. [PMID: 36596921 DOI: 10.1007/s00266-022-03239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
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40
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Pletyanova IV. [Expert characteristic of fatal outcomes related to operative interventions in aesthetic plastic surgery]. Sud Med Ekspert 2023; 66:18-23. [PMID: 37796455 DOI: 10.17116/sudmed20236605118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
THE AIM OF THE STUDY Is to investigate fatal outcomes related to operative interventions in aesthetic plastic surgery for the period from 2010 to 2022 yrs., and to analyze the defects in health care delivery (DHCD), revealed during forensic medical examinations of fatal outcomes. The number of fatal outcomes equal 36, related to operative interventions in aesthetic plastic surgery, was analyzed. The data were collected from the expert's archival opinions (forensic medical examinations of corpse, commission forensic medical examinations based on materials of medical cases and expert opinions), and from judicial acts. The most frequent cause of death (19% of cases) was postoperative development of pulmonary artery thromboembolia, that requires further screening to assess the relationship between denoted reason and type of performed operative intervention as well as the use of anticoagulant therapy. In addition, 19% of the causes of death were related to the toxic lidocaine effects, that shows the necessity of strict control while using anaesthesia during operative interventions. During the forensic medical examination in 55.5% of cases were found the defects in health care delivery (DHCD), with an average of about two DHCD cases. Cause-effect relationship between identified drawbacks of health care delivery and fatal outcome was established in 18 (90%) of the 20 cases. Among them, the DHCD, which are extremely rare in other types of surgical specialty (health care delivery in an inappropriate place and by unqualified persons), were reliably determined in 30% of cases. The necessity of strict control by the relevant competent organizations in health care delivery for plastic surgery specialty, the need for a single system collection of information about fatal cases, associated with operative interventions in aesthetic plastic surgery, and the study of fatality structure and causes in this field were proved. The above mentioned will make it possible to develop unified approaches for the commission forensic medical examinations in this type of cases, and will also contribute to the fatal outcomes' prevention.
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Affiliation(s)
- I V Pletyanova
- Russian Centre of Forensic Medical Expertise, Moscow, Russia
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41
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Bravo FG. International Collaborative Innovation in Aesthetic Surgery. Aesthet Surg J 2022; 42:1485-1491. [PMID: 35748852 DOI: 10.1093/asj/sjac172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Indexed: 12/30/2022] Open
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42
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Tillo O, Nassab R, Pacifico MD. The British Association of Aesthetic Plastic Surgeons (BAAPS) Gluteal Fat Grafting Safety Review -and Recommendations. Aesthet Surg J 2022; 43:675-682. [PMID: 36495200 DOI: 10.1093/asj/sjac316] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Superficial gluteal lipofilling (SGL) is a fat grafting procedure that is performed to correct a trochanteric depression and buttock deflation. Brazilian Butt Lift (BBL) is gluteal lipofilling procedure traditionally associated with exaggerated appearance and intramuscular fat transfer. The risk of mortality from fat embolism in Brazilian Butt Lift (BBL) was previously reported as being 1:2500. The actual risk was later estimated to be nearer 1:15,000, which is similar to the mortality risk in abdominoplasty. There is increasing evidence regarding the safety of subcutaneous gluteal lipofilling. This has principally been related to new technologies, surgical techniques and training being developed to avoid intramuscular injection of fat. The efficacy and benefits of using intraoperative ultrasound scan has been demonstrated in guiding the subcutaneous placement of fat and avoiding inadvertent deep lipofilling. Other serious risks and complications must be considered in addition to mortality. These include hypothermia, sepsis, skin necrosis, and poor aesthetic results, as well as the much-publicised risk of fat embolism. Complications are better controlled and managed in strictly regulated healthcare settings. Patients seeking surgery at unregulated facilities or via medical tourism are deemed to be at higher risk of being exposed to these serious complications and/or inadequate subsequent management.
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Affiliation(s)
- Omar Tillo
- Consultant plastic surgeon in private practice, London, United Kingdom
| | - Reza Nassab
- Consultant plastic surgeon in private practice, Knutsford United Kingdom
| | - Marc D Pacifico
- Consultant plastic surgeon in private practice, Kent, United Kingdom
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Cotofana S, Frank K, Alfertshofer MG, Freytag L, Chaney GK, Ziebart R, Moellhoff N. Invited Discussion on: A 7-Step Guide to High-Definition Liposuction. Aesthetic Plast Surg 2022; 46:2880-2881. [PMID: 35840696 DOI: 10.1007/s00266-022-03005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022]
Abstract
Athanasiou et al. present a 7-step guide to high-definition (HD) liposuction in the current issue of Aesthetic Plastic Surgery. [1] The guide was based on the authors vast experience in HD-liposuction performed in 568 patients (247 males and 321 females) with a mean age of 43 years (range, 22-64) and a mean BMI of 25.6 (range 21-29 kg/m2) over a 6-year time-period. The authors provide detailed information on their approach regarding pre-operative markings, methods of anesthesia and composition of tumescence solution, incision points and access, surgical technique, and fat transfer. In addition, they performed a time-dependent analysis of the type and quantity of observed complications over the study-period, as well as the mean surgical operative time. 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 http://www.springer.com/00266 .
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Michael G Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Lysander Freytag
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Grace K Chaney
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Rachel Ziebart
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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A 7-Step Guide to High-Definition Liposuction. Aesthetic Plast Surg 2022; 46:2863-2879. [PMID: 35729373 DOI: 10.1007/s00266-022-02965-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND High-Definition (HD) Liposuction refers to the most advanced body contouring technique, offering an athletic and healthy body appearance. The latest available devices, the criteria of proper selection, and an expert surgeon's tips are highlighted in a 7-step guide approach. METHODS A retrospective study of prospectively maintained database was conducted from 2015 to 2020. Demographic information, personal history, outcomes, complications were collected and analyzed from 568 patients who underwent the same surgical procedure. RESULTS 568 patients (247 male and 321 female) were included in the study with a mean BMI of 25.6 (range 21-29 kg/m2) and follow up time ranging from 1 to 48 months. The first 50 procedures represented the initial learning curve, during which most complications had occurred (14 patients/50 patients). Using the 7-step guide, we managed to minimize the overall complications to a rate of 3%. CONCLUSION The outlined steps have been simplified in a 7-step guide for plastic surgeons to understand, practice and refine HD liposuction in a contemporaneous, efficient, and reproducible manner. 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.
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Aydin A, David Manuel G, Cortese S, Marchal F, Dolivet G. Embolie graisseuse carotidienne dans les suites d’un lipofilling temporal. ANN CHIR PLAST ESTH 2022; 68:167-172. [PMID: 36463024 DOI: 10.1016/j.anplas.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2022]
Abstract
Lipofilling is a well-known procedure, initially described by Coleman in 1991. Many cases of fat embolism following this procedure are published. Our patient had a common carotid fat embolism after a temporal autologous fat graft.
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Dai Y, Chen Y, Hu Y, Zhang L. Current Knowledge and Future Perspectives of Buttock Augmentation: A Bibliometric Analysis from 1999 to 2021. Aesthetic Plast Surg 2022; 47:1091-1103. [DOI: 10.1007/s00266-022-03140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/02/2022] [Indexed: 11/01/2022]
Abstract
Abstract
Background
The number of patients undergoing buttock augmentation surgery has increased rapidly with time, changes in people’s aesthetic perceptions, and the increased concern for their shape. The number of publications regarding buttock augmentation has also continued to increase. However, no bibliometric analysis concerning buttock augmentation has been published. This study aimed to provide a qualitative and quantitative evaluation of buttock augmentation-related publications using bibliometric analysis and information on research hotspots and trends in this field.
Methods
The buttock augmentation-related publications published between 1999 and 2021 were extracted from the Web of Science Core Collection (WOSCC) database for analysis. The data were analysed and presented using VOSviewer and Microsoft Excel.
Results
There were 492 articles in the (WOSCC) database, including 442 (89.84%) original research articles, with the number of publications increasing each year. The USA (208 publications, 42.28%) is the leading contributor in this field and has a high academic reputation. The most productive and co-cited journal on this subject is “Plastic and Reconstructive Surgery” (66 publications, 13.41%, 2200 citations). Cardenas-Camarena (9 publications, 1.83%, 158 citations) was the most published and co-cited author. Research hotspots include the following three topics: experience and technology of buttock augmentation, autologous fat buttock augmentation and its safety, and buttock aesthetics study. There will be more publications in the future, and research trends will focus on silicone implants, safety, satisfaction, and autologous fat grafting.
Conclusion
Buttock augmentation research is rapidly evolving, and this study provides a perspective view of buttock augmentation research in Plastic and Reconstructive Surgery.
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.
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Wallner C, Kruber S, Adebayo SO, Ayandele O, Namatame H, Olonisakin TT, O. Olapegba P, Sawamiya Y, Suzuki T, Yamamiya Y, Wagner MJ, Drysch M, Lehnhardt M, Behr B. Interethnic Influencing Factors Regarding Buttocks Body Image in Women from Nigeria, Germany, USA and Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13212. [PMID: 36293797 PMCID: PMC9602659 DOI: 10.3390/ijerph192013212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Body image research deals a lot with awareness of the body as an entity. Studies that consider individual anatomical aspects and place them in an intercultural context are rarely present. METHODS For this purpose, general data, body perception and judgment of body images from 2163 (48% female and 52% male) participants from Germany, Nigeria, the USA and Japan were evaluated as part of a survey. RESULTS There were clear differences in the personal body image of the participants' own buttocks, the buttocks as a beauty ideal and the way in which dissatisfaction was dealt with in different countries. In addition to sexual well-being (importance score: 0.405 a.u.), the country of origin (0.353), media consumption (0.042) and one's own weight (0.069) were also identified as influencing factors for satisfaction with one's own buttocks. A clear evolution could be derived regarding a WHR (waist-to-hip ratio) of well below 0.7, which was consistently favored by the participants but also propagated by influencers through images (p < 0.001). In this context, participants who indicated celebrities as role models for the buttocks showed a correspondingly high level of dissatisfaction with their own buttocks (R = -0.207, p < 0.001, ρ = -0.218). CONCLUSION Overall, a highly significant correlation was shown between the consumption frequency of Instagram, TikTok and pornography with the negative perception of women's own buttocks.
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Affiliation(s)
- Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Svenja Kruber
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | | | - Olusola Ayandele
- Department of Psychology, University of Ibadan, Ibadan 200005, Nigeria
- Department of General Studies, The Polytechnic, Ibadan 200285, Nigeria
| | - Hikari Namatame
- Faculty of Human Sciences, University of Tsukuba, Ibaraki 305-8577, Japan
| | | | - Peter O. Olapegba
- Department of Psychology, University of Ibadan, Ibadan 200005, Nigeria
| | - Yoko Sawamiya
- Faculty of Human Sciences, University of Tsukuba, Ibaraki 305-8577, Japan
| | - Tomohiro Suzuki
- Department of Child Psychology, Tokyo Future University, Tokyo 120-0023, Japan
| | - Yuko Yamamiya
- Department of Undergraduate Studies, Temple University, Japan Campus, Tokyo 154-0004, Japan
| | - Maximilian Johannes Wagner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Marius Drysch
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
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Cao W, Sheng L. Buttock Augmentation with Fat Grafting. Clin Plast Surg 2022; 50:171-179. [DOI: 10.1016/j.cps.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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49
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Langley S. Cosmetic surgery changes for patient safety. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n2.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Circumferential Liposuction of the Thigh with Concomitant Fat Transplantation to the Infragluteal Region: A Promising Option for Preventing Postliposuction Gluteal Ptosis. Plast Reconstr Surg 2022; 150:60e-68e. [PMID: 35511052 DOI: 10.1097/prs.0000000000009262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gluteal ptosis is a common complication of circumferential liposuction of the thigh. The authors propose a novel concept of combining circumferential liposuction of the thigh with concomitant fat transplantation to the infragluteal/posterior thigh junction region to prevent postliposuction gluteal ptosis. METHODS Patients underwent circumferential liposuction of the thigh with or without concomitant fat transplantation from 2015 to 2020 and were retrospectively reviewed. The postoperative changes in the grade of gluteal ptosis, length of hospitalization, time to recovery, postoperative complications, and patient satisfaction were evaluated. RESULTS A total of 109 patients were enrolled in this study, including 46 patients in the liposuction-only group and 63 patients in the liposuction plus fat transplantation group. There was no significant difference in fat removal volume between the liposuction-only group and the liposuction plus fat transplantation group ( p = 0.152). Aggravation of gluteal ptosis occurred in 43 patients (93.5 percent) in the liposuction-only group and four patients (6.3 percent) in the liposuction plus fat transplantation group ( p < 0.001). The length of hospitalization and time to recovery was not significantly different between the two groups ( p = 0.402 and p = 0.423, respectively). Complications were rare in both groups. With a minimum evaluation time of 6 months, patients in the liposuction plus fat transplantation group showed significantly higher satisfaction ( p < 0.001). CONCLUSION Concomitant fat transplantation to the infragluteal/posterior thigh junction region during circumferential liposuction of the thigh is effective in preventing postliposuction gluteal ptosis and improving patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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