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Borille G, Giannini R, Zancanaro M, Ribeiro V, Filho GP, Valente DS. Redefining Abdominal Contours: An Analysis of Medium Definition Liposuction Abdominoplasty. Aesthetic Plast Surg 2024:10.1007/s00266-024-04058-2. [PMID: 38902340 DOI: 10.1007/s00266-024-04058-2] [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: 02/14/2024] [Accepted: 04/09/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION This study elucidates the application of Medium Definition Liposuction Abdominoplasty, a novel technique for achieving well-defined abdominal contours. The technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. METHODS Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. Digital image measurements facilitated by an image software constituted the basis for these assessments. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites, with two measurements taken at each site and subsequently averaged. RESULTS Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. However, complications such as partial diminution of tension in the muscular wall (2%), distal flap necrosis (0.6%), and minor muscular hernia (0.3%) were observed. CONCLUSION The employment of combined muscle plication emerges as an efficacious methodology in meticulously rectifying alterations inherent within the muscular aponeurotic abdominal wall. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. BULLET POINTS The study introduces a novel technique, Medium Definition Liposuction Abdominoplasty, for achieving well-defined abdominal contours. This technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites. Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. 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)
| | | | | | | | | | - Denis Souto Valente
- Federal University of Medical Sciences of Porto Alegre, Rua Antonio Carlos Berta 475-7th floor, Porto Alegre, RS, 91340-020, Brazil.
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Lv Q, Gu Y, Sun X, Yang M, Li J, Xin M, Han X, Ma G. Aesthetic Improvement of Body Proportion Through Trunk Liposculpture: A Waistline-based Strategy. Aesthet Surg J 2024; 44:NP246-NP253. [PMID: 38048421 DOI: 10.1093/asj/sjad361] [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: 08/07/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Abdominal contouring through liposuction has been practiced for decades. However, few studies have focused on describing the definition and enhancement of the waistline in torso contouring procedures. OBJECTIVES In the present study, the authors proposed a waistline-based strategy for abdominal liposculpture to achieve a better aesthetic outcome and emphasize high overall patient satisfaction. METHODS The data of patients who underwent the waistline-based liposculpture procedure from 2020 to 2023 were retrospectively reviewed. Aesthetic improvement of the central trunk contour was evaluated and analyzed by comparing preoperative and postoperative photogrammetric measurements. Satisfaction with the outcome was assessed with a patient satisfaction questionnaire. RESULTS A total of 70 patients were enrolled in this study. During 6 months of postoperative evaluation, the shape of the central trunk contour improved significantly (both waist concavity and hip convexity increased quantitatively, P < .05), while the position of the waist did not differ significantly postoperatively (P > .05). All patients were satisfied with their postoperative outcomes, including their overall aesthetic appearance, waistline position, and waist-to-hip ratio. There were no intraoperative complications or rare postoperative complications. CONCLUSIONS Waistline-based liposculpture is a simple and effective procedure to improve the aesthetic outcomes of trunk contouring and has highly satisfactory results after long-term follow-up. LEVEL OF EVIDENCE: 5
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Cala Uribe LC, Perez Pachon ME, Babaitis R, Zannin Ferrero A, Aljure Diaz MF. Variable Energy and Ultrasound-based Liposculpture of the Arms: Multicenter and Multidevice Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5649. [PMID: 38948160 PMCID: PMC11213598 DOI: 10.1097/gox.0000000000005649] [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: 11/30/2023] [Accepted: 01/16/2024] [Indexed: 07/02/2024]
Abstract
Incorporation of new technologies to assist the liposuction procedure is becoming increasingly common. These technologies allow for a softer technique, balanced shaping, elimination of excess adipose tissue, and skin tightening. Some of these technologies include ultrasound (US; US-assisted liposculpture, VASER-assisted liposuction), power suction (power-assisted liposuction), radiofrequency (RF; RF-assisted lipolysis), and laser (laser-assisted liposuction). In addition, some of these devices have been shown to reduce the incidence of hematomas/inflammation and shorten recovery time. We report our experience in high-definition liposculpture of the arms in addition to new technologies to improve skin retraction, comparing their results in terms of complications, satisfaction score, and aesthetic outcomes. We included patients with mild-to-moderate arm dermatochalasis (Duncan classification) fat deposits in the upper extremities who were considered candidates for third-generation US-assisted liposculpture, power-assisted liposuction, RF-assisted lipolysis/skin tightening, and laser-assisted liposuction. A total of 683 consecutive patients met the inclusion criteria for the study. Most of them were women (n = 605, 88%). Fat grafting was performed in 80 patients (11.7%). A significant portion of the patients were secondary cases (n = 223, 33%). Age ranged from 18 to 70 years (median = 38 years). BMI ranged from 17.8 to 34.8 kg/m2 (mean = 24.3 kg/m2). RF-assisted and laser-assisted high-definition liposculpture of the arms are both effective and reproducible techniques for patients who seek an athletic and slim arm contour. A low rate of complications and high satisfaction index support our findings.
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Affiliation(s)
| | | | | | | | - Manuel F. Aljure Diaz
- Department of Plastic and Reconstructive Surgery, Universidad El Bosque, Bogota, Colombia
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Hamadani F, Theodorou SJV. Invited Discussion "From the SAFE to the SAFEST Liposuction: Combining PAL and RFAL Technology in Body Contouring Procedures". Aesthetic Plast Surg 2024:10.1007/s00266-023-03792-3. [PMID: 38216790 DOI: 10.1007/s00266-023-03792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/30/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Fadi Hamadani
- Division of Plastic & Reconstructive Surgery, H Clinic Hospital, Ramallah, 9730000, Palestine
| | - Spero J V Theodorou
- Clinical Assistant Professor of Surgery, Aesthetic Plastic Surgery, Zucker School of Medicine Hofstra University, 128 Central Park South, New York, NY, 10019, USA.
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De La Cruz E. Lipoplasty in the Overweight Patient. Clin Plast Surg 2024; 51:29-43. [PMID: 37945074 DOI: 10.1016/j.cps.2023.06.010] [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: 11/12/2023]
Abstract
The practice of large volume liposuction, when executed by board-certified plastic surgeons using a variety of energy-assisted liposuction devices, has been substantiated as a secure procedure, yielding enhanced aesthetic results and minimal complications. Techniques including the superwet technique and ultrasonic-assisted liposuction are utilized to diminish blood loss, while also maintaining a keen awareness of the maximum volume of infiltration fluid permissible for safe infusion. Adherence to evidence-based protocols is of paramount importance to reduce the risk of postoperative complications. These protocols encompass hypothermia prevention, deep vein thrombosis (DVT) prophylaxis, and perioperative antibiotic prophylaxis. To ensure the highest quality of care, it is recommended that large volume liposuction procedures be performed in accredited hospitals or certified ambulatory surgery centers. Postoperative procedures should include overnight admission of patients to facilitate proper hemodynamic monitoring. While the employment of multiple devices such as VASERLipo and Renuvion has been noted to augment skin and soft tissue contraction, it is worth noting that there may be a heightened risk of seroma formation (at 2.27%) and subcutaneous emphysema (at 1.47%). Consequently, prudent use of these advanced medical devices is essential to avoid any potential adverse events.
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Sharkov EV. The Role of Noninvasive and Minimally Invasive Techniques in Open Surgical Interventions for the Purpose of Body Contouring. Clin Plast Surg 2024; 51:147-159. [PMID: 37945071 DOI: 10.1016/j.cps.2023.06.005] [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: 11/12/2023]
Abstract
In his practice, the author has been using noninvasive devices, including Evolve X-radiofrequency-based procedure for tightening of the skin, melting of the subdermal fat deposits and muscle stimulation, all done simultaneously together and truSculpt flex-electrical muscle stimulation. Minimally invasive procedures include BodyTite, FaceTite, and AccuTite, radiofrequency-based procedures for permanent fat destruction and tightening of the skin. Morpheus8 and Morpheus8 Body are radiofrequency based-procedures for tightening of the skin. VASERlipo is an ultrasound-based procedure for liposuction and muscle definition. Vibrational type of liposuction has been used for the purpose of liposuction and muscle definition in combination with VASERlipo.
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Olivas-Menayo J, Chang-Azancot L. From the SAFE to the SAFEST Liposuction: Combining PAL and RFAL Technology in Body Contouring Procedures. Aesthetic Plast Surg 2023; 47:2486-2494. [PMID: 36849664 DOI: 10.1007/s00266-023-03291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/19/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The SAFE liposuction technique is a worldwide extended method used to achieve great and reproducible results after the surgical aspiration of fat. We propose an evolution of the technique to address one of the major limitations of liposuction, loose skin. The SAFEST liposuction technique combines PAL and RFAL to achieve skin tightening and fat reduction with minimal added morbidity. METHODS Patients treated with the SAFEST liposuction technique between December 2019 and February 2022 were included in the study. Demographic and surgical data were collected retrospectively. Photographs and satisfaction interviews were conducted preoperatively and 12 months postoperatively in every case. RESULTS Sixty-five patients (58 female and 7 male) were included in the cohort, and a total of 169 anatomical areas were treated with the SAFEST liposuction technique (abdomen, arms, back, flanks and thighs). Globally, satisfaction at 12 months follow-up was of 94.1% and complications only presented in 4.7% of the treated areas. 6 of the 38 treated abdomens (18.4%) presented a complication (4 seromas and 2 access point infections) and 2 of the 38 treated flanks (5.3%) presented one (2 seromas). The rest of the treated anatomical areas (arms, back and thighs) showed no complications and high satisfaction rates. CONCLUSIONS The SAFEST liposuction technique achieves outstanding and satisfying results with minimal complications by safely combining the advantages of two different technologies, PAL and RFAL. The main advantages of the presented technique are the skin tightening, the body ligament contraction, the coagulation and the reduction of the 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 www.springer.com/00266 .
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Affiliation(s)
- Jesus Olivas-Menayo
- MS Medical Institutes by Exclusive Doctors, Lisbon, Portugal.
- FEMM Cirugía y Medicina Estética, Madrid, Spain.
| | - Luis Chang-Azancot
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
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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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Sturm A, Shokri T, Ducic Y. Nonsurgical Rejuvenation of the Neck. Clin Plast Surg 2023; 50:497-507. [PMID: 37169415 DOI: 10.1016/j.cps.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Nonsurgical skin tightening in the neck is an area of significant growth with seemingly countless devices. Optimal treatment choice depends on the patient's concerns, anatomy, and lifestyle. Patients with minimal skin laxity, but dynamic platysmal bands may benefit from botulinum toxin injections. Mild to moderately lax skin can be addressed with microfocused ultrasound or radiofrequency with microneedling. Significant sun damage and laxity can both be addressed with fractional ablative lasers. Options for submental preplatysmal fat include percutaneous radiofrequency, radiofrequency-helium plasma, deoxycholic acid injections, and cryolipolysis. Of these, percutaneous radiofrequency has the highest patient satisfaction and lowest complication rate.
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Affiliation(s)
- Angela Sturm
- Private Practice, 6750 West Loop South, Suite 1060, Bellaire, TX 77401, USA; Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.
| | - Tom Shokri
- George Washington University, 2300 M Street, NW, 4th Floor, Washington, DC 20037, USA
| | - Yadro Ducic
- Private Practice, 4300 North Central Expressway #110, Dallas, TX 75206, USA
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Cala Uribe LC, Perez Pachon ME, Zannin Ferrero A, Neri Morales C, Silva Gutierrez J, Manrique Cruz AD, Maza MF, Acero Mondragon EJ, Celis Regalado LG. Effects of Bipolar Radiofrequency on Collagen Synthesis from Patients with Brachial Ptosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4924. [PMID: 37063507 PMCID: PMC10101252 DOI: 10.1097/gox.0000000000004924] [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: 11/18/2022] [Accepted: 02/14/2023] [Indexed: 04/18/2023]
Abstract
Radiofrequency is frequently used for skin rejuvenation, localized fat elimination and cellulite treatment. It prompts the expression of thermal shock proteins that lead to dermal thickening as a result of collagen synthesis. The authors report a histological and clinical analysis of the arm subdermal changes before and after bipolar radiofrequency treatment plus liposuction to determine their benefits for arm contouring. Methods Inclusion criteria included patients with stage 1, 2a, and 2b brachial ptosis (Duncan classification) and upper limb fat deposits who were considered candidates for third-generation ultrasound-assisted liposculpture plus radiofrequency-assisted lipolysis/skin tightening. Arm subdermal tissue samples (5 mm³) were analyzed before and after the intervention. We used 10% formaldehyde for tissue fixation and stained each sample with hematoxylin/eosin, Masson trichrome, and antibody markers against the cell cycle Ki-67 protein. Results We analyzed a total of 12 biopsies from six patients who meet the inclusion/exclusion criteria. Histological findings with hematoxylin/eosin revealed hyperplastic and metaplastic changes with focal distribution within the papillary and reticular dermis. Masson trichrome staining showed an increase of the characteristic basophilia of thin type-I and type-III collagen fibers. In contrast, molecular analysis reported an increase in fibroblast activity mediated by the activation of the heat shock protein HSP47. Conclusion Radiofrequency may be a great alternative to improve skin retraction in patients with mild to moderate brachial dermatochalasis through the activation of HSP47 heat shock protein and the production of type-I and type-III collagen.
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Affiliation(s)
| | | | - Andreina Zannin Ferrero
- The Cell Therapy and Metabolism Research Group at Universidad De La Sabana School of Medicine, Bogotá, Colombia
| | - Constanza Neri Morales
- The Cell Therapy and Metabolism Research Group at Universidad De La Sabana School of Medicine, Bogotá, Colombia
| | - Juliana Silva Gutierrez
- The Cell Therapy and Metabolism Research Group at Universidad De La Sabana School of Medicine, Bogotá, Colombia
| | - Angela D. Manrique Cruz
- The Cell Therapy and Metabolism Research Group at Universidad De La Sabana School of Medicine, Bogotá, Colombia
| | - María F. Maza
- The Cell Therapy and Metabolism Research Group at Universidad De La Sabana School of Medicine, Bogotá, Colombia
| | | | - Luis G. Celis Regalado
- The Cell Therapy and Metabolism Research Group at Universidad De La Sabana School of Medicine, Bogotá, Colombia
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The Application of Subcutaneous Radiofrequency After Liposuction for the Lower Face and Neck Contouring Under Local Anesthesia. J Craniofac Surg 2023; 34:616-619. [PMID: 35996216 DOI: 10.1097/scs.0000000000008925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Radiofrequency-assisted liposuction (RFAL) is a new choice in energy-assisted body-contouring techniques. The purpose of this study is to observe the clinical effect and safety of RFAL on lower face and neck contouring under local anesthesia, and different outcome compared with traditional liposuction. METHODS From November 2016 to November 2020, a total of 72 patients with fat accumulation and skin laxity in lower face and neck, including 42 patients underwent subcutaneous radiofrequency after liposuction (group A) and 30 patients underwent traditional liposuction only (group B). The patient's parameters recorded involved age, sex, body mass index, the volume of fat aspirated, energy delivered, operative time, and complications. They were photographed for comparison before and after treatment. At 3 and 6 months after the operation, improvement in skin tightening and patient satisfaction was surveyed postoperatively and assessed by third-party surgeons. RESULTS At 6 months after the operation, evaluations scores of the contouring outcome had significant difference between 2 groups (3.0±0.9 versus 2.5±1.0, P =0.045). There was no significant difference at 3 months (2.8±1.0 versus 2.6±1.0, P =0.265). Although the satisfaction rate of group A was higher than that of group B both at 3 months (76.2% versus 66.7%) and 6 months (80.9% versus 60.0%), there were no significant differences in average score ( P >0.05). No significant complications or adverse events requiring further medical or surgical intervention after treatment. CONCLUSION Subcutaneous radiofrequency after Liposuction is a safe and effective treatment that can achieve significant improvement of the fat accumulation and skin laxity of the lower face and neck under local anesthesia.
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Filippou A, Damianou C. Experimental evaluation of high intensity focused ultrasound for fat reduction of ex vivo porcine adipose tissue. J Ultrasound 2022; 25:815-825. [PMID: 35106735 PMCID: PMC9705658 DOI: 10.1007/s40477-022-00663-6] [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: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The present study was stimulated by the continuous growth of commercially available high intensity focused ultrasound (HIFU) systems for fat reduction. Herein, HIFU was utilised for fat ablation using a single-element ultrasonic transducer operating in thermal mode. METHODS The custom-made concave transducer that operates at 1.1 MHz was assessed on excised porcine adipose tissue for its ability to reduce fat. Ultrasonic sonications were executed on the adipose tissue utilising acoustical power between 14 and 75 W and sonication time in the range of 1-10 min. The mass of the adipose tissue sample was weighed afore and after ultrasonic sonications and the effect of the sonication on the mass change was recorded. RESULTS Mass change was linearly dependent with either increasing acoustical power or sonication time and was in the range of 0.46-1.9 g. High acoustical power of 62.5 W for a sonication time of 1 min and a power of 75 W for a sonication time of 5 min, respectively resulted in the formation of a lesion or possible cavitation on the piece of excised adipose tissue. CONCLUSION The study demonstrated the efficacy of the proposed transducer in achieving a reduction of excised fat tissue. The present findings indicate the potential use of the transducer in a HIFU system indicated for the reduction of subcutaneous adipose tissue where increased values of acoustical power can result in increased amounts of fat reduction.
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Affiliation(s)
- Antria Filippou
- Department of Electrical Engineering, Computer Engineering and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus
| | - Christakis Damianou
- Department of Electrical Engineering, Computer Engineering and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus.
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The Role of Subcutaneous Radiofrequency-Assisted Liposculpture in the Facial Plastic Surgeon's Practice. Facial Plast Surg Aesthet Med 2022; 24:S11-S16. [DOI: 10.1089/fpsam.2022.0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Saheb-Al-Zamani M. Labia Majora Reduction (Majoraplasty). Clin Plast Surg 2022; 49:489-494. [PMID: 36162943 DOI: 10.1016/j.cps.2022.06.010] [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: 11/16/2022]
Abstract
This article provides a complete literature review of labia majora reduction. Pertinent anatomy, various presentations, indications for treatment, and aesthetic goals are defined. The full assessment of the majora is outlined, and the recommended surgical treatment options are detailed. Pearls and pitfalls associated with each procedure are discussed to guide successful treatment and patient satisfaction.
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Affiliation(s)
- Maryam Saheb-Al-Zamani
- Private Practice, ICLS Plastic Surgery, 1344 Cornwall Road, Oakville, Ontario L6J 7W5, Canada.
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Wang Y, Yin B, Li F. Facial Rejuvenation and Contouring with Radiofrequency-Assisted Procedures in Asians. Clin Plast Surg 2022; 50:43-49. [DOI: 10.1016/j.cps.2022.08.009] [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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Sturm A, Shokri T, Ducic Y. Nonsurgical Rejuvenation of the Neck. Facial Plast Surg Clin North Am 2022; 30:407-417. [DOI: 10.1016/j.fsc.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Technique for Minimally Invasive Face and Neck Contouring with Bipolar Radiofrequency Devices. Plast Reconstr Surg 2022; 150:337e-340e. [PMID: 35666170 DOI: 10.1097/prs.0000000000009358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiofrequency devices have grown in popularity as minimally invasive options for the treatment of skin laxity in the face and neck. These treatments are often combined with liposuction procedures to provide enhanced tissue contraction alongside the reduction in adiposity. Proper patient selection and intra-operative technique are crucial to achieving the desired outcomes in a safe manner. In this article, we discuss our indications and technique for the treatment of the face and neck with bipolar radiofrequency devices.
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Two-stage Radiofrequency-assisted Lipoabdominoplasty. Plast Reconstr Surg Glob Open 2022; 10:e4212. [PMID: 35494885 PMCID: PMC9038494 DOI: 10.1097/gox.0000000000004212] [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: 10/09/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022]
Abstract
Decades of lipoabdominoplasty safety, reliability, and efficacy have permitted more aggressive contouring of the abdominoplasty flap without increased risk for wound healing complications. However, the recent introduction of unrestricted liposuction of all vascular zones and high-definition liposculpting continue to challenge the vascularity of the abdominoplasty flap, particularly in high-risk patients. The present study reviews the authors' approach to abdominal lipodystrophy, and introduces a technique which maximizes fat extraction and skin excision while reducing risk of complication (two-stage radiofrequency-assisted liposuction and abdominoplasty).
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Hurwitz DJ, Davila AA. Contemporary Management of Gynecomastia. Clin Plast Surg 2022; 49:293-305. [DOI: 10.1016/j.cps.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cook J, DiBernardo BE, Pozner JN. Bipolar Radiofrequency as an Adjunct to Face and Body Contouring: A 745-Patient Clinical Experience. Aesthet Surg J 2021; 41:685-694. [PMID: 33388742 DOI: 10.1093/asj/sjaa417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Radiofrequency (RF) technology has ushered in a new paradigm in body contouring for patients with mild to moderate skin laxity who desire fat removal without exacerbating skin laxity issues. A bipolar internal RF device, used as an adjunct to liposuction, has been found to be simpler and more accurate than previous technologies. OBJECTIVES The aim of this study was to review the authors' clinical experience with bipolar RF-assisted liposuction (RFAL). METHODS We conducted a review of our large experience with bipolar RFAL, evaluating the nuances from appropriate patient selection and specific treatment areas. The review covered 745 patients treated from January 2017 to January 2020 at 2 centers. A retrospective chart review was performed of the first and last 50 patients treated at each center (for a total of 100 patients in each group) to assess trends in outcomes and adverse events. RESULTS Results were generally excellent from physician evaluation, and overall patient satisfaction was high (96%). The two most common adverse events were temporary swelling (9%) and nodules (8.5%). Selected examples of a variety of cases are reviewed. CONCLUSIONS The ability to tighten skin with a minimally invasive tool adds much to the contemporary approach to the body-contouring patient with skin laxity. Adverse events were minimal and greatly decreased after an initial short learning curve. Bipolar RFAL is a strong addition to our surgical armamentarium and has become an essential tool for our practices. LEVEL OF EVIDENCE: 4
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Kam J, Frost A, Bloom JD. Radiofrequency Rejuvenation of the "Tweener" Patient: Under, Over, or Through the Skin. Facial Plast Surg 2021; 37:240-248. [PMID: 33511577 DOI: 10.1055/s-0041-1722890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The demand for noninvasive facial rejuvenation continues to increase as younger, well-informed patients enter the aesthetic market. We refer to a subset of these patients as "tweeners," those who present with early signs of neck and facial aging, but who have not yet developed changes significant enough to warrant a traditional excisional surgery approach. Many of these patients are in search of a minimally invasive intervention, a bridge in between observation and surgery. The authors describe their experience with radiofrequency (RF) technology as an in-office tool to address the aging face in a select patient population. This review also attempts to comprehensively search the existing body of literature to describe the RF technologies and devices available for facial rejuvenation. The efficacy and safety profiles of the devices are discussed, and the devices are categorized by their method of RF delivery-over (contact), through (microneedle), and under (percutaneous) the skin.
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Affiliation(s)
- Joanna Kam
- Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariel Frost
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason D Bloom
- Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.,Bloom Facial Plastic Surgery, Bryn Mawr, Pennsylvania
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Demesh D, Cristel RT, Gandhi ND, Kola E, Dayan SH. The use of radiofrequency-assisted lipolysis with radiofrequency microneedling in premature jowl and neck laxity following facialplasty. J Cosmet Dermatol 2020; 20:93-98. [PMID: 33128284 DOI: 10.1111/jocd.13824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND A subset of facelift patients have premature redevelopment of skin laxity in the lower face and neck. Many patients seek alternatives to revision facelifts to avoid high risks and costs. Radiofrequency-assisted lipolysis (RFAL) with Radiofrequency (RF) microneedling may be alternative minimally invasive options. OBJECTIVE/AIM To evaluate the efficacy of radiofrequency energy devices for treatment of premature jowl and neck skin laxity following facialplasty. METHODS This is a single-center, prospective study of patients seeking treatment for jowl and neck skin laxity 1-5 years following facialplasty. Treatment was performed with the InMode radiofrequency AccuTite® and Morpheus8® systems. Study duration was 12 months with 6 months of follow-up. Endpoints included improvement in skin tightening assessed by blinded investigators, and investigator and subject assessment of skin appearance. Subjects also rated satisfaction with treatment and pain levels. RESULTS The study protocol was completed by nine patients. Based on investigator evaluations, 33% had marked improvement at 3 months, which increased to 55% at 6-month postprocedure. Patient-reported improvement was "markedly improved" in 67%, "moderate improvement" in 11%, and "slight improvement" in 22% at 3 months. Overall patient satisfaction was rated as "very satisfied" by 33% and "satisfied" by 67% at 3 months. There were no adverse events reported. CONCLUSION The results of this study provide supporting evidence that RFAL technology can provide a safe, minimally invasive, and effective treatment for skin laxity in the jowls and neck in patients who desire further correction after undergoing primary facelift.
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Affiliation(s)
- Daniel Demesh
- Department of Otolaryngology-Head & Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert T Cristel
- Department of Otolaryngology-Head & Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nimit D Gandhi
- DeNova Research, Chicago, IL, USA.,Chicago Center for Facial Plastic Surgery, Chicago, IL, USA
| | - Eljona Kola
- DeNova Research, Chicago, IL, USA.,Chicago Center for Facial Plastic Surgery, Chicago, IL, USA
| | - Steven H Dayan
- Department of Otolaryngology-Head & Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, University of Illinois at Chicago, Chicago, IL, USA.,DeNova Research, Chicago, IL, USA.,Chicago Center for Facial Plastic Surgery, Chicago, IL, USA
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Multimodal Radiofrequency Application for Lower Face and Neck Laxity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2862. [PMID: 32983756 PMCID: PMC7489644 DOI: 10.1097/gox.0000000000002862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
Nonexcisional facial skin tightening has long been an elusive goal in aesthetic surgery. The "treatment gap" includes cases who are not "severe" enough for excisions surgery but not "mild" enough for most traditional noninvasive aesthetic modalities. In this retrospective review, we present the largest evaluation to date of radiofrequency (RF) skin tightening technology combination including bipolar RF (FaceTite; InMode) and fractional bipolar RF (Fractora modified to Morpheus8; InMode). Methods A multicenter retrospective study was conducted between January 2013 and December 2018 using a combination of bipolar RF and fractional bipolar RF for the treatment of facial aging. Data collection included demographic information, Baker Face/Neck Classification, amount of energy used, adverse events, and patient satisfaction. Four cadaver dissections were also conducted to correlate the underlying neuromuscular anatomy with RF treatment of the lower face and neck. Results Two hundred forty-seven patients (234 women and 13 men) were included in the study. Average age was 55.1 years (SD, ±8), body mass index was 24.3 (±2.4), and 9% (23/247) of patients were active smokers at the time of treatment. Patients had an average Baker Face/Neck Classification score of 3.1 (SD, ±1.4). The procedure was performed under local anesthesia in 240/247 cases (97.2%). Patients objectively improved their Baker Face/Neck Classification score by 1.4 points (SD, ±1.1). Ninety-three percent of patients indicated that they were pleased with their results and would undergo the procedure again. Complications recorded for our cohort included prolonged swelling >6 weeks (4.8%, 12/247), hardened area >12 weeks (3.2%, 8/247), and marginal mandibular neuropraxia (1.2%, 3/247), which all resolved without further intervention. When considering possible control variables, age seems to be a significant factor. That is, older patients were more likely to benefit from a larger magnitude of the treatment effect (as demonstrated by a decrease in the Baker rating from pre- to posttreatment) when compared with younger patients. However, both groups did demonstrate significant improvements across time. Conclusion While this combination RF treatment (FaceTite bipolar RF and fractional bipolar RF) does not aim to replace a facelift/necklift in appropriate candidates, it does broaden the plastic surgeons' armamentarium to potentially fill a treatment gap.
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The Use of Radiofrequency in Aesthetic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2861. [PMID: 32983755 PMCID: PMC7489578 DOI: 10.1097/gox.0000000000002861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
The use of radiofrequency for soft tissue tightening has increased over the past 10 years. Both minimally invasive and noninvasive devices are frequently in use. This article describes the different types of radiofrequency technology and the current evidence behind their safety and efficacy.
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Yoo KH, Kwon TR, Kim JH, Kim BJ. Preclinical evaluation for removal of bulging lower eyelid fat using ultrasound-assisted lipolysis on a Yorkshire pig. Skin Res Technol 2020; 27:93-100. [PMID: 32750741 DOI: 10.1111/srt.12916] [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: 04/27/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the efficacy and safety of treating lower eyelid fat bulging with ultrasound-assisted lipolysis (UAL) by performing a preclinical evaluation of the procedure on a Yorkshire pig. METHODS Two white Yorkshire pigs had lower eyelid fat bulging treated with UAL using a probe with a diameter of 1.0 mm or less. Fourteen days after treatment, we evaluated the changes in fat thickness from ultrasound, changes in skin contour (volume and height) from the Antera 3D™, and the disruption of fat cells and changes in collagen synthesis from histological evaluation. RESULTS Fourteen days after treatment, the fat layer was significantly reduced with no damage to the skin surface. The mean change in the subcutaneous fat layer thickness was decreased 1.51-0.75 mm in ultrasound analysis. The skin contour of the treated area also decreased with time from 202.5 to 163.5 mm in mean volume and 0.8111 to 0.646 mm in mean height. Masson's trichrome staining showed that the UAL treatment induced the regeneration and remodeling of collagen. CONCLUSION The results of this study demonstrate that UAL successfully reduced the bulging lower eyelid fat of a Yorkshire pig and also increased collagen contraction to tighten skin. UAL may be a beneficial and well-tolerated treatment option for lower eyelid fat bulging.
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Affiliation(s)
- Kwang Ho Yoo
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Tae Rin Kwon
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jong Hwan Kim
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Beom Joon Kim
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
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Abstract
Noninvasive and minimally invasive treatments are increasingly supplanting, or complimenting, abdominoplasty. For optimal delivery of patient care and to maintain a dominant share of the body-contouring market, plastic surgeons need to embrace these new technologies. High capital purchases, costly disposables, maintenance fees, lack of experience, conflicting anecdotal reports, energy-related complications, marketing hyperbole, and rapid obsolescence are formidable barriers to this adoption. Receptive plastic surgeons may be best served by accepting brief short-term retrospective reports by reputable innovative body contouring surgeons who present a succinct and clinically supported message.
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Affiliation(s)
- Dennis J Hurwitz
- Hurwitz Center for Plastic Surgery, 3109 Forbes Avenue, #500, Pittsburgh, PA 15213, USA.
| | - Lauren Wright
- Hurwitz Center for Plastic Surgery, 3109 Forbes Avenue, #500, Pittsburgh, PA 15213, USA
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Araco A. A case report of deep skin burns following radiofrequency-assisted liposculpting technology of BodyTite. Dermatol Ther 2020; 33:e13683. [PMID: 32449183 DOI: 10.1111/dth.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Antonino Araco
- Aesthetic Medicine Department, University Tor Vergata of Roma, Viale Oxfor 180, Rome, Italy
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Saad AN, Pablo Arbelaez J, De Benito J. High Definition Liposculpture in Male Patients Using Reciprocating Power-Assisted Liposuction Technology: Techniques and Results in a Prospective Study. Aesthet Surg J 2020; 40:299-307. [PMID: 31361804 DOI: 10.1093/asj/sjz218] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High-definition liposculpture (HDL) consists of techniques developed to emulate an athletic and attractive surface anatomy. OBJECTIVES The aim of this study was to describe our experience, including techniques and postoperative outcomes, when performing HDL with power-assisted liposuction (PAL) technology in male patients. METHODS In this prospective study PAL was used for fat extraction and to perform HDL. Intraoperative data were collected and the techniques used were recorded. Postoperatively, photographs were taken, and data were collected regarding the use of compression garments and pain medication, return to work and full activity, and satisfaction levels. RESULTS All patients were males, with an average age of 32.3 years and a body mass index of 26.45 kg/m2; the follow-up period averaged 7.6 months. Intraoperatively, all patients received HDL of the chest, abdomen, back, and upper arms, and fat transfer to the chest. The average operative time was 3.4 hours. None of patients had drains left intraoperatively. Postoperatively, all patients were completely off their pain medications by postoperative day 9. They received, on average, 3.7 sessions of lymphatic massage and wore compression garments for an average of 3 weeks. They returned to work 6.1 days after surgery and were back to full activity in 3.2 weeks. Minor complications were reported in 2 patients. Patient satisfaction was on average 9.8 (on a scale of 1-10) at 6 months. CONCLUSIONS HDL with PAL technology is a safe procedure that delivers reproducible natural-looking results with high patient satisfaction rates, low risk of complications, and a relatively short and tolerable recovery process. LEVEL OF EVIDENCE: 4
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Locketz GD, Bloom JD. Percutaneous Radiofrequency Technologies for the Lower Face and Neck. Facial Plast Surg Clin North Am 2019; 27:305-320. [DOI: 10.1016/j.fsc.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Swanson E. Concerns Regarding Photographic Representation of the Results of Radiofrequency Treatment. Aesthet Surg J 2019; 39:354-356. [PMID: 31242299 DOI: 10.1093/asj/sjz147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dayan E, Chia C, Burns AJ, Theodorou S. Adjustable Depth Fractional Radiofrequency Combined With Bipolar Radiofrequency: A Minimally Invasive Combination Treatment for Skin Laxity. Aesthet Surg J 2019; 39:S112-S119. [PMID: 30958550 PMCID: PMC6460431 DOI: 10.1093/asj/sjz055] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Increasingly, patients are seeking minimally invasive methods to tighten skin and remodel adipose tissue. A large treatment gap exists among 3 types of patients: (1) the younger demographic, who increasingly desire soft tissue tightening without traditional operations, scars, and downtime; (2) patients with soft tissue laxity who are not “severe enough” to justify an excisional procedure, but not “mild enough” to rely on liposuction with soft tissue contraction alone; and (3) those with recurrent laxity who already underwent traditional excisional procedures. In these populations, plastic surgeons risk under- or overtreating with traditional methods. The purpose of this supplement is to describe the utility of radiofrequency (RF) microneedling (Fractora modified to Morpheus8 InMode Aesthetic Solutions, Lake Forest, CA) in combination with bipolar RF (FaceTite/BodyTite, InMode Aesthetic Solutions). By combining these procedures, the aforementioned treatment gap can be addressed. The RF microneedling allows for subdermal adipose remodeling and skin tightening. Addition of bipolar RF also tightens the skin by contraction of the underlaying fibroseptal network in addition to induction of neocollagenesis, elastogenesis, and angiogenesis at skin surface temperatures of 40° to 50°C. In our experience, these technologies have been effective and safe in these patient populations. Level of Evidence: 4![]()
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Affiliation(s)
- Erez Dayan
- Plastic and Reconstructive Surgeon, Division of Plastic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Christopher Chia
- Plastic and Reconstructive Surgeons, Division of Plastic Surgery, Manhattan Eye, Ear, Throat Infirmary, New York, NY
| | - A Jay Burns
- plastic and reconstructive surgeon in private practice in Dallas, TX
| | - Spero Theodorou
- Plastic and Reconstructive Surgeons, Division of Plastic Surgery, Manhattan Eye, Ear, Throat Infirmary, New York, NY
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Swanson E. A Critique of Radiofrequency Treatments for Facial Rejuvenation. Aesthet Surg J 2019; 39:NP26-NP28. [PMID: 30608573 DOI: 10.1093/asj/sjy192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Swanson E, Brown T. A Discussion of Conflicts of Interest in Plastic Surgery and Possible Remedies. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e2043. [PMID: 30656120 PMCID: PMC6326602 DOI: 10.1097/gox.0000000000002043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/10/2018] [Indexed: 01/31/2023]
Affiliation(s)
| | - Tim Brown
- Private Practice, Berwick, Victoria, Australia
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