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Aburub A, Darabseh MZ, Badran R, Shurrab AM, Amro AA, Ledger SJ. Ant-waist surgery adversely affects lung function: a cross-sectional study. Multidiscip Respir Med 2024; 19:984. [PMID: 39093016 PMCID: PMC11299848 DOI: 10.5826/mrm.2024.984] [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: 05/21/2024] [Accepted: 06/06/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Body contouring surgery for the removal of the 11th and 12th ribs is undertaken for aesthetic appeal in female and transgender populations. The potential adverse effects of the surgery on lung function and respiratory muscle strength have not been previously studied. Therefore, this study aimed to determine the effects of 'Ant-waist' surgery on lung function and respiratory muscle strength in individuals who had undergone surgery. METHODS This was a cross-sectional study with two groups, an Anti-waist group who had undergone surgery and an age and gender matched control group. Participants performed lung function tests to determine measurements of FEV1, FVC, FEV1/FVC, PEF, MIP, and MEP. Independent t-tests were performed to determine between-group differences in outcomes and Pearson's correlation coefficients determined the relationship between lung function and respiratory muscle strength, and number of years since surgery. RESULTS There was a significant between-group difference in FEV1 (-0.83; 95%CI -1.30, -0.36; p<0.001), FEV1%pred. (-34.91; 95%CI -48.92, -20.90; p<0.001), FVC%pred. (-22.73; 95%CI -32.84, -12.62; p<0.001), PEF%pred. (-44.18; 95%CI -61.52, -26.84; p<0.001) and MEP (-68.27; -102.48, -34.07; p<0.001). There were significantly large, negative correlations (r>0.5) between the number of years after surgery and FEV1 (p=0.002), FEV1%pred. (p=0.0001); and PEF%pred. (p=0.032). CONCLUSIONS This study has identified that aesthetic surgery for the removal of ribs 11 and 12 had a significant adverse effect on lung function and respiratory muscle strength in Jordanian females. The potential adverse effects should be carefully explained by surgeons to patients considering the surgery.
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Affiliation(s)
- Aseel Aburub
- Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
| | - Mohammad Z. Darabseh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Rahaf Badran
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Middle East University Amman, Jordan
| | - Ala’a M. Shurrab
- Department of Basic Medical Science, Faculty of Medicine, Al-Balqa Applied University, Al salt, Jordan
| | - Anwaar A. Amro
- Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
| | - Sean J. Ledger
- Physiotherapy, School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
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Zaussinger M, Kerschbaumer C, Schwartz B, Bachleitner K, Ehebruster G, Schmidt M. Influence of Tranexamic Acid in Body Contouring Surgery: Significant Changes on Complication Rates after Abdominoplasty. Aesthetic Plast Surg 2024; 48:2872-2878. [PMID: 38750226 DOI: 10.1007/s00266-024-04094-y] [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: 01/10/2024] [Accepted: 04/15/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Complications after abdominoplasty remain an unsolved issue in body contouring surgery. The antifibrinolytic drug tranexamic acid (TXA) has gained increasing recognition as a valuable pharmacologic agent within plastic surgery. The aim of this study was to investigate the influence of intravenously administered TXA on complications and patient safety after abdominoplasty. METHODS Within this retrospective single-center study, patients who underwent abdominoplasty and received intravenous TXA were selected and compared to randomly selected patients who underwent abdominoplasty without administration of TXA. The patient population was divided into two study groups (TXA vs no TXA). Demographic and surgical data as well as complications were evaluated and compared. Appropriate statistical analysis was performed. RESULTS Fifty-seven female and 3 male patients with a median age of 38 years and a mean BMI of 25.6 ± 3.3 kg/m2 were included in the study. Except smoking history, demographic data showed no statistically significant differences between both groups. The most common complication was seroma formation (n = 16; 23.9%), and its occurrence was statistically significantly lower in the TXA group (p = 0.023). Furthermore, postoperative seroma aspiration was performed in statistically significant lower numbers in the TXA group (p < 0.05). No thromboembolic events or seizures were observed. DISCUSSION The outcomes of this study showed that the intravenous administration of TXA leads to a significant reduction of seroma formation and postoperative seroma aspiration after abdominoplasty. Simultaneously, no adverse thromboembolic events were detected. Hence we would recommend administration of TXA in body contouring surgery to decrease the incidence of seroma formation. 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)
- Maximilian Zaussinger
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria.
- Doctoral Degree Program in Medical Science, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - Celina Kerschbaumer
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Bernhard Schwartz
- Department of Research and Development, University of Applied Sciences for Health Professions Upper Austria, Semmelweisstraße 34, D3, 2, 4020, Linz, Austria
| | - Kathrin Bachleitner
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Gudrun Ehebruster
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Manfred Schmidt
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
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3
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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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4
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Ahmed MB, Doi SA, Habib AM, Glass GE, Hammouda A, Alyazji ZTN, Al-Mohannadi FS, Khoogaly H, Syed A, Alsherawi A, Badran S. Bioelectrical Impedance Analysis Detects Body Fat Changes After Surgical Subcutaneous Fat Removal. Metab Syndr Relat Disord 2024; 22:281-286. [PMID: 38502809 DOI: 10.1089/met.2023.0223] [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: 03/21/2024] Open
Abstract
Background: The risk and metabolic effects of obesity are determined by the distribution of fat throughout the body. It has been proposed that the distribution of abdominal fat is more closely related to the metabolic risks of obesity. High prevalence of overweight and obesity has thereby contributed to an increased uptake of surgical subcutaneous fat removal (SSFR) procedures. The goal of this study was to determine whether bioelectrical impedance analysis (Tanita system) can be used to detect the removal of excess abdominal subcutaneous fat tissue during SSFR when studying the metabolic effects of such procedures. Methods: Study population comprised patients who received body contouring procedures at the Hamad General Hospital's plastic surgery department between November 2020 and December 2022. To evaluate the factors of interest, subjects were prospectively followed up at two time points: within 1 week before the surgery and within 1-2 weeks thereafter. The following factors were measured: body weight, body fat percentage, body fat mass, body mass index (BMI), fat-free mass, estimated muscle mass, total body water, visceral fat score, and basal metabolic rate. Results: In total, 22 patients were included in the study. The two visits' medians for height, weight, BMI, fat percent (fat%), fat mass, visceral fat rating, and Doi's weighted average glucose (dwAG) were compared. Only in the case of Tanita fat% and fat mass, were the preoperative and postoperative medians significantly different. Furthermore, there was no association between these Tanita measures and dwAG or homeostatic model assessment (HOMA; insulin resistance [IR]) changes (before and after surgery). Tanita measures overestimated fat loss, as seen by the mountain plot and Bland-Altman plot agreement methods. Conclusions: Our findings indicated that the only two Tanita measures exhibited meaningful early associations with the amount of tissue excised which were fat mass and fat% differences. Although dwAG and HOMA-IR are not impacted immediately postsurgery, a trend was seen that suggested improvements in those parameters, even though the changes are not clinically significant.
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Affiliation(s)
- Mohamed Badie Ahmed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Plastic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Suhail A Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Abdella M Habib
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Graeme E Glass
- Department of Surgery, Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar
- Department of Surgery, Sidra Medicine, Doha, Qatar
| | - Atalla Hammouda
- Department of Plastic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zaki T N Alyazji
- Department of Plastic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Hoda Khoogaly
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Asma Syed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Abeer Alsherawi
- Department of Plastic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Saif Badran
- Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri, USA
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Kohan J, Vyas K, Erotocritou M, Khajuria A, Tehrani K. High-Intensity Focused Electromagnetic (HIFEM) Energy With and Without Radiofrequency for Noninvasive Body Contouring: A Systematic Review. Aesthetic Plast Surg 2024; 48:1156-1165. [PMID: 37957393 DOI: 10.1007/s00266-023-03730-3] [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: 08/20/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Emsculpt Neo (EmSculpt NEO Device, BTL Industries, Inc.) is a FDA-cleared noninvasive body contouring treatment for increasing muscle tone and/or reducing fat. The device uses high-intensity electromagnetic energy to stimulate muscle contractions and to build muscle mass (Emsculpt) or a combination of electromagnetic energy with radiofrequency (Emsculpt NEO) to produce a synergistic effect of building muscle mass and reducing fat. In this study, we conduct a high-quality systematic review to evaluate outcomes for Emsculpt and Emsculpt NEO treatments for noninvasive body contouring. METHODS An electronic search was performed of the PubMed, MEDLINE, Embase, and Web of Science databases using the key terms "High intensity focused electromagnetic therapy; HIFEM; Emsculpt; Emsculpt NEO; BTL Industries." The search included all articles published in English through January 2023. Inclusion criteria included articles noninvasive body contouring and reporting at least one outcome of interest (clinical or patient-reported outcomes). Methodological quality and risk of bias were assessed using the GRADE criteria. Articles involving applications other than for body contouring, animal studies, and review articles were excluded. RESULTS Of the 159 articles identified in the initial search strategy, 51 met relevance based on abstract screening. Fifteen clinical studies were identified, including Emsculpt (n=11) and Emsculpt NEO (n=2). The typical protocol involved four treatments given over a 2-4-week period (range 3-8 treatments) with increase to 100% intensity setting and 1-6-month follow-ups. No complications were reported. Abdominal measurements were obtained using imaging were reported in eight studies. Treated areas included the buttocks (n=4), thighs (n=3), arms or calves (n=1), and abdomen (n=11). For abdominal contouring, mean reductions of fat thickness were 5.5 mm, muscle thickness of 2 mm, and rectus diastasis improvement of 3.0 mm. No studies reported weight change before and after treatment. All studies with patient-reported outcomes report high patient satisfaction. Two studies report marginal or no benefit of treatment. Certain studies failed to report comorbidities or demographic characteristics other than age and sex, which precludes analysis of specific subgroups that may benefit from treatment. Furthermore, certain studies failed to address how missing data or the final study population was analyzed. CONCLUSION This systematic review reports on currently published evidence regarding the efficacy and safety of Emsculpt and Emsculpt NEO for body contouring. High-quality level data reporting with patient-reported outcomes will optimize shared decision-making and informed consent. LEVEL OF EVIDENCE II Therapeutic study. 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)
- Joshua Kohan
- The Robert Larner MD College of Medicine at The University of Vermont, Burlington, Vermont, USA.
- , New York, USA.
| | - Krishna Vyas
- Aristocrat Plastic Surgery and MedAesthetics, New York, New York, USA
| | - Marios Erotocritou
- Kellogg College, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ankur Khajuria
- Kellogg College, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Tehrani
- Aristocrat Plastic Surgery and MedAesthetics, New York, New York, USA
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6
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David JA, Gusenoff JA. Circumferential Surgical Contouring of the Upper and Lower Body. Clin Plast Surg 2024; 51:95-110. [PMID: 37945080 DOI: 10.1016/j.cps.2023.06.003] [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: 11/12/2023]
Abstract
Body contouring surgeons encounter a wide range of deformities affecting multiple areas of the body. Combining and staging procedures can assist in optimizing outcomes, but there is no one-size-fits-all approach to surgical sequencing and timing. A meticulous, individualized approach to preoperative planning can lead to reliable, aesthetically pleasing results that align with the patient's goals and preferences. In this article, we present our latest ideas on circumferential body contouring surgery and discuss the integration of lower body lift procedures with those of the abdomen, upper body, breasts, back, and arms to create a comprehensive 360° transformation.
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Affiliation(s)
- Joshua A David
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA
| | - Jeffrey A Gusenoff
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA.
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7
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Capla J, Hanna SA. Patient Evaluation and Surgical Staging. Clin Plast Surg 2024; 51:7-12. [PMID: 37945077 DOI: 10.1016/j.cps.2023.07.004] [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 present article discusses the evaluation and surgical planning of body contouring procedures for weight loss patients. These patients require thorough preoperative evaluation and patient education. Distinction should be made between massive weight loss and moderate medication-assisted weight loss (MMA) as these patient populations are managed differently and there are unique preoperative considerations with the MMA population. Given that weight loss patients often have multiple concerns, combination procedures are often utilized and must be planned with the patient's goals and safety in mind.
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Affiliation(s)
- Jennifer Capla
- Department of Plastic Surgery, Lenox Hill Hospital, Northwell Health System, 125 East 63rd Street, New York, NY 10065, USA.
| | - Steven A Hanna
- Department of Plastic Surgery, Manhattan Eye, Ear & Throat Hospital, 210 East 64th Street, New York, NY, USA
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8
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Ant Waist Surgery: Aesthetic Removal of Floating Ribs to Decrease the Waist-hip Ratio. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4852. [PMID: 36891563 PMCID: PMC9988318 DOI: 10.1097/gox.0000000000004852] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/19/2023] [Indexed: 03/08/2023]
Abstract
Decreasing waist circumference has become an essential feature in modern body contouring surgery owing to the attractiveness of hourglass body shapes. Traditionally, this can be achieved through lipomodeling and abdominal musculature strengthening techniques. An adjunctive procedure for ideal shaping of the waistline is resection of the 11th and 12th ribs, referred to as floating ribs. This study aimed to report and analyze clinical outcomes and self-reported patient satisfaction after "ant waist" surgery (floating rib removal) for aesthetic reasons. We retrospectively reviewed the medical records of five patients who had undergone bilateral 11th and 12th rib resections at a single institute in Taiwan in an outpatient setting. The mean lengths of the resected left and right 11th ribs were 9.1 and 9.5 cm, respectively. The mean lengths of the resected left and right 12th ribs were 6.3 and 6.4 cm, respectively. The mean waist-to-hip ratio decreased from 0.78 preoperatively to 0.72 postoperatively, with a mean decrease of 7.7%. No adverse events were reported. Generally, all patients reported being satisfied with the operation. Floating rib resection proved useful and effective in decreasing the waist-to-hip ratio using a safe, simple, and reproducible technique without significant complications. Although preliminarily, the authors' comprehensive demonstration of this ant waist surgery supports further studies focusing on waistline contouring.
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Chabot AB, Puyana S, Lindsey JT. The Use of Mean Gray Value (MGV) as a Guide to Tension-Reducing Strategies in Body Contouring Surgery Reduces Wound-Related Morbidity. Aesthet Surg J 2023; 43:NP122-NP130. [PMID: 35951531 DOI: 10.1093/asj/sjac223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Currently there are no known structural parameters of the integument that can be measured noninvasively which are used in the planning of body contouring surgery. OBJECTIVES The aim of this study was to see if mean gray value (MGV), when taken into account preoperatively, can reduce wound-related morbidity. METHODS This project was a prospective cohort study. Ultrasound imaging of the subcutaneous tissue was performed prospectively on patients undergoing body contouring surgery to quantify the superficial fascial system so that average MGV could be calculated over the proposed surgical sites. Patients with average to poor MGV (≤0.127) were identified preoperatively for tension-reducing procedures. Wound complication rates were compared with rates in a retrospective cohort which did not undergo preoperative imaging. RESULTS There were 115 patients in each of the 2 cohorts. There were 3 exclusions due to loss of ultrasound images, leaving 112 patients available for analysis in the prospective cohort. The cohorts were similar except for a higher incidence of patients with diabetes in the retrospective group (1 vs 9, P = 0.026). The wound complication rate was significantly reduced in the prospective group (5/112, 4.4%) when compared with the retrospective group (20/115, 17%, P = 0.0062). The revision and infection rates were also significantly reduced in the prospective group (1/112, 0.9%; 3/112, 2.6%) when compared with the retrospective group (8/115, 7%, P = 0.019; 10/115 8.6%, P = 0.051). CONCLUSIONS MGV is a unique, patient- and area-specific structural parameter of the integument, and its measurement may be useful in reducing wound-related morbidity in body contouring surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- A Bert Chabot
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Salomon Puyana
- Division of Plastic and Reconstructive Surgery, Tulane University, New Orleans, LA, USA
| | - John T Lindsey
- Division of Plastic and Reconstructive Surgery, Tulane University, New Orleans, LA, USA
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10
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Metabolic changes after surgical fat removal: A dose-response meta-analysis. J Plast Reconstr Aesthet Surg 2023; 76:238-250. [PMID: 36527906 DOI: 10.1016/j.bjps.2022.10.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Bariatric surgery averts obesity-induced insulin resistance and the metabolic syndrome. By contrast, surgical fat removal is considered merely an esthetic endeavor. The aim of this article was to establish whether surgical fat removal, similar to bariatric surgery, exerts measurable, lasting metabolic benefits. METHODS PubMed, Embase, and Scopus were searched using the Polyglot Search Translator to find studies examining quantitative expression of metabolic markers. Quality assessment was done using the MethodologicAl STandard for Epidemiological Research scale. The robust-error meta-regression model was employed for this synthesis. RESULTS Twenty-two studies with 493 participants were included. Insulin sensitivity improved gradually with a maximum reduction in fasting insulin and homeostatic model assessment for insulin resistance of 17 pmol/L and 1 point, respectively, at postoperative day 180. Peak metabolic benefits manifest as a reduction of 2 units in body mass index, 3 kg of fat mass, 5 cm of waist circumference, 15 µg/L of serum leptin, 0.75 pg/ml of tumor necrosis factor-alpha, 0.25 mmol/L of total cholesterol, and 3.5 mmHg of systolic and diastolic blood pressure that were observed at day 50 but were followed by a return to preoperative levels by day 180. Serum high-density lipoproteins peaked at 50 days post-surgery before falling below the baseline. No significant changes were observed in lean body mass, serum adiponectin, resistin, interleukin-6, C-reactive protein, triglyceride, low-density lipoproteins, free fatty acids, and fasting blood glucose. CONCLUSION Surgical fat removal exerts several metabolic benefits in the short term, but only improvements in insulin sensitivity last beyond 6 months.
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11
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Body Contouring Screening Questionnaire: A Simple Quality Improvement Measure to Improve Clinical Resource Utilization. Plast Reconstr Surg 2023; 151:175e-177e. [PMID: 36576842 DOI: 10.1097/prs.0000000000009754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Zaussinger M, Wenny R, Schwartz B, Ehebruster G, Huemer GM, Schmidt M. De-epithelialized Dermal Flap to Reduce Sacral Wound Healing Complications After Lower Body Lift Procedure. Aesthet Surg J 2022; 42:NP451-NP460. [PMID: 35079779 DOI: 10.1093/asj/sjac012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lower or circumferential body lift procedures in the massive-weight-loss population have been associated with significant complication rates. Particularly, the sacral area is at risk of wound-healing problems due to high wound tension or shear forces. OBJECTIVES The authors introduced a de-epithelialized dermal flap to reinforce the sacral area. METHODS Within this retrospective study, outcomes of 40 consecutive patients who underwent lower body lift between 2017 and 2021 were analyzed. The patient population was divided into 2 study groups (sacral flap vs no flap) including 20 patients each. Demographic and surgical data as well as complications were evaluated and compared. Appropriate statistical analysis was performed. RESULTS Thirty-seven female and 3 male patients with a median age of 36.5 years (range, 23-54 years) and a mean weight loss of 46.3 ± 12 kg participated in the study. The most common complication was sacral wound dehiscence (n = 7, 17.5%), and its occurrence was statistically significantly lower in the sacral flap group (P = 0.037). The odd ratios for complications when executing the sacral flap procedure were reduced to 0.306 (95% confidence interval = 0.075 to 1.246) and 0.261 (95% confidence interval = 0.055 to 1.250) for the uncorrected and corrected logistic regressions, respectively. In addition, findings showed a significantly shorter hospital stay as well as statistical trends towards a lower occurrence of overall complications in the sacral flap group. Concerning the remaining data, no statistically significant differences between study groups were detected. CONCLUSIONS The presented de-epithelialized dermal flap leads to a significant reduction of sacral wound-healing complications and a shorter hospital stay for patients. This surgical technique is easily reproduceable, rapid, and effective; therefore, we would recommend it for each circumferential or lower body lift procedure. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Raphael Wenny
- Johannes Kepler University Linz Medical Faculty , Linz , Austria
| | - Bernhard Schwartz
- Department for Research and Development, University of Applied Sciences for Health Professions , Linz , Austria
| | | | - Georg M Huemer
- Johannes Kepler University Linz Medical Faculty , Linz , Austria
| | - Manfred Schmidt
- Johannes Kepler University Linz Medical Faculty , Linz , Austria
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13
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Makarawung D, Al Nawas M, Smelt H, Monpellier V, Wehmeijer L, van den Berg W, Hoogbergen M, Mink van der Molen A. Complications in post-bariatric body contouring surgery using a practical treatment regime to optimise the nutritional state. JPRAS Open 2022; 34:91-102. [PMID: 36211632 PMCID: PMC9535379 DOI: 10.1016/j.jpra.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Post-bariatric body contouring surgery (BCS) treats redundant skin after massive weight loss; however, the complication risk is relatively high (23-70%). Most complications are wound-related, which may be partly due to a poor nutritional status after bariatric surgery. The objective of this observational study was to optimise nutrition preoperatively and assess the prevalence of wound-related complications after BCS. Methods This prospective cohort study included 140 patients. Patients were treated according to the post-bariatric BCS guideline. Nutritional parameters were collected via pre- and peri-operative blood sampling; any deficiencies were treated. A protein-enriched diet was prescribed by a dietician 4 weeks preoperatively up until closure of all wounds. Complications were recorded using the Clavien-Dindo classification. Univariate and multivariate regression analyses were performed to identify variables associated with wound-related complications. Results The overall wound-related complication rate was 51%. Most complications were minor, with only 4.3% was considered major. No significant differences in patient characteristics were found between patients with and without complications. Variables indicating an optimised nutritional state were not significantly associated with a decreased risk of complications; the most influential factor was a sufficient post-operative protein intake (OR 0.27, 95% CI 0.07 – 1.02, p = 0.05). Conclusion The overall wound-related complication rate was in accordance with previous literature; however, major complications were few. This study showed a weak correlation between optimising nutritional state and better outcome after BCS, especially following a protein-enriched diet post-operatively. Therefore, we recommend continuing research on nutrition and wound-related complications, using homogeneous study populations and well-defined complications.
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Affiliation(s)
- D.J.S. Makarawung
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - M. Al Nawas
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - H.J.M. Smelt
- Department of General Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - V.M. Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - L.M. Wehmeijer
- Department of Plastic, Reconstructive and Hand Surgery, Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - W.B. van den Berg
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - M.M. Hoogbergen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - A.B. Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
- Corresponding author. Aebele B. Mink van der Molen, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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Zaussinger M, Wenny R, Zucal I, Staud C, Schmidt M, Duscher D, Huemer GM. The Three-Hour Lower Body Lift: Evolution of a Technique and Personal Experience after 155 Consecutive Cases. Aesthetic Plast Surg 2022; 46:1293-1302. [PMID: 34761290 DOI: 10.1007/s00266-021-02651-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/23/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Body-contouring is a surgical field in growing demand, as the number of massive weight loss patients following bariatric surgery is increasing. The purpose of this study was to provide a straightforward and time-efficient circumferential body lift technique to achieve optimal lower truncal contouring. PATIENTS AND METHODS A total of 155 massive weight loss patients (133 women and 22 men) underwent lower body lift surgery between 2006 and 2018. The mean preoperative weight reduction and body mass indices were 56.5 ± 16.6 kg and 26.7 ± 4.7 kg/m2, respectively. The preoperative markings focused on the back and gluteal region, and the modified surgical technique are described. Additionally, improvements of intra-operative repositioning of the patient and how to deal with sterilization and dressings are elucidated. RESULTS The average intra-operative time was 178 ± 54.6 minutes. The mean follow-up of all patients was 8.2 ± 2.4 years. The most common complications were related to wound dehiscence (n = 38) and seroma (n = 18). The mean weight of the resected tissue was 3 056 ± 1 816.5 g. CONCLUSION The lower body lift represents an effective and safe body contouring procedure to treat massive weight loss patients with multiple regions of concern. The current study describes a modified surgical technique that reduces operating time and complications, notably. 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)
- Maximilian Zaussinger
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria.
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria.
| | - Raphael Wenny
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
| | - Isabel Zucal
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
| | - Clement Staud
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Manfred Schmidt
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
| | - Dominik Duscher
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Georg M Huemer
- Section of Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Krankenhausstrasse 9A, 4020, Linz, Austria.
- Medical Faculty, Johannes Kepler University Linz, Altenberger Straße 69, 4040, Linz, Austria.
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15
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A Prospective, Matched Comparison of Health-Related Quality of Life in Bariatric Patients following Truncal Body Contouring. Plast Reconstr Surg 2022; 149:1338-1347. [PMID: 35383722 DOI: 10.1097/prs.0000000000009098] [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
BACKGROUND Massive weight loss after bariatric surgery can lead to excess skin associated with functional and aesthetic sequelae. Access to the benefit provided by body contouring procedures may be limited by insurance approval, which does not consider health-related quality of life. The aim of this study was to quantify the benefit in health-related quality of life for patients who undergo body contouring procedures after massive weight loss. METHODS Patients evaluated for postbariatric body contouring procedures were systematically identified and prospectively surveyed using the BODY-Q. Health-related quality-of-life change for each functional scale was compared between those who underwent body contouring procedures (operative group, preoperatively versus postoperatively) and those who did not (nonoperative group, preoperatively versus resurvey) using t tests. Propensity score matching allowed the authors to balance baseline demographics, comorbidities, physical symptoms, and risk factors between cohorts. RESULTS Fifty-seven matched patients were analyzed (34 operative versus 23 nonoperative). No significant difference in age, body mass index, time between surveys, or preoperative BODY-Q scores existed between cohorts. The surgical group demonstrated a significant improvement in 10 out of 11 BODY-Q functional scales. The nonoperative group realized no improvements and, in the interim, had a significant deterioration in four BODY-Q scales. CONCLUSIONS Postbariatric body contouring procedures represent a critical and final step in the surgical weight loss journey for patients and are associated with significant improvements in health-related quality of life. Further deterioration in psychosocial and sexual health-related quality of life occurs in patients who do not undergo body contouring procedures following bariatric surgery. This study provides prospective comparative data that validate the field's standard intervention and justification for insurance approval. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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16
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Motamedi M, Almeida J, Allert S. [Lipoabdominoplasty in post-bariatric Surgery: a relevant Alternative to Fleur-de-Lis abdominoplasty?]. HANDCHIR MIKROCHIR P 2022; 54:98-105. [PMID: 35419779 DOI: 10.1055/a-1759-3181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The number of bariatric procedures, and thus also the number of post-bariatric operations, has increased dramatically in recent years. Although long scars are common in post-bariatric surgery and accepted in favour of body shape reconstruction, we increasingly notice the wish for aesthetically pleasing results in addition to the desire for body contouring. In particular, Fleur-de-Lis abdominoplasty (FdL) is viewed critically by younger patients after massive weight loss due to the visible vertical scar. Surgeons are also often bothered by the unsatisfying aesthetic outcome as well as the higher rate of complications. METHODS Retrospective analysis of 20 female patients with massive weight loss following bariatric surgery, who received lipoabdominoplasty instead of Fleur-de-Lis abdominoplasty in the period from January 2019 to June 2020. Data analysis was based on measurements of preoperative vertical and horizontal excess skin and fat (Pittsburgh Rating Scale), Body Mass Index, surgical technique and final result. RESULTS Twenty female patients with an indication for FdL abdominoplasty underwent radical liposuction of the abdomen combined with abdominoplasty. The original weight before massive weight reduction ranged between 100 and 168 kg. Average weight reduction was 56.5 kg. The mean BMI was 27.3 kg/m². The average age of our cohort was 40 years. One patient (5 %) had a major complication. This was an infected seroma which could be treated conservatively. Two other patients (10 %) developed an uninfected seroma as a minor complication. CONCLUSION Our work shows that lipoabdominoplasty can be performed safely and well even in patients after massive weight loss. It is possible to achieve good body contours without vertical incisions and with a high degree of patient satisfaction. The number of patients who have to undergo FdL abdominoplasty can be successfully reduced by this technique.
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Affiliation(s)
- Melodi Motamedi
- Sana Klinikum Hameln-Pyrmont, Plastische und Ästhetische Chirurgie, Handchirurgie
| | - Jessica Almeida
- Sana Klinikum Offenbach GmbH, Plastische und Ästhetische Chirurgie - Handchirurgie
| | - Sixtus Allert
- Sana Klinikum Hameln-Pyrmont, Plastische und Ästhetische Chirurgie, Handchirurgie
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17
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Stein MJ, Matarasso A. The Male Abdominoplasty. Clin Plast Surg 2022; 49:285-291. [DOI: 10.1016/j.cps.2022.01.002] [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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18
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Yang M, Gu Y, Sun J, Lv Q, Qi Y, Jin J, Liu Z, Ma G. Difficulty of Severe Post-liposuction Infragluteal Deformity Correction With Autologous Fat Transplantation: A Case Report. Front Surg 2022; 9:758566. [PMID: 35198594 PMCID: PMC8858828 DOI: 10.3389/fsurg.2022.758566] [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: 08/14/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Overaggressive liposuction of the infragluteal region can lead to iatrogenic infragluteal fold deformity and result in esthetic defects in the gluteal contour. We report a case of using autologous fat transplantation to correct severe post-liposuction infragluteal fold deformity. In the process of reconstruction, the patient experienced fat graft overabsorption, fat graft translocation, and gluteal ptosis aggravation. Despite multiple operations, the effect of fat transplantation was limited. In conclusion, severe post-liposuction infragluteal deformity is very difficult to correct. The infragluteal region should be preserved during liposuction to avoid deformity.
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19
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Agochukwu-Nwubah N, Patronella C. Expanding the Progressive Tension Suture Concept: A Study of Its Utility in Body Contouring Procedures. Aesthet Surg J 2021; 41:1386-1395. [PMID: 33755729 DOI: 10.1093/asj/sjab120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Seroma is one of the most common complications following body contouring. Progressive tension sutures (PTSs) have been shown to decrease the seroma rate following abdominoplasty, component separation, and facelifts and following latissimus flap and deep inferior epigastric artery perforator flap harvest. OBJECTIVES The aim of this study was to investigate the effects of PTS techniques and their impact on the seroma rate in body contouring flap procedures. METHODS A retrospective review was performed of all patients undergoing a flap procedure (defined as any procedure that produces a dead space and subsequent susceptibility to seroma) by a single surgeon at a single institution over 3 years. All patients/procedures utilized PTS techniques, as is routine in the surgeon's practice. No drains were used. Patient demographics and complications, including seroma, were tracked. RESULTS A total of 441 flap procedures were performed in 351 patients over the 3-year study period. These procedures comprised 305 abdominoplasties, 68 lower body lifts, 17 medial thigh lifts, 36 brachioplasties, and 15 torsoplasties. PTSs were used in all procedures. No drains were utilized. Complications occurred in 72 procedures (16.3%), with the most common complication being minor wound dehiscence without infection. There were no cases of seroma. CONCLUSIONS PTSs represent an effective technique for reducing the seroma rate, eliminating the potential space and promoting tissue adherence in flap procedures for body contouring. This is the first study of its kind demonstrating the use and role of this technique in body contouring procedures beyond the scope of abdominoplasty. LEVEL OF EVIDENCE: 4
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20
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Safety and efficacy of gluteal contouring based on stromal enriched lipograft in 194 patients. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Facchin F, Pagani A, Marchica P, Pandis L, Scarpa C, Brambullo T, Bassetto F, Vindigni V. The Role of Portable Incisional Negative Pressure Wound Therapy (piNPWT) in Reducing Local Complications of Post-bariatric Brachioplasty: A Case-Control Study. Aesthetic Plast Surg 2021; 45:1653-1659. [PMID: 33481062 PMCID: PMC7821840 DOI: 10.1007/s00266-020-02122-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Due to the great impact of bariatric surgery on the overweight epidemic, the number of post-bariatric body-contouring procedures is constantly increasing worldwide. The portable incisional negative pressure wound therapy (piNPWT) is a promising medical device for accelerating wounds closure and controlling post-operative complication, which have been shown promising results in post-bariatric population. We aimed to evaluate the role of piNPWT in optimizing wound healing and controlling post-operative complications after a post-bariatric brachioplasty. PATIENTS AND METHODS 26 post-bariatric female patients who underwent a brachioplasty followed by either a piNPWT (14 cases) or a standard wound treatment (12 controls) were analyzed. The number of post-operative dressing changes, the rate of local post-operative complications (re-operation, hematoma and serosa development, dehiscence and necrosis), the time to dry as well as the scar quality and hospitalization length were evaluated. RESULTS None of the patients prematurely stopped treatment with piNPWT due to intolerance. The piNPWT patient group showed a significant lower healing time as well as a significant reduction of the number of post-operative dressing changes and hospital stay. Despite the scarring process was excellent from the functional point of view in the long term, we noticed a higher rate of hyperchromic scarring at 90 days after surgery. CONCLUSION The piNPWT is a cost-effective and user-friendly medical tool that increase and promote wound healing. We suggest the use of this device in post-bariatric patients who undergo a brachioplasty, especially if there is the need to minimize the number of post-operative dressing changes. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Federico Facchin
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Nicolò Giustininani 2, 35128 Padua, Italy
| | - Andrea Pagani
- Clinic and Policlinic of Plastic and Hand Surgery, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Paolo Marchica
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Nicolò Giustininani 2, 35128 Padua, Italy
| | - Laura Pandis
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Nicolò Giustininani 2, 35128 Padua, Italy
| | - Carlotta Scarpa
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Nicolò Giustininani 2, 35128 Padua, Italy
| | - Tito Brambullo
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Nicolò Giustininani 2, 35128 Padua, Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Nicolò Giustininani 2, 35128 Padua, Italy
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Nicolò Giustininani 2, 35128 Padua, Italy
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Ferry AM, Chamata E, Dibbs RP, Rappaport NH. Avoidance and Correction of Deformities in Body Contouring. Semin Plast Surg 2021; 35:110-118. [PMID: 34121946 DOI: 10.1055/s-0041-1727207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Body contouring procedures are highly impactful because of their potential to improve a patient's quality of life. These procedures, particularly when performed on patients following massive weight loss, may require secondary intervention to treat residual contour abnormalities. Presently, there is a paucity of information in the literature detailing the avoidance and correction of body contouring deformities. Herein, we will discuss the management of patients seeking revisional body contouring procedures.
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Affiliation(s)
- Andrew M Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward Chamata
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rami P Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Norman H Rappaport
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Houston Center for Plastic Surgery, Houston, Texas
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Aesthetic Contouring of the Chest wall with Rib Resection. Aesthetic Plast Surg 2021; 45:1099-1104. [PMID: 33037473 DOI: 10.1007/s00266-020-01988-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In past decades, several invasive and noninvasive aesthetic procedures have been sought as a way to improve body contouring, and one may resort to uncertified and potentially dangerous procedures to achieve that goal. An example of this practice would be the resection of ribs to reduce the waist for aesthetic reasons. The objective was to check scientific evidence on the effectiveness and safety of removal of floating ribs for aesthetic purposes. METHODS A systematic review of the literature was carried out in EMBASE/Elsevier, Cochrane, Scopus, Medline, PubMed, BVS, SciELO, OneFile, and Lilacs, throughout the period until June 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Fifty-six articles were found in all databases. After applying the inclusion criteria, by reading the title and abstract of the studies found, only two articles were definitively included. One addressed the possibility of removing the 7th and 8th ribs for improving body contouring in patients with an exaggerated anterior projection of the chest wall, without showing cases or surgical techniques. The other demonstrated procedures of body contouring in transgender by the removal of the 11th and 12th ribs in five of the 22 patients studied, just providing a brief description of the surgical technique used, without details. CONCLUSIONS Despite the relevance of the theme and its popularity, there is not enough scientific evidence to support the practice, effectiveness and safety of the resection of ribs for aesthetic purposes. 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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Baron ME, Minteer DM, Gusenoff BR, Gusenoff JA. Patient Selection for Pedal Soft Tissue Augmentation. Aesthet Surg J Open Forum 2020; 2:ojaa031. [PMID: 33791654 PMCID: PMC7671290 DOI: 10.1093/asjof/ojaa031] [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] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pedal fat grafting has been shown to improve pain and functional impairment from forefoot fat pad atrophy. OBJECTIVES The authors aimed to determine if patient demographics and foot characteristics play a role in the level of impact that is achieved following surgery. METHODS The authors performed a retrospective review of patients who received forefoot autologous fat injections for the treatment of pedal fat pad atrophy. Patient improvement of pain and functional impairment were evaluated for correlation with patient characteristics, including gender, age, BMI, unilateral vs bilateral injections, flexible vs rigid arch, previous foot deformity or surgery, and presence of callus. RESULTS Forty-four patients received fat injections into the ball of their foot; 73% of them were women; their mean age was 61 years, and mean BMI was 26.6 kg/m2; 75% had injections performed bilaterally; 41% had a flexible arch, 73% had a past history of pedal deformity or surgery, and 43% had callus. Only female gender was found to correlate with an improvement in pain from the time of surgery to 12 months later (P = 0.02). CONCLUSIONS Bilateral rigid, high arched foot type is a risk factor for foot pain and disproportionately represented among these patients. The only patient characteristic found to be correlated with improvement in pain at 12 months post-surgery was female gender. BMI and laterality of injections impacted the course of improvement after surgery. Given current data, all patients with suspected pedal fat pad atrophy should be considered for soft tissue augmentation. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Marissa E Baron
- School of Medicine and the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Danielle M Minteer
- School of Medicine and the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Beth R Gusenoff
- School of Medicine and the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Jeffrey A Gusenoff
- School of Medicine and the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
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25
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Pajula S, Gissler M, Kaijomaa M, Jyränki J, Tukiainen E, Koljonen V. Pregnancy and delivery after lower body contouring surgery is safe for the mother and child. J Plast Reconstr Aesthet Surg 2020; 74:143-151. [PMID: 32859569 DOI: 10.1016/j.bjps.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/18/2020] [Accepted: 08/01/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Obesity in fertile age women has increased worldwide leading to increased bariatric procedures. Lower body contouring surgery (LBCS) is one of the most commonly performed esthetic operations, mainly owing to massive weight loss. However, there is a paucity of data regarding pregnancy and delivery after LBCS. In this study, we examined whether LBCS influences pregnancy or delivery and mother and baby outcome. METHODS In this national registry-based study, we used data from the Finnish Institute of Health and Welfare and the Causes of Death registry. We included fertile age women, from 18 to 54 years who had LBCS with or without a bariatric procedure and who experienced pregnancy and delivery were compared to all deliveries in Finland during 1999- 2016. RESULTS We identified 92 women who had LBCS before delivery. These 92 women had planned cesarean sections more often (P < .001) and preterm delivery was more common (P < .001). None of the mothers or babies died. Of the 92 women, 26 had a preceding bariatric procedure. The preceding bariatric procedures did not increase the risk for preterm delivery or low birth weight. The need for urgent or emergency sections was not increased. The heightened number of planned cesareans is caused by the different demographics of the study group, indicating that previous LBCS is not a contraindication for vaginal delivery. CONCLUSION Pregnancy and delivery are safe for the mother and the baby after LBCS. The possible deviations from normal pregnancy and delivery should be discussed with fertile age women seeking LBCS.
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Affiliation(s)
- Susanna Pajula
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland; Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Marja Kaijomaa
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Janne Jyränki
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Virve Koljonen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Janis JE, Jefferson RC, Kraft CT. Panniculectomy: Practical Pearls and Pitfalls. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3029. [PMID: 32983784 PMCID: PMC7489615 DOI: 10.1097/gox.0000000000003029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/08/2020] [Indexed: 02/03/2023]
Abstract
Panniculectomy is an increasingly common operation, given the current obesity epidemic and the increasing prevalence of bariatric surgery. At first glance, it could be considered a technically simple operation; however, this procedure can be fraught with complications, given the patient population and high demands placed on compromised abdominal tissue. Sufficient attention must be given to the nuances of patient optimization and surgical planning to maximize safe and ideal outcomes. We highlight our practical tips when performing standard or massive panniculectomy for preoperative optimization, intraoperative techniques, and postoperative management to reduce complication and maximize outcomes of this procedure from a surgeon's and a patient's perspective.
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Affiliation(s)
- Jeffrey E. Janis
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
| | - Ryan C. Jefferson
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
| | - Casey T. Kraft
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
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Bonan P, Verdelli A. Combined microwaves and fractional microablative CO2 laser treatment for postpartum abdominal laxity. J Cosmet Dermatol 2020; 20:124-131. [PMID: 32463169 DOI: 10.1111/jocd.13510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Postpartum abdominal changes represent a major esthetic concern affecting women. As the abdomen stretches during pregnancy and some of the muscles lose tone, there is an increased skin laxity and a loss of abdominal elasticity. As a result, the abdomen becomes saggy. AIMS To evaluate the performance of a combined microwaves and fractional microablative CO2 laser treatment for reshaping and improvement of abdomen texture/laxity and striae distensae in postpartum women. PATIENTS/METHODS Fifteen women (median age 38 years) received three monthly abdomen treatments with a new microwaves platform, the ONDA Coolwaves® (DEKA) system, followed by a treatment with fractional microablative CO2 laser (SmartXide2; DEKA) a month thereafter. We followed up each patient's weight and nutritional habits. Outcome was assessed using reproducible circumference and abdominal measurements, digital and 3D photography, the laxity score as well as patient satisfaction index. RESULTS The overall mean circumferences reduction was 3.6 ± 1.2 cm. Significant improvement in skin laxity and tightening was noted by physicians and patients as well as a reduction of striae distensae. Interestingly, as a result of skin remodeling, repositioning of the umbilicus was also demonstrated. Treatments were well tolerated with no side effects. CONCLUSIONS Our data showed a sustainable reduction in circumference and improvement in appearance of abdomen in postpartum women, without compromising patients' safety.
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Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Alice Verdelli
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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Cammarata MJ, Kantar RS, Rifkin WJ, Greenfield JA, Levine JP, Ceradini DJ. Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy. Obes Surg 2019; 29:426-433. [PMID: 30238217 DOI: 10.1007/s11695-018-3492-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Widespread adoption of bariatric surgery in the treatment of obesity has led to greater numbers of patients seeking panniculectomy, including aged patients, who represent a rapidly growing proportion of the U.S population. Although the quality of life and functional benefits of abdominal panniculectomy have been established, its safety in patients 65 years and older has not been evaluated. METHODS The American College of Surgeons National Surgical Quality Improvements (ACS-NSQIP) database was used to identify patients undergoing panniculectomy between 2010 and 2015. Age 65 years and older was the risk factor of interest, and primary outcomes included 30-day wound complications, overall complications, reoperation, readmission, and mortality. Multivariate regression was performed to control for confounders. RESULTS Review of the database identified 7030 patients who underwent abdominal panniculectomy. When stratified by age, 6455 (91.8%) of patients were younger than 65, and 575 (8.2%) were 65 or older. Multivariate regression analysis demonstrated that age over 65 was a significant independent risk factor for wound complications (OR = 1.81; 95% CI 1.35-2.42; p < 0.001) and all complications (OR = 1.46; 95% CI 1.15-1.87; p = 0.002). BMI, smoking, diabetes, and partial or total dependence were also identified as significant independent risk factors for wound and all complications. CONCLUSION Our analysis demonstrates that advanced age is an independent risk factor for wound and overall complications following abdominal panniculectomy. These results highlight the importance of preoperative evaluation and optimization of modifiable preoperative risk factors as well as close postoperative follow-up for safe outcomes in patients 65 and older.
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Affiliation(s)
- Michael J Cammarata
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - William J Rifkin
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - Jason A Greenfield
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - Jamie P Levine
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA
| | - Daniel J Ceradini
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 540 1st Avenue, Lab 2-3, New York, NY, 10016, USA.
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Near-circumferential Lower Body Lift: A Review of 40 Outpatient Procedures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2548. [PMID: 32537298 PMCID: PMC7288879 DOI: 10.1097/gox.0000000000002548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/04/2019] [Indexed: 12/16/2022]
Abstract
Lower body lift surgery has increased in popularity. A circumferential body lift or belt lipectomy is often recommended to treat skin redundancy. A drawback for this procedure is the midline scar bridging the lower back causing elongation of the gluteal cleft. Autoaugmentation methods have not been shown to provide a net increase in buttock volume.
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Malyar M, Peymani A, Johnson AR, Chen AD, Van Der Hulst RRWJ, Lin SJ. The Impact of Resident Postgraduate Year Involvement in Body-Contouring and Breast Reduction Procedures. Ann Plast Surg 2019; 82:310-315. [DOI: 10.1097/sap.0000000000001714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Influence of Massive Weight Loss on the Perception of Facial Age: The Facial Age Perceptions Cohort. Plast Reconstr Surg 2019; 142:481e-488e. [PMID: 30252813 DOI: 10.1097/prs.0000000000004738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Knowledge is scarce about the role of massive weight loss in facial age perception. The aim of this study was to verify whether there is a change in the perception of facial age when comparing people with morbid obesity before surgery and 1 year after the procedure. METHODS Patients with morbid obesity have been analyzed, through a prospective cohort, before and 1 year after undergoing bariatric surgery. Seven plastic surgeons estimated the age of each subject. RESULTS Seventy patients participated. Five patients were excluded because of the exclusion criteria. There was no drop-off among the subjects participating in this cohort. Before surgery, the mean facial age perception was 40.8 years; after surgery, mean facial age perception was 43.7 years (95 percent CI, 0.58 to 2.95; p = 0.004). Men older than 40 years, with a preoperative body mass index between 40 and 49.9 kg/m, weight greater than 127.65 kg before surgery, and percentage of excess weight lost greater than 75.13 percent demonstrated greater perceived facial aging. CONCLUSION Massive weight loss appears to produce facial aging. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abdominal Panniculectomy: Determining the Impact of Diabetes on Complications and Risk Factors for Adverse Events. Plast Reconstr Surg 2019; 142:462e-471e. [PMID: 29979373 DOI: 10.1097/prs.0000000000004732] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The prevalence of obesity along with bariatric surgery and massive weight loss requiring panniculectomy is increasing in the United States. The effect of diabetes mellitus on outcomes following panniculectomy remains poorly defined despite its prevalence. This study aims to evaluate the impact of diabetes mellitus on complications following panniculectomy and determine risk factors for adverse events. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients undergoing panniculectomy between 2010 and 2015. Patients were stratified based on diabetes status. RESULTS Review of the database identified 7035 eligible patients who underwent panniculectomy, of which 770 (10.9 percent) were diabetic. Multivariate regression showed that diabetes mellitus was a significant risk factor for wound dehiscence (OR, 1.92; 95 percent CI, 1.41 to 3.15; p = 0.02). Obesity was a significant risk factor for superficial (OR, 2.78; 95 percent CI, 1.53 to 3.69; p < 0.001) and deep (OR, 1.52; 95 percent CI, 1.38 to 3.97; p = 0.01) incisional surgical-site infection. Smokers were also at an increased risk for superficial (OR, 1.42; 95 percent CI, 1.19 to 1.75; p = 0.03) and deep (OR, 1.63; 95 percent CI, 1.31 to 2.22; p = 0.02) incisional surgical-site infection. CONCLUSIONS Diabetes mellitus is an independent risk factor for wound dehiscence following panniculectomy. Obesity and smoking were significant risk factors for superficial and deep incisional surgical-site infection. These results underscore the importance of preoperative risk factor evaluation in patients undergoing panniculectomy for safe outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Abstract
The abdomen is the most common area of concern among patients with massive weight loss (MWL). Abdominal contouring techniques in the MWL population include panniculectomy, standard abdominoplasty, fleur-de-lis abdominoplasty, reverse abdominoplasty and various combinations of these techniques as part of circumferential procedures such as, circumferential abdominoplasty, and lower body lift. The authors believe that the optimal surgical approach to the abdomen is an integration of the patient aesthetic preferences and the surgeon assessment and experience. The authors recommend to limit total body reconstruction of MWL patients to 2 stages, and include the abdominal area in the first stage.
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Affiliation(s)
- Tali Friedman
- The Body Contouring Center, 47 Brodezky Street, Tel- Aviv, Israel.
| | - Itay Wiser
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA
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Capla J, Shikowitz-Behr L. Patient Evaluation and Surgical Staging. Clin Plast Surg 2018; 46:9-14. [PMID: 30447833 DOI: 10.1016/j.cps.2018.08.002] [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: 10/27/2022]
Abstract
Comprehensive evaluation of the massive-weight-loss patient is a key factor to minimize complications while optimizing surgical outcomes. Special attention is given to medical and weight loss history, nutritional status, and physical examination. Massive-weight-loss patients often present with multiple areas of concern and therefore benefit from staged procedures. Staging requires knowledge on how the tissues are affected by each procedure and an understanding of the patient's priorities and goals.
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Affiliation(s)
- Jennifer Capla
- Department of Plastic Surgery, Lenox Hill Hospital, Northwell Health System, 125 East 63rd Street, New York, NY 10065, USA.
| | - Lauren Shikowitz-Behr
- Department of Plastic Surgery, Lenox Hill Hospital, Northwell Health System, 48 Chestnut Hill, Roslyn, NY 11576, USA
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Abstract
Body contouring after weight loss is becoming more prevalent. An appropriate systematic approach that starts from the first consultation needs to focus on residual comorbidities and weight of the patient. A thorough discussion about potential outcomes manages expectations. Preoperative optimization with smoking, herbal cessation, and nutritional assessment is mandatory. Planned staged approach minimizes lengthy procedures associated with increased postoperative morbidity. In the operating room, appropriate ambient temperature, positioning of the patient, and continuous discussion between surgeon and anesthesiologist prevent further complications. Careful transition to postoperative care with early ambulation and use of compressive garments add to an approach to minimize postoperative complications.
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Affiliation(s)
- George Kokosis
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 601 North Caroline street, Baltimore, MD 21287, USA
| | - Devin Coon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 601 North Caroline street, Baltimore, MD 21287, USA.
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Simpson AM, Donato DP, Kwok AC, Agarwal JP. Predictors of complications following breast reduction surgery: A National Surgical Quality Improvement Program study of 16,812 cases. J Plast Reconstr Aesthet Surg 2018; 72:43-51. [PMID: 30291050 DOI: 10.1016/j.bjps.2018.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 08/13/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Breast reduction is one of the most common procedures performed by plastic surgeons. Despite good outcomes and high patient satisfaction, there are little national data on the predictors that lead to complications in this patient population. We accessed a national outcomes database to examine these factors. METHODS This is a retrospective study examining the National Surgical Quality Improvement Program database from 2006 to 2015. Patients who underwent primary breast reduction were identified. Patients who underwent any cancer-related procedures were excluded. We identified patient-related and procedure-related factors for analysis. Univariate and multivariate logistic regression analyses were used to identify independent predictors of complications. RESULTS In total, 16,812 individual cases were identified. The overall complication rate for the cohort was 6.2%, and the major complication rate was 3.0%. Diabetes, bleeding disorder, hypertension, obesity, smoking, steroid use, and prolonged operative time were associated with increased risk of complications (p < 0.05). Concurrent body contouring was a predictor of increased major complications; however, liposuction was not. CONCLUSIONS Common surgical risk factors are associated with complications in breast reduction surgery. Although liposuction is not an independent risk factor, concurrent body contouring is associated with increased complications. Surgeons should be aware of these associations when discussing breast reduction with patients.
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Affiliation(s)
- Andrew M Simpson
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA.
| | - Daniel P Donato
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
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Closed Incision Negative-Pressure Therapy (ciNPT) Reduces Minor Local Complications in Post-bariatric Abdominoplasty Body Contouring: a Retrospective Case-Control Series. Obes Surg 2018; 28:2096-2104. [DOI: 10.1007/s11695-018-3279-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Guest RA, Amar D, Czerniak S, Dreifuss SE, Schusterman MA, Kenny EM, Chernoff EF, Barnett JM, Koesarie KR, Gusenoff JA. Heterogeneity in Body Contouring Outcomes Based Research: The Pittsburgh Body Contouring Complication Reporting System. Aesthet Surg J 2017; 38:60-70. [PMID: 29040346 DOI: 10.1093/asj/sjx081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Body contouring complications after massive weight loss (MWL) vary significantly in frequency and type. Currently, no standardized recommendations exist regarding which complications are most important to report. OBJECTIVES We aim to provide a guideline for complication reporting in the body contouring literature. The Pittsburgh Body Contouring Complication Reporting System (PBCCRS) will aid in risk stratification of body contouring procedures and will decrease under-, over-, and nonreporting of complications. METHODS The authors reviewed the literature for the terms "body contouring," "MWL," and "complications." Elimination criteria included: non-English language, case report, meta-analysis, outpatient, non-MWL, unclear demographics, N <30 and lack of numeric results. Data were analyzed in 2 groups: truncal contouring and extremity contouring. RESULTS Eighty-nine papers were reviewed and 21 met inclusion criteria. The weighted mean rates as percentages for complications in the extremity group were: dehiscence (29.0), seroma (18.6), scarring (14.9), infection (8.8), lymphedema (7.8), hematoma (3.5), necrosis (1.9), deep venous thrombosis (DVT) or pulmonary embolism (PE) (0), and death (0). In the truncal group, weighted mean complication rates as percentages were: dehiscence (15.4), seroma (13.1), scarring (2.9), infection (9.4), lymphedema (1.3), hematoma (6.4), necrosis (7.2), DVT/PE (1.5), and death (0.6). Lymphedema was seldom reported, and suture extrusion was not reported in any selected papers. Weighted mean rates of DVT/PE in the extremity vs truncal contouring groups were significantly different. Differences in rates of scarring, lymphedema, and hematoma rates neared significance. CONCLUSIONS Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Body Contouring Complication Reporting System provides suggested recommendations on complication reporting in massive weight loss body contouring surgery.
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Affiliation(s)
- Rachel A Guest
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Dalit Amar
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Sharona Czerniak
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Stephanie E Dreifuss
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Mark A Schusterman
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Elizabeth M Kenny
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Eva F Chernoff
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Joshua M Barnett
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Kathleen R Koesarie
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| | - Jeffrey A Gusenoff
- University of Pittsburgh School of Medicine and the Department of Plastic Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
- Body Contouring Section, Aesthetic Surgery Journal
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Abstract
Liposuction is the most popular cosmetic surgical procedure performed in men. Aside from traditional liposuction using the tumescent technique, several energy-assisted liposuction technologies have emerged and been proven safe and particularly beneficial for the male patient demographic. The differences in fat distribution and unique goals and emotional perspective in men need to be taken into account when performing liposuction, to ensure meeting the patient's needs and expectations for satisfactory results.
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Panniculectomy: Perioperative nursing considerations. Nursing 2017; 47:32-38. [PMID: 28891822 DOI: 10.1097/01.nurse.0000524753.74764.5e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wiser I, Heller L, Spector C, Fliss E, Friedman T. Body contouring procedures in three or more anatomical areas are associated with long-term body mass index decrease in massive weight loss patients: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2017; 70:1181-1185. [PMID: 28676320 DOI: 10.1016/j.bjps.2017.05.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/23/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Massive weight loss (MWL) patients who undergo body contouring plastic surgery (BCPS) display superior long-term weight maintenance. The effect of the number of anatomical areas contoured on weight dynamics is undetermined. OBJECTIVES To determine whether body mass index (BMI) dynamics following BCPS are associated with the number of anatomical areas operated. METHODS A retrospective cohort study was conducted. Study groups were defined by the number of anatomical areas operated (1, 2, and 3+). BMI velocity was defined as a ratio between BMI change following BCPS and follow-up time. Multinomial logistic regression was performed to assess the independent association with BMI velocity. RESULTS A total of 222 patients undergoing 513 BCPSs between 2009 and 2014 were included in the study (mean age 36.8 ± 10.9 years, 77% females). Group 3+ (n = 88) had a negative mean BMI velocity compared with positive values in Groups 1 and 2 (-0.11 ± 1.0 vs. 0.44 ± 1.4 and 0.03 ± 1.2, respectively; p = 0.03). Independent risk factors for positive BMI velocity (>0.5 kg/m2/year) included single anatomical area BCPS compared to three or more (OR = 3.37; CI 95% 1.24-9.14; p = 0.017) and psychiatric medication use (OR = 6.73; CI 95% 1.15-39.35; p = 0.034). Independent protective factors included diabetes mellitus (OR = 0.094; CI 95% 0.01-0.99; p = 0.049). CONCLUSIONS BCPS in three or more anatomical areas following MWL is associated with a long-term weight loss following BCPS. As part of the health strategy to maintain normal BMI values and achieve overall quality of life improvement in MWL patients, clinicians and health policy makers should positively consider recommending BCPS in multiple anatomical areas.
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Affiliation(s)
- Itay Wiser
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Lior Heller
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Coral Spector
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Fliss
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tali Friedman
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Oranges CM, Tremp M, di Summa PG, Haug M, Kalbermatten DF, Harder Y, Schaefer DJ. Gluteal Augmentation Techniques: A Comprehensive Literature Review. Aesthet Surg J 2017; 37:560-569. [PMID: 28203698 DOI: 10.1093/asj/sjw240] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Many studies of gluteal augmentation techniques have been published in recent decades, including case reports, retrospective and prospective case series, and multicenter survey reviews. However, to date, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques. Objectives The authors performed a comprehensive literature review to determine outcomes and complications of gluteoplasty techniques, including patient satisfaction. Methods A search on PubMed/Medline was performed for clinical studies involving gluteal augmentation techniques. A priori criteria were used to review the resulting articles. Results Fifty-two studies, published from 1969 through 2015, were included - representing 7834 treated patients. Five gluteal augmentation techniques were identified from these studies: gluteal augmentation with implants (n = 4781), autologous fat grafting (n = 2609), local flaps (n = 369), hyaluronic acid gel injection (n = 69), and local tissue rearrangement (n = 6). The overall complication rates of the most commonly utilized techniques were: 30.5% for gluteal augmentation with implants, 10.5% for autologous fat grafting, and 22% for local flaps. Patients' satisfaction was reported as consistently high for all the five techniques. Conclusions Implant-based gluteal augmentation is associated with high patients' satisfaction despite a high complication rate, while autologous fat grafting is associated with the lowest complication rate yet including serious major complications such as fat embolism. Local flaps and local tissue rearrangements are the ideal procedures in case of massive weight loss patients. A paucity of data is available for hyaluronic acid gel injections, which appear to be effective but temporary and expensive. Level of Evidence 4
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Affiliation(s)
- Carlo M Oranges
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Mathias Tremp
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Pietro G di Summa
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Yves Harder
- Division of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano (ORL), Breast Centre of Switzerland (CSSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
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The Impact of Body Contouring Procedures on Urologic Outcomes in Massive Weight Loss Patients. Plast Reconstr Surg 2017; 139:1086e-1092e. [PMID: 28445359 DOI: 10.1097/prs.0000000000003251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Post-massive weight loss body contouring is a growing area of plastic surgery. Studies have shown preexisting urinary incontinence amelioration in patients undergoing abdominal body-contouring procedures. These studies are small, focus on cosmetic abdominoplasties, and lack use of standardized surveys. The purpose of this study was to evaluate urinary incontinence endpoints in massive weight loss patients undergoing body-contouring procedures. METHODS A retrospective review was conducted over a 6-year period. Patients excluded had previous body-contouring procedures or previously treated urinary incontinence. Participants completed validated surveys to catalogue preoperative and postoperative urinary habits. Patients were then subdivided based on presence of preoperative incontinence. Outcomes were compared within and between cohorts using the t test and chi-square test. RESULTS A total of 102 patients completed the survey. Of those, 44 had preoperative urinary incontinence. Patients with incontinence were found to be significantly older than those who did not. Postoperatively, patients with preoperative incontinence had significant decreases in incidence and severity of symptoms (p < 0.01, respectively), and significantly improved their quality of life (p < 0.02). Over 20 percent noted symptom resolution, and 67 percent were mostly or completely satisfied with the outcome. CONCLUSIONS This study is the first to document amelioration of urinary incontinence symptoms in massive weight loss patients undergoing body-contouring procedures. It adds to the literature suggesting that abdominoplasties in select patients may improve incontinence symptoms. Future work will focus on evaluating the mechanism of this outcome and documenting improvement in an objective, prospective manner. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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