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Wang B, He P, Zhao R. B-ultrasound-assisted gluteal fat grafting in Asians: A prospective study of quantitative results from three-dimensional imaging and B-ultrasound analysis. J Plast Reconstr Aesthet Surg 2024; 94:12-19. [PMID: 38729047 DOI: 10.1016/j.bjps.2024.04.035] [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: 11/04/2023] [Revised: 03/16/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The increasing number of fatalities caused by gluteal fat grafting is concerning; thus, there is a need to determine ways to obtain the ideal aesthetic effect while ensuring a safe operation. In this study, three-dimensional (3D) measurements combined with B-ultrasound were used to evaluate the effect of gluteal fat augmentation in Asians, whose safety and effectiveness were confirmed using quantitative data. METHODS Thirty-five consecutive female patients were evaluated in this prospective clinical study. All patients underwent B-ultrasound-assisted gluteal fat augmentation on the subcutaneous plane alone. 3D imaging and B-ultrasound analysis of the adipose tissue thickness in the gluteal region were performed preoperatively and at 1 week, 3 months and 6 months post-operatively. RESULTS The waist circumference of the patients decreased, gluteal circumference and length of the gluteal crease increased and average waist-to-hip ratio improved from 0.78 to 0.74. At 3 months and 6 months post-operatively, the adipose tissue thickness decreased by 5.1% and 15.1%, respectively. The fat retention rates calculated using 3D imaging measurements at 3 months and 6 months post-operatively were 77.9% and 64.7%, respectively. According to the BODY-Q scale scores, patients reported a high level of satisfaction post-operatively. CONCLUSIONS B-ultrasound guidance can effectively prevent the occurrence of fatal fat embolism during gluteal fat grafting and maximise the augmentation effect. The quantitative data obtained using 3D measurements and B-ultrasound confirmed the safety and effectiveness of fat injections for gluteal augmentation under B-ultrasound guidance.
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Affiliation(s)
- Baicheng Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Runlei Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China.
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2
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Güzey S, Ergan Şahin A. Brazilian Butt Lift: An Experience Over 3000 Patients. Aesthetic Plast Surg 2024; 48:2677-2693. [PMID: 38580866 DOI: 10.1007/s00266-024-03965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/23/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer. METHOD Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure. RESULTS Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures. CONCLUSION BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. LEVEL OF EVIDENCE 3: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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3
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Afifi AM, Seitz AJ, Albano NJ. Vibration-Assisted Volume Optimization Mammaplasty: An Alternative Approach for Large-Volume Fat Grafting to the Breast. Plast Reconstr Surg 2024; 153:1080e-1083e. [PMID: 37184478 DOI: 10.1097/prs.0000000000010653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
SUMMARY Fat grafting has become an integral part of aesthetic and reconstructive breast surgery. However, the ideal method for harvesting and injecting the fat remains unclear. The authors describe an alternative approach for large-volume fat grafting in the breast, vibration-assisted volume optimization mammaplasty, that builds on the experience of other authors with using the power-assisted liposuction machine for fat injection. The authors implemented this approach in 138 breasts over 2 years and found low rates of complications (4%). This new approach substantially reduces the time required to inject the fat graft and is simpler and faster to set up than previously described techniques. The authors believe vibration-assisted volume optimization mammaplasty can be used to perform large-volume fat grafting safely and efficiently in the breast with an acceptable rate of complications.
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Affiliation(s)
- Ahmed M Afifi
- From the University of Wisconsin School of Medicine and Public Health
| | - Allison J Seitz
- From the University of Wisconsin School of Medicine and Public Health
| | - Nicholas J Albano
- From the University of Wisconsin School of Medicine and Public Health
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Kelishadi SS, Chiemi JA, Chowdhry S, Colorado A, Herring NR, Kinney B, Wilhelmi BJ. Accurate Plane Fat Grafting in Gluteal Augmentation: An Anatomic Study. Aesthet Surg J 2024; 44:311-316. [PMID: 37707558 DOI: 10.1093/asj/sjad298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The safety of gluteal fat grafting is a global concern in plastic surgery. OBJECTIVE The goal of this study was to test whether fat grafting to the buttocks with Auto Stop Reach (ASR) technology prevents penetration from the subcutaneous space into the fascia and muscle layers of the buttocks. METHODS Fat transfer simulation was performed with blue dye on 8 fresh tissue cadaver buttocks by 3 board-certified plastic surgeons (S.S.K., S.C., B.W.). An open control was utilized to visualize the process in the different anatomic layers, and all of the other procedures were performed blindly, akin to live surgery. After blue dye transfer reached maximum capacity (ranging from 400-800 mL per buttock), dissection of the anatomical layers of the buttocks was performed to determine the plane(s) of injection. RESULTS Blue dye fat transfer injection to the buttocks did not penetrate the gluteal fascia or muscle layers from the subcutaneous space while using ASR. CONCLUSIONS Auto Stop Reach technology supports the safety of gluteal fat transfer in the subcutaneous space by board-certified plastic surgeons. LEVEL OF EVIDENCE: 4
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Cohen SR, Patton S, Wesson J, Agovino A. Fat Grafting to the Breast for Aesthetic Indications: Techniques and Outcomes in 165 Consecutive Patients. Aesthetic Plast Surg 2024; 48:580-589. [PMID: 37985505 DOI: 10.1007/s00266-023-03746-9] [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: 09/06/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Fat grafting to the breast for aesthetic indications has become increasingly popular. Herein, methods, aesthetic outcomes, and complications are reviewed in a retrospective case series. METHODS Female patients (n=165) with an average age of 45 years (range: 17-78 years) who underwent fat grafting to breast were evaluated. Demographic parameters, the type of procedure, the amount of fat transferred, the site(s) of fat harvest, operative times, and the patient's postoperative recovery and outcomes were recorded. RESULTS Of the 165 patients, 105 had breast augmentation with fat only. Of these 105 patients, 14(8%) had implant removal with and without capsulectomy, and 61(37%) had mastopexies. Composite augmentation was performed in the remaining 60 patients. The average amount of fat used was 208 cc (range: 10 to 945 cc) per breast. Forty-five patients (27%) underwent a second procedure. Of the 165 patients, 37(22%) had adverse events unrelated to the fat graft, including suture abscesses, scarring, and minor incision cite skin breakdown. Four patients (2.4%) had a complication related to fat grafting including 'lump' formation between the breast, abnormal mammograms, and the need for simple aspiration of a lipid cyst. CONCLUSIONS Autologous fat grafting should be considered for both primary and secondary aesthetic breast surgery to enhance outcomes. Complications related to fat grafting are uncommon. Revisional and secondary surgeries may be needed to achieve the desired outcome. Power-assisted liposuction, with vibratory infiltration of the tumescent solution, auto-infusion of fat, and Expansion Vibration Lipofilling using a closed system has become our preferred technique. Fat grafting to breast can be considered for both primary and secondary aesthetic breast surgery Complications related to fat grafting are uncommon There does not appear to be an overall increase in complications of associated mastopexy and composite augmentation LEVEL OF EVIDENCE V: 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)
- Steven R Cohen
- FACES+ Plastic Surgery, Skin and Laser Center, San Diego, USA.
- London Regenerative Institute, London, UK.
| | - Sarah Patton
- FACES+ Plastic Surgery, Skin and Laser Center, San Diego, USA
| | - Jordan Wesson
- FACES+ Plastic Surgery, Skin and Laser Center, San Diego, USA
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6
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Olivas-Menayo J, Chang-Azancot L. From the SAFE to the SAFEST Liposuction: Combining PAL and RFAL Technology in Body Contouring Procedures. Aesthetic Plast Surg 2023; 47:2486-2494. [PMID: 36849664 DOI: 10.1007/s00266-023-03291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/19/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The SAFE liposuction technique is a worldwide extended method used to achieve great and reproducible results after the surgical aspiration of fat. We propose an evolution of the technique to address one of the major limitations of liposuction, loose skin. The SAFEST liposuction technique combines PAL and RFAL to achieve skin tightening and fat reduction with minimal added morbidity. METHODS Patients treated with the SAFEST liposuction technique between December 2019 and February 2022 were included in the study. Demographic and surgical data were collected retrospectively. Photographs and satisfaction interviews were conducted preoperatively and 12 months postoperatively in every case. RESULTS Sixty-five patients (58 female and 7 male) were included in the cohort, and a total of 169 anatomical areas were treated with the SAFEST liposuction technique (abdomen, arms, back, flanks and thighs). Globally, satisfaction at 12 months follow-up was of 94.1% and complications only presented in 4.7% of the treated areas. 6 of the 38 treated abdomens (18.4%) presented a complication (4 seromas and 2 access point infections) and 2 of the 38 treated flanks (5.3%) presented one (2 seromas). The rest of the treated anatomical areas (arms, back and thighs) showed no complications and high satisfaction rates. CONCLUSIONS The SAFEST liposuction technique achieves outstanding and satisfying results with minimal complications by safely combining the advantages of two different technologies, PAL and RFAL. The main advantages of the presented technique are the skin tightening, the body ligament contraction, the coagulation and the reduction of the operative time. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jesus Olivas-Menayo
- MS Medical Institutes by Exclusive Doctors, Lisbon, Portugal.
- FEMM Cirugía y Medicina Estética, Madrid, Spain.
| | - Luis Chang-Azancot
- Plastic Surgery Department, Complejo Hospitalario Universitario de Albacete, 02006, Albacete, Spain
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Danilla S, Troncoso E, Jara R, Dominguez C, Albornoz C, Erazo C, Sepulveda S, Nielsen J, Serra S, Yamada N. What Makes a Beautiful Buttock Beautiful? A Case-Control Study Comparing Buttocks Models versus Normal Women by Magnetic Resonance Imaging, Photography and Anthropometry. Aesthetic Plast Surg 2023; 47:1896-1904. [PMID: 36542093 DOI: 10.1007/s00266-022-03222-w] [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: 10/15/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe characteristics of women with aesthetically ideal buttocks and differentiate them from women with normal buttocks. METHODS Case-control study comparing anatomy of women with ideal buttocks (buttocks models) to women with normal buttocks using magnetic resonance images, anthropometric measurements and photography. RESULTS Comparing to normal women, buttocks models have a narrower waist, narrower iliac crest, wider C point, wider hips and bigger and thicker gluteus maximus muscle (GMM). A bigger GMM adds more projection to the C point, point of maximum projection in the lateral view is 2.7 cm higher than the pubic bone. The amount of subcutaneous fat was equal in models and controls. CONCLUSIONS Our study provides new knowledge regarding the tridimensional aspects of the beauty of the buttocks area. A beautiful buttock is a conjunction of adequate bony shape, muscle development, subcutaneous fat layer, and tight skin. Comparing to normal women, buttocks models have a narrower waist, narrower iliac crest, wider C point, wider hips and bigger and thicker Gluteus Maximus Muscle. Accurate understanding of the aesthetic goals in a given patient can guide surgical technique. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Stefan Danilla
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile.
| | - Ekaterina Troncoso
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Rocio Jara
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Carlos Dominguez
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Claudia Albornoz
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Cristian Erazo
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Sergio Sepulveda
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Johanna Nielsen
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Sofia Serra
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Naomi Yamada
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
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8
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Ghavami A, Vranis NM. Patient Pre-operative Planning of Gluteal Augmentation. Clin Plast Surg 2023; 50:525-532. [PMID: 37704320 DOI: 10.1016/j.cps.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Demand for autologous gluteal augmentation with fat transfer continues to rise paralleling the increasingly complex nature of the operation. Improved overall aesthetic outcomes are a result of: (1) donor site fat harvest has evolved to circumferential torso high-definition lipo-sculpting; (2) a shift from indiscriminate buttock augmentation to precise gluteal re-shaping. Discussing complex operations with patients, particularly ones of artistic nature, can be challenging. The senior author has developed a gluteal re-shaping graphic to focus a patient's attention to the four most important areas. It also serves as a foundation for surgeons to create operative plans and track outcomes for professional development.
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Affiliation(s)
- Ashkan Ghavami
- Department of Surgery, Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Private Practice, Ghavami Plastic Surgery, 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA.
| | - Neil M Vranis
- Private Practice, Ghavami Plastic Surgery, 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA
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9
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Ghavami A, Vranis NM. The S-Curve®: Clinical Importance of the Gluteal Ligaments in Efficacious Fat Transfer. Clin Plast Surg 2023; 50:553-561. [PMID: 37704323 DOI: 10.1016/j.cps.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Liposuction cannulas are versatile tools in a plastic surgeon's armamentarium useful for dissection, deep subcutaneous ligamentous release, fat extraction, and lipofilling. Experienced surgeons develop the ability to navigate subcutaneous anatomy through real-time tactile feedback of the cannula's depth, angulation, excursion, and resistance. Peripheral gluteal ligaments acting as anatomic boundaries must be understood and protected. However, central ligaments tether the dermis to deeper structures precluding expansion. Appropriate, targeted ligamentous weakening improves focal capacitance allowing precise gluteal contouring while staying in safe planes. This maneuver is critical during subcutaneous lipofilling of the S-Curve® procedure to create an aesthetically pleasing, convex gluteal silhouette.
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Affiliation(s)
- Ashkan Ghavami
- Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Private Practice, Ghavami Plastic Surgery, 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA.
| | - Neil M Vranis
- Private Practice, Ghavami Plastic Surgery, 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA
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10
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Hoyos Ariza AE, Perez Pachon M. Combining Gluteal Shaping with High-Definition Liposuction: New Concepts and Techniques. Clin Plast Surg 2023; 50:541-552. [PMID: 37704322 DOI: 10.1016/j.cps.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Gluteal contouring has been subject to numerous publications in aesthetic plastic surgery. Not only the female but also the male features that govern such procedures have been thoroughly described by different authors. In this article, we will provide the reader with an updated account of how gluteal contouring blends with High Definition Liposculpture (HDL). We discuss the most current techniques for buttocks reshaping through a holistic approach of new anatomical and artistic concepts. We will dive into new techniques to perform multiplanar and 4-dimensional Fat Grafting and equalization of the buttocks and surrounding areas, which we believe might help plastic surgeons to improve the quality of their patient outcomes. In effect, a proper understanding of the anatomical structures and its variations among different gender and ethnicities, will both help the surgeon to individualize the procedure based on patient preferences.
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11
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Danilla S, Micheli D. Aesthetic Ideals of the Female Buttocks: Concepts and Techniques. Clin Plast Surg 2023; 50:533-540. [PMID: 37704321 DOI: 10.1016/j.cps.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
This article explores the importance of understanding the tridimensional artistic anatomy of the back, pelvis, and thighs in gluteal surgery. It emphasizes the need for plastic surgeons to have a comprehensive knowledge of these anatomic structures to achieve successful outcomes. The authors highlight the significance of ethnic differences in determining ideal aesthetic results and stress the importance of considering and respecting these variations. Individualization of treatment is a key principle in gluteal surgery, as each patient has unique preferences and needs. Effective communication and collaboration between the surgeon and the patient are crucial in determining desired aesthetic goals and achieving satisfactory outcomes.
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Affiliation(s)
- Stefan Danilla
- Cirujano Plástico Magíster en Epidemiología Clínica, Clínica AUREA, Santiago, Chile.
| | - Diana Micheli
- Equipo de Cirugia Plástica, Pontificia Universidad Catolica, Santiago, Chile
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12
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César Durán Vega H. Buttock and Full Body Contouring Harmony. Clin Plast Surg 2023; 50:573-585. [PMID: 37704325 DOI: 10.1016/j.cps.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The concept of the gluteal framework has significantly enhanced our understanding of the gluteal anatomy. The buttock does not constitute a bulging area in the human body. To be attractive, it must harmonize with all elements of the human body around it. Nevertheless, the changes in patient desires and demands, in addition to innovations in surgical technique open a field of opportunity to achieve more beautiful and natural results. In this work, the main updates in the management of body contouring are condensed, including new safe and aesthetic fat infilration techniques.
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Affiliation(s)
- Héctor César Durán Vega
- ASAPS, ASPS, AMCPER, FILACP, Centro Medico de Las Americas CMA, Consultorio#317 Calle 54 #365 x 33-a y Av. perez Ponce Colonia Centro, Merida, Yucatán CP 97000, Mexico; Hospital Eme Red hospitalaria, Calle 33 Número 496, Consultorio 229, Entre 56 y 56 A, Centro, 97000 Mérida, Yucatán, México.
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13
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Aslani A. Combining Fat and Implants for Gluteal Augmentation. Clin Plast Surg 2023; 50:563-571. [PMID: 37704324 DOI: 10.1016/j.cps.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Guidelines for optimal buttock implant management, time-efficient preparation of implant pocket, and breakdown of optimal implant choice, combined with large-volume fat transfer for best possible outcome.
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Affiliation(s)
- Alexander Aslani
- Cirumed Clinic Marbella, Edificio Panorama, Autovía del Mediterráneo, km 184, planta baja, local 2B y 2C, Marbella, Málaga 29603, Spain.
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Pazmiño P. Ultrasound-Guided Gluteal Fat Grafting: A to Z. Clin Plast Surg 2023; 50:587-601. [PMID: 37704326 DOI: 10.1016/j.cps.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Low-cost, high-resolution ultrasound systems allow surgeons to visualize and manipulate the subcutaneous space and inject fat graft with millimeter accuracy.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami.
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15
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Ghavami A, Halani SH, Amirlak B. The Hybrid Technique for Autologous Gluteal Augmentation. Aesthet Surg J Open Forum 2023; 5:ojad042. [PMID: 37700791 PMCID: PMC10494780 DOI: 10.1093/asjof/ojad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
This article accompanying these videos will describe the technique created and innovated by the senior author for gluteal augmentation with autologous fat transfer. While the principles of gluteal fat grafting originated with Pitanguy, Regnault, Gonazalez, and Spina, the nuances vary greatly from surgeon to surgeon. Although there is much controversy regarding gluteal fat grafting, the major principle of avoiding intramuscular injection is the central pillar of safe and effective augmentation today. The senior author fine-tuned his method to optimize patient outcomes over the past 14 years and demonstrated lasting, aesthetic results while maximizing patient safety with his technique. More recently, the senior surgeon has developed the Hybrid Technique, involving manual injection of fat through a syringe and a power-assisted cannula to maximize aesthetic outcomes while adhering to safety principles. This method follows the deep and moderate depth subcutaneous injection principle while respecting the muscular, neurovascular, and ligamentous anatomy of the buttock. Level of Evidence 4
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Affiliation(s)
| | | | - Bardia Amirlak
- Corresponding Author: Dr Bardia Amirlak, UT Southwestern Department of Plastic Surgery, Dallas, TX 75390, USA. E-mail: ; Instagram: @dramirlak
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16
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Atiyeh B, Emsieh S. Letter-to-the-Editor: Effect of Delivery Technique on Fat Graft Survival. Aesthetic Plast Surg 2023; 47:199-201. [PMID: 36447094 DOI: 10.1007/s00266-022-03203-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- American University of Beirut Medical Center, Beirut, Lebanon.
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17
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Atiyeh B, Emsieh S. Letter to the Editor: Does Mechanical Condensing of Low-Density Fat Improve Large-Volume Autologous Fat Graft (AFG) Retention Rate for Breast Reconstruction? Aesthetic Plast Surg 2023; 47:202-204. [PMID: 36470984 DOI: 10.1007/s00266-022-03210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- American University of Beirut Medical Center, Beirut, Lebanon.
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18
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Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us. Plast Reconstr Surg 2023; 151:342e-343e. [PMID: 36374287 DOI: 10.1097/prs.0000000000009867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Frojo G, Halani SH, Pessa JE, Pazmiño P, Wall S, Kenkel JM, Del Vecchio DA. Deep Subcutaneous Gluteal Fat Compartments: Anatomy and Clinical Implications. Aesthet Surg J 2023; 43:76-83. [PMID: 35977084 DOI: 10.1093/asj/sjac230] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Advances in gluteal fat grafting have resulted in diminished risks through improved understanding of regional anatomy and technical nuances. No anatomic studies identifying the presence or absence of buttock fat compartments have yet been reported. OBJECTIVES The aim of this cadaveric study was to identify and characterize the deep subcutaneous gluteal fat compartments to further understand the nuanced differences between deep and superficial subcutaneous fat layers. METHODS A cadaveric study was performed to identify the fat compartments. Latex injection into the iliac artery and vein was used to prepare 4 fresh (N = 8 hemibuttocks) hydrated cadavers for dissection. Preliminary work identified the likely position of deep gluteal fat compartments. The cannula was positioned under ultrasound guidance in between the superficial and deep gluteal layers. Cadaveric buttocks were infiltrated by the static technique with dyed human fat, dyed applesauce, and dyed saline in an attempt to identify the gluteal deep subcutaneous fat compartments. RESULTS Dissection identified and characterized 7 discrete deep gluteal fat compartments. These comprise 3 medial fat compartments (superior, middle, and inferior); a central fat compartment; and 3 lateral (superior, middle, and inferior) deep fat compartments. CONCLUSIONS Seven deep gluteal fat compartments have been identified that have distinct boundaries and maintain injected contents separate from each other above the gluteal muscle fascia. These compartments can be selectively expanded for buttock augmentation. Knowledge of these compartments enables surgeons to perform gluteal augmentation by static infiltration, injecting autologous fat under ultrasound guidance in the deep subcutaneous fat layer, while optimizing aesthetic considerations. RESUMEN
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Del Vecchio D, Wall S, Stein MJ, Jovic TH, Whitaker IS. Simultaneous Separation and Tumescence: A New Paradigm for Liposuction Donor Site Preparation. Aesthet Surg J 2022; 42:1427-1432. [PMID: 35689968 DOI: 10.1093/asj/sjac130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND An ever-increasing demand for liposuction and fat transplantation procedures in the United States reflects their continued safety and clinical effectiveness. Technical breakthroughs, such as the utilization of tumescent infiltration and fat separation techniques, have been instrumental in optimizing outcomes but add time to the surgical procedure. Simultaneous separation and tumescence (SST) is a new technique combining these innovations to further improve safety and efficiency in liposuction. OBJECTIVES The authors describe their technique for utilizing SST on more than 1200 patients spanning a 6-year period. A split abdomen study was designed to compare the vasoconstrictive effectiveness of SST with traditional Klein infiltration techniques. METHODS A quantification perfusion analysis utilizing indocyanine green angiography was performed on 4 patients to illustrate the vasoconstrictive effectiveness of SST over traditional Klein infiltration techniques. A mean relative vasoconstriction score was calculated relative to the umbilicus for each technique. RESULTS Compared with traditional Klein tumescence techniques, SST has a similar complication rate, utilizes similar infiltrative volumes, and increases vasoconstriction (mean 89.6% SST hemiabdomen vs 48.1% Klein hemiabdomen at 2 minutes, P < 0.0001). CONCLUSIONS SST represents a novel, long-overdue departure from Klein tumescence, which has been a valuable mainstay for donor site preparation for over 3 decades. SST will pave the way for more efficient operative times and potentially higher volumes of fat being safely extracted. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Daniel Del Vecchio
- Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Simeon Wall
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Michael J Stein
- Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Thomas H Jovic
- Department of Reconstructive Surgery and Regenerative Medicine Research Centre, Swansea University, Swansea, UK
| | - Iain S Whitaker
- Department of Reconstructive Surgery and Regenerative Medicine Research Centre, Swansea University, Swansea, UK
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A 7-Step Guide to High-Definition Liposuction. Aesthetic Plast Surg 2022; 46:2863-2879. [PMID: 35729373 DOI: 10.1007/s00266-022-02965-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND High-Definition (HD) Liposuction refers to the most advanced body contouring technique, offering an athletic and healthy body appearance. The latest available devices, the criteria of proper selection, and an expert surgeon's tips are highlighted in a 7-step guide approach. METHODS A retrospective study of prospectively maintained database was conducted from 2015 to 2020. Demographic information, personal history, outcomes, complications were collected and analyzed from 568 patients who underwent the same surgical procedure. RESULTS 568 patients (247 male and 321 female) were included in the study with a mean BMI of 25.6 (range 21-29 kg/m2) and follow up time ranging from 1 to 48 months. The first 50 procedures represented the initial learning curve, during which most complications had occurred (14 patients/50 patients). Using the 7-step guide, we managed to minimize the overall complications to a rate of 3%. CONCLUSION The outlined steps have been simplified in a 7-step guide for plastic surgeons to understand, practice and refine HD liposuction in a contemporaneous, efficient, and reproducible manner. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Loder S, Rubin JP. Commentary on: Safety and Effectiveness of Single Session Mega Volume Fat Grafting for Breast Augmentation: A Space Creating Concept and Clinical Experiences. Aesthet Surg J 2022; 42:NP592-NP594. [PMID: 35690024 DOI: 10.1093/asj/sjac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shawn Loder
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
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Rios LM. Commentary on: Practice Advisory on Gluteal Fat Grafting. Aesthet Surg J 2022; 42:1030-1031. [PMID: 35639818 DOI: 10.1093/asj/sjac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luis M Rios
- Plastic surgeon in private practice in Edinburg , TX
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Body Feminization Combining Large-Volume Fat Grafting and Gluteal Implants. Plast Reconstr Surg 2022; 149:1197-1203. [PMID: 35311795 DOI: 10.1097/prs.0000000000009049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With the increase in popularity of fat transfer to the buttocks in body contouring surgery, new patient subsets are emerging. The gender confirmation patient has specific characteristics that must be addressed to achieve the best outcomes. METHODS The authors performed an observational prospective study including 36 consecutive patients who underwent body feminization as a gender affirming operation using large-volume fat transplantation with or without gluteal implants. RESULTS Thirty-six consecutive male-to-female transgender patients have undergone large-volume fat transplantation to the buttocks performed by the authors, between July of 2016 and January of 2019. In 12 of these 36 cases, large-volume fat grafting was supplemented by intramuscular placement of silicone implants. The mean waist-to-hip ratio before surgery was 1.11, and this improved to 0.81 after surgery (fat transfer-only group, 0.88; fat transfer plus implants group, 0.75). CONCLUSIONS The transgender patient is a unique patient requiring a specific set of surgeon's skills and intraoperative strategies to achieve good outcomes. Composite solutions with both implants and lipofilling lead to better outcomes in terms of waist-to-hip ratio in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
On January 31, 2018, The Multi-Society Task Force for Safety in Gluteal Fat Grafting released a Practice Advisory regarding gluteal fat grafting. The Task Force was assembled in the wake of several highly publicized patient deaths involving Brazilian Butt Lift ("BBL") and produced a second practice advisory in August 2019. In 2021 the ASAPS President commissioned a Working Group on BBL Patient Safety, charging the Group to address new guidelines affecting safety and welfare of BBL patients. The "Practice Advisory on Gluteal Fat Grafting" is the first advisory developed since the Working Group was formed. In addition to surgical technique as a major cause of fatal complications of BBL, the Working Group focused on micro-economic trends of operative time and regional BBL pricing and considered fatigue and distraction in formulating the current guidelines. In Florida the majority of BBL deaths occur at the end of the week. Such a non-normalized distribution most likely represents the result of fatigue and/or distraction, which has been linked to surgical mortality in multiple published communications. In addition, mortality is likely due to uncertainty or lack of documentation as to the correct plane of fat injection. Therefore, the newest and most compelling recommendations from these guidelines include the use of ultrasound-guided documentation of cannula placement prior to and during fat injection, and the limitation of 3 BBL cases as a maximum amount of total operative cases per day. The authors thank members of the Task Force for the insights they brought to this process.
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Affiliation(s)
| | - Jeffrey M Kenkel
- Betty and Warren Woodward Chair, Department of Plastic Surgery, University of Texas Southwestern Medical Center , Dallas, TX , USA
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Asokan A, Sudheendran MK. Gender Affirming Body Contouring and Physical Transformation in Transgender Individuals. Indian J Plast Surg 2022; 55:179-187. [PMID: 36017408 PMCID: PMC9398519 DOI: 10.1055/s-0042-1749099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a subset of transgender individuals, who after having undergone gender affirming surgeries want body contouring so that the overall body shape is congruent to the body image. Hormonal therapy can bring about a considerable change in the physical transformation. However, there is an increase in requests for specific body contouring procedures because of increased awareness in the society. There are significant differences between the skeletal as well as soft tissue characteristics of male and female body. Body contouring in transgender individuals can be achieved by altering the skeletal structure or the overlying soft tissues or combining both. In this article, we discuss body contouring as an adjunct to gender affirming surgeries, in both male to female and female to male transgender individuals.
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Affiliation(s)
- Arjun Asokan
- Department of Plastic Surgery, Renai Medicity, Cochin, Kerala, India
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[Current status and prospects of clinical application of liposuction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:127-132. [PMID: 35038811 PMCID: PMC8844613 DOI: 10.7507/1002-1892.202108077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To review the characteristics and deficiencies of various liposuction methods to provide reference for choosing more suitable liposuction in clinic and ideas for the improvement and development of liposuction equipment. METHODS The literature related to liposuction in recent years was consulted, and the principle, indications as well as existing problems were reviewed. RESULTS Liposuction can be divided into two categories according to the principles of fat separation. The first type relies on physical cutting to separate fat, including suction-assisted liposuction (SAL), power-assisted liposuction (PAL), and water-assisted liposuction (WAL). SAL and PAL are simple to operate and low in price, but the effect of liposuction mainly depends on the experience of the surgeon, and complications such as uneven appearance, hematoma, and ecchymosis may occur. WAL saves time and effort, but has lower cost performance. The second type relies on energy destruction to separate fat, including ultrasound-assisted liposuction, laser-assisted liposuction, and radiofrequency-assisted liposuction. This type of surgery has the advantages of less trauma, fast postoperative recovery, and skin tightening. However, the equipment is more expensive, and has a risk of skin burns. CONCLUSION Liposuction can effectively reduce local fat accumulation, but it still has limitations. Equipment improvement and fat transplantation are important directions for liposuction's future development.
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Safety Comparison of Abdominoplasty and Brazilian Butt Lift: What the Literature Tells Us. Plast Reconstr Surg 2021; 148:1270-1277. [PMID: 34847113 DOI: 10.1097/prs.0000000000008599] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although abdominoplasty is a mainstay of the plastic surgeon, the safety of the Brazilian butt lift (BBL) has been questioned, effectively being prohibited in some countries. The central rationale for the safety concern over the BBL stems from a publication stating a mortality rate of one in 3000. The question remains: What is the real safety of these procedures? METHODS Focusing on mortality, literature searches were performed for BBL and for abdominoplasty. The 2017 Aesthetic Surgery Education and Research Foundation survey data and publication were examined and analyzed. Additional data from the American Association for Accreditation of Ambulatory Surgical Facilities were obtained independently. RESULTS Abdominoplasty and BBL appear to have similar safety based on mortality; however, the nature of their mortalities is different. Although most abdominoplasty deaths are secondary to deep venous thrombosis/pulmonary embolism-inherent circulatory thrombotic abnormality-BBL mortality is associated with iatrogenic pulmonary fat embolism. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000. CONCLUSIONS Although deep venous thrombosis/pulmonary embolism will always remain an abdominoplasty risk, intraoperative BBL pulmonary fat embolism has the potential to be reduced dramatically with a better understanding of dynamic anatomy, surgical instrumentation, and technique. The authors are now presented with a better lens with which to view a more accurate safety profile of BBL surgery, including its place among other commonly performed aesthetic procedures.
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Pacifico M, Kanapathy M, Dancey A, MacQuillan A, Ross G, Mosahebi A. Summary document on safety and recommendations for aesthetic liposuction: Joint British Association of Aesthetic Plastic Surgeons (BAAPS)/British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) expert liposuction group. J Plast Reconstr Aesthet Surg 2021; 75:941-947. [PMID: 34776388 DOI: 10.1016/j.bjps.2021.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/22/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
Liposuction is one of the commonest surgical aesthetic procedures performed worldwide. Despite being perceived to be a technically simple procedure, poor patient selection, sub-optimal technical execution or sub-optimal peri‑operative management could lead to significant harm. This guidance was produced on behalf of the British Association of Aesthetic Plastic Surgeons (BAAPS) and British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) by the expert liposuction group. The guidance is based on the evidence available in the literature along with specialist expert opinion in aesthetic liposuction to provide plastic surgeons with consensus recommendation. The aim is to identify best practice to maximise the safety of patients. This article summarises current practices and safety considerations and outlines recommendations covering various aspects of patient care.
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Affiliation(s)
- Marc Pacifico
- Purity Bridge, 19 Mount Ephraim, Tunbridge Wells, Kent TN4 8AE, United Kingdom.
| | - Muholan Kanapathy
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London WC1E 6BT, United Kingdom.
| | - Anne Dancey
- Parkway Hospital, 1 Damson Parkway, Solihull B91 2PP, United Kingdom.
| | | | - Gary Ross
- University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London WC1E 6BT, United Kingdom.
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Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11167507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.
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Abstract
Breast augmentation is consistently one of the most commonly performed aesthetic operations every year. Unfortunately, revision rates following primary augmentation remain as high as 36%. There are several causes for revision breast augmentation; however, the most common and challenging of these include capsular contracture, implant malposition, and ptosis of the aging breast following augmentation. Successful management of these problems requires knowledge on how to best treat the implant and capsule with the corresponding soft tissue simultaneously. While surgical management is important, understanding the pathological causes of these entities during the primary operation can reduce the need for revision. This article utilizes the most up-to-date literature to review the appropriate clinical evaluation and surgical management of these complex cases.
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Affiliation(s)
- Brad D Denney
- Department of Surgery, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,Mountain Brook Plastic Surgery, Birmingham, Alabama
| | - Alvin B Cohn
- Department of Surgery, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,Grotting and Cohn Plastic Surgery, Birmingham, Alabama
| | - Jeremy W Bosworth
- Department of Surgery, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pallavi A Kumbla
- Department of Surgery, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Saad A, Altamirano-Arcos CA, Nahas Combina L, Saad M. Power-Assisted Liposculpture in Male Patients: A Spectrum of Definitions. Aesthet Surg J 2021; 41:NP447-NP455. [PMID: 33400776 DOI: 10.1093/asj/sjaa435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Liposculpture procedures have gained popularity over the last 2 decades with the evolution of surgeons' skills and technological advancement. According to the 2018 The Aesthetic Society report, liposuction is the second-most popular aesthetic procedure in the United States. OBJECTIVES The authors aimed to demonstrate that a spectrum of liposculpture definitions can be achieved utilizing power-assisted liposuction (PAL). Also, the authors sought to describe the satisfaction and complication rates in mild-, moderate-, and high-definition groups utilizing the PAL technology. METHODS The authors designed a single-center retrospective study, including male patients who underwent PAL liposculpture of the chest, abdomen, back, and arms. Inclusion criteria were male patients >18 years of age and body mass index <30 kg/m2. Measured outcomes included extent of definition, complication rates, and levels of satisfaction. RESULTS Fifty male patients were included in this study between January 2018 and November 2019. The average age was 37.34 years (range = 25-56 years). The average body mass index was 26.4 kg/m2 (range = 24-30 years). A total of 54.3% of patients opted for high definition (HD), 36.4% for moderate definition, and 9.2% for mild definition. There were no major complications. The HD subgroup registered the highest incidence of minor complications (21%). Patient satisfaction levels were high in all 3 subgroups, with the highest scores in the HD subgroup (9.3/10). CONCLUSIONS A spectrum of definitions can be safely achieved utilizing the PAL technology, with high patient satisfaction in mild-, moderate-, and high-definition liposculpture subgroups and low complication rates. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ahmad Saad
- University of California in San Diego School of Medicine, San Diego, CA
| | | | | | - Mariam Saad
- American University of Beirut, Beirut, Lebanon
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Wall S, Claiborne JR. Discussion: Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Plast Reconstr Surg 2021; 147:1084-1086. [PMID: 33890891 DOI: 10.1097/prs.0000000000007933] [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]
Affiliation(s)
- Simeon Wall
- From The Wall Center for Plastic Surgery; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Louisiana State University Health Sciences Center; and Northshore Plastic Surgery
| | - Jeffrey R Claiborne
- From The Wall Center for Plastic Surgery; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Division of Plastic Surgery, Louisiana State University Health Sciences Center; and Northshore Plastic Surgery
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Batiukov D, Podgaiski V, Mikulich D, Kalinin S. Multiple polyurethane implant punctures during fat grafting: case report and review of the literature. BMC Surg 2020; 20:248. [PMID: 33081756 PMCID: PMC7576805 DOI: 10.1186/s12893-020-00915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast augmentation with implants continues to be the most popular aesthetic surgical procedure performed worldwide. Fat grafting may improve the results of breast augmentation and breast reconstruction with implants. However, fat grafting to the breast with implants carries the risk of implant puncture. To our best knowledge this is the first case in which polyurethane implant puncture during fat grafting is described. CASE PRESENTATION We report multiple bilateral implant punctures with the cannula during fat grafting in a patient who previously underwent breast reconstruction with polyurethane implants. CONCLUSIONS Implants that promote tissue ingrowth may be more prone to puncture with the cannula during fat grafting. Specific planning and surgical maneuvers decrease the risk of implant puncture. LEVEL OF EVIDENCE Level V, case report.
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Affiliation(s)
- Dmitry Batiukov
- Medical Center "Antes Med", Kozlova Lane 25-7, 220037, Minsk, Belarus.
| | - V Podgaiski
- Belorussian Medical Academy of Postgraduate Education, Brovki 3, b. 3, 220013, Minsk, Belarus
| | - D Mikulich
- Breast Cancer and Reconstructive Surgery Department, National Cancer Centre of Belarus, Minsk District, 223040, Lesnoy, Minsk Region, Belarus
| | - S Kalinin
- Department of Plastic and Aesthetic Surgery of the 4th City Clinical Hospital Named After N.E. Savchenko, Rozy Lyuksemburg str. 110, 220089, Minsk, Belarus
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Sadideen H, Akhavani MA, Mosahebi A, Harris PA. Current perceptions of 'Brazilian butt lift' (BBL) surgery in the UK: A BAAPS-led survey of BAAPS members. J Plast Reconstr Aesthet Surg 2020; 73:1966-1975. [PMID: 32919948 DOI: 10.1016/j.bjps.2020.08.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 08/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The BAAPS advice against Brazilian butt lift (BBL) surgery in the UK was set in October 2018. A Delphi study conducted by BAAPS highlighted the importance of defining current practice and perceptions amongst UK surgeons, as this is currently unknown. OBJECTIVES To evaluate BAAPS members' current practice and perceptions around BBL surgery to ensure patient safety and propose better recommendations. METHODS A BAAPS-commissioned survey was emailed to all BAAPS members through an on-line link. The survey collected quantitative and qualitative information in several domains. RESULTS This survey received a 44% response rate. Of 102 respondents, 32 surgeons undertook BBL surgery before the BAAPS advice to halt it. There was a wide variation in actual fat volumes injected, and in perceptions of what constituted a small or large volume. Virtually all respondents (96.9%) performed only subcutaneous fat injections. There were differences in fat harvest techniques. The majority (66.7%) felt that BAAPS should maintain its recommendation against undertaking BBL surgery until further data became available. Nearly a quarter of 102 respondents (20.6%) had been treated for BBL complications, the majority as a result of surgical tourism. CONCLUSIONS The survey provides member-reported perception and experience with regard to BBL surgery in the UK. The demand for BBL surgery and its provision should be reassessed in the UK. This information will be analysed with further national and international data to better define and shape the scope of the safety of BBL surgery in the UK. BAAPS will use such data towards the production of future guidance and support for surgeons and patients.
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Affiliation(s)
- H Sadideen
- Cadogan Clinic, 120 Sloane Street, London,UK; Department of Surgery and Cancer, Imperial College London, London, UK.
| | - M A Akhavani
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - A Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Abstract
Optimizing patient safety and outcomes remains at the forefront of cosmetic surgery today. The five most commonly performed procedures are breast augmentation, liposuction, rhinoplasty, blepharoplasty, and abdominoplasty. Safety of all cosmetic surgery is a necessity for its successful, continued practice. This article seeks to elucidate the current literature detailing the major and minor complication profiles of the five most practiced areas in cosmetic surgery.
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Male Aesthetics for the Gluteal Area: Anatomy and Algorithm for Surgical Approach for Dynamic Definition Body Contouring. Plast Reconstr Surg 2020; 146:284-293. [PMID: 32740577 DOI: 10.1097/prs.0000000000007032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gluteal prominence is a unique characteristic that is widely acknowledged in female contouring but ignored in the male population. This study focuses on male gluteal aesthetics based on a muscular anatomical approach. METHODS A retrospective review of gluteal contouring in men from January of 2012 to September of 2019 was conducted. Male body sculpting surgery in the gluteal area was performed in most cases. Patients were included according to preoperative assessment and the American Heart Association risk analysis. The gluteal area was divided into four main anatomical contouring zones and classified according to the procedure type. The follow-up period of 3 months to 6 years was included with photographs and medical assessment data. A nonstandardized satisfaction survey was performed postoperatively. RESULTS The analysis included data from 374 consecutive gluteal dynamic definition liposculptures performed in men (mean age, 38.2 years; range, 20 to 66 years). Patients were treated according to the authors' new classification of deformities. Fat extraction, liposhifting, and fat grafting were performed on a regular basis to enhance and define the gluteal area. A satisfaction index of 92.5 percent was reported. Minor complications were reported: seroma, 0.2 percent; prolonged bruising, 1.3 percent; and swelling, 1.8 percent. No necrosis, burns, or infections were reported. CONCLUSIONS Men have been increasingly requesting improvement and definition of the buttocks, and our novel algorithm allows for a reliable method in this regard. The high satisfaction index supports the natural and athletic results accomplished with our new approach.
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Abstract
BACKGROUND Despite rapid growth, gluteal fat transplantation has a dismal safety record and often results in inadequate domal projection. Implants alone for gluteal augmentation have also been reported to be less than ideal, with significant complication rates. The idea of combining both implants and fat, as has been described in the breast, was therefore applied to surgery of the buttocks. METHODS One hundred forty-seven consecutive cases of buttock augmentation were reviewed. Average follow-up was 18 months. The technique of composite buttock augmentation used progressive instrument dissection to precisely define the correct intramuscular plane of the implant pocket with a minimum amount of pocket access dissection. RESULTS Operating times averaged 1 hour 55 minutes. The average volume of fat inserted was 380 cc. The average implant volume was 300 cc. Complications included implant displacements and implant pocket infections requiring surgical intervention. There were no cases of pulmonary thromboembolism, fat embolism, or death. CONCLUSIONS Taking a lesson from composite breast augmentation, composite buttock augmentation is a new method for gluteal reshaping that seeks to use the best of both worlds: the reliable core projection of an implant combined with the natural appearance and feel of fat. Progressive instrument dissection seeks to minimize unnecessary dissection and to accurately and safely define the intramuscular pocket. The intramuscular placement of implants instead of fat should eliminate the risk of fatal fat pulmonary embolism in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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To Ban or Not to Ban "Brazilian Butt Lifts"? Plastic Surgery, Responsibility, and the Public Health. Plast Reconstr Surg 2020; 144:952e-953e. [PMID: 31425418 DOI: 10.1097/prs.0000000000006189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khouri RK, Calva-Cerqueira D. Commentary on: Power-Assisted Liposuction and Lipofilling: Techniques and Experience in Large-Volume Fat Grafting. Aesthet Surg J 2020; 40:191-193. [PMID: 31201736 DOI: 10.1093/asj/sjz127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abboud MH, Dibo SA, Abboud NM. Power-Assisted Liposuction and Lipofilling: Techniques and Experience in Large-Volume Fat Grafting. Aesthet Surg J 2020; 40:180-190. [PMID: 30715216 DOI: 10.1093/asj/sjz019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Power-assisted liposuction and lipofilling (PALL) is a simple and reproducible surgical technique for large volume fat grafting. OBJECTIVES The authors share their 7-year experience with their large-volume fat transfer technique, PALL. METHODS A total of 417 patients who underwent PALL-related surgeries involving the breast and buttock were evaluated in a retrospective study. Liposculpting and fat harvesting were performed with power-assisted liposuction. Fat was transferred with simultaneous power-assisted vibration and tunnelization to provoke expansion of the recipient site. Following lipofilling, additional external vibration of the recipient site was performed to enhance diffusion of the injected fat. RESULTS Liposuction volumes up to 5000 mL were recorded, and injection volumes ranged from 300 to 900 mL per side for each session. Operating times ranged from 45 to 120 minutes. Patients were followed-up for 1 to 4 years. No major complications were recorded. CONCLUSIONS PALL is an efficient, safe, and reproducible procedure with myriad applications in aesthetic and reconstructive surgery. Level of Evidence: 4.
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Affiliation(s)
- Marwan H Abboud
- Division of Plastic Surgery, Centre Hospitalier Universitaire de Tivoli, Brussels, Belgium
| | - Saad A Dibo
- Division of Plastic Surgery, Centre Hospitalier Universitaire de Tivoli, Brussels, Belgium
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Wall S, Claiborne JR. Commentary on: Power-Assisted Liposuction and Lipofilling: Techniques and Experience in Large-Volume Fat Grafting. Aesthet Surg J 2020; 40:194-196. [PMID: 31905384 DOI: 10.1093/asj/sjz286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Simeon Wall
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Safran T, Abi-Rafeh J, Alhalabi B, Davison PG. The Potential Role of Corticosteroid Prophylaxis for the Prevention of Microscopic Fat Embolism Syndrome in Gluteal Augmentations. Aesthet Surg J 2020; 40:78-89. [PMID: 31152663 DOI: 10.1093/asj/sjz166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Microscopic fat embolism syndrome (micro-FES) has been recently identified as a potentially fatal complication following gluteal augmentation utilizing autologous fat grafts; safety recommendations advocating for subcutaneous lipo-injections may be insufficient for its prevention. OBJECTIVES The authors of this systematic review evaluated the potential role of corticosteroid prophylaxis for the prevention of micro-FES in gluteal augmentation procedures. METHODS The authors performed a systematic search employing the National Library of Medicine (PubMed), Medline, and Embase databases. Search terms were those pertaining to studies reporting the efficacy of prophylactic corticosteroid administration on micro-FES incidence in a high-risk surrogate population. RESULTS Thirteen articles met the inclusion criteria for review, comprising 2 studies reporting on the efficacy of a single intravenous (IV) corticosteroid dose for the prophylaxis of micro-FES, 9 studies reporting on multiple prophylactic IV doses, and 2 additional studies reporting on the efficacy of inhaled corticosteroids in this context. All studies were identified from the orthopedic literature given that none were available directly from within plastic surgery. The prophylactic efficacy of multiple IV doses of methylprednisolone, or a single larger dose, was established, whereas the efficacy of inhaled corticosteroids remains elusive. CONCLUSIONS A single perioperative IV dose of methylprednisolone may be most appropriate for utilization by plastic surgeons; the safety and implication of this therapy on wound healing and fat graft survival are discussed. Further studies directly evaluating the efficacy of corticosteroid prophylaxis in the gluteal augmentation population are indicated. Finally, recommendations pertaining to the prevention, timely recognition, and effective management of micro-FES are discussed.
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Affiliation(s)
- Tyler Safran
- Department of Surgery, Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Becher Alhalabi
- Department of Surgery, Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Peter G Davison
- Department of Surgery, Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
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Autogenous Fat Grafting to the Breast and Gluteal Regions: Safety Profile Including Risks and Complications. Plast Reconstr Surg 2019; 143:1625-1632. [PMID: 31136476 DOI: 10.1097/prs.0000000000005617] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Given the widespread utility and therapeutic potential of autogenous fat grafting, plastic surgeons should be familiar with its safety profile and associated adverse events. This article provides a critical review of the literature and delineates risk factors associated with various complications when grafting to the breast and gluteal regions. The majority of adverse events are related to fat necrosis and require minimal diagnostic or therapeutic intervention. Larger graft volumes, as in cosmetic augmentation, are associated with higher incidences of fatty necrosis. The oncologic safety of fat grafting is supported by multiple clinical studies with thousands of breast cancer patients, albeit predominantly retrospective in nature. Although less frequent, serious complications include fat emboli during gluteal augmentation. Identification of associated risk factors and implementation of proper surgical techniques may minimize the occurrence of life-threatening complications.
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Teitelbaum S. Commentary on: Experience With High-Volume Buttock Fat Transfer: A Report of 137 Cases. Aesthet Surg J 2019; 39:533-535. [PMID: 30535328 DOI: 10.1093/asj/sjy263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steven Teitelbaum
- Associate Clinical Professor (Voluntary), David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
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Discussion: Clinical Implications of Gluteal Fat Graft Migration: A Dynamic Anatomical Study. Plast Reconstr Surg 2018; 142:1196-1197. [PMID: 30511973 DOI: 10.1097/prs.0000000000005060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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"Brazilian Butt Lift" under Local Anesthesia: A Novel Technique Addressing Safety Concerns. Plast Reconstr Surg 2018; 142:1468-1475. [PMID: 30489520 DOI: 10.1097/prs.0000000000005067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The gluteal lift ("Brazilian butt lift") has improved significantly in technique and in outcomes. Some postulate that fat embolism occurs because of damage to veins superficial to the gluteus muscles and that fat must be injected intramuscularly to achieve satisfactory aesthetic results. The purpose of this article is to present data where gluteal lift is performed under local anesthesia, address safety concerns, and clarify these speculations. METHODS All patients underwent gluteal lift under local anesthesia using oral medications and tumescent infiltration. Fat was harvested by closed-system liposuction, separated by gravity, injected using a peristaltic pump and reticulating basket cannulas. RESULTS Thirty-two female patients with an average age of 38.6 years and a body mass index of 24.8 kg/m underwent 47 gluteal lift operations under local anesthesia over 52 months. The average volume of injected fat was 359 ml per buttock. There were no deaths or complications. CONCLUSIONS Recent concerns regarding buttock injections have been raised due to death from fat embolism. Despite numerous theories on the mechanism of entry, the fact that venous injury occurs with the introduction of boluses of fat in enough quantities to cause mechanical disruption of the cardiopulmonary circuit is not in dispute. The authors believe this cannot occur in the awake patient without the surgeon being acutely aware of a misguided cannula. These data suggest that buttock fat grafting under local anesthesia is a safe and effective procedure with an excellent safety profile and durable results. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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