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Ge H, Lin B, Fang B. Ultrasound to Improve the Anatomic Approach to the Temple and a Retrospective Study on the Efficacy of Large-Volume Autologous Fat Grafting. Plast Reconstr Surg 2024; 154:262e-270e. [PMID: 37220395 DOI: 10.1097/prs.0000000000010725] [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] [Indexed: 05/25/2023]
Abstract
BACKGROUND Autologous fat grafting (AFG) has been used widely in temporal-hollowing augmentation, but its efficacy and safety are unclear. The authors examined the use of Doppler ultrasound (DUS) in large-volume lipofilling after performing an anatomic study of the temporal region. METHODS To clarify safe and stable levels of AFG of the temporal fat compartments, 5 cadaveric heads (10 sides) were dissected after dye was injected into targeted fat pads with DUS guidance. In addition, the authors retrospectively analyzed 100 patients with temporal fat transplantation, including groups with conventional AFG ( n = 50) and DUS-guided large-volume AFG ( n = 50). RESULTS The anatomic study revealed the approach of 5 injection planes and 2 fat compartments in the temporal region: the superficial and deep temporal fat pads. In the AFG study, all patients were female, and there were no statistically significant differences between the groups in age, body mass index, tobacco or steroid use, or previous filling history. Between the conventional AFG group and the DUS-guided large-volume AFG group, the average volume of temporal lipofilling per side was 10.55 ± 2.25 versus 22.32 ± 5.19 mL/side ( P < 0.001), surgeon Likert scale score was 2.86 ± 0.97 versus 4.24 ± 0.66 ( P < 0.001), and rate of satisfaction was 74% versus 92% ( P < 0.05) (statistically significant differences). CONCLUSIONS The anatomic approach to the main temporal fat compartment is feasible. DUS-guided large-volume AFG is an effective and safe way to improve temporal hollowing augmentation.
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Affiliation(s)
- Haojie Ge
- From the Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University
| | | | - Bairong Fang
- From the Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University
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2
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Daneshi K, Mansour HRK, Pacheco-Barrios N, Asaju A, Pérez Pachon M, Hoyos A, Khajuria A. A Bibliometric Analysis of the Top 100 Papers on Gluteal Augmentation. Aesthet Surg J Open Forum 2024; 6:ojae053. [PMID: 39100865 PMCID: PMC11295219 DOI: 10.1093/asjof/ojae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
Background Gluteoplasty or gluteal augmentation is a popular cosmetic procedure that is used to improve the volume, shape, and contour of the buttocks. Objectives This bibliometric analysis aims to characterize emerging research trends and to assess the methodological quality of the highest impact gluteoplasty research. Methods The 100 most-cited publications in gluteoplasty were identified on Web of Science, across all available journal years (from Inception to August 2023). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. Oxford Centre for Evidence Based Medicine level of evidence (LOE) of each study was assessed. Results The 100 most-cited publications regarding gluteoplasty were cited by a total of 2375 publications. Citations per publication ranged from 5 to 176 (mean 23.75 ± 25.86), with the highest-cited study being authored by Simonacci, discussing autologous fat grafting (n = 176). Most publications were LOE 5 (n = 55), representative of the large number of case series and reports. The number of publications for LOE 1, 2, 3, and 4 was 1, 9, 13, and 22, respectively. The main content focus was "surgical technique" in 38 publications, followed by "outcomes" (n = 34) and "risk factors/prognosis" (n = 10). Patient-reported outcome measures (PROMs) were used in 20 publications, and 33 publications reported aesthetic outcome measures. Conclusions This analysis demonstrates a need for improvement in research methodologies regarding gluteoplasty research. This advancement would be facilitated by robust, high-quality research through randomized control trials and multicenter studies, as well as the further development of validated PROMs for gluteoplasty. Level of Evidence 2
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Affiliation(s)
| | | | | | | | | | | | - Ankur Khajuria
- Corresponding Author: Dr Ankur Khajuria, Department of Surgery and Cancer, London W2 1NY, UK. E-mail:
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3
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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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Seabra Robalo Gomes Jorge AC, Feng YS, Santos Stahl A, Grözinger G, Nikolaou K, Glanemann M, Daigeler A, Stahl S. Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting. Aesthetic Plast Surg 2024; 48:1597-1605. [PMID: 38302712 PMCID: PMC11058931 DOI: 10.1007/s00266-023-03824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Knowledge of the vascular anatomy is critical to performing safe gluteal surgery. To date, only the course of the main blood vessels within the muscles has been outlined. These findings are based on MRI and CTA images that do not conform to a topographically standardized and normalized probability distribution. OBJECTIVES The aim of this study was to develop a three-dimensional mapping of the gluteal zones of high vascular density in relation to anatomical landmarks. MATERIALS AND METHODS This single-center retrospective cohort analysis comprised all consecutive patients who underwent cone-beam computed tomography (CBCT) scans between January 2016 and October 2021. The location of blood vessels in the gluteal region was allometrically normalized in relation to anatomical landmarks. Moreover, the caliber and area of the blood vessels were assessed. RESULTS CBCT scans of 32 patients with an average age of 64 ± 12 years (range 34-87 years) were included. Fifty-three percent were female. The median [IQR] caliber of the intramuscular gluteal vessels was 1.47 [1.15-1.88] mm, significantly greater than that of the subcutaneous vessels 1.09 [0.72-1.44] mm (p < 0.001). Vascular density was higher intramuscularly, as 4.5% of the area of the muscle was occupied by blood vessels, as opposed to 0.3% in the adipose tissue. CONCLUSION The analysis of the CBCT scans showed a higher vascular density and larger vessels intramuscularly. We, therefore, recommend the injection of autologous fat merely to the subcutaneous plane. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | | | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Matthias Glanemann
- Department of General, Visceral, Vascular, and Pediatric Surgery, Saarland University Hospital, Kirrberger Straße, 66421, Homburg, Saarland, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Clinic Tübingen, Tübingen, Germany
| | - Stéphane Stahl
- CenterPlast private practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany
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5
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Vidal-Laureano N, Huerta CT, Perez EA, Earle SA. Augmented Safety Profile of Ultrasound-Guided Gluteal Fat Transfer: Retrospective Study With 1815 Patients. Aesthet Surg J 2024; 44:NP263-NP270. [PMID: 38124368 DOI: 10.1093/asj/sjad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Gluteal augmentation with autologous fat transfer is one of the fastest growing aesthetic surgical procedures worldwide over the past decade. However, this procedure can be associated with high mortality from fatal pulmonary fat embolism events caused by intramuscular injection of fat. Ultrasound-guided fat grafting allows visualization of the transfer in the subcutaneous space, avoiding intramuscular injection. OBJECTIVES The aim of this study was to assess the safety and efficacy of gluteal fat grafting performed with ultrasound-guided cannulation. METHODS A retrospective chart review of all patients undergoing ultrasound-guided gluteal fat grafting at the authors' center between 2019 and 2022 was performed. All cases were performed by board-certified and board-eligible plastic surgeons under general anesthesia in ASA Class I or II patients. Fat was only transferred to the subcutaneous plane when over the gluteal muscle. Patients underwent postoperative follow-up from a minimum of 3 months up to 2 years. Results were analyzed with standard statistical tests. RESULTS The study encompassed 1815 female patients with a median age of 34 years. Controlled medical comorbidities were present in 14%, with the most frequent being hypothyroidism (0.7%), polycystic ovarian syndrome (0.7%), anxiety (0.6%), and asthma (0.6%). Postoperative complications occurred in 4% of the total cohort, with the most common being seroma (1.2%), local skin ischemia (1.2%), and surgical site infection (0.8%). There were no macroscopic fat emboli complications or mortalities. CONCLUSIONS These data suggest that direct visualization of anatomic plane injection through ultrasound guidance is associated with a low rate of complications. Ultrasound guidance is an efficacious adjunct to gluteal fat grafting and is associated with an improved safety profile that should be considered by every surgeon performing this procedure. LEVEL OF EVIDENCE: 3
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Manzaneda Cipriani RM, Cárdenas Larenas JP, Viaro MSS, Flores González EA, Adrianzen G, Babaitis R, Duran Vega H, Stefanelli M, Ventura R. Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5695. [PMID: 38525493 PMCID: PMC10959562 DOI: 10.1097/gox.0000000000005695] [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: 06/10/2023] [Accepted: 02/06/2024] [Indexed: 03/26/2024]
Abstract
Background The rejuvenation and restoration of a well-defined jawline contour are crucial for enhancing facial aesthetics in both men and women. Within the jawline aesthetic unit (mandibular angle), the masseter muscle plays a significant role, as it is responsible for mandibular masticatory movements. We propose a new approach using ultrasound-guided intramuscular fat transfer to enhance the mandibular angle and jawline. Methods The multicenter study included 20 patients from three countries (Peru, Brazil, and Mexico). After fat harvesting, the ultrasound-guided masseteric fat transfer was performed with a 1.5-mm Viaro cannula from an incision beneath the ear lobule. The fat was then injected intramuscularly into the masseter at each side of the mandibular angle. Results Masseter ultrasound-guided fat transfer was performed on 10 men and 10 women between 2021 and 2022. The patients had a mean age of 34.4 ± 6.39 years and a mean body mass index of 22.39 ± 2.59 kg per m2. The mean injected volume was 5.83 mL and 5.58 mL on the right and left sides, respectively. Muscle thickness increased in patients immediately postsurgery, but decreased after 1 month. The muscle remained significantly thicker on each side than the presurgery measurements in patients regardless of gender (both P < 0.0001). Conclusions Ultrasound-guided intramuscular fat transfer is a safe and reproducible technique for enhancing the jawline contour at the mandibular angle. We believe that it could be a more durable solution than other procedures, although further evaluation of long-term results is necessary.
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Affiliation(s)
| | | | | | | | - Gerardo Adrianzen
- Human Medicine Department, Physician, Cayetano Heredia University, Human Medicine Department, Lima, Peru
| | - Ricardo Babaitis
- Plastic and Reconstructive Surgeon, Private Practice, Buenos Aires, Argentina
| | - Héctor Duran Vega
- Plastic and Reconstructive Surgeon, Private Practice, Merida Yucatán, México
| | - Matt Stefanelli
- Plastic and Reconstructive Surgeon, Plastic Surgery Department, Cocoona Clinic, Dubai, UAE
| | - Ricardo Ventura
- Plastic and Reconstructive Surgeon, Sculptor Clinic Medical Director, Dominican Republic
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7
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Pazmiño P, Del Vecchio D. Static Injection, Migration, and Equalization (SIME): A New Paradigm for Safe Ultrasound-Guided Brazilian Butt Lift: Safer, Faster, Better. Aesthet Surg J 2023; 43:1295-1306. [PMID: 37158159 DOI: 10.1093/asj/sjad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Although the Brazilian butt lift (BBL) is one of the most popular procedures in body contouring, it has been associated with the risk of pulmonary fat embolism when fat graft is injected into the gluteal muscles. The subcutaneous plane has been identified as a safe site for fat graft injection, but deaths from fat embolism continue to occur because there is no mechanism to confirm consistent subcutaneous placement. OBJECTIVES The aim of this paper was to determine if real-time intraoperative ultrasound could accurately identify the subcutaneous gluteal anatomic landmarks and permit a single surgeon to consistently target fat graft placement in the subcutaneous space. METHODS In total, 4150 BBLs were performed with real-time intraoperative ultrasound being used to confirm the subcutaneous position of a static cannula during fat graft injection. Serial deposits of fat graft were performed in each buttock. Ultrasound confirmed that fat graft consistently remained above the deep gluteal fascia and migrated through the deep subcutaneous space. These fat graft deposits were then equalized with a moving cannula to correct any contour deformities. Operative times were recorded and compared with BBL performed by expansion vibration lipofilling without ultrasound. RESULTS Real-time intraoperative ultrasound allowed for the visual confirmation of consistent subcutaneous fat graft deposition and the targeting of fat graft into specific gluteal subcutaneous compartments. CONCLUSIONS Real-time intraoperative ultrasound allows the surgeon to confirm a subcutaneous-only fat graft injection, target specific gluteal subcutaneous compartments, and take advantage of the unique architecture of the deep subcutaneous space to create gluteal projection and correct contour deformities.
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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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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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Pazmiño P, Del Vecchio D. Static Injection, Migration, and Equalization: A New Paradigm for Safe Ultrasound-Guided BBL: Safer, Faster, Better. Clin Plast Surg 2023; 50:603-614. [PMID: 37704327 DOI: 10.1016/j.cps.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Static injection, migration, and equalization allows for always subcutaneous-targeted fat grafting to either the deep or the superficial subcutaneous spaces.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami, 848 Brickell Avenue, Suite 820, Miami, FL 33131, USA.
| | - Daniel Del Vecchio
- Department of Plastic Surgery, Massachusetts General Hospital, 38 Newbury Street, Suite 502, Boston, MA 02116, USA
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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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Manzaneda Cipriani RM, Babaitis R, Vega HD, Viaro M, Flores E, Adrianzen GA. Intramuscular Posterior Thigh Volumization: An Aesthetic and Harmonious Transition to the Gluteal Region (Hv-FAT). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4918. [PMID: 37020987 PMCID: PMC10069849 DOI: 10.1097/gox.0000000000004918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/16/2023] [Indexed: 04/05/2023]
Abstract
The gluteal region remains the preferred site for fat grafting. However, the transition from the gluteal region to the thighs has not been well studied. This study aimed to describe an echographic guidance hamstring volumization procedure (Hv-FAT) as a complement to body contouring surgery.
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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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Circumferential Liposuction of the Thigh with Concomitant Fat Transplantation to the Infragluteal Region: A Promising Option for Preventing Postliposuction Gluteal Ptosis. Plast Reconstr Surg 2022; 150:60e-68e. [PMID: 35511052 DOI: 10.1097/prs.0000000000009262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gluteal ptosis is a common complication of circumferential liposuction of the thigh. The authors propose a novel concept of combining circumferential liposuction of the thigh with concomitant fat transplantation to the infragluteal/posterior thigh junction region to prevent postliposuction gluteal ptosis. METHODS Patients underwent circumferential liposuction of the thigh with or without concomitant fat transplantation from 2015 to 2020 and were retrospectively reviewed. The postoperative changes in the grade of gluteal ptosis, length of hospitalization, time to recovery, postoperative complications, and patient satisfaction were evaluated. RESULTS A total of 109 patients were enrolled in this study, including 46 patients in the liposuction-only group and 63 patients in the liposuction plus fat transplantation group. There was no significant difference in fat removal volume between the liposuction-only group and the liposuction plus fat transplantation group ( p = 0.152). Aggravation of gluteal ptosis occurred in 43 patients (93.5 percent) in the liposuction-only group and four patients (6.3 percent) in the liposuction plus fat transplantation group ( p < 0.001). The length of hospitalization and time to recovery was not significantly different between the two groups ( p = 0.402 and p = 0.423, respectively). Complications were rare in both groups. With a minimum evaluation time of 6 months, patients in the liposuction plus fat transplantation group showed significantly higher satisfaction ( p < 0.001). CONCLUSION Concomitant fat transplantation to the infragluteal/posterior thigh junction region during circumferential liposuction of the thigh is effective in preventing postliposuction gluteal ptosis and improving patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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15
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Liao X, Wang X, Xu Z, Guo S, Gu C, Jin Z, Su T, Chen Y, Xue H, Yang M. Assessment of facial autologous fat grafts using Dixon magnetic resonance imaging. Quant Imaging Med Surg 2022; 12:2830-2840. [PMID: 35502384 PMCID: PMC9014153 DOI: 10.21037/qims-21-570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/24/2022] [Indexed: 09/07/2023]
Abstract
BACKGROUND Autologous fat grafting is a procedure that treats soft tissue defects by reallocating fat to improve a patient's physical appearance. Imaging methods may be used to evaluate and monitor the grafted fat after transplantation. The goal of imaging is to examine the signal and volume of the grafted fat after autologous fat grafting during the adipose tissue recovery. However, researchers have yet to examine the feasibility of using fat-only imaging to assess the autologous fat graft. METHODS In this prospective and observational study, 46 injected sides in 23 female patients (age 35±7.8 years) were included in the image evaluation. The patients underwent autologous fat grafting surgery with filtered and washed fat. A total of 16, 18, and 12 sides were scanned 7 days, 3 months, and 1 year after fat grafting, respectively. Fat-only images were obtained using Dixon imaging, and then the image quality and contrast of the T1W and T2W were rated to evaluate the application of this method when imaging the autologous fat. The signal and volume of the autologous fat graft were recorded to assess the retention during recovery of the autologous fat tissue. RESULTS Fat-only T1W magnetic resonance imaging (MRI) was used to identify and delineate grafted fat because this method had better image quality and image differentiation than did T2W MRI. The average signal contrast and retention rate measured 7 days postoperation (28.8%±4.7%; 94.1%±5.8%) was the highest and then decreased at 3 months (16.3%±2.1%; 48.7%±17.3%) and 1 year (3.3%±1.3%, 33.1%±12.9%) after surgery. There were statistically significant differences between the signal and volume retention measurements at each postoperative recovery phase. CONCLUSIONS The T1W fat-only images produced by Dixon MRI is a feasible approach for identifying grafted fat and measure postoperative changes during clinical evaluation. We found a significant decrease in signal contrast and volume of the grafted fat from the surgery date to 3 months postoperation and from 3 months to 1-year postoperation.
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Affiliation(s)
- Xueyin Liao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoqi Wang
- Philips Healthcare, the World Profit Centre, Beijing, China
| | - Zhentan Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiwei Guo
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congmin Gu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingyong Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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O’Neill RC, Hanson SE, Reece E, Winocour S. Safety Considerations of Fat Grafting in Buttock Augmentation. Aesthet Surg J 2021; 41:S25-S30. [PMID: 34002766 DOI: 10.1093/asj/sjab092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Autologous fat grafting for buttock augmentation is one of the fastest growing plastic surgery procedures, but has also received significant publicity for the relatively high mortality rate secondary to fat emboli. The literature has grown exponentially in the past 5 years on this subject, helping to clarify our knowledge and providing recommendations to minimize risks, including avoiding intramuscular injections, placing the patient in the jackknife position, and utilizing larger-bore cannulas. Since the application of these recommendations, the rate of pulmonary fat embolism has decreased from 0.097% to 0.04%, with a current mortality of 1 in 14,921, making it statistically safer than abdominoplasty. Despite the evolution in our knowledge, techniques, and outcomes, it remains of utmost importance to properly select and educate patients about the safety of fat grafting for buttock augmentation. Level of Evidence: 4.
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Affiliation(s)
- Rebecca C O’Neill
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Summer E Hanson
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Edward Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sebastian Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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17
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Ye Y, Zou J, Tan M, Hu K, Jiang J. Phenotypic and Cellular Characteristics of a Stromal Vascular Fraction/Extracellular Matrix Gel Prepared Using Mechanical Shear Force on Human Fat. Front Bioeng Biotechnol 2021; 9:638415. [PMID: 33718340 PMCID: PMC7952646 DOI: 10.3389/fbioe.2021.638415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/03/2021] [Indexed: 11/23/2022] Open
Abstract
The retention of fat-derived grafts remains a challenge for regenerative medicine. Fat aspirates from patients undergoing liposuction were prepared into standard Coleman fat grafts or further isolated using mechanical shear force to prepare a stromal vascular fraction (SVF)/extracellular matrix (ECM) gel. The retention rate of the SVF/ECM gel was significantly higher than that of the Coleman fat at 3, 14, 28, and 60 days following transplantation on the backs of nude mice. The viscosity of the fat was directly proportional to the shearing force. Although the mechanical isolation did not affect the total number of cells, it significantly decreased the number of living cells. Flow cytometry showed a greater number of mesenchymal stem cells, supra-adventitial (SA)-adipose stromal cells (ASCs), and adipose-derived stem cells but a lower number of endothelial progenitor cells in the SVF/ECM gel than in the Coleman fat. Thus, mechanical isolation of fat can increase the pluripotency of adipocytes, which can improve graft retention in cell therapy.
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Affiliation(s)
- Yuan Ye
- Department of Plastic and Cosmetic Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jingjiang Zou
- Department of Plastic and Cosmetic Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Meijun Tan
- Department of Plastic and Cosmetic Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Kuikui Hu
- Department of Plastic and Cosmetic Surgery, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jindou Jiang
- Department of Plastic and Cosmetic Surgery, Guangdong Women and Children Hospital, Guangzhou, China
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18
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Slow-growing buttock mass after failure of incorporation of autologous fat transfer for gluteal augmentation: ultrasound and MRI features. Skeletal Radiol 2020; 49:1669-1675. [PMID: 32506226 DOI: 10.1007/s00256-020-03487-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/16/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
Gluteal augmentation procedures are gaining popularity and encompass a variety of surgical techniques and methods of graft preparation. While surgical history remains essential for diagnosis, the radiologist must avoid pitfalls and rely on imaging features to recognize both the expected appearance and complications of gluteal augmentation procedures. We report a case of a slowly growing buttock mass after gluteal augmentation with autologous fat transfer 1 year after surgery. The potential diagnostic imaging pitfalls and characteristics on ultrasound and contrast-enhanced MRI are discussed. Multiplicity of fat-containing lesions depicted on large field-of-view images and granulated appearance of the intralesional fat on MRI should allow the radiologist to recognize the appearance of failed fat graft incorporation that can present as a slowly growing encapsulated collection with layered fat and fluid contents.
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19
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Abstract
BACKGROUND Fat transplantation is becoming increasingly popular for off-face rejuvenation. OBJECTIVE To provide an update in the literature of current knowledge and emerging concepts in the use of fat transplantation for nonfacial applications. MATERIALS AND METHODS This update includes the potential benefits and risks of using fat transfer techniques on the body. RESULTS The current literature and author experiences are provided to help understand this growing field of aesthetic procedures. CONCLUSIONS The use of nonfacial fat transplantation is increasing and will become a larger part of aesthetic practices.
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20
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Viaro MSS, Danilla S, Cansanção AL, Viaro PS. Ultra HD Liposuction: Enhancing Abdominal Etching Using Ultrasound-Guided Rectus Abdominis Fat Transfer (UGRAFT). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2818. [PMID: 33133894 PMCID: PMC7572093 DOI: 10.1097/gox.0000000000002818] [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: 10/31/2019] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
High-definition (HD) liposuction has allowed surgeons to sculpt the abdomen, enhancing abdominal etching. To create a more athletic abdomen, fat grafting has been used subcutaneously, and rectus abdominis fat grafting has been performed in patients undergoing lipoabdominoplasty. With the objective of increasing muscle volume to obtain a natural-looking abdomen in patients who are not suitable for abdominoplasty, we propose the use of ultrasound-guided rectus abdominis fat grafting (UGRAFT) in association with HD liposuction. PATIENTS A prospective study with 10 consecutive patients undergoing UGRAFT was conducted. After HD liposuction, UGRAFT was performed from an incision in the umbilical region, using a blunt 2.5-mm cannula assisted by ultrasound. Fat injection was done closer to the anterior rectus sheath in the lower and middle muscle bellies. RESULTS UGRAFT was performed in 10 patients. The mean age was 34.8 years (range, 24-51 years). The mean body mass index was 23.83 kg/m2 (range, 20.58-28.39 kg/m2). The mean volume of fat injected per "pack" was 34 cm3 (range, 20-40 cm3). UGRAFT added a mean time of 20 minutes (range, 15-30 minutes) to HD liposuction. Comparing the rectus abdominis muscle thickness pre-UGRAFT and post-UGRAFT, average muscle thickness increase was 5.1 mm (55.7% ± 37%), with P < 0.0001. CONCLUSION UGRAFT showed to be helpful for obtaining muscle expansion and a more natural abdominal contour, avoiding that unnatural appearance that HD liposuction may provide in patients who gain weight or have skin laxity.
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Affiliation(s)
| | - Stefan Danilla
- Department of Plastic and Reconstructive Surgery, University of Chile Clinical Hospital, Santiago, Chile
| | - Alvaro Luiz Cansanção
- Department of Plastic Surgery, Universidade Iguaçu (UNIG), Hospital da Plástica, Rio de Janeiro, RJ, Brazil
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21
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O'Neill RC, Abu-Ghname A, Davis MJ, Chamata E, Rammos CK, Winocour SJ. The Role of Fat Grafting in Buttock Augmentation. Semin Plast Surg 2020; 34:38-46. [PMID: 32071578 PMCID: PMC7023974 DOI: 10.1055/s-0039-3401038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Autologous fat grafting is now considered the gold standard for buttock augmentation. Although a variety of techniques are currently being used by surgeons around the world, methods of fat grafting to the buttocks remain unsystematized, poorly understood, and controversial in terms of their safety and efficacy. Nonetheless, buttock augmentation by fat grafting has a satisfaction rate of 97.1%, and its mean complication rate has been estimated to be around 7 to 10%, with serious complications occurring in less than 1% of cases. Fat emboli are one such serious complication, with several reports in the literature discussing morbidity and mortality, specifically with intramuscular injection. With the increasing popularity of fat grafting for buttock augmentation, it is more important than ever to continue researching and learning to safeguard the satisfaction and safety of our patients.
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Affiliation(s)
- Rebecca C. O'Neill
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew J. Davis
- 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
| | - Charalambos K. Rammos
- Division of Plastic Surgery, Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois
| | - Sebastian J. Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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