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Adipose Tissue Transfer in Dynamic Definition Liposculpture Part II. The Lower Limb: Gastrocnemius, Vastus Medialis, Vastus Lateralis, and Rectus Femoris Muscles. Plast Reconstr Surg Glob Open 2023; 11:e4765. [PMID: 36733949 PMCID: PMC9886515 DOI: 10.1097/gox.0000000000004765] [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: 07/06/2022] [Accepted: 09/20/2022] [Indexed: 01/30/2023]
Abstract
One big challenge of body contouring surgery is the liposculpture of the lower limbs, probably because of the imperative symmetry and the risk of contour irregularities. We are reporting our experience in fat grafting of the thighs and calves for men and women undergoing dynamic definition liposculpture. Methods We did cadaveric dissections of the vastus lateralis, vastus medialis, rectus femoris, and gastrocnemius muscles and identified each of their primary pedicles. We also performed fat grafting of these muscles in the contralateral virgin cadaveric specimen. We searched our records for patients who underwent fat grafting of the lower extremity in addition to dynamic definition liposculpture, from January 2016 to May 2022 at a single center in Bogotá, Colombia. Results Seventy-three consecutive patients met the inclusion criteria (26 men and 47 women). We grafted 102 gastrocnemius muscles, 86 vastus medialis muscles, 98 vastus lateralis muscles, and 22 rectus femoris muscles. Mean age was 34 and 41 years for men and women, respectively. Range of the fat graft volume was 50-200 mL. No complications were recorded related to fat grafting. Almost all patients were satisfied with the procedure (89%). Follow-up period ranged from 2 to 36 months. Conclusions Fat grafting of the lower limb muscles should be considered an alternative operative technique to enhance volume and athletic appearance of this body segment. Based on cadaveric dissections and clinical evidence, our technique is considered reliable and reproducible with remarkable outcomes and a very low complication rate.
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Calf Augmentation and Volumetric Restoration: A Systematic Review and Meta-Analysis. J Plast Reconstr Aesthet Surg 2022; 75:3551-3567. [DOI: 10.1016/j.bjps.2022.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/10/2022] [Indexed: 11/22/2022]
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Agaoglu G, Erol O. Response to: Additional Thoughts on the Combination of Non-Ablative Fractional Laser and Microfat for Hair Graft Survival on Post-Burn Scars. Aesthet Surg J 2021; 41:NP1798-NP1799. [PMID: 34139770 DOI: 10.1093/asj/sjab254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Galip Agaoglu
- Department of Plastic Reconstructive and Aesthetic Surgery, Koç University, Istanbul, Turkey
| | - Onur Erol
- ONEP Plastic Surgery Science Institute, Istanbul, Turkey
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Agaoglu G, Özer F, Karademir S, Agaoglu E, Erol O. Hair Transplantation in Burn Scar Alopecia After Combined Non-Ablative Fractional Laser and Microfat Graft Treatment. Aesthet Surg J 2021; 41:NP1382-NP1390. [PMID: 34000048 DOI: 10.1093/asj/sjab225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Burn scar and alopecia on hair-bearing areas can severely affect the social life of patients. Unlike healthy skin, poor biological and mechanical properties of scar tissue in the recipient area can reduce the survival rate of hair graft following hair transplantation. OBJECTIVES The authors sought to determine if combined non-ablative fractional laser (NAFL) and microfat injection could improve the survival rate of hair grafts on post burn scar. METHODS Thirteen patients with alopecia resulting from burn scar in hair-bearing areas of the scalp and face were treated with combined NAFL and microfat graft and subsequent follicular unit extraction hair transplantation. Cicatricial alopecia occurred on the scalp, eyebrow, mustache, and beard areas. Patients were treated with 3 to 6 sessions of NAFL and 2 to 5 sessions of microfat graft injections, followed by 1 session of hair transplantation employing the follicular unit extraction technique. RESULTS Hair transplantation was successfully performed with good to excellent results. The survival rate of transplanted follicular units ranged from 76% to 95% (mean, 85.04%), and the density success rate per square centimeter ranged from 76.9% to 95.2% (mean, 84.54%). All patients expressed high satisfaction with the results and no complication was encountered. CONCLUSIONS Hair transplantation, after combined NAFL and microfat injection, is a promising treatment for post burn alopecia. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Galip Agaoglu
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Koç University, Istanbul, Turkey
| | - Fırat Özer
- ONEP Plastic Surgery Science Institute, Istanbul, Turkey
| | - Sacit Karademir
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Koç University, Istanbul, Turkey
| | - Esra Agaoglu
- Dermatology Department, Harakani State Hospital, Kars, Turkey
| | - Onur Erol
- ONEP Plastic Surgery Science Institute, Istanbul, Turkey
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Añorve Borquez IR. A New Technique for Remodelling and Increasing the Diameter of the Legs through Lipotransfer and Vertical Subcutaneous Fasciotomy of the Posterior Tibial Aponeurosis. Aesthetic Plast Surg 2021; 45:1642-1650. [PMID: 33575877 DOI: 10.1007/s00266-021-02147-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/17/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe a new technique for performing thigh and calf augmentation and remodelling through thigh lipotransfer, subcutaneous vertical fasciotomy and leg lipotransfer. METHODS Patients with thin legs due to hypotrophy or hypoplasia of the medial portion of the thighs and legs as well as a patient with a prominent tibialis anterior giving the appearance of male legs were selected. RESULTS A total of 214 surgeries were performed in 107 patients with minimal complications, and most patients reported a high rate of satisfaction. DISCUSSION Lipotransfer with fasciotomy improves the standard results of liposculpture in body contour management, which allows balanced relationships among the waist, hips, thighs and legs to be achieved in many patients who are not candidates for the placement of silicone prostheses because their legs and thighs are thin and hypotrophic. 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)
- Ignacio Roberto Añorve Borquez
- , Av. Rafael Buelna 198, edificio polimédica local 616, Col. Fraccionamiento hacienda las cruces, C.P. 821010, Mazatlán Sinaloa, México.
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Andjelkov K, Atanasijevic TC, Popovic VM, Colic M, Llull R. Safe Composite Calf Augmentation: A Staged Procedure. Aesthet Surg J 2021; 41:NP26-NP35. [PMID: 32215546 DOI: 10.1093/asj/sjaa080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Calf augmentation can be achieved by fat grafting, calf implants, or a combination of both methods (composite augmentation). For safety reasons, it is important to be aware of important calf anatomic features, specific physiologic considerations, and some health conditions that can hinder the outcome of these procedures. OBJECTIVES The aim of this study was to present our experience with performing composite calf augmentation, and to describe indications, surgical techniques and safety issues. METHODS We retrospectively analyzed 63 patients who had undergone composite calf augmentation for cosmetic and reconstructive surgery in our practice. We reviewed group demographics, complications, and results, and identified all the pitfalls encountered in our cases. Additionally, dissection of the calf regions in fresh cadavers was performed to obtain more accurate anatomy. We also measured intracompartmental pressures before and after calf augmentation with implants in 6 cases to determine pressure changes. RESULTS All cases received subfascial implant insertion and fat grafting as a delayed procedure. If there is a need for multiple implants, we recommend a staged procedure. Our study showed high muscle sensitivity to pressure increase after augmentation. Hence, from the standpoint of safety, we advocate subcutaneous fat grafting only. No patients developed compartment syndrome. CONCLUSIONS Composite calf augmentation surgery is safe and easy to reproduce, with a short recovery period and a low complication rate when done as a staged procedure and respecting specific anatomic and physiologic calf features. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | - Vesna M Popovic
- Institute for Forensic Medicine, Faculty of Medicine, University of Belgrade, Serbia
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Chavoin JP, Lupon E, Moreno B, Leyx P, Grolleau JL, Chaput B. Correcting of Calf Atrophy With a Custom-Made Silicone Implant: Contribution of Three-Dimensional Computer-Aided Design Reconstruction: A Pilot Study. Aesthet Surg J 2021; 41:NP12-NP22. [PMID: 32593168 DOI: 10.1093/asj/sjaa171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Calf shape is an essential aesthetic parameter of the leg, and calf atrophy can lead to complex problems. The functional consequences of calf atrophy are generally moderate. Prefilled silicone gel implants represent the vast majority of currently placed prostheses, but this technique does not ensure optimal adaptation of the implant shape due to loss of volume. OBJECTIVES The aim of this study was to describe an innovative procedure for correcting acquired calf atrophy based on 3-dimensional (3D) modeling. METHODS The study involved 22 patients treated for calf atrophy caused by illness. Implants were made with solid rubber silicone, and 3D reconstructions were created by computer-aided design based on computed tomography scans. The implants were introduced through a horizontal popliteal incision. RESULTS Forty-one implants were placed. No cases of infection, hematoma, or compartment syndrome were encountered. We experienced 1 case of skin necrosis and 1 case of periprosthetic seroma. In addition, lipofilling was performed in 5 cases. Two patients sought to benefit from a surgical reduction in implant size. CONCLUSIONS Our innovative procedure to correct calf atrophy with custom solid rubber silicone implants produces a calf shape that better adapts to volume loss than prefilled silicone gel implants. The material maintains its shape and facilitates retrofitting of the prosthesis. There is no risk of hull formation or breakage, and the life span of the implants is limitless. This 3D computer-aided design approach has optimized our reconstructions. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jean-Pierre Chavoin
- Department of Plastic Surgery, University Toulouse III Paul Sabatier, Toulouse, France
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elise Lupon
- Department of Plastic Surgery, University Toulouse III Paul Sabatier, Toulouse, France
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Jean-Louis Grolleau
- Department of Plastic Surgery, University Toulouse III Paul Sabatier, Toulouse, France
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Benoit Chaput
- Department of Plastic Surgery, University Toulouse III Paul Sabatier, Toulouse, France
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Okumus A. Combination of Lipofilling With Liposuction in the Correction of Pseudo Genu Varus Deformity. Aesthet Surg J 2020; 40:NP94-NP100. [PMID: 31676892 DOI: 10.1093/asj/sjz305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The combined use of lipofilling and liposuction has not been reported for the correction of pseudo genu varus deformity. OBJECTIVES The aim of this study was to evaluate the utility of combined liposuction and lipofilling for a bilateral correction of pseudo genu varus deformity based on a single-center experience over a 13-year period. METHODS A total of 72 patients with pseudo genu varus deformity treated with combined liposuction and lipofilling were included. Data on postoperative complications, the need for additional rounds of lipofilling, and aesthetic outcomes over an average of 5 years (range, 1-9 years) were recorded. RESULTS Fat harvested from the upper medial portion of the knee was sufficient for lipofilling in 12 (16.7%) patients, and additional donor sites were used in 60 (83.3%) patients. A second round of lipofilling (average, 20 mL; range, 15-50 mL) was required in 17 (23.6%) patients within 6 months to 1 year after the operation. The need for additional lipofilling or liposuction was not noted for any other patients. None of the patients developed major complications such as fat necrosis, infections, contour deformities, or medial concavities during knee flexion. CONCLUSIONS The current findings strongly suggest that the combined use of liposuction and lipofilling for the correction of pseudo genu varus deformity is a feasible, effective, and safe alternative that seems to offer additional benefits compared with fat grafting alone, including a fast recovery, a low risk of complications, and an increased likelihood of a long-lasting correction of the calf contour. LEVEL OF EVIDENCE: 4
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Melita D, Innocenti A. Surgical Calf Augmentation Techniques: Personal Experience, Literature Review and Analysis of Complications. Aesthetic Plast Surg 2019; 43:973-979. [PMID: 30868304 DOI: 10.1007/s00266-019-01347-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/24/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND More attention is paid to calf appearance, both in males and females, and several surgical techniques are available. Different studies have been published over time for calf augmentation, but, to the best of our knowledge, no comprehensive literature review and complications analysis have been published. OBJECTIVES The aim of the study is to analyse the overall complication rate of calf augmentation surgical procedures and complication rates associated with the investigated techniques, namely subfascial implant placement, submuscular implant placement and fat grafting or lipofilling. Demographic analysis, including age and gender, is also performed. MATERIALS AND METHODS A literature review on the PubMed database was performed for clinical studies regarding calf augmentation surgical procedures. The authors selected and analysed 26 articles among the actual literature on this field and reported personal experience in calf augmentation surgery. RESULTS Twenty-six studies, published from 1993 to 2018, were included in the study for a total amount of 1498 patients, with a total of 2629 calves treated. Three different surgical techniques have been reviewed, excluding medical procedures: subfascial implant augmentation (n = 1929), submuscular implant augmentation (n = 435) and fat grafting (n = 265). The overall complication rate was 4.4883%. Calf augmentation with subfascial implants presented a total complication rate of 5.702%. The submuscular implant placement complication rate was 0.92%. Fat grafting presented a global complication rate of 1.509%. CONCLUSIONS Calf augmentation, with all reviewed surgical techniques, has a low rate of complications compared to other body contouring procedures, but a high rate of satisfaction among patients. Fat grafting has the lowest rate of complications, but multiple sessions are required. Specific complications of implants, such as capsular contracture, malposition or rupture, are less common compared to the use of implants for other cosmetic purposes. Procedures should always be performed by experienced plastic surgeons. 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)
- Dario Melita
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Via Valdichiana 88, 50127, Florence, Italy.
| | - Alessandro Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Via Valdichiana 88, 50127, Florence, Italy
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Onur Erol O, Agaoglu G, Jawad MA. Combined Non-Ablative Laser and Microfat Grafting for Burn Scar Treatment. Aesthet Surg J 2019; 39:NP55-NP67. [PMID: 30403775 DOI: 10.1093/asj/sjy291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Burn scar treatment persists as an unsolved problem, involving thousands of affected patients disfigured for life. OBJECTIVES We sought to present our experience with the use of combined treatments for patients with burn scars. METHODS This was a case series report of the senior author's experience during 8 years utilizing the combined treatments of Fraxel Restore (fractional laser) and microfat graft injection for 288 patients with burn scars. RESULTS Laser treatment reduced scar intensity and attenuated skin irregularities and hyperpigmentation. All patients demonstrated marked improvement of skin texture and an increase in scar softness after 3 sessions of microfat grafting. However, the degree of improvement varied between patients and was related to the severity of the scar and the type of tissue. Overall, a 40% to 80% improvement was noted in our patients. All patients and their families expressed satisfaction with the results. CONCLUSIONS The combined treatment of Fraxel and microfat grafting is an effective technique for improving the appearance of a hypertrophic scar or keloid on burn patients. Fat tissue stem cells may have helped to repair the damaged skin. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- O Onur Erol
- ONEP Plastic Surgery Science Institute, Istanbul, Turkey
| | - Galip Agaoglu
- ONEP Plastic Surgery Science Institute, Istanbul, Turkey
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Abstract
Soft-tissue deficits in amputation stumps can lead to significant pain and disability. An emerging treatment option is stem cell-enriched fat grafting. This is the first study assessing the potential for this treatment modality in lower extremity amputation sites. In this prospective cohort study, five injured military personnel suffering from pain and limited function at amputation sites were recruited. Fat grafting enriched with stromal vascular fraction was performed at amputation sites to provide additional subcutaneous tissue padding over bony structures. Outcomes measures included complications, demographic data, physical examination, cellular subpopulations, cell viability, graft volume retention, pain, Lower Extremity Functional Scale, Functional Mobility Assessment, 36-Item Short-Form Health Survey, and rates of depression. Follow-up was 2 years. There were no significant complications. Volume retention was 61.5 ± 24.0 percent. Overall cell viability of the stromal vascular fraction was significantly correlated with volume retention (p = 0.016). There was no significant correlation between percentage of adipose-derived stem cells or number of cells in the stromal vascular fraction and volume retention. There was a nonsignificant trend toward improvement in pain scores (3.0 ± 2.5 to 1.2 ± 1.6; p = 0.180 at 2 years). There were no significant changes in disability indexes. Results from this pilot study demonstrate that stromal vascular fraction-enriched fat grafting is a safe, novel modality for the treatment of symptomatic soft-tissue defects in traumatic lower extremity amputations. Volume retention can be anticipated at slightly over 60 percent. Further studies are needed to assess efficacy. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
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Calf Augmentation and Restoration: Long-Term Results and the Review of the Reported Complications. Aesthetic Plast Surg 2017; 41:1115-1131. [PMID: 28488211 DOI: 10.1007/s00266-017-0885-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Augmentation or reconstruction of the calves is indicated in patients with thin legs, for bodybuilders, or when there is a defect after an injury or illness. The principle of placing implants under the investing crural fascia was worked out in the 1980s. The senior author (I.N.) introduced many technical modifications and improvements for this operation, among them the new instrument, an inserter for the calf implants. Presented patient material is unique in that the more challenging reconstructive cases almost equal the numbers of the aesthetic cases. METHODS During the years 1991 through 2016, 50 patients underwent 60 calf contour corrections. Indications were aesthetic in 23 patients, six were bodybuilders, and 21 underwent lower leg reconstruction because of deformity caused by illness. RESULTS According to evaluation by the surgeon, excellent-to-good results were obtained in 30 out of 37 followed patients. Patients rated their results as very good (18), good (10), acceptable (7) and bad (2). One 28-year-old professional bodybuilder sustained acute anterior compartment syndrome in one leg. Implants were removed 16 h after surgery, but he developed ischaemia in the anterior compartment leading to the necrosis of muscles. After several surgical operations, including microsurgical transfer of the innervated central caput of the quadriceps femoris muscle, he could resume his bodybuilding activities. Other complications were minor and manageable. CONCLUSION Calf augmentation, performed properly, has evolved to be a safe, efficient and aesthetically pleasing operation. The possibility of acute compartment syndrome should be kept in mind. 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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Skorobac Asanin V, Sopta J. Lower Leg Augmentation with Fat Grafting, MRI and Histological Examination. Aesthetic Plast Surg 2017; 41:108-116. [PMID: 28008461 DOI: 10.1007/s00266-016-0716-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Nowadays, there is an increasing demand for contouring of the entire lower leg, in addition to corrections at the level of the muscle only. Accordingly, it becomes advantageous to use fat tissue for this purpose, for its availability in high quantities, potential for its easy implantation in all leg parts, biological compatibility, low antigen potential, and minimal donor morbidity. METHODS Forty-eight female patients, aged 20-54 (47.1 % younger than 35 and 52.9 % older than 35), underwent lower leg augmentation with autologous fat. We compared pre- and 1, 3, and 6 months postoperative morphological and volumetric characteristics of the recipient region by circumferential measuring of particular parts of the lower legs and evaluating the presence of live transplanted fat by MRI and histological examination. RESULTS The augmentation of certain circumferences of the lower leg at the 6-month follow-up examination is significantly related to preoperative circumference as well as to the quantity of infiltrated fat. Therefore, lower the baseline circumference, the greater the augmentation, and the greater the quantity of infiltrated fat, the greater the augmentation. CONCLUSION Ensuring adequate technique in the transfer of fat tissue from the donor region to the recipient region of the lower leg is definitely the least invasive method of lower leg contouring. For patients with muscle dystrophies or those with injuries, this technique could become the first choice for its minimal complications. The simplicity of the procedure invites its wide application in plastic surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. www.springer.com/00266 .
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Yazar M, Kurt Yazar S, Kozanoğlu E. Calf restoration with asymmetric fat injection in polio sequelae. J Plast Reconstr Aesthet Surg 2016; 69:1254-9. [PMID: 27424999 DOI: 10.1016/j.bjps.2016.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 06/01/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many things cause leg asymmetry and sequelae seen after poliomyelitis infections are still a cause of leg deformities. In this study, lipofilling and liposuction combinations are performed on patients with poliomyelitis sequelae. Volume deficiency is not the only leg problem with polio sequelae, leg length is also a problem. For this reason, the length deficiency must be addressed in order to achieve the desired symmetry. The aim of this study is correcting limb asymmetry by a method addressing both limb length deficiency by heel raise and volume deficiency by injection of fat based on corrected limb length. PATIENTS AND METHODS From 2011 through 2013, 10 female patients who had unilateral leg atrophy as a result of paediatric polio infections were included in our study. All of the patients were treated with liposuction and lipofilling combinations. During planning, a ridge was placed under the affected leg in order to equalize the lengths of both legs. The fat injection sites on the affected leg were marked to mimic the unaffected leg. RESULTS All the patients stated that they were satisfied with the results. Transient hypoesthesia was seen in only one patient, but this was spontaneously resolved six months later. CONCLUSION The study results indicate that the asymmetric fat injection procedure can be a good technique to use with patients who have polio sequelae, both with short legs and volume deformities. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Memet Yazar
- Sisli Etfal Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Istanbul, Turkey.
| | - Sevgi Kurt Yazar
- Istanbul Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Istanbul, Turkey
| | - Erol Kozanoğlu
- Istanbul University, Istanbul Medicine Faculty, Plastic, Reconstructive and Aesthetic Surgery Clinic, Istanbul, Turkey
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Mundinger GS, Vogel JE. Calf Augmentation and Reshaping with Autologous Fat Grafting. Aesthet Surg J 2016; 36:211-20. [PMID: 26333990 DOI: 10.1093/asj/sjv166] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite multiple advantages of fat grafting for calf augmentation and re-shaping over traditional silicone calf implants, few reports have been published. OBJECTIVES To report our technique and results with autologous fat grafting for calf augmentation and reshaping. METHODS A retrospective review of the senior author's (JEV) experience with autologous fat grafting for calf augmentation was performed. Medial and lateral calf augmentation was accomplished with injection of prepared autologous lipoaspirate intramuscularly and subcutaneously. RESULTS Over a 5-year period, 13 patients underwent calf augmentation and reshaping with the described technique. Ten cases were bilateral (77%), and 3 cases (23%) were performed for congenital leg discrepancies. Mean 157 cc of prepared lipoaspirate was transferred per leg, with roughly 60% and 40% transferred into the medial and lateral calf, respectively. Four patients (31%) underwent a second round of autologous fat injection for further calf augmentation because they desired more volume. At mean 19.6 month follow-up, durable augmentation and improvement in calf contour was documented by comparison of standardized preoperative and postoperative photographs. CONCLUSIONS Autologous calf fat grafting is a viable alternative to traditional implant-based calf augmentation for congenital calf discrepancies and the aesthetic pseudo-varus deformity. This technique provides results comparable to those obtainable with traditional methods. LEVEL OF EVIDENCE 4: Therapeutic.
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Affiliation(s)
- Gerhard S Mundinger
- From the Department of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - James E Vogel
- From the Department of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
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Monreal J. Autologous Fat Grafting in Severe Lower Extremity Asymmetries: Report of Four Cases. Cureus 2015; 7:e402. [PMID: 26824005 PMCID: PMC4725679 DOI: 10.7759/cureus.402] [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] [Indexed: 11/15/2022] Open
Abstract
Background: Lower extremity asymmetries are challenging problems in plastic and aesthetic surgery practice. Regardless of their origin, atrophies and asymmetries can be extremely varied and difficult to solve with simple techniques. Objectives: The author reports his experience in the treatment of four patients suffering from severe lower extremity atrophy and asymmetry of different etiologies with autologous fat grafting. Methods: A total of four cases are presented. Patient selection was based on the severity of atrophy and asymmetry. Two patients were treated with two sessions of simple fat grafting and two patients with one session of cell-enriched fat grafting. The end point in each session was determined by tension/blanching of soft tissues. All patients were followed up for at least 12 months after the last session. During the postoperative follow-up, variables, such as objective volume improvement, objective girth loss, return to daily activities, and patient satisfaction, were analyzed. Results: The initial analysis of postoperative results showed a good patient satisfaction rate with no relevant complications and an early return to daily activities. Estimated mean volume improvement for simple fat grafting cases was estimated as 44% after two treatments. Mean volume improvement in cell-enriched fat grafting cases was estimated as 25% after only one treatment. Conclusions: Autologous fat grafting is a safe, effective, and reliable technique to perform aesthetic and reconstructive reshaping of a lower extremity in cases of atrophy or severe asymmetry. Depending on the preoperative soft tissue compliance, cell-assisted fat grafting will play an important role in reducing the number of sessions to perform.
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Li GK, Chung JH, Liu LH, Chow VL, Lau GIS, Chan RC. Fat grafting: A safe and effective treatment of craniofacial depression. SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- George K.H. Li
- Department of Surgery; The University of Hong Kong, Queen Mary Hospital; Hong Kong
| | - Joseph H.P. Chung
- Department of Surgery; The University of Hong Kong, Queen Mary Hospital; Hong Kong
| | - Lawrence H.L. Liu
- Department of Surgery; The University of Hong Kong, Queen Mary Hospital; Hong Kong
| | - Velda L.Y. Chow
- Department of Surgery; The University of Hong Kong, Queen Mary Hospital; Hong Kong
| | - Gregory Ian S.K. Lau
- Department of Surgery; The University of Hong Kong, Queen Mary Hospital; Hong Kong
| | - Richie C.L. Chan
- Department of Surgery; The University of Hong Kong, Queen Mary Hospital; Hong Kong
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Abstract
BACKGROUND In Asia, one of the most important factors in being physically attractive is to have aesthetically pleasing legs, which has made calf contouring surgery an issue nowadays. When one leg is abnormally changed because of various factors (e.g., iatrogenic causes, poliomyelitis, cerebral palsy, trauma, and tumor resection), the tissue atrophies. Such asymmetric calves can be corrected by various surgical methods. METHODS Calf asymmetry is defined as a difference in the maximal circumference greater than 2.0 cm between both calves. From 2005 to 2012, the authors carried out calf contouring operations on 68 patients. For patients with mild or moderate asymmetry, selective neurectomy with or without liposuction was performed on the hypertrophic calf according to shape and severity. For patients with severe asymmetry, selective neurectomy with liposuction was performed for the hypertrophic calf, whereas the hypotrophic calf was treated with fat injection or silicone implantation. RESULTS At a minimum of 3 months' follow-up, the mild group patients had a size difference less than 0.5 cm. The moderate and severe asymmetry groups showed size differences less than 1.2 and 2.3 cm, respectively. No functional problems or major complications were shown. Minor complications included five cases of wound dehiscence, three cases of hematoma, and six cases of hypertrophic scar at the incision site. CONCLUSION Classifying patients into three groups according to the maximal circumferential difference between both legs and treating them separately using different surgical methods could significantly provide satisfying outcomes in both functional and aesthetic aspects. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Fraccalvieri M, Contessa L, Salomone M, Zingarelli EM, Bruschi S. Preoperative Color Duplex Echographical Venous Mapping Before Autologous Fat Graft for Calf Augmentation. Ann Plast Surg 2014; 73:137-40. [DOI: 10.1097/sap.0b013e318271007b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Injectable fillers are sometimes necessary to correct slight skin irregularities. However, there have been reports of necrosis after injection of alloplastic materials and heterogeneous transplants. On the other hand, the advantages of autogenous tissue grafts over those fillers are well established. Volumetric reshaping of the face with autologous tissue injection is a popular and reliable method with good long-term results. However, procedures performed on the fragile skin of the nose are prone to complications. OBJECTIVES The author conducted a study of injectable autologous microfat grafting to the nose in patients with secondary nasal deformities. METHODS During a 5-year period, 313 patients who had secondary nasal deformities with slight skin irregularities or severe nasal skin damage were treated with microfat grafting. At each patient's first injection session, excess harvested fat was cryopreserved for subsequent injection. To correct minor irregularities, 0.3 to 0.8 mL of microfat was injected during each session; for major irregularities or defects, 1 to 6 mL was required for each session. RESULTS One to 3 injections of microfat provided satisfactory results in all patients who had minor irregularities. For patients with multiple and severe irregularities, 3 to 6 injections were necessary and resulted in high patient satisfaction. In another group of patients, with severe traumatic skin damage, 6 to 16 injections were necessary for reconstruction. After repeated injections, each patient's skin damage was repaired. CONCLUSIONS Autologous microfat injection appears to be safe and effective for correcting slight irregularities of the nose. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- O Onur Erol
- Dr Erol is Professor Emeritus, Department of Plastic Surgery at Hacettepe University, Ankara; Past Head of the Department of Plastic Surgery at Istanbul Science University; and a staff surgeon at American-Koc Hospital, Istanbul, Turkey
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Jung MS, Jeong HS, Lee BH, Kim JH, Park SH, Ahn DK, Suh IS. Correction of Severely Asymmetric Calf using Latissimus Dorsi Musculocutaneous Free Flap and Customized Silicone Implant. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2014. [DOI: 10.14730/aaps.2014.20.2.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Min Su Jung
- Department of Plastic and Reconstructive Surgery, KangNam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Hii Sun Jeong
- Department of Plastic and Reconstructive Surgery, KangNam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Byeong Ho Lee
- Department of Plastic and Reconstructive Surgery, KangNam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Joo Hyun Kim
- Department of Plastic and Reconstructive Surgery, KangNam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Seong Hoon Park
- Department of Plastic and Reconstructive Surgery, KangNam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Duk Kyun Ahn
- Department of Plastic and Reconstructive Surgery, KangNam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - In Suck Suh
- Department of Plastic and Reconstructive Surgery, KangNam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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Erol OO, Agaoglu G. Facial rejuvenation with staged injections of cryopreserved fat and tissue cocktail: clinical outcomes in the past 10 years. Aesthet Surg J 2013; 33:639-53. [PMID: 23813395 DOI: 10.1177/1090820x13493904] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Facial rejuvenation by autologous fat transfer is common in aesthetic plastic surgery. The main drawback is progressive resorption, requiring repeated harvesting and microfat grafting. OBJECTIVE The authors present a method for cryopreservation of excess harvested fat and tissue to enable subsequent use of previously harvested excess material. METHODS Fat grafts were harvested using a 50-mL syringe and a 3- or 4-mm cannula. A tissue "cocktail" composed of dermis, fascia, and fat was prepared from excised scar tissue, tissue from abdominoplasty, or tissue from reduction mammaplasty. Cocktail specimens were placed in sterile tubes, immersed in a liquid nitrogen tank (-196°C), and stored at -80°C. At 3- to 6-month intervals, repeated cryopreserved fat graft injections were performed. Patients were evaluated by comparing preoperative and postoperative photographs. RESULTS Between 2000 and 2010, a total of 5199 cryopreserved fat or tissue injections were performed in 2439 consecutive patients (age range, 19-80 years). Nasolabial folds and lips were the most common injection sites. Clinical outcomes were satisfactory, and improved contour was achieved in most patients after repeated injections. CONCLUSIONS Cryopreservation of excess tissue for future injection is promising since repetitive injections are often required after resorption of microfat grafts. In our study, the survival of cryopreserved tissue cocktail or fat was comparable to that of fresh fat grafts and is therefore an effective adjuvant method for facial rejuvenation.
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Calf lipo-reshaping. J Plast Reconstr Aesthet Surg 2013; 66:956-61. [DOI: 10.1016/j.bjps.2013.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/06/2013] [Accepted: 03/09/2013] [Indexed: 11/22/2022]
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de la Peña-Salcedo JA, Soto-Miranda MA, Lopez-Salguero JF. Calf implants: a 25-year experience and an anatomical review. Aesthetic Plast Surg 2012; 36:261-70. [PMID: 21959790 DOI: 10.1007/s00266-011-9812-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 08/22/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Body contouring in the calf region is becoming a more frequently requested procedure. There are several techniques for calf enhancement, including implants, liposuction, and free flaps. Alloplastic augmentation can be performed with several implant types and several layers of pocket dissection. We present our 25 years of experience using the subfascial technique for calf implantation along with an anatomical study to illustrate all the important steps and relevant anatomy of this augmentation technique. METHODS The subfascial technique was performed in 25 cadavers, in which the important layers were dissected for high-resolution photos of the surgery to learn about the relevant anatomy of the region. Also, we did a retrospective study of our experience with calf implants, studying the aesthetic outcome, the presence of early complications, and the presence of late complications. RESULTS We performed dissections in 25 cadavers and surgery in 63 patients (126 implants). In our series of patients the final aesthetic index was of 9.8. The early complications were severe postoperative pain (11.11%), infection (0.79%), seroma (21.42%), hematoma (0%), and wound dehiscence (7.14%). The late complications were capsular contracture (Baker grades III and IV) (3.17%), implant rupture (1.58%), implant leaking (0%), implant displacement (3.96%), numbness at the ankle (2.38%), and palpability of the implant (0%). CONCLUSION The subfascial technique for calf augmentation has complication rates low enough and surgical outcomes good enough to recommend it as the gold standard for alloplastic calf augmentation.
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Wilson A, Butler PE, Seifalian AM. Adipose-derived stem cells for clinical applications: a review. Cell Prolif 2011; 44:86-98. [PMID: 21199013 PMCID: PMC6496460 DOI: 10.1111/j.1365-2184.2010.00736.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 08/27/2010] [Indexed: 01/05/2023] Open
Abstract
The use of stem cells derived from adipose tissue as an autologous and self-replenishing source for a variety of differentiated cell phenotypes, provides a great deal of promise for reconstructive surgery. In this article, we review available literature encompassing methods of extraction of pluripotent adipose stem cells (ASCs) from lipoaspirate locations, their storage, options for culture, growth and differentiation, cryopreservation and its effect on stem cell survival and proliferation, and new technologies involving biomaterials and scaffolds. We will conclude by assessing potential avenues for developing this incredibly promising field.
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Affiliation(s)
- A Wilson
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, UK
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Agaoglu G, Erol OO. Additional references document the history of gluteal augmentation with cryopreserved fat. Aesthet Surg J 2010; 30:762; author reply 763. [PMID: 20884909 DOI: 10.1177/1090820x10381749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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