Redefining Abdominal Contours: An Analysis of Medium Definition Liposuction Abdominoplasty.

INTRODUCTION: This study elucidates the application of Medium Definition Liposuction Abdominoplasty, a novel technique for achieving well-defined abdominal contours. The technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. METHODS: Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. Digital image measurements facilitated by an image software constituted the basis for these assessments. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites, with two measurements taken at each site and subsequently averaged. RESULTS: Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. However, complications such as partial diminution of tension in the muscular wall (2%), distal flap necrosis (0.6%), and minor muscular hernia (0.3%) were observed. CONCLUSION: The employment of combined muscle plication emerges as an efficacious methodology in meticulously rectifying alterations inherent within the muscular aponeurotic abdominal wall. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. BULLET POINTS: The study introduces a novel technique, Medium Definition Liposuction Abdominoplasty, for achieving well-defined abdominal contours. This technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites. Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluating the Role of Rectus Abdominis Fat Transfer (RAFT) in Improving Muscle Thickness: Does it Really Work? A 12-Month Follow-Up Cohort Study.

BACKGROUND: Looking for an adequate solution for those patients who desire abdominal definition, but are not candidates for liposuction alone, Danilla developed a technique, using selective fat grafting into the rectus abdominis (RAFT) to increase the muscle volume in addition to selective liposuction and abdominoplasty to provide an optimal body contouring. OBJECTIVE: To determine whether intramuscular fat grafting in the rectus abdominis muscles leads to an increase in muscle thickness after one year. METHODS: This is a prospective cohort study, from a single center, carried out over 24 months (October 2021-September 2023). Sixty-two patients who underwent lipoabdominoplasty and RAFT, had their rectus abdominis cross section measured by ultrasound pre- and 12 months postoperatively. To compare the muscle thickness, a paired t-test statistic was used. A p-value of 0.05 was considered statistically significant (IBM SPSS Statistics V26). RESULTS: After 1 year, all 62 patients showed an increase in the size of the rectus muscle cross section, although only 58 (94%) had fat identifiable in the US. Preoperatively, the mean muscle cross-sectional size was 1, 4 cm. After RAFT, overall mean muscle cross section was 2, 3 cm (0, 9 cm/66.9% increase). When stratified into groups with and without identifiable fat, the group in which the graft remained showed greater increase than the group with no visible fat (69, 9% vs 19,6%). CONCLUSION: The RAFT provided a significant increase in the muscle cross section in most cases after 1 year. The presence of fat is related to a statistically significant increase in the muscle compartment (pack). 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 .

Prevention of Umbilical Sagging After Medium Definition Liposuction.

BACKGROUND: The loss of the umbilical vertical axis, causing a horizontal shape deformity after liposuction, is a current aesthetic issue. The use of energy devices, such as LASER and VASER, has been advocated as an option for improving skin retraction, but no data are available on the prevention of umbilical sagging. OBJECTIVES: The authors sought to describe a technique for preventing umbilical deformities after medium definition liposuction employing suction-assisted liposuction. METHODS: Over a period of 31 months, 62 patients underwent medium definition liposuction with direct needle fixation of the umbilical stalk to prevent horizontal umbilical deformities. All patients underwent surgery performed by a single surgeon (G.B.). All patients underwent objective measurements of the umbilical shape before and after the procedure utilizing digital image measurements by Mirror Image software, version 6.0 (Fairfield, NJ). Statistical analysis was performed with IBM SPSS Statistics V26. The mean age of the patients was 28.8 years. The follow-up evaluation was performed 2 weeks and 9 months postoperatively. RESULTS: Over a period of 31 months, 60 patients (96.7%) who underwent abdominal etching liposuction showed maintenance of (n = 9, 14.5%) or improvements in the umbilical shape 9 months postoperatively (n = 51, 82.2%, P < 0.05). Two patients (3.2%) experienced worsening of the umbilical shape after surgery despite suture fixation. CONCLUSIONS: Horizontal shape deformities of the umbilicus after liposuction can be improved by utilizing direct needle fixation of the umbilical stalk. The approach has been shown to be effective, safe, and reproducible for the prevention of umbilical sagging in selected patients.

Surgical Correction of Abdomen Irregularities after Liposuction: Case Series.

Background: The occurrence of surface irregularities in the abdomen after liposuction is frequent and can be due to the fact that more liposuctions are being done nowadays, and perhaps, the fact that more noncore surgeons are doing it could be an important factor. These superficial changes compromise the aesthetic results of surgery, and their correction is a major technical challenge. Methods: The author presents a systematized approach for surgical treatment of fibrosis and post liposuction irregularities. Twenty-three patients underwent liposuction and abdominoplasty or mini abdominoplasty by a single surgeon (G.B.B.) over a period of 24 months to correct superficial abdominal wall irregularities after previous liposuction. All patients underwent evaluation through digital photography by two independent senior plastic surgeons according to an objective aesthetic outcome scale, 12 months after the operation. Results: All 23 patients showed an improvement in the appearance of the abdominal wall according to the aesthetic outcome scale used. Eighty-seven percent of the patients operated on in this series had previously undergone liposuction using technologies and 4.3% underwent liposuction alone. The overall minor complication rate was 26%. No major complications were noted. Conclusions: The combination of liposuction, direct fibrosis removal, and flap tensioning (abdominoplasty or mini abdominoplasty) could correct in this series the multiple factors (fibrosis, skin laxity, residual fat deposits post liposuction) related to abdominal wall surface irregularities in a safe, effective, and reproducible manner.

Surgical Correction of Low-positioned Umbilicus after Mini-abdominoplasty.

Background: The umbilicus detachment and reinsertion in umbilical float mini-abdominoplasty results in its lower position with or without shape distortion. This event creates a stigmatizing look, elongating the upper abdomen and creating variable grades of infra umbilical/pubis bulging. This lack of proportion causes an unpleasant, artificial look, and is very difficult to fix. The study aimed to describe a sequence of abdominoplasty and combined upper abdomen horizontal muscle plications to correct umbilicus malposition after a mini-abdominoplasty. Methods: Over a period of 24 months, 12 patients underwent a liposuction (suction-assisted liposuction) and abdominoplasty with horizontal supraumbilical muscle plication. All patients underwent objective measurements before and after the procedure, using digital image measurements by Mirror Image software, version 6.0 (Fairfield, N.J.). The follow-up evaluation was performed 12 months postoperatively. Statistical analysis was performed using IBM SPSS Statistics V26. Results: Over 24 months, 12 patients (100%), who underwent abdominoplasty combined with horizontal plication in the upper abdominal wall, have shown adequate umbilicus elevation (2.98 ± 0.242 cm; 95% confidence level), restoring the abdominal muscle wall proportion at 12 months follow-up. One patient (8%) had a seroma, and one (8%) had a small muscular hernia (1.5 cm) in the lower abdomen. Conclusions: The combination of abdominoplasty and upper horizontal muscle plication can fix the malpositioned umbilicus, restoring the aesthetic and anatomic proportions in those patients who underwent an umbilical float mini-abdominoplasty.

Medium Definition Liposuction Abdominoplasty.

Not all patients who exercise regularly and follow a balanced diet will obtain a well-defined abdomen. Medium definition liposuction, together with the removal of abdominal skin, can recreate an adequate connection between the skin/subcutaneous components and the myo-aponeurotic layer, resulting in the perception of muscle definition. Methods: Over a period of 36 months, 351 patients underwent medium definition liposuction associated with abdominoplasty performed by a single surgeon (G.B.). All patients underwent an evaluation through digital photographs by two independent senior plastic surgeons, using an objective grading system for aesthetic outcomes proposed by Strasser, 12 months after the operation. Results: According to the Strasser Scale, 326 patients (93%) were considered to have good and excellent results. Twenty-two patients (6.2%) had moderate/mediocre results' and three patients (0.8%) had poor results. The overall complication rate was 4.8%. Conclusion: Medium definition liposuction associated with abdominoplasty has been shown to be effective, safe, and reproducible for most patients.

Preoperative Use of Dexamethasone in Rhinoplasty: A Randomized, Double-blind, Placebo-Controlled Clinical Trial.

IMPORTANCE: Postoperative edema and ecchymosis following rhinoplasty are a cause of anxiety for both patients and physicians and can affect the cosmetic results. Corticosteroids have been used to reduce these events. OBJECTIVE: To determine whether preoperative use of dexamethasone sodium phosphate alters the occurrence of edema and ecchymosis following rhinoplasty. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled clinical trial at an institutional referral center among a sample of individuals with rhinomegaly. INTERVENTIONS: Patients were randomized into 2 groups. In group 1, dexamethasone was intravenously injected before surgery. In group 2, normal saline solution was intravenously injected before surgery. MAIN OUTCOMES AND MEASURES: When patients returned at 1 week after surgery, standardized photographs were obtained. The photographs were analyzed by 5 plastic surgeons who were blinded as to whether dexamethasone or normal saline solution had been injected. The plastic surgeons rated the degree of edema and ecchymosis. RESULTS: Forty-two patients participated in the study. Randomization by lottery resulted in 20 patients in group 1 and 22 patients in group 2. Group 1 showed lower rates of postoperative ecchymosis than group 2; the difference of 0.62 (P = .02) reflects less perceived ecchymosis when dexamethasone was administered. Group 1 also showed lower rates of postoperative edema than group 2; the difference of 0.68 (P = .01) reflects less perceived edema when dexamethasone was administered. CONCLUSIONS AND RELEVANCE: Preoperative use of dexamethasone reduced edema and ecchymosis at 7 days after rhinoplasty. Rigorous methods in this trial demonstrate the beneficial effect of preoperative corticosteroid administration in this surgical procedure. LEVEL OF EVIDENCE: 1.

Prognóstico da videocirurgia da região frontal com técnica modificada de fixação / Prognosis of frontal region video surgery with a modified fixation technique

INTRODUÇÃO: A videoendoscopia tem se estabelecido como procedimento de escolha no tratamento da ptose do supercílio e das rugas da região frontal. O acesso minimamente invasivo produz vantagens em relação à tradicional incisão coronal. Diversos métodos de fixação são relatados na literatura, apresentando resultados semelhantes. Nesta série de casos, descrevemos a fixação direta com agulha. OBJETIVO: Avaliar o prognóstico da videocirurgia, utilizando-se a técnica direta com agulha. MÉTODO: Avaliação fotográfica computadorizada de 37 pacientes submetidos à videoendoscopia da região frontal com a fixação direta com agulha, realizada em dois hospitais privados na cidade de Porto Alegre-RS. Resultados: A elevação média do supercílio foi de 5,7 mm no terço lateral e de 4,4 mm no terço medial. Após um pequeno descenso da elevação, no primeiro mês pós-operatório, o reposicionamento do supercílio permaneceu inalterado nas medidas subsequentes até 24 meses. CONCLUSÃO: A fixação direta com agulha é capaz de produzir resultados duráveis, seguros e reprodutíveis no período em que foram realizadas as medições.

INTRODUCTION: Video endoscopy has become a procedure of choice for the treatment of eyebrow ptosis and forehead wrinkles. This minimally invasive technique has several advantages over traditional coronal incision. Several fixation methods are reported in the literature, with similar results. In this study, we describe direct needle fixation. OBJECTIVE: To evaluate the prognosis of video endoscopic surgery using a direct needle technique. METHOD: Computerized photographic evaluations of 37 patients undergoing video endoscopy of the frontal region with needle direct fixation were conducted in two private hospitals in the city of Porto Alegre in Rio Grande do Sul, Brazil. RESULTS: The mean eyebrow elevations were 5.7 and 4.4 mm in the lateral and middle third measurements. After a small dip in elevation in the first month after surgery, the repositioning of the eyebrow remained unchanged in subsequent measurements up to 24 months later. CONCLUSION: Direct needle fixation produced lasting, reliable, and reproducible results during the period in which measurements were made.

Otimização da marcação da incisão na dermolipectomia abdominal com emprego de molde padronizado / Optimization of incision marking in abdominoplasty using a standardized template", "_e": "n

A marcação pré-operatória da incisão na dermolipectomia abdominal tem papel fundamental na forma e no posicionamento da cicatriz resultante. Além da marcação, o descolamento, a tração e a ressecção dos tecidos excedentes também contribuem para esse desfecho. Após observação e análise estatística de 36 abdominoplastias, foi desenvolvido um molde de marcação pré-operatória que reproduz a forma das incisões consideradas adequadas do ponto de vista estético. A forma de incisão considerada adequada apresenta 3 segmentos de reta: um central, de 11 ± 0,4 cm, e 2 laterais angulados em 155 graus, com 16,5 ± 2,3 cm. O molde consegue reproduzir a forma das incisões consideradas adequadas de modo rápido, barato e reprodutível.

Preoperative marking of the incision in abdominoplasty plays a key role in the shape and position of the resulting scar. The undermining, traction, and resection of redundant tissue also influence these outcomes. After observation and statistical analysis of 36 abdominoplasty procedures, a preoperative marking template, which reproduces the incision shape that is considered the most suitable from an aesthetic point of view, was developed. The most suitable incision shape has 3 line segments: one central segment that is 11 cm ± 0.4 cm in length and 2 lateral segments that are 16.5 ± 2.3 cm in length at an angle of 155°. The template provides a quick, inexpensive, and consistent technique for reliably reproducing the suitable incision shape.