Smoking and Physical Activity Significantly Influence Stromal Vascular Fraction Cell Yield and Viability.

BACKGROUND: Subcutaneous tissue is an abundant source of adipose-derived regenerative cells. It is readily available and easy to extract by means of liposuction, making it one of the most popular sources for tissue engineering and regenerative medical applications. METHODS: The stromal vascular fraction (SVF) cell yield and viability of the lipoaspirate obtained from 43 patients undergoing elective liposuction were examined in correlation with their age, gender, body mass index, smoking status, and physical activity. The lipoaspirate was processed with the Celution® 800/CRS system to isolate the SVF and a few drops of the obtained pellet were used for cell counting with NecleoCounter® NC-100TM. RESULTS: Twenty-eight (65.1%) were men and 15 (34.9%) were women with an average age of 40.7 ± 10.4 years (women) and 38.9 ± 11.8 years (men). Viable SVF cells/g fat was significantly correlated with smoking level (negative correlation, ρ= - 0.312, P < 0.05) and with marginal significance with female gender. Cell viability showed a significant negative correlation with physical activity level (ρ = - 0.432, P < 0.01); borderline significance for correlation of this parameter with smoking level should not be neglected. Other parameters did not influence the cell yield nor the viability of the stromal vascular fraction. CONCLUSION: Many factors may influence SVF cell yield and viability. Our findings indicate that age and smoking significantly influenced SVF cell yield, age positively while smoking negatively. Increased physical activity had a negative correlation with SVF cell viability. LEVEL OF EVIDENCE N/A: 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 .

Assessment of Female Genital Surgery Education in Plastic Surgery Training: Report of an Expert Opinion Survey.

BACKGROUND: Patient demand for aesthetic genital surgery has markedly increased. The International Society of Aesthetic Plastic Surgery reported 95,010 labiaplasties and 50,086 vaginal rejuvenation procedures in 2015. METHODS: We performed an online anonymous survey to evaluate the teaching of female genital procedures in plastic surgery training programs worldwide. RESULTS: A total of 1033 board certified plastic surgeons answered the survey. Most respondents were from the USA, Brazil, Mexico and Colombia. The majority of plastic surgeons performing these procedures were in private practice (77.62%) and (22.38%) in academic settings. Most plastic surgeons (75.63%) did not receive formal education in female genital rejuvenation procedures however 54.31% did receive education in reconstruction procedures. During their training, most were exposed to vaginal reconstruction (15.94%), labia minora reduction (11.9%), vulva reconstruction (11.53%), flaps for vaginal agenesis (11.39%) and monsplasty (7.98%). Additional training for female genital procedures was mostly at meetings and shadowing experts. Sixty-two percent reported that patients seldom requested those procedures, and 63.73% reported these procedures comprised less than 5% of their practice. The most commonly performed procedures were labia minora reduction, labia majora augmentation or reduction and monsplasty. The materials used were mostly fat grafting, hyaluronic acid injections and lasers. CONCLUSION: Additional formal training during residency for aesthetic genital surgery would be beneficial. Additionally, courses at meetings would be useful for plastic surgeons who have had insufficient training. More studies need to be conducted on the different female genital rejuvenation procedures offered in order to evaluate patients' long-term outcomes and satisfaction. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Role of International Volunteers in the Growth of Surgical Capacity in Post-earthquake Haiti.

BACKGROUND: The 2010 Haiti earthquake severely strained local healthcare infrastructure. In the wake of this healthcare crisis, international organizations provided volunteer support. Studies demonstrate that this support improved short-term recovery; however, it is unclear how long-term surgical capacity has changed and what role volunteer surgical relief efforts have played. Our goal was to investigate the role of international surgical volunteers in the increase of surgical capacity following the 2010 Haiti earthquake. METHODS: We retrospectively analyzed the operative reports of 3208 patients at a general, trauma and critical care hospital in Port-au-Prince from June 2010 through December 2013. We collected data on patient demographics and operation subspecialty. Surgeons and anesthesiologists were categorized by subspecialty training and as local healthcare providers or international volunteers. We performed analysis of variance to detect changes in surgical capacity over time and to estimate the role volunteers play in these changes. RESULTS: Overall number of monthly operations increased over the 2.5 years post-earthquake. The percentage of orthopedic operations declined while the percentage of other subspecialty operations increased (p = 0.0003). The percentage of operations performed by international volunteer surgeons did not change (p = 0.51); however, the percentage of operations staffed by volunteer anesthesiologists declined (p = 0.058). The percentage of operations performed by matching specialty- and subspecialty-trained international volunteers has not changed (p = 0.54). CONCLUSIONS: Haitian post-earthquake local and overall surgical capacity has steadily increased, particularly for provision of subspecialty operations. Surgical volunteers have played a consistent role in the recovery of surgical capacity. An increased focus on access to surgical services and resource-allocation for long-term surgical efforts particularly in the realm of subspecialty surgery may lead to full recovery of surgical capacity after a large and devastating natural disaster.

A modified approach to component separation using biologic graft as a load-sharing onlay reinforcement for the repair of complex ventral hernia.

BACKGROUND: Components separation has been proposed as a means to close large ventral hernia without undue tension. We report a modification on open components separation that allows for the incorporation of onlaid noncrosslinked porcine acellular dermal matrix (Strattice, LifeCell Corp, Branchburg, NJ) as a load-sharing structure. METHODS: This was a retrospective case series including all cases using Strattice from July 2008 through December 2009. Data evaluated included patient demographics, comorbidities associated with risk of recurrence, hernia grade, and postoperative complications. The primary outcomes were hernia recurrence and surgical site occurrences. RESULTS: There were 58 patients; 60.8% presented with a recurrent incisional hernia. Average length of follow-up was 384 days. There were 4 hernia recurrences (7.9%). Complications included surgical site infection (20.7%), seroma (15.5%), and hematoma (5%) requiring intervention. Four deaths occurred in the series due to causes unrelated to the hernia repair, only 1 within 30 days of operation. CONCLUSIONS: This series demonstrates that components separation reinforced with noncrosslinked porcine acellular dermal matrix onlay is an efficacious, single-stage repair with a low rate of recurrence and surgical site occurrences.

The expanded inframammary fold triangle: Improved results in large volume breast reductions.

CONTEXT: The inferior pedicle, Wise-pattern reduction mammaplasty is the most popular technique for breast reduction because of its reproducible results and reliability. However, complication rates in super obese patients or patients receiving large volume reductions are high, ranging from 35 to 78%. These complications include delayed healing, infection, seroma, nipple-areolar complex necrosis, fat necrosis and development of hypertrophic scars. AIMS: This study aimed to determine whether a modification to the standard Wise-pattern reduction technique, an expanded inframammary fold skin triangle, produces improved outcomes in high-risk large volume breast reduction patients. We report that this modification leads to improved outcomes by decreasing wound complications and improving aesthetic appearance. SETTINGS AND DESIGN: Twenty-two patients received the inferior pedicle Wise-pattern reduction mammaplasty, which was modified to include an 8 cm wide inferior pedicle. This pedicle was de-epithelialized and an 8 × 3 cm(2) triangle of skin was preserved at the inferior base to reduce tension at the triple point, inverted T-closure. MATERIALS AND METHODS: A retrospective review was performed on all patients who underwent reduction mammaplasty with the expanded inframammary fold (eIMF) technique as well as all patients who received the standard wise pattern technique. STATISTICAL ANALYSIS USED: A student t-test was performed for both reduction populations using SPSS software package. Statistical significance was defined as P < 0.05. RESULTS: The average patient age was 32.25 years old (range 18-59), average BMI was 35.0, and average tissue mass removed per breast was 1378.39 g. The modified technique was found to produce a statistically significant (P < 0.05) increase in the amount of breast tissue removed (693.96 g increase in the left and 571.21 g in the right) as well as a statistically significant (P < 0.05) reduction in dehiscence (75% reduction) and post-operative infection (44.10%). CONCLUSIONS: This method is an easily reproducible and reliable technique that produces a favourable cosmetic outcome with acceptable, sustainable results in high-risk reductions in obese patients.

Incisional negative-pressure wound therapy versus conventional dressings following abdominal wall reconstruction: a comparative study.

BACKGROUND: Improvements in surgical techniques have allowed us to achieve primary closure in a high percentage of large abdominal hernia repairs. However, postoperative wound complications remain common. The benefits of negative-pressure wound therapy (NPWT) in the management of open abdominal wounds are well described in the literature. Our study investigates the effects of incisional NPWT after primary closure of the abdominal wall. METHODS: A retrospective chart review was performed for the period between September 2008 and May 2011 to analyze the outcomes of patients treated postoperatively with incisional NPWT versus conventional dry gauze dressings. Patient information collected included history of abdominal surgeries, smoking status, and body mass index. Postoperative complications were analyzed using χ exact test and logistic regression analysis. RESULTS: Fifty-six patients were included in this study; of them, 23 were treated with incisional NPWT, whereas 33 received conventional dressings. The rates of overall wound complications in groups I and II were 22% and 63.6%, respectively (P = 0.020). The rates of skin dehiscence were 9% and 39%, respectively (P = 0.014). Both outcomes achieved statistical significance. Rates of infection, skin and fat necrosis, seroma, and hernia recurrence were 4%, 9%, 0%, and 4% for group I and 6%, 18%, 12%, 9% for group II, respectively. CONCLUSIONS: This study suggests that incisional NPWT following abdominal wall reconstruction significantly improves rates of wound complication and skin dehiscence when compared with conventional dressings. Prospective, randomized, controlled studies are needed to further characterize the potential benefits of this therapy on wound healing after abdominal wall reconstruction.

Comparison of 3 techniques of fat grafting and cell-supplemented lipotransfer in athymic rats: a pilot study.

BACKGROUND: Given the wide application of autologous fat grafting, a new emphasis on fat processing techniques has emerged in an effort to limit unpredictable degrees of resorption often seen with this procedure. With the growing interest in regenerative medicine, approaches to supplement fat grafts with adipose-derived stem cells are evolving in hopes of promoting vascularization and neoadipogenesis. OBJECTIVE: The authors evaluated the outcomes of the most common processing techniques for fat grafting--decantation, washing, high-speed centrifugation--and stromal vascular cell-supplemented lipotransfer to determine which method yields a higher percentage of retention and better quality graft. METHODS: A total of 32 subcutaneous injections of processed human lipoaspirate were carried out in 8 athymic rats. Each animal received all 4 processing conditions, with end points at 4, 8, and 12 weeks postinjection. Evaluation of graft survival included serial measurements of volume retention and histologic analysis. RESULTS: At 12 weeks postinjection, cell-supplemented and centrifuged grafts showed the most consistent volume maintenance. Based on histologic analysis, cell-supplemented and washed grafts had higher scores of viability and vascularity, with the former presenting the least cystic necrosis and calcification as well as minimal inflammation. CONCLUSIONS: Cell-supplemented lipotransfer had optimal outcomes for graft retention, viability, and vascularity, while washing resulted in high viability with a less intensive process. High-speed centrifugation resulted in consistent volume retention but lower viability. Each of these approaches is ideal under different circumstances and contributes to the versatility and reliability of fat grafting.

Significant predictors of complications after sternal wound reconstruction: a 21-year experience.

BACKGROUND: We sought to identify patient comorbidities that predict complications after tissue flap sternal reconstruction. METHODS: A retrospective study, December 1989 to December 2010, analyzed numerous comorbidities, including diabetes mellitus (DM), hypertension (HTN), coronary artery disease, congestive heart failure (CHF), and renal insufficiency, as independent risk factors for postoperative complications. Pearson χ2 test, Fisher exact test, 2-sample t test, and median-unbiased estimation were used for data analysis. Significance was P≤0.05. RESULTS: In all, 106 patients received 161 sternal tissue flap repairs. Nineteen patients (18%) required reoperation because of complications, including recurrent wound infection, tissue necrosis, wound dehiscence, mediastinitis, and hematoma formation. Our analysis found DM, HTN, and CHF as significant predictors of complications after sternal reconstruction (P=0.014, 0.012, and 0.006). CONCLUSIONS: Results suggest DM, HTN, and CHF may contribute to complications after tissue flap repair of sternal wounds, possibly through impaired perfusion and healing of repairs.

The post-adjustable gastric band abdominoplasty.

Serious complications associated with post-laparoscopic adjustable gastric band (LAGB) abdominoplasty have been reported in the medical literature. Furthermore, others have noted aesthetic problems with closure of the umbilicus due to apparatus port proximity. Currently, no clinical protocol or formal industry guidance for LAGB apparatus management during abdominoplasty is available in the medical literature. In this article, the authors describe their procedure for safe LAGB apparatus management during abdominoplasty and illustrate key surgical principles by presenting unique cases from their series of 20 patients treated with this technique.

Fat Grafting as Regenerative Surgery: A Current Review.

SUMMARY: Autologous fat grafting has long been regarded as an ideal filler, lauded for its ability to restore soft-tissue contour. In recent times, fat grafting has exhibited regenerative capacity, largely secondary to the action of adipose-derived stem cells and preadipocytes in the stromal vascular fraction of adipose tissue. This has birthed a new field of regenerative surgery with benefits germane to scarring, fibrosis, atrophy, burns, neuropathic pain, and autoimmune disease. The broad clinical applications of regenerative fat grafting have the potential to improve quality of life through functional and aesthetic improvement. Fat grafting has the potential to serve as a regenerative option for difficult clinical problems that cannot be treated effectively at the present time. Fat grafting also exhibits angiogenic and immunomodulatory properties in the context of autoimmune disease. The broad clinical applications of regenerative fat grafting have the potential to improve quality of life both functionally and aesthetically. It may present a less invasive avenue for clinical issues that today necessitate conventional surgical techniques. However, regenerative fat grafting is still in its infancy; further research is required to ascertain evidence-based protocols for the various clinical indications and better understand the precise regenerative mechanisms after fat grafting.

Triple suture for neck contouring: 14 years of experience.

BACKGROUND: Preferred techniques for rejuvenation and contouring of the neck region have evolved over the past 40 years. A slender neckline is recognized as an attractive feature of youth, whereas aging of the lower face often includes ptosis of the soft tissues of the chin and banding or cording of the muscles of the anterior and lateral neck. Aesthetic rejuvenation of the face and neck involves repositioning of poorly supported soft tissues. OBJECTIVES: The authors review their 14-year experience with a technique incorporating standard submental liposuction with a method of triple suturing the medial platysmal bands associated with lateral plication of the superficial muscular aponeurotic system (SMAS)-platysma. METHODS: Between 1994 and 2008, 507 patients (451 women and 56 men) were treated with this technique which consisted of placing a first line of sutures distributing tension between the medial platysmal bands and the anterior belly of the digastric muscles, a second single suture at the distal medial borders of the platysma, and a third running suture starting at the level of the thyroid cartilage up to the supramental region. In most cases, a lateral plication of the SMAS-platysma and a "stair-like" SMAS plication were performed in order to define the cervicomandibular line and treat midface flaccidity, respectively. RESULTS: Mean follow-up was eight years. Complications included hematomas (4.6%) and seromas (3.6%). Four percent of patients underwent a second procedure approximately seven years after their primary procedure. Overall the majority of patients exhibited long-lasting results satisfactory to both patients and surgeons. CONCLUSION: The triple-suture technique for neck contouring creates a median vertical vector of traction, whereas lateral plication produces a lateral posterior oblique vector. The combination of these two procedures is an easily reproducible and reliable option for surgeons when patients are seeking a more youthful appearance of the neck.

Plication of the brachial fascia: an important step in dermolipectomy procedures of the arm.

BACKGROUND: Both the aging process and postobesity deformities of the upper extremities are associated with lipodystrophy, loss of muscular mass, weakening of the fascia, and skin laxity. Many different surgical procedures have been described to correct these deformities, but most of them have limitations, particularly with respect to postsurgical scarring. OBJECTIVES: The authors present a technique in which plication of the brachial fascia is performed before dermolipectomy in order to obtain greater flap advancement and limit tension on the final scars, thereby diminishing postoperative complications. METHODS: From 1997 to 2007, the authors retrospectively followed 41 female patients who had undergone brachial dermolipectomy procedures associated with plication of the fascia on the internal aspect of the arm. This technique permitted greater advancement of the entire thickness of the flap, creating a better support for the flap with larger skin resection. The distance between the two incisions was also shortened, reducing dead space between the two planes, the incidence of seromas, and tension on the suture line. RESULTS: The scarring complications caused by tension on the skin were eliminated. Therefore, our complication rate was low, with only three cases of small foci of dehiscence, two cases of seroma, and four cases of hypertrophic scars in certain areas. The mean follow-up period was seven years, during which 92% of the patients were pleased with their outcomes. CONCLUSIONS: The described surgical approach provided excellent overall extremity contour with favorable scars while simultaneously addressing axillary contour and forearm deformities when present.

Effects of centrifugation on cell composition and viability of aspirated adipose tissue processed for transplantation.

BACKGROUND: Centrifugation is one of the preferred methods of fat processing. Although it has been promoted for nearly three decades to separate adipose tissue components before grafting, there remain many controversies regarding the results obtained with centrifuged adipose tissue. OBJECTIVES: The authors demonstrate the effects of centrifugation on the cellular components of aspirated fat. METHODS: Fat harvested from the lower abdomen of 10 female patients undergoing liposuction was divided in two equal parts, then processed by decantation or centrifugation and sent to the laboratory. Each processed lipoaspirate was analyzed histologically after hematoxylin and periodic acid-Schiff staining for the presence of intact adipocytes. It was then cultured and analyzed by multicolor flow cytometry for identification of adipose-derived mesenchymal stem cells. RESULTS: The middle layer of the centrifuged lipoaspirate, which is used by many surgeons, showed a great majority of altered adipocytes and very few mesenchymal stem cells in comparison with the decanted sample, which maintained the integrity of the adipocytes and showed a greater number of mesenchymal stem cells. The pellet observed as a fourth layer at the bottom of the centrifuged lipoaspirate showed the greatest concentration of endothelial cells and mesenchymal stem cells, which play a crucial role in the angiogenic and adipogenic effect of the grafted tissue. CONCLUSIONS: If centrifuged lipoaspirate is used, the pellet (rich in adipose-derived mesenchymal stem cells) and the middle layer should be employed to increase fat graft survival.

A 3-step Mechanical Digestion Method to Harvest Adipose-derived Stromal Vascular Fraction.

BACKGROUND: Adipose stromal vascular fraction (SVF) isolation with enzymatic digestion is the gold standard, but is expensive, having practical and legal concerns. The alternative mechanical SVF isolation methods provide lower cell yields as they employ either centrifugation, emulsification, or digestion steps alone. We combined mechanical processing with buffer incubation and centrifugation steps into an isolation method called "mechanical digestion" and compared the cell yields with that of enzymatic digestion. METHODS: A total of 40-mL lipoaspirate was harvested from 35 women undergoing liposuction and was submitted to conventional enzymatic digestion for SVF isolation or mechanical digestion using a closed unit harnessing 3 ports with blades, followed by buffer incubation and centrifugation. Culture of the SVFs and flow cytometry were performed. RESULTS: The SVF cell yield obtained by enzymatic digestion was significantly higher 3.38 × 106/mL (±3.63; n = 35) than that obtained by mechanical digestion 1.34 × 106/mL (±1.69; n = 35), P = 0.015. The average cell viability was 82.86% ± 10.68 after enzymatic digestion versus 85.86% ± 5.74 after mechanical digestion, which was not significant. Mechanical digested SVF expressed 2-fold higher stem cell surface markers compared with enzymatically digested SVF. Mechanical digestion was less time consuming, cost effective, and did not require a specific laboratory environment. CONCLUSIONS: Mechanically digested SVF was comparable to enzymatically digested SVF in terms of stromal cell composition and viability. With mechanical digestion, we can isolate 30%-50% SVF cells of that isolated with enzymatic digestion. Further studies are warranted to determine the clinical outcomes.

An Enzyme-free Method for Isolation and Expansion of Human Adipose-derived Mesenchymal Stem Cells.

Mesenchymal stem cells (MSCs) are a population of multipotent cells that can be isolated from various adult and fetal tissues, including adipose tissue. As a clinically relevant cell type, optimal methods are needed to isolate and expand these cells in vitro. Most methods to isolate adipose-derived MSCs (ADSCs) rely on harsh enzymes, such as collagenase, to digest the adipose tissue. However, while effective at breaking down the adipose tissue and yielding a high ADSC recovery, these enzymes are expensive and can have detrimental effect on the ADSCs - including the risks of using xenogeneic components in clinical applications. This protocol details a method to isolate ADSCs from fresh lipoaspirate and abdominoplasty samples without enzymes. Briefly, this method relies on mechanical disassociation of any bulk tissue followed by an explant-type culture system. The ADSCs are permitted to migrate out of tissue and onto the tissue culture plate, after which the ADSCs can be cultured and expanded in vitro for any number of research and/or clinical applications.

"Brazilian Butt Lift" Performed by Board-Certified Brazilian Plastic Surgeons: Reports of an Expert Opinion Survey.

BACKGROUND: Gluteal fat augmentation has increased worldwide, and so have major complications. Brazilian plastic surgeons have been performing this procedure for more than 30 years, and more often every year. Therefore, the authors performed a study among board-certified plastic surgeons, members of the Brazilian Society of Plastic Surgery, to evaluate their techniques; identify their preferences, complications, and outcomes with this procedure; and make some recommendations. METHODS: An anonymous Web-based survey consisting of 16 questions was sent to 5655 members in July of 2017. A supplementary survey was subsequently sent to obtain more information about major complications. RESULTS: A total of 853 responses were analyzed. The highest percentage of responses in the different categories were as follows: fat decantation for processing, injection with a 3-mm-diameter cannula, use of superior incisions, subcutaneous fat grafting only, and with a volume of 200 to 399 ml of fat per buttock. The majority of surgeons received training in this procedure during residency. The most common complications were contour irregularities. The estimated mortality rate was one in 20,117 cases, and the rate of nonfatal fat embolism was one in 9530. The risk of death was 16 times greater when fat was injected intramuscularly. CONCLUSIONS: Based on this survey, the authors recommend injecting fat only subcutaneously, by means of superior incisions, using cannulas 3 mm in diameter or more. They find that by following these recommendations, this procedure can be as safe as any other. More research to establish guidelines and increase its safety is necessary.

Subcutaneous-Only Gluteal Fat Grafting: A Prospective Study of the Long-Term Results with Ultrasound Analysis.

In recent years, gluteal fat augmentation has exhibited some of the most significant growth among all plastic surgery procedures. However, as the popularity of and media attention to gluteal fat augmentation continue to rise, reports of fatalities, largely attributed to fat embolism, have raised valid concerns. Many plastic surgeons inject fat in the intramuscular plane and claim better graft take in the muscles and the possibility of injecting more volume in the gluteal region. Because of the large caliber of vessels, subcutaneous fat augmentation has been a preference of many. However, the long-term outcome of fat injected into the subcutaneous layer has been questionable, and there is a lack of prospective quantitative studies of subcutaneous-only fat grafting. Therefore, the authors evaluated the long-term maintenance of gluteal adipose thickness when fat was injected only subcutaneously. Fifty consecutive female patients were evaluated in this prospective clinical study. All patients underwent gluteal fat augmentation in the subcutaneous plane only. Ultrasound analysis of the adipose tissue thickness of the gluteal region was performed preoperatively, immediately postoperatively, and at 12 months postoperatively. Immediate postoperative measurements revealed an average increase in gluteal subcutaneous layer thickness of 56.51 percent (range, 39.5 to 108.6 percent) (p < 0.0001). At 12 months postoperatively, the gluteal adipose tissue thickness decreased by an average of 18.16 percent (range, 6.8 to 24.8 percent) (p < 0.0001). Subcutaneous-only gluteal fat augmentation is shown to be as effective as previous studies reporting intramuscular fat injection with regard to long-term fat retention in the buttocks. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Use of Tranexamic Acid to Reduce Blood Loss in Liposuction.

BACKGROUND: The use of tranexamic acid for blood loss prevention has gained popularity in many specialties, including plastic surgery. However, its use in liposuction has not been studied. The authors present a prospective, double-blind, nonrandomized study evaluating the efficacy of tranexamic acid in reducing perioperative blood loss during liposuction. METHODS: Twenty women undergoing liposuction were divided into two cohorts. Group 1 (n = 10) received a standard dose of 10 mg/kg of tranexamic acid intravenously in the preoperative and postoperative periods, whereas group 2 (n = 10) received a placebo. Patient hematocrit levels were evaluated preoperatively and postoperatively. Blood volume in the infranatant of the lipoaspirate was also measured; t tests were used for statistical analysis. RESULTS: Age, body mass index, and volume of lipoaspirate were comparable between the two cohorts. The volume of blood loss for every liter of lipoaspirate was 56.2 percent less in the tranexamic group compared with the control group (p < 0.001). Hematocrit levels at day 7 postoperatively were 48 percent less in group 1 compared with group 2 (p = 0.001). Furthermore, a 1 percent drop in the hematocrit level was found after liposuction of 812 ± 432 ml in group 1 and 379 ± 204 ml in group 2. Thus, the use of tranexamic acid could allow for aspiration of 114 percent more fat, with comparable variation in hematocrit levels. CONCLUSIONS: Tranexamic acid has been shown to be effective for minimizing perioperative blood loss in liposuction. Further large randomized controlled studies are required to corroborate this effect. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.