Evaluation of Non-invasive Fat Reduction Using a Resistive Electric Transfer-based Radiofrequency Device With Multi-channel Handpieces.

BACKGROUND/AIM: Various devices for non-invasive body shape correction are being developed along with the growth of the beauty industry. Radiofrequency (RF) can selectively reduce subcutaneous fat without causing skin damage. The efficacy of the procedure can be improved by applying RF to a large area simultaneously with multiple handpieces. This study evaluated the safety and efficacy of a new RF device with multi-channel handpieces. MATERIALS AND METHODS: In ex vivo experiments, the RF device was used to treat porcine tissue comprising the skin, subcutaneous, and muscle layers. The device's safety was evaluated by temperature measurements of porcine tissue and histological analysis. In in vivo experiments, the dorsal skin of pigs was treated with the RF device. The safety and efficacy of the device were evaluated by measuring the skin temperature, subcutaneous fat layer thickness, and conducting histological analysis. RESULTS: The skin temperature did not exceed the set temperature during treatment, and skin damage was not observed in histologic analysis in both ex vivo and in vivo experiments. In in vivo experiments, the subcutaneous fat layer thickness and subcutaneous lipocyte size were decreased after treatment. In addition, the fibrous tissue between subcutaneous lipocytes was increased in the RF treatment group compared with the non-treatment group. CONCLUSION: The RF device used in this study effectively reduced the size of subcutaneous lipocytes and increased fibrous tissue without skin damage. Therefore, the safe and effective use of this device for non-invasive fat reduction may be possible in clinical settings.

Comprehensive Evaluation of the BeShape One Device: Assessing Thermal Safety in Noninvasive Body Contouring Using Advanced Techniques.

OBJECTIVES: This study aims to assess the thermal safety profile of the BeShape One Device, a noninvasive, high-intensity, non-focused ultrasound device designed for reducing waist circumference. This device possesses several features that distinguish it from other commercial ultrasound-based fat reduction devices. The study focuses on evaluating temperature-related physiological changes through thermal safety analysis and histopathology in a swine model. MATERIALS AND METHODS: The study utilized three types of applicators-active, demo, and modified-to comprehensively assess the device's impact on various skin layers. Five female Large White X Landrace swine were involved in the study, and the BeShape One Device was applied to designated treatment sites using a specific treatment protocol. The assessment included clinical observations, skin reaction evaluations, gross pathology, histopathological analyses, and advanced temperature measurement techniques, including needle thermocouples, thermal cameras, COMSOL modeling, and CEM43 analysis. RESULTS: Clinical observations indicated the animals' overall well-being throughout the study. Skin reactions, including erythema, edema, bruising, and crust formation, were temporary and resolved over time. Gross pathology revealed no treatment-related pathologies, except for a discoloration related to a tattoo procedure. Histopathological analyses at 30 and 90 days posttreatment demonstrated an absence of heat-related lesions in skin layers. Needle thermocouples and thermal camera measurements supported the device's ability to maintain consistent thermal homogeneity. COMSOL modeling and CEM43 analysis predicted no thermal damage to the skin, confirming the safety of the BeShape One Device. CONCLUSIONS: Under the experimental conditions, the BeShape One Device demonstrated a favorable safety profile. Clinically and histopathologically, no adverse effects were observed. The device's ability to achieve thermal homogeneity in skin layers was validated through advanced temperature measurement techniques. COMSOL modeling and CEM43 analysis further supported the conclusion that the device is safe, making it a promising option for noninvasive body contouring procedures.

Employing machine learning for enhanced abdominal fat prediction in cavitation post-treatment.

This study investigates the application of cavitation in non-invasive abdominal fat reduction and body contouring, a topic of considerable interest in the medical and aesthetic fields. We explore the potential of cavitation to alter abdominal fat composition and delve into the optimization of fat prediction models using advanced hyperparameter optimization techniques, Hyperopt and Optuna. Our objective is to enhance the predictive accuracy of abdominal fat dynamics post-cavitation treatment. Employing a robust dataset with abdominal fat measurements and cavitation treatment parameters, we evaluate the efficacy of our approach through regression analysis. The performance of Hyperopt and Optuna regression models is assessed using metrics such as mean squared error, mean absolute error, and R-squared score. Our results reveal that both models exhibit strong predictive capabilities, with R-squared scores reaching 94.12% and 94.11% for post-treatment visceral fat, and 71.15% and 70.48% for post-treatment subcutaneous fat predictions, respectively. Additionally, we investigate feature selection techniques to pinpoint critical predictors within the fat prediction models. Techniques including F-value selection, mutual information, recursive feature elimination with logistic regression and random forests, variance thresholding, and feature importance evaluation are utilized. The analysis identifies key features such as BMI, waist circumference, and pretreatment fat levels as significant predictors of post-treatment fat outcomes. Our findings underscore the effectiveness of hyperparameter optimization in refining fat prediction models and offer valuable insights for the advancement of non-invasive fat reduction methods. This research holds important implications for both the scientific community and clinical practitioners, paving the way for improved treatment strategies in the realm of body contouring.

B-ultrasound-assisted gluteal fat grafting in Asians: A prospective study of quantitative results from three-dimensional imaging and B-ultrasound analysis.

BACKGROUND: The increasing number of fatalities caused by gluteal fat grafting is concerning; thus, there is a need to determine ways to obtain the ideal aesthetic effect while ensuring a safe operation. In this study, three-dimensional (3D) measurements combined with B-ultrasound were used to evaluate the effect of gluteal fat augmentation in Asians, whose safety and effectiveness were confirmed using quantitative data. METHODS: Thirty-five consecutive female patients were evaluated in this prospective clinical study. All patients underwent B-ultrasound-assisted gluteal fat augmentation on the subcutaneous plane alone. 3D imaging and B-ultrasound analysis of the adipose tissue thickness in the gluteal region were performed preoperatively and at 1 week, 3 months and 6 months post-operatively. RESULTS: The waist circumference of the patients decreased, gluteal circumference and length of the gluteal crease increased and average waist-to-hip ratio improved from 0.78 to 0.74. At 3 months and 6 months post-operatively, the adipose tissue thickness decreased by 5.1% and 15.1%, respectively. The fat retention rates calculated using 3D imaging measurements at 3 months and 6 months post-operatively were 77.9% and 64.7%, respectively. According to the BODY-Q scale scores, patients reported a high level of satisfaction post-operatively. CONCLUSIONS: B-ultrasound guidance can effectively prevent the occurrence of fatal fat embolism during gluteal fat grafting and maximise the augmentation effect. The quantitative data obtained using 3D measurements and B-ultrasound confirmed the safety and effectiveness of fat injections for gluteal augmentation under B-ultrasound guidance.

An Updated Analysis of Body Contouring Malpractice Cases.

INTRODUCTION: Body contouring procedures are commonly performed in the United States for patients seeking to sculpt specific areas of their bodies. The aim of this study was to provide an updated analysis of the factors that influence medical malpractice litigation surrounding body contouring surgery. METHODS: The following terms were used to search the Westlaw Campus Legal research Database for cases with earliest documentation after January 2013: ("contouring" OR "abdominoplasty" OR "liposuction" OR "tummy tuck" OR "body lift" OR "thigh lift" OR "arm lift" OR "brachioplasty" OR "thighplasty" OR "lipectomy" OR "panniculectomy") AND "surgery" AND "medical malpractice." Cases were only included if there was a complaint of medical malpractice subsequent to a body contouring procedure, and details of the cases were provided. Information was collected on the location of the lawsuit, the earliest year of available case documentation, patient demographics, procedure(s) performed, alleged injury, specialty involvement, and verdicts. RESULTS: A total of 32 cases were included in the study. Most of the patients involved in the cases were women (n = 30, 93.8%) and alive (n = 28, 87.5%). New York state had the most cases (n = 7, 21.9%). Abdominoplasty (56.3%), liposuction (53.1%), and buttock augmentations (15.6%) were the most common procedures. Plastic surgeons were involved in 93.8% (n = 30) of the cases, and anesthesia, emergency medicine, dermatology, and oncology were also involved. Claims of malpractice most often discussed negligent technique (71.9%) and poor postoperative management (62.5%). Common postoperative complications were infection/sepsis (40.6%), scarring (31.3%), and emotional distress/prolonged pain (31.3%). One available ruling was in favor of the plaintiff. CONCLUSION: Although many of the cases in this analysis cited negligent technique, none were founded in their argument. Because involvement in these cases can place a burden on attending physicians, clear expectations of postoperative infections, scarring, and prolonged pain should be addressed during the informed consent process.

Bioelectrical Impedance Analysis Detects Body Fat Changes After Surgical Subcutaneous Fat Removal.

Background: The risk and metabolic effects of obesity are determined by the distribution of fat throughout the body. It has been proposed that the distribution of abdominal fat is more closely related to the metabolic risks of obesity. High prevalence of overweight and obesity has thereby contributed to an increased uptake of surgical subcutaneous fat removal (SSFR) procedures. The goal of this study was to determine whether bioelectrical impedance analysis (Tanita system) can be used to detect the removal of excess abdominal subcutaneous fat tissue during SSFR when studying the metabolic effects of such procedures. Methods: Study population comprised patients who received body contouring procedures at the Hamad General Hospital's plastic surgery department between November 2020 and December 2022. To evaluate the factors of interest, subjects were prospectively followed up at two time points: within 1 week before the surgery and within 1-2 weeks thereafter. The following factors were measured: body weight, body fat percentage, body fat mass, body mass index (BMI), fat-free mass, estimated muscle mass, total body water, visceral fat score, and basal metabolic rate. Results: In total, 22 patients were included in the study. The two visits' medians for height, weight, BMI, fat percent (fat%), fat mass, visceral fat rating, and Doi's weighted average glucose (dwAG) were compared. Only in the case of Tanita fat% and fat mass, were the preoperative and postoperative medians significantly different. Furthermore, there was no association between these Tanita measures and dwAG or homeostatic model assessment (HOMA; insulin resistance [IR]) changes (before and after surgery). Tanita measures overestimated fat loss, as seen by the mountain plot and Bland-Altman plot agreement methods. Conclusions: Our findings indicated that the only two Tanita measures exhibited meaningful early associations with the amount of tissue excised which were fat mass and fat% differences. Although dwAG and HOMA-IR are not impacted immediately postsurgery, a trend was seen that suggested improvements in those parameters, even though the changes are not clinically significant.

Analysis of the Thigh Aesthetic Profiles: One of Physical Ideal Body Proportions.

BACKGROUND: The contour of the thigh is increasingly being recognized as crucial component of the ideal human physique, giving rise to heightened interest in attaining the perfect thigh profile. Notwithstanding, the contemporary landscape of cosmetic surgery appears to be bereft of efficient and precise objective methodologies to evaluate the outcomes of thigh contouring treatments. The present study is aimed to investigate the aesthetic appeal of varying thigh contours, employing specialized software as an indispensable instrument for quantitative and qualitative analysis. METHODS: Standardized photographs of the lower body were obtained from a sample of 200 healthy volunteers. A linear analysis was conducted, examining aspects such as the vertical length and transvers width of the thigh, as well as angular measurements including the posterior gluteal angle (PGA) and lateral angle thigh (LAT). Variables relating to thigh measurements and body mass index (BMI) were documented, with the relationships between them ascertained through Pearson's correlation and regression analysis. RESULTS: In males, the LAT was measured at 168 ± 3.9, and the PGA at 170 ± 3.4, while in females, these measurements were 166 ± 2.8 ve 166 ± 2.8, respectively. Linear analyses, including the vertical length of thigh (VLT), transverse width of thigh (TWT), lateral width (LW), and posterior width (PW), were conducted. Based on the LW inferior/LW superior ratio values, the most commonly observed thigh types were Type III (0.90) at 45% and Type II (0.85) at 24.75% while the least common was Type V at 4% (0.99). PW inferior/PW superior was 84.7%. The PWI/PWS ratio was highest for Type V, at 0.99, accounting for 84.70% of the total. Furthermore, an increase in the LWI/LWS ratio leads to an increase in the PWI/PWS ratio.  The frequency of the VLT/TW1 ratio 0.31-0.35 (Type 3) was found to be on the left side and Type 4 on the right side. A strong correlation was found between BMI and all thigh indexes, with a significant positive correlation between the index and factors tied to the buttocks and upper thigh. CONCLUSIONS: The concept of an ideal thigh may vary based on an individual's gender, race, country of residence, and self-esteem, aiming to achieve a more natural silhouette. Focusing on the different ratios of hip and thigh varieties in the study is quite intriguing. Further inquiry and rigorous exploration are warranted to delineate the optimal techniques and methodologies for attaining ideal thigh proportions. 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 .

A Novel Approach to Shaping the Lateral Abdomen: Simultaneous Application of High-Intensity Focused Electromagnetic (HIFEM) Therapy and Synchronized Radiofrequency at the Flanks: A Multicenter MRI Study.

BACKGROUND: An accumulation of adipose tissue on the lateral abdomen (flanks) coupled with muscle deconditioning negatively affects core stability, muscular balance, and the intrinsic strength essential for maintaining optimal body mechanics and posture. This lateral fat accumulation and diminution of muscle result in an unfavorable abdominal profile and present challenges in finding appropriately fitting attire. OBJECTIVES: The aim of this study was to explore the effectiveness and safety of the simultaneous application of high-intensity focused electromagnetic (HIFEM) therapy and synchronized radiofrequency for sculpting the lateral abdomen. METHODS: All patients were scheduled to undergo four 30-minute treatments at approximately weekly intervals and then subsequent follow-up visits at 1 month and 3 months after the last treatment. The primary evaluation assessed changes in the oblique muscles, adipose tissue thickness, and cross-sectional area (CSA) by MRI performed at baseline and follow-ups. The secondary outcomes included digital photographs of the treated areas, a Subject Satisfaction Questionnaire, and a Therapy Comfort Questionnaire. Adverse events and side effects were monitored throughout the study duration. RESULTS: The muscle tissue showed a substantial increase in thickness (+27.2%) and CSA (+29.0%). The adipose tissue measurements showed a decrease of -30.5% in CSA and -28.8% in thickness. As secondary outcomes, 81.8% of patients reported feeling more toned, and 84.9% of patients found the treatment comfortable and reported less than mild pain. CONCLUSIONS: Based on the evaluation, the study suggests that the simultaneous application of HIFEM and synchronized radiofrequency is safe and effective for reducing adipose tissue and strengthening muscle in the area of the lateral abdomen.

Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting.

INTRODUCTION: Knowledge of the vascular anatomy is critical to performing safe gluteal surgery. To date, only the course of the main blood vessels within the muscles has been outlined. These findings are based on MRI and CTA images that do not conform to a topographically standardized and normalized probability distribution. OBJECTIVES: The aim of this study was to develop a three-dimensional mapping of the gluteal zones of high vascular density in relation to anatomical landmarks. MATERIALS AND METHODS: This single-center retrospective cohort analysis comprised all consecutive patients who underwent cone-beam computed tomography (CBCT) scans between January 2016 and October 2021. The location of blood vessels in the gluteal region was allometrically normalized in relation to anatomical landmarks. Moreover, the caliber and area of the blood vessels were assessed. RESULTS: CBCT scans of 32 patients with an average age of 64 ± 12 years (range 34-87 years) were included. Fifty-three percent were female. The median [IQR] caliber of the intramuscular gluteal vessels was 1.47 [1.15-1.88] mm, significantly greater than that of the subcutaneous vessels 1.09 [0.72-1.44] mm (p < 0.001). Vascular density was higher intramuscularly, as 4.5% of the area of the muscle was occupied by blood vessels, as opposed to 0.3% in the adipose tissue. CONCLUSION: The analysis of the CBCT scans showed a higher vascular density and larger vessels intramuscularly. We, therefore, recommend the injection of autologous fat merely to the subcutaneous plane. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Body Contouring Surgery After Bariatric Surgery Improves Long-Term Health-Related Quality of Life and Satisfaction With Appearance: An International Longitudinal Cohort Study Using the BODY-Q.

OBJECTIVE: To examine health-related quality of life (HRQL) and satisfaction with appearance in patients who have undergone bariatric surgery (BS) with or without subsequent body contouring surgery (BCS) in relation to the general population normative for the BODY-Q. BACKGROUND: The long-term impact of BS with or without BCS has not been established using rigorously developed and validated patient-reported outcome measures. The BODY-Q is a patient-reported outcome measure developed to measure changes in HRQL and satisfaction with appearance in patients with BS and BCS. METHODS: Prospective BODY-Q data were collected from 6 European countries (Denmark, the Netherlands, Finland, Germany, Italy, and Poland) from June 2015 to February 2022 in a cohort of patients who underwent BS. Mixed-effects regression models were used to analyze changes in HRQL and appearance over time between patients who did and did not receive BCS and to examine the impact of patient-level covariates on outcomes. RESULTS: This study included 24,604 assessments from 5620 patients. BS initially led to improved HRQL and appearance scores throughout the first postbariatric year, followed by a gradual decrease. Patients who underwent subsequent BCS after BS experienced a sustained improvement in HRQL and appearance or remained relatively stable for up to 10 years postoperatively. CONCLUSIONS: Patients who underwent BCS maintained an improvement in HRQL and satisfaction with appearance in contrast to patients who only underwent BS, who reported a decline in scores 1 to 2 years postoperatively. Our results emphasize the pivotal role that BCS plays in the completion of the weight loss trajectory.

A Bibliometric Analysis of the 50 Most Cited Articles on Body Contouring Surgery After Massive Weight Loss.

BACKGROUND: Body contouring surgery after massive weight loss has emerged a safe and reliable option to improve self-esteem, social life, work ability, physical activity, and sexual activity, and it is considered as an essential step in the multidisciplinary approach to morbid obesity. In this study, we aim to provide a comprehensive overview of the current state of literature on body contouring after massive weight loss, identifying research trends and areas for future investigation. METHODS: The Web of Science Core Collection was used to identify the 50 most cited publications on post-massive weight loss surgery. Data collected from each article included: title, journal, publication year, total citations, average citations per year, authors, study type, study topic, country, and institution of origin. RESULTS: The top 50 most-cited articles include 44 original articles and 6 review articles. The most cited article, published by Lockwood in 1991, received a total of 224 citations. The research areas included surgical outcomes and complications (n=19, 38%), psychological aspects such as body image, quality of life and desire for body contouring procedures (n=18, 36%), surgical techniques (n=11, 22%), an anatomical study (n=1, 2%), and a classification system (n=1; 2%). Plastic and Reconstructive Surgery journal published most (44%) of the papers identified. The University of Pittsburgh was the single institution that contributed the most (n=11; 22%). CONCLUSION: This bibliometric analysis provides insights and research trends for clinicians interested in body contouring after massive weight loss, facilitating the understanding and evolution of post-bariatric surgery and elucidating the rationale behind current practice. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Fibrosis Management Algorithm in Secondary Liposculpture.

BACKGROUND: Liposuction is considered one of the most common procedures in plastic surgery. However, major postoperative complications such as visceral injury, fluid overload, and necrotizing fasciitis still occur. Likewise, minor complications such as ecchymosis, seromas, infections, and contour irregularities that do not threaten the life of the patient do generate significant dissatisfaction. Current evidence regarding the management of fibrosis after previous liposuction remains limited. OBJECTIVES: The objective of this article is to standardize a management algorithm based on the extensive experience and successful results of the primary author (G.M.). METHODS: Patients who underwent secondary liposculpture between August 2022 and May 2023 were evaluated prospectively. Inclusion criteria comprised females between 18 and 60 years old, nonsmokers, with a BMI < 35 kg/m2 and a history of previous body contouring surgeries. Identification of the patient's skin condition and subcutaneous lesions in the adipose tissue were obtained in detail. Statistical analysis of preoperative and postoperative medical photographs was also performed with the Fiji Biological image analyzer. RESULTS: Photographic analysis of preoperative and postoperative photographs showed a statistically significant difference between the areas affected by fibrosis (P < .001). The most frequent clinical findings were depressions in 99% of the females (74), followed by soft nodules in 95% (70), hard nodules in 81% (61), adhesions in 47% (35), and finally cutaneous bursas in 4%. CONCLUSIONS: Our classification system and management algorithm for fibrosis and contour irregularities is a safe and reliable tool. Results were objectively verified, yielding statistically significant outcomes.

[Postbariatric plastic surgery for body reconstruction]. / Postbariatrische plastische Körperrekonstruktionen.

Massive weight loss following bariatric surgery is often accompanied by functional impairments due to the resulting excess skin and soft tissues. To achieve both functional reconstruction and restoration of the body silhouette, it is imperative to undergo body contouring surgery involving the strategic transposition of tissues. Several surgical techniques are available for the affected body regions and their application for treatment is determined by the unique circumstances specific to each patient. When conducted by skilled practitioners, postbariatric body reconstruction can be executed safely, leading to outcomes that are both functionally and esthetically satisfying, ultimately contributing to an enhanced quality of life for patients. This article provides the fundamental principles for patient selection, surgical preparation, treatment planning, surgical techniques and the postoperative care following bariatric surgery.

Complications Following Body Contouring: Performance Validation of Bard, a Novel AI Large Language Model, in Triaging and Managing Postoperative Patient Concerns.

INTRODUCTION: Large language models (LLM) have revolutionized the way humans interact with artificial intelligence (AI) technology, with marked potential for applications in esthetic surgery. The present study evaluates the performance of Bard, a novel LLM, in identifying and managing postoperative patient concerns for complications following body contouring surgery. METHODS: The American Society of Plastic Surgeons' website was queried to identify and simulate all potential postoperative complications following body contouring across different acuities and severity. Bard's accuracy was assessed in providing a differential diagnosis, soliciting a history, suggesting a most-likely diagnosis, appropriate disposition, treatments/interventions to begin from home, and red-flag signs/symptoms indicating deterioration, or requiring urgent emergency department (ED) presentation. RESULTS: Twenty-two simulated body contouring complications were examined. Overall, Bard demonstrated a 59% accuracy in listing relevant diagnoses on its differentials, with a 52% incidence of incorrect or misleading diagnoses. Following history-taking, Bard demonstrated an overall accuracy of 44% in identifying the most-likely diagnosis, and a 55% accuracy in suggesting the indicated medical dispositions. Helpful treatments/interventions to begin from home were suggested with a 40% accuracy, whereas red-flag signs/symptoms, indicating deterioration, were shared with a 48% accuracy. A detailed analysis of performance, stratified according to latency of postoperative presentation (<48hours, 48hours-1month, or >1month postoperatively), and according to acuity and indicated medical disposition, is presented herein. CONCLUSIONS: Despite promising potential of LLMs and AI in healthcare-related applications, Bard's performance in the present study significantly falls short of accepted clinical standards, thus indicating a need for further research and development prior to adoption. 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 .

High-Intensity Focused Electromagnetic (HIFEM) Energy With and Without Radiofrequency for Noninvasive Body Contouring: A Systematic Review.

BACKGROUND: Emsculpt Neo (EmSculpt NEO Device, BTL Industries, Inc.) is a FDA-cleared noninvasive body contouring treatment for increasing muscle tone and/or reducing fat. The device uses high-intensity electromagnetic energy to stimulate muscle contractions and to build muscle mass (Emsculpt) or a combination of electromagnetic energy with radiofrequency (Emsculpt NEO) to produce a synergistic effect of building muscle mass and reducing fat. In this study, we conduct a high-quality systematic review to evaluate outcomes for Emsculpt and Emsculpt NEO treatments for noninvasive body contouring. METHODS: An electronic search was performed of the PubMed, MEDLINE, Embase, and Web of Science databases using the key terms "High intensity focused electromagnetic therapy; HIFEM; Emsculpt; Emsculpt NEO; BTL Industries." The search included all articles published in English through January 2023. Inclusion criteria included articles noninvasive body contouring and reporting at least one outcome of interest (clinical or patient-reported outcomes). Methodological quality and risk of bias were assessed using the GRADE criteria. Articles involving applications other than for body contouring, animal studies, and review articles were excluded. RESULTS: Of the 159 articles identified in the initial search strategy, 51 met relevance based on abstract screening. Fifteen clinical studies were identified, including Emsculpt (n=11) and Emsculpt NEO (n=2). The typical protocol involved four treatments given over a 2-4-week period (range 3-8 treatments) with increase to 100% intensity setting and 1-6-month follow-ups. No complications were reported. Abdominal measurements were obtained using imaging were reported in eight studies. Treated areas included the buttocks (n=4), thighs (n=3), arms or calves (n=1), and abdomen (n=11). For abdominal contouring, mean reductions of fat thickness were 5.5 mm, muscle thickness of 2 mm, and rectus diastasis improvement of 3.0 mm. No studies reported weight change before and after treatment. All studies with patient-reported outcomes report high patient satisfaction. Two studies report marginal or no benefit of treatment. Certain studies failed to report comorbidities or demographic characteristics other than age and sex, which precludes analysis of specific subgroups that may benefit from treatment. Furthermore, certain studies failed to address how missing data or the final study population was analyzed. CONCLUSION: This systematic review reports on currently published evidence regarding the efficacy and safety of Emsculpt and Emsculpt NEO for body contouring. High-quality level data reporting with patient-reported outcomes will optimize shared decision-making and informed consent. LEVEL OF EVIDENCE II: Therapeutic study. 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 .

Non-invasive Body Contouring Technologies: An Updated Narrative Review.

INTRODUCTION: Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices. METHODS: We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring. RESULTS: Totally 193 references were used in 11 main topics. CONCLUSION: In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section. LEVEL OF EVIDENCE I: This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .

Flowchart in Post-Bariatric Surgery: A Research for the Appropriate Type and Timing of Plasties Reshaping the Body.

INTRODUCTION: Obesity is a chronic disease with significant health implications. Bariatric surgery is an effective treatment for obesity-related conditions. However, the timing of post-bariatric body contouring surgery remains uncertain. MATERIALS AND METHODS: We conducted a retrospective study of 1336 patients who underwent bariatric surgery. We analyzed weight trends and variations after different types of bariatric procedures. The Pittsburgh Index was used to evaluate body contouring outcomes. RESULTS: The majority of patients were women, and sleeve gastrectomy was the most common procedure. Weight loss varied depending on the surgery type, with different outcomes for male and female patients. The Pittsburgh Index remained stable in most cases. CONCLUSION: Our findings suggest that the timing of body contouring surgery should be tailored to the type of bariatric procedure performed. Abdominoplasty is recommended as a last procedure for sleeve gastrectomy patients, while gastric bypass patients are suitable candidates for early abdominoplasty. Biliopancreatic diversion patients should stabilize their weight before abdominoplasty. The Pittsburgh Index is a valuable tool for assessing the timing of post-bariatric plastic surgery. Further research is needed to optimize surgical planning and outcomes. 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 .

Weight Loss After VASER-Assisted Liposuction.

BACKGROUND: Liposuction is one of the most common procedures used for body contouring. In this study, we aimed to determine whether there is a weight change with VASER-assisted liposuction (VAL) procedure and the demographic factors affecting it. METHODS: A total of 51 patients (30 females and 21 males) who underwent VAL between the years of 2020 and 2022 were included in the study. Participants' weights before VAL, body mass indexes (BMI), aspiration volumes, demographic data, and weights and BMIs one month after VAL were recorded and analyzed. In addition, the fat ratio in the aspirate was determined in ten patients. RESULTS: The mean aspiration volume with VAL was 4832.50 ± 2373.26 ml in females and 5176.90 ± 1602.61 ml in males. Body weights (baseline, 90.34 ± 9.17 vs. 71.01 ± 8.87; one month later, 86.95 ± 8.34 vs. 66.28 ± 10.04: p < 0.001) and BMIs (baseline, 28.59 ± 2.97 vs. 26.40 ± 3.69; one month later, 27.54 ± 2.92 vs. 24.59 ± 3.76: p = 0.009) were higher in males than females, both at baseline and after VAL. There was a significant decrease in body weights and BMIs after VAL in both females (4.73 ± 4.73 kg) and males (3.39 ± 4.27 kg) (p < 0.001). However, no correlation was observed between the decrease in body weights and BMIs after VAL and gender, age, aspirate volume, and fat volume. CONCLUSION: Although there was a decrease in mean body weight and mean BMI in both males and females one month after VAL, no associations were observed between weight drop after VAL and gender, age, aspiration volume, and fat volume. 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 .

Interplay of Oblique Flankplasty with Vertical Medial Thighplasty.

After 25 years' experience, the authors present the senior author's current integration of lower body lift with vertical medial thighplasty. Mostly, oblique flankplasty with lipoabdominoplasty (OFLA) has replaced the traditional transverse posterior lower body lift and abdominoplasty due to improved esthetics and lower rate of complications. OFLA proceeds either immediately or as a first stage to the medially based reduction of thighs. L-vertical medial thighplasty, facilitated by excision site liposuction and scalpel assisted skin avulsion, is our preferred complimentary operation for predictable results and low rate of complications.

Cryolipolysis in the United States-Review of the clinical data.

BACKGROUND: Noninvasive body contouring is becoming more popular in the United States as an alternative to liposuction. The most popular of these methods, cryolipolysis, uses precisely controlled cooling to reduce focal adiposities. The number of cryolipolysis procedures performed annually has experienced rampant growth in United States markets, and the indications have likewise diversified. In light of this change, it is imperative to perform an updated review of available US safety and efficacy data on cryolipolysis. AIMS: To examine the safety and efficacy of cryolipolysis treatments in the United States using data extracted from research performed exclusively at US-based sites. METHODS: In order to identify relevant studies, a literature search was conducted on PubMed using the terms "CoolSculpting" OR "cryolipolysis" OR "lipocryolysis." Articles were manually reviewed to exclude literature reviews, research not performed on humans, studies on experimental combinations of techniques, and any studies not performed in the United States. RESULTS: The initial literature search returned 246 results. Following manual review, a total of 18 studies were selected for data extraction. Mean reduction in fat thickness by ultrasound was 2.0-5.1 mm or 19.6%-32.3%; mean reduction by body caliper was 2.3-7 mm or 14.9%-21.5%. Side effects were mild and transient. Four instances of PAH were documented in 3453 treatment cycles. CONCLUSIONS: Cryolipolysis is a safe, modestly effective method for reducing focal adiposity. Complications are rare and treatable. However, US-based studies are few in number and often of low power and/or quality. More high-quality research is needed for all aspects of cryolipolysis.