Microliposuction and Radiofrequency Combined With Fat Grating as a New Method for Hybrid-Type Nasolabial Folds.

BACKGROUNDS: The hybrid-type nasolabial fold is a special, complex type of nasolabial fold with various causes, making it difficult to obtain an ideal effect with a single treatment. OBJECTIVES: This study aimed to investigate the effect and complications of a comprehensive therapy combining microliposuction, radiofrequency, and fat grafting on hybrid-type nasolabial folds. RESULTS: Twenty-one patients aged 27 to 45 (mean: 34.71±5.41) years, who underwent the therapy for hybrid-type nasolabial folds were retrospectively analyzed. All patients were followed up for 12 months. Two independent observers conducted postoperative follow-ups at 1 week and 12 weeks. One week postoperatively, the hematoma, mass nodule, and skin scald ecchymosis scores were 1.24±0.43, 1.62±0.58, and 1.48±0.59, respectively. At 12 weeks, the scores of mass nodules and skin scald ecchymosis decreased (1.19±0.39 and 1.05±0.21, respectively) without obvious hematoma. The WSRS grade decreased from 4.33±0.47 to 2.19±0.39 (P<0.001), and the hybrid-type nasolabial folds significantly improved. The Face-Q scale score was 20.43±2.63 points (standard score: 85.12±10.95 points). 76.19% of the patients scored more than 80 points in the subjective Face-Q evaluation. CONCLUSION: Microliposuction and radiofrequency combined with fat grafting effectively treats hybrid-type nasolabial folds, resulting in high patient satisfaction. Most complications can be prevented, and optimal outcomes can be obtained by comprehensive surgical methods and correct procedures, which is thus worthy of clinical promotion.

Comparing the safety and effectiveness of different liposuction techniques for lipedema.

INTRODUCTION: Lipedema is a relatively common, frequently misdiagnosed, chronic condition that is often treated using liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL) are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aimed to assess the efficacy and safety of liposuction in patients with lipedema. METHODS: Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with post-operative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, and 2 articles used PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity. RESULTS: A total of 2542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). TTL, PAL, and WAL led to significant improvements in pain reduction P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). However, WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for the studies that used TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%). CONCLUSION: Liposuction techniques, including TTL, PAL, and WAL, resulted in significant symptom improvement in patients with lipedema with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. To the best of our knowledge, this is the first meta-analysis investigating liposuction data in lipedema treatment.

Does Secondary Mechanical Manipulation of Lipoaspirate Enhance the Vasculogenic Potential of Fat Grafts? A Systematic Review.

BACKGROUND: Fat grafting is a highly versatile option in the reconstructive armamentarium but with unpredictable retention rates and outcomes. The primary outcome of this systematic review was to assess whether secondary mechanically processed lipoaspirate favorably enhances the vasculogenic potential of fat grafts when compared to unprocessed lipoaspirate or fat grafts prepared using centrifugation alone. The secondary outcome was to assess the evidence around graft retention and improved outcomes when comparing the aforementioned groups. METHODS: A search on MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted up to February 2022. All human and animal research, which provided a cross-comparison between unprocessed, centrifuged, secondary mechanically fragmented (SMF) or secondary mechanically disrupted (SMD) fat grafts, was included. RESULTS: Thirty-one full texts were included. Vasculogenic potential was assessed by quantification of angiogenic growth factors and cellular composition. Cellular composition of mesenchymal stem cells, perivascular stem cells, and endothelial progenitor cells was quantified by fluorescence activated cell sorting (FACS) analysis. Fat graft volume retention rates and fat grafting to aid wound healing were assessed. Although the presence of industry-funded studies and inadequate reporting of methodological data in some studies were sources of bias, data showed SMF grafts contain an enriched pericyte population with increased vascular endothelial growth factor (VEGF) secretion. Animal studies indicate that SMD grafts may increase rates of fat graft retention and wound closure compared to centrifuged grafts; however, clinical studies are yet to show similar results. CONCLUSIONS: In this systematic review, we were able to conclude that the existing literature suggests mechanically processing fat, whether it be through fragmentation or disruption, improves vasculogenic potential by enhancing angiogenic growth factor and relevant vascular progenitor cell levels. Whilst in vivo animal studies are scarce, the review findings suggest that secondary mechanically processed fat enhances fat graft retention and can aid with wound healing. Further clinical studies are required to assess potential differences in human studies.

Assessing the Efficacy of Submental Liposuction Association in Orthognathic Surgery: A Systematic Review.

PURPOSE: Despite the vast literature on submental liposuction, there are few studies describing its simultaneous association in orthognathic surgery. This systematic review aimed to evaluate the available evidence on the effectiveness of the combination between the 2 techniques. METHODS: This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist and used a comprehensive literature search across 7 databases. All studies discussing submental liposuction in orthognathic surgery were eligible for inclusion, regardless of language. The Joanna Briggs Institute assessment tools were used to assess risk of bias. After a 2-step selection process, a total of 10 studies were included, including 2 cohort studies, 1 case-control study, 1 case series, and 6 case reports. RESULTS: Sixty-seven patients from 5 countries were evaluated. Ages ranged from 15.1 to 50 years. The prevalence according to the facial pattern was similar, with a higher incidence in women. The major indications for surgery were related to the presence of skeletal deformities and aesthetic changes in the cervical region. The forms of evaluation used to indicate surgery were photographs (n = 29; 43.28%), visual scale by 2 surgeons (n = 20; 29.85%), clinical examination (n = 23; 34.32%), and cephalometric analysis (n = 17; 25.37%). The postoperative follow-up time ranged from 6 months to 7.9 years. Despite the different forms of evaluation, all articles mentioned benefits with the association of submental liposuction in orthognathic surgery. The most cited complications were sensory changes in the lower lip (n = 4; 5.97), facial nerve injury (n = 2; 2.98%), infection (n = 2; 2.98%), maintenance of submental lipomatosis (n = 2; 2.98%), and skin irregularities (n = 2; 2.98%). CONCLUSION: This systematic review showed that submental liposuction associated with orthognathic surgery improves cervical aesthetics and that it is safe, with a low rate of complications. However, the number of studies on this topic is limited, and the studies are not standardized. There is lack of information especially regarding the evaluation methods used. Metric techniques such as ultrasound and tissue caliper adipometry could be possibilities for future studies.

Breast reconstruction through exclusive lipomodeling or in addition to a flap: Current status in Franche-Comté.

INTRODUCTION: Breast reconstruction after cancer surgery through lipomodeling can be performed alone or in combination with a flap. Our objective is to describe the proportion of techniques used on patients who underwent autologous reconstructive surgery after tumorectomy or mastectomy in Franche-Comté. MATERIALS AND METHODS: A bicentric retrospective observational study was conducted between October 2017 and December 2021 (NCT06101732), including three groups: those who underwent exclusive lipomodeling reconstruction after mastectomy (1) or in addition to a flap (2), and those who underwent exclusive lipomodeling reconstruction after tumorectomy (3). Socio-demographic, medical, and surgical data were collected and recorded in a specially designed software. RESULTS: Two hundred and fifty-one lipomodeling procedures were performed on 91 patients. In group 1, the average transferred volume was 1191mL with an average number of sessions of 4.4 spreads over 19.4months. In group 2, the average transferred volume was 676mL with an average operative time of 2.5 spread over 16.1months. In group 3, the average transferred volume was 223mL with an average number of sessions of 1.5 spreads over 6.2months. Regarding postoperative complications, 11% had cysts of fat necrosis, 4.4% had infections, and 2.2% had hematomas. CONCLUSION: Lipomodeling is a technique that has clearly established itself in the field of breast reconstructive surgery. It results in a few complications and improves the final aesthetic outcome whether used exclusively or in addition to a flap.

Surgical Technique Selection in the Management of Pediatric Gynecomastia.

INTRODUCTION: Although the majority of pubertal onset gynecomastia is self-resolving in nature, persistent deformity may require surgical intervention. This study aims to identify patient factors associated with surgical technique selection and proposes an algorithm for the surgical management of pediatric gynecomastia. METHODS: A retrospective analysis was performed of all surgically managed pediatric gynecomastia patients operated on at a single institution from 2012 to 2022. Charts and patient photos were analyzed for patient and operative demographics, endocrinologic comorbidities, complications, and outcomes. Data were analyzed using bivariate and logistic regression analysis. RESULTS: Fifty-six surgically managed gynecomastia patients less than 18 years of age were included. The average age at surgery was 16.1 years old, with a mean BMI of 26.9. Most patients were overweight or obese (54.8%) and had Simon grade IIb or greater gynecomastia (55.4%) at presentation. All patients underwent 1 of 4 mastectomy techniques with or without liposuction: inferior periareolar (n=25, 44.6%), circumareolar (n=13, 23.1%), transverse with pedicled nipple (n=4, 7.1%), or free nipple graft (n=14, 25.0%). Bivariate and logistic regression analysis revealed significant differences in sternal notch-to-nipple distance, nipple-to-inframammary fold distance, breast resection weight, and gynecomastia grade between the 4 surgical techniques used in this study. An algorithm incorporating these factors was devised to guide surgical decision-making. CONCLUSIONS: The proposed algorithm guides surgical technique selection for pediatric gynecomastia and is contingent upon the degree of ptosis and skin excess, anticipated resection weight, and skin quality.

Comparative Study of 1444 nm Laser Monotherapy versus Integrated Liposuction in the Treatment of Axillary Osmidrosis.

Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO and compared the results with those of a group treated only with a laser. Materials and Methods: This study compared the outcomes of AO treatment between the two groups up to six months postoperatively. The first group of 18 patients underwent laser treatment alone, and the second group of 12 patients underwent integrated liposuction surgery in addition to laser treatment. Outcomes were assessed using the following variables: degree of malodor (DOM), sweating area, patient satisfaction, pain levels, and complications, such as burns, swelling, and contractures. Results: Compared to the laser-only group, the integrated liposuction group demonstrated significantly superior outcomes in terms of DOM (p = 0.002) and patient satisfaction (p = 0.006), as well as a reduction in the sweating area (p = 0.012). The pain rating was higher in the liposuction group, but the difference was not statistically significant (p = 0.054). Compared with the patients in the integrated liposuction treatment group, those in the laser treatment group exhibited a significantly higher number of burns under the axillae (p = 0.025). However, no significant differences were observed in the swelling or contracture between the groups. Conclusions: Integrated liposuction with laser therapy significantly improved treatment outcomes, including malodor, patient satisfaction, sweat test results, and decreased complication rates.

Effectiveness of ultrasound-guided rhomboid intercostal and sub-serratus block for perioperative analgesia in male patients undergoing combined power-assisted liposuction with pull-through excision of the gland for breast definition and reshaping.

BACKGROUND: The newly introduced ultrasound guided interfacial rhomboid intercostal and sub-serratus (RISS) block technique demonstrated promising efficacy in managing perioperative pain among patients undergoing abdominal and thoracic procedures. Thus, this study investigated the efficiency of bilateral ultrasound-guided RISS (US-RISS) as a perioperative pain control technique in male subjects receiving gynecomastia surgery. METHODS: This prospective randomized study involved sixty patients who underwent gynecomastia surgery. Individuals were randomly divided into two groups: the RISS group (N.=30) and the control group (N.=30). After anesthesia induction, the patients received bilateral US-RISS using 40 mL of 0.25% levobupivacaine, or conventional intravenous analgesia with no intervention, respectively. The primary outcome was the overall morphine consumption in 24 hours, and the secondary endpoints involved the time elapsed till rescue analgesia was requested, the quality of recovery after 24 hours and side effects' incidence. RESULTS: Morphine consumption was noticeably decreased in the RISS group compared to the control group, with 14.07±4.91 mg and 35.83±1.70 mg mean values, respectively (P<0.001). Furthermore, in the RISS group, the initial rescue analgesia request occurred significantly later than in the control group, with mean values of 15.58±1.41 hours and 0.96±0.63 hours, respectively (P<0.001). Additionally, within the RISS group, there was a high quality of recovery observed, with a low incidence of opioid-related adverse events in comparison to the control group. CONCLUSIONS: Bilateral US-RISS block is a beneficial intervention in gynecomastia surgery for pain management and improves the quality of recovery.

Poloxamer 188 washing of lipoaspirate improves fat graft survival: A comparative study in nude mice.

BACKGROUND: Autologous fat transplantation is limited by the uncertainty of graft retention, impeding its application. Among the current strategies for processing lipoaspirates, high-density fat (HDF) is recommended owing to the enrichment of stem cells and washing before cotton concentration for simplicity of operation. Poloxamer 188 (P188) washing has been shown to repair the membranes of damaged cells. This study aimed to investigate the effect of P188-washing on fat graft survival and identify the best technique for processing lipoaspirates. METHODS: Lipoaspirates were prepared using centrifugation to obtain HDF, which was then washed with saline or P188 followed by cotton concentration. Tissue integrity, adipocytic activity, and viability of stromal vascular fraction (SVF) in the samples from the 3 groups were assessed. Samples were sequenced in vitro using high-throughput RNA-seq, and differentially expressed genes were validated using qPCR and western blotting (WB). After transplantation under the dorsum of nude mice for 8 weeks, the grafts were extracted and examined for residual volume, histologic characteristics, and vascularization. RESULTS: The HDF and P188 groups showed a higher survival rate of SVF, more Ki67-positive cells, intact tissue structure, and lesser fibrosis than the saline group. There were no significant differences in the density of SVF and residual volume of grafts. HDF showed significantly improved vascularization during 8 weeks. Through RNA-seq and bioinformatic analysis, notable changes in several related genes after transplantation were observed. CONCLUSIONS: P188 treatment can prevent cells from apoptosis and preserve tissue viability, thereby improving graft quality. HDF contains large amounts of SVF and can be regarded as an excellent grafting material.

Concentrated Deoiled Fat: A Novel Method of Fat Processing to Improve Fat Graft Survival-A Basic Research.

BACKGROUND: Oil compromises graft outcomes via inflammation, which accounts for the unpredictability of volume retention rates as low as 20%. Existing techniques for oil removal are relatively inefficient. In this study, a novel approach was taken to prepare concentrated deoiled fat (CDF) by utilizing flocculation and centrifugation to remove the oil. The hypothesis put forward in this study was that CDF would exhibit improved volume retention and quality by enhancing purification efficiency and reducing inflammation. METHODS: This basic research involved both in vitro and in vivo experiments using samples obtained from women who underwent abdominal liposuction. The CDF was prepared by flocculation and centrifugation. In the vitro experiments, the microstructure of fat was assessed using Calcein acetoxymethyl ester (AM) staining for living cells and propidium iodide (PI) staining for dead nuclei in two groups: Coleman fat group and CDF group. Additionally, the glucose uptake capacity of these two groups was evaluated using the glucose transport test (GTT). In the vivo experiments, the study included three groups: two experimental groups (low-volume concentrated deoiled fat, LCDF; high-volume concentrated deoiled fat, HCDF) and one control group (Coleman fat), with 10 healthy female BALB/c nude mice in each group, 1ml of the graft was injected subcutaneously to each mouse. After 8 weeks, the fat grafts were harvested and subjected to volume evaluation, HE staining and immunostaining for perilipin to assess graft outcomes. RESULTS: In the vitro experiments, the concentration rate of the CDF was found to be 79.6% that of Coleman fat, with 15.1% more oil separated. Cell viability, as assessed by AM/PI staining, did not show a significant difference between the two grafts, but the results of the GTT showed that the tissue viability of the CDF was higher than that of Coleman fat. In the vivo experiments, the CDF had higher volume retention than Coleman fat, as measured by water displacement. Histopathologic scoring indicated that HCDF group and LCDF group had a more intact fat structure with fewer vacuoles, inflammation, and fibrosis compared to Coleman fat. Additionally, the percentages of perilipin-positive area in the LCDF group and HCDF group were higher than in the Coleman group, indicating improved graft quality and outcome with the use of concentrated deoiled fat. CONCLUSIONS: "Concentrated deoiled fat" refers to an autologous fat graft from which oil has been removed by flocculation and centrifugation. This process increases volume retention and viable cells and decreases infiltrated inflammatory cells. 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 .

Multidisciplinary Experience for Gluteal Fat Grafting.

BACKGROUND: Gluteal fat grafting, colloquially known as Brazilian Butt Lift, has experienced a significant rise in popularity in recent years. Despite this increase, potential complications associated with the procedure have also been observed, necessitating a thorough examination of the current practices and outcomes. METHODS: This study collected experiences of a multidisciplinary group of surgeons through a detailed survey sent in April 2022. This study aimed to shed light on the practices employed by these surgeons, the frequency and types of complications they encounter, and the overall outcomes of their procedures. RESULTS: Of the 100 surgeons surveyed, 86 responded. The study identified that pulmonary fat embolism (PFE) was the most serious complication, with fatality due to PFE recorded at a rate of 1:23,878. Liposuction site seromas were the most common complications, with an overall rate of 2.45%. Although there were no overall differences in complications between plastic and non-plastic surgeons, plastic surgeons were found to have a sixfold increase in the odds of experiencing a liposuction seroma. The survey also revealed substantial practice variations, particularly regarding fat preparation methods, recipient-site preparation, antibiotic use, and postoperative care protocols. CONCLUSION: Despite known complications, a strong tendency to continue performing these procedures was observed among surgeons, demonstrating the sustained demand and acceptance of the procedure. This study underscores the need for continued surveillance and research to enhance the safety and effectiveness of gluteal fat grafts. The experiences and data gathered from practicing surgeons provide valuable insights, paving the way for refining techniques, building consensus, and facilitating informed discussions with patients about the risks and benefits of the procedure. 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 .

Lipoabdominoplastia con definición anatómica. Actualización / Lipoabdominoplasty with anatomical defi nition. Update

Existe en la práctica diaria de los cirujanos plásticos una búsqueda continua de mejores alternativas técnicas para el tratamiento de las deformidades del contorno abdominal. La LADE (Lipoabdominoplastia con defi nición anatómica) da un paso más adelante de la técnica LAP tradicional. Esta técnica incorpora los principios de resaltar la defi nición de la musculatura abdominal, consiguiendo resultados más naturales y con menos estigmas de una intervención quirúrgica. Los resultados estéticos son mucho más armoniosos, con un verdadero aspecto abdominal rejuvenecido. Logramos reducir la morbilidad preservando los vasos sanguíneos perforantes y suspendiendo la fascia de Scarpa. Una correcta selección del paciente asociado a la estandarización de esta técnica hace que el procedimiento sea seguro y reproducible

There is a continuous search for better technical alternatives for the treatment of abdominal contour deformities in the practice of plastic surgeons. LADE ­ Lipoabdominoplasty with Anatomical Defi nition ­ is a step ahead of the traditional LAP technique. This technique incorporated the principles of highlighting the defi nition of the abdominal musculature, achieving more natural results with fewer reminders of a surgical intervention. The aesthetic results are much harmonious, with a true abdominal rejuvenated appearance. We can reduce morbidity by preservation of perforating blood vessels and suspension of Scarpa's fascia. The correct selection of the patient associated with the standardization of this technique makes the procedure safe and reproducible

A randomized intraindividual comparative study evaluating the effects of two ultrasound-assisted liposuction devices on the abdomen.

BACKGROUND: Ultrasound-assisted liposuction (UAL) has become popular because of its favorable outcomes in fat emulsification, blood loss reduction, and skin tightening. This study aimed to compare the effects of two UAL devices on the abdomen by assessing postsurgery skin biomechanical properties. METHODS: This single-blind, prospective study (2020-2022) involved 13 liposuction procedures performed on patients without chronic diseases. Each patient's abdomen was divided vertically from the xiphoid to the perineum. Vibration amplification of sound energy at resonance (VASER)-assisted liposuction (Solta Medical, Inc., Hayward, CA) was performed on one half, while the other half underwent liposuction with high-frequency ultrasound energy (HEUS)-assisted technology. Skin biomechanical measurements, including distensibility, net elasticity, biological elasticity, hydration, erythema, melanin, and skin firmness, were taken at 12 and 24 months postsurgery, focusing on the anterior abdomen, 8 cm to the right and left of the umbilicus. RESULTS: Analysis of the above skin biomechanical measurements revealed no significant differences between the HEUS and VASER devices, except for skin firmness, which showed a notable increase following HEUS surgery. Patient-perceived clinical differences were assessed via nonvalidated questionnaires, revealing no distinctions between devices. CONCLUSION: Biomechanical skin results post-UAL surgery with these devices on the abdomen were not significantly different, although HEUS revealed increased skin firmness. This suggests that HEUS-assisted technology, akin to other devices, is a viable option for UAL procedures.

Clinical Results of Asymmetric Blepharoplasty Plastic Repair.

OBJECTIVE: To investigate plastic surgery repair's effects and adverse reactions in the clinical therapy of asymmetric double eyelids. METHODS: All 126 sufferers who came to the hospital for asymmetric double eyelid plastic repair from January 2022 to October 2022 were selected as the research objects, and they were divided into a control group and an observation group using the random number method, with 63 cases in each group, in which sufferers in the control group underwent full incision blepharoplasty and sufferers in the observation group underwent small incision liposuction with submerged sutures. The general data, treatment results, treatment satisfaction, related surgical indicators, and frequency of adverse reactions of the 2 groups of sufferers with asymmetric double eyelid plastic repair were compared. RESULTS: It had no statistically obvious distinction between the control group and the observation group of sufferers in terms of general data such as sex, age, weight, and height ( P> 0.05); the total therapy efficiency of the sufferers in the observation group (95.24%) was greater than the control group (74.60%), with P value <0.05; the total treatment satisfaction of the patients in the observation group (96.83%) was significantly higher than that in the control group (76.19%), with P value <0.05; compared with the control group, patients in the observation group had shorter operative time and healing time and less intraoperative bleeding, with P value < 0.05; the total frequency of adverse reactions of sufferers in the observation group (4.76%) was less than the control group (17.46%), with P value < 0.05. CONCLUSION: Small incision liposuction with submerged sutures for plastic repair has significant efficacy, relatively high patient satisfaction, and low incidence of adverse reactions, in line with patient esthetic review, which has a broad clinical application prospect.

Synchronous supraclavicular vascularized lymph node transfer and liposuction for gynecological cancer-related lower extremity lymphedema: A clinical comparative analysis of three different procedures.

OBJECTIVE: Gynecological cancer-related lower extremity lymphedema (GC-LEL), a chronic, progressive condition, lacks a standardized treatment. Currently, supraclavicular vascularized lymph node transfer (SC-VLNT) is a favored approach in the treatment of lymphedema, and there is a trend toward combination technology. This study conducts a comparative analysis of three techniques for treating GC-LEL with simultaneous SC-VLNT and liposuction. METHODS: A cohort of 35 patients with GC-LEL was examined, comprising 13 patients who underwent single lymph nodes flap with a skin paddle (SLNF+P), 12 who received single lymph nodes flap without a skin paddle (SLNF), and 10 who accepted dual lymph nodes flap without a skin paddle (DLNF). Patient demographics and outcomes were meticulously documented, covering intra- and postoperative variables. RESULTS: The median limb volume reduction were 56.4% (SLNF+P), 60.8% (SLNF), and 50.5% (DLNF) in stage II, and 54.0% (SLNF+P), 59.8% (SLNF), and 54.4% (DLNF) in stage III. DLNF group procedures entailed longer flap harvesting and transplantation times. The SLNF+P group, on average, had an 8-day postoperative hospitalization, longer than others. All patients noted subjective improvements in Lymphedema Quality of Life scores, with lymphoscintigraphy revealing enhanced lymphatic flow in 29 of the 35 cases. A notable decrease in cellulitis incidence was observed. Additionally, the occurrence of cellulitis decreased significantly, except for DLNF (Stage Ⅱ). The median follow-up time was 16 months (range, 12-36 months), with no reported severe postoperative complications. CONCLUSIONS: For advanced GC-LEL, SLNF combined with liposuction is a preferred treatment, offering fewer complications, shorter operative time, and hospitalization.

Paradoxical Adipose Hyperplasia Following Cryolipolysis.

Cryolipolysis (CL) is a noninvasive technique in which applicators cool tissue to temperatures that selectively destroy adipocytes. Since its introduction to the market, it has rapidly become one of the leading nonsurgical modalities to reduce fat in the aesthetic industry. Paradoxical adipose hyperplasia (PAH) is a rare adverse reaction to CL, in which there is initial reduction in fat volume, followed by abnormal fat growth exceeding the original volume in the treated area. The incidence of PAH is thought to be underreported, and its pathophysiology and management remains unclear. The objective of this study was to present a series of PAH cases and review efficacy of management modalities.

Aesthetic Improvement With Topical Body Skin Treatment as a Complement to Cryolipolysis.

BACKGROUND: A firming and toning cosmetic body lotion (FTB) was developed to target key pathways relevant to body skin health and rejuvenation that may complement the improvements observed after noninvasive body contouring (NIBC). A pilot study explored the efficacy and tolerability of FTB as an adjunct to cryolipolysis. METHODS: An open-label, single-site, single-arm, 12-week study enrolled subjects aged 20 to 65 who had pre-elected to receive 1 or more cryolipolysis treatments (CoolSculpting® or CoolSculpting® Elite; Zeltiq Aesthetics, Inc.) on the inner thigh, back/bra fat, or submental areas. Immediately post-procedure, the investigator applied FTB to the treated area. Subjects then applied FTB topically twice daily for 12 weeks on the treated area. Skin texture and firmness were graded visually by the investigator using a 10-point scale, and subjects graded effectiveness, product attributes, and satisfaction with a questionnaire.  Results: Seventeen subjects (16 women, 1 man) enrolled. After 12 weeks of FTB application, significant improvements in skin firmness were observed in all treated areas, while skin texture showed improvements on the inner thigh and back/bra fat (all P≤0.009). With continued use following cryolipolysis, more than 70% of subjects agreed that FTB improved skin firmness, smoothness, and overall appearance. Subjects indicated that FTB was an effective adjunct to cryolipolysis. Throughout the study, 86% to 92% of subjects reported “fair,” “good,” or “excellent” satisfaction with FTB.  Conclusion: This pilot study suggests that FTB may complement skin improvements seen post-NIBC.J Drugs Dermatol. 2024;23(4): doi:10.36849/JDD.7917.

Risks and Complications Rate in Liposuction: A Systematic Review and Meta-Analysis.

Liposuction is a surgical procedure used to remove localized excess adipose tissue. According to The Aesthetic Society's latest annual report, liposuction is the most commonly performed cosmetic procedure. Despite its popularity, the existing literature lacks a unified understanding of the risks associated with liposuction. The aim of this study was to measure complications of liposuction. A systematic review and meta-analysis was reported according to PRISMA guidelines and registered on the PROSPERO database (CRD42023471626). The primary outcome was overall complication rate. The absolute risk for individual complications was also assessed. From 2957 articles, 39 studies were selected for analysis. In total, 29,368 patients were included, with a mean age of 40.62 years and mean BMI of 26.36 kg/m2. Overall, the rate of any complication was 2.62 (95% CI, 1.78-3.84). The most common complication was contour deformity, with a prevalence of 2.35% (95% CI, 1.05%-5.16%). The prevalence of hyperpigmentation was 1.49% (95% CI, 1.12%-1.99%), seroma 0.65% (95% CI, 0.33%-1.24%), hematoma 0.27% (95% CI, 0.12%-0.60%), superficial burn 0.25% (95% CI, 0.17%-0.36%), allergic reaction 0.16% (95% CI, 0.050%-0.52%), skin necrosis 0.046% (95% CI, 0.013%-0.16%), generalized edema 0.041% (95% CI, 0.0051%-0.32%), infection 0.020% (95% CI, 0.010%-0.050%), venous thromboembolism 0.017% (95% CI, 0.0060%-0.053%), and local anesthesia toxicity 0.016% (95% CI, 0.0040%-0.064%). Liposuction is a safe procedure with low complications, of which contour deformity is the most common. Raising awareness of specific risks can enhance surgical outcomes and improve patient-physician understanding.

Brazilian Butt Lift: An Experience Over 3000 Patients.

INTRODUCTION: The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer. METHOD: Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure. RESULTS: Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures. CONCLUSION: BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. LEVEL OF EVIDENCE 3: 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 .