Assessment of the Efficacy of Cryolipolysis on Abdominal Fat Deposits: A Prospective Study.

BACKGROUND: Cryolipolysis is a non-invasive and efficacious procedure for body contouring. The effectiveness of cryolipolysis has been demonstrated on multiple areas of the body, but on a limited number of subjects. The aim of this study is to demonstrate the effectiveness and the safety of cryolipolysis in the lower abdomen adipose tissue thickness reduction. METHODS: A prospective study on 60 healthy women was carried out using CryoSlim Hybrid device. Each patient underwent two cryolipolysis sessions centered on the abdominal area. The primary endpoint was to decrease the thickness of the abdominal fat deposits. The change in the abdominal circumference and the thickness of the subcutaneous fat layer were assessed. Patient satisfaction and tolerance of the procedure were also taken into account. RESULTS: A significant reduction of the abdominal circumference and subcutaneous fat layer thickness was observed. The mean decrease in abdominal circumference was 2.10 cm (3.1%) 3 months after the procedure and 4.03 cm (5.8%) 6 months after the procedure. The mean decrease in fat layer thickness was 1.25 cm (43.81%) 3 months after the procedure and 1.61 cm (41.73%) 6 months after the procedure. No major adverse events were noted. All patients were very satisfied, and minimal pain was reported. CONCLUSIONS: Cryolipolysis is an effective technique to treat abdominal localized fat deposits. No major adverse events have been described for this procedure. Our promising results should encourage further studies aimed at optimizing the efficacy of the procedure without a considerable increase in the risks. 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 http://www.springer.com/00266 .

Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon.

INTRODUCTION: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. MATERIAL AND METHODS: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. RESULTS: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the loca-tion of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only signifi cant pre-dictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fi stula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multi-variable adjustment. CONCLUSIONS: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.

Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon

ABSTRACT Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. Material and methods: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment. Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.

Cutting through the fat: a retrospective analysis of clinical outcomes, cost, and quality of life with the addition of panniculectomy to ventral hernia repair in overweight patients.

BACKGROUND: Due to the increased prevalence of overweight patients with ventral hernia, abdominal wall reconstruction combining ventral hernia repair (VHR) with panniculectomy (VHR-PAN) in overweight patients is increasingly considered. We present a retrospective comparison between VHR-PAN and VHR alone in overweight patients by examining costs, clinical outcomes, and quality of life (QoL). METHODS: Patients with body mass index (BMI) > 25.0 kg/m2 underwent VHR-PAN or VHR alone between September 2015 and May 2017 with a single surgeon and were matched into cohorts by BMI and age (n = 24 in each cohort). QoL was assessed using the Hernia-related Quality of Life Survey (HerQLes). Cost was assessed using billing data. Statistical analyses were performed using Fisher's exact tests, Mann-Whitney U tests, and regression modeling. RESULTS: Hernia defect size (p = 0.127), operative time (p = 0.140), mesh placement (p = 0.357), and recurrence rates (p = 0.156) did not vary significantly between cohorts at average follow up of one year. 60% of patients completed QoL surveys, with 61% net improvement in VHR-PAN postoperatively (p = 0.042) vs 36% in VHR alone (p = 0.054). Mean total hospitalization costs were higher for VHR alone (p = 0.019). Regression modeling showed no significant independent contribution of procedure performed due to differences in cost, wound complications, or hernia recurrence. CONCLUSIONS: At mean follow up of 2 years, VHR-PAN patients reported a comparable increase in QoL to those who received VHR alone without significantly different cost and complication rates. Concurrent VHR-PAN may therefore be a safe approach for overweight patients presenting with hernia and excess abdominal skin.

Avaliação prospectiva das repercussões no perfil lipídico das cirurgias que envolvem lipoaspiração e dermolipectomias / Prospective assessment of the repercussions on the lipid profile of surgeries involving liposuction and dermolipectomies

Introdução: Lipoaspiração associada a dermolipectomias é o procedimento cirúrgico mais comumente realizado em cirurgia plástica. Apesar de ser considerada uma cirurgia extremamente segura, algumas considerações devem ser levantadas a respeito dos possíveis efeitos metabólicos que essas cirurgias possam causar. O desenvolvimento da técnica tumescente de lipoaspiração permitiu a remoção de grande quantidade de gordura de modo mais seguro. O objetivo é comparar as variações do perfil lipídico em pós-operatório precoce e tardio de pacientes submetidos à lipoaspiração e dermolipectomias. Métodos: Entre outubro de 2006 e junho de 2012, 40 pacientes do sexo feminino candidatas a cirurgias que envolviam lipoaspiração e dermolipectomias foram acompanhadas prospectivamente e o perfil lipídico foi analisado por meio de exames no pré-operatório e no pós-operatório. As cirurgias realizadas foram: mamoplastia + lipoaspiração, abdominoplastia + lipoaspiração e lipoabdominoplastia + mamoplastia. Resultados: Das 40 pacientes que foram acompanhadas no estudo, 20 pacientes do sexo feminino foram selecionadas (após a aplicação dos critérios de exclusão). Em consonância com nosso estudo, Cazes, em 1996, demonstrou que após 12 meses de pós-operatório de lipoabdominoplastia não houve alteração do perfil lipídico das pacientes. Conclusão: Após análise pré- e pós-operatória de 20 pacientes, observamos que não há alterações estatísticas significantes em relação ao perfil lipídico com tendência de equilíbrio das aferições em um ano em patamares próximos aos observados no pré-operatório.

Introduction: Liposuction associated with dermolipectomies is the most commonly performed surgical procedure in plastic surgery. Although regarded as an extremely safe surgery, some considerations must be taken on the possible metabolic effects of these surgeries. The development of the tumescent technique in liposuction allowed the safer removal of large amounts of fat. The objective is to compare lipid profile variations in the early and late postoperative period in patients undergoing liposuction and dermolipectomies. Methods: Between October 2006 and June 2012, 40 female patients who were candidates for surgeries involving liposuction and dermolipectomies were prospectively followed, and the lipid profile was analyzed through preoperative and postoperative examinations. The surgeries performed were mammoplasty + liposuction, abdominoplasty + liposuction, and lipoabdominoplasty + mammoplasty. Results: Of the 40 female patients who were followed, 20 were selected (after applying the exclusion criteria). In agreement with our study, in 1996, Cazes showed that there were no changes in the lipid profile of patients 12 months after lipoabdominoplasty. Conclusion: After a preoperative and postoperative analysis of 20 patients, it was observed that there were no statistically significant changes in the lipid profile and that the measurements after 1 year were close to those obtained in the preoperative period.

Efectividad y seguridad de las intervenciones para el manejo del linfedema / Effectiveness and safety of interventions for the management of lymphedema

INTRODUCCIÓN: Se recibe un pedido de evaluación del tratamiento del linfedema, en relación a su posible incorporación al Programa Médico Obligatorio (PMO). El Linfedema se define como una acumulación anormal de líquido intersticial y tejido fibroadiposo que ocurre como consecuencia de lesiones, infecciones o anomalías congénitas del sistema de drenaje linfático. En los países desarrollados la mayoría de los casos corresponden a formas de Linfedema Secundario, principalmente asociadas a neoplasias o a sus tratamientos, y entre ellos el cáncer de mama es la causa más frecuente. TECNOLOGÍAS EVALUADAS: Terapia descongestiva compleja (TDC), Drenaje linfático manual, Terapia de compresión, Ejercicios de reducción linfática, "Kinesio Taping", Láser de baja intensidad, Cirugía (incluyendo procedimientos escisionales, Procedimientos de liposucción y Procedimientos de reconstrucción linfática) El comparador utilizado fue el conjunto de tecnologías destinadas al manejo de esta condición que ya se encuentran incluídas en el PMO. Se llevó a cabo una búsqueda de estudios secundarios (revisiones sistemáticas, guías de práctica clínica, informes de ETS). Se incluyeron Revisiones Sistemáticas cuya calidad metodológica fue valorada con la herramienta PRISMA. RESULTADOS Y COMENTARIOS: Se incluyeron 10 revisiones sistemáticas cuya calidad metodológica fue en general buena. Sin embargo los estudios primarios en los que se basaron dichas revisiones presentan en su gran mayoría importantes deficiencias metodológicas y elevado riesgo de sesgos. La evidencia en relación a las intervenciones no invasivas muestra un grado variable de efectividad de las mismas. En el caso de la terapia descongestiva compleja el cuerpo de la evidencia mostró resultados variables en los distintos estudios. La mayoría de éstos reportaron diferencias no significativas. El drenaje linfático manual combinado con diferentes intervenciones también tuvo resultados heterogéneos en distintos estudios y para diversos desenlaces clínicos. La mayoría fueron no significativos. Para los desenlaces de calidad de vida, la fisioterapia en combinación con el ejercicio tuvo um beneficio estadísticamente significativos para sus componentes físico y mental en el período post tratamiento. El ejercicio mostró beneficios estadísticamente significativos también en cuanto a la reducción de volumen del miembro afectado. En el caso de las mangas y vendajes compresivos el resultado fue no significativo desde el punto de vista estadístico en la primera fase del tratamiento, pero sí resultó efectivo en la fase de mantenimiento. En el caso de la compresión neumática intermitente, el beneficio del tratamento compresivo resultó significativo estadísticamente. La intervención denominada kinesio-taping no mostró efectividad. Los resultados del tratamiento con láser se mostraron favorables para el desenlace reducción del volumen del miembro afectado, sin consignarse la significación clínica de la intervención, y no significativos para la mejoría del dolor. Las intervenciones no invasivas mencionadas no se asociaron a efectos adversos significativos y fueron bien toleradas por los pacientes. En cuanto a las distintas intervenciones quirúrgicas, se reportaron diferentes grados de efectividad con respecto a los desenlaces analizados. Sin embargo, la heterogeneidad con respecto principalmente a las poblaciones analizadas y severidad de la enfermedad, así como las importantes limitaciones metodológicas de los estudios, dificulta la interpretación de sus resultados. Los procedimientos escisionales en los estudios relevados reportaron beneficios para reducir el volumen pero sólo se emplearon en pacientes con estadíos avanzados de la patología; lo que impide la evaluación de su efectividad o seguridad en otros grupos de pacientes. Se presentaron mayor número de complicaciones en relación a las demás estrategias quirúrgicas. La evidencia en los procedimientos de liposucción muestra que estos fueron aplicados a pacientes con estadíos avanzados de la enfermedad en quienes no se reportaron complicaciones y se halló efectividad en cuanto a la reducción de volumen del miembro afectado como en mejoría en la calidad de vida (aunque el modo de valoración de este último desenlace resultó sumamente heterogéneo). Sin embargo el tiempo de seguimiento de la mayoría de los estudios incluídos impresiona demasiado breve para valorar la efectividad del tratamiento. En cuanto a los procedimientos de reconstrucción linfática, tanto LVA como VLNT la evidencia encontrada mostró efectividad clínica para los desenlaces estudiados de manera más consistente con respecto al resto de las intervenciones; en el caso de las complicaciones, su frecuencia fue muy variable pero no se reportaron eventos adversos severos. Es probable que los resultados heterogéneos de todas las intervenciones de manera global no justifiquen un cambio de conducta terapéutica en relación a la que se realiza de manera habitual. El beneficio de las intervenciones no invasivas está fuertemente relacionado a la adherencia a largo plazo por parte de los pacientes.

[Liposuction]. / Liposuktion.

Liposuction began in the 1920s when the Parisian surgeon Charles Dujarier became interested in body shaping and fat removal. Today, it is estimated that 1,453,000 liposuctions are annually performed worldwide. In Germany, 45,000 liposuctions are performed annually. The majority of liposuctions are performed as self-pay services. The aim of this article is to outline the development of liposuction, to explain the various liposuction procedures and methods, to clarify the indications for treatment, and point out the complications and pitfalls described in the literature.

The Ideal Thigh: A Crowdsourcing-Based Assessment of Ideal Thigh Aesthetic and Implications for Gluteal Fat Grafting.

BACKGROUND: As the popularity of aesthetic gluteoplasty continues to grow, there is renewed focus on defining the ideal buttocks. However, the literature lacks studies characterizing an ideal thigh, despite the impact of thigh contour on overall gluteal aesthetic. OBJECTIVES: The authors performed the first population analysis of the characteristics of perception of attractive thighs, to identify a role for fat grafting of the thigh in gluteoplasty. METHODS: Survey images were digitally modified to create thighs of varying widths and angles relative to fixed buttocks. Thigh-to-buttock ratios and the buttock-thigh junction were studied. Data were stratified and analyzed according to age, gender, and ethnicity of the respondents. Amazon Mechanical Turk was used as a novel crowdsourcing platform for surveying aesthetic preferences. RESULTS: A total of 1034 responses were included of whom 54.4% were male, and 45.6% were female. All age groups and ethnicities were represented. Overall, 43.8% of respondents preferred the widest buttock-thick junction angle on posterior view. There was no clear preference between larger or smaller thigh-to-hip ratios on lateral view. CONCLUSIONS: Characteristics of the ideal thigh include wider thighs with greater horizontal projection, creating a more natural contour from the augmented buttock. These findings represent a paradigm shift from the traditionally assumed preference for slender thighs. Plastic surgeons should carefully consider thigh anatomy in their gluteal augmentation patients, as simultaneous thigh augmentation may lead to a more aesthetically pleasing outcome. Further research is needed into best practices and techniques to attain ideal thigh proportions.

Experimental and numerical assessment of hyperthermic laser lipolysis with 1,064 nm Nd:YAG laser on a porcine fatty tissue model.

BACKGROUND AND OBJECTIVES: The aim of this study was to develop experimental and numerical models for a better understanding of hyperthermic laser lipolysis (HHL). STUDY DESIGN: A 3 cm thick porcine fat sample was irradiated over a 4.3 × 4.7 cm2 area for 2 minutes with a 1,064 nm Nd:YAG laser using 1.2 W/cm2 irradiance. Two irradiation scenarios were considered: without and with forced air cooling. Following the irradiation, the sample was left to cool down by natural convection. During the irradiation period, the surface temperature of the sample was continuously recorded by an infrared camera. Additionally, temperature depth profiles during the cooling period were also obtained. A one-dimensional model of the laser irradiation procedure was developed, including light and heat transport. The model was used to determine the absorption coefficient of the fat and the heat convection coefficients from the measured data, and to evaluate the treatment by varying the parameters. RESULTS: The measured temperature depth profiles revealed a maximum temperature (45.5°C) at the surface for a non-cooled sample, and a surface temperature of 38°C with a subsurface temperature peak of 42.6°C at a depth of 5.7 mm for a cooled sample. This corresponded well with the measured surface temperature increase following the irradiation as a result of heat diffusion from the heated deeper fat layers. The developed numerical model was used to fit the measured data. A good agreement between the model and the measurements was obtained. By varying the treatment parameters, basic empirical relations connecting the treatment, thermal signal, and temperature depth profile parameters were found. CONCLUSIONS: The results of this study provide a better understanding of transcutaneous laser lipolysis. The developed numerical model can be extended to transcutaneous laser lipolysis of human subjects. Lasers Surg. Med. 50:125-136, 2018. © 2017 Wiley Periodicals, Inc.

Is There a Limit? A Risk Assessment Model of Liposuction and Lipoaspirate Volume on Complications in Abdominoplasty.

BACKGROUND: Combining liposuction and abdominoplasty is controversial because of concerns for increased complications and potential for vascular compromise of the abdominoplasty flap. Also, the lipoaspirate volume in abdominoplasty is regulated in some areas to as little as 500 ml when performed with abdominoplasty. This study measures abdominoplasty complication rates when performed with and without trunk liposuction, and evaluates the effect of lipoaspirate volume on complications. METHODS: Abdominoplasty and liposuction of the trunk procedures were identified in the Tracking Operations and Outcomes for Plastic Surgeons database. Multivariate regression models determined the effect of liposuction with abdominoplasty on complications compared with abdominoplasty alone and determined the effect of liposuction volume on complications. RESULTS: Eleven thousand one hundred ninety-one patients were identified: 9638 (86.1 percent) having abdominoplasty with truncal liposuction and 1553 (13.9 percent) having abdominoplasty alone. Overall complication rates were 10.5 percent and 13.0 percent, respectively. Combined liposuction and abdominoplasty was independently associated with a reduced risk of both overall complications (p = 0.046) and seroma (p = 0.030). Given existing laws limiting liposuction volume to 500 or 1000 ml in combination with abdominoplasty, each of these thresholds was evaluated, with no effect on complications. Surprisingly, increasing liposuction volume was not independently associated with an increased risk of any complication. CONCLUSIONS: When done by board-certified plastic surgeons, abdominoplasty with truncal liposuction is safe, with fewer complications than abdominoplasty alone. Regulations governing liposuction volumes in abdominoplasty are arbitrary and do not reflect valid thresholds for increased complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Liposuction-Augmentation Mammaplasty.

BACKGROUND: The female breast loses superior fullness and becomes more ptotic over time. Women often present to their plastic surgeon requesting reversal of this evolution. While liposuction alone has been proven to lift the breast, no solution combining augmentation and liposuction has been reported. OBJECTIVES: Herein, we introduce a technique called liposuction-augmentation mammaplasty (LAM) that can achieve "scarless" lifting or simply volume equalization prior to inserting same-sized implants. We then compare its safety and efficacy to two gold-standard techniques with similar aims, mastopexy-augmentation mammaplasty (MAM) and reduction-augmentation mammaplasty (RAM). METHODS: A retrospective 3-year chart review was conducted on 359 patients (652 breasts) undergoing LAM (n = 125), MAM (n = 188), and RAM (n = 46). Patient demographics, operative details, and revisions were documented. Degree of lift was measured on pre- and postoperative photographs using sternal notch-to-nipple distances (SN-N). Statistical differences were assessed between the groups. RESULTS: The LAM group's mean age and OR time (37 years, 46 minutes) were significantly lower than those of MAM (43 years, 90 minutes) and RAM (42 years, 106 minutes). Mean BMIs and revision rates were uniform between the LAM and MAM groups (24, 2.5%), but significantly higher for RAM (28, 4.6%). Aspirate volumes and resection weights averaged 151 cc and 307 g (left breast) and 173 cc and 298 g (right breast). Minimum follow up was 12 months. The LAM group's mean SN-N reduction (~6%) was statistically significant, albeit much lower than MAM (~16%) and RAM (~22%). CONCLUSIONS: LAM is a safe, facile, reliable solution for the ptotic, fatty breast. Patients can direct their volumetric outcome and enjoy lower costs and shorter downtime.

Assessment of the Efficacy of Cryolipolysis on Saddlebags: A Prospective Study of 53 Patients.

BACKGROUND: Cryolipolysis is a noninvasive subcutaneous fat removal technique. Its efficacy has been demonstrated on various fatty areas but not yet on saddlebags. The main objective of this study was to demonstrate the efficacy, patient tolerance, and safety of cryolipolysis on the saddlebags. METHODS: This prospective study enrolled 53 patients with saddlebags. Patients with a history of liposuction or other surgical procedure on the saddlebag area and those on diet pills were excluded. The primary endpoint was a decrease in fat thickness at 3 and 6 months, as assessed by thigh circumference measurement and by ultrasound evaluation of subcutaneous fat. Pain associated with cryolipolysis was assessed using a visual analogue scale. Body mass index at the different time points and adverse events were recorded. All patients completed a satisfaction questionnaire at the end of the study. RESULTS: At 6 months, there was a mean decrease of 5.63 cm in thigh circumference; the mean decrease in fat layer thickness measured by ultrasound was 1.31 cm. The satisfaction questionnaire showed that 93.75 percent of patients were satisfied with the results. The mean visual analogue scale score was 1.66 of 10 after the session. Reversible skin changes such as postprocedure postinflammatory hyperpigmentation were observed in 8.33 percent of patients. CONCLUSIONS: Cryolipolysis is an effective technique for reducing saddlebag fat and is well tolerated by patients. A substantial risk of skin lesions, including postinflammatory hyperpigmentation that resolved after a few months, was observed. Cryolipolysis is a good alternative to liposuction in women with moderate, well-localized saddlebags. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Criolipólisis: su aplicación en la medicina estética / Cryolipolysis: its application in aesthetic medicine

INTRODUCCIÓN: La adiposidad localizada está frecuentemente asociada a insatisfacción con la forma del cuerpo, alteración de la autoestima y de las relaciones interpersonales. En la actualidad, el auge de procedimientos estéticos es impulsado por la generación del baby boom, que busca minimizar o retrasar los signos del envejecimiento, lo cual muchas veces se transforma en una obsesión por alcanzar estándares de belleza y formas ideales del cuerpo. Una encuesta reveló que, en el año 2016, los estadounidenses gastaron más de 15 mil millones de dólares en procedimientos estéticos quirúrgicos combinados con aquellos no quirúrgicos, siendo el procedimiento más popular la liposucción. Sin embargo, desde su advenimiento en los años ´70, el número de procedimientos quirúrgicos ha disminuido, tal vez por conocerse los inconvenientes provocados por la anestesia y los riesgos inherentes a la cirugía, sumados los tiempos de reposo prolongado y a efectos tales como dolor e hinchazón. Mientras tanto, el número de procedimientos mínimamente invasivos - denominados lunch time procedures pues se completan en menos de 2 horas- han aumentado, registrándose en el año 2000 un incremento del 137%. Entre los tratamientos no quirúrgicos se encuentran: láser (lipólisis), ultrasonido, radiofrecuencia y luz infrarroja con evidencia variable en cuanto a su eficacia. Todos ellos tienen por ventaja que el paciente puede volver a su actividad normal inmediatamente después del tratamiento. Sin embargo, no tuvieron éxito debido a sus limitaciones terapéuticas, sumadas a la cantidad de sesiones y los escasos resultados clínicos. La propuesta estética actual para deshacerse de aquellos cúmulos grasos que persisten en pacientes que realizan dieta y ejercicio es la criolipólisis (CL), la cual ha presentado resultados estadísticamente significativos, con efectos adversos leves que desaparecen a las semanas del tratamiento. La CL surge como una técnica no invasiva, la cual es controlada y focalizada, cuya finalidad es la reducción del contorno corporal, para destruir el tejido adiposo subcutáneo a través de la apoptosis de los adipocitos, sin afectar al tejido circundante. Si bien un solo tratamiento de CL puede bastar para resolver el problema de pequeñas acumulaciones de grasa localizada, los resultados no son inmediatos, sino que hay que esperar 2 o 3 semanas para comenzar a ver cambios considerables en el área tratada. Por lo tanto, este procedimiento estético no es aconsejado para pacientes obesos con flacidez cutánea considerable, pues no es una forma de perder peso o de tratar la obesidad. Además, es muy importante tener en cuenta que, en la actualidad, no existen estudios que evidencien que el tratamiento de CL este asociado a la pérdida permanente de grasa. OBJETIVO: Evaluar la seguridad y eficacia de la criolipólisis (CL) en la reducción del contorno corporal. TECNOLOGÍA: En la actualidad existe una gran oferta de técnicas y procedimientos estéticos, ya sea para corregir arrugas como para aumentar o reducir zonas, eliminar la grasa ó modelar zonas del cuerpo. Una amplia variabilidad tecnológica se encuentra disponible para satisfacer la demanda de los usuarios, hombres y mujeres, brindando procedimientos más seguros y de menor costo, con tiempos de recuperación más cortos. Como hemos mencionado precedentemente, la CL es una técnica no invasiva para la reducción del tejido adiposo subcutáneo por enfriamiento controlado y localizado de los adipocitos, la cual se propone como el procedimiento alternativo a la liposucción o a la lipólisis (técnica láser), siendo menos costos, menos riesgosa e igual de efectiva. El equipo de CL se compone de un aplicador en forma de copa, que utiliza vacío moderado para tirar de la capa de piel y grasa, posicionándola entre dos placas de enfriamiento. Éstas producen una intensa bajada de temperatura, lo que induce a la muerte de adipocitos del área de tratamiento; el hielo lipídico intracelular se forma alrededor de los 4 a 10° C (en comparación con el agua a 0° C). Un estudio demostró que, aún en condiciones de temperatura de 1° C, los adipocitos presentan daños y sus posibilidades de supervivencia disminuyen. DISCUSIÓN: En las últimas décadas, las opciones para el rejuvenecimiento de quienes quieren mejorar su apariencia física se han multiplicado en virtud de la amplia variedad de tecnologías disponibles, que continúa creciendo, y que incluyen neuromoduladores, rellenos, escleroterapia, peelings químicos, lipoescultura, el uso de láseres, IPL, CL, entre otros. Al igual que ocurre con todas las tecnologías terapéuticas, los pacientes que reciben este tipo de tratamientos estéticos no están exentos de riesgo. Por lo tanto, el conocimiento oportuno de las complicaciones para su uso por parte de los profesionales es fundamental a la hora de resguardar la salud del paciente. En el presente informe hemos descripto a la CL como una técnica de tratamiento segura y efectiva para la reducción del exceso de tejido adiposo localizado30 acorde a la evidencia disponible, la cual proviene de revisiones sistemáticas, ensayos clínicos cuasiexperimentales o serie de casos, siendo las limitaciones de éstos el pequeño tamaño muestral, la heterogeneidad en cuanto a temperatura y factor de enfriamiento utilizados en los tratamientos estudiados y la posibilidad de la existencia de sesgos de publicación, habida cuenta que muchos estudios han sido financiados por los fabricantes del equipamiento. Los mejores resultados clínicos estarían asociados con la realización de masajes manuales después del tratamiento. Respecto del dolor y el disconfort durante el tratamiento, algunos autores destacan que fueron. resueltos con la administración de AINEs. No se observaron cambios en las estructuras nerviosas según las biopsias realizadas. No han sido evaluados los efectos de la CL a largo plazo. Sólo se ha publicado un pequeño estudio de dos sujetos tratados unilateralmente en un flanco y fotográficamente analizados luego de 5 años posteriores al procedimiento. En este estudio, se encontró que la reducción de grasa era duradera a pesar de las fluctuaciones en el peso corporal. Las evidencias disponibles en la actualidad muestran que la CL es una técnica en principio bien tolerada, con EA leves a moderados dentro de los cuales se incluyen: hormigueo, eritema, edema, moretones y entumecimiento, los cuales se resolvieron espontáneamente entre los 42 y 63 días posteriores a la intervención. CONCLUSIÓN: La CL es un procedimiento estético no invasivo que permite la reducción de pequeñas acumulaciones de grasa corporal en áreas que incluyen caderas, abdomen, cara interna y externa de los muslos, carilla interna de rodillas, brazos, espalda alta y baja, flancos, el tejido del pecho y el área submentoniana (debajo del mentón). Este procedimiento está indicado para su implementación sólo con fines estéticos y en aquellas personas que se encuentran dentro de un rango de peso apropiado para su talla y edad (IMC ≤ 30), realizan ejercicio de manera regular, mantienen una dieta saludable, poseen pequeños cúmulos grasos visibles en el tronco, miembros superiores e inferiores y cuello, y están dispuestos a mantener los resultados obtenidos en el procedimiento mediante un estilo de vida saludable y activo. Es muy importante resaltar el hecho de que esta técnica no está recomendada para pacientes con obesidad, dado que esta enfermedad sistémica crónica requiere tratamiento médico. Los estudios disponibles evaluados son de mediana o baja calidad, muestran que esta intervención es eficaz y bien tolerada con una baja incidencia de EA leves a moderados de resolución espontánea en el corto plazo. Dado que no hay estudios que evalúen su efectividad y seguridad a largo plazo, se debería proveer de estudios de mayor tiempo de seguimiento para comprobar su efectividad y seguridad. La población específica que se beneficia con su uso está bien determinada, y es de buena práctica no ampliar su indicación a poblaciones no estudiadas.

Is There a Safe Lipoaspirate Volume? A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index.

BACKGROUND: No concrete data exist to support a specific volume at which liposuction becomes unsafe; surgeons rely on their own estimates, professional organization advisories, or institutional or government-imposed restrictions. This study represents the first attempt to quantify the comprehensive risk associated with varying liposuction volumes and its interaction with body mass index. METHODS: Suction-assisted lipectomies were identified from the Tracking Operations and Outcomes for Plastic Surgeons database. Multivariate regression models incorporating the interaction between liposuction volume and body mass index were used to assess the influence of liposuction volume on complications and to develop a tool that returns a single adjusted odds ratio for any combination of body mass index and liposuction volume. Recursive partitioning was used to determine whether exceeding a threshold in liposuction volume per body mass index unit significantly increased complications. RESULTS: Sixty-nine of 4534 patients (1.5 percent) meeting inclusion criteria experienced a postoperative complication. Liposuction volume and body mass index were significant independent risk factors for complications. With progressively higher volumes, increasing body mass index reduced risk (OR, 0.99; 95 percent CI, 0.98 to 0.99; p = 0.007). Liposuction volumes in excess of 100 ml per unit of body mass index were an independent predictor of complications (OR, 4.58; 95 percent CI, 2.60 to 8.05; p < 0.001). CONCLUSIONS: Liposuction by board-certified plastic surgeons is safe, with a low risk of life-threatening complications. Traditional liposuction volume thresholds do not accurately convey individualized risk. The authors' risk assessment model demonstrates that volumes in excess of 100 ml per unit of body mass index confer an increased risk of complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Classification and surgical correction of asymmetric calves in Asians.

BACKGROUND: In Asia, one of the most important factors in being physically attractive is to have aesthetically pleasing legs, which has made calf contouring surgery an issue nowadays. When one leg is abnormally changed because of various factors (e.g., iatrogenic causes, poliomyelitis, cerebral palsy, trauma, and tumor resection), the tissue atrophies. Such asymmetric calves can be corrected by various surgical methods. METHODS: Calf asymmetry is defined as a difference in the maximal circumference greater than 2.0 cm between both calves. From 2005 to 2012, the authors carried out calf contouring operations on 68 patients. For patients with mild or moderate asymmetry, selective neurectomy with or without liposuction was performed on the hypertrophic calf according to shape and severity. For patients with severe asymmetry, selective neurectomy with liposuction was performed for the hypertrophic calf, whereas the hypotrophic calf was treated with fat injection or silicone implantation. RESULTS: At a minimum of 3 months' follow-up, the mild group patients had a size difference less than 0.5 cm. The moderate and severe asymmetry groups showed size differences less than 1.2 and 2.3 cm, respectively. No functional problems or major complications were shown. Minor complications included five cases of wound dehiscence, three cases of hematoma, and six cases of hypertrophic scar at the incision site. CONCLUSION: Classifying patients into three groups according to the maximal circumferential difference between both legs and treating them separately using different surgical methods could significantly provide satisfying outcomes in both functional and aesthetic aspects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Assessment of effects of physical or chemical factors on fat particle viability by glucose transport test.

BACKGROUND: It is important to protect fat viability during grafting. This study aimed to clarify whether physical or chemical factors damage fat viability. METHODS: Fat was harvested under high and low tumescence pressure, using syringes and a liposuction machine; this fat was injected through different gauge needles and cultured with lidocaine or epinephrine. Samples were subjected to glucose transport test and observed histologically. RESULT: The viability and microstructure of fat harvested under high and low tumescence pressure, and by syringe and liposuction machine, were similar (P > 0.05). The viability and intactness of fat cells injected through needles decreased with decreasing needle diameter (P < 0.05). Lidocaine (P < 0.05) and epinephrine (P < 0.05) weakened fat viability. CONCLUSIONS: Fat used for grafting can be harvested by tumescent techniques and a liposuction machine. Fat cell viability during injection increases with increasing needle diameter. Fat should be purified to remove drugs.

Broad overview of a clinical and commercial experience with CoolSculpting.

BACKGROUND: Cryolipolysis has been shown to be a safe and effective noninvasive procedure for the reduction of localized subcutaneous fat. OBJECTIVES: The authors examine the safety, efficacy, and procedural growth of cryolipolysis (via the CoolSculpting device; Zeltiq, Pleasanton, California) in a single plastic surgery practice. METHODS: A retrospective chart review was conducted for 528 consecutive patients who underwent cryolipolysis treatment from January 2010 to December 2012. The number of patients, the number of treatment cycles, the average number of cycles per patient, all treatment areas, and all procedural complications were recorded and analyzed. Overall practice growth with the device was also analyzed. RESULTS: Over the study period, 1785 anatomic sites were treated with 2729 cycles, primarily in the lower abdomen (28%, n = 490 cycles), upper abdomen (11%, n = 189), left flank (19%, n = 333), right flank (19%, n = 333), inner thigh (6%, n = 111), outer thigh (5%, n = 87), and back (6%, n = 99). The age distribution for men and women was similar (46.6 ± 12.8 years for women and 46.5 ± 12.3 years for men; overall range, 18-79 years). Only 3 cases of mild or moderate pain/neuralgia were reported and resolved in 4 or fewer days. No adverse events were reported. Procedure volume showed consistent growth, with treatment cycles increasing by 823% by 2012. CONCLUSIONS: Based on the results in this single plastic surgery practice, cryolipolysis is a safe and effective nonsurgical body contouring method associated with high patient satisfaction that can generate steady, significant business growth.

Methods for the assessment of the efficacy of products and slimming treatments for cellulite according to the Italian Interdisciplinary Group for the standardization of efficacy tests on cosmetic products.

Cellulite is a very common skin alteration with a complex pathogenesis; different degrees of severity of cellulite can be observed in most part of people after puberty, and numerous cosmetic or more invasive treatments have been proposed, with variable efficacy. Since reproducible methods of evaluation of the effectiveness of cellulite treatments are lacking, the purpose of our group was to define and set general testing principles for evaluating the efficacy of slimming products and treatments/remodeling methods for cellulite, to achieve a delineation of reliable and reproducible research steps following a well-designed and scientifically valid methodology. After a careful review of literature and textbooks and according to personal experience, we defined assessment protocols based on clinical and instrumental tools. In order to make studies reliable, reproducible and safe, a protocol standardization is needed. The sponsor is responsible for assuring quality and information concerning the product under investigation; moreover, investigators should be experienced on cellulite evaluation and treatment, and, finally, the duration and modalities of application of the product should be specified. A treated VS non treated area comparison can be performed, to evaluate the severity of cellulite and the clinical outcomes of the treatment. Besides clinical evaluation, instrumental methods should always be implemented to provide objective data for treatment outcome.