[Trochanteric under gluteus lift or bodylift, technique for massive trochanteric lipodystrophy: About 11 cases]. / Le lifting ou bodylifting trochantéro sous-fessier (TSF) une technique adaptée aux gros excès trochantériens : à propos de 11 cas.

INTRODUCTION: There is a growing demand for weight loss sequelae. Some women have a particular morphology with a major trochanteric excess that warrants specific treatment. MATERIALS AND METHODS: On the basis of the technique published in 1964 by Pitanguy, the authors suggest a lift of the external face of the thigh with the scar redrawing the lower part of the buttock, from the gluteal fold to the inguinal region by crossing the trochanteric region. Eleven cases of major trochanteric excess after slimming are presented. In 4 cases, the trochanteric excess is solely treated by trochanteric under gluteus lift. In 7 cases, it is associated with abdominoplasty to perform a trochanteric under gluteus bodylifting. RESULTS: Complications and results are presented. The trochanterian excess is reduced, the buttock is harmonious and the patients satisfied. DISCUSSION: Modifications are made to the much criticized technique of Pitanguy. The lipectomy replaces the monobloc resection, the scar is verticalized on the trochanter to join the abdominoplasty scar. This technique is an alternative to the vertical trochanteric resection associated with classic bodylift. CONCLUSION: The trochanteric under gluteus lift is an elegant solution for treating large trochanteric excess. It is adaptable. It can become bodylifting TSF in the cases of great slimming.

Sclerosing Mesenteritis Presenting as a Pseudotumor of the Greater Omentum.

OBJECTIVE: The aim was to demonstrate a diagnostic challenge of sclerosing mesenteritis initially considered as liposarcoma. CLINICAL PRESENTATION AND INTERVENTION: A 45-year-old man was admitted with a painful abdominal mass. Abdominal computed tomography demonstrated a well- demarcated tumor in his left hemiabdomen, with a large fat component and areas of soft tissue attenuation suggestive of liposarcoma. Intraoperative findings showed a tumor arising from the greater omentum. The tumor was completely removed, and histopathology confirmed a pseudotumorous type of sclerosing mesenteritis with dominant mesenteric lipodystrophy. CONCLUSION: This case showed that a pseudotumorous type of sclerosing mesenteritis should be considered in the differential diagnosis of the mesenteric tumors.

Brachioplasty: A Personal Approach.

Brachioplasty has become one of the most rapidly growing operations in plastic surgery. There are a variety of arm presentations, due to either weight loss or other reasons, and the extent of the defect can carry into the lateral chest wall and the back. In this featured operative technique article, the author describes indications, patient selection, and criteria for classifying brachioplasty, and illustrates the surgical techniques of this procedure. Markings, scar positioning, and the various operative steps are described along with the intricacies of postoperative care, including scar control. A personal experience, along with the limitations of brachioplasty, are discussed.

Prostaglandin-Associated Periorbital Lipodystrophy in Cosmetic Eyelid Surgery: A Novel Cause of Facial Asymmetry.

A 70-year-old woman presented to our practice with profound ptosis of the left upper eyelid and notable asymmetry of the periocular area. On examination, she was noted to have significant atrophy of the periocular tissues on the left side, with lower eyelid retraction. These features were present but less severe on the right side. Upon further questioning, she stated that she had cataract surgery on the left side that was complicated by a high intraocular pressure and required subsequent secondary surgery. She had taken a prostaglandin eyedrop for many months after her cataract surgery to keep the eye pressure low. Recently, a newly recognized adverse effect of prostaglandin eyedrops has been described in the ophthalmic literature in which patients develop periorbital lipodystrophy. This case emphasizes that this may occur unilaterally in patients taking the eyedrop in only one eye, and should be recognized prior to considering functional and aesthetic surgery of the periocular area.

Functional and Therapeutic Indications of Liposuction: Personal Experience and Review of the Literature.

Liposuction is the most common cosmetic surgical procedure worldwide. It has evolved from being designed primarily for body contouring to becoming essential adjunct to various other aesthetic procedures, greatly enhancing their outcome. Despite its hard clear differentiation between an aesthetic and therapeutic indication for some pathologic conditions, liposuction has been increasingly applied to a gamut of disorders as a therapeutic tool or to improve function. In fact, liposuction has ceased to define a specific procedure and became synonymous to a surgical technique or tool same as the surgical knife, laser, electrocautery, suture material, or even wound-dressing products. At present, there seems to be an enormous potential for the application of the basic liposuction technique in ablative and reconstructive surgery outside the realm of purely aesthetic procedures. The present review contemplates the various nonaesthetic applications of liposuction, displaying the enormous potentials of what should be considered a basic surgical technique rather than a specific aesthetic procedure. Implications of this new definition of liposuction should induce third-party public payers and insurance companies to reconsider their remuneration and reimbursement policies.

Precautions in using a perforator free flap to treat mandibuloacral dysplasia--a case report.

Mandibuloacral dysplasia (MAD) is a rare form of inherited lipodystrophy. The type B pattern is characterized by a generalized absence of subcutaneous tissues. There is also a deficiency of perivascular adiposity that makes the dissection not only of perforators and their source vessels difficult, but the recipient site vasculature as well. Perforator flaps in the MAD patient by definition will never be bulky, and instead a challenge in every respect as the perforators are extremely diminutive and therefore fragile. However, if a large, thin flap with a long pedicle of reasonable caliber is indicated, the attributes of a perforator flap may still be indicated as demonstrated in this case report for a recalcitrant heel pressure sore that had failed the usual conservative medical treatment.

Post-liver transplant leptin results in resolution of severe recurrence of lipodystrophy-associated nonalcoholic steatohepatitis.

We describe the first case of a patient undergoing orthoptic liver transplantation for acquired generalized lipodystrophy-related nonalcoholic steatohepatitis who developed severe recurrence of nonalcoholic fatty liver disease in the first few months posttransplant but responded rapidly to the administration of exogenous leptin. The beneficial effects of therapy were supported by histology along with magnetic resonance spectroscopy studies, which demonstrated that leptin therapy greatly reduced fat deposition in the liver. Leptin therapy may have a role to play in preventing patients with lipodystrophy developing end-stage liver disease or in rescuing such patients who develop disease recurrence postliver transplantation.

Fat preserving by laser 1210-nm.

INTRODUCTION: The 1210-nm wavelength has absorption-affinity for Lipid-Rich Tissue and has demonstrated to stimulate adipocytes and mesenchymal cells of the subcutaneous tissue, with a new concept: Selective Photothermostimulation (SPS). The application in Liposuction of this wavelength is determined by its preservation of the integrity of adipocytes, making possible the use of these materials for fat grafting in Liposculpture, Breast Reconstruction or as filler in Face Rejuvenation, proven that this technique is less traumatic. MATERIALS AND METHODS: 102 patients diagnosed with lipodystrophy either associated to skin flaccidity or not were applied the 1210-nm diode laser (ORlight®) between June 2010 and August 2011. The protocol was followed and verified through ultrasound imaging. Intraoperative and subcutaneous cellular tissue temperatures were measured. Samples of the aspirated tissue were sent for histological analysis to prove alteration/preservation of adipocytes and connective tissues, including mitochondrial activity. RESULTS: Histological analyses revealed 98% preservation of aspirated adipocytes. The 1210-nm diode laser shows affinity for adipose tissue. In addition, the technique poses a reduced trauma level on tissues, allowing for the performance of associated procedures for the body or face. No major complications were observed; and only minor complications, mainly ecchymosis on 2% of the total body surface area, have been recorded. The recovery period is 24 hours. The Liposuction Diode Laser (LSDL) 1210-nm is ideal for Liposculpture.

Modern lipostructure: the use of platelet rich fibrin (PRF).

OBJECTIVES: To evaluate the interest of growth factors adjonction during lipostructure. MATERIALS AND METHODS: Between May 2005 and June 2012, 232 patients benefited from this modern approach of lipostructure with concentrate of platelets. The technique evolves on the simplification way. RESULTS: All the patients were satisfied with the result with minimal associated resorptions. No massive resorption requiring a resumption of lipostructure was noted. CONCLUSION: By offering a matricial support to angiogenesis and by stimulating the proliferation of pre-adipocytes, the PRF could have a beneficial role on the cicatrization and the consolidation of an adipocyte graft.

Severe symmetrical facial lipoatrophy in a patient with discoid lupus erythematosus.

Acquired partial lipodystrophy is a rare disorder, and it is characterized by the absence of subcutaneous fat from the face, the neck, the trunk, and the upper extremities. The etiology of acquired partial lipodystrophy includes scleroderma and discoid lupus erythematosus. Literature review reveals studies involving 10 patients until today with lipoatrophy due to or after the onset of discoid lupus erythematosus; all are female patients. We want to report a young male patient with progressive symmetrical facial lipoatrophy. In addition, he has discoid lupus erythematosus and celiac disease. Fat grafting and adjuvant oral coenzyme Q10 tablets (Deka-none; Deka Pharmaceuticals, Istanbul, Turkey) were administered for treatment. To our knowledge, this case involves the first male patient in the literature presenting with symmetrical facial lipoatrophy with very prominent periorbital lipoatrophy and bitemporal hollowing symptoms.

One-stage transfer of 2 paddles of thoracodorsal artery perforator flap with 1 pair of vascular anastomoses for Barraquer-Simons syndrome.

We report a novel technique: a 1-stage transfer of 2 paddles of thoracodorsal artery perforator (TAP) flap with 1 pair of vascular anastomoses for simultaneous restoration of bilateral facial atrophy. A 47-year-old woman with a severe bilateral lipodystrophy of the face (Barraquer-Simons syndrome) was surgically treated using this procedure. Sufficient blood supply to each of the 2 flaps was confirmed with fluorescent angiography using the red-excited indocyanine green method. A good appearance was obtained, and the patient was satisfied with the result. Our procedure has advantages over conventional methods in that bilateral facial atrophy can be augmented simultaneously with only 1 donor site. Furthermore, our procedure requires only 1 pair of vascular anastomoses and the horizontal branch of the thoracodorsal nerve can be spared. To our knowledge, this procedure has not been reported to date. We consider that 2 paddles of TAP flap are safely elevated if the distal flap is designed on the descending branch, and this technique is useful for the reconstruction of bilateral facial atrophy or deformity.

Neck rejuvenation--anatomy and clinical correlation.

The restoration of the aesthetic contour of the neck is a challenging but important component of facial rejuvenation. Numerous techniques have been developed to improve the aesthetic outcome. We plan to give an overview of anatomic principles and their clinical correlation.

Contouring the gluteal region with tumescent liposculpture.

BACKGROUND: For quite some time, plastic surgeons have experimented with novel techniques for enhancing the gluteal region. However, all of the previously-described techniques have the disadvantage of postoperative scarring, most of which is visible. As an alternative, fat injection in the gluteal region has been shown to have permanent and satisfactory results. OBJECTIVES: The authors discuss the results of liposuction and lipoinjection in the gluteal region. METHODS: Between March 2000 and March 2007, 300 female patients who presented with lipodystrophy of the gluteal and paragluteal regions underwent liposuction with a modified tumescent technique. The treated sites were classified into six anatomical zones, and the patients were retrospectively grouped into types based on the frequency of treatment in each zone. RESULTS: The patients ranged in age from 16 to 54 years. The follow-up period ranged from six to 36 months. Fifty percent of patients underwent liposuction in Zone I, 90% in Zone II, 0% in Zone III, 40% in Zone IV, 30% in Zone V, and 75% in Zone VI. The largest percentage of patients underwent treatment in Zones I, II, and V, with subsequent lipoinjection. Comparison of pre- and postoperative photographs and measurements revealed gluteal lifting in all patients at the point of greatest projection. Improved contour was shown in Zones I, II, and IV when all zones were treated in a combined form. CONCLUSIONS: The concept of refining techniques for liposuction and lipoinjection according to individual anatomical zones is essential to the evolution of the procedure. In this series, the results indicated that improving the intraoperative treatment of the hip region resulted in improved aesthetic contouring. Therefore, the authors believe that this technique can reduce the need for more aggressive surgical procedures, which thereby decreases the risk of complications, recovery time, and sequelae.

[Barraquer-Simons syndrome]. / Syndrome de Barraquer-Simons.

The Barraquer-Simons syndrome is a rare acquired acral partial lipodystrophy of unknown etiology. It progressively develops during childhood. It leads to a complete loss of subcutaneous fat in the face, neck, trunk and upper limbs. The disease is more common in female than male patients and causes facial dysmorphy. Free fat transplantation seems to be an appropriate technique to treat facial abnormalities encountered in this syndrome.

Circumferential Lipobrachioplasty Is a Safe Procedure.

BACKGROUND: Excess fat and skin in the upper arms have become troublesome with aging and especially after the advancement in methods of weight reduction. Arm contouring procedures can be divided into three groups: those dealing with skin redundancy, those dealing with the lipodystrophy, and a combination of both. This study tries to find an answer to the debate about the safety of simultaneous circumferential liposuction and brachioplasty. METHODS: Sixty-two patients (49 women and 13 men) were operated on by simultaneous circumferential suction-assisted lipectomy followed by brachioplasty. Preoperative and postoperative arm circumferences and outcomes (including complications and patient satisfaction) were evaluated starting at least 6 months after the procedure. RESULTS: Only two patients (3.2 percent) developed small areas of wound dehiscence that healed after repeated dressing and an extended period of compression garment use. One patient (1.6 percent) complained of hypertrophic scarring, which was managed by local compression and silicone sheets. The average reduction in mid arm circumference was 9 cm (range, 5 to 14 cm). Approximately 95.2 percent of the patients in the study are highly satisfied, and 4.8 percent reported a mild degree of satisfaction. CONCLUSIONS: Simultaneous circumferential arm liposuction followed by brachioplasty addresses both the lipodystrophy and arm ptosis in a single hospital admission. This combination does not increase the complication rate. The results are highly satisfactory to the patients. According to the results of this study, circumferential arm lipobrachioplasty is considered to be a safe, efficient, reliable, and feasible procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[Surgical treatment of lipodystrophy]. / Chirurgie des lipodystrophies.

With the introduction of highly active antiretroviral therapy HIV has become a chronic but not necessarily a life-threatening disease. One drawback of the medication is the lipodystrophy syndrome that develops. Its precise mechanisms underlying are not well understood. The syndrome includes peripheral fat wasting (e.g. face, buttocks) and central fat accumulation. This condition can be very distressing to the patient who may be depressed and lose self-esteem which eventually leads to social withdrawal. The facial lipoatrophy is often experienced as the main problem as it is a social stigma telling other people that the patient is infected with HIV. The second zone bothering these patients is the buttocks. Buttocks lipoatrophy constitutes both an esthetic problem as well as a functional problem causing pain on sitting and even on walking.

Lipotransfer provides effective soft tissue replacement for acquired partial lipodystrophy.

We present a 48-year-old female patient who presented with features consistent with acquired partial lipodystrophy (APL) also known as 'Barraquer-Simons syndrome'. It is a rare disease characterised by a gradual and progressive onset of lipoatrophy limited to the face, neck, upper limbs, thorax and abdomen and sparing the lower extremities. The resultant physical appearance can have significant psychosocial sequelae, further compounded by misdiagnosis and delay in recognition and management. Treatment is aimed at surgical correction of soft tissue destruction. Autologous fat transfer is an established plastic and reconstructive procedure that is safe and minimally invasive and can be used to reconstruct a variety of soft tissue defects and has shown to be an effective treatment modality in patients with APL.

Unilateral atrophy of the cheek: autologous fat injection as treatment of choice.

Lipodystrophies are a set of heterogeneous conditions resulting from defective lipid metabolism and characterized by adipose tissue atrophy. We report on a 54-year-old woman who presented at the Department of Oral and Maxillofacial Surgery with an increasing unilateral atrophy of her left cheek for the past 3 years. The patient's history showed that she had sustained a left zygoma fracture 35 years ago but did not have any other disease. According to the patient's wish, a correction of the left cheek was performed by autologous fat injection, which led to a highly acceptable postoperative result. We compare this treatment with different alternatives.

Idiopathic facial lipoatrophy in a healthy middle-aged woman: a case report.

BACKGROUND: Facial lipoatrophy is a rare condition described by the disappearance of facial subcutaneous fat. The etiology of lipoatrophy can be congenital, or acquired including traumatic, iatrogenic or idiopathic. Idiopathic facial lipoatrophy has only been previously identified in three case reports, among which, the patient demographics vary considerably. Two of these case reports have identified a role for autologous fat transfer as a means of treatment. This case differs from those in the literature in patient demographics and severity of the facial lipoatrophy. The aim of the current report is to present a rare case of idiopathic facial lipoatrophy, and to assess the use of autologous fat transfer as a treatment modality. CASE PRESENTATION: We present a case of a 40-year old woman from Nova Scotia, Canada who presented with asymptomatic idiopathic facial lipoatrophy. The patient was otherwise healthy, taking no medications with no trauma or surgery in the region affected. Investigations, including a full autoimmune workup, were unremarkable. The facial lipoatrophy was considerably disfiguring and was assessed as a Grade 4 on the facial lipoatrophy scale. The patient was treated over the course of 2 years with two autologous fat transfers. CONCLUSIONS: Achieving resolution of idiopathic lipoatrophy is important to patients because it can manifest in a disfiguring form and have negative effects on quality of life. The current study reports a treatment of idiopathic lipoatrophy that achieved results acceptable to the patient.

Circumferential abdominoplasty.

BACKGROUND: In Italy, 34.2% of the population has a BMI higher than 25, and another 9.8% of the population has a BMI higher than 30. In Italy, there are 4 million and 700,000 obese people. Bariatric surgery has evolved as a very effective therapy for morbid obesity. After such dramatic weight loss, patients are usually left with redundant skin and unwieldy subcutaneous tissue. The circumferential truncal excess cannot be corrected by a regular abdominoplasty alone. In this group of patients, lateral excess can actually be over accentuated by a traditional abdominoplasty. In our institution, we are used performing abdominoplasty according to Pascal-Le Louarn's surgical technique. In our cases, the adoption of this technique has been successful with a high rate of very satisfied patients, no major complications and few minor complications primarily in the smoker patients. METHODS: The charts of 41 consecutive circumferential abdominoplasty were reviewed. The preoperative markings, the surgical technique, the post-operative course, and the complications are described. RESULTS: The average operative time was 220 min. The average lipoaspirate was 1,600 cc. The mean weight loss during the surgery was 3.4 kg. There were 18 immediate complications, including 11 seromas, and 7 partial wound dehiscences. There were 26 late complications, including 8 hypertrophic scars and 18 local hypoestesia. All seromas were resolved within 3 weeks. All patients were satisfied. CONCLUSION: Circumferential abdominoplasty performed with Pascal-Le Louarn's surgical technique is an effective, appropriate, and safe method to treat patients with lipodistrophy of the trunk following massive weight loss.