Fat grafting in breast surgery: a retrospective single-breast centre 6-year experience.

PURPOSE: In recent years, fat grafting has gained importance as a valuable technique in breast surgery. As a breast center that has embraced this approach, we aimed to investigate the indications and complications of fat grafting. METHODS: In this retrospective study, we examined a total of 263 lipofilling treatments on 121 patients. Five groups were identified: the reconstruction group (72.7%), consisting of 24.8% autologous and 38% implant-based reconstructions after cancer, and correction of the tuberous breasts (10.7%). An almost equivalent group (10.7%), consisted of patients treated for cosmetic reasons. Patients after breast-conserving therapy amounted to 16.5%. Twenty patients (16.5%) were treated to alleviate pain. RESULTS: No major complications, and no cancer recurrence or metastasis were observed. One case of infection occurred at the injection site (infection rate: 0.38%). ANOVA showed statistically significant results for age (p < 0.001) and mean fat volume (p = 0.001). Posthoc analysis showed that the mean age of the tuberous group (21 years) was significantly smaller compared to all other categories (p < 0.001). Post-hoc analysis for fat volume indicated that the mean value for the cosmetic category (447.08 cc) was significantly greater than that of the breast-conserving and implant reconstruction categories (p = 0.009 and p = 0.030, respectively), while not significantly different from the tuberous and autologous reconstruction categories (p = 0.928 and p = 0.648, respectively). CONCLUSIONS: Lipofilling has proven a valuable adjunct in reconstructive and aesthetic breast surgery with a low complication profile. The versatility of this low-cost technique and the low rate of complications make it a powerful asset of modern breast centers.

Safety of Breast Liposuction and Oncologic Considerations.

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 .

A Novel Approach for Treating Lipomas: Percutaneous Microwave Ablation Combined with Liposuction.

Lipomas, benign adipose tissue tumors, are a common occurrence but currently, the options for their treatment are limited, with surgical excision being the most frequently used management pathway. This scenario can often lead to unsatisfactory cosmetic results and significant patient discomfort. This paper introduces a novel technique, percutaneous microwave ablation with liposuction, to address these challenges. The innovative procedure aims to enhance patient satisfaction, minimize post-operative discomfort, and improve aesthetic outcomes. The technique involves two key steps: (1) the application of percutaneous microwave ablation to selectively disrupt the lipoma cells, followed by (2) a targeted liposuction procedure to remove the ablated lipoma tissue. Our approach optimizes the removal of the lipoma and preserves the surrounding healthy tissue, reducing the risk of local recurrence and improving the cosmetic result. The use of preoperative ultrasound imaging allows for precise localization and delineation of the lipoma, aiding in the planning and execution of the procedure. This novel approach to lipoma treatment is reliable, associated with minimal morbidity, and consistently yields effective results. Additionally, it provides a new perspective on lipoma management, potentially changing the paradigm of current treatment approaches.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical Efficacy Analysis of Circumferential Upper Arm Liposuction with Double Incision: A Study of 496 Cases.

BACKGROUND: In cases where the upper arm exhibits an irregular cylindrical appearance with subcutaneous fat concentrated primarily in the posterior lateral aspect, traditional localized fat suction techniques may lead to uneven or disharmonious results when addressing this concern. Many practitioners have turned to circumferential fat suction methods using multi-incision approaches to ensure effective results and fat removal. However, these methods often involve numerous incisions and complex procedures, necessitating the development of new, more efficient surgical techniques. METHODS: We collected and screened patients who underwent upper arm circumferential liposuction with a double incision technique at our hospital from October 2020 to February 2023. A total of 496 cases were included in our retrospective analysis, in which we examined factors such as the length of surgery, arm circumference before and after surgery, subcutaneous tissue thickness before and after surgery, fat suction volume, postoperative satisfaction, and postoperative complications of the patients. RESULTS: The average length of surgery was 71.7 min. 458 cases (92.3%) showed significant improvement, 23 cases (4.6%) reported satisfaction, and 10 cases (2.0%) were essentially satisfied. Additionally, 339 cases (68.3%) experienced an improvement in skin laxity. Four cases (0.8%) developed localized hard nodules with slight tenderness in the early postoperative period, which resolved without special treatment after observation and follow-up for 1-3 months. Three cases (0.6%) reported localized pain or numbness, and they were given oral medication. Their symptoms disappeared after 1-3 months of observation and follow-up. Three cases (0.6%) had localized pain or numbness, and their symptoms disappeared. All of these cases improved and resolved after one month of taking mecobalamin tablets. There were also three cases (0.6%) with mild pigmentation of the incision and two cases (0.4%) with mild limitation of unilateral upper arm abduction movement. However, upper arm activities were not affected after three months to one year of follow-up. No serious complications were reported, resulting in an overall satisfaction rate of 99.0%. CONCLUSION: The double incision upper arm liposuction is safe, effective, time-saving, with high satisfaction and fewer complications, and is worthy of clinical popularization and application. 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 .

Liposuction-Only Breast Reduction: A Systematic Review of Outcomes.

INTRODUCTION: Over the past few decades, there have been multiple reports of liposuction assisted breast reduction. This technique appeals to patients due to the limited scars and complication profile, compared to traditional reduction mammaplasty techniques. We aimed to systematically review the literature, to elucidate the outcomes and safety of liposuction-only breast reduction. METHODS: A systematic review was performed using the Ovid (Medline/PubMed) database, in accordance with the PRISMA checklist. RESULTS: In total 7 articles were included within this systematic review. A total of 652 patients were included. Liposuction-only breast reduction appears to lead to improvements in subjective outcome measures, patient satisfaction, and objective outcomes such as moderate breast volume reduction and reduction in breast ptosis. Overall, the procedure had a low complication profile. Liposuction did not preclude further surgery. No evidence of malignancy or difficulty in future breast cancer screening was noted. CONCLUSION: Macromastia leads to a considerable health burden, especially in health-related costs. From the current evidence base, liposuction-only breast reduction appears to be a safe and effective procedure, especially in patients requiring a mild-moderate breast volume reduction and mild ptosis correction. More research is required, with standardised subjective and objective outcome measures, and longer follow-up periods to confirm the effectiveness and safety of this technique. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Expanding Usage of Superior Pedicled Techniques with Reducing Resistance in the Pedicle by Lipoaspiration.

BACKGROUND: Despite the advantages of the superior pedicles in breast reduction, there are some limitations with this technique. The mobility of the pedicle may be augmented by liposuction in the pedicle area which may relieve tissue resistance and decrease pedicle compression in order to overcome circulation problems. In fact, the indications of breast reduction using superior pedicles may be expanded by liposuction in the pedicle area. METHODS: The patients who underwent breast reduction with superior pedicle techniques between March 2014 and November 2020 and whose pedicle resistances were decreased by liposuction were included in this study. Internal breast morphology was classified into three groups based on the morphology of the periareolar tissues. Group 1 breasts were lipomatous, Group 2 breasts were lipo-glandular and Group 3 breasts were fibroglandular. During the short-term follow-up, the circulation of the nipple-areola complex (NAC) was evaluated both clinically and with an hand held Doppler device. The long-term aesthetic results were evaluated at the postoperative twelfth month with a visual analogue scale. RESULTS: One hundred eighty-nine patients with either Group 1 or Group 2 breasts were included in this study. The mean age of the patients was 38.3 years. The mean follow-up period was 31.7 months. Neither partial nor total NAC loss was observed and none of the patients had bottoming-out deformity. CONCLUSION: Liposuction to the pedicle area is an effective and reliable method that both reduces the resistance in the pedicle and overcomes the circulation problems in certain patient groups (groups 1 and 2), increases the mobilization of the pedicle, reduces the breast to the desired size and prevents bottoming-out in the long term and increases the use of superior pedicle techniques. According to our clinical results, it was demonstrated that pedicle vascular mapping with preoperative Doppler sonography was not necessary in these patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Safety of Breast Liposuction and Oncologic Considerations.

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 .

Small Intestinal Perforation after 360-Degree Liposuction: A Case Report.

OBJECTIVE: As one of the most commonly performed cosmetic procedures, liposuction is relatively safe. Bowel injury following liposuction is a rare but devastating complication, which necessitates hospital admission and surgical intervention. The authors highlight a case report describing the presentation, diagnosis, and management of a patient with bowel injury following liposuction. CASE: A 58-year-old woman presented with abdominal pain, erythema, and discharge three days after 360-degree abdominal liposuction with concomitant fat grafting to bilateral buttocks at an outpatient surgery center. Bowel perforation was suspected after CT-scan revealed extraluminal gas in the abdomen and communication that traversed the peritoneum. Exploratory laparotomy was performed which demonstrated at least one site of distinct perforation of the small bowel and an area omentum noted to be inflamed, thickened and with a purulent rind. The patient underwent 20-cm small bowel resection and partial omentectomy temporarily closed with negative pressure wound therapy. After subsequent abdominal wall debridements the patient received ventral hernia repair with bridging mesh and abdominal closure. CONCLUSIONS: While safe, elective cosmetic procedures are not without risk of serious and even fatal complications. Providers must be familiar with the presentation of bowel injury following abdominal liposuction to prevent delays in appropriate surgical and medical care. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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

BACKGROUND: The contour of the thigh is increasingly being recognized as crucial component of the ideal human physique, giving rise to heightened interest in attaining the perfect thigh profile. Notwithstanding, the contemporary landscape of cosmetic surgery appears to be bereft of efficient and precise objective methodologies to evaluate the outcomes of thigh contouring treatments. The present study is aimed to investigate the aesthetic appeal of varying thigh contours, employing specialized software as an indispensable instrument for quantitative and qualitative analysis. METHODS: Standardized photographs of the lower body were obtained from a sample of 200 healthy volunteers. A linear analysis was conducted, examining aspects such as the vertical length and transvers width of the thigh, as well as angular measurements including the posterior gluteal angle (PGA) and lateral angle thigh (LAT). Variables relating to thigh measurements and body mass index (BMI) were documented, with the relationships between them ascertained through Pearson's correlation and regression analysis. RESULTS: In males, the LAT was measured at 168 ± 3.9, and the PGA at 170 ± 3.4, while in females, these measurements were 166 ± 2.8 ve 166 ± 2.8, respectively. Linear analyses, including the vertical length of thigh (VLT), transverse width of thigh (TWT), lateral width (LW), and posterior width (PW), were conducted. Based on the LW inferior/LW superior ratio values, the most commonly observed thigh types were Type III (0.90) at 45% and Type II (0.85) at 24.75% while the least common was Type V at 4% (0.99). PW inferior/PW superior was 84.7%. The PWI/PWS ratio was highest for Type V, at 0.99, accounting for 84.70% of the total. Furthermore, an increase in the LWI/LWS ratio leads to an increase in the PWI/PWS ratio.  The frequency of the VLT/TW1 ratio 0.31-0.35 (Type 3) was found to be on the left side and Type 4 on the right side. A strong correlation was found between BMI and all thigh indexes, with a significant positive correlation between the index and factors tied to the buttocks and upper thigh. CONCLUSIONS: The concept of an ideal thigh may vary based on an individual's gender, race, country of residence, and self-esteem, aiming to achieve a more natural silhouette. Focusing on the different ratios of hip and thigh varieties in the study is quite intriguing. Further inquiry and rigorous exploration are warranted to delineate the optimal techniques and methodologies for attaining ideal thigh proportions. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of Heated Infiltration Solutions and Forced-Air Heating Blankets on Intraoperative Hypothermia During Liposuction: A Factorial Randomized Controlled Trial.

BACKGROUND: This study was conducted to compare the effects of heat preservation by two recommended methods, heated infiltration solutions and forced-air heating blankets, in patients undergoing liposuction under general anesthesia. METHODS: Forty patients were divided into four groups based on whether heated infiltration solutions or forced-air heating blankets were used. Group A received general anesthesia liposuction plastic surgery routine temperature care. Based on the care measures of group A, heated infiltration solutions were used in group B; forced-air heating blanket was used in group C; and heated infiltration solutions and forced-air heating blankets were both used in group D. The primary end point was intraoperative and perioperative temperature measured with an infrared tympanic membrane thermometer. Secondary end points included surgical outcomes, subjective experience, and adverse events. RESULTS: Compared with group A, the intraoperative body temperatures of groups B, C, and D were significantly higher, indicating that the two intervention methods were helpful on increasing the core body temperature. Pairwise comparisons of these three groups showed that there was no significant difference between group C and group D. However, using forced-air heating blankets had a marked effect compared with using heated infiltration solutions alone at three time points. The same trend could be seen in other surgical outcomes. CONCLUSIONS: Heated infiltration solutions and forced-air heating blankets could reduce the incidence of intraoperative hypothermia and improve patients' prognosis after liposuction under general anesthesia. Compared with the heated infiltration fluid, the forced-air heating blanket may have a better thermal insulation effect. LEVEL OF EVIDENCE I: 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 .

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 .

Liposuction Through an Axillary Fold Incision Combined with a Small Areola Incision to Treat Gynecomastia.

BACKGROUND: Gynecomastia is a progressive disease characterized by enlarged breasts, affecting a significant proportion of men. Persistent gynecomastia negatively affects the psychological and emotional development of patients; therefore, surgical intervention is required. In this article, we describe a surgical technique, where liposuction through an axillary incision is used in combination with a single small periareolar incision, to obtain the most minimal scars in the treatment of gynecomastia. METHODS: Between June 2021 and June 2023, 125 patients with different Simon grades of gynecomastia were enrolled. The patients' basic conditions and operation processes were recorded. Following surgery, a score was assigned according to the five main aesthetic aspects of the surgical procedure. RESULTS: In total, 125 patients with gynecomastia were treated with a pre-axillary fold incision combined with a small areolar incision. There were 17 cases of Simon grade I, 46 grade IIA, 42 grade IIB, and 20 grade III. The average operation time was 45.8 min, the average liposuction volume was 250.5 mL, the average glandular tissue volume was 50.5 g, intraoperative blood loss ranged from 15 to 60 mL, and the average hospital stay was 3.2 days. Regarding the postoperative aesthetic effect, doctors scored > 4 points, and the patient satisfaction score was > 7.5, which fully affirmed the aesthetic effect of this method. CONCLUSIONS: Treatment of gynecomastia through an anterior axillary fold incision combined with a small areolar incision is safe and feasible, involving a simple procedure, short operation time, and few complications. Its efficacy and cosmetic effects could lead to its use as a primary surgical method to treat gynecomastia. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Weight Loss After VASER-Assisted Liposuction.

BACKGROUND: Liposuction is one of the most common procedures used for body contouring. In this study, we aimed to determine whether there is a weight change with VASER-assisted liposuction (VAL) procedure and the demographic factors affecting it. METHODS: A total of 51 patients (30 females and 21 males) who underwent VAL between the years of 2020 and 2022 were included in the study. Participants' weights before VAL, body mass indexes (BMI), aspiration volumes, demographic data, and weights and BMIs one month after VAL were recorded and analyzed. In addition, the fat ratio in the aspirate was determined in ten patients. RESULTS: The mean aspiration volume with VAL was 4832.50 ± 2373.26 ml in females and 5176.90 ± 1602.61 ml in males. Body weights (baseline, 90.34 ± 9.17 vs. 71.01 ± 8.87; one month later, 86.95 ± 8.34 vs. 66.28 ± 10.04: p < 0.001) and BMIs (baseline, 28.59 ± 2.97 vs. 26.40 ± 3.69; one month later, 27.54 ± 2.92 vs. 24.59 ± 3.76: p = 0.009) were higher in males than females, both at baseline and after VAL. There was a significant decrease in body weights and BMIs after VAL in both females (4.73 ± 4.73 kg) and males (3.39 ± 4.27 kg) (p < 0.001). However, no correlation was observed between the decrease in body weights and BMIs after VAL and gender, age, aspirate volume, and fat volume. CONCLUSION: Although there was a decrease in mean body weight and mean BMI in both males and females one month after VAL, no associations were observed between weight drop after VAL and gender, age, aspiration volume, and fat volume. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of Blood Loss in Third-Generation Internal Ultrasound-Assisted Liposuction.

BACKGROUND: In large-volume liposuction procedures, one of the most important limitations of total lipoaspirate volume is blood loss. In this study, we aimed to determine the amount of blood loss in individuals who underwent a third-generation internal ultrasound-assisted liposuction (UAL). METHODS: Eleven female and eleven male participants with a mean age of 35.31 (range 20-47) were included in this prospective study. The third-generation internal UAL was performed on multiple anatomical regions using the VASER® Internal Ultrasound Device (Sound Surgical Technologies; Louisville, CO). The demographic characteristics of the participants, the amount of aspirate collected, and hemoglobin (Hgb) and hematocrit (Htc) values before and after the third-generation internal UAL were evaluated. RESULTS: The mean third-generation internal UAL time was 74.81 ± 17.95 minutes, and the mean aspiration amount was 5,122.27 ± 1,597.43 ml. The aspirated amount was 6.64% ± 2.20 of body weight. The mean Hgb value was 13.87 ± 1.99 before the third-generation internal UAL and 11.26 ± 2.16 (g/dL) after the third-generation internal UAL (z = 4.108, p < 0.001). The mean reduction in Hgb levels with the third-generation internal UAL was 2.61 ± 1.73 and 0.53 ± 0.36 per liter of aspirate taken. The mean Htc value after the third-generation internal UAL was 33.91 ± 6.03 and was significantly lower than the mean Htc value before the third-generation internal UAL, 41.39 ± 5.13 (z = -3.946, p < 0.001). The mean reduction in Htc with the third-generation internal UAL was 7.48 ± 5.42, and the Htc value decreased by 1.50 ± 1.13 per liter of aspirate ingested. The amount of aspirated supernatant was responsible for 44.4% of the change in Hgb and 30.9% of the change in Htc after the third-generation internal UAL. CONCLUSION: Knowing the reduction rates in Hgb and Htc with the third-generation internal UAL is useful to plan the amount of aspirate to be taken, the amount of blood loss that may occur with the third-generation internal UAL, and the postoperative care of the patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Redefining Abdominal Contours: An Analysis of Medium Definition Liposuction Abdominoplasty.

INTRODUCTION: This study elucidates the application of Medium Definition Liposuction Abdominoplasty, a novel technique for achieving well-defined abdominal contours. The technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. METHODS: Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. Digital image measurements facilitated by an image software constituted the basis for these assessments. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites, with two measurements taken at each site and subsequently averaged. RESULTS: Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. However, complications such as partial diminution of tension in the muscular wall (2%), distal flap necrosis (0.6%), and minor muscular hernia (0.3%) were observed. CONCLUSION: The employment of combined muscle plication emerges as an efficacious methodology in meticulously rectifying alterations inherent within the muscular aponeurotic abdominal wall. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. BULLET POINTS: The study introduces a novel technique, Medium Definition Liposuction Abdominoplasty, for achieving well-defined abdominal contours. This technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites. Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. 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 .

Application of Liposuction and Superior Pedicle Vertical Mammoplasty for Severe Breast Hypertrophy.

BACKGROUND: Vertical mammoplasty techniques have been widely used for breast reduction. The authors present the combination of superior pedicle vertical mammoplasty with liposuction in different regions in the treatment of severe breast hypertrophy in obese patients. We also propose some innovative methods in terms of surgical approach, breast parenchymal anatomy pattern and liposuction. METHODS: A retrospective study of 50 female patients with severe hypertrophic breasts and obesity who underwent breast reduction in our department from February 2019 to February 2022 was performed. Pre- and postoperative photographs, breast parenchyma distribution and postoperative patient satisfaction were recorded. RESULTS: Fifty patients underwent breast reduction. Through clinical examination, patient photo evaluation and satisfaction survey results. Good breast shape and projection, full upper pole of the breast, and high satisfaction results were obtained. There were no serious complications. CONCLUSION: This technique is acceptable and reproducible. It is suitable for patients with varying degrees of breast hypertrophy, especially those with severe hypertrophic breasts and obesity. There are fewer associated complications and a lower rate of re-repair. 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 .

Combining Liposuction and Thread-Lifting for Middle-Lower Facial Rejuvenation.

BACKGROUND: Thread-lifting (TL) is a minimally-invasive technique for facial rejuvenation, whereas liposuction is commonly used for facial contouring. This retrospective cohort study aims to introduce and evaluate a novel technique that combines liposuction and thread-lifting for mid-lower facial rejuvenation. METHODS: Consecutive patients who underwent TL for mid-lower facial rejuvenation from May 2016 to May 2021 were divided into thread-lifting group (TL group) or thread-lifting plus liposuction group (TLL group) according to whether liposuction was performed adjunctively. The co-primary outcomes were the changes between the preoperative and 6-month postoperative Wrinkle Severity Rating Scale (WSRS) and Facial Aging Evaluation Scale (FAES). RESULTS: A total of 185 patients (184 females) with an average age of 34.5±5.5 years were included. There were no significant differences in patients' age, number of threads, and preoperative WSRS and FAES between the two groups. The TLL group (n = 128) had significantly lower postoperative WSRS (1.5±0.6 vs. 1.8±0.8, p<0.001) and FAES (2.5±1.4 vs. 3.8±2.1, p<0.001) than the TL group (n = 57). The decrease in WSRS (0.8±0.6 vs. 0.2±0.7, p<0.001) and FAES (2.7±1.3 vs. 1.6±1.6, p<0.001) were greater in the TLL group. Only 3.8% patients experienced slight side effects and totally recovered. CONCLUSIONS: The combination of TL and liposuction is an effective and safe technique for simultaneous contour improvement and facial rejuvenation in middle-aged East Asian females. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Enhancing Safety in Tumescent Liposuction: Managing Sedation-Related Respiratory Issues and Serious Complications Under Deep Sedation with the Propofol-Ketamine Protocol.

BACKGROUND: Over the past 4 years, aesthetic surgery, notably liposuction, has substantially increased. Tumescent liposuction, a popular technique, has two variants-true tumescent liposuction (TTL) and semi-tumescent liposuction. While TTL reduces risks, it has limitations. There is no literature reported on semi-tumescent liposuction under deep sedation using the propofol-ketamine protocol, which is proposed as a potentially safe alternative. METHODS: The retrospective analysis covered 8 years and included 3094 patients performed for tumescent liposuction under deep sedation, utilizing the propofol-ketamine protocol. The evaluation of patient safety involved an examination of potential adverse events with a specific focus on respiratory issues related to sedation, including instances of mask ventilation. RESULTS: Among the 3094 cases, no fatalities were recorded. Noteworthy events included 43 mask ventilation instances, primarily occurring in the initial 10 min. Twelve cases experienced surgery cancellation due to various factors, including respiratory issues. Three patients were transferred to upper-level hospitals, while another three required blood transfusions. Vigilant management prevented significant complications, and other adverse events like venous thromboembolism (VTE), fat embolism, severe lidocaine toxicity, and so on were not observed. CONCLUSIONS: The analysis of 3094 tumescent liposuction cases highlighted the overall safety profile of the propofol-ketamine protocol under deep sedation. The scarcity of severe complications underscores its viability. The study emphasizes the significance of thorough preoperative assessments, careful patient selection, and awareness of potential complications. Prompt interventions, particularly in addressing sedation-related respiratory issues, further contribute to positive outcomes for patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Development and Implementation of an Evidence-Based Tumescent Liposuction Protocol, Online Educational Course for Perioperative Staff, and Discharge Instructions: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement project was to improve perioperative management of patients undergoing tumescent liposuction (TL) through the development and implementation of a perioperative evidence-based protocol, educational course for perioperative staff, and patient discharge instructions. DESIGN: The TL protocol was validated using the modified Delphi process. The educational course and discharge instructions used a pre and postimplementation design. METHODS: An evidence-based protocol, an educational course for perioperative staff, and readable discharge instructions for patients undergoing TL were developed in accordance with best practice guidelines. The protocol was validated by subject matter experts at the facility and submitted for adoption. The evidence-based educational course was implemented, and the effectiveness of the course was evaluated for improving providers' knowledge and self-confidence. The evidence-based discharge instructions were implemented and evaluated for patient satisfaction and readability. FINDINGS: Three items were removed from the protocol, 2 items were modified, and 25 items were accepted with no change from modified Delphi analysis. Provider knowledge scores improved from 85.7% ± 16.18 to 97.1% ± 4.88; however, this was not statistically significant (P = .066). There was a trend toward improved confidence scores (P = .180). Overall patient satisfaction scores slightly improved postimplementation; results were not statistically significant (P > .05). CONCLUSIONS: All three phases of perioperative care in patients receiving TL were evaluated, reflecting best practice guidelines and successful adoption. There was no statistically significant improvement in provider knowledge, provider self-confidence, or patient satisfaction. A small sample size was a significant limiting factor.

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.