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1.
Aesthetic Plast Surg ; 46(1): 287-296, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34750657

RESUMEN

BACKGROUND: Obesity is considered a condition of systemic chronic inflammation. Under this condition, adipose tissue macrophages switch from an M2 (anti-inflammatory) activation pattern to an M1 (proinflammatory) activation pattern. OBJECTIVE: The study aimed to verify the profile of skin macrophage activation after bariatric surgery as well as the role of MMP-1 in extracellular tissue remodeling. METHODS: This is a prospective, controlled and comparative study with 20 individuals split into two groups according to their skin condition: post-bariatric and eutrophic patients. Histological and morphometric analyses based on hematoxylin-eosin, picrosirius red (collagen), orcein (elastic fiber systems), and alcian blue (mast cells)-stained sections and immunohistochemical analysis (CD68, iNOS, and mannose receptor) for macrophages and metalloproteinase-1 were performed. RESULTS: Post-bariatric skin showed an increase in inflammation, angiogenesis, CD68, M1 macrophages (P< 0.001), and mast cells (P< 0.01); a decrease in M2 macrophages (P< 0.01); and a significant decrease in the collagen fiber network (P< 0.001). MMP-1 was increased in the papillary dermis of post-bariatric skin and decreased in the epidermis compared to eutrophic skin (P< 0.05). CONCLUSION: This study shows that post-bariatric skin maintains inflammatory characteristics for two years. Mast cells and M1 macrophages maintain and enhance the remodeling of the dermal extracellular matrix initiated during obesity in part due to the presence of MMP-1 in the papillary dermis. EBM LEVEL 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 .


Asunto(s)
Cirugía Bariátrica , Bariatria , Cirugía Bariátrica/efectos adversos , Humanos , Macrófagos , Estudios Prospectivos , Piel
2.
Aesthet Surg J ; 41(11): NP1394-NP1404, 2021 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-33453100

RESUMEN

BACKGROUND: Facial aging is a degenerative process that impairs contour and angle prominence. Rejuvenation is based on tissue replacement, volumization of the atrophic areas, and improving flaccidity and cutaneous photoaging. OBJECTIVES: The aim of this study was to apply structural fat grafting to manage volumetric deficits of the face, following a new systematic protocol called "Regen Fat Code" (RF Code) that was created to standardize structural lipotransfer methods. METHODS: This is a prospective clinical trial involving 80 healthy candidates for facial rejuvenation who were split into 2 groups. Group A underwent only structural lipotransfer; Group B underwent replacement of deep facial structures by face-lifting plus structural lipotransfer. Structural lipotransfer followed the protocol "RF Code" and 3 clinical tools were adopted for pre- and postoperative facial volumetric analysis. RESULTS: Total volume (mL) of lipotransfer in Groups A and B ranged between 1 and 20 mL (mean [standard deviation], 12 [5] mL), distributed to the different areas as follows: nasolabial fold, 3.32 [0.92] mL; superior lip, 2.0 [0.62] mL; inferior lip, 2.76 [0.71] mL; malar, 8.51 [5.25] mL; inferior eyelid, 1.2 [0.54] mL; and chin, 7.18 [1.99] mL. Areas with less mobility showed a lower absorption index than dynamic areas. CONCLUSIONS: The development of the RF Code protocol demonstrated the potential of grouping many parameters based on the lipotransfer method used to volumize and regenerate atrophic areas of the face. The protocol is easy to apply, and allows different volumizing and regenerative effects to be proposed, according to the demands of each surgical area.


Asunto(s)
Ritidoplastia , Envejecimiento de la Piel , Tejido Adiposo/cirugía , Humanos , Estudios Prospectivos , Rejuvenecimiento
3.
Aesthetic Plast Surg ; 44(5): 1498-1507, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32728763

RESUMEN

BACKGROUND: Studies have demonstrated the importance of anthropometric measurements of the breasts, based on linear measurements for the selection of the volume of breast implants, their positioning, and surgical planning. OBJECTIVES: The objective of this study is to evaluate the main changes in anthropometric measurements in breast augmentation. METHODS: A prospective, randomized clinical study with 74 female candidates for breast augmentation. All the individuals were split into five groups, according to the implant volume. The implants used were of different textures, from three different brands (LifeSil, Politech, and Silimed). The following measures were taken: distance from the nipple to the inframammary fold (N-IMF), inter-nipple-areolar complex distance (N-N), distance from the Sternal notch to the Nipple (SN-N), areola diameter, and breast projection. RESULTS: The most significant breast anthropometric alteration after mammoplasty was the N-IMF distance; that is, an expansion of the lower pole of the breast, followed by an increase in the areolar diameter. Mostly of measurements showed stability between 3rd and 6th months after the surgery. The projection was the most interesting measure due to presenting two patterns of behavior according to the analysis criteria performed. When comparing the implant projection and the final breast projection, it was observed that the implant profile represented a 27% increase in the final breast projection. CONCLUSIONS: This study provides an essential comparative analysis between anthropometric changes in breast augmentations and serves as a predictive tool in the preoperative evaluation of the patient during surgical planning. 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 .


Asunto(s)
Implantes de Mama , Mamoplastia , Implantes de Mama/efectos adversos , Estética , Femenino , Estudios de Seguimiento , Humanos , Mamoplastia/efectos adversos , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento
4.
Aesthetic Plast Surg ; 42(6): 1600-1608, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30259166

RESUMEN

BACKGROUND: Seroma formation has become the most reported complication after abdominoplasties. In 2000, progressive tension sutures (PTS) were described and reported to be associated with a seroma rate of 0.1%. Surgeons worldwide use PTS to prevent seroma; however, there are discrepancies in the number of PTS commonly used, starting from five up to 35 sutures. The absence of standardization may cause a lack of seroma prevention, increased surgical time, and general hesitation to perform the technique. OBJECTIVE: To determine whether 11 PTS are sufficient to prevent seroma in abdominoplasties. METHODS: We performed a single-blind, prospective, comparative, randomized clinical trial of 63 healthy patients from January to December 2017. Patients were divided into groups: group 1, classic abdominoplasty without the use of PTS and drains; group 2, abdominoplasty with the use of 11 PTS and drains; and group 3, abdominoplasty with the use of 22 PTS and drains. The duration of the surgical technique, presence of clinical seroma, number of aspirations, and days to drain removal were evaluated. The Cochran-Armitage, Fisher exact, Kruskal-Wallis, and t tests were used in the statistical analyses. RESULTS: PTS reduced the rate of seroma formation to 3.5%. Results showed that there is a benefit in using 11 PTS instead of 22 PTS because using more sutures led to an increased surgical time (30 min vs. 13 min) and possible complications. Compared to patients with PTS, those without PTS underwent more seroma aspirations and delayed drain removal. CONCLUSIONS: Eleven PTS should be used in classic abdominoplasties. 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 .


Asunto(s)
Abdominoplastia/efectos adversos , Seroma/prevención & control , Técnicas de Sutura , Suturas , Cicatrización de Heridas/fisiología , Abdominoplastia/métodos , Adulto , Drenaje/métodos , Estética , Femenino , Estudios de Seguimiento , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Medición de Riesgo , Seroma/etiología , Método Simple Ciego , Resultado del Tratamiento , Adulto Joven
5.
Aesthet Surg J ; 38(3): 321-328, 2018 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-29040421

RESUMEN

BACKGROUND: In previous papers, we demonstrated that the treatment of human photoaged skin with stromal-vascular fraction-enriched fat or expanded adipose-derived stem cells showed a decrease of elastosis and the appearance of new oxytalan elastic fibers in dermis and an increase in the vascular network. The utilization of fat plus platelet-rich plasma (PRP) led to an increase in the vascular permeability and reactivity of the nervous component. OBJECTIVES: The purpose of this study was to analyze the histologic and ultrastructural changes of human skin after the injection of only PRP in the retroauricular area that was not exposed to sun and did not present the photoaging process, in comparison with our previous results. METHODS: This study was performed in 13 patients who were candidates for facelift and whose ages ranged between 45 and 65 years. The PRP injection was performed in the mastoidea area. Fragments of skin were removed before and 3 months after treatment and analyzed by optical and electron microscopy. RESULTS: After the injection of PRP, we observed an increase of reticular dermis thickness because of the deposition of elastic fibers and collagen, with a fibrotic aspect. A modified pattern of adipose tissue was also found at the dermohypodermal junction. Significative regenerative aspects were not found at histologic and ultrastructural analysis. The presence of foci of moderate inflammation and microangiopathy were observed. CONCLUSIONS: Treatment with PRP increased reticular dermis thickness with a fibrotic aspect. In the long term, the presence of inflammation and microangiopathy caused by PRP injection could lead to trophic alteration of the skin and the precocious aging process.


Asunto(s)
Técnicas Cosméticas/efectos adversos , Plasma Rico en Plaquetas , Envejecimiento de la Piel , Dermis/anatomía & histología , Femenino , Humanos , Inyecciones Subcutáneas/efectos adversos , Inyecciones Subcutáneas/métodos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
6.
Aesthet Surg J ; 37(9): 975-985, 2017 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-29025229

RESUMEN

Background: Unpredictable volume maintenance in the long term is a major limitation of autologous fat grafting. Objectives: The authors compared results of autologous lipotransfer to the face with or without enrichment of fat with the stromal vascular fraction (SVF). Methods: Thirty patients with asymmetric depletion of facial volume were included in a prospective study. Patients were randomly assigned to undergo a single session of autologous fat transfer with washed adipose tissue (control group) or with washed adipose tissue combined with the pellet of centrifuged lipoaspirate, which contained the SVF (enriched group). Patients were evaluated clinically and from photographs. A subset of 5 patients in each group underwent computed tomography (CT) preoperatively and 12-months postoperatively for quantitative assessment of graft retention. Washed and fractionated lipoaspirates were evaluated histochemically and with flow cytometry to determine relative abundances of viable cells. Results: No major complications occurred. CT findings 12 months postoperatively indicated that patients who received SVF-enriched fat had significantly better volume retention (9.6% volume loss vs 24% in the control group; P = 0.013). Independent surgeons more frequently rated long-term aesthetic outcomes as "excellent" for patients in the enriched group (82.5% vs 47.6% for control group). Laboratory results indicated that each pellet contained approximately 16,000 intact adipose-derived stem cells. Conclusions: Lipotransfer with SVF-enriched adipose tissue is safe and associated with improved volume retention, compared with transplantation of unenriched fat. The SVF can be dissociated from lipoaspirate by centrifugation to yield a large quantity of viable regenerative cells, without enzymatic digestion. Level of Evidence: 2.


Asunto(s)
Tejido Adiposo/trasplante , Hemiatrofia Facial/terapia , Células del Estroma/trasplante , Tejido Adiposo/citología , Adulto , Femenino , Citometría de Flujo , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Células del Estroma/citología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
7.
Aesthet Surg J ; 36(3): 261-70, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26879294

RESUMEN

BACKGROUND: In a previous study, the authors demonstrated that treatment with expanded adipose-derived stem cells or stromal vascular fraction (SVF)-enriched fat modify the pattern of the dermis in human beings, representing a skin rejuvenation effect. Considering that expanded stem cells require a cell factor, the authors wanted to assess similar results by replacing them with platelet-rich plasma (PRP), which is easier to obtain and for which an empirical regenerative effect has been already described. OBJECTIVES: To determine if PRP injection could replace the cutaneous regenerative effect of adipose-derived stem cells. METHODS: This study was performed in 13 patients who were candidates for facelift. The patients underwent sampling of fat by liposuction from the abdomen and submitted to one of three protocols: injection of SVF-enriched fat or expanded adipose-derived stem cells or fat plus PRP in the preauricular areas. Fragments of skin were removed before and 3 months after treatment and analyzed by optical and electron microscopy. RESULTS: The use of fat plus PRP led to the presence of more pronounced inflammatory infiltrates and a greater vascular reactivity, increasing in vascular permeability and a certain reactivity of the nervous component. The addition of PRP did not improve the regenerative effect. CONCLUSION: The use of PRP did not have significant advantages in skin rejuvenation over the use of expanded adipose-derived stem cells or SVF-enriched fat. The effect of increased vascular reactivity may be useful in pathological situations in which an intense angiogenesis is desirable, such as tissular ischemia.


Asunto(s)
Tejido Adiposo/citología , Técnicas Cosméticas , Trasplante de Células Madre Mesenquimatosas/métodos , Plasma Rico en Plaquetas/citología , Rejuvenecimiento , Envejecimiento de la Piel , Piel/ultraestructura , Anciano , Brasil , Femenino , Humanos , Lipectomía , Masculino , Microscopía Electrónica de Rastreo , Microscopía Electrónica de Transmisión , Persona de Mediana Edad , Factores de Tiempo , Trasplante Autólogo , Resultado del Tratamiento
8.
Aesthet Surg J ; 35(3): 334-44, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25805285

RESUMEN

BACKGROUND: Transplanted adipose tissue has many applications in regenerative medicine. However, fat grafting yields unpredictable results because the fat that is transferred can suffer variable degrees of fat reabsorption. It is necessary to identify methods and maneuvers to minimize reabsorption rates and provide predictable long-term results. OBJECTIVES: Our study aimed to identify the optimal method of harvesting, as well as the optimal pressure regime for fat aspiration. The primary objective was to assess the degree of adipocyte and mesenchymal stem cell death that occurred with the various devices and pressure levels used to harvest fat. METHODS: This study was a prospective, randomized, comparative study in 15 healthy male and female subjects aged 25 to 60 who were undergoing abdominal cosmetic surgery. Various apparatuses and pressure regimens were used to harvest 8 samples of fat tissue. These samples (R1 = R8) underwent histological analysis in order to verify the integrity and functionality of the adipocytes and mesenchymal stem cells that had been harvested. RESULTS: A total of 14 females and 1 male underwent abdominal cosmetic surgery. Quantitative analysis revealed that the adipocytes in all 8 samples had homogeneous quantitative profiles. The adipose mesenchymal stem cell (AMSC) analysis, according to Friedman ANOVA, revealed no significant variation in the percentage of mesenchymal stem cells (P = .045) between the various samples. CONCLUSIONS: The type of device, nozzle diameter tip, and pressure regimen used in this study for harvesting fat tissue did not significantly affect the number of the adipocytes or viable AMSC harvested. LEVEL OF EVIDENCE: 3 Therapeutic.


Asunto(s)
Adipocitos/citología , Tejido Adiposo/citología , Células Madre Mesenquimatosas/citología , Recolección de Tejidos y Órganos/métodos , Adipocitos/trasplante , Tejido Adiposo/trasplante , Adulto , Supervivencia Celular , Femenino , Humanos , Masculino , Trasplante de Células Madre Mesenquimatosas/métodos , Persona de Mediana Edad , Presión , Estudios Prospectivos
9.
Aesthet Surg J ; 34(4): 516-9, 2014 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-24609943

RESUMEN

In this article, the authors present a case of postrhinoplasty periorbital subcutaneous emphysema in a 35-year-old woman. This is an uncommon and benign rhinoplasty complication that can sometimes result from other pathologies such as barotrauma, hematoma, and allergic reaction. This patient's symptoms appeared to be a result of postanesthesia agitation. The patient's symptoms resolved after 1 week.


Asunto(s)
Rinoplastia/efectos adversos , Enfisema Subcutáneo/etiología , Adulto , Ojo , Femenino , Humanos , Valor Predictivo de las Pruebas , Factores de Riesgo , Enfisema Subcutáneo/diagnóstico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
11.
J Plast Reconstr Aesthet Surg ; 74(5): 1093-1100, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33250388

RESUMEN

BACKGROUND: Breast prostheses could be associated with complications, despite many studies on surgical materials and techniques. The role of surgical drainage in preventing complications on breast prostheses surgery is controversial. OBJECTIVES: This study aimed to evaluate the role and effectiveness of vacuum drainage in the augmentation mammoplasty. METHODS: A prospective multicentric randomized comparative clinical trial was conducted with 150 patients, who were the candidates for breast augmentation. The candidates were split into two groups to analyze the breast drain role. Group1: closed-suction drainage; measurements were taken every 24 h for 48 h. Group2: control (no drainage); all the patients were submitted to a clinical and postoperative ultrasonography evaluation (7th day and 3rd month). The late consultations (1st-, 2nd-, and 3rd-year postoperative time) were carried out to identify any complication, such as infection, seroma, hematoma, asymmetry, hypertrophic scarring, rippling, implant position, visible edges, and sensibility alteration. RESULTS: A total of 150 female patients were operated with 300 breast implants placed into subglandular pocket. In the first 24 h postoperative (D1), the drainage volume ranged from 12 ml to 210 ml (mean= 74.90 ml; SD= 43.29 ml). After 24 h, on the second day (D2), the collected volume ranged from 10 ml to 120 ml (mean= 44.76 ml; SD= 24.80 ml). The total drainage volume in the 48 h ranged from 22 ml to 320 ml (mean= 119.7 ml; SD= 62.20 ml). The breast ultrasonography series (BUSGS) analysis was done on the 7th day and 3rd month in both groups. There was no significant difference between G1 and G2 groups (p = 0.05 and 0.25, respectively). In the follow-up, some patients (33-44%) declared sensitivity disturbing on the nipple-areola complex (NAC) and lower breast segment. CONCLUSIONS: The closed-suction breast drainage in breast augmentation was associated with high cost and time-consuming and not demonstrated any benefit in a recent postoperative time.


Asunto(s)
Implantes de Mama , Drenaje/métodos , Mamoplastia/métodos , Complicaciones Posoperatorias/prevención & control , Adolescente , Adulto , Brasil , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Ultrasonografía Mamaria , Vacio
12.
Clin Plast Surg ; 47(1): 99-109, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31739903

RESUMEN

Autologous fat graft has limitations, especially long-term unpredictability of volume maintenance. The mechanical enrichment of fat graft with adipose-derived stem cells (ADSCs) could guarantee the survival of fat grafts. After decantation, washing, and centrifugation of lipoaspirate, the authors carried out histochemical analysis and flow cytometry to determine the best layers for preparing ADSC-enriched fat. After centrifugation, the stromal vascular fraction (SVF) was separated by mechanical dissociation and mixed with another layer of intact adipocytes, which was injected into patients. All patients showed volumetric improvement after a single lipotransfer section, without overcorrection. The method is safe, has low cost, and is easily reproducible.


Asunto(s)
Adipocitos/trasplante , Tejido Adiposo/trasplante , Cara/cirugía , Procedimientos de Cirugía Plástica , Células del Estroma/trasplante , Supervivencia de Injerto , Humanos , Trasplante Autólogo
13.
Stem Cells Int ; 2020: 2032359, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32724312

RESUMEN

BACKGROUND: Stem cells from adipose tissue (ADSCs) and platelet-rich plasma (PRP) are innovative modalities that arise due to their regenerative potential. OBJECTIVE: The aim of this study was to characterize possible histological changes induced by PRP and ADSC therapies in photoaged skin. METHODS: A prospective randomized study involving 20 healthy individuals, showing skin aging. They underwent two therapeutic protocols (protocol 1: PRP; protocol 2: ADSCs). Biopsies were obtained before and after treatment (4 months). RESULTS: PRP protocol showed unwanted changes in the reticular dermis, mainly due to the deposition of a horizontal layer of collagen (fibrosis) and elastic fibers tightly linked. Structural analyses revealed infiltration of mononuclear cells and depot of fibrotic material in the reticular dermis. The ADSC protocol leads to neoelastogenesis with increase of tropoelastin and fibrillin. There was an improvement of solar elastosis inducing an increment of macrophage polarization and matrix proteinases. These last effects are probably related to the increase of elastinolysis and the remodeling of the dermis. CONCLUSIONS: The PRP promoted an inflammatory process with an increase of reticular dermis thickness with a fibrotic aspect. On the other hand, ADSC therapy is a promising modality with an important antiaging effect on photoaged human skin.

14.
Plast Reconstr Surg ; 145(6): 1037e-1049e, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32459770

RESUMEN

BACKGROUND: The major intrinsic cause of facial skin degeneration is age, associated with extrinsic factors such as exposure to sun. Its major pathologic causes are degeneration of the elastin matrix, with loss of oxytalan and elaunin fibers in the subepidermal region, and actinic degeneration of elastin fibers that lose their functional properties in the deep dermis. Therapy using autologous adipose mesenchymal stem cells for regeneration of extracellular matrix in patients with solar elastosis was addressed in qualitative and quantitative analyses of the dermal elastic fiber system and the associated cells. METHODS: Mesenchymal stem cells were obtained from lipoaspirates, expanded in vitro, and introduced into the facial skin of patients submitted after 3 to 4 months to a face-lift operation. In the retrieved skin, immunocytochemical analyses quantified elastic matrix components; cathepsin K; matrix metalloproteinase 12 (macrophage metalloelastase); and the macrophage M2 markers CD68, CD206, and hemeoxygenase-1. RESULTS: A full de novo formation of oxytalan and elaunin fibers was observed in the subepidermal region, with reconstitution of the papillary structure of the dermal-epidermal junction. Elastotic deposits in the deep dermis were substituted by a normal elastin fiber network. The coordinated removal of the pathologic deposits and their substitution by the normal ones was concomitant with activation of cathepsin K and matrix metalloproteinase 12, and with expansion of the M2 macrophage infiltration. CONCLUSION: The full regeneration of solar elastosis was obtained by injection of in vitro expanded autologous adipose mesenchymal stem cells, which are appropriate, competent, and sufficient to elicit the full structural regeneration of the sun-aged skin. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Tejido Adiposo/citología , Trasplante de Células Madre Mesenquimatosas/métodos , Cuidados Preoperatorios/métodos , Ritidoplastia , Envejecimiento de la Piel , Anciano , Biopsia , Brasil , Elastina/análisis , Elastina/metabolismo , Matriz Extracelular/metabolismo , Proteínas de la Matriz Extracelular/análisis , Proteínas de la Matriz Extracelular/metabolismo , Cara , Femenino , Estudios de Seguimiento , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Rejuvenecimiento , Piel/patología , Piel/efectos de la radiación , Luz Solar/efectos adversos , Trasplante Autólogo/métodos , Resultado del Tratamiento
15.
Plast Reconstr Surg Glob Open ; 8(6): e2853, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32766034

RESUMEN

BACKGROUND: The first visible change in an aging face and neck is the loss of neck contour, which can be corrected by treating the platysmal bands; however, it remains unclear as to which is the best strategy to approach these bands. The aim of the present study is to verify whether the lateral platysmal bands approaches, before the medial ones, cause widening of the gap between them. METHODS: This is a prospective, randomized, comparative study involving 30 individuals presenting various stages of neck and facial flaccidity and sagging. The patients were split into 2 groups according to the lateral platysmal approach (group A: lateral platysmal traction/plication; group B: lateral platysmal undermined/traction). A protocol was established to measure the gap between the medial bands, 3 and 5 cm away from the chin, before and after superficial musculoaponeurotic system/platysma lateral suspension. Measurements were taken using a compass and a ruler. The endpoint was to determine whether the gap between the medial platysmal bands widens after the lateral procedure. RESULTS: Group A, first measure (1-M): the gap ranged between 1.0 and 1.6 cm in point M3 (3 cm away from chin) and between 1.8 and 3.0 cm in point M5 (5 cm away from chin) (mean in M3 = 1.2; SD, 0.22 and mean in M5 =2.3; SD, 0.52). Group A, second measure (2-M): the measure ranged between 1.0 and 1.7 cm in point M3 and between 1.8 and 3.2 cm in point M5 (mean = 1.28; SD, 0.25 and mean = 2.42; SD, 0.63, respectively). Group B, first measure (1-M): the gap ranged between 1.1 and 1.7 cm in M3 (mean = 1.32; SD, 0.21) and between 1.8 and 3.2 cm in M5 (mean = 2.38; SD, 0.57). Group B, second measure (2-M): the measure ranged between 1.2 and 1.7 cm in M3 (mean = 1.4; SD, 0.18) and between 2.0 and 3.2 cm in M5 (mean = 2.5; SD, 0.55). Group A: P = 0.07 (M3) and 0.10 (M5); Group B: P = 0.09 (M3) and 0.07 (M5). CONCLUSION: The lateral platysmal approach, plication or undermined, does not lead to a widening of the gap between the medial platysmal bands.

16.
Plast Reconstr Surg ; 135(4): 999-1009, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25811565

RESUMEN

BACKGROUND: The regenerative property of fat grafting has been described. However, it is not clear whether the clinical results are attributable to the stem cells or are linked to other components of the adipose tissue. This work is aimed at analysis of the histologic and ultrastructural changes of aged facial skin after injection of fat graft in addition to its stromal vascular fraction, obtained by centrifugation, and to compare the results with those obtained by the injection of expanded adipose-derived mesenchymal stem cells. METHODS: This study was performed in six consecutive patients who were candidates for face lift and whose ages ranged between 45 and 65 years. The patients underwent sampling of fat by liposuction from the abdominal region. The injection of fat and its stromal vascular fraction or expanded mesenchymal stem cells was performed in the preauricular areas. Fragments of skin were removed before and 3 months after each treatment and analyzed by optical and electron microscopy. RESULTS: After treatment with the autologous lipidic component and stromal vascular fraction, the skin showed a decrease in elastic fiber network (elastosis) and the appearance of new oxytalan elastic fibers in papillary dermis. The ultrastructural examination showed a modified tridimensional architecture of the reticular dermis and the presence of a richer microvascular bed. Similar results following treatment with expanded mesenchymal stem cells were observed. CONCLUSION: This study demonstrates that treatment with either fat and stromal vascular fraction or expanded mesenchymal stem cells modifies the pattern of the dermis, representing a skin rejuvenation effect.


Asunto(s)
Tejido Adiposo/citología , Tejido Adiposo/trasplante , Técnicas Cosméticas , Trasplante de Células Madre Mesenquimatosas , Rejuvenecimiento , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Envejecimiento de la Piel
17.
Rev. bras. cir. plást ; 34(2): 174-186, apr.-jun. 2019. tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1015964

RESUMEN

Introdução: A última pesquisa da Sociedade Internacional de Cirurgia Estética (ISAPS) mostrou que 2.524.115 cirurgias plásticas foram realizadas no Brasil em 2017. O aumento de mama tem sido um dos procedimentos plásticos mais comumente realizados no Brasil, totalizando mais de 200.000 cirurgias no ano de 2016. O objetivo é avaliar as práticas e tendências atuais em aumento de mama no Brasil. Métodos: Um questionário de 31 itens foi construído e enviado para 6.200 membros ativos da Sociedade Brasileira de Cirurgia Plástica (SBCP). A pesquisa abordou algumas tendências atuais e práticas controversas considerando cinco áreas: controvérsias atuais, novas tecnologias, implantes mamários, considerações técnicas em procedimentos secundários e aspectos demográficos. O questionário foi desenhado para delinear o perfil das práticas, procedimentos e crenças entre os cirurgiões plásticos sobre o uso dos implantes mamários no Brasil. Resultados: Foram coletadas 505 respostas, representando uma taxa de resposta em torno de 10%, bem acima da taxa média de resposta de um questionário da SBCP. Os resultados foram distribuídos em 5 tabelas de acordo com as áreas de interesse. Conclusão: Nesta pesquisa, as práticas mais comuns incluíram o uso de implantes redondos de microtextura e silicone revestido com poliuretano no procedimento primário, poket subglandular, incisões inframamárias, dimensionamento pré-operatório com amostras de implante redondas, antibióticos intravenosos e orais, irrigação com duplo antibiótico, implante faixa de tamanho geralmente menos 325cc e sem drenagem. Não há consenso sobre a lipotransferência mamária e o manejo da contratura capsular e da deformidade da bolha dupla.


Introduction: The latest research by the International Society of Aesthetic Plastic Surgery (ISAPS) showed that 2,524,115 plastic surgeries were performed in Brazil in 2017. Breast augmentation has been one of the most commonly-performed plastic procedures in Brazil, totaling more than 200,000 surgeries in 2016. The objective is to evaluate the current practices and trends in breast augmentation in Brazil. Methods: A 31- item questionnaire was constructed and sent to 6,200 active members of the Brazilian Society of Plastic Surgery (SBCP). The research addressed some current trends and controversial practices in five areas: current controversies, new technologies, breast implants, technical considerations in secondary procedures, and demographic aspects. The questionnaire was designed to profile practices, procedures, and beliefs among plastic surgeons regarding the use of breast implants in Brazil. Results: A total of 505 responses were collected, representing a response rate around 10%, which is well above the average response rate for Brazilian Society of Plastic Surgery (SBCP) questionnaires. The results were distributed in five tables by area of interest. Conclusion: In this study, the most common practices included the use of microtexture round implants and polyurethane-coated silicone as the primary procedure, a subglandular pocket, inframammary incisions, preoperative sizing with round implant samples, intravenous and oral antibiotics, double irrigation antibiotics, an implant size that was generally less than 325 cc, and without drainage. There is no consensus on breast lip balancing and the management of capsular contracture and double bubble deformity.


Asunto(s)
Humanos , Mama/cirugía , Mamoplastia/efectos adversos , Mamoplastia/métodos , Implantación de Mama/efectos adversos , Implantación de Mama/métodos , Encuestas y Cuestionarios , Estética
18.
Rev. bras. cir. plást ; 32(1): 141-144, 2017. ilus
Artículo en Inglés, Portugués | LILACS | ID: biblio-832691

RESUMEN

Neste artigo, apresentamos um caso de uma deformidade auricular de difícil correção cirúrgica, envolvendo unidade escafo-helicoidal associada com a orelha proeminente em uma paciente de 25 anos de idade. Esta é uma malformação congênita incomum da orelha, o que resulta em uma borda helicoidal achatada, não curvilínea e dobrada sobre a escafa, comprometendo a aparência helicoidal. Foi proposto um tratamento cirúrgico com abordagem posterior e enxerto de cartilagem conchal à restauração do contorno borda helicoidal em um procedimento único. Esta nova abordagem proporciona um resultado agradável para o ouvido, principalmente por restaurar uma nova unidade escafo-helicoidal sem cicatriz na superfície orelha anterior e tratamento da orelha proeminente.


In this paper, we present a case of auricular deformity whose surgical correction is difficult, involving scapha-helical unit associated with prominent ear in a 25-year-old female patient. This is an uncommon congenital malformation of the ear, resulting in a flattened, straightened and folded helical rim over the scapha, compromising the helical appearance. The proposed surgical treatment involved posterior approach and conchal cartilage graft to the restoration of the helical rim contour in a single procedure. This new approach provides a fine result to the ear, particularly because it restores the scapha-helical unit with no scar on the surface of the anterior ear and also effectively treats the prominent ear.


Asunto(s)
Humanos , Femenino , Adulto , Historia del Siglo XXI , Procedimientos de Cirugía Plástica , Oído , Cartílago Auricular , Deformidades Adquiridas del Oído , Pabellón Auricular , Procedimientos de Cirugía Plástica/métodos , Oído/anomalías , Oído/cirugía , Oído/patología , Cartílago Auricular/anomalías , Cartílago Auricular/cirugía , Cartílago Auricular/patología , Deformidades Adquiridas del Oído/cirugía , Deformidades Adquiridas del Oído/patología , Pabellón Auricular/anomalías , Pabellón Auricular/cirugía , Pabellón Auricular/patología
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