Waist Reduction through Conversion from False to Floating Ribs.

Background: Waist reduction by ultrasound-guided monocortical fracture (RibXcar), usually performed on floating ribs, may show limitations when performed on false ribs (9 and 10) because of the stress force exerted on the anterior fixation point (cartilage union to sternum). Hence, we introduced a procedure for conversion from false to floating ribs to improve the final result of the treatment of false ribs through a rib treatment scheme. Methods: Forty-nine female patients undergoing rib surgery were recruited. Waist measurements and angular variations were compared between two groups of patients, the first (26 patients) consisting of patients who underwent RibXcar with conversion surgery (ribs 9 and 10) and the second (23 patients) consisting of patients who underwent RibXcar without conversion surgery (ribs 9 and 10). Results: The waist measurements taken after 6 months showed a mean decrease of 8.70 cm in the group where only RibXcar was performed, whereas a statistically significant mean reduction of 17.04 cm was observed in the group where RibXcar was performed with rib conversion surgery. Conclusions: The false-to-floating-rib conversion technique combined with RibXcar demonstrated more reduction in waist circumference and a more efficient rib angulation compared with RibXcar alone.

Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer.

Background: The rejuvenation and restoration of a well-defined jawline contour are crucial for enhancing facial aesthetics in both men and women. Within the jawline aesthetic unit (mandibular angle), the masseter muscle plays a significant role, as it is responsible for mandibular masticatory movements. We propose a new approach using ultrasound-guided intramuscular fat transfer to enhance the mandibular angle and jawline. Methods: The multicenter study included 20 patients from three countries (Peru, Brazil, and Mexico). After fat harvesting, the ultrasound-guided masseteric fat transfer was performed with a 1.5-mm Viaro cannula from an incision beneath the ear lobule. The fat was then injected intramuscularly into the masseter at each side of the mandibular angle. Results: Masseter ultrasound-guided fat transfer was performed on 10 men and 10 women between 2021 and 2022. The patients had a mean age of 34.4 ±â€…6.39 years and a mean body mass index of 22.39 ±â€…2.59 kg per m2. The mean injected volume was 5.83 mL and 5.58 mL on the right and left sides, respectively. Muscle thickness increased in patients immediately postsurgery, but decreased after 1 month. The muscle remained significantly thicker on each side than the presurgery measurements in patients regardless of gender (both P < 0.0001). Conclusions: Ultrasound-guided intramuscular fat transfer is a safe and reproducible technique for enhancing the jawline contour at the mandibular angle. We believe that it could be a more durable solution than other procedures, although further evaluation of long-term results is necessary.

Waist Remodeling without Incision, with Ultrasound-guided Monocortical Fracture.

Background: Rib remodeling is a surgical technique for waist shaping in women and men. However, one of the main patient complaints is the scar. We aimed to describe a scarless, ultrasound-guided rib remodeling (RibXcar) technique that assessed the degree of angular variation of the fracture by ultrasound and the variation in waist measurement and patient satisfaction through a survey. Methods: The RibXcar technique was performed in 30 women aged 18-35 years in Peru, Colombia, and Mexico between October and December 2022 by three board-certified plastic surgeons trained in ultrasound and in this technique. The plastic surgeons measured costal angles before and immediately, 1 month, and 3 months after the surgery by ultrasound, as well as the waist in the same site and at these time points. Similarly, patient satisfaction was surveyed 3 months after the surgery, in which questions were asked about body aesthetics and the puncture site. Results: Ultrasound angular measurements before and immediately, 1 month, and 3 months after the surgical procedure were 168.00, 158.00, 160.00, and 160.43 degrees in the 10th rib, 170.50, 160.50, 152.50, and 163.50 degrees in the 11th rib, and 172.00, 162.00, 154.00, and 165.00 degrees in the 12th rib, respectively. The satisfaction survey showed that patients were satisfied with the aesthetic results of both the shape of the waist and the puncture site. Conclusions: RibXcar surgery maintains the angular variation over time. Similarly, waist measurements show a sustained reduction. Three months postoperatively, the patients were satisfied with the aesthetic results of the waist and the puncture site.

Ultrasonography as a Tool to Improve Preoperative Marking in Body Contour Surgery.

Background: Body contouring surgery and surgical drawings are usually performed based on the surgeon's experience without considering the nature of the unique anatomical structures of each patient. Thus, we propose a more reliable surgical design approach that considers the anatomical structures of each patient. Ultrasonography is increasingly used in plastic surgery and helps plastic surgeons to highlight anatomical features representing results in their interventions by providing a better understanding of the patients' unique structures. Methods: This study presents a series of cases involving 100 recruited patients (36 men and 64 women) between 18 and 60 years of age. Five surgeons examined the patients and created a presurgical design based on palpation, which was validated later by a physician skilled in evaluating the anterior wall of the abdomen using ultrasonography. The concordance between the findings of the palpation and ultrasonography was assessed for each patient. Results: The concordance rate for each structure in both evaluations was midline (49%) (P > 0.92), diastasis recti (15%), semilunar line (23%), upper edge of rectus abdominis muscles (12%), lower edge of pectoral muscles (16%), border of oblique muscle (13%), number of tendinous intersections (12%), shape of tendinous intersections (11%), serratus anterior muscle (15%), subcostal triangle (15%), and oblique triangle (26%) (P < 0.0001). Conclusion: All the structures evaluated by palpation in comparison with ultrasound show discordance, except the midline where agreement is evident, with a very good level of statistical significance.

Anatomical Bases for Aesthetic Costal Surgery: Assessing the Thoracoabdominal Limits.

Background: Knowing the anatomy of the ribs is crucial for understanding various rib procedures. The present study is aimed at describing radiological measurements and ratios of 83 Latin American patients undergoing thoracoabdominal computed tomography (CT). Methods: A total of 83 thoracoabdominal computed tomography scans of women aged 18-35 conducted at a medical center in Lima, Peru, were reviewed from January 2022 to January 2023. The resulting measurements and ratios were used to calculate frequency distributions. All data were stored in a Microsoft Excel database and analyzed using statistical analysis software SPSS version 28. Results: Ratios and measures of the tenth, eleventh, and twelfth ribs are shown in the different tables, and costal characteristics with an adequate statistical significance are defined. Conclusions: Using radiological measurements and rib ratios, we were able to find key anatomical relationships with an adequate level of significance, which could help establish objective results in rib procedures.

Preservation Rhinoplasty: A New Approach to Mestizo Noses.

Preservation rhinoplasty is a widely used technique; however, its use on mestizo noses is poorly documented. Our objective was to assess the level of satisfaction of our mestizo patients 1 year after their preservation rhinoplasty. Methods: The Rhinoplasty Outcome Evaluation (ROE), a Likert-type questionnaire validated in Spanish, was used to assess the level of satisfaction of 14 mestizo patients who underwent preservation rhinoplasty from March to July 2021 at 1 year after their surgery at the Higuereta Clinic in Lima, Peru. Results: The study included 14 patients, three men and 11 women, who underwent preservation rhinoplasty. A presurgical ROE questionnaire was applied, presenting a minimum value of 6, a maximum value of 21, and a mean of 12. When applied 1 year after surgery, the same ROE questionnaire presented a minimum value of 28, a maximum value of 30, and a mean of 30. The variation had a minimum value of 9 and a maximum value of 23, with a mean of 17 (P < 0.001). Conclusions: Preservation rhinoplasty can be successfully implemented in mestizo noses with good aesthetic results.

Intramuscular Posterior Thigh Volumization: An Aesthetic and Harmonious Transition to the Gluteal Region (Hv-FAT).

The gluteal region remains the preferred site for fat grafting. However, the transition from the gluteal region to the thighs has not been well studied. This study aimed to describe an echographic guidance hamstring volumization procedure (Hv-FAT) as a complement to body contouring surgery. Methods: Hv-FAT was performed in 19 patients from four countries (Peru, Argentina, Brazil, and Mexico) from May to June 2022 by four surgeons trained in soft-tissue ultrasound and in the aforementioned technique. All the patients met the following criteria: age older than 18 years and younger than 60 years; a body mass index of 30 kg/m² or less, and a surgical risk score of 2 or less, according to the Goldman index. Results: A total of four men and 15 women were included in this study, whose ages ranged from 22 to 58 years (mean: 36.37 years). After fat grafting, on average, the thickness of the right biceps femoris increased by 54.07%, maintaining 95.02% of this thickness one month postoperatively, whereas the thickness of the left biceps femoris increased by 46.57%, maintaining 94.86% of this thickness in the same postoperative period. In turn, the right semitendinosus muscle thickness increased by 181.90%, maintaining 97.42% of this thickness, whereas the left semitendinosus muscle increased by 111.90%, maintaining 95.29% of this thickness 1 month postoperatively (P < 0.0001). Conclusion: Hv-FAT is an effective and reproducible procedure for volumizing the biceps femoris and semitendinosus muscles, maintaining significant results one month postoperatively.

Echo-guided Lower-back Sculpture and Volumization as a Complement to High-definition Liposuction (XPINE-FAT).

Background: Knowledge about lower-back aesthetics is very limited, especially regarding surgical techniques that improve its appearance. Thus, this study aimed to describe a high-definition liposuction technique with intramuscular grafting of erector spinae muscles (longissimus). Methods: A total of 15 female patients 25-48 years of age were recruited between November 2021 and January 2022, who underwent body contouring surgery and subsequently underwent a low-back lipodefinition and echo-guided intramuscular erector spinae (longissimus) fat graft to complement the procedure. As part of the study, measurements were performed before surgery and in the immediate postoperative period. The data were stored in a database and analyzed with the SPSS Version 25 statistical software. Results: The patients' ages ranged from 25 to 48 years (mean: 37 years), with a body mass index of 18.6-29.3 (mean: 25.5). The surgical times ranged between 1 and 8 hours (mean: 3.73 hours); hospitalization times were 0.7-1 days (mean: 0.940 days). Lipograft was performed on the erector spinae muscles (longissimus), the right one with a range of 20-60 cm3 (mean: 43.33 cm3) and percentage increase of 65.3% (P < 0.0001). Regarding the left erector, similar volumes between 20 and 60 cm3 (mean: 44.67 cm3) were grafted with a percentage increase of 66.4% (P < 0.0001). Conclusions: XPINE-FAT is a safe technique that allows an increase in the immediate intramuscular thickness of the erector spinae muscles (longissimus). We observed no adverse events during the study.

Aesthetic Preferences of the Anterior Thigh as a Beauty Factor in Women.

BACKGROUND: In body contouring surgery, some regions, such as the abdomen, thorax, upper limbs, and glutes, are prioritized over others, including the lower limbs, particularly the anterior thighs. This study aimed to identify anterior thigh preferences by age, sex, ethnicity, and region and assess their importance as a factor of female beauty by conducting an online survey. METHODS: Photographs of a 24-year-old female model were modified in two front-view and side-view panels. Through a survey on the Amazon Mechanical Turk platform, participants were asked to order the images from the most beautiful to the least beautiful, and the results were broken down by age, sex, ethnicity, and region. RESULTS: A total of 1000 respondents were surveyed, all of whom answered the survey without error; therefore, no one was excluded. Of the 1000 respondents, 504 were men (50.4%) and 496 were women (49.6%). The predominant age group was 26-35 years, with 443 people (44.3%), the region with the highest number of participants was North America, with 484 respondents (48.4%), and the predominant ethnicity was White, with 555 respondents (55.5%). The survey showed that the most beautiful images were image A on the side-view panel (25.9%) and image I on the front-view panel (28.5%)(P < 0.001). CONCLUSIONS: In the side view, the aesthetic preferences of the anterior thigh do not appear to be associated with the anterior projection. However, in the front view, the increase in width generates a beauty trend, but only up to an intermediate level, quantified in the ratio (0.44).

Lipo Definition in Thighs: Volumizing and Defining the Vastus Muscles by Fat Transfer.

Volumizing muscles in the thighs by fat grafting to complement body contouring surgeries has not been adequately investigated. Our objective was to describe a technique (VDVFAT) that defines and volumizes thigh muscles by lipotransfer in the vastus medialis and vastus lateralis muscles. METHODS: VDVFAT was performed in 52 patients by the same surgeon at a private clinic in Lima, Peru, between 2018 and 2019. All patients were aged between 18 and 60 years, had no cutaneous flaccidity of the thighs, had a body mass index less than 28, and had Goldman surgical risk below Class II. RESULTS: A total of 45 women aged 19-41 years (mean: 29.2 years) and seven men aged 24-41 years (mean: 33 years) were included. A mean of 173.36 cm3 of intramuscular fat was grafted to the vastus lateralis, resulting in increased muscle thickness of 21.09 mm, which is equivalent to 88.31% of the initial size of the muscle (P < 0.0001). An intramuscular fat mass of 123.53 cm3 was grafted into the vastus medialis, resulting in increased muscle thickness of 30 mm, which is equivalent to 87.02% of the initial size of the muscle (P < 0.0001). CONCLUSIONS: Volumizing and defining the vastus muscles by fat transfer is a safe and reproducible method for defining and volumizing muscles. However, further studies are necessary to determine the durability of fat grafts.