Female Abdominal Landmarks and Their Improvements Using Polydioxanone Thread Placement for Umbilicus Elevation.

Background: Different landmarks on the abdomen have been used to evaluate abdominal aesthetics. However, because researchers use different methods for landmark measurements, there is no consensus as to which landmarks to use for either assessing abdominal aesthetics or guiding surgical planning. Methods: Female model photographs were analyzed for abdominal aesthetics with the umbilicus as the key dividing point. Because of the limitation on the number of landmarks that could be shown with model photographs, abdominal landmarks on actual female patients were studied. The variations of landmark metrics due to positional changes and before/after our polydioxanone (PDO)-assisted high-definition liposuctions were recorded. Results: For model photographs, the abdominal apex to mid-umbilicus distance (AU) versus midumbilicus to lower abdominal skin crease (UC) ratio was 1.626. Almost all bony landmarks demonstrated significant caudal shift when switched from standing to supine positions. Meanwhile, other landmarks also underwent substantial changes. This provides evidence that metrics taken in different positions cannot be compared with one another. As expected, after umbilici were elevated with our special technique, the relevant metrics improved postoperatively, with results close to being ideal. However, marked deviations from the mean measured values do exist. Conclusions: Abdominal landmarks change with positional adjustment. In standing position, many landmarks can be used for assessment of abdominal aesthetics. Ideally, efforts should be made such that the final AU/UC is close to 1.618, and XU/UP and UIC close to ideal, for satisfactory surgical results. Nevertheless, in actual practice, umbilicus positions can be varied to accomplish desired goals.

Restoration Liposuction of the Abdomen: High-Definition Liposuction With Umbilicus and Lower Abdomen Improvement Using Polydioxanone Threads.

BACKGROUND: Abdominal high-definition liposuction has been practiced for many years. However, problems such as low-lying, "sad-looking" umbilici and lower abdominal "pooches" remain unresolved. Additionally, the waistline, as the pivotal point connecting the chest and hips, deserves more attention and improvement. OBJECTIVES: The aim of this study was to use polydioxanone (PDO) threads after liposuction: (1) to improve the shape and position of the umbilicus permanently; (2) to tighten the lower abdomen permanently; and (3) to redefine "high-definition" liposuction. METHODS: All patients underwent high-definition liposuction of the abdomen and waist. After liposuction, bidirectional, barbed PDO threads were placed in the upper central abdomen. The threads were pulled to cinch the upper abdominal skin and then tied. The resulting umbilicus elevation was measured for up to 12 months. Higher waistlines were also created to match higher-positioned umbilici. RESULTS: Fifty-two female subjects were included. The range of umbilicus elevation at 12 months was 0.8 to 3.6 cm. Most umbilici were converted to vertical orientation, and lower abdomens became lengthened, flattened, and tightened. Moreover, the enhanced waistlines and body curves created better body proportions. CONCLUSIONS: This technique results in permanent elevation and shape enhancement of both umbilicus and lower abdomen. In addition, because the umbilicus is raised, a higher waistline can be created without any discordance, making the lower limbs appear longer. Overall, the maneuvers contributed to the restoration/rejuvenation of the abdomen and created a better overall body shape and proportion.

Nose Tip Elongation and Elevation: A Novel Filler Injection Technique.

BACKGROUND: Filler injection for nose tip improvement remains a difficult treatment due to efficacy and safety issues. OBJECTIVES: The authors sought to better the techniques and safety for nose tip improvement with a filler. METHODS: Patients seeking nose tip improvement were recruited regardless of their pretreatment conditions. A hyaluronic acid filler was injected through the skin behind the nose tip into the potential septal space. To achieve tip elevation, the filler was retro-injected from the anterior nasal spine, stopping at the mid-level of medial crura. To elongate the nose, the filler was deposited just in front of the caudal septal cartilage. The tip extended in the sagittal plane, causing the nose tip to move either caudally (tip elongation) or anteriorly (tip elevation), or both, as directed by the surgeon. RESULTS: Depending on the patients, the nose could be elongated by 2 to 6 mm, and the tip could be elevated by 2 to 8 mm. Additionally, stronger columellar support, finer tip structures, and improved nasolabial angle were observed. Interestingly, the upper lip appeared shorter. The nostril shapes and the alar widths were also improved. A total of 1288 cases are reported. Only 2 patients expressed dissatisfaction. CONCLUSIONS: This technique is easy and safe to perform, and the results are natural and comparable with those from rhinoplasty surgeries. Further, this report of filler nose lengthening may be the first large series in the world. Finally, this technique works well in all populations.