Progressive Contouring of the Platysma With Barbed Sutures.

BACKGROUND: As the prevalence of neck lift surgeries increases, the field is continually enriched by evolving techniques for enhancing neck aesthetics. While many recent publications focus on deep neck procedures, it is essential not to overlook the significance of platysmal contouring as an integral aspect of neck rejuvenation surgery. Accordingly, we would like to elucidate our unique approach to contouring the platysma. OBJECTIVES: This study was designed to assess the efficacy of the progressive contouring concept, a technique in which the neck is reshaped with barbed sutures synergistically with other treatment strategies. METHODS: Our study encompassed 337 patients who received neck rejuvenation treatment with the progressive contouring technique from 2014 to 2021. We conducted a retrospective review to evaluate the change in cervicomental angle (CMA) with Mirror software during the preoperative and postoperative stages. RESULTS: The study sample predominantly comprised females (304 out of 337), with a median age of 61 years (24-88). Most patients (95%) underwent deep cervicoplasty, with a surgical net applied in all cases for skin adaptation. After a median follow-up of 14 months, significant improvements were observed in CMA values (reduced from 149.8° to 106.7°). This demonstrated statistically significant differences when comparing preoperative and postoperative outcomes. CONCLUSIONS: Progressive shaping of the neck with barbed sutures is an effective technique in neck rejuvenation. It utilizes multipoint and multivector plication, particularly when integrated with other adjunctive surgical maneuvers.

Inferior and Medially Based Breast Parenchymal Rotation Flap: A New Mastopexy Technique for Replacing Breast Volume After Breast Implant Explantation.

BACKGROUND: Recently, a growing number of patients have been opting for the removal of breast implants. This often results in a degree of volume loss that can vary from mild to substantial, contingent on the size of the implant, with many patients requiring a mastopexy. Although autoaugmentation mastopexy serves as the primary surgical approach to restore shape and fill the void left by the implant, the fullness attained with the implant cannot be replicated through autoaugmentation. OBJECTIVES: Our goal was to present the technical details and utilization of an inferomedial pedicle-based breast parenchymal flap, without rotational restriction from the parenchyma, for autoaugmentation after explantation. METHODS: A retrospective chart review was performed of 12 patients who underwent surgery with this technique between the years of 2019 to 2022, with emphasis on reasons for explantation, early and late complications, and satisfaction scores on a Likert scale. RESULTS: Capsular contracture was the most common reason for explantation, and only 2 patients experienced minor wound dehiscence in the early postoperative period. With a mean follow-up of nearly 2 years, no bottoming out was encountered in any of the patients, and satisfactory breast shape was obtained. Further, postoperative satisfaction was significantly higher than preoperative satisfaction. CONCLUSIONS: The inferomedial-based parenchymal rotation flap is a new procedure that can be applied in this patient group because of its wide rotation arc and reliable vascularity. It is also an effective option for creating the desired conical breast shape in patients who do not want breast implants over the long term.

Abdominoplasty with Circumferential Liposuction: A Review of 1000 Consecutive Cases.

BACKGROUND: The authors present the technique called "abdominoplasty with concurrent circumferential liposuction," where the whole trunk is addressed as a single aesthetic unit. METHODS: Between January of 2008 and June of 2016, abdominoplasty with circumferential liposuction was performed in 1000 patients (984 women and 16 men) by the senior author. Patients had a mean body mass index of 27.5 kg/m (range, 18.1 to 34.5 5 kg/m). Liposuction was performed circumferentially and the abdominal flap was detached up to the costal margins. Simultaneous fat grafting was also performed if required. Outcomes and complications were documented. RESULTS: Traditional abdominoplasty incisions were used in 359 patients, whereas extended incisions were used in 641 patients. The mean duration of follow-up was 27 months (range, 12 days to 61 months), and the mean duration of surgery was 154 minutes (range, 109 to 260 minutes). The mean amount of simultaneously aspired supernatant lipoaspirate was 1940 cc (range, 1700 to 4580 cc). Simultaneous gluteal fat grafting was performed in 34 percent. None of the patients had any skin necrosis. The most common complication was seroma (19 percent). CONCLUSIONS: In abdominoplasty, the entire central body should be considered as a single unit. Circumferential widespread liposuction with standard undermining of the abdominal flap up to the costal margins is safe and yields superior aesthetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Autologous Flap Gluteal Augmentation: Split Gluteal Flap Technique.

Postbariatric, cosmetic, and circumferential body lift patients seek to avoid a flattened buttock contour. Gluteal implants have been described with various rates of complications and difficulties. Lipografting moderately increases buttock volume; neither procedure directly addresses ptosis. The procedure described in this article addresses the volume deficit and ptosis. Most adipocutaneous flaps originate within the superior gluteal region and maintain volume in the top half of the buttocks, lacking the ability to reach the midportion of the buttocks. The ideal flap should be versatile, result in a superior gluteal concavity, and give the maximum projection at the midlevel of the buttocks.