House-roof Neoumbilicoplasty: Six-step Procedure for a Natural Navel.

Background: The umbilicus significantly contributes to abdominal aesthetics, with its reconstruction often necessary after certain procedures like umbilical herniorrhaphy, laparotomies, and abdominoplasty. Neoumbilicoplasty techniques have evolved, addressing various issues through approaches like skin and cartilage grafts, and local flaps. We are reporting our technique for neoumbilicoplasty. Methods: This study describes a novel neoumbilicoplasty technique implemented in 90 patients (88 women, two men) who underwent lipoabdominoplasty between February 2021 and June 2023. Exclusion criteria included procedures unrelated to neoumbilicoplasty. Surgical steps involved precise marking, dissection, and suturing to create a natural umbilical hood. Patient satisfaction was measured using the Global Aesthetic Improvement Scale. Results: The mean age was 37.7 years, with pre- and postoperative anatomics of 24.9 kg per m² and 24.2 kg per m², respectively. The average surgery duration was 84 minutes. No major complications occurred, but minor complications included dehiscence (6%), granuloma (5%), superficial infection (2%), bruising (1%), seroma (1%), and flattening (8%). Most complications were resolved with minor interventions. Patient satisfaction was high, with 96% of patients and the surgeon expressing significant satisfaction. Conclusions: House-roof neoumbilicoplasty is an innovative technique designed to effectively restore abdominal aesthetics through straightforward steps and timing, combined with high-definition lipoabdominoplasty.

Variable Energy and Ultrasound-based Liposculpture of the Arms: Multicenter and Multidevice Study.

Incorporation of new technologies to assist the liposuction procedure is becoming increasingly common. These technologies allow for a softer technique, balanced shaping, elimination of excess adipose tissue, and skin tightening. Some of these technologies include ultrasound (US; US-assisted liposculpture, VASER-assisted liposuction), power suction (power-assisted liposuction), radiofrequency (RF; RF-assisted lipolysis), and laser (laser-assisted liposuction). In addition, some of these devices have been shown to reduce the incidence of hematomas/inflammation and shorten recovery time. We report our experience in high-definition liposculpture of the arms in addition to new technologies to improve skin retraction, comparing their results in terms of complications, satisfaction score, and aesthetic outcomes. We included patients with mild-to-moderate arm dermatochalasis (Duncan classification) fat deposits in the upper extremities who were considered candidates for third-generation US-assisted liposculpture, power-assisted liposuction, RF-assisted lipolysis/skin tightening, and laser-assisted liposuction. A total of 683 consecutive patients met the inclusion criteria for the study. Most of them were women (n = 605, 88%). Fat grafting was performed in 80 patients (11.7%). A significant portion of the patients were secondary cases (n = 223, 33%). Age ranged from 18 to 70 years (median = 38 years). BMI ranged from 17.8 to 34.8 kg/m2 (mean = 24.3 kg/m2). RF-assisted and laser-assisted high-definition liposculpture of the arms are both effective and reproducible techniques for patients who seek an athletic and slim arm contour. A low rate of complications and high satisfaction index support our findings.

Mesh-like External Suture Splint: A Way to Improve Results and Reduce Postoperative Complications after High-definition Liposculpture.

High-definition liposculpture with variable degrees of muscular definition allows both patients and surgeons to broaden the procedure to fit almost any individual preferences; however, skin laxity and those secondary cases still represent a big challenge for the surgeon to achieve optimal outcomes. We are reporting our experience with a new suture-splint procedure to reduce edema, avoid skin laxity, and increase muscular definition after liposculpture. We enrolled patients undergoing HDL with any risk factor that could compromise aesthetic outcomes. Tumescent technique with VASER fat emulsification and power-assisted liposuction were used to complete HDL. We performed a continuous suture over the midline and other areas of muscular definition right before patients awakened from anesthesia. Real-time ultrasound imaging was performed to ensure the safety of the procedure. A total of 52 consecutive patients were treated with MesHD in our study. Only two patients voluntarily dropped off from postoperative analysis due to geographical limitations. Postoperative edema was referred by only one patient after surgery. No major complications were reported. Three patients complained of stabbing pain over one of the stitches, which resolved completely after suture removal. All patients were satisfied with postoperative results. Mesh suture-splint at body areas with high risk of adverse effects after body contouring surgery may be an effective procedure to improve recovery by decreasing edema formation, enhancingmuscular definition, decreasing risk of fibrosis, and avoiding skin laxity postoperative appearance.

Effects of Optimal Temperature Control in Body Contouring Surgery: A Nonrandomized Controlled Clinical Trial.

BACKGROUND: Perioperative hypothermia in plastic surgery has underestimated risks, including increased risk of infection, cardiac events, blood loss, prolonged recovery time, and increased nausea, pain, and opioid usage. Inadequate preventive measures can result in up to 4 hours of normothermia restoration. OBJECTIVES: The aim was to compare the impact of different strategies for normothermia during plastic surgery procedures and their relationship with clinical outcomes. METHODS: A nonrandomized clinical trial was conducted in a single center in Bogota, Colombia. We enrolled adult patients undergoing body contouring surgery and divided them into 4 intervention groups with different measures to control body temperature. Univariate and bivariate analyses were performed, comparing several clinical symptoms to evaluate outcomes. RESULTS: A total of 197 patients were analyzed. Most of them were females (84.3%). Mean age was 38.6 years, and the median procedure duration was 260 minutes. Demographic and clinical characteristics did not exhibit significant differences between the groups. There were notable variations in temperature measurements at crucial moments during the surgical procedure among the groups, attributed to the implementation of distinct thermal protective strategies. Group comparisons showed a relationship between hypothermia and increased nausea, vomiting, shivering, pain, and additional analgesia requirements. CONCLUSIONS: Incorporation of active thermal protective measures, such as Blanketrol or HotDog, during body contouring procedures, markedly diminishes the risk of hypothermia and enhances overall clinical outcomes. Implementing these active measures to maintain the patient in a state of normothermia not only improves operating room efficiency but also leads to a reduction in recovery room duration.

Aesthetic Rib Cage Remodeling with Osteosynthesis: Body Structural High-Definition Reshaping (RIBOSS).

BACKGROUND: Rib cage remodeling has shown promising aesthetic results as a new technique for body contouring yet risks and complications associated with the procedure have not been well established. The aim of our study is to assess safety, efficacy and patient satisfaction rate associated with a new surgical technique for waistline definition. METHODS: We looked into our records for patients who underwent waist narrowing through a new rib remodeling procedure with osteosynthesis of the 11th and 12th ribs; from October 2022 to June 2023. Follow up was carried out at 1 and 3 months after surgery. Outcomes were evaluated based on waist and hip measures, body images, pain and a patient satisfaction survey. RESULTS: A total of 27 consecutive patients were included in the analysis. Our technique resulted in a significant reduction in waist circumference, as evidenced by a decrease of 12.1 cm and 13.0 cm at the first and third month respectively (p<0.005). A reduction of hip circumference of 6.2 cm and 8.7 cm was also reported. A high patient satisfaction rate was reported. Postoperative complications included only one case of wound dehiscence and one case of mild pain. Pain levels were also reduced, with a mean pain score of 2.4 at week 1 and 0.26 at month 1. CONCLUSION: Rib osteotomy with osteosynthesis emerges as an innovative, safe, and reliable approach for waist narrowing. Our results suggest that this technique can be applied to a wide variety of patients and presents might entail significant advantages compared to those from other techniques. TYPE OF STUDY: Retrospective cohort. Level of Evidence: III.

Ultrasonic- and Ultrasound-assisted Improvement of Silhouette of the Torso: Bone Structure High-definition Remodeling (Part I).

Background: High-definition liposculpture allowed plastic surgeons to achieve better aesthetic results by carving the underlying muscles and contours in a new way. Several authors have improved the original technique by adding other procedures and new technologies. We designed a new improvement by incorporating bone transformation surgery to overcome the lack of silhouette at the waist and, as a result, optimize the breast-waist-hip ratios. Methods: We carried out a prospective multicenter study, with five different surgeons performing the same rib remodeling technique for waist definition. We used an ultrasonic piece for costal corticotomy and real-time ultrasound imaging to perform green-stick fractures over the last two or three floating ribs. Ours is a new technique based on the prior one described by Kudzaev. Results: We reported 131 consecutive patients who were enrolled in this study. Waistline diameter decreased an average of 8 cm after surgery (P < 0.05). Most patients were women (n = 125, 95.4%). No major complications were reported. Most common complication was prolonged pain, with only three cases of contour asymmetry, all of which were attributable to noncompliance of constantly wearing the corset + compressive garments. Patients reported a high satisfaction rate and fast recovery (Body-QoL survey). Conclusions: Ultrasonic- and ultrasound- assisted indentation surgery of the thorax is a safe and reliable technique for waistline definition, with a high satisfaction rate, almost-invisible scars, and minimal risk for complications. Incorporation of high-definition liposculpture to rib remodeling opens up a new horizon for bone structure modification surgery (S-high-definition remodeling) that can be safely performed for patients who seek better aesthetic outcomes in body contouring.

Effects of Bipolar Radiofrequency on Collagen Synthesis from Patients with Brachial Ptosis.

Radiofrequency is frequently used for skin rejuvenation, localized fat elimination and cellulite treatment. It prompts the expression of thermal shock proteins that lead to dermal thickening as a result of collagen synthesis. The authors report a histological and clinical analysis of the arm subdermal changes before and after bipolar radiofrequency treatment plus liposuction to determine their benefits for arm contouring. Methods: Inclusion criteria included patients with stage 1, 2a, and 2b brachial ptosis (Duncan classification) and upper limb fat deposits who were considered candidates for third-generation ultrasound-assisted liposculpture plus radiofrequency-assisted lipolysis/skin tightening. Arm subdermal tissue samples (5 mm³) were analyzed before and after the intervention. We used 10% formaldehyde for tissue fixation and stained each sample with hematoxylin/eosin, Masson trichrome, and antibody markers against the cell cycle Ki-67 protein. Results: We analyzed a total of 12 biopsies from six patients who meet the inclusion/exclusion criteria. Histological findings with hematoxylin/eosin revealed hyperplastic and metaplastic changes with focal distribution within the papillary and reticular dermis. Masson trichrome staining showed an increase of the characteristic basophilia of thin type-I and type-III collagen fibers. In contrast, molecular analysis reported an increase in fibroblast activity mediated by the activation of the heat shock protein HSP47. Conclusion: Radiofrequency may be a great alternative to improve skin retraction in patients with mild to moderate brachial dermatochalasis through the activation of HSP47 heat shock protein and the production of type-I and type-III collagen.