TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. A Multicenter Study of 845 Cases.

BACKGROUND: TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) is the acronym for a radically different lipoabdominoplasty, intended to add simplicity, improve vascular safety, and attain good results. Modifications are unrestricted liposuction, no flap detachment, massive transverse infraumbilical plication, umbilicus amputation, neoumbilicoplasty, diminished tension wound closure, and low transverse scar settlement. The objectives of this article are to describe the technique and analyze a multicenter experience. METHODS: Sixty-eight plastic surgeons from 10 countries provided data for a retrospective review of 845 patients. Aesthetic results were scored by each surgeon using the Salles scale and analyzed in combination with complications to identify associations between patient and surgery characteristics. RESULTS: Of the patients, 95.5 percent were female, 19.7 percent were obese, 35.6 percent had prior scars, 10.4 percent had undergone previous abdominoplasty, 6.5 percent were postbariatric, and 6.6 percent were smokers. One patient had a kidney transplant, and 16.5 percent had comorbidities. Surgery characteristics varied widely, being on average as follows: lipoaspirate, 2967 ml; resection, 1388 g; and surgical time, 3.9 hours; 46.5 percent were not hospitalized. Averaged results were 8.68 of 10 points, besides adequate positioning and proportion of scar and umbilicus, without epigastric compensatory bulging (4.97 of 6 points). Overall complications were 16.2 percent, mostly seroma (8.8 percent); vascular-related complications (i.e., necrosis, wound dehiscence, and infection) constituted 2.7 percent. There were no fatalities. The logistic regression model demonstrated that smoking and obesity duplicate the risk of complications; if age older than 60 years is added, the risk of complication increases seven to nine times. Reported indications were multiple; however, pathologic diastasis was excluded. CONCLUSION: TULUA lipoabdominoplasty is a new reproducible procedure with good quantified results and an acceptable complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Lipoatrofia por inyección de esteroides - Diagnóstico y tratamiento / Lipoatrophy by injection of steroids - Diagnosis and treatment

Existen diferentes opciones para el tratamiento de la lipoatrofi a secundaria a la inyección local de esteroides. Presentamos las diferentes alternativas de tratamiento y sus resultados sobre cuatro pacientes con diferente grado de lesión y en diferentes áreas corporales.

There are diff erent options for the treatment of lipoatrophy secondary to the local injection of steroids. We present the diff erent treatment alternatives and their results on four patients with diff erent degrees of injury and in diff erent body areas.

Face expressive lifting (FEL): an original surgical concept combined with bipolar radiofrequency.

BACKGROUND: Aging can lead to changes in facial expressions, transforming the positive youth expression of happiness to negative expressions as sadness, tiredness, and disgust. Local skin distension is another consequence of aging, which can be difficult to treat with rejuvenation procedures. The "face expressive lifting" (FEL) is an original concept in facial rejuvenation surgery. On the one hand, FEL integrates established convergent surgical techniques aiming to correct the age-related negative facial expressions. On the other hand, FEL incorporates novel bipolar RF technology aiming to correct local skin distension. METHODS: One hundred twenty-six patients underwent FEL procedure. Facial expression and local skin distension were assessed with 2 years follow-up. RESULTS: There was a correction of negative facial expression for 96 patients (76 %) and a tightening of local skin distension in 100 % of cases. CONCLUSIONS: FEL is an effective procedure taking into account and able to correct both age-related negative changes in facial expression and local skin distension using radiofrequency. Level of Evidence: Level IV, therapeutic study.

Corrugator supercilii muscle terminal nerve ablation using a novel thread technique for the treatment of hyperdynamic vertical glabellar furrows.

BACKGROUND: A novel percutaneous corrugator supercilii muscle terminal nerve CSMTN ablation technique is proposed for the treatment of hyperdynamic vertical glabellar furrows (HVGF). TECHNIQUE: Two surgical marks are placed on each eyebrow. One is placed at the level of the lateral canthus and the second at the outer border of the limbus. At each of the four marks, the following steps are carried out: (1) a guiding needle is used to punch the frontal skin at 3 mm above the eyebrow (orifice A) and will then travel deeply at the level of the supraperiostium and emerge outside the skin 3 mm below the eyebrow (orifice B) at the palpebral skin; (2) the needle is then reentered exactly at orifice B and will travel underneath the skin at a more superficial level in the subcutaneous layer and then emerge outside exactly at orifice A. Both ends of the thread are gently pulled in a sawing motion with counter tension until no more resistance is felt from the anatomical structures involved, and then the loops of thread are withdrawn from orifice A. RESULTS: Forty-seven subjects underwent bilateral CSMTN ablation. In the first 10 cases, the authors performed only one neurotomy per eye and observed a 50 percent HVGF recurrence rate. Then, the authors chose to perform two neurotomies per side and had a three percent recurrence rate (1/37) with a high degree of patient satisfaction. Major complications such as deforming hematomas, eyelid ptosis, abscess, scar formation or adhesions were not observed during follow up. CONCLUSION: This novel technique may represent a simple and permanent solution for HVGF.

Utilización de plasma rico en plaquetas como cicatrizante en dermoabrasión quirúrgica / Use of platelet rich plasma to accelerate healling in the surgical dermoabrasive process

Introducción: con la dermoabrasión quirúrgica se tratan diversas imperfecciones de la piel utilizando instrumentos abrasivos como lijas, fresas y cepillos de alambre. El Plasma Rico en Plaquetas (PRP) es un preparado autólogo obtenido por centrifugación de sangre venosa extraída del propio paciente que contiene un 95 % de plaquetas y se puede utilizar en forma tópica sobre la herida post abrasión, lo que acelera la regeneración y la cicatrización tisular. Material y métodos: se trataron 32 pacientes (12 hombres y 20 mujeres) con promedio de 38 años de edad: 15 por cicatrices de acné, 13 por arrugas y surcos profundos y 4 por rejuvenecimiento facial. La dermoabrasión se realizó con anestesia local tumescente, utilizando lijas o fresas. El PRP se obtuvo de sangre venosa autóloga centrifugada y se aplicó en forma tópica. Resultados: todos los pacientes evolucionaron satisfactoriamente, con escasa formación de costras e inicio de reepitelización a los 5 días. Conclusión: En medicina cosmética y estética existen varias maneras de utilizar el PRP. Nosotros, los empleamos en forma tópica, como cicatrizante luego de la dermoabrasión quirúrgica, con muy buenos resultados. Las contraindicaciones son escasas y siendo un preparado autólogo rico en agentes hemostáticos, su uso evita la infección de las heridas así como el desarrollo de equimosis y hematomas.

Introductions: The surgical dermoabration consistes in the removal of the superficial dermis through out an abrasive process with sandpaper and/or diamonds drills that intends the attenuation of facial wrinkes, acne sequels and skin hiperpigmentation. The platelets rich plasma (PRP) is an autologous, nontoxic, nonalergenic product obtained from the patient's blood centrifugation, it contains 95 % of platelet and it can be used topically over the post dermoabration wound and it accelerates the repair and healing of the wounds. Material and method: we treated 32 patients (12 male and 20 female) of 38 years average: 15 with acne sequels, 13 with facial wrinkes and 4 because of facial rejuvenation. we did the surgical dermoabration with local tumescent anesthesia infiltration using sandpaper and/or diamonds drill. The PRP is obtained from the patient's autologous venous blood centrifugation. Results: All the patients had satisfactory results with less scar formation and a faster reepitelization process. Conclusion: In cosmetic and esthetic medicine there are many ways of uses the PRP. This paper shows our experience in the topical use of PRP in patients submitted to a surgical dermoabration. It's observed that when placing PRP in the wound the process of reepitelization of the wound is accelerated, allowing a better healing which is noticed as a shorter recovery time, avoiding infections and hematomas. it has not contraindications because is an autologous, nontoxic, nonalergenic product obtained by the patient blood centrifugation.

A safety and feasibility study of a novel radiofrequency-assisted liposuction technique.

BACKGROUND: The feasibility, safety, and efficacy of a novel radiofrequency device for radiofrequency-assisted liposuction were evaluated in various body areas. METHODS: From July to December of 2008, 23 subjects underwent radiofrequency-assisted liposuction using the BodyTite system. Information regarding aesthetic results and local and systemic complications was collected immediately after the procedure and at 6- and 12-week follow-up. RESULTS: The mean age of the patients was 38.8 +/- 12.4 years, and 87 percent were women. Radiofrequency-assisted liposuction was performed successfully in all cases; volume aspirated per patient was 2404 +/- 1290 ml, whereas operative time was 158 +/- 44 minutes. All patients underwent liposuction at the hip and low abdominal areas, bilaterally. Body contour improvement was observed postoperatively in all patients and there were no severe systemic or local complications, although postoperative pain was minimal in all patients. Weight and circumference reductions were significant at both 6-week and 3-month follow-up. Skin tightening was judged optimal by the surgeon in all patients. CONCLUSIONS: The authors' study suggests that the removal of moderate volumes of fat with concurrent subdermal tissue contraction can be performed safely and effectively with radiofrequency-assisted liposuction. Additional benefits of this technique are excellent patient tolerance and fast recovery time. Nonetheless, a larger sample is required to confirm the authors' results and guarantee the efficacy and safety of the procedure. Direct comparison with traditional liposuction or energy-assisted liposuction techniques may provide some insights to tailor future indications of this novel technique.

Multiple eccrine hidrocystomas: a new therapeutic option with botulinum toxin.

BACKGROUND: Multiple eccrine hidrocystomas are benign cystic lesions that are associated with a chronic course and seasonal variability. Even though in the literature it is presented as a very infrequent pathology, we think this is more a lack of knowledge of the existence of said pathology and the fact that patients confuse it with comedo. OBJECTIVE: To treat multiple eccrine hidrocystomas of the face. RESULTS: We present a case of multiple eccrine hidrocystomas of the face in a cook man. Hidrocystoma is a benign cystic tumor of the sweat glands eccrine or apocrine. Multiple eccrine hidrocystomas are benign cystic lesions that are associated with a chronic course and seasonal variability. They appear like multiple shining small papule. Although a solitary eccrine hidrocystoma can be treated easily with surgical excision, the elimination of multiple lesions is problematic because of their number and location. CONCLUSION: The benefits of BTX-A treatment for multiple eccrine hidrocystomas include ease of application, no risk of scarring, and a good postoperative course. Because of the blockage produced by BTX-A on cholinergic terminals of the parasympathetic system that governs sweat glands secretion, it is suggested that periodic doses of BTX-A are injected in the superficial epidermis in order to treat multiple eccrine hidrocystomas.

Autologous vein transplantation for correction of dermal atrophic changes.

BACKGROUND: Many filling substances are useful in correcting dermal defects and/or wrinkles. OBJECTIVE: To describe a novel autologous dermal implant. METHOD: Unwanted leg/hand veins and/or varicose veins are extracted in an ambulatory phlebectomy technique. The veins are then either chopped into pieces and injected into the defect or inserted whole after cellular destruction with 23.4% hypertonic saline. RESULTS: Excellent correction of dermal defect has been obtained with long-lasting and possible permanent results. No complications have occurred. CONCLUSION: Autologous vein collagen transplantation can correct dermal defects with long-lasting and perhaps permanent results.

Laserlipólise: lipoaspiraçäo com Nd-YAG laser

The authors report their experience with laserlipolysis, a surgical procedure that uses a Nd-YAG type laser with a 1064nm wavalenght to treat localized adiposity, as an isolated or associated method to other traditional procedures. The physical principles of laser action on the adipocyte, anesthetic details, application techinique, cases, advantages, limitations, disadvantages, complications and long-term results are analysed. Moreover, the principle of action of laserlipolysis - photo-hyperthermia - on fat and adjacent tissue is demonstrated and analysed by histological studies.