Assessment of the Efficacy of Cryolipolysis on Abdominal Fat Deposits: A Prospective Study.

BACKGROUND: Cryolipolysis is a non-invasive and efficacious procedure for body contouring. The effectiveness of cryolipolysis has been demonstrated on multiple areas of the body, but on a limited number of subjects. The aim of this study is to demonstrate the effectiveness and the safety of cryolipolysis in the lower abdomen adipose tissue thickness reduction. METHODS: A prospective study on 60 healthy women was carried out using CryoSlim Hybrid device. Each patient underwent two cryolipolysis sessions centered on the abdominal area. The primary endpoint was to decrease the thickness of the abdominal fat deposits. The change in the abdominal circumference and the thickness of the subcutaneous fat layer were assessed. Patient satisfaction and tolerance of the procedure were also taken into account. RESULTS: A significant reduction of the abdominal circumference and subcutaneous fat layer thickness was observed. The mean decrease in abdominal circumference was 2.10 cm (3.1%) 3 months after the procedure and 4.03 cm (5.8%) 6 months after the procedure. The mean decrease in fat layer thickness was 1.25 cm (43.81%) 3 months after the procedure and 1.61 cm (41.73%) 6 months after the procedure. No major adverse events were noted. All patients were very satisfied, and minimal pain was reported. CONCLUSIONS: Cryolipolysis is an effective technique to treat abdominal localized fat deposits. No major adverse events have been described for this procedure. Our promising results should encourage further studies aimed at optimizing the efficacy of the procedure without a considerable increase in the risks. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Effect of focused ultrasound cavitation augmented with aerobic exercise on abdominal and intrahepatic fat in patients with non-alcoholic fatty liver disease: A randomized controlled trial.

OBJECTIVES: The study aimed to examine the effect of focused ultrasound cavitation augmented with aerobic exercise on localized abdominal and intrahepatic fat in fatty liver patients. METHODS: 34 fatty liver patients aged 30-45 with a body mass index (BMI) of 30-40 kg/m2 were randomly assigned into two equally numbered groups. Group A received focused ultrasound cavitation and moderate aerobic exercise for three months, while Group B (control group) received moderate aerobic exercise only. Abdominal subcutaneous fat volume, visceral fat volume, liver-to-spleen ratio (L/S ratio), body weight, BMI, and waist circumference were measured both before and after the study period. RESULTS: Both groups showed significant improvements in subcutaneous fat volume, visceral fat volume, body weight, BMI, and waist circumference relative to baseline where (P < 0.001), with a higher percentage in group A. L/S ratio only showed a significant improvement in group A. Between-group differences were noteworthy regarding L/S ratio and waist circumference where (P < 0.0001). CONCLUSION: While substantial risky measures in non-alcoholic fatty liver disease have been modified by aerobic exercise, its combination with focused ultrasound cavitation causes more notable effects on the reduction of abdominal and intrahepatic fat, making it a superior option. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04161703.

Meta-analysis on the comparative efficacy of drains, progressive tension sutures and subscarpal fat preservation in reducing complications of abdominoplasty.

INTRODUCTION: Abdominoplasty is a popular aesthetic operation. Complication rates vary from 4-80%. To date, there is a lack of evidence for complication-reducing techniques. The aim of this meta-analysis was to summarise and quantify the effects of these techniques on complication rates and determine the safest combination. METHODS: A literature search was undertaken from MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases. Two authors assessed the abstracts and evaluated their suitability for inclusion in the review. For each complication (including overall), a random effects meta-analysis was conducted to investigate the average number of complications. The log rate and associated variance is calculated in R using the "escalc" function from the metafor R package. For the forest plots the model output is back-transformed to the original scale. RESULTS: 4295 patients were included in the meta-analysis. Overall complication rates ranged from 9.3-33.8%. Revision rates were 3-21.9%. Forest plots of data extracted from observational studies demonstrated summary measures favouring the sub-scarpal fat preservation and drains, and drains only groups for overall complications. There were no significant differences between groups for seroma, haematoma, infection/abscess, skin/fat necrosis, dehiscence, surgical revision rate and VTE rate. CONCLUSIONS: The rates of individual complications are no different with or without the use of PTS, drain or sub-Scarpal fat preservation in different combinations.

The effect of ultrasound cavitation in combination with cryolipolysis as a non-invasive selective procedure for abdominal fat reduction.

BACKGROUND AND AIM: Fat reduction and body contouring have become popular procedures in the cosmetic surgery industry over the past decade. There have been studies to replace invasive methods such as liposuction, with safer non-invasive procedures. We aimed to evaluate the effect of a non-invasive combination therapy of ultrasound cavitation and cryolipolysis on abdominal adipose tissue. METHODS: This pilot interventional study comprised 90 female individuals aged 18-65-years-old who were recruited into one of three groups of 30 participants. Group 1 was treated with diet alone (the control group), group 2 with cryolipolysis and diet, and group 3 with a combination of ultrasound cavitation, cryolipolysis, and diet for 8 weeks. Anthropometric parameters were measured before, during, and after the trial included total body weight, body mass index(BMI), body fat mass, fat-free mass, and abdomen circumference. RESULTS: All three groups demonstrated significant reductions in each parameter at the end of the intervention (P < 0.01). Apart from fat-free mass (P = 0.66), the combination therapy significantly reduced body fat mass, weight, BMI, and abdomen circumference compared to the control group (P < 0.01). There was no significant difference between the combination therapy and cryolipolysis-alone groups. CONCLUSION: Treatment using a combination of cryolipolysis and ultrasound cavitation is no more effective in improving the anthropometric indices than cryolipolysis alone.

Immunohistochemical expression of plasminogen activator inhibitor-1 in subcutaneous versus omental adipose tissue in patients after elective abdominal surgery

Plasminogen activator inhibitor-1 (PAI-1) is a biomarker of thrombosis. Adipose and vascular tissues are among the major sources of PAI-1 production. Previous studies indicated that fat deposits mediate increased cardiovascular risk among obese individuals. We investigated the immunohistochemical (IHC) expression of PAI-1 in adipose and vascular tissues from the omentum and the subcutaneous tissue. The pathology samples were selected from 37 random patients who underwent elective abdominal surgery between 2008-2009. PAI-1 expression was semi-quantitatively scored and compared between the groups. Significant differences were noted in the IHC expression of PAI-1 between the omental and the subcutaneous adipose tissues (1.1 ± 0.8 versus 0.8 ± 0.6, respectively (p=0.05)). Adipose tissue displayed higher IHC expression of PAI-1 compared to vascular wall tissue in both omentum and subcutaneous sections (1.1 ± 0.8 versus 0.5 ± 0.9 (p=0.004), and 0.8 ± 0.6 versus 0.4 ± 0.6 (p=0.003), respectively). In conclusion, our study compared PAI-1 expression in the omentum versus the subcutaneous tissue and adipose versus vascular tissues. IHC expression of PAI-1 level was significantly higher in the omental adipose tissue compared to the subcutaneous adipose tissue. Adipose tissue displayed significantly higher PAI-1 expression than vascular tissue. The study elucidates the biological differences of adipose and vascular tissue from subcutaneous versus omental sections.

Comparison of Cardiovascular Benefits of Bariatric Surgery and Abdominal Lipectomy.

PURPOSE OF REVIEW: The purpose of this review is to examine recent evidence supporting effectiveness of bariatric surgery and abdominal lipectomy as interventional strategies aimed at reduction in incidence of cardiovascular disease (CVD) and related morbidity and mortality in obese and metabolic syndrome patients. RECENT FINDINGS: While several studies show reduction in CVD risk factors in patients who have undergone both the Roux-en-Y gastric bypass and sleeve gastrectomy, very few demonstrate actual improvements in cardiovascular function, or a decrease in CVD events or CVD-related mortality. Consequently, the cardiovascular benefits of the less invasive sleeve gastrectomy in comparison to the gastric bypass are also unclear. Striking new data on large patient samples demonstrate significant positive correlation between gastric bypass and CVD risk factor reduction only in patients who are diabetic or > 50 years of age at the time of surgery, with no significant differences in non-diabetic and younger patients and with significant side effects. On the other hand, a markedly less invasive removal of abdominal subcutaneous adipose tissue via lipectomy consistently and significantly improved CVD risk factors as well as cardiovascular function in the very few studies available. Overall, neither the potential nor the definitive cardiovascular benefits of either of the commonly used bariatric surgical or the various lipectomy procedures have been adequately explored. Future basic science and clinical studies have the opportunity to understand the mechanisms and long-term consequences of both approaches and develop personalized approaches with higher benefit to side effect ratios.

Application of a Minimally Invasive Liposuction Technique for Harvesting Fat during Transsphenoidal Surgery: A Technical Note.

Secure reconstruction in transsphenoidal surgery (TSS) is important for the prevention of the major and serious complication of postoperative cerebrospinal fluid (CSF) leak. Although abdominal fat can be safely and effectively used as a reconstruction tissue, harvesting it from the abdominal wall is traumatic and invasive, resulting in cosmetic problems. In this report, we present a method of harvesting abdominal fat using a minimally invasive liposuction technique to avoid cosmetic issues. Since 2016, we have been using fat harvested from the abdominal wall by suctioning with a dedicated syringe for reconstruction after TSS in selected cases. The liquefied fat obtained by the liposuction technique was wrapped with an oxycellulose sheet and changed its form to what we termed "fatty candy". In this form, the fat maintained its configuration and could be handled almost as easily as a conventional fat graft. In our experienced series, there was no case with wound complication nor postoperative or late-onset CSF leak during a postoperative follow-up of at least 3 months. The fat harvested by this simple and minimally invasive liposuction technique can be expected to provide an autologous graft that is adequate not only for prevention of cosmetic problems but also for prevention of postoperative CSF leak.

Laser-Assisted Liposuction (LAL) Versus Traditional Liposuction: Systematic Review.

INTRODUCTION: Liposuction is the most performed surgical procedure in Brazil and the second in the world. In recent years, new technologies have been developed in an attempt to improve liposuction, such as laser. The objective of this study is to evaluate the efficacy and safety of laser-assisted liposuction (LAL) compared to traditional liposuction through a systematic review of the literature. METHOD: The search strategy used was the combination of the descriptors [lasers (MeSH Terms)] and (lipectomy [MeSH Terms]) in the PubMed database. Two independent researchers carried out the reading of the abstracts and selection of the studies according to the eligibility criteria. The risks of study bias were evaluated using an instrument similar to that used by the Cochrane Collaboration. RESULTS: Initially, 80 studies were obtained and, after evaluating the eligibility criteria, seven remained. Five of them observed that LAL has benefits when compared to traditional liposuction, and the main outcomes were compared with regard to histological analysis (2 products), further reduction of subcutaneous fat (2), better retraction of the skin (3), and higher personal satisfaction of the patient (2). The qualitative assessment identified high risks of bias in various areas in the studies. CONCLUSION: Although studies have concluded that LAL promotes greater fat reduction, better skin retraction, and greater patient satisfaction compared to traditional liposuction, the high bias impedes a more reliable conclusion. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Neuropeptide Y promotes adipogenic differentiation in primary cultured human adipose-derived stem cells.

Neuropeptide Y (NPY) is an important neurotransmitter in the control of energy metabolism. Several studies have shown that obesity is associated with increased levels of NPY in the hypothalamus. We hypothesized that the release of NPY has coordinated and integrated effects on energy metabolism in different tissues, such as adipocyte tissue, resulting in increased energy storage and decreased energy expenditure. Whether NPY has role in the molecular mechanism of human adipocyte tissue remains unclear. We established the model of human adipose derived stem cells (hADSCs) from human adipose tissue and differentiated it into adipocytes in the presence of NPY at different concentrations (10-15-10-6 mmol/L). We then assessed hADSCs proliferation and differentiation by quantifying lipid accumulation and examining the expression levels of related adipocyte markers after differentiation. Furthermore, the specific markers of white adipocyte tissue (WAT) in hADSCs were also analyzed. The results showed that low doses of NPY stimulated hADSCs proliferation (p < 0.05), while high doses of NPY inhibited hADSCs proliferation (p < 0.05). NPY significantly promoted lipid accumulation and increased the size of lipid droplets during human adipogenic differentiation; the levels of adipocyte markers PPAR-γ and C/EBPα were also increased. At the same time, NPY also increased the levels of WAT markers Cidec and RIP140 after adipocyte differentiation. The results suggested high dose NPY inhibits the proliferation of hADSCs while promotes adipocyte differentiation and increases the expression of WAT markers. This may be the reason why increased levels of NPY can lead to a rise in body weight.

Surgical Management of the Giant Pannus: Indications, Strategies, and Outcomes.

The obesity pandemic continues to produce an inexorable increase in the number of patients requiring surgical treatment of obesity and obesity-related complications. Along with this growing number of patients, there is a concomitant increase in the complexity of management. One particular example is the treatment of patients with an exceptionally large and morbid pannus. In this report, we detail the management of seven patients suffering from a giant pannus. Medical and surgical variables were assessed. A quality of life questionnaire was administered pre- and postoperatively. All seven patients suffered some obesity-related medical morbidity and six of seven (86%) had local complications of the giant pannus. Each patient underwent giant panniculectomy [resection weight > 13. 6 kg (30 lb)]. The mean resection weight was 20.0 kg. Four of seven (57%) patients experienced postoperative complications, with two (29%) requiring re-operation and blood transfusion. Six patients were available for long-term follow-up; 100% of participants indicated an increased quality of life while five (83%) reported additional postoperative weight loss, increase in exercise frequency and walking ability, and improved ability to work. Our results indicate that giant panniculectomy is a challenging and risky procedure, but careful patient selection and intraoperative scrutiny can ameliorate these risks and afford patients a dramatically improved quality of life. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Bidirectional, Absorbable, No-Drain Abdominoplasty.

This article outlines the author's technique, and the concepts of Bidirectional, Absorbable, No-Drain Abdominoplasty (BAND-Abdominoplasty). The attendant advantages and disadvantages are reviewed in the context of a retrospective, 5-year, single surgeon series. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Criopreservación de células estromales derivadas del tejido adiposo: viabilidad utilizando un medio definido libre de proteína animal / Cryopreservation of adipose derived stromal cells: viability using a defined free of animal protein médium

Introducción y Objetivo. El tejido adiposo es una fuente de células estromales de fácil acceso. Para su almacenamiento y posterior aplicación en clínica es importante que el método de criopreservación a utilizar mantenga adecuadas tasas de viabilidad tras un ciclo de congelación. El objetivo del presente trabajo es obtener células estromales humanas derivadas del tejido adiposo, implementar un protocolo de criopreservación libre de proteína animal y medir las tasas de viabilidad posterior a un ciclo de criopreservación para su eventual aplicación clínica. Material y Método. Utilizamos grasa fresca de 5 pacientes sometidas a lipoaspiración y aislamos las células estromales mediante técnicas de digestión enzimática y expansión celular. Realizamos la caracterización de las células mediante inmunofenotipificación. Criopreservamos las células utilizando dimetil-sulfóxido 10% y las almacenamos durante 1 mes en nitrógeno líquido. Evaluamos la tasa de viabilidad mediante ioduro de propidio y citometría de flujo, antes y después de un ciclo de criopreservación. Resultados. Obtuvimos células estromales derivadas del tejido adiposo, confirmado con el panel de inmunofenotipificación. Las tasas de viabilidad promedio obtenidas con ioduro de propidio fue 61.89% mientras que la tasa de mortalidad fue 32.68% tras un ciclo de criopreservación. Conclusiones. Mediante un protocolo de criopreservación utilizando un medio definido con dimetil-sulfóxido 10% en ausencia de proteína animal, es posible obtener tasas aceptables de viabilidad de las células estromales derivadas del tejido adiposo tras un ciclo de criopreservación (AU)

Background and Objective. Adipose tissue is an easy access source of stromal cells. For storage and subsequent clinical application, it is important that the method of cryopreservation used maintain adequate viability rates after a cycle of freezing. Our aim is to get stromal cells derived from human adipose tissue, implement a protocol of cryopreservation free of animal protein and subsequent measure viability rates after a cryopreservation cycle for its posterior clinical use. Methods. Fresh adipose tissue of 5 patients undergoing liposuction was used and stromal cells were isolated by enzymatic digestion techniques and cell expansion. Characterization of the cells was performed by immunophenotyping. Cells using 10% dimethylsulfoxide and stored for 1 month were cryopreserved in liquid nitrogen. Viability rates were assessed by propidium iodide and flow cytometry before and after a cryopreservation cycle. Results. Stromal cells derived from adipose tissue, confirmed immunophenotyping panel, were obtained. The average viability rates obtained with propidium iodide was 61.89% while the mortality rate was 32.68% after a cryopreservation cycle. Conclusions. Using a cryopreservation protocol with a defined medium with 10% dimethylsulfoxide and animal protein free, it is possible to obtain acceptable viability rates of stromal cells derived from adipose tissue after a cryopreservation cycle (AU)

Impact of Abdominal Lipectomy on Post-Sleeve Gastrectomy Surgery Weight Loss.

BACKGROUND: Abdominal lipectomy after bariatric surgery is recommended because of residual excess skin resulting in difficulty with maintaining hygiene, recurrent infections, and functional impairment, interfering with daily activities. There is a dearth of literature examining weight loss outcomes in patients undergoing abdominal lipectomy post sleeve gastrectomy (SG). The purpose of this study was to examine whether post-SG patients who received abdominal lipectomy achieved greater percent excess weight loss (%EWL) than post-SG patients who did not receive abdominal lipectomy. METHODS: Retrospective study of patients who underwent minimally invasive SG at the University of Illinois Hospital and Health Sciences System from March 2008 to June 2015 was conducted. The cohort was divided into 2 groups: patients who underwent abdominal lipectomy after SG (PS-SG) and patients who underwent SG alone (SG). Demographics, comorbidities, and %EWL were examined. RESULTS: Twenty-nine patients were included in the PS-SG group versus 287 patients in the SG group. Significant differences were found in %EWL at 24 (P < 0.0001), 36 (P < 0.005), and more than 36 months (P < 0.005) follow-up between groups, with a greater %EWL in patients in the PS-SG group versus the SG group. CONCLUSIONS: This preliminary study revealed that patients in the PS-SG group achieved greater %EWL than patients with SG alone. Although larger studies are needed, this study supports using abdominal lipectomy as an adjunctive procedure to assist with long-term weight loss as part of the overall treatment of bariatric surgery patients.

Improved fat transplantation survival by using the conditioned medium of vascular endothelial growth factor transfected human adipose-derived stem cells.

Autologous fat transplantation has been applied widely in clinic. However, the low survival rate is still a problem to be solved. Studies shows that the human adipose-derived stem cells (ADSCs) transfected by vascular endothelial growth factor (VEGF) can improve the survival rate of autologous fat transplantation. Our study is to evaluate the effects of the conditioned medium of VEGF-transfected human adipose-derived stem cells (VEGF-ADSCs-CM) on fat transplantation. ADSCs were isolated and transfected with MOI = 40. The study was divided into three groups, VEGF-ADSCs-CM group, normal-ADSCs-CM group and control group. The conditioned media for VEGF-ADSCs-CM group and normal-ADSCs-CM group were collected, and then mixed with fat, with the mixtures being injected into the back of nude mice. On 4, 7, 15, 30, 60 days after transplantation, the grafts were evaluated on the wet weight, histology, ELISA and western blot. As the results revealed, the survival rate of VEGF-ADSCs-CM group was highest with the best fat cell morphology, and the VEGF secretion of VEGF-ADSCs-CM group was also highest. Therefore, our study demonstrates that VEGF-ADSCs-CM can improve the survival rate of fat transplantation effectively, and VEGF-ADSCs-CM can be regarded as an effective assisted method for fat transplantation.

[Buried Penis: A Comprehensive Review on Aetiology, Classification and Plastic-Surgical Reconstruction]. / "Buried Penis": Aktuelle Übersicht über Ätiologie, Klassifikation und plastisch-chirurgische Rekonstruktion.

The buried penis, also called hidden or concealed penis, is associated with morbid obesity or seen after massive weight loss in adults. In highly obese, bariatric patients, the penile shaft invaginates into the pre-pubic fat masses, resulting in voiding problems and urine wetting of the surrounding tissue. This leads to infection, skin maceration, lichen sclerosus and eczema. Sole circumcision without mons pubis plasty or penile fixation does not suffice to alleviate the discomfort and leads to recurrence. In post-bariatric patients, penile retraction is only partially present or absent, but abundant pre-pubic skin tissue forms an apron covering the genitals with problems in hygiene and sexual intercourse. In these cases, plastic-reconstructive interventions include mons pubis plasty with or without penile fixation. This article provides a comprehensive overview on aetiology, a novel classification of the buried penis and plastic-surgical reconstructive interventions matched to the stages of the condition.

The effect of lipoaspirates vs. dissected abdominal fat on breast cancer cells in vitro.

BACKGROUND: Cancer cells are typically surrounded by stromal cells and embedded in extracellular matrix (ECM). The stromal compartment interacts with cancer cells to promote growth and metastasis. For decades, autologous fasciocutaneous flaps have been safely applied for breast reconstruction after mastectomy. In contrast, the safety of fat grafting (lipofilling) procedure has been under debate regarding the risk of cancer recurrence. METHODS: Harvested fat tissue (lipoaspirates) and dissected abdominal fat (DAF) were co-cultured with MCF-7 breast cancer cells. The vitality of MCF-7 cells was measured using AlamarBlue® consecutively for 5 days. ECM degradation was determined by detection of matrix metalloproteinase-1 (MMP-1) expression in MCF-7 cells. Integrin α2 was measured by Western blot to assess the degree of adhesion and motility of MFC-7 cells. RESULTS: The MCF-7 proliferation increased substantially when co-cultured with fat tissue. However, there was no significant difference between the proliferation stimulating effects of lipoaspirates and DAF. Similarly, MMP-1 protein expression was equally elevated in MCF-7 cells by both lipoaspirates and DAF. Importantly, MCF-7 cells showed an increased level of integrin α2 once co-cultured with either lipoaspirates or DAF. CONCLUSION: Fat tissue increases the proliferation of MCF-7 cells in vitro. Our data suggest that lipoaspirates as well as DAF might possess a considerable potency to promote tumorigenic growth of breast cancer cells. Thus, clinical trials are needed to address the safety of lipofilling by breast reconstruction surgery after mastectomy.

Zones of Adhesion of the Abdomen: Implications for Abdominoplasty.

BACKGROUND: The elucidation of the superficial fascial system (SFS) by Lockwood in 1991 has been the cornerstone of our understanding of abdominal excisional dynamics for the last 25 years. The SFS can be used for closure and, appropriately mobilized, for tension transmission in abdominoplasty, and lower body lifts. The pattern of SFS adhesion to muscle fascia and the zones of adhesion was also described but there are inconsistencies between the description and clinical experience. OBJECTIVES: This study was performed to better describe the pattern of subcutaneous tissue adhesion to the trunk. METHODS: Twenty pre-abdominoplasty patients were studied. A series of points were marked around the trunk and the skin moved in four opposing directions. The excursions were measured and the median plotted on a diagram. Two fresh cadavers were also dissected, removing all subcutaneous tissue circumferentially from the trunk muscle fascia and marking the strength of the adhesion with a colored pin. Three grades of adhesion were mapped. RESULTS: In the current study, maximal laxity was shown in the mid-lower abdomen and the anterior and lateral chest. Laxity was limited in the anterior and posterior midlines, over the lower back, and the lateral upper thigh. The cadaver dissection mapped adhesion which correlated with the skin laxity diagram. CONCLUSIONS: The detailed skin adhesion map better explains features of surface anatomy. Incorporating this understanding a tension vector of abdominoplasty closure obliquely inwards is proposed to maximally harvest the laxity of the anterior and lateral chest and to create further lowering and narrowing of the waist.