Comparative Analysis of Ventral Hernia Repair and Transverse Abdominis Release With and Without Panniculectomy: A 4-Year Match-Pair Analysis.

INTRODUCTION: Amid rising obesity, concurrent ventral hernia repair and panniculectomy procedures are increasing. Long-term outcomes of transverse abdominis release (TAR) combined with panniculectomy remain understudied. This study compares clinical outcomes and quality of life (QoL) after TAR, with or without panniculectomy. METHODS: A single-center retrospective review from 2016 to 2022 evaluated patients undergoing TAR with and without panniculectomy. Propensity-scored matching was based on age, body mass index, ASA, and ventral hernia working group. Patients with parastomal hernias were excluded. Patient/operative characteristics, postoperative outcomes, and QoL were analyzed. RESULTS: Fifty subjects were identified (25 per group) with a median follow-up of 48.8 months (interquartile range, 43-69.7 months). The median age and body mass index were 57 years (47-64 years) and 31.8 kg/m2 (28-36 kg/m2), respectively. The average hernia defect size was 354.5 cm2 ± 188.5 cm2. There were no significant differences in hernia recurrence, emergency visits, readmissions, or reoperations between groups. However, ventral hernia repair with TAR and panniculectomy demonstrated a significant increase in delayed healing (44% vs 4%, P < 0.05) and seromas (24% vs 4%, P < 0.05). Postoperative QoL improved significantly in both groups (P < 0.005) across multiple domains, which continued throughout the 4-year follow-up period. There were no significant differences in QoL among ventral hernia working group, wound class, surgical site occurrences, or surgical site occurrences requiring intervention (P > 0.05). Patients with concurrent panniculectomy demonstrated a significantly greater percentage change in overall scores and appearance scores. CONCLUSIONS: Ventral hernia repair with TAR and panniculectomy can be performed safely with low recurrence and complication rates at long-term follow-up. Despite increased short-term postoperative complications, patients have a significantly greater improvement in disease specific QoL.

Assessing Long-Term Volume Retention in Breast Fat Grafting: A Comparative Study of Lipoaspirate Processing Techniques.

INTRODUCTION: Autologous fat grafting is a method of improving aesthetic outcomes after both breast reconstruction and aesthetic surgery through volume enhancement and tissue contouring. Long-lasting effects are linked to greater patient satisfaction and more optimal augmentation results. Harvesting, processing, and injection techniques may all affect the longevity of deformity filling. Our objective is to evaluate the effect of lipoaspirate processing modality on longitudinal volume retention after surgery. METHODS: A prospective, single-institution, randomized control trial placed consented postmastectomy fat grafting patients into 1 of 3 treatment arms (active filtration, low-pressure decantation, and standard decantation) in a 1:1:1 ratio. A preoperative 3-dimensional scan of the upper torso was taken as baseline. At the 3-month postoperative visit, another 3D scan was taken. Audodesk Meshmixer was used to evaluate the volume change. RESULTS: The volume of fat injected during the initial procedure did not differ significantly between the treatment arms (P > 0.05). Both active filtration and low-pressure decantation resulted in higher percentage volume retention than traditional decantation (P < 0.05). Active filtration and low-pressure decantation exhibited comparable degrees of fat maintenance at 3 months (P > 0.05). DISCUSSION: Compared with using traditional decantation as the lipoaspirate purification technique, active filtration and low-pressure decantation may have led to higher levels of cell viability by way of reduced cellular debris and other inflammatory components that may contribute to tissue resorption and necrosis. Further immunohistochemistry studies are needed to examine whether active filtration and low-pressure decantation lead to lipoaspirates with more concentrated viable adipocytes, progenitor cells, and factors for angiogenesis.

Evaluación del efecto de la liposucción con o sin abdominoplastia sobre la resistencia a la insulina en pacientes normoglucémicas con sobrepeso: un estudio prospectivo de cohorte / The effect of liposuction versus liposuction with abdominoplasty on insulin resistance in normoglycemic non-obese females: A prospective cohort study

Introducción: Varios estudios han evaluado el efecto de la liposucción o de la abdominoplastia sobre la salud metabólica, incluyendo la resistencia a la insulina, con resultados mixtos. A varias pacientes con sobrepeso, sin obesidad marcada, se les recomienda el procedimiento de liposucción combinado con abdominoplastia, sin que exista publicada evidencia alguna sobre la efectividad de combinar ambos procedimientos en la salud metabólica. Métodos: El presente estudio prospectivo de cohorte evaluó el cambio en la resistencia a la insulina y otros parámetros metabólicos en dos grupos de mujeres hispanoamericanas normoglucémicas con sobrepeso. Las pacientes del primer grupo fueron sometidas a liposucción únicamente (LIPO), mientras que el segundo grupo fue sometido a liposucción con abdominoplastia (LIPO+ABDO). Resultados: Un total de 31 pacientes fueron evaluadas, incluyendo a 13 con LIPO y 18 con LIPO+ABDO; ambos grupos mostraron HOMA-IR prequirúrgicos similares (p>0,72). En las del grupo LIPO evaluadas 60días después del procedimiento, se observaron HOMA-IR similares a sus niveles prequirúrgicos (2.,98±0,4 vs. 2,70±0,3, p>0,20); las del grupo LIPO+ABDO, sin embargo, mostraron HOMA-IR significativamente reducidos en comparación de sus índices prequirúrgicos (2,37±0,2 vs. 1,73±0,1, p<0,001). También en este grupo, esta reducción se correlacionó positivamente con el valor prequirúrgico de HOMA-IR (p<0,001) y, de manera interesante, se observó una correlación negativa entre la edad de la paciente y el grado de disminución en el HOMA-IR tras la cirugía (Spearman r=−0,56, p<0,05). No se observaron cambios en los otros parámetros bioquímicos evaluados. Conclusiones: Los datos de este estudio sugieren que cuando es combinada con abdominoplastia, la liposucción mejora la resistencia a la insulina en pacientes hispanoamericanas. Se requieren de estudios adicionales para probar dicha posibilidad.(AU)

Introduction: Several studies have evaluated the effect of liposuction or abdominoplasty on metabolic health, including insulin resistance, with mixed results. Many overweight patients, with no marked obesity, are recommended to undergo liposuction combined with abdominoplasty, but no study has evaluated the effectiveness of combining the two procedures on metabolic health. Methods: The present prospective cohort study compares the metabolic parameters of two groups of normoglycemic Hispanic women without obesity. The first group underwent liposuction only (LIPO), while the second group had combined liposuction and abdominoplasty (LIPO+ABDO). Results: A total of 31 patients were evaluated, including 13 in the LIPO group and 18 in the LIPO+ABDO group. The two groups had similar HOMA-IR before surgery (P>.72). When tested 60days after surgery, women in the LIPO group had similar HOMA-IR compared to their preoperative levels (2.98±0.4 vs. 2.70±0.3; P>.20). However, the LIPO+ABDO group showed significantly reduced HOMA-IR values compared to their preoperative levels (2.37±0.2 vs. 1.73±0.1; P<.001). In this group, this decrease also positively correlated with their preoperative HOMA-IR (Spearman r=0.72; P<.001) and, interestingly, we observed a negative correlation between the age of the subjects and the drop in HOMA-IR after surgery (Spearman r=−0.56; P<.05). No changes were observed in the other biochemical parameters that were assessed. Conclusions: These data suggest that, when combined with abdominoplasty, liposuction does improve insulin resistance in healthy Hispanic females. More studies are warranted to address this possibility.(AU)

Aesthetic Improvement With Topical Body Skin Treatment as a Complement to Cryolipolysis.

BACKGROUND: A firming and toning cosmetic body lotion (FTB) was developed to target key pathways relevant to body skin health and rejuvenation that may complement the improvements observed after noninvasive body contouring (NIBC). A pilot study explored the efficacy and tolerability of FTB as an adjunct to cryolipolysis. METHODS: An open-label, single-site, single-arm, 12-week study enrolled subjects aged 20 to 65 who had pre-elected to receive 1 or more cryolipolysis treatments (CoolSculpting® or CoolSculpting® Elite; Zeltiq Aesthetics, Inc.) on the inner thigh, back/bra fat, or submental areas. Immediately post-procedure, the investigator applied FTB to the treated area. Subjects then applied FTB topically twice daily for 12 weeks on the treated area. Skin texture and firmness were graded visually by the investigator using a 10-point scale, and subjects graded effectiveness, product attributes, and satisfaction with a questionnaire.  Results: Seventeen subjects (16 women, 1 man) enrolled. After 12 weeks of FTB application, significant improvements in skin firmness were observed in all treated areas, while skin texture showed improvements on the inner thigh and back/bra fat (all P≤0.009). With continued use following cryolipolysis, more than 70% of subjects agreed that FTB improved skin firmness, smoothness, and overall appearance. Subjects indicated that FTB was an effective adjunct to cryolipolysis. Throughout the study, 86% to 92% of subjects reported “fair,” “good,” or “excellent” satisfaction with FTB.  Conclusion: This pilot study suggests that FTB may complement skin improvements seen post-NIBC.J Drugs Dermatol. 2024;23(4): doi:10.36849/JDD.7917.

Delayed-Onset Idiopathic Intracranial Hypertension After Liposuction: A Case Report and Review.

ABSTRACT: Although systemic complications following liposuction are rare, visual impairment has been reported in a few cases and may occur for a variety of reasons. Here we present the case of a 31-year-old woman who underwent 360° liposuction and subsequently developed headaches and delayed partial visual disturbance 10 days after the procedure. She had symptoms suggestive of idiopathic intracranial hypertension, which was confirmed by lumbar puncture. A literature search revealed other case reports of visual changes or headaches following high-volume liposuction. Our case provides further evidence of a rare association between liposuction and idiopathic intracranial hypertension, emphasizing the need for thorough preoperative evaluations and the consideration of possible risks.

Siguiendo la trayectoria de la abdominoplastia TULUA ­ Revelación de su evolución e impacto global / Tracing the Trajectory of TULUA Abdominoplasty ­ Unveiling its Evolution and Global Impact

La técnica de abdominoplastia TULUA, fue concebida por el Dr. Francisco Villegas en Colombia, su acrónimo en inglés refleja sus principios fundamentales: plicatura Transversal, Sin despegamiento, Liposucción sin restricción que incluye la línea media y flancos, Neo umbilicoplastia, ubicación baja de cicatriz y libre posición del ombligo. A lo largo de los últimos 12 años, la técnica TULUA ha ganado espacio en América Latina, Norteamérica, la zona árabe e India. Destacando su relevancia, se ha propuesto la publicación de un libro monográfico, programado para 2024, que abarcará desde los principios fundamentales hasta las experiencias internacionales con la técnica. Las indicaciones de la abdominoplastia TULUA han evolucionado, incluyendo casos estéticos, secundarios, hernias, cicatrices previas, pérdida masiva de peso, alta definición, aumento muscular y combinaciones con otras plicaturas. Ha sido aplicada con éxito en cierre del abdomen donante de reconstrucción mamaria. A través de investigaciones especializadas y revisiones de pares, la TULUA ha sido reconocida por su aplicabilidad y beneficios, especialmente en la realización segura de liposucción en abdominoplastias. Se sugieren estudios adicionales para evaluar los resultados y posibles complicaciones, abriendo oportunidades para una mayor comprensión y refinamiento. El futuro de la abdominoplastia TULUA parece prometedor, anticipando trabajos prospectivos, indicaciones adicionales y un enfoque gradual para cirujanos en formación. En última instancia, la técnica se presenta como una adición al repertorio de procedimientos estéticos abdominales, contribuyendo al avance de la cirugía abdominal estética.

The TULUA abdominoplasty technique, conceived by Dr. Francisco Villegas in Colombia, its acronym in English reflects its fundamental principles: Transverse plication, no Undermined flap above the umbilicus, Liposuction without restrictions including midline and flanks, Neo umbilicoplasty, low scar placement, and free umbilical positioning. Over the past 12 years, the TULUA technique has gained acceptance in Latin America, North America, the Arab region, and India. Highlighting its relevance, the publication of a monographic book has been proposed, its launch is scheduled for 2024, covering from fundamental principles to international experiences with the technique. Indications for TULUA abdominoplasty have evolved, including aesthetic cases, secondary cases, hernias, previous scars, massive weight loss, high definition, muscle augmentation, and combinations with other plications. It has been successfully applied in closing the donor abdomen for breast reconstruction. Through specialized research and peer reviews, TULUA has been recognized for its applicability and benefits, especially in safely performing liposuction during abdominoplasties. Additional studies are suggested to evaluate results and potential complications, opening opportunities for greater understanding and refinement. The future of TULUA abdominoplasty appears promising, anticipating prospective works, additional indications, and a gradual approach for surgeons in training. Ultimately, the technique presents itself as an addition to the repertoire of abdominal aesthetic procedures, contributing to the advancement of aesthetic abdominal surgery.

[Treatment of abdominal lipocutaneous excess in massive weight loss patients]. / Traitement de l'excès cutanéo-adipeux abdominal après perte de poids massive.

In massive weight loss patients, abdominal lipocutaneous excess is a frequently encountered complication with major psychological, medical and functional consequences. A wide variety of corrective techniques exists, each with its advantages and side effects, and the choice of the technique must be made in conjunction with the patient, taking into account his unique anatomy, his wishes and his risk factors, in order to obtain the best aesthetic result while minimising the per- and post-operative complications. Liposuction, if prudently executed with the correct technique, permits a further harmonisation of the body contour in zones not reached by the surgical correction, representing a very useful and efficient additional tool.

L'excès cutanéo-adipeux abdominal est une conséquence très fréquente chez les patients après une perte de poids massive, avec d'importantes répercussions psychologiques, médicales et fonctionnelles. Plusieurs techniques de correction des déformations existent, avec leurs avantages et complications spécifiques. Le choix doit être individualisé et partagé avec le patient sur la base de ses caractéristiques anatomiques uniques, de ses souhaits et de ses facteurs de risque, pour un résultat esthétique optimal avec une minimisation des complications. La liposuccion, lorsqu'elle est effectuée de façon prudente et selon les règles de l'art, est un outil additionnel très efficace pour une harmonisation des contours dans les zones non directement ciblées par l'intervention choisie.

Temporary external skin plication: a helpful new technique in gynecomastia surgery.

OBJECTIVE: The aim of this study was to elucidate the external temporary skin plication (ETSP) technique in gynecomastia surgery and evaluate its role in mitigating complications and enhancing cosmetic outcomes. PATIENTS AND METHODS: This study was conducted on patients diagnosed with gynecomastia, explicitly falling under Rohrich Grades IIB and III, with dermal quality being a crucial determinant. Between September 2018 and November 2021, surgical interventions were performed on 96 qualifying patients by the senior author. The operative protocol consisted of ultrasonic and suction-assisted liposuction, supplemented by lateral periareolar piecemeal gland excision. Within the cohort, 42 patients were subjected to the novel ETSP technique. In contrast, the remaining 54 patients underwent standard treatment, serving as the control group for subsequent comparative assessment. RESULTS: One patient required revisions for contour irregularities, while partial nipple necrosis was observed in two patients but healed without surgical intervention. However, saucer-like deformity and total nipple necrosis were not observed in our series. The overall complication rate in our series was 19%, with 9.5% of cases requiring revision. In our control group, the overall complication rate in our series was found to be 22%, with 13% of cases requiring revision. CONCLUSIONS: ETSP provides a homogeneous spread of the excess skin and greatly reduces or eliminates the amount of skin fold formation. ETSP reduces the need for possible skin excision and reduces visible scars and incisions, and it helps improve the results of skin-protective surgeries that are widespread today.

Lower Gluteal Liposuction Combined With Upper Gluteal and Infragluteal Region Fat Grafting: A Novel Concept to Improve Gluteal Ptosis.

BACKGROUND: Gluteal ptosis results in a severe disturbance of gluteal aesthetics. Currently, satisfactory procedures for improving gluteal ptosis are lacking. OBJECTIVES: To improve gluteal ptosis, the authors propose a novel concept of combined liposuction of the lower gluteal region and fat grafting to the upper gluteal and infragluteal regions, and verify its efficacy and safety. METHODS: Patients who underwent liposuction of the lower gluteal region combined with fat grafting to the upper gluteal and infragluteal regions between January 2020 and July 2023 were retrospectively reviewed. Postoperative changes in the gluteal ptosis grade, complications, and patient satisfaction were evaluated. RESULTS: A total of 28 patients were enrolled in this study; 21 (75.0%) patients had gluteal ptosis grade 4 and 7 (25.0%) patients had gluteal ptosis grade 5. The median fat removal volume was 210 mL, and the median fat graft injected volume was 355 mL in the gluteal region and 180 mL in the infragluteal region. All patients showed improvement in gluteal ptosis; 16 (57.1%) patients improved by 1 grade and 12 (42.9%) patients showed a 2-grade improvement. All patients were satisfied with their posttreatment outcomes. Only 1 patient showed lateral translocation of the fat graft. No other complications were observed. CONCLUSIONS: Liposuction of the lower gluteal region combined with fat grafting to the upper gluteal and infragluteal regions is effective in improving gluteal ptosis, with a low risk of complications and high patient satisfaction.

Quality of life following liposuction for lipoedema: a prospective outcome study.

BACKGROUND: The study examines, for the first time, the impact on quality of life after liposuction for lipoedema. The influence of aesthetic plastic interventions and their effects on treatment outcomes has been a major focus of our research group over the past 20 years. METHODS: A total of 35 patients were invited to participate in our prospective study, with 30 responding to both the pre- and postoperative questionnaires. The patients received the questionnaires pre-operatively, and 6 months after the liposuction. Our questionnaire set included a self-developed, indication-specific part, along with standardised and validated questionnaires such as the Questions on Life Satisfaction (FLZM), Patient Health Questionnaire (PHQ-4), Rosenberg Self-Esteem Scale (RSES) and the Freiburg personality inventory-revised (FPI-R). RESULTS: Our self-developed questionnaire showed that our patients feel more balanced, more attractive and more self-confident after the treatment. The FLZM showed significant improvements in all three modules: the general satisfaction with life, the state of health and the outer appearance (body image). Using the PHQ-4, a significant improvement in the two subscales of anxiety and depression could be determined, as well as a reduction in overall mental stress. In addition, the RSES showed a significant improvement in self-esteem post-operatively. Furthermore, the FPI-R indicated a significant improvement in emotional stability. CONCLUSIONS: Liposuction improves the quality of life in lipoedema patients. Post-operatively, our patients reported less pain and were more satisfied with their bodies and appearance. The hypothesis that liposuction in lipoedema improves the quality of life as a multidimensional construct could be confirmed.

The effect of liposuction versus liposuction with abdominoplasty on insulin resistance in normoglycemic non-obese Mexican females: A prospective cohort study.

INTRODUCTION: Several studies have evaluated the effect of liposuction or abdominoplasty on metabolic health, including insulin resistance, with mixed results. Many overweight patients, with no marked obesity, are recommended to undergo liposuction combined with abdominoplasty, but no study has evaluated the effectiveness of combining the two procedures on metabolic health. METHODS: The present prospective cohort study compares the metabolic parameters of 2 groups of normoglycemic Hispanic women without obesity. The first group underwent liposuction only (LIPO), while the second group had combined liposuction and abdominoplasty (LIPO + ABDO). RESULTS: A total of 31 patients were evaluated, including 13 in the LIPO group and 18 in the LIPO + ABDO group. The 2 groups had similar HOMA-IR before surgery (P > 0.72). When tested 60 days after surgery, women in the LIPO group had similar HOMA-IR compared to their preoperative levels (2.98 ± 0.4 vs 2.70 ± 0.3; P > .20). However, the LIPO+ABDO group showed significantly reduced HOMA-IR values compared to their preoperative levels (2.37 ± 0.2 vs 1.73 ± 0.1; P < .001). In this group, this decrease also positively correlated with their preoperative HOMA-IR (Spearman r = 0.72; P < .001) and, interestingly, we observed a negative correlation between the age of the subjects and the drop in HOMA-IR after surgery (Spearman r = -0.56; P < .05). No changes were observed in the other biochemical parameters that were assessed. CONCLUSIONS: These data suggest that, when combined with abdominoplasty, liposuction does improve insulin resistance in healthy Hispanic females. More studies are warranted to address this possibility.

Liposuction for Advanced Lymphedema in a Multidisciplinary Team Setting in Australia: 5-Year Follow-Up.

BACKGROUND: Liposuction for International Society of Lymphology late stage 2 or 3 limb lymphedema is an established surgical option to remove excessive adipose tissue deposition and has been performed in Australia since 2012 at the Australian Lymphoedema Education, Research, and Treatment (ALERT) Program of Macquarie University. METHODS: Between May of 2012 and May of 2017, 72 patients with unilateral primary or secondary lymphedema of the arm or leg underwent suction-assisted lipectomy using the Brorson protocol. This prospective study presents 59 of these patients who had consented to research with a 5-year follow-up. RESULTS: Of the 59 patients, 54 (92%) were women, 30 (51%) had leg lymphedema, and 29 (49%) had arm lymphedema. For patients with arm lymphedema, the median preoperative volume difference between the lymphedematous and the contralateral arm was 1061 mL, which was reduced to 79 mL 1 year after surgery and to 22 mL 5 years after surgery. For patients with leg lymphedema, the median preoperative volume difference was 3447 mL, which was reduced to 263 mL 1 year after surgery but increased to 669 mL 5 years after surgery. CONCLUSION: Suction-assisted lipectomy is a long-term option for the management of selected patients with International Society of Lymphology late stage 2 or 3 limb lymphedema when conservative management can offer no further improvement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Comprehensive Assessment of Lower-Face Volume Reduction Using Laser-Assisted Liposuction as an Additive Procedure in Asian Rhytidectomy.

The most important factor that distinguishes a youthful appearance from an aged one is the shape of the lower face. This study aimed to examine the outcome of volume reduction of the lower face using laser-assisted liposuction (SmartLipo) at the time of rhytidectomy in Asians. There were 20 patients (Group 1) for whom only extended deep-plane rhytidectomy were performed, while extended deep-plane rhytidectomy with laser-assisted liposuction was performed on 42 patients (Group 2). This study was performed retrospectively. The FACE-Q questionnaire was given to evaluate the subjective result of the patient. Efficacy was evaluated by measuring the fat quantity at the midpoint and anterior border of the masseter muscle on each side by using an ultrasound scan in Group 2. Then, the correlation between the change in the quantity of fat and the FACE-Q was investigated. The overall satisfaction, and satisfaction for the lower face, jawline, and the area under the chin were significantly higher for Group 2 for which the procedure was concurrently performed in comparison to Group 1. In Group 2, change in the fat was reduced by 21.2% (Rt.) and 22.5% (Lt.) at the mid-point and 24.5% (Rt.) and 26.4% (Lt.) at the anterior border of the masseter muscle. Changes in the fat quantity and lower face satisfaction displayed a significant correlation. With a greater reduction in fat quantity, the score of lower face satisfaction was higher. In addition, with a higher level of satisfaction for the lower face and jawline, the overall satisfaction score displayed a higher positive correlation. Laser-assisted liposuction was useful for the additive procedure at the time of rhytidectomy and improved patient's satisfaction after surgery.

Application of complete decongestive therapy after lymphaticovenular anastomosis of the lower limb combined with liposuction-A retrospective study research.

BACKGROUND: Complete decongestive therapy (CDT) is a conservative treatment for lymphedema that combines interventions and lifestyle changes. We evaluated the application of CDT after lymphaticovenular anastomosis (LVA) of the lower limb combined with liposuction. METHODS: A total of 55 patients who underwent LVA of the lower limb combined with liposuction from January 2021 to July 2022 were enrolled in the study. The patients were divided into groups A (n = 24) and B (n = 31) according to whether they adhered to CDT treatment during the 12-month follow-up. Group A was the non-adherence CDT group and Group B was the adherence CDT group. Lower Extremity Lymphedema Index (LELI) and Lymphoedema Functioning, Disability, and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) were used as prognostic indicators to observe the remission of postoperative lymphedema symptoms in the two groups. RESULTS: At 6-month and 12-month follow-up, LELI and the score of Lymph-ICF-LL in group B and group A were lower than before the operation (p < .05). The circumference of the affected limb was reduced, and the quality of life was improved in both groups after the operation. The reduction of LELI and Lymph-ICF-LL in group B was higher than in group A, and the difference was statistically significant (p < .05). CONCLUSION: This study preliminarily proves the effectiveness of CDT after LVA of the lower limb combined with liposuction, which can maintain and strengthen the surgical effect. Further, CDT treatment is still needed after the operation, which is necessary to reduce the circumference of the affected limb and improve patients' quality of life.

Innovation of the protocol for the application of cryolipolysis: Effects and mechanisms of action.

BACKGROUND: In recent years, aesthetic procedures aiming at body remodeling and have grown exponentially. Cryolipolysis (CLL) has stood out as a noninvasive resource that acts directly on the subcutaneous adipose tissue promoting a significant reduction of adipose tissue through of cooling that could lead to the crystallization cytoplasmic lipids, loss of cellular integrity, apoptosis/necrosis of adipocytes, and local inflammation, producing selective loss of adipose tissue. Thus, the objective of the present study was to evaluate the effects of a specific technique of CLL application on the inflammatory reactions of the target tissue in different post-application times. METHODS: This is a randomized, blind clinical study that evaluated the tissue sample of six patients after 45, 60, and 90 days of an innovative protocol for the application of CLL, with samples collected through abdominoplasty surgeries. The samples were evaluated by immunohistochemical analyses of several markers. RESULTS: A significantly greater increase in fibroblasts was observed at 45 days and greater phagocytic action at 60 days. Regarding the apoptosis process, the expression of caspase 3 and cleaved caspase 3 markers varied at different times, with cleaved caspase 3 being higher at 45 and 90 days after CLL application. CONCLUSION: The protocol of the CLL presented in this study was able to induce inflammatory responses in addition to confirming the selective apoptotic action at the different times studied.

A Novel Surgical Technique for Gynecomastia: Air-Assisted Minimally Invasive Surgery With Single Axillary Incision.

BACKGROUND: Gynecomastia is a benign condition that develops due to the proliferation of breast tissue in men. Surgical excision is the most effective treatment method. Minimally invasive techniques can be used to avoid visible scarring. We evaluated the efficacy and safety of air-assisted subcutaneous mastectomy in the treatment of gynecomastia. PATIENT AND METHODS: 10 patients with gynecomastia underwent air-assisted subcutaneous mastectomy and liposuction through a single axillary incision, between June 2022 and February 2023. Demographic and clinical data of the patients, duration of surgery, and complications were recorded. The satisfaction levels of the patients regarding physical appearance, mental status, and social environment were measured. The body Q questionnaire was performed preoperatively and in the postoperative third month. RESULTS: The median age was 26 (range, 18-54). Surgical excision was measured as a median of 69 gr (range, 41-177), and liposuction volume was measured as a median of 210 ccs (range, 63-400). The median operation time was 50 minutes (range, 21-60) for excision and 21 minutes (range, 20-75) for liposuction. Body, chest, and nipples related appearance satisfaction levels were measured preoperatively as a median of 44 (range, 36.5-52), 31 (range, 27.5-39), and 51.5 (range, 21-69.8) points vs postoperatively as 92 (range, 92-100), 93 (range, 93-94.8) and 90 (range, 90-100) points, respectively. The patients had a median follow-up of 6 months (range, 3-11). No complications were observed during the follow-up period. CONCLUSION: Air-assisted subcutaneous mastectomy and liposuction is a feasible technique that may provide good cosmetic outcomes by avoiding anterior chest wall scarring.

Evaluation of thermodynamic bioeffects of long-pulsed 1064 nm laser in the photothermal lipolysis.

OBJECTIVES: To evaluate the lipolysis effect of air cooling assisted long-pulsed 1064 laser for improving local adiposity. MATERIALS AND METHODS: The second-level (pulse duration of 0.3-60 s) long-pulsed Nd:YAG 1064 nm laser (LP1064 nm) with or without forced-air cooling was used to irradiate ex-vivo subcutaneous adipose tissue (SAT) of pig or human and in-vivo inguinal fat tissue of Sprague Dawley rats. The temperature of skin surface as well as 5 mm deep SAT was monitored by a plug-in probe thermal couple, and the former was confined to 39°C or 42°C during the treatment. Histological analysis of SAT response was evaluated by SAT sections stained with hematoxylin-eosin and oil red O. Ultra-microstructure changes were examined by transmission electron microscopy. A pilot study on human subject utilizing LP1064 nm laser with air cooling was conducted. The changes in gross abdomen circumference and ultrasonic imaging were studied. RESULTS: Histological examination showed that LP1064 nm laser treatment induced adipocyte injury and hyperthermic lipolysis both in- and ex-vivo. It was also confirmed by clinical practice on patients. By real-time temperature monitoring, we found that in comparison with LP1064 nm laser alone, additional air cooling could increase the temperature difference between epidermis and SAT, promoting heat accumulation deep in fat tissue, as well as providing better protection for epidermis. CONCLUSION: LP1064 nm laser provided reliable adipose tissue thermolysis when the temperature of skin surface was sustained at 39°C or 42°C for 10 min. Application of air-cooling during the laser treatment achieved better effect and safety of photothermal lipolysis. LP1064 nm laser, as a noninvasive device, has comparable thermal lipolysis effect as other common heat-generating devices.

Unraveling the Enigma: A Rare Case of Recurrent Idiopathic Gynecomastia in an Adolescent.

Gynecomastia presents as abnormal hypertrophy of mammary tissue in males that is typically asymptomatic and usually does not require intervention. Gynecomastia responds well to medical and surgical treatment, when necessary, with low recurrence rates. The authors report an atypical case of recurrent idiopathic unilateral gynecomastia first presenting in an adolescent male. Physical examination, hormonal, and oncologic evaluations were normal. After subcutaneous mastectomy with liposuction and treatment with Tamoxifen at 19 years old, his unilateral gynecomastia recurred over the course of 3 years, requiring a second surgery. Furthermore, we review the literature for recurrent gynecomastia after surgical management to examine prevalence and risk factors.