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1.
Plast Reconstr Surg ; 145(2): 545-554, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985657

RESUMO

BACKGROUND: Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population. METHODS: The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage. RESULTS: Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415). CONCLUSIONS: For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.


Assuntos
Abdominoplastia/economia , Cirurgia Bariátrica/economia , Contorno Corporal/economia , Cobertura do Seguro/economia , Seguro Saúde/estatística & dados numéricos , Abdominoplastia/estatística & dados numéricos , Dorso/cirurgia , Estudos Transversais , Humanos , Seguradoras/economia , Seguradoras/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Lipectomia/economia , Lipectomia/estatística & dados numéricos , Cuidados Pós-Operatórios/economia , Estados Unidos
2.
Clin Plast Surg ; 47(1): 81-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739901

RESUMO

In this article the authors introduce a compartment-based fat graft for facial contouring, focusing on the anatomy of temporal region and midface, the 3L3M integrated fat transfer technique, and the facial compartment-based fat injection in the face. This article includes details of pre-evaluation methods, results of cases, and postoperation care. Readers will have a clear view of how to do facial contouring fat graft in the face after reading this article. There seldom are complications while using the 3L3M technique for fat grafting. The targeted fat grafting can lead to steady and efficient results.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal , Face/cirurgia , Humanos
3.
Clin Plast Surg ; 47(1): 91-98, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739902

RESUMO

The concept of microautologous fat transplantation (MAFT), proposed by Lin and colleagues in 2007, emphasized that the volume of each delivered parcel should be less than 0.01 mL to avoid potential fat grafting morbidities. The MAFT-GUN facilitates control of the parcel volume and therefore substantially avoids central necrosis and associated complications. In this article, the authors present a simple, reliable, and consistent procedure based on MAFT for profiloplasty. Favorable outcomes with sustainable long-term effectiveness were obtained, further confirming that the MAFT technique is an alternative for facial contouring in the nose and chin.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal , Queixo/cirurgia , Nariz/cirurgia , Humanos , Transplante Autólogo
4.
Rev. bras. cir. plást ; 34(4): 458-467, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047901

RESUMO

Introdução: A lipoaspiração tem sido submetida à evolução constante desde a sua consolidação e emprego sistemático. O auxílio de tecnologia ultrassônica de terceira geração, VASER® (Vibration Amplification of Sound Energy at Resonance), se destina a facilitar a execução da lipoaspiração e trazer maior segurança e resultados satisfatórios, especialmente na busca por maior definição e lipoaspiração superficial. Métodos: No período de 2015 a 2017, 76 pacientes foram submetidas à lipoaspiração para melhora de contorno corporal no Centro Hospitalar Santa Mônica em Erechim. Foram avaliados os resultados obtidos, as possíveis complicações e a segurança do emprego do VASER®. Resultados: A utilização rotineira do VASER® gera aperfeiçoamento de resultados em contorno corporal. A emulsificação gerada pelo dispositivo associada à lipoaspiração em diversos níveis permite uma maior definição e evidenciação dos marcos anatômicos. Conclusão: Lipoaspiração associada ao VASER® permite ao cirurgião plástico o refinamento de seus resultados com a preservação da segurança do paciente.


Introduction: Liposuction has been improved continuously since it was first introduced. The third-generation ultrasound technology VASERTM (Vibration Amplification of Sound Energy at Resonance) facilitates liposuction, providing improved safety and satisfactory results, especially in the search for greater definition and superficial liposuction. Methods: From 2015 to 2017, 76 patients underwent liposuction to improve their body contour at the Santa Monica Hospital Center in Erechim, Rio Grande do Sul, Brazil. The results, complications, and the safety of VASERTM were evaluated. Results: The routine use of VASERTM improves body contour. The emulsification generated by the device, along with liposuction, resulted in greater definition and revelation of the anatomical landmarks. Conclusion: Liposuction associated with VASERTM allows plastic surgeons to refine the results better while ensuring patient safety is maintained.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , História do Século XXI , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Operatórios , Lipectomia , Tecido Adiposo , Gordura Subcutânea/cirurgia , Segurança do Paciente/normas , Contorno Corporal , Lipodistrofia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Lipectomia/métodos , Tecido Adiposo/cirurgia , Gordura Subcutânea , Segurança do Paciente , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Lipodistrofia/cirurgia , Lipodistrofia/complicações
5.
Rev. bras. cir. plást ; 34(4): 468-476, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047904

RESUMO

Introdução: A lipoaspiração corporal e abdominoplastia são cirurgias muitas vezes realizadas em conjunto para obter melhores resultados na modelagem corporal. Cirurgias associadas sempre aumentam a espoliação, por isto conhecer o comportamento da hemoglobina (Hb) no pós-operatório e a recuperação do paciente submetido a estas cirurgias combinadas é importante para sua segurança. O objetivo deste trabalho foi estudar a queda da Hb e a recuperação clínica e laboratorial dos pacientes submetidos à cirurgia combinada de lipoaspiração corporal e lipoabdominoplastia. Métodos: Realizou-se um estudo prospectivo em pacientes submetidos à lipoaspiração corporal e lipoabdominoplastia, coletando-se hemogramas antes da indução anestésica, ao final da cirurgia, antes da alta hospitalar, após a 1ª, 2ª e 4ª semanas de pós-operatórios e também acompanhando suas evoluções clínicas. Resultados: A média da Hb ao final da cirurgia e na alta hospitalar foi de 10,4g/dl (desvio padrão (DP) 0,76) e 8,92g/dl (DP 0,86), respectivamente. A recuperação em média da Hb após 1ª, 2ª e 4ª semanas foi de 2,4% (DP 18,07), 41,6% (DP 18,4) e 74% (DP 15,2), respectivamente, em relação a redução que ocorreu entre a Hb inicial e a da alta hospitalar. Queixas de fraqueza e lipotimia foram frequentes até o segundo dia. Conclusão: A melhora clínica ocorreu até o segundo dia de pós-operatório (DPO) e a hemoglobina levou aproximadamente 1 mês para normalizar na maioria dos pacientes tratados apenas com reposição oral de ferro, sem necessidade de hemotransfusão.


Introduction: Body liposuction and abdominoplasty are surgeries often performed together to obtain superior results in body modeling. Since associated surgeries often increase spoliation, being aware of the evolution of hemoglobin (Hb) in the postoperative period and during the recovery of the patients undergoing these associated surgeries is important for their safety. This study aimed to analyze the decrease in Hb and the clinical and laboratory results throughout the recovery of patients undergoing body liposuction associated with lipoabdominoplasty. Methods: A prospective study was conducted with patients undergoing body liposuction and lipoabdominoplasty. CBCs were collected before anesthetic induction, at the end of the surgery, before hospital discharge, after the 1st, 2nd, and 4th postoperative weeks, and during their clinical follow-up period. Results: The average Hb values at the end of surgery and hospital discharge were 10.4 g/dL (standard deviation (SD) 0.76) and 8.92 g/dL (SD 0.86), respectively. The average values during the recovery of Hb after the 1st, 2nd, and 4th weeks were 2.4% (SD 18.07), 41.6% (SD 18.4), and 74% (SD 15.2), respectively. This is in relation to the reduction between the initial Hb and at hospital discharge. Complaints of weakness and lipothymia were frequent until the second day. Conclusion: Clinical improvement was observed until the second postoperative day (PO day). Hemoglobin required approximately 1 month to normalize in most patients. These patients were treated only with oral iron replacement and did not require blood transfusions.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Pacientes , Complicações Pós-Operatórias , Pesquisa , Cirurgia Plástica , Lipectomia , Evolução Clínica , Estudos Prospectivos , Abdome , Contorno Corporal , Anemia , Complicações Pós-Operatórias/sangue , Pesquisa/normas , Cirurgia Plástica/métodos , Lipectomia/efeitos adversos , Lipectomia/métodos , Evolução Clínica/métodos , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Abdome/cirurgia , Anemia/complicações
6.
Plast Reconstr Surg ; 144(5): 1057-1065, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688750

RESUMO

BACKGROUND: Aesthetic facial contouring procedures, particularly forehead augmentation, continue to increase in popularity in the Asian population. However, there are very few reports in the literature specifically examining the long-term outcomes of forehead fat grafting. In the present study, the authors aimed to objectively evaluate the efficacy of autologous forehead fat grafting through evaluation of facial proportions and patient-reported outcomes. METHODS: Patients who underwent autologous fat grafting for forehead contouring procedures between July of 2011 and June of 2017 were recruited for participation in the study. Patient demographic and clinical variables were collected preoperatively and postoperatively. Facial proportion analysis was collected and compared from preoperative and postoperative photographs. Satisfaction with outcome was assessed by the patient, the surgeon, and a layperson postoperatively. A related-samples Wilcoxon signed rank test was used for statistical analysis. RESULTS: Postoperative outcomes were evaluated in a total of 24 patients who underwent forehead autologous fat-grafting procedures. The average postoperative follow-up was 8.1 months. There were no intraoperative or postoperative complications. More than 50 percent of the postoperative results were evaluated as "satisfactory" by all three groups (i.e., patient, surgeon, and layperson) in terms of aesthetic contouring. Average forehead projection increased 0.24 U (ratio of horizontal distance from midforehead plane to cornea plane/cornea diameter) after one round of fat grafting (p = 0.01). Seven patients (29.2 percent) required more than a single round of fat grafting to achieve optimal results. CONCLUSIONS: Autologous fat grafting remains a viable option for forehead contouring and augmentation. The findings of this study demonstrate that the operation is effective and offers stable satisfactory results after long-term follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Tecido Adiposo/transplante , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Testa/cirurgia , Cirurgia Plástica/métodos , Adulto , Contorno Corporal/métodos , Estudos de Coortes , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Estatísticas não Paramétricas , Transplante Autólogo , Resultado do Tratamento
7.
Cir Cir ; 87(S1): 8-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501623

RESUMO

Background: Procedures to remove adiposities and skin, such as dermolipectomy, can develop wounds that are difficult to heal by conventional therapies. Mesenchymal stem cells are indicated as potential candidates for regenerative therapy in wounds, due to their multipotentiality, low immunogenicity, modulating capacity of inflammation and tissue modeling processes. Case report: Patient with dehiscent chronic ulcer secondary to dermolipectomy, who received cutaneous treatment with mesenchymal stem cells. The therapy induced scar formation and neovascularization, as well as the decrease of infiltrated leukocytes and proinflammatory cytokines. Mesenchymal cells are proposed as an interesting alternative for the treatment of postoperative lesions.


Assuntos
Contorno Corporal/efeitos adversos , Lipectomia/efeitos adversos , Transplante de Células-Tronco Mesenquimais , Medicina Regenerativa/métodos , Úlcera Cutânea/terapia , Deiscência da Ferida Operatória/terapia , Geleia de Wharton/citologia , Adipogenia , Adulto , Antígenos de Superfície/biossíntese , Antígenos de Superfície/genética , Separação Celular , Doença Crônica , Cicatriz/etiologia , Feminino , Expressão Gênica , Humanos , Inflamação , Células-Tronco Mesenquimais , Neovascularização Fisiológica , Osteogênese , Úlcera Cutânea/etiologia , Deiscência da Ferida Operatória/etiologia , Cicatrização
8.
Psychiatr Danub ; 31(Suppl 3): 406-410, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488761

RESUMO

BACKGROUND: Bariatric surgery or reconstructive body contouring surgery performed after weight loss, has the potential to have a major impact one's body image, health-related quality of life (HRQOL) and mental wellbeing. Many researches show interest in measuring this impact using generic instruments that unfortunately are not specifically oriented toward bariatric or surgery patients. The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring. In this article, we describe the methods used to translate and culturally adapt the French version of the BODY-Q. MATERIAL AND METHOD: We followed the recommendation for translation process established by the International Society for Pharmacoeconomics and Outcome Research (ISPOR) and the World Health Organisation (WHO). This process included two forward translations, one backward translation, a review by a panel of expert and cognitive debriefing interviews with patient. Our aim was to ensure a conceptual and culturally valid translation. RESULTS: This translation process led to a conceptually and culturally equivalent French version of the Body-Q. Backward translation comparison to the English original version led to the identification of 16 differences necessitating re-translation. The expert panel offered support to identify inadequate expressions and proposed changes to the translations. The cognitive debriefing interviews with 15 patients contributed to minor changes in the translation. CONCLUSIONS: This thorough method of translation and cultural adaptation allowed us to develop a conceptually and culturally valid French translation of the BODY-Q.


Assuntos
Contorno Corporal/psicologia , Linguística , Medidas de Resultados Relatados pelo Paciente , Traduções , Imagem Corporal/psicologia , Competência Cultural , França , Humanos , Qualidade de Vida , Reprodutibilidade dos Testes , Perda de Peso
9.
Rev. bras. cir. plást ; 34(3): 336-343, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047149

RESUMO

Introdução: A lipoaspiração de definição abdominal consiste na criação de sulcos em locais específicos do abdome através da retirada de gordura em toda sua espessura, incluindo a camada superficial, permitindo um maior detalhamento da musculatura. O objetivo deste estudo foi avaliar os resultados da técnica de lipoaspiração na definição abdominal. Métodos: Foram avaliadas 80 pacientes do sexo feminino no período de 2017 a 2018. O grau de definição e as complicações relacionadas ao procedimento foram avaliadas pelo autor. Todas as pacientes responderam um questionário padrão sobre grau de definição abdominal, satisfação, naturalidade do resultado, aumento da atividade física e melhora da alimentação. Resultados: A média de idade das pacientes foi de 38,97 anos e a média de índice de massa corporal, 24,01. Gestação prévia foi observada em 75% dos casos, cirurgia abdominal pregressa em 25% e tabagismo em 2,5%. Cirurgias simultâneas foram realizadas em 90%. Em relação ao tipo de cirurgia realizada, ocorreu a seguinte distribuição: 40% lipoaspiração isolada, 36,25% lipoabdominoplastia, 12,5% minilipoabdominoplastia, 10% lipoaspiração pós-abdominoplastia e 1,25% lipoabdominoplastia reversa. Grau 2 de definição abdominal foi observado em 86,25% e complicações ocorreram em 8 pacientes. O índice de satisfação foi de 91,7% e o resultado foi classificado como natural por 97,5% das pacientes. Conclusão: A lipoaspiração de definição abdominal promoveu um alto índice de satisfação e naturalidade à região abdominal. Esse resultado pode ser atingido através da técnica de lipoaspiração convencional, sem nenhum dispositivo tecnológico adicional. Contudo, são necessários novos estudos para avaliação dos resultados em longo prazo.


Introduction: Abdominal etching involves improvement of the appearance of the abdominal musculature by removing fat from several skin layers, including the superficial layer. This study evaluated the aesthetic results of abdominal etching using liposuction. Methods: The aesthetic results and surgical complications of female patients were evaluated between 2017 and 2018. All study patients answered a standard questionnaire about the extent of improvement in body image, overall satisfaction level, naturalness of the result, and changes in exercise and dietary habits. Results: The mean patient age was 38.97 years, while the mean body mass index was 24.01. In our sample, 75% of the subjects had previous pregnancies, 25% had previous abdominal surgeries, and 2.5% had a history of smoking. Simultaneous surgeries were performed in 90% of cases. The following surgery types were performed: liposuction alone (40.00%), liposuction + abdominoplasty (36.25%), miniabdominoplasty (12.50%), abdominoplasty + liposuction (10.00%), and reverse abdominoplasty (1.25%). Moderate aesthetic improvement was observed in 86.25% of the patients, and surgical complications occurred in eight patients. The satisfaction rate was 91.7%, and the result was classified as natural by 97.5% of the patients. Conclusion: Abdominal etching promoted high patient satisfaction and achieved a natural appearance of the abdomen. This surgical outcome was achieved using conventional liposuction without the need for additional techniques. However, further studies are needed to evaluate long-term outcomes.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Lipectomia , Satisfação do Paciente , Procedimentos Cirúrgicos Reconstrutivos , Gordura Subcutânea , Estética , Abdominoplastia , Contorno Corporal , Lipectomia/efeitos adversos , Lipectomia/métodos , Satisfação do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Gordura Subcutânea/cirurgia , Estética/psicologia , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos
10.
Plast Reconstr Surg ; 144(3): 601-609, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461012

RESUMO

BACKGROUND: Gluteal fat augmentation has increased worldwide, and so have major complications. Brazilian plastic surgeons have been performing this procedure for more than 30 years, and more often every year. Therefore, the authors performed a study among board-certified plastic surgeons, members of the Brazilian Society of Plastic Surgery, to evaluate their techniques; identify their preferences, complications, and outcomes with this procedure; and make some recommendations. METHODS: An anonymous Web-based survey consisting of 16 questions was sent to 5655 members in July of 2017. A supplementary survey was subsequently sent to obtain more information about major complications. RESULTS: A total of 853 responses were analyzed. The highest percentage of responses in the different categories were as follows: fat decantation for processing, injection with a 3-mm-diameter cannula, use of superior incisions, subcutaneous fat grafting only, and with a volume of 200 to 399 ml of fat per buttock. The majority of surgeons received training in this procedure during residency. The most common complications were contour irregularities. The estimated mortality rate was one in 20,117 cases, and the rate of nonfatal fat embolism was one in 9530. The risk of death was 16 times greater when fat was injected intramuscularly. CONCLUSIONS: Based on this survey, the authors recommend injecting fat only subcutaneously, by means of superior incisions, using cannulas 3 mm in diameter or more. They find that by following these recommendations, this procedure can be as safe as any other. More research to establish guidelines and increase its safety is necessary.


Assuntos
Atitude do Pessoal de Saúde , Contorno Corporal/métodos , Nádegas/cirurgia , Gordura Subcutânea/transplante , Cirurgia Plástica/métodos , Adulto , Contorno Corporal/efeitos adversos , Prova Pericial , Humanos
11.
Facial Plast Surg Clin North Am ; 27(3): 273-290, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280843

RESUMO

The Renuvion/J-Plasma helium based plasma device from Apyx Medical has technological features that result in a unique and effective method of action for the contraction of subdermal soft tissue. The device achieves soft tissue contraction by instantly heating tissue to temperatures greater than 85°C for between 0.040 and 0.080 seconds. The tissue surrounding the treatment site remains at much cooler temperatures resulting in rapid cooling of the tissue through conductive heat transfer. Compared to bulk tissue heating devices, this method of action results in effective soft tissue contraction with a lower risk of injury to surrounding tissue.


Assuntos
Contorno Corporal/métodos , Crioterapia/métodos , Regeneração da Pele por Plasma/métodos , Rejuvenescimento/fisiologia , Envelhecimento da Pele , Estética , Face , Humanos , Pescoço
12.
Plast Reconstr Surg ; 144(1): 83-92, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246807

RESUMO

BACKGROUND: The deep intramuscular approach during buttock augmentation with fat grafting has been associated with a significantly increased risk for pulmonary fat embolism. This study was designed to provide guidance for injection into the subcutaneous fat. METHODS: The authors investigated 150 Caucasian individuals with an equal distribution of men and women (n = 75 each) and a balanced distribution of age (n = 30 per decade: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 69 years) and body mass index (n = 50 per group: ≤24.9 kg/m, between 25.0 and 29.9kg/m, and ≥30 kg/m). Ultrasound-based measurements were conducted of the thickness of the total, superficial, and deep gluteal fatty layers. RESULTS: An increase in body mass index of 1.0 kg/m corresponded to an increase of 3 mm of the total gluteal subcutaneous fat of men and a 4-mm increase of the total gluteal subcutaneous fat in women. With increasing age, the thickness of the deep fatty layer increased, whereas with increasing body mass index the thickness of the superficial layer primarily increased. Formulas were generated to estimate the total thickness of the gluteal subcutaneous fatty layer for men [total thickness (in millimeters) = -33.56 + (age × 0.078) + (body mass index × 3.042)] and women [total thickness (in millimeters) = -56.997 + (age × 0.1) + (body mass index × 3.86)]. CONCLUSIONS: Knowing the total thickness of the gluteal subcutaneous fat (i.e., the safe space) allows surgeons to estimate their operating range for cannula motion even if no ultrasound machine is available during buttock augmentation with fat grafting. This can increase safety, potentially reducing the number of adverse events.


Assuntos
Envelhecimento/fisiologia , Contorno Corporal , Nádegas/anatomia & histologia , Caracteres Sexuais , Gordura Subcutânea/anatomia & histologia , Adulto , Idoso , Índice de Massa Corporal , Nádegas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Rev. bras. cir. plást ; 34(2): 196-203, apr.-jun. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1015966

RESUMO

Introdução: A mamoplastia redutora é ainda um procedimento que desafia o cirurgião plástico. O objetivo é demonstrar os resultados no tratamento de variados graus de hipertrofia e ptose mamária utilizando-se a técnica de Marcação Única, proposta por Pessoa, durante o treinamento de novos cirurgiões plásticos. Métodos: Coorte retrospectivo de 95 pacientes submetidas à mamoplastia redutora pela técnica de Pessoa. Incluídas pacientes com ptose, hipertrofia, gigantomastia e/ou assimetria das mamas. Os procedimentos foram realizados por residentes do primeiro, segundo e terceiro ano. Como fatores de exclusão foram usados: distúrbios psicológicos, obesidade mórbida e/ou pacientes com indicação de implante de prótese sem redução de pele e/ou aréola. Foram avaliados a idade, sexo, volume resultante, grau de satisfação, complicações e dificuldades dos residentes para realização do procedimento cirúrgico. Resultados: Todas as pacientes do sexo feminino, com idade entre 21 e 61 anos. 90,53% das pacientes declararam-se muito satisfeitas, 5,26% satisfeitas, 3,16% pouco satisfeitas e 1,05% insatisfeita. Como complicações, foram observadas necrose de complexo areolopapilar (1,05%), epidermólise (11,58%) e deiscência de sutura (9,47%). As dificuldades encontradas pelos residentes, dependendo da etapa do procedimento cirúrgico, variaram entre 11,1% e 55,6%. Conclusões: Verificou-se alto grau de satisfação tanto da parte das pacientes quanto dos residentes envolvidos. Os resultados encontrados confirmam a efetividade da técnica no treinamento de residentes.


Introduction: Reduction mastoplasty is still a challenging procedure for plastic surgeons. The Objective is to show the results of the treatment of different degrees of breast hypertrophy using Pessoa's single marking technique performed while training plastic surgeons. Methods: A retrospective cohort of 95 patients underwent reduction mastoplasty using Pessoa's technique. The cohort included patients with breast ptosis, hypertrophy, gigantomastia, and/ or breast asymmetry. The procedures were performed by first-, second-, and third-year residents. The exclusion criteria were psychological disorders, morbid obesity, and/or indication for prosthesis implantation without skin and/or areola reduction. The analyzed factors were age, sex, final size, patient's degree of satisfaction, complications, and difficulties experienced by the residents in performing the surgery. Results: All patients were women aged between 21 and 61 years. Of the patients, 90.53% reported being very satisfied; 5.26%, satisfied; 3.16%, poorly satisfied; and 1.05%, dissatisfied. The complications observed were necrosis of the nipple-areola complex (1.05%), epidermolysis (11.58%), and suture dehiscence (9.47%). The rate of difficulty experienced by the residents varied between 11.1% and 55.6%, depending on the step of the surgical procedure. Conclusions: A high degree of satisfaction was reported by both the patients and residents. The results confirm the effectiveness of the technique while training residents.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Cirurgia Plástica/métodos , Mama/cirurgia , Avaliação de Resultados (Cuidados de Saúde)/métodos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Satisfação do Paciente , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estética
14.
Plast Reconstr Surg ; 143(6): 1625-1632, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136476

RESUMO

Given the widespread utility and therapeutic potential of autogenous fat grafting, plastic surgeons should be familiar with its safety profile and associated adverse events. This article provides a critical review of the literature and delineates risk factors associated with various complications when grafting to the breast and gluteal regions. The majority of adverse events are related to fat necrosis and require minimal diagnostic or therapeutic intervention. Larger graft volumes, as in cosmetic augmentation, are associated with higher incidences of fatty necrosis. The oncologic safety of fat grafting is supported by multiple clinical studies with thousands of breast cancer patients, albeit predominantly retrospective in nature. Although less frequent, serious complications include fat emboli during gluteal augmentation. Identification of associated risk factors and implementation of proper surgical techniques may minimize the occurrence of life-threatening complications.


Assuntos
Tecido Adiposo/transplante , Nádegas/cirurgia , Embolia Gordurosa/prevenção & controle , Mamoplastia/métodos , Cirurgia Plástica/métodos , Adulto , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Neoplasias da Mama/cirurgia , Embolia Gordurosa/mortalidade , Estética , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco , Cirurgia Plástica/efeitos adversos , Taxa de Sobrevida , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
15.
Plast Reconstr Surg ; 143(5): 1343-1351, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033816

RESUMO

BACKGROUND: Recent anatomical studies have demonstrated that fat placed subjacent to the fascia of the gluteus maximus muscle can migrate deep through the muscle into the submuscular space, possibly causing tears in the gluteal veins, leading to fat embolisms. The purpose of this study was to define and to study subcutaneous migration and to determine whether fat placed in the subcutaneous space under a variety of pressures and fascial integrity scenarios can indeed migrate into the deep submuscular space. METHODS: Four hemibuttocks from two cadavers were used. Proxy fat was inserted using syringes with various fascia scenarios (1: fascia intact; 2: cannula perforations; 3: 6mm fascia defects) or using expansion vibration lipofilling (4: fascia intact). Subcutaneous pressures were recorded. After injections, anatomical dissections were performed to evaluate the migration of the proxy fat for each of the scenarios. RESULTS: Scenario 1: pressure reached approximately 125 to 150 mmHg and then plateaued and all the proxy fat remained in the subcutaneous space. Scenario 2: pressure reached a 199-mmHg plateau and no proxy fat spread deeper into the muscle or beneath it. Scenario 3: pressure gradually rose to 50 mmHg then fell again and the submuscular space contained a significant amount of proxy fat. Scenario 4: pressure rose to a maximum of 30 mmHg and all of the proxy fat remained in the subcutaneous space. CONCLUSIONS: The gluteus maximus fascia is a stout wall that sets up the dangerous condition of deep intramuscular migration with subfascial injections and the protective condition of subcutaneous migration with suprafascial injections. These persuasive findings are profound enough to propose a new standard of care: no subfascial or intramuscular injection should be performed, and all injections should be performed exclusively into the subcutaneous tissue.


Assuntos
Contorno Corporal/efeitos adversos , Nádegas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Gordura Subcutânea/transplante , Tela Subcutânea/cirurgia , Contorno Corporal/instrumentação , Contorno Corporal/métodos , Cadáver , Cânula , Feminino , Humanos , Injeções , Complicações Pós-Operatórias/etiologia
16.
Plast Reconstr Surg ; 143(5): 946e-955e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033817

RESUMO

BACKGROUND: The BODY-Q is a widely used patient-reported outcome measure of surgical outcomes in weight loss and body contouring patients. Reducing the length of the BODY-Q assessment could overcome implementation barriers in busy clinics. A shorter BODY-Q could be achieved by using computerized adaptive testing, a method to shorten and tailor assessments while maintaining reliability and accuracy. In this study, the authors apply computerized adaptive testing to the BODY-Q and assess computerized adaptive testing performance in terms of item reduction and accuracy. METHODS: Parameters describing the psychometric properties of 138 BODY-Q items (i.e., questions) were derived from the original validation sample (n = 734). The 138 items are arranged into 18 scales reflecting Appearance, Quality of Life, and Experience of Care domains. The authors simulated 1000 administrations of the computerized adaptive testing until a stopping rule, reflecting assessment accuracy of standard error less than 0.55, was met. The authors describe the reduction of assessment length in terms of the mean and range of items administered. The authors assessed accuracy by determining correlation between full test and computerized adaptive testing scores. RESULTS: The authors ran 54 simulations. Mean item reduction was 36.9 percent (51 items; range, 48 to 138 items). Highest item reduction was achieved for the Experience of Care domain (56.2 percent, 22.5 items). Correlation between full test scores and the BODY-Q computerized adaptive test scores averaged 0.99. CONCLUSIONS: Substantial item reduction is possible by using BODY-Q computerized adaptive testing. Reduced assessment length using BODY-Q computerized adaptive testing could reduce patient burden while preserving the accuracy of clinical patient-reported outcomes for patients undergoing weight loss and body contouring operations.


Assuntos
Cirurgia Bariátrica , Contorno Corporal , Sobrepeso/cirurgia , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Idoso , Simulação por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Software , Resultado do Tratamento , Adulto Jovem
17.
J Cosmet Dermatol ; 18(4): 1014-1019, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30980602

RESUMO

BACKGROUND: Cryolipolysis combined with shockwave therapy has been previously shown to have synergistic effects in body contouring results. OBJECTIVE: This open-label, prospective, multicenter, comparative study investigated the safety and efficacy of combined cryolipolysis, shockwave therapy with cryolipolysis, shockwave therapy, and injection polyenylphosphatidylcholine-based lipolysis. METHODS: Enrolled patients were treated in the abdominal or flank area with cryolipolysis, shockwave therapy and injection lipolysis (n = 10) or cryolipolysis and shockwave therapy (n = 4). All treatments were conducted the same day. Evaluations were conducted 3 months after treatment and included histological analysis, standardized photography, blinded-investigator efficacy, and safety ratings, as well as patient ratings of satisfaction and tolerance. RESULTS: Compared to baseline, the 3-month follow-up histological analysis revealed a more profound subcutaneous adipose tissue reaction with the triple combination therapy (cryolipolysis, injection lipolysis, radial shock wave) than with the double combination with regard to adipocyte damage and grade of inflammation. Waist circumference was significantly reduced in patients of both groups, but patients in the triple combination group were shown to have a significantly more pronounced reduction in subcutaneous fat. Factors that were shown to influence treatment outcome included baseline BMI and waist circumference. Age and gender had no effect. The abdominal area reacted better to the treatment compared to flanks. No significant side effects or adverse events were reported. The procedure was well-tolerated, and the majority of patients were satisfied with the treatment results. CONCLUSIONS: Combination of cryolipolysis, radial shockwave, and injection lipolysis is a safe, well-tolerated treatment for reduction in subcutaneous fat.


Assuntos
Contorno Corporal/métodos , Crioterapia/métodos , Emulsões Gordurosas Intravenosas/administração & dosagem , Ondas de Choque de Alta Energia/uso terapêutico , Adulto , Contorno Corporal/efeitos adversos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Crioterapia/efeitos adversos , Feminino , Ondas de Choque de Alta Energia/efeitos adversos , Humanos , Injeções Subcutâneas , Lipólise/efeitos dos fármacos , Lipólise/efeitos da radiação , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Gordura Subcutânea/efeitos dos fármacos , Gordura Subcutânea/efeitos da radiação , Resultado do Tratamento
18.
J Plast Surg Hand Surg ; 53(4): 189-197, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30977713

RESUMO

The 'Danish Scale' (DS) is a visual rating scale of massive weight loss body contour deformities and excessive skin in female MWL-patients with current BMI < 30 kg/m2 and massive weight loss defined as BMI loss (delta-BMI) > 15 kg/m2, regardless of weight loss method. The scope of the scale is to simplify the reporting of objective findings by a three-step grading of minor, moderate and severe body contour changes in six different body regions: breasts, abdomen, upper back, buttocks, arms and legs. The DS is presented with descriptions of the conceptualization and construct of the scale. It provides a new visual reference tool for indications and preoperative planning in MWL body contouring, that is specific for the post-MWL BMI-range between 21 and 30 kg/m2 and, at the same time, simpler than previous scales. The scale combines evaluations of different and adjacent body regions in a simple manner and presents modern cut-off points for health insurance reimbursement for MWL body contouring as offered in the Danish public health care system. The DS was developed by repeat expert discussions until final nationwide consensus was reached and can act as an adjunct to the written guidelines by the National Board of Health in Denmark.


Assuntos
Contorno Corporal , Tomada de Decisão Clínica , Perda de Peso , Adulto , Cirurgia Bariátrica , Dinamarca , Feminino , Humanos , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Fotografação , Cuidados Pré-Operatórios
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