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PubMed1987

Recent advances in neck lift.

In reconstruction of the redundant neck, combining skin lift, muscle lift, and suction lipectomy gives superior results more often than use of only one of these. The history of the development of the operation is reviewed. Points in preoperative planning, stressing the extent of the platysma muscle and volume of submandibular fat in obtaining good results, are emphasized. Pertinent anatomy of the subcutaneous musculoaponeurotic platysma system is reviewed. Specific points of operative technique are reviewed, such as my preference to elevate the skin in the neck prior to suction lipectomy. Variances in technique related to thin, "normal," and obese patients are discussed.

Adipose Tissue↗

PubMed2002

'Defatting' tracheotomy in morbidly obese patients.

OBJECTIVES/HYPOTHESIS: Standard-sized tracheostomy tubes often fit morbidly obese patients poorly because of increased submental and anterior cervical girth. The surgeon has two options to overcome this problem: Modify the tracheostomy tube to fit the patient or recontour the neck to accommodate a standard tube. The purpose of the study was to assess the safety and morbidity of the latter technique, the "defatting" tracheotomy. STUDY DESIGN: Retrospective cohort study of 23 patients treated between 1994 and 2001 with cervical lipectomy and tracheotomy. METHODS: Medical charts were reviewed for indications, demographics, body mass index, tracheotomy-related complications, and decannulation results. RESULTS: The average age of patients was 50 years (age range, 34-77 y). The mean preoperative body mass index was 55.9 (range, 39.2-73.5). Indications for the procedure were respiratory failure requiring chronic ventilation in 16 patients (70%) and obstructive sleep apnea in 7 (30%). Four patients died postoperatively from causes unrelated to tracheotomy. The mean follow-up time of survivors was 23 months. The overall tracheotomy-related complication rate was 43%. Four patients developed wound infections in the perioperative period, one patient developed a neck abscess, and one patient required neck exploration for control of hemorrhage. Four patients (22%) developed late complications including tracheitis (1), neck abscess (1), and stenosis of the tracheocutaneous tract (2). Eight patients (44%) ultimately had decannulation. CONCLUSIONS: Defatting tracheotomy is a safe technique that allows for the placement of a standard tracheostomy tube in morbidly obese patients. It is associated with a high rate of minor infectious complications. Even so, we think that cervical lipectomy with tracheostomy tube placement is the preferred surgical option for this patient population.

Adipose Tissue↗

PubMed1980

The extended neck lift: the "bottom line".

Although adequate submental lipectomy and procedures to reposition and modify the supportive role of the platysma muscles have added to the quality and duration of neck lifts, the "bottom line" is still excision of as much excess skin as possible. A method of extended neck lift is described. It involves ancillary methods of cervical lipectomy and platysma repositioning but it also permits excision of large amounts of excess skin, by extending the posterior incisions medially and inferiorly and pulling the dog ears toward the midline. The results appear to make the additional effort worthwhile.

Adipose Tissue↗

PubMed1983

Lipodissection in body sculpturing: the dry procedure.

We have used the honeycombed suction lipectomy (wet and/or dry) in over 700 patients. It represents a major advancement in the treatment of the localized adiposities of the body. Its advantages are eliminating the need for long, unsightly scars and reducing operating time and morbidity. Selection of appropriate patients is of paramount importance for reliable results because this technique is truly sculpting of the soft tissues. Results improve also with the proper training and experience of the surgeon. The indications and complications have been discussed. This technique (honeycombed suction lipectomy) appears more reliable than suction curettage that employs sharp dissection.

Abdomen↗

PubMed1983

Regional fat aspiration for body contouring.

Our experience with the original suction lipectomy is presented. The fat removal, done with a specially designed suction tube, is performed layerwise, creating a continuous, regular cavity that is transformed into a virtual space by compressive dressings. The main indication being excessive peritrochanteric fat pads, the operation is done under either epidural or general anesthesia. No antibiotics or anticoagulants are administered, and the patients are mobilized as soon as fully awake. Practicing suction-assisted lipectomy for more than seven years, we have never observed an infection, thrombosis, or fat embolism. In experienced hands, good results can be expected in about 80 percent of patients. Complications are almost always of an aesthetic nature as a result of bad indications. The method is not a surgical treatment for severe obesity.

Abdomen↗

PubMed1987

Gynecomastia: analysis of 159 patients and current recommendations for treatment.

Gynecomastia has been treated surgically in 159 patients during the past 22 1/2 years. Prior to 1980, all patients had traditional excision, which was followed by a high incidence of complications and undesired sequelae, not the least of which was that the results of this aesthetic operation were often unaesthetic. Since 1980, when suction lipectomy became the cornerstone of treatment, the results have been much better. As a result, current recommendations for treatment are as follows: If the gynecomastia is entirely due to fat, suction lipectomy alone is sufficient treatment. However, since suction will not remove breast parenchyma, those patients whose gynecomastia is due to parenchymal hypertrophy also require local excision of the parenchyma. Skin excision is rarely, if ever, necessary.

Adipose Tissue↗

PubMed2005

An aesthetic perquisite of rectus muscle transplantation in extremity reconstruction.

The authors combine a rectus abdominis muscle harvest with a mini-abdominoplasty in patients with Matarasso type II and III body types admitted for extremity reconstruction. The dermo-lipectomy tissue was used as a source for split-thickness skin graft. Twenty-five patients underwent the combined procedure. All flaps survived. Average quantity of skin harvested from the dermo-lipectomy tissue was 150 cm2 (range 100-250 cm2). Twenty-three of 25 (92%) required no additional skin grafting. The remaining 2 cases required less than 50 cm2 of additional split-thickness skin graft. There were no complications related to the mini-abdominoplasty. All patients were satisfied with their abdominal recontouring. The combined procedure results in an aesthetic improvement at the abdominal donor site and elimination or significant reduction of the morbidity related to a conventional skin graft donor site at the upper lateral thigh. This technique also allows thicker skin graft harvest without an associated increase in morbidity. The authors believe that this technique should be considered for patients with appropriate body habitus when a rectus abdominis muscle is the flap of choice or when multiple flaps including the rectus abdominis muscle are equal for the task.

Abdominal Wall↗

PubMed1985

Recovery of lipid mass after removal of adipose tissue in ground squirrels.

Male golden-mantled ground squirrels subjected to surgical removal of substantial portions of inguinal, retroperitoneal, and epididymal adipose tissue [lipectomy (Lipx)] or to sham lipectomy (Sham) during the early prehibernatory fattening phase did not differ in body mass 4 mo later at the time of their annual body weight peaks. Body mass restoration by Lipx squirrels was achieved without compensatory increases in food intake. There was little or no regeneration of epididymal adipose tissue, complete regeneration of the retroperitoneal depot, and an increase in mass of subcutaneous fat of Lipx animals. Epididymal and retroperitoneal adipocytes were equivalent in size in Sham and Lipx squirrels; adipocytes in subcutaneous fat were 20% larger in Lipx than in Sham animals. Generation of the annual body mass cycle of this ground squirrel involves active regulation of the lipid mass.

Adipose Tissue↗

PubMed1986

Brown fat mediates increased energy expenditure of cold-exposed overfed neonatal rats.

Genetically lean rat pups, overfed by being raised in small litters of three from day 1 postpartum, rapidly become obese compared with pups raised in standard sized litters of eight. Because of the rapid onset of their obesity, we expected that overfed pups would exhibit defective brown fat thermogenesis as is seen in neonatal genetically obese rodents. O2 consumption (VO2) was measured in 2-, 4-, 6-, and 8-day-old homozygous lean (Fa/Fa) Zucker pups from each treatment. We determined minimum rate of VO2 at thermoneutrality and maximum VO2 in response to progressively colder ambient temperatures. Overfed pups were fatter than standard-fed pups (P less than 0.001). But contrary to our prediction, overfed pups had a significantly increased maximum VO2 in response to acute cold exposure. To test the hypothesis that brown fat mediated the increased VO2 in the overfed pups, scapular brown fat lipectomies were performed on a new group of overfed pups at 2 days of age and compared with sham-operated littermate controls. On day 8, no differences in minimum VO2 were seen at thermoneutrality when brown fat is turned off. But maximum VO2 in response to cold, when brown fat is turned on maximally, was significantly reduced in the lipectomized overfed pups compared with sham-operated overfed littermates. These data suggest that manipulations of diet, accomplished by raising pups in small litters, can increase brown fat thermogenic function. The results of the lipectomy experiment imply that brown adipose tissue is a primary mediator of the increased energy expenditure in response to acute cold exposure in the overfed pups.

3-Hydroxyacyl CoA Dehydrogenases↗

PubMed1989

Surgical removal of brown fat results in rapid and complete compensation by other depots.

Interscapular, scapular, and cervical brown adipose tissue (BAT) depots were removed from young male rats (BATX). These depots represented 40% of both the total dissectible mass and cytochrome oxidase content of BAT in these animals. Sham-operated and BATX rats were fed a low (8%) protein diet for periods of 9 or 16 days. Over both periods, body weight gain and energy intake, gain, expenditure, and efficiency were almost identical in sham and BATX groups. Four days after lipectomy the maximal thermogenic response (increase in O2 consumption) to norepinephrine (400 micrograms/kg sc) was 30% lower for BATX rats than for controls, but by day 13 this difference had disappeared. Nine days after lipectomy the total mass and cytochrome oxidase activity of the remaining dissectible BAT was comparable to that of the sham-operated controls, although the protein content was slightly reduced. The specific mitochondrial GDP binding (an index of thermogenic activity) was increased significantly in BATX rats, and total BAT mitochondrial GDP binding was no different from control values. At the end of the experiment (day 16), no regeneration of excised tissue had occurred, but the remaining BAT depots had shown almost complete compensation; the mass and the oxidative and thermogenic capacity of the total dissectible brown fat were virtually identical in both groups.

Adipose Tissue, Brown↗

PubMed1998

[Dermatolipectomy of the abdominal wall].

The authors describe clinical cases of dermatolipectmy of the abdominal wall performed during the last 15 years: a group of six female patients with excess skin after rapid and excessive reduction of adipose tissue, a second group of 42 patients with cumulation of subcutaneous fat in the region of the hypogastrium with formation of massive skinfolds, the so-called clinical picture of "venter pendulus". The third group of 122 patients with excessive adipose tissue and skin combined with diastasis of the rectus abdominis muscles or even prolapse of the abdominal organs. Transverse puboinguinal dermatolipectomy was performed. In 56 patients, high transverse resection is not used by the authors. Vertical lipectomy in the median line was performed in three patients and combined transverse-vertical lipectomy in 104 patients. From the total number of 170, operations satisfactory from the aspect of the surgeon and in particular the patient, were achieved in 122 (71.7%) cases, good results in 43 (25.4%) and satisfactory results in 5 (2.9%).

Abdominal Muscles↗

PubMedDate not supplied

Endoscopic liposhaving for neck recontouring.

OBJECTIVE: To describe a modified technique of liposuction that combines endoscopic techniques and a soft tissue shaver for neck recontouring. DESIGN: Nonrandomized, nonblinded, retrospective evaluation of endoscopic liposhaving for patients requiring neck recontouring in a facial plastic surgery practice. INTERVENTIONS: Endoscopic liposhaving was performed on 5 patients undergoing neck recontouring with platysma plication using a small submental incision. MAIN OUTCOME MEASURES: Subjective evaluation by the surgeon. RESULTS: Direct visualization with the endoscope ensures complete removal of excess fat while maintaining a small amount of fat over the platysma muscle and on the skin flap. The fat was easily and precisely removed with minimal trauma and edema. There were no resulting facial nerve injuries, dimpling, hematomas, or significant asymmetries. CONCLUSIONS: Endoscopic liposhaving for neck recontouring is a precise and less traumatic method of lipectomy than the current techniques. Direct fat visualization with an endoscope allows more accuracy than the external visualization and palpation relied on in conventional liposuction or direct liposhaving. Using these 2 newer modalities can lead to quicker recovery time. There are no known previous reports of use of these 2 techniques together. Arch Facial Plast Surg. 2000;2:264-268

Combined Modality Therapy↗

PubMed1993

Use of submentoplasty to enhance cervical recontouring in face-lift surgery.

A number of surgical techniques for recontouring the aging neck are available. Using liposuction and direct lipectomy, the surgeon can sculpt the jowl and submental contour. Posterior tightening of the ptotic platysma refines the submental area, while incisional or excisional techniques, along with midline plication, remove anterior banding. Despite these maneuvers, recurrent submental and cervical ptosis is noted in some patients. These individuals can benefit from a secondary submentoplasty, a submental tuck-up face-lift operation, usually within 6 to 18 months after their initial surgery. We have identified several reliable causes for a secondary submentoplasty. Submentoplasty as a planned second-stage surgery in certain patients allows achievement of more dramatic and long-lasting rejuvenation of the neck.

Adult↗

PubMed1994

The treatment of enophthalmos by orbital injection of fat autograft.

OBJECTIVE: To evaluate the effects of retro-orbital intramuscular cone injection of fat in the treatment of posttraumatic enophthalmos in both patients with intact globes and those patients who have had globes removed. DESIGN: Case series. SETTING: Private practice involving an otolaryngologist and an ophthalmologist. PATIENTS: Three groups of patients were treated: group 1 included those patients with an intact globe; group 2, patients with an orbital implant following enucleation; and group 3, patients with no orbital implant following enucleation. INTERVENTION: Autogenous fat was harvested from the abdomen using a microsuction lipectomy technique. The fat was injected into the intramuscular cone in the retrobulbar or retroimplant space using a 14-gauge needle. OUTCOME: Sustained improvement of enophthalmos measured by Hertel's exophthalmometry in those patients with an intact globe. Subjective appearance of prosthesis by physician and patient were used for end points in patients whose globes were removed. RESULTS: In group 1, all patients were able to maintain a correction to within 1 mm of the normal eye. In groups 2 and 3, all patients had a subjective improvement in appearance, but they had development of enophthalmos if the prosthesis was decreased in size. Seven patients (64%) required multiple injections. CONCLUSION: Retro-orbital injection of fat autografts allows correction of persistent posttraumatic enophthalmos.

Adipose Tissue↗

PubMed1995

The soft-tissue shaving procedure for removal of adipose tissue. A new, less traumatic approach than liposuction.

OBJECTIVE: To introduce the soft-tissue shaving cannula, a new, precise alternative to conventional liposuction that embodies an entirely different method of soft-tissue extraction and that appears to be less traumatic and more precise than methods currently used in liposuction. DESIGN: Nonrandomized, nonblinded comparison of the soft-tissue shaver and conventional liposuction devices in fresh cadavers, followed by clinical use of the liposhaver in selected patients undergoing cosmetic facial liposuction. INTERVENTIONS: Conventional liposuction devices and the soft-tissue shaving cannulas in fresh cadavers (< 8 hours old). A submental lipectomy and a melolabial fold liposhaving were performed in a clinical setting. OUTCOME MEASURES: Subjective evaluation by the operating surgeons. RESULTS: The fat was cleanly shaved and the contour result was even, without dimpling or asymmetry. CONCLUSIONS: Our early experiences suggest that this new liposhaving technique may offer a precise, less traumatic alternative to conventional liposuction. Fat can be shaved in an open fashion under direct vision. It does not rely on a vacuum seal. The soft-tissue shaving cannula shaves fat one layer at a time. The depth of each layer removed, the depth of soft-tissue injury, and the optimal settings and sizes for various procedures remain to be reported.

Adipose Tissue↗

PubMed1996

The liposhaver in facial plastic surgery. A multi-institutional experience.

OBJECTIVE: To report a multi-institutional clinical experience with the liposhaver in facial plastic surgery. DESIGN: Nonrandomized, nonblinded, multi-institutional evaluation of the liposhaver in a clinical setting in patients presenting for cosmetic facial liposuction. INTERVENTIONS: Cosmetic facial surgery with the liposhaver was performed in 19 patients (21 procedures) who underwent submental lipectomy, facelift with defatting beneath the facelift flap, and/or correction of deep nasolabial folds. Standardized preoperative and postoperative photographs were obtained. Fat obtained from the abdomen of 1 patient was also studied histologically. This fat was excised sharply and was then liposhaved at varying oscillation speeds. OUTCOME MEASURES: Subjective evaluation by the operating surgeons. RESULTS: The liposhaver was used successfully in all cases. The fat was cleanly shaved and the contour results were even, without dimpling or asymmetry. Operative time was comparable to that for conventional liposuction. Preferred cannula sizes and settings were determined. There were no cases of facial nerve injury, no evidence of increased bleeding intraoperatively, and no hematomas in the immediate postoperative period. One patient developed a small hematoma on postoperative day 5 that was effectively treated with needle aspiration and a pressure dressing. Histologic evaluation of liposhaved abdominal fat showed normal fat cells and well-preserved architecture. CONCLUSIONS: The liposhaver offers a precise alterative to conventional liposuction. It may be less traumatic because it requires low suction pressures and does not rely on the potentially bruising, vigorous, back-and-forth motion for fat extraction typical of conventional liposuction.

Adipose Tissue↗

PubMed1997

Biochemical assessment of cellular damage after adipocyte harvest.

Free fat transplantation for soft tissue augmentation yields variable results, which may be related to the technique of fat harvest. To compare the viability of adipocytes harvested by liposuction (sal) or by excision (exc), fat harvested by both techniques from seven lipectomy patients was analyzed by glycerol-3-phosphate dehydrogenase (G3PDH) enzyme assay. Leakage of this lipogenic enzyme through the plasma membrane is a potential indicator of fat cell damage. Preliminary experiments showed this assay to be sensitive and specific for adipocyte G3PDH activity. Treatment of fat tissue with collagenase H resulted in complete release of the component fat cells for analysis with less loss of G3PDH activity, compared to other collagenase preparations. Each sample was digested and separated into three compartments: mature adipocytes-floating layer (F), acellular supernatant (S), and stromal pellet (P). Samples from each compartment were assayed for G3PDH activity, normalized to DNA content, and represented as a percentage of the whole (F + S + P). Within the subgroups, the fat cell fraction of the liposuction samples (Fsal) showed statistically more activity than the excised samples (Fexc) by paired Student's t test (P = 0.004). The supernatant (representing leaked G3PDH) and pellet fractions of excised samples revealed more G3PDH activity than the same fractions from liposuctioned tissue; the former (Sexc) to a significant degree (P = 0.036). Using this assay, the results indicate that liposuction fat harvest does not result in increased fat cell damage compared to fat harvested by excision.

3T3 Cells↗

PubMed1992

A new safe and aesthetic approach to suction abdominoplasty.

Suction abdominoplasties are associated with a number of surgical complications, mainly in obese people and diabetic patients. The aesthetic result is often spoiled by poor balance caused by improper distance between the "guide points" of an harmonious abdomen (e.g., minimum of 10 cm between the pubic scar and the umbilicus). Almost all surgical complications are caused by extensive undermining and can be avoided by an en bloc resection without any undermining (the suction lipectomy of the upper flat creates a "mesh undermining" which is almost as efficient). A new neo-umbilicoplasty, described here, can be situated in the "right position" with good aesthetic results.

Abdomen↗