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Deep neck contouring can achieve dramatic results in young and old patients. Both genetic predisposition and aging contribute to the malposition of deep neck structures and a poorly contoured neckline. Depending on the patient's anatomy, deep neck contouring should involve a combination of submental liposuction, platysmaplasty, subplatysmal fat lipectomy, resection of the anterior belly of the digastric muscle, and either cautery or resection of the submandibular glands. Resorption of the facial bony skeleton that occurs with aging affects the ultimate postoperative mandibular contour, and postoperative results thus differ in the young versus old patient. In patients in which there is concern for excess skin laxity, a concurrent facelift is necessary to excise excess neck skin. This article includes a discussion on how a combination of aging and genetics influence a patient's neck anatomy, critical preoperative considerations prior to performing deep neck contouring, intraoperative technique, and adjunct procedures that can further improve a patient's neckline. [ABSTRACT FROM AUTHOR]

Ultrasonic deep-plane neck lift is a new approach for addressing both the subsuperficial musculoaponeurotic system and subplatysmal soft tissues during facial rejuvenation procedures. This innovative surgical approach utilizes 2.2, 2.9, and 3.7 stainless steel probes that are powered by high-frequency ultrasound. Using high-frequency ultrasound in the subcutaneous spaces has been accomplished for the past 20 years with a very suitable safety profile. In this technique, emulsification of the fat layer in both the superficial and deep planes is accomplished with tumescence of the soft tissues in the same fashion as subcutaneous liposuction. In ultrasonic deep-plane neck lift, the superficial and deep layers of fat are targeted for emulsification, and this creates a loosening of these spaces for lifting and repositioning. The procedure facilitates more accurate surgery, because the tissue effects include hemostasis and scalpel- and scissor-free undermining due to the emulsification of the fat layers of the face and neck. The other advantages of ultrasound-assisted facial contouring and rejuvenation include treatment of hard-to-treat areas like the perioral region and distal neck, which can be rapidly and safely undermined utilizing this technology. The third component of ultrasound- and energy-based facial rejuvenation surgery is the long-term remodeling and tightening that occurs beginning approximately 8 weeks after the procedure. When many conventional facelifts are beginning to fall at 3 to 4 months postoperatively, the energy-based facelifts are still tightening and this remodeling continues for up to a year after the procedure. Combining technology with conventional facelift procedures is a new approach to facial rejuvenation and is the result of 15 years of research and cooperation with the aesthetic device industry. The result of this merger of technology with conventional surgery is TESLA Facelifting, the facelift of the future. [ABSTRACT FROM AUTHOR]

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Dynamic definition liposculpture (HD2) is considered a highly sought after procedure in body sculpting surgery by patients. Radiofrequency microneedling is a cutting edge technology with evidence-based outcomes demonstrating skin tightening and retraction. These ancillary procedures complement and enhance the results of dynamic definition liposculpture. A retrospective review of patient records from 2022 to 2024 was conducted. All patients who underwent high definition (HD) or HD2 in combination with fractional radiofrequency microneedling treatments by the senior author (A.E.H.) were included. Data collected included patient demographics, areas treated, and any complications. A total of 86 patients were included: 16 in 2022, 62 in 2023, and 8 in 2024. The most frequently treated area was the abdomen, followed by the back, face, neck, thighs, and arms. The average age of patients was 40.0 years in 2022, 40.8 years in 2023, and 44.4 years in 2024. The average BMI was 23.9 kg/m2 in 2022, 24.3 kg/m2 in 2023, and 25.2 kg/m2 in 2024. Minimal complications were observed, with some patients requiring further interventions such as scar correction and nevus resection. Avoiding superficial liposuction by relying on radiofrequency microneedling to target the adipose tissue directly beneath the dermis decreases the risk for iatrogenic (cannula related) superficial contour irregularities and makes the overall operation safer and more reliable. [ABSTRACT FROM AUTHOR]

Background Liposuction has gained significant popularity, leading to increased demand for secondary procedures due to complications such as scars and fibrosis that affect aesthetic outcomes. High-definition liposuction has emerged as a preferred technique, but the presence of fibrosis from previous surgeries may limit its effectiveness. Objectives The aim of this study was to explore the application of ultrasound (US)-assisted VASER (vibration amplification of sound energy at resonance; VASER-Solta Medical, Bothell, WA) liposuction in secondary abdominal liposculpture to address these challenges. Methods A prospective cohort study was conducted between May 2022 and May 2023 of patients undergoing secondary abdominal liposculpture with US-assisted VASER liposuction, at least 12 months after their initial procedure. Preoperative US examinations were performed to identify and mark findings related to previous liposuction. Data on demographics, photographic results, and complications were collected and analyzed. Results Intraoperative ultrasound (I-US) significantly improved the detection of fibrotic lesions, leading to more precise, rapid, and atraumatic outcomes. The use of I-US optimized surgical procedures, reducing both costs and operation time. Clear communication with patients regarding potential limitations due to chronic damage was essential for setting realistic expectations. Conclusions I-US has proven to be an invaluable tool in secondary liposculpture, enhancing surgical precision and outcomes. This methodology allows for better recognition of complications, promoting effective treatment strategies and ultimately improving patient satisfaction in the context of secondary abdominal liposculpture. Level of Evidence: 4 (Therapeutic) [ABSTRACT FROM AUTHOR]

Liposuction is the most frequently performed cosmetic procedure. Tranexamic acid (TXA) has emerged as a promising blood loss reducing agent in plastic surgery, but its value in liposuction is still being studied. This systematic review investigates the safety and efficacy of TXA in reducing blood loss during liposuction procedures. A systematic review of PubMed, EMBASE, and Cochrane databases from inception to June 2023 was performed. The primary objective was to compare blood loss, hematoma rate, and ecchymosis from liposuction procedures in patients who received TXA with those who did not. The secondary objective was to assess the incidence of TXA-related complications. A total of 9 studies were included, published between 2018 and 2023, of which 8 were prospective and 1 was retrospective. A total of 345 intervention vs 268 control arms were compared. Follow-up time ranged from 1 to 14 days. Mean age and mean BMI ranged from 33 to 50 years and 23 to 30 kg/m2, respectively. Blood loss in aspirate was significantly less with TXA administration as assessed in 5 studies (P <.05). Of the 5 studies that described assessment of the incidence of ecchymosis, all reported less bruising with TXA use. Among all the studies, only 1 reported postoperative complications in 5 patients requiring transfusion in the control group (without TXA). The evidence provided in the literature suggests that TXA administration in liposuction is safe and effective for reducing blood loss and ecchymosis by both intravenous and local administration. Level of Evidence: 3 (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Liposuction has emerged as one of the most common cosmetic procedures globally, increasing by more than two-fold since 1997. While different liposuction techniques exist, each with distinct advantages and potential sequelae, a comprehensive comparative analysis of complication rates across various techniques in purely aesthetic cases remains unexplored. We aimed to (1) systematically review the literature on complications of distinctliposuction techniques, and (2) compare complication rates between different techniques. Methods: PubMed, EMBASE, and Web of Science databases were searched for studies reporting on complications of isolated cosmetic liposuction techniques in specific anatomical regions. Complication rates were pooled, and heterogeneity was assessed using the I² statistic. Publication bias was evaluated using the Luis Furuya-Kanamori index and Doi plot. Results: Twenty-three studies were included. Laser-assisted liposuction (LAL) demonstrated the lowest overall complication rates for hemorrhage, infection, seroma formation, thermal injury, and cutaneous necrosis (all 0.13%). Power-assisted liposuction (PAL) exhibited the highest rates for hemorrhage (0.72%), infection (1.34%), and cutaneous necrosis (0.72%). Radiofrequency-assisted liposuction (RFAL) showed the highest rates for seroma formation (3.93%) and thermal injuries/blistering (1.64%). Suction-assisted liposuction (SAL) presented the highest rate of cutaneous irregularities (3.36%). Heterogeneity varied widely across complication types and techniques, with I² values ranging from 0 to 91.4%. Conclusions: This study provides the first comprehensive comparison of complication rates across different liposuction techniques in aesthetic cases. LAL demonstrated superior safety profiles, while PAL and RAL showed higher rates for specific complications. These findings can inform surgical decision-making and patient counseling. Level of Evidence: Not gradable. [ABSTRACT FROM AUTHOR]

Background: The abdomen is the aesthetic and physical center of the body. Abdominal etching is used to enhance the appearance of the abdominal musculature. Body contouring and abdominal etching are popular among both men and women, and these procedures have been shown to result in high patient satisfaction and are considered safe. The aim of this study was to describe a novel classification for abdominal etching based on the senior author's technique and experience. Methods: This single surgeon, nonrandomized, retrospective study was conducted from December 2016 to September 2022. Patients were classified into 4 groups based on their body habitus, abdominal skin pinch test and skin quality, and the surgical plan was tailored accordingly. Results: Sixty-two patients (42 male) with an average age of 36 years underwent abdominal etching during the study period. Subgrouping included 4 (6.45%) in Class 1, 22 (35.5%) in Class 2, 32 (51.6%) in Class 3 and 4 (6.45%) in Class 4. The most common complication was seroma. Concomitant procedures included silicone implants to the pectoral region (male), fat injection to the buttocks, breast reduction and mastopexy and treatment of post-liposuction irregularities. Conclusions: The abdominal etching technique is safe and reproducible. It has demonstrated long-lasting results and high patient satisfaction. Our classification of patients will enable surgeons to better understand the problem presented and provide aesthetic and efficient results. Use of these guidelines and tailoring treatment options will further improve patient and physician satisfaction. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Background: Despite its estimated high prevalence among women and increasing awareness, lipedema remains under-investigated. Ignoring its debilitating nature, surgical treatment for this condition is frequently covered by health insurance only in advanced stages and after the exhaustion of conservative therapies. Methods: A total of 1015 patients with lipedema were recruited via social media platforms. Of these, 860 patients provided answers to at least one complete section of the modified Body-Q questionnaire (response rate 85%). The Mann–Whitney U and Kruskal–Wallis tests were utilized to assess the impact of the surgical treatment by means of patient-reported outcomes on the self-perception of various body areas. Results: The satisfaction scores among conservatively treated patients for abdominal appearance, arms, back, body, buttocks, and inner thighs showed a statistically significant decline with increasing stages of lipedema. The comparison of patient evaluation scores in the appearance domain demonstrated better patient self-perception scores in patients who received at least one session of the surgical treatment for the hips and thighs (p < 0.01), inner thighs (p < 0.01), and excess skin (0.01) scales. On the body scale, the patients who underwent liposuction again reported better satisfaction scores; however, this did not reach statistical significance (p < 0.081). In the health-related quality of life domain, the patients who received liposuction treatment reported a better outcome in the body image (p < 0.01), physical function (p = 0.05), physical symptoms (p = 0.04), and psychological function (p < 0.01) scales. Conclusions: The current study underscores the burden of lipedema of affected patients and its negative impact on self-perception. As the disease progresses, conservatively treated patients experience a decline in satisfaction with various aspects of their appearance. However, surgical interventions, particularly liposuction, does not address esthetic concerns but significantly improve health-related quality of life across multiple domains, emphasizing the comprehensive benefits of surgical intervention in the management of lipedema. [ABSTRACT FROM AUTHOR]

Background: Lymphedema is primarily treated conservatively using complex physical decongestion treatment (CDT). Lymphovenous anastomosis (LVA), vascularized lymph node transplantation (VLNT) and liposuction are available as surgical treatment methods; however, reimbursement in the diagnosis-related groups (DRG) system is sometimes inadequate or only possible following an individual application. The costs of these relatively new surgical procedures have not yet been set in relation to those of CDT. Method: The costs of conservative treatment were determined in accordance with the guidelines. The costs for LVA, VLNT and liposuction of the upper and lower extremities were estimated on the basis of the DRG reimbursement per case and the expected reduction in conservative measures according to current knowledge. The annual treatment costs were then compared. Results: The annual treatment costs of LVA and VLNT are already lower than conservative treatment alone in the second postoperative year. Liposuction reaches this point in the 6th (upper extremity) or 47th postoperative year (lower extremity). Conclusion: The evidence for the positive effects of lymphatic surgery is still limited; however, it is recognizable that the curative surgical approach can significantly reduce the treatment costs and improve the quality of life of lymphedema patients; however, there is a lack of adequate reflection of the surgical effort in the reimbursement. [ABSTRACT FROM AUTHOR]

There is more and more non-invasive treatment proposed in face rejuvenation. However, there are only a few treatments that decrease volume of the tissue efficiently. Submental liposuction is not classically considered as a non-invasive treatment. We reviewed from October 2020 until August 2022; 695 patients were operated by the first author under local anesthesia. Complications exist but are minimal. The most important is irregularity that can be managed by massage and ultrasound treatment. With our experience of over 600 cases, we believe that submental liposuction should be considered and proposed to patient as non-invasive before of this efficiency and very low drawbacks, was presented. [ABSTRACT FROM AUTHOR]

The article provides a historical overview of the Journal of Dermatologic Surgery, tracing its origins back to the founding of the American Society for Dermatologic Surgery in 1970. The journal has evolved over the years under the leadership of various editors, each contributing to its growth and development. Notable milestones include the transition to electronic submissions, the expansion of editorial leadership, and the introduction of podcasts to enhance accessibility to the journal's content. As the journal approaches its 50th anniversary, it continues to be a significant resource for dermatologists worldwide, showcasing top-quality peer-reviewed content that has shaped the field of dermatologic surgery. [Extracted from the article]

The advent of liposuction has driven the development and advancement of autologous fat grafting techniques. However, the absorption rate of grafts after fat tissue transplantation is high and often requires multiple surgeries. Long-term freezing of autologous fat tissue can reduce the number of liposuction, improve the efficiency of the treatment, and realize the possibility of “one liposuction, multiple transplantation”. Therefore, adipose tissue freezing technology is of great clinical significance for autologous fat grafting treatment. This paper reviews the research progress of adipose tissue cryopreservation protocol, and clarifies the challenges and directions of the current research, so as to provide reference for the subsequent research. [ABSTRACT FROM AUTHOR]

Background: Significant advancements have been made in the field of clinically relevant fat research over the past decade. A systematic analysis of publications in this domain is essential. This study aims to identify research hotspots and evolving trends in clinically relevant adipose tissue research through bibliometric analysis. Methods: Publications related to fat clinical research from 2014 to 2023 were extracted and analyzed from the Web of Science (WOS) Core Collection database. The data from this 10-year period were divided into two 5-year intervals (2014-2018 and 2019-2023) for analysis. Various aspects such as author keywords, countries, institutions, authors, and journal co-occurrence were studied. The data were analyzed and visualized using VOSviewer. Results: After selecting the retrieval strategy, a total of 892 publications were extracted for the period 2014-2018 and 1622 publications for 2019-2023. Comparing the two intervals, the United States was the country with the highest number of publications (354 publications vs. 546 publications). The institution with the highest output was Peking Union Medical College (26 publications vs. 87 publications). The most prolific author was Klinger M (4 publications) vs. Hua Zuguang (18 publications). The most active journal was Plastic and Reconstructive Surgery (178 publications) vs. Aesthetic Surgery Journal (244 publications). The most active research areas were focused on "fat grafting," "liposuction," and "body contouring," with a rapid increase in research related to "facial rejuvenation" using fat grafting, suggesting it may be the next research hotspot. Conclusion: Clinical research related to fat is rapidly evolving. This study provides a visual network and trend analysis of fat research over the past decade. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Liposuction is a common cosmetic procedure aimed at addressing localized fat deposits. While metabolic disruptions associated with adiposity are well documented, the specific impacts of liposuction on metabolic parameters remain unclear. Materials and Methods: Seventeen individuals underwent liposuction inclusive of the abdominal area, while eleven underwent liposuction excluding the abdomen. Metabolic parameters including glucose, insulin, HOMA-IR, HbA1c, and C-peptide levels were measured preoperatively and postoperatively at 1, 3, and 6 months. Results: Both groups exhibited significant postoperative reductions in glucose, insulin, HOMA-IR, HbA1c, and C-peptide levels. However, the abdominal liposuction group demonstrated more pronounced reductions of these variables. Conclusion: These findings suggest that addressing abdominal adiposity may provide greater metabolic benefits following liposuction. Further research is warranted to explore the long-term sustainability and clinical implications of these metabolic improvements with additional markers. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, liposuction techniques have significantly evolved, moving from basic fat removal to sophisticated methods aimed at improving safety, efficiency, and cosmetic outcomes. This study evaluates the efficacy and safety of a combined approach using ultrasound-assisted liposuction (UAL) and helium plasma radiofrequency (HPRF) technology to enhance skin tightening without the need for extensive surgical interventions. Methods: We conducted a retrospective analysis of 639 patients who underwent the combined UAL and HPRF liposuction technique. The patient cohort had an average age of 31.5 years and a mean BMI of 27.9 kg/m2. The procedure predominantly targeted the abdomen, with an average of 2.4 body areas treated per patient. Surgical duration averaged 118 minutes, with a mean aspirate volume of 1698 mL. Results: Minimal residual skin laxity was observed in 87% of patients, and 91% achieved excellent improvement in body contouring. The complication rates were low, with minor occurrences of seroma (5.6%) and a very low incidence of infection (0.3%). This combined technique demonstrated safety and efficacy, providing significant skin tightening and reducing recovery time compared to more invasive procedures. Conclusions: The combined use of UAL and HPRF technology offers a safe and effective method for enhancing skin tightening and improving body contouring outcomes. Despite the promising results, this study acknowledges the limitations of its retrospective design. Future prospective, multicenter studies are recommended to further validate these findings. This technique represents a significant advancement in the field of cosmetic surgery, emphasizing minimally invasive solutions with substantial esthetic benefits. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Lipedema is a subcutaneous adipose tissue disorder mainly affecting women. Its progressive nature often requires high-volume liposuction for efficient pain reduction. However, aspiration volumes of more than 5 L within a single session may lead to a variety of complications. Thus, we examined the effect of high-volume liposuctions on lipedema patients and the incidence of associated complications. Methods: We analyzed perioperative differences in lipedema patients undergoing low- or high-volume liposuctions. Statistical analyses were performed, investigating postoperative complications and the correlation of patients' BMI, total amount of aspiration, duration of surgery, hospital stay and hemoglobin alterations. Complications were investigated according to the Clavien–Dindo Classification. Patients were divided in two groups based on the volume aspirated at liposuction (low-volume vs. high-volume liposuction). Results: Overall, 121 sessions were investigated. Mean total volume of aspiration was 8227.851 mL ± 3643.891. Mean preoperative hemoglobin levels were 13.646 g/dL ± 1.075 g/dL. Preoperatively, 7.44% of patients were anemic (Hb < 12 g/dL). Mean postoperative hemoglobin was 10.563 g/dL ± 1.230 g/dL. Postoperatively, 90.10% of patients showed Hb levels below 12 g/dL. Hemoglobin loss differed significantly between the two groups (p = 0.001). Significant correlations between pre- (p = 0.015) and postoperative (p < 0.001) hemoglobin levels and pre- (p < 0.001) and postoperative (p < 0.001) anemia with Class II complications were also seen. The total volume of aspiration did not correlate with complication rates (p = 0.176). Conclusions: Complication rates in high-volume liposuctions are hemoglobin-dependent rather than volume-associated. Preoperative anemia was the most influential for the occurrence of postoperative complications. To safely conduct high-volume liposuctions in lipedema patients, adequate patient selection and preoperative patient preparation are imperative. [ABSTRACT FROM AUTHOR]

Desmoid fibromatosis is a rare, slowly growing, locally aggressive mesenchymal tumor. It primarily affects young adult females with a female-to-male ratio of 2:1. It rarely affects children and elderly patients. Most desmoid fibromatoses arise in extra-abdominal locations, mainly, the extremities. We report the case of a 39-year-old female patient who presented with a lower back post-liposuction paraspinal desmoid fibromatosis. Lumbar spine magnetic resonance imaging (MRI) revealed a mass in the right paramedian area opposite to the level of L2, not infiltrating the underlying structures, with normal overlying subcutaneous tissue. Wide local excision with free margins was performed. Literature review revealed 97 cases of paraspinal desmoid fibromatosis. We extensively analyzed the clinical, radiological, and pathological features of these cases. Fibromatosis is a non-metastasizing, but locally aggressive slowly growing tumor currently classified by the World Health Organization (WHO) as a mesenchymal tumor of intermediate (borderline) malignancy. The exact cause of desmoid fibromatosis is not clear. It has been narratively linked to genetic abnormalities, trauma, steroid sex hormones, and bone malformations. The diagnosis of fibromatosis is challenging due to its ambiguous and pathological features. To the best of our knowledge, this is the first report of a post-liposuction paraspinal desmoid fibromatosis and is the first report of a paraspinal desmoid fibromatosis in the Arabian Gulf region. Universal guidelines for the management of desmoid fibromatosis are still lacking. [ABSTRACT FROM AUTHOR]

Lymphedema surgeries have been proven effective in treating lymphedema and are not considered experimental or unproven. The medical literature consistently supports the safe and successful use of physiologic drainage lymphedema surgeries such as lymphaticovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and reductive surgeries such as suction-assisted protein lipectomy (SAPL) when performed by an experienced lymphedema surgery team to treat properly selected patients. Proper integration of lymphedema therapy is critical to achieving successful outcomes. We review effective lymphedema surgeries, their indications, patient selection, and the proper application of surgical treatments to achieve optimal results. [ABSTRACT FROM AUTHOR]

The article discusses the use of volumizing threads to correct marionette lines, which are wrinkles that form around the corners of the mouth due to aging. Thread lifting is highlighted as a popular and minimally invasive technique for facial rejuvenation. The insertion of volumizing threads perpendicular to the marionette line is described as a method to reduce the visibility of fat layers and improve the appearance of the jawline. Case studies are presented to demonstrate the effectiveness of this technique in enhancing facial aesthetics. The article emphasizes the importance of precise thread insertion and patient selection for optimal outcomes in addressing marionette lines. [Extracted from the article]

An aesthetically pleasing neck is an important component of a youthful appearance of the face. It is frequently targeted by many surgical and nonsurgical methods to achieve the best results. Today, patients are looking for a minimally invasive option that gives permanent results and has a quick recovery. Therefore, ultrasound-assisted liposuction of the chin and jawline has become an important part of the cosmetic surgeon's armamentarium. The objective of this article is to describe the technique, mechanism of action, and most common complications and to establish ultrasound-assisted face liposuction under local anesthesia as an effective method to achieve facial slimming especially in the Indian population. [ABSTRACT FROM AUTHOR]

Background Gynecomastia results in a feminine appearance of the male chest, leading to social embarrassment and loss of self-esteem in the afflicted males. Grade 4 gynecomastia is expected to have less than perfect results with liposuction and gland excision alone. This study was done to assess the long-term outcome of this surgery for grade 4 gynecomastia. Materials and Methods From January 2021 to December 2022, 81 patients with grade 4 gynecomastia were treated by us. All the patients underwent vibration amplification of sound energy at resonance (VASER) and suction-assisted liposuction of the chest and side rolls with excision of the gland with crescentic lift in the cases with ptosis. A retrospective study was done to analyze the long-term surgical outcomes in these patients by review of clinical records. Results Symmetry was achieved in 37/39 patients with grade 4a gynecomastia but only in 33/42 patients with grade 4b gynecomastia. The inframammary fold disappeared in 35/39 patients with grade 4a gynecomastia but only in 25/42 of grade 4b gynecomastia patients. Ptosis was corrected in 35/42 grade 4b gynecomastia patients. The mean follow-up was 15 months (range: 12–24 months). Only seven patients desired a second stage to correct the remaining deformity. Conclusion Liposuction with gland removal alone in grade 4a gynecomastia and with liposuction with crescentic nipple–areola complex (NAC) lift in patients of grade 4b gynecomastia give satisfactory results in patients with massively enlarged breasts. While grade 4a gynecomastia has overall better results and lesser complications as compared with grade 4b gynecomastia, the latter also has acceptable outcomes. Realistic prognosis needs to be explained to the patient preoperatively. [ABSTRACT FROM AUTHOR]

In surgery for gynecomastia, it is not sufficient to just remove the gland or do a liposuction that addresses the front of the chest only as it is not aesthetically pleasing for the patient and the surgeon alike. Most patients expect to achieve a sculpted look, which includes not only the breast area but also the surrounding areas such as the sides, the axillae, and the infraclavicular region. To tackle these areas and achieve a well-sculpted and aesthetic look, we describe the 4Dx (4 Directions) technique of liposuction for gynecomastia. It also makes the procedure more objective for plastic surgeons while allowing for individualization of the procedure. [ABSTRACT FROM AUTHOR]

Axillary breasts are a common entity with a reported incidence of 2 to 6% in women and 1 to 3% in men. They are more common amongst Asians than Caucasians, namely amongst South East Asians and Indians, with the highest incidence amongst Japanese. While modalities like CoolScupting™, Kybella™ injections, and BodyTite™ have been used by surgeons for management of axillary breasts, the most effective treatment for this condition remains surgical management involving a combination of liposuction of the axillary breast with excision of the gland and skin. In the author's experience, primary skin excision always leaves a long visible scar that widens over time, at times leading to contractures and restricted axillary movements even when closure looks tension free on the table. Any skin excess is best dealt with secondarily. The author uses a modified protocol without any primary skin excision in axillary breast management to achieve excellent results with minimal scars. [ABSTRACT FROM AUTHOR]

Background: Epinephrine in liposuction solution mediated vasoconstriction thus decrease in adrenergic side effects, local anesthetic toxicity, and bleeding. The optimum safe adrenaline concentration was not well investigated. Aim: This study aimed to compare between adrenaline 1 mg/L and 2 mg/L in tumescent fluid concerning hemodynamics during abdominal liposuction operations. Methods: Forty cases scheduled for liposuction for abdomen and flanks and body were involved in this randomized, triple-blind, controlled trial. Cases were randomized equally into two groups. Group A (low adrenaline concentration group): received 1 mg per liter of epinephrine. Group B (high adrenaline concentration group): received 2 mg per liter of epinephrine. Results: Intraoperative heart rate and mean arterial blood pressure at base line were insignificantly different between both groups (p value > 0.05) while at 30, 60, 90, and end of surgery were significantly higher in group B group as opposed to group A (p value < 0.05). Incidence of sinus tachycardia and PVCs were significantly higher in group B than group A (P < 0.05), while surgeon satisfaction was comparable between both groups (p value > 0.05). Conclusions: In liposuction procedures, the safest adrenaline concentration is 1 mg/L as evidenced by hemodynamics stability and surgeon satisfaction thus even in high volume liposuction, the adrenaline concentration should not exceed 1 mg/L and should be handled to cover the used crystalloid solution. [ABSTRACT FROM AUTHOR]

Liposuction has been popular with the public since its inception. The fat accumulated in the body is sucked outside the body through negative pressure suction, thereby reducing the fat cells in the body and achieving the effect of local plasticity. Although liposuction is a relatively safe procedure, due to the lack of correct judgment of the patient's condition and treatment by quite a few cosmetic practitioners, the complications of liposuction are gradually increasing. We describe a case of subcutaneous hydrops after lumboabdominal liposuction, which was found to have multi-layer tissue defects of the right lower abdominal wall and local peritoneal rupture after multiple sclerosing agent injections and two debridement procedures. This case provides us with a warning about the use of sclerosing agents. [ABSTRACT FROM AUTHOR]

Background: Tumescent local anesthesia (TLA) involves infusing a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While liposuction under general anesthesia remains the most used treatment, we introduce a novel TLA approach for gynecomastia surgery, drawing from our extensive experience in recent years. Methods: Between the years 2010 and 2023, we performed gynecomastia surgery on 60 male patients under TLA. The gynecomastia was treated by liposuction plus periareolar excision technique. Liposuction was carried out on both breasts in every case, regardless of whether the gynecomastia was bilateral or unilateral. The tumescent solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated between the pectoral fascia and the mammary gland, and then the surgery was carried out. Results: The average volume of tumescent solution infiltrated during TLA was 300 mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. We observed a major postoperative complications rate of 6.7%, represented by three incident of hematoma and one case of seroma. A minor complication rate of 5% was observed: two cases of retraction of the NAC and one case of gynecomastia recurrence, the latter undergoing an additional combination procedure with liposuction and subcutaneous mastectomy. Follow-up time ranged from 30 days to 1 year. Conclusions: We developed a new outpatient surgical method for gynecomastia using liposuction and periareolar excision under tumescent local anesthesia. This technique, supported by a comprehensive rehabilitation plan, proved a successful and quick recovery, and high patient satisfaction. Our results suggest it is a feasible and effective option, warranting further consideration in gynecomastia treatment strategies. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Background: Looking for an adequate solution for those patients who desire abdominal definition, but are not candidates for liposuction alone, Danilla developed a technique, using selective fat grafting into the rectus abdominis (RAFT) to increase the muscle volume in addition to selective liposuction and abdominoplasty to provide an optimal body contouring. Objective: To determine whether intramuscular fat grafting in the rectus abdominis muscles leads to an increase in muscle thickness after one year. Methods: This is a prospective cohort study, from a single center, carried out over 24 months (October 2021–September 2023). Sixty-two patients who underwent lipoabdominoplasty and RAFT, had their rectus abdominis cross section measured by ultrasound pre- and 12 months postoperatively. To compare the muscle thickness, a paired t-test statistic was used. A p-value of 0.05 was considered statistically significant (IBM SPSS Statistics V26). Results: After 1 year, all 62 patients showed an increase in the size of the rectus muscle cross section, although only 58 (94%) had fat identifiable in the US. Preoperatively, the mean muscle cross-sectional size was 1, 4 cm. After RAFT, overall mean muscle cross section was 2, 3 cm (0, 9 cm/66.9% increase). When stratified into groups with and without identifiable fat, the group in which the graft remained showed greater increase than the group with no visible fat (69, 9% vs 19,6%). Conclusion: The RAFT provided a significant increase in the muscle cross section in most cases after 1 year. The presence of fat is related to a statistically significant increase in the muscle compartment (pack). Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Vertical mammoplasty techniques have been widely used for breast reduction. The authors present the combination of superior pedicle vertical mammoplasty with liposuction in different regions in the treatment of severe breast hypertrophy in obese patients. We also propose some innovative methods in terms of surgical approach, breast parenchymal anatomy pattern and liposuction. Methods: A retrospective study of 50 female patients with severe hypertrophic breasts and obesity who underwent breast reduction in our department from February 2019 to February 2022 was performed. Pre- and postoperative photographs, breast parenchyma distribution and postoperative patient satisfaction were recorded. Results: Fifty patients underwent breast reduction. Through clinical examination, patient photo evaluation and satisfaction survey results. Good breast shape and projection, full upper pole of the breast, and high satisfaction results were obtained. There were no serious complications. Conclusion: This technique is acceptable and reproducible. It is suitable for patients with varying degrees of breast hypertrophy, especially those with severe hypertrophic breasts and obesity. There are fewer associated complications and a lower rate of re-repair. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Study Design: The study was a retrospective cross-sectional database analysis. Objective: Deoxycholic acid (DOC) injections are a novel, in-office procedural alternative to submental liposuction or submentoplasty to address excess submental fat. Post-market safety data regarding this treatment is currently limited. The objective of this study is to analyze adverse events reported in the Manufacturer and User Facility Device Experience (MAUDE) database. Methods: The MAUDE database was queried for all reports related to adverse events involving deoxycholic acid using the search terms "KYBELLA" and "deoxycholic acid." Reports were individually reviewed by 2 reviewers and categorized with special attention to adverse events. Results: A total of 34 medical device reports were identified from the database query. Thirteen of these reports (21 total events) were included in the analysis after excluding duplicates, unrelated adverse events, or events associated with the off-label use of DOC. Reported adverse events include excessive swelling (n = 5, 24%), marginal mandibular nerve weakness (n = 4, 19%), unsatisfactory aesthetic outcome (n = 4, 19%), numbness (n = 3, 14%), dysphagia (n = 1, 5%), infection (n = 1, 5%), and skin necrosis (n = 3, 14%). Two patients required hospitalization for skin necrosis management; both had underlying systemic diseases. Conclusions: Adverse events following DOC injections included excessive swelling, dysphagia, numbness, infection, unsatisfactory aesthetic outcome, facial nerve weakness, and skin necrosis requiring hospitalization and/or surgery. Patient counseling regarding these adverse events should be discussed when offering DOC injections for submental convexity. [ABSTRACT FROM AUTHOR]

Objective: Gynecomastia and lipomastia are benign proliferations of the male breast affecting 32–65% of men. Numerous surgical procedures often result in stigmatizing scars when it comes to skin resection. The purpose of this study was to review skin-sparing techniques and to describe our skin-sparing approach to treat skin excess using transcutaneous netting. Materials and Methods: A comprehensive review of the literature was conducted aiming at identifying available techniques to avoid skin resection in gynecomastia or lipomastia patients (Simon's grade IIb and III). Surgical techniques, patient satisfaction, time of follow-up, and complications were assessed. Results: Seven studies detailed skin retraction techniques, including laser-, ultrasound-, and radiofrequency-assisted liposuction (LAL, UAL, and RAL), microneedling, and nipple-areolar complex (NAC) plaster lifting. All articles provided Simon's grade classification, with most studies including patients with and without skin laxity. Complication rates were low (1.5–10%), and patient satisfaction ranged from 87.5% to 100%.While transcutaneous netting has been reported to reduce hematoma in gynecomastia surgery, no studies specifically examined its role in managing skin redundancy. Conclusions: Limited data exist on scarless skin retraction techniques for gynecomastia. While LAL, UAL, and RAL show some potential, controlled studies are lacking, and skin resection is often performed for high skin redundancy. We recommend a skin-sparing approach using liposuction and transcutaneous netting for gynecomastia up to Simon's grade III, which allows for skin retraction and NAC fixation. No literature was found assessing the efficacy of transcutaneous netting in promoting skin retraction in gynecomastia.

Fowler syndrome is a rare entity that occurs in young women, with a high incidence of polycystic ovary syndrome. It consists of episodes of acute urinary retention that have a characteristic electromyographic pattern. Its etiology is unclear and is usually preceded by a trigger such as a surgical procedure, childbirth, other acute medical conditions, and opioid use. There is no report in the literature that links any Plastic Surgery procedure to Fowler Syndrome. We present the case of a 31-year-old female patient who had an episode of acute urinary retention 36 hours after liposculpture and augmentation mammoplasty. Infectious, anatomical and functional causes were ruled out upon admission to the emergency room, confirming the diagnosis of Fowler Syndrome. The patient was treated with bladder catheterization for 72h and tamsulosin for 15 days, with adequate response. Subsequent to this she presented a favorable evolution without new episodes of difficulty for urination, without functional sequelae or complications in the aesthetic surgical result.

ABSTRACT: Background: Vibration amplification of sound energy at resonance (VASER) liposuction is an innovative technique that allows surgeons to selectively remove fat and shape desired areas of the body, resulting in more precise and controlled outcomes compared to traditional liposuction techniques. VASER liposuction offers several advantages, including targeted action that reduces trauma to the surrounding tissues, limiting pain, swelling and recovery time. Purpose: This study compared the complication rates among patients who underwent VASER liposuction in relation to their body mass index (BMI) and the amount of fat aspirated. Methods: The authors reviewed the medical records of all patients who underwent VASER liposuction at Scalera Clinic in Naples, dividing them into two groups: the first with BMI < 24.9 kg/m2 and second with BMI >25.0 kg/m2. Results: The authors examined 117 patients who were operated on within a year (2022/2023), with 48 of them having BMIs < 24.9 kg/m2 and 69 showing BMIs >25.0 kg/m2. In patients with a BMI >25 kg/m2, the most common complications were contusion, hematomas and abnormal skin retraction, whereas no complications were observed in the patients with normal-weight. Conclusions: To minimise post-operative complications and maximise results, it is advisable to select patients based on their BMI assessment, the anatomy of the treated body area and the volume of fat to be removed. This approach aims to ensure that the patients are suitable for the procedure and the achieved results align with their aesthetic expectations.

Abstract This study aimed to develop and validate a machine learning (ML)-based model for predicting liposuction volumes in patients with obesity. This study used longitudinal cohort data from 2018 to 2023 from five nationwide centers affiliated with 365MC Liposuction Hospital, the largest liposuction hospitals in Korea. Fifteen variables related to patient profiles were integrated and applied to various ML algorithms, including random forest, support vector, XGBoost, decision tree, and AdaBoost regressors. Performance evaluation employed mean absolute error (MAE), root mean square error (RMSE), and R-squared (R2) score. Feature importance and RMSE importance analyses were performed to compare the influence of each feature on prediction performance. A total of 9,856 were included in the final analysis. The random forest regressor model best predicted the liposuction volume (MAE, 0.197, RMSE, 0.249, R2, 0.792). Body fat mass and waist circumference were the most important features of the random forest regressor model (feature importance 71.55 and 13.21, RMSE importance 0.201 and 0.221, respectively). Leveraging this model, a web-based application was developed to suggest ideal liposuction volumes. These findings could be used in clinical practice to enhance decision-making and tailor surgical interventions to individual patient needs, thereby improving overall surgical efficacy and patient satisfaction.

Gynecomastia is characterized by abnormal and excessive development of breast tissue in male patients. Depending on the volume of the breasts and the amount of excess skin, it may be unilateral or bilateral. Surgery is considered the standard of care, with several techniques documented, including different types of incisions made in the periareolar or intra-areolar skin. The most common surgical technique is conventional open surgery, which utilizes a semicircular inferior periareolar incision. To achieve superior aesthetic outcomes, various alternatives to open surgery have been proposed, including vacuum-assisted excision, endoscopic mastectomy, and liposuction Herein, we present two cases involving male patients, aged 29 and 24, who reported bilateral breast enlargement. We used the same incision for both liposuction and glandular excision. Our patients underwent combined liposuction on two planes: subcutaneous and subglandular, accompanied by sharp parenchymal excision. These small incisions, measuring 1–1.5 cm, are discreetly placed within the inframammary fold across the breast width. The patients experienced an uneventful recovery without any complications.

Background Lipedema is a chronic, incurable disorder characterized by painful fat accumulation in the extremities. While the application of liposuction in lipedema management has become increasingly popular, the safety and effectiveness of this approach remain contentious. Our systematic review and meta-analysis aimed to assess various liposuction modalities in lipedema management to verify their safety and efficacy.

This study aimed to develop and validate a machine learning (ML)-based model for predicting liposuction volumes in patients with obesity. This study used longitudinal cohort data from 2018 to 2023 from five nationwide centers affiliated with 365MC Liposuction Hospital, the largest liposuction hospitals in Korea. Fifteen variables related to patient profiles were integrated and applied to various ML algorithms, including random forest, support vector, XGBoost, decision tree, and AdaBoost regressors. Performance evaluation employed mean absolute error (MAE), root mean square error (RMSE), and R-squared (R2) score. Feature importance and RMSE importance analyses were performed to compare the influence of each feature on prediction performance. A total of 9,856 were included in the final analysis. The random forest regressor model best predicted the liposuction volume (MAE, 0.197, RMSE, 0.249, R2, 0.792). Body fat mass and waist circumference were the most important features of the random forest regressor model (feature importance 71.55 and 13.21, RMSE importance 0.201 and 0.221, respectively). Leveraging this model, a web-based application was developed to suggest ideal liposuction volumes. These findings could be used in clinical practice to enhance decision-making and tailor surgical interventions to individual patient needs, thereby improving overall surgical efficacy and patient satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: Wilkie’s syndrome is an unusual cause of high intestinal obstruction generated by vascular compression of the third portion of the duodenum. Objective: To present the clinical case of a 41-yearold female patient in postoperative period after liposuction, who developed acute clinical symptoms of abdominal pain, nausea, vomiting, imaging study confirmed Wilkie’s syndrome. Results: Young patient without relevant clinical history, presented a condition compatible with Wilkie Syndrome in postoperative period of liposuction, requiring conservative management with complete resolution of the clinical condition. Discussion and Conclusions: After diagnosis the patient received conservative treatment with complete resolution of the entity, after reviewing the literature on this syndrome, etiology and medicalsurgical management we can conclude that anatomical changes after plastic surgery of the abdominal wall associated with external medical compression devices and vascular anatomical variants of the patient may predispose to the development of this syndrome, timely diagnosis and treatment avoid major complications but more studies are needed to determine the true prevalence. [ABSTRACT FROM AUTHOR]

In recent years, the incidence of obesity has been on the rise. Bariatric surgery is widely recognized as a safe and effective method for treating obesity. In the short term following bariatric surgery, a significant reduction in body weight can be achieved, but this is often accompanied by excess skin and soft tissue, which not only affects appearance but also impairs daily activities. Skin diseases are more likely to occur in areas with skin folds. Abdominoplasty is one of the most commonly performed body contouring procedures for post-bariatric surgery patients. This article summarizes the characteristics of abdominal wall deformities following bariatric surgery and reviews the anatomical basis and current surgical treatment methods for abdominal contouring after bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: Gynecomastia is a progressive disease characterized by enlarged breasts, affecting a significant proportion of men. Persistent gynecomastia negatively affects the psychological and emotional development of patients; therefore, surgical intervention is required. In this article, we describe a surgical technique, where liposuction through an axillary incision is used in combination with a single small periareolar incision, to obtain the most minimal scars in the treatment of gynecomastia. Methods: Between June 2021 and June 2023, 125 patients with different Simon grades of gynecomastia were enrolled. The patients' basic conditions and operation processes were recorded. Following surgery, a score was assigned according to the five main aesthetic aspects of the surgical procedure. Results: In total, 125 patients with gynecomastia were treated with a pre-axillary fold incision combined with a small areolar incision. There were 17 cases of Simon grade I, 46 grade IIA, 42 grade IIB, and 20 grade III. The average operation time was 45.8 min, the average liposuction volume was 250.5 mL, the average glandular tissue volume was 50.5 g, intraoperative blood loss ranged from 15 to 60 mL, and the average hospital stay was 3.2 days. Regarding the postoperative aesthetic effect, doctors scored > 4 points, and the patient satisfaction score was > 7.5, which fully affirmed the aesthetic effect of this method. Conclusions: Treatment of gynecomastia through an anterior axillary fold incision combined with a small areolar incision is safe and feasible, involving a simple procedure, short operation time, and few complications. Its efficacy and cosmetic effects could lead to its use as a primary surgical method to treat gynecomastia. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Secondary lymphedema (LE) following breast cancer‐related surgery is a life‐long complication, which currently has no cure. LE induces significant regional adipose tissue deposition, requiring liposuction as a treatment. Here, we aimed to elucidate the transcriptional, metabolomic, and lipidomic signature of the adipose tissue developed due to the surgery‐induced LE in short‐ and long‐term LE patients and compared the transcriptomic landscape of LE adipose tissue to the obesity‐induced adipose tissue. Adipose tissue biopsies were obtained from breast cancer‐operated females with LE from the affected and non‐affected arms (n = 20 patients). To decipher the molecular properties of the LE adipose tissue, we performed RNA sequencing, metabolomics, and lipidomics combined with bioinformatics analyses. Differential gene expression data from a cohort of lean and obese patients without LE was used for comparisons. Integrative analysis of functional genomics revealed that inflammatory response, cell chemotaxis, and angiogenesis were upregulated biological processes in the LE arm, indicating a sustained inflammation in the edematous adipose tissue; whereas, epidermal differentiation, cell–cell junction organization, water homeostasis, and neurogenesis were downregulated in the LE arm. Surprisingly, only a few genes were found to be the same in the LE‐induced and the obesity‐induced adipose tissue expansion, indicating a different type of adipose tissue development in these two conditions. In metabolomics analysis, we found reduced levels of a branched‐chain amino acid valine in the LE arm and downregulation of the mRNA levels of its transporter SLC6A15. Lipidomics analyses did not show any significant differences between the LE and non‐LE arms, suggesting that other factors affect the lipid composition of the adipose tissue more than the LE in these patients. Our results provide a detailed molecular characterization of adipose tissue in secondary LE after breast cancer‐related surgery. We also show distinct differences in transcriptomic signatures between LE‐induced adipose tissue and obesity‐induced adipose tissue, but only minor differences in metabolome and lipidome between the LE and the non‐LE arm. [ABSTRACT FROM AUTHOR]

Introduction: This study elucidates the application of Medium Definition Liposuction Abdominoplasty, a novel technique for achieving well-defined abdominal contours. The technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. Methods: Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. Digital image measurements facilitated by an image software constituted the basis for these assessments. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites, with two measurements taken at each site and subsequently averaged. Results: Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. However, complications such as partial diminution of tension in the muscular wall (2%), distal flap necrosis (0.6%), and minor muscular hernia (0.3%) were observed. Conclusion: The employment of combined muscle plication emerges as an efficacious methodology in meticulously rectifying alterations inherent within the muscular aponeurotic abdominal wall. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. Bullet Points: The study introduces a novel technique, Medium Definition Liposuction Abdominoplasty, for achieving well-defined abdominal contours. This technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites. Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Lipomas, benign adipose tissue tumors, are a common occurrence but currently, the options for their treatment are limited, with surgical excision being the most frequently used management pathway. This scenario can often lead to unsatisfactory cosmetic results and significant patient discomfort. This paper introduces a novel technique, percutaneous microwave ablation with liposuction, to address these challenges. The innovative procedure aims to enhance patient satisfaction, minimize post-operative discomfort, and improve aesthetic outcomes. The technique involves two key steps: (1) the application of percutaneous microwave ablation to selectively disrupt the lipoma cells, followed by (2) a targeted liposuction procedure to remove the ablated lipoma tissue. Our approach optimizes the removal of the lipoma and preserves the surrounding healthy tissue, reducing the risk of local recurrence and improving the cosmetic result. The use of preoperative ultrasound imaging allows for precise localization and delineation of the lipoma, aiding in the planning and execution of the procedure. This novel approach to lipoma treatment is reliable, associated with minimal morbidity, and consistently yields effective results. Additionally, it provides a new perspective on lipoma management, potentially changing the paradigm of current treatment approaches. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

The incorporation of new technologies such as ultrasound, J-Plasma (helium plasma) and MicroAire (power assited liposuction) has facilitated liposculpture procedures, resulting in greater patient satisfaction. The benefits of these technologies are accompanied by low reported complications; this case is the fourth description of pneumomediastinum secondary to the use of Renuvion® (J-Plasma) after liposuction for fat removal in the arms and thighs. This rare complication should be considered as part of the differential diagnosis during the study of clinical dyspnea and subcutaneous emphysema in the postoperative period. [ABSTRACT FROM AUTHOR]

Lipedema is a relatively common, frequently misdiagnosed, chronic condition that is often treated using liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL) are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aimed to assess the efficacy and safety of liposuction in patients with lipedema. Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with post-operative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, and 2 articles used PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity. A total of 2542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). TTL, PAL, and WAL led to significant improvements in pain reduction P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). However, WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for the studies that used TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%). Liposuction techniques, including TTL, PAL, and WAL, resulted in significant symptom improvement in patients with lipedema with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. To the best of our knowledge, this is the first meta-analysis investigating liposuction data in lipedema treatment. [ABSTRACT FROM AUTHOR]

(1) Background: The demand for body-contouring procedures has surged, with lipolysis emerging as a common technique for excess fat removal. Laser-assisted lipolysis (LAL) has gained attention as a potential alternative to surgical fat removal (SFR), offering perceived advantages in safety and efficacy. However, the comparative benefits of LAL and SFR remain uncertain. (2) Objective: To conduct a review of the existing literature comparing the efficacy, safety, and patient satisfaction of LAL and SFR. (3) Methods: A comprehensive search of major electronic databases was conducted to identify studies comparing LAL and SFR for body-contouring procedures. Studies were included if they were published in English, involved human subjects, and reported outcomes for LAL and SFR. All studies were classified according to the Oxford Center for Evidence-Based Medicine evidence hierarchy (4) Results: LAL may not be a safer and more effective option than SFR. However, the evidence for these differences was limited by the quality of the studies and the heterogeneity of the results. (5) Conclusions: This review suggests that LAL may not be a safer and more effective option than SFR for body-contouring procedures because LAL is associated with higher risks of complications such as burns and scarring, whereas SFR offers a more established safety profile and consistent efficacy. [ABSTRACT FROM AUTHOR]