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OBJECTIVES: The primary objective of this pilot study was to confirm the safety of a 1064-nm laser device with a novel robotic arm for noninvasive subcutaneous fat reduction in the flank area. Secondary objectives included: assessing the extent of subject discomfort during treatment, overall subject satisfaction with the results of the procedure, and a determination of subcutaneous fat reduction in the treated area, in preparation for larger upcoming trials. MATERIALS AND METHODS: A 110-cm2 area on both flanks of enrolled subjects (N = 11; 22 flanks) was treated for 20 minutes with a Food and Drug Administration-cleared robotic noncontact 1064-nm laser system (EON®; Dominion Aesthetic Technologies, Inc.). Patients were followed for 12 weeks, and examined routinely at 2 weeks, 12 weeks, and additionally as needed, posttreatment. Ad hoc surveys were administered to assess patient satisfaction. A 2-week posttreatment ultrasound scan was used to check for changes in the treated area. Ultrasound measurements were also used to determine the subcutaneous adipose tissue thickness at a center of each treatment zone before treatment and at 12 weeks posttreatment for efficacy determination, with mean thicknesses calculated per subject. RESULTS: The treatment had a low incidence of adverse effects, with only one subject developing a palpable thickening in the subcutaneous tissue following treatment. This was noted at the 2-week time period and had resolved by the 12-week posttreatment exam. No other predefined adverse effects were noted. On a scale of 0-10, the mean pain score during the procedure was 1.95, decreasing to 0.9 at 30 minutes postprocedure. Subject satisfaction was "Excellent" for all subjects (100%). At Week 12 after one treatment, the mean reduction in subcutaneous adipose thickness on the treated flanks was 6.1 mm per patient (-15%; p < 0.01). CONCLUSION: Similar to a prior abdominal study with the same robotic laser device, this pilot study confirms the safety of this 1064-nm noncontact laser device for treating subcutaneous fat on the flanks. The procedure is well tolerated with a high degree of subject satisfaction. The amount of subcutaneous fat reduction in the flank area appears similar to that seen in the abdomen, but larger studies are required for confirmation. CLINICALTRIALS: gov Identifier: NCT04797988.

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Preoperative assessment of a potential surgical patient has long been a cornerstone of patient safety. As more patients get, and recover from, COVID, plastic surgeons will be faced with the challenge of evaluating the health status and operative risk of convalescent COVID patients who now desire elective surgery. A significant fraction of these patients, however, can have new or persistent health issues as a result of COVID-19, which can affect surgical safety. This paper briefly examines the current relevant literature regarding the post-COVID patient, reviews the waiting period for adequate recovery, and suggests an evidence-based framework for preoperative assessment, based on the severity of the prior COVID-19 episode, ongoing symptoms, and basic screening tests.

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BACKGROUND: A novel FDA-cleared device uses a 1064-nm laser to noninvasively induce apoptosis for lipolysis of subcutaneous abdominal fat while maintaining comfortable skin temperatures with a proprietary jet cooling system (eon; Dominion Aesthetic Technologies, Inc., San Antonio, TX). A programmable articulated robotic arm moves the treatment head without any subject contact, maintaining an appropriate 3-dimensional treatment path, compensating for patient movement. OBJECTIVES: The goal of this prospective, single center, open-label study was to demonstrate the safety and effectiveness of this device for reducing subcutaneous abdominal fat when operated with an updated power delivery curve. METHODS: Male and female subjects with Fitzpatrick skin types I to VI (N = 26) were treated. Four abdominal zones up to 150 cm2 each, customized in size and location for body habitus, were treated. Each zone underwent a single 20-minute treatment session. Follow-up visits occurred after 6 and 12 weeks. A standardized protocol was used to obtain ultrasound measurement of subcutaneous abdominal fat thickness, abdominal circumference, reported patient satisfaction and digital images. RESULTS: The mean treatment area was 378.5 cm2. At Week 12, there was a 21.6% or 6.3 mm mean reduction in abdominal subcutaneous fat thickness and a 4.1-cm (1.6-inch) mean reduction in abdominal circumference. Most subjects (84.6%) were satisfied or very satisfied with their results. The mean pain score was 2.5 on an 11-point ordinal scale. There were no nonresponders. Only 2 adverse events were noted: mild transient erythema (n = 1, 3.8%) and localized subcutaneous firmness (n = 1, 3.8%) which resolved without intervention within 12 weeks. CONCLUSIONS: This contact-free device is safe and effective for reducing subcutaneous abdominal fat and represents an improvement on the prior treatment protocol.

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BACKGROUND: Pain control following abdominoplasty is a major source of concern for the patient and surgeon alike. Pain pumps and opiate medications are currently the frontline therapies. With the following technique, Exparel (liposomal bupivacaine, 72-hour duration of action) has been used for transversus abdominis plane (TAP) blocks under direct visualization during abdominoplasty with the goal of improving pain control during the early and intermediate recovery period. MATERIALS AND METHODS: In this pilot study, 13 consecutive patients were treated with the direct, fascial-splitting technique to reach the TAP plane. Using a spinal needle, 20 mL of liposomal bupivacaine was injected deep to the internal oblique fascia bilaterally under direct vision. Primary and secondary endpoints of total opiate use and patient reported pain scores were assessed. RESULTS: All 13 patients met inclusion criteria as abdominoplasty patients with adequate follow-up data. The average visual analog scale pain score was 2.5 on postoperative day 1 and 1.7 on postoperative day 3. The average total opiate use (the number of 10 mg oxycodone tabs consumed) was 7.5 or 75 mg per patient. CONCLUSIONS: This pilot study demonstrates the safety and efficacy of liposomal bupivacaine TAP blocks under direct vision. Favorable pain control was demonstrated. This represents an exciting opportunity to decrease postoperative pain in the early and intermediate recovery period after abdominoplasty.

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BACKGROUND: The transversus abdominis plane (TAP) block is an effective regional nerve block for the anterior abdominal wall. An anesthesiologist typically administers the TAP block preoperatively with ultrasound guidance. It is not yet commonly used during abdominoplasty, where postprocedural pain remains a major concern for patients and surgeons. OBJECTIVES: The author investigated the feasibility of administering the TAP block under direct vision and compared postoperative narcotic use in patients who received analgesia by TAP block vs by a standard nerve block, both performed under direct vision during abdominoplasty with or without flank liposuction. METHODS: In this pilot study, 32 consecutive patients received either a TAP block (n = 16) or a combination of pararectus injections and ilioinguinal/iliohypogastric nerve blocks (n = 16) during abdominoplasty. Patients in both groups also received an injection of bupivacaine in the rectus plication. All patients were then monitored for narcotic use patterns during the first 16 hours after surgery. Statistical significance was ascertained with the t test. RESULTS: Patients in the TAP block group required a significantly smaller mean dose of postoperative hydromorphone (TAP block group: 2.63 mg; standard treatment group: 4.31 mg; P = .024) and had a significantly longer mean time to first request for as-needed pain medication (TAP block group: 3 hours 11 minutes; standard treatment group: 1 hour 27 minutes; P = .022). CONCLUSIONS: The open TAP block provided more effective analgesia than a standard nerve block in the observation period after abdominoplasty with or without flank liposuction. Larger studies are needed to confirm the results.

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While most surgeons are well aware of outcomes studies and quality assessment based on technical quality (TQ) measurements, there has been little attention given in the plastic surgery literature to the discussion of functional quality (FQ)-the process by which a health care service is delivered, as opposed to the actual procedure itself. Most patients judge the quality of their hospital experience based on FQ issues. They use their assessment of FQ to secondarily infer a judgment of the TQ level of a surgeon or facility. Surgeons, conversely, typically rate their own success with purely technical quality measures, paying little attention to FQ. This article reviews the relevant service-quality medical literature and introduces plastic surgeons to the importance of differentiating between TQ and FQ. Important FQ assessment techniques are reviewed. Implications for the plastic surgeon are discussed.

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