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BACKGROUND: Abdominoplasty has been evolving since the 1960s with many technical innovations throughout the years. It has become one of the most frequent and common procedures done in aesthetic plastic surgery, with the ultimate goal of not only to remove the excess tissue in the abdominal area but also to achieve an aesthetic trunk silhouette. OBJECTIVE: The prime objective of this article was to describe our preferred approach for a full cosmetic abdominoplasty. METHODS: We summarized all the key technical aspects from our shared surgical approach for abdominoplasty. The article describes collective experiences from authors performing the surgery in South America, North America, and Asia. RESULTS: The key technical aspects identified were conservative muscle plication, customized excess tissue resection, and ultrasound-assisted liposuction to improve definition in the abdominal lines and body curves, combined with lipofilling. The aesthetic results are presented. CONCLUSIONS: Abdominoplasty should be customized to every patient's anatomy and desired cosmetic outcome, taking into consideration all the anatomical areas surrounding the abdominal wall.
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Parede Abdominal , Abdominoplastia , Lipectomia , Parede Abdominal/cirurgia , Ásia , Humanos , América do SulRESUMO
BACKGROUND: Contemporary periorbital rejuvenation is undergoing a paradigm shift to an approach that prioritizes volume preservation and/or augmentation. However, the technical difficulties of using traditional fat grafting techniques in this area and the distinct ethnic features make periorbital rejuvenation in Asians especially challenging. Here, the authors present their approach to enhance the periorbita and outcomes. METHODS: A retrospective chart review was performed for 33 consecutive patients who underwent microautologous fat transplantation (MAFT) to the periorbita using the MAFT gun device combined with excisional blepharoplasty. Additionally, preoperative and postoperative photographs were analyzed by external evaluators to grade the aesthetic outcomes and fat resorption rates. RESULTS: Three months after surgery, patients looked on average 5.4 ± 3.4 years younger, and the aesthetic result was graded 7.4 ± 2 in a one-to-ten scale. The fat resorption rate was 19.6% ± 3.5% at 3 months and 32.2% ± 3.9% after 12 months (range: 12-24 months; P = 0.007). The overall morbidity rate was 12% (4 patients), including 1 visible lump (3%), an overcorrection case (3%) in the lower eyelid, and 2 palpable lumps in the upper eyelid (6%) which were not visible. One case of lower eyelid hollowness required secondary fat grafting. CONCLUSIONS: Traditional blepharoplasty procedures can be combined with fat grafting techniques to address volume loss and tissue descend while keeping ethnic identity. A fat injection device like the MAFT gun is safe and effective and provides long-term predictable outcomes for fat grafting around the periorbital thin skin.
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BACKGROUND: Animal models and clinical cases of facial allotransplantation have been performed as a single stage procedure. A staged surgery might offer some advantages in selected cases. In this study, a two-stage face transplantation approach was performed on rat and the feasibility and safety were evaluated. METHODS: Brown Norway rats were used as donors and Lewis rats as recipients in the allotransplantation groups. A total of 33 hemiface-scalp transplantations were performed. Syngeneic orthotopic transplantations were performed either in one-stage (one single stage surgery; N = 3), local two-stage [heterothopic transplantation to the neck during the first stage and graft rotation as a pedicled flap to cover the facial defect on postoperative day (POD) 2; N = 3], or distant two-stage approaches (heterothopic transplantation to the groin during the first stage and free graft transfer to the face on postoperative day 2; N = 3). In the allotransplantation groups using the same approaches, 12 received no treatment (N = 4 each subgroup) and 12 received the same tapering dose of cyclosporine (10 to 2 mg/Kg/day; N = 4 each subgroup). Graft survival and the rejection grades were assessed clinically and pathologically. RESULTS: All syngeneic transplants survived for the follow-up period of 180 days. The mean rejection-free survival and total survival of the allograft in the no treatment group was 6 ± 0.3 and 14.3 ± 4.5 days in the one-stage group, 6 ± 0.4 and 18.5 ± 1 days in the local two-stage group and 6 ± 0.2 and 14.3 ± 5.7 (P > 0.05). All allografts in the treatment groups did not develop rejection during the 42 days follow-up period. CONCLUSIONS: It is feasible, reliable, reproducible, and safe to perform a two-stage face transplantation in rats. This novel approach has the potential to be applied in research and eventually in selected clinical cases of facial allotransplantation.
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Transplante de Face/métodos , Animais , Estudos de Viabilidade , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Masculino , Ratos , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Reprodutibilidade dos TestesRESUMO
Vascularized bone marrow transplantation (VBMT) appears to promote tolerance for vascularized composite allotransplantation (VCA). However, it is unclear whether VBMT is critical for tolerance induction and, if so, whether there is a finite amount of VCA that VBMT can support. We investigated this with a novel VCA combined flap model incorporating full-thickness hemiabdominal wall and hindlimb osteomyocutaneous (HAW/HLOMC) flaps. Effects of allograft mass (AM) and VBMT on VCA outcome were studied by comparing HAW/HLOMC VCAs with fully MHC-mismatched BN donors and Lewis recipients. Control groups did not receive treatments following transplantation. Treatment groups received a short course of cyclosporine A (CsA), antilymphocyte serum, and three doses of adipocyte-derived stem cells (POD 1, 8, and 15). The results showed that all flaps in control allogeneic groups rejected soon after VCAs. Treatment significantly prolonged allograft survival. Three of eight recipients in HLOMC treatment group had allografts survive long-term and developed donor-specific tolerance. Significantly higher peripheral chimerism was observed in HLOMC than other groups. It is concluded that the relative amount of AM to VBMT is a critical factor influencing long-term allograft survival. Accordingly, VBMT content compared with VCA mass may be an important consideration for VCA in humans.