Louisville Aesthetic Plastic Surgery

Research Roundup

Mechanical Supplementation With the Stromal Vascular Fraction Improved Volume Retention in Facial Lipotransfer: A 1-year Comparative Study

Natale Ferreira Gontijo-de-Amorim, PhD, Luiz Charles-de-Sa, MD; Aesthet Surg J 2017; 37 (9): 975-985

Background

Fat transfer procedures have demonstrated a wide variety of benefits in both aesthetic and reconstructive surgery.  The procedure involves the transfer of fat from one area to another.  The transferred fat adds volume and may improve the surrounding tissue quality due to stem cells located within the adipose cells.  There is no consensus regarding the method of transfer that will result in the best volume retention.

Methods

Lipoaspirate (fat from liposuction) was separated through a common procedure involving centrifugation.  This yields 3 layers of tissue- aqueous, adipose, stromal vascular fraction (SVF).  Patients undergoing fat transfer procedures either received fat alone or fat with SVF enrichment.  Patients were evaluated by CT scan and subjective aesthetic outcomes.  The different fat preparations were evaluated histologically.

Results

No complications were observed.  Fat that was enriched with SVF demonstrated an increase in volume retention versus fat alone.  Patients treated with enriched fat demonstrated an improved subjective outcome.  Histology demonstrated a large amount of stem cells within the SVF.

Conclusion

Fat transfer procedures including SVF are associated with improved aesthetic appearance and better volume retention.

               

Take-home message

Fat grafting procedures are a very powerful tool in plastic surgery.  Fat transfer allows for increase in volume and may improve surrounding tissue quality.  New methods may further enhance these results.  Fat transfer is different than using dermal fillers.  Dermal fillers are temporary and do not contain stem cells that are associated with tissue regeneration. Fat transfer is now utilized in combination with a variety of aesthetic facial plastic surgery procedures.

Louisville Aesthetic Plastic Surgery

Research Roundup

Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures

Christodoulos Kaoutzanis, MD, Varun Gupta, MD, MPH, Julian Winocour, MD, John Layliev, MD, Roberto Ramirez, MD, James C. Grotting, MD, FACS, Kent Higdon, MD, FACS; Aesthet Surg J 2017; 37 (6): 680-694

Background

Liposuction represents the most common procedure in plastic surgery.  Over 396,000 procedures were performed in 2015.  Liposuction is now commonly utilized in addition to other procedures, such as abdominoplasty, thigh lift, facial aesthetic procedures, fat grafting, breast augmentation, and breast lifting procedures.  This study sought to evaluate adverse events to better educate patients and to help make informed decisions when deciding on procedures to be performed.     

Methods

Databases were reviewed to evaluate the incidence of adverse events in over 2500 patients undergoing liposuction, either alone or in combination with other procedures.  Adverse events evaluated included hematoma, infection, wound healing problems, pulmonary and cardiac problems, blood clots (venous thromboembolism), and physiologic fluid problems.

Results

 Liposuction procedures were associated with an overall 0.7% risk of major adverse events.  When combined with other procedures, the risk of adverse events was approximately 3.5%.  Factors that were associated with increased risk include: advanced age, obesity, tobacco use, diabetes, female gender, procedures performed in hospitals, and combined procedures. 

Conclusion

Overall, liposuction has a low rate of adverse events when used primarily or in combination with other procedures.  Several risk factors were identified: advanced age, obesity, tobacco use, diabetes, female gender, procedures performed in hospitals.  This data allows for better patient education and ability to enhance patient safety.

               

Take-home message

Liposuction is associated with a low rate of adverse events, when used alone or in combination with other procedures.  It is important to consider risk factors when deciding on procedures performed.  Patients should be honest with their surgeons regarding their medical problems and tobacco use.  Patient safety is the number one priority in plastic surgery.  It is important to trust your surgeon if he/she advises against a procedure based on your risk.  As an old mentor once said, “just because you can do something, it doesn’t mean that you should”.

Louisville Aesthetic Plastic Surgery

Research Roundup

Breast Implant Volume Required to Increase Bra Size

Nina-Marie NM King; What Is the Standard Volume to Increase a Cup Size for Breast Augmentation Surgery? A Novel Three-Dimensional Computed Tomographic Approach. Plast Reconstr Surg. 2017 May;139(5):1084-1089

Background

Women commonly inquire about the size of an implant needed to increase bra cup size.  Historic approximations indicated that each 100cc increment increases one cup size.  Subsequent studies have shown a wide variation.  Different bra manufacturers are not always consistent regarding cup sizes.  This study is designed to analyze the volume needed to increase one cup size, utilizing a variety of bra manufacturers.           

Methods

Size 34 B-E bras were evaluated from 3 different bra manufacturers.  The actual volume of each cup size was evaluated by a variety of methods, including volume displacement, measurements and CT reconstruction.  79 patients were evaluated who had undergone breast augmentation.  These patients had been studied using the a 3-dimensional imaging device (Vectra).  All women received silicone, form-stable implants.

Results

Actual bra volumes were variable among different manufacturers for the same cup size. Looking at bra cup volume by itself, the average volume required to increase one cup size ranged from 108-151cc’s across the different manufacturers.  The implant volume required to increase one cup size varied between patients from 75-295cc, with a mean of 138cc.

Conclusion

Bra manufacturers are inconsistent regarding cup sizes.  Some manufacturers have different cup sizes for the same actual volume.  Therefore, it is very difficult to predict the volume needed to consistently increase one cup size. Nevertheless, an average volume of 130cc’s was required for smaller band sizes, and 150cc’s for larger band sizes.

               

Take-home message

Patients and surgeons know well that bra sizes vary among manufacturers.  My experience is that professional sizing at particular stores is vital.  It is also very helpful to be consistent when choosing bra brands.  More accurate data now shows that an increase of around 150cc’s will equate to increase in one cup size.  This is still just an estimation, as there are a variety of breast implant consistencies (saline vs. traditional silicone vs. form-stable silicone) and projection (low vs. moderate vs. high) for the same implant volume.

Louisville Aesthetic Plastic Surgery

Research Roundup

Decreasing Complications Associated with Abdominoplasty

Luis H. Macias, MD, FACS, Edwin Kwon, MD, Daniel J. Gould, MD, PhD, Michelle A. Spring, MD, FACS, W. Grant Stevens, MD, FACS; Decrease in Seroma Rate After Adopting Progressive Tension Sutures Without Drains: A Single Surgery Center Experience of 451 Abdominoplasties Over 7 Years. Aesthet Surg J 2016; 36 (9): 1029-1035.

Background

                Abdominoplasty is the fourth most common aesthetic procedure in plastic surgery.  A common complication is the development of seroma.  Traditional techniques have included the placement of drains during the procedure to decrease the incidence of seroma.  More recent experience has shown that placement of progressive tension sutures may decrease the risk of seroma compared to placement of drains.

Methods

                The authors reviewed the data on 453 abdominoplasty procedures over a 7 year period.  Drains were used during the initial 4 years.  There was a transition to the use of progressive tension sutures over the next 3 years. A retrospective review was performed to evaluate the incidence of post-operative complications, including: seroma, hematoma, delayed wound healing, need for revision surgery, and pulmonary embolism/deep venous thrombosis.

Results

                Development of seroma and need for scar-revision were decreased in the patients who received progression tension sutures compared to placement of drains.  There were no significant differences in the incidence of the remaining complications.

Conclusion

                Placement of progressive tension sutures decreased the rate of seroma formation.  Further study is recommended to validate these results

Take-home message

                Abdominoplasty (tummy-tuck) is a common aesthetic procedure to remove excess skin and fat from the lower abdomen and to tighten the abdominal muscles.  The development of seroma (fluid collection beneath the skin) is a known complication.  This may require additional procedures to address.  Traditionally, drains have been used to decrease the rate of seroma.  Newer techniques during the procedure have been shown to decrease the rate of seroma and eliminate the use of drains. 

            This study demonstrates that abdominoplasty procedures may be safely performed without the use of drains in certain patients. Newer techniques may even decrease the risk of certain complications compared with traditional techniques.  Avoidance of drain placement may significantly decrease the discomfort associated with abdominoplasty procedures.

Louisville Aesthetic Plastic Surgery

New Addition- Research Roundup

Aesthetic surgery is an exciting and ever-changing field.  There is a great deal of research in the field that constantly aims to improve results of aesthetic procedures.  I am actively involved in aesthetic surgery research to help other surgeons.  I strive to offer the most cutting-edge options in aesthetic surgery.  An educated and informed patient is vital in my practice.  I feel that sharing significant research and summarizing it in an easy to understand format may help my patients.  Therefore, I will be adding a new section that reviews cutting-edge research and relate how it is incorporated in the care of my patients.