BOOK
Body Contouring and Liposuction E-Book
J. Peter Rubin | Mark L. Jewell | Dirk Richter | Carlos Oscar Uebel
(2012)
Additional Information
Book Details
Abstract
Master the full spectrum of "body sculpting" procedures with Body Contouring and Liposuction by J Peter Rubin, MD, FACS, Mark L Jewell, MD, Dirk Richter, MD, PhD, and Carlos O Uebel, MD, PhD! From fat grafts and liposuction through total body lift following massive weight loss surgery, full-color photos and procedural videos show you exactly how to proceed, step by step, and achieve gratifying results.
- Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located.
- Exceed your patients' expectations thanks to expert, multimedia guidance from many of today's most accomplished experts in aesthetic plastic surgery.
- Know what to look for and how to proceed thanks to videos and full-color illustrations demonstrating brachioplasty, breast reshaping after massive weight loss, thigh and buttock contouring, combining abdominoplasty and mastopexy, and other in-demand procedures.
- Find the answers you need quickly through a user-friendly organization.
- Access the complete contents online, as well as videos and downloadable illustrations, at www.expertconsult.com.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Body Contouring and Liposuction | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Preface | vii | ||
| Dedication | vii | ||
| List of Contributors | viii | ||
| Introduction | 1 | ||
| Further Reading | 2 | ||
| 1 Patient evaluation and safety | 4 | ||
| 1 Patient safety in body contouring | 4 | ||
| Key Points | 4 | ||
| Introduction | 4 | ||
| Preoperative Assessment and Patient Selection | 4 | ||
| Medical Assessment | 4 | ||
| Nutritional Assessment | 6 | ||
| Psychiatric and Behavioral | 6 | ||
| Intraoperative Management | 7 | ||
| Staging | 9 | ||
| Postoperative Management | 9 | ||
| Postoperative Antibiotics | 9 | ||
| DVT Prophylaxis | 9 | ||
| Antiplatelet and Beta-blockers | 10 | ||
| Glycemic Control | 10 | ||
| Postoperative Nausea and Emesis (PONV) | 10 | ||
| Respiratory Management | 10 | ||
| Patient Safety in Your Practice | 10 | ||
| Complications and Their Management | 12 | ||
| Conclusion | 12 | ||
| References | 12 | ||
| 2 Upper extremity contouring | 14 | ||
| 2 Liposuction of the upper extremities | 14 | ||
| Key Points | 14 | ||
| Introduction | 14 | ||
| Preoperative Preparation | 14 | ||
| Patient Selection | 14 | ||
| Surgical Technique | 14 | ||
| SAL | 15 | ||
| VAL (VASER) | 15 | ||
| Laser-Assisted Liposuction (LAL) and Laser Tissue Interaction | 16 | ||
| Surgical Technique for LAL on the Upper Arm | 16 | ||
| Forearm | 17 | ||
| Optimizing Outcomes | 17 | ||
| Postoperative Care | 17 | ||
| Complications and Their Management | 18 | ||
| Conclusion | 18 | ||
| References | 18 | ||
| 3 Brachioplasty with bicipital groove scar | 19 | ||
| Key Points | 19 | ||
| Introduction | 19 | ||
| Preoperative Preparation | 19 | ||
| Surgical Technique | 21 | ||
| Optimizing Outcomes | 22 | ||
| Postoperative Care | 23 | ||
| Complications and Their Management | 23 | ||
| References | 23 | ||
| 4 Brachioplasty – the double ellipse technique | 24 | ||
| Key Points | 24 | ||
| Introduction | 24 | ||
| Preoperative Preparation | 24 | ||
| Surgical Technique | 25 | ||
| Preoperative Markings: Double Ellipse Technique | 25 | ||
| Surgical Sequence | 25 | ||
| Postoperative Care | 26 | ||
| Optimizing Outcomes | 27 | ||
| Complications and Their Management | 27 | ||
| Conclusion | 28 | ||
| References | 28 | ||
| 5 Brachioplasty with liposuction resection | 29 | ||
| Key Points | 29 | ||
| Introduction | 29 | ||
| Preoperative Preparation | 29 | ||
| Surgical Technique (Fig. 5.3) | 30 | ||
| Optimizing Outcomes | 32 | ||
| Postoperative Management | 33 | ||
| Complications and Their Management | 33 | ||
| Conclusion | 34 | ||
| References | 34 | ||
| 6 Limited scar brachioplasty | 35 | ||
| Key Points | 35 | ||
| Introduction | 35 | ||
| Preoperative Preparation | 35 | ||
| Surgical Technique | 35 | ||
| Markings | 35 | ||
| The Procedure | 36 | ||
| Optimizing Outcomes | 38 | ||
| Postoperative Care | 38 | ||
| Complications | 40 | ||
| Conclusion | 41 | ||
| References | 42 | ||
| 3 Breast | 43 | ||
| 7 Fat grafting to the breast | 43 | ||
| Key Points | 43 | ||
| Introduction | 43 | ||
| History of Fat Grafting | 43 | ||
| Principle of Low Pressure Fat Harvesting | 43 | ||
| Autologous Fat Grafting to the Breast | 45 | ||
| Technique | 45 | ||
| Harvesting | 45 | ||
| Local Infiltration | 45 | ||
| Cannulae | 45 | ||
| Fat Cell Preparation | 45 | ||
| Fat Injection | 45 | ||
| Postoperative Care | 46 | ||
| Fat Grafting for Implant Failure | 46 | ||
| Fat Grafting in Conjuction with Mastopexy | 46 | ||
| Preoperative Preparation | 46 | ||
| Surgical Technique | 47 | ||
| Fat Grafting for Augmentation | 47 | ||
| Fat Grafting Over Existing Implants | 49 | ||
| Fat Grafting for Breast Reconstruction | 49 | ||
| Fat Grafting for Congenital Breast Deformities | 49 | ||
| Optimizing Outcomes | 53 | ||
| Conclusion | 54 | ||
| References | 54 | ||
| 8 Ultrasound-assisted breast reduction | 56 | ||
| Key Points | 56 | ||
| Introduction | 56 | ||
| Preoperative Preparation | 56 | ||
| Patient Selection | 56 | ||
| Preoperative Mammography | 56 | ||
| Contraindications | 56 | ||
| Preoperative Planning | 56 | ||
| Surgical Technique | 56 | ||
| Infiltration | 56 | ||
| Skin Incisions | 57 | ||
| Probes | 58 | ||
| Technique | 58 | ||
| Fat Emulsification | 59 | ||
| Subcutaneous UAL Undermining | 59 | ||
| Optimizing Outcomes | 59 | ||
| Postoperative Care | 60 | ||
| Clinical Results | 60 | ||
| Mastopexy | 60 | ||
| Histologic Changes | 60 | ||
| Markings | 61 | ||
| Complications and Their Management | 64 | ||
| Skin Necrosis | 65 | ||
| Loss of Sensation | 65 | ||
| Hematoma | 65 | ||
| Mastitis | 65 | ||
| Seroma | 65 | ||
| Selectivity and Specificity of Ultrasound | 65 | ||
| Calcifications | 66 | ||
| Potential Risks | 66 | ||
| Conclusion | 66 | ||
| References | 66 | ||
| 9 Combined abdominal contouring and mastopexy | 68 | ||
| Key Points | 68 | ||
| Introduction | 68 | ||
| Abdominoplasty | 68 | ||
| Preoperative Preparation | 68 | ||
| Anesthesia | 70 | ||
| Surgical Technique | 70 | ||
| Tumescent Infiltration and Assisted Liposuction | 70 | ||
| Supraumbilical Incision and Epigastric Tunnel Undermining | 70 | ||
| Pull-down Approach | 72 | ||
| Umbilical Stalk Circumcision and Inferior Flap Block Resection | 72 | ||
| Fat Trimming | 72 | ||
| Rectus Muscle Aponeorotic Plication | 72 | ||
| Exteriorization of the Umbilicus Stalk | 72 | ||
| Subcutaneous Adhesion Stitches and Closing Sutures | 75 | ||
| Mammaplasty | 75 | ||
| Breast Augmentation with Silicone Prostheses | 75 | ||
| Mastopexy with Pitanguy–Ariê approach and Superior Pedicle Flap | 75 | ||
| Breast Hypertrophy Reduction | 75 | ||
| Postoperative Remarks and Optimizing Outcomes | 78 | ||
| Complications and Their Management | 79 | ||
| Conclusion | 79 | ||
| References | 86 | ||
| 10 Breast reshaping using autologous tissues after massive weight loss | 87 | ||
| Key Points | 87 | ||
| Introduction | 87 | ||
| Clinical Approach | 87 | ||
| Techniques Based on Locoregional Tissue | 87 | ||
| Techniques Based on Distant Tissue | 88 | ||
| Preoperative Preparation | 88 | ||
| Surgical Technique | 88 | ||
| LICAP Flap (Fig. 10.1) | 88 | ||
| DIEAP Flap (Fig. 10.2) | 90 | ||
| TMG Flap | 93 | ||
| Postoperative Care | 94 | ||
| Complications and Their Management | 94 | ||
| Conclusion | 94 | ||
| References | 95 | ||
| 11 Combined abdominoplasty and breast enlargement by autologous tissue transfer or transabdominal implant placement | 96 | ||
| A. Augmentation Mammaplasty by Reverse Abdominoplasty | 96 | ||
| Introduction | 96 | ||
| Preoperative Planning/ Patient Selection | 96 | ||
| Surgical Technique | 96 | ||
| Superiorly Based Augmentation Mammaplasty by Reverse Abdominoplasty | 97 | ||
| Peri- and Postoperative Care | 98 | ||
| Case Examples | 98 | ||
| Complications and Their Management | 98 | ||
| Conclusion | 98 | ||
| B. Transabdominal Breast Augmentation | 98 | ||
| Introduction | 101 | ||
| Preoperative Planning/ Patient Selection | 101 | ||
| Marking and Anesthesia | 101 | ||
| Surgical Technique | 102 | ||
| Peri- and Postoperative Care | 104 | ||
| Complications and Their Management | 104 | ||
| Conclusion | 104 | ||
| References | 104 | ||
| 12 Mammaplasty with L-shaped scar | 105 | ||
| Key Points | 105 | ||
| Introduction | 105 | ||
| Proportions and Anatomy of the Beautifully Shaped Breast | 105 | ||
| Shape and Volume | 105 | ||
| Frontal View | 105 | ||
| Lateral View | 106 | ||
| Vertical View | 107 | ||
| Diagnosis of Breast Shapes and Volume Alterations | 109 | ||
| Flaccidity (Ptosis) | 109 | ||
| Measurement | 109 | ||
| Nipple–Areola Esthetic Disorders | 111 | ||
| Surgical Technique | 111 | ||
| Cone Modeling of Group I | 111 | ||
| Breast Modeling of Group II – Hypertrophies | 112 | ||
| Gland Modeling of Group III – Hypertrophies | 112 | ||
| Gland Modeling of Group IV – Hypertrophies | 113 | ||
| Modeling Asymmetric Breasts | 115 | ||
| Mammaplasty with L-Shaped Scar | 115 | ||
| Marking | 115 | ||
| Ouvir | 117 | ||
| Ler Foneticamente | 117 | ||
| References | 121 | ||
| Further Reading | 121 | ||
| 13 Breast reshaping after massive weight loss | 122 | ||
| Key Points | 122 | ||
| Introduction | 122 | ||
| Preoperative Preparation | 123 | ||
| Surgical Procedure | 123 | ||
| Spiral Flap of Hurwitz with Upper Body Lift | 123 | ||
| Dermal Suspension Mastopexy of Rubin with Auto-augmentation | 126 | ||
| Optimizing Outcomes | 128 | ||
| Postoperative Care | 128 | ||
| Complications | 128 | ||
| Conclusions | 129 | ||
| References | 137 | ||
| 14 Breast reshaping after massive weight loss, implant based | 139 | ||
| Key Points | 139 | ||
| Introduction | 139 | ||
| Preoperative Preparation | 140 | ||
| Preoperative Planning – Primary Augmentation Mammaplasty | 141 | ||
| Incision | 141 | ||
| 141 | |||
| Implant | 142 | ||
| Surgical Technique | 142 | ||
| Primary Augmentation Mammaplasty | 142 | ||
| Surgical Technique – Staged Augmentation Mammaplasty | 145 | ||
| Optimizing Outcomes | 146 | ||
| Postoperative Care | 146 | ||
| Complications and Their Management | 147 | ||
| Implant Malposition | 147 | ||
| Recurrent Ptosis | 148 | ||
| Conclusion | 148 | ||
| References | 148 | ||
| 4 Upper trunk contouring | 149 | ||
| 15 Liposuction of upper back/bra rolls | 149 | ||
| Key Points | 149 | ||
| Introduction | 149 | ||
| Anatomical Aspects | 149 | ||
| Surgical Treatment | 149 | ||
| Planning – Demarcation | 149 | ||
| Anesthesia | 149 | ||
| Positioning on the Operation Table | 151 | ||
| Surgical Technique | 153 | ||
| Postoperative Care and Results | 153 | ||
| Complications | 154 | ||
| Conclusion | 154 | ||
| Further Reading | 158 | ||
| 16 Transverse upper body lift | 159 | ||
| Key Points | 159 | ||
| Introduction | 159 | ||
| Preoperative Preparation | 159 | ||
| Patient Evaluation | 159 | ||
| Preoperative Markings | 160 | ||
| Surgical Technique | 161 | ||
| Postoperative Care | 162 | ||
| Complications and Management | 162 | ||
| Conclusion | 165 | ||
| References | 165 | ||
| 17 Upper body lift with lateral excision | 166 | ||
| Key Points | 166 | ||
| Introduction | 166 | ||
| Preoperative Preparation | 166 | ||
| Markings | 168 | ||
| Surgical Technique | 168 | ||
| Brachioplasty/Mammaplasty/Bra-line Backlift | 168 | ||
| Upper Lateral Thoracic Lift | 170 | ||
| Optimizing Outcomes | 171 | ||
| Postoperative Care | 171 | ||
| Complications and Their Management | 171 | ||
| Conclusion | 176 | ||
| References | 176 | ||
| Further reading | 176 | ||
| 5 Abdominal contouring procedures | 177 | ||
| 18 Aesthetic classification of the abdomen | 177 | ||
| Key Points | 177 | ||
| Introduction | 177 | ||
| Preoperative Preparation | 178 | ||
| Options | 181.e1 | ||
| Surgical Technique | 181 | ||
| Optimizing Outcomes | 181 | ||
| Postoperative Care | 183.e1 | ||
| Complications and Their Prevention, Diagnosis, and Management | 183 | ||
| Conclusion | 184 | ||
| Further Reading | 185 | ||
| 19 Anatomy of the abdominal wall and aesthetic classification | 186 | ||
| Key Points | 186 | ||
| Introduction | 186 | ||
| Anatomy of the Anterior Abdominal Wall and its Surgical Implications on Abdominoplasty | 186 | ||
| Fine Contour and Anatomical Unities of the Abdomen | 186 | ||
| Subcutaneous Anatomy of the Anterior Abdominal Wall | 186 | ||
| Blood Supply of the Abdominal Wall | 186 | ||
| Sensitive Innervation of the Abdominal Wall | 187 | ||
| Lymphatic System | 187 | ||
| Myoaponeurotic Anatomy | 187 | ||
| The Umbilicus | 188 | ||
| Preoperative Preparation | 188 | ||
| Diagnosis of the Abdominal Wall Deformities and Surgical Technique | 188 | ||
| Esthetic Classification of Abdominal Wall Deformities | 188 | ||
| Classification Based on the Excess Skin and Subcutaneous Tissue | 188 | ||
| Type 0 | 188 | ||
| Type I | 188 | ||
| Type II | 188 | ||
| Type III | 191 | ||
| Classification Based on the Myoaponeurotic Deformity | 191 | ||
| Type A | 191 | ||
| Type B | 192 | ||
| Type C | 192 | ||
| Type D | 192 | ||
| Optimizing Outcomes | 192 | ||
| Postoperative Care | 193 | ||
| Local Complications and Their Management | 195 | ||
| Conclusion | 195 | ||
| References | 196 | ||
| 20 Lipomyosculpture | 197 | ||
| Key Points | 197 | ||
| Introduction | 197 | ||
| Preoperative Preparation | 197 | ||
| Morpho-Histology of Subcutaneous Adipose Tissue | 197 | ||
| Surgical Technique | 199 | ||
| Marking | 199 | ||
| Patient Position | 199 | ||
| Liposuction | 200 | ||
| Submental | 200 | ||
| Arm | 200 | ||
| Upper Abdomen | 200 | ||
| Lower Abdomen | 200 | ||
| Back | 200 | ||
| Flank, Sacral Promontory, and Lateral Thigh | 200 | ||
| Buttocks | 201 | ||
| Anterior Thigh | 201 | ||
| Medial Thigh | 201 | ||
| Knee | 201 | ||
| Postoperative Care | 201 | ||
| Complications | 201 | ||
| Conclusion | 201 | ||
| Further Reading | 208 | ||
| 21 Classic abdominoplasty with adhesion tension sutures | 209 | ||
| Key Points | 209 | ||
| Introduction | 209 | ||
| Surgical Technique | 209 | ||
| Seven Comments | 212 | ||
| References | 219 | ||
| 22 Lipoabdominoplasty with previous flap resection | 220 | ||
| Key Points | 220 | ||
| Introduction | 220 | ||
| Preoperative Preparation | 220 | ||
| Patient Selection | 221 | ||
| Surgical Technique | 221 | ||
| Postoperative Care | 224 | ||
| Complications and Their Management | 224 | ||
| Comments and Conclusion | 224 | ||
| References | 226 | ||
| 23 Reverse abdominoplasty | 227 | ||
| Key Points | 227 | ||
| Introduction | 227 | ||
| Preoperative Preparation | 227 | ||
| Surgical Technique | 228 | ||
| Optimizing Outcomes | 231 | ||
| Postoperative Care | 231 | ||
| Complications and Their Management | 231 | ||
| Conclusion | 231 | ||
| References | 234 | ||
| 24 Endoscopic plication techniques for the treatment of abdominal contour | 235 | ||
| Key Points | 235 | ||
| Introduction | 235 | ||
| Basic Science | 235 | ||
| Diagnosis/Patient Presentation | 236 | ||
| Patient Selection | 236 | ||
| Surgical Technique | 236 | ||
| Materials for Video-endoscopy | 236 | ||
| Video Imaging System | 241 | ||
| Methods for Creating and Maintaining the Optical Cavity | 241 | ||
| Dissectors | 241 | ||
| Video-Assisted Technique | 241 | ||
| Postoperative Care | 242 | ||
| Outcomes, Prognosis, and Complications | 242 | ||
| Secondary Procedures | 242 | ||
| References | 243 | ||
| Further Reading | 244 | ||
| 25 High lateral tension abdominoplasty | 245 | ||
| Key Points | 245 | ||
| Introduction | 245 | ||
| Preoperative Preparation | 245 | ||
| Skin Excess | 245 | ||
| Skin Quality and Texture | 247 | ||
| Excess Fat within Flap | 247 | ||
| Excess Fat in Contiguous Areas | 249 | ||
| Rectus Diastasis/Hernia | 250 | ||
| Intraabdominal Fat | 250 | ||
| Anatomy | 250.e1 | ||
| Blood Supply | 250.e1 | ||
| Musculofascial Layer | 250.e1 | ||
| Surgical Technique | 250 | ||
| Postoperative Care | 252 | ||
| Optimizing Outcomes | 252 | ||
| Complications and Their Management | 253 | ||
| Conclusion | 253 | ||
| References | 253 | ||
| Further Reading | 253 | ||
| 26 Fleur-de-lis abdominoplasty including mons contouring | 254 | ||
| Key Points | 254 | ||
| Introduction | 254 | ||
| Preoperative Preparation | 254 | ||
| Patient Evaluation | 254 | ||
| Preoperative Markings | 255 | ||
| Surgical Technique | 256 | ||
| Postoperative Care | 258 | ||
| Complications and Their Management | 258 | ||
| Conclusion | 262 | ||
| Further Reading | 263 | ||
| 27 Panniculectomy in patients with super obesity | 265 | ||
| Key Points | 265 | ||
| Introduction | 265 | ||
| Preoperative Preparation | 265 | ||
| Surgical Technique | 267 | ||
| OPTIMIZING OUTCOMES | 270 | ||
| Postoperative Treatment | 273 | ||
| Complications and Their Treatment | 274 | ||
| Conclusion | 275 | ||
| References | 276 | ||
| Further Reading | 276 | ||
| 28 Lipoabdominoplasty | 278 | ||
| A. Lipoabdominoplasty | 278 | ||
| Introduction | 278 | ||
| 6 Thigh, buttock and lower extremity contouring | 345 | ||
| 34 Transverse medial thigh lift | 345 | ||
| Key Points | 345 | ||
| Introduction | 345 | ||
| Preoperative Preparation | 345 | ||
| Anatomical Considerations | 345 | ||
| Fat Layers | 345 | ||
| Lymphatic Distribution | 345 | ||
| Skin Particularities | 346 | ||
| Surgical Technique | 346 | ||
| Marking of the Incisions (Fig. 34.2A, B) | 346 | ||
| Preparation and Positioning | 346 | ||
| Skin Release | 346 | ||
| Skin Resection | 346 | ||
| Optimizing Outcomes | 348 | ||
| Postoperative Care | 348 | ||
| Complications and Their Management | 348 | ||
| Lymphatic Drainage and Lymphocele | 348 | ||
| Skin Necrosis | 349 | ||
| Acute Anemia | 349 | ||
| Clinical Cases | 349 | ||
| Conclusion | 349 | ||
| References | 352 | ||
| 35 Vertical medial thigh lift with liposuction | 353 | ||
| Key Points | 353 | ||
| Introduction | 353 | ||
| Preoperative Preparation | 353 | ||
| Surgical Technique | 359 | ||
| Optimizing Outcomes | 360 | ||
| Postoperative Care | 362 | ||
| Complications and Their Management | 364 | ||
| Conclusion | 365 | ||
| References | 365 | ||
| 36 Short vertical scar medial thigh lift | 366 | ||
| Key Points | 366 | ||
| Introduction | 366 | ||
| Applied Anatomy | 366 | ||
| Preoperative Preparation | 369 | ||
| Surgical Technique | 369 | ||
| Skin Marking: Erect and Supine Positions | 369 | ||
| Optimizing Outcomes | 371 | ||
| POSTOPERATIVE Care | 372 | ||
| Complications and Their Management | 372 | ||
| Hematoma | 372 | ||
| Infection | 372 | ||
| Wound Dehiscence | 373 | ||
| Seroma/Lymphocele | 373 | ||
| Poor Scar | 373 | ||
| Conclusion | 373 | ||
| Acknowledgments | 373 | ||
| References | 373 | ||
| 37 Autologous gluteal augmentation with mid-pedicle superior pole perforator flaps | 374 | ||
| Key Points | 374 | ||
| Introduction | 374 | ||
| Preoperative Preparation | 374 | ||
| Surgical Technique | 375 | ||
| Optimizing Outcomes | 377 | ||
| Avoiding Pitfalls in Preoperative Markings | 377 | ||
| Understanding the Geometric Shape of the Gluteal Region | 377 | ||
| Understanding the Relevance of the Upper Gluteal Pole Perforator Anatomy | 377 | ||
| Postoperative Care | 377 | ||
| Complications and Their Management | 378 | ||
| Assessment of Gluteal Projection and Possible Dermal-Fat Complications and Calcifications | 380 | ||
| Conclusion | 383 | ||
| References | 384 | ||
| 38 Liposuction and circumferential lower truncal dermatolipectomy | 385 | ||
| Key Points | 385 | ||
| Introduction | 385 | ||
| Preoperative Preparation | 385 | ||
| Markings | 386 | ||
| General Considerations | 387 | ||
| Surgical Technique | 387 | ||
| Dorsal Preparation | 387 | ||
| Anterior Preparation | 388 | ||
| Standard Technique | 388 | ||
| Fleur-de-lis Technique | 392 | ||
| Optimizing Outcomes | 392 | ||
| Operation Time | 396 | ||
| Symmetry | 396 | ||
| Wound Healing Disorders | 396 | ||
| Scarring | 396 | ||
| Seroma | 397 | ||
| Buttock and Waist Formation | 397 | ||
| Infection | 397 | ||
| Blood Loss | 398 | ||
| Thrombosis | 398 | ||
| Postoperative Care | 399 | ||
| Complications and Their Management | 400 | ||
| Conclusion | 401 | ||
| References | 402 | ||
| Further Reading | 402 | ||
| 39 Gluteal contouring and rejuvenation | 403 | ||
| Key Points | 403 | ||
| Introduction | 403 | ||
| Preoperative Preparation | 403 | ||
| Surgical Technique | 405 | ||
| Prosthetic Gluteal Augmentation – An Overview | 405 | ||
| Prosthetic Gluteal Augmentation – Submuscular Approach | 406 | ||
| Prosthetic Gluteal Augmentation – Intramuscular Approach | 407 | ||
| Prosthetic Gluteal Augmentation – Subfascial Approach | 409 | ||
| Prosthetic Gluteal Augmentation – Optimizing Outcomes | 410 | ||
| Liposculpture – An Overview | 410 | ||
| Liposculpture – Liposuction with Lipoinjection | 411 | ||
| Liposculpture – Optimizing Outcomes | 411 | ||
| Autologous Tissue Flaps – An Overview | 411 | ||
| Autologous Tissue Flaps – Lower Body Lift with Autologous Gluteal Augmentation | 412 | ||
| Autologous Tissue Flaps – Optimizing Outcomes | 414 | ||
| Postoperative Care | 414 | ||
| Prosthetic Gluteal Augmentation | 414 | ||
| Liposculpture | 414 | ||
| Autologous Tissue Flaps | 414 | ||
| Complications | 415 | ||
| Prosthetic Gluteal Augmentation | 415 | ||
| Liposculpture | 415 | ||
| Autologous Tissue Flaps | 415 | ||
| Conclusion | 416 | ||
| References | 416 | ||
| 40 Buttock implants | 418 | ||
| A. Gluteal Implant Augmentation | 418 | ||
| Introduction | 418 | ||
| Evolution of Technique | 418.e1 | ||
| Subcutaneous Plane | 418.e1 | ||
| Submuscular Plane | 418.e2 | ||
| Intramuscular Plane | 418.e3 | ||
| Subfascial (Subaponeurotic) Plane | 418.e3 | ||
| Indications | 418 | ||
| Why Is the Subfascial Plane Recommended? | 419 | ||
| Implant Decision | 420 | ||
| Implant Characteristics | 420 | ||
| Incision | 420 | ||
| Preoperative Preparation | 421 | ||
| Markings | 421 | ||
| Proposed Classification for Gluteal Ptosis (Fig. 40.15C) | 421 | ||
| Liposculpting and Gluteal Implants | 423 | ||
| Anesthesia | 423 | ||
| Patient Positioning | 423 | ||
| Surgical Procedure | 423 | ||
| Surgical Technique | 424 | ||
| Optimizing Outcomes | 425 | ||
| Adjunctive Procedures | 425 | ||
| Fat Grafting | 426 | ||
| Postoperative Care | 426 | ||
| Recovery | 426 | ||
| Outcomes and Results | 426 | ||
| Complications and Their Management | 426.e1 | ||
| References | 430 | ||
| Further Reading | 430 | ||
| B. Intramuscular Buttocks Implants: The “XYZ” Method | 431 | ||
| The Problems of Superficial Planes: Subcutaneous and Subfascial | 431 | ||
| The Advantages of the Intramuscular Plane | 431 | ||
| Principles for Intramuscular Undermining | 431.e1 | ||
| The Muscle Bipartition | 431.e1 | ||
| The Sandwich Plane: The Ideal Intramuscular Plane | 431.e1 | ||
| Surgical Technique | 431 | ||
| Skin Marks: The Line A and the Heart Inverted Mark | 431 | ||
| Dissecting the Sandwich Plane Guided by the A Line and Three Points | 432 | ||
| GM Lateral Limits, Line G | 433 | ||
| The “X” And “Y” Points and Intraoperative Identification of the GM Muscle’s Thickness | 433 | ||
| Point X – the Medial Point | 433 | ||
| Point “Y” – the Lateral Point | 433 | ||
| The Muscular Bisection Maneuver | 434 | ||
| Creating A Triangular Plane | 434 | ||
| Adjusting the Pocket According to the Implant Size and Shape | 434 | ||
| Drainage | 435.e1 | ||
| Closing the Incisions | 435.e1 | ||
| Postoperative Care | 435.e1 | ||
| Complications | 435.e1 | ||
| Avoiding Complications | 435.e1 | ||
| Seroma | 435.e1 | ||
| Dehiscence | 435.e2 | ||
| Pain | 435.e2 | ||
| Visible Implants | 435.e2 | ||
| Implant Choice | 435 | ||
| References | 437 | ||
| C. Gluteal Implants | 437 | ||
| Introduction | 437 | ||
| Anatomy | 437 | ||
| Sciatic Nerve | 438 | ||
| Anatomic Reference Point Marking | 438 | ||
| Implants | 438 | ||
| Surgical Technique | 439 | ||
| Postoperative Care | 440 | ||
| Results | 441 | ||
| Discussion | 444 | ||
| Conclusion | 446 | ||
| References | 446 | ||
| 41 Buttock contouring with liposuction and fat injection | 447 | ||
| Key Points | 447 | ||
| Introduction | 447 | ||
| Preoperative Preparation | 447 | ||
| Markings of Esthetic Units | 447 | ||
| Medications | 450 | ||
| Preparation in OR | 450 | ||
| Surgical Techniqu: Tumescent Mixture | 450 | ||
| Infiltration | 450 | ||
| Suctioning Details | 450 | ||
| Positioning | 451 | ||
| Supine Position | 451 | ||
| Lateral Decubitus Position | 451 | ||
| The Upper Buttock/Zone 3 | 452 | ||
| Prone Position | 453 | ||
| Straining | 454 | ||
| Syringe Loading Depending on Fat Density | 454 | ||
| Loading | 456 | ||
| Fat Injections | 456 | ||
| Fat Transfer in Supine and Lateral Decubitus Positions | 457 | ||
| Prone Position Injections | 457 | ||
| Postoperative Care | 457 | ||
| Drains | 457 | ||
| Garments and Pressure Pads | 457.e4 | ||
| Recovery Room | 458 | ||
| Sitting/Sleeping | 460 | ||
| Postoperative Instructions | 460 | ||
| Further Reading | 460 | ||
| 42 Liposuction of the lower extremities and leg reshaping with fat | 461 | ||
| Key Points | 461 | ||
| Introduction | 461 | ||
| Preoperative Preparation | 461 | ||
| Sedative Before Surgery | 464 | ||
| Surgical Technique | 464 | ||
| ALTERNATIVE TREATMENT | 466 | ||
| Optimizing Outcomes | 467 | ||
| Combined Techniques: Pros and Cons | 468 | ||
| Complications | 468 | ||
| Results | 468 | ||
| Conclusion | 468 | ||
| References | 469 | ||
| 43 Calf and thigh implants | 470 | ||
| Key Points | 470 | ||
| Introduction | 470 | ||
| Background | 470 | ||
| Anatomy | 470 | ||
| Materials and Methods | 470 | ||
| Surgical Technique | 471 | ||
| Calf Implants | 471 | ||
| Thigh Implants | 472 | ||
| Discussion | 474 | ||
| Postoperative Care | 474 | ||
| Complications and Their Management | 474 | ||
| Conclusion | 474 | ||
| References | 478 | ||
| Further Reading | 478 | ||
| 7 Liposuction and fat grafting | 479 | ||
| 44 Lipoplasty – history and principles | 479 | ||
| Key Points | 479 | ||
| Introduction | 479 | ||
| Evolution of Lipoplasty | 479 | ||
| The Initial Techniques of Fat Removal | 479.e1 | ||
| Lipoplasty Begins and Gains Popularity in the US | 480.e1 | ||
| Wetting Solutions | 480 | ||
| Lipoplasty Wetting Solutions and Corresponding Lipocrit Values | 480 | ||
| Xylocaine Toxicity | 481 | ||
| Ultrasound Technology Emerges | 481 | ||
| External Ultrasound-Assisted Lipoplasty (EUAL) | 482 | ||
| Additional Lipoplasty Advances | 482.e1 | ||
| Power-Assisted Lipoplasty Emerges | 482 | ||
| Additional Technologies | 482.e1 | ||
| Fundamentals of Lipoplasty | 482 | ||
| Applied Surgical Anatomy of the Subcutaneous Fat | 482 | ||
| Physics and Equipment | 483.e1 | ||
| Vacuum Source, Tubing, and Cannulae | 483.e1 | ||
| Biohazards | 483.e1 | ||
| Patient Selection | 483 | ||
| Preoperative Markings | 490 | ||
| Surgical Intervention | 490 | ||
| Prepping and Patient Positioning | 490 | ||
| Infusion of Wetting Solutions | 490 | ||
| Pretunneling Extraction and Mesh Undermining | 491 | ||
| When Performing PAL | 491 | ||
| When Performing UAL | 492 | ||
| When Performing Superficial Lipoplasty | 492 | ||
| Large Volume Removals | 493 | ||
| Secondary Lipoplasty | 493 | ||
| Postoperative Management | 494.e1 | ||
| Conclusion | 494 | ||
| References | 494 | ||
| 45 Tumescent local anesthesia for liposuction | 497 | ||
| Key Points | 497 | ||
| Introduction | 497 | ||
| Historical Background | 497 | ||
| Preoperative Preparation | 498 | ||
| Surgical Technique | 500 | ||
| Optimizing Outcomes | 500 | ||
| Postoperative Care | 501 | ||
| Complications and Contraindications | 502 | ||
| References | 502 | ||
| Further Reading | 502 | ||
| 46 Treatment of liposuction complications | 503 | ||
| Key Points | 503 | ||
| Introduction | 503 | ||
| Complications and Their Management | 503 | ||
| Life-threatening or Systemic Complications | 503 | ||
| Fat Embolism Syndrome (FES) | 503 | ||
| Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) | 503 | ||
| Extended Infection | 504 | ||
| Hypovolemia/Anemia | 504 | ||
| Lidocaine Toxicity | 504 | ||
| Esthetic Complications | 505 | ||
| Contour Irregularities (Figs 46.3–46.7) | 505 | ||
| Inner Thighs | 508 | ||
| Anterior Face of the Thigh | 508 | ||
| Buttocks | 508 | ||
| Skin Necrosis | 508 | ||
| Seromas | 509 | ||
| Hyperpigmentation (Fig. 46.17) | 510 | ||
| Asymmetry (Fig. 46.18) | 510 | ||
| Scar (Fig. 46.19) | 511 | ||
| Chronic Induration (Fig. 46.20) | 511 | ||
| Conclusion | 512 | ||
| References | 512 | ||
| 47 Fat grafting in body contouring surgery | 513 | ||
| Key Points | 513 | ||
| Introduction | 513 | ||
| Preoperative Preparation | 513 | ||
| Surgical Technique | 513 | ||
| Example: Correction of Buttocks Crease Deformity | 514 | ||
| Optimizing Outcomes | 514 | ||
| Postoperative Care | 514 | ||
| Complications and Their Management | 516 | ||
| Infection | 516 | ||
| Damage to Underlying Structures | 516 | ||
| Embolization after Intravascular Injection | 516 | ||
| Esthetic Complications | 516 | ||
| Swelling | 518 | ||
| Conclusion | 518 | ||
| References | 520 | ||
| 48 Minimal scar breast augmentation using autologous fat grafting | 521 | ||
| Key Points | 521 | ||
| Introduction | 521 | ||
| Preoperative Preparation | 521 | ||
| Surgical Technique | 523 | ||
| Breast Augmentation | 523 | ||
| Breast Implant Replacement | 523 | ||
| Preparation Procedures of Graft Materials | 523 | ||
| Conventional Lipoinjection | 523 | ||
| Cell-Assisted Lipotransfer (CAL) | 525 | ||
| Full-CAL | 525 | ||
| Mini-CAL | 526 | ||
| SVF Isolation Procedure | 526 | ||
| Optimizing Outcomes | 527 | ||
| Understanding of Cellular Events in Fat Grafting | 527 | ||
| Optimization of Individual Procedural Technique | 531 | ||
| Key Factors of Graft Materials | 531 | ||
| Pre- and Postoperative Care | 532 | ||
| Complications and Their Management | 532 | ||
| Conclusion | 532 | ||
| References | 532 | ||
| 49 Principles of new invasive modalities | 534 | ||
| Key Points | 534 | ||
| A. Laser-Assisted Liposuction | 534 | ||
| Introduction | 534 | ||
| Preoperative Preparation | 534 | ||
| Surgical Technique | 535 | ||
| Postoperative Care | 535 | ||
| Complications and Their Management | 536 | ||
| Conclusion | 537 | ||
| B. Cryolipolysis | 537 | ||
| Introduction | 537 | ||
| Preprocedure Preparation | 538 | ||
| Technique | 539 | ||
| Optimizing Outcomes | 539 | ||
| Postprocedure Care | 539 | ||
| Complications and Their Management | 540 | ||
| Conclusion | 540 | ||
| C. External Ultrasonic Devices | 540 | ||
| Introduction | 540 | ||
| Preprocedure Preparation | 540 | ||
| Technique | 540 | ||
| Optimizing Outcomes | 541 | ||
| Postprocedure Care | 541 | ||
| Complications and Their Management | 541 | ||
| Conclusion | 541 | ||
| References | 542 | ||
| Further Reading | 542 | ||
| 50 Ultrasonic liposuction | 543 | ||
| Key Points | 543 | ||
| Introduction | 543 | ||
| Historical Perspective | 543 | ||
| Basic Physics of Ultrasonic Liposuction | 544 | ||
| Preoperative Preparation | 546 | ||
| Surgical Technique | 548 | ||
| General Guidelines | 548 | ||
| UAL Posterior Trunk | 549 | ||
| UAL Abdomen | 550 | ||
| UAL Extremities and Buttocks | 550 | ||
| UAL Treatment of Gynecomastia | 550 | ||
| UAL Face and Neck | 551 | ||
| UAL Treatment of HIV-Associated Cervicodorsal Lipodystrophy | 551 | ||
| Optimizing Outcomes | 553 | ||
| Postoperative Care | 553 | ||
| UAL Complications and Their Management | 555 | ||
| Conclusion | 556 | ||
| References | 557 | ||
| 8 Body contouring with HIFU or injectables | 559 | ||
| 51 High intensity focused ultrasound and non-invasive body contouring | 559 | ||
| Key Points | 559 | ||
| Introduction | 559 | ||
| Ultrasonic Energy | 559 | ||
| Tissue Thermodynamics | 560 | ||
| Tissue Effect and Biology of Thermal HIFU | 561 | ||
| Thermal HIFU as A Noninvasive Body Contouring Device | 561 | ||
| Clinical Research Results | 562 | ||
| The Liposonix Process | 564 | ||
| Staff Training and Qualifications to Operate HIFU-Emitting Devices | 568 | ||
| Patient Selection | 568 | ||
| Patient Comfort | 569 | ||
| Aftercare | 569 | ||
| Adverse Events | 569 | ||
| The Business of Noninvasive Body Contouring | 570 | ||
| Marketing of Noninvasive HIFU Body Contouring | 570 | ||
| The Future | 570 | ||
| CONCLUSION | 570 | ||
| References | 571 | ||
| 52 Mesotherapy for body contouring and cellulite | 572 | ||
| Key Points | 572 | ||
| Introduction | 572 | ||
| Selection of Patients for Mesotherapy | 572 | ||
| Formulations | 573 | ||
| PrepAration for Mesotherapy | 575 | ||
| Injections | 575 | ||
| Side Effects and Treatment | 575 | ||
| Conclusion | 579 | ||
| References | 579 | ||
| 9 Special considerations for the massive weight loss patient | 580 | ||
| 53 Describing the deformities | 580 | ||
| Key Points | 580 | ||
| Introduction | 580 | ||
| Anatomic Considerations | 580 | ||
| Mid-body Excision | 580 | ||
| Surgery of the Breast | 580 | ||
| Brachioplasty or Recontouring of the Arm and Axilla | 581 | ||
| Surgery of the Back | 581 | ||
| Surgery of the Thighs | 581 | ||
| Surgery of the Face and Neck | 581 | ||
| Surgical Considerations | 582 | ||
| Mid-body Excision | 582 | ||
| Breast Reconstruction after Weight Loss | 582 | ||
| Brachioplasty | 582 | ||
| Surgery of the Back | 583 | ||
| Thigh Surgery | 583 | ||
| Face and Neck | 583 | ||
| Chronology | 583 | ||
| Conclusion | 583 | ||
| References | 584 | ||
| 54 Psychological and nutritional evaluation | 585 | ||
| Key Points | 585 | ||
| Introduction | 585 | ||
| Nutritional Considerations for the Post-Bariatric Patient | 585 | ||
| Bariatric Surgery History | 585 | ||
| Weight Loss History | 586 | ||
| Protein | 586 | ||
| Iron | 587 | ||
| Vitamin B12 and Vitamin B9 (Folate) | 587 | ||
| Vitamin B1 (Thiamine) | 587 | ||
| Calcium and Vitamin D | 587 | ||
| Other Nutritional Deficiencies | 587 | ||
| Perioperative Considerations | 588 | ||
| Psychological Considerations for the Bariatric Patient | 589 | ||
| Discussion | 589 | ||
| References | 590 | ||
| 55 Staging and combining procedures | 593 | ||
| Key Points | 593 | ||
| Introduction | 593 | ||
| Understanding Body Image and Weight Loss | 593 | ||
| Preoperative Evaluation of the Massive Weight Loss Patient | 593 | ||
| Screening for Medical Problems | 593 | ||
| Physical Examination | 594 | ||
| Patient Selection | 594 | ||
| Weight Stability | 594 | ||
| Favorable BMI | 594 | ||
| Nutritional Status | 594 | ||
| Medical and Psychosocial Stability | 594 | ||
| Goals and Expectations | 595 | ||
| Overview of Staging Strategies | 595 | ||
| Patient Safety | 595 | ||
| Surgeon Experience and Setting | 595 | ||
| Patient Preference | 595 | ||
| Considerations for Combining Procedures | 596 | ||
| Abdominoplasty/Mastopexy | 596 | ||
| Lower Body Lift/ Vertical Medial Thigh Lift | 600 | ||
| Upper Body Lift/Brachioplasty | 600 | ||
| Upper Body Lift/Lower Body Lift | 600 | ||
| Abdominal Wall Reconstruction/Abdominoplasty | 602 | ||
| Conclusion | 603 | ||
| References | 603 | ||
| Index | 604 | ||
| A | 604 | ||
| B | 605 | ||
| C | 606 | ||
| D | 607 | ||
| E | 607 | ||
| F | 608 | ||
| G | 608 | ||
| H | 608 | ||
| I | 609 | ||
| J | 609 | ||
| K | 609 | ||
| L | 609 | ||
| M | 610 | ||
| N | 611 | ||
| O | 611 | ||
| P | 611 | ||
| Q | 612 | ||
| R | 612 | ||
| S | 612 | ||
| T | 613 | ||
| U | 613 | ||
| V | 614 | ||
| W | 614 | ||
| X | 614 | ||
| Y | 614 | ||
| Z | 614 |