Alan Matarasso

Body Contouring After Massive Weight Loss

The increase in the number of bariatric surgery procedures over the last decade has led to a large number of massive-weight-loss patients seeking improvement in their resultant body contour deformities caused by the process of weight gain and subsequent loss. In this chapter, the reader will become familiar with the typical presentation of the massive-weight-loss patient to the plastic surgeon and the most common body-contouring procedures utilized to improve their deformities.

Awareness and avoidance of abdominoplasty complications

Abdominoplasty is a major surgical procedure associated with a variety of complications. Some studies1–3 indicate that the risk of severe complications, including mortality, ranges from 1 in 617 to 1 in 2320. This article focuses on avoiding and treating some of the more common problems typically encountered in abdominoplasty.nnOne “complication” that is not reported routinely occurs when an operation is successful but the patient is disappointed with the results. Invariably this situation is the result of a lack of communication or a misunderstanding. Initially patients should be educated about the objectives of the operation, and these objectives should be reconciled with their goals and concerns. In addition, patients should have a thorough understanding of the basic technique of the surgery, the use of anesthesia, and the recovery process, which will limit any surprises that may be upsetting to the uninformed. Furthermore, the surgeon should attempt to understand the patients motivations and goals to avoid any conflicts. Although some patients may be anatomically suitable for a procedure, not everyone is a candidate for elective surgery.nnnnAlan Matarasso, MD, New York, NY , is a board-certified plastic surgeon and an ASAPS member.nnnnThe combination of liposuction and abdominoplasty has improved our ability to contour the abdomen. However, potential wound healing problems (Table 1), particularly in the abdominoplasty triangle (from umbilicus to pubis), should be considered6 (Figure 1). Undermining the flap in an inverted “V” fashion (thereby preserving the Huger Zone III intercostal blood supply), avoiding excess tension on the flap closure, limiting flap thinning, and limiting excessive liposuction are measures that aid in preserving flap integrity (Figure 2). If an abdominal flap appears to be compromised, the umbilicus can be externalized after surgery, thereby preserving some additional midline crossover blood …

Managing the Buccal Fat Pad

The author performs buccal fat pad excision to improve facial contour in some patients with buccal lipodystrophy and to treat buccal fat pad pseudoherniation. He recommends an intraoral approach, taking care not to pull on the fat pad and resecting only that which protrudes easily with gentle pressure.

Bariatric plastic surgery

As aesthetic surgeons, we have an interest not only in the appearance of our patients but also in their general health. Obesity undeniably has a great impact on both. As radical but effective procedures to treat obesity become more common, as is happening now, our surgical expertise in treating the after-effects of massive weight loss will be in greater demand. This is likely to foster the development of what might be dubbed the “new” field of bariatric plastic surgery .nnThe twin epidemics of obesity and diabetes continue to spread unchecked in the United States. The facts about obesity are alarming and their implications profound. A study by the Centers for Disease Control and Prevention, published in the Journal of the American Medical Association ,1 reported that in 1991, 21% of the population — more than 44 million people — were obese (body-mass index > 30), 60% were overweight or obese, and 6 million were morbidly obese. Eight percent of …

Effective Use of Botox for Lateral Canthal Rhytids

The authors discuss why Botox is their preferred nonsurgical treatment for lateral canthal rhytids, or crows-feet. Three or 4 injections are spaced at 1.0- to 1.5-cm intervals beginning immediately beneath the lateral edge of the eyebrow and extending down to the lateral infraorbital rim. Complications are infrequent and can usually be avoided with the injection techniques described.

Remembering September 11

By early afternoon on September 11, New York was a different city than it had been just hours before, and lower Manhattan was a different world. A thick cloud of smoke from the devastation at the World Trade Center filled the sky and could be seen from almost every corner of the city. Sidewalks were filled with stunned throngs of people who had been directed to walk north. The shrill sirens of fire trucks and ambulances could be heard blaring as they raced in the opposite direction. Lines formed around hospitals and other facilities where blood donations were being collected, and rescue volunteers assembled in front of armories where armed guards in full combat gear were stationed.nnFor me, the day had started out like most others. I had planned on a full schedule of elective surgery in the morning, new patients …

Suspension of the gluteal region with silhouette sutures.

The authors present their minimally invasive gluteopexy technique, using polypropylene 2-0 sutures with 10 absorbable polylactic cones in their distal section (Silhouette Lift, Irvine, California) to improve the anteroposterior projection of the gluteal region. Histological study of the reaction of adipose tissue surrounding the cones previously has shown that, 3 months after insertion of the sutures, fibrous scar tissue is sufficiently developed to resist the weight of the tissues. On the basis of this finding, the authors decided to perform the gluteopexy with sutures, in 2 surgical steps. During the first step, the sutures are inserted in the adipose tissue without any proximal fixation. In the second step, performed 3 months after the first procedure when the fibrous reaction is more solid, the sutures are tightened to obtain the gluteopexy. Among the advantages of this technique are its simplicity, the fact that it produces no traumatic effects, and the fact that it can be performed with local anesthetic, reducing surgical time. It is also possible to combine this procedure with lipofilling or liposuction techniques.

Botulinum Toxin A for Managing Focal Hyperhidrosis

According to the authors, Botox is a safe, rapid, and effective treatment for focal hyperhydrosis with uniformly good results, few complications, and high patient satisfaction. Studies have shown that the therapeutic effect persists for 8 to 9 months on average.

Dietary supplements: "safe..., at certain speeds".

After an intensive, industry-financed lobbying and publicity campaign, Congress approved the Dietary Supplement Health and Education Act in 1994. This law stipulates that, to remove a product from the market, usually as a result of consumer harm or injury, the Food and Drug Administration (FDA) has to prove it unsafe. Moreover, the product can remain available until the FDA finishes its testing and proves its allegations in court. Often the process of removing a product is hastened only after significant adverse publicity and complications cause a drop in sales (as in the case of L-tryptophan).nnIt is estimated that approximately 60% to 80% of the American population has taken or would take herbs, nutritional supplements, or vitamins (dietary supplements). Annual sales of these over-the-counter products now represent a

Secondary Breast Reduction

12 billion industry. There are …