José Horácio Aboudib

Hand rejuvenescence by fat filling.

&NA; The advantages of fat filling for hand rejuvenescence are discussed. Seventy‐two patients treated by this method are presented, including their follow‐up, complication rate, and details of combined operations. Preference is given to local anesthesia when no other major surgeries are associated with the method. A highly satisfactory rate was obtained (98.62%) with a low complication rate (4.15%).

Gluteoplasty: Anatomic Basis and Technique

BACKGROUND Although the placement of implants for gluteal augmentation is becoming more common, the procedure still faces strong resistance from patients and some surgeons as a result of unsatisfactory outcomes in the past. OBJECTIVE The authors describe easily-identifiable anatomic reference points that can assist the surgeon in the performance of gluteoplasty, making the procedure simpler and safer. METHODS Based on a literature review, an anatomic study was performed of dissections of the gluteal region in seven formalinized and fresh cadavers. This study allowed the authors to observe anatomic details and propose bony reference points to guide gluteoplastic surgery. Between July 2006 and February 2009, 105 patients underwent gluteoplasty according to the guidelines resulting from the cadaveric study. RESULTS All patients were female, ages 22 to 50 years. The surgical procedure, once refined, resulted in a low complication rate. In the final 50 patients in the series, there was only one seroma, one wound infection, and no cases of dehiscence. Bruising on the side of the thigh was encountered in four of the total 105 cases (3.8%). The clinical photos demonstrate the positive aesthetic results of this technique. CONCLUSIONS When gluteoplasty is performed utilizing a systematic strategy based on bone anatomy references, it can be a predictable procedure with reproducible results and minimal complications.

T abdominoplasty to remove multiple scars from the abdomen.

A patient presented with multiple scars on the abdomen from previous surgical procedures. Much of the scarring was eliminated and the form of the abdomen restored by an atypical inverted T abdominoplasty.

Extensive Cervical and Lower Face Lipectomy: Its Importance and Anatomical Basis

The authors propose a more extensive lipectomy than usual along and above the mandibular branch, to obtain better results in the neck and lower face in rhytidectomy. The operative technique is based on anatomical findings. Results are excellent when the procedure is indicated and properly performed. Lipectomy is recommended in patients with abnormal fat deposits about the lower face and neck; it. is not advised for obese patients.

Mammaplasty Utilizing the Periareolar Approach

An analysis of 300 cases of reduction mammaplasty done utilizing a periareolar approach at the University Hospital of the State of Rio de Janeiro and our own private clinic during the period from September 1989 through October 1995 is presented in this article. The technical evolution of this procedure is described in detail as well as how the complications were eliminated and the aesthetic results improved. A thorough analysis of recommendations and comments on the results are made by the authors.

Intramuscular technique for gluteal augmentation: determination and quantification of muscle atrophy and implant position by computed tomographic scan.

Background: New surgical techniques for gluteal augmentation have improved final results. It is estimated that more than 35,000 patients have undergone augmentation gluteoplasty using implants. The authors sought to determine and quantify the presence of muscle atrophy, and to evaluate implant positioning using the intramuscular technique. Methods: Twenty-three female patients were selected prospectively for this study and underwent intramuscular gluteal augmentation using gluteal implants of a round or oval base. Computed tomographic scanning and three-dimensional volumetric reconstruction were used to investigate muscle atrophy and implant position, with comparison of the results between the preoperative scan and scans obtained 3, 6, and 12 months after surgery. Results: Three-dimensional reconstruction and volumetric analysis showed muscular atrophy. After 12 months of follow-up, 34 gluteal muscles (17 patients) were analyzed, with 4.3 percent atrophy remaining on the right side and 2.6 percent on the left side. Twenty-three patients were studied regarding position (46 gluteal implants). All oval base implants introduced in a vertical direction (seven patients) turned to an oblique direction, following the direction of muscle fibers by 3 months after surgery. Two patients showed rotation of the implant. Conclusions: The presence of a gluteal implant caused muscle atrophy. However, it did not lead to clinical or physical limitations. It is not important whether the implants are positioned vertically or obliquely, provided that they are symmetric. The technique proved to be safe in maintaining the intramuscular position of the implant, with good satisfaction for the patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Anatomical Variations Analysis of the External Jugular Vein, Great Auricular Nerve, and Posterosuperior Border of the Platysma Muscle

This article describes the observations collected from the dissection of 10 nonformalinized cadavers analyzed in respect to the anatomical relation variations between the external jugular vein, the great auricular nerve, and the posterosuperior border of the platysma muscle.Abstract. This article describes the observations collected from the dissection of 10 nonformalinized cadavers analyzed in respect to the anatomical relation variations between the external jugular vein, the great auricular nerve, and the posterosuperior border of the platysma muscle.

Volumetric and functional evaluation of the gluteus maximus muscle after augmentation gluteoplasty using silicone implants.

Background: The gluteal muscles have been very important throughout the evolution of mankind for the adoption of the bipedal posture. Over the past 15 years, the intramuscular technique has become popular and has been improved, with enhanced results and reduced levels of postoperative complications. The insertion of gluteal implants within the musculature may be an intrinsic compression factor of these muscles. The objective of the present study was to evaluate the gluteus maximus function and its variation over a 12-month period after the insertion of the implant. Methods: This was a prospective, controlled, clinical study. All subjects were female patients, with anthropometric characteristics and body mass index within preset limits to establish similar groups. Isokinetic test gluteus computed tomographic scans and clinical nutritional assessment were conducted in four stages during the study period: preoperatively and 3, 6, and 12 months after surgery. Results: The study group presented 6.14 percent muscle atrophy to the left and 6.43 percent muscle atrophy to the right after the procedure. Muscle strength presented differences in hip flexion and adduction tests. Conclusions: The gluteus maximus muscle presents atrophy secondarily to gluteal augmentation surgery with implants. Variations in gluteus maximus muscle strength should not be attributed primarily to the surgical procedure or to the implants; physiologic and multifactorial variations should also be considered. Strength and volume variations did not show a significant correlation. Gluteal augmentation with implants was effective in improving the waist-to-hip ratio and in changing the anthropometric pattern from android to gynoid. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Gluteal implant displacement: diagnosis and treatment.

Background: First reported in 1969, buttocks implant surgery has evolved greatly since the introduction of the intramuscular technique. This technique provides good implant coverage and protects the sciatic nerve from compression. However, it enables the occurrence of a new complication, intramuscular hernia or implant displacement. The goal of this research study is to describe, classify, and standardize the treatment of gluteal implant displacement. Methods: The treatment algorithm was developed after dissection of fresh human cadavers and analysis of computed tomographic scans in patients with implant displacement. After elaborating the treatment protocol for implant displacement, it was prospectively applied in 24 patients that presented with visible implants. Results: Intramuscular dissection has proven to be technically possible when a minimum of 2 cm of muscle thickness is achieved. One-stage surgery was applied in 41 buttocks (21 patients). The control computed tomographic scan obtained 3 months after surgery has shown fibrosis in the buttocks area, corresponding to the subcutaneous capsule housing the implant in the anomalous position. The operative wound complications were more frequent, and treatment failure with relapse of the implant superficial displacement occurred in only one of 47 buttocks (2.1 percent). Conclusions: The treatment of gluteal implant displacement can be a one-stage surgical procedure for most patients. This decision is based on the thickness of the gluteus maximus muscle just below the implant. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The Polymethylmethacrylate Effects on Auricle Conchal Cartilage: Report of 21 Cases

BACKGROUND Both surgical and nonsurgical techniques, including soft tissue augmentation, are available to restore a youthful appearance to the face. Soft tissue augmentation with nonabsorbable fillers is increasingly important, as a growing number of patients are seeking aesthetic improvement without the downtime and cost of major surgical procedures. Polymethylmethacrylate (PMMA), an injectable implant composed of a suspension of microspheres in different media, is one such soft tissue filler. OBJECTIVES Because the application of PMMA into the pericartilage of the ear is becoming a more common practice among plastic surgeons, the authors offer a systematic analysis of its effects. They believe this information to be of paramount importance to prevent injuries and deformities. METHODS Twenty-one patients who presented to the lead authors clinic with prominent ears during a period of 16 months between 2007 and 2008 were retrospectively reviewed. The authors analyzed PMMAs effects on each patients ear shell cartilage, which was extracted during correction without causing any kind of injury or deformity to the participants in this study. RESULTS The histopathologic study from the excised skin and cartilage samples showed a granulomatous inflammation in all patients. There was no association between the incidence of tissue alterations and the mean length of PMMA on the conchal cartilage. CONCLUSIONS The potential consequences of PMMA injection in close proximity to cartilage cannot be predicted and the possibility of myxomatous cartilage degeneration is a serious potential adverse event because it can cause permanent deformities of the cartilaginous skeleton.