Julius Newman

The Effect of Mechanical Stress on Adipocyte Morphology and Metabolism

This paper describes the effect of mechanical stress following lipo-suction surgery and passage of fat pads through needles on adipocyte morphology and metabolism. Biochemical assays for glucose oxidation, lipid synthesis, and insulin stimulation confirm the morphological evaluations, i.e., needles larger than 20 gauge have little, if any, effect. New strategies need to be developed for injection of adipocytes using needles smaller than 20 gauge. In addition, these assays may prove useful for clinicians to optimize fat pad preparation and the use of biological modifiers to enhance the successful outcome of autogenous lipografts.

Facial Lipo-Transplant Surgery

* The Graduate Hospital, One Graduate Plaza, Philadelphia, Pennsylvania 19146 History I n 1985 the senior author utilized fat that was retrieved from lipo-suction procedures and experimented with its reinjection into other body areas. During these initial experiments a 3-cc syringe was used with a 12-gauge needle to aspirate fat from the local areas of the abdomen; the fat was then reinjected into a recipient site with an I8-gauge needle. Large quantities of fat were difficult to acquire very quickly with this method, and much blood and tissue debris were also aspirated with the fat. The difficulty of reinjecting this fat tissue evident by frequent blockage of the needle from the fibrous tissue that was aspirated during fat harvesting. Furthermore, reimplantation of the fat immediately-without proper preparation, washing, and separation of the broken cellular debris, fatty acids, and bloodcould contribute to decreased fat cell survival and to reactions similar to those of hematoma. During these early periods of experimentation we decided that a new system of harvesting was necessary, and that fat had to be properly prepared for reinjection into recipient sites. Since 1893 there have been numerous attempts to graft fat from one part of the body to another. 1 Until present, the more common approach had been excision of adipose tissue from a donor site with reimplantation into the recipient site again by simple surgical incision. With the initiation of modem lipo-suction techniques a relatively atraumatic way of harvesting the fat and reinjecting it has been established. Recycled fat can now be used to augment soft tissue deformities of the head and neck areas secondary to congenital, developmental, and acquired surgical deformities.

The Biographical History of Fat Transplant Surgery

* Chairman, t Fellow, Department of Cosmetic Surgery, The Graduate Hospital, Philadelphia, Pennsylvania 19146 The search for an ideal soft tissue substitute is still an ongoing task. In the past century, medical science has witnessed the rise and fall of many artificial as well as natural products, including paraffin, liquid silicone, encapsulatedsilicone, silastic, plastic, and various collagen extracts. Physicians have found some of these products to be unsatisfactory as the incidence of infection, inflammation, formation of capsules, and interference with the immune system are some of the contraindications, not to mention the obvious necessity for incision and the resulting scarring. The objectives of this article are to summarily review the history of autologous fat transplantation as it pertains solely to cosmetic surgery and attempt to define how the most modem technologies of the 1980s may indeed prove that such transplants are close to the ideal substitute for soft tissue deficiencies.

Facial profileplasty by liposuction extraction.

Facial profileplasty can include the removal of abnormal fat deposits In the face and neck as an Individual begins to age and, In many cases, the correction of chin projection to achieve a better neck-chin contour line. In this report we retrospectively analyze the complications and results from 142 patients undergoing facial liposuction alone or In combination with chin augmentation or rhytldectomy during a follow-up period of 14 months, the liposuction technique offers very low morbidity and Is superior to conventional exclslonal methods.

Complications and Pitfalls of Facial Lipo-Suction Surgery

Department of Cosmetic Surgery The Graduate Hospital One Graduate Plaza Philadelphia. PA INTRODUCTION F acial lipo-suction surgery is a new technique in the surgical armamentarium for the treatment of aesthetic facial deformities. Lipo-suction surgery had been developed for body contouring surgery and the authors have applied it to the facial and neck regions. In a series of 642 cases, we have observed several complications and noted pitfalls that might lead to other complications. This paper discusses complications that we have observed and the techniques that have evolved to avoid repetition of such complications.

International Study of 63,073 Liposuction Procedures

* Chairman, Department of Cosmetic Surgery, The Graduate Hospital t Fellow, Department ofCosmetic Surgery, The Graduate Hospital This is a survey of the complications from liposuction surgery. The survey was conducted by the American Academy of Cosmetic Surgery in cooperation with the American Society of Liposuction Surgery. It was conducted using a voluntary questionnaire categorized by the various complications occurring in different areas of the body. A total of 63,073 procedures were reported by 212 surgeons. The overall complication rate was 1.64%. The most common complication was permanent surface irregularities. There was no mortality noted in this survey.

The Facelift Bypass

Introduction Patients present for facial rejuvenative surgery for a variety of reasons. They may have fine periocular or perioral wrinkling, generalized actinic skin changes, malar soft tissue hypoplasia, jowl ptosis, truly sagging facial skin, or various combinations of the above. Most also have significant degenerative changes of the neck skin and the appearance of their neck is a major concern in the majority of cases. Analysis of these patients in the younger age group rarely shows any facial relaxation problems. 1 Older individuals similarly may have little facial skin laxity but are more likely to show accompanying malar soft tissue atrophy or ptosis of the jowls. It is our belief that a large number of patients do not need a classic facelift but rather need a neck tuck.f The desirability of neck restoration as a solution to an isolated complaint has become increasingly apparent. 3-5 Additionally, many patients, especially males, are opposed to operations that might leave visible scars. Some are unwilling to be isolated for the length of time required for scar maturation. They will however accept a less obvious operation to obtain the same end. In an effort to meet the needs and desires of these groups of patients we have devised a simplified approach bypassing the classic facelift in favor of posterior neck lift. Our simplified neck lift has greatly decreased the surgical time, morbidity, and recuperative time.

Closed Flap Lipo-Dissect Facelift

* Chairman, Department of Cosmetic Surgery, The Graduate Hospital, One Graduate Plaza, Philadelphia, PA 19146. t Fellow, Department ofCosmetic Surgery, The Graduate Hospital, One Graduate Plaza, Philadelphia, PA 19146. T he closed flap lipo-dissect facelift procedure is a technically simple alternative to the often tedious and precarious sharp dissection required in conventional facelift techniques. Utilizing two unique dissecting instruments, the facelift dissection is performed in a closed fashion prior to making the flap opening incisions. This alleviates the need for prolonged retraction of the flaps, while facilitating the development of a uniform subdermal plane. Inherent in the technique is a greater protection of the underlying nerves, vessels, and fascia. Because the underlying muscles are not disturbed, it provides a relatively dry surgical field with minimal chance of postoperative hematoma.

Retrograde Suspension Malarplasty

Malar prominences have long been considered as an important aesthetic area on the face, yet the technique of malar augmentation has not been standardized and made available to the general public. Our technique of suspension malarplasty, performed through an intraoral Caldwell–Luc-type incision, offers excellent exposure with complete visualization of vital structures in the malar-zygomatic region. The implant is herd in position with a stay suture exited at the temple area. This report retrospectively analyzes the complications and results of 182 patients receiving malar implants during a follow-up period of 36 months. The procedure entails minimal operating time, few complications, and high patient acceptance. The creation of more prominent cheekbones can provide patients who have an elongated, flat midface or square jaws with a more pleasing appearance in both frontal and oblique views, therefore enhancing the results of other facial cosmetic procedures.

Introduction of the Facial Lipo-Spatula Extractors

*Chairman, Department of Cosmetic Surgery The Graduate Hospital, Philadelphia, PA Introduction T he perfection of facial profIleplasty by lipo-suction has led to a quest for an ideal suction cannula to manage the tightly adherent and delicate cutaneous adipose complex in the lower face and neck. Construction of the facial fat extractor was initiated from the early use of a plastic abortion cannula which was shortly replaced by a set of round, bullet-type tip extractors which were smaller and shorter versions of the body suction extractors designed only for collapsing surgery in the areas of thick fatty deposits of the body and extremities. For facial contouring, based on the concept of concomitant complete fat extraction and creation of a skin flap for redraping purpose, the senior author developed a new design of facial extractors that have a combination of round body and blunt flat tip. Clinical evaluation showed that the flat spatula-shaped tip offers great advantages for easier tissue penetration in the cervico-facial region, low incidence of skin injury and perforation as well as deep tissue injury. Used for open lipo-suction, an aperture on a flat surface has a better suction capability because of its greater sealing effect. This new design has made the technique of facial lipo-suction more manageable with very low morbidity.