Sang Won Seo

Impact of Large-Volume Liposuction on Serum Lipids in Orientals: A Pilot Study

Recent advances in liposuction techniques now make it possible to remove considerable amounts of subcutaneous adipose tissue. However, the metabolic consequences of this procedure are not well documented. The aim of this study was to identify the effects from the surgical removal of subcutaneous fat on the body weights and serum lipids of patients who have undergone large-volume liposuction. In this study, eleven consecutive patients with a minimum aspirate volume of 5,000 ml were evaluated, and their serum lipids were measured at a postoperative 2-month follow-up assessment. Tumescent fluid was infiltrated using the superwet technique. The liposuction device used was a Liposlim® power-assisted liposuction system. The amount of solution infiltrated and the volume of aspirate were measured. Pre- and postoperative serum lipids, body weights, and body mass indices were compared. Statistical analysis was performed on lipid profile changes and aspirate volumes using Spearman’s correlations. The average volumes of infiltrate and aspirate were 7,241 and 6,790 ml, respectively. Mean body weight decreased from 64.5 ± 18.8 to 59.9 s ± 17.8 kg (p < 0.01). The change in body weight per 1 l of aspirate volume was 0.67 ± 0.10 kg/l. The mean body mass index dropped from 23.8 ± 4.4 to 22.0 ± 4.2 kg/m2 (p < 0.01), and the mean total serum cholesterol levels from 168.2 ± 23.6 to 162.9 ± 26.5 mg/dl, an average of 3.2%. The mean low-density lipoprotein (LDL) decreased from 94.3 ± 20.5 to 89.5 ± 19.0 mg/dl, a 5.1% drop, and the mean high-density lipoprotein (HDL) decreased from 55.8 ± 9.5 to 53.7 ± 10.7 mg/dl, a 3,8% drop. The mean HDL/LDL proportion increased from 62.6 ± 20.9% to 63.5 ± 22.4%, averaging 1.4%. However, no significant correlation was found between the aspirated volume of fat and lipid profile change. In conclusion, over a 2-month period, large-volume liposuction reduced weight and total cholesterol level and increased the HDL/LDL ratio. The authors hope to discover whether the therapeutic impact of liposuction is long-lasting, and to determine whether it reduces the morbidity and mortality associated with obesity.

Clinical experience with complications of hand rejuvenation

PURPOSE Prominent signs of ageing of the hands have recently been treated with permanent or longer-lasting injectable dermal fillers. However, few previous studies have described the long-term complications of such hand rejuvenation. The purpose of our report was to share our experience of 15 cases with long-term complications following hand rejuvenation using various medical fillers. PATIENTS AND METHODS We performed a retrospective review of the management of 15 patients who presented with complications from the injection of synthetic fillers for hand rejuvenation at a tertiary medical centre over a period of 10 years from March 2002 to January 2011. RESULTS Injected materials included polymethylmethacrylate (PMMA) microsphere filler, calcium hydroxyapatite filler, hyaluronic acid filler, poly-l-lactic acid (PLLA) filler and other medical fillers. Of the total study sample of 15 patients, nine underwent surgical excision, six patients with a history of PMMA or PLLA filler injection received intralesional steroid therapy and three patients with a history of hyaluronic acid filler injection received injection therapy using hyaluronidase. CONCLUSIONS Hand rejuvenation complications can be successfully treated according to our proposed algorithm.

Clinical experience with polymethylmethacrylate microsphere filler complications.

Polymethylmethacrylate (PMMA) filler is widely used for the correction of wrinkles because of its relative long-lasting cosmetic improvements and the rarity of reported complications. However, early and delayed complications, ranging from minor to severe, can occur following PMMA filler injection. We evaluated and treated 13 cases of PMMA filler-related complications that were referred to our institution from July 2005 to June 2010. Of these patients, 92.3% were female and 7.7% were male. Complications were roughly classified as (1) nodular masses, (2) inflammation, (3) allergic reactions, and (4) discoloration. Affected locations were the lips, periocular wrinkles, nasolabial folds, forehead, marionette wrinkles, and cheeks. As there is no standard treatment modality for PMMA filler complications, patients were managed with various treatments aimed at minimizing morbidity. In the cases of lip granuloma, we recommended intralesional steroid injection first, followed by surgical excision, including lip mucosa and orbicularis oris muscle in intractable cases. Additional studies should be conducted to determine the safety of PMMA injection, reduce the occurrence of adverse reactions, and identify risk factors that are associated with higher complication rates.

Histologic Changes of Implanted Gore Bio-A in an Experimental Animal Model

Gore Bio-A has been reported to be an ideal synthetic bioabsorbable scaffold material for hernia repair. The purpose of this study was to determine the effectiveness of Gore Bio-A in soft tissue augmentation. Six New Zealand white rabbits were used in the study. Five subcutaneous pockets were created on the back of the rabbit, and 20 × 20 mm sized square shaped Gore Bio-A sheets, each 1.5 mm, 3 mm, 4.5 mm, 6 mm, and 7.5 mm in thickness, were implanted into each pocket (1 layer to 5 layers). To analyze the morphologic and histologic changes, the implants were harvested 1, 3, and 6 months after implantation. Following the gross analysis, absorption rate was accelerated with increased implant duration and decreased thickness. Histological analysis of the implants demonstrated progressive neovascularization, fibroblast infiltration, and neocollagenation over time. Six months after implantation, Gore Bio-A was almost absorbed and degenerated, not maintaining its volume. Based on this study, Gore Bio-A was revealed as a biocompatible material; however, it is not suitable for soft tissue augmentation because it is absorbed in the process of changing into soft tissue without maintaining its own volume. Therefore, this material is incomplete and needs more study to overcome this limitation.

Three-Dimensional Circumferential Liposuction of the Overweight or Obese Upper Arm

AbstractDue to recent trends in liposuction, anatomic consideration of the body’s fatty layers is essential. Based on this knowledge, a circumferential approach to achieving maximal aesthetic results is highlighted. In the upper arm, aspiration of fat from only the posterolateral region can result in skin flaccidity and disharmony of the overall balance of the upper arm contour. Different suction techniques were applied depending on the degree of fat accumulation. If necessary, the operation area was extended around the axillary and scapular regions to overcome the limitations of the traditional method and to achieve optimal effects. To maximize skin contracture and redraping, the authors developed three-dimensional circumferential liposuction (3D-CL) based on two concepts: circumferential aspiration of the upper arm, to which was applied different fluid infiltration and liposuction techniques in three anatomic compartments (anteromedial, anterolateral, and posterolateral), and extension of liposuction to the periaxillar and parascarpular areas. A total of 57 female patients underwent liposuction of their excess arm fat using this technique. The authors achieved their aesthetic goals of a straightened inferior brachial border and a more slender body contour. Complications occurred for five patients including irregularity, incision-site scar, and transient pigmentation. Through 3D-CL, the limitations of traditional upper arm liposuction were overcome, and a slender arm contour with a straightened inferior brachial border was produced. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at http://www.springer.com/00266.

The effects of sterilization methods on lyophilized cartilage grafts in an experimental model.

BackgroundCartilage graft is an effective method for reconstructing the bony framework of the face and covering the bony defect site. As a process method of cartilages, lyophilization has the advantages of long-term storage and easy handling. We hypothesized that the type of procedure used to sterilize lyophilized cartilage may affect outcomes after implantation into the body. We compared the effects of ethylene oxide (EO) gas, &ggr;-irradiation, and autoclaving methods on cartilage grafts. MethodsAfter sterilization, lyophilized human rib cartilage was inserted into subperiosteal pockets created in New Zealand white rabbit skulls. We assessed the weights and ratios of the remaining cartilage and examined histologic changes throughout the implantation period. ResultsOver a 5-week period, the &ggr;-irradiated grafts remained more than the other grafts, but after more than 5 weeks, there were no significant differences between &ggr;-irradiated and EO gas–sterilized cartilages. Autoclave-sterilized cartilages were totally resorbed at 10 weeks. ConclusionsOver 10 weeks of follow-up, based on persistence measurements and histologic appearance, there was little difference between &ggr;-irradiated and EO gas–sterilized lyophilized cartilage used in experimental bone grafts.