Fat Preservation Research Articles

Periorbital rejuvenation in composite rhytidectomy

Conventional blepharoplasty and rhytidectomy techniques do not adequately address the periorbital area in facial rejuvenation. Conventional blepharoplasty, whether transcutaneous or transconjunctival, normally removes lower-eyelid fat when present and only redrapes the skin from the incision line to the orbital rim. The eyelid frequently appears more hollow after surgery. The diameter of the periorbit does not become youthful, and narrow because the complete orbicularis muscle has not been repositioned. Traditional rhytidectomy techniques redrape facial tissues in a lateral direction toward the ear without repositioning of the orbicularis muscle. Composite rhytidectomy and arcus marginalis release create periorbital rejuvenation by preservation and repositioning of the lower-eyelid fat and repositioning of the orbicularis oculi muscle. This procedure satisfies the goal of harmonious facial rejuvenation by making the lower-eyelid-cheek complex appear as young as the remaining parts of the face that have been surgically rejuvenated. Recent modifications of the arcus marginalis release and the orbicularis repositioning allow more predictable results. These modifications are a zygorbicular (zygorbicular-orbicularis) cheek dissection with an arcus marginalis release and septal reset. A transcanthal canthopexy stabilizes the lateral canthal position. Creation of a firm suborbicularis convex surface with this periorbital rejuvenative technique prevents a hollow lower eyelid and improves the appearance of redraped eyelid skin.

Septo-orbitoperiostoplasty for the treatment of palpebral bags: a 10-year experience.

The orbital region is sensitive to the undesirable effects of any surgical intervention, because of its anatomical location and the importance of the eyelids in facial sign language. The procedures performed for correction of baggy eyelids may have remarkable undesired results. In recent years, we have made a special effort to analyze the causes, to minimize these undesirable effects, and to be able to offer patients more natural and safer results. We have designed a new technique called septo-orbitoperiostoplasty for the treatment of baggy eyelids, based on preservation of orbital fat and correction of the supportive layer. This technique consists of placing the orbital fat back into the orbital cavity and its retention by suturing the lax septum to the periosteum of the orbital rim. Neither an incision on the orbital septum nor an excision of the orbital fat is performed. It can be performed for both upper and lower eyelids. This paper describes the surgical procedure and shows the results obtained from 74 patients who had been treated with this technique over a 10-year period. All patients were followed up for an average of 5 years.

Recombinant human growth hormone for AIDS-associated wasting.

To review the current literature regarding the role of recombinant human growth hormone (rhGH) in the treatment of AIDS-associated wasting and to briefly describe alternative therapies. A literature search was performed on MEDLINE and AIDSLINE for the period from January 1985 through September 1997. Key words used in the search strategy were growth hormone, human immunodeficiency virus, acquired immune deficiency syndrome, wasting, and weight gain. All articles were considered for possible inclusion in this review. Abstracts were included only when they were judged to add critical information. Thereafter, the inclusion was restricted to English-language articles and abstracts on clinical trials and human studies in AIDS-associated wasting. Body wasting, characterized by an involuntary loss of body cell mass, is a well-recognized feature of many chronic diseases, including infection with HIV AIDS-associated wasting is a metabolic disorder characterized by weight loss, depletion of lean body mass (LBM), and preservation of body fat, leading to muscle weakness and organ failure. rhGH has been approved by the Food and Drug Administration for use in treating AIDS-associated wasting. The adverse event profile is similar to that of other rhGH products. The recommended dosage of rhGH is 4-6 mg administered by subcutaneous injection daily. It offers a more expensive alternative to appetite stimulants such as megestrol acetate and dronabinol. Trials with rhGH on the control of wasting in patients with AIDS have been encouraging, but with limited conclusive evidence of sustainable positive outcomes. Studies demonstrate that rhGH increases LBM and decrease adipose tissue, but how these translate into long-term outcomes such as decreased hospitalization, morbidity, and mortality has yet to be determined. A formal health economic assessment is needed to properly determine the impact of rhGH on the healthcare system.

HIV wasting syndrome: treatment update.

To review the pathophysiology and treatment of HIV wasting syndrome. MEDLINE searches (January 1987-September 1997) of the English-language medical literature were conducted. Bibliographies were also selected during a manual review. HIV-related weight loss, often referred to as HIV wasting syndrome, is a common manifestation of advanced HIV infection. Wasting in HIV involves the preferential loss of lean body mass with a paradoxical preservation of body fat. The etiology of wasting appears to be the result of many factors, which may include decreased caloric intake, malabsorption, alterations in energy expenditure and metabolism, cytokine effects, and endocrine dysfunction. Pharmacologic treatment options include appetite stimulants (e.g., dronabinol, megestrol acetate), cytokine inhibitors (e.g., thalidomide, cyproheptadine, ketotifen, pentoxifylline, fish oil, N-acetylcysteine), and anabolic agents (e.g., testosterone, nandrolone, oxandrolone, recombinant human growth hormone). Wasting associated with HIV has a high morbidity and mortality rate if not adequately managed. Therapeutic strategies include appetite stimulants, cytokine inhibitors, and growth-promoting agents. Selection of the appropriate agent(s) depends on the underlying cause for weight loss, adverse effects, and cost of therapy.

The role of orbital fat preservation in facial aesthetic surgery: A new concept

The role of orbital fat preservation in facial aesthetic surgery: A new concept

Cross-sectional and longitudinal evaluation of body composition in men with HIV infection.

Body wasting is an increasingly prevalent AIDS-defining condition and an independent risk factor for mortality in patients infected with HIV. Largely on the basis of studies conducted early in the epidemic, HIV-associated wasting has been assumed to feature a disproportionate loss of lean tissue. We report the results obtained from cross-sectional and longitudinal studies that differ from these earlier observations. In a cross-sectional analysis, weight and body composition determined by dual-energy x-ray absorptiometry and bioelectrical impedance analysis in 32 HIV-infected men with documented weight loss of > or = 10% were compared to those in 46 HIV-positive men without significant weight loss and 32 HIV-negative controls. Fat, lean body mass (LBM), and body cell mass (BCM) were significantly lower in men with weight loss relative to controls (p < 0.001 for fat and BCM; p = 0.01 for LBM). Two thirds of the difference in weight was fat. For the longitudinal analysis, the composition of weight lost over time was evaluated in paired measurements in men grouped by body fat content (<15% or >15%, n = 10 per group). Weight loss in patients with baseline fat of more than 15% was only 16% LBM, but the composition of weight lost in men with baseline fat of less than 15% was 70% LBM. We conclude that progressive decreases in fat and lean tissue occur in men with HIV infection, with the composition of weight lost depending on baseline fat content. These results argue against the widely held notion that HIV-associated wasting is characterized by preservation of fat at the expense of lean tissue.

The role of orbital fat preservation in facial aesthetic surgery: A new concept: Hamra ST. Clin Plast Surg 23:17, 1996

The role of orbital fat preservation in facial aesthetic surgery: A new concept: Hamra ST. Clin Plast Surg 23:17, 1996

The Role of Orbital Fat Preservation in Facial Aesthetic Surgery: A New Concept

Preservation of lower orbital fat in facial rejuvenation is a new concept for preventing the "operated" appearance that may follow fat removal in conventional blepharoplasty. By creating a narrower, more shallow orbit, the surgeon can create a truly youthful eyelid-cheek complex. Orbital fat advanced over the complete inferior orbital rim hides the bony framework that becomes apparent with normal aging. This technique is used routinely in isolated blepharoplasty and with composite rhytidectomy. It accompanies repositioning of the orbicularis oculi muscle, cheek fat, and facial platysma muscle. It is a procedure that can correct postoperative problems caused by excess orbital fat removal, lower eyelid retraction, and contour problems resulting from malar augmentation. The orbital fat is one of the many deep "pieces" of the human face that must be preserved and repositioned for optimal facial rejuvenation.

Arcus marginalis release and orbital fat preservation in midface rejuvenation.

With aging, the periorbital area reveals progressive exposure of underlying skeletal anatomy as compared with the lower areas of the face, whose thicker soft tissues continue to cover underlying bony landmarks. With recent techniques in cheek fat repositioning and orbicularis muscle repositioning, rejuvenation results of the midface have been markedly improved. Conventional lower blepharoplasty techniques that remove lower eyelid fat can create a concave contour deformity of the lower eyelids that causes the "operated" appearance. This paper describes a new technique to preserve the lower eyelid fat and to advance it beyond the infraorbital rim. An arcus marginalis release is accomplished, and the subseptal fat is advanced and sutured beyond the entire infraorbital rim and under the repositioned orbicularis muscle. By camouflaging the lower orbital rim anatomy, rejuvenation of the midface is more complete. A total of 152 cases have been done over a 3-year period with impressive results and minimal complications. This procedure is done in all composite rhytidectomies and in isolated blepharoplasty patients without advanced facial aging. It is particularly indicated in secondary procedures correcting overresection of orbital fat or deformities resulting from malar augmentation.

Autologous Fat Injection for Vocal Fold Paralysis: Long-Term Histologic Evaluation

Many techniques have been developed for medialization of the paralyzed vocal fold. The purpose of this study is to evaluate autologous fat as an alternative to alloplastic substances for use in vocal fold medialization. Eight dogs underwent left recurrent laryngeal nerve sectioning. Autologous fat was harvested, and the paralyzed vocal fold was medialized by injecting the fat into the thyroarytenoid muscle. The animals were divided into three groups for evaluation at 1, 3, and 6 months. Videolaryngoscopy was performed prior to sacrificing the animals. The larynges were sectioned coronally, and histologic studies were performed. The studies confirmed the preservation of viable fat at the injected site in all animals. Only a minimal inflammatory response was observed in the 1-month group. It would appear that fat injection is a viable alternative to Teflon injection and thyroplasty; it eliminates the need for alloplastic materials, does not appear to migrate, and does not require an open procedure.

The anatomical basis for retrorenal extensions of pancreatic effusions: the role of the renal fasciae

Retrorenal extension of pancreatic inflammatory processes are considered to involve invasion of the posterior pararenal space. Analysis of computed tomographic (CT) images demonstrates preservation of posterior pararenal fat in most patients, implicating some other mechanism. We have examined the anatomical basis for these retrorenal extensions in static and functional studies of 12 cadavers using CT imaging, dissection and histological techniques. We observed that the posterior renal fascia was thicker than the anterior, that it could be easily separated into two layers by manual dissection and injections of liquid latex, that the inner (anterior) layer of the posterior fascia was continuous with the anterior fascia and the outer layer continuous with the lateroconal fascia. The point at which the two layers of the posterior fascia separated laterally and the medial extent of the posterior fascia varied considerably in CT scans of 100 patients. These data are interpreted to mean that pancreatic effusions extend posterior to the kidney by separating the two layers of the posterior renal fascia.

Intraperitoneal paravesical spaces: CT delineation with US correlation.

The urinary bladder, obliterated umbilical arteries, and inferior epigastric vessels located within the extraperitoneal space of the anterior abdominal wall indent the anterior parietal peritoneum, forming intraperitoneal paravesical fossae. These are the supravesical space and the medial and lateral inguinal fossae. More posteriorly, the peritoneum covering the bladder is reflected onto the rectum to form the rectovesical space, which is divided by the uterus into an anterior vesicouterine recess and a posterior rectouterine pouch, or cul-de-sac. The cul-de-sac is continuous with the pararectal and ovarian fossae and is bounded posterolaterally by the rectouterine (sacrogenital) folds. These peritoneal compartments form a large potential space for the accumulation of ascites and are separated from the equally large extraperitoneal paravesical spaces by only a thin layer of peritoneum or peritoneum and umbilicovesical fascia. The computed tomographic scans of 100 patients with ascites were reviewed, with particular attention to the differentiation between intraperitoneal and extraperitoneal paravesical collections. The scans of intraperitoneal collections were found to have certain characteristic appearances, including inferior displacement of the distended urinary bladder, visualization of the umbilical folds, and preservation of the preperitoneal fat.

Lumbar disk surgical tricks for safeguarding the “root's ecology”

Restoration of a physiologic periradicular environment is a fundamental step toward improving the results of surgical procedures on the herniated lumbar disk. Combined with the preservation of periradicular fat (or free trans-plant of subcutaneous fat), reconstruction of the yellow ligament, recreating the interlaminar plane, may act as a barrier against postoperative adhesions. An operative technique is described that is aimed toward preserving the yellow ligament with the purpose of reconstructing it at the end of the surgical procedure on the root.

Microlumbar Discectomy

Microlumbar discectomy is an extremely conservative microsurgical procedure for the treatment of the virgin herniated lumbar disc. The technique has been utilized in 530 patients over a 5 1/2-year period, and features no laminectomy or curettement of the disc space. Preservation of extradural fat and blunt perforation of the annulus fibrosus, rather than scalpel incision, appear to minimize reherniations and adhesion reactions. Operating time has averaged 37 minutes and postoperative stay 3.1 days during the past 36 months (46% of these were compensation cases). In this series, a satisfactory result is defined as those patients who remain economically productive and physically comfortable at the time of followup. Satisfactory results were achieved in 91% of patients after one procedure.

Water-soluble plastic mounting media.

Several new water-soluble mounting media derived from polyvinyl alcohol and acrylic resins have been reported. These are of use in the preservation of various azo dye products, fats and histological stains. They may also offer an approach to new embedding techniques.