Ultrasound-assisted Liposuction Research Articles

A pilot study on ultrasound-assisted liposuction of the greater omentum in porcine models

The greater omentum is the largest depot of visceral fat, and recent studies implicate removal of omental fat as a therapeutic option for metabolic syndrome (MS). This study evaluated the technical feasibility of reducing omental fat by using ultrasound-assisted liposuction (UAL) in porcine models. We removed as much omental adipose tissues as possible with a novel ultrasonic aspirator specifically designed for visceral liposuction that was inserted into the peritoneal cavity via the bilateral hypochondrial trocars. The greater part of the omental surface was emulsified and suctioned within 12.4 ± 9.2 (mean ± SD) min. In the survival study, all animals survived for two weeks without clinically evident complications following UAL. Histological examinations confirmed a substantial reduction in omental fat in pigs subjected to UAL. In conclusion, the pilot animal study conducted here demonstrated the technical feasibility of omental liposuction. UAL thus has potential as a relatively non-invasive liposuction approach to treat MS by selectively reducing the visceral fat content of the greater omentum.

The American Society for Aesthetic Plastic Surgery (ASAPS) Survey: Current Trends in Liposuction

The emergence of new technologies necessitates a study of current trends in liposuction and other methods for fat removal. The American Society for Aesthetic Plastic Surgery (ASAPS) conducted a survey of its members to gain valuable information from Board-certified plastic surgeons about their experience with new technologies for fat removal and managing complications after liposuction. The ASAPS Current Trends in Liposuction Survey was emailed to 1713 ASAPS members. Data were tabulated and examined to determine current trends in liposuction and other fat removal techniques performed by ASAPS members. The response rate for the survey was 28.7% (n = 492). Most ASAPS respondents reported performing between 50 and 100 liposuction procedures annually. Most plastic surgeons currently employ or have previous experience with suction-assisted lipectomy/liposuction (SAL), ultrasound-assisted liposuction (UAL), and power-assisted liposuction, but fewer reported experience with laser-assisted liposuction (LAL), mesotherapy, or external, noninvasive devices. SAL was the preferred method of fat removal for 51.4%. UAL, LAL, and SAL were most commonly associated with complications. Only 10.5% of ASAPS members employ LAL; 38% have treated a patient with complications secondary to LAL. Valuable information about current trends in liposuction and other fat removal techniques has been gained from this survey. Although many studies have been published that review issues related to safety, morbidity, aesthetics, and recovery after different methods of fat removal, more prospective studies with standardized objective outcome measures comparing these techniques, particularly newer modalities, are needed to continue improving safety-related standards of care.

Determinants of Patient Satisfaction With Ultrasound-Assisted Liposuction

Liposuction is one of the most common aesthetic procedures and a number of options are available to practitioners in terms of surgical technique. One of those options is ultrasound-assisted liposuction (UAL), which has garnered considerable attention in the literature and from patients themselves. Because the role of ultrasound in body sculpting is continuing to increase over time, the authors believe that a comprehensive assessment of patient satisfaction after the procedure is essential. Currently, there are very few reports in the literature examining patient satisfaction with UAL, and to the authors' knowledge, no reports in the literature have successfully outlined the determinants and predictors of long-term satisfaction with the procedure. The authors examine the correlates and predictors of patient satisfaction after UAL. The authors conducted a prospective cross-sectional study on 609 consecutive patients who underwent UAL from 2002 to 2008. One hundred and sixty (54%) out of 300 patients with whom the authors could make contact agreed to answer a standardized questionnaire regarding their overall satisfaction. Nearly 80% of the patients were completely or mostly satisfied with UAL. Seventy-five percent reported that they had or would recommend UAL to others. Women (P=.009), patients who did not gain weight after their UAL procedure (P<.001), patients who were content with their body appearance (P<.001), patients whose dress sizes decreased after UAL (P=.001), and patients with confidence in their body (P<.001) showed statistically significant higher rates of satisfaction with UAL. Among these correlates, confidence in body (odds ratio [OR]=24.4; 95% confidence interval [CI]: 6.8-83.3) and contentment with body appearance (OR=5.5; 95% CI: 1.5-19.4) were found to be reliable independent predictors of patient satisfaction. Most patients were satisfied with UAL, but certain patient responses were more highly correlated with overall satisfaction than others and therefore can be considered predictors of long-term patient satisfaction with this procedure. The results of this study may provide plastic surgeons with valuable clues that can enhance preoperative planning and therefore enable further improvement of patients' satisfaction with UAL.

Early Results Using Ultrasound-Assisted Liposuction as a Treatment for Fat Necrosis in Breast Reconstruction

Fat necrosis is a common complication from autologous breast reconstruction that can compromise the aesthetic outcome and can be confused with recurrent breast cancer. Removal of fat necrosis through direct excision can be difficult with lesions in the periphery and may result in contour deformities. The article describes a case series of patients with fat necrosis treated with ultrasound-assisted liposuction. A retrospective database was created consisting of consecutive patients treated with ultrasound-assisted liposuction at a single academic institution. Patient demographics and complications were identified, including initial size of fat necrosis, number of ultrasound-assisted liposuction treatments, and final size of fat necrosis. Surgical technique was standardized over the entire series. There were 54 breast reconstructions with fat necrosis treated with ultrasound-assisted liposuction. The average initial size of fat necrosis was 2.72 cm. Twenty-seven lesions (50.0 percent) were treated once, 20 (37.0 percent) were treated twice, and seven (13.0 percent) were treated three times. The final size of fat necrosis was 0.44 cm (p < 0.0001), with an average time to follow-up of 17.8 months. Complete resolution (<0.5 cm) was seen in 44 lesions (81.5 percent). Only one complication, a thermal burn, was seen from ultrasound-assisted liposuction, and this resolved with conservative management. This case series describes the successful use of ultrasound-assisted liposuction for treatment of fat necrosis after autologous breast reconstruction. The authors find this technique to be safe, effective, and reproducible, as the majority of fat necrosis areas resolved with one or two treatments.

Refinements in Abdominoplasty: A Critical Outcomes Analysis over a 20-Year Period

The use of liposuction combined with abdominoplasty has been controversial. The combination of techniques has been associated with an increased rate of venous thromboembolism and wound-healing complications. Through improvements in venous thromboembolism prophylaxis, refinements in liposuction techniques, and an understanding of anatomy, this cumulative risk has decreased, although the negative stigmata persist. This study describes the evolution of abdominal body contouring through a critical review of a single surgeon's 20-year experience with abdominoplasty. This clinical outcome analysis will highlight the significant contributions that have led to the improvement in the safety and efficacy of this technique. A retrospective review of patients undergoing abdominoplasty procedures was performed. Patient demographics and procedural information, including postoperative course and complications, were recorded. Preoperative and postoperative photographs were scored by blinded evaluators for aesthetic result and scar quality. Two hundred fifty patients undergoing abdominoplasty from 1987 to 2007 were included in the study. The use of a "superwet" liposuction technique in combination with abdominoplasty significantly decreased intraoperative blood loss (p < 0.04) and length of hospital stay (p < 0.05). Liposuction volume and region had no significant effect on abdominoplasty outcome, although refinements in operative technique, including abdominal and flank ultrasound-assisted liposuction, high superior tension, and limited abdominal undermining, did improve the postoperative aesthetic score. Venous thromboembolic events significantly decreased with aggressive venous thromboembolism prophylaxis (p < 0.001). The technical evolution of a single surgeon's 20-year experience demonstrates that liposuction can be safely and effectively combined with abdominoplasty. Preoperative trunk analysis, intraoperative surgical refinements including superwet technique and ultrasound-assisted liposuction, and perioperative venous thromboembolism prophylaxis significantly improve the outcome of abdominoplasty.

Gynecomastia: Evolving Paradigm of Management and Comparison of Techniques

Since 1997, the authors have used a minimally invasive technique for the management of gynecomastia using ultrasound-assisted liposuction and the arthroscopic shaver to remove breast tissue through a remote incision. This technique has allowed for a consistent, refined, "unoperated" postoperative appearance in this patient population. This study analyzes the outcomes of this procedure and compares the procedure against established techniques. A retrospective study was performed on all patients who underwent surgery for gynecomastia at the authors' institution between January of 1988 and October of 2007. A total of 227 patients were divided into four groups: group 1, open excision only (n = 45); group 2, open excision plus liposuction (n = 56); group 3, liposuction only (n = 50); and group 4, liposuction plus arthroscopic shaver (n = 76). Medical records and photographs were used to compare groups for complications and results. Complications using the liposuction plus arthroscopic shaver technique included seroma (n = 2), hematoma (n = 1), scar revision (n = 1), and skin buttonhole from the arthroscopic shaver (n = 1). There was no difference between groups in the overall incidence of complications (p < 0.20) or the need for reoperation (p < 0.325). Results were scored on a scale of 1 (poor) to 5 (excellent). Group 4 (liposuction plus arthroscopic shaver) had the overall highest mean score, with statistical significance between group 2 (open excision plus liposuction) and group 4 (p < 0.0001). Arthroscopic mastectomy for gynecomastia is a safe and effective technique, with excellent cosmetic results and an acceptable complication rate.

Combined Use of Ultrasound-Assisted Liposuction and Limited-Incision Platysmaplasty for Treatment of the Aging Neck

Combined Use of Ultrasound-Assisted Liposuction and Limited-Incision Platysmaplasty for Treatment of the Aging Neck

Overview of Ultrasound-Assisted Liposuction, and Body Contouring With Cellulite Reduction

Body contouring is a rapidly growing sector of esthetic procedures and dermatologic surgery. Currently, liposuction is one of the most popular cosmetic procedures with considerable research being conducted into devices that would facilitate fat emulsification. The advent of ultrasound-assisted liposuction presented physicians with a great tool in approaching more superficial as well as fibrous adipose irregularities. Additionally, our increasing understanding of laser, light, and radiofrequency interaction with adipose tissue is allowing for these energy sources to be used noninvasively to improve body contours. This article will provide an overview of the vibration amplification of sound energy at resonance third-generation ultrasound device for liposuction as well as the VelaShape platform for noninvasive adipose and cellulite reduction. As body contouring technology and coinciding experience grow, so will the ability to achieve the aims of more efficient, safer, and cosmetically pleasing body sculpting.

External Ultrasound-Assisted Liposuction of the Abdomen: A Report of our Experience

Introduction: Ultrasound-assisted liposuction (UAL) is currently an accepted and commonly used method, although the incidence of complications is noteworthy. In 1997, Silberg introduced the concept of external ultrasound-assisted liposuction (XUAL) to facilitate the standard technique with an expected decreased incidence of complications when compared with UAL. This article reports our experience with XUAL of the abdomen at a single cosmetic surgery center over a 1-year period. Methods: Two groups of 15 patients each underwent abdominal liposuction. Group 1 received the tumescent technique, and Group 2 received external ultrasound treatment, again using the tumescent technique. Ultrasonic energy was applied to the entire abdominal area in a standard fashion using the Intellect Legend Combo 2-C ultrasound unit set to 1.5 watts/cm2 continuous pulse for 10 minutes immediately following infusion of the tumescent solution. Patients were evaluated postoperatively for adverse events. Adverse events were defined as excessive edema, ecchymosis, seroma greater than 50 cc, hematoma, infection, and wound breakdown. Results: No cases of adverse events occurred in any patient in the immediate postoperative period. However, at the first postoperative appointment, it was notable that 2 of 15 patients in group 1 (13%) had developed a significant (&gt;50 cc) lower abdominal seroma. Both patients were successfully treated with a single closed drainage procedure in the office via needle aspiration. In group 2 at the first postoperative visit, it was notable that 5 of the 15 patients (33%) presented with a significant (&gt;50 cc) lower abdominal seroma. All patients in group 2 were successfully treated with drainage of the fluid via needle aspiration or by opening the midline lower port and placing a passive drain (in several cases). An average of 2.5 drainage procedures was required for resolution of the seromas in group 2. Discussion: The incidence of seroma formation was clearly linked to higher body mass index (BMI) and total fat volume removed. Consistent variables included tumescent volume infused, amount of ultrasound energy delivered, and cannula size used during the tumescent infusion and aspiration procedure. In most patients, the flanks and low back were also sculpted with the liposuction technique; however, the abdomen was the only area treated preoperatively with ultrasound. It is notable that the only area to develop a seroma was the abdomen, which suggests that the ultrasound could be related to seroma formation. The cause of seroma formation remains unknown; however, the possibilities of septal breakdown, lymphatic and venous damage, and cavity formation are reasonable. Conclusion: The incidence of seroma formation may be increased with XUAL of the abdomen. Additional studies are needed to prove that the benefits of XUAL treatment provided preoperatively outweigh the risk for adverse events.

Ultrasound-Assisted Lipoplasty: The Ad Hoc Situation

The article by Roustaei et al. [1] about the safety and value of ultrasound-assisted liposuction (UAL) is somewhat too enthusiastic so that the results and their relationship to numerous previous evaluations should not be left without some additional remarks. The safety and relevance of UAL compared with conventional liposuction techniques has been studied and evaluated by various authors [2] over more than 10 years, mostly in the U.S. between 1997 and 2003 after the first reports more than 5 years earlier from Europe. The outcome of this Iranian study, where the UAL technique had not been available earlier, describes an extremely low complication rate even although a statistically relevant number of cases is evaluated. This desirable outcome may be due to the fact that only one surgeon performed the procedures. Such consecutive experience always provides useful insight in the critical evaluation of a technique and its reproducibility. The conclusions of the authors, however, do not adequately represent the actual situation of use of UAL by plastic surgeons in Europe or the U.S. Although the authors cited some of the most important publications on UAL versus other liposuction techniques, the results of these publications are not implemented completely. Among others in the cited article Blondeel et al. [3] conclude that ‘‘UAL is, therefore, probably more beneficial to the surgeon than to the patient. The financial investment in the device is justified for surgeons with large liposuction practices, mainly, and probably solely, because of the reduced physical strain for the surgeon.’’ The latest overview in liposuction techniques, including the various UAL devices, by Jewell [4] last year defines the actual state of the art in liposuction techniques and the need for further research and studies. The conclusion of the authors that ‘‘The additional benefits of the UAL technique combined with fewer local complications and no SAEs, compared with other liposuction techniques (TL and SAL), suggest that it may become a more widely used modality in liposuction surgery’’ does not meet these long-term goals and should be considered critically.

Safety of Ultrasound-Assisted Liposuction: A Survey of 660 Operations

Ultrasound-assisted liposuction (UAL), although providing some advantages over tumescent liposuction (TL) and traditional or suction-assisted liposuction (SAL), has been found to have some controversial complications. We performed this study to evaluate UAL's complications and to compare UAL with the previous routine techniques for liposuction. Six hundred sixty UALs were performed on 609 consecutive volunteers by one cosmetic surgeon. Demographic characteristics, local and systemic complications, and also severe adverse events (SAE) were registered intraoperatively and at 1, 4, and 12 weeks postoperatively. No SAEs were identified and only nine complications, consisting of two systemic complications (two cases of hypotension) and seven local complications (3 seromas, 3 cases of contact dermatitis, and 1 case of hemorrhage), were registered. This yields a complication incidence of 1.36%. There was no association between the number of complications and the body region, age, gender, or body mass index (BMI). Our findings are in line with others in that performing UAL using local tumescent anesthesia is a safe procedure with a very low complication rate and has remarkable advantages over other liposuction techniques (TL and SAL). In addition, there was no correlation between the incidence of complications and body region, age, gender, or BMI.

Combined Use of Ultrasound-Assisted Liposuction and Limited-Incision Platysmaplasty for Treatment of the Aging Neck

BackgroundMany techniques have been introduced for the surgical treatment of the aging neck. In this study the combination therapy of ultrasound-assisted liposuction and limited-incision platysmaplasty for cervicofacial rejuvenation is presented.MethodsFifteen female patients (age = 43–75 years) were treated for grade II–III (n = 2), III (n = 6), and grade IV (n = 7) cervicomental angle deformity. The outcome of surgery was retrospectively evaluated by a panel.ResultsUltrasonic energy was applied for an average of 2 min (range = 45 s–6.5 min). The mean aspiration volume was 125 ml. No immediate or delayed adjuvant skin reduction was needed in any of the patients. No complications were encountered in this series. After treatment significant improvement of the cervicomental angle was observed.ConclusionFor treatment of all grades of the aging neck we advocate the combination of UAL and limited-incision platysmaplasty. This combination therapy has little morbidity and leads uniformly to significant improvement of the cervicomental angle.

Ultrasound-Assisted Liposuction as a Treatment of Fat Necrosis After Deep Inferior Epigastric Perforator Flap Breast Reconstruction

A single case is reported utilizing ultrasound-assisted liposuction (UAL) to treat fat necrosis after deep inferior epigastric artery perforator flap breast reconstruction. UAL treatment resulted in softening of the fibrous fat necrotic areas, while maintaining acceptable breast contour. UAL is safer and less invasive than traditional treatments for fat necrosis including direct excision and suction-assisted liposuction.

External Ultrasound-Assisted Lipectomy: Effects on Abdominal Adipose Tissue

Sir: The use of ultrasound “on the surface” was hypothesized by Scuderi et al. in 19871 and resumed by Zocchi in 1996.2 Ultrasound-assisted liposuction is as a technique that can be associated with suction- assisted lipectomy.3 This new technique is called external ultrasound-assisted lipectomy. Whereas ultrasound-assisted liposuction emulsifies adipose tissue due to adipocyte membrane lysis, external ultrasound-assisted lipectomy, being less “invasive,” induces cell-to-cell contact loss and alters collagenic fibers. This leads to an easier detachment of adipose cells, which remain unaltered and can be mechanically removed. The external ultrasound-assisted lipectomy technique is the transcutaneous application of ultrasound by means of high-frequency ultrasound upon massive infiltrated tissue, followed by traditional liposuction. Results showed that several different effects were detected on both adipocytes and collagen fibers. In fact, patients treated with a 1-MHz frequency and a potency of 3 W showed no cell destruction, and collagenic fibers were partly conglomerated. In particular, using standard histological methods, it was difficult to distinguish between artifacts, detectable in both treated and control samples, and putative ultrasound destruction. Oil red-O staining, performed on cryosections, is capable of avoiding artifacts and confirmed that in only a small quantity of cases did adipocytes present with rounded membranes, and in limited cases, cells were detached from one another. In fact, immunofluorescence showed that these fibers were either intact or conglomerated, when the ultrasound frequency was 1 MHz (Fig. 1).Fig. 1.: Abdominal adipose biopsy from a patient treated with 1 MHz. Immunofluorescence phycoerythrin staining for collagen type I fibers showed that they had a normal appearance (original magnification ×200).In contrast, when the ultrasound frequencies were 2 and 3 MHz with a potency of 3 W, adipocyte alterations were observed. The latter was confirmed using the oil red-O stain, showing complete derangement of fat tissue occurring in biopsies of 3-Mhz-treated patients. In addition, a diffuse collagen fiber retraction, as shown at the immunofluorescence level (Fig. 2), was observed. This was particularly evident when comparing the biopsies of intact controls, which showed normal adipose tissue and intact collagen fibers.Fig. 2.: Abdominal adipose biopsy belonging to a patient treated with a frequency of 3 MHz. Immunofluorescence phycoerythrin staining for collagen type I fibers showed that they were completely retracted (original magnification ×200).External ultrasound-assisted lipectomy is a good method for the removal of localized fat in patients with moderate obesity.4 Few studies have been performed up to now with regard to the effects of external ultrasound-assisted lipectomy on adipose cells. A previous study5 focused on adipose and breast tissue, but it did not take into consideration that adipose cells are subjected to many histological artifacts. In addition, no observations were made of collagen fibers. This is rather important when using external ultrasound-assisted lipectomy, because fat tissue derangement may involve the whole architecture and, primarily, collagen. In conclusion, we have assessed that when using a frequency of 1 MHz, no alterations or only limited adipocytic alterations are observed, which do not include collagen fibers. Therefore, the technique can be used in aesthetic medicine (localized lipodystrophy, first-degree PEFS), using these frequencies. Both the 2- and 3-MHz frequencies are able to lead to complete fat tissue disruption, including adipose cells and collagenic fibers and can be indicated for fibrous and inveterate cellulitis (second and third- degree PEFS), in body contouring surgery. Francesco D’Andrea, M.D. Giuseppe A. Ferraro, M.D. Gian Franco Nicoletti, M.D. Dipartimento di Scienze Ortopediche, Traumatologiche, Riabilitative e Plastico-Ricostruttive Francesco De Francesco, M.D. Dipartimento di Medicina Sperimentale Sezione di Istologia ed Embriologia TESLAB Seconda Università di Napoli Napoli, Italy

Calf-Contouring Surgery of Gastrocnemius Hypertrophy: Selective Neurectomy of the Sural Nerve

Generally, Asians tend to have obese calves that are shorter and thicker than those of Caucasians. The cause of the enlarged calves is either an excess of subcutaneous fat or calf muscular hypertrophy, but some patients have both conditions. These features are accentuated by the contraction of the calf muscles when patients stand in tiptoe position or wear high heels. In the case of calf muscular hypertrophy without excessive subcutaneous fat, manipulation of the calf muscle is an effective method for reducing calf circumference. From January 2005 to December 2006, the authors performed selective sural neurectomy for 20 patients who complained of obese calves. Using a popliteal incision, the sural nerve branches to the medial and/or lateral gastrocnemius muscles were dissected from the posterior tibial nerve. Using a nerve stimulator, the branches with the most contractile portions were resected in 1 cm lengths at the distal ends. One medial branch was resected in 15 patients, and two branches were resected in 5 patients. In the case of a lateral neurectomy, only one branch was resected. Ultrasound-assisted liposuction was combined for five patients who also showed excessive subcutaneous fat. The patients ranged in age from 19 to 29 years (mean, 23 years). The follow-up period varied from 6 to 18 months. The circumferential change was checked 6 months postoperatively 15 cm below the medial condyle and 15 cm above the medial malleolus. These average circumferences were reduced, respectively, from 36.6 and 32.5 cm to 35.5 and 32.2 cm. In gait analysis performed at 6 months postoperatively, the calf muscle power was slightly reduced to 95% of the preoperative state, but still remained above the normal range. Subjectively, no patient complained of muscle weakness or gait disturbance. One patient showed lower leg edema after mountain climbing that subsided after 1 day of rest. The authors believe a selective neurectomy technique can be an effective method for treating obese calves.

Power-Assisted Liposuction and the Pull-Through Technique for the Treatment of Gynecomastia

Gynecomastia is a common condition affecting many adolescent and adult males. Surgical techniques utilizing a variety of incisions, excisions, suction-assisted lipectomy, ultrasound-assisted liposuction, power-assisted liposuction, or some combination of these methods have been used in the treatment of gynecomastia. This article describes the authors' method of using power-assisted liposuction and the pull-through technique to treat gynecomastia. This technique involves the use of power-assisted liposuction to remove fatty breast tissue. The pull-through technique is then performed utilizing several instruments to sever the subdermal attachments of fibroglandular breast tissue; this tissue is removed through the incision used for liposuction. Finally, power-assisted liposuction is performed again to contour the remaining breast tissue. A chart review of 99 consecutive patients (197 breasts) treated between January of 2003 and November of 2006 was performed. Ninety-six patients (192 breasts) were successfully treated using this technique. Power-assisted liposuction was performed in all cases, and the average volume aspirated per breast was 459 ml (range, 25 to 1400 ml). Using the pull-through technique, the authors were able to remove between 5 and 70 g of tissue per breast. Complications were minimal (1.0 percent of breasts), and no revisions were required. Since January of 2003, the authors have used this technique to successfully treat 97 percent of their gynecomastia patients. Combining power-assisted liposuction and the pull-through technique has proven to be a versatile approach for the treatment of gynecomastia and consistently produces a naturally contoured male breast while resulting in a single inconspicuous scar.

Surgical Algorithm for Management of HIV Lipodystrophy

The accepted standard for treatment of human immunodeficiency virus disease, highly active antiviral therapy, may cause significant side effects, such as facial lipoatrophy and lipodystrophy. Facial wasting or a buffalo hump deformity may be pathognomonic for treated human immunodeficiency virus disease. In addition to facial wasting, cystic parotid degeneration may further distort the face. The authors outline the defects as a series of triangles defined by anatomical boundaries. In a group of 27 patients, 17 were treated for buffalo hump (three isolated and 14 with associated facial wasting). Another 10 patients were treated for isolated facial wasting. The 14 patients who underwent liposuction of the buffalo hump with subsequent injection of the aspirate into the face had approximately 40 to 50 percent of the grafts survive. Recurrent or severely fibrous humps were treated with ultrasound-assisted liposuction. In six patients, autografts to the lypoatrophic face were utilized. Two patients undergoing gynecomastia reduction had successful grafting with the resected breast. Three patients with cystic degeneration of the parotid underwent superficial parotidectomy with rotation or grafting of the parotid into the defect, for a total of six individual procedures. The authors present an algorithm for treatment of buffalo hump and facial wasting deformities associated with human immunodeficiency virus lipodystrophy syndrome, with an emphasis on long-term results with autogenous tissue.

Strategies in the treatment of HIV-1-associated adipose redistribution syndromes

HIV-1/highly active antiretroviral therapy-associated lipodystrophy syndrome (HALS) is presently the most common long-term adverse effect limiting the doubtless efficacy of antiretroviral therapy. It has a great impact on the quality of life of patients, it is stigmatising and its psychologically devastating consequences may ultimately impact on the adherence to treatment of patients, eventually leading to treatment failure. Despite considerable advances in recent times, the pathogenesis of HALS remains elusive. Factors involved belong to three categories: those intrinsic to the host, some of them modifiable and some not, those associated with antiretroviral therapy, that are sometimes modifiable as well, and finally those related to HIV-1 infection and its consequences, most often not modifiable. The most commonly used strategies for HALS reversion have included host-dependent factors such as lifestyle and dietary modifications and antiretroviral-dependent factors such as switching or avoiding the use of drugs more prone to promote HALS. Lifestyle modifications and switching thymidine analogues have been associated with moderate success. Pharmacological interventions have included the use of insulin-sensitising agents and hormone therapy with disappointing results, whereas treatment with pravastatin or pioglitazone, and uridine supplementation seem to be associated with fat gain in preliminary studies. The only interventions with almost immediate results that may render a patient's appearance similar to his past one have included filling techniques for facial lipoatrophy and ultrasound-assisted liposuction for cervical fat pad hypertrophy. Among the filling options, semipermanent reabsorbable materials and autologous fat transfer have been associated with acceptable outcomes. As of now, the best hope should rely on the use of drugs friendly for fat, on defining the appropriate timing for starting antiretroviral and on continuing the research effort to understand the basic mechanisms underlying HALS pathogenesis. Only through this effort can the best chances for preventing or reverting established HALS be recognised.

Tratamiento quirúrgico de la lipodistrofia asociada a la infección por VIH. Conclusiones de una Reunión Multidisciplinar

To discuss the treatment for lipodystrophy associated with antiretroviral therapy, a meeting was held among infectious disease specialists, plastic surgeons and psychologists with extensive expertise in the care of HIV-infected patients. Lipodystrophy has an important impact on the patients' quality of life. There is now sufficient experience with surgical correction of facial lipoatrophy to consider it a useful technique for these patients. This treatment should be provided to patients with moderate to severe lipoatrophy, and to certain patients with mild lipoatrophy under special circumstances. There are no indications for correcting lipoatrophy of the limbs. Ultrasound-assisted liposuction is the technique of choice for the treatment of lipohypertrophy and is indicated in patients with mechanical or functional abnormalities. Patients with clear indications should have access to the surgical techniques that have proven to be useful for correcting lipodystrophy.

Treatment with Ultrasound-Assisted Liposuction of Accessory Axillary Breast Tissues

Supernumerary nipples and breast tissue often are dismissed as cosmetic curiosities. These structures have the potential for pathologic degeneration and may be associated with significant congenital abnormalities. In a prospective comparison of 100 Native American women with 100 non-Native American women, these accessory organs were found much more commonly among Native American women. Careful attention should be given to thorough evaluation and long-term follow-up evaluation of any patient with this anomaly. This study investigated a patient who underwent surgical removal of her axillary breast tissue with ultrasound-assisted liposuction. The advantages of this method include a minimal incision scar from the liposuction cannula and the ability to detect residual axillary breast by ultrasound.