Plastic Surgeons Consider Skin Retraction, Not Just Fat Removal, As Technique Evolves

According to Two senior plastic surgeons in different parts of the world have shown that low complication rates and excellent results with liposucture of the hips, flanks, and thighs

In the report plastic surgeons Yixin Zhang, MD, PhD, of Shanghai JiaoTong University and Manuel Francesco Castello, MD, of Clinica Villa Salaria, Rome, conclude that, “based on our 20 years of experience and observations on three-dimensional liposuction, we can suggest it a reliable method with proven results.” In the report they and their coauthors describe and analyze their technique and outcomes of lower-body liposculpture in more than 4,000 patients.

They write that liposculpture “is a very sophisticated method that goes beyond the simple aspiration of adipose tissue [fat] and allows the surgeon to modify the shape of the body and recontour the profile.”

The key part of the technique is not only to remove underlying fat, but also to guide and promote skin retraction after fat removal. This includes thinning of the skin to allow it to retract and adapt to the new shape.

The new report outlines each step of the procedure, from initial evaluations, to preoperative marking, patient preparation and liposuction technique. Postoperative care includes compression garments and bandages to guide skin adaptation to the carefully sculpted underlying fat.

They note that their cosmetic results have been well-maintained during follow-up, including in patients with pregnancies or weight loss or gain. “If performed correctly, three-dimensional liposuction of trunk, hips and thighs can yield very satisfying outcomes because of the excellent contour and enhanced skin retraction provided by the thin cutaneous [skin] adipose flap,” they write.

Complications rates were low, with only one serious complication—an infection that responded to antibiotics—in more than 4,000 patients.

Drs Zhang and Castello and coauthors believe their experience demonstrates the excellent cosmetic results and safety record of three-dimensional liposculpture of the hips, flanks, and thighs—and highlights the role of techniques aimed at promoting good skin adaptation to the new shape.


Conservative Treatment Normalizes Head Shape in Children with Skull Flattening

A recent study by ASPS Member Surgeon Frank A. Vicari, MD, and colleagues of Ann and Robert H. Lurie Children’s Hospital of Chicago reports on the effectiveness of both conservative and helmet therapy, as confirmed by objective measurements.

This study of positional cranial deformity (PCD) reports that more than three-fourths of infants experiencing skull flattening related to sleep position achieve normal head shape with conservative treatment -without the need for helmet therapy. Their report found that the addition of a helmet led to a success rate of over 90%.

Dr. Vicari and colleagues analyzed 4,378 infants with flattening of one side of the head (plagiocephaly) or of the back of the head (brachycephaly). These problems can occur when the baby always sleeps in the same position, causing pressure on the same spot on the skull. This has become a common issue since the recommendation to place babies on their backs to sleep. This campaign, now called the “Safe to Sleep” campaign, has been highly effective in lowering nationwide rates of sudden infant death syndrome (SIDS).


The researchers compared final skull shape for nearly 3,000 infants initially receiving conservative therapy for PCD and nearly 1,000 infants receiving helmet therapy. “Conservative” treatment consists of advice and/or physical therapy, including practices such as encouraging “tummy time” when the baby is awake. “Helmet therapy” consists of a custom-made orthosis to help shape the developing skill.

The researchers measured final skull shape using 3D laser surface scanning.

Conservative treatment normalized skull shape in 77% of infants, with approximately 16% of infants initially assigned to conservative treatment were switched to helmet therapy. The remaining seven percent had “incomplete correction” of skull flattening.

For infants initially treated with helmet therapy, the rate of complete correction was 94%. “In the majority of infants, delaying helmet therapy for a trial of conservative treatment does not preclude the achievement of complete correction,” Dr. Vicari and coauthors write.

American Society of Plastic Surgeons Reports Cosmetic Procedures Increased 3% in 2014

According to the American Society of Plastic Surgeons (ASPS) 15.6 million people in the United States underwent cosmetic procedures in 2014, indicating an increase of 3% compared to the previous year. These findings include both minimally-invasive and surgical procedures, and findings also indicate that 5.8 million reconstructive surgeries were performed, up by 1% since 2013.

“The demand for plastic surgery continues to grow as medical advancements are made and technology improves resulting in a wider array of options for patients,” states ASPS President Scot Glasberg, MD.

“Today, more than ever, patients are empowered with choices to achieve the results they are seeking” he says. “Through open communication and a mutual understanding of expectations, patients work closely with their surgeon to determine the procedures most appropriate for them to achieve their optimal outcomes.”

Minimally-invasive cosmetic procedures increased 4 percent, with more than 13.9 million procedures in 2014. The top five minimally-invasive procedures were:

  1. Botulinum Toxin Type A (6.7 million procedures up 6 percent from 2013 to 2014)
  2. Soft tissue fillers (2.3 million procedures up 3 percent from 2013 to 2014)
  3. Chemical peel (1.2 million procedures up 7 percent from 2013 to 2014)
  4. Laser hair removal (1.1 million procedures up 3 percent from 2013 to 2014)
  5. Microdermabrasion (881,905 procedures down 9 percent from 2013 to 2014)

Cosmetic surgical procedures rose 1 percent, to nearly 1.7 million procedures in 2014. The top five surgical procedures were:

  1. Breast augmentation (286,254 procedures, down 1 percent)
  2. Nose reshaping (217,124 procedures, down 2 percent)
  3. Liposuction (210,552 procedures, up 5 percent)
  4. Eyelid surgery (206,509 procedures, down 4 percent)
  5. Facelift (128,266 procedures, down 4 percent)