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Dermatologic Surgery : Official... Oct 2020The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of... (Review)
Review
BACKGROUND
The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of response.
OBJECTIVE
Results from clinical trials that target different anatomical aspects of cellulite can provide insights into the underlying pathophysiology of cellulite.
MATERIALS AND METHODS
A search of the PubMed database and ClinicalTrials.gov website was conducted to identify clinical trials that have investigated treatments for cellulite.
RESULTS
A lack of trial protocol standardization, objective means for quantification of improvement and reported cellulite severity, and short-term follow-up, as well as variation in assessment methods have made comparisons among efficacy studies challenging. However, the lack of durable efficacy and inconsistency seen in clinical results suggest that dermal or adipose tissue changes are not the primary etiologies of cellulite. Clinical studies targeting the collagen-rich fibrous septae in cellulite dimples through mechanical, surgical, or enzymatic approaches suggest that targeting fibrous septae is the strategy most likely to provide durable improvement of skin topography and the appearance of cellulite.
CONCLUSION
The etiology of cellulite has not been completely elucidated. However, there is compelling clinical evidence that fibrous septae play a central role in the pathophysiology of cellulite.
Topics: Aponeurosis; Buttocks; Cellulite; Clinical Trials as Topic; Extracorporeal Shockwave Therapy; Humans; Lipectomy; Massage; Microbial Collagenase; Muscle, Skeletal; Phototherapy; Radiofrequency Therapy; Skin; Skin Cream; Subcutaneous Fat; Thigh; Treatment Outcome
PubMed: 32976174
DOI: 10.1097/DSS.0000000000002388 -
Cleveland Clinic Journal of Medicine Jun 2020Liposuction is the second most commonly performed cosmetic surgery in the United States and the most common surgical procedure in patients between the ages of 35 and 64;... (Review)
Review
Liposuction is the second most commonly performed cosmetic surgery in the United States and the most common surgical procedure in patients between the ages of 35 and 64; practitioners of medicine and surgery will undoubtedly encounter these patients in their practice. This brief review discusses the role of liposuction and fat transfer in aesthetic and reconstructive surgery, as well as key considerations, indications, and safety concerns.
Topics: Adipose Tissue; Body Contouring; Cosmetic Techniques; Humans; Lipectomy; Postoperative Complications
PubMed: 32487557
DOI: 10.3949/ccjm.87a.19097 -
Wounds : a Compendium of Clinical... Mar 2020The lymphatic system is arguably the most neglected bodily system. As a result, its contribution to human health and disease is not well understood. In this review, the... (Review)
Review
The lymphatic system is arguably the most neglected bodily system. As a result, its contribution to human health and disease is not well understood. In this review, the clinical approaches based on new knowledge and developments of the lymphatic system are covered. The lymphatic system has 3 major functions: (1) the preservation of fluid balance; (2) a nutritional function, as intestinal lymphatics are responsible for fat absorption; and (3) host defense. Lymph vessels return the capillary ultrafiltrate and escaped plasma proteins from most tissues back, ultimately, to the blood circulation. Hence, lymphatics are responsible for maintaining tissue (and plasma) volume homeostasis. Impaired lymph drainage results in peripheral edema (lymphedema) and may have more far-reaching effects on cardiovascular disease, in particular hypertension and atherosclerosis. Lymphatics have an important immune surveillance function, as they represent the principal route of transport from tissues for antigen and immune cells. Intestinal lymphatics (lacteals) are responsible for most fat absorption, first documented by Gaspare Aselli in 1627, when the lymphatic system was discovered. A relationship between fat and lymphatics may exist well beyond the gut alone. Fat deposition is a defining clinical characteristic of lymphedema. Suction-assisted lipectomy of lymphedema has shown the swelling is not just fluid but is dominated by fat. Lymphatics are the preferred route for the metastatic spread of cancer. Accordingly, the lymphatic system may be important for defense against cancer by generating immune responses to malignant cell antigens. Preventing lymphatic entry and propagation of malignant metastasis would effectively render the cancer nonfatal. As one can see, the lymphatic circulation is fundamentally important to cardiovascular disease, infection and immunity, cancer, and, in all likelihood, obesity - 4 of the major challenges to health care in the 21st century.
Topics: Humans; Lymphatic System; Lymphedema; Lymphoscintigraphy
PubMed: 32163039
DOI: No ID Found -
Obesity (Silver Spring, Md.) Oct 2019Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women,... (Review)
Review
Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.
Topics: Body Fat Distribution; Diagnosis, Differential; Female; Humans; Lipectomy; Lipedema; Male; Obesity
PubMed: 31544340
DOI: 10.1002/oby.22597 -
Plastic and Reconstructive Surgery Jun 2015Cryolipolysis is a nonsurgical technique for localized fat reduction. With the increased risk of complications from more invasive methods such as liposuction,... (Review)
Review
BACKGROUND
Cryolipolysis is a nonsurgical technique for localized fat reduction. With the increased risk of complications from more invasive methods such as liposuction, cryolipolysis presents a promising method for nonsurgical body contouring. This study presents a systematic review of the available clinical data, with an emphasis on the efficacy, methods, safety, and complications of cryolipolysis.
METHODS
To identify clinical studies that assessed outcomes of cryolipolysis, a systematic review of the MEDLINE and Cochrane databases was performed with the search algorithm cryolipolysis OR cool sculpting OR fat freezing OR lipocryolysis.
RESULTS
The primary literature search returned 319 articles. After inclusion criteria were applied and additional articles were idenfied via manual review of article references, 19 studies were selected for review. Average reduction in caliper measurement ranged from 14.67 percent to 28.5 percent. Average reduction by ultrasound ranged from 10.3 percent to 25.5 percent. No significant impact on lipid levels or liver function tests after cryolipolysis treatments was noted in any study. Only mild, short-term side effects, such as erythema, swelling, and pain, were noted. Paradoxical adipose hyperplasia was described in one patient.
CONCLUSIONS
Cryolipolysis is a promising procedure for nonsurgical fat reduction and body contouring and presents a compelling alternative to liposuction and other, more invasive methods. This procedure appears to be safe in the short term, with a limited side effect profile, and results in significant fat reduction when used for localized adiposities. It remains unclear whether posttreatment manual massage and multiple treatments in the same anatomic area enhance the efficacy of cryolipolysis.
Topics: Body Mass Index; Cosmetic Techniques; Cryotherapy; Databases, Factual; Esthetics; Female; Follow-Up Studies; Humans; Lipectomy; Male; Obesity; Patient Safety; Patient Satisfaction; Risk Assessment; Subcutaneous Fat; Treatment Outcome
PubMed: 26017594
DOI: 10.1097/PRS.0000000000001236 -
Annals of Plastic Surgery Mar 2021Abdominoplasty has been evolving since the 1960s with many technical innovations throughout the years. It has become one of the most frequent and common procedures done...
BACKGROUND
Abdominoplasty has been evolving since the 1960s with many technical innovations throughout the years. It has become one of the most frequent and common procedures done in aesthetic plastic surgery, with the ultimate goal of not only to remove the excess tissue in the abdominal area but also to achieve an aesthetic trunk silhouette.
OBJECTIVE
The prime objective of this article was to describe our preferred approach for a full cosmetic abdominoplasty.
METHODS
We summarized all the key technical aspects from our shared surgical approach for abdominoplasty. The article describes collective experiences from authors performing the surgery in South America, North America, and Asia.
RESULTS
The key technical aspects identified were conservative muscle plication, customized excess tissue resection, and ultrasound-assisted liposuction to improve definition in the abdominal lines and body curves, combined with lipofilling. The aesthetic results are presented.
CONCLUSIONS
Abdominoplasty should be customized to every patient's anatomy and desired cosmetic outcome, taking into consideration all the anatomical areas surrounding the abdominal wall.
Topics: Abdominal Wall; Abdominoplasty; Asia; Humans; Lipectomy; South America
PubMed: 33278073
DOI: 10.1097/SAP.0000000000002639 -
Medicina Oral, Patologia Oral Y Cirugia... May 2022Liposuction is one of the most commonly performed cosmetic procedures worldwide. Complications associated with submental liposuction are rare. However, when they occur... (Review)
Review
BACKGROUND
Liposuction is one of the most commonly performed cosmetic procedures worldwide. Complications associated with submental liposuction are rare. However, when they occur they are significant and can cause disfiguring consequences. The objective of this study was evaluated complications from submentual liposuction in literature and description of clinical experience of complication after submentual liposuction.
MATERIAL AND METHODS
At first, a scoping review was carried out online search with no time restrictions for complications after submental liposuction was performed in the databases Medline / PubMed, Embase, and Web of Science. The variables analyzed were: age, sex, type of esthetic procedure, anesthesia, complications, time after Procedure, treatment, follow-up care, and sequelae. Then, a case of a patient with submental hematoma after an aesthetic procedure for submental liposuction was described.
RESULTS
Firstly, 539 articles were selected, after application of the inclusion criteria, 4 studies were included. Most cases were female (8:1), with a mean age of 55.77 years. Postoperative complications were found, such as submental depression, submental edema, hypertrophic scar formation, scar contracture, cervical necrotizing fasciitis, Cervico-facial dystonia and transient facial nerve paralysis. The follow-up period for cases ranged from 3 to 12 months. The clinical case presented there was no sequelae.
CONCLUSIONS
Submental liposuction requires the surgeon's attention. Anatomical knowledge, correct clinical and surgical management, diagnosis, and immediate approach to adverse situations are points that must be respected in this type of esthetic procedure to avoid more serious complications.
Topics: Esthetics, Dental; Female; Humans; Lipectomy; Male; Middle Aged; Neck; Postoperative Complications
PubMed: 35420070
DOI: 10.4317/medoral.25122 -
Dermatologic Surgery : Official... Apr 2006Mesotherapy was originally conceived in Europe as a method of utilizing cutaneous injections containing a mixture of compounds for the treatment of local medical and... (Review)
Review
BACKGROUND
Mesotherapy was originally conceived in Europe as a method of utilizing cutaneous injections containing a mixture of compounds for the treatment of local medical and cosmetic conditions. Although mesotherapy was traditionally employed for pain relief, its cosmetic applications, particularly fat and cellulite removal, have recently received attention in the United States. Another treatment for localized fat reduction, which was popularized in Brazil and uses injections of phosphatidylcholine, has been erroneously considered synonymous with mesotherapy. Despite their attraction as purported "fat-dissolving" injections, the safety and efficacy of these novel cosmetic treatments remain ambiguous to most patients and physicians.
OBJECTIVE
To distinguish mesotherapy from phosphatidylcholine injections by reviewing their history and the relevant experimental or clinical findings.
METHODS
A comprehensive search of Medline indexed literature and conference proceedings.
RESULTS
All the published studies evaluating the clinical efficacy of traditional mesotherapy currently originate from Europe. These reports focus primarily on musculoskeletal pain and vascular disease, rather than cosmetic applications. Although experimental data suggest that a number of traditional mesotherapy ingredients may theoretically reduce fat, these effects have not been supported in peer-reviewed studies. An increasing number of reports demonstrate that subcutaneous injections of a formula containing phosphatidylcholine combined with its emulsifier, deoxycholate, are effective in removing small collections of adipose tissue. Cell lysis, resulting from the detergent action of deoxycholate, may account for this clinical effect.
CONCLUSIONS
Mesotherapy is distinct from a method of treating adipose tissue with subcutaneous injections of deoxycholate alone or in combination with phosphatidylcholine. Additional clinical and experimental studies are necessary to more definitively establish the safety and efficacy of these treatments.
Topics: Adipose Tissue; Cosmetic Techniques; Fat Emulsions, Intravenous; Humans; Injections, Intralesional; Injections, Subcutaneous; Lipectomy; Phosphatidylcholines
PubMed: 16681654
DOI: 10.1111/j.1524-4725.2006.32100.x -
Gland Surgery Jul 2023We have successfully carried out single-hole inflator-free endoscopic thyroidectomy through a submental approach, which has the advantages of less trauma, fewer...
We have successfully carried out single-hole inflator-free endoscopic thyroidectomy through a submental approach, which has the advantages of less trauma, fewer complications, and hidden incisions. However, for patients with submandibular fat accumulation, submental incisions are not easy to hide, which directly affects the cosmetic effect. We developed a new surgical strategy "submandibular suction lipectomy and single-hole inflator-free endoscopic thyroidectomy with a submental approach" for these patients. We initially used submandibular suction lipectomy to reduce the accumulation of submandibular fat and obvious fat protrusion and, thus, restore the normal depression, placing the submental incision back where it is hidden in the submental shadow. Subsequentially, we began to use single-hole inflator-free endoscopic thyroidectomy with a submental approach. We aimed to explore the feasibility and cosmetic effect of this method for the treatment of thyroid disease patients with submandibular fat accumulation. The average operation time was 4.2 hours; and the average hospitalization time was 4.75 days. There were no postoperative complications, such as hoarseness, low calcium, hand and foot numbness, etc., and no special complications and no recurrence or metastasis seen in the 6-month follow-up examination. The aesthetic satisfaction survey results of patients half a year after surgery were satisfactory and above. For thyroid cancer patients with submandibular fat accumulation, this method not only hides the surgical incision in the neck but also meets the patient's requirement for "submental aesthetics"; thus it has good application prospects. It should be pointed out that the current findings are preliminary results, based on data from only four patients.
PubMed: 37727332
DOI: 10.21037/gs-22-624