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Contouring of the Extremities

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Ultrasound-Assisted Liposuction

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Abstract

The latest procedural statistics from the American Society of Plastic Surgeons rank liposuction as the second most common aesthetic surgical procedure performed by board certified plastic surgeons. In the author’s experience, 40% of liposuction cases involve the extremities and the great majority of these cases are carried out on female patients. Individuals who are close to their ideal body weight and have a disproportionately high distribution of fat in the lower extremities in relation to their trunk are still the best candidates for thigh liposuction. Poor patient selection and overextraction resulting in excessive skin laxity and contour deformities are the most common causes of inferior aesthetic results following contouring of the thighs. There are five zones of adherence in the thighs and these are areas that should be avoided during liposuction procedures: (1) the gluteal crease, (2) the posterior distal thigh above the popliteal crease, (3) the lower lateral thigh area of the iliotibial tract, (4) the lateral gluteal depression, and (5) the mid-medial thigh area. The author’s approach to thigh contouring involves the use of VASER-assisted liposuction since it is associated with less blood loss, good skin retraction, and a relatively comfortable postoperative course for the patient. Patients with significant skin laxity are best treated with thighplasty or VASER-assisted thighplasty depending on the degree of lipodystrophy present. Preoperative planning of upper extremity contouring involves a comparison of the relationship between the excess arm fat and the skin envelope of the arm. In cases of arm lipodystrophy with good skin tone, VASER-assisted liposuction allows for easier fat extraction with good skin retraction. Poor skin tone, regardless of the amount of arm fat, usually dictates that an open tightening procedure be performed in order to properly contour the arm. Patients with poor skin tone and a significant amount of excess arm fat are best treated by a VASER-assisted brachioplasty.

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References

  1. Cimino WW. History of ultrasound assisted lipoplasty. In: Shiffman MA, Di Giusseppe A, editors. Body contouring: art, science and clinical practice. Berlin: Springer; 2010. p. P399–403.

    Chapter  Google Scholar 

  2. Jewell ML, Fodor PB, de Souza Pinto EB, et al. Clinical application of VASER-assisted lipoplasty: a pilot study. Aesth Surg J. 2002;22:131–46.

    Article  Google Scholar 

  3. Garcia O, Nathan N. Comparative analysis of blood loss in suction-assisted lipoplasty and third generation internal ultrasound-assisted lipoplasty. Aesth Surg J. 2008;28:430–5.

    Article  Google Scholar 

  4. De Souza Pinto EB, Abdala PC, Maciel CM, et al. Liposuction and VASER. Clin Plast Surg. 2006;33:107–15.

    Article  Google Scholar 

  5. Rohrich RJ, Beran SJ, Kenkel JM. Patient selection and planning. In: Rohrich RJ, Beran SJ, Kenkel JM, editors. Ultrasound-assisted liposuction. St. Louis: Quality Medical Publishing; 1998. p. 87–119.

    Google Scholar 

  6. Vartanian E, Gould DJ, Hammoudeh ZS, et al. The ideal thigh: a crowd-sourcing assessment of ideal thigh aesthetic and implications for gluteal fat grafting. Aesth Surg J. 2018;38:861–9.

    Article  Google Scholar 

  7. Ali A. Commentary on: the ideal thigh: a crowd-sourcing assessment of ideal thigh aesthetic and implications for gluteal fat grafting. Aesth Surg J. 2018;38:870–2.

    Article  Google Scholar 

  8. Gilliland MD, Lyos AT. CAST liposuction: an alternative to brachioplasty. Aesthet Plast Surg. 1997;21:398–402.

    Article  CAS  Google Scholar 

  9. Cimino WW. Ultrasonic power quantification and efficiency optimization. Aesth Surg J. 2001;21:233–40.

    Article  CAS  Google Scholar 

  10. Grazer FM, de Jong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Discussion. Plast Reconstr Surg. 2000;105:436–46.

    Article  CAS  Google Scholar 

  11. Temourian B, Rogers WB III. A national survey of complications associated with suction lipectomy: a comparative study. Plast Reconstr Surg. 1989;84:628.

    Article  Google Scholar 

  12. Garcia O. Liposuction of the upper and lower extremities. In: Aly A, Nahas F, editors. The art of body contouring: a comprehensive approach. New York: Thieme Medical Publishers; 2017. p. 361–95.

    Google Scholar 

  13. De Jong RH. Titanic anesthesia. Dermatol Surg. 1998;24:689–92.

    Article  Google Scholar 

  14. Garcia O. Liposuction for body contouring: discussion. In: Cohen MN, Thaller SR, editors. The unfavorable result in plastic surgery: avoidance and treatment. New York: Thieme Medical Publishers; 2018. p. 451–5.

    Google Scholar 

  15. Wall S Jr. SAFE circumferential liposuction with abdominoplasty. Clin Plast Surg. 2010;37:485.

    Article  Google Scholar 

  16. Trott SA, Stool LA, Klein KW. Anesthetic considerations. In: Rohrich RJ, Beran SJ, Kenkel JM, editors. Ultrasound-assisted liposuction. St. Louis: Quality Medical Publishing; 1998. p. 69–84.

    Google Scholar 

  17. Garcia O. Ultrasonic liposuction. In: Rubin JP, Jewell ML, Richter DF, et al., editors. Body contouring and liposuction. Philadelphia: Saunders; 2013. p. 543–58.

    Google Scholar 

  18. Correa-Inturraspe M, Fernandez JC. Dermatolipectomia braquial. Prensa Med Argent. 1954;43:24–32.

    Google Scholar 

  19. Hurwitz DJ, Holland SW. The L-brachioplasty: an innovative approach to correct excess tissue of the upper arm, axilla and lateral chest. Plast Reconstr Surg. 2006;117:403–11.

    Article  CAS  Google Scholar 

  20. Hurwitz DJ. Brachioplasty with liposuction resection. In: Rubin JP, Jewell ML, Richter DF, et al., editors. Body contouring and liposuction. Philadelphia: Saunders; 2013. p. 29–34.

    Google Scholar 

  21. Strauch B, Greenspun D. Approach to the arm after weight loss. In: Rubin JP, Matarasso A, editors. Aesthetic surgery after massive weight loss. Oxford: Elsevier; 2007.

    Google Scholar 

  22. Downey S. Brachioplasty with bicipital groove scar. In: Rubin JP, Jewell ML, Richter DF, et al., editors. Body contouring and liposuction. Philadelphia: Saunders; 2013. p. 19–23.

    Google Scholar 

  23. Capella JF. Body and extremity contouring after massive weight loss. In: Cohen MN, Thaller SR, editors. The unfavorable result in plastic surgery: avoidance and treatment. New York: Thieme Medical Publishers; 2018. p. 478–93.

    Google Scholar 

  24. Baroudi R. Traditional approach to brachioplasty. In: Aly A, Nahas F, editors. The art of body contouring: a comprehensive approach. New York: Thieme Medical Publishers; 2017. p. 276–96.

    Google Scholar 

  25. Chamosa M, Murillo J, Vazquez T. Lipectomy of arms and lipograft of shoulders balance the upper body contour. Aesth Plast Surg. 2005;29:567–70.

    Article  Google Scholar 

  26. Berman B, Perez OA, Kond S. A review of the biologic effects, clinical efficacy and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg. 2007;33:1291.

    PubMed  CAS  Google Scholar 

  27. Nguyen L, Gupta V, Afshari A, et al. Incidence and major complications in brachioplasty: analysis of 2,294 patients. Aesth Surg J. 2016;36:792–803.

    Article  Google Scholar 

  28. The American Society for Aesthetic Plastic Surgery. Cosmetic Surgery National Data Bank, Procedural Statistics; 2017.

    Google Scholar 

  29. Lewis JR. The thigh lift. J Int Coll Surg. 1957;27:330.

    PubMed  Google Scholar 

  30. Sozer SO, Agullo FJ, Palladino H. Spiral lift: medial and lateral thigh lift with buttock lift and augmentation. Aesth Plast Surg. 2008;32:120–5.

    Article  Google Scholar 

  31. Kirwan L. Anchor thighplasty. Aesth Surg J. 2004;24:61–4.

    Article  Google Scholar 

  32. Schultz R, Feinber LA. Medial thigh lift. Ann Plast Surg. 1979;55:551–8.

    Google Scholar 

  33. Vilain R, Dandour JC. Aesthetic surgery of the medial thigh. Ann Plast Surg. 1986;17:176–83.

    Article  CAS  Google Scholar 

  34. Cannistra C, Valero R, Benelli C, et al. Thigh and buttock lift after massive weight loss. Aesth Plast Surg. 2007;31:233–7.

    Article  Google Scholar 

  35. Lockwood TE. Maximizing aesthetics in lateral tension abdominoplasty and body lifts. Clin Plast Surg. 2004;31:523–37.

    Article  Google Scholar 

  36. Lockwood TE. Lower body lift with superficial fascial system suspension. Plast Reconstr Surg. 1993;92:1112–22.

    Article  CAS  Google Scholar 

  37. Hurwitz DH. Medial thighplasty. Aesth surg J. 2005;25:180.

    Article  CAS  Google Scholar 

  38. Cram A, Aly A. Thigh reduction in the massive weight loss patient. Clin Plast Surg. 2008;35:165–72.

    Article  Google Scholar 

  39. Mathes DW, Kenkel JM. Current concepts in medial thighplasty. Clin Plast Surg. 2008;35:151–63.

    Article  Google Scholar 

  40. Shermak MA, Mallalieu J, Chang D. Does thighplasty for upper thigh laxity after massive weight loss require a vertical scar? Aesth Surg J. 2009;29:513–22.

    Article  Google Scholar 

  41. Capella JF, Woehrle S. Vertical medial thigh lift with liposuction. In: Rubin JP, Jewell ML, Richter DF, et al., editors. Body contouring and liposuction. Philadelphia: Saunders; 2013. p. 353–65.

    Google Scholar 

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Authors and Affiliations

  1. Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA

    Onelio Garcia Jr.

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  1. Onelio Garcia Jr.
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Editors and Affiliations

  1. Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA

    Onelio Garcia Jr.

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Garcia, O. (2020). Contouring of the Extremities. In: Garcia Jr., O. (eds) Ultrasound-Assisted Liposuction. Springer, Cham. https://doi.org/10.1007/978-3-030-26875-6_8

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  • DOI: https://doi.org/10.1007/978-3-030-26875-6_8

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26874-9

  • Online ISBN: 978-3-030-26875-6

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