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Lipoedema is a congenital fat distribution disorder. It leads to a pathological increase in adipose tissue due to a hypertrophy and hyperplasia of the adipocytes. Currently, the disease affects approximately 10% of women. A common treatment of the disease is liposuction to remove the pathologic fat cells. A total of 47 patients (mean age: 62.00 ± 12.96 years) were treated with the conventional tumescent liposuction and 25 patients (mean age of 45.16 ± 12.87 years) with waterjet-assisted liposuction (WAL), a gentle, tissue-conserving method that washes out fat cells. WAL is thought to cause less damage to surrounding tissue than tumescent liposuction and thus, less trauma. At the postoperative level, the C-reactive protein was significantly (p * = 0.0195) lower after WAL treatment, implying a lower inflammation level than after tumescent liposuction. Also, a decrease of electrolytes such as potassium in the blood serum was observed in some cases. The postoperative potassium level dropped by 0.30 ± 0.24 mmol/l, a value that was significantly lower in WAL-treated patients where the level dropped by 0.47 ± 0.31 mmol/l. The mean fat aspirate using the conventional tumescent method was 3302.13 ± 1345.89 ml and 3727.08 ± 151.96 ml with the WAL treatment. WAL is a tissue-conserving method that washes out fat cells with less trauma to surrounding tissue as observed with conventional tumescent liposuction. WAL causes a lower inflammation level but higher loss of potassium ions. This latter aspect needs attention after the liposuction treatment. Waterjet-assisted liposuction reduces inflammation but increases the risk of hypokalemia when compared to conventional tumescent liposuction in patients with lipoedema, DRKS00034711. Registered July 17, 2024 - Retrospectively registered. Trial registration number DRKS00034711. [ABSTRACT FROM AUTHOR]

Background: Epinephrine in liposuction solution mediated vasoconstriction thus decrease in adrenergic side effects, local anesthetic toxicity, and bleeding. The optimum safe adrenaline concentration was not well investigated. Aim: This study aimed to compare between adrenaline 1 mg/L and 2 mg/L in tumescent fluid concerning hemodynamics during abdominal liposuction operations. Methods: Forty cases scheduled for liposuction for abdomen and flanks and body were involved in this randomized, triple-blind, controlled trial. Cases were randomized equally into two groups. Group A (low adrenaline concentration group): received 1 mg per liter of epinephrine. Group B (high adrenaline concentration group): received 2 mg per liter of epinephrine. Results: Intraoperative heart rate and mean arterial blood pressure at base line were insignificantly different between both groups (p value > 0.05) while at 30, 60, 90, and end of surgery were significantly higher in group B group as opposed to group A (p value < 0.05). Incidence of sinus tachycardia and PVCs were significantly higher in group B than group A (P < 0.05), while surgeon satisfaction was comparable between both groups (p value > 0.05). Conclusions: In liposuction procedures, the safest adrenaline concentration is 1 mg/L as evidenced by hemodynamics stability and surgeon satisfaction thus even in high volume liposuction, the adrenaline concentration should not exceed 1 mg/L and should be handled to cover the used crystalloid solution. [ABSTRACT FROM AUTHOR]

Study Design: The study was a retrospective cross-sectional database analysis. Objective: Deoxycholic acid (DOC) injections are a novel, in-office procedural alternative to submental liposuction or submentoplasty to address excess submental fat. Post-market safety data regarding this treatment is currently limited. The objective of this study is to analyze adverse events reported in the Manufacturer and User Facility Device Experience (MAUDE) database. Methods: The MAUDE database was queried for all reports related to adverse events involving deoxycholic acid using the search terms "KYBELLA" and "deoxycholic acid." Reports were individually reviewed by 2 reviewers and categorized with special attention to adverse events. Results: A total of 34 medical device reports were identified from the database query. Thirteen of these reports (21 total events) were included in the analysis after excluding duplicates, unrelated adverse events, or events associated with the off-label use of DOC. Reported adverse events include excessive swelling (n = 5, 24%), marginal mandibular nerve weakness (n = 4, 19%), unsatisfactory aesthetic outcome (n = 4, 19%), numbness (n = 3, 14%), dysphagia (n = 1, 5%), infection (n = 1, 5%), and skin necrosis (n = 3, 14%). Two patients required hospitalization for skin necrosis management; both had underlying systemic diseases. Conclusions: Adverse events following DOC injections included excessive swelling, dysphagia, numbness, infection, unsatisfactory aesthetic outcome, facial nerve weakness, and skin necrosis requiring hospitalization and/or surgery. Patient counseling regarding these adverse events should be discussed when offering DOC injections for submental convexity. [ABSTRACT FROM AUTHOR]

This study aimed to develop and validate a machine learning (ML)-based model for predicting liposuction volumes in patients with obesity. This study used longitudinal cohort data from 2018 to 2023 from five nationwide centers affiliated with 365MC Liposuction Hospital, the largest liposuction hospitals in Korea. Fifteen variables related to patient profiles were integrated and applied to various ML algorithms, including random forest, support vector, XGBoost, decision tree, and AdaBoost regressors. Performance evaluation employed mean absolute error (MAE), root mean square error (RMSE), and R-squared (R2) score. Feature importance and RMSE importance analyses were performed to compare the influence of each feature on prediction performance. A total of 9,856 were included in the final analysis. The random forest regressor model best predicted the liposuction volume (MAE, 0.197, RMSE, 0.249, R2, 0.792). Body fat mass and waist circumference were the most important features of the random forest regressor model (feature importance 71.55 and 13.21, RMSE importance 0.201 and 0.221, respectively). Leveraging this model, a web-based application was developed to suggest ideal liposuction volumes. These findings could be used in clinical practice to enhance decision-making and tailor surgical interventions to individual patient needs, thereby improving overall surgical efficacy and patient satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: Wilkie’s syndrome is an unusual cause of high intestinal obstruction generated by vascular compression of the third portion of the duodenum. Objective: To present the clinical case of a 41-yearold female patient in postoperative period after liposuction, who developed acute clinical symptoms of abdominal pain, nausea, vomiting, imaging study confirmed Wilkie’s syndrome. Results: Young patient without relevant clinical history, presented a condition compatible with Wilkie Syndrome in postoperative period of liposuction, requiring conservative management with complete resolution of the clinical condition. Discussion and Conclusions: After diagnosis the patient received conservative treatment with complete resolution of the entity, after reviewing the literature on this syndrome, etiology and medicalsurgical management we can conclude that anatomical changes after plastic surgery of the abdominal wall associated with external medical compression devices and vascular anatomical variants of the patient may predispose to the development of this syndrome, timely diagnosis and treatment avoid major complications but more studies are needed to determine the true prevalence. [ABSTRACT FROM AUTHOR]

In recent years, the incidence of obesity has been on the rise. Bariatric surgery is widely recognized as a safe and effective method for treating obesity. In the short term following bariatric surgery, a significant reduction in body weight can be achieved, but this is often accompanied by excess skin and soft tissue, which not only affects appearance but also impairs daily activities. Skin diseases are more likely to occur in areas with skin folds. Abdominoplasty is one of the most commonly performed body contouring procedures for post-bariatric surgery patients. This article summarizes the characteristics of abdominal wall deformities following bariatric surgery and reviews the anatomical basis and current surgical treatment methods for abdominal contouring after bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: Gynecomastia is a progressive disease characterized by enlarged breasts, affecting a significant proportion of men. Persistent gynecomastia negatively affects the psychological and emotional development of patients; therefore, surgical intervention is required. In this article, we describe a surgical technique, where liposuction through an axillary incision is used in combination with a single small periareolar incision, to obtain the most minimal scars in the treatment of gynecomastia. Methods: Between June 2021 and June 2023, 125 patients with different Simon grades of gynecomastia were enrolled. The patients' basic conditions and operation processes were recorded. Following surgery, a score was assigned according to the five main aesthetic aspects of the surgical procedure. Results: In total, 125 patients with gynecomastia were treated with a pre-axillary fold incision combined with a small areolar incision. There were 17 cases of Simon grade I, 46 grade IIA, 42 grade IIB, and 20 grade III. The average operation time was 45.8 min, the average liposuction volume was 250.5 mL, the average glandular tissue volume was 50.5 g, intraoperative blood loss ranged from 15 to 60 mL, and the average hospital stay was 3.2 days. Regarding the postoperative aesthetic effect, doctors scored > 4 points, and the patient satisfaction score was > 7.5, which fully affirmed the aesthetic effect of this method. Conclusions: Treatment of gynecomastia through an anterior axillary fold incision combined with a small areolar incision is safe and feasible, involving a simple procedure, short operation time, and few complications. Its efficacy and cosmetic effects could lead to its use as a primary surgical method to treat gynecomastia. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Secondary lymphedema (LE) following breast cancer‐related surgery is a life‐long complication, which currently has no cure. LE induces significant regional adipose tissue deposition, requiring liposuction as a treatment. Here, we aimed to elucidate the transcriptional, metabolomic, and lipidomic signature of the adipose tissue developed due to the surgery‐induced LE in short‐ and long‐term LE patients and compared the transcriptomic landscape of LE adipose tissue to the obesity‐induced adipose tissue. Adipose tissue biopsies were obtained from breast cancer‐operated females with LE from the affected and non‐affected arms (n = 20 patients). To decipher the molecular properties of the LE adipose tissue, we performed RNA sequencing, metabolomics, and lipidomics combined with bioinformatics analyses. Differential gene expression data from a cohort of lean and obese patients without LE was used for comparisons. Integrative analysis of functional genomics revealed that inflammatory response, cell chemotaxis, and angiogenesis were upregulated biological processes in the LE arm, indicating a sustained inflammation in the edematous adipose tissue; whereas, epidermal differentiation, cell–cell junction organization, water homeostasis, and neurogenesis were downregulated in the LE arm. Surprisingly, only a few genes were found to be the same in the LE‐induced and the obesity‐induced adipose tissue expansion, indicating a different type of adipose tissue development in these two conditions. In metabolomics analysis, we found reduced levels of a branched‐chain amino acid valine in the LE arm and downregulation of the mRNA levels of its transporter SLC6A15. Lipidomics analyses did not show any significant differences between the LE and non‐LE arms, suggesting that other factors affect the lipid composition of the adipose tissue more than the LE in these patients. Our results provide a detailed molecular characterization of adipose tissue in secondary LE after breast cancer‐related surgery. We also show distinct differences in transcriptomic signatures between LE‐induced adipose tissue and obesity‐induced adipose tissue, but only minor differences in metabolome and lipidome between the LE and the non‐LE arm. [ABSTRACT FROM AUTHOR]

Introduction: This study elucidates the application of Medium Definition Liposuction Abdominoplasty, a novel technique for achieving well-defined abdominal contours. The technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. Methods: Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. Digital image measurements facilitated by an image software constituted the basis for these assessments. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites, with two measurements taken at each site and subsequently averaged. Results: Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. However, complications such as partial diminution of tension in the muscular wall (2%), distal flap necrosis (0.6%), and minor muscular hernia (0.3%) were observed. Conclusion: The employment of combined muscle plication emerges as an efficacious methodology in meticulously rectifying alterations inherent within the muscular aponeurotic abdominal wall. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. Bullet Points: The study introduces a novel technique, Medium Definition Liposuction Abdominoplasty, for achieving well-defined abdominal contours. This technique focuses on revealing the patient's inherent muscular volume and form by creating thinner flaps compared to traditional liposuction methodologies. Objective evaluations of the abdominal wall's configuration were systematically executed both pre- and post-intervention for each participant. The Body Fat Index was computed using precise measurements from seven distinct anatomical sites. Over a span of 63 months, 300 patients underwent this combined procedure, resulting in discernible enhancements in the configuration of their abdominal walls in 97.6% of cases. This technique ensures the preservation of the original anatomical structure and functional dynamics, thereby circumventing the manifestation of local distortions that may arise from inadequate or excessive corrections. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Lipomas, benign adipose tissue tumors, are a common occurrence but currently, the options for their treatment are limited, with surgical excision being the most frequently used management pathway. This scenario can often lead to unsatisfactory cosmetic results and significant patient discomfort. This paper introduces a novel technique, percutaneous microwave ablation with liposuction, to address these challenges. The innovative procedure aims to enhance patient satisfaction, minimize post-operative discomfort, and improve aesthetic outcomes. The technique involves two key steps: (1) the application of percutaneous microwave ablation to selectively disrupt the lipoma cells, followed by (2) a targeted liposuction procedure to remove the ablated lipoma tissue. Our approach optimizes the removal of the lipoma and preserves the surrounding healthy tissue, reducing the risk of local recurrence and improving the cosmetic result. The use of preoperative ultrasound imaging allows for precise localization and delineation of the lipoma, aiding in the planning and execution of the procedure. This novel approach to lipoma treatment is reliable, associated with minimal morbidity, and consistently yields effective results. Additionally, it provides a new perspective on lipoma management, potentially changing the paradigm of current treatment approaches. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Lipedema is a relatively common, frequently misdiagnosed, chronic condition that is often treated using liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL) are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aimed to assess the efficacy and safety of liposuction in patients with lipedema. Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with post-operative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, and 2 articles used PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity. A total of 2542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). TTL, PAL, and WAL led to significant improvements in pain reduction P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). However, WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for the studies that used TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%). Liposuction techniques, including TTL, PAL, and WAL, resulted in significant symptom improvement in patients with lipedema with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. To the best of our knowledge, this is the first meta-analysis investigating liposuction data in lipedema treatment. [ABSTRACT FROM AUTHOR]

(1) Background: The demand for body-contouring procedures has surged, with lipolysis emerging as a common technique for excess fat removal. Laser-assisted lipolysis (LAL) has gained attention as a potential alternative to surgical fat removal (SFR), offering perceived advantages in safety and efficacy. However, the comparative benefits of LAL and SFR remain uncertain. (2) Objective: To conduct a review of the existing literature comparing the efficacy, safety, and patient satisfaction of LAL and SFR. (3) Methods: A comprehensive search of major electronic databases was conducted to identify studies comparing LAL and SFR for body-contouring procedures. Studies were included if they were published in English, involved human subjects, and reported outcomes for LAL and SFR. All studies were classified according to the Oxford Center for Evidence-Based Medicine evidence hierarchy (4) Results: LAL may not be a safer and more effective option than SFR. However, the evidence for these differences was limited by the quality of the studies and the heterogeneity of the results. (5) Conclusions: This review suggests that LAL may not be a safer and more effective option than SFR for body-contouring procedures because LAL is associated with higher risks of complications such as burns and scarring, whereas SFR offers a more established safety profile and consistent efficacy. [ABSTRACT FROM AUTHOR]

Guangdi Li, Guiwen Zhou, Qiang Fu, Minliang Chen Department of Plastic Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of ChinaCorrespondence: Minliang Chen, Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 10048, People’s Republic of China, Email chenml@sohu.comAbstract: Liposuction has been popular with the public since its inception. The fat accumulated in the body is sucked outside the body through negative pressure suction, thereby reducing the fat cells in the body and achieving the effect of local plasticity. Although liposuction is a relatively safe procedure, due to the lack of correct judgment of the patient’s condition and treatment by quite a few cosmetic practitioners, the complications of liposuction are gradually increasing. We describe a case of subcutaneous hydrops after lumboabdominal liposuction, which was found to have multi-layer tissue defects of the right lower abdominal wall and local peritoneal rupture after multiple sclerosing agent injections and two debridement procedures. This case provides us with a warning about the use of sclerosing agents.Keywords: liposuction, lauromacrogol, multilayer tissue injury of the abdominal wall, reconstruction of abdominal wall

Objective: Gynecomastia and lipomastia are benign proliferations of the male breast affecting 32–65% of men. Numerous surgical procedures often result in stigmatizing scars when it comes to skin resection. The purpose of this study was to review skin-sparing techniques and to describe our skin-sparing approach to treat skin excess using transcutaneous netting. Materials and Methods: A comprehensive review of the literature was conducted aiming at identifying available techniques to avoid skin resection in gynecomastia or lipomastia patients (Simon's grade IIb and III). Surgical techniques, patient satisfaction, time of follow-up, and complications were assessed. Results: Seven studies detailed skin retraction techniques, including laser-, ultrasound-, and radiofrequency-assisted liposuction (LAL, UAL, and RAL), microneedling, and nipple-areolar complex (NAC) plaster lifting. All articles provided Simon's grade classification, with most studies including patients with and without skin laxity. Complication rates were low (1.5–10%), and patient satisfaction ranged from 87.5% to 100%.While transcutaneous netting has been reported to reduce hematoma in gynecomastia surgery, no studies specifically examined its role in managing skin redundancy. Conclusions: Limited data exist on scarless skin retraction techniques for gynecomastia. While LAL, UAL, and RAL show some potential, controlled studies are lacking, and skin resection is often performed for high skin redundancy. We recommend a skin-sparing approach using liposuction and transcutaneous netting for gynecomastia up to Simon's grade III, which allows for skin retraction and NAC fixation. No literature was found assessing the efficacy of transcutaneous netting in promoting skin retraction in gynecomastia.

Fowler syndrome is a rare entity that occurs in young women, with a high incidence of polycystic ovary syndrome. It consists of episodes of acute urinary retention that have a characteristic electromyographic pattern. Its etiology is unclear and is usually preceded by a trigger such as a surgical procedure, childbirth, other acute medical conditions, and opioid use. There is no report in the literature that links any Plastic Surgery procedure to Fowler Syndrome. We present the case of a 31-year-old female patient who had an episode of acute urinary retention 36 hours after liposculpture and augmentation mammoplasty. Infectious, anatomical and functional causes were ruled out upon admission to the emergency room, confirming the diagnosis of Fowler Syndrome. The patient was treated with bladder catheterization for 72h and tamsulosin for 15 days, with adequate response. Subsequent to this she presented a favorable evolution without new episodes of difficulty for urination, without functional sequelae or complications in the aesthetic surgical result.

ABSTRACT: Background: Vibration amplification of sound energy at resonance (VASER) liposuction is an innovative technique that allows surgeons to selectively remove fat and shape desired areas of the body, resulting in more precise and controlled outcomes compared to traditional liposuction techniques. VASER liposuction offers several advantages, including targeted action that reduces trauma to the surrounding tissues, limiting pain, swelling and recovery time. Purpose: This study compared the complication rates among patients who underwent VASER liposuction in relation to their body mass index (BMI) and the amount of fat aspirated. Methods: The authors reviewed the medical records of all patients who underwent VASER liposuction at Scalera Clinic in Naples, dividing them into two groups: the first with BMI < 24.9 kg/m2 and second with BMI >25.0 kg/m2. Results: The authors examined 117 patients who were operated on within a year (2022/2023), with 48 of them having BMIs < 24.9 kg/m2 and 69 showing BMIs >25.0 kg/m2. In patients with a BMI >25 kg/m2, the most common complications were contusion, hematomas and abnormal skin retraction, whereas no complications were observed in the patients with normal-weight. Conclusions: To minimise post-operative complications and maximise results, it is advisable to select patients based on their BMI assessment, the anatomy of the treated body area and the volume of fat to be removed. This approach aims to ensure that the patients are suitable for the procedure and the achieved results align with their aesthetic expectations.

Abstract This study aimed to develop and validate a machine learning (ML)-based model for predicting liposuction volumes in patients with obesity. This study used longitudinal cohort data from 2018 to 2023 from five nationwide centers affiliated with 365MC Liposuction Hospital, the largest liposuction hospitals in Korea. Fifteen variables related to patient profiles were integrated and applied to various ML algorithms, including random forest, support vector, XGBoost, decision tree, and AdaBoost regressors. Performance evaluation employed mean absolute error (MAE), root mean square error (RMSE), and R-squared (R2) score. Feature importance and RMSE importance analyses were performed to compare the influence of each feature on prediction performance. A total of 9,856 were included in the final analysis. The random forest regressor model best predicted the liposuction volume (MAE, 0.197, RMSE, 0.249, R2, 0.792). Body fat mass and waist circumference were the most important features of the random forest regressor model (feature importance 71.55 and 13.21, RMSE importance 0.201 and 0.221, respectively). Leveraging this model, a web-based application was developed to suggest ideal liposuction volumes. These findings could be used in clinical practice to enhance decision-making and tailor surgical interventions to individual patient needs, thereby improving overall surgical efficacy and patient satisfaction.

Gynecomastia is characterized by abnormal and excessive development of breast tissue in male patients. Depending on the volume of the breasts and the amount of excess skin, it may be unilateral or bilateral. Surgery is considered the standard of care, with several techniques documented, including different types of incisions made in the periareolar or intra-areolar skin. The most common surgical technique is conventional open surgery, which utilizes a semicircular inferior periareolar incision. To achieve superior aesthetic outcomes, various alternatives to open surgery have been proposed, including vacuum-assisted excision, endoscopic mastectomy, and liposuction Herein, we present two cases involving male patients, aged 29 and 24, who reported bilateral breast enlargement. We used the same incision for both liposuction and glandular excision. Our patients underwent combined liposuction on two planes: subcutaneous and subglandular, accompanied by sharp parenchymal excision. These small incisions, measuring 1–1.5 cm, are discreetly placed within the inframammary fold across the breast width. The patients experienced an uneventful recovery without any complications.

Background Lipedema is a chronic, incurable disorder characterized by painful fat accumulation in the extremities. While the application of liposuction in lipedema management has become increasingly popular, the safety and effectiveness of this approach remain contentious. Our systematic review and meta-analysis aimed to assess various liposuction modalities in lipedema management to verify their safety and efficacy.

Haotian Chen, Juan Zhi, Lei Wang, Zibin Jin, Jin Xu, Fei Xing, Chao Wen, Qianyu Wang, Chunmei Chen, Weiou Li, Ermeng Xu, Jie An, Lingxin Wei Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of ChinaCorrespondence: Lingxin Wei, Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People’s Republic of China, Tel +86 010 85557917, Email weilx3934@sina.comPurpose: Esketamine have anesthetic and analgesic properties. This study aimed to observe the enhancing effect of subanesthetic doses of esketamine (0.15– 0.3 mg/kg/h) with dexmedetomidine and remifentanil during anesthesia for liposuction surgery.Patients and Methods: A total of 155 subjects were randomized with a 1:1 ratio to Group E (esketamine-dexmedetomidine/remifentanil, n=78) or Group C (saline-dexmedetomidine/remifentanil group, n=77). The primary outcome was satisfaction of patient and surgical team with the procedure. The secondary outcomes were the postoperative Athens Insomnia Scale (AIS) and Hospital Anxiety and Depression Scale (HADS) scores, hemodynamic and respiratory changes, drug consumption, adverse event rates, and predictors associated with patient satisfaction.Results: Patient and surgical team satisfaction with the procedure was significantly higher in Group E than in Group C (4.7 ± 0.6 vs 4.2 ± 0.7, P < 0.001; 4.7 ± 0.5 vs 4.4 ± 0.7, P = 0.005). The postoperative AIS (4 [1, 6] vs 5 [2, 9], P = 0.012) and HADS-A (1 [0, 3] vs 2 [0, 6], P = 0.012) scores were significantly lower in Group E than in Group C. Hemodynamic and respiratory parameters were more stable in Group E than in Group C, with the lower opioids consumption of sufentanil (0 [0, 4] vs 5 [2.5, 7.7], P < 0.001) and remifentanil (700 [480, 900] vs 800 [500, 1200], P = 0.023) in Group E compared to Group C. On ordinal logistics regression, postoperative sleep quality (OR, 0.70; 95% CI, 0.62– 0.79), anxiety level (OR, 0.77; 95% CI, 0.62– 0.95) and recovery time in post-anesthesia care unit (PACU) (OR, 0.69; 95% CI, 0.56– 0.98) were identified as significant predictors associated with patient satisfaction.Conclusion: A subanesthetic dose of esketamine (0.15– 0.3 mg/kg/h) as an adjuvant can improves the sedative and analgesic effects of dexmedetomidine and remifentanil during anesthesia for liposuction surgery.Clinical Trial Registration: ChiCTR2400080363.Keywords: esketamine, sedation, analgesia, satisfaction, liposuction

Background: In cases where the upper arm exhibits an irregular cylindrical appearance with subcutaneous fat concentrated primarily in the posterior lateral aspect, traditional localized fat suction techniques may lead to uneven or disharmonious results when addressing this concern. Many practitioners have turned to circumferential fat suction methods using multi-incision approaches to ensure effective results and fat removal. However, these methods often involve numerous incisions and complex procedures, necessitating the development of new, more efficient surgical techniques. Methods: We collected and screened patients who underwent upper arm circumferential liposuction with a double incision technique at our hospital from October 2020 to February 2023. A total of 496 cases were included in our retrospective analysis, in which we examined factors such as the length of surgery, arm circumference before and after surgery, subcutaneous tissue thickness before and after surgery, fat suction volume, postoperative satisfaction, and postoperative complications of the patients. Results: The average length of surgery was 71.7 min. 458 cases (92.3%) showed significant improvement, 23 cases (4.6%) reported satisfaction, and 10 cases (2.0%) were essentially satisfied. Additionally, 339 cases (68.3%) experienced an improvement in skin laxity. Four cases (0.8%) developed localized hard nodules with slight tenderness in the early postoperative period, which resolved without special treatment after observation and follow-up for 1–3 months. Three cases (0.6%) reported localized pain or numbness, and they were given oral medication. Their symptoms disappeared after 1–3 months of observation and follow-up. Three cases (0.6%) had localized pain or numbness, and their symptoms disappeared. All of these cases improved and resolved after one month of taking mecobalamin tablets. There were also three cases (0.6%) with mild pigmentation of the incision and two cases (0.4%) with mild limitation of unilateral upper arm abduction movement. However, upper arm activities were not affected after three months to one year of follow-up. No serious complications were reported, resulting in an overall satisfaction rate of 99.0%. Conclusion: The double incision upper arm liposuction is safe, effective, time-saving, with high satisfaction and fewer complications, and is worthy of clinical popularization and application. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Introduction: The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer. Method: Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure. Results: Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures. Conclusion: BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. Level of Evidence 3: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Lipedema is a chronic disorder primarily affecting women, characterized by abnormal fat deposition in the extremities, leading to pain, mobility issues, and psychological distress. These fat deposits are clear-cut and spare hands and feet. Often misdiagnosed as lymphedema, its prevalence remains uncertain due to a lack of universally accepted diagnostic criteria and difficulty in differentiating it from obesity or lymphedema. Genetic factors and hormonal influences are likely related to the pathophysiology of the disease, though the specific causes remain unknown. Imaging techniques may aid evaluation, but no definitive test exists, and diagnosis is made clinically. Conservative treatments such as lifestyle modifications and compression garments are considered first-line treatments, while surgical options such as liposuction and lipectomy are reserved for severe or refractory cases. Psychological support may be recommended, given lipedema's impact on quality of life and self-esteem. This review aims to present the current understanding of this condition, including challenges in diagnosis, current guideline recommendations for clinical care, and associated comorbid conditions. [ABSTRACT FROM AUTHOR]

Background Lipedema is a chronic, incurable disorder characterized by painful fat accumulation in the extremities. While the application of liposuction in lipedema management has become increasingly popular, the safety and effectiveness of this approach remain contentious. Our systematic review and meta-analysis aimed to assess various liposuction modalities in lipedema management to verify their safety and efficacy. Methods In-line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a comprehensive literature review from inception until March 2023 using the following electronic databases: CENTRAL, MEDLINE, Google Scholar, and EMBASE. Results From the 562 initially identified articles, 20 met our inclusion/exclusion criteria for evaluation. Our review encompassed 14 prospective cohort studies, 3 retrospective studies, 2 case series, and 1 cross-sectional study. A meta-analysis of nine articles revealed a notable improvement in the quality of life, pain, pressure sensitivity, bruising, cosmetic impairment, heaviness, walking difficulty, and itching among lipedema patients who underwent liposuction. Although complications such as inflammation, thrombosis, seroma, hematoma, and lymphedema-related skin changes were reported, severe complications were rare. Crucially, no instances of shock, recurrence, or mortality were reported. Conclusion Liposuction is a safe and beneficial therapeutic intervention for managing lipedema symptoms and enhancing quality of life. However, the impact of liposuction on secondary lymphedema remains unreported in the literature. Further high-quality, large-scale trials are necessary to assess the safety and effectiveness of different liposuction modalities. These studies will contribute valuable insights to optimize liposuction as a therapeutic option for individuals with lipedema. Level of Evidence I, risk/prognostic study. [ABSTRACT FROM AUTHOR]

Background: Primary lymphedema is a chronic condition caused by a developmental abnormality of the lymphatic system, leading to its malfunction. Various surgical options, including physiologic and excisional procedures, have been proposed. The aim of this study was to present a comprehensive algorithm for the treatment of primary lower extremity lymphedema: the Primary LYmphedema Multidisciplinary Approach (P-LYMA). Methods: Nineteen patients were treated following the P-LYMA protocol. Patients underwent pre- and postoperative complex decongestive therapy (CDT). A variety of physiologic and excisional procedures were performed, either independently or in combination. The primary outcome was to assess the circumferential reduction rate (CRR). The Lymphedema Quality of Life Score (LeQOLiS), reduction in the number of cellulitis episodes, and complications were recorded. Results: The mean CRR was 73 ± 20% at twelve months postoperatively. The frequency of cellulitis episodes per year decreased from a mean of 1.9 ± 0.8 preoperatively to 0.4 ± 0.6 during follow-up. Two patients experienced minor complications. The mean hospitalization time was 5 days. Patients' quality of life, as measured by the LeQOLiS, significantly improved from 70.4 ± 12 preoperatively to 24 ± 14 at twelve months postoperatively. Conclusions: The P-LYMA algorithm maximizes surgical outcomes and improves the quality of life in patients with primary lymphedema. CDT is essential for optimizing results. [ABSTRACT FROM AUTHOR]

This retrospective study rigorously compares the clinical efficacy of three surgical methodologies for treating gynecomastia while providing guidance for future surgical modality selection. We analyzed records of 77 gynecomastia patients treated between January 2015 and October 2022. Patients were categorized into three groups: Group A (subcutaneous gland resection via areola incision), Group B (liposuction combined with single‐hole endoscopic gland resection), and Group C (liposuction combined with three‐hole endoscopic gland resection). Parameters assessed included patient demographics, intraoperative bleeding, surgical duration, hospitalization duration, costs, postoperative drainage, complications, and patient satisfaction. Group A had significantly shorter operation time and lower cost than Groups B and C (P < 0.05). There were no significant differences in postoperative drainage (P > 0.05). Group A had a higher incidence of subcutaneous fluid complications. All groups achieved 100% overall postoperative efficiency. Group B demonstrated superior outcomes for scarring and patient satisfaction. All three surgical modalities effectively treat gynecomastia. Circumareolar incision subcutaneous gland resection is optimal for mild to moderate cases due to reduced operation time and cost. Liposuction with single‐hole endoscopic gland resection and three‐hole endoscopic gland resection offers fewer complications and discreet incisions. Notably, the liposuction and single‐hole endoscopic approach yielded superior postoperative patient satisfaction, aligning with minimally invasive principles and warranting broad clinical application. [ABSTRACT FROM AUTHOR]

Background Different types of abdominoplasties have been developed to address individual patient characteristics. However, an analysis of complication rates and risk factors for different types of abdominoplasties has yet to be reported. Objectives The aim of this study was to evaluate the complication rates and risks associated with each type of abdominoplasty. Methods Utilizing the CosmetAssure database, patients undergoing an abdominoplasty from 2015 to 2022 were identified. Demographic factors and major complications were recorded and analyzed with a chi-square test or analysis of variance. A logistic regression was performed to identify the risk for developing complications associated with each type of abdominoplasty. Results A total of 55,596 patients underwent an abdominoplasty procedure by any method. The overall complication rate was 2.1%. There was a significant difference in the overall complication rates of all 7 types of abdominoplasties (P <.05), with fleur-de-lis abdominoplasty having the highest complication rate. The year of surgery, being underweight or morbidly obese, having diabetes, and being male placed patients at a significantly higher risk for developing a postoperative complication. Over 15,000 patients (27.2%) had concurrent procedures related to breast surgery, other body contouring, liposuction, or facial surgery. When accounting for various risk factors in a regression model, there was no significant added risk for major complications after a combination procedure with an abdominoplasty compared to abdominoplasty alone. Conclusions Among the different types of abdominoplasties, a fleur-de-lis abdominoplasty has the highest complication rate. Concurrent cosmetic procedures with an abdominoplasty showed no added risk for major complications when compared to abdominoplasty alone. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background Abdominoplasty procedures continue to evolve because combining techniques such as suction-assisted lipectomy or direct subscarpal lipectomy have proven to be powerful adjuncts to achieve optimal aesthetic results. However, concern has been expressed about combining techniques simultaneously given the potential to damage the vascularity of the abdominoplasty flap. Objectives The aim of this study was to assess the safety and efficacy of simultaneous direct subscarpal lipectomy combined with liposuction in abdominoplasty patients. Methods A 4-year retrospective review of consecutive abdominoplasties (n = 200) performed by a single surgeon was conducted. Liposuction of the abdominal flap and flanks was performed in all patients. After raising the abdominoplasty flap, undermining was performed to just beyond the xyphoid, the lower rib margins superiorly, and the anterior axillary line laterally. Fat deep to Scarpa's fascia was then removed by direct tangential excision in all zones of the abdominal flap. Results The patients had a mean age of 42.19 years and BMI of 28.10 kg/m2; the mean follow-up time was 7 months. Seroma occurred in 13 patients (6.5%), superficial wound dehiscence treated with local wound care in 16 patients (8%), hypertrophic scarring in 16 patients (8%), partial umbilical necrosis in 1 patient (0.5%), and partial umbilical epidermolysis in 6 patients (3%). No patients experienced major or minor full-thickness tissue loss. No patients needed reoperation. Conclusions Simultaneous direct excision of subscarpal fat with liposuction of the abdomen and flanks does not appear to subject any zone of the abdominoplasty flap to increased risks of vascular compromise. No flap necroses were observed. The technique described is safe and may provide superior abdominoplasty results. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background: High-definition body sculpting has revolutionised body contouring surgery worldwide. Intramuscular fat grafting for cosmetic purposes has been utilised for many years to enhance the underlying muscular anatomy. The purpose of this study is to present a novel technique of muscular fat grafting to the oblique muscles aimed at enhancing the outcomes of high-definition body contouring surgeries. This technique is referred to as the Semilunaris Parallel to Rectus Fat Transfer technique (SPARTAN). Methods: This method of oblique muscle amplification can be executed under direct vision during an abdominoplasty or under ultrasound (US) guidance in patients undergoing liposuction alone. The objective is to infiltrate fat tissue into the oblique muscles, thereby enhancing the athletic appearance of the abdominal region. Results: The SPARTAN technique was applied to 51 patients, with no complications observed. This procedure complemented the Rectus Abdominis Fat Transfer (RAFT) and Ultrasound-guided Rectus Abdominis Fat Transfer (Ug-RAFT) techniques. Conclusions: The SPARTAN technique serves as an adjunct to muscle enhancement, achieving a more defined and athletic look in high-definition body contouring. It can be performed under direct vision or with US assistance. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to compare the effects of heat preservation by two recommended methods, heated infiltration solutions and forced-air heating blankets, in patients undergoing liposuction under general anesthesia. Methods: Forty patients were divided into four groups based on whether heated infiltration solutions or forced-air heating blankets were used. Group A received general anesthesia liposuction plastic surgery routine temperature care. Based on the care measures of group A, heated infiltration solutions were used in group B; forced-air heating blanket was used in group C; and heated infiltration solutions and forced-air heating blankets were both used in group D. The primary end point was intraoperative and perioperative temperature measured with an infrared tympanic membrane thermometer. Secondary end points included surgical outcomes, subjective experience, and adverse events. Results: Compared with group A, the intraoperative body temperatures of groups B, C, and D were significantly higher, indicating that the two intervention methods were helpful on increasing the core body temperature. Pairwise comparisons of these three groups showed that there was no significant difference between group C and group D. However, using forced-air heating blankets had a marked effect compared with using heated infiltration solutions alone at three time points. The same trend could be seen in other surgical outcomes. Conclusions: Heated infiltration solutions and forced-air heating blankets could reduce the incidence of intraoperative hypothermia and improve patients' prognosis after liposuction under general anesthesia. Compared with the heated infiltration fluid, the forced-air heating blanket may have a better thermal insulation effect. Level of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Thread-lifting (TL) is a minimally-invasive technique for facial rejuvenation, whereas liposuction is commonly used for facial contouring. This retrospective cohort study aims to introduce and evaluate a novel technique that combines liposuction and thread-lifting for mid-lower facial rejuvenation. Methods: Consecutive patients who underwent TL for mid-lower facial rejuvenation from May 2016 to May 2021 were divided into thread-lifting group (TL group) or thread-lifting plus liposuction group (TLL group) according to whether liposuction was performed adjunctively. The co-primary outcomes were the changes between the preoperative and 6-month postoperative Wrinkle Severity Rating Scale (WSRS) and Facial Aging Evaluation Scale (FAES). Results: A total of 185 patients (184 females) with an average age of 34.5±5.5 years were included. There were no significant differences in patients' age, number of threads, and preoperative WSRS and FAES between the two groups. The TLL group (n = 128) had significantly lower postoperative WSRS (1.5±0.6 vs. 1.8±0.8, p<0.001) and FAES (2.5±1.4 vs. 3.8±2.1, p<0.001) than the TL group (n = 57). The decrease in WSRS (0.8±0.6 vs. 0.2±0.7, p<0.001) and FAES (2.7±1.3 vs. 1.6±1.6, p<0.001) were greater in the TLL group. Only 3.8% patients experienced slight side effects and totally recovered. Conclusions: The combination of TL and liposuction is an effective and safe technique for simultaneous contour improvement and facial rejuvenation in middle-aged East Asian females. Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: The gluteal region if of importance in esthetic medicine. A common adverse event in esthetic liposuction of the thigh and the infragluteal fold ("banana fold") is gluteal ptosis. Patients and Methods: We analyzed our data on liposuction for female patients with lipedema grade II and III and liposuction of dorsal thighs and the infragluteal fold. Results: Surprisingly, most of our patients did not experience an aggravated gluteal ptosis after the procedure. Some of the patients even presented with a mild gluteal lift in the lateral view, despite no gluteal liposuction had been performed. Conclusions: There seem to be two factors contributing: (a) the chronic inflammation and fibrosis in lipedema and (b) the inflammatory response induced by liposuction. The latter is of temporary nature and obviously not sufficient to prevent ptosis. [ABSTRACT FROM AUTHOR]

Introduction Simple mastectomies are routinely performed in the military health care system as gynecomastia can cause significant pain and discomfort when wearing body armor. Postoperative recovery negatively impacts personnel readiness. In this study, we sought to study time to return to duty in active duty service members who undergo surgery for gynecomastia. Methods and Materials We conducted a single-center retrospective review of active duty patients undergoing a surgical operation for gynecomastia from July 2020—June 2022. A total of 96 patients were included. Our primary outcome of interest was time from surgery to return to duty. A multivariate analysis was performed to assess for factors independently associated with surgical complications including patient demographics and operative techniques. Results The median number of days to return to duty after surgery was 28 days (IQR 13-37). The median loss of duty days because of gynecomastia without surgery was 19 days (IQR 10-21), which was different on the Mann–Whitney U test. Surgical complications were observed in 19 patients (19.7%) with the most common complications being seroma (11), hematoma (4), nipple-areolar complex necrosis (2), and infection (2). Patients with a complication have significantly more time to return to duty (28 vs. 49 days, P  < .001). Risk factors associated with an increased risk of complication include ranks E1-E4, behavioral health diagnosis, "open" vs. "combined" technique with liposuction, length of operation greater than 58 minutes, and excised breast mass greater than 17.9 g. Conclusions Gynecomastia surgery is associated with a detriment to personnel readiness. Surgery should be reserved for patients with severe symptoms that prevent the performance of daily duties. Furthermore, factors associated with an increased risk for complications include ranks E1-E5, behavioral health diagnosis, length of operation >58 minutes, and excised breast mass >17.9 g. The operating surgeon should be mindful of these factors. [ABSTRACT FROM AUTHOR]

Background Lower extremity trauma often necessitates reconstruction with flap transfer. One of the reconstructive goals is a thin soft tissue coverage with appropriate contour. Therefore, a secondary debulking of the flap is usually performed. Methods Debulking through conventional lipectomy is compared with liposuction followed by excision of the defatted flap excess. Demographic data, surgical details, and postoperative outcomes are compared and analyzed. The perfusion dynamics of the flaps undergoing liposuction debulking are studied by means of perioperative indocyanine green fluorescence angiography, as well as postoperative laser Doppler imaging. Results Patients undergoing lipectomy (n = 69; 57.5%) or liposuction (n = 51; 42.5%) debulking had a similar rate of postoperative complications. Partial necrosis was observed in 7.2% (lipectomy) versus 7.8% (liposuction) of flaps. Fluorescence angiography showed a substantial decrease in flap perfusion following the infiltration with an epinephrine-containing tumescent solution (74.3% ± 8.2% prior to infiltration versus 16.8% ± 7.1% after infiltration; p < 0.001), resulting in a dark flap appearance. Laser Doppler imaging confirmed the hypoperfusion on postoperative day 1. Conclusion Secondary debulking of a lower extremity flap can be safely and efficiently performed through liposuction combined with peripheral excision of the defatted flap in a single stage. Perfusion studies may show a misleading hypoperfusion of the defatted flap, which does not accurately predict subsequent necrosis or complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium–Aluminum–Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO and compared the results with those of a group treated only with a laser. Materials and Methods: This study compared the outcomes of AO treatment between the two groups up to six months postoperatively. The first group of 18 patients underwent laser treatment alone, and the second group of 12 patients underwent integrated liposuction surgery in addition to laser treatment. Outcomes were assessed using the following variables: degree of malodor (DOM), sweating area, patient satisfaction, pain levels, and complications, such as burns, swelling, and contractures. Results: Compared to the laser-only group, the integrated liposuction group demonstrated significantly superior outcomes in terms of DOM (p = 0.002) and patient satisfaction (p = 0.006), as well as a reduction in the sweating area (p = 0.012). The pain rating was higher in the liposuction group, but the difference was not statistically significant (p = 0.054). Compared with the patients in the integrated liposuction treatment group, those in the laser treatment group exhibited a significantly higher number of burns under the axillae (p = 0.025). However, no significant differences were observed in the swelling or contracture between the groups. Conclusions: Integrated liposuction with laser therapy significantly improved treatment outcomes, including malodor, patient satisfaction, sweat test results, and decreased complication rates. [ABSTRACT FROM AUTHOR]

Objective: The possibility of using a color contrast method to evaluate blood loss during liposuction was assessed. A color chart of blood–lipid content associated with different blood volumes was developed. Methods: Three color cards with different concentrations of blood were developed based on clinical parameters. The color cards were used to evaluate the volume of blood present in liposuction solutions obtained from 60 clinical liposuction patients. The red blood cell count also was evaluated for each patient. The data obtained using each evaluation method were compared and statistically analyzed to determine the most accurate calculation formula. Results: The red blood cell counts were compared to the color card results. The paired t test results for the calculated values for the 3:1, 2:1, and 1:1 color cards and the red blood cell count values were comparable (44.3 ± 22.1 ml vs. 53.6 ± 25.0 ml, t = 10.5; 45.4 ± 19.0 ml vs. 55.2 ± 20.7 ml, t = 18.1; 41.9 ± 25.6 ml vs. 52.8 ± 28.3 ml, t = 14.0). The P values were < 0.05, and the difference between the two groups was statistically significant. The average standard error of the mean was 0.90, 0.54, and 0.77, respectively. Sixty samples were evaluated in a scatter diagram using the two detection methods. Trend analysis revealed that the two results demonstrated a linear increase (y = 5.6 + 1.1x), R2 = 0.989, indicating that the two inspection methods were highly correlated with only small errors. Conclusion: The colorimetric card protocol developed in this study could quickly, accurately, and conveniently calculate blood volumes in liposuction fluids, which has considerable clinical significance. No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Introduction: Mycobacterium abscessus infection after liposuction/fat grafting is a rare complication that is hard to diagnose and treat. Misdiagnosis could result in treatment failure and prolonged hospital stays. The paradoxical reaction is another complication that rarely occurs in non-HIV patients infected with nontuberculosis mycobacteria. This study reported 3 cases infected with M. abscessus complicated by the paradoxical reaction after liposuction and fat grafting. It highlighted characteristics giving clues of the paradoxical reaction and a successful strategy. Also, a systematic review was conducted to comprehensively provide varied aspects of M. abscessus infection after liposuction and/or fat grafting. Methods: Three cases were retrospectively included reporting data characteristics of patients, cosmetic procedures, and treatment strategy. PubMed, Scopus, Virtual Health Library (VHL), and Global Health Library (GHL) were searched to find and include cases with M. abscessus infection after liposuction and/or fat grafting based on defined selection criteria. Relevant data were extracted and summarized. The risk of bias in included studies was assessed using JBI critical appraisal checklists. Results: Twenty-four articles were included in the systematic review. Symptoms often developed approximately 1 month after the cosmetic surgery. Culture, AFB, and PCR were common methods of diagnosis of M. abscessus after liposuction and/or fat grafting. It took about 33 days on average from the presentation to isolate and detect the pathogens. Antibiotics based on susceptibility testing results along with surgical interventions were effective methods of treatment. Our three cases which were complicated by the paradox were addressed by adding methylprednisolone for 2 weeks to the macrolide-based therapy. Conclusions: Awareness of this disease should be widely raised among physicians for early diagnosis and proper treatments. Cultures of specimens and AFB should be repeated many times before excluding the possibility of Mycobacterium spp. A paradoxical reaction should be suspected if the symptoms were worse after the antibiotic therapy based on susceptibility testing results and proper surgical interventions, especially if patients had taken corticosteroids before being admitted. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Obesity is a chronic and complex syndrome resulting from the interactions of genetic, environmental, metabolic, and psychological factors. This dataset collected clinical information from 101 patients with obesity who had undergone large-volume laser-assisted liposuction. Demographic, personal, and family history of disease were recorded, and weight and height were determined and subsequently used to calculate body mass index, % of total weight loss (%TWL), and % of excess body mass index loss (% EBMIL). Short-term incidence (

Liposuction is one of the most commonly performed procedures in aesthetic surgery, with an increasing variety of available methods that enhance both the effectiveness and safety of this treatment. The aim of this paper is to analyze and compare three primary techniques: ultrasonic, laser, and traditional liposuction, as well as to highlight potential directions for the development of this procedure. Based on available literature and research findings, both the effectiveness and potential risks associated with each of these methods will be assessed, allowing for the identification of optimal solutions tailored to the individual needs of patients.

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