Body lifts are surgical procedures that are infrequently performed because the length of operating time increases the risk to the patient as well as the likelihood of surgeon fatigue. The other drawback of body lifts is the long incision line. However in our experience, these incisions are well accepted if they are well placed and if the results of body change is significant. The goal of this paper is to show how operating time can be shortened and the scar be correctly positioned by using precise preoperative markings. In addition to high superior tension abdominoplasty, the two innovations of this type of body lift are the dermal fat flap and the suspension of tissue in the trochanteric and buttock regions. Meticulous hemostasis limited undermining, and the closure of dead space are factors that produce a more reliable procedure, both in terms of postoperative problems and the final results.
Although abdominoplasty has always been a routine operation, demands for it are constantly increasing for diverse reasons. For one, stomach reduction practiced by digestive surgeons is becoming a regular procedure. Massive weight loss induced by this surgery leads to a demand for abdominoplasty with increased risks of a difficult postoperative period and complications. In addition, more and more patients are looking for an improvement of a moderate cutaneous excess following pregnancy. In this case, standard abdominoplasty technique does not permit a sufficient skin resection and the surgeon must perform a vertical below umbilical scar and an insufficient epigastrium tension. Finally, a hematic or lymphatic collection is obviously undesirable and can lead to an aesthetic disaster. For these reasons, surgeons, more than ever, need a reliable technique that adapts to those different situations.
Cutaneous facial aging is responsible for the increasingly wrinkled and blotchy appearance of the skin, whereas aging of the facial structures is attributed primarily to gravity. This article purports to show, however, that the primary etiology of structural facial aging relates instead to repeated contractions of certain facial mimetic muscles, the age marker fascicules, whereas gravity only secondarily abets an aging process begun by these muscle contractions. Magnetic resonance imaging (MRI) has allowed us to study the contrasts in the contour of the facial mimetic muscles and their associated deep and superficial fat pads in patients of different ages. The MRI model shows that the facial mimetic muscles in youth have a curvilinear contour presenting an anterior surface convexity. This curve reflects an underlying fat pad lying deep to these muscles, which acts as an effective mechanical sliding plane. The muscle's anterior surface convexity constitutes the key evidence supporting the authors' new aging theory. It is this youthful convexity that dictates a specific characteristic to the muscle contractions conveyed outwardly as youthful facial expression, a specificity of both direction and amplitude of facial mimetic movement. With age, the facial mimetic muscles (specifically, the age marker fascicules), as seen on MRI, gradually straighten and shorten. The authors relate this radiologic end point to multiple repeated muscle contractions over years that both expel underlying deep fat from beneath the muscle plane and increase the muscle resting tone. Hence, over time, structural aging becomes more evident as the facial appearance becomes more rigid.
Plastic surgeons often are asked to perform horizontal medial thigh lifts because the skin of this area has poor elasticity, inducing excess skin, and also because there is upper fat deposit. This excess skin and fat lead to irritation and even functional problems. But surgeons dislike this operation because of its justified bad reputation. Obviously, this area is difficult to manage because of the many possible side effects (e.g., healing difficulty, scar migration, necrosis, effusions, pain) and unreliable results. A new way of thinking is proposed to lighten this operation and make its more frequent use possible. This horizontal technique presents several innovating points: -A new incision line located along the labia major in the perineal crease remains at the same height backward. The incision never descends into the buttock fold. -No undermining whatsoever occurs even in the resection area. Liposuction is the key to avoidance of any undermining. It is performed everywhere in the thigh, but most importantly under the resection area where all the fat must be eliminated to lighten the flap and favor its lifting. -The resection removes only the skin layers (epidermis and dermis) and not the liposucted tissue, which is very thin. Consequently, all lymphatic and other vessels are preserved, and the healing process is much easier. Moreover, there is no dead space after ascension of the flap and no risk of effusion. -The resection is realized on demand, depending on the excess of skin brought on the incision line by each anchor suture. Therefore, any tension on the skin closure is avoided. -The direction of the skin stretching is concentric toward the labia minor. Consequently, the length of the scar is shortened at both the front and the rear. -Anchor sutures pull a nonundermined skin, thus drastically decreasing the risk of necrosis. In the past 2 years, 25 patients, most of them as outpatients, have undergone surgery using this technique, with a real improvement in the quality of the result, as compared with the results from the standard technique.
The upper arm is a difficult area to manage after massive weight loss. The goal of the authors' new technique is to avoid complications in massive weight loss cases and simple cases because of aging. After analysis of the excess skin, the authors explain their markings. The main innovation is to preserve all the lymphatic vessels, both the deep and superficial ones, thanks to liposuction and very superficial resection. This eliminates effusions and maintains good vascularization of the wound edges. The suturing technique used to close the wound is very important for minimizing the risks of widening the scar.
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