Lipomyosculpture

Chapter 20 Lipomyosculpture



Ewaldo Bolivar Souza Pinto Sr., Pablo Silva Frizzera Delboni, Matheus Monseff Vieira Borela



Key Points




• Morphological and histological analysis demonstrates differences in the superficial layer, regarding the layout of lobes, the shape disposition of interlobular septa tissue (collagen), and thickness of the different body parts.


• Marking before surgery is considered a key step for successful surgery. This should always be performed with the patient standing in front of the mirror. This ensures three-dimensional mobility and the patient can monitor all the surgeon’s movements and tracings.


• Ultrasonic energy (UAL) and vibroliposuction (VL) are useful as aids to conventional liposuction, but not for skin retraction.


• Liposuction must respect the histological peculiarities of the superficial layer of fat in order to stimulate skin retraction, and follow the muscle fibers’ direction; this makes it possible to carve the fat on the muscle, avoiding criss crossing.



Introduction


Since the first half of the twentieth century, many surgeons have been trying to change body contours in accordance with changing concepts of beauty. Since its introduction by Illouz, liposuction has become the best option for body contouring surgery. Improvements in conventional surgery became possible with the development of new liposuction equipments and methods.


In this chapter we describe a new body contouring technique, based on the direction of muscle fibers and collagen, rather than the more traditional crossing tunnels. Excellent results have been achieved, with less trauma and better skin retraction.



Preoperative Preparation


The clinical evaluation should be as thorough as possible, based on detailed history and physical examination.


It is important to have data on: age, sex, comorbidities, medications, allergies, gastroesophageal reflux, any history of tranfusions and their reactions, abuse of legal and illegal drugs, anesthesia complications, the possibility of pregnancy, and functional capacity.


A complete physical examination should be performed, with emphasis on cardiovascular disorders and volume status.


Supplementary examinations should not be carried out randomly and indiscrimately, but in accordance with the clinical evaluation in order to recommend and implement pre- and postoperative care aimed at reducing the surgical risk.



Morpho-Histology of Subcutaneous Adipose Tissue


The subcutaneous tissue is divided into two layers. Its morphological and histological analysis demonstrates differences in the superficial layer, regarding the layout of lobes, shape, disposition of interlobular septa tissue (collagen), and thickness of different body parts (Fig. 20.1).



• Upper abdomen: irregular (50%), elliptical (40%) and rounded (10%) lobes with a parallel arrangement to the epidermis, thick (50%) and thin (50%) septa with a parallel arrangement in relation to the lobes (Fig. 20.2).


• Lower abdomen: irregular (50%), elliptical (30%) and rounded (20%) lobes with a parallel arrangement to the epidermis, thick (70%) and thin (30%) septa with a parallel arrangement in relation to the lobes (Fig. 20.3).


• Lateral thigh: irregular (80%), elliptical (10%) and rounded (10%) lobes with a parallel arrangement to the epidermis, thick (70%) and thin (30%) septa surrounding the lobes (Fig. 20.4).


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FIG. 20.1 Layout of fat cells in different areas of the body. Topography of the areas studied.


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FIG. 20.2 Upper abdomen: thick and parallel septa tissue.


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FIG. 20.3 Lower abdomen: thick and surrounding septa tissue, irregular lobes of adipose tissue.


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FIG. 20.4 Lateral thigh: thick and perforating septa tissue.


• Anterior thigh: irregular (60%), elliptical (30%) and rounded (10%) lobes with a parallel arrangement to the epidermis, thick (50%) and thin (50%) septa surrounding and penetrating the lobes (Fig. 20.5).


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FIG. 20.5 Anterior thigh: thick and surrounding septa tissue, irregular lobes of adipose tissue.


• Medial thigh: irregular (90%) and elliptical (10%) lobes with a parallel and perpendicular arrangement to the epidermis, thick (30%) and thin (70%) septa surrounding and perforating the lobes (Fig. 20.6).


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FIG. 20.6 Medial thigh: thin and surrounding septa tissue, irregular lobes.


• Dorsal region: irregular (80%), elliptical (10%) and rounded (10%) lobes with a parallel arrangement to the epidermis, thick (80%) and thin (20%) septa (Fig. 20.7).


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FIG. 20.7 Back: thick and perforating septa tissue.


• Flank: irregular (70%), elliptical (20%) and rounded (10%) lobes with a perpendicular arrangement to the epidermis, thick (50%) and thin (50%) septa surrounding and perforating the lobes (Fig. 20.8).


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FIG. 20.8 Flank: surrounding septa tissue, irregular lobes of adipose tissue.


• Gluteal region: irregular (80%), elliptical (10%) and rounded (10%) lobes with a parallel arrangement to the epidermis, thick (90%) and thin (10%) septa surrounding and perforating the lobes (Fig. 20.9).


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FIG. 20.9 Gluteal region: thick and perforating septa tissue, irregular lobes of adipose tissue.

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Brachioplasty with liposuction resection Liposuction of the abdomen and trunk Short vertical scar medial thigh lift Upper body lift with lateral excision Autologous gluteal augmentation with mid-pedicle superior pole perforator flaps Breast reshaping after massive weight loss: Autologous tissue techniques

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Jul 23, 2016 | Posted by in Aesthetic plastic surgery | Comments Off on Lipomyosculpture

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