Abdominoplasty, Liposuction and Brazilian Butt Lift (BBL) in Kinshasa in the Democratic Republic of Congo. My Experience in This Aesthetic Plastic Surgery with Black African Women in a Low-Income Country

Background: In low-income African countries, the demand and use of plastic surgery operations including abdominoplasty, liposuction and Brazilian butt lift (BBL) are increasing. The goal of this work is to present my experience and the challenges of this aesthetic plastic surgery among black African women. Material and Methods: A retrospective study was conducted about the abdominoplasties, liposuctions and Brazilian butt lift (BBL) which I operated in public and private hospitals at Kinshasa (Democratic Republic of Congo) in black African women. It covers a period of 13 years, going from December 1, 2010 to December 1, 2023. For this study, I had at least 6 months period (to Juin 1, 2024) to assess the occurrence of early and late postoperative complications. Results: I performed 84 abdominoplasties, 144 liposuctions and 23 Brazilian butt lifts (BBL). The average age at the time of abdominoplasty was 44 years with extremes ranging from 26 to 55 years and a concentration of cases (60.7%) in the age group of 40 to 49 years. The age group of 20 to 29 years old represented the lowest rate of requests for abdominoplasty (4.7%). Patients with a BMI of 30 to 2 were the majority (61.9%), followed by those between 25 to 2 (29.7%). 67.8% of patients were obese (BMI ≥ 30 kg/m2). The average age at the time of liposuction was 41 years with extremes ranging from 21 years to 69 years;and more than half of cases (68%) in the age group between 30 and 49 years. As for Brazilian butt lift (BBL), the average age was 33 years with extremes ranging from 24 to 42 years and a concentration of patients (91.3%) between 20 and 39 years. The immediate postoperative complications of abdominoplasties observed were: seroma in 7% of cases, hematoma and partial infection of the surgical site in 5% of cases. Pathological scars (hypertrophic, keloid) after abdominoplasties were observed in 9% of cases. The most common complication of liposuction was contour deformity. I observed 16 patients (11.1%) with soft-tissue depressions or elevations, skin panniculus or folds. For Brazalian Butt Lift (BBL), complications like asymmetry for 2 patients (8.9%), contour irregularities for 2 patients (8.9%), and excessive fat removal for 6 patients (26%), had observed. I have not recorded any cases of death or pulmonary embolism. Conclusion: I perform aesthetic plastic surgery procedures in black African women with a high socioeconomic standard of living compared to the average of the general population. The renunciation of planned surgery is motivated by the impossibility of paying the cost of the operation as well as by popular and religious perceptions regarding cosmetic surgery. The results of these aesthetic plastic surgery procedures carried out are very satisfactory for them. The challenges to overcome are mainly threefold: the unforeseeable complications of these cosmetic plastic surgery procedures, popular and religious perceptions of cosmetic surgery as well as the poverty of the population.

Clinical Study of Liposuction Combined with Subareolar Incision Adenectomy for Gynecomastia

Objective: To investigate the clinical effect of liposuction combined with subareolar incision glandectomy in the treatment of Simon Grade Ⅲ adipo-glandular gynecomastia (GYN). Methods: From March 2021 to March 2022, the data of patients with Simon Grade Ⅲ adipo-glandular GYN treated by liposuction combined with glandectomy in the Department of Plastic Surgery, Zhongshan Hospital Affiliated to Dalian University and Henan Plastic Surgery and Aesthetic Hospital were retrospectively analyzed. Based on the medical records, color ultrasound was performed on the patient’s breast before surgery, which was determined to be GYN (more than 50% glandular tissue). A 3 mm long incision was made at the lower boundary of the surgical range, through which the adipose tissue in the hypertrophic region of the breast was repeatedly aspirated until a satisfactory thickness was achieved. The residual glandular tissue was removed by a semicircular arc incision under the areola, and then the areola incision was sutured in position. The blood flow, sensation, and wound healing of bilateral nipples and areola were observed after surgery, and the morphology of bilateral thorax and scar of incision were followed up. Results: A total of 15 GYN patients aged 18 to 35 years with body mass index of 23.8 to 26.5 kg/m2 (mean = 24.8 kg/m2) were included in this study. The average intraoperative liposuction volume of unilateral breast was 170 mL (150-200 mL), the average glandectomy volume was 115 g (95-125 g), and the average blood loss was about 40 mL (15-75 mL). Postoperative hypertrophic breast volume decreased significantly, and no complications such as hematoma, infection, skin ischemic necrosis, or sensory disturbance occurred in the nipple and areola, during the healing process. The patients were followed up for 3 to 6 months, and the bilateral thorax was smooth, symmetrical, and natural in contour. The incision was concealed, and the scar was not obvious. Conclusion: Liposuction combined with subareolar incision glandectomy in the treatment of Simon Grade Ⅲ adipo-glandular GYN is safe. The postoperative chest contour is smooth and natural, and the scar is small and invisible, which achieves good aesthetics.

Using Tallquist Haemoglobin Scale for Estimating Intraoperative Blood Loss in Liposuction

Introduction: Intraoperative blood loss remains as a concern for all surgeons. Proper estimation of intraoperative blood loss is critical and can be challenging, especially if the blood is mixed with other fluids such as tumescent fluid in liposuction cases. In such cases, proper estimation of intraoperative blood loss will lead to fewer mistakes in fluid resuscitation. In this article, Tallquist Haemoglobin Scale was tried to estimate intraoperative blood loss in liposuction. Objectives: Proper estimation of intraoperative blood loss in liposuction cases. Method: Tallquist Haemoglobin Scale will be tried to estimate the approximate intraoperative blood loss in liposuction cases using a mathematical formula that considers total fluid loss, patient’s preoperative haemoglobin and the reading from Tallquist kit. Results: Tallquist Haemoglobin Scale can be considered as a valid method for proper estimation of intraoperative blood loss in liposuction cases, the thing that will lead to correct fluid resuscitation and fewer complications. Conclusion: Proper estimation of intraoperative blood loss leads to fewer mistakes in fluid resuscitation and fewer related complications of under or overcorrection. Tallquist Haemoglobin scale is a trusted, cheap and fast method for proper estimation of intraoperative blood loss in liposuction cases.

Higher Cell Viability and Enhanced Sample Quality Following Laser-Assisted Liposuction versus Mechanical Liposuction

Background: Despite the popularity of autologous fat transfer applications, high resorption rates, and consequential volume loss, have been reported. Viable adipocyte content has been defined as a key determinant of fat transfer longevity. Moreover, traces of blood, free oil fat and fibrotic tissue accelerate adipocyte degradation. Objective: To compare the effectiveness of a 1470 nm, radial emitting laser-assisted liposection device to a mechanical liposection device in maintaining adipocyte viability in fat tissue harvests. Methods: Bilateral subcutaneous adipose tissue samples were harvested from ten female patients. Fat was harvested from one side using the LipoLife laser-assisted liposuction device and from the other side with a Byron mechanical aspirator. Samples were visually analyzed and blood:fat ratios and cell viability were determined. Results: Laser-harvested samples separated into two distinct phases, with a negligible blood phase at the bottom (1.1%) and a significant adipose phase at the top (98.9%), containing small, uniform-sized cells, of which 95.7% ± 2.7% proved viable. Mechanically harvested samples separated into blood (18%), adipose (60%) and lipid (22%) phases. The adipose phase contained significant amounts of connective tissue, large adipose tissue fragments, large oil droplets and a mean 79.7% ± 18.3% viable adipocytes. Conclusions: Laser liposuctioning was superior to mechanical liposuctioning, providing both higher cell viability and enhanced sample quality. The 1470 nm diode laser bears the potential of improving long-term clinical outcomes of fat transfer procedures. Improved purity of the harvested sample and heightened preadipocyte content are projected to provide for extended graft longevity.

Facial liposuction combined with botulinum toxin type A:A technique for lower facial contouring

Background:Botulinum toxin type A injection,a noninvasive alternative method for treating masseteric hypertrophy,is inadequate for treating patients with a round lower face.This study aimed to investigate the operative technique and clinical results of liposuction followed by botulinum toxin type A injections in patients with masseteric hypertrophy and excessive subcutaneous fat.Methods:Sixty-five patients(50 women and 15 men)were treated using this technique between May 2014 and January 2019.Their mean age was 26.3 years(range,18–35 years)and the mean follow-up period was 13 months(range,8–18 months).Results:All patients achieved slimmer lower cheeks with improved jaw definitions after the procedure.Among the 65 patients,61(94%)expressed satisfaction with the results and believed that the procedure produced their desired face shape.No major complications were observed.The effect of this combination treatment remained stable for 12 months after the procedure.Conclusion:The authors believe that liposuction followed by botulinum toxin type A injections is an effective technique for the treatment of masseteric hypertrophy and excessive subcutaneous fat.It is also a relatively simple and safe treatment approach.

Study on Nursing Effects of Liposuction and Volume Reduction Surgery for Lymphedema Perioperative Nursing Care

Objective:To study the nursing effect of liposuction and volume reduction in the treatment of lymphedema during the perioperative period.Method:A total of 68 patients treated with liposuction volume reduction surgery for pseudo-lymphedema of lower limbs admitted from May 2019 to May 2020 in a tertiary hospital in Xi’an,Shaanxi Province were selected,and they were divided into observation group and control group by random grouping method.There were 34 cases in each group.The control group took routine care during the perioperative period,while the observation group performed full care during the perioperative period.The complication rate and pain degree of the two groups were compared.Results:The complication rate of the study group was 5.88%,while that of the control group was 26.67%.Compared with the study group,the complication rate was significantly higher than that of the control group,and the gap was statistically significant(P>0.05).The pain scores of patients in the study group were significantly lower than those in the control group at 3 and 6 days after surgery,and the gap was statistically significant(P>0.05).Conclusion:Lymphedema should be taken care of during the perioperative period of liposuction and volume reduction,which can effectively reduce the occurrence of pain and complications.It is worthy of extensive clinical promotion.

Lipedema:A common though often unrecognized condition

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.

Abdominoplasty with simultaneous liposuction

Abdominoplasty procedures have dramatically increased over the past decade or more.The American Society for Aesthetic Plastic Surgery(ASAPS)Cosmetic Surgery National Data Bank reported in 2005 an increase of 344%[1].Saldanha introduced Lipoabdominoplasty in the early 2000[2].Over the past two decades,Abdominoplasty,a common procedure performed by plastic surgeons worldwide has undergone progressive gradual changes with the inclusion of liposuction contouring of the trunk.The author discusses his experience and technical preferences in the performance and management of complete/full abdominoplasty patients,including the floating umbilicus technique,with simultaneous liposuction obtained over the past 40 years in private practice.

Fat Embolism as a Rare Complication of Large‑volume Liposuction in a Plastic Patient

Fat embolism is a dreaded complication in of procedures of multiple disciplines including plastic surgery.As the popularity of liposuction increases,cases of pulmonary embolism after liposuction are increasingly reported.However,documents of cerebral embolism after liposuction are rarely presented.The degree of disability with respect to Fat fat Embolism embolism Symdrome syndrome(FES)is a Gordian Knot in the evaluation of legal medicine.Therefore,it is of great significance for us to that we report the case of a 30‑year‑old woman who underwent a large‑volume liposuction that resulted in serious complications,especially cerebral embolism.Untypical symptoms of fat embolism hamper the clinical diagnosis,particularly after a surgical procedure such as liposuction.Such a seldom‑seen case would easily trigger medical disputes,especially in countries like China suffering increasing claims of medical malpractice and,medical negligences and lawsuits.Detailed descriptions of this case are presented below along with the discussion of the clinical symptoms and the diagnostic approaches to fat embolism.

Free deep inferior epigastric perforator flap after abdominal liposuction:reconsidering a contraindication

Autologous breast reconstruction with perforators has been previously avoided in tissues that have undergone liposuction.We present a case series and literature review of breast reconstruction with deep inferior epigastric perforator(DIEP)flaps after abdominal wall liposuction.An MEDLINE search was performed for all relevant articles describing breast reconstruction with DIEP flap technique following the abdominal wall liposuction.Key search words used included“DIEP”,“DIEAP”,“deep inferior epigastric perforator”,“liposuction”and“free flap”.All published data on the topic from 1965 to December 2014 were reviewed.Articles were assessed for reports of clinical cases,complications,age,liposuction amount,time since liposuction and number of perforators for comparison.We have also presented 2 patients who underwent a DIEP procedure with a previous history of liposuction.Eight cases of autologous breast reconstruction using a DIEP flap after liposuction were identified in the literature in addition to the presented cases.The preoperative and postoperative course was uneventful in all cases except one patient who had a mild cellulitis managed with antibiotics and a second patient with a drainable hematoma.The average age was 52 years±6.4 years old,one perforator was used in all cases except one where 2 were used,and the average amount of total liposuction was 1,084 mL.No major complications were reported.Previous liposuction is not an absolute contraindication for free-flap breast reconstruction.Preoperative management should include evaluation of suitable perforators by duplex ultrasound or computed tomography angiography.Larger case series are needed to better understand the safety of perforator flaps after liposuction.

Indocyanine green lymphangiography-guided liposuction in breast cancer-related lymphedema treatment-patient selection and technique

Aim:The rationale of using liposuction to treat lymphedema is that the chronic inflammatory process of lymphedema results in fat hypertrophy.The authors describe the technique of indocyanine green lymphangiography-guided liposuction,its rationale,and our patient selection criteria for better clinical outcomes.Methods:Thirty-two patients underwent liposuction for breast cancer-related lymphedema.Indocyanine green lymphangiography was performed prior to liposuction.For patients without linear and splash patterns in indocyanine green lymphangiography,circumferential liposuction was performed liberally.For patients who had linear or splash patterns,liposuction was not performed at regions with remaining functional lymphatic vessels.Outcomes were assessed using circumferential reduction rate.Results:At a mean follow-up of 24.5±6.5 months,all(100%)patients had a reduction in limb circumferences after liposuction.The mean circumference reduction rate was 67.6%±27.9%.Conclusion:Liposuction is a valuable treatment for breast cancer-related lymphedema.We believe patients with fat predominant lymphedema are the best candidates for liposuction.

Liposuction for chronic medical diseases and noncosmetic conditions:review of the literature

The purpose of this systematic literature review was to evaluate the safety of liposuction techniques and to identify the cosmetic and noncosmetic application of liposuction.Liposuction can be used to improve the quality-of-life in patients with disabling medical conditions in addition to its use for cosmetic rejuvenation.An online search of the Cochrane Library,MEDLINE,Embase,and SciELO were conducted.Forty-seven original articles reported from 1982 to February 2014 were included in this review.The articles reported on the use as well as the limitations of liposuction for treatment of noncosmetic and disabling medical conditions.The criteria used for selection of articles were:large sample size and originality.The case reports were excluded.There was a broad agreement about the applicability and the efficacy of the liposuction for treatment of these chronic medical conditions,such as multiple systemic lipomatosis,dercum’s disease,chronic lymphedema,and axillary hyperhidrosis.Literatures review confirmed that Liposuction technique has provided significant and stable cure for these chronic medical conditions.Liposuction is the most frequent esthetic procedure for adipose tissue reduction and treatment of lipedema worldwide.Apart from esthetic indications,liposuction can also be used to treat chronic medical diseases and noncosmetic conditions.

Incidence of Haematoma in Post Bariatric Abdominoplasty Cases

Objective: This study aims at assessing the incidence of haematoma formation in abdominoplasty cases who had previous bariatric surgery and in those who did not have bariatric surgery before. Patients and Methods: This is a 4 years retrospective study involving patients who underwent abdominoplasty surgery between the period of July 2015 and June 2019. The incidence of haematoma formation was assessed in relation to history of previous bariatric surgery in these patients. Results: 164 patients met the inclusion criteria of the study;46 of them were males and 118 were females. The mean age of the patients included in the study was 38.6 (21 - 60 years). The mean BMI was 27 kg/m2 (21.4 - 34.7 Kg/m2). The mean hospital stay was 6.6 days (4 - 19 days). 107 patients had history of previous bariatric surgery performed and 57 had not. 21 patients developed haematoma (12.8%). 16 of the patients who had haematoma had previous bariatric surgery done (15% of post bariatric surgery cases) while 5 patients developed haematoma with no history of previous bariatric surgery (8.8%). Sixteen male patients out of the 46 male patients in the study developed postoperative haematoma (34.8% of the male patients) while only 5 of the 118 female patients developed postoperative haematoma (4.2% of the female patients) which shows a significant difference in haematoma formation when comparing males to females in general (p Conclusion: Our study shows that the incidence of post abdominoplasty haematoma formation is significantly higher in male patients who had bariatric surgery before when compared to those who had not (p < 0.05). The incidence was higher in males when compared to females (p < 0.001) indicating that males with previous history of bariatric surgery have the highest chance of developing haematoma formation. Combining liposuction of the lower flanks, plication of the recti muscles or both to the abdominoplasty procedure did not result significantly in an increased risk of haematoma formation.

Non-Excisional Face and Neck Tightening Using a Novel Subdermal Radiofrequency Thermo-Coaugulative Device

42 patients with broad age and ethnic demographics where treated with a novel, non-excisional, minimally invasive device to coagulate a very thin layer of sub-dermal septo-fascial fat, denature the deep reticular dermis and tighten the skin and sub-dermal matrix of connective tissue. The detailed treatment protocol and results are presented. Patients were observed for up to 6 month following the procedure. No major side effects were observed. The aesthetic outcome of this non-excisional procedure includes improvement of the position and shape of the cheek, lower lid-cheek junction, jawline and neck. The overall aesthetic results deliver a noticeable and impressive tightening of the soft-tissue and may be compared with a conservative, small excisional procedure. The authors propose this versatile device and treatment as a non-excisional, moderate facial rejuvenation procedure on its own, or as an adjunct to open procedures performed simultaneously, or as a simplified treatment for secondary skin laxity in combination with a lift procedure.

Enrichment with Adipose-Derived Stem Cells Does Not Enhance Water-Jet Fat Graft Survival in the Breast—A Prospective Comparative Study

Objective: Although research increasingly underlines the theoretical importance of adipose-derived stem cells (ASC) for successful fat transplantation, we could not prove this notion in cosmetic breast augmentation. Stem-cell-enriched breast fat transplantation did not yield better results than grafting based on the WAL (water-jet assisted liposuction) technique in terms of volume persistence. To overcome inter-individual variation, intra-individual comparison was performed. Material and Methods: Four women underwent breast augmentation utilizing WAL fat transplantation with and without ex-vivo ASC isolation performed with the Multistation System. All patients underwent two fat transplantations for breast augmentation. In the first procedure, the left breast was augmented with stem-cell-enriched fat grafts and the right with plain WAL fat grafts. In the second surgery, the lipofilling was performed the other way round to exclude intra-individual differences in fat cell persistence. Results: MRI volumetry revealed a mean volume survival of 56% of the whole (watery) graft in the breasts with WAL only and 56% in the breasts with WAL and stem cell enrichment. While centrifugation of the WAL grafts demonstrated an average adipose content of 68%, the average volume survival of the adipose tissue itself was 83% in the breasts augmented with WAL only and 83% in those with WAL with stem cell enrichment. Conclusion: Breast augmentation by means of lipofilling using WAL alone is faster and more inexpensive, carrying a lower risk of contamination and offering an equal take rate. We do not see any advantage in stem-cell-enrichment in cosmetic fat transplantation to the breast.

Fat Re-Grafting in Facial Asymmetry: A 2-Case Report

Fat redistribution through recycling of previously grafted fat hasn’t been reported. Two facial asymmetry patients are presented with history of fat grafting to the mandibular angle areas. Collected fat from these formerly fat grafted zones and swollen on subsequent extra body weight gain has been re-grafted in the temporal regions for contour enhancement and has retained volume as photographically documented up to 30 months.

Non-invasive focused ultrasound for abdominal circumference reduction:does it really work?

Aim:Non-invasive body contouring is a promising modality.However,due to a lack of good evidence-based data,the mechanism by which contouring occurs remains unclear.The purpose of this study was to evaluate the effect of treatment with the Contour I™ultrasound system(Ultrashape®,Syneron®,Israel)on abdominal circumference and to compare 2 power levels for efficacy and safety.Methods:A prospective,self-controlled double-blind design was used.Thirty-six women,aged 30-45 years,were randomized to receive treatment with the Contour I at high or low acoustic outputs in 3 successive sessions,1 month apart.Safety was evaluated by adverse events,local skin reaction,and pain.Efficacy was evaluated by the change in abdominal circumference relative to baseline and to the untreated thigh area(internal control).Patients were followed for 28 days after the last treatment session.Results:At 1 month after the first session,the mean reductions in abdominal circumference measured 1.65 cm(P<0.001)and 0.87 cm(P<0.019)in the high and low-power groups,respectively.At 1 month after the last session,the cumulative reductions in circumference were 2.56 cm(P<0.001)and 1.49 cm(P<0.012),respectively.There was no change in the internal-control circumference throughout treatment.There were no treatment-induced severe adverse events.Conclusion:Multiple successive treatments of the abdominal area with the Contour I lead to a significant progressive reduction in circumference.The magnitude of the reduction is directly correlated to the acoustic power output which suggests that the technology itself is the main cause for the contouring effect.

Surgical debulking, lymphatico venous anastomosis, vascularised lymph node transfer in lower limb lymphoedema

Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection.The optimal treatment of lymphoedema is still elusive.Management is tailored according to clinical features,investigations and expectations of each patient.Lymphoedema patients should undergo a trial of conservative management with compression therapy,manual lymphatic drainage and external sequential compression devices.Early lymphoedema is treated by lymphovascular anastomosis,where the lymph vessels are connected to the subdermal veins by supermicrosurgery.In late cases when the limb is fibrotic,vascularised lymph node transfers are done,where lymph nodes are transferred from a healthy area to the affected area.In advanced cases,when the limb is fibrotic with cutaneous folds and skin changes,surgical debulking is done.In lymphoedema,along with accumulation of lymphatic tissue,there is also fat deposition,which can be removed by liposuction.One should be conversant with all treatment modalities to provide the lymphoedema patient with optimal care.

Breast cancer-related lymphedema: focus on surgical treatment

Breast cancer-related lymphedema(BCRL)can affect breast cancer patients,especially after axillary surgery and radiation treatment,for life.First line treatment is conservative and involves physical therapy and compression.It requires absolute,life-long compliance with treatment by the patient and,in some cases,it is ineffective.In recent years,surgery has emerged as a possible alternative or even,complementary therapy for BCRL.The most commonly reported techniques are reconstructive or debulking procedures.Reconstructive procedures are aimed at restoring the lymphatic pathways and can be effective early in the disease process,when increased arm volumes are mostly due to the accumulation of protein-rich fluid in the interstitial space.In more advanced stages,where fibrotic and hypertrophic adipose tissues are dominant,debulking techniques such as liposuction can be recommended.A standard of care for the treatment of BCRL has not been established.Currently,different techniques can be combined to optimize clinical outcomes,and the surgical approach must be individualized for each patient,based on sound clinical and imaging assessment.BCRL surgical treatment remains a challenging topic that requires further study before it can be standardized.