As Technique Evolves, Plastic Surgeons Consider Skin Retraction—Not Just Fat Removal, Reports PRS Global Open

Two decades of experience by senior plastic surgeons in different parts of the world show excellent cosmetic results and low complication rates with liposculpture of the hips, flanks, and thighs, reports a paper in Plastic and Reconstructive Surgery—Global Open®, the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).

Plastic surgeons Yixin Zhang, MD, PhD, of Shanghai JiaoTong University and Manuel Francesco Castello, MD, of Clinica Villa Salaria, Rome, report on their joint experience using modern liposuction techniques for sculpting the lower body—hips, flanks, and thighs. They conclude, "Based on our 20 years of experience and observations on three-dimensional liposuction, we can suggest it a reliable method with proven results."

Modern Liposculpture Technique Leads to Excellent Results

Drs Zhang and Castello and coauthors describe and analyze their technique and outcomes of lower-body liposculpture in more than 4,000 patients. Liposculpture "is a very sophisticated method that goes beyond the simple aspiration of adipose tissue [fat] and allows the surgeon to modify the shape of the body and recontour the profile," the researchers write.

A key aspect of the technique is not only to remove underlying fat, but also to promote and guide skin retraction after fat removal. This includes careful thinning of the skin in order to allow it to better retract and adapt to the new shape. "The skin should no longer be considered a passive element during superficial liposuction, but instead as an active, structural and dynamic constituent," the authors believe.

Drs Zhang and Castello outline each step of their procedure: from initial patient evaluation, to preoperative marking of the skin, through patient preparation and liposuction technique. Postoperative care includes compression garments and bandages to guide skin adaptation to the carefully sculpted underlying fat.

"If performed correctly, three-dimensional liposuction of trunk, hips and thighs can yield very satisfying outcomes because of the excellent contour and enhanced skin retraction provided by the thin cutaneous [skin] adipose flap," the researchers write. They note that their cosmetic results have been well-maintained during follow-up, including in patients with pregnancies or weight loss or gain.

Complications rates were low, with only one serious complication—an infection that responded to antibiotics—in more than 4,000 patients.

Fifty patients had postoperative seromas (fluid collections) which resolved after repeated drainage. Other patients had minor cosmetic issues that were later "touched up" with simple proceudres.

Drs Zhang and Castello and coauthors believe their experience demonstrates the excellent cosmetic results and safety record of three-dimensional liposculpture of the hips, flanks, and thighs—and highlights the role of techniques aimed at promoting good skin adaptation to the new shape. They conclude, "A careful application of the technique combined with an accurate surgical planning, a thorough preoperative explanation of real expectations and post-operative care are crucial."

Plastic and Reconstructive Surgery—Global Open® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About PRS Global Open

Plastic and Reconstructive Surgery—Global Open (PRS Global Open) is an open access, rigorously peer-reviewed, international journal focusing on global plastic and reconstructive surgery. PRS Global Open educates and supports plastic surgeons globally to provide the highest quality patient care and maintain professional and ethical standards through education, research, and advocacy.

About Wolters Kluwer Health

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About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. 

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