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Autologous fat grafting is increasingly used in reconstructive surgery. However, resorption rates ranging from 25% to 80% have been reported. Therefore, methods to increase graft viability are needed. Here, we report the results of a triple-blind, placebo-controlled trial to compare the survival of fat grafts enriched with autologous adipose-derived stem cells (ASCs) versus non-enriched fat grafts. Healthy participants underwent two liposuctions taken 14 days apart: one for ASC isolation and ex-vivo expansion, and another for the preparation of fat grafts. Two purified fat grafts (30 mL each) taken from the second liposuction were prepared for each participant. One graft was enriched with ASCs (20 × 106 cells per mL fat), and another graft without ASC enrichment served as a control. The fat grafts were injected subcutaneously as a bolus to the posterior part of the right and left upper arm according to the randomisation sequence. The volumes of injected fat grafts were measured by MRI immediately after injection and after 121 days before surgical removal. The primary goal was to compare the residual graft volumes of ASC-enriched grafts with those of control grafts. This study is registered at www.clinicaltrialsregister.eu, number 2010-023006-12. 13 participants were enrolled, three of whom were excluded. Compared with the control grafts, the ASC-enriched fat grafts had significantly higher residual volumes: 23·00 (95% CI 20·57–25·43) cm3 versus 4·66 (3·16–6·16) cm3 for the controls, corresponding to 80·9% (76·6–85·2) versus 16·3% (11·1–21·4) of the initial volumes, respectively (p<0·0001). The difference between the groups was 18·34 (95% CI 15·70–20·98) cm3, equivalent to 64·6% (57·1–72·1; p<0·0001). No serious adverse events were noted. The procedure of ASC-enriched fat grafting had excellent feasibility and safety. These promising results add significantly to the prospect of stem cell use in clinical settings, and indicate that ASC graft enrichment could render lipofilling a reliable alternative to major tissue augmentation, such as breast surgery, with allogeneic material or major flap surgery. Danish Cancer Society, Centre of Head and Orthopaedics Rigshospitalet, and Moalem Weitemeyer Bendtsen.

Introduction Cryolipolysis was developed in 2007 as a method of reducing excessive adipose tissue using low temperatures. During the procedure, lipid crystallization occurs at temperatures much higher than the freezing point of water in the tissues. This is followed by the recruitment of macrophages, the number of which peaks at 4 weeks and disappears at about 3 months after treatment. Material and Methods The study involved 15 women who were divided into a control group and a study group. All subjects completed the QEB questionnaire, had body circumference measurements taken, and had a body composition analysis performed before the start of therapy and 1 month after the end of therapy. The study group underwent three cryolipolysis treatments to the abdominal area, with a treatment duration of 45 min and a temperature of −8°C. Approval from the bioethics committee was obtained prior to the study. Results Comparing the results of the control group and the study group after 3 months of the study, differences in mean values of body fat, abdominal circumference, and BMI values are evident, while statistical analysis showed a significant difference in changes in BMI values (p < 0.05), while changes in body fat were on the borderline of statistical significance (p = 0.05). Conclusion The study confirms that cryolipolysis is a safe method of reducing locally accumulated fat, especially in the abdominal area in women.

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 .

Background Hematomas are common complications following plastic and esthetic surgeries. Large and complex hematomas might result in prolonged hospitalization, further interventions, additional expenses, and poor esthetic outcome. Tranexamic acid (TXA), an antifibrinolytic agent, has long been used to reduce blood loss. Its use in the field of plastic surgery has gained popularity recently. Several studies have presented the ability of TXA to reduce blood loss, hematomas, and ecchymoses after liposuctions. However, the proper dose and the route of administration remained controversial. Objective The objective of the study was to quantify the effect of a low dose of TXA in an irrigation method in reducing hematomas and ecchymoses following liposuction. Methods A prospective randomized controlled trial was conducted. Following liposuction, 400 mg of TXA were administered in an irrigation protocol to one side of the body in each patient, while the other side was administered with saline. The patients were photographed on 1, 2, 4, and 11 post-operative days. Ecchymosis and hematoma were measured and rated. Results No statistical difference was observed between the intervention and control groups in terms of RBC in liposuction area ( p  = 0.11), RBC in lipoaspirate ( p  = 0.79), bruising size on days 1, 2, 4, and 11 ( p  = 0.68, 0.21, 0.42, and 0.75), and average ecchymosis score on the same days ( p  = 0.34, 0.72, 0.09, and 1) Conclusions The use of a low-dose TXA irrigation solution did not demonstrate a statistically significant difference in post-operative hematoma formations rates and subsequent ecchymosis size and scale. 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 www.springer.com/00266 .

(1) Background: Although lipedema has gained more interest among researchers, specific treatment methods are still unknown. This study aims to identify the effects of compression therapy combined with exercises compared to exercising only. Moreover, the aim is to assess the methodology and outcome measurements before conducting a larger study. (2) Methods: Six women with lipedema were enrolled in the study; three were undergoing exercise program and compression therapy using compression leggings, and the remaining three were undergoing exercises only. During the first 4 weeks, intervention was under the supervision of a physiotherapist, and in the remaining weeks, participants were exercising independently. Measurements of circumference, weight, thickness of the skin and adipose tissue, symptom severity, and quality of life were taken at baseline, after 4 weeks and after 6 weeks; (3) Results: There was a significant decrease in the subjectively reported tendency for bruising and pain at palpation among patients that received compression therapy. Additionally, there was a tendency to reduce or maintain the circumference of the legs in patients using compression, while it tended to increase in patients without compression. (4) Conclusions: Preliminary results indicate that compression therapy, combined with exercises, could improve the quality of life and decrease the severity of lipedema symptoms. Further studies on a large clinical group are advisable.

Background Autologous fat grafting is widely used in reconstructive surgery and its use is increasing in different areas of regenerative medicine. This study evaluates the impact of elliptical lipoaspirate activation on adipose tissue grafting outcomes, focusing on scar-related pain reduction, improved scar characteristics, and increased tissue elasticity, comparing these outcomes with the traditional Coleman method. Methods This randomized double-blinded clinical trial study was conducted at the Humanitas Research Hospital in Milan from October 2022 to December 2023. Forty-three women aged 18–75 undergoing second-stage breast reconstruction were enrolled. The control group (19 patients) received the Coleman technique, while the study group (24 patients) underwent an additional elliptically oriented centrifugation. Method for evaluations included the Visual Analog Scale (VAS) for pain, Range of Movement (ROM), the Patient and Observer Scar Assessment Scale (POSAS), and shear wave elastography for tissue elasticity. Results Both groups showed significant improvements over time. The case group demonstrated a greater decrease in VAS scores at 3 months ( p = 0.015). POSAS scores were consistently better in the elliptical lipoaspirate activation group, significantly improving scar pruritus, pain, color, stiffness, thickness, and irregularity. Total POSAS score for both patient and observer scales were statistically higher for the case group at 12 months ( p = 0.009 and p = 0.003, respectively). Elastography showed higher tissue softness in the case group at 6 months ( p = 0.015) and 12 months ( p = 0.0005). Tissue hardness, measured with elastography, was significantly lower for the case group at 12 months ( p = 0.003). Conclusions The elliptical lipoaspirate activation technique significantly enhances clinical outcomes, reducing pain and improving scar quality and tissue elasticity compared to the standard Coleman method. 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 .

Objective The purpose of this study was to evaluate the yield, viability, clinical safety, and efficacy of the stromal vascular fraction (SVF) separated with a new protocol with all clinical-grade drugs. Materials and Methods SVF cells were isolated from lipoaspirate obtained from 13 participants aged from 30 to 56 years by using a new clinical protocol and the laboratory protocol. The cell yield, viability, morphology, mesenchymal stem cell (MSC) surface marker expression, and differentiation abilities of the SVF cells harvested from the two protocols were compared. Furthermore, three related clinical trials were conducted to verify the safety and efficiency of SVF cells isolated by the new clinical protocol. Results There were no significant differences in the yield, viability, morphology, and differentiation potential of the SVFs isolated with the clinical protocol and laboratory protocol. Adipose-derived mesenchymal stem cell (ASC) surface marker expression, including that of CD14, CD31, CD44, CD90, CD105, and CD133, was consistent between the two protocols. Clinical trials have demonstrated the effectiveness of the SVF isolated with the new clinical protocol in improving skin grafting, promoting mechanical stretch-induced skin regeneration and improving facial skin texture. No complications occurred. Conclusion SVF isolated by the new clinical protocol had a noninferior yield and viability to that of the SVF separated by the laboratory protocol. SVFs obtained by the new protocol can be safely and effectively applied to improve skin grafting, promote mechanical stretch-induced skin regeneration, and improve facial skin texture. Trial Registration The trials were registered with the ClinicalTrials.gov ( NCT03189628 ), the Chinese Clinical Trial Registry ( ChiCTR2000039317 ), and the ClinicalTrials.gov ( NCT02546882 ). All the three trials were not patient-funded trials. 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 www.springer.com/00266 .

Liposuction remains one of the most frequently performed cosmetic surgical procedures and its popularity is increasing every year. However, since its inception, justified concerns regarding patient safety have placed limits on the volume of fat that can be aspirated, influenced by hemodynamic fluctuations and blood loss during liposuction. Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the conversion of plasminogen to plasmin, thus preventing the binding and degradation of fibrin. Despite the existence of evidence of the effectiveness of TXA in orthopedic and cardiac surgeries, there is little evidence of its use in liposuction. The objective of this study was to evaluate the efficacy and safety of tranexamic acid in the control of surgical bleeding in patients undergoing liposuction, through a prospective, open, randomized and controlled clinical trial. Two groups of 25 participants each were formed to whom the application of TXA in a tumescent solution prior to liposuction or liposuction with the traditional technique was randomly assigned. The results showed a decrease in blood loss reflected by the differences in the final hematocrit values, as well as decrease in the same per aspirated volume (p = 0.003). No adverse events were found related with the TXA application and no blood transfusions were required in this group, in contrast to the control group where the need for blood transfusion was present in 20% of the intervened participants.Level of Evidence IIThis 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.

Objective This study investigates the comparative short-term and long-term efficacy of endoscopic lipolysis and liposuction versus traditional open excision in the treatment of gynecomastia. Methods A total of 140 male patients diagnosed with gynecomastia and admitted to our hospital from April 2021 to May 2022 were enrolled in this study. Patients were randomly assigned to two groups based on the surgical treatment method: the control group (traditional open excision, n  = 70) and the observation group (liposuction under endoscope, n  = 70). Comprehensive demographic and clinical data were collected for both groups. Surgical indicators, postoperative complication rates, and pain levels measured using the Visual Analog Scale (VAS) one month post-surgery were observed and compared. Additionally, recurrence rates and patient satisfaction scores were evaluated one year after the procedure. Results There were no significant differences in demographic and clinical characteristics between the two groups ( P  > 0.05). The observation group exhibited shorter incision lengths, reduced operation times, and decreased hospital stays compared to the control group ( P  < 0.05), alongside less intraoperative bleeding ( P  < 0.05). The incidence of postoperative complications was significantly lower in the observation group ( P  < 0.05). At one and three weeks post-surgery, the observation group reported lower VAS scores for pain compared to the control group ( P  < 0.05). There were no significant differences in recurrence rates between the groups one year post-surgery ( P  > 0.05). However, the observation group achieved higher scores in terms of chest appearance, wound scarring, nipple and areola aesthetics, and overall satisfaction ( P  < 0.05). Conclusion Endoscopic lipolysis and liposuction not only demonstrate advantages such as lower complication rates and expedited recovery in the treatment of gynecomastia but also provide long-term efficacy comparable to traditional surgical methods. This approach significantly enhances patient satisfaction, establishing it as a preferred treatment option due to its safety profile and ability to deliver superior cosmetic outcomes.

The study aimed to examine the effect of focused ultrasound cavitation augmented with aerobic exercise on localized abdominal and intrahepatic fat in fatty liver patients. 34 fatty liver patients aged 30-45 with a body mass index (BMI) of 30-40 kg/m2 were randomly assigned into two equally numbered groups. Group A received focused ultrasound cavitation and moderate aerobic exercise for three months, while Group B (control group) received moderate aerobic exercise only. Abdominal subcutaneous fat volume, visceral fat volume, liver-to-spleen ratio (L/S ratio), body weight, BMI, and waist circumference were measured both before and after the study period. Both groups showed significant improvements in subcutaneous fat volume, visceral fat volume, body weight, BMI, and waist circumference relative to baseline where (P < 0.001), with a higher percentage in group A. L/S ratio only showed a significant improvement in group A. Between-group differences were noteworthy regarding L/S ratio and waist circumference where (P < 0.0001). While substantial risky measures in non-alcoholic fatty liver disease have been modified by aerobic exercise, its combination with focused ultrasound cavitation causes more notable effects on the reduction of abdominal and intrahepatic fat, making it a superior option. ClinicalTrials.gov: NCT04161703.