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Liposuction is one of the most popular cosmetic surgery procedures currently performed by plastic surgeons around the world. It must be clear at the outset that liposuction is not primarily a modality for weight loss, it is meant to be a body contouring procedure and therefore the inherent limitations and safety issues related to this must always be respected if complications and unfavourable results are to be avoided as far as possible.

Background Liposuction is one of the most common procedures in the practice of plastic surgery. Since it evolved, continuous modifications have been to decrease blood loss so that patients are hemodynamically stable intra- and postoperatively. Tranexamic acid (TXA) has long been used for its antifibrinolytic properties that were beneficial in reducing blood loss, rate of transfusion, and hemoglobin drop in major trauma and surgeries. Its use in plastic surgery, however, is still limited. In this study, we aim to illustrate the effect of intravenous (IV) and local infiltration of TXA on blood loss in liposuction surgery. Methods Between April 2019 and April 2021, 90 patients who requested liposuction for various body parts were randomly allocated into 3 equal groups: control group, IV TXA, and local infiltration of TXA. A sample was taken from infranatant and sent for hematocrit calculation. Volume of blood in lipoaspirate was then calculated. Patients were assessed for blood loss and postoperative bruising. Results Volume of blood loss in lipoaspirate was considerably lower in the TXA groups, with 60% decrease in blood loss for the local TXA group in comparison with the control group. TXA has also been shown to markedly decrease bruising tendency in postoperative liposuction patients. Conclusions TXA can be used to decrease blood loss in large-volume liposuction, modify the need for blood transfusion intra- and postoperative, and improve the results of liposuction procedure without the need for multiple sessions. Level of evidence: Level II, Risk/Prognostic Study.

Background Body contouring surgery is increasingly requested by patients, both for aesthetic and post-bariatric purposes. There has also been a rapid increase in demand for noninvasive aesthetic treatments. While brachioplasty is burdened by numerous complications and unsatisfactory scars, and conventional liposuction is unsuitable for all patients, nonsurgical arm remodeling performed with radiofrequency-assisted liposuction (RFAL) allows to effectively treat most of patients, regardless of the amount of fat and ptosis of the skin and avoiding surgical excision. Methods A prospective study was conducted on 120 consecutive patients who presented to the author's private clinic and required upper arm remodeling surgery for aesthetic purposes or after weight loss. Patients were classified according to the modified classification of El Khatib and Teimourian. Pre- and posttreatment upper arm circumferences were taken after 6 months of follow-up to assess the degree of skin retraction obtained by treating the arm with RFAL. A satisfaction questionnaire regarding the appearance of the arms (Body-Q upper arm satisfaction) was administered to all patients before surgery and after 6 months of follow-up. Results All patients were effectively treated with RFAL, and no cases required conversion to brachioplasty. The average reduction in arm circumference was 3.75 cm at 6 months follow-up, and patients’ satisfaction increased from 35 to 87% posttreatment. Conclusions Radio frequency is a valid tool to treat most patients with upper limbs skin laxity, with significant aesthetic results and a high degree of patient satisfaction, regardless of the degree of skin ptosis and lipodystrophy of the arm. Level of Evidence IV 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 .

Goals/Purpose Thigh lifts historically have been performed using a vertical excision to correct the horizontal laxity.1However, this leaves an unsightly scar when wearing shorts or a bikini bottom. More recently the horizontal scar saving thighplasty has been described, but this only addresses a limited medial portion of the thigh laxity.2While plastic surgeons perform abdominoplasty concurrently with medial thigh lifts,3 there is no described technique of this type of spiral lift in the literature. The spiral lift does not use liposuction of the medial thighplasty portion of the procedure as is used in many of the published techniques.4 Moreover, compared to other described horizontal thigh lift techniques, which use a much smaller horizontal incision,5 the spiral lift extends this incision in the groin crease and into the inferior gluteal crease, resulting in a longer but very well hidden incision. This provides maximal lift of the entire thigh while avoiding a vertical scar. Our goal was to develop a technique to lift the medial and lateral aspect of the leg and the buttock skin while also minimizing visible scarring. Methods/Technique The lower abdominoplasty/belt lipectomy incision is designed in the pre-operative area such that the post-operative incision will be hidden in a pair of underwear of choice. The thighplasty incisions are designed in the groin crease, continuing into the lower abdominoplasty incision, and extend posteromedially around into the inferior gluteal crease. A pinch test is used to determine the appropriate amount of tissue that can be excised. The patient is intubated on the stretcher, then flipped into the prone position on an OR bed. Excision is performed to the level of the thoracolumbar fascia on the back and Scarpa’s fascia for the thighs to avoid the posterior cutaneous nerve. Two drains are left in the back. Following closure, the patient is flipped supine onto a second OR bed. A standard abdominoplasty is then performed in continuation with the back incision to complete the belt lipectomy. The anterior medial thigh excision is again performed at the level of Scarpa’s fascia, staying superficial in the region of the femoral vessels and lymphatics. Two drains are placed anterior in the abdomen. Results/Complications A total of 12 pts have undergone a full belt lipectomy with the spiral lift thighplasty since it first was performed in July 2019. This technique has shown good cosmetic results (Figures 1&2), providing a circumferential vertical lift of the buttock and entire thigh while also addressing the abdomen and back. We have had good success in both men and women. This procedure is especially beneficial for massive weight loss patients, but we have also done the spiral thigh lift with abdominoplasties not requiring circumferential body lift. Five patients also underwent additional concurrent procedures involving the breast (mastopexy, augmentation, etc). Some patients had same day surgery (7), while five were observed overnight. The patients do tend to get some mild swelling of the mons. Scrotal swelling can be minimized with scrotal elevation and compression. Three patients had dehiscence of the thigh wounds, two of which were minor and were managed with dressing changes. One was caused by a fall at home and required return to the operating room for repair, but also had subsequent dehiscence requiring dressing changes. This was one of two patients that were re-admitted following the procedure, the other being a patient admitted for UTI sepsis 10 days after surgery. Forty-two percent of patients have had minor revisions following the procedure, 80% of which are performed concurrently with another primary surgery (eg. brachioplasty, cervicoplasty). One patient experienced transient lymphedema of the bilateral thighs. We have experienced no major infections. Some patients have experienced descent of the anterior medial thigh incision, visible in bikini bottoms. Conclusion The spiral lift is a technique that can successfully achieve a full body lift and address the thigh laxity circumferentially while completely hiding the scars in the underwear lines or natural skin creases.

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.

BackgroundLiposuction is one of the most common procedures used for body contouring. In this study, we aimed to determine whether there is a weight change with VASER-assisted liposuction (VAL) procedure and the demographic factors affecting it.MethodsA total of 51 patients (30 females and 21 males) who underwent VAL between the years of 2020 and 2022 were included in the study. Participants’ weights before VAL, body mass indexes (BMI), aspiration volumes, demographic data, and weights and BMIs one month after VAL were recorded and analyzed. In addition, the fat ratio in the aspirate was determined in ten patients.ResultsThe mean aspiration volume with VAL was 4832.50 ± 2373.26 ml in females and 5176.90 ± 1602.61 ml in males. Body weights (baseline, 90.34 ± 9.17 vs. 71.01 ± 8.87; one month later, 86.95 ± 8.34 vs. 66.28 ± 10.04: p < 0.001) and BMIs (baseline, 28.59 ± 2.97 vs. 26.40 ± 3.69; one month later, 27.54 ± 2.92 vs. 24.59 ± 3.76: p = 0.009) were higher in males than females, both at baseline and after VAL. There was a significant decrease in body weights and BMIs after VAL in both females (4.73 ± 4.73 kg) and males (3.39 ± 4.27 kg) (p < 0.001). However, no correlation was observed between the decrease in body weights and BMIs after VAL and gender, age, aspirate volume, and fat volume.ConclusionAlthough there was a decrease in mean body weight and mean BMI in both males and females one month after VAL, no associations were observed between weight drop after VAL and gender, age, aspiration volume, and fat volume.Level of Evidence IV 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.