Articles by Dr. Little

Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures

Christodoulos Kaoutzanis, MD, Varun Gupta, MD, MPH, Julian Winocour, MD, John Layliev, MD, Roberto Ramirez, MD, James C. Grotting, MD, FACS, Kent Higdon, MD, FACS; Aesthet Surg J 2017; 37 (6): 680-694

Liposuction represents the most common procedure in plastic surgery. Over 396,000 procedures were performed in 2015. Liposuction is now commonly utilized in addition to other procedures, such as abdominoplasty, thigh lift, facial aesthetic procedures, fat grafting, breast augmentation, and breast lifting procedures. This study sought to evaluate adverse events to better educate patients and to help make informed decisions when deciding on procedures to be performed.

Databases were reviewed to evaluate the incidence of adverse events in over 2500 patients undergoing liposuction, either alone or in combination with other procedures. Adverse events evaluated included hematoma, infection, wound healing problems, pulmonary and cardiac problems, blood clots (venous thromboembolism), and physiologic fluid problems.

Liposuction procedures were associated with an overall 0.7% risk of major adverse events. When combined with other procedures, the risk of adverse events was approximately 3.5%. Factors that were associated with increased risk include: advanced age, obesity, tobacco use, diabetes, female gender, procedures performed in hospitals, and combined procedures.

Overall, liposuction has a low rate of adverse events when used primarily or in combination with other procedures. Several risk factors were identified: advanced age, obesity, tobacco use, diabetes, female gender, procedures performed in hospitals. This data allows for better patient education and ability to enhance patient safety.

Take-home message
Liposuction is associated with a low rate of adverse events, when used alone or in combination with other procedures. It is important to consider risk factors when deciding on procedures performed. Patients should be honest with their surgeons regarding their medical problems and tobacco use. Patient safety is the number one priority in plastic surgery. It is important to trust your surgeon if he/she advises against a procedure based on your risk. As an old mentor once said, “just because you can do something, it doesn’t mean that you should”.

Fat Grafting – Part 1

Fat grafting has become an integral treatment in aesthetic and reconstructive procedures. Fat grafting has been performed for many years. It is not until recently that we understand how fat grafting works and the potential benefits. Fat grafts were initially used in the late 1800’s. However, it was not until the 1980’s that the widespread use of liposuction allowed for easier harvesting of fat grafts. Since that time, there has been a revolution in the research related to the optimal techniques required and possible benefits. Fat grafting is now used for a variety of aesthetic uses as both a filling agent and therapy for damaged tissue. In the face, it can be used to increase volume throughout. It can be used as a stand-alone therapy or as an adjunct to other procedures such as a facelift or blepharoplasty. Fat-grafting has been utilized in breast augmentation and is commonly used as an adjunctive procedure in breast reconstruction after treatment of breast cancer. There is a considerable buzz around fat grafting for gluteal augmentation, often termed “Brazilian Butt-Lift”. In addition to adding volume, fat grafts have been shown to regenerate and improve the surrounding tissue. The science is complex and the exact mechanisms are not yet fully understood. This series of articles will review many of these issues surrounding fat grafting.

Fat Grafting – Part 2 – Science of Fat Grafting

The transfer of fat to other regions of the body was initially performed in the 1800’s. Surgical techniques limited their use until the early 1980’s. At that time, suction-assisted lipectomy (liposuction) became widely accepted. The fat removed could then be transferred to other regions. Early results were disappointing. This was attributed to volumes transferred and techniques used. Since that time, there had been a tremendous amount of scientific data studying the molecular dynamics, benefits, and optimal techniques required.

The transfer of fat has demonstrated many claimed and validated benefits. It does not cure cancer. However, it does act to increase volume and improve the quality of the tissue in the areas treated. Many studies have documented long-term fat retention (maintenance of volume) and improvement of the overlying skin. These improvements are seen as increased skin thickness, decreased pore size, decreased wrinkling, and other microscopic variables associated with the improvement of skin quality.

Current research is focusing on the techniques to optimize grafting, the molecular dynamics of these grafts, and the modalities utilized to evaluate long-term results. As with many new aesthetic options, there will be many “snake-oil” claims. This series of articles aims to present the current scientific data and dispel some of the myths that make it to the mainstream media.

Preoperative Photographing and Morphing for Predictable Profiles in Rhinoplasty- Precision Profileplasty

Fazıl Apaydın, MD; Berke Özücer,MD JAMA Facial Plastic Surgery 2018 April 26 E1-2

Comparison of preoperative and postoperative photos is useful for educational and medicolegal reasons. Preoperative digital morphing software enables patients to visualize their desired operative outcomes. This study aims to aid those wishing to utilize software for predicting outcomes after rhinoplasty.

Preoperative photos are loaded into Adobe Photoshop software. Software utilities are used to “morph” photos into desired results. Measurements are obtained from desired outcomes and translated into the surgical plan.

Preoperative morphing software was useful in predicting outcomes in certain aspects of rhinoplasty procedures. Intraoperative decision-making still takes precedent.

Software modeling may be useful in predicting postoperative results after rhinoplasty

Take-home Message
Computer modeling software is very popular for predicting postoperative results. This may provide reasonable expectations for some procedures, which have instantaneous results (breast augmentation). However, I strongly disagree with its use in rhinoplasty. Rhinoplasty is widely considered one of the most difficult of all aesthetic surgical procedures. It is physically impossible to translate a computer-generated result to real life. Rhinoplasty is extremely complex, and a final result is not realized for many months. There are numerous variables that are not considered by computer software (airway problems, skin thickness, previous surgery, intranasal anatomy, facial anatomy, etc.). Perhaps more than any other procedure, the most important aspects of rhinoplasty planning are trust and relationship built with your surgeon and surgeon competence…. Not a computer.