Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO and compared the results with those of a group treated only with a laser. Materials and Methods: This study compared the outcomes of AO treatment between the two groups up to six months postoperatively. The first group of 18 patients underwent laser treatment alone, and the second group of 12 patients underwent integrated liposuction surgery in addition to laser treatment. Outcomes were assessed using the following variables: degree of malodor (DOM), sweating area, patient satisfaction, pain levels, and complications, such as burns, swelling, and contractures. Results: Compared to the laser-only group, the integrated liposuction group demonstrated significantly superior outcomes in terms of DOM (p = 0.002) and patient satisfaction (p = 0.006), as well as a reduction in the sweating area (p = 0.012). The pain rating was higher in the liposuction group, but the difference was not statistically significant (p = 0.054). Compared with the patients in the integrated liposuction treatment group, those in the laser treatment group exhibited a significantly higher number of burns under the axillae (p = 0.025). However, no significant differences were observed in the swelling or contracture between the groups. Conclusions: Integrated liposuction with laser therapy significantly improved treatment outcomes, including malodor, patient satisfaction, sweat test results, and decreased complication rates.

The newly introduced ultrasound guided interfacial rhomboid intercostal and sub-serratus (RISS) block technique demonstrated promising efficacy in managing perioperative pain among patients undergoing abdominal and thoracic procedures. Thus, this study investigated the efficiency of bilateral ultrasound-guided RISS (US-RISS) as a perioperative pain control technique in male subjects receiving gynecomastia surgery.
This prospective randomized study involved sixty patients who underwent gynecomastia surgery. Individuals were randomly divided into two groups: the RISS group (N.=30) and the control group (N.=30). After anesthesia induction, the patients received bilateral US-RISS using 40 mL of 0.25% levobupivacaine, or conventional intravenous analgesia with no intervention, respectively. The primary outcome was the overall morphine consumption in 24 hours, and the secondary endpoints involved the time elapsed till rescue analgesia was requested, the quality of recovery after 24 hours and side effects\' incidence.
Morphine consumption was noticeably decreased in the RISS group compared to the control group, with 14.07±4.91 mg and 35.83±1.70 mg mean values, respectively (P<0.001). Furthermore, in the RISS group, the initial rescue analgesia request occurred significantly later than in the control group, with mean values of 15.58±1.41 hours and 0.96±0.63 hours, respectively (P<0.001). Additionally, within the RISS group, there was a high quality of recovery observed, with a low incidence of opioid-related adverse events in comparison to the control group.
Bilateral US-RISS block is a beneficial intervention in gynecomastia surgery for pain management and improves the quality of recovery.

BACKGROUND: Autologous fat transplantation is limited by the uncertainty of graft retention, impeding its application. Among the current strategies for processing lipoaspirates, high-density fat (HDF) is recommended owing to the enrichment of stem cells and washing before cotton concentration for simplicity of operation. Poloxamer 188 (P188) washing has been shown to repair the membranes of damaged cells. This study aimed to investigate the effect of P188-washing on fat graft survival and identify the best technique for processing lipoaspirates.
METHODS: Lipoaspirates were prepared using centrifugation to obtain HDF, which was then washed with saline or P188 followed by cotton concentration. Tissue integrity, adipocytic activity, and viability of stromal vascular fraction (SVF) in the samples from the 3 groups were assessed. Samples were sequenced in vitro using high-throughput RNA-seq, and differentially expressed genes were validated using qPCR and western blotting (WB). After transplantation under the dorsum of nude mice for 8 weeks, the grafts were extracted and examined for residual volume, histologic characteristics, and vascularization.
RESULTS: The HDF and P188 groups showed a higher survival rate of SVF, more Ki67-positive cells, intact tissue structure, and lesser fibrosis than the saline group. There were no significant differences in the density of SVF and residual volume of grafts. HDF showed significantly improved vascularization during 8 weeks. Through RNA-seq and bioinformatic analysis, notable changes in several related genes after transplantation were observed.
CONCLUSIONS: P188 treatment can prevent cells from apoptosis and preserve tissue viability, thereby improving graft quality. HDF contains large amounts of SVF and can be regarded as an excellent grafting material.

Incorrect bispectral index (BIS) values have been reported due to interference with this monitoring system. We report a case of a 46-year-old woman who underwent liposuction and breast lipofilling, where we observed a misinterpretation by the BIS algorithm that has not yet been reported. Concurrently with abdominal and thigh liposuction, an increase in the BIS value was observed. The importance of examining electroencephalogram (EEG) and density spectral array (DSA) readings during liposuction procedures is highlighted in this case report, extending our observations beyond just the numerical BIS value, which is not always reliable.

Liposuction is a surgical procedure performed worldwide. Although many fatal complications of liposuction have been reported, to our knowledge, no cases of fatal liposuction complications specifically related to the face region have been reported. Here, we present a case of a woman in her 30s who developed a cervical hematoma and upper airway obstruction following facial liposuction. We present this unique case to highlight the rare occurrence of fatal complications specific to facial liposuction. The patient underwent liposuction during surgery at a cosmetic surgical clinic and awoke from anesthesia after the procedure. Two hours later, she developed a neck swelling and dyspnea. While the anesthesiologist managed her airway, she went into cardiopulmonary arrest. She was then transferred to the emergency room but died on day 7 of hospitalization. The autopsy revealed swelling of the right cheek and mandible, a subcutaneous hematoma in the same area, and laryngeal edema. A damaged facial artery branch was identified, which was consistent with the computed tomography (CT) findings on admission. CT also showed that the hematoma compressed the right internal jugular vein, suggesting that venous outflow impairment caused by the hematoma may have exacerbated the airway obstruction. This case reveals that cervical hematoma caused by facial liposuction can cause fatal upper airway obstruction and the onset of the hematoma may be gradual.

The mammalian target of rapamycin (mTOR) inhibitors are used to prevent organ transplant rejection and are preferred over other immunosuppressants due to its low nephrotoxicity. However, mTOR inhibitors have been associated with various adverse effects including lymphedema. Although rare in incidence, previously known treatments for mTOR inhibitor-induced lymphedema were limited to discontinuation of related drugs and complex disruptive therapy with variable results. In this article, three patients who developed lymphedema in their lower limbs after using mTOR inhibitors, including two bilateral and one unilateral case, were treated with physiologic surgery methods such as lymphovenous anastomosis (LVA) and lymph node transfer. The efficacy of the treatment was evaluated. In the three cases described, cessation of the drug did not lead to any reduction in edema. The use of LVA and lymph node transfer resulted in early reductions in volume but failed to sustain over time. All patients underwent secondary nonphysiologic surgery such as liposuction resulting in sustained improvement. This series presents the first physiologic approach to mTOR inhibitor-induced lymphedema. Although further study is warranted, the physiologic surgical options may have limited success and nonphysiologic options may offer better sustainable results.

BACKGROUND: Ultrasound-assisted liposuction (UAL) has become popular because of its favorable outcomes in fat emulsification, blood loss reduction, and skin tightening. This study aimed to compare the effects of two UAL devices on the abdomen by assessing postsurgery skin biomechanical properties.
METHODS: This single-blind, prospective study (2020-2022) involved 13 liposuction procedures performed on patients without chronic diseases. Each patient\'s abdomen was divided vertically from the xiphoid to the perineum. Vibration amplification of sound energy at resonance (VASER)-assisted liposuction (Solta Medical, Inc., Hayward, CA) was performed on one half, while the other half underwent liposuction with high-frequency ultrasound energy (HEUS)-assisted technology. Skin biomechanical measurements, including distensibility, net elasticity, biological elasticity, hydration, erythema, melanin, and skin firmness, were taken at 12 and 24 months postsurgery, focusing on the anterior abdomen, 8 cm to the right and left of the umbilicus.
RESULTS: Analysis of the above skin biomechanical measurements revealed no significant differences between the HEUS and VASER devices, except for skin firmness, which showed a notable increase following HEUS surgery. Patient-perceived clinical differences were assessed via nonvalidated questionnaires, revealing no distinctions between devices.
CONCLUSIONS: Biomechanical skin results post-UAL surgery with these devices on the abdomen were not significantly different, although HEUS revealed increased skin firmness. This suggests that HEUS-assisted technology, akin to other devices, is a viable option for UAL procedures.

A 19-year-old student developed hypoventilation and cyanosis at the end of a cosmetic liposuction procedure. She was awake, but severely abulic, disoriented, and unable to stand and walk due to severe locomotor ataxia. Neuropsychological evaluation showed psychomotor slowness, and deficits in memory encoding and retrieval, and on executive, and visuospatial and visuoperceptual tests; oral comprehension and constructional praxis were spared. ¹H-MRS showed a reduction of NAA. A year later, her cognitive and neurological exam, and NAA returned to normal, and she resumed her normal life. The severity of the acute manifestations of hypoxic encephalopathy not always entail a poor prognosis.

BACKGROUND: The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer.
METHODS: Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure.
RESULTS: Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures.
CONCLUSIONS: BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. LEVEL OF EVIDENCE 3: 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: A firming and toning cosmetic body lotion (FTB) was developed to target key pathways relevant to body skin health and rejuvenation that may complement the improvements observed after noninvasive body contouring (NIBC). A pilot study explored the efficacy and tolerability of FTB as an adjunct to cryolipolysis.
METHODS: An open-label, single-site, single-arm, 12-week study enrolled subjects aged 20 to 65 who had pre-elected to receive 1 or more cryolipolysis treatments (CoolSculpting® or CoolSculpting® Elite; Zeltiq Aesthetics, Inc.) on the inner thigh, back/bra fat, or submental areas. Immediately post-procedure, the investigator applied FTB to the treated area. Subjects then applied FTB topically twice daily for 12 weeks on the treated area. Skin texture and firmness were graded visually by the investigator using a 10-point scale, and subjects graded effectiveness, product attributes, and satisfaction with a questionnaire.  Results: Seventeen subjects (16 women, 1 man) enrolled. After 12 weeks of FTB application, significant improvements in skin firmness were observed in all treated areas, while skin texture showed improvements on the inner thigh and back/bra fat (all P≤0.009). With continued use following cryolipolysis, more than 70% of subjects agreed that FTB improved skin firmness, smoothness, and overall appearance. Subjects indicated that FTB was an effective adjunct to cryolipolysis. Throughout the study, 86% to 92% of subjects reported “fair,” “good,” or “excellent” satisfaction with FTB.  Conclusion: This pilot study suggests that FTB may complement skin improvements seen post-NIBC.J Drugs Dermatol. 2024;23(4): doi:10.36849/JDD.7917.