Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_577_Библиотеки_им_академика_М_И_Перельмана
.pdf
270
https://t.me/medicina_free
abc
de gf
A. Di Giuseppe and F. Giovagnoli
Fig. 19.7 Banana fold deformity post liposuction. (a, d) Pre op, (b) planning, (c, e) immediate post op, (f) pre op lateral view, (g) post op lateral
view. Pre and 1year post op photos
Pre- and 1-year post of photos.
Pre- and post correction results are shown in Fig.19.8c
and d.
Pre- and 1-year post-op photos.
19.8.2 Correction ofAsymmetries Secondary
toSurgery
Case 1
This 43-year-old patient had two previous liposuctions with
other surgeons, combined with breast surgery.
The result was unpleasant: in Fig.19.8a, lots of irregularities in shape of abdomen and anks are visible, with multiple
dimples, irregularities, depressions, together there were
areas of fat excess.
Surgical plan (Fig.19.8b) consisted in VASER secondary
liposculpture, with supercial sculpturing of the abdominal
muscle edges and fat transfer in selected areas to correct the
dimples and defects from the previous surgery.
Case 2
This 32-year-old patient sustained two previous superficial liposuction to contour minor shape defect of the
outer buttocks, outer thigh, gluteal fold, inner lower
thigh, and knees. She was left with several areas of dimples, depression, and irregularities (see blue arrows in
Fig.19.9a). She underwent fat transfer in several areas to
improve the contour and to smooth the surface as well.
No further liposuction was performed as the patient was
scared [5].
Pre- and 1-year post-op photos.
ab
cd
19 Body Fat Grafting Contouring intheFemale Patient
https://t.me/medicina_free
Fig. 19.8 Correction of
asymmetries secondary to
surgery. (a, c) Pre op, (b)
planning, (d) post op. Pre and
1year post op photos
271
19.8.3 Muscle Edges Denition
alba and outer edge of the rectus abdomini muscles. Fat was
integrated into the outer thighs and buttocks to better shape
Combining fat extraction and fat adding has become the
routine in the majority of body contouring cases manage-
and round those areas [6].
Pre- and 1-year post-op photos (Fig.19.10).
ment. In the case of Fig.19.8, there is an overweighted gure in the abdomen and ank areas, while a deciency in the
outer thighs and lack of denition in the abdominal muscle
edges. VASER body contouring liposculpture was performed, combined with the denition of the vertical linea
272
ab
cd
gh
https://t.me/medicina_free
Fig. 19.9 Irregularities of
contour after liposuction of
thighs and legs. See blue
arrows (a). patient had fat
transfer in multiple areas to
compensate. Pre and 1year
post op photos, back (a) and
front (b)
A. Di Giuseppe and F. Giovagnoli
ab
ef
Fig. 19.10 Improve denition of muscle edges and contouring. (a, c, e, g) Pre op; (b, d, f, h) post op. Pre and 1year post op photos
cd
19 Body Fat Grafting Contouring intheFemale Patient
https://t.me/medicina_free
273
abc
Fig. 19.11 Correction of primary asymmetry of gluteal, buttocks and external thigh. (a) Pre op deformity, (b) post op correction with fat transfer,
(c) post op oblique view. Pre and 1year post op photos
ab
ef
Fig. 19.12 Treatment of cellulitis. (a, e) pre op, (b) planning, (c, d) immediate post op, (f) post op. Pre and 1year post op photos
19.8.4 Correction ofPrimary Asymmetries
This patient presented a primary deformity of the external
gluteal fold bilaterally, interesting partially the medial gluteal muscle, as well as the fat layer.
This case was treated with BeautiFill device, and 400ml
of fat transfer for each side. Pre- and post-op photos are
8months apart.
Pre- and 1-year post-op photos (Fig.19.11).
19.8.5 Treatment ofCellulitis
Cellulitis treatment is one of the most controvert issues in
esthetic medicine.
This case of gluteal cellulites plus lipodistrophy of anks
and buttock deciency was treated with BeautiFill with laser
liposuction of posterior trunk and anks and abdomen, and
fat transfer to lateral, central and medial buttocks, to correct
cellulitis and contour deciency.
Pre- and 1-year post-op photos (Fig.19.12).
274
ab
cd
https://t.me/medicina_free
A. Di Giuseppe and F. Giovagnoli
19.8.6 Posttraumatic Defect Correction
This case concerns a 45-year-old patient with important
asymmetry of the thighs and buttocks, celluliis of the same
areas, and mostly an important depression at the left side of
the external thigh, due to a previous trauma, which caused a
mild herniation of the tensor fascia lata muscle and thus an
asymmetry.
Vaser liposuction was used to shape and contour the outer
thighs, anks, inner thighs and buttocks.
Supercial Vaser undermining and fat emulsication fur-
ther allowed the treatment of cellulitis.
Finally, around 150ml of fat were harvested and inltrated
on the left outer thigh, in order to correct and compensate the
area of deciency. Liposhifting of the fat on top of the depression helped in shaping properly the dimples of this area [7, 8].
Pre- and 1-year post-op photos (Fig.19.13).
19.8.7 Enhance Body Frame by Increasing
Areas ofDeciency
This 38-year-old patient presents the following body
problems:
Fig. 19.13 45 year patient with lipodystrophy, cellulitis and post traumatic depression of the left lateral outer thigh. See blue arrows in front
and lateral views (a, b). (c) Note important asymmetry of the gluteal
fold. (d) Pre op planning, with correction of asymmetries, and fat transfer to integrate the area of depression. (e, f) Pre and post op after Vaser
liposuction and fat transfer to left outer thigh. Front view. (g, h) Pre and
post op after Vaser liposuction and fat transfer to left outer thigh.
Posterior view. (i, l) Pre and post op after Vaser liposuction and fat
transfer to left outer thigh. Lateral view. Pre and 1year post op photos
gh
cd
gh
19 Body Fat Grafting Contouring intheFemale Patient
https://t.me/medicina_free
ef
275
il
Fig. 19.13 (continued)
ab
ef
Fig. 19.14 Body asymmetry and depression of the outer buttock. (a,
b) Body frame analysis. Blue arrows indicate areas of depression. (c, d)
Pre and post op after Vaser liposuction and fat transfer. Front view. (e,
f) Pre and post op after Vaser liposuction and fat transfer. Oblique view.
(g, h) Pre and post op after Vaser liposuction and fat transfer. Posterior
view. Pre- and 1-year post-op photos
276
https://t.me/medicina_free
A. Di Giuseppe and F. Giovagnoli
1. anks lipodystrophy with asymmetry in shape and
volume
2. outer thighs excess
3. square buttocks shape
4. depression in the areas between outer thigh and lower
anks (see blue arrows in Fig.19.13a, b).
After this analysis of the body frame, surgical plan
included Vaser liposuction of all those areas and fat transfer
to the depressed area, in order to achieve a nicer prole and
contour.
Pre- and 1-year post-op photos (Fig.19.14).
References
1. Shiffman MA, Di Giuseppe A.Body contouring. Art, science, and
clinical practice. Springer-Verlag Berlin Heidelberg; 2010.
2. Shiffman MA, Di Giuseppe A.Liposuction. Principles and practice.
Springer-Verlag Berlin Heidelberg; 2016.
3. Shiffman MA, Di Giuseppe A.Contorneado Corporal. Arte, Ciencia
y Practica Clinica. Amolca; 2013.
4. Pereira LH, Sterodimas A. Correction for the iatrogenic form of
banana fold and sensous triangle deformity. Aesthet Plast Surg.
2008;32(6):923–7.
5. Pereira LH, Nicaretta B, Sterdimas A. Correction of liposuction
sequelae by autologous fat transplantation. Aesthet Plast Surg.
2011;35(6):1000–8.
6. Di Giuseppe A, Giovagnoli F, Di Giuseppe S, Ronconi D.Vaser
body contouring achieving a more dened shape. The art of body
contouring. London: IntechOpen; 2019. p.105–122.
7. Shiffman MA, Blugerman G.Fat shifting for the treatment of skin
indentations. Liposuction. Principles and practice. Springer-Verlag
Berlin Heidelberg; 2016.
8. Saylan Z.Liposhifting: treatment of postliposuction irregularities.
Int J Cosmet Surg. 1999;7(1):71–3.
9. Levenberg A, Scheinowitz M, Sharabani-Yosef O. Higher cell viability and enhanced sample quality following laser assisted liposuction versus mechanical liposuction. J Cosmet Dermatol Sci App.
2015;5(3):238–45.
Three-Dimensional Thigh Contouring
https://t.me/medicina_free
theRole ofFat Grafting
AlbertoDi Giuseppe andFedericoGiovagnoli
Contents
20.1 Introduction 277
20.2 Anatomy 281
20.3 Planning 284
20.4 Surgical Technique 286
20.5 Step by Step 286
20.6 Clinical Cases of 3D Circumferential Thigh Contouring with VASER 289
20.7 The Role of Fat Transfer in Thigh Contouring 292
20.8 Complications 300
References 300
20
20.1 Introduction
In 1487, Leonardo da Vinci published his celeber drawing of
the Vitruvian Man (conserved in Galleria dell’Accademia,
Venice, Italy) [1].
Vitruvius, the human body was the source of all geometry.
As a man of his time, Vitruvius followed the Pythagorean
tradition and considered nature the source of all knowledge,
transcribed in the form of the perfect number 10. To Vitruvius,
the human body is nature’s prime work, incorporating the
only creature with ten ngers, and the ability to think, create,
and manufacture objects. The Vitruvian man does not move
to produce geometry, “at on his back and passive, he is
made e to produce it.” The active agents, as Vitruvius tells it,
are the compass and the set square. The results produced are
meaningful through the action of the architect and the culture
to which he belongs. Leonardo da Vinci rediscovered the
Vitruvian man in the Renaissance and created its most
famous descriptive drawing in which man is not static at all,
but standing and in motion. Leonardo called this system a
A. Di Giuseppe (*)
University of Padova, Padova, Italy
F. Giovagnoli
University Vita-Salute San Raffaele, Milan, Italy
Canon of Proportions in which 16 possible positions for the
human body are systematized in the same drawing, generated by variations on two main positions overlapped and
inscribed within the cosmological symbols of the circle and
the set square. It must be no coincidence either that
Leonardo’s Canon of Proportions depicts 16 actions.
Leonardo’s interpretation of the Vitruvian man is standing,
following the Roman theology of the feet.
To follow, Leonardo realized 50 sheets of drawings of the
human body, made between about 1485 and 1510–1515,
which are based on the artist’s own anatomical dissections
and show his evolving understanding of physiology. The
drawings demonstrate, as well, Leonardo’s progress from
technical mastery of his subject to consummate
draftsmanship.
In the primitive conditions of the late fteenth century,
and with no medical training, this astonishing man acquired
a knowledge of human anatomy far in advance of the medical profession of his day.
From those drawings (Figs.20.1 and 20.2), it is clear the
concept, that Leonardo emphatized, of drawing and measuring the proportion of thighs, knees, and legs in a circumferential way. He did use some measurement and proportion
numbers to transform into mathematics his view of the
esthetics.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
A. Di Giuseppe et al. (eds.), Fat Transfer in Plastic Surgery, https://doi.org/10.1007/978-3-031-10881-5_20
277
278
https://t.me/medicina_free
Fig. 20.1 The proportions of
the human body
A. Di Giuseppe and F. Giovagnoli
20 Three-Dimensional Thigh Contouring theRole ofFat Grafting
https://t.me/medicina_free
Fig. 20.2 Drawings of ideal
proportions [2]
279
In body contouring of thighs, for ages the proportion con-
sidered was only the anteroposterior view (Fig.20.3).
At that time, in planning correction of the body gure, I
was considering only the anterior and the posterior parts of
the thighs. No matter how the full dimension of the entire
thigh was looking. This direction was given by my teachers
and masters in plastic surgery at the time (1980–1995). This
perspective was deeply inuenced by the drawings of Gerald
Illouz who published the “Zone of adherence” in body [3].
He described a total of ve zones of adherence from trunk
to lower extremity: lateral gluteal depression, gluteal crease,
distal posterior thigh, mid-medial thigh, and inferolateral
ileo-tibial truck (Fig.20.4).
Those zones were considered to be the “forbidden areas”
in thighs and buttocks contouring: the reason was that the fat
layer in those areas is really minimal, and an excessive aspiration in these areas could cause severe deformities, difculty to be corrected. Minding those anatomical issues, and
in consideration of the diameter of the cannulas utilized at
that time by Illouz (6mm cannula), this was a wise advise to
surgeons to prevent deformities, irregularities, dimples, and
depression. For ages, plastic surgeons world wide have
treated thighs without considering in a 3D way, as scared of
potential secondary damages.
The lateral view, and the oblique view of thighs, introduces
the need for a three-dimensional artistic understanding of the
Соседние файлы в папке Библиотека им академика М.И. Перельмана