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_591_Библиотеки_им_академика_М_И_Перельмана
.pdf
Tribute to Prof. Ivo Pitanguy and Prof. Yves G.Illouz
https://t.me/medicina_free
xi
silhouette of the body by fat suction, liposuction, represents an immense contribution to our led, therefore with pleasure and warm feelings we pay homage to Prof.
Illouz in this book—Body Contouring.
Sincerely,
Juarez Moraes Avelar, MD
Ricardo Cavalcanti Ribeiro, MD
Preface
https://t.me/medicina_free
Since I was realizing the dream of my life of graduating in Medicine in December
1968, I took an unusual decision to work in Amazon Forest as a volunteer physician
to help poor people, even Indians inside of the jungle. I used to attend many patients
expecting to solve all kinds of health problems. Some of them used to see me just to
touch my hands or my arms to certify that I was a human being similar to them,
since they had never seen a doctor. Recognizing such a strange situation gave me
one more special reason to be there. So far, among different patients, when I saw
someone presenting overweight with fatty abdomen, arms, legs, and buttocks that
shocked me deeply, since it was impossible to help them there. I could not operate
them since I was not technically prepared to perform any procedure to remodel their
body. Although I was not able to do it, their strange physical appearance remained
in my mind and in my soul.
After I concluded my volunteer job in the interior of the jungle, I returned to Rio
de Janeiro to start my Plastic Surgery Post Graduation Course with Professor
Pitanguy’s Inrmary at Santa Casa da Misericódia (General Hospital) as well as in
his world renowned Clinic. Ever since I was his resident, quite often I used to see
some patients presenting similar deformities that I had seen in the interior of the
Amazon Forest. It was fascinating to observe Professor Pitanguy performing his
technique to repair those complex body deformities achieving very smooth and harmonious surgical results. Meantime, I used to hear from him the term body contouring surgery and facial contouring surgery as well. It was clear in my mind that those
expressions were related to combined procedures improving body and facial contour respectively. In fact, I did not perform any operations on those patients I saw in
Amazon, but that unusual body image remained in my mind, even now when I am
preparing the manuscripts having Prof. Ricardo Cavalcanti Ribeiro as my partner
for this book.
These body contouring concepts impressed me very much during the period of
my training as well as when Professor Pitanguy was invited to perform a surgical
demonstration at the Hadassah Hospital in Jerusalem (Israel) during the Second
Congress of ISAPS held in June 1973. While I was there, he asked me to participate
xiii
xiv
https://t.me/medicina_free
Preface
in a surgical demonstration of his technique of trochanteric lipodystrophy with outstanding surgical results.
So far, when I started my professional activities in São Paulo City I became motivated to organize the Brazilian Symposium of Abdominoplasty in 1982 and on the
next year the Brazilian Symposium on Facial Contouring in which Prof. Pitanguy
gave a lecture and wrote two remarkable chapters about both subjects. In fact, associated operations were performed frequently during the period of my training at his
clinic under excellent team organization in the operating room as well as with outstanding surgical results improving very much body and facial contouring.
When one looks fty years back in the history of plastic surgery concerning body
contouring, it is evident that good surgical results were possible to achieve in breast
surgery. However, concerning abdominoplasty there were several challenges specially about complications during and after surgery.
So far, in 1980 Illouz developed and published liposuction which is one of the
most revolutionary techniques during the last decades of twentieth century with
deep changes on concepts in plastic surgery. The complex deformities on trochanteric lipodystrophy became possible remodeling body contouring through liposuction approach leaving only some punctiform scars. Even other regions of the human
body such as abdomen and torso received so much improvement employing liposuction. However, the combination of Illouz’s method with traditional abdominoplasty presented a very high rate of complications which bother very much patients
and surgeons.
I was worried about these problems, therefore, I dedicated so much effort performing anatomical research trying to improve surgical results as well as minimizing complications. After a long time, in 1999 I found that it would be possible to
perform abdominoplasty combined with liposuction as long as the abdominal panniculus is not undermined with preservation of perforator vessels. Therefore, I
achieved my anatomical research and published “new concepts on abdominoplasty”
as well as further applications as lipoabdominoplasty.
To publish this book is an accomplishment of my professional activities started
during my period of specialization with Professor Pitanguy with intense effort all
the way through my practice.
To organize this publication, Professor Ricardo Cavalcanti and I, besides writing
our chapters, we invited outstanding Brazilian plastic surgeons to participate in the
Table of Contents with useful chapters about multiple aspects concerning body contouring in order to present to readers the most updated contribution. I take this
opportunity to thank all of our colleagues for the important participation in this
book expressing the most advanced techniques as well as concepts about the subject.
São Paulo, Brazil JuarezMoraesAvelar
Preface
https://t.me/medicina_free
Body contour is one of the most fascinating chapters in plastic surgery due to variation of procedures. To perform such kind of operations, surgeons must have skills
for dealing with different body regions.
During the last decades, many new procedures have been incorporated to achieve
better results. One example was liposuction which appeared changing dramatically
the outcomes and increasing the possibilities. Less invasive approaches, substitute
conventional surgeries, where results were only obtained by skin and fat removal.
Many surgeons refused to incorporate the technique in the very rst moment, however, with the learning curve, they gained condence on the surgery, and it became
an indispensable tool in body surgery armamentarium.
With time, studies were conducted improving safety and effectiveness in liposuction. Physiological knowledge and understanding the body response to fat removal
turned this surgery asequible in the vast majority of body contour procedures around
the world.
Furthermore, new technologies are being developed constantly reducing complications rates and time consumption.
Body surgery is one of the most performed operations among Brazilian plastic
surgeons. Personally, during my participation in international events for the last
three decades, I have perceived that it is always a Brazilian surgeon sharing expertise and new ideas for improving body contouring techniques and long term results.
Avelar and I have accepted the challenges of editing a book, which involves time
consumption, knowledge of each part of content, as well critical analyses to turn the
subject a continuously source of learning for the readers.
Thinking in terms of currents concepts as the main topic for a book, along with
inviting a constellation of experienced collaborators, whom have a tied agenda, was
a difcult task, however, after our rst request, all of them agreed enthusiastically to
share their experience.
Thus, we tried to gather up to date contents covering all the body regions and we
believe in a constant development on this eld.
We must express our gratitude to all of those colleagues for their contribution in
the diffusion of Brazilian plastic surgery.
Rio de Janeiro, Brazil RicardoCavalcantiRibeiro
xv
Acknowledgment
https://t.me/medicina_free
Although my parents Anisio and Maria Ana are not anymore in this world, I am
deeply thanking them for the constant enthusiasm during all of our lives. Due to
their warm and comforting presence I have had the courage to follow my way, my
gratitude to both.
To my lovely son Thiago and my wife Gloria, who have been a constant source
of inspiration for this publication and permanent witnesses to my scientic activities.
I am deeply thankful to Prof. Pitanguy, although he is not beside me during
preparation of this book, but wherever he is, I feel his presence providing inspiration
and organization to prepare this publication.
To Dr. Edgar Bollanho, for his outstanding work on technical illustrations in this
book, and other projects along of my career.
Juarez Moraes Avelar
First, I want to express my gratitude to my parents for believing in me and giving
me the opportunity to be a doctor of medicine.
As surgical specialists, continous training is of utmost importance, which
requires patience, resiliency, and mentorship. Fortunately, I had the privilege to
learn with many masters, such as Virmar Ribeiro Soares, Ewaldo Bolivar, John
Bostwick, Ruy Vieira, Ives Gerard Illouz, Al Ali, among others. My learning curve
in body contouring was done by understanding principles and key points during
international meetings, surgical demonstrations, and fellowship periods.
From my residents, I have been learning to absorb fresh and new ideas of the
young minds. Always, I try to understand their ways of thinking, encouraging them
to pursue and develop their ideas. For me this coexistence is great mental exercise
and a way to learn more.
I want to thank my wife Luciana for her patience and understanding of my
absences due to several calls and meetings during this job.
Finally, I want to express my gratitude to Dr. Luis Fernandez de Córdova Rio de
La Loza for his invaluable assistance and support during the book’s elaboration.
Ricardo Cavalcanti Ribeiro
xvii
Contents
https://t.me/medicina_free
Part I Introduction: Surgical Fundaments for Body Contouring Surgery
1 Surgical Principles for Body-Contouring Approaches . . . . . . . . . . . . 3
Juarez Moraes Avelar
2 Anatomy of the Subcutaneous Layers in the Human Body . . . . . . . . 27
Juarez Moraes Avelar
3 Importance and Behavior of Fascia Superficialis
for Body-Couturing Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Juarez Moraes Avelar
Part II Abdominoplasty on Body Contouring
4 Sinder’s Technique: A Useful and Safe Approach
for Abdominoplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Juarez Moraes Avelar
5 The Beginning, Development, and Current Status of
Lipoabdominoplasty: New Concepts for Abdominoplasty . . . . . . . . . 87
Juarez Moraes Avelar
6 Personal Experience with Abdominoplasty Without Undermining
and Its Modifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Ricardo Cavalcanti Ribeiro, Wilson Novaes,
and Luis Fernandez de Cordova
7 Surgical Principles and Classification of Lipoabdominoplasty . . . . . 121
Juarez Moraes Avelar and Ricardo Cavalcanti Ribeiro
8 Lipoabdominoplasty: Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
João Erfon, Claudio Mauricio M. Rodrigues,
and Aleksandra Markovic
xix
xx
https://t.me/medicina_free
Contents
9 Classification for Indications of Lipoabdominoplasty . . . . . . . . . . . . . 163
Wilson Novaes Matos Jr, Ricardo Cavalcanti Ribeiro,
and Luis Fernandez de Córdova
10 Medium Definition Lipoabdominoplasty: A Natural Evolution
of High- Definition Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Giuliano Borille and Luis Fernandez de Córdova
11 MILA-Minimally Invasive Robotic and Endoscopic
Lipo- Abdominoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Marco Aurelio Faria-Correa
12 Creation of a New Umbilicus During Abdominoplasty
and Its Importance in Body Contouring . . . . . . . . . . . . . . . . . . . . . . . . 213
Juarez Moraes Avelar
13 Abdominoplasty (The Umbilical Lozenge Technique) . . . . . . . . . . . . . 231
Marcelo de Oliveira e Silva
14 The Excision-Suture Tactic: A Quick and Low Bleeding
Option for Tissue Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Ithamar Nogueira Stocchero, Gustavo Flosi Stocchero,
Guilherme Flosi Stocchero, and Alexandre Siqueira Franco Fonseca
Part III Behavior of Breast Surgery Improving Body Contouring
15 Reduction Mammoplasty with Lower Pedicle . . . . . . . . . . . . . . . . . . . 265
Ricardo Cavalcanti Ribeiro, Aline Guimarães Gomes de Sousa,
and Luis Fernandez de Córdova
16 Importance of Glandular and Dermoglandular Flaps
for Breast Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Carlos Oscar Uebel
17 Classification and Correction of Asymmetrical Breasts
to Achieve a Balance in Body Contouring . . . . . . . . . . . . . . . . . . . . . . 285
Juarez Moraes Avelar, Marcelo Vaccari, and Jose Carlos Miranda
18 L-Shaped Scar for Reduction Mastoplasty . . . . . . . . . . . . . . . . . . . . . . 305
Lybio Martire Junior
19 Endoscopic Breast Reduction and Lifting . . . . . . . . . . . . . . . . . . . . . . 315
Marco Aurelio Faria-Correa
20 The Sting Technique: A New Procedure for the Correction
of the Hypoplastic Lower Breast Poles
. . . . . . . . . . . . . . . . . . . . . . . . . 329
Gianluca Campiglio
21 Importance of Evaluation of the Breasts by Photos
and Photometry Related with Body Contouring . . . . . . . . . . . . . . . . . 343
Paulo Rogério Quieregatto do Espirito Santo,
Thales Waltenior Trigo Jr, Miguel Sabino Neto,
and Lydia Masako Ferreira
Contents
https://t.me/medicina_free
xxi
22 Breast Anomalies: Diagnosis and Treatment . . . . . . . . . . . . . . . . . . . . 349
Ricardo Cavalcanti Ribeiro, Carlos José Ramírez Hanke,
and Luis Fernandez de Córdova
23 Tuberous Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Ricardo Cavalcanti Ribeiro, Carolina Durán,
and Luis Fernandez de Córdova
24 Aesthetic Approaches for Breast Reconstruction . . . . . . . . . . . . . . . . . 373
Ricardo Cavalcanti Ribeiro, Ana Beatriz Arduini,
and Luis Fernandez Cordova
25 Basic Science/Disease Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Ricardo Cavalcanti Ribeiro, Luis Fernandez de Córdova,
and Ana Beatriz Arduini
26 Gynecomasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Luis Fernandez de Córdova and Ricardo Cavalcanti Ribeiro
27 Importance of Mastoplasty Combined with Abdominoplasty
Concerning Body Contouring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Paulo Roberto Becker-Amaral, Leonardo Possamai,
and Luciana Carvalho da Cunha
28 Renuvion-Assisted Body Contouring Surgery . . . . . . . . . . . . . . . . . . . 417
John Edwin Garcia Serna, Ricardo Cavalcanti Ribeiro,
and Luis Fernandez de Córdova
Part IV Importance of Liposuction Improving Body Contouring
29 Critical Analysis and the Future of Liposuction
for Body Contouring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Luiz S. Toledo
30 Liposuction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Luis Fernandez de Córdova and Ricardo Cavalcanti Ribeiro
31 High-Definition Liposculpture: Critical Vision
and Future Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Felipe Massignan and Filipe Fuzinatto
32 Numerical Methodology for Evaluation
of Results in Liposuction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489
Ronan Horta de Almeida, André Villani Correa Mafra,
Gnana Keith Marques de Araujo, and Huberth André Vieira Zuba
33 Laser Lipolysis: Skin Tightening in Lipoplasty Using HPL
Dual Diode Laser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499
Moisés Wolfenson, Lydia Massako Ferreira, Joaquim Figueiredo,
and Bruna Alves
xxii
https://t.me/medicina_free
Contents
34 Liposuction: A Safer Approach in Four Stages . . . . . . . . . . . . . . . . . . 513
Arnaldo Lobo Miró and Julio Wilson Fernandes
35 Summary: Liposculpture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Ewaldo Bolivar de Souza Pinto
Part V Lipografting Improving Body Contouring
36 Frag Fat: Fragmented Fat for Lipografting . . . . . . . . . . . . . . . . . . . . . 551
Flavio Henrique Mendes and Fausto Viterbo
37 Behavior of Fat Tissue Transferred for Mastoplasty . . . . . . . . . . . . . . 567
Alberto Magno Lott Caldeira
38 Importance of Fat Grafting for Reparation
of Unsatisfactory Results After Liposuction . . . . . . . . . . . . . . . . . . . . . 585
Luiz Haroldo Pereira, Beatriz Nicaretta, and Aris Sterodimas
39 Liposculpture and Buttock Lipograft: Safety Aspects . . . . . . . . . . . . 599
Marcelo Paulo Vaccari-Mazzetti, Juarez Moraes Avelar,
Ryane Schmidt Brock, and Thalita Galdino de Oliveira
40 Fat Grafting for Remodeling Gluteal Regions . . . . . . . . . . . . . . . . . . . 619
Lybio Martire Junior
41 Liposculpture: Improving Results with Standard Lipografts
and Mesenchymal Cells Lipografts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633
Marcelo Paulo Vaccari-Mazzetti, Juarez Moraes Avelar,
Ryane Schmidt Brock, and Thalita Galdino de Oliveira
Part VI Body Lift After Weight Loss
42 Brachioplasty in the Post-Bariatric Patient . . . . . . . . . . . . . . . . . . . . . 647
Roberto Kaluf, Roberto Kaluf Filho, and Rafael Alves Tumeh
43 Body Lift and Gluteoplasty with Flaps . . . . . . . . . . . . . . . . . . . . . . . . . 657
Marcelo Aniceto
44 Combined Surgeries in Massive Weight Loss Patients . . . . . . . . . . . . 679
Carlos del Pino Roxo and Luigi Losco
45 Abdominoplasty in Post-Bariatric Patients . . . . . . . . . . . . . . . . . . . . . 689
Roberto Kaluf, Roberto Kaluf Filho, and Rafael Alves Tumeh
46 Neo-Omphaloplasty in Anchor-Line Abdominoplasty . . . . . . . . . . . . 703
Alfredo Donnabella
47 Post-Bariatric Cruroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 719
Moacyr Pires de Mello Fillho, Rolf Gemperli,
Otávio Machado de Almeida,
Fernando José Gatto Ribeiro de Oliveira, and Marcos Bandiera Paiva
Contents
https://t.me/medicina_free
xxiii
48 Panniculectomy in Morbidly Obese and Post-Massive
Weight Loss Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 731
Horacio F. Mayer
Part VII Behavior of Torsoplasty for Body Contouring
49 Body Contouring: Concepts, Evolution, and Patient
Engagement. Plastic Surgery: Concept of Stretching
X Working Volumes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 751
Jose Carlos Daher and Leonardo Daher
50 Torsoplasty Improving Body Contouring . . . . . . . . . . . . . . . . . . . . . . . 761
Marcelo Daher and Alvaro Daher
51 Flankplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 779
Barbara Helena Barcaro Machado
52 Lipotorsoplasty: A Novel Body-Contouring
Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793
Wilson Novaes Matos, Ricardo Cavalcanti Ribeiro, Paola Martinez,
and Luis Fernandez de Córdova
53 Thoracobrachioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803
Francesco Mazzarone, Raphael Schemberk Chamma,
and Márcio Mendes Manente
Part VIII Upper and Lower Extremities
54 Brachioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 811
Francesco Mazzarone and Raphael Schemberk Chamma
55 Block Resection in Tight Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819
Gisela Hobson Pontes, Ronaldo Pontes, and Clara Pontes
56 Calf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 833
Nicola Menichelli
57 Thigh Implant: Its Importance to Achieve Harmony
of Lower Extremities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 843
Nicola Menichelli
58 Body Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 859
Ivan Abadesso, Ricardo Cavalcanti Ribeiro, Marcos D. Pumarol N,
Emir Duquela S, and Luis Fernandez de Córdova
59 Calves and Ankle Liposuction: Advanced Concepts . . . . . . . . . . . . . . 889
Guilherme Miranda De Freitas
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 907
Соседние файлы в папке Библиотека им академика М.И. Перельмана