Descripción: Recientemente se ha vuelto a hablar del empleo de los ultrasonidos en Medicina Cosmética por el trato de los excesos adiposos y nuevas propuestas metodológicas y nuevas instrumentaciones son ofrecidas por este empleo. Habiendo estudiado desde hace tiempo el efecto biológico de las olas ultrasónicas y habiendo puesto a punto una técnica por el trato de los lipomas y de las adiposidades localizadas por los primeros años '90, creo necesaria una precisación científica sobre este argumento.

Descripción: This article presents the author's experience in the treatment of the flaccid “unhappy buttock” form with his surgical procedure of buttock lift by suture, without incision scars. The author at the 3rd International Congress of the South-American Academy of Cosmetic Surgery at Buenos Aires, October 19-21, 2001 first presented this new operation technique [2], and after that over the world [3, 4]. The result is a visual change in the buttock position to a higher one, which elongates the lower limbs and changes the proportions between lower and upper half of the body. OBJECTIVE: The aim of this study is to describe a new procedure of beautification of the buttock form without scars by creating a lifting effect on the buttock’s subcutaneous tissue, using a suture that takes the inferiorly positioned deep fibrose tissue and fixes it upwards to the fascia of m. gluteus maximus. Aesthetic and technical considerations required sculpting properly the buttocks to a higher position and nicely rounded form are demonstrated. Preoperative shape is discussed and patient evaluations, operative techniques, postoperative management, and results after 4 years of experience are emphasized. METHODS: From September 1998 to September 2002, 23 female patients, aged 18-34 years, with ptosis and cellulite on the buttocks were treated on an outpatient basis by the “Serdev’s suture technique without visible scars”. Important instrumentarium is a long, straight, elastic needle and Polycon - elastic Bulgarian antimicrob polyamide silk surgery fibres, produced in PK “Tonzos”, Jambol. This operation has been performed either alone or after ultrasonic assisted liposculpture (UAL) that reduces the fat amount and heaviness. RESULTS: All patients reported a high degree of satisfaction. A stable improvement in the buttock position and form was observed for the period described. In the postoperative period the complication rate was minimal and solved in the first 4-5 days post op. The skin contact in the perianal zone makes antibiotic prophylaxis obligate as well as a strict follow up for the first 7 days. Some pain in lower sitting position (driving or sitting in a car) was observed for at least 5 to 10 days, but all other social and professional duties and activities were possible. CONCLUSIONS: This outpatient procedure is effective in the correction of buttock laxity and ptosis and creates a new form, universally accepted as “happy buttocks”.

Descripción: Liposuction has proven to be a reliable and popular means for body contouring. Cervico-facial liposuction has also been well accepted. However, autologous fat transplantation has received more circumspect attention due to the fear of fat resorption over time. The senior author has employed liposuction and lipotransfer successfully for the past 23 years with outstanding aesthetic results. This article outlines proper technique in liposuctioning, handling of extracted adipose, and delivery of autologous fat to ensure optimal viability. Adipose anatomy, histology and physiology are also reviewed for a better understanding of the mechanism by which fat transfer is possible. The unique aesthetic ideals and anatomic constraints particular to the Asian race should inform every surgical endeavor for the Asian patient.

Descripción: The original concept described by Mitz and Peyronie states that the fibro-aponeurotic part of the superficial cervical fascia of the face and neck ensheathing the superficial mimetic muscles of the face is the SMAS (superficial musculo-aponeurotic system). Since, after its discovery, lifting and plicating the SMAS has been traditionally considered essential in order to achieve better and long lasting results in face and neck lift procedures. The authors have modified the original SMAS concept, which they call as SMAFS (superficial musculo-aponeurotic-fatty system). The authors believe that the superficial muscles of facial expression, the fibro-aponeurotic sheath encircling the muscles, together with the superficial fat, should be considered as a single unit in facial and neck lifting. In order to achieve good longer lasting results, it is essential that not only the fibro-aponeurotic part, but also the superficial muscular part must be plicated, lifted, and attached to the bony periosteum if required. Since the SMAFS is considered together as a unit and is subject to considerable variations, surgeons performing facial and neck surgery must be able to assess various types and gross parameters of SMAFS by external examination preoperatively. The various types of SMAFS should be handled according to the nature and type of tissues present. Only in this way, the most appreciative and durable results of face and neck lifting will be achieved.