Jonathan P. Brower’s research while affiliated with University of Pittsburgh and other places

Brachioplasty has risen in popularity as a safe and effective method to address upper arm contour, particularly as increasingly common bariatric procedures have generated a large population of massive weight loss (MWL) patients. Surgical decision-making is guided by physical examination which will reveal excess of skin, adiposity, or both. Patients must be carefully selected and counseled to manage their expectations, as brachioplasty results in a conspicuous scar. Minimally invasive options may provide satisfactory results in some patients, but do not adequately contour the arm and chest in patients who have had loss of skin elasticity as a result of massive weight loss. Brachioplasty can be safely and effectively provided alone or in combination with most other upper body contouring procedures, including mastopexy and upper body lift.KeywordsArm contouringArm liposuctionArm liftBody contouringMassive weight loss

Descent of back skin that occurs with massive weight loss (MWL) frequently results in prominent bothersome rolls that are visible in clothing and obscure the natural waist line. Therefore, correction of the deformity can be consistently achieved by resuspending the back tissue to its native position. The upper body lift requires a transverse scar that can be reliably hidden by a bra strap, and designed to terminate within the inframammary fold of the breast. The near-circumferential nature of this procedure makes it uniquely suited for combination with other body contouring procedures of the upper body, including brachioplasty and mastopexy. The technique provides consistent results with a low complication rate.

Background Many techniques and devices have been developed to improve small volume fat grafting efficiency and consistency for use in the operating room and outpatient procedure room. These methods require cumbersome or messy processing to remove excess oil and fluid from adipose graft. Objectives The aim of this study was to compare fat processing efficiency of a novel hand-held device, the Push-to-Spin (P2S™) system, to other common processing techniques and validate tissue quality after lipoaspirate processing. Methods Human lipoaspirate samples were processed using one of three experimental methods, including cotton gauze (Telfa) rolling, centrifugation (Coleman technique), or using the P2S™ system. Efficiency of fat processing was evaluated by total processing time, fat harvest ratio, and fat processed ratio. Histological examination and immunohistochemical staining were used to compare tissue morphology and adipocyte viability, respectively. Experimental samples were compared to unprocessed lipoaspirate controls. Results Lipoaspirate processing was significantly faster using the P2S™ device compared with other techniques. All three methods achieved similar fat harvest and fat processing ratios. Additionally, the P2S™, Telfa, and Coleman techniques yielded grafts with similar cellularity, and perilipin and GPDH expression. Measured differences between experimental and control samples were statistically significant. Conclusions The P2S™ device is an easy, efficient, and potentially cost-effective handheld device that can be used for lipoaspirate harvest, processing, and grafting in any procedural setting. The resulting adipocytes have similar morphology, viability, and function to those yielded by techniques. This handheld technology decreases procedure time, thereby improving surgeon efficiency and patient experience.

The 3-stage paramedian forehead flap is the gold standard for subtotal and complete nasal defects, but significant surgeon artistry and experience are required to achieve good, consistent results. The authors describe the use of virtual surgical planning and three-dimensional printing to create a patient-specific soft tissue cutting guide for the design of a forehead flap in the reconstruction of a hemirhinectomy defect. Application of this technology to these challenging reconstructive scenarios promises to improve accessibility and consistency of results.

After massive weight loss (MWL), patients present with deformities that are more severe and often different than those observed in standard cosmetic abdominoplasty. The first step is careful consideration of the special factors involved in preoperative screening of patients with MWL presenting for body contouring surgery. Once these patient factors are optimized and surgery is considered, careful analysis of anatomic deformities should ensue. Technical variations of standard abdominoplasty are often required. With proper attention to safe screening, analysis of the anatomic deformities, and application of relevant techniques, plastic surgeons can have a positive impact on the lives of these patients.

An increasing proportion of transgender and gender-diverse (TGD) individuals are pursuing gender-affirming surgery (GAS), but surgery in the TGD youth population remains controversial. Differing opinions among providers and advocates add to the complexities of surgical decision-making. Evaluating patient candidacy is a shared responsibility of the entire multidisciplinary team. Primary care and mental health providers play a critical role in educating their patients and referring appropriate individuals to surgeons for more rigorous evaluation of their candidacy for GAS. There is no discrete algorithm that can determine which patients should proceed with surgery. The needs and goals of each patient must be weighed alongside a number of other considerations, including patient age, medical and psychological history, type of surgery requested, lifestyle factors, social support, and resources. Above all, the decision to proceed with surgical care must involve shared decision-making among the patient and all members of their care team.