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Quest’anno Agorà, con l’obiettivo della ricerca di un costante miglioramento e progresso scientifico, ha voluto approfondire la bibliografia di riferimento per le tematiche delle Sessioni Coordinate e metterle disposizione dei partecipanti alla Sessione in Sede Congressuale.

In questa pagina troverete a disposizione gli abstract degli articoli che Agorà ha selezionato come bibliografia di riferimento per la sessione coordinata "TRATTAMENTO DELLE GINOCCHIA: PROTOCOLLI E SINERGIE". I Soci Agorà avranno inoltre la possibilità di scaricare gli articoli originali in versione integrale.



Dermatologic Surgery

2019 August; 45(1):S12-S21

PMID: 31246868

Validated assessment scales for skin laxity on the posterior thighs, buttocks, anterior thighs and knees in female patients

Michael S. Kaminer, Gabriela Casabona, Wouter Peeters, Rolf Bartsch, Kimberly Butterwick, Yates Yen-Tu Chao, Joana Costa, Joseph Eviatar, Sabrina Guillen Fabi, Thorin L. Geister, Kate Goldie, Jenny Grice, Doris Hexsel, Paul Lorenc, Mary Lupo, Rainer Pooth, Gerhard Sattler, Heidi A. Waldorf, Yana Yutskovskaya, Martina Kerscher

BACKGROUND: The demand for noninvasive skin-tightening body procedures is increasing.

OBJECTIVE: To develop a set of grading scales for the objective assessment of skin laxity and assess their reliability and validity.

MATERIALS AND METHODS: Two photonumeric grading scales were created and validated for skin laxity in female patients: Skin Laxity-Posterior Thighs/Buttocks, and Anterior Thighs/Knees. Fifteen aesthetic experts rated photographs of 50 women in 2 validation sessions. Responses were analyzed to assess inter-rater and intra-rater reliability.

RESULTS: Overall inter-rater reliability according to intraclass correlation efficient (ICC) 2.1 and weighted kappa was at least "substantial" for both scales in both sessions, and "almost perfect" (≥0.81) for the Anterior Thighs and Knees scale in session 2. Intra-rater reliability was "almost perfect" for both scales (ICC 2.1) and "substantial" to "almost perfect" by weighted kappa. A correlation between the skin laxity scales and body mass index, age, weight, sun exposure, and cellulite severity was observed.

CONCLUSION: The skin laxity photonumeric grading scales are valid and reliable instruments for assessing laxity on the posterior thighs and buttocks, and anterior thighs and knees. The scales will be of value for standardizing clinical evaluations and quantifying outcome measurements in research and clinical practice.

Aesthetic Plastic Surgery

2013 February; 37(1):117-120

PMID: 23254908

Knee dermolipectomy: a simple operation with significant functional improvement

N. Bertheuil, V. Huguier, M. Beuzeboc, S. Aillet, E. Watier

BACKGROUND: Obesity is a major public health problem in Western societies. It may lead to difficulties in daily life that have an impact on quality of life and create psychological disorders. After failure of diet and exercise, patients can undergo bariatric surgery, but some obese patients are not motivated to undergo a bariatric procedure. For such patients, plastic surgeons can correct some excess fat to improve their quality of life. This report describes an original technique for correcting the excess fat at the medial part of the knees to regain a normal walking perimeter.

METHODS: A 68-year-old woman was admitted to the authors' center for correction of a functional walking disorder. Indeed, her clinical examination found a static disorder, with a valgus knee morphotype related to a major excess of skin and fat in the medial part of the knees. She underwent a knee dermolipectomy to obtain a solely functional result.

RESULTS: No complications were observed in the woman's postoperative course. At this writing, the result is stable 18 months after the surgical procedure, with a minimal visible scar hidden in the internal face of the knees. The woman has experienced a loss of her genu valgum and regained a walking distance longer than 1 km. She also has lost 10 kg of weight.

CONCLUSIONS: Knee dermolipectomy is a simple procedure with good results and few complications that improves the quality of life for obese patients.

Aesthetic Plastic Surgery

2013 April; 37(2):246-253

PMID: 23354763

Laser lipolysis using a 924 and 975 nm laser diode in the lower extremities

Elena Bravo Branas, Javier Moreno Moraga

BACKGROUND: Laser technology provides the desired destruction of adipose tissue, hemostasis, and good skin retraction with a minimum of discomfort and a quick return to normal life for the patient. Here we present our experience with the use of laser-assisted liposuction (LAL) with a 924- and 975-nm laser diode and compare it with traditional liposuction alone.

METHODS: A total of 430 patients were reviewed for this study. Three hundred thirty patients were treated with the 924- and 975-nm laser diode for laser lipolysis and 100 patients were treated with traditional liposuction of the anterior and inner thigh, the knee, the calf, and the trochanter. Patients were assessed by means of ultrasound. Pictures were taken and the degree of satisfaction was assessed. All complications were recorded.

RESULTS: A total of 521 laser lipolysis procedures were performed at different areas: anterior thigh (86), inner thigh (122), trochanter (204), knee (67), and calf (42). The mean energy was area-dependent and evaluated in kJ: anterior thigh (15), inner thigh (14), trochanter (22), knee (5), and calf (4.5). The mean reduction of subcutaneous tissue with LAL in the anterior part of the thigh, the inner thigh, the calf, the knees, and the trochanter was 1.45, 1.9, 1.15, 1.2, and 3.6 cm, respectively. One hundred traditional liposuction procedures were performed for different areas: anterior thigh (27), inner thigh (38), trochanter (72), knee (21), and calf (12). The mean reduction of subcutaneous tissue in the anterior part of the thigh, the inner thigh, the calf, the knees, and the trochanter was 1.2, 1.6, 0.9, 0.6, and 3.2 cm, respectively. All patients who underwent LAL had superior satisfaction compared to those who had liposuction alone.

CONCLUSION: Laser lipolysis with 924- and 975-nm diodes is adequate treatment for removal of adipose deposits and to obtain aesthetically good skin results, with a minimum of recovery time and high patient satisfaction.

Dermatologic Therapy

2022 May; 12(5):1253-1261

PMID: 35499741

PMCID: PMC9110628

Efficacy of noninvasive 1060 nm diode laser for medial knee fat reduction

Chadakan Yan, Rungsima Wanitphakdeedecha, Kristy Elleza R. Evangelista, Ploypailin Tantrapornopong, Panittra Suphatsathienkul, Nittaya Lektrakul, Thanya Techapichetvanich, Sasima Eimpunth, Woraphong Manuskiatti

INTRODUCTION: Laser lipolysis is a rapidly growing noninvasive body-contouring treatment in Asians. There is increasing demand for leg contouring, especially in areas where unwanted fat deposits are prominent despite diet and exercise. Medial fat knees are one of the esthetic concerns of women today and can be a challenging problem in terms of treatment. There are few noninvasive options to remove fat from these areas. This study aims to evaluate the safety and efficacy of a 1060-nm diode laser for medial knee fat reduction.

METHODS: Nineteen subjects with localized unwanted fat on the medial knees were enrolled into this study. All of them were treated with a single session of 1060-nm diode laser at a power setting of 1.0-1.4 W/cm2, depending on patient tolerance. Body weight, knee circumference at 3 cm above the medial epicondyle of the femur, and knee fat thickness measured by ultrasonography were recorded at baseline and 1, 3, and 6 months after treatment. Clinical photographs and ultrasound images were taken before and after treatment. Side effects were documented during follow-up visits. Subjects answered a satisfaction questionnaire at the completion of the study.

RESULTS: All subjects were female, with mean age of 32.3 ± 5.3 years and body weight of 59.8 ± 11.6 kg. The average power setting was 1.3 ± 0.1 W/cm2 with pain score of 6.1 ± 1.0. Significant reduction in knee circumferences (p < 0.001) at 1-, 3-, and 6-month follow-up visits compared with baseline, and knee fat thickness measured by ultrasound in both axial and sagittal plane at 1 and 6 months after treatment (p = 0.036 and p < 0.001, respectively) were recorded. Side effects were mild and transient, including mild erythema and tenderness.

CONCLUSION: The 1060-nm diode laser is effective and safe for knee circumference and medial knee fat layer thickness reduction.

Dermatologic Therapy

2021 March; 34(2):e14850

PMID: 33533560

PMCID: PMC8047906

Significant improvement in body contour with multiple cycles of CoolSculpting: results of a prospective study

Darren J. McKeown, Joanne Payne

ABSTRACT: Cryolipolysis is a nonsurgical body sculpting technique that uses controlled cooling for localized fat reduction. The aim of the present study was to assess whether an intensive regimen of CoolSculpting based on multiple cycles/sessions on the same body area(s) could yield greater (more clinically significant) improvements in body contour. This was a prospective analysis of consecutive, healthy, adult patients undergoing CoolSculpting in routine practice across a variety of treatment areas. Patients underwent ≤4 cycles of CoolSculpting per body area during an initial treatment session, and ≤4 further cycles 4 weeks later (if required). They were followed up for ≥12 weeks. Twenty-eight patients were enrolled (n = 26 female; mean age: 51.6 ± 9.0 years; mean body weight: 69.4 ± 13.7 kg). They were treated across 58 body areas: 48 in a single session; 10 across two sessions. The mean number of cycles per area was 2.8 ± 1.5. Twenty-seven patients (54 body areas) were considered as treatment "responders." In these individuals, mean skinfold thickness decreased from 35.4 ± 9.9 mm pretreatment to 22.2 ± 7.6 mm at 12 weeks (mean change: -40%; P < .001). Mean change in skinfold thickness was greater with ≥3 vs 1 to 2 cycles of CoolSculpting (P = .01). Patient satisfaction was high (n = 51/58; 88%). No adverse events were recorded. The study shows that multiple cycles/sessions of CoolSculpting can safely improve overall treatment benefit in body contouring, with greater decreases in skinfold thickness than have typically been previously observed.

Journal of Ultrasonography

2021 December; 20(83):e273-e278

PMID: 33500794

PMCID: PMC7830143

The efficacy of high-frequency ultrasound-guided injection lipolysis in reducing fat deposits located on the inside of the knees

Robert Krzysztof Mlosek, Ewa Skrzypek, Bartosz Migda, Michal Migda, Witold Wozniak

INTRODUCTION: Many women consider local fat deposits unacceptable for aesthetic reasons as they have negative impact on appearance and thus, contribute to reduced self-esteem. Injection lipolysis (intralipotherapy) may be an alternative for conventional liposuction in reducing fat deposits.

AIM: The aim of this paper was to assess the efficacy of high-frequency ultrasound-guided injection of deoxycholic acid (intralipotherapy) to remove fat deposits on the inner side of knees.

MATERIALS AND METHODS: The procedure was performed in 7 women (14 inner sides of knees). The formulation was administered under high-frequency ultrasound guidance. The procedure was performed twice at 4-week intervals in each patient. High-frequency ultrasound guidance was used to monitor such parameters as the thickness of the dermis (DermaMed, Dramiński S.A.) or the subcutaneous tissue (Philips Epiq 5, USA). Ultrasound was performed both before and after treatment. Additionally, anthropometric measurements were taken, a questionnaire was performed, and a photographic documentation was recorded.

RESULTS: Reduction in knee circumference and subcutaneous tissue occurred in 71.42% of patients.

CONCLUSIONS: Intralipolysis with deoxycholic acid formulation is an effective method for reducing fat deposits on the inner part of the knees. Ultrasonography proved to be a useful method to monitor the procedure (correct administration of the preparation) and to assess treatment outcomes. A small sample size was a limitation of our study; therefore further studies are needed.

Dermatologic Surgery

2016 October; 42(10):1199-1208

PMID: 27668925

Consensus reccomendations for combined aesthetic interventions using botulinum toxin, fillers and microfocused ultrasound in the neck, décolletage, hand and other area of the body

Sabrina F. Fabi, Cheryl Burhess, Alastair Carruthers, Jeans Carruthers, Doris Day, Kate Goldie, Martina Kerscher, Andreas Nikolis, Tatjana Pavicic, Nark-Kyoung Rho, Berthold Rzany, Sonja Sattler, Kyle Seo, William Philip Werschler, Gerhald Sattler

BACKGROUND: The popularity of aesthetic procedures in the face has led to greater disparity between treated areas and those that still show evidence of true age. Although many areas of the body often require multiple treatment procedures for optimal rejuvenation, combination therapy for specific areas is not yet well defined.

OBJECTIVE: To develop recommendations for the optimal combination and ideal sequence of botulinum toxin (BoNT), hyaluronic acid, calcium hydroxylapatite (CaHA), and microfocused ultrasound with visualization in nonfacial areas across all skin phototypes.

METHODS: Fifteen specialists convened under the guidance of a certified moderator. Consensus was defined as approval from 75% to 94% of all participants, whereas agreement of ≥95% denoted a strong consensus.

RESULTS: Recommendations have been provided for the neck, décolletage, and hands and include the timing and sequence of specific procedures when used concurrently or over several treatment sessions. Position statements are offered in lieu of consensus for the upper arms, abdomen, buttocks, and knees.

CONCLUSION: Nonfacial rejuvenation often requires multiple procedures for optimal results in individuals with significant age-related changes. Further clinical studies are recommended to raise awareness of non-facial indications and provide clinicians with the best evidence for best treatment practices.

Journal of Cosmetic and Laser Therapy

2014 October; 16(5):225-229

PMID: 25065380

Use of micro-focused ultrasound with visualization to lift and tighten lax knee skin

Michael H. Gold, Whitney Sensing, Julie Biron

INTRODUCTION: Public interest in noninvasive, aesthetic treatments for the rejuvenation of appearance continues to grow. The following prospective, open-label, nonrandomized trial was conducted to evaluate the safety and efficacy of micro-focused ultrasound with visualization (MFU-V) for achieving lift and tightening of lax skin above the knee.

MATERIALS AND METHODS: Healthy adult women (N = 30) with mild- to moderate bilateral skin laxity above the knees were enrolled. MFU-V was applied to a grid of eight 25 mm(2) squares above each knee. MFU-V was first applied using a 4 MHz, 4.5 mm transducer followed by a 7 MHz, 3.0 mm transducer. Approximately 320 treatment lines applied to each knee [corrected]. The primary efficacy endpoint was lifting and tightening of lax skin above the knee as determined by the principle investigator using the Physician Global Aesthetic Improvement Scale (PGAIS).

RESULTS: Among 28 evaluable subjects, 24 subjects (86%) showed improved lifting and tightening of knee skin laxity at 90- and 180-day follow-up visits. Three subjects showed no change and the appearance of one subject worsened. There were no adverse events or evidence of skin injury.

CONCLUSION: Similar to its safety and efficacy for tightening facial skin and reducing wrinkles, MFU-V is an effective, noninvasive method for reducing skin laxity and improving the appearance of skin above the knee.

Aesthetic Plastic Surgery

2004 August; 28(4):222-225

PMID: 15599534

Carbon dioxide therapy: effects on skin irregularity and its use as a complement to liposuction

Cesare Brandi, Carlo D'Aniello, Luca Grimaldi, Elena Caiazzo, Elisabetta Stanghellini

ABSTRACT: For a successful conventional or superficial liposuction, it is necessary to consider the competence of the surgeon who is to administer the procedure necessary for this type of surgery as well as the physical and psychological evaluation of the determined patient. A poor result often is related to the persistence of adipose tissue irregularity in the form of fatty tissue accumulation. This complication, common to this type of surgery, has called for research to determine methods for its treatment. Carbon dioxide (CO2) therapy refers to the transcutaneous and subcutaneous administration of CO2 for therapeutic purposes. This treatment originated at the Royal Spas of France in 1932 with the treatment of patients affected by obliteration of arteriopathies. Recent studies have demonstrated the effect of subcutaneous CO2 therapy performed to improve local parameters of circulation (performed by Doppler, laser-Doppler, and trans-cutaneous partial pressure of oxygen determination), and to reduce localized adiposities (verified reporting variations in maximum circumference and performing histologic studies). With these results, the absence of toxicity, and the relevant side effects related to this treatment taken into consideration, the Plastic Surgery Unit of Siena has been committed to researching the role that CO2 therapy can play in the treatment of skin irregularity and as a complement to liposuction. The authors report their experience using Carbomed programmable automatic CO2 therapy apparatus and 30GA1/2 0,3X13 microlance needles for the treatment of patients with adipose tissue accumulations located on the thighs and knees. In their study, 42 patients were divided into three groups: A, B, and C. In Group A, only liposuction was performed. In group B 3 weeks after liposuction CO2 therapy was administered in two weekly subcutaneous applications of CO2 for 10 consecutive weeks. In group C, CO2 therapy alone was administered with the same contingencies used for group B (two weekly subcutaneous applications of CO2 for 10 consecutive weeks). The objective was to assess the effectiveness of CO2 therapy for skin irregularity and as a complement to liposuction for adipose tissue accumulation by reporting variations in circumference and skin elasticity monitored by the Cutometer SEM 474 in all treated areas. The data obtained were analyzed statistically. Values of p less than 0.05 were considered significant. The authors report their experience and the results achieved from the study.

Aesthetic Plastic Surgery

2012 August; 36(4):795-802

PMID: 22447150

1,000 consecutive cases of laser-assisted liposuction and suction-assisted lipectomy managed with local anesthesia

Christopher T. Chia, Spero J. Theodorou

BACKGROUND: Advances in suction-assisted lipectomy (SAL) include improved instrumentation, better understanding of fluid dynamics, and an improved concept of appropriate indications. The tumescent technique uses subcutaneous injection of isotonic fluid containing vasoconstrictive and analgesic agents and is proved to be safe, with low morbidity and mortality rates. Laser-assisted liposuction (LAL) using local infiltration of an anesthetic and no general anesthesia or sedation has been developed, with claims of fat destruction and skin tightening. This study aimed to review 1,000 consecutive cases of LAL and SAL performed with the patient under local anesthesia and to determine whether this represents a safe technique with few complications.

METHODS: During a period of 22 months, 581 consecutive patients (486 females and 95 males) underwent 1,000 LAL/SAL operations, 545 of whom had multiple procedures performed. None of the patients had a body mass index (BMI) higher than 30 kg/m2. The patients ranged in age from 18 to 62 years. The fat aspirate ranged from 50 to 1,400 ml. Patients were given an oral sedative, an antibiotic, and an analgesic. Ringer's lactate solution containing lidocaine and epinephrine was injected into the subcutaneous space. The 1,064-nm and/or 1,320-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used for laser lipolysis followed by SAL using standard and/or power-assisted liposuction (PAL) cannulas. The treated areas included the neck, triceps, male breast, midback, flanks, axilla, abdomen, mons pubis, thighs, presacrum, and knees. No patient was administered intravenous sedation or general anesthesia.

RESULTS: The average number of areas treated was 1.8, and no major complications or mortalities were observed. There were three burns, two infections, one hematoma, and one seroma. A total of 73 secondary procedures were performed (7.3%). No tertiary procedures were required.

CONCLUSION: For appropriately selected patients, comparable results can be obtained with an excellent safety profile and short recovery period using LAL and SAL with the patient under local anesthesia. The awake patient is able to participate in body positioning and to provide physiologic monitoring. No major complications occurred in this series. The burn and hematoma complications occurred in the first 25 cases and may have been related to a learning curve. One case of cellulitis occurred in the triceps region, and a second infection occurred in the abdomen. Both responded to antibiotics. Altogether, 73 touch-up procedures (7.3%) were performed. The amounts of fat removal were comparable with the volumes obtained using traditional liposuction. In conclusion, this series demonstrated that LAL/SAL using local anesthesia is a safe procedure for selected patients, with acceptably low morbidity and revision rates.



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