A changing paradigm: the brazilian butt lift is neither brazilian nor a lift-why it needs to be called safe subcutaneous buttock augmentation

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A changing paradigm: the brazilian butt lift is neither brazilian nor a lift-why it needs to be called safe subcutaneous buttock augmentation

ORANGES, Carlo M, et al.

ORANGES, Carlo M, et al . A changing paradigm: the brazilian butt lift is neither brazilian nor a lift-why it needs to be called safe subcutaneous buttock augmentation. Plastic and

Reconstructive Surgery , 2020, vol. 146, no. 4, p. 502e-503e

DOI : 10.1097/PRS.0000000000007200 PMID : 32639431

Available at:

http://archive-ouverte.unige.ch/unige:155272

Disclaimer: layout of this document may differ from the published version.

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Plastic and Reconstructive Surgery • October 2020

Reply: Analysis of the Visual Perception of Female Breast Aesthetics and Symmetry:

An Eye-Tracking Study

Sir:I thank Dr. Sandberg for his interest in our study and commend him for emphasizing that eye-tracking data should be interpreted with caution. We are fully aware of this. Thus, in our article, we highlighted this matter, discussing the potential biases that can influ- ence the eye-tracking research and emphasized the need for conducting additional similar experiments.¹ However, although eye-tracking technology is gaining more attention in the field of plastic and reconstructive surgery, it is too early to confirm or deny its useful- ness.² My colleagues and I are far from an attempt to establish how a specific visual stimulus directly influ- ences one’s sense of aesthetics. Instead, we focus on the creation and comparative analysis of gaze patterns of various observer groups such as medical professionals, patients, and healthy controls.

I do share Dr. Sandberg’s assumption regarding the possible differences in breast visual perception between surgeons and laypersons; however, until objectively investigated with eye tracking, it is only a hypothesis. The same can be said about Dr. Sandberg’s opinion on the role of specific landmarks of the breast.

It is worth mentioning that in our last eye-tracking study, conducted on the same standardized visual stimuli material, we managed to find some statistically significant differences in breast observation patterns between healthy women and postmastectomy patients before the reconstructive procedure.³ The breast can- cer survivors tend to look longer at the nipple-areola complex and inframammary fold, the structures that are absent in their case. Perhaps breast reconstruction would create a shift of this pattern, “normalizing” the gaze path. Perhaps, if confirmed, it could serve as a method of assessing patient satisfaction (or rehabili- tation) with the treatment results on a subconscious level. This example is only one of many potential appli- cations of eye-tracking technology in plastic surgery.

A question of who should analyze the appearance of the body or, for that matter, the surgical result is aca- demic in nature. In contrast to Dr. Sandberg, I would not deprive the patients or laypersons of their sense of aesthetics. As a very subjective term, it cannot be defined merely as a scientific parameter. Personally, I believe that it is not the plastic surgeon or the patient’s opinion but the judgment of society regarding the aesthetic outcome that matters the most. That is especially true in reconstructive surgery, the role of which, in a way, is to make the patient blend into a group of people, become unno- ticeable in the crowd. The surgeon’s or the patient’s aesthetic outcome assessment is often biased for mul- tiple reasons. In contrast, the opinion of representative laypeople, not involved in the treatment process, seems to be more neutral and essential from a social point of view. Therefore, eye-tracking data, most of all, from this group, should be obtained and valued the most.

Eye tracking is a relatively new technology in the field of plastic and reconstructive surgery; therefore, the data it provides must be interpreted with caution.

The upcoming years will determine whether it meets the hopes placed in it.

DOI: 10.1097/PRS.0000000000007199

Piotr Pietruski, M.D., Ph.D.

Department of Plastic and Reconstructive Surgery Medical Centre of Postgraduate Education Prof. W. Orlowski Memorial Hospital Czerniakowska 231 Street 00-416 Warsaw, Mazowieckie, Poland pietruski.piotr@gmail.com Facebook: @DrPietruski

DISCLOSURE

The author has no financial interest to disclose. No funding was received for this communication.

REFERENCES

1. Pietruski P, Paskal W, Paskal AM, Jaworowski J, Paluch Ł, Noszczyk B. Analysis of the visual perception of female breast aesthetics and symmetry: An eye-tracking study. Plast Reconstr Surg. 2019;144:1257–1266.

2. Asaad M, Dey JK, Al-Mouakeh A, et al. Eye tracking technology in plastic and reconstructive surgery: A systematic review.

Aesthet Surg J. E-published ahead of print February 3, 2020.

3. Pietruski P, Noszczyk B, Paskal AM, Paskal W, Paluch Ł, Jaworowski J. The impact of mastectomy on women’s visual perception of breast aesthetics and symmetry: A pilot eye- tracking study. Aesthet Surg J. 2020;40:850–861.

A Changing Paradigm: The Brazilian Butt Lift Is Neither Brazilian Nor a Lift—Why It Needs to Be Called Safe Subcutaneous Buttock Augmentation Sir:

W

e read with extreme interest the article by Del Vec-

chio and Rohrich entitled “A Changing Paradigm:

The Brazilian Butt Lift Is Neither Brazilian Nor a Lift—

Why It Needs to Be Called Safe Subcutaneous Buttock Augmentation” published in the January issue of the Journal.¹ We commend the authors for their excellent work that clarifies the history of the procedure and con- tributes to orient our plastic surgery community to oper- ate according to the highest standards of safety shown by the most advanced research conducted in the field.

Del Vecchio and Rohrich correctly point out that this cosmetic intervention is not a lift, but more appro- priately a buttock augmentation, potentially almost always associated with liposuction of waist, lower back, and subgluteal and trochanteric regions to generate an aesthetically pleasant result respectful of the propor- tions characterizing universal and ethnic-specific ideals of beauty.^2–4 We also strongly support their suggestion of including the terms “safe” and “subcutaneous” to a standardized expert-recognized denomination of fat grafting buttock augmentation, which we believe to be able to capture the essence of a secure approach.

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Volume 146, Number 4 • Letters

503e

Moreover, we would like to particularly acknowl- edge the correctness of the historical reconstruction proposed by the authors, which accurately recognizes that despite the tremendous contributions of Brazil and the Brazilian legends of plastic surgery, gluteal augmentation was not first described by Brazilian authors.⁵ Indeed, our previous comprehensive analysis of the entire body of the PubMed/MEDLINE literature demonstrated that the first description of gluteal augmentation was produced in the United States and pub- lished in the Journal by Bartels et al., who reported the use of a Cronin prosthesis to correct an asymmetry.^2,5,6 Cocke and Ricketson were instead the two U.S. authors who first performed an implant-based bilateral gluteal augmentation for purely cosmetic indications.^2,5,7

Finally, if we limit our analysis to the area of fat grafting gluteal augmentation, the first article on this topic was published by the Mexican group of Cárdenas- Camarena and colleagues in 1999. With their retrospec- tive review of 66 patients, they presented a gluteoplasty technique combining liposuction of lumbosacral, subgluteal, and trochanteric areas and lipoinjection of the medial third of the buttocks.^2,8 At a mean follow-up of 17 months, they observed a 95.5 percent rate of patient satisfaction, whereas the complications of this initial report were seroma (n = 4), visible irregularities (n = 6), palpable irregularities (n = 2), hyperemia and ery- thema (n = 12), and, very importantly, fat embolism (n = 1).⁸ Notably, all these pioneering studies were pub- lished in Plastic and Reconstructive Surgery, confirming the consistency of the leading role played by the Journal during its over 70 years of glorious existence.⁵

DOI: 10.1097/PRS.0000000000007200

Carlo M. Oranges, M.D., Ph.D.

Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery Basel University Hospital Basel, Switzerland Pietro G. di Summa, M.D., Ph.D.

Department of Plastic, Reconstructive, and Aesthetic Surgery Lausanne University Hospital Lausanne, Switzerland Salvatore Giordano, M.D., Ph.D.

Department of Plastic and General Surgery Turku University Hospital University of Turku Turku, Finland Daniel F. Kalbermatten, M.D., Ph.D.

Dirk J. Schaefer, M.D.

Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery Basel University Hospital Basel, Switzerland Correspondence to Dr. Oranges Department of Plastic, Reconstructive, Aesthetic,

and Hand Surgery Basel University Hospital Spitalstrasse 21

Basel 4031, Switzerland carlo.oranges@usb.ch Twitter: @carlo_oranges Instagram: @carlomariaoranges

DISCLOSURE

The authors have no financial interest to declare in rela- tion to the content of this communication. No funding was received for this work.

REFERENCES

1. Del Vecchio DA, Rohrich RJ. A changing paradigm: The Bra- zilian butt lift is neither Brazilian nor a lift—Why it needs to be called safe subcutaneous buttock augmentation. Plast Reconstr Surg. 2020;145:281–283.

2. Oranges CM, Tremp M, di Summa PG, et al. Gluteal augmentation techniques: A comprehensive literature review.

Aesthet Surg J. 2017;37:560–569.

3. Oranges CM, Gohritz A, Kalbermatten DF, Schaefer DJ. Eth- nic gluteoplasty. Plast Reconstr Surg. 2016;138:783e–784e.

4. Oranges CM, Haug M, Schaefer DJ. Body contouring. Plast Reconstr Surg. 2016;138:944e–945e.

5. Oranges CM, Gohritz A, Schaefer DJ. Plastic and reconstructive surgery short articles: How do they impact our practice?

Plast Reconstr Surg. 2016;138:954e–955e.

6. Bartels RJ, O’Malley JE, Douglas WM, Wilson RG. An unusual use of the Cronin breast prosthesis: Case report. Plast Recon- str Surg. 1969;44:500.

7. Cocke WM, Ricketson G. Gluteal augmentation. Plast Recon- str Surg. 1973;52:93.

8. Cárdenas-Camarena L, Lacouture AM, Tobar-Losada A.

Combined gluteoplasty: Liposuction and lipoinjection. Plast Reconstr Surg. 1999;104:1524–1531; discussion 1532–1533.

Exosomes Are Comparable to Source Adipose Stem Cells in Fat Graft Retention with Up- Regulating Early Inflammation and Angiogenesis Sir:

W

e read the article entitled “Exosomes Are Compa-

rable to Source Adipose Stem Cells in Fat Graft Retention with Up-Regulating Early Inflammation and Angiogenesis” by Chen et al.¹ published in Plastic and Reconstructive Surgery. The effects of stem cell–enriched fat grafting have been evaluated by many experiments since cell-assisted lipotransfer was first introduced by Matsumoto et al.² A meta-analysis involving 387 cases demonstrated that cell-assisted lipotransfer had better efficacy than non–cell-assisted lipotransfer.³ In the article by Chen et al., exosomes and source adipose stem cells showed similar effects in boosting fat retention with the underlying mechanisms, including up-regulation of early inflammation and angiogenesis. This study confirmed that exosomes could be used as a cell-free alter- native strategy in fat grafting. We appreciate the work and want to discuss some questions with the authors.

The authors stated that at the first injection, 1 × 10⁴ cells of adipose-derived stem cells or 40 μg of adipose-derived stem cell–derived exosomes were