ABSTRACTBackgroundPostsurgical atrophic scars tend to respond poorly to treatments, especially non‐energy‐based ones. Hydrophilic PN HPT (Polynucleotides High Purification Technology) injected intradermally is a non‐energy‐based option with an immediate volume‐enhancing effect that indirectly improves the fibroblast synthesis of collagen and extracellular matrix. The PN HPT ingredient has the further benefit of a dermal “priming” effect that enhances the efficacy of other scar treatments.ObjectivesVerify retrospectively, with advanced techniques, the efficacy of PN HPT monotherapy as postsurgical scar treatment.MethodsRetrospective data collection in 18‐ to 65‐year‐old women with moderate‐to‐severe atrophic scars after mammary surgery undergoing a five‐session intradermal treatment course with 0.75% PN HPT gel formulation in single‐use syringes starting 6 months after surgery. Primary retrospective efficacy parameter: changes in scar morphology and symptom severity after three and 6 months (modified Vancouver Scar Scale, mVSS). Secondary efficacy parameters: roughness score 6 months after baseline (Antera 3D CS tridimensional skin analysis system) and Global Aesthetic Improvement Scale (GAIS, Investigator and Patient subscales) after three and 6 months.ResultsTotal mean mVSS highly significantly improved from 11.2 ± 1.92 at baseline to 7.0 ± 1.68 and 6.9 ± 1.55 after three and 6 months, respectively; the mean Antera 3D CS roughness score improved from 13.5 ± 4.14 to 10.0 ± 3.49 after 6 months. After three and 6 months, the GAIS subscores for investigators and cohort subjects were identical (3.0 ± 0.81 and 3.0 ± 0.72, respectively). The photographic documentation supported the previous results.ConclusionsIn monotherapy, the intradermal PN HPT ingredient seems to quickly and safely relieve the burden of postsurgical atrophic scars. However, the lack of a formal parallel control group is a severe limitation. The objective quantitative measurements confirmed the long‐lasting benefits.

Abstract BackgroundBreast augmentation with implants recorded over 1.6 billion procedures globally in 2022. To reduce surgical trauma and complications and facilitate a fast recovery, we employ an ultrasound-guided local–regional anesthesia technique, the creation of a partial submuscular implant pocket by direct endoscopic visualization and minimal skin access on the mammary fold. ObjectivesThe aim in this study is to evaluate whether breast augmentation performed in endoscopy under local–regional anesthesia reduces postoperative recovery time, reduces complications, and increases patient satisfaction. MethodsPatients provided their consent through a signed form. We set strict inclusion and exclusion criteria. We prospectively evaluated postoperative pain and recovery times, the rate of complications, and patient satisfaction at 12 months postsurgery. ResultsBetween January 2021 and September 2022, 200 patients met the inclusion criteria. The average operation time was 54.2 min. Patients were discharged from the hospital within 2 to 3 h. Eighty-nine percent of patients expressed great satisfaction with the result. None of the patients experienced postsurgical complications. ConclusionsIn our initial study, we showed that endoscopic breast augmentation conducted under localized anesthesia is safe. It allows for quick recovery postsurgery and swift resumption of everyday activities. The overall complication risk is less than what has been reported in scientific studies for the classic dual-plane technique. Moreover, this approach yields excellent patient satisfaction. Additional prospective and randomized studies will be required to enhance the scientific validity of this technique. Moreover, a larger patient cohort will be essential to stratify the risks associated with varying prosthetic volumes. Level of Evidence: 4

Introduction: The mandibular profile undergoes progressive wasting with aging, and the deepening of nasolabial folds (NLFs) has a leading role. Hyaluronic acid (HA) efficiently controls tissue hydration and permeability to small and large molecules. NLFs are an acknowledged HA target; at the same time, another class of agents, PN-HPT (R) (Polynucleotides Highly Purified Technology), enjoy growing acknowledgement in aesthetic medicine. This exploratory, prospective study probed the rationale of sequentially associating PN-HPT (R) as a first priming agent acting in the skin followed by HA dermal filler injections for correcting moderate to severe NLFs. Methods: Following strict inclusion and exclusion criteria, the authors screened Caucasian ambulatory women aged 40-65 with moderate to severe NLFs and randomly selected two NLFs for each enrolled woman. Due to the purely explorative nature of the study, the authors initially planned to enroll no >10 women. According to a split-face design, the selected right-side NLFs received 4 ml of PN-HPT (R) intradermally in the initial priming phase ("NLF Rx group"); the selected left-side NLFs received 4 ml of saline (placebo) ("NLF Lx group"). After 3 and 6 weeks, all patients received 2 ml of subdermal cross-linked HA over both NLF areas (4 ml overall). The total study follow-up was 6 months after the first injection, with objective assessments, based on the qualitative and quantitative Antera 3D (R) and Vectra H2 (R) skin imaging technologies, after 6 weeks and 3 and 6 months. Results: Because of the favorable early outcomes, the authors let enrollment progress between January and June 2020 up to a total of 20 women and 40 NLFs. All treated women completed the six-month follow-up without reporting side effects, even clinically minor. The Antera 3D (R) device demonstrated that wrinkles and skin texture significantly improved in the NLF Rx after 6 weeks (monotherapy phase) and 3 and 6 months (PN-HPT (R) priming + HA phase) compared with baseline. HA levels, measured with the quantitative Vectra H2 (R) assessment technology in the right NLFs, were significantly higher than contralaterally at both 3 and 6 months. Conclusions: Although conceived only as an exploratory investigation, the study confirmed that PN-HPT (R) monotherapy might be a valuable and effective option to rapidly improve the skin dermis texture and quality in individuals with moderate to severe NLFs. Acting as a priming agent in the skin, PN-HPT (R) prolong the clinical efficacy of cross-linked HA. Well-designed trials in larger treatment groups will hopefully confirm these early promising results.

Background Managing acne scars is a challenge and therapies are divided into nonsurgical and surgical. Highly Purified Technology Polynucleotides (PN-HPT) is a compound that contains a mixture of DNA polymers of different lengths. Numerous studies have shown that PN-HPT also serves as an energy source, thus influencing cellular growth and cell vitality. Objectives The authors aimed to assess the improvement in dermal quality and acne scars after PN-HPT vs placebo according to Antera 3D and the patient responses to the patient satisfaction questionnaire after a comparison of pretreatment and posttreatment photographs at 1 and 3 months. Methods Included were women aged 30 to 50 years with grade 3 to 4 moderate-to-severe atrophic scars according to the Goodman classification; nonsmokers; and had not had active acne during the past 5 years. Ten patients (PN-HPT group) were treated with 4.0 mL of PN-HPT, and 10 patients (control) were treated with 4.0 mL of normal saline. All medical treatments were performed in a double-blinded manner; neither the injection doctor nor the patient knew if the PN-HPT or the placebo was being administered. Results Twenty women who fit the inclusion criteria were enrolled in this study. Only patients in the PN-HPT group improved significantly at 1 and 3 months after treatment compared with baseline. Conclusions This prospective and randomized study showed that PN-HPT in monotherapy was safe and effective treatment for atrophic scar acne compared with placebo. Prospective and randomized studies will be necessary to investigate the clinical effectiveness in a larger cohort of patients and for a longer follow-up. Level of Evidence: 2

BACKGROUND:A new topical formulation (TF) based on 3 main lifting components has been developed to reduce superficial facial wrinkles. OBJECTIVES:Determine the effectiveness of this new TF in reducing superficial face wrinkles and restructuring the dermal matrix. METHODS:Women, aged 30-65 y.o. with moderate to severe crow's feet wrinkles were included. EXCLUSION CRITERIA:men; younger than 30 or older than 65 years old; smokers. Patients received 15 IU of botulinum toxin on crow's feet and 2 creams. Fifty patients (Group 1) applied the TP (Product A) and 50 (Group 2) a placebo (Product B). Assessments were made by digital macro-photography's, Antera 3D, and a patient satisfaction questionnaire. RESULTS:From April to June 2019, 100 women were enrolled in the study and were divided into two homogeneous groups. No major or minor side effects were reported. In group 1, wrinkles, texture, static and dynamic crow's feet wrinkles improved significantly at 3 and 6 months. Patients were very satisfied at 3 months and satisfied at 6 months. In group 2, wrinkles and texture improved significantly at 3 months but did not improve at 6 months. Static and dynamic crow's feet wrinkles improved significantly at 1 and 3 months but did not improve significantly at 6 months. CONCLUSIONS:Our prospective and randomized study has shown that the new TF is safe and effective in reducing superficial face wrinkles and producing dermal regeneration. It, therefore, prolongs the duration of the botulinum toxin. Further controlled study would be necessary to compare the new TF to neurotoxin treatment, or its action alone.

BACKGROUND Recent studies have shown that transcutaneous microfocused ultrasound with visualization is beneficial for noninvasive skin tightening, collagen regeneration, and lower face contour improvement. OBJECTIVES The primary study endpoint was the improvement of the laxity and ptosis face skin; the secondary endpoint was the improvement of wrinkles, texture, and hemoglobin content; and the third endpoint was the patient's responses to a patient satisfaction questionnaire. METHODS Patients with soft to moderate skin laxity and ptosis of the face and neck were enrolled and their sex, ethnicity, age, Fitzpatrick skin type, and smoking habit recorded. Patient assessment was made by digital macro-photographs, Vectra H2, and Antera 3D, and strict exclusion criteria were set up. RESULTS From November 2017 to November 2018, 47 women and 3 men with a mean age of 52.8 ± 7.43 years and Araco's Ptosis Scale System 2.7 ± 0.46, which fit the inclusion criteria, were enrolled in the study. All patients signed a consent form and received 1200 spot-lines (400 lines from each transducer) of microfocused ultrasound with visualization. No major side effects were reported during the study and all patients completed the follow-up after 6 months. Wrinkles, texture, Surgeon Assessment Scoring System scores, and patient satisfaction questionnaire scores improved significantly. Patients found the treatment tolerable according to the patient pain scale rate. No statistically significative differences were found among homogenous groups of smokers and nonsmokers. CONCLUSIONS The study proves that microfocused ultrasound with visualization in a single session of treatment in monotherapy is safe and effective for the treatment of face laxity and ptosis when a proper number of energy spot-lines is delivered in the correct tissue layer. LEVEL OF EVIDENCE: 4

BACKGROUND:Acne scars are the most common sequelae of the severe inflammatory process of acne, and its managing is a challenge. Objective of this study was to assess safety and effectiveness of calcium hydroxylapatite monotherapy and its association with high-intensity microfocused ultrasound for treating moderate-to-severe atrophic acne scars. METHODS:Women with moderate-to-severe atrophic scars of the face were enrolled on the study. Assessments were made by digital macrophotographs, Vectra H2, and Antera 3D. RESULTS:From October to December 2019, twenty women which fitted the inclusion criteria signed a consent form and received 3.0 mL of calcium hydroxylapatite and after 4 weeks, 400 lines of HIFU. No major side effects were reported during the study, and all patients completed the follow-up after 6 months. At 1 month, patients treated with calcium hydroxylapatite (group 1) improved wrinkles and skin texture compared to placebo (group 2). At 3 and 6 months, all patients improved acne scars. CONCLUSION:Our study showed that that both calcium hydroxylapatite and HIFU in monotherapy were safe and effective treatments for atrophic scar acne. Calcium hydroxylapatite was clinically effective when compared with placebo, though the combination of calcium hydroxylapatite and HIFU did not enhance the clinical efficacy compared to monotherapy.

Dermatologic TherapyVolume 33, Issue 4 e13683 IMCAS: Letter A case report of deep skin burns following radiofrequency-assisted liposculpting technology of BodyTite Antonino Araco, Corresponding Author Antonino Araco aracoantonino@gmail.com orcid.org/0000-0002-4177-9976 Aesthetic Medicine Department, University Tor Vergata of Roma, Viale Oxfor 180, Rome, Italy Correspondence Antonino Araco, Aesthetic Medicine Department, University Tor Vergata of Roma, Piazza Dei Re di Roma 71, 00183 Roma, Italy. Email: aracoantonino@gmail.comSearch for more papers by this author Antonino Araco, Corresponding Author Antonino Araco aracoantonino@gmail.com orcid.org/0000-0002-4177-9976 Aesthetic Medicine Department, University Tor Vergata of Roma, Viale Oxfor 180, Rome, Italy Correspondence Antonino Araco, Aesthetic Medicine Department, University Tor Vergata of Roma, Piazza Dei Re di Roma 71, 00183 Roma, Italy. Email: aracoantonino@gmail.comSearch for more papers by this author First published: 24 May 2020 https://doi.org/10.1111/dth.13683 Dermatologic Therapy Journal is partnering with IMCASAcademy.com to bring you the best of IMCAS Alert, the online service that allows physicians to submit their difficult clinical cases and complications for quick advice from international experts. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume33, Issue4July/August 2020e13683 RelatedInformation

Introduction: The goal of our prospective study was to assess the efficacy of the topical Platelet-rich plasma on reducing superficial perioral wrinkles and restoring the dermal matrix. Materials and methods: 50 women with moderate to severe perioral wrinkles were treated on the perioral area by a single session of fractional CO2 laser skin resurfacing plus intradermal injection of prp. 25 patients (group 1) applied topically prp twice a day for 12 weeks as post laser treatment. 25 (group 2) applied gentamicin and betamethasone twice a day for the first 7 days and then hyaluronic acid gel for the following 12 weeks. Results: In group 1, moisture (p < 0.001), amount of collagen fiber (p < 0.001) skin elasticity (p < 0.001), PSAl (p < 0.001) and SSAl (p < 0.001) improved significantly. In group 2 all the parameters investigated improved but did not reach significant difference. Discussion: Our medical device with a plasma-like formulation is able to maintain prp active for a period of 7 days so patients are able to apply topically growth factors at home. Conclusions: Our prospective study proves that the use of topical prp reduces superficial perioral wrinkles and restore dermal matrix when used at home for 12 weeks.

We evaluated whether the quantity of fat removed during abdominoplasty and liposuction correlated with the occurrence of surgical site infection (SSI). We selected patients of similar age, sex, smoking status, obesity, and post-bariatric weight loss, retrospectively, and classified them into groups according to the development of SSI. The total amount of fat removed and aspirated was compared. The size of the flap removed from the abdomen and the amount of fat aspirated with liposuction differed significantly between the SSI and no-SSI groups (1.6 ± 0.2 vs. 0.6 ± 0.3 kg and 2 ± 0.2 vs. 0.9 ± 0.3 l, respectively; p < 0.001). The four SSI patients with the most fat removed (1.4 ± 0.2 kg) or aspirated (2 ± 0.1 l kg) had the deepest infections. SSI was strongly correlated with the size of flap resection (ρ = 0.80; p < 0.001) and liposuction (ρ = 0.72; p < 0.001). The quantity of fat removed or aspirated can influence the occurrence of SSI. If confirmed, these data could be used to better stratify patients according to their risk.

Background: Different studies have investigated the anatomical and operative factors associated with alterations of nipple-areola complex sensitivity after aesthetic breast augmentation. The authors conducted a retrospective evaluation of a large series of patients to assess the risk factors that could be associated with such alterations. Methods: Data were collected retrospectively from the personal archive of the first author from May of 2004 to September of 2010. Excluded were those that underwent operations on the breast different from augmentation (i.e., breast reductions), augmentations associated with other operations that could influence the nipple-areola complex (e.g., mastopexy, lifting of the nipple, inverted nipple, reduction of the nipple, capsulectomy), breast revisions, breast implant replacements, or monolateral or nonsymmetrical augmentations. Results: The number of patients included in the study was 1222. The only factor associated with nipple-areola complex sensitivity alterations and areolar pain at 6 months was the type of skin incision used. Alterations were more present postoperatively with the periareolar than with the submammary incision (chi-square test, p = 0.001). The periareolar incision increased the risk of nipple-areola complex sensitivity alterations almost threefold and the risk of areolar pain by more than threefold. Conclusions: The type of skin incision adopted for breast augmentation seems to influence the occurrence of postoperative nipple-areola complex alterations of sensitivity or areolar pain. Although this affects a small percentage of patients, it is worth mentioning so that a more lucid informed consent and agreement to the operation can be achieved. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The transversus abdominis plane (TAP) block acts on the nerves localised in the anterior abdominal wall muscles. We evaluated the efficacy on post-bariatric (PB) patients undergoing body-contouring abdominoplasty. We retrospectively evaluated PB patients undergoing abdominoplasty with flank liposuction and compared results to a matched group of TAP aesthetic patients. Outcomes evaluated were the analgesic requirements during the early postoperative days. Fifty-one patients (PB n = 27, aesthetic n = 24) were assessed. No complications were observed. All PB patients required analgesia until the second postoperative day contrarily to most aesthetic ones. Patients with greater flap resected and higher pre-abdominoplasty BMI had greater morphine consumptions. In PB patients, the larger amount of tissues resected corresponded to a greater stimulation of pain fibres that cannot be paralleled by a concomitant increase of the local anesthetic administered. This partially invalidates TAP’s efficacy on PB patients.

Sir: Postoperative pain is an important issue with abdominoplasties and flank liposuction procedures. Different anesthetic techniques have been developed to overcome this problem, including the bilateral thoracic paravertebral block, the epidural block, and infiltration of the rectus sheath with local anesthetics. The transversus abdominis plane block was recently introduced for operations that involve the abdominal wall.1 In the plane between the transversus abdominis muscle and the internal oblique muscle travel the intercostal nerves T7 to T11, the subcostal nerve (T12), and the ilioinguinal and iliohypogastric nerves (L1). The local anesthetic injected in the plane blocks the sensory afferents of all these nerves, providing pain relief for the entire anterior abdominal wall. To date, the transversus abdominis plane block has been evaluated in retropubic prostatectomies,1 cesarean deliveries,2 hysterectomies,3 and laparoscopic4 and abdominal surgery.5 In all of them, it reduced the postoperative pain, morphine requirements, and sedation.2,3,5 Since January of 2009, we have assessed the feasibility of this technique in patients undergoing body contouring abdominoplasties with flank liposuction, and prospectively collected data regarding pain medication requirements. All patients were operated on by one surgeon (A.A) with the same technique and standard general anesthesia. Patients chronically consuming pain medication were excluded from the analysis. After the flap resection and before muscle plication, a 2-cm oblique incision is performed on both sides on the muscular fascia, 3 cm medial and 4 to 5 cm superior to the anterior superior iliac spines. The external oblique muscles are identified and the fibers of the external and internal oblique muscles are separated by blunt dissection until the transversus abdominis muscles are visualized (Fig. 1, above). Bupivacaine hydrochloride (0.5%, 5 mg/ml; total dose, 2 mg/kg) is injected bilaterally in the plane between the internal oblique muscles and the transversus abdominis muscles using a blunt needle (Fig. 1, below). The OEM fascia is then repaired and tumescence liposuction with modified Klein solution (without anesthetic) proceeds as normal. Postoperative analgesia is administered, when required, with morphine (5 mg intramuscularly) in the first postoperative hour and with paracetamol-opioid combination tablets (co-codamol: codeine, 30 mg; paracetamol, 500 mg) afterward.Fig. 1.: (Above) Dissection of external and internal oblique muscles with visualization of the transversus abdominis muscle. (Below) Deposition of the local anesthetic in the plane between the oblique internal and the transversus abdominis muscles.Between January of 2009 and June of 2009, 24 women were operated on (Table 1). Five patients (21 percent) required 5 mg of morphine in the first postoperative half hour; none required morphine in the second half. No patients received oral codeine/paracetamol until postoperative hour 6, seven patients (29 percent) received one tablet from hours 7 to 12, three patients (13 percent) received one tablet from hours 13 to 24, and only one patient (4 percent) received one tablet from hours 25 to 48. No intraoperative or postoperative complications related to the anesthetic or surgical technique were recorded.Table 1: Sociodemographic and Clinical Characteristics of Patients Operated onResults confirm that the transversus abdominis plane block is safe for aesthetic abdominal operations. The technique is also simple, as the flap is already elevated and the muscular fibers are easily identified under direct visualization without the need for ultrasonographic guidance. The technique is associated with low postoperative requirements for morphine or other pain medication. Future randomized studies should now compare abdominoplasties with or without the block to confirm the advantages of this technique in abdominal aesthetic operations. Antonino Araco, M.D. Jack Pooney, M.D. Dolan Park Hospital Bromsgrove Birmingham, United Kingdom Luca Memmo, M.D. Department of Surgery Hôpital Erasme Bruxelles, Belgium Gianpiero Gravante, M.D. Department of Hepatobiliary and Pancreatic Surgery University Hospitals of Leicester Leicester, United Kingdom

INTRODUCTION:The transversus abdominis plane (TAP) block is a technique of locoregional anesthesia that blocks the sensorial afferent nerves localized between the transversus abdominis muscle and the internal oblique muscle. We describe results obtained with a case control study between patients undergoing abdominoplasty with the TAP block compared with a similar group of patients not receiving the block.MATERIALS AND METHODS:Medical notes were reviewed, and patients were classified according to the presence of TAP. Outcomes evaluated were the requirements of morphine in the first postoperative hour and the number of co-codamol tablets administered afterward.RESULTS:Seventy-five patients were screened. No intra- or postoperative complications were recorded. TAP+ patients required significantly less analgesia during the first 12 postoperative hours (P < 0.001). The patients with increased body mass index and large flap resected were more likely to fail the anesthetic block and required postoperative analgesia.CONCLUSIONS:In aesthetic abdominal surgery, the TAP block is safe, is performed without ultrasound guidance, and markedly reduces the requirement of postoperative opioid analgesia. Future studies will now confirm these results and evaluate the consequences in terms of postoperative nausea, vomiting, and overall satisfaction of patients.

Postbariatric patients undergoing abdominoplasties were retrospectively analyzed to correlate postoperative local complications with the 2 most commonly used techniques of raising the abdominal flap: diathermocoagulation versus scalpel. All patients undergoing body-contouring abdominoplasties were included. Excluded were patients with ongoing clinical infections, those that received a complete course of antibiotic in the 6 months before operation, those requesting steroid therapy, those with systemic diseases that could impair wound repair (arteriosclerosis, diabetes mellitus), and those who had undergone apronectomy. One hundred thirty-seven patients were divided into 2 groups (diathermocoagulation = 90 vs. scalpel = 47). Overall, 7 seromas (5.1%), 7 hematomas (5.1%), and 28 wound infections (20.4%) were detected. A higher occurrence of postoperative hematomas was found after the flap raised using a scalpel (12.8% vs. 1.1%, Fisher exact test, P < 0.05), with a relative risk of 11.6. A significant association existed between postoperative hematomas and wound infections with delayed healing (n = 10, 7.3%): 43% of patients with a hematoma also experienced a wound infection with delayed healing versus 5.4% of those that did not develop hematomas (Fisher exact test; P < 0.01). In patients for whom a scalpel had been used to raise the flap, this correlation persisted (50% of patients with a hematoma had developed a wound infection with delayed healing vs. 7.3% of those that did not develop hematomas; Fisher exact test; P < 0.05).In postbariatric patients, diathermocoagulation reduces the occurrence of postoperative hematomas and wound infections with delayed healing compared with the cold knife.

Pseudomonas aeruginosa infections may involve any organ or body district and may give serious clinical sequelae. We report the case of an infection of the abdominoplasty flap that compromised wound closure and jeopardized the aesthetic outcome. To the best of our knowledge, this is the first such case reported in the literature for this group of patients. We have presented this case in order to alert plastic and general surgeons who may encounter this complication in future, such that they may be aware of the need to adopt an aggressive approach to manage these patients. This consisted of the accurate monitoring of the patient's clinical condition, prescribing appropriate antibiotics, and performing serial debridement of necrotic tissue.

Sir: Abdominoplasty is a procedure that manifests postoperative seromas in 5 to 22 percent of cases.1,2 Different risk factors have been investigated. Although age and body mass index have been associated with their occurrence,3 progressive tension sutures gave contrasting results, and the use of drains or concomitant liposuction was not related to seroma occurrence.4 In this retrospective analysis, we tried to correlate the risk of seromas with the amount of flap resected and of fat aspirated with liposuction. We also analyzed the influence of associated liposuction, progressive tension sutures, fibrin tissue adhesives (Tissucol), patient smoking status, and two techniques for flap raising (diathermocoagulation versus cold knife). Data were retrospectively collected from the personal archive of two surgeons (A.A. and V.C.) working at the Dolan Park Hospital, in Bromsgrove, United Kingdom, and at the Plastic Surgery Department of the University “Tor Vergata,” in Rome, Italy. We excluded from the analysis morbidly obese and postbariatric patients who had undergone panniculectomy following massive weight loss. A total of 494 patients who underwent full abdominoplasty were analyzed (A.A.: September of 2004 to December of 2007; V.C.: January of 2001 to December of 2007). Descriptive statistics and clinical characteristics are summarized in Table 1.Table 1: Descriptive Statistics and Clinical CharacteristicsWe recorded 23 seromas (4.7 percent) and 34 hematomas (6.9 percent). Wound infections were present in 60 patients (12.1 percent). They occurred after a mean period of 8 ± 3 days. The most common organism isolated was Staphylococcus epidermidis. No cases of deep vein thrombosis or pulmonary embolism were observed. The chi-square and Mann-Whitney tests confirmed that groups (seromas versus nonseromas) were homogeneous for all variables analyzed, except for the amount of flap resected during the abdominoplasty (Table 1). The analysis of smoking status in both groups produced no significant differences, nor did the amount of flap aspirated with liposuction, the use of tissue adhesives, or the use of diathermocoagulation versus the cold knife approach. The comparison between groups produced a prognostic cut-off value for the amount of flap removed (Figs. 1 and 2). This value (700 g) was determined with receiver operating characteristic curves to find the greatest areas of sensitivity and specificity (area = 0.665). According to this cut-off, the relative risk for the incidence of postoperative seromas in patients who removed more than 700 g of fat was 3.8 compared with the others [(15/167)/(8/327)] (chi-square test; p < 0.001).Fig. 1.: Scatter plot with cut-off line for the amount of flap resected of patients who experienced seromas (red circles) versus those who did not (blue circles).Fig. 2.: Area of receiver operating characteristic (ROC) curves refers to cut-off of tissue removed. Diagonal segments are produced by ties.Results of our study suggest that the amount of fat removed during surgery could be an important factor for the occurrence of postoperative seromas, increasing their risk of occurrence almost four times when the quantity removed exceeded 700 g. We previously demonstrated that the quantity of fat removed influences the risk of pulmonary embolism when it exceeds 1500 g,5 and our personal observations also suggest a relationship with the occurrence of postoperative surgical-site infections. No other factor was associated with the occurrence of seromas, especially concomitant liposuction or the use of progressive tension sutures. However, although based on a large series, our analysis is retrospective in nature and the results obtained need to be confirmed in future prospective trials. A. Araco Dolan Park Hospital Bromsgrove, United Kingdom G. Gravante Department of Surgery Whipps Cross University Hospital London, United Kingdom F. Araco Dolan Park Hospital Bromsgrove, United Kingdom R. Sorge Department of Human Physiology Laboratory of Biometry University Tor Vergata Rome, Italy V. Cervelli Department of Plastic Surgery University Tor Vergata Rome, Italy