Publications by authors named "Nicolas Abboud"

12 Publications

  • Page 1 of 1

The Combined Effect of Intravenous and Topical Tranexamic Acid in Liposuction: A Randomized Double-Blinded Controlled Trial.

Aesthet Surg J Open Forum 2021 Jan 12;3(1):ojab002. Epub 2021 Jan 12.

Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.

Background: Tranexamic acid (TXA) use in surgical procedures due to its hemostatic effects has been gaining an increased interest. In plastic surgery, the effects of TXA have been studied intravenously (IV), and there have been some reports regarding local use.

Objectives: A comparative study examining the combined effect of IV and local TXA was conducted.

Methods: A randomized double-blinded controlled trial was performed for patients undergoing breast reduction treatment with liposuction and resection following the power-assisted liposuction mammaplasty (PALM) technique. All patients received 5 mL IV of 0.5 g/5 mL TXA on induction. Before installation, one researcher prepared two solutions of 1 L normal saline: one with 5 mL of 0.5 g/5 mL TXA associated with epinephrine 1:100,000 and the other with only epinephrine 1:100,000. These were randomly infiltrated in either the left or right breast. Clinical dermal bleeding was assessed for both breasts after deepithelialization. The lipoaspirate from these breasts was then compared with each other. A postoperative evaluation at 24 hours was performed to compare the ecchymosis rate.

Results: Ratios of decanted volume to total lipoaspirate was measured in bottles and compared between breasts. There was a statistical difference ( = 0.0002) in the ratio of decanted to lipoaspirated volume when comparing the control group (ratio: 0.21) with the treatment group (0.13). Video analysis revealed decreased dermal bleeding in the TXA group and postoperative evaluation less ecchymosis.

Conclusions: The combined use of IV and local TXA can help reducing blood loss in liposuction as measured by decantation in separate drain bottles and as assessed clinically preoperatively and postoperatively.

Level Of Evidence 2:
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http://dx.doi.org/10.1093/asjof/ojab002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240743PMC
January 2021

Corrigendum to: A New Suturing Method for Optimal Wound Healing: Technique and Experience.

Aesthet Surg J Open Forum 2020 Dec 22;2(4):ojaa039. Epub 2020 Sep 22.

[This corrects the article DOI: 10.1093/asjof/ojaa008.].
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http://dx.doi.org/10.1093/asjof/ojaa039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671242PMC
December 2020

Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation With Power-Assisted Liposuction and Lipofilling (PALLL).

Aesthet Surg J 2021 06;41(7):770-782

Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium.

Background: An increasing number of women wish breast implant removal whilst maintaining an acceptable projection and form were possible.

Objectives: The authors propose a technique to remodel the breast after implant removal utilizing internal suture loops to project the breast, recruit abdominal and axillary tissue cranially and medially, and provide a matrix for lipofilling.

Methods: A prospective analysis was performed of consecutive patients undergoing implant extraction followed by power-assisted liposuction loops and lipofilling. Patient characteristics were measured. The aesthetic results were evaluated by 2 independent raters. Patient-reported satisfaction was measured by standardized questionnaires.

Results: Implants in 52 patients with an average age of 55 and body mass index of 23.7 were extracted followed by breast remodeling. A total of 73% of patients had implants for aesthetic reasons, 41% were smokers, and 43% of the reconstruction cases received radiotherapy. A total of 28% had implant extraction for rupture, 58% for capsular contracture, and 14% due to pain and migration. The average volume of the implants removed was 292 cc, followed by an average lipofilling of 223 cc, yielding a ratio of 0.76 to 1. The average tissue recruited by loops was 82.5 cc. Independent raters measured 79% of results as good, 13% as acceptable, and 8% as requiring improvement; 80% of patients were satisfied to very satisfied.

Conclusions: The authors propose implant extraction followed by power-assisted liposuction loops and lipofilling can provide footprint definition, sustained projection, and high patient satisfaction. Moreover, the recruitment of a vascularized adipo-cutaneous flap by loops allows a reduced ratio of fat grafting to implant volume.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjaa327DOI Listing
June 2021

Scarless Composite Breast Reconstruction Utilizing an Advancement Skin Flap, Loops, and Lipofilling.

Aesthet Surg J 2021 Jan 28. Epub 2021 Jan 28.

From the Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli in La Louvière, Belgium.

Background: Autologous fat grafting has gained popularity in breast reconstructive surgery. To further increase the breast volume and provide a reliable breast shape, a skin flap can be advanced from the upper abdomen and lateral thorax to the breast.

Objectives: We propose a method of breast reconstruction utilizing the principles of power-assisted liposuction and lipofilling (PALL) for breast matrix dissociation applied through infiltration, tunnelization, extensive undermining and lipofilling, in combination with loops (PALLL) to recruit a vascularized flap to reshape the breast.

Methods: A prospective study was performed from January 2014 to January 2019. Demographic data, surgical procedure information with volumes of the recruited advancement flap and lipofilling, stages of lipofilling, and complication data were collected. Patient-reported outcomes were measured by a questionnaire, including satisfaction and well-being.

Results: 37 women (41 breasts) underwent breast reconstruction utilizing PALLL with an average follow-up of 26 months. The mean age was 54 years, mean BMI 29, mean recruited flap volume 197 mL, mean first session lipofilling volume 153 mL, second session 190 mL, and third session 110 mL. Nine patients needed three sessions, 27 two sessions, and one patient only one session. 94% were satisfied with their breast shape. All patients reported sensitive breasts. There were minimal complications.

Conclusions: Breast reconstruction utilizing PALLL is a minimally invasive alternative to reconstruct and reshape sensate breasts utilizing a vascularized skin flap recruited by loops from breast surroundings and combined with fat grafting. It provides long-term shape stability with minimal scarring and low complication rates.
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http://dx.doi.org/10.1093/asj/sjab049DOI Listing
January 2021

A Surgical Alternative in the Treatment of Recurrent Diaphragmatic Hernia after Total Gastrectomy.

Plast Reconstr Surg Glob Open 2020 Dec 21;8(12):e3302. Epub 2020 Dec 21.

Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium.

Treament of hiatal hernia remains a challenge for surgeons. The techniques for treatment started with cruroplasty, which was later associated with extensive mobilization of the esophagus, with or without fundoplication. Other solutions included the use of synthetic or biological mesh and autologous tissue reinforcement. Despite these therapeutic strategies, the recurrence rate for hiatal hernia is significant, and no existing treatments have had much success in reducing this rate. Total gastrectomy, as in this case, represents an additional challenge because of the absence of gastric tissue, which can buttress the pillars' repair. This case report introduces a novel approach for the treatment of recurrent hiatal hernia, using a pedicled vertical rectus abdominis myocutaneous flap.
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http://dx.doi.org/10.1097/GOX.0000000000003302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787302PMC
December 2020

No-Scar Breast Reduction Utilizing Power-Assisted Liposuction Mammaplasty, Loops, and Lipofilling.

Aesthet Surg J 2021 04;41(5):550-562

Free University of Brussels (ULB), Brussels, Belgium.

Background: In continued interest to develop and refine minimally invasive procedures, recent publications reported a scarless approach in breast lifting.

Objectives: The authors sought to describe a power-assisted lipomodeling technique combined with surgical loops to achieve breast reduction and reshaping with minimal scars.

Methods: Between 2014 and 2018, 94 patients underwent breast reduction by combined liposuction and loops. Following infiltration of the breasts, liposuction of the outer quadrants and the lower pole was achieved to reduce the breast footprint and the lateral and inferior heaviness of the breast. After multiaxial multiplanar tunnelization, 3 types of loops were taken around the breast to suspend and elevate the breast skin envelope and parenchyma. Each loop was guided through a 3-mm, 3-hole cannula passed through skin stab incisions. The first loop was designed to reduce the breast footprint and enhance the breast projection, whereas the second loop was designed to achieve breast conus remodeling. The third loop was passed circumferentially around the areola and then cephalad along the breast axis and pulled until the desired nipple-areola complex elevation was reached. Each loop was pulled to achieve the desired breast projection and shape.

Results: The authors achieved breast reduction with a mean nipple elevation of 7.3 cm, and 88% of patients were satisfied with their breast shape. The total complication rate was 1%, including mild cellulitis in 1 breast, treated efficiently with oral antibiotics.

Conclusions: The proposed technique is a novel, simple, and safe alternative to achieve breast reduction and reshaping without a scar.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjaa165DOI Listing
April 2021

Improving the Female Silhouette and Gluteal Projection: An Anatomy-Based, Safe, and Harmonious Approach Through Liposuction, Suspension Loops, and Moderate Lipofilling.

Aesthet Surg J 2021 03;41(4):474-489

Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium.

Background: Liposuction is the main technique to improve body contour, emphasize appealing curves, and highlight one's muscular definition. The number of procedures in which the harvested fat is utilized for gluteal augmentation has greatly increased.

Objectives: The authors aim to demonstrate their technique in order to obtain a sculpted harmonious body through a safe procedure, as well as review their 101 consecutive cases between 2014 and 2018.

Methods: Anatomical guidelines and preoperative markings were provided to guide the 3-step procedure: zones of maximal and mild liposuction, barbed wire suspension, and moderate fat grafting. Novel concepts are introduced as the anterior body diagonal, posterior body diagonal as well as other specific axes the pubic unit, and a vertical ratio for the buttock, which are the basic foundations for sculpting the female body into a pleasing hourglass shape with a well projected buttock. Recommendations for location of sacral diamond, sacral dimples, and the maximally projected point of the buttock are given. The authors explain their philosophy through 4 principles: knowledge of anatomy, the relationship between specific body areas and surrounding zones, a balanced gluteal augmentation is not achieved through large volume fat grafting alone, and grafting in the subcutaneous layer.

Results: A total of 101 patients were treated following the described technique and examples are shown. The complication rate was low. No serious adverse effects were recorded apart from 1 ruptured suspension loop.

Conclusions: The described anatomy-based approach, including liposuction, suspension loops, and fat grafting, is a novel and safe technique leading to a desirable, long-lasting outcome.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjaa157DOI Listing
March 2021

A New Suturing Method for Optimal Wound Healing: Technique and Experience.

Aesthet Surg J Open Forum 2020 Jan 27;2(1):ojaa008. Epub 2020 Feb 27.

Head of the Division of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire de Tivoli, Brussels, Belgium.

Background: Wound closure utilizing barbed sutures has been associated with healing problems, such as thread extrusion, infection, and the increase of an inflammatory response around the scar.

Objectives: In our study, the senior author described a novel technique of skin incision and wound closure based on de-epithelization and bi-layer tension-free closure that minimizes complications.

Methods: In this retrospective study, the authors reviewed the evolution of wound healing for the novel technique developed by the senior author by analyzing clinical reports of 817 patients who underwent surgery for abdominoplasty or breast reduction utilizing power-assisted liposuction mammaplasty with the new incision and closure technique. In addition, three separate plastic surgeons reviewed the wound characteristics and overall appearance by analyzing photographs that were taken over the course of 12 months to document the healing process.

Results: The overall complication rate was 14.1%, with 0.4% hematoma, 1.25% infection, 0.8% seroma, 1.5% necrosis, 3.75% erythema, 3.3% delayed wound healing, and 3.1% suture extrusion. The authors reported the rate of step-off border (9%), contour irregularities (6.5%), margin separation (1.25%), edge inversion (3.2%), excessive distortion (0.9%), and bad overall appearance (6.4%) of the cases.

Conclusions: This new technique in wound incision and closure based on de-epithelization and bilayer tension-free closure reduces the complications associated with barbed sutures.
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http://dx.doi.org/10.1093/asjof/ojaa008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780452PMC
January 2020

New measurement method for matching areola size prior to tattooing.

Breast J 2019 03 21;25(2):346-348. Epub 2019 Feb 21.

Centre Hospitalier Universitaire Tivoli, La Louviere, Belgium.

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http://dx.doi.org/10.1111/tbj.13228DOI Listing
March 2019

Power-Assisted Liposuction and Lipofilling: Techniques and Experience in Large-Volume Fat Grafting.

Aesthet Surg J 2020 01;40(2):180-190

Universite Libre de Bruxelles, Brussels, Belgium.

Background: Power-assisted liposuction and lipofilling (PALL) is a simple and reproducible surgical technique for large volume fat grafting.

Objectives: The authors share their 7-year experience with their large-volume fat transfer technique, PALL.

Methods: A total of 417 patients who underwent PALL-related surgeries involving the breast and buttock were evaluated in a retrospective study. Liposculpting and fat harvesting were performed with power-assisted liposuction. Fat was transferred with simultaneous power-assisted vibration and tunnelization to provoke expansion of the recipient site. Following lipofilling, additional external vibration of the recipient site was performed to enhance diffusion of the injected fat.

Results: Liposuction volumes up to 5000 mL were recorded, and injection volumes ranged from 300 to 900 mL per side for each session. Operating times ranged from 45 to 120 minutes. Patients were followed-up for 1 to 4 years. No major complications were recorded.

Conclusions: PALL is an efficient, safe, and reproducible procedure with myriad applications in aesthetic and reconstructive surgery.

Level of Evidence: 4.
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http://dx.doi.org/10.1093/asj/sjz019DOI Listing
January 2020

Brachioplasty by Power-Assisted Liposuction and Fat Transfer: A Novel Approach That Obviates Skin Excision.

Aesthet Surg J 2016 Sep 23;36(8):908-17. Epub 2016 Feb 23.

Dr Abboud is Head and Dr Dibo is a Fellow, Division of Plastic Surgery, Centre Hospitalier Universitaire de Tivoli, Brussels, Belgium. Mr Abboud is a fourth-year medical student, Universite Libre de Bruxelles, Brussels, Belgium.

Background: Current brachioplasty techniques include excisional surgery alone or in combination with liposuction. These techniques are associated with poor outcomes, such as residual contour deformities and unfavorable scarring.

Objectives: The authors proposed a new classification system and treatment algorithm for brachial ptosis and described their experience with power-assisted liposuction and lipofilling to treat brachial ptosis without excisional surgery.

Methods: Ninety-five patients with grades 1, 2, or 3 brachial ptosis who underwent brachioplasty were evaluated in a prospective study. Power-assisted liposuction was applied to the posterior arm and para-axillary region, and power-assisted lipofilling was applied to the so-called "bicipital triangle" of the medial arm.

Results: The patients' mean age was 39 years, mean body mass index was 28 kg/m(2), mean lipoaspirate volume was 240 mL per arm, and mean fat-injection volume was 110 mL per side. The mean operating time was 50 minutes, and the average follow-up period was 24 months. Hematoma developed in 2 patients who underwent brachioplasty in combination with another body contouring procedure (1 abdominal hematoma and 1 thigh hematoma; 2.1% complication rate). No other complications were recorded.

Conclusions: Brachioplasty by means of power-assisted liposuction and lipofilling is a safe and reliable option that obviates excisional surgery in patients with mild to moderate brachial ptosis.

Level Of Evidence: 4 Therapeutic.
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http://dx.doi.org/10.1093/asj/sjv277DOI Listing
September 2016

Power-assisted gluteal augmentation: a new technique for sculpting, harvesting, and transferring fat.

Aesthet Surg J 2015 Nov 15;35(8):987-94. Epub 2015 Sep 15.

Dr Abboud is Head and Dr Dibo is a Fellow, Division of Plastic Surgery, Centre Hospitalier Universitaire de Tivoli, Brussels, Belgium. Mr Abboud is a fourth-year medical student, Universite Libre de Bruxelles, Brussels, Belgium.

Background: A simple and reproducible surgical technique for gluteal shaping and augmentation with autologous fat is needed.

Objectives: The authors describe a novel approach to large-volume gluteal augmentation that combines power-assisted liposculpting and fat harvesting of the zones around the buttock with autologous fat transfer.

Methods: One hundred ten patients who underwent gluteal augmentation were evaluated in a prospective study. Liposculpting and fat harvesting were performed with power-assisted liposuction. Fat then was transferred to the gluteal region with simultaneous power-assisted vibration and tunnelization. A questionnaire to assess patient satisfaction was administered at 6 months postoperatively.

Results: The mean body mass index of the patients was 30 kg/m(2) (range, 26-36 kg/m(2)). Liposuction volumes ranged from 1400 to 5000 mL, and injection volumes ranged from 300 to 900 mL per side for each session. Operating times ranged from 60 to 120 minutes. Patients were monitored for an average of 20 months (range 12-48 months). Complications included a burning sensation in 5 of 110 patients (4.5%), persistent swelling in the lower back in 3 patients (2.7%), and a mild infection in 1 patient (0.9%).

Conclusions: Power-assisted gluteal augmentation with autologous fat is an efficient, safe, and reproducible procedure that produces an aesthetically pleasing gluteal projection and contour.

Level Of Evidence: 4 Therapeutic.
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http://dx.doi.org/10.1093/asj/sjv161DOI Listing
November 2015
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