Publications by authors named "Onelio Garcia"

12 Publications

  • Page 1 of 1

Brazilian Butt Lift-Associated Mortality: The South Florida Experience.

Aesthet Surg J 2022 Aug 11. Epub 2022 Aug 11.

From the Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.

Background: Brazilian Butt Lift (BBL) surgery has been the fastest growing aesthetic surgical procedure over the past decade. Unfortunately, by 2017, the surgery was associated with the highest mortality rate of any aesthetic surgical procedure. South Florida carries the highest BBL mortality by far in the nation.

Objectives: The purpose of this study was to explore the factors involved in making South Florida an outlier, as it relates to BBL mortality.

Methods: The anatomical findings of the gluteal dissections in 11 post-BBL surgery autopsies (22 hemi-buttocks) were assessed for commonalities. The authors examined the records of patients who died from BBL-related Fat Emboli to determine commonalities.

Results: All cases had fat grafts injected into the gluteal musculature in multiple different levels. Another commonality in these cases involved the location of where the surgery took place, with the great majority of patients (92%) undergoing surgery at high-volume budget clinics located in South Florida. Short surgical times of approximately 90 minutes, appeared to be the norm for these cases.

Conclusions: South Florida has experienced 25 BBL related fat emboli deaths from 2010-2022, however 14 of those deaths have taken place after the Aesthetic Surgery Education and Research Foundation (ASERF) guidelines and the Florida Board of Medicine BBL "subcutaneous-only" rule. The working environment at the clinics and the short surgical times for these cases, may be the most important contributors to the BBL mortality in South Florida.
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http://dx.doi.org/10.1093/asj/sjac224DOI Listing
August 2022

Two Cases Surviving Macro Fat Emboli Complications Following Gluteal Fat Grafting.

Aesthet Surg J 2022 Aug;42(8):902-906

Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Media attention has in recent years created an increased patient demand for gluteal contouring and augmentation. Gluteal augmentation and contouring with autologous fat transfer, colloquially referred to as the "Brazilian butt lift" (BBL), can be performed safely and effectively, with an overall complication rate ranging from 1.5% to 6.8%. However, there have been an alarming number of lethal events from intravenous passage of injected fat and fatal pulmonary embolism due to macro-fat emboli (MAFE). MAFE (fat emboli >1 cm in diameter), distinct from micro-fat emboli, can quickly result in catastrophic cardiopulmonary compromise and death. Accurate mortality estimates are limited by difficulties in determining accurate values for the total number of BBL procedures performed because most of these cases are performed at budget clinics. Accurate morbidity estimates are limited by a lack of published outcomes and a low level of evidence in published studies. The first case of survival of MAFE secondary to BBL was reported in 2019 by Peña et al. Few highly morbid complications secondary to MAFE have been reported because such events are almost universally lethal. We present 2 recent cases of survival after MAFE in the setting of gluteal fat transfer following expedient transfer to a tertiary care setting, allowing for timely and successful intervention. We illustrate examples of how MAFE is a highly lethal complication of gluteal fat grafting. Early recognition and immediate aggressive vital support to stabilize the patient are key for survival.

Level Of Evidence: 5:
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http://dx.doi.org/10.1093/asj/sjac063DOI Listing
August 2022

Changes in Opioid Prescribing Patterns: A Survey of the Florida Society of Plastic Surgeons.

Ann Plast Surg 2020 12;85(6):e54-e58

From the Division of Plastic, Aesthetic and Reconstructive Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard Miller School of Medicine, University of Miami, Miami, FL.

Introduction: With thousands of people in the United States dying of opioid overdose each month, the opioid epidemic has become a serious public health concern. Legislators have attempted to address this problem at various levels of the government. Evaluation of outcomes of these measures is a necessary part of resolving the epidemic. Our survey was designed to evaluate the impact of measures enacted in Florida State in 2018 upon prescribing practices of plastic surgeons.

Methods: The survey was prepared electronically using the online Qualtrics platform. Survey questions were multiple choice and inquired regarding changes in prescribing practices after enactment of mandatory query of the prescription drug monitoring program database and prescribing limits in Florida. The survey was distributed by e-mail 1 year after these laws took effect. Two survey reminder e-mails were sent at 2-week intervals after the initial message. Results were collected for an additional 3 weeks after the final correspondence.

Results: Thirty-two survey responses were received after distribution to the 156 members of the Florida Society of Plastic Surgeons, for a response rate of 20.5%. Twenty-two respondents reported changing their prescribing practices. The most common change reported was decreased number of tablets prescribed. Most respondents reported they believe that mandatory prescription drug monitoring program query and prescribing limits will be effective. This included 17 (53.1%) and 18 (56.3%) respondents, respectively.

Conclusions: Results from our survey indicate that Florida plastic surgeons have adjusted their prescribing practices in response to recently enacted legislation. Most plastic surgeons reported decreased number of tablets of opioids prescribed. Many also reported incorporating nonopioid analgesics. Further study will be necessary to determine the impact of these changes on rates of opioid overdose.
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http://dx.doi.org/10.1097/SAP.0000000000002318DOI Listing
December 2020

Response to "Comments on: Commentary on: 'The Potential Role of Corticosteroid Prophylaxis for the Prevention of Microscopic Fat Embolism Syndrome in Gluteal Augmentations'".

Authors:
Onelio Garcia

Aesthet Surg J 2020 01;40(2):NP80-NP81

Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL.

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http://dx.doi.org/10.1093/asj/sjz294DOI Listing
January 2020

Commentary on: The Potential Role of Corticosteroid Prophylaxis for the Prevention of Microscopic Fat Embolism Syndrome in Gluteal Augmentations.

Authors:
Onelio Garcia

Aesthet Surg J 2020 01;40(1):90-92

Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL.

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http://dx.doi.org/10.1093/asj/sjz196DOI Listing
January 2020

Management of Asymmetry After Breast Reduction.

Authors:
Onelio Garcia

Clin Plast Surg 2016 Apr 3;43(2):373-82. Epub 2016 Feb 3.

Division of Plastic Surgery, University of Miami, Miller School of Medicine, 3850 Bird Road, Suite 102, Miami, FL 33146, USA. Electronic address:

Breast reduction surgery has achieved one of the highest patient satisfaction rates among plastic surgery procedures. Most of the complications encountered are usually minor and related to wound healing. Revision surgery to address these problems is common and usually consists of scar revisions. Postoperative breast asymmetry of a mild degree is also common; however, postoperative asymmetry severe enough to warrant surgical revision is a rare event, occurring in less than 1% of cases. Postmammaplasty revision surgery needs to be individualized. The asymmetry could be the result of nipple malposition or it could consist of a volume or shape discrepancy between the breast mounds.
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http://dx.doi.org/10.1016/j.cps.2015.12.002DOI Listing
April 2016

Histologic characterization of acellular dermal matrices in a porcine model of tissue expander breast reconstruction.

Tissue Eng Part A 2015 Jan 29;21(1-2):35-44. Epub 2014 Sep 29.

1 Department of Bioengineering, University of Pittsburgh , Pittsburgh, Pennsylvania.

Background: Acellular dermal matrices (ADMs) have been commonly used in expander-based breast reconstruction to provide inferolateral prosthesis coverage. Although the clinical performance of these biologic scaffold materials varies depending on a number of factors, an in-depth systematic characterization of the host response is yet to be performed. The present study evaluates the biochemical composition and structure of two ADMs, AlloDerm(®) Regenerative Tissue Matrix and AlloMax™ Surgical Graft, and provides a comprehensive spatiotemporal characterization in a porcine model of tissue expander breast reconstruction.

Methods: Each ADM was characterized with regard to thickness, permeability, donor nucleic acid content, (residual double-stranded DNA [dsDNA]), and growth factors (basic fibroblast growth factor [bFGF], vascular endothelial growth factor [VEGF], and transforming growth factor-beta 1 [TGF-β1]). Cytocompatibility was evaluated by in vitro cell culture on the ADMs. The host response was evaluated at 4 and 12 weeks at various locations within the ADMs using established metrics of the inflammatory and tissue remodeling response: cell infiltration, multinucleate giant cell formation, extent of ADM remodeling, and neovascularization.

Results: AlloMax incorporated more readily with surrounding host tissue as measured by earlier and greater cell infiltration, fewer foreign body giant cells, and faster remodeling of ADM. These findings correlated with the in vitro composition and cytocompatibility analysis, which showed AlloMax to more readily support in vitro cell growth.

Conclusions: AlloMax and AlloDerm demonstrated distinct remodeling characteristics in a porcine model of tissue expander breast reconstruction.
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http://dx.doi.org/10.1089/ten.TEA.2014.0095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292858PMC
January 2015

Analysis of acellular dermal matrix integration and revascularization following tissue expander breast reconstruction in a clinically relevant large-animal model.

Plast Reconstr Surg 2013 May;131(5):741e-751e

Miami, Fla.; and Providence and Warwick, R.I. From the Division of Plastic Surgery, University of Miami, Miller School of Medicine; the Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University; and C. R. Bard, Inc. (Davol).

Background: Postmastectomy breast reconstruction remains one of the most frequently performed plastic surgery procedures in the United States. Acellular dermal matrix has been used extensively in expander-implant breast reconstruction and therefore is an appropriate material to be used to develop a clinically relevant animal model of breast reconstruction.

Methods: The study population consisted of 18 female Yorkshire pigs, which were assigned randomly to bilateral expander breast reconstruction with either AlloMax Surgical Graft or AlloDerm Regenerative Tissue Matrix (n = 9 per group). Each group was further randomized to 4-, 8-, or 12-week time points (n = 3), to evaluate integration and neovascularization by means of microcirculatory and histologic techniques.

Results: Microcirculatory analysis revealed early acellular dermal matrix angiogenesis at 4 weeks on the skin flap surfaces only, and well-formed vasculature on both acellular dermal matrix surfaces at 8 weeks. Both surfaces were vascularized and exhibited detectable flow at 12 weeks after implantation. Progressive acellular dermal matrix angiogenesis was also histologically observed over time by means of hematoxylin and eosin-stained slides, as indicated by direct vascular identification/scoring at 4, 8, and 12 weeks.

Conclusions: The authors have developed a clinically relevant large-animal model of breast reconstruction using acellular dermal matrix. The acellular dermal matrix inflammatory, neovascularization, and tissue integration response should be evaluated in an in vivo setting that accurately simulates the anatomy, biomaterials, surgical techniques, and timeframes encountered in human postmastectomy breast reconstruction to appropriately predict clinical performance. Neovascularization of the acellular dermal matrix with detectable blood flow took place after postimplantation week 8, a much slower process than previously reported in models not clinically relevant to acellular dermal matrix-assisted tissue expander breast reconstruction.
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http://dx.doi.org/10.1097/PRS.0b013e3182865c6dDOI Listing
May 2013

The effects of nonfocused external ultrasound on tissue temperature and adipocyte morphology.

Aesthet Surg J 2013 Jan 7;33(1):117-27. Epub 2012 Dec 7.

Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL 33146, USA.

Background: Nonfocused externally applied ultrasound energy has been used extensively in the clinical setting for noninvasive body contouring on the premise that ultrasonic diathermy may have a reducing effect on adipose tissue.

Objectives: The authors document both the time/temperature relationships and cellular changes following nonfocused and weakly focused ultrasound treatments in an animal model.

Methods: Nonfocused ultrasound treatments were administered to 3 Yorkshire pigs, at clinically recommended settings, for two 12-minute intervals. Tissue temperatures were recorded. Lymph fluid samples were taken pretreatment from the control side and posttreatment from the treated side. Biopsies were taken of the skin, adipose tissue, muscle, and lymph nodes on both the control side (pretreatment) and the ultrasound-treated side (posttreatment) for histological examination.

Results: Lymph fluid analysis revealed highly elevated triglyceride values on the treated side versus the control. Analysis of lymph node biopsies revealed free vacuoles of fat within the lymph node tissue on the treated side compared with normal controls. In situ temperature measurements indicated that the device produced uniform heating throughout the adipose tissue layer. Electron microscopy of the treated adipose tissue revealed alterations in the cellular architecture without necrosis and free lipids within the extracellular space.

Conclusions: On the basis of the increase of free lipids in the lymph system posttreatment, the increase in free lipids within the lymph nodes on the treated side, and the free lipids in the extracellular space without cell necrosis, we conclude that treatment with this device reduces adipose tissue by altering the permeability of the adipocytes.
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http://dx.doi.org/10.1177/1090820X12469627DOI Listing
January 2013

Comparative analysis of blood loss in suction-assisted lipoplasty and third-generation internal ultrasound-assisted lipoplasty.

Aesthet Surg J 2008 Jul-Aug;28(4):430-5

Division of Plastic Surgery, Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA.

Background: Lipoplasty remains the most common cosmetic surgical procedure performed in the United States. In spite of its well documented clinical advantages, ultrasound-assisted lipoplasty (UAL) accounts for less than 20% of all lipoplasty procedures currently performed.

Objective: The purpose of this study is to determine the blood content of third-generation internal UAL aspirate and compare it to traditional lipoplasty aspirate.

Methods: The lipoplasty aspirate of 27 consecutive patients who underwent traditional suction-assisted lipoplasty (SAL) of their back and posterior flanks was compared to the aspirate of 30 consecutive patients who underwent third-generation internal UAL of their backs and posterior flanks using the VASER Internal Ultrasound Device (Sound Surgical Technologies; Louisville, CO). The volume and composition of the wetting solution used was the same for both groups. The aspirate analysis was performed by an independent laboratory on a Beckman Coulter LH 750 blood analyzer (Fullerton, CA) and consisted of complete blood counts after separation of the fat.

Results: The hemoglobin content of SAL aspirate was 7.5 times greater than in the aspirate. The hematocrit value of SAL aspirate was 6.5 times greater than in the VASER-assisted lipoplasty aspirate. Statistical analysis using an independent t test confirmed that the data was statistically significant with P values of < .0001 for both hemoglobin content and hematocrit values.

Conclusions: We conclude that third-generation internal UAL should be considered for patients undergoing large-volume lipoplasty procedures or lipoplasty of tight, fibrous areas, such as the back and posterior flanks, where increased blood loss is expected.
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http://dx.doi.org/10.1016/j.asj.2008.04.002DOI Listing
April 2009

Reconstruction of total absence of the breast.

Authors:
Onelio Garcia

Ann Plast Surg 2007 Jan;58(1):12-7

Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.

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http://dx.doi.org/10.1097/01.sap.0000250751.58504.86DOI Listing
January 2007
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