Invited Discussion on: High Definition Lipoabdominoplasty
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: High Definition Lipoabdominoplasty Francisco G. Bravo1
Received: 9 September 2020 / Accepted: 9 September 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors. www.springer.com/00266. It was a pleasure to read the paper by Tiago Sarmento Sima˜o entitled ‘‘High Definition Lipoabdominoplasty’’ [1]. The author presents a retrospective study of 146 patients in which he performed a procedure similar to the one originally proposed by Alfredo Hoyos [2] but ‘‘without the need to use expensive technologies for fat emulsification.’’ This indeed has been considered as a possible shortcoming of the technique described by Hoyos [3] and the investigation on whether similar results may be obtained without the concomitant use of energy devices warrants the interest of this study and others [4]. The strength of the paper lies in the considerable series of patients operated on by a single surgeon, which is invaluable when assessing outcomes of complex procedures with multiple surgical steps and techniques in which results and complications oftentimes rely on the experience and artistry of the specialist performing the surgery. The recollection and analysis of the complications occurring postoperatively are thorough and allows the author to rightly make conclusions regarding the safety of the technique proposed. The mean follow-up was 10.6 months, with the longest follow-up being 2 years. Unfortunately, the minimum follow-up, as presented in Table 2, was only 2 months, which & Francisco G. Bravo [email protected] 1
Clinica Gomez Bravo, c/ Claudio Coello 76, 28001 Madrid, Spain
may have caused an underreporting of some complications presented in Table 3, such as hypertrophic scarring or irregularities, which often do not become apparent initially. An analysis of the aesthetic results achieved, carried out either by independent observers or by the patients themselves, would have added value to the paper, although the outcomes of 6 patients are illustrated through preoperative and postoperative photographs, showing excellent results. Regarding these, the omission of images in the threequarter view is surprising, as this is probably the view that provides the most information about the fine improvements in contour, which are the hallmark of high definition remodeling. The lack of standardization and inconsistency in lighting between the preoperative and postoperative photographs of the patients presented, is also unfortunate, as it is precisely the presence of shadows and highlights in specific anatomic areas which define the success of the procedure and these can easily be modified independently from surgery, by altering the direction and intensity of the light source bet
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