Letter to the Editor
Response to “Comments on ‘AbdominoplastyDerived Dermal-Fat Graft Augmentation Gluteoplasty’”
Aesthetic Surgery Journal 2015, Vol 35(3) NP80 © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: [email protected] DOI: 10.1093/asj/sju041 www.aestheticsurgeryjournal.com
Claude Muresan, MD; Gary M. Brownstein, MD; and Samir F. Shureih, MD
infection rate, and will alleviate the current skepticism regarding use of such a large nonpedicled graft.
Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
REFERENCES 1. Raposo do Amaral CE. Comments on abdominoplastyderived dermal-fat graft augmentation gluteoplasty. Aesthet Surg J. 2015;35(3):NP79. 2. Muresan C, Brownstein GM, Shureih SF. AbdominoplastyDerived Dermal-Fat Graft Augmentation Gluteoplasty. Aesthet Surg J. 2014;34(8):1234-1243. 3. Raposo do Amaral CE, Cetrulo CL Jr., Pereira CL, Guidi Mde C, Raposo do Amaral CM. Augmentation gluteoplasty with dermal-fat autografting from the lower abdomen. Aesthet Surg J. 2006;26(3):290-296.
Dr Muresan is a General Surgery Resident, Department of Surgery, Union Memorial Hospital in Baltimore, MD. Dr Brownstein is a plastic surgeon in private practice in Berlin, NJ. Dr Shureih is a plastic surgeon in private practice in Baltimore, MD. Corresponding Author: Dr Samir F. Shureih, 10 East 31st St, Baltimore, MD 21218, USA. E-mail: [email protected]
Downloaded from http://asj.oxfordjournals.org/ at Simon Fraser University on October 6, 2015
We thank Raposo do Amaral and his colleagues for their insightful critique1 of our article2 that detailed the use of our modified dermal-fat graft augmentation gluteoplasty operation. We read with equal interest the article by Raposo do Amaral et al3 that first described this type of operation and gave us the basis from which we developed our version. Our technique uses 2 intergluteal incisions, longtipped electrocautery, and lighted retractors. We chose these instruments, which are easily accessed, with the specific intention of making this operation readily reproducible and thus encouraging other plastic surgeons to attempt it. Indeed, we alluded to reproducibility in our article; the lead senior surgeon preformed the first 7 operations before discussing the technique with his colleague, who was then able to independently reproduce this procedure. Dissection of the pocket is the most challenging part of the operation; however, with meticulous dissection under clear visualization, it is readily achievable. Our technique encourages undermining of the pocket up to the gluteal crease in order to maximize lower pole fullness. The pocket is snug, not tight, much like that which one would achieve when creating a pocket in the breast for a free deep inferior epigastric perforator flap. Similar to what is done with deep inferior epigastric perforator flaps, we handle our dermalfat graft minimally with due respect. With regard to size, we can only speculate from the figures presented in the article by Raposo do Amaral et al3 that there may be a difference between the grafts used in the 2 series. To achieve the desired end of maximum posterior projection, we used larger grafts. This clearly necessitated use of long, lighted instruments and creation of a larger pocket. We trust that our series has done justice to the pioneering efforts of Raposo do Amaral et al and that both series will garner for the technique the attention it deserves. Certainly, further implementation of this novel procedure—especially in much needed larger prospective studies—will supply the necessary specifics, such as accurate determination of the
Response to “Comments on ‘AbdominoplastyDerived Dermal-Fat Graft Augmentation Gluteoplasty’”
Aesthetic Surgery Journal 2015, Vol 35(3) NP80 © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: [email protected] DOI: 10.1093/asj/sju041 www.aestheticsurgeryjournal.com
Claude Muresan, MD; Gary M. Brownstein, MD; and Samir F. Shureih, MD
infection rate, and will alleviate the current skepticism regarding use of such a large nonpedicled graft.
Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
REFERENCES 1. Raposo do Amaral CE. Comments on abdominoplastyderived dermal-fat graft augmentation gluteoplasty. Aesthet Surg J. 2015;35(3):NP79. 2. Muresan C, Brownstein GM, Shureih SF. AbdominoplastyDerived Dermal-Fat Graft Augmentation Gluteoplasty. Aesthet Surg J. 2014;34(8):1234-1243. 3. Raposo do Amaral CE, Cetrulo CL Jr., Pereira CL, Guidi Mde C, Raposo do Amaral CM. Augmentation gluteoplasty with dermal-fat autografting from the lower abdomen. Aesthet Surg J. 2006;26(3):290-296.
Dr Muresan is a General Surgery Resident, Department of Surgery, Union Memorial Hospital in Baltimore, MD. Dr Brownstein is a plastic surgeon in private practice in Berlin, NJ. Dr Shureih is a plastic surgeon in private practice in Baltimore, MD. Corresponding Author: Dr Samir F. Shureih, 10 East 31st St, Baltimore, MD 21218, USA. E-mail: [email protected]
Downloaded from http://asj.oxfordjournals.org/ at Simon Fraser University on October 6, 2015
We thank Raposo do Amaral and his colleagues for their insightful critique1 of our article2 that detailed the use of our modified dermal-fat graft augmentation gluteoplasty operation. We read with equal interest the article by Raposo do Amaral et al3 that first described this type of operation and gave us the basis from which we developed our version. Our technique uses 2 intergluteal incisions, longtipped electrocautery, and lighted retractors. We chose these instruments, which are easily accessed, with the specific intention of making this operation readily reproducible and thus encouraging other plastic surgeons to attempt it. Indeed, we alluded to reproducibility in our article; the lead senior surgeon preformed the first 7 operations before discussing the technique with his colleague, who was then able to independently reproduce this procedure. Dissection of the pocket is the most challenging part of the operation; however, with meticulous dissection under clear visualization, it is readily achievable. Our technique encourages undermining of the pocket up to the gluteal crease in order to maximize lower pole fullness. The pocket is snug, not tight, much like that which one would achieve when creating a pocket in the breast for a free deep inferior epigastric perforator flap. Similar to what is done with deep inferior epigastric perforator flaps, we handle our dermalfat graft minimally with due respect. With regard to size, we can only speculate from the figures presented in the article by Raposo do Amaral et al3 that there may be a difference between the grafts used in the 2 series. To achieve the desired end of maximum posterior projection, we used larger grafts. This clearly necessitated use of long, lighted instruments and creation of a larger pocket. We trust that our series has done justice to the pioneering efforts of Raposo do Amaral et al and that both series will garner for the technique the attention it deserves. Certainly, further implementation of this novel procedure—especially in much needed larger prospective studies—will supply the necessary specifics, such as accurate determination of the
