Tridimensional Combined Gluteoplasty: Liposuction, Buttock Implants, and Fat Transfer.

INTRODUCTION: Many studies of gluteal augmentation techniques have been published in recent decades, including case reports, retrospective and prospective case series, and multicenter survey reviews. However, to date, there has been no study of the overall complications or satisfaction rates associated with the wide spectrum of techniques. This comprehensive literature review aims to determine outcomes and complications of gluteal augmentation techniques, including patient satisfaction. MATERIALS AND METHODS: A search on PubMed/Medline was performed with the following search algorithm: ((gluteoplasty) OR (buttock augmentation) OR (gluteal augmentation)) AND ((etiology) OR (epidemiology) OR (classification) OR (indications) OR (treatment)). The inclusion criterion was clinical studies in which techniques of gluteal augmentation were described. Excluded from the study were publications not dealing with surgical procedures, review articles, and reports on secondary interventions. RESULTS: Forty-four studies, published from 1969 through 2015, were included; this represented 6909 treated patients. Five gluteal augmentation techniques were identified from these studies: gluteal augmentation with implants (n=4071), autologous fat grafting (n=2394), local flaps (n=349), hyaluronic acid gel injection (n=69), and local tissues rearrangement (26). The overall complication rates of the two most commonly utilized techniques were 24.3% for gluteal augmentation with implants and 8.6% for autologous fat grafting. The most common post-operative complications included wound dehiscence (5.1%) after gluteal augmentation with implants and seroma of the donor site (3.5%) after autologous fat grafting. Patient satisfaction was reported as consistently high for all the five techniques. CONCLUSIONS: There is great heterogeneity of surgical methods for gluteal augmentation, which yield different outcomes. Implant-based gluteal augmentation is associated with high patient satisfaction despite a high complication rate. Autologous fat grafting is associated with lower complication rate, although provides variable results in terms of volume retention. Further prospective studies with preoperative randomization of patients are required to compare different techniques and establish best practices.

Gluteal Augmentation and Contouring with Autologous Fat Transfer: Part I

Career and Job Satisfaction

Gluteal augmentation is one of the most requested cosmetic procedures. This article describes the surgical technique and early results of an innovative minimally invasive video-assisted submuscular gluteal augmentation with implants. The authors aimed to perform a technique that would reduce complications and surgical time. Fourteen healthy women without obesity or relevant pathologic background who requested gluteal augmentation with implants as a single procedure were included. The procedure was performed through bilateral parasacral 5-cm incisions at cutaneous and subcutaneous planes as far as the gluteus maximus muscle fascia. Through a 1-cm incision in the fascia and muscle, the index finger was introduced under the gluteus maximus, and a submuscular space was created by blunt dissection toward the greater trochanter to avoid a sciatic nerve injury, until the middle gluteus level was reached. Next, the balloon shaft of a Herloon trocar was introduced in the dissected space. Balloon dilatation in this submuscular space was performed as required. The balloon shaft was replaced by the trocar, through which a 30-degree 10-mm laparoscope was introduced. Submuscular pocket anatomic structures were observed, and while the laparoscope was being retrieved, hemostasis was verified. The submuscular plane collapsed, leaving the pocket for the implant to be placed. There were no intraoperative complications. The only postoperative complication was a self-limited seroma in one patient (7.1%). This innovative technique was simple to perform and safe, allowing direct visualization and hemostasis, with a short surgical time, low complication rate, and high degree of satisfaction.

Introduction: We sought to compare our experience in the 2 primary techniques for buttock augmentation and determine if one is clearly superior to the other from the standpoints of complications, postoperative pain, and patient satisfaction. Materials and Methods: A retrospective search of patient records was performed for the period 2008–2011. A total of 129 patients were identified as having undergone buttock augmentation, 33 via fat transfer with stem cell therapy and 96 by way of silicone prosthesis. Complications were tabulated. Medcalc version 12.1 was used for analysis. Results: Over a 4-year period, we found that a total of 96 implant augmentations had been performed versus 33 fat-grafting augmentations. The overall satisfaction of the patients receiving buttock augmentation was 76.0% (73/96) for augmentation with implants and 69.7% (23/33) for augmentation with fat, which was statistically significant ( P < .001; 95% confidence interval [CI], 67.93–71.47). Seroma formation was more prevalent in the implant group (3.0% versus 17.7%; P = .02; 95% CI, 0.070–15.7). Lumps or dents were more prevalent in the fat-grafting group (33.3% versus 2.1%; P < .0001; 95% CI, 17.9–51.8). Complications isolated to those undergoing implant augmentation included dehiscence (14.6%) and contracture (13.5%). Conclusions: Although fat grafting for buttock augmentation is rising in popularity among surgeons, its results are not as consistent as those seen with buttock implant augmentation. This consistency of results is offset by the risk of capsular contracture and dehiscence, which are seen in implant surgery. Cosmetic surgeons should be aware of both techniques in buttock augmentation and their respective risks and benefits.

While the work situation for nurse assistants in residential care is strenuous, they themselves often state that they are satisfied with their job. More knowledge is clearly needed of the interrelationship of variables associated with job satisfaction. This study aims to investigate job satisfaction and explore associated variables among nurse assistants working in residential care. A total of 225 respondents completed a questionnaire measuring general job satisfaction, satisfaction with nursing-care provision and measures concerning person-centered care, work climate, leadership, and health complaints. Job satisfaction was the outcome measure and comparisons were made among those reporting low, moderate, and high levels of job satisfaction; multiple regression analyses were used to explore associated variables. The caring climate and personalized care provision were associated with general job satisfaction. High levels of satisfaction with nursing-care provision were also associated with the general work climate, organizational and environmental support, and leadership. Low job satisfaction was mainly associated with health complaints. Nurse assistants working in a positive work climate, caring climate, with a positive attitude to their leaders, who receive organizational and environmental support, provide person-centered care and experience a higher degree of job satisfaction. It seems essential, however, to include both general and context-specific measures when investigating job satisfaction in this field as they reveal different aspects of the nurse assistant's work situation.

This case study examines consumer satisfaction levels and the number of complaints about the Trendyol brand posted on the sikayetvar.com website. This research presents the approach to analyzing the content of electronic complaints and categorizing them via the MAXQDA 2020 data analysis software. The results concur with published research that has observed that the lesser-known brands with low trade volume have high satisfaction levels and a small number of complaints, while well-known brands with high trade volume have high complaints and low satisfaction levels. Consumer dissatisfaction and negative brand image categories account for 54.76% of the complaints. In addition, it has been concluded that supply and cargo problems cause consumer dissatisfaction, and consumer dissatisfaction can negatively affect the brand image. In this context, the consumer-based equity of the brand may increase when the reproach and distrust of the brand decrease. Complaints of other electronic commerce companies can be also examined in prospective studies and their code-related maps can be created, compared, and partially combined in working towards producing a canonical theme, code, and exemplary expressions.

The combination of liposuction and abdominoplasty has been slow to be accepted, primarily due to a perceived higher incidence of complications associated with the procedure. There has also been extensive debate about the combined procedure's effects on flap vascularity and viability and the extent to which liposuction may be performed in conjunction with surgical abdominoplasty. The authors present data from their four-year experience supporting lipoabdominoplasty as a safe and effective procedure for body contouring. The authors retrospectively reviewed a case series of lipoabdominoplasties performed between 2004 and 2008 by the senior author (KK). A total of 173 consecutive patients who presented for abdominal contouring were included in the study. Each patient underwent a combined procedure beginning with liposuction utilizing the superwet technique, followed by an inverted V-pattern abdominoplasty. Of the patients included in this study, 171 (98.8%) were women and two (1.2%) were men. The average age of the patients was 41.53 years, and the average body mass index was 26. The average amount of total lipoaspirate from the flanks was 2166.09 mL, and the average specimen weight resected was 972.80 g. Complications included partial dehiscence/skin necrosis (12 patients; 6.9%), infection requiring antibiotic therapy and/or intervention (13 patients; 7.5%), suture spitting (one patient; 0.5%), seroma (six patients; 3.4%), major fat necrosis requiring local debridement (one patient; 0.5%), and skin flap necrosis requiring readvancement of the abdominal flap (two patients; 1.1%). There was a revision rate of 8.0%: two patients required additional liposuction to smooth out unevenness, five patients required scar revision, and seven patients had dog-ears requiring intervention. All revisions were performed under local anesthesia. There were also five instances of confirmed deep vein thrombosis (2.8%) and two cases of pulmonary embolism requiring hospitalization (1.1%). The senior author's (KK) lipoabdominoplasty technique, combined with his current preoperative and postoperative protocols, is believed to be a safe procedure that results in excellent cosmetic results. In contrast to some of the current literature, the data show a reduction of overall complications as compared to historical norms.

This pioneering study evaluates the safety, efficacy, and Aesthetic outcomes of Ergonomix2 Motiva Ergonomic Implants in breast augmentation. It aims to assess their capability to offer more natural touch and dynamics, delineate the learning curve for surgical techniques, and examine their safety profile compared to Ergonomix1 implants. A prospective cohort study was conducted, comparing 31 patients who received Ergonomix2 implants with a control group of 51 patients with Ergonomix1 implants. Eligible patients were those seeking Aesthetic breast augmentation without prior surgeries or chronic illnesses. Detailed documentation of surgical techniques, implant characteristics, and patient demographics was performed. The study assessed surgical learning curve, implant positioning accuracy, and short-term and early complications. Aesthetic outcomes were evaluated using the BreastQ questionnaire and quantitative elastography. Patients with Ergonomix2 implants showed significant improvements in Aesthetic outcomes, including breast contour symmetry and natural feel. The learning curve demonstrated a decrease in surgical time and higher implant positioning accuracy. The safety profile was favorable, with a low complication rate and high patient satisfaction levels. Ergonomix2 implants exhibited enhanced softness and pliability, closely mimicking natural breast tissue, as confirmed by elastographic analyzes. Ergonomix2 implants represent a significant advancement in Aesthetic breast surgery, offering natural-feeling and dynamically adaptable outcomes. Despite the promising results, the need for specialized surgical techniques and further research on long-term safety and efficacy is emphasized. This study contributes foundational knowledge to the field of ergonomic breast implants and their application in modern plastic surgery. 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 .

Gluteal augmentation procedures are gaining popularity and encompass a variety of surgical techniques and methods of graft preparation. While surgical history remains essential for diagnosis, the radiologist must avoid pitfalls and rely on imaging features to recognize both the expected appearance and complications of gluteal augmentation procedures. We report a case of a slowly growing buttock mass after gluteal augmentation with autologous fat transfer 1year after surgery. The potential diagnostic imaging pitfalls and characteristics on ultrasound and contrast-enhanced MRI are discussed. Multiplicity of fat-containing lesions depicted on large field-of-view images and granulated appearance of the intralesional fat on MRI should allow the radiologist to recognize the appearance of failed fat graft incorporation that can present as a slowly growing encapsulated collection with layered fat and fluid contents.

Background: Loss of all teeth in the elderly is one of the effects of the aging process. Treatment using complete dentures can be a solution for the elderly to restore aesthetic, phonetic, and masticatory functions. Patient satisfaction is the result of patient evaluation that is formed through emotional responses, such as happiness feelings of pleasure and satisfaction arising from the results of a job. One of the goals in complete denture treatment is the success of the treatment. Success of denture treatment can be judged from patient satisfaction. Aim: To describe the level of satisfaction in the elderly who wear complete dentures. Method: This type of research is descriptive observational with a cross-sectional design. This research was conducted by distributing PDA-ID (Patients Denture Assessment-ID) questionnaires to 22 elderly people at the Sasana Tresna Werdha Ria Pembangunan orphanage. Result: There are 21 respondents out of a total of 22 respondents had a high level of satisfaction with the complete denture used. 1 respondent who has a low level of satisfaction with complete dentures make dentures at a dental handyman. Conclusion: Most of the elderly respondents who use complete dentures at the Sasana Tresna Werdha Ria Pembangunan nursing home have a high level of satisfaction with the complete dentures used.

With the increase in popularity of fat transfer to the buttocks in body contouring surgery, new patient subsets are emerging. The gender confirmation patient has specific characteristics that must be addressed to achieve the best outcomes. The authors performed an observational prospective study including 36 consecutive patients who underwent body feminization as a gender affirming operation using large-volume fat transplantation with or without gluteal implants. Thirty-six consecutive male-to-female transgender patients have undergone large-volume fat transplantation to the buttocks performed by the authors, between July of 2016 and January of 2019. In 12 of these 36 cases, large-volume fat grafting was supplemented by intramuscular placement of silicone implants. The mean waist-to-hip ratio before surgery was 1.11, and this improved to 0.81 after surgery (fat transfer-only group, 0.88; fat transfer plus implants group, 0.75). The transgender patient is a unique patient requiring a specific set of surgeon's skills and intraoperative strategies to achieve good outcomes. Composite solutions with both implants and lipofilling lead to better outcomes in terms of waist-to-hip ratio in these patients. Therapeutic, IV.

ObjectiveChina is attempting to establish a voluntary contracting system in primary care. This study aimed to determine the degree of consumer satisfaction with the entitlements of contract arrangements and its associated factors.MethodsA stratified cluster sampling strategy was adopted to recruit study participants from three administrative districts of Hangzhou municipality, each containing six residential communities. In each community, 50 households were recruited. A questionnaire was administered through face-to-face interviews with members of the households who signed a contract with community health centers, to collect data regarding their sociodemographic characteristics, health conditions, and knowledge of and attitudes toward the contract entitlements. Consumer satisfaction was measured using six items rated on a five-point Likert scale ranging from “1=very dissatisfied” to “5=very satisfied” and a summed score was calculated. A mixed linear regression model was established to identify individual predictors of consumer satisfaction after adjustment of the random (intercept) effect of household clusters.ResultsOverall, the respondents reported low levels of awareness and understanding of the contract entitlements, with an average knowledge score of 8.21 (SD = 3.74) out of a maximum possible of 19. The respondents had relatively lower levels of satisfaction (satisfied or very satisfied) with their prioritized entitlements (51.5%) and hospitals at home and telemedicine services (31.3%), compared with the contract and insurance policies (85.5%) and medical services provided (87.0%). Female gender, older age, chronic conditions, and perceived better health were associated with higher levels of satisfaction, while poor awareness and knowledge were associated with lower levels of satisfaction.ConclusionThe study participants perceived limited benefits from the contract arrangements in primary care, which may jeopardize the policy purpose of the arrangements to encourage patients to use primary care as the first contact point in accessing health care services. It is evident that consumer satisfaction with the contract entitlements varies by healthcare needs. Lower levels of satisfaction are associated with poor awareness and knowledge of the entitlements.

Sir: The government of Canada introduced round silicone gel implants to the Canadian market through the Special Access Program in 1999. Anatomical silicone gel implants became available through the Special Access Program in 2000. There has been a large increase in the use of silicone implants by Canadian plastic surgeons since the Special Access Program reintroduced them into the Canadian market in 2000. This increase is consistent across all provinces in Canada. The most dramatic increase in use has been for breast augmentation (Fig. 1).Fig. 1.: Silicone implant use in Ontario from 2000 to 2005 according to type of surgery.Health Canada lifted the restricted use label in October of 2006, granting licenses to Allergan, Inc. (Irvine, Calif.) and Mentor Medical Systems (Santa Barbara, Calif.) to market their silicone gel implants in Canada.1 The U.S. Food and Drug Administration quickly followed suit in November of 2006, also approving the marketing of silicone gel implants made by Allergan and Mentor for breast reconstruction and augmentation.2 A survey tailored to practicing plastic surgeons in Ontario was designed to evaluate surgeons’ attitudes toward the use of silicone implants for breast reconstruction and augmentation procedures. There was a 64 percent (89 of 140) response rate to the survey. Although silicone implants were the most common preference for reconstruction patients (46 percent), saline implants (21 percent) and autologous tissue (30 percent) were also commonly indicated as preferences. Surgeon preferences were more evenly divided for their augmentation patients, as 45 percent preferred silicone implants, 45 percent preferred saline implants, and 10 percent indicated they made their choice based on the patient’s preference. Many surgeons felt that shape (54 percent), consistency (78 percent), and durability (41 percent) were benefits of silicone implants. Few surgeons (<3 percent) rated these qualities as advantages of saline implants. However, 75 percent of surgeons listed other advantages of saline implants, including a smaller incision for insertion, less patient anxiety, and less expense for the patient. Surgeons were asked to consider the following earlier controversies surrounding silicone implants: Increased cancer risk Increased risk of connective tissue diseases Increased incidence of fibromyalgia Existence of systemic silicone syndrome The majority of surgeons currently feel that all of these issues are likely either false or will be proven to be false. Surgeons were then asked how much these issues currently influence their decision to recommend silicone implants to either reconstruction or augmentation patients. With regard to the reconstruction patients, 38 percent feel these issues do not at all influence their decision to recommend silicone implants. However, 17 percent feel these issues affect their decision to recommend silicone implants greatly, and 33 percent feel they affect their decision moderately. With regard to augmentation patients, 36 percent feel these issues do not at all influence their decision to recommend silicone implants. However, 20 percent feel these issues affect their decision to recommend silicone implants greatly, and 39 percent feel they affect their decision moderately. Leading up to the release of silicone breast implants in Canada, plastic surgeons in Ontario had been using increasing numbers of silicone implants. This seems to reflect increased confidence in the safety of silicone implants. Many plastic surgeons feel that silicone implants have advantages over saline implants, including shape, consistency, and durability, which also may in part account for the resurgence of silicone implant use. We recognize that since Health Canada and the U.S. Food and Drug Administration have made silicone implants more accessible, some of the concerns noted in our survey may no longer be present. Laura Snell, M.D. Nancy Baxter, M.D. John L. Semple, M.D. Sunnybrook Women’s College Health Center Toronto, Ontario, Canada DISCLOSURE None of the authors has a financial interest in any of the products, devices, or drugs mentioned or implied in this article.

Background: Patient rights may be considered as one of the main bases for defining the standards of clinical services. On the other hand, the concept of patient rights has been on the rise alongside the ever-growing interest of international organizations in human rights. Also nurses have more responsibility than physicians in this regard, because they are usually in closer contact with patients than other health care workers. Thus, nurses are the most suitable supporters of their rights. Aim: The aim of the study was to assess nurses’ compliance toward patients' rights and its relation to patients’ satisfaction. Research Design: The study was conducted using descriptive comparative research design. Setting: The study was carried out Coronary Care Unit (CCU) at Minia General Hospital and Minia University Hospital in Minia city. Subject: participated ofthe study included a convenience of patients total number (n=110) patient admitted to hospitals, and all staff nurses who working in CCU during the period of data collection. Their total numbers were (55) nurses. Tool: Two tools were used; Nurses’ compliance to the patient’s rights questionnaire and patient satisfaction scale. Results: there was more than half at Minia University Hospital staff nurses had high level of compliance toward patients' rights as (51.9%), less than half of the sample had moderate level of compliance toward patients' rights as (48.1%), also none of them were low level of compliance toward patients' rights in the three times observation. But nurses in General Hospital had low level of compliance toward patients' rights in the first, second, and third observation as (25.9%, 55.6% and 59.3%) respectively, also more than one third to less than two thirds of them had moderate level of compliance toward patients' rights in the first, second, and third observation as (63%, 44.4% and 37%) respectively, but the lowest percent of them have high level of compliance toward patients' rights in in the first, second, and third observation as (11.1%, 0.0% and 3.7%) respectively. Also more than half (50.9%) of patient at Minia University Hospital exhibit the responses toward moderate level and low half (43.6%) of them responses toward high level of satisfaction. But the majority (87.3%) of patient at Minia general hospital exhibit the responses toward moderate level and (12.7%) of them responses toward low level ofsatisfaction. Conclusions: More than half of staff nurses had high level of compliance toward patients' rights and low half (43.6%) of patients responded toward high level of satisfaction at Minia University Hospital. But about half of staff nurses on second and third observation had low level of compliance toward patients' rights and the majority of patient exhibited the responses toward moderate level of satisfaction at General University Hospital. Recommendation: Nurse need to attend training program about patient rights that enhance patient satisfaction, also the hospital should made policy, rules and regulations that enhance patient rights