Since the latter half of the twentieth century, there has been an increasing focus on the body as a vehicle for identity and self-expression, with a greater recognition of the role of appearance and the desire for self-improvement.
A naturally harmonious body contour is usually the result of a fortunate genetic heritage, appropriate calorie intake, a healthy lifestyle, or a combination of these factors. The development of liposuction provided Prof. Moawd with a safe and effective way to surgically sculpt the human figure and correct any aesthetic deficiencies resulting from nature or lifestyle choices.
The procedures and instrumentation used in liposuction procedures have evolved significantly since the technique was first introduced. Dry liposuction has given way to various forms of tumescent procedures.
At the same time, techniques involving new devices and instrumentation, such as power assisted (PAL), ultrasound-assisted liposuction (UAL), radiofrequency assisted RAL) and laser-assisted liposuction (LAL), have been introduced. Prof Moawad’s experience (more than 30 years) showed that externally applied ultrasound energy and vibro-liposuction or power assisted (PAL) are most advantageous add to traditional use of tumescent liposuction with suction machine assisted, micro-cannula and syringe liposuction.
Patients with body dysmorphic disorder will not benefit from surgical fat intervention and have been observed in aesthetic surgery settings to seek surgical enhancement at a reported prevalence of 6 to 15 percent.
The current recommendation is for the patient to be within 30 percent of the ideal body mass index, but whether liposuction can be a contributing factor to weight loss in individuals with a high body mass index is an area of controversy.
Massive weight loss patients may have persistent areas of lipodystrophy amenable to liposuction.
In 2014, liposuction replaced breast augmentation as the most frequently performed surgical procedure, with a 16 percent increase over 2013 and more than $1 billion being spent on the procedure in the United States alone.
Hyperhidrosis, a disorder of excessive sweat, may be focal, involving specific areas of the body, or generalized, involving the entire body. Focal hyperhidrosis most commonly affects the axillae, hands, feet, and face. Axillary hyperhidrosis is due to overactivity of eccrine glands, unlike axillary osmidrosis, which is mainly apocrine in origin. Symptomatic hyperhidrosis is always accompanied by the “goaty odor” of apocrine bromhidrosis and clothing discoloration.
Hyperhidrosis may have significant effects on patients’ lives including social embarrassment; interference with intimacy, activities of daily living, and certain kinds of employment; and physical discomfort and a negative impact on health-related quality of life (QOL).
Early identification and proper management of patients with hyperhidrosis are crucial to lessen the emotional, psychosocial, and physical impact of their condition. The most important guideline for clinicians is to choose an effective treatment without major complications.
Local surgical intervention has been found to be the best curative method for axillary bromhidrosis. It appears to be the most applicable to eliminate the malodor and hyperhidrosis, because most of the apocrine and eccrine glands are located in the subcutaneous tissue and the dermo-subcutaneous junction and there is no need to remove the skin.
Since Prof Moawad master Liposuction for 30 years, he pioneered liposuction of apocrine as well as eccrine glands through one or two tiny incision holes. The success of this technique may be due to disruption of the nerve supply to the sweat glands and removal or destruction of the apocrine glands that are present in high density in the axilla.
He believes that axillary liposuction is the treatment of choice with high efficacy, low complication rate, minimal low rate and minimal post-operative care.
Fat transfer is now one of the most common aesthetic procedures performed. Use of fat avoids the complications of other fillers, including solid and injectable, both temporary and permanent. Fat for transfer is available on almost all patients so that there is essentially no cost.
Local anesthesia and/or tumescent local anesthesia are most commonly used, and this increases the safety of the procedure.
The effects of fat transfer are marked, resulting in a younger appearance, completing the three-dimensional correction of the face, and elevating depressions and deficits. Fat transfer may also prevent excessive fibrosis in non-cosmetic applications. The techniques have improved allowing better volume retention of fat.
In recent years, there has been an increase in the use of autologous fat to correct soft tissue defects from trauma, congenital defects, radiation damage, and cancer. Additionally, there has been interest and use in aesthetic rejuvenation through volume enhancement with fat. Volume enhancement restores a more youthful contour and shape to the face.
Soft tissue deficits, contour defects, and volume depletion are commonly encountered in the surgical management of traumatic injuries, congenital malformations, and aging.
Despite recent advancements in the treatment of soft tissue defects, there has been no perfect management, until perhaps now, with improvements in both harvesting and transferring of lipoaspirate. Therapies have traditionally been limited to prosthetic implants, injectable Non-autologous fillers, dermal fat grafts, and pedicled and free tissue flaps, all of which possess drawbacks.
Fat grafting is particularly appealing, in part due to the abundance of autologous adipose tissue, the relative ease of harvesting, and the longevity of the grafts due to improvement in techniques.
It has been written that ‘‘there is no single disease which causes more psychic trauma, more maladjustment between parent and children, more general insecurity and feelings of inferiority and greater sums of psychic suffering than does acne vulgaris.’’
Acne scars lead to emotional debilitation, embarrassment, poor self-esteem, social isolation, preoccupation, low confidence, altered social interactions, body image alterations, identity difficulties, anger, frustration, confusion, unemployment, lowered academic performance, exacerbation of psychiatric disease, anxiety, or depression.
Treatment of the true scars resulting from acne must reflect several considerations by the physician. Cost of treatment, severity of lesions, physician goals, patient expectations, side-effect profiles, psychological or emotional effect to the patient, and prevention measures should all play a role. The goal of any intervention is for improvement, not for a total cure or perfection.
The therapies ⁄ techniques used for the treatment of acne scars are to be individualized, taking into consideration many factors like age, gender, Fitzpatrick skin phototype, site of scars, clinical type of acne scars, grading of scars, socioeconomical constraints, psychological and physical health of the patient, etc.
Various treatment modalities available for acne scars are topical therapies, chemical peelings, micro-needling or microdermabrasion, subcision, autologous ⁄ non-autologous dermal fillers, fractionated ⁄ non-fractionated lasers, ablative ⁄ nonablative lasers, pigment or vascular-specific lasers, pigment transfer techniques, and minor surgical procedures. Many a times, combination of these modalities is required to obtain satisfactory results in an individual patient.