Grading of “Back Rolls”: Guide to Treatment Options

True body sculpting demands a three-dimensional artistic understanding of the anatomic and surgical adipose layers of the central trunk when performing circumferential liposuction. This is essential in preventing complications from both ultrasound-assisted and suction-assisted lipoplasty. The authors describe five zones of adherence that should be avoided to prevent contour deformities in the central trunk area when performing circumferential liposuction. The anatomy of the subcutaneous tissue of these five anatomic zones is reviewed and correlated radiographically with magnetic resonance imaging studies. Aesthetic and technical considerations required to properly liposculpt the central trunk are demonstrated by case analysis of primary and secon-dary liposuction patients. These cases also delineate how to prevent and/or minimize deformities after liposuction.

Background: Phosphatidylcholine and deoxycholate (PC–DC) injections have been used as nonsurgical alternatives to liposuction. DC as a constituent for lipolysis has recently been approved by the US Food and Drug Administration. Aim: PC and DC have independently been used in lipolysis. We hereby present a systematic review of literature on injection lipolysis and share our experience of using DC in combination with PC for injection lipolysis. We have retrospectively evaluated the effects of PC–DC treatments in varied age groups, both sexes, and over different target areas. Materials and Methods: This study spans over 14 years wherein 1269 patients of different age groups and sex were treated with injection lipolysis with PC–DC combination. The PC–DC cocktail injection was given to all patients for an average four sessions every 4 weeks, and the results were assessed after 8 weeks from the last session. Results: The effects were best appreciated over the face (malar, jawline, and submental areas) and upper arm, whereas average effect was observed on the thighs and around the knees. We have also used lipolysis as a primary modality as well as a touch-up modality following liposuction. The results are better appreciated in primary lipolysis. The need for follow-up sessions (1–2 sessions) of lipolysis and the quantification of results in subsequent sessions reveal that maximal improvement is achieved in the first session. Conclusion: PC–DC cocktail used for lipolysis as a local administration is effective for reducing unwanted fat. It shows great efficacy in treating localized fat, especially over the face and bra roll in the women of younger age group (20–30 years).

Upper back deformity caused by aging or fluctuations in weight are cosmetically and functionally unappealing to patients. Natural upper torso adherence zones create tether points that lead to horizontal and vertical laxity. Bra-line back lift is a versatile technique that can be used in any individual showing signs of redundant skin and adiposity. A 3-layered space-obliterating suture closure method prevents seroma and eliminates need for drain. Predictable outcomes correcting laxity from neck to lower back can be achieved. Gentle learning curve yields consistent and predictable results. Patient acceptance of the procedure, its results, and satisfactory morbidity rates have been universal.