Letter to the Editor

Comments on “Abdominoplasty-Derived Dermal-Fat Graft Augmentation Gluteoplasty”

Aesthetic Surgery Journal 2015, Vol 35(3) NP79 © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: [email protected] DOI: 10.1093/asj/sju039 www.aestheticsurgeryjournal.com

Cassio Eduardo Raposo-Amaral, MD, PhD

Disclosures The author declares no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding The author received no financial support for the research, authorship, and publication of this article.

REFERENCES 1. Muresan C, Brownstein GM, Shureih SF. Abdominoplastyderived dermal-fat graft augmentation gluteoplasty. Aesthet Surg J. 2014;34:1234-1243. 2. 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;26:290-296. 3. Raposo do Amaral CE. Enxertia de tecido dermogorduroso do abdome para aumento glúteo. In: 40° Congresso Brasileiro de Cirurgia Plástica, Fortaleza-Brasil, 2003.

Dr Raposo-Amaral is the Medical Director of Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil. Corresponding Author: Dr Cassio Eduardo Raposo-Amaral, Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz 100, Caixa Postal 6028, Campinas, São Paulo 13084-880, Brazil. E-mail: [email protected]

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We read with great interest the article by Muresan, Brownstein, and Shureih entitled “Abdominoplasty-derived dermal-fat graft augmentation gluteoplasty.”1 The authors described their experience of successfully using a slight modification of our technique2 in 9 patients who underwent gluteal augmentation using dermal-fat grafts from their abdomens. In addition, they also followed some guidelines we previously described on their series of patients.2 The authors honestly highlighted the two minimal differences between our approach and theirs. The authors used two intergluteal incisions instead of one and used basic lighted retractors to inset oval-shaped dermal-fat grafts instead of using our crochet-hook instrument, which was specially designed for this operation. Our instrument allows insertion of a “tubulized” dermal-fat graft with limited exposure, pocket undermining, and handling of the dermal-fat graft. Early in our series, we sought to create an instrument that would allow less pocket undermining, avoiding eventual dead space and facilitating graft take. These two conditions may ultimately decrease infection rate. In addition, the manipulation of the dermal-fat graft into a tight pocket may cause death of fat cells and may lead to postoperative intercurrences or complications. These are the reasons we continue to use our crochet-hook instrument instead of directly inserting the dermal-fat graft under basic lighted retractors. Otherwise, we agree with all comments written by the authors. Historically, in 2003 when we first presented this technique to plastic surgeons from the Brazilian Society of Plastic Surgery,3 most surgeons were quite skeptical of this procedure and some criticism arose. Almost 11 years later, Drs Muresan, Brownstein, and Shureih should be commended for this interesting study showing excellent results on a larger series of patients using a similar technique and for highlighting the potential benefits of dermal-fat graft for gluteal augmentation.

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