Michael Anurov

Objective. To evaluate the results of abdominoplasty without umbilical scar compared to classical techniques regarding advantages and limitations of this method. Material and methods. The study included retrospective and prospective analysis of 64 patients (57 women and 7 men) aged 25-68 years (mean 44.2±9.1 years). All ones underwent abdominoplasty in 2021-2025. Patients were divided into two groups: no umbilical scar (n=32) and classical umbilicoplasty (n=32). Liposuction of anterior abdominal wall was performed by VASER ultrasound in 35 patients. Surgical results and aesthetic satisfaction of patients were assessed using a validated BODY-Q. Results. The navel-free technique demonstrated significant (p<0.001) superiority over classical umbiliplasty in all domains of the validated BODY-Q questionnaire (scale 0—100). Psychological distress was lower in the group without scarring by 14.4 (95% CI 16.2 — 12.6) points (18.3±4.1 vs. 32.7±6.8 points). Body image perception improved by 14.4 (95% CI 11.2; 17.6) points (86.5±5.2 vs. 72.1±7.9 points). Satisfaction with abdominal contour was higher by 13.4 (95% CI 10.1 — 16.7) points (89.2±4.7 vs. 75.8±8.3 points). Scar assessment demonstrated maximum differences (22.6 (95% CI 19.3 — 25.9) points, 91.0±3.5 vs. 68.4±9.1 points). Differences remained clinically and statistically significant (p<0.001) after 6-month follow-up. The incidence of complications did not differ (6.3% in both groups; p=0.74). Conclusion. The navel-free technique of abdominoplasty provides natural abdominal contour, minimizes postoperative scars and accelerates rehabilitation. It is indicated for patients with moderate skin excess and preserved elasticity, high or normal navel position and provides optimal aesthetic results. Ultrasound liposuction technique reduces moderate excess skin above the navel and expands the indications for original technique of abdominoplasty.

Introduction: Standard abdominoplasty inevitably causes scarring in the umbilical region. Given the aesthetic significance of the navel, as the central anatomical landmark of the anterior abdominal wall, techniques that preserve the natural anatomy are warranted. The criteria for patient selection for such operations remain poorly defined, limiting their clinical application. Objective: The aim of this study was to define the indications and contraindications for scarless abdominoplasty in the umbilical region through a comparative analysis of clinical and subjective outcomes. Materials and Methods: A comparative study was conducted involving 115 patients operated on between 2021 and 2026. The experimental group consisted of 32 patients who underwent abdominoplasty without scarring in the umbilical region, while the control group comprised 83 patients who underwent standard abdominoplasty with umbilical transposition. The technique of scarless abdominoplasty in the umbilical region entailed limited mobilization of the cutaneous–subcutaneous flap, energy-based ultrasound-assisted liposuction in the supraumbilical region, suturing of rectus abdominis diastasis when clinically indicated, and fixation of the umbilicus in its physiological position without a skin incision around it. Energy-based ultrasound-assisted liposuction permits skin contraction in the supraumbilical area through a controlled internal thermal effect. The incidence of complications and BODY-Q questionnaire outcomes were evaluated at 3 months, 6 months, and one year. No significant differences in baseline clinical characteristics were observed between the groups. Results: The overall rate of postoperative complications in the experimental group was 18.8% (n = 6), compared to 24.1% (n = 20) in the control group; the difference was not statistically significant (p > 0.05). According to the BODY-Q questionnaire, patients in the experimental group reported significantly higher satisfaction with scar appearance (91.0 ± 3.5 vs. 83.0 ± 5.7; p < 0.001) and the umbilical region. The umbilicus retained its anatomically natural shape and depth. The use of energy-based ultrasound-assisted liposuction in the supraumbilical area contributed to the contraction of the upper cutaneous–subcutaneous flap, which made it possible to prevent extensive mobilization and the formation of a significant scar around the umbilicus in these patients. Conclusions: Scarless abdominoplasty in the umbilical region is a safe and effective technique in appropriately selected patients. Energy-based ultrasound-assisted liposuction produces an internal thermal effect that enhances the contraction of the cutaneous flap. Indications for this method comprise a moderate amount of excess skin tissue in the supraumbilical region, preserved skin elasticity, a normal or high umbilical position, and rectus abdominis diastasis grade I–II. Contraindications include pronounced excess skin tissue in the supraumbilical region, a low umbilical position, and general somatic contraindications to surgery.

Aim . To develop and validate a test setup for measuring the load under compression elements (CE) of multilayer bandages composed of materials with different stiffness. Materials and methods . Prototypes of multilayer bandages were fabricated in the laboratory by combining three types of CEs (foam polymer and dense nonwoven viscose material) with three types of fixing fabrics (FF) based on polyester and viscose/polyester. The test setup consisted of an upper-limb model made of rigid plastic covered with artificial skin and a block with two strain‑gauge sensors that recorded the load in gram-force (gf) under the CE area and in a control zone without a CE at an external pressure of 40 mmHg. For each CE–FF combination, 10 repeated measurements were performed in two regions of the sample (60 values per sensor per group), and the data were analysed using nonparametric statistical tests. Results . The load under the CE differed significantly between groups ( p < 0.001) and depended on the type and stiffness of the material: the median load under type 3 CE with the highest stiffness was 259.4 (252.6; 263.3) gf, whereas under type 1 CE with the lowest stiffness it was 149.9 (145.1; 171.9) gf. Type 2 CE produced intermediate values of 241.7 (206.4; 259.3) gf. Testing of the FFs also showed statistically significant differences in pressure in the absence of a CE ( p < 0.001): the highest load was recorded under type 2 FF (viscose/polyester) at 141.0 (140.2; 142.1) gf, and the lowest under type 1 FF made of polyester with higher surface density at 14.5 (14.3; 15.6) gf; type 3 FF provided an intermediate level of 65.7 (64.9; 69.3) gf. Conclusion . The developed in vitro setup shows high sensitivity to differences in CE stiffness and FF properties and can be used as a screening tool for quantitative comparative assessment of multilayer bandage prototypes with locally differentiated compression areas prior to in vivo studies.

Incisional ventral hernia repair is a complex problem. Rives-Stoppa technique is the most common procedure for patients with large incisional hernias. However, in cases of incisional hernias with a large defect width and/or the rectus to defect ratio (RDR) of less than 2, component separation is often required. At the same time, posterior component separation (PCS) is a technically challenging procedure. Currently, the evaluation of postoperative outcomes after PCS is primarily based on analysis of wound morbidity and recurrence rate. The aim of our study was to evaluate long-term surgical outcome after different types of PCS for midline incisional ventral hernias based on postoperative CT data and patient-reported outcome. Our study is a retrospective analysis of a prospectively collected database from 2017 to 2022 for patients with midline incisional hernia after different types of bilateral PCS (eTAR/TAR or Carbonell). All patients were evaluated by physical examination, a low dose computed tomography (CT) of the abdominal wall and quality of life assessment by EuraHS score. Total of 180 patients with midline incisional ventral hernia underwent Rives-Stoppa repair in combination with bilateral PCS. Long-term results were obtained in 120 patients (66.7%). According to CT data, most patients (79%) did not have any pathological changes of abdominal wall. Unfavorable outcomes were diagnosed in 24 patients (20.0%). We interpreted unfavorable outcomes as the presence of recurrence or interparietal hernia (IPH), or a combination of both. A total of 8 recurrences were identified: 3 - in open TAR group, 3 - in Carbonell group and 2 recurrences in eTAR group. A total of 20 (16.7%) postoperative IPH were revealed based on CT scans. The overall values of EuraHS-QoL score were significantly higher in the group with CT-complications (8 (4-15) vs. 4 (0-10), p = 0.024). Detection of interparietal hernia for comprehensive long-term outcomes after posterior component separation is equally important as recurrence, because both can influence on quality of life.

Objective. To evaluate the effect of different types of unidirectional barbed sutures on the mechanical properties of postoperative scars at various time points following closure of an experimental musculoaponeurotic defect. Material and methods. Forty male Wistar rats were randomly assigned to two groups according to the suture material used: absorbable V-Loc 180 and nonabsorbable V-Loc PBT. At 3 and 6 weeks after abdominal wall defect closure, 10 animals from each group were euthanized for mechanical testing of postoperative scars and histological examination. Results. At week 3, the highest tensile strength was observed in the V-Loc PBT group, significantly exceeding that in the V-Loc 180 group (0.87 ± 0.17 N/mm² vs. 0.64 ± 0.12 N/mm²; p=0.035). Between weeks 3 and 6, tensile strength remained unchanged in the V-Loc 180 group (p=0.68), whereas in the V-Loc PBT group it decreased (p=0.017) alongside an increase in extensibility (p=0.027). By week 6, scar thickness significantly increased in both groups, with no significant intergroup differences in mechanical parameters. At week 3, a pronounced tissue reaction around the sutures was noted, which markedly subsided by week 6, with the sutures surrounded by mature connective tissue. In two animals from the V-Loc 180 group (at weeks 3 and 6), impaired connective tissue formation was observed, characterized by mature chondrocyte appearance around the suture material. Conclusion. Long-lasting absorbable and nonabsorbable unidirectional barbed sutures elicit different early tissue responses after experimental musculoaponeurotic defect closure, influencing wound healing and the mechanical strength of postoperative scars.

Objective. To evaluate the effectiveness of fat autografts for cervicomental rejuvenation procedures and chin augmentation. Material and methods. The study included 70 male and female patients aged 35-65 years with age-related changes in the lower third of the face, localized fat deposits in cervicomental area and insufficient chin projection between 2020 and 2024. All patients were divided into three groups: the 1st group (n=30) — medial platysmaplasty and chin augmentation with subplatysmal fat autograft; the 2nd group (n=15) — removal of Bichat’s fat and chin augmentation with fat autograft using Bichat’s fat pad; the 3rd group (n=25) — medial platysmaplasty and chin contouring with lipofilling. Results. Patients with various age-related changes in the lower third of the face and insufficient chin projection underwent cervicomental rejuvenation and chin augmentation. In case of chin augmentation with subplatysmal fat autograft, chin prominence increased by 0.6±0.2 cm after 3 months, 0.5±0.3 cm after 6 months and 0.4±0.2 cm after 12 months. In chin augmentation using Bichat’s fat pad autograft, chin projection increased by 0.5±0.2, 0.4±0.2 and 0.3±0.4 cm, respectively. In chin contouring with lipofilling, chin projection increased by 0.6±0.4, 0.4±0.2 and 0.2±0.1 cm, respectively. In the 1st group, 2 (3%) patients had uneven chin contours. There were no infectious-inflammatory complications. Conclusion. Autologous fat injections (lipofilling and fat autografts) are preferable for chin augmentation. Augmentation with subplatysmal fat autografts is a minimally invasive, safe, predictable, and long-term method for chin augmentation.

The authors consider modern trends in abdominoplasty aimed at improving aesthetic outcomes with simultaneous minimizing scars in abdominal contouring. One of the important trends includes a minimally invasive approach with minimal incisions and scars. Liposuction has become a safe and widespread method. The last one is used in abdominoplasty not only to achieve a flatter abdomen, but also to improve contours while maintaining natural appearance of umbilicus and sculpting muscle relief. Endoscopic techniques are attracting more and more attention. They allow not only to eliminate diastasis recti and abdominal wall hernia, but also to correct concomitant abdominal pathologies. For example, removal of gallbladder during abdominoplasty has obvious advantages for patients with gallstones. Additional research is needed to study the feasibility of these trends and optimize surgical protocols.

Objectives: The objective of this study was to assess the tissue response and strength of traditional and unidirectional suture materials, depending on the conditions of use and the timing following implantation. Methods: Eighty male Wistar rats were randomly assigned to four groups depending on the suture used: unidirectional absorbable V-loc^TM 180 or non-absorbable V-loc^TM PBT and traditional absorbable Maxon^TM or non-absorbable Novafil^TM. Three and six weeks following the closure of the abdominal wall defect (AWD) and subcutaneous suture implantation at the withers according to group assignment, 10 animals from each group were euthanized for implanted sutures mechanical testing and histological examination. Results: The inflammatory reaction in the AWD closure area was maximal and significantly different from the subcutaneous implantation by week 3 for all groups. At six weeks, the tissue reaction did not depend on the place of implantation. However, four rats from the Maxon^TM group demonstrated suture failure with diastasis formation. Non-absorbable barbed sutures exhibited an absence of suture failure and the maximum scar thickness. Both intact absorbable materials (V-Loc^TM 180 and Maxon^TM) exhibited a significant breaking strength margin over the non-absorbable. By week 6, the preserved strength of the V-loc^TM 180 sutures at the AWD was 33% (15–58%), and under the skin—49.7% (48–59%) (p = 0.005). For Maxon^TM, these values were 38% (35–48%) for the AWD and 44% (34–49%) for the subcutaneous implantation. Conclusions: Absorbable and non-absorbable suture materials, depending on the conditions and timing of implantation, cause various tissue reactions which could affect the wound healing and the number of postoperative complications.

The purpose of a study was to compare the blepharoplasty methods of pretarsal (Asian eyelid blepharoplasty) and sub-brow approaches in patients of the Asian ethnic group based on the analysis the surgical correction results of age-related upper eyelids changes.Material and methods. The prospective clinical study included 133 mongoloid race people aged 45 to 71 years in the period up 2019 to 2024. The study participants were randomly divided into two groups. The 1st group (72 people) underwent age-related Asian blepharoplasty using a pretarsal approach, the 2nd group (61 people) underwent blepharoplasty using a sub-brow approach. The validated FACE-Q Satisfaction with Eyes questionnaire was used to assess the treatment results before, 3 and 6 months after blepharoplasty.Results. Comparison of preoperative groups with blepharoplasty did not reveal statistically significant differences in satisfaction with eye appearance (p = 0.089). After blepharoplasty, we were unable to find differences between the study groups when assessing the degree of satisfaction with the appearance of the eyes after 3 months (92 (92–100) in patients of the 1st group and 92 (92–100) in patients of the 2nd group, p = 0.192). The score 6 months after blepharoplasty was statistically significantly higher in patients of 2nd group than in study participants from 1st group 100 (92–100), 96 (92–100) points, respectively, p = 0.027).No complications such as postoperative brow ptosis or recurrence of lateral blepharochalasis were observed performing blepharoplasty using a sub-brow approach (group 2). This fact indicates that the risk of these complications is minimized.Conclusion. Blepharoplasty using a sub-brow approach is a promising method of surgical correction of agerelated upper eyelids changes in patients of the Asian ethnic group, showing comparable effectiveness in comparison with age-related blepharoplasty of Asian eyelids. Using myo-periosteal fixation, this technique gives fewer complications in the form of postoperative brow ptosis.

The article presents a comparative analysis of existing aesthetic methods for augmenting the chin area. An assessment of the risks of postoperative complications was conducted. It was found that chin augmentation using a subplatysmal autologous fat graft is a minimally invasive, safe, predictable, and long-lasting method that works well in combination with other facial rejuvenation procedures.