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Objectives: Patient selection is the key to successful treatment.
Try to connect the patient’s expectations to his anatomy and lifestyle.
Work with the anatomy of the patient, don’t fight it.
Adding lipofilling to the procedure could cause: higher risks (fat emboli), longer operation, unpredicted outcome and most importantly: fluctuations in patient's weight could end up in grotesque results

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Objectives: Explain lipoedema as an evolutionary mismatch.
Provide the detailed information of superdry4D liposuction for extremities.
Describe the medical protocols and standart of care in superdry4D liposuction as an advanced technique.
Review the importance of evolutionary medicine to prevent recurrence after treatment in lipoedema patients.

Introduction: Lipoedema is a chronic, progressive, and inflammatory syndrome characterized by large amount of subcutaneous fat in the upper and lower legs in women.
nked to the agricultural revolution and developed as part of biological adaptation based on a radically changed lifestyle. It is an evolutionary mismatch.
In this presentation, the author will also share his over 20 years experience with his personal technique, superdry4D liposuction and the evolutionary medical approach to lipoedema.
Superdry4D liposuction under a tourniquet allows the surgery to be performed  conscientiously  and safely.

Materials / method: The diagnosis was made by patient history and clinical examination. MR and ⁄ or dynamic lymphoscintigraphy were used if complaints cannot fully be explained by fat accumulation.

Over 300 patients between 19  and 65 years of age  with lipoedema were consecutively treated with a combination of the superdry 4d liposuction and the evolutionary medical approach by a single surgeon.In six patients, selective neurectomy  of the gastrocnemius muscle was  used in conjunction with the superdry liposuction 4D. Compression stockings were applied in theatre and continued postoperatively for three mont

Results: There was significant improvement in the form, proportion and diameters of the extremities as well as a dramatic improvement of symptoms including pain, sensitivity to pressure, swelling, bruising and low energy. Mean volume of aspirate was 2300 mL (range 750-6000 mL). None of the serious complications associated with liposuction  were observed in this series. Minor complications included localized residual fat deposits in   8 patients, hyperpigmented scar in 6 patients, epidermolysis in 4 patients, minor asymmetry in 8 patients and sagging skin around the knees in 10 patients.

Conclusion: Superdry 4D liposuction for the lower legs and mid-leg and the other liposuction techniques for the remaining part is the mandatory step to break the vicious circle in lipoedema. Lipoedema certainly requires a lifestyle similar to hunter-gatherers. This does not only prevent them from having recurrence, but also improves the overall result they have obtained.

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Objectives: 1. Understanding Gynecomastia Types
2. Diagnostic Role of Ultrasonography
3. Clinical Correlations
4. Surgical Implications

Introduction: Gynecomastia, the most common male breast condition, requires accurate clinical diagnosis, with ultrasonography playing a crucial role in enhancing diagnostic precision and guiding surgical planning. This study categorizes ultrasonographic findings of gynecomastia into three distinct types: nodular, diffuse glandular, and fatty.

Materials / method: The nodular type appears as a hypoechoic or isoechoic mass with a round or dendritic shape located in the retroareolar region. The diffuse glandular type is identified by a hyperechoic mass with an extensive spreading pattern within the same area. Conversely, the fatty type consists solely of adipose tissue without glandular hyperplasia.

Results: We analyzed 100 patients, correlating their ultrasonographic findings with intraoperative observations.
Among them, 88 exhibited nodular-type ultrasonographic patterns, corresponding to soft glandular tissue intraoperatively. Five patients showed diffuse glandular-type ultrasonographic patterns, correlating with firm glandular tissue during surgery. Seven patients initially classified with the fatty type on ultrasonography were confirmed to have breast ductal tissue upon postoperative pathological examination, confirming gynecomastia.

Conclusion: This study highlights the pivotal role of ultrasonography performed by plastic surgeons in precisely diagnosing and effectively planning surgical interventions for gynecomastia.

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