The body posture and gravitational forces govern in part the intrinsic skin tensile strength because they influence the orientation of the dermal fibre networks. Our objective was to assess changes in shear wave propagation in the skin according to the body posture and orientation of the gravitational forces. The study was performed in 30 middle-aged women with a normal body mass index. The Reviscometer^® was used to assess the mechanical wave propagation on the volar forearm in extension or flexion. Similar measurements were made on the supra-areolar region of the breast when the trunk was in the horizontal or vertical position. Four measurements were made in each of 4 directions at given angles with regard to the body axis. The device gave reproducible data. Shear wave propagation was influenced by the body posture. The intra-individual variability in shear wave velocity according to the directions of measurements increased when the tissues were in a relaxed position. Skin tensile anisotropy increased in a relaxed body posture. Shear wave propagation may be a convenient non-invasive tool to better identify the natural skin tension lines in the skin, thus refining the orientation of incision during cutaneous surgery.

Breast surgery currently remains very subjective and each intervention depends on the ability and experience of the operator. To date, no objective measurement of this anatomical region can codify surgery. In this light, we wanted to compare and validate a new technique for 3D scanning (LifeViz 3D) and its clinical application. We tested the use of the 3D LifeViz system (Quantificare) to perform volumetric calculations in various settings (in situ in cadaveric dissection, of control prostheses, and in clinical patients) and we compared this system to other techniques (CT scanning and Archimedes' principle) under the same conditions. We were able to identify the benefits (feasibility, safety, portability, and low patient stress) and limitations (underestimation of the in situ volume, subjectivity of contouring, and patient selection) of the LifeViz 3D system, concluding that the results are comparable with other measurement techniques. The prospects of this technology seem promising in numerous applications in clinical practice to limit the subjectivity of breast surgery.

Tensile properties of skin determine some important physical attributes of skin. They may be conveniently assessed using recent technologies. The aim of the study was to compare ex vivo the tensile properties of normal looking skin and striae distensae. The Cutometer was used with 2 and 4 mm diameter probes. Skin distensibility values were dependent on the suction force and area of the skin tested. Conversely, tensile ratios yielding elasticity parameters were not affected by the same variables. Although tensile properties of excised normal skin resembled those previously reported in vivo, striae distensae showed markedly different properties in vivo and ex vivo. The ex vivo and in vivo evaluations of the tensile properties and functions of skin are complementary particularly when the connective tissue is abnormal.

Benign symmetric lipomatosis is a rare form of typical fat distribution in the shoulders, the arms, and the neck that can compromise the respiratory, nutritional, and psychological status of the patient. Alcoholism, malignant tumors of the upper airways, endocrine tumors, hypothyroidism, diabetes, and hypertriglyceridemia are often associated with its occurrence. Surgical removal via lipectomy or liposuction can give good cosmetic results, although recurrences often occur. Liposuction has become the first choice to treat this disorder in patients with smaller masses. We have operated on four such cases in which liposuction failed and surgical excision had to be performed. We present a summary of the clinical characteristics of all four patients and discuss the different treatment options.

There are glaring discrepancies in the microanatomical descriptions of cellulite in the literature. We revisited this common skin condition in women with a microscopic examination of 39 autopsy specimens. A control group consisted of 4 women and 11 men showing no evidence of cellulite. The lumpy aspect of the dermohypodermal interface appeared to represent a gender-linked characteristic of the thighs and buttocks without being a specific sign of cellulite. Incipient cellulite identified by the mattress phenomenon was related to the presence of focally enlarged fibrosclerotic strands partitioning the subcutis. Such strands possibly serve as a physiologic buttress against fat herniation limiting the outpouching of fat lobules on pinching the skin. These structures might represent a reactive process to sustained hypodermal pressure caused by fat accumulation. Full-blown cellulite likely represents subjugation of the hypertrophic response when connective tissue is overcome by progressive fat accumulation. Histologic aspects reminiscent of stretch marks are identified within the hypodermal strands, resulting in clinical skin dimpling.