Evaluation of the Efficacy and Patient Satisfaction of Endoscope-Assisted High-Speed Rotary Cutter for Nuchal Fat Pad Removal.

Objective: To evaluate the clinical efficacy and patient satisfaction of high-speed rotary cutter combined with endoscopy for the treatment of nuchal fat pads. Methods: A total of 68 adult patients with hypertrophic nuchal fat pads were included in this study. Under super-wet tumescent anesthesia, incisions were marked around the fat pads. A fork-shaped dissector was first used to sharply dissect the adipose tissue through multiplanar and multiangular separation. Subsequently, an endoscope-assisted high-speed rotary cutter was employed to completely resect and aspirate the isolated fat. Thin liposuction cannulas were then used to refine the contour of the transition zone between the residual fat pads and the normal adipose tissue to achieve a smooth, natural gradient. The incisions were closed using oil-coated sutures, followed by figure-of-8 compression bandaging. Patients were instructed to use a rice pillow postoperatively and were followed up for 3 to 6 months to monitor complications, assess cervical contour improvement, and evaluate patient satisfaction. Results: The mean operative time was 65 minutes. All patients experienced varying degrees of pain and swelling within 1-2 months after surgery. Among them, 7 cases (10.29%) exhibited bruising or ecchymosis, 3 cases (4.41%) had palpable subcutaneous cords or induration, and 1 case (1.47%) developed a seroma within two weeks. Swelling began to subside from the third postoperative day. Complete resolution of swelling was achieved in 63 patients (92.65%) within one month, and in the remaining 5 patients (7.35%) within one and a half months. One case (1.47%) showed delayed wound healing, which improved after two weeks of active dressing care; the other 67 cases (98.53%) achieved primary healing. One patient (1.47%) presented with a slight "step-off" appearance at the transition zone upon one-month follow-up, while the other 67 cases (98.53%) achieved complete fat removal, resulting in a natural and smooth nuchal contour. Within 3-6 months postoperatively, all patients recovered normal skin sensation, elasticity, and color in the operative area. No serious complications such as skin necrosis, infection, neurovascular injury, or fat embolism occurred. The satisfaction survey showed that 58 patients were satisfied, 8 were somewhat satisfied, and 2 reported fair satisfaction, yielding an overall satisfaction rate of 97.06%. Conclusion: The combination of a high-speed rotary cutter and endoscopy for nuchal fat pad removal demonstrates a natural appearance, short operative time, low complication rate, and high patient satisfaction. This technique is effective and worthy of clinical promotion.