bluuebunny/crossref_metadata_2025 huggingface dataset:
Fat Autograph Retention: Use of Albumin to Correct Physiologic Perturbation Caused by Klein Solution
Authors: Kaminski Mitchell V. , de Vaughan Rose Lopez
Published: January 2017

Introduction:

Correction of the dilution effect of Kline Solution on colloid osmotic pressure in fat harvested for autografting may be an important factor in enhancing graft viability. The specific deficit is an acute decrease in interstitial soluble protein concentration as tumescent solution is infiltrated for local anesthesia. The most important protein component creating colloid osmotic pressure in interstitial fluid is albumin. Thus, the commercial availability of human serum albumin makes correction of this physiologic perturbation easily accomplished by the addition of 1 ml of albumin per 10-ml fat-harvesting syringe.

Materials and Methods:

Review of the literature and description of technique.

Results:

The steps to ensure fat autograph retention include: harvest using small cannulas (16- or 18-gauge), restore colloid pressure using albumin in the collection syringe, inject the graft with relatively atraumatic needles (modified 18- or 22-gauge needles), and inject the fat to produce a trail of small beads in multiple fine layers with each bead touching the nutrient bed.

Discussion:

The study of fat grafting continues to evolve. As it does, the science behind graft has led to better understanding of the adipocyte as a member of a dynamic organ with endocrine, apocrine, and paracrine functions. The fat mass is dynamic. Adipocyte number is not as stagnant as previously thought. They can differentiate and dedifferentiate and become stem cells with the potential to become bone, cartilage, fat and nerve cells. Stem cells from lipo-aspirate make more sense than bone marrow or embryonic sources. For one thing, fat is easy to obtain, and when used in the same patient its endogenous genetic code is identical, removing another obstacle to retention.

Conclusion:

These observations are reported here as they seem to result in a nearly 90% graft retention rate and reduce the need to overfill.
Repair of the Pixie Ear Deformity with Modified V to Y Plasty during Rhytidectomy
Authors: Chen Achih H. , O'Rourke Ashli K. , Harper J. Garrett , Kamer Frank M.
Published: January 2017

Introduction:

The “pixie ear,” an attached, tapering, inferiorly displaced ear lobule may be congenital or iatrogenic. As a postrhytidectomy complication, the pixie ear deformity is the hallmark of excessive skin tension and a telltale sign of surgery. It is often the result of excessive skin excision or anchoring of the skin to the ear lobule causing it to become displaced in an anterio-inferior direction with elongation and obliteration of the free-hanging edge.

Methods:

Described is a method of correction useful in addressing both congenital and iatrogenic pixie ear deformities during rhytidectomy that uses a modified V to Y advancement flap where the advanced “V” portion is excised with the redundant skin and the vertical portion of the “Y” is hidden along the contour of the newly created lobule.

Results:

This technique, used in every patient presenting for rhytidectomy from July 1, 2003, to June 30, 2007, with iatrogenic or congenital pixie ear deformity (n > 30 at the Lasky Clinic and the Georgia Center for Facial Plastic Surgery) results in restoration of the natural, rounded, free border of the ear lobule, while avoiding any conspicuous skin incisions beyond that of the standard rhytidectomy.

Conclusions:

This method for correcting the pixie ear deformity is easily incorporated into the rhytidectomy and yields excellent cosmetic results. It is useful in correcting iatrogenic pixie ear during revision rhytidectomy or in correcting congenital pixie ear during primary rhytidectomy.
A Cosmetic Surgeon's Decade of Experience Performing Eyelash Transplantation
Authors: Duplantis Kathryn , Cosio-Lima Ludmila , Reynolds Katy , Hodges Tabitha
Published: January 2017

Introduction:

Single-hair grafts to the eyelids, performed using a very challenging technique, offer cosmetic surgery patients a natural-looking solution for alopecia of the eyelid due to various causes, ranging from overcurling and trauma to systemic and metabolic processes. The technique described in this article requires the cosmetic surgeon to have a vast experience in both hair transplantation and eyebrow transplantation.

Methods:

We present a technique that requires simple instrumentation and the aid of one well-trained assistant. The procedure has been performed on 20 male and 350 female patients over a 10-year period.

Results:

The procedure has resulted in a mean graft survival percentage of 95%. The technique produces cosmetically pleasing outcomes, and complications are rare.

Conclusions:

A challenging technique for eyelash transplantation can successfully effect a pleasing and natural look for cosmetic surgery patients.
Drains in Breast Augmentation
Authors: Thomas Mohan , Menon Harikumar , D'Silva James Allen
Published: January 2017

Introduction:

Capsular contracture is the most discussed aspect in breast augmentation. Drains are important in preventing hematoma and subsequent capsule formation, but drains have been associated with increased incidence of early breast contracture and infection. The purpose of this article is to review the use of drains during breast augmentation surgery and to present their effect on the incidence of capsule contracture observed in a short-term study of patients receiving breast augmentation with cohesive gel implants.

Material and Methods:

Sixty consecutive cases of breast augmentation with cohesive gel implants were followed up for 6 months. All cases had tube drains for 24 to 48 hours postoperatively.

Results:

Infection and early capsular contracture were not observed in this study.

Discussion:

With the US Food and Drug Administration's clearance of cohesive gel implants, subglandular placements are bound to increase. Subglandular placement is associated with increased incidence of capsular contracture. Meticulous hemostasis and the use of drains to prevent hematoma are important aspects in preventing capsular contracture.

Conclusion:

Our experience shows that drains are safe and effective and do not increase infection rates or cause early capsular contracture.
Treating Internal Nasal Valve Collapse: The Intranasal Valvuloplasty
Authors: Major Troy E. , English Jim L.
Published: January 2017

Introduction:

Nasal obstruction requires a careful and thorough examination of the nose and nasal cavity. Particular interest should be placed on the internal and external nasal valves and their collapse. We discuss a simple yet effective technique to resolve obstruction of the internal nasal valve, called the intranasal valvuloplasty/valvulopexy. These procedures can be of benefit for valvular obstruction, especially postrhinoplasty.

Objective:

Nasal obstruction as sequela to aesthetic surgery may occur more often than recognized. The purpose of this paper is to explain a relatively simple yet expedient technique to address nasal valvular collapse.

Method:

Retrospective review of patients treated with the intranasal valvuloplasty/valvulopexy technique in the outpatient setting.

Results:

We reviewed our last 6 patients with the technique our senior author has been performing for 20 years. The patients noted 80–100% subjective improvement and we noted comparable objective improvement. Of the 6 patients, 50% were done bilaterally and 33% were combined with either a septoplasty or with a septorhinoplasty. Of these, 66.7% had a history of prior nasal surgery, usually rhinoplasty.

Discussion:

The valvuloplasty is an effective and straightforward approach to nasal valve collapse either alone or in conjunction with other rhinological procedures.
Treatment of Large Skin Necrosis following a Modified Avelar Abdominoplasty with the Erchonia EML 635 nm Laser and Platelet-Rich Plasma
Authors: Lopez Quita
Published: January 2017

Objective:

Skin necrosis of the flap and delayed wound healing are common complications of abdominoplasty surgery. A case report is presented of a patient who was treated with the 635 nm or low-level laser therapy (LLLT) and platelet-rich plasma (PRP). Both of these modalities have been shown to accelerate wound healing and improve the appearance of the scar.

Materials and Methods:

Case report.

Case Presentation:

A 62-year-old female with chronic hypertension underwent a modified Avelar abdominoplasty. She developed skin necrosis at the midline from her umbilicus to the lower horizontal incision. Also, mild necrosis was noted in her upper abdomen in the area of the left superior epigastric vessel. The patient had negative bacterial cultures and was given daily 635 nm laser treatments for the first month. PRP (Smart PReP System, Harvest Technologies Corp, Plymouth, Mass) was used for the early small open wounds and then on the large midline wound after the eschar had lifted.

Discussion:

Skin necrosis is a complication that can occur after abdominoplasty surgery. The area between the umbilicus and the lower incision is the area where profound devascularization occurs, as was demonstrated by Mayr. Despite upper abdominal undermining limited at the midline to 3 cm, skin necrosis still occurred in this patient and was evident 6 days postoperatively. LLLT was started on the first postoperative day to treat surgical pain and inflammation; treatments were provided daily after necrosis was diagnosed on the sixth postoperative day. When the patient developed open wounds near the umbilicus, activated PRP (PRP with calcium chloride and topical thrombin) was placed in the deepithelialized wounds to accelerate healing. The activator was made by combining 5 ml of 10% calcium chloride with 5000 units of bovine thrombin in a PRP-to-activator ratio of 10:1. An increase in tissue exudate was noted with LLLT. When the eschar had lifted, the wound was treated with activated PRP and with daily 635 nm laser treatments. The patient healed within 3 months.

Conclusion:

Ischemic flaps can be treated with LLLT and with PRP. When both modalities are used, the healing is accelerated, and the final aesthetic appearance of the scar is improved, so future corrective surgery is avoided.
Recent Changes in Medical—Legal Statutory and Case Law and Their Application to Cosmetic Surgery
Authors: Breitenbach Edwin E.
Published: January 2017

In the mid 1970s medical malpractice insurance carriers, faced with huge increases in both the number of claims and the size of awards, elected either to discontinue writing medical malpractice insurance policies or to raise premiums for this type of insurance by a factor of two or three. Faced with the prospect of unavailability of affordable medical malpractice insurance many physicians elected to go without any malpractice coverage, went into early retirement terminating their practices altogether, or narrowed the scope of their practices to eliminate those procedures which carried an inordinately high risk of medical malpractice litigation.

In response to the potential unavailability of adequate health care because of the impending medical malpractice insurance crisis many states enacted remedial emergency legislation in an attempt to deal with the crisis by providing an incentive for insurance carriers to either reenter the medical malpractice field or for those remaining to limit their proposed premium increases substantially. California was one of those states which enacted broad remedial legislation. In addition other states enacted legislation quite similar to California's.

An attempt will be made to review those statutes passed by California in specific response to the medical malpractice crisis and their history as they underwent constitutional attack in the California appellate court system. The legislation reviewed here is of course applicable only in California. However, many other states have enacted comparable legislation and many jurisdictions currently are considering statutory changes which would parallel California's laws. California's current statutes dealing with medical malpractice litigation could be considered a model for those jurisdictions currently facing a crisis in affordability or availability of malpractice insurance coverage.
Lateral Pull Lower Lid Blepharoplasty
Authors: Newman Julius , Fetzek John R. , Nguyen Abram
Published: January 2017

The lateral pull lower lid blepharoplasty with steri-strip closure has proved to be a safe, reliable, and aesthetically pleasing procedure. This technique offers multiple benefits, including decreased operating time, simplified the surgical procedure, and decreased postoperative morbidity. Preoperative marking and evaluation of lower lid laxity has been eliminated. Precision tailoring of the skin muscle flap decreases the risk of ectropion or scleral show. Appropriate muscle excision improves the contour of the lower eyelid, particularly in the area of the incision, and relieves tension from the lateral pull. The steri-strip closure decreases operating time, eliminates the usual problems associated with conventional suture, and may decrease the risk of orbital hematoma. We have used this steri-strip lower lid blepharoplasty procedure in 397 patients seen over the previous 38 months and found it to be an effective and safe blepharoplasty technique. We have had no permanent complications and have had excellent cosmetic results with this procedure.
Breast Cancer and its Management
Authors: Shiffman Melvin A.
Published: January 2017

The cosmetic surgeon should be aware of the natural history of breast cancer, the method for diagnosis, and alternatives of treatment. Diagnosis can be made prior to or during a cosmetic breast procedure, usually at a time when the neoplasm is highly curable.
Aesthetic Recontouring of the Midfacial Skeleton: A Regional Approach
Authors: Giampapa Vincent C.
Published: January 2017

Aesthetic facial skeleton recontouring, whether done for traumatic, congenital, or aesthetic indications, is gaining in popularity. In the past, its success has largely depended upon the aesthetic sense of the surgeon.

Through the use of cadaver dissections, the underlying bony anatomy of the midface was studied and subsequently divided into three distinct regions. The contribution of each of these regions of the midface to the oblique and frontal profiles is described.

With utilization of moulages taken from the surface of skulls in these regions, anatomically contoured implants were designed.

To facilitate clinical implant placement and symmetry, skin markings employing superficial landmarks of the face are described.

The standard blepharoplasty incision for subperiosteal placement of the regional implants is detailed, and the benefits of this technique over previously described routes of insertion are discussed.

A total of 73 malarplasties in 35 patients have been performed in a period of more than 4 years. Surgery is easily done under local anesthesia either alone or in conjunction with rhinoplasty, blepharoplasty, or rhytidectomy.
The Nasolabial Fold: Applied Surgical Anatomy and Histology
Authors: Walker Lee R. , Mudrovich Steven , Epker Bruce N.
Published: January 2017

In aesthetic facial surgery, the nasolabial fold is the most resilient to attempts at its surgical correction. Numerous surgical techniques have been employed, but none produce satisfying and lasting results. Therefore, a more thorough evaluation of the surgical anatomy and histology of the nasolabial fold was undertaken in order to seek improved methods for its correction. Four cadaver heads, three fresh-frozen and one preserved, were bilaterally dissected and studied anatomically and histologically. The most demonstrable anatomic feature was an abundance of fat superior to the nasolabial fold crease, which became thin and almost nonexistent inferior to the crease in the upper lip. Second, the fold was entirely confined to the subcutaneous fat layer of the face. Along the superior half of the nasolabial fold crease, adjacent to the nasal ala, the crease was directly attached to the nasalis and levator labii superioris muscles. This attachment of skin to underlying muscle, continued throughout the upper lip. In addition, the SMAS could not be dissected from other fascial layers in the area of the nasolabial fold, and the only surgical plane of dissection that exists in the nasolabial fold area was in the subcutaneous plane superficial to the muscular layer.
Cranioplasty: Surgical Repair of Cranial Defects
Authors: Leake Donald
Published: January 2017

A lightweight polymeric composite material is described for use with bone grafting for the restoration of complex contour defects of the neurocranium. Custom fabrication based on three-dimensional computed tomography provides an anatomically precise reconstruction with reestablishment of the bony integrity of the skull.
Carbon-Dioxide-Laser-Assisted Lower Facelift: A Preliminary Report
Authors: Morrow David M. , Morrow Linda B.
Published: January 2017

This report describes our experience over a 36-month period with 110 lower facelift surgeries using the CO2 laser as the primary or only cutting and undermining instrument. Carbon dioxide laser surgery was safe and effective in these 110 cases. Using the laser provided excellent hemostasis, absence of postoperative pain, and minimal postoperative bruising and swelling. There were no complications specific to the laser. There were no operating room fires and no laser accidents to the skin, eyes, or other tissues of the patients or operative personnel. Postoperatively there were no hematomas, no infections, no unusual scarring, no flap necrosis, and no dehiscence of incision lines.
Treatment of Facial Acne Scarring with the Carbon Dioxide Laser
Authors: Ratz John Louis , McGillis S. Teri
Published: January 2017

In the past, the treatment of “ice pick” and pox-type scarring has been a perplexing problem. Successful methods of treatment have included excision, punch excision, and punch replacement. These are usually first-stage procedures, however, and often require secondary treatment. This paper describes a method of treating these types of scars with the CO2 laser which can give excellent results and, in some cases, be an end-stage procedure.
The Evolution of Anesthesia for Liposuction
Authors: Coleman William P. , Hanke C. William
Published: January 2017

Ten years ago, most liposuction cases were performed under general anesthesia using the “dry technique.” In recent years, liposuction under local anesthesia using the “tumescent technique” has led to extremely safe liposuction with rapid postoperative recovery.
Aesthetic Reconstruction of Skin Cancer Defects Using Flaps and Grafts
Authors: Johnson Timothy M. , Nelson Bruce R.
Published: January 2017

The purpose of this article is to develop the basic principles and concepts used for local reconstructive flap and graft surgery following removal of skin cancer. Key concepts will be developed and commonly used flaps and grafts are described and illustrated.
Breast Contouring by Autologous Fat Transfer
Authors: Fulton James E.
Published: January 2017

The breast augmentation controversy continues. One alternative to silicone implants is to utilize the patient's own fat. Twenty patients completed the procedure of breast contouring with autologous fat transfer and have been followed closely with repeated breast volumetric measurements and mammograms for 1 to 5 years. The average fat retention has been 71% and the patients have been satisfied with the augmentation procedure. There has been no instance of firmness in these breasts and periodic mammogram examinations have demonstrated no distortion or masking of the breast tissue. The breast calcifications that have developed are of the benign type and are typical of any kind of breast sugery. The breasts may get larger with time. We feel this technique is a useful addition to our breast augmentation armamentarium and will become the procedure of choice for those who cannot have silicone implants and have good areas of disharmonious obesity to serve as donor sites.
Dermatologic Cosmetic Laser Surgery
Authors: Goldberg David J.
Published: January 2017

Dermatologic cosmetic laser surgery has greatly evolved over the last 30 years. Today's lasers can treat a wide gamut of vascular and pigmented lesions, as well as tattoos, with a high degree of success and minimal incidence of scarring. In addition, with some refinements, older laser systems are playing a renewed role in the cosmetic dermatologic surgeon's armamentarium. Dermatologic cosmetic laser surgery is one of the most exciting and rapidly growing areas in the field of cosmetic surgery.
Plasty Prostheses: A New Approach
Authors: Faivre Jacques
Published: January 2017

Hypotrophic breasts associated with ptosis is a frequent condition. The simple insertion of a prosthesis generally does not give very satisfactory results. The breast swings on the prosthesis, aggravating the ptosis in the long term. Furthermore, hypotrophy is often associated with malposition of the areola: either excessively short areolo-infra-mammary distance, less than 5 cm, or areola projected too medially or too laterally. The absence of correction of this malformation is a factor responsible for a poor aesthetic result.
A New Method of Hair Replacement Using Osseointegrated Prostheses
Authors: Pignataro Anthony S. , Schaaf Norman G.
Published: January 2017

Osseointegrated prostheses have been used to replace teeth, eyes, ears, and noses. They may now be applied to hair replacement. Our objective is to offer patients further alternatives to traditional hair prostheses or hair replacement surgery. Standard implantology techniques were used to place maxillofacial implants in a patient's cranium. New prosthetic techniques allow attachment of a pliable hair prosthesis to a static implant abutment. The implant system has been found to be an excellent method for attachment of hair prostheses. The method introduced here incorporates surgical techniques with prosthetic hair replacement. It has all the advantages of being able to guarantee a full head of hair, while at the same time greatly decreasing surgical risks.
Achieving the Optimal Result with the Modified-S Pattern for Scalp Reduction
Authors: Schauder Craig S. , Stough D. Bluford , Spencer David M.
Published: January 2017

Scalp reduction continues to be an effective treatment of crown vertex alopecia. Success with this technique depends upon proper design and planning, good surgical technique, and proper patient selection. The modified-S pattern has become our most frequently used pattern and we describe its proper design and planning. We also discuss two scalp extension devices that can be used adjunctively for maximizing the amount of scalp removed per procedure.
Planning a Hair Transplantation: The Artist's Touch
Authors: Lucas Manfred
Published: January 2017

A good hair transplantation consists of more than simply restoring a person's hair status as it was in his youth. The transplanted hair—which always remains exactly where it was put in—must harmonize with its changing environment for the rest of the patient's life. Creating integral harmony that will last for the rest of a person's life using only limited material calls for artistic imagination. Examples will explain this procedure in detail.
Scalp-Lifting and Brow-Lifting through a Coronal-Type Incision
Authors: Brandy Dominic A.
Published: January 2017

Because the incision line of extensive scalp-lifting extends from one sideburn to the other, coronal brow-lifting can be combined effectively with this technique. A detailed description of how to perform this combination procedure and the vector considerations are described.
Laser Treatment for Acne Vulgaris
Authors: Kunachak Somyos
Published: January 2017

This study reports 30 resistant cases of acne vulgaris that were treated by carbon dioxide laser. The patients range in age from 13 to 26 years old. The lesions treated were all types of acne, which included cysts, nodules, papules, pustules, black heads, and white heads. The results were gratifying, with a quick initial clearance of the lesion; no scar or changing of skin texture was observed in most of the cases. These results could suggest another, not previously reported, application of the carbon dioxide laser in the field of medicine.
The Long-Term Effects of Facial Implants: Preliminary Study
Authors: Glasgold Alvin I. , Silver Frederick H.
Published: January 2017

The objective was to study the long-term safety and benefits of facial implants. This was a retrospective study of patients undergoing facial implant surgery over a 10-year period. All surgery was performed by the senior author in a hospital or ambulatory facility. Four hundred and eighty-four questionnaires were sent to patients of the senior author who underwent malar or mandibular augmentation with preformed silicone implants during the years 1982 to 1992. Two hundred and seven replies were received. Patient satisfaction rate of 99% was recorded. No serious complications occurred. There were no instances of connective tissue or other related systemic disease in any of our patients following facial implant surgery.

Silastic implants in the malar and mandibular areas are safe procedures with a very high rate of patient satisfaction and a very low complication rate. Based on our study and those of others, there does not seem to be a relationship between silicone implants and the development of connective tissue disease.
Anterior Malo-Labial Face-Lift: Technique and Indications
Authors: Faivre Jacques , Faivre Jean-Marie , Gueran Philippe
Published: January 2017

The correction of a thickened and deep nasolabial fold and commissural and juxta-commissural buccal lesions constitutes one of the principal difficulties of the malar phase of a cervicofacial face-lift. However, the correlation of these lesions is important as ptosis of the nasolabial fold and labial commissures is an almost constant early sign of aging. This correction is the objective of the anterior malo-labial face-lift.
Cyanoacrylate Tissue Adhesives
Authors: Maw Jennifer , Quinn Jim
Published: January 2017

Cyanoacrylate adhesives have been available for many years. Until recently, they have been limited by their physical properties, and their popularity has been sporadic due to their incorrect and inappropriate use. A new medical-grade cyanoacrylate adhesive has been developed that has greater strength and flexibility than previous adhesives. This new formulated octylcyanoacrylate will broaden the indications for the use of cyanoacrylate adhesives and has the potential to revolutionize wound care.
L Scar in Reduction Mammaplasty with Dermal Brassiere
Authors: De Longis Ermete
Published: January 2017

In the surgical correction of a ptotic or hypertrophic breast (mastopexy, reduction mammaplasty) the preference for one technique is associated with the choice and experience of the surgeon. The decision as to the type of surgery depends on the anatomic nature, the degree of ptosis, the age of the patient, and, above all, the aesthetic sense of the surgeon. The improvement that the surgeon obtains in shape, volume, and position of the breast must not be compromised by prominent and nonaesthetic scars that alter the final result. Today in mammaplasty, the goal of most surgeons is to give the breast new form, volume, and durable shape with minimal scarring. Starting from these considerations, the author prefers the techniques that involve a vertical or an L scar, which avoid incisions in the so-called hypertrophic areas of the chest (medial and lateral extremities of the submammary fold). The author has used a modification of the Arie technique since 1984 for marked ptosis and hypertrophy. The technique shortens and transforms the long vertical scar into an L-shaped limited scar. The method is based on nipple-areola transposition on a wide superior flap in the new predetermined side (supraareolar dermopexy). The skin of the inferior pole of the breast is deepithelialized to form an inferior dermal or dermo glandular flap for retropectoral dermopexy (dermal brassiere). This flap gives stability to the breast and makes it more durable.
Autologous Fat Transplantation
Authors: Shiffman Melvin A.
Published: January 2017

A preliminary analysis of the methods that have been used and the results achieved since fat grafts were first used in 1889 is presented. Descriptions of the techniques used by several practicing physicians were collected by personal communication and a review of the literature and are recorded in this paper. Although the process of fat transplantation has not been standardized, it can no longer be considered an experimental procedure as enough surgeons have shown that there can be consistently good results. Failures and complications are not the result of the theory that fat cannot be transplanted, but the result of errors in technique and not adequate attention to detail.
Elastocompression in Cosmetic Surgery
Authors: Ferreira Julio A.
Published: January 2017

It is the aim of the author to call to the aesthetic doctor's attention the updating of elastocompression as well as the advantages of employing it in the immediate postoperative period for the prevention of thrombosis, hematomas, or edema. Elastocompression thus decreases postoperative pain and pigmentation. Its correct postoperative use helps prevent keloids from appearing in the treated area. Correct and systematic employment of the different elements involved in elastocompression following plastic surgery, cosmetic surgery, and phlebology are discussed.
Tumescent Anesthesia for Strip or Elliptical Harvesting
Authors: Nusbaum Bernard P.
Published: January 2017

Tumescent anesthesia can be used to facilitate donor harvesting in hair transplant procedures. The technique increases the speed of surgery, optimizes graft yield, and improves cosmetic results in the donor area.
The Use of Asymmetrical Incisions in Liposuction
Authors: Brandy Dominic A.
Published: January 2017

Liposuction surgery has advanced dramatically over the past 10 years with the advent of tumescent anesthesia, the use of microcannulas, smaller incisions, incisions not closed with sutures, and specially designed garments. However, there has not been much improvement in the science of incision placement. This article discusses a technique that makes liposuction incisions less conspicuous to the human eye by placing the incisions in asymmetric patterns.
Autologous Fat Grafting: A Study of Residual Intracellular Adipocyte Lidocaine Concentrations after Serial Rinsing with Normal Saline
Authors: Alexander Robert W. , Maring Thomas S. , Aghabo Tara
Published: January 2017

Introduction:

With evolution of sophisticated lipocontouring techniques increased interest has developed in utilization of vacuum harvested autologous fat cells for grafting purposes. Transplantation of viable adipocytes for contour augmentation, enlargement, or filling of defects has clinically become more important. Based on evidence that lidocaine solution may alter the metabolic activity, evaluation of the effects of multiple rinsing was undertaken.

Materials and Methods:

Gas chromatography was utilized to measure changes in intracellular concentration of lidocaine from closed syringe harvested adipocytes following serial rinsing with equal volumes of normal saline in preparation for fat grafting procedures.

Results:

Use of standard tumescent local anesthesia as a medium for harvesting mature fat cells via closed syringe techniques resulted in substantial absorption of lidocaine. Statistically significant reduction of intracellular lidocaine was accomplished via serial rinsing with normal saline solution. It was concluded that a minumum of three rinses utilizing equal volume of saline to autologous fat achieved significant and substantial reduction of intracellular lidocaine levels, but did not result in complete removal.

Discussion:

The importance of thorough rinsing and removal of cellular debris from harvested fat cell grafts prior to transfer is widely recognized to improve efficacy and predictability. This study proves that serial rinsing of fat cells harvested with closed syringe system using a tumescent fluid technique does statistically reduce the retention of intracellular lidocaine. It is believed that high concentrations of retained intracellular lidocaine may inhibit the metabolic activity and impact the survivability of autologous fat grafts.
Long-Term Frozen Fat for Tissue Augmentation
Authors: Takasu Katsuya , Takasu Shizu
Published: January 2017

Introduction:

This study presents our experience over 9 years of transplantation of frozen fat to correct the aging face.

Materials and Methods:

Thirty-six patients were treated with frozen fat. For the treatment, fat is harvested from a convenient site such as the abdomen, buttock, or thigh with the pateint under tumescent anesthesia. The fat is placed in 15-mL sterile test tubes and put into a freezer, where the fat is maintained at a temperature of −70°C. The fat is thawed at room temperature for several hours, and reinjection is performed in the same manner as for fresh adipose tissue.

Results:

Of the 36 patients treated with frozen fat, 19 were injected once and 9 were injected twice. The remaining 8 patients received 4 to 7 injections of frozen fat. Frozen fat showed an approximate 30–70% volume loss during the 4–6-week follow-up period. The storage time in the freezer between harvest and reinjection ranged from 2 months to 7 years. It was found from clinical observation that the adipose tissue frozen for a longer period provided results no different from those for adipose tissue stored for a shorter period. No complications related to the use of frozen fat occurred.
Tumescent Technique in Aesthetic Plastic Surgery with Low Doses of Prilocaine Solution, Part I
Authors: Mang Werner L. , Sawatzki Karsten , Materak Jan
Published: January 2017

Introduction:

In Germany the local anesthetic prilocaine has gained popularity for use in tumescent solutions. However, although prilocaine shows the lowest toxicity of the local anesthetics, the use of prilocaine in higher doses leads to methemoglobinemia. We report a clinical study that determines whether adequate local anesthesia can be achieved with low concentrations of prilocaine (less than 0.05%).

Materials and Methods:

Twelve patients from anesthesia risk groups ASA I and II participated in the study. The patients were medicated with 25 mg piritramide orally and with 1000 mg acetaminophen by suppository. By means of an infusion system and a pump syringe, tumescent solution was injected into the subcutis until the tissue was completely infiltrated. This initial injection used approximately two thirds of the total quantity of solution, and the remaining tumescent solution was injected roughly 30 minutes later, resulting in ultratumescence. A 0.038% solution of prilocaine was used. Two 3-L bags with additives were instilled as the standard for treatment. The total injection volume was 6.3 L. A total of 2400 mg of prilocaine was administered, which is 4 times higher than the recommended maximum dose for infiltration anesthesia using prilocaine with epinephrine. The subjective tolerability of the tumescent local anesthesia was measured by interview and documentation.

Results:

In all cases, it was possible to perform the liposuction using prilocaine in a concentration of 0.038%. Eight of the 12 patients needed supplemental intravenous doses of 3.75–11.25 mg of piritramide. Discomfort was reported by 3 patients during the infiltration and by 6 patients during liposuction. Two patients received analgesic during the infiltration, and 8 patients received analgesic during liposuction. All patients were ambulatory immediately following surgery. All patients were satisfied with the tumescent local anesthesia and would agree to using it again in liposuction.

Discussion:

The low concentration of prilocaine used in the tumescent solution (0.038%) proved sufficient for liposuction. The more dilute solution allows for a greater volume of the tumescent solution to be used without causing more side effects. The increased procedure time of up to 6 hours seems justified by the safety and efficacy of the technique.
Effect of Perfusion with Water on Demineralization of Human Dentin in vitro
Authors: Özok A.R. , Wu M.-K. , ten Cate J.M. , Wesselink P.R.
Published: January 2017

Dentinal fluid rarely features in caries studies of dentin. The mutual effects of in vitro perfusion and dentin demineralization were investigated. The correlation between the remaining dentin thickness and demineralization was also analyzed. Buccal cervical dentin windows in human tooth segments were demineralized either with or without perfusion with water at 3.14 kPa. Transverse microradiography revealed that dentin perfusion reduced the amount of mineral loss from the lesions by 22vol%; the reduction in lesion depth was 8%. Perfusion rate, which was measured throughout the demineralization process by means of a fluid transport model, did not change significantly. Lesions formed closer to the pulp exhibited increased mineral loss and lesion depth. In conclusion, dentinal fluid flow offers some protection against demineralization. For a better approximation of clinical reality, therefore, in vitro studies on dentinal caries should consider the effect of dentinal fluid flow.
Autosomal-dominant Hypoplastic Form of Amelogenesis Imperfecta Caused by an Enamelin Gene Mutation at the Exon-Intron Boundary
Authors: Kida M. , Ariga T. , Shirakawa T. , Oguchi H. , Sakiyama Y.
Published: January 2017

Amelogenesis imperfecta (AI) is currently classified into 14 distinct subtypes based on various phenotypic criteria; however, the gene responsible for each phenotype has not been defined. We performed molecular genetic studies on a Japanese family with a possible autosomal-dominant form of AI. Previous studies have mapped an autosomal-dominant human AI locus to chromosome 4q11-q21, where two candidate genes, ameloblastin and enamelin, are located. We studied AI patients in this family, focusing on these genes, and found a mutation in the enamelin gene. The mutation detected was a heterozygous, single-G deletion within a series of 7 G residues at the exon 9-intron 9 boundary of the enamelin gene. The mutation was detected only in AI patients in the family and was not detected in other unaffected family members or control individuals. The male proband and his brother showed hypoplastic enamel in both their deciduous and permanent teeth, and their father showed local hypoplastic defects in the enamel of his permanent teeth. The clinical phenotype of these patients is similar to that of the first report of AI caused by an enamelin gene mutation. Thus, heterogeneous mutations in the enamelin gene are responsible for an autosomal-dominant hypoplastic form of AI.
Human Masticatory Muscle Volume and Zygomatico-mandibular Form in Adults with Mandibular Prognathism
Authors: Kitai N. , Fujii Y. , Murakami S. , Furukawa S. , Kreiborg S. , Takada K.
Published: January 2017

Although several investigators have reported associations between masticatory muscles and skeletal craniofacial form, there is no agreement on the association. We tested the hypothesis that masticatory muscle volume correlates with the size and form of the adjacent local skeletal sites. For this purpose, we investigated the morphological association of the cross-sectional area and volume of temporal and masseter muscles with zygomatico-mandibular skeletal structures using computerized tomography (CT) in 25 male adults with mandibular prognathism. Muscle variables significantly correlated with widths of the bizygomatic arch and temporal fossa but not with the cranium width. Masseter volume significantly correlated with cross-sectional areas of the zygomatic arch and mandibular ramus. Masseter orientation was almost perpendicular to the zygomatic arch and mandibular antegonial region. The zygomatic arch angle significantly correlated with the antegonial angle. The results of the study suggest that the masticatory muscles exert influence on the adjacent local skeletal sites.
Staurosporine Mobilizes Ca2+ from Secretory Granules by Inhibiting Protein Kinase C in Rat Submandibular Acinar Cells
Authors: Kim Y.J. , An J.M. , Shin D.M. , Lee S.-I. , Sugiya H. , Seo J.T.
Published: January 2017

Staurosporine was previously shown to mobilize Ca2+ from the thapsigargin-insensitive Ca2+ store in rat submandibular acinar cells. However, the nature of the store is not yet known. Therefore, in the present study, the staurosporine-releasable intracellular Ca2+ store was characterized. Staurosporine increased the cytosolic Ca2+ concentration ([Ca2+]c) after the inositol 1,4,5-trisphosphate (IP3)-sensitive Ca2+ store was depleted. Ionomycin caused only small increases in [Ca2+]c after the depletion of the IP3-sensitive Ca2+ store, whereas ionomycin+monensin caused large increases. However, ionomycin+monensin did not increase [Ca2+]c when added after [Ca2+]c was increased by staurosporine, indicating that the acidic Ca2+ store was the main source of Ca2+. The acidic Ca2+ store appeared to be associated with secretory granules, since ionomycin+monensin- and staurosporine-induced [Ca2+]c increases were significantly reduced when the acinar cells were degranulated. The effect of staurosporine on [Ca2+]c was mimicked by other protein kinase C inhibitors. Therefore, we conclude that staurosporine mobilizes Ca2+ from secretory granules, probably through the inhibition of protein kinase C in rat submandibular acinar cells.
Dental Fluorosis: Variability among Different Inbred Mouse Strains
Authors: Everett E.T. , McHenry M.A.K. , Reynolds N. , Eggertsson H. , Sullivan J. , Kantmann C. , Martinez-Mier E.A. , Warrick J.M. , Stookey G.K.
Published: January 2017

Concurrent with the decline in dental caries has been an increase in the prevalence of dental fluorosis, a side-effect of exposure to greater than optimal levels of fluoride during amelogenesis. The mechanisms that underlie the pathogenesis of dental fluorosis are not known. We hypothesize that genetic determinants influence an individual’s susceptibility or resistance to develop dental fluorosis. We tested this hypothesis using a mouse model system (continuous eruption of the incisors) where genotype, age, gender, food, housing, and drinking water fluoride level can be rigorously controlled. Examination of 12 inbred strains of mice showed differences in dental fluorosis susceptibility/resistance. The A/J mouse strain is highly susceptible, with a rapid onset and severe development of dental fluorosis compared with that in the other strains tested, whereas the 129P3/J mouse strain is least affected, with minimal dental fluorosis. These observations support the contribution of a genetic component in the pathogenesis of dental fluorosis.
Moving From Field Text to Research Text in Narrative Inquiry
Authors: Manankil-Rankin Louela
Published: January 2017

Narrative Inquiry is a research methodology that enables a researcher to explore experience through a metaphorical analytic three-dimensional space where time, interaction of personal and social conditions, and place make up the dimensions for working with co-participant stories. This inquiry process, analysis, and interpretation involve a series of reflective cognitive movements that make possible the reformulations that take place in the research journey. In this article, I retell the process of my inquiry in moving from field texts (data sources) to research text (interpretation of experience) in Narrative Inquiry. I draw from an inquiry on how nurses experience living their values amidst organizational change to share how I as an inquirer/researcher, moved from field texts to narrative accounts; narrative resonant threads; composite letter as the narrative of experience; personal, practical, and social justifications to construct the research text and represent it another form as a poem. These phases in the inquiry involve considerations in the analytic and interpretive process that are essential in understanding how to conduct Narrative Inquiry. Lastly and unique to my inquiry, I share how a letter can be used as an analytic device in Narrative Inquiry.
Osteoinduction of stem cells by collagen peptide-immobilized hydrolyzed poly(butylene succinate)/β-tricalcium phosphate scaffold for bone tissue engineering
Authors: Patntirapong Somying , Janvikul Wanida , Theerathanagorn Tharinee , Singhatanadgit Weerachai
Published: January 2017

Bone substitute is a therapeutic approach to treat bone abnormalities. A scaffold serves mainly as osteoconductive elements. To facilitate a better biological performance, short collagen peptide was immobilized onto hydrolyzed poly(butylene succinate)/β-tricalcium phosphate (HPBSu/TCP) scaffolds. PBSu/TCP (80:20) scaffolds were fabricated by a supercritical CO2 technique, hydrolyzed with 0.6 M NaOH and conjugated with short collagen peptide tagged with or without red fluorescence. The surface morphology and porous structure of scaffolds were characterized by scanning electron microscopy and micro-computed tomography. Human mesenchymal stem cells were cultured onto the scaffolds and examined for osteogenic differentiation and biomineralization in vitro by means of alkaline phosphatase activity, alizarin red staining, and reverse transcription-polymerase chain reaction. The PBSu/TCP and HPBSu/TCP scaffolds were successfully prepared. Scanning electron microscopy and micro-computed tomography results showed that the porosity was distributed throughout the scaffolds with the pore sizes in the range of 250–900 µm. Fluorescence microscopy demonstrated retention of tagged short collagen peptide on the scaffold. Mesenchymal stem cells adhered and grew well on the material. Under osteogenic induction, cells cultured on the short collagen peptide -immobilized scaffold significantly produced a greater amount of alkaline phosphatase activity and positive mineralization than those cultured on the control scaffold. The present results have shown that the short collagen peptide-immobilized HPBSu/TCP scaffold enhanced osteoinduction and biomineralization of stem cell-derived osteoblasts, possibly via stimulation of alkaline phosphatase activity. This suggests the potential use of osteogenic peptide-immobilized material in bone tissue engineering for correcting bone defects.
Refugees, Islamophobia, and Ayaan Hirsi Ali
Authors: Briskman Linda , Latham Susie
Published: January 2017

As global discourses on refugees and Muslims become more exclusionary, the ethics and traditions of our profession mean social workers arguably have a particular responsibility to work for transformative change. This column argues that social workers need to be wary of direct complicity with harsh policies through implementation roles and, indirectly, through co-option into dominant discourses about refugees and Islam more generally and Muslim women specifically.
Structuring the Cherokee Nation Justice System: The History and Function of the Cherokee Nation Marshal Service
Authors: Heck William P. , Keen Ralph , Wilds Michael R.
Published: January 2017

On July 4, 1986, a Cherokee tribal member was shot in the leg and arrested by a deputy in Adair County, Oklahoma. In a subsequent civil action, the Tenth Circuit Court of Appeals ruled that absent a statutory grant of authority by Congress or consent from the tribe itself, Oklahoma law enforcement officers have no criminal jurisdiction “in Indian country” unless the crime is committed by a non-Indian against another non-Indian or the crime is a victimless crime committed by a non-Indian. Realizing that they were no longer protected by the state, the Cherokee Nation responded by creating its own Marshal Service. This article describes the evolution of that agency, checkerboard jurisdiction, and the need for cross deputization. In particular, the article addresses the recent political tribal crisis that almost devastated the newly formed Marshal Service and the tribe's current struggle to regain stability in the politically charged aftermath.