bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Patients' Assessments on Overall Facial Rejuvenation and Procedural Pain Seen with a Fluorescent Pulsed-Light Source and Those Seen with a Traditional Intense Pulsed-Light Source
Authors: Nahm Walter K. , Chipps Lisa K. , Wrone David A. , Ma Fangchao , Lee David A. , Iwasaki Julie K. , Shin Edward C. , Moy Ronald L.
Published: January 2017

Introduction:

Intense pulsed-light (IPL) treatments are effective alternatives to ablative procedures for improving the appearance of photodamaged skin. Currently, there are multiple IPL sources to modulate photoaged skin, but there are no studies comparing the efficacy of or pain associated with 2 different PL sources. Therefore, we chose to compare patients' assessments of overall cutaneous rejuvenation and pain associated with a fluorescent PL source and a traditional IPL source.

Materials and Methods:

We performed a retrospective analysis of 24 patients who were treated with both a fluorescent PL source and a traditional IPL source. These patients completed questionnaire surveys that assessed (by a graded scale) pain during the procedure and overall satisfaction with each IPL source. The Wilcoxon signed-rank test for paired data as well as McNemar's test were used to compare overall facial rejuvenation and procedural pain between the 2 light sources.

Results:

For both light sources, most patients reported “fair” or better improvement in skin appearance. The patients did not report a significant difference in overall skin improvement between the treatments with each light source. In addition, most patients did not report having pain during recovery after procedures by either light source. However, patients did report significantly less pain during treatments with the fluorescent device compared with the traditional IPL source.

Discussion:

IPL sources provide safe and effective nonablative treatment for facial photorejuvenation. Patients are equally satisfied with the effects seen with both traditional and fluorescent PL source, but reported less pain with the fluorescent PL procedure during treatments.
Ambulatory Abdominoplasty: Body Mass Index Used to Select Surgery Candidates
Authors: Williams Troy C. , Hardaway Michele , Altuna Brenda
Published: January 2017

Introduction:

Body mass index (BMI) has been used in many applications. In the adult population, it is gender independent and therefore applicable to both men and women. This study presents the results of our evaluation of 22 cases of outpatient abdominoplasty where BMI was used to delineate which abdominoplasty candidates could safely undergo abdominoplasty on an outpatient basis by the tumescent technique.

Methods and Materials:

The charts for 22 patients who underwent ambulatory abdominoplasty were reviewed. In each patient, the preoperative evaluation, intraoperative surgical technique, and postoperative care were examined. Each of the patients had a BMI between 22 and 34. All the patients had an American Society of Anesthesiologist (ASA) I or II classification based on having no health concerns or I health matter that was well controlled.

Results:

All 22 patients spent between 40 and 75 minutes recovering and were discharged into the care of a responsible adult upon meeting discharge criteria the same day the surgery was performed. No surgical- or sedation-related complications were reported after several months of clinical observation. We found that abdominoplasty performed under intravenous sedation with a tumescent anesthetic could be safe and effective if performed on properly selected patients.

Conclusion:

BMI and risk assessment by Anesthesia can be a reliable method to help determine the proper candidates for outpatient office-based surgery. Using strict criteria, we can avoid many of the complications seen with the combination of abdominoplasty and liposuction and perform these operations safely.
Comparison of Commonly Used Dressing Techniques after Carbon Dioxide Laser Facial Resurfacing
Authors: Fattahi Tirbod , Kirkpatrick David
Published: January 2017

Introduction:

We sought to evaluate the advantages and disadvantages of the most commonly used bio-occlusive dressings applied to the facial region after carbon dioxide laser resurfacing. The composition, application process, ease of use, cost, and specific manufacturer's directions for use were assessed for each type of dressing.

Materials and Methods:

The most commonly used dressings following carbon dioxide laser facial resurfacing include: composite foam, hydrogel, polymer film, polymer mesh, and silicone gel. Specific findings for each dressing including composition of material, ease of application, cost, and unique manufacturers' directions were recorded.

Results:

There are several manufactures offering wound dressings for use after carbon dioxide laser resurfacing of the face. Each dressing has its own unique clinical properties, ease of application, and cost.

Conclusions:

Although several post-laser resurfacing dressing choices are available to the laser surgeon, it is imperative that the appropriate material is used based on a selection criteria including cost, ease of use, ingredients, patient comfort, and clinical performance. Regardless of the claims made by the manufactures, the clinician must be keenly aware of the healing process after a carbon dioxide laser resurfacing so that the appropriate dressing can be safely applied to the patient.
Bicipital Augmentation
Authors: Chugay Nikolas V. , Racanelli Joseph , Hsu John , Chugay Paul N.
Published: January 2017

Introduction:

This article describes the surgical procedure used to implant a bicipital prosthesis with little injury to surrounding anatomic structures into the arm of a 32-year-old man who desired greater upper body symmetry.

Materials and Methods:

The solid silicone implant used in this procedure was initially developed for reconstruction of the upper extremity after traumatic injury to the region of the biceps or excessive resection of a tumor from the area. A custom bicipital implant is inserted below the fascia into a submuscular pocket. Meticulous hemostasis is achieved by electrocautery to prevent postoperative complications. The biceps muscle is then reapproximated with 3-0 Vicryl sutures, with the knots buried very deep. Afterward, the bicipital fascia is repaired with 4-0 Vicryl suture.

Results:

Aesthetically pleasing and dramatic results can be obtained from this procedure.

Discussion:

Bicipital augmentation surgery is a relatively straightforward procedure that affords great results. The vast majority of dissection during the procedure is blunt with natural tissue planes, thus preventing any damage to vital structures in the upper arm. Regarding potential complications that may be encountered, one should be mindful of the location of the lateral antibrachial cutaneous nerve to avoid loss of sensation in the lateral aspect of the forearm. Prudent dissection of the pocket for the implant is essential for optimal cosmesis and to prevent implant malposition. Multilayer closure with absorbable monofilament suture has proven beneficial in avoiding hypertrophic postoperative scars.
Modification of the Nasolabial Crease with Wire Scalpel and Autologous Fat Transfer
Authors: Kotlus Brett S. , Dryden Robert M.
Published: January 2017

Introduction:

We describe a novel approach to the management of pronounced nasolabial rhytids.

Materials and Methods:

Two clinical cases of prominent nasolabial creases are reported. Both underwent subcutaneous dissection with wire scalpel with autologous fat transplantation. Photographic documentation, operative reports, and patient records were retrospectively reviewed.

Results:

Both patients attained a desirable aesthetic outcome.

Conclusions:

Wire scalpel dissection in conjunction with lipoinjection is an effective means of addressing the prominent nasolabial creases of the aging face.
The Use of Injectable Silicone Microdroplets to Improve Small Facial Defects and Imperfections in the Nose
Authors: Aronsohn Richard B.
Published: January 2017

Introduction:

After rhinoplasty, an imperfection often becomes apparent after healing. Such imperfections usually present as a depression that can be corrected using a serial puncture technique with the injection of sequential microdroplets of silicone. The injection technique, results, and minor complications are presented.

Materials and Methods:

The technique using microdroplets of 1000-centistoke silicone injected through a 30-gauge needle into depressions around the nose is presented. Seven patients are chosen to illustrate the procedure.

Results:

Preinjection and postinjection photographs demonstrate the degree of correction of minor imperfections without adverse tissue reactions.

Discussion:

Silicone offers a safe and easier alternative to saving a patient's own cartilage for use as filler material. Storing cartilage requires a refrigerated germicidal solution and a tissue bank license. Using a serial puncture technique with the injection of microdroplets of silicone is an easier and more rapid method of correction than performing surgery again and implanting cartilage or other solid filler material. Although silicone is not absolutely inert, it elicits less physiological activity than any other foreign substance known today. It is indestructible and nonallergenic; it is never metabolized; it does not support bacterial growth; and no immunologic diseases have been associated with it. The eventual response to its injection is fibrosis resulting in slightly increased collagen deposition localized to the immediate surrounding area. The fibrosis is self-limited and does not become extensive.

Conclusion:

When properly used, pure liquid silicone ranks as one of the most remarkable substances to emerge in the field of cosmetic surgery. In this author's opinion, it is the “gold standard” of all injectables. This modality is inexpensive with no downtime, it is an office procedure that is rapid with minimal discomfort, and it is extremely safe.
The J-Lift/Internal Face-Lift for Facial Rejuvenation
Authors: Leach J. L. , Verret D. J. , Gilmore J.
Published: January 2017

Objective:

To evaluate our experience with the J-lift/internal facelift, which includes lipoaspiration of the lateral cheek and neck, limited subcutaneous dissection with multivector superficial musculoaponeurotic system plication, and subperiosteal dissection in the jowl and malar areas with implant placement.

Methods or Design:

A retrospective chart review of 139 patients who underwent J-lift and internal face-lift between 2001 and 2004. The number of complications was addressed and results analyzed photographically using a 3 point scale.

Results:

137 patients expressed satisfaction with the technique. The two that did not suffered from extensive adiposity in the neck tissues. There were three complications, which consisted of a small eschar over the tragus, a widened preauricular scar and some asymmetry of one prejowl implant which were successfully addressed with minor revision surgery. There were no cases of expanding hematoma, postoperative auricular displacement, injury to cranial nerves V or VII, or loss of hair in the temporal area. Photographic assessment of the results indicated fair to moderate improvement in the midface and good to excellent improvement in the jowl and cervicomental angle.

Conclusions:

The J-lift is an effective and safe technique for patients with jowl and cervicomental angle rhytids.
Treatment of Rhinophyma with a Radiofrequency Device
Authors: Iwasaki Julie , Marra Diego E. , Fincher Edgar F. , Moy Ronald L.
Published: January 2017

Background:

Rhinophyma is an uncommon complication of long-standing rosacea that is caused by sebaceous gland hypertrophy. There is no consensus regarding the treatment of rosacea. Retinoids, steroids, antibiotics, electrocautery, ablative laser therapy, dermabrasion, and excisional modalities have been used, but no single treatment method has proved effective for all patients.

Objective:

Radiofrequency has been shown to decrease sebaceous gland activity in acne vulgaris. Thus, the authors postulated that it could also improve the clinical course and severity of rhinophyma by acting on the hypertrophied sebaceous apparatus.

Methods:

A 77-year-old man presenting with long-standing rhinophyma received 2 monopolar radiofrequency treatment spaced 3 months apart.

Results:

Two months after treatment, the patient reported significant improvement in symptoms. Specifically, the frequency of pustular flares decreased notably from once weekly before treatment to once every 3 weeks after the second treatment. The intensity of flares also decreased significantly, from 7–8 on a 10-point scale before treatment to 3–4 after the second treatment. The patient has continued to do well 5 months after his initial treatment, using only topical maintenance therapy.

Conclusions:

Monopolar radiofrequency can effectively improve the clinical course and severity of rhinophyma. This noninvasive, nonablative modality may be a valuable adjunct in managing this often refractory and therapeutically challenging condition.
Introducing COSMET: An Active Learning Study Tool for Cosmetic Surgery
Authors: Burchett Kelly D. , English Jim L.
Published: January 2017

In the academia of cosmetic surgery, multiple specialties contribute to the advancement of knowledge and surgical techniques. To surgeons attempting to learn or review cosmetic surgery, the volume of information can seem overwhelming with different articles and texts emphasizing different ideas. In an attempt to better standardize the education of cosmetic surgeons in an active format, the authors introduce COSMET, or Cosmetic Organized Study Material and Educational Tutorial. In its current form, COSMET is a 25-topic study guide currently under construction and covering the major aspects and procedures of cosmetic surgery. Each topic directs the physician by asking specific board-relevant questions and referring to key authors/articles. This is an ideal tool for fellowship training and may be structured according to a board review course. At a rate of one topic per week, a fellow may complete the tutorial twice over a 1-year term. Experts from around the country may be recruited to contribute to specific topics that they emphasize. COSMET may be reviewed as weekly PowerPoint presentations for fellows and staff, creating a “library” that may be enhanced each year. This tool would also benefit established surgeons seeking a review or recertification. COSMET could be made available in a Portable Document Format for easy web access.
Eutectic Mixture of Local Anesthesia (EMLA) Toxicity after Application for Laser Surgery: A Case Report
Authors: Mallalieu Jared , VanAntwep Ross James
Published: January 2017

Objective:

Eutectic mixture of local anesthesia (EMLA) is widely used and generally regarded as safe. However, the potentially devastating effects of EMLA cannot be forgotten. It is the objective of this paper to discuss the presentation and treatment of EMLA toxicity as it applies to cosmetic surgery.

Methods:

A case report.

Case Presentation:

A 29-year-old white woman sought cosmetic treatment of abdominal striae with laser at an outpatient surgical center. The patient arrived a half-hour before her appointment, complaining of parasthesias, and soon became agitated. Generalized seizure and respiratory arrest ensued. The patient was emergently intubated in the office and transferred to the hospital, where she was treated for lidocaine toxicity. Phenobarbital coma was induced. As lidocaine levels fell, the phenobarbital was stopped, and the patient was eventually extubated.

Discussion:

Lidocaine blood levels ranging from 0.5 to 5 μg/mL are considered therapeutic. At therapeutic levels, side effects may include burning, transient paleness, erythema, and edema at the site of application. At such levels, lidocaine has anticonvulsant properties. As the levels approach 5 μg/mL, however, minor central nervous system (CNS) symptoms begin to manifest. Typically, these include vertigo, drowsiness, tinnitus, dysarthria, and perioral numbness. As levels approach or exceed 7.5 μg/mL, objective CNS signs, such as tremors, confusion, and shivering, are evident. By 10 μg/mL seizures arise. Respiratory depression and, ultimately, coma will eventually result. Cardiovascular toxicity may also result, leading to bradycardia, dysrhythmias, and eventually cardiac arrest.

Conclusion:

Management for lidocaine toxicity should focus on treating the seizures and cardiovascular collapse. Initially, the treating physician must establish and maintain vital functions, and lidocaine levels should be measured every 12 hours. It is important that in all situations where EMLA is used, a physician capable of the acute management of toxicity is present. Additionally, facilities in which EMLA is used should be properly equipped with the tools necessary for managing EMLA toxicity.
Single-Center, Prospective, Randomized, Phase 4 Clinical Trial to Determine the Effects of Single-Pass 560-nm Filter Intense Pulsed Light with or without an Additional Pass with a 755-nm Filter for the Reduction of Facial Rhytides
Authors: Saluja Raminder , Khoury Jane , Goldman Mitchel P.
Published: January 2017

Objective:

To investigate the clinical efficacy of the addition of a triple pulsed, 755-nm filtered flashlamp intense pulsed light to a single-pass 560-nm filter for the treatment of facial rhytids and other aspects of photodamage.

Design:

A single-center, prospective, randomized, phase 4 split-face clinical trial.

Methods:

Twenty female volunteers with Fitzpatrick skin type I–IV with a Rao-Goldman wrinkle score of 2 or higher received 2 split-face treatments 4 weeks apart, in which half of the face was treated with 1 pass of a double-pulsed 560-nm filter and the other half was treated with a double-pulsed 560-nm filter followed by a triple-pulsed 755-nm filtered nonablative intense pulsed light. Fluence varied from 15–19 J/cm2. Efficacy was evaluated by patient self-assessments and by blinded clinical and photographic evaluations 1 month after the final treatment. Adverse effects were assessed clinically.

Results:

All patients noted improvement in pigmentation on both sides of the face, and 60% of patients noted an improvement in skin texture on the side that received the 755-nm filter; however, there was no discernable difference in rhytid reduction between the 560 + 755 filtered side compared with the 560 filtered side alone.

Discussion:

Two split-face intense pulsed light treatments delivered 4 weeks apart with half of the face receiving double-pulsed 560 filter treatment and the other half receiving a double-pulsed 560 filter + triple-pulsed 755 filter treatment showed no improvement in rhytid reduction. There was a subjective improvement in texture and pore size noted by patients on the side treated with the 560 + 755-nm filtered intense pulsed light treatment.
Knowledge about and Attitudes towards Cosmetic Breast Surgery among Nigerian Undergraduates
Authors: Oladele A. O. , Olabanji J. K. , Akinpelu O. V. , Oladele H. O. , Akinkuolie A. A.
Published: January 2017

Background:

Cosmetic breast surgery (CBS) is rarely requested in our surgical practice. Local data on the practice of CBS is also scarce. Therefore, we embarked on this study to explore the issues and attitudes that might influence the decision of Nigerian undergraduates to undergo cosmetic breast surgery.

Methods:

Structured questionnaires were administered to undergraduates of the Obafemi Awolowo University, Ile-Ife, Nigeria. Information extracted included the participants' demographic data, awareness of CBS, attitudes about CBS, and perceptions regarding disproportionate breast size. These were analyzed using SPSS for Windows with simple descriptive statistics.

Results:

Of the 735 respondents, 71% were women and 28.7% were men. In addition, 90% had some knowledge of cosmetic breast surgery and 38% were aware of at least one person who had undergone CBS. Information sources included television, magazines, and radio. Only 14% of the surveyed participants acknowledged their approval of CBS. Reasons given for disapproval included no definite reason, cultural and religious arguments, inability to breast-feed after surgery, and interference with pregnancy. More than 50% of respondents thought CBS caused cancer. More than 70% knew at least one person that they thought had excessively small or large breasts, and half of these thought such persons might benefit from CBS.

Conclusion:

A number of issues affect a person's decision to undergo CBS. Social acceptance, interference with fertility, and perceptions of health issues appear to be important factors in the low approval rate of CBS in this population. It may be possible to extrapolate this information and compare it with other populations where media influence and public information are more available.
Experience and Evaluation of a New, Saline-Filled Implant for Cosmetic Lip Augmentation
Authors: Niamtu Joe
Published: January 2017

Purpose:

The purpose of this article is to discuss the author's experience with a new saline-filled lip implant technology in an initial series of patients.

Materials and Methods:

The novel saline-fillable implant (VeraFil; Evera Medical) is composed of a thin expanded polytetrafluoroethylene outer membrane bonded, only at the ends of the device, to a silicone inner membrane creating a slip plane between layers and is intended to heal with mild cellular incorporation and to remain soft and elastic over time. At implantation, the saline volume is adjusted as desired through a temporary fill tube and a self-sealing microvalve. The author's previous experience with lip implants is presented as a detail of the surgical placement of this technologically unique implant. The author's series of 25 implants over a 7-month period is reviewed as well as international experience with more than 475 implants of the same type.

Results:

In the author's series of 25 implants, there was no mechanical failure or displacement, and there was no incidence of extrusion or infection. Two implants were removed and repositioned because of improper placement. In the worldwide experience, 475 implants have been placed by 41 surgeons. A total of 399 implants were placed in the lips, 90 in the nasolabial folds, 4 in the tear trough region, and 2 in the chin. As of November 10, 2007, 139 implants have been in place for more than 18 months, 32 of which have been in place for more than 2 years. There has been 1 confirmed infection and 1 suspected infection as well as a single case of dehiscence (surgeon's first case) through the incision. One implant shifted superiorly in the lip and was removed and replaced. There have been no cases of late extrusions. No implants have ruptured, and none have been surrounded by thick capsules.

Conclusion:

The VeraFil saline-filled implant is a new technology for lip augmentation. The implant is unique in design and materials and can be placed in less than 15 minutes. All patients in the author's initial series have been happy with the augmentation result and the natural look and feel, and no patient has complained about loss or change of oral function. There has been no incidence of infection, rejection, implant deflation, migration, or device failure in the author's series, which has mirrored the worldwide experience of at least 475 implants. The VeraFil saline-filled lip implant appears to be a viable and promising technology that could be a welcomed addition to the armamentarium of the cosmetic surgeon dealing with lip enhancement.
Subcutaneous Forehead Lift: Technique and Early Results
Authors: Kahana Alon , Lemke Bradley N. , Burkat Cat N. , Lucarelli Mark J.
Published: January 2017

Objective:

To present our indications, technique, and results for a modified subcutaneous forehead lift.

Methods:

Retrospective chart review of 16 patients who underwent a subcutaneous forehead lift.

Results:

Tumescent anesthesia was used in all 16 patients. Seven patients underwent the procedure without the use of a fibrin sealant, whereas a commercially available fibrin sealant was used in the other 9 surgeries. In 1 of 7 patients in whom a fibrin sealant was not used, a postoperative seroma was evacuated in the first 24 hours after surgery. In patients in whom a fibrin sealant was used, there were no cases of hematomas or seromas. Twelve patients had concomitant upper eyelid surgery (ptosis repair and/or blepharoplasty), and 4 patients had no upper eyelid surgery. Two patients had a small dehiscence with no long-term sequelae. There were no instances of keloid formation. Postoperative brow position was judged to be good in 9 patients, adequate in 4 patients, and undercorrected in 3 patients. Forehead rhytids were improved in all patients. There were 2 cases of asymmetry, 1 of them in a patient with a history of Bell's palsy. There were no cases of symptomatic postoperative scalp hypoesthesia or decreased forehead movement. Our analysis revealed a trend toward improved postoperative brow position with increasing experience, which was manifested in a more aggressive release of the subcutaneous attachments of the lateral brow and a larger skin excision.

Conclusions:

Subcutaneous forehead lift with tumescent anesthesia and a fibrin sealant is a safe and effective technique that provides the surgeon with good control of brow positioning while directly addressing forehead rhytids. It avoids significant postoperative scalp hypoesthesia. In our series, the use of a fibrin sealant was correlated with elimination of postoperative hematoma or seroma, even though these patients had no postoperative pressure dressings. This technique can be an important addition to the oculofacial surgical armamentarium.
The History of Hair Transplantation
Authors: Pak Jae P. , Gazoni Paulo , Zeballos Alvaro , Rassman William
Published: January 2017

Throughout history man has searched for the cause of hair loss. It is only in recent years, with greater knowledge of genetics and the chemistry of sexual hormones, that we have begun to understand the causes. The most common type of hair loss is androgenic alopecia, which afflicts more than 50% of the male population to some degree. The allusive cure for androgenic alopecia can be traced back thousands of years to the ancient Egyptians or the Romans who applied a variety of ointments and salves to their balding heads. In the modern era, hair restoration surgery has gained popularity as a permanent means of addressing alopecia.
Transconjunctival, Sublabial, and Temporal Subperiosteal Approach Midface-Lift for Persistent Lower Eyelid Retraction after Blepharoplasty
Authors: Mancini Ronald , Nakra Tanuj , Saulny Stanley M. , Goldberg Robert A. , Shorr Norman
Published: January 2017

Purpose:

To define a subgroup of postblepharoplasty patients with persistent lower eyelid retraction despite attempted lower eyelid reconstruction and midface-lifting, and to propose a revisional midface-lifting procedure to address complex cicatricial patterns in these patients.

Methods:

This is a retrospective observational case series of consecutive patients with bilateral persistent cicatricial lagophthalmos from lower blepharoplasty despite prior lower eyelid reconstruction and midface-lifting. An approach for midface-lifting and lower eyelid reconstruction was designed that consisted of transconjunctival, sublabial, and temporal approaches to the subperiosteal space with manual distraction cicatricial scar matrix lysis. Routine postoperative evaluation of clinical outcome, safety, patient satisfaction, and photographic analysis was performed.

Results:

A total of 8 patients who underwent revisional midface-lift surgery (15 ipsilateral surgeries) were identified. In all 15 cases, a 3-dimensional cicatricial matrix was identified that involved the lower eyelid and midface and limited visual exposure of the subperiosteal space and mobility of the midface despite complete subperiosteal release to the sublabial incision. Manual anterior distraction of the midface via the sublabial incision provided a mechanism for lysis of the cicatricial matrix. Improved midface mobility allowed successful vertical fixation with maximal anterior lamellar recruitment and lower eyelid support. No complications were encountered. All patients reported improvement in cosmesis and ocular comfort. Average improvements in lower margin to reflex distance (MRD2) was 0.9 mm, scleral show was 0.8 mm, palpebral fissure height at the medial limbus was 1.2 mm, and palpebral fissure height at the lateral limbus was 1.2 mm.

Conclusion:

Patients who presented with postblepharoplasty cicatricial lagophthalmos after unsuccessful lower eyelid reconstruction, including midface-lifting, may have a complex 3-dimensional cicatricial matrix involving the lower eyelid and midface. A combined transconjunctival, sublabial, and temporal subperiosteal approach with manual scar matrix release for midface elevation and lower eyelid support is a safe and effective management paradigm.
The Avelar Lipoabdominoplasty: Initial Operative Experience and Results in 67 Consecutive Patients
Authors: Lonergan Ian , Mangubat E. Antonio
Published: January 2017

Background:

Traditionally, liposuction techniques have been used to address excess abdominal fat, and abdominoplasty procedures have been used to address excess abdominal skin and abdominal muscular laxity. The Avelar lipoabdominoplasty is a procedure that combines abdominal liposuction with abdominoplasty and can address all of these issues with a single operative procedure. In this series, we report on our initial operative results using this operative technique.

Methods:

A total of 67 patients underwent Avelar lipoabdominoplasty during the period from November 2004 to June 2006 and were included in this series. Intraoperative and postoperative complications were recorded. Overall patient satisfaction with the procedure was recorded as well.

Results:

Patient satisfaction surveys were recorded for all 67 patients who underwent Avelar lipoabdominoplasty in this series. In all, 55 patients (82%) stated that they were very satisfied with the procedure, 9 patients (13%) stated that they were satisfied with the procedure, 2 patients (3%) stated that they were somewhat satisfied with the procedure, and 1 patient (2%) expressed dissatisfaction with the procedure. No intraoperative complications were encountered for patients undergoing the Avelar lipoabdominoplasty in this series. Postoperative complications during this series were recorded and included 4 seromas (6%), 5 minor wound infections (7%), and 2 minor skin necroses (3%).

Conclusions:

The Avelar lipoabdominoplasty is a safe and effective operative technique that can address excess abdominal fat, abdominal muscular laxity, and excess abdominal skin with a single operative procedure. The technique is associated with a high level of patient satisfaction and is more rapid than traditional abdominoplasty techniques.
Marcaine: A Dependable Local Anesthetic for Breast Augmentation
Authors: Dampier Loucinda R. , Smith Lane F.
Published: January 2017

Background:

Many investigators have evaluated the utility of local anesthetic use before, during, and after augmentation mammoplasty. Routes used include subcutaneous injections, intercostal nerve blocks, pump infusions, drain infusions, and “splashing” into the submuscular pocket. Although many of these techniques yield statistically significant results, they can add time to the operation and can cause additional complications. In particular, local anesthetic pump infusions add significant cost and require a foreign body to be in contact with the skin in a pocket with a sterile implant. We sought to find an affordable solution that would decrease postoperative recovery time, reduce narcotic requirements, and decrease pain in the early postoperative period without adding significant cost or risk to the procedure.

Objective:

To determine whether Marcaine placement into the breast pocket during breast augmentation actually improves patient pain in the early postoperative period, and to determine whether this therapy has any detrimental effects.

Methods:

This double-blind, randomized study was undertaken to compare the effects of placing 10 mL 0.25% Marcaine with epinephrine into 1 or both breast pockets of each patient undergoing bilateral breast augmentation. We sought to evaluate whether this therapy improved postoperative pain and to assess the safety of using Marcaine for this purpose.

Results:

A total of 26 patients voluntarily enrolled in and completed our study. Of these, 25 received Marcaine in 1 or both breast pockets. In all, 24 patients reported less pain on the Marcaine-infused side, and 1 believed that her pain was equal in the 2 breasts. Among 4 patients who received Marcaine in both pockets, no narcotics were required in the recovery suite. No negative reactions to Marcaine were reported in any patient, nor were any infections or hematomas noted.

Conclusions:

Placing 10 mL of 0.25% Marcaine with epinephrine into each breast pocket during breast augmentation is a safe and effective form of early postoperative analgesia.
Body Dysmorphic Disorder
Authors: Shiffman Melvin A.
Published: January 2017

Introduction:

Body dysmorphia disorder (BDD) is defined as a preoccupation with an imagined or a very slight defect in physical appearance that causes significant distress to the individual. Patients with body dysmorphia may approach cosmetic surgeons or dermatologists seeking surgery or medical treatments, and this places the doctor at risk of having a patient who is continually dissatisfied with whatever is done.

Symptoms:

With BDD there is preoccupation with the supposed appearance problem. The patient takes actions to “hide” the defect or avoid certain situations because they feel ugly and do not want to be seen by others. Many patients with BDD also suffer from depression and from obsessive compulsive disorders, such as eating disorders, anxiety disorders, trichotillomania (hair pulling), and abuse of drugs or alcohol. There is a high rate of suicidal ideation.

Discussion:

Serotonin-reuptake inhibitors (SRIs) are a group of medications that appear to be useful and effective in patients with BDD. Cognitive behavioral therapy appears to be an effective treatment for BDD. The behavioral component consists of exposure and response prevention, where the patient exposes his or her defect in situations that they would usually avoid and response prevention involves helping the patient stop the compulsive behavior related to the defect.

Conclusion:

Treatment for patients with BDD is medication, usually SRIs, or psychiatric care with cognitive behavioral therapy. Surgeons need to identify patients with BDD before surgery, tell them that surgery is not the treatment for their problem, and refer them to a psychiatrist for treatment.
Low-Level Laser Therapy Effectiveness for Reducing Pain after Breast Augmentation
Authors: Jackson Robert F. , Roche Gregory , Mangione Todd
Published: January 2017

Introduction:

The purpose of this Institutional Review Board (IRB)-approved, placebo-controlled, randomized, double-blinded parallel-grouped, multicenter trial was to determine the effectiveness of low-level laser therapy (LLLT) in decreasing patients' postoperative pain 24 hours post breast augmentation surgery.

Materials and Methods:

The Erchonia EML, 630–640 nm, (Erchonia Medicial, Inc., McKinney, Texas) with 2 7-mw laser-emitting diodes was used within 10 minutes of the start of the procedure over each breast for 4 minutes at a distance of 6 inches. This was repeated within 10 minutes of completion of the procedure with the same methodology. One hundred and four (104) patients participated in the study, 50 test subjects and 54 controls. Primary investigator and patient were blinded with respect to treatment group.

Results:

The success criteria for this study using the standardized Visual Analogue Scale (VAS) was a self-reported degree-of-pain rating of less than 30 at 24 hours after the implant procedure. At this time the patient had not taken pain medication for 4 hours. Overall study success criteria were defined as at least 30% difference between treatment groups with respect to proportion of successes. At the 24-hour time interval 37 (74%) of the test subjects and 20 (37%) of the control subjects met the success criteria, a difference of 37% (p<.0002). The amount of pain medication used over the first 7 days post operatively was measured as a covariant. The test subjects used less medication 848 versus 932 total doses (p<.01).

Conclusion:

Low-level laser therapy is effective at significantly decreasing postoperative pain and the amount of pain medication needed after breast augmentation at 1 day and 1 week respectfully. All other covariants studied including, implant type, implant size, incision size, implant location, test site location, amount of swelling measurements, hydration level, and adverse events were found to be neglible.
Ideal Breast LiftSM Augmentation Mastopexy for Moderately to Severely Ptotic Breasts: Previsualizing Breast Shape and Symmetry with an Innovative and Versatile Stapling Technique
Authors: Eisenberg Ted S.
Published: January 2017

Introduction:

Augmentation mastopexy is one of the more challenging surgeries. This article presents a new technique in which tailor tacking with skin staples provides maximum tightening of the redundant breast tissue and allows me to previsualize breast shape and symmetry—before the scalpel is raised for a 1-stage skin resection. I believe this is a more precise approach than the standard technique of drawing a pattern, resecting skin, and then tailor tacking the tissues together.

Materials and Methods:

A total of 41 patients with moderate to severe ptosis and hypotrophy were reviewed for this article. They all had bilateral submuscular saline breast augmentation with bilateral mastopexy with this stapling technique. Surgeries were performed over a 5-year period. The technique is described in detail. Preoperative and postoperative photographs are provided.

Results:

Patients reported great satisfaction with their results. Only 6 had small areas that healed by secondary intention, and only 1 patient had a mildly hypertrophic scar. Subjectively, this technique allowed me to achieve consistent, reproducible symmetry with single en bloc tissue resection and with less anxiety and guesswork.

Conclusions:

This augmentation/mastopexy technique produces predictable and reproducible results regardless of the implant size or the amount of skin that needs to be resected. With the adage of measure twice, cut once, it is very comforting to be able to preview the surgery results before having to cut skin.
Evaluation of a Web-based Patient Education Tool for Breast Augmentation
Authors: DeLuca-Pytell Danielle , Spanknebel Kathryn , Rosenberg Michael , Petro Jane , Bonanno Philip
Published: January 2017

Introduction:

To evaluate the utility of a Web-based educational tool for women who have had or who are considering breast augmentation.

Materials and Methods:

A definitive Web-based resource, http://www.breastimplantcare.com , was developed for use by patients and physicians, which summarizes, in lay terminology, contemporary, evidence-based information for decision-making and long-term follow-up regarding breast augmentation. Urchin Web analytics v.5.7.03 data and Google Analytics for Web site traffic reporting were analyzed.

Results:

Over a 1-year period, the Web site received over 12 800 hits. Within 6 months, there were 2548 unique visitors. The number of daily visitors has ranged from 12 to 71. The average visitor looks at 5 to 6 pages of the site. Monitoring Your Implants is the most popular page viewed. Patients have contacted this site from a wide geographic area looking for immediate postoperative advice and for help with long-term problems. Those with immediate postoperative questions are referred back to their treating physician. Though over 70 visitors have visited the pages with downloadable forms to be a part of a prospective study funded by the Cosmetic Surgery Foundation (CSF), only 5 new patients have joined the study.

Discussion:

This Web-based educational tool for women who have had or are considering breast augmentation has demonstrated utility in providing information and helping educate women who are considering or who have had breast augmentation. The site is less effective as a recruiting tool for the grant study, but from a Web marketing standpoint, it is a good return on investment.
Do You Know Your Fat? A Review of Adipose Tissue and its Implications in Cosmetic Surgery
Authors: Mallalieu Jared , O'Connell Adrienne , Forouzanpour Fardad
Published: January 2017

Introduction:

New procedures and technologies abound in cosmetic surgery as in other areas of medicine. It is critical that physicians performing cosmetic procedures involving adipose tissue have knowledge about the embryology, anatomy, and physiology of adipose tissue. This knowledge will allow informed decision making with regard to patient selection, procedure implementation, and postoperative expectations.

Method:

A review of the literature.

Results:

Anatomically, adipose tissue is an intricate structure consisting of a variety of cell types working together. It functions in thermoregulation of the body and provides protection for internal organs. Physiologically, it is an endocrine organ whose adipokines impact the entire body, including determining feelings of satiety and ultimately, body composition. Adipose metabolism is itself regulated by a host of hormones. Obese patients will likely experience complications, including those resulting from insulin resistance, diabetes, hypertension, hyperlipidemia, and hyperandrogenism in women. These complicating conditions are more strongly associated with intra-abdominal and upper body fat, than to overall adiposity.

Discussion:

The estimated prevalence of overweight individuals, when defined by body mass index (BMI) > 25, continues to rise. Currently, more than 60% of men and more than 55% of women fall into this category. The cosmetic surgeon must be aware that a patient with excess fat will be at an increased risk for intraoperative and postoperative complications associated with higher rates of diabetes, hypertension, and atherosclerosis. Surgeon and patient must consider the ramifications of fat volume removal, and the implications it has on the patient's metabolism and adipokine levels. Since the data about the ramification of manipulating of adipose tissue are conflicting, disrupting adipose tissue may have unforeseen consequences for the patient.
Severe Infection and Filler Migration 5 Years after Injection of Polyalkylimide 4% (Bio-Alcamid): A Case Report and Review of the Literature
Authors: Kim King , Kaltman Jordan , McClure Shawn
Published: January 2017

Patients undergoing standard highly-active antiretroviral therapy for the treatment of human immunodeficiency virus may suffer from severe facial lipotrophy, also known as facial wasting. Facial wasting can impose a devastating psychosocial burden to the affected patients. Injectable filler materials are currently used worldwide for soft-tissue augmentation in various parts of the body. Injectable filler materials can be absorbable, semipermanent, or permanent. Permanent injectable filler materials have been used to augment facial soft-tissue defects, to treat rhytids, or to treat patients affected by facial lipoatrophy secondary to human immunodeficiency virus–associated antiretroviral therapy.
Auricular Sandwich Graft for Caudal Septal Augmentation
Authors: Newman Julius , Nguyen Abram , Anderson Roger
Published: January 2017

Retraction of columella and collapse of nasal tip may be a primary phenomenon or secondary to poor results of rhinoplasty. This may be due to excessive resection of dorsocaudal septum or inappropriate removal of the nasal spine.

Reconstruction of the columella is a difficult surgical procedure and many techniques have been described. This report describes a technique of interposition of a composite skin-conchal cartilage graft between the caudal septum and columella. The graft will restore the projection of the nasal tip and correct a retracted columella by increasing its base. The newly positioned columella forms an aesthetically acceptable obtuse angle with the lip and is 2–3 mm lower than the alar rims.

The cartilage from the concha of the ear is an excellent grafting material for nasal reconstruction. It has been used for augmentation of the nasal dorsum, tip grafting, and correction of vestibular atresia. The graft is harvested utilizing a technique that allows for minimal postoperative auricular deformity at the donor site. Aesthetic results have been satisfactory, with very low morbidity following this method.
The Gynecologist in Cosmetic Surgery
Authors: Minyard Frank
Published: January 2017

It is my belief that OB-GYN physicians are qualified to practice cosmetic body surgery—lipo-suction, breast augmentations, and abdominoplasties. Their aesthetic abilities have always been present, but they have not been aware of them. Such physicians' training and practice skills have given them the necessary foundation to perform all of the cosmetic procedures as well as handle all of the complications. The OB-GYN is the physician for the “total woman” and already has patients present in his or her practice for cosmetic body surgery.
Surgical Treatment of Aging of the Orolabial Region
Authors: Faivre Jacques
Published: January 2017

The labial region is an important area in aging of the face. Until recently, the techniques proposed to treat this area have been disappointing, as they do not resolve all of the problems associated with this form of aging. The use of a dermo-adipose graft according to the technique described herein constitutes an important contribution.
Silicone Breast Implants and Cancer
Authors: Shiffman Melvin A.
Published: January 2017

Cancer is a result of genetic changes precipitated by heredity, viruses, industrial agents, drugs, radiation, diet, and many other unknown agencies. At least 2 and perhaps as many as 10 or more chromosomal abnormalities are necessary. Certain genetic aberrations cause the malignancy to become more aggressive and metastasize. At this time, there is little evidence that silicone can cause cancer in the human except, perhaps, under the theory of solid-state carcinogenesis.

Information on all types of cancers in patients with silicone breast implants has to be gathered. Prospective studies must be started and retrospective analyses and clinical cases should be reported. This article adds six new cases to the record and offers a review of the literature.
The Exclusive Use of Slit Mini-Micrografting for the Correction of a Large Frontoparietal Scalp Defect
Authors: Brandy Dominic A.
Published: January 2017

In this article slit mini-micrografting is used exclusively for the correction of a large frontoparietal scalp defect. This method was used as an alternative to tissue expansion, transposition-rotation flaps, free flaps, or conventional punch hair-grafting. The protocol consisted of three well-organized sessions of #15 blade and 18-gauge needle slits made very obliquely into the scarred defect. Mini- and micrografts were then placed into these incisions. This approach yielded a good result which was felt to be due to the combination of the minimal trauma caused by slits and the limited circulation required for the survival of mini- and micrografts. Minigrafts were also much easier to insert into scar tissue when compared with conventional grafts. In conclusion, it was felt that the exclusive use of slit mini-micrografting appears to be a viable method for the correction of frontoparietal cicatrial alopecia.
Cocaine: A Historical and Modern Perspective
Authors: Engel John D.
Published: January 2017

The history of cocaine is a long and storied one that dates back to ancient times. More recently, cocaine has gained notoriety for its use as an illicit drug on the streets. Surgeons involved in cosmetic and functional surgery of the nose commonly use cocaine in their practice and should be well versed in the pharmacologic and physiologic effects of the drug.