bluuebunny/crossref_metadata_2025 huggingface dataset:
Advances in Cognitive-Behavioural Therapy for Unipolar Depression
Authors: Kuyken Willem , Dalgleish Tim , Holden Emily R
Published: January 2017

Objective:

To describe the main innovations in our theoretical understanding of depression and key clinical developments in cognitive-behavioural therapy (CBT). We outline the current status of CBT and discuss how it can respond to the public health problem of depression.

Method:

We undertook a narrative literature review.

Results:

CBT provides a sophisticated, empirically grounded account of depression and an evidence-based therapeutic approach for people who suffer from depression. Beyond its efficacy in treating acute depression, it has prophylactic effects and is acceptable to various populations in a range of settings. Good theoretical accounts of the emergence of depression in adolescence are forthcoming; to date, however, attempts at primary prevention are unconvincing. Our understanding of factors contributing to positive outcomes is growing, allowing CBT to be tailored to individual client needs.

Conclusions:

CBT is a mainstay approach to depression. Significant remaining challenges include tailoring it to different populations and settings and, most importantly, ensuring that it is more readily accessible.
How Well Do Psychosocial Interventions Work in Bipolar Disorder?
Authors: Zaretsky Ari E , Rizvi Sakina , Parikh Sagar V
Published: January 2017

Objective:

Although medication is the mainstay of treatment for bipolar disorder, several adjunctive psychosocial interventions have been manualized over the last decade. This paper's objective is to empirically evaluate the different treatment approaches.

Method:

We conducted a systematic review of the recent literature pertaining to psychosocial interventions in bipolar, using MEDLINE and PsycINFO. Bibliographies of papers were scrutinized for further relevant references. Articles published from 1999 up to and including 2006 were reviewed. Randomized controlled trials were emphasized.

Conclusions:

Although psychological models of bipolar disorder fail to inform the psychotherapy treatment to the same extent as in unipolar depression, manualized adjunctive, short-term psychotherapies have been shown to offer fairly consistent benefits to bipolar disorder patients. Cognitive-behavioural therapy, family-focused therapy, and psychoeducation offer the most robust efficacy in regard to relapse prevention, while interpersonal therapy and cognitive-behavioural therapy may offer more benefit in treating residual depressive symptoms.
Structured Assessment of Mental Health Status in Psychogeriatrics: Validity of the French HoNOS65+
Authors: Canuto Alessandra , Weber Kerstin , Gold Gabriel , Notaridis Grigorios , Michon Agnès , Giardini Umberto , Delaloye Christophe , Herrmann François , Giannakopoulos Panteleimon
Published: January 2017

Objective:

To assess the reliability, validity, and feasibility of a French version of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+).

Method:

Twenty mental health professionals completed the scale for 126 elderly patients. We assessed interrater reliability in inpatient and outpatient settings, together with construct and discriminant validity, as well as concurrent validity compared with several widely used clinical instruments.

Results:

Excellent agreement among raters was observed in the outpatient subgroup (kappa range 0.77 to 1.00), whereas interrater reliability was modest in the inpatient subgroup (kappa values < 0.55). In cases where the patient–caregiver relationship lasted more than 1 month, the reliability of the scale improved. Construct validity analysis revealed no subscale structure. All items except “self-injury” displayed high concurrent validity (significant Spearman correlations with 8 other questionnaires). In terms of discriminant validity, the “cognitive impairment” (area under the curve [AUC] 0.91) and “depressive symptoms” (AUC 0.79) items showed high sensitivity and specificity values.

Conclusion:

Our results indicate that the French version of HoNOS65+ is a promising clinical assessment tool to evaluate mental disorders in the elderly in outpatient settings. We support its use in routine clinical practice, with the condition that a relatively long and individualized patient–caregiver relationship has been established.
Episodic Memory Bias and the Symptoms of Schizophrenia
Authors: Lepage Martin , Sergerie Karine , Pelletier Marc , Harvey Philippe-Olivier
Published: January 2017

Much of the research on episodic memory in schizophrenia spectrum disorders has focused on memory deficits and how they relate to clinical measures such as outcome. Memory bias refers to the modulatory influence that state or trait psychopathology may exert on memory performance for specific categories of stimuli, often emotional in nature. For example, subjects suffering from depression frequently have better memory for negative stimuli than for neutral or positive ones. This dimension of memory function has received only scant attention in schizophrenia research but could provide fresh new insights into the relation between symptoms and neurocognition.

This paper reviews the studies that have explored memory biases in individuals with schizophrenia. With respect to positive symptoms, we examine studies that have explored the link between persecutory delusions and memory bias for threatening information and between psychosis and a memory bias toward external source memory. Although relatively few studies have examined negative symptoms, we also review preliminary evidence indicating that flat affect and anhedonia may lead to some specific emotional memory biases. Finally, we present recent findings from our group delineating the relation between emotional valence for faces and memory bias toward novelty and familiarity, both in schizophrenia patients and in healthy control subjects.

A better understanding of the biasing effects of psychopathology on memory in schizophrenia (but also on other cognitive functions, such as attention, attribution, and so forth) may provide a stronger association between positive and negative symptoms and memory function. Memory measures sensitive to such biases may turn out to be stronger predictors of clinical and functional outcome.
The History of the Psychopharmacology of Schizophrenia
Authors: Lehmann Heinz E , Ban Thomas A
Published: January 2017

Objective:

To review the historical development of the psychopharmacological treatment of schizophrenia.

Method:

A chronological literature review of the clinical practices and theoretical models that have controlled drug treatment of schizophrenia at different times.

Results:

Effective treatment of schizophrenia was achieved only after the introduction of antipsychotic drugs, in the 1950s, and is still progressing.

Conclusion:

Close collaboration between basic neuroscience and careful and informed clinical practice are likely to lead to continued progress.
Eating Disorders and Hyperactivity: A Psychobiological Perspective
Authors: Davis Caroline
Published: January 2017

Objective:

To review the eating disorder research investigating the psychobiological connections between self-starvation and high-level exercising, including both animal experimentation and clinical field studies. In recent years it has been proposed that physical activity plays a central role in the pathogenesis and progression of the eating disorders—in particular, anorexia nervosa.

Method:

A review of research from animal experimentation and from clinical field studies investigating the biological and psychological implications of physical activity and starvation in the pathogenesis of eating disorders.

Results:

Animal research indicates that physical activity and starvation seem to potentiate one another and that alterations in the serotonergic system may underlie this process. Similar behavioural results have been found in recent clinical studies with eating-disordered patients, which suggests that physical activity plays a more central role in the development and maintenance of the eating disorders than had previously been thought.

Conclusions:

The emerging picture is that psychosocial factors seem to provide the most compelling factors in the etiology and onset of the disorder, while biological factors—in most cases induced by severe malnutrition and strenuous overexercising—predominate in the maintenance of the disorder.
Past, Present, and Future of Psychiatry: Personal Reflections
Authors: Eisenberg Leon
Published: January 2017

Objective:

To review the past half century of North American psychiatry from personal experience and to gauge its future prospects.

Method:

An examination of the relevant literature, recollections from a long academic career, and analysis of trends.

Results:

The pendulum of psychiatric theory continues its swing from its psychological to its biological pole; current economic forces are driving it toward reductionistic biology. The very considerable gains in the npsychosocial and neurobiogical knowledge base of our field will ultimately have a potent yield in patient care once the restrictive controls on its application to service provision are lifted.

Conclusion:

The future of research in the sciences basic to psychiatry has never been more promising. How rapidly rogress will occur will be a function of the resources society is willing to commit to mental health research. The prognosis for the translation of the new findings to clinical practice will depend on whether professionals can mobilize public support for quality care for the mentally ill.
Boundary Violations and Personality Traits among Psychiatrists
Authors: Garfinkel Paul E , Bagby R Michael , Waring EM , Dorian Barbara
Published: January 2017

Objective:

To demonstrate that sexual abuse of patients by psychiatrists can be due to a variety of contributors, which may include therapists' psychopathic and narcissistic personality styles.

Method:

Data from a prospective cohort of residents training in psychiatry were examined to evaluate the personality traits of 2 psychiatrists subsequently convicted of boundary violations.

Results:

The 2 psychiatrists who lost their licenses were identifiable at the beginning of their residency training as individuals with significant character pathology.

Conclusions:

For some psychiatrists, repetitive sexual abuse of patients represents one aspect of an ongoing pattern of exploitative relationships. The professional and ethical implications of these findings as they relate to early identification for those at risk are considered.
Clinical Profile of Mania in Children and Adolescents from the Indian Subcontinent
Authors: Reddy YC Janardhan , Girimaji Satishchandra , Srinath Shoba
Published: January 2017

Objectives:

To see whether classic DSM-III-R criteria for mania are applicable to Indian youngsters and to examine the clinical presentation of mania in an Indian child and adolescent psychiatric sample.

Method:

Fifty subjects with a diagnosis of functional psychosis as per the definition in ICD-9 were recruited from the population referred during the study period of approximately one year (n = 840) to the Child and Adolescent Psychiatry (CAP) clinic of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, South India. The subjects were systematically evaluated using a standardized clinical interview and demographic questionnaire and were classified according to DSM-III-R. The subjects who satisfied DSM-III-R criteria for mania formed the sample for this study.

Results:

Twenty-one subjects received a diagnosis of mania according to DSM-III-R. The most common symptoms of mania included pressure of speech, irritability, elation, distractibility, increased self-esteem, expansive mood, flight of ideas, and grandiose delusions. No subject had comorbid attention-deficit hyperactivity disorder (ADHD). Additionally, 13 (61%) of the 21 manic subjects had delusions and/or hallucinations. The other common symptoms included psychomotor agitation, reduced sleep, anger, temper tantrums, decreased concentration, disobedience, aggression, and hyperactivity.

Conclusions:

Mania was diagnosable in Indian children and adolescents using classic DSM-III-R criteria. The clinical profile appears to be generally similar to that seen in adults. ADHD is not a comorbid condition. The presence of aggressive or disruptive behaviours and hyperactivity in childhood- and adolescent-onset mania, however, could lead to a misdiagnosis of attention-deficit hyperactivity disorder/conduct disorder (ADHD/CD). Similarly, the presence of psychotic features could lead to a misdiagnosis of schizophrenia.
An Investigation of Competency to Participate in Legal Proceedings in Canada
Authors: Whittemore Karen E , Ogloff James RP , Roesch Ronald
Published: January 2017

Objective:

To assess fitness to stand trial, competency to plead guilty, and competency to understand Charter cautions to determine if the level of competency varies across these domains.

Methods:

The Fitness Interview Test-Revised (FIT-R) and the Test of Charter Comprehension (ToCC) were administered to a group of individuals held on remand for fitness evaluations. Additionally, several questions from the FIT-R that address the ability to make a guilty plea were assessed separately and constituted an individual measure of competency to plead guilty (CoP).

Results:

As predicted, the results indicated that the fact that an individual is competent at one juncture in the criminal proceedings does not mean that the individual necessarily is competent at all other stages of the proceedings.

Conclusions:

These findings suggest a need for a stage-specific approach to forensic competency assessments, requiring specialized instruments designed to assess the legal issues of competency at the various stages of legal proceedings.
Preliminary Results Using a Magnet-Embedded Compression Garment after Liposuction Surgery
Authors: Dedo Douglas D. , Biemer Theresa A.
Published: January 2017

Introduction:

Magnetic fields have been touted as a cure and method of treatment for a variety of illnesses and medical conditions, and revenues from the sales of health-related magnetic products reportedly add up to billions of dollars. Magnets and the magnetic fields they create are marketed as having no associated risks; however, the medical community questions their benefits, and the Food and Drug Administration has not approved static magnetic fields for the treatment of any medical ailment.

Methods and Materials:

This study evaluated the postoperative effects of a magnetic garment on patients undergoing liposuction. For each standard postoperative compression garment, one half was fitted with elasticized magnetic neoprene material and the other half with nonmagnetized neoprene. The manufacturer sent the garments to the authors without identifying which sides had the active magnetic strips.

Results:

Preliminary results of this study showed no statistical difference in bruising, swelling, or postoperative results between the magnetized and the nonmagnetized treated areas. Although theories abound concerning the effects of magnetic field on optimizing the supply of nutrients and oxygen to the magnetic field area, this clinical study did not support any significant difference in the rate of wound healing. However, this study did show that pain and tenderness were markedly reduced on the side covered with the magnetic field. Eight of the 9 patients noted a decrease in pain and discomfort postoperatively on the left side, which was the half of the garment with the magnetized neoprene strips. The greatest reduction in pain was observed in the first 24 hours of treatment with the magnets, and the improvement increased with the passage of time. This study also found a reduction in the amount of analgesics needed by the patients using magnets during the treatment period.

Discussion:

Magnetic volume is important in delivering a therapeutic effect. Having more volume means that more tissues are experiencing the magnetic field. The neoprene magnetic strength is low in gauss units but high in Maxwell units because of the configuration of the north-south pole orientation described. Conversely, a unipolar magnet with a high magnetic strength delivers a low magnetic volume and is not considered important for therapeutic use. To date, researchers are uncertain whether low-level magnetic fields are hazardous to biological tissues. There has been some concern about safety issues for long-term whole-body exposure, but this may not be applicable to brief exposure to small areas of the body associated with static magnets. The theoretical basis for the physiologic response from static magnets has not been clearly identified. A search and review of the medical literature resulted in a limited number of studies. Few studies have evaluated magnets for relief of chronic pain for disease states and musculoskeletal pain, and even fewer have addressed mechanism of action.
State of the Art in Phalloplasty
Authors: Krakovsky Alexander A.
Published: January 2017

Introduction:

After Sigmund Freud “opened the bedroom door,” significant shifts in social attitudes, behaviors, and institutional regulations concerning male and female body images and the understanding of human sexuality began to occur. Today, male cosmetic genital enhancement surgery, or phalloplasty, has become the subject of recent surgical achievements that are gaining significant popularity in the United States and abroad. Appropriate methodology and surgical techniques have been developed to fulfill the demand in this field of cosmetic surgery. The objective of this study is to review the state of the art in phalloplasty and provide information about the availability of the techniques to the medical community and the public to inform them of surgical treatments that may improve unsatisfactory sexual performance, relationships, intimacy, and love by increasing the size of a man's penis.

Material and Methods:

Two surgeons performed phalloplasty on 594 patients at multiple surgical facilities over a 2-year period. Phalloplasty procedures include penile lengthening, penile girth enhancement, dual augmentation (combined lengthening and girth enhancement), penile glanular enhancement, scrotal web resection, and reconstruction. The patients' own satisfaction with the results of their surgeries was analyzed by using the Penis Image Assessment Scale Questionnaire. The assessment was based upon questions related to penis size, satisfaction of sexual experiences, and the psychological perspective of patients regarding their penises before and after phalloplasty.

Results:

Patient scores on the Penis Image Assessment Scale Questionnaire were higher before surgery (almost twice as high) than they were after surgery, showing an increase in patient satisfaction with penis size and performance after enhancement. Seventeen patients required subsequent surgery to treat local infection. Twenty-nine patients experienced localized swelling 3–7 days after surgery. The results showed enormous patient satisfaction with the cosmetic surgical procedures performed.

Discussion:

Penis size has always symbolized strength, virility, power, and domination in relationships. Although this subject was taboo some years ago, today many men are interested in learning about how phalloplasty may improve their self-confidence, sexual relationships, and female partners' satisfaction. Consequently, phalloplasty has acquired wide acceptance and tremendous popularity.
Decreasing the Recovery Time from Breast Augmentation: Changing the Mind-Set of the Patient, the Technique of the Surgeon, and the Postoperative Care
Authors: Scarlett William L. , Borsand Marvin A.
Published: January 2017

Introduction:

Dr John Tebbetts first described his 24-hour recovery from breast augmentation in Plastic and Reconstructive Surgery in 2002. His original article describes the inframammory approach, using direct visualization, implants ranging in size from 220 to 350 cc, and postoperative exercises. Dr Tebbetts limited the administration of muscle relaxants to the intraoperative period and did not administer narcotics in the postoperative period. Critics of Dr Tebbetts' work have stated that his ability to return patients to normal daily activities in such a short time is, in large part, due to his use of smaller implants. Although other articles have been written on augmentation recovery, the goal of our study was to institute Dr Tebbetts' ideas with our patient population, without limiting the size of the implants used or limiting the procedure to augmentation, and to analyze the results.

Materials and Methods:

We instructed 100 consecutive primary breast augmentation patients on postoperative exercises, limited the administration of narcotics, immediate postoperative use of ibuprofen, and encouraged the mentality of an earlier return to normal activities. Our patients were administered a survey on postoperative day 7.

Results:

The overall ability to return to work was 4.0 days after surgery. The use of narcotics was least in the groups where dissection was completed using direct visualization. Ninety-five percent of all patients thought that the postoperative exercises decreased their pain. We did have 5 patients (5%) who developed hematomas requiring evacuation, which was an increase for the practice, but still fell within the national average of 1–6%.

Discussion:

Our conclusions are that early postoperative arm exercises and encouraged activity, coupled with dissection under direct visualization, does allow for limited use of postoperative narcotics and an earlier return to normal activity. We observed an increase in the number of hematomas, which may suggest that ibuprofen in the immediate postoperative period affects the patients' platelets.
What Five Years of Florida Data Show about Office Surgery Safety
Authors: Coldiron Brett M.
Published: January 2017

Introduction:

In 2000, Florida mandated that all physicians report all adverse events occurring in an office setting to a central collecting agency. The purpose here is to analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2005.

Methods and Materials:

All reported adverse incidents (eg, the death of a patient or ahospital transfer) occurring after an office procedure as reported to the Florida Agency for Health Care Administration from March 1, 2000, through March 1, 2005, were reviewed. Additional information was gained via telephone follow-up and Internet searches.

Results:

Of 351 reported office adverse events, 110 occurred in association with an office surgical procedure—25 deaths and 85 hospital transfers. Thirteen complications and 5 deaths were clearly associated with use of intravenous sedation anesthesia or general anesthesia. Two deaths and 11 complications were at the hands of anesthesiologists with an MD or DO credential, 2 deaths were attributable to plastic surgeons using intravenous sedation, and 1 death and 2 hospital transfers were attributable to certified registered nurse anesthetists administering anesthesia. No adverse events were associated with use of dilute local (tumescent) anesthesia.

Discussion:

Dermatologists are currently under scrutiny by legislative and regulatory bodies because they perform liposuction under tumescent local anesthesia in an office setting. But the data from Florida, presented here and elsewhere, clearly show that dermatologists are not the problem. An extraordinarily high percentage of cosmetic surgery deaths and hospital transfers were attributable to board-certified plastic surgeons. A fair analysis of the data indicates that any restrictions on office procedures should start with the specialty demonstrating the most adverse events. State and/or national legislation establishing reporting systems for adverse events should be supported and should require the reporting of delayed deaths. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase them if patients are forced into liposuction under deeper anesthesia.
B Mastopexy: Versatility and 5-Year Experience
Authors: Peterson Steven W. , Tobin Howard A.
Published: January 2017

Introduction:

Many women are searching for restoration of a younger outward physical appearance. Mastopexy with or without augmentation may help improve or restore a woman's breast shape at the price of scars on the breast. We describe our experience with the versatility and improved aesthetic result using the B mastopexy technique, which provides a natural-appearing breast contour with less scarring.

Materials and Methods:

A retrospective review was performed on 40 patients who underwent B-type mastopexy from June 2000 through August 2005. Our technique is described in detail including our approach when simultaneous augmentation is performed. Patients undergoing simultaneous augmentation to give additional fill to the breast typically received an implant size ranging from 240 mL to 300 mL.

Results:

B mastopexy was performed on 40 patients with simultaneous augmentation performed in 27 patients. There were no complications, and only 1 patient underwent scar revision. All patients were satisfied with final outcome.

Conclusion:

B mastopexy provides an approach to restoring a naturally appearing breast contour and a more youthful look when augmentation is performed simultaneously. The versatility and limited scar makes this our procedure of choice.
Reduction of Postoperative Nausea and Vomiting through Patient Risk Stratification
Authors: Pippin Gregory W. , Liukkonen John , Garret Michael , Silver William
Published: January 2017

Objective:

To develop a patient risk stratification algorithm that will reduce the incidence of postoperative nausea and vomiting (PONV) in an ambulatory plastic surgery practice by increasing the use of prophylactic medications as the risk of PONV increases.

Design:

Retrospective review of an ambulatory plastic surgery practice before and after a PONV patient risk stratification algorithm was introduced. A patient risk stratification algorithm was developed based on known causes of PONV. Incidence of patients experiencing PONV before and after the introduction of the patient risk stratification algorithm was compared. Results of the study were analyzed with logistic regression.

Results:

The rate of PONV was 17.7% before the patient risk stratification algorithm was instituted and 4.47% after. This difference is significant (one-sided P value against no difference in true incidence of PONV = .003). A history of PONV and longer lengths of anesthesia were associated with higher likelihoods of PONV (P = .02 and .0056, respectively), and application of our patient algorithm (ie, membership in the study group as opposed to the control group) was associated with a lower likelihood of PONV (P < .001).

Conclusion:

Patient risk stratification and a multimodality approach to PONV prophylaxis effectively reduce the rate of PONV in an ambulatory plastic surgery practice.
Superficial Liposuction for Permanent Hair Removal
Authors: Khawaja Hassan Abbas , Shiffman Melvin A. , Hernandez-Perez Enrique , Hernandez-Perez Jose Enrique , Hernandez-Perez Mauricio
Published: January 2017

Introduction:

Superficial liposuction is the most common procedure for facial and body contouring. This article reports the results of a study in which superficial liposuction was utilized for permanent hair removal on the face (sideburn areas), the chin including the submental area, the neck, back, and upper and lower extremities of female and male patients. Possible complications are discussed.

Materials and Methods:

Thirty patients (25 women and 5 men) between 22 and 65 years of age were included. All patients were of Fitzpatrick skin types III or TV.

Results:

In 22 patients, 19 women and 3 men, 70–80% complete hair loss was noted by all observers in a single session. Follow-up at 3 months, 6 months, 1 year, and 2 years, showed no hair regrowth in any patient in the hair loss areas. In 8 patients, 6 women and 2 men, 50–60% of hair loss was noted after a single session. Complete hair loss was noted in all cases in the central areas where liposuction of the subcutaneous fat was complete, the direction of the dermal tunnels was superior, and where subsequent inflammation and postoperative hardening were intense.

Conclusion:

Superficial liposuction for hair removal is a quick method of permanent hair removal in selected patients removing maximum number of hairs in a single session. It is safe in experienced hands.
The Problem Patient: Prevention and Treatment
Authors: Wright Mary Ruth
Published: January 2017

This article boldly and practically discusses the potential problem patient. Prevention and treatment are the primary focus. Throughout the article the author stresses the surgeon's responsibility for recognizing and controlling the many psychological conditions and reactions that could create doctor-patient conflict, and consequently cause a patient to become a problem.
Retrograde Suspension Malarplasty
Authors: Newman Julius , Nguyen Abram , Anderson Roger
Published: January 2017

Malar prominences have long been considered as an important aesthetic area on the face, yet the technique of malar augmentation has not been standardized and made available to the general public. Our technique of suspension malarplasty, performed through an intraoral Caldwell–Luc-type incision, offers excellent exposure with complete visualization of vital structures in the malar-zygomatic region. The implant is herd in position with a stay suture exited at the temple area. This report retrospectively analyzes the complications and results of 182 patients receiving malar implants during a follow-up period of 36 months. The procedure entails minimal operating time, few complications, and high patient acceptance. The creation of more prominent cheekbones can provide patients who have an elongated, flat midface or square jaws with a more pleasing appearance in both frontal and oblique views, therefore enhancing the results of other facial cosmetic procedures.
Practical Applications of Nasal Asymmetries in Rhinoplasty
Authors: Parkes Morey L. , Waller Todd S.
Published: January 2017

Comparing the bones that make up each side of the nose by anthropometry reveals asymmetries caused by both developmental and traumatic processes, which precludes performing osteotomies using a set procedure. The frontal process of the maxilla is a key structure in narrowing the bony contours of the nose to correct the “open roof syndrome” (incomplete closure of the roof of the nose) after hump removal. It must be included in many instances in order to achieve a satisfactory infracture. This is especially important in the management of a large or asymmetric frontal process. Furthermore, osteotomies should be placed sufficiently lateral to the nasal bones to prevent the aesthetically unpleasing complication of the so-called step deformity. The questionable efficacy of osteotomies in rhinoplasty on the non-Caucasian nose is also briefly considered in this article.
Lipo-Suction Surgery of the Knees
Authors: Tobin Howard A.
Published: January 2017

Ideal aesthetic proportions of the lower limb call for a tapering thigh leading obliquely inward toward the knee. A very small medial and anterior convexity at the knee forms the transition to lower leg. Although frequently ignored in anatomy texts, significant fat deposits are often present in the lower thigh above and medial to the knee, especially in females. Current fashion, calling for skirts with hemlines above the knee, heightens concern among wearers about the appearance of the knees. Fat in this area is ideally suited to removal by lipo-suction surgery. This article will review the anatomy of the region with recommendations for a technique of lipo-suction surgery that combines the ability for adequate removal, safety, and the distinct advantage of avoiding all visible scars. The technique, in essence, calls for removal of the fat by the use of a long #10 cannula introduced through incisions in the groin and/or the top of the crease between the buttocks overlying the upper coccyx.
Treatment of Pitted Scars: Punch-Graft Transplant Technique
Authors: Johnson Waine C.
Published: January 2017

A technique for treatment of pitted scars of the face is described. The pitted scar is removed by a skin punch and replaced by donor grafts obtained from postauricular skin. The graft is placed so that it will be level or slightly elevated and is held in place by using tissue glue, Steri-Strip, or other methods. After 3 to 4 weeks, the skin is leveled by a dermabrasion or other technique. Expected results and complications are discussed.
A New Simplified Method of Liposuction of the Neck Which is Also Suitable for Lipotransfer
Authors: Erian Anthony
Published: January 2017

A review of a new simplified method of liposuction of the neck using a small cannula and syringe is presented. The method does not require high pressure or bulky instrumentation and could easily be done in conjunction with open procedures (e.g., rhymidectomy) or on its own. One can also transfer the aspirated fat directly to any area using a small beveled cannula.
Mandibular Osteotomies in the Treatment of Lower Facial Disharmony
Authors: Milder David G. , Tanner John P. , Moore David L.
Published: January 2017

Facial disharmony may result from underlying skeletal deformity. Evaluation usually discloses the nature of the disorder and guides treatment. Correction of the deformity often begins with the dental occlusal relationship and usually necessitates orthodontics prior to surgical intervention. When the etiology of the skeletal deformity is mandibular, various surgical procedures may be used. This report discusses three common hard-tissue orthognathic techniques that can be employed for the correction of these deformities and presents examples of patients treated by these methods. The operations described, when utilized appropriately, can provide a harmonious skeletal framework for simultaneous or future adjunctive cosmetic surgical procedures.
David-Baker Eyelid Retractor
Authors: David Laurence M. , Baker Sterling S.
Published: January 2017

A modified eyelid retractor designed to put the skin and aponeurosis of upper eyelid levator on stretch while protecting the cornea and globe during eyelid surgery is presented. There are several advantages to the use of this retractor as compared to other, previously used instruments.
Surgical Removal of Lower Eyelid Fat Using the Carbon Dioxide Laser
Authors: Trelles M. A. , Sanchez J. , Sala P. , Elspas S.
Published: January 2017

The CO2 laser, used for lower eyelid blepharoplasty, presented here according to David's technique, approaches the lower eyelid fat via the transconjunctival route. This technique avoids the possible sequelae associated with conventional surgical blepharoplasty, such as scarring and lower lid retraction. Postoperative recovery time is extremely rapid and associated with very little or no discomfort. CO2 laser surgery helps to prevent the risk of hemorrhage and infection, and keeps edema, when it occurs, to a minimum. The cosmetic results are excellent.
Combined Carbon Dioxide Laser Resurfacing and TCA Chemical Peel
Authors: David Laurence M. , Glassberg Edward , Lask Gary P.
Published: January 2017

Currently, various modalities such as phenol and TCA peels and dermabrasion are available for regeneration of the aged skin. A prior study by our group has demonstrated the clinical effectiveness of CO2 laser resurfacing in treating actinically damaged skin of the entire face with concomitant histologic improvement characterized by elimination of the solar elastosis and replacement by new collagen bundles. In the present study, we have taken this approach one step further and are presenting results of a series of 130 patients treated with combined CO2 laser resurfacing and trichloracetic acid (TCA) chemical peeling. The laser is used primarily for wrinkles, keratotic lesions, and pigmentary changes; and TCA is used to blend affected and unaffected skin. Fewer complications were noted with CO2 laser resurfacing/TCA peels than with phenol peels or dermabrasion. This combined technique can be a useful modality in the cosmetic as well as therapeutic treatment of the aged skin, as marked clinical and histologic improvement has been demonstrated.
Strategic Planning and Establishment of a Laser Unit in an Office Surgical Practice
Authors: McBurney Elizabeth I.
Published: January 2017

Laser surgery in an outpatient setting requires preparation, investigation, and education. To establish a successful office laser surgery unit, the physician should purchase a safe, functional laser and adjuvant equipment, acquire the necessary skills, set up proper documentation, distribute appropriate patient information brochures, and ensure proper education of staff, patients, and the public.
Advances in Sclerotherapy Treatment of Varicose and Telangiectatic Leg Veins
Authors: Goldman Mitchel P.
Published: January 2017

Sclerotherapy as a treatment for varicose veins originated in the 1800s. Unfortunately, experience with this treatment modality has been fraught with complications and failures. Recent interest by the general public in this form of treatment has uncovered a lack of formal training and protocols within the medical establishment. Nevertheless, recent experience with sclerotherapy has been found to be more positive than previously realized. Three “advances” in sclerotherapy treatment for varicose and telangiectatic leg veins have occurred within the last 20 years. We term these “advances” not because they are new, but because they are newly popular—proper diagnosis prior to treatment; optimal choice of sclerosing solutions and concentrations; and ideal compression techniques to limit sclerophlebitis, recanalization and complications. These advances will be detailed in the following paper.
Honeydew: A Practice Model for Hair Replacement Surgery
Authors: Brandy Dominic A.
Published: January 2017

In the past, the teaching of hair transplantation surgery had been carried out on either pig skin, a cadaver, or a live patient's head. In an attempt to find a substance not hard to come by and inexpensive, while being conducive to the learning process, the author began using honeydew. Besides being easily obtainable and inexpensive, this melon is of good consistency and is approximately the size of a human head, thus making it an excellent teaching tool for hair replacement surgery.
Applications of Medpor Porous Polyethylene in Facial Bone Augmentation
Authors: Golshani Shapour , Zhou Zhao Yi , Gade Prasad
Published: January 2017

We report our experience in facial bone augmentation and nasal dorsal onlays with the Medpor porous polyethylene implant. Medpor is a highly stable, somewhat flexible alloplast which has been sintered to form a network of interconnecting pores. Its surface characteristics and porosity have been shown to promote rapid tissue ingrowth, vascularization, and fixation to the underlying bone. A total of 88 implants were placed in 68 patients during a 5-year period. Implants were used for augmentation in the chin (15), malar area (11), nasal dorsum (20), the orbit (19), and the cranium (23). The patients ranged in age from 10 to 76 years old. The etiologies of deformities were related to trauma (40), burns (17), aesthetic (8), and congenital (3). One malar implant became infected and was removed. There were no other implant-related complications. As a result of rapid soft-tissue ingrowth all implants became firmly fixed in position. No subsequent bone resorption, implant migration, or exposure were observed in our patient group. On the basis of these findings, we recommend the Medpor porous polyethylene implant as a dependable choice in the array of alloplastic materials available for facial reconstruction. Its remarkable stability, conductivity for tissue ingrowth, and ease of use allow for an accurate and reliable establishment of contour and symmetry in the craniofacial skeleton.
Delineating the “Safe” Donor Area for Hair Transplanting
Authors: Unger Walter , Solish Nowell , Giguere David , Bertucci Vince , Coleman William , Loukas Michael , Unger Russell
Published: January 2017

Three hundred twenty-eight patients were examined and classified according to age (65–69, 70–74, 75–79, and ≥80 years) and degree of male pattern baldness Hamilton/Norwood Class I-VII. In addition, the inferior to superior height of potential temporal, parietal, and occipital donor sites containing at least eight hairs per 4-mm round circle was measured. A schematic drawing of the borders of this “safe” donor area containing permanently hair-bearing scalp with adequate hair density for transplanting is presented.
The Principles of Scalp Extension
Authors: Brandy Dominic A.
Published: January 2017

This article is written to help the reader understand the physical principles behind scalp extension. A review of the history and physiology of scalp extension is first discussed. The newest form of scalp extension is then reviewed and a series of equations developed by the author are analyzed to help the reader understand what is really occurring with the latest twist on extension (i.e. burying a stretched silicone sheet to each opposing galeal surface). When scalp extension is applied to circumferential scalp reduction, the primary advantage is a reduction in the time interval between surgeries from 3 months to 1 month. When scalp extension is applied to midline scalp reduction, the primary advantages are an elimination of stretch-back and a decreased time interval between surgeries. Because circumferential scalp reduction does not normally incur stretch-back, the surgeon performing midline scalp reduction will perceive a much greater improvement in overall cosmesis from extension because the elimination of a previous loss (50% stretch-back) will be perceived as a gain postoperatively.
Tumescent Anesthesia for Hair Transplantation
Authors: Coleman William P.
Published: January 2017

Tumescent local anesthesia has developed into a widely accepted technique applicable to a variety of scalp surgeries. This innovative use of large volumes of dilute lidocaine and epinephrine provides consistent anesthesia and enhanced vasoconstriction. Both are superior to that afforded by commercially available anesthetic formulations. For hair transplantation, anesthesia is administered with less discomfort in both the donor and recipient areas. Decreased bleeding makes a variety of surgical techniques more precise. In scalp reduction surgery, there is an immediate tissue expansion effect and hydrodissection, both enhancing the amount of bald scalp removed. Although invented originally for liposuction, tumescent local anesthesia has become an important advance for surgical procedures for baldness.
Combining Orthognathic Surgery with Facial Cosmetic Procedures
Authors: Belinfante Louis S.
Published: January 2017

The purpose of this paper is to discuss the concept of performing simultaneous orthognathic and facial cosmetic surgery. At times, this will necessitate rigid internal fixation of the maxilla, mandible, or both. Also, the endotracheal tube may have to be moved from a nasal port to an oral port should a rhinoplasty be involved. The combination of procedures has been performed over the last six years with no apparent adverse sequelae.
Comparison of the Conventional and the Ultrasound Methods of Liposuction
Authors: Saylan Ziya
Published: January 2017

This article compares the results of the ultrasound and the conventional methods of liposuction and tries to determine the advantages of the ultrasound method. In comparison to the conventional method, ultrasound liposuction shows much better results in saddlebags, the abdominal wall, and the buttocks. The treatment of cellulite with ultrasound liposuction has proved to be more successful and the lift effect of the skin remains 4–6 months longer than with conventional liposuction. On the other hand, the long-term results do not show any significant differences between the two methods; we have observed equal results from both techniques after six months. Ultrasound liposuction at the knees, inner thighs, arms, and ankles has proven not to be very successful. The advantages of the ultrasound method are less pain, less bruising, less blood in the aspirate, and a short recovery time. The disadvantages are the very high expenses and the impossibility of using the aspirated fat again.
Five Years of Experience Using Fat for Leg Contouring
Authors: Berdeguer Pedro
Published: January 2017

In 1991 and at the 10th World Congress on Liposuction, Lipotransplant, and Lipocollagen, I reported my preliminary experience and the results obtained on 21 patients where I used fat to give contour to their legs. The fat is extracted mainly from the abdomen by the syringe method and an average of 60 cc is reimplanted to the hypotrophic areas of each leg. In this article I share my 5-year experience in 70 patients where a satisfactory long-term cosmetic result has been obtained. Case selection, indications, contraindications, and possible adverse effects are discussed.
Personal Experience with Breast Cancer
Authors: Finestone Sandra
Published: January 2017

One woman's personal experience with breast cancer, breast reconstruction, and breast implants. The article presents the author's conviction that there is no link between breast implants and the various ailments being reported. The author's concern that a woman facing breast cancer or a person requiring an artificial joint may find in the future fewer options available to help in the healing process because of misinformation and the way the media and FDA have handled the silicone gel implant issue.
Family Limited Partnership—A Shelter for Assets
Authors: Walker Burke A. , Volsky Roman
Published: January 2017

There are significant benefits from the creation of a family limited partnership. A limited partnership allows an individual to maintain control over assets that are protected from creditors. This paper highlights the advantages of a family limited partnership and reviews the historical origins of this institution.
Face-Lifts and Their Long-Term Results
Authors: Botti Giovanni
Published: January 2017

Introduction:

The literature on face-lifting over its history varies from simple to complex. It can be difficult to determine which technique is best for each individual patient. We collected a series sufficiently large to show valid conclusions up to 6 years postoperatively.

Materials and Methods:

Between January 1987 and January 1997, 348 female and 26 male patients underwent face-lifting. Based on complexity of the procedure, the cases were stratified into 5 groups. Group A had limited skin undermining out to 5 cm, with submuscular aponeurotic system (SMAS) plication (21 patients). Group B had longer skin flaps with undermining out to 10 cm, with SMAS plication (27 patients). Group C had skin undermining out to 7–8 cm and sub-SMAS dissection to the anterior border of the parotid, with myofascial imbrication (136 patients). Group D had skin undermining and sub-SMAS dissection to the caudal limit of the melolabial groove and mandibular ligament and for 7–8 cm below the platysma, with myofascial imbrication (153 patients). Group E had composite lifts according to Hamra (37 patients). At 2 and 6 years' follow-up, patients were evaluated in a blinded fashion with direct observation by 2 nurses and with photographic comparisons made by 3 independent surgeons.

Results:

Two-year follow-up evaluations were performed for 189 patients. Six-year follow-up evaluations were performed for 128 patients. At 2 years, the degree of improvement tended to favor the more complex techniques, and at 6 years, it definitely favored the more complex techniques. Complications were: 10 hematomas, evenly distributed among the groups; 13 cases of temporary facial nerve weakness, with a higher percentage in groups D and E; 4 skin sloughs, 1 for group B and 3 for group D; and no infections.

Discussion:

While some patients can obtain satisfactory results with skin undermining and SMAS plication, the majority of our patients enjoyed longer-lasting results with more complex face-lifts, encompassing SMAS dissection and imbrication.