bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Surgical Scars: A Pilot Study Comparing Fractional Photothermolysis with Pulsed Dye Laser
Authors: Tierney Emily , Mahmoud Bassel , Srivastava Divya , Ozog David , Kouba David 
Published: January 2017

Introduction: Fractionated resurfacing has been demonstrated in case reports to notably improve the cosmetic outcome of surgical scars. The aim of this study was to compare fractionated resurfacing (fractional photothermolysis [FP]) with the pulsed dye laser (PDL). If novel minimally invasive therapies such as FP are proven to be safe and effective for the treatment of surgical scars, patients receiving cutaneous surgery will be significantly allayed in their concern about the cosmetic outcomes of their surgical scars. Materials and Methods: Randomized, double-blinded split scar study in 15 scars in a total of 12 patients after Mohs surgery for nonmelanoma skin cancer on the face, neck, chest, or back. Patients were treated on one-half of the scar with 1550-nm erbium doped fiber laser and on the contralateral half with the 595 nm V-Beam PDL. Patients were treated with each laser device on half of the scar for a total of 2 treatment sessions at 2-week intervals. Results: After a series of 2 treatments, greater improvements were noted in the portion of surgical scars treated with FP than with PDL in overall cosmetic outcome (FP, mean improvement = 59.7%, range = 40–80% vs PDL, mean improvement = 47.9%, range = 20–60%; P= .05). In pigmentary variation (FP, mean improvement = 47.2%, range = 20–80% vs PDL, mean improvement = 28.5%, range = 0–40%; P<.05); scar thickness (FP, mean improvement = 71.4%, range = 40–80% vs PDL, mean improvement = 35.4%, range = 0–60%; P<.05); and scar texture (FP, mean improvement = 64.3%, range = 40–80% vs PDL, mean improvement = 43.4%, range = 20–60%; P< .05). A total of 4 scars with significant hypopigmentation had improvements in pigmentation after treatment with FP (mean improvement = 45.0%, range = 20–80%) with no improvement after treatment with PDL (0%) (P < .05). There was no incidence of dyspigmentation, ulceration, or scarring with either device. Conclusions: To the authors' knowledge, this is the first study to compare the outcome of treatment with PDL with FP in terms of pigmentary variation, textural change, and overall cosmetic improvement. The data presented herein suggest that FP results in significantly greater improvements in surface pigmentation, textural variation, and scar thickness relative to PDL. Similar to previous case reports, FP was uniquely successful in improving hypopigmented scars. The greater depth of penetration and significant skin remodeling induced with FP likely account for its greater improvement in textural change and thickness of surgical scars. Both FP and PDL appear to be highly safe modalities for the treatment of surgical scars with minimal discomfort and no adverse effects.
Use of the Breast Bolster to Address Intraoperative Asymmetries in Breast Augmentation Surgery
Authors: Blyer Scott M. , Sherry Steven , Watson Stephen W. 
Published: January 2017

Introduction: Breast asymmetry is a common complication following breast augmentation surgery. It is a frequent cause for reoperation and many times can be prevented with good preoperative examination and planning. Iatrogenic asymmetric breast pocket development is among the unforeseeable causes of breast asymmetry. We submit a simple technique to prevent breast asymmetry intraoperatively if asymmetric pocket development has been identified. Materials and Methods: A 46-year-old female patient with no preoperative asymmetries was planned for submuscular breast augmentation. Upon creation of the submuscular pocket, an asymmetry was noted in a more inferiorly positioned right breast. Using the breast bolster technique, this problem was addressed and corrected intraoperatively. The details of the procedure are presented. Results: Evaluation on 4-week and 3-month follow-up appointments revealed an excellent result with high patient satisfaction. Discussion: The application of the breast bolster is a quick procedure with little to no morbidity and could potentially prevent a need for further corrective surgery. Its application may be used to prevent such problems as symmastia when identified intraoperatively.
Helmet Design Excision for Management of Skin Excess in Patients with Grade 2b/3 Gynecomastia Treated with Liposuction
Authors: Thomas Mohan , Silva James D. , Menon Hari , Satish Chetan 
Published: January 2017

Introduction: With the advent of liposuction, key-hole surgery for gynecomastia is on the rise. However, the skin excess in Grade 2b/3 gynecomastia that exists in vertical and horizontal axes in most cases has to be excised after completion of the liposuction. For the management of patients with Grade 2b/3 gynecomastia, we propose the helmet design for removing skin excess effectively and for relocating the nipple-areola complex in proper position concomitantly with suction-assisted liposuction. Method: The helmet design technique is described here. This technique was performed on 5 consecutive patients with Grade 2b/3 gynecomastia treated at our institute over a period of 2 years from November 2006 to November 2008 with a minimum follow-up period of 3 months. The aesthetic outcome was evaluated by patients on a grading scale from Grade 1 to Grade 3 (Grade J = poor, Grade 2 = satisfactory, Grade 3 = good). All patients were treated on a day care basis. Results: The helmet design technique takes care of the excess skin that remains after liposuction and avoids the skin pleating and puckering that result from use of the circumareolar method of skin excision. We did not encounter any complications when using this technique. Two patients had decreased nipple sensation that recovered later. The aesthetic outcome was rated as Grade 2 by 1 patient and Grade 3 by 4 patients. Conclusion: The helmet design excision used in patients with Grade 2b/3 gynecomastia treated with suction-assisted liposuction helps in relocating the nipple-areola complex to proper position and in achieving complete removal of excess skin. This is an effective single-stage treatment for patients with Grade 2b/3 gynecomastia.
Vacuum Pressures during Autologous Fat Transfer (AFT): A Study of the Closed Syringe Type and other Aspirator Pressures
Authors: Shippert Ron D. 
Published: January 2017

Objective: Vacuum pressures have long been thought to damage the lipocytes during harvest. Several studies have described this as well as the need to reduce the pressure during harvest. The goals of this article are to increase awareness of the pressures associated with the closed syringe technique and other methods of harvesting for autologous fat transfer (AFT). Methods: The closed syringe pressures are presented for 60-, 30-, and 10-mL syringes. Note that the vacuum force for any manual syringe is the plunger and the position of the plunger will dictate the pressure that will be applied to the fat. Results: The closed syringe tests on 60-, 30-, and 10-mL syringes (three brands) show that a 60-mL syringe will produce an 18.5-in mercury vacuum pressure, but only when the plunger is withdrawn to maximum. The tests also showed that when the plunger is at 30 mL, the response is 16 in of mercury; at 10 mL the response is 6 in of mercury. Thus, the smaller the syringe capacity, the lower the vacuum pressure. This lessening of the vacuum pressure is not due to the plunger losing pressure around its gasket, but it is directly related to the empty space (volume) left in the syringe. Thus, a 60-mL syringe that is half full of fat renders an identical pressure to an empty 30-mL syringe, that being 16 in of mercury. Discussion: Electrically powered vacuum sources do not respond in this manner because the motor will maintain a relatively constant pressure throughout the procedure. The economic advantages of the closed syringe technique are discussed with emphasis on the availability of generic materials and thus lessened cost. The disadvantages include the varying downward pressures during harvest, the added time to decant or centrifuge the harvested material, and the need for added transfers. Also presented are the 2 filter-type harvest units on the market today (Lipivage and TissuTrans) that will save considerable time by separating out the unwanted material during the harvest and without additional transfers. Conclusion: Knowing the pressures administered (to fat) by the syringes or reservoirs used in all types of fat harvesting equipment is important and part of the standardization process.
Per-Sternomastoid Neck Suspension in Rhytidectomy: A Technical Note
Authors: Mommaerts Maurice Y. , Moreno David J. Durán 
Published: January 2017

Introduction: Compound skin platysma suspension to the tympanoparotid fascia according to Labbé is an efficient technique in neck lift with minimal dissection and morbidity. One disadvantage remains in the fatty neck; the lifted tissue block is pulled over one of the most prominent features of a young neck: the retromandibular fovea situated between the ascending mandibular ramus and the insertion of the sternomastoid muscle (SCM). The authors propose to pull the compound flap medially by suspending it deep through the SCM to the mastoid fascia. This also helps to support a ptotic submandibular gland. Materials and Methods: Computed tomography (CT) scans and magnetic resonance imaging (MRI) of 40 patients (20 female, 20 male) with oropharyngeal malignancy were analyzed for the thickness of the SCM and the safety distance to the internal jugular vein. Results: The total average thickness of the SCM was 10.5 mm (SD 1.4) for females and 11.7 mm (SD 1.9) for males. A security distance of 6 mm from the medial SCM surface to the jugular vein was noted in females, and 7–8 mm in males. Conclusion: Deep per-sternomastoid suspension of the platysma to the mastoid fascia, performed with an Obwegeser mandibular awl coming from the superoposterior direction, is a safe and useful modification of the Labbé platysma suspension.
Kirschner Pin Migration Associated with the Sliding Genioplasty
Authors: Gingrass David J. 
Published: January 2017

The sliding genioplasty for cosmetic augmentation of microgenia is a common procedure performed by maxillofacial and cosmetic surgeons. There are multiple designs for this osteotomy, and multiple fixation techniques proposed, among which include wires, screws, bone plates, and pins. Likewise, there are many advantages and disadvantages to each of the designs and the fixation techniques that will be utilized according to the surgical indications and the surgeon's preference. A techique used at the Medical College of Wisconsin in Milwaukee involves fixation of the osteotomy segments with Kirschner pins placed at multiple divergent angles. This technique allows for placement of the free segments in virtually any location, and provides for a type of rigid stabilization, particularly in large anterior and vertical movements. One criticism that has been suggested with the use of Kirschner pins is the possibility of migration. This retrospective study evaluates 13 patients who underwent augmentation genioplasty, rigidly fixated with Kirschner pins. Twenty-eight total Kirschner pins were placed, with one being removed. The mean postoperative follow-up was 32 months, and the average number of pins placed was 2.15 per patient. It would appear then, from this study, that migration of Kirschner pins when used with the sliding genioplasty, is not a significant postoperative concern.
Correction of the Overprojected Nasal Tip
Authors: Ordon Andrew P. 
Published: January 2017

Our approach to decrease tip projection is presented. These techniques may be applied to the three degrees of overprojection, namely the relative, moderate, and ultraprojecting tip. We feel that our techniques will apply to all clinical situations where decrease in projection is desirable. Our concepts have emerged from review of previous techniques and have evolved over our past 1000 rhinoplasties. Excess nasal septum including the nasal spine area, redundancy in the feet of the medial crura, and soft tissue excess may all contribute to the overprojecting tip. However it is excess in the lower lateral cartilage complex, specifically in the medial crus, that requires the most surgical attention and alteration. Our technique in reducing the medial crus to decrease projection is patterned after the Universal Tip Technique described by Parkes and Kanodia. This endonasal technique utilizes a laterally based unipedicled lower lateral cartilage flap, which is freely rotational, but does not violate the continuity of the vestibular skin. With development of our laterally based unipedicle lower lateral cartilage flap, the number of millimeters desired to reduce the projection is removed from the medial crus and eliminated in the final adjustment of tip projection and, in this way, decreases tip projection. In the moderate case, approximately 3 mm of medial crus is excised. In the more severe or ultraprojecting tip, ≥5 is removed from the medial crus. In extreme overprojecting noses, excess soft tissue is addressed by excision of an ellipse of mucosa at the intercartilaginous incision at the septal angle. In the ultraprojecting tip, in addition to resection of redundant cephalic lower lateral cartilage and a ≥5-mm segment of medial crus, it may be necessary to also resect the lateralmost extension of the lower lateral cartilage, the feet of the medial crura, and alar bases. Septal modification, including an inferior strip resection of septum including the nasal spine, may also contribute to decreasing projection. We have found this technique to be effective and predictable over the last 10 years.
Modified Gasparotti Superficial Liposuction
Authors: Yvorchuk William A. 
Published: January 2017

The superficial technique of liposuction as recently introduced by Marco Gasparotti and others allows for improved contouring results in patients with loss of skin elasticity and with excess skin redundancy, and may allow for improved success in patients previously thought to be poor candidates for conventional deep suction-assisted lipectomy. The traditional Gasparotti technique can be described as the primary use of syringe liposuction, along with aspiration with beveledcannulae with endholes in a “multiple biopsy” technique, with specific contouring techniques and replacement ofautolo-gous fat for maximal contour improvement. Modifications in the superficialliposculpture technique can be afforded through greater use of the vacuum pump, through the use ofspatula cannulae, and through changes in specific contouring goals and techniques in keeping with the desires ofa North American patient profile.
Vermilion Border Cheiloplasty
Authors: Gilbert Scott E. 
Published: January 2017

The aging process is, in part, characterized by thinning lips, This is antithetical to our culture, which idolizes youth and the plump, full lips associated with youthfulness. Because the appearance of aging lips is not desirable, and many times aging face techniques accentuate the thinning, techniques have been developed to augment aging oral labia. Substances such as fat tissue and bovine collagen are among the choices for use in injectable augmentation. Use of these products will temporarily fill thinning, wrinkled lips, as well as other perioral structures. The use of Gore-Tex provides more permanent enhancement, but is limited as to results. Vermilion border cheiloplasty is a permanent surgical procedure to augment labial tissue that can create lips of virtually any size or shape, as well as excise perioral rhytids. Herein we review 65 lip-lifts (cheiloplasty), with or without corner lifts, where the incision extends beyond commissure. These procedures may be performed together or independently on both the upper and lower labia. However, poor scar formation, asymmetries, and prolonged healing make this a procedure for those who fail lesser techniques.
Epithelial Insert Trial for Retention of Prosthetic Hair Replacement
Authors: Pignataro Anthony S. 
Published: January 2017

Introduction: Success in the retention of prosthetic teeth has led the author to believe that dental technology could be applied to scalp hair retention. The question to be answered is, “Can epithelial inserts work for prosthetic hair replacement?” Material and Methods: One volunteer was utilized to test the epithelial insert for prosthetic hair replacement. A pilot hole was drilled into the scalp on each side. On one side, a 5-mm mucosal insert was used, and on the other side, a 9-mm mucosal insert that engaged the underlying bone was utilized. Results: Pain, inflammation, discharge, and induration occurred in both implants. The implants were removed at the end of 6 weeks; there was no maturation of either one. Discussion: At the present time, epithelial inserts for retention of prosthetic hair replacement are not a viable option. Perhaps future studies can be designed to prevent the inflammatory and infectious process.
Orbicularis Oculi Muscle Resection for Crow's-Feet Rhytids
Authors: Johnston O. Lawrence , Chugay Nikolas V. 
Published: January 2017

Introduction: Crow's-feet rhytids are a common sign of aging. The deformity is produced by smiling and becomes persistent with dermal collagen shortening and skin laxity during the aging process. It was hypothesized that resection of the lateral orbicularis oculi muscle (OOM) would result in permanent loss of the rhytids lateral to the eyes. Materials and Methods: A retrospective analysis was made of 14 patients who had resection of a beveled crescent of the OOM between September 1993 and September 1996, either as a primary procedure or during a face-lift or brow-lift. Local anesthesia with intravenous sedation was used. Results: Each of the patients had marked improvement or complete resolution of the lateral eye rhytids. The only complication was temporary temporal alopecia following a concurrent forehead–brow lift. Discussion: Medical therapy for crow's-feet rhytids has included injections of collagen, fat, silicone microdrops, and Botulinum Toxin A as well as application of chemical peels, laser, retinoids, and vitamin A. Permanent resolution of the rhytids does not occur with these modalities. Surgical manipulation of the OOM with splitting and suturing techniques have resulted in only minimal success. Beveled crescent resection of the lateral portion of the OOM has eradicated or markedly improved the crow's-feet over a follow-up period of 1 to 51 months.
Secondary Rhinoplasty Using Autologous Bone for Nasal Dorsum Defects
Authors: Tapia Antonio , Blanch Agustin 
Published: January 2017

Introduction: Secondary rhinoplasty is a difficult procedure that requires familiarity (on the part of the practitioner) with the anatomy of the different possible deformities. The use of autologous grafts from parietal bone to augment the nasal dorsum is evaluated. Materials and Methods: There were 14 cases (6 female and 8 male) involving patients with saddle nose deformities; 9 of these cases involved patients with posttraumatic deformities, and 5 cases involved secondary rhinoplasties performed to treat the sequelae of aesthetic surgery. The ages of the patients ranged from 22 to 43 years; the average age of patients was 30.57 years. Results: During the immediate postoperative period, one hematoma was produced without consequences, and one case of slight displacement of the graft was observed 11 months postoperatively. The minimum length follow-up was 8 months and the maximum length was 3 years; the average length of follow-up was 12 months. Conclusion: The parietal bone graft allows for a high level of patient satisfaction, minimum risk, and unnoticeable residual deformity of the donor site.
Soft Tissue Contouring with Acellular Dermal Matrix Grafts
Authors: Maloney Brian P. 
Published: January 2017

Introduction: Acellular dermal grafts have been used extensively in the treatment of burn patients to replace lost dermis in combination with an overlying thin-skin graft. This study reports on the use of acellular dermal matrix grafts (AlloDerm) for soft tissue contouring of the face. Placement of grafts subcutaneously has resulted in successful enhancement of facial areas such as lips, forehead, tear trough deformity, acne, depressed scars, and nasolabial folds. Materials and Methods: Acellular dermal matrix grafts with biocompatible properties have been used in the treatment of burns, in plastic/reconstructive procedures, and in periodontal surgeries (AlloDerm acellular dermal graft, LifeCell Corporation, The Woodlands, Texas). AlloDerm is processed from donated skin procured by skin and tissue banks in the United States that comply with standards set forth by the Food and Drug Administration and the American Association of Tissue Banks. All donated materials are thoroughly screened serologically via culture for fast-growing microbes; donors are screened serologically for human immunodeficiency virus 1 and 2 (HIV-1 and -2); human lymphotrophic virus 1 (HTLV 1); hepatitis A, B, and C; and syphilis. Eighty-five procedures using the acellular dermal graft were performed on 39 patients with follow-up from 9 to 18 months. Patients with autoimmune connective tissue disease were excluded from receiving the graft. Conclusions: The study patients reported on here exhibited unique postoperative courses with this biological implant, these courses were characterized by initial swelling and contraction and then by either expansion and augmentation or else resorption. Short- and long-term postoperative observations are described, with a focus on the methods used to achieve optimal graft results. Acellular dermal matrix grafts make an excellent soft-tisue augmentation material. The process of tissue integration or remodeling of the matrix using the patients's own tissue makes this a very exciting implant.