bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.