bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications of Long-Lasting Facial Fillers
Authors: Saylan Ziya 
Published: January 2017

Introduction: Although facial fillers have been popular for years, some complications have been associated with their injection or inappropriate application. Because these products are so long lasting, such untoward consequences would be difficult or impossible to correct without surgical intervention. Despite the attractions that longevity and permanency offer, the long-term effects of injecting long-lasting fillers such as acryl pearls and polyacrylamide facial filler materials deserve serious consideration by both physicians and patients before injection treatment is initiated. The author presents in this article the results of his research into possible adverse reactions to facial fillers. Methods and Materials: A total of 110 patients were selected for this study, and each received an injection into a single location on the face. Ten patients were treated with Artecoll and 100 patients were treated with Dermalive (n = 50) and Dermadeep (n = 50). The injections were made in the glabella, nasolabial fold, lips, perioral, cheeks, and chin. To achieve a more accurate study result, injection into a single area of the face at a time was necessary. Results: Between 1992 and 2003, 57 patients presented with problems after acryl injections into the face. The granulomas caused by Artecoll were smaller and fewer than those caused by Dermalive and Dermadeep. Discussion: Two products that are relatively new to the esthetic treatment industry are poly-L-lactic acid, also known by the product names Sculptra in the United States and New-Fill in Europe, and hydrophilic polyacrylamide gel, known by the product names Bio-Alcamid, Amazingel, and Aqua-Mid. These materials also form granulomas. The ethical question about whether we as surgeons should implant materials into the face that we can never completely remove without damaging the surrounding healthy tissue should be discussed further. Conclusions: Permanent fillers that provide satisfactory results at first may become more visible or create an unnatural appearance as aging progresses. Because these products are so long lasting, such untoward consequences would be difficult or impossible to correct without surgical intervention. Given these problems, it is legitimate to question the necessity for such permanent fillers.
Fat Autograph Retention: Use of Albumin to Correct Physiologic Perturbation Caused by Klein Solution
Authors: Kaminski Mitchell V. , de Vaughan Rose Lopez 
Published: January 2017

Introduction: Correction of the dilution effect of Kline Solution on colloid osmotic pressure in fat harvested for autografting may be an important factor in enhancing graft viability. The specific deficit is an acute decrease in interstitial soluble protein concentration as tumescent solution is infiltrated for local anesthesia. The most important protein component creating colloid osmotic pressure in interstitial fluid is albumin. Thus, the commercial availability of human serum albumin makes correction of this physiologic perturbation easily accomplished by the addition of 1 ml of albumin per 10-ml fat-harvesting syringe. Materials and Methods: Review of the literature and description of technique. Results: The steps to ensure fat autograph retention include: harvest using small cannulas (16- or 18-gauge), restore colloid pressure using albumin in the collection syringe, inject the graft with relatively atraumatic needles (modified 18- or 22-gauge needles), and inject the fat to produce a trail of small beads in multiple fine layers with each bead touching the nutrient bed. Discussion: The study of fat grafting continues to evolve. As it does, the science behind graft has led to better understanding of the adipocyte as a member of a dynamic organ with endocrine, apocrine, and paracrine functions. The fat mass is dynamic. Adipocyte number is not as stagnant as previously thought. They can differentiate and dedifferentiate and become stem cells with the potential to become bone, cartilage, fat and nerve cells. Stem cells from lipo-aspirate make more sense than bone marrow or embryonic sources. For one thing, fat is easy to obtain, and when used in the same patient its endogenous genetic code is identical, removing another obstacle to retention. Conclusion: These observations are reported here as they seem to result in a nearly 90% graft retention rate and reduce the need to overfill.
Repair of the Pixie Ear Deformity with Modified V to Y Plasty during Rhytidectomy
Authors: Chen Achih H. , O'Rourke Ashli K. , Harper J. Garrett , Kamer Frank M. 
Published: January 2017

Introduction: The “pixie ear,” an attached, tapering, inferiorly displaced ear lobule may be congenital or iatrogenic. As a postrhytidectomy complication, the pixie ear deformity is the hallmark of excessive skin tension and a telltale sign of surgery. It is often the result of excessive skin excision or anchoring of the skin to the ear lobule causing it to become displaced in an anterio-inferior direction with elongation and obliteration of the free-hanging edge. Methods: Described is a method of correction useful in addressing both congenital and iatrogenic pixie ear deformities during rhytidectomy that uses a modified V to Y advancement flap where the advanced “V” portion is excised with the redundant skin and the vertical portion of the “Y” is hidden along the contour of the newly created lobule. Results: This technique, used in every patient presenting for rhytidectomy from July 1, 2003, to June 30, 2007, with iatrogenic or congenital pixie ear deformity (n > 30 at the Lasky Clinic and the Georgia Center for Facial Plastic Surgery) results in restoration of the natural, rounded, free border of the ear lobule, while avoiding any conspicuous skin incisions beyond that of the standard rhytidectomy. Conclusions: This method for correcting the pixie ear deformity is easily incorporated into the rhytidectomy and yields excellent cosmetic results. It is useful in correcting iatrogenic pixie ear during revision rhytidectomy or in correcting congenital pixie ear during primary rhytidectomy.
A Cosmetic Surgeon's Decade of Experience Performing Eyelash Transplantation
Authors: Duplantis Kathryn , Cosio-Lima Ludmila , Reynolds Katy , Hodges Tabitha 
Published: January 2017

Introduction: Single-hair grafts to the eyelids, performed using a very challenging technique, offer cosmetic surgery patients a natural-looking solution for alopecia of the eyelid due to various causes, ranging from overcurling and trauma to systemic and metabolic processes. The technique described in this article requires the cosmetic surgeon to have a vast experience in both hair transplantation and eyebrow transplantation. Methods: We present a technique that requires simple instrumentation and the aid of one well-trained assistant. The procedure has been performed on 20 male and 350 female patients over a 10-year period. Results: The procedure has resulted in a mean graft survival percentage of 95%. The technique produces cosmetically pleasing outcomes, and complications are rare. Conclusions: A challenging technique for eyelash transplantation can successfully effect a pleasing and natural look for cosmetic surgery patients.
Drains in Breast Augmentation
Authors: Thomas Mohan , Menon Harikumar , D'Silva James Allen 
Published: January 2017

Introduction: Capsular contracture is the most discussed aspect in breast augmentation. Drains are important in preventing hematoma and subsequent capsule formation, but drains have been associated with increased incidence of early breast contracture and infection. The purpose of this article is to review the use of drains during breast augmentation surgery and to present their effect on the incidence of capsule contracture observed in a short-term study of patients receiving breast augmentation with cohesive gel implants. Material and Methods: Sixty consecutive cases of breast augmentation with cohesive gel implants were followed up for 6 months. All cases had tube drains for 24 to 48 hours postoperatively. Results: Infection and early capsular contracture were not observed in this study. Discussion: With the US Food and Drug Administration's clearance of cohesive gel implants, subglandular placements are bound to increase. Subglandular placement is associated with increased incidence of capsular contracture. Meticulous hemostasis and the use of drains to prevent hematoma are important aspects in preventing capsular contracture. Conclusion: Our experience shows that drains are safe and effective and do not increase infection rates or cause early capsular contracture.
Treating Internal Nasal Valve Collapse: The Intranasal Valvuloplasty
Authors: Major Troy E. , English Jim L. 
Published: January 2017

Introduction: Nasal obstruction requires a careful and thorough examination of the nose and nasal cavity. Particular interest should be placed on the internal and external nasal valves and their collapse. We discuss a simple yet effective technique to resolve obstruction of the internal nasal valve, called the intranasal valvuloplasty/valvulopexy. These procedures can be of benefit for valvular obstruction, especially postrhinoplasty. Objective: Nasal obstruction as sequela to aesthetic surgery may occur more often than recognized. The purpose of this paper is to explain a relatively simple yet expedient technique to address nasal valvular collapse. Method: Retrospective review of patients treated with the intranasal valvuloplasty/valvulopexy technique in the outpatient setting. Results: We reviewed our last 6 patients with the technique our senior author has been performing for 20 years. The patients noted 80–100% subjective improvement and we noted comparable objective improvement. Of the 6 patients, 50% were done bilaterally and 33% were combined with either a septoplasty or with a septorhinoplasty. Of these, 66.7% had a history of prior nasal surgery, usually rhinoplasty. Discussion: The valvuloplasty is an effective and straightforward approach to nasal valve collapse either alone or in conjunction with other rhinological procedures.
Treatment of Large Skin Necrosis following a Modified Avelar Abdominoplasty with the Erchonia EML 635 nm Laser and Platelet-Rich Plasma
Authors: Lopez Quita 
Published: January 2017

Objective: Skin necrosis of the flap and delayed wound healing are common complications of abdominoplasty surgery. A case report is presented of a patient who was treated with the 635 nm or low-level laser therapy (LLLT) and platelet-rich plasma (PRP). Both of these modalities have been shown to accelerate wound healing and improve the appearance of the scar. Materials and Methods: Case report. Case Presentation: A 62-year-old female with chronic hypertension underwent a modified Avelar abdominoplasty. She developed skin necrosis at the midline from her umbilicus to the lower horizontal incision. Also, mild necrosis was noted in her upper abdomen in the area of the left superior epigastric vessel. The patient had negative bacterial cultures and was given daily 635 nm laser treatments for the first month. PRP (Smart PReP System, Harvest Technologies Corp, Plymouth, Mass) was used for the early small open wounds and then on the large midline wound after the eschar had lifted. Discussion: Skin necrosis is a complication that can occur after abdominoplasty surgery. The area between the umbilicus and the lower incision is the area where profound devascularization occurs, as was demonstrated by Mayr. Despite upper abdominal undermining limited at the midline to 3 cm, skin necrosis still occurred in this patient and was evident 6 days postoperatively. LLLT was started on the first postoperative day to treat surgical pain and inflammation; treatments were provided daily after necrosis was diagnosed on the sixth postoperative day. When the patient developed open wounds near the umbilicus, activated PRP (PRP with calcium chloride and topical thrombin) was placed in the deepithelialized wounds to accelerate healing. The activator was made by combining 5 ml of 10% calcium chloride with 5000 units of bovine thrombin in a PRP-to-activator ratio of 10:1. An increase in tissue exudate was noted with LLLT. When the eschar had lifted, the wound was treated with activated PRP and with daily 635 nm laser treatments. The patient healed within 3 months. Conclusion: Ischemic flaps can be treated with LLLT and with PRP. When both modalities are used, the healing is accelerated, and the final aesthetic appearance of the scar is improved, so future corrective surgery is avoided.
Recent Changes in Medical—Legal Statutory and Case Law and Their Application to Cosmetic Surgery
Authors: Breitenbach Edwin E. 
Published: January 2017

In the mid 1970s medical malpractice insurance carriers, faced with huge increases in both the number of claims and the size of awards, elected either to discontinue writing medical malpractice insurance policies or to raise premiums for this type of insurance by a factor of two or three. Faced with the prospect of unavailability of affordable medical malpractice insurance many physicians elected to go without any malpractice coverage, went into early retirement terminating their practices altogether, or narrowed the scope of their practices to eliminate those procedures which carried an inordinately high risk of medical malpractice litigation. In response to the potential unavailability of adequate health care because of the impending medical malpractice insurance crisis many states enacted remedial emergency legislation in an attempt to deal with the crisis by providing an incentive for insurance carriers to either reenter the medical malpractice field or for those remaining to limit their proposed premium increases substantially. California was one of those states which enacted broad remedial legislation. In addition other states enacted legislation quite similar to California's. An attempt will be made to review those statutes passed by California in specific response to the medical malpractice crisis and their history as they underwent constitutional attack in the California appellate court system. The legislation reviewed here is of course applicable only in California. However, many other states have enacted comparable legislation and many jurisdictions currently are considering statutory changes which would parallel California's laws. California's current statutes dealing with medical malpractice litigation could be considered a model for those jurisdictions currently facing a crisis in affordability or availability of malpractice insurance coverage.
Aesthetic Recontouring of the Midfacial Skeleton: A Regional Approach
Authors: Giampapa Vincent C. 
Published: January 2017

Aesthetic facial skeleton recontouring, whether done for traumatic, congenital, or aesthetic indications, is gaining in popularity. In the past, its success has largely depended upon the aesthetic sense of the surgeon. Through the use of cadaver dissections, the underlying bony anatomy of the midface was studied and subsequently divided into three distinct regions. The contribution of each of these regions of the midface to the oblique and frontal profiles is described. With utilization of moulages taken from the surface of skulls in these regions, anatomically contoured implants were designed. To facilitate clinical implant placement and symmetry, skin markings employing superficial landmarks of the face are described. The standard blepharoplasty incision for subperiosteal placement of the regional implants is detailed, and the benefits of this technique over previously described routes of insertion are discussed. A total of 73 malarplasties in 35 patients have been performed in a period of more than 4 years. Surgery is easily done under local anesthesia either alone or in conjunction with rhinoplasty, blepharoplasty, or rhytidectomy.
The Long-Term Effects of Facial Implants: Preliminary Study
Authors: Glasgold Alvin I. , Silver Frederick H. 
Published: January 2017

The objective was to study the long-term safety and benefits of facial implants. This was a retrospective study of patients undergoing facial implant surgery over a 10-year period. All surgery was performed by the senior author in a hospital or ambulatory facility. Four hundred and eighty-four questionnaires were sent to patients of the senior author who underwent malar or mandibular augmentation with preformed silicone implants during the years 1982 to 1992. Two hundred and seven replies were received. Patient satisfaction rate of 99% was recorded. No serious complications occurred. There were no instances of connective tissue or other related systemic disease in any of our patients following facial implant surgery. Silastic implants in the malar and mandibular areas are safe procedures with a very high rate of patient satisfaction and a very low complication rate. Based on our study and those of others, there does not seem to be a relationship between silicone implants and the development of connective tissue disease.
Autologous Fat Grafting: A Study of Residual Intracellular Adipocyte Lidocaine Concentrations after Serial Rinsing with Normal Saline
Authors: Alexander Robert W. , Maring Thomas S. , Aghabo Tara 
Published: January 2017

Introduction: With evolution of sophisticated lipocontouring techniques increased interest has developed in utilization of vacuum harvested autologous fat cells for grafting purposes. Transplantation of viable adipocytes for contour augmentation, enlargement, or filling of defects has clinically become more important. Based on evidence that lidocaine solution may alter the metabolic activity, evaluation of the effects of multiple rinsing was undertaken. Materials and Methods: Gas chromatography was utilized to measure changes in intracellular concentration of lidocaine from closed syringe harvested adipocytes following serial rinsing with equal volumes of normal saline in preparation for fat grafting procedures. Results: Use of standard tumescent local anesthesia as a medium for harvesting mature fat cells via closed syringe techniques resulted in substantial absorption of lidocaine. Statistically significant reduction of intracellular lidocaine was accomplished via serial rinsing with normal saline solution. It was concluded that a minumum of three rinses utilizing equal volume of saline to autologous fat achieved significant and substantial reduction of intracellular lidocaine levels, but did not result in complete removal. Discussion: The importance of thorough rinsing and removal of cellular debris from harvested fat cell grafts prior to transfer is widely recognized to improve efficacy and predictability. This study proves that serial rinsing of fat cells harvested with closed syringe system using a tumescent fluid technique does statistically reduce the retention of intracellular lidocaine. It is believed that high concentrations of retained intracellular lidocaine may inhibit the metabolic activity and impact the survivability of autologous fat grafts.
Long-Term Frozen Fat for Tissue Augmentation
Authors: Takasu Katsuya , Takasu Shizu 
Published: January 2017

Introduction: This study presents our experience over 9 years of transplantation of frozen fat to correct the aging face. Materials and Methods: Thirty-six patients were treated with frozen fat. For the treatment, fat is harvested from a convenient site such as the abdomen, buttock, or thigh with the pateint under tumescent anesthesia. The fat is placed in 15-mL sterile test tubes and put into a freezer, where the fat is maintained at a temperature of −70°C. The fat is thawed at room temperature for several hours, and reinjection is performed in the same manner as for fresh adipose tissue. Results: Of the 36 patients treated with frozen fat, 19 were injected once and 9 were injected twice. The remaining 8 patients received 4 to 7 injections of frozen fat. Frozen fat showed an approximate 30–70% volume loss during the 4–6-week follow-up period. The storage time in the freezer between harvest and reinjection ranged from 2 months to 7 years. It was found from clinical observation that the adipose tissue frozen for a longer period provided results no different from those for adipose tissue stored for a shorter period. No complications related to the use of frozen fat occurred.
Tumescent Technique in Aesthetic Plastic Surgery with Low Doses of Prilocaine Solution, Part I
Authors: Mang Werner L. , Sawatzki Karsten , Materak Jan 
Published: January 2017

Introduction: In Germany the local anesthetic prilocaine has gained popularity for use in tumescent solutions. However, although prilocaine shows the lowest toxicity of the local anesthetics, the use of prilocaine in higher doses leads to methemoglobinemia. We report a clinical study that determines whether adequate local anesthesia can be achieved with low concentrations of prilocaine (less than 0.05%). Materials and Methods: Twelve patients from anesthesia risk groups ASA I and II participated in the study. The patients were medicated with 25 mg piritramide orally and with 1000 mg acetaminophen by suppository. By means of an infusion system and a pump syringe, tumescent solution was injected into the subcutis until the tissue was completely infiltrated. This initial injection used approximately two thirds of the total quantity of solution, and the remaining tumescent solution was injected roughly 30 minutes later, resulting in ultratumescence. A 0.038% solution of prilocaine was used. Two 3-L bags with additives were instilled as the standard for treatment. The total injection volume was 6.3 L. A total of 2400 mg of prilocaine was administered, which is 4 times higher than the recommended maximum dose for infiltration anesthesia using prilocaine with epinephrine. The subjective tolerability of the tumescent local anesthesia was measured by interview and documentation. Results: In all cases, it was possible to perform the liposuction using prilocaine in a concentration of 0.038%. Eight of the 12 patients needed supplemental intravenous doses of 3.75–11.25 mg of piritramide. Discomfort was reported by 3 patients during the infiltration and by 6 patients during liposuction. Two patients received analgesic during the infiltration, and 8 patients received analgesic during liposuction. All patients were ambulatory immediately following surgery. All patients were satisfied with the tumescent local anesthesia and would agree to using it again in liposuction. Discussion: The low concentration of prilocaine used in the tumescent solution (0.038%) proved sufficient for liposuction. The more dilute solution allows for a greater volume of the tumescent solution to be used without causing more side effects. The increased procedure time of up to 6 hours seems justified by the safety and efficacy of the technique.