bluuebunny/crossref_metadata_2025_split huggingface dataset:
Staged Treatment of a Traumatic Cheek and Jowl Avulsion: Using a Purse-String Technique, Rhombic Flap, and Rhytidectomy
Authors: Hanna Todd C. , Waite Peter D. 
Published: November 2015

Introduction: This article describes a 3-stage treatment modality for a traumatic cheek and jowl avulsion consisting of a purse-string technique, rhombic flap, and face-lift. This approach has not been previously published. Materials and Methods: This case report and literature review discusses the management of a complex left cheek wound consisting of a 6-cm-diameter avulsion and a 5-cm-linear extension. Primary closure was not possible, and a staged treatment modality was selected. The avulsed portion was reduced with a purse-string suture. Primary closure was achieved 3 weeks later with a rhombic flap. Asymmetry was addressed at 6 months postinjury with bilateral rhytidectomy and liposculpture. Successful outcome was determined through patient satisfaction, clinical examination, and comparison of perioperative photographs. Results: The initial defect was reduced in size by more than one-half, from 6 cm to 2.5 cm in diameter, with the purse string. Primary repair was achieved with a smaller local flap, preserved facial landmarks and central oval, and a satisfactory scar. Jowl and nasolabial fold symmetry was effectively restored with bilateral rhytidectomy. No major complications occurred, including flap necrosis, infection, or facial nerve injury. Conclusions: For facial soft-tissue avulsions that are not amenable to primary closure, a purse-string technique allows for circumferential tissue recruitment, creep, and expansion. This creates a smaller defect and potentiates a more conservative definitive closure. Residual nasolabial and jowl asymmetry may be improved with bilateral rhytidectomy. Patients must be fully informed of the complexities of staged treatment including multiple surgeries, increased wound care and appointments, and delayed results.
The Circles of Prominence: Ideal Ratios That Determine the Basis of Facial Beauty
Authors: Young Philip A. 
Published: November 2015

Introduction: To test a key ratio within the face that establishes a basic order thought to define facial beauty. The ratio is based on the distance between the horizontal level of the iris to the nasal tip, the nasal tip to the lower lip, and the lower lip to the menton. Materials and Methods: This was a subjective survey in which 27 pictures (3 variables with 3 values) were displayed to evaluators who would judge all of the pictures to assess their general attractiveness. To construct the pictures, we varied the distance between (1) the horizontal level of the iris, (2) the center of the nasal tip, (3) center of the lower lip, and (4) menton with the distance from the center of the iris to the midline fixed at 3 iris widths. These 3 distances were varied by 2, 3, or 4 iris widths. One hundred random patients (data not shown) from a head and neck surgery clinic were asked to place all of the photos in order from most aesthetically pleasing to least aesthetically pleasing. The rankings of all 100 patients/evaluators were averaged for each picture. Essentially, the lower the average, the more aesthetically pleasing the picture was thought to be by our test population. Because of the equivocal results from the first part of this study, we carried out another study placing the 2 most aesthetically pleasing pictures (pictures 5 and 14) from the first part of the study in another head-to-head study. In the second part of the study, we asked 127 patients from a facial plastic surgery office to judge whether picture 5 or 14 was the more attractive picture. Results: The first part of the study showed that 2 facial representations of picture 5 (average ranking 4.67) and picture 14 (average ranking 4.28) were determined to be the most aesthetically pleasing, where rank 1 was judged to be the most attractive. Statistically through permutation tests (P < .01), picture 14 (ratio 3, 3, 3) was shown to be more preferred over all pictures other than picture 5 (ratio 4, 3, 3). Picture 5 had a P = .2230. A Bonferroni correction showed that picture 14 was ranked No. 1 more often than picture 5, with P < .0011. In the head-to-head study, 88 people chose picture 14 and 39 chose picture 5. A 1-sample test of proportion showed that this was highly significant, showing that picture 14 was indeed the more pleasing picture (P < .01). Conclusion: The study supports the idea of the importance of the iris, nasal tip, and lower lip as the main objects used when people assess beauty within a face. When the distance between these objects are varied, the presence of beauty is also varied. Based on this study, when these elements are balanced equally between each other, this arrangement is found to be more beautiful. Statistically, we were able to show that picture 14 was judged to be the most attractive where the distances were all equal (3 iris widths). This study further supports the validity of the Circles of Prominence as a theory on facial beauty.
Modified Short-Scar Face-Lift: Technique, Pearls, and Outcomes
Authors: Wei Leslie A. , Goel Shubhra , Rose John G. 
Published: November 2015

Introduction: The modified small-incision face-lift is a safe, effective, minimally invasive way to treat facial rhytidosis in carefully selected patients. The purpose of this study is to describe a modified small-incision face-lift technique. Materials and Methods: Institutional review board– approved retrospective case series. Results: Twenty-six patients underwent a modified small-incision face-lift. The average age of the patients was 62.1 years. Two patients developed hypertrophic scarring requiring surgical revision. There were no other complications, including infection, wound dehiscence, or flap necrosis. Patient satisfaction with the procedure was high. Conclusions: The modified short-scar face-lift is a safe and effective procedure that can be done in the office with or without sedation and requires less recovery time than traditional face-lift techniques.
Combination Laser Resurfacing with Facial Plastic Surgery is Superior to Lasers Alone
Authors: Sorensen Robert H. , Connor Matthew P. , Lospinoso Joshua A. , Lospinoso Danielle J. , Barrera Jose E. 
Published: November 2015

Introduction: This study was designed to demonstrate through validated objective wrinkle scales that the combining of facial plastic surgery with fractionated CO2 lasers in the perioperative setting is superior to CO2 laser only in the treatment of rhytidosis. Materials and Methods: Data were gathered and reviewed from 2 patient groups who were treated with either combined facial plastic surgery with fractionated CO2 lasers or laser-only therapy. Surgeries were performed by the senior author (J.E.B.) at a level 1 trauma center from July 2009 through May 2014. Preoperative and postoperative photographs were gathered for all patients and distributed in random order to a facial plastic surgeon and a dermatologist who objectively rated them. Both raters were blinded to patient data and treatment information. The study included 32 patients (30 females and 2 males). Nineteen patients received adjunctive fractionated CO2 laser resurfacing in the setting of facial plastic surgery; the second group consisting of 13 patients was treated with fractionated CO2 laser only. Surgeries performed included blepharoplasty, deep plane rhytidectomy, forehead rhytidectomy, submental liposuction, and rhinoplasty. Raters used validated scales to objectively assess the 2 patient groups. These included the Glogau, Fitzpatrick, and Modified Fitzpatrick scales. Numerical values were assigned to before and after pictures of patients in the frontal and profile views. Results: Patients treated with the combination of laser plus facial plastic surgery showed a greater decrease in wrinkles than patients treated with laser-only therapy (estimate = −0.78, P = .07) when evaluated with the Glogau scale. In addition, younger patients and patients with darker pigmentation showed a greater reduction in wrinkles compared with their counterparts (estimates negative, P values <.001). Discussion: A combined technique using facial plastic surgery in conjunction with fractional CO2 laser resurfacing is superior in treating rhytidosis in comparison to fractional CO2 laser-only treatment. This technique can be used safely in a wide range of patients and is convenient and cost-effective.
Lower Eyelid Synechia: A Complication of Periorbital CO2 Laser Resurfacing
Authors: Niamtu Joe 
Published: November 2015

Introduction: Laser resurfacing of the lower eyelids is a popular option for rejuvenation. Lower eyelid synechia (adhesions) can occur with laser skin resurfacing, but literature searches for this topic failed to show any dedicated articles addressing this complication. Materials and Methods: The author routinely performs more than 120 procedures per year involving high-fluence, high-density, multipass CO2 laser skin resurfacing to the lower eyelids (which includes full-face and periorbital treatment combined). This article discusses the author's clinical experience dealing with lower eyelid synechiae. Health Insurance Portability and accountability Act guidelines as well as the World Medical Association Declaration of Helsinki regarding ethical principles for medical research were followed. Results: Lower eyelid synechiae are an uncommon complication in the reepithelialization phase of laser resurfacing. If recognized and treated early, permanent tissue adhesion is rare; if allowed to totally reepithelialize; however, permanent deformity may occur. Conclusion: Laser resurfacing remains a popular option for rhytid effacement, skin tightening, and dyschromia improvement of the lower eyelids whether performed as an isolated procedure or as part of full-face laser resurfacing. Lower eyelid synechiae are an uncommon but potential complication that can lead to permanent disfigurement if not diagnosed and treated early in the healing period after laser treatment. All physicians and staff that perform laser resurfacing should be familiar with the early diagnosis and early treatment of lower eyelid synechiae.
Preoperative Intravenous Acetaminophen Improves Recovery Time after Abdominoplasty
Authors: Murray Matthew , Haiavy Jacob 
Published: November 2015

Introduction: Abdominoplasty can be a major and difficult procedure for patients. They can have prolonged postoperative pain and difficulty moving and eating. These difficulties can increase the time patients are in the postoperative unit, increase costs, and decrease overall patient satisfaction. This retrospective study compared the recovery time for patients who did and patients who did not receive intravenous (IV) acetaminophen before abdominoplasty. Materials and Methods: Twenty-seven patients were randomly selected for the study. The 12 patients chosen as a control group were given a standard pain regimen without IV acetaminophen. Fifteen patients were given the standard pain regimen, including preoperative IV acetaminophen. The total time in the postanesthesia care unit was recorded from entry to the area to the patients' leaving the facility. The Aldrete score was used for discharge criteria, and the time was recorded once the patient scored 10 out of 10 and had good pain control. Results: The average recovery time for the control group was 117 minutes. The average recovery time for the IV. acetaminophen group was 83 minutes for an improvement in discharge time of 34 minutes. The number of patients discharged from the facility within 90 minutes of arriving in the postoperative care unit increased from 33% to 73%. Conclusions: Compared with patients given standard medical therapy, patients in the preoperative IV acetaminophen group improved discharge times, and more patients were discharged within 90 minutes of arriving in the postoperative care unit.
Evaluation and Excision of Firm, Immobile Forehead Masses
Authors: Brumm John David , Paul Benjamin C. , Miller Philip J. 
Published: November 2015

Introduction: The differential diagnosis of a firm, immobile lesion of the forehead includes more than just osteoma. Preoperative computed tomography (CT) imaging may alter surgical precautions and reduce the complications to allow for a minimally invasive approach. Materials and Methods: This is a retrospective case series of a single, private facial plastic surgeon in New York, New York, of patients evaluated for a firm, immobile forehead mass. The impact of CT scan on diagnosis and treatment was analyzed. Intraoperative and postoperative complications, recurrences, and patient satisfaction were recorded. Results: Nineteen patients (age range = 19–66 years; mean age = 36 years) presented with one or more firm, immobile forehead masses measuring <4 cm. Before 2011, preoperative CT evaluation was not routinely performed; during this period, 5 patients underwent excision of presumed osteomas with no complications. In 2011, patient 6 was found to have an intradiploic hemangioma on outside CT scan. From 2011 to 2014, preoperative CT was recommended (n = 13) to confirm osteoma. Ultimately, our series (n = 19) revealed 17 osteomas (16 patients), 1 intradiploic hemangioma, 1 pneumosinus dilitans, and 1 compact lipoma. Follow-up (mean = 3 months) did not reveal any complications. All patients reported high satisfaction with the aesthetic outcome, and there was no recurrence or need for revision surgery. Conclusions: The differential diagnosis of a firm, immobile forehead mass includes various pathologies of the scalp and calvarium. Though these masses are most commonly osteomas, other pathologies may present similarly. Preoperative CT scans without contrast can distinguish these unexpected etiologies. With proper evaluation and diagnosis, minimally invasive excision may be performed with excellent results.
Nonsurgical Rhinoplasty with Injectable Fillers: Italian Technique for Reshaping the Tip of the Nose
Authors: Amore Roberto , Donnamaria Daniele , Marini Fabio , Amuso Domenico , Leonardi Vincenza , Di Vito Francesco Milena 
Published: November 2015

Introduction: The rhino filler is a relatively recent complementary technique to rhinoplasty. The filler provides good results in certain selected cases, camouflaging irregularities of the dorsum and tip. This study aims to evaluate the Italian technique for the modification of the tip, a seemingly trivial but very effective technique. In selected cases, it is possible to successfully modify the tip of the nose using a simple double injection of filler within a few seconds. Materials and Methods: A total of 212 subjects were treated with filler in a single session. The patients were carefully selected, and each presented to varying degrees and in different ways with the tip of the nose projected and/or turned downward. The goal of the treatment is to provide greater projection and an upward lift of the tip. Follow-up visits evaluated the result, degree of patient satisfaction, and adverse reactions. Results: Of the patients, 79.2% claimed to be completely satisfied, 11.3% moderately satisfied, and 9.5% had no observable improvement. When evaluated photographically, 92.4% demonstrated improvement. Discussion: The technique has inherent limitations. It cannot change the structure of bone or cartilage, and it can correct only with an increase. For this reason, it is essential to select patients carefully. This study reported no major adverse events, and this is encouraging. Conclusions: This technique standardizes the reshaping of the tip with injectable fillers, reducing the number of injections to 2 boluses, by becoming a safer treatment, easier carrying, quick, well tolerated, economical, durable, and with maximum results.
Infection Rates Comparing Topical Antibiotic versus Antibiotic-Free Ointment in Blepharoplasty Surgery
Authors: Alford Mark 
Published: November 2015

Introduction: The purpose of the study was to determine the rate of postoperative surgical-site infections following blepharoplasty by comparing patients using topical antibiotic ointment and those using topical lubricating ointment without antibiotic. Materials and Methods: In an observational, cohort study, 2 similar groups of patients were evaluated for rates of allergic reactions and postoperative infections. For 15 months, 384 consecutive patients, (171 men, 213 women; age range = 38 to 87 years; mean age = 69.2 years), underwent bilateral upper eyelid blepharoplasty. Postoperatively, patients applied bacitracin ophthalmic ointment twice a day for 7 days. Patients with a known allergy to bacitracin were excluded. For the subsequent 9 months, a second cohort of 158 patients, (64 men, 94 women; age range = 30 to 96 years; mean age= 69.3 years) used sterile Refresh PM ophthalmic ointment twice a day for 7 days. All patients had surgery at 1 of 2 fully accredited surgery centers. Both cohorts underwent identical betadine preparations, and all procedures were performed under sterile conditions with full gloves, gowns, and drapes. Surgical technique, instruments, and suture materials were consistent in both groups. Patients were seen 1 week following surgery. Results: In the bacitracin group, 14 of 384 (3.65%) patients had an allergic reaction to the ointment characterized by bilateral erythema, swelling, and itching without any evidence of purulent material along the incision line. In 1 patient (0.26%) a positive culture indicated infection with a methicillin-sensitive Staphylococcus species. In the group using Refresh PM, 10 of 158 (6.3%) patients had a culture-positive surgical-site infection characterized by erythema and purulent material along the incisions. All but 1 infection was bilateral. All cultures grew community-acquired methicillin-resistant Staphylococcus aureus. The study was discontinued in light of the high incidence of infection. Conclusions: In these very similar age-matched cohorts, a lower rate of infection (P < .001) was identified in patients using topical antibiotic ointment postoperatively.
Autologous Fat Grafting for Breast Augmentation in Patients after Implant Removal
Authors: Chiu Cheng Hung 
Published: November 2015

Introduction: Patients diagnosed with symptomatic capsular contracture or with safety concerns for the implant are often reluctant to accept the operation of implant exchange, choosing instead removal without exchange or taking other options to rebuild their breasts. These patients may benefit from augmenting the overlying soft tissue of the breasts with autologous fat grafting (AFG) after removing the prosthesis if the aesthetic appearance of their breasts is an issue. A retrospective analysis of patients receiving AFG for breast augmentation after implant removal was performed. The outcomes in these patients were compared with those of the patients receiving AFG for breast augmentation as their first breast surgery during the same period. Materials and Methods: Between March 2011 and November 2013, 27 patients receiving AFG after breast implant removal (BIR) were assigned to group A and 325 patients who underwent AFG for breast augmentation without preexisting implant by the same surgeon were assigned to group B. Objective evaluation was made by measuring the change in the difference of breast circumference (BCD) and breast thickness measured by ultrasonography taken before and after the treatment. Aesthetic evaluation was performed using a 5-point Likert-type scale for patient satisfaction and comparing preoperative and postoperative digital photographs for physician satisfaction. Results: Relative to group B, patients in group A were older and had higher complication rates, including infection, fat necrosis, indurations, and calcifications (P < .05). The changes in BCD and breast thickness between the 2 groups were of no clinical significance. The reoperation rate in group A was significantly higher (P < .05). Conclusions: The number of postoperative complications of AFG for breast augmentation was found to be higher in patients after BIR. The optimal timing of AFG in the patients after BIR should be further studied if 2-stage augmentation with fat grafting is to be performed. Reoperation with fat grafting to the breasts should be considered if patients expect to have the original volume of their breasts restored.
“Umbilicosliding” or Repositioning of the Navel during or after Abdominal Liposuction to Prevent or Correct the “Sad Umbilicus” Appearance
Authors: Blugerman Guillermo , Schavelzon Diego , Wexler Gabriel , Lotocky Marcelo 
Published: November 2015

Introduction: The umbilical scar is the only scar that is culturally accepted and whose dysmorphia or absence catches people's attention. Studies have discussed numerous umbilicus reconstruction techniques but not any for repositioning the umbilicus during or after liposuction. In this study, we will introduce a technique called “umbilicosliding” that is used to prevent or correct a defect known as the “sad umbilicus” without visible scarring. Method: A retrospective study was conducted from 2010 to 2014 in which 32 patients fulfilled the inclusion criteria. Preoperative and postoperative photographs were analyzed by two plastic surgeons that were not on the team at the time of the procedures. Patients were recalled and surveyed about results. Results: The external assessment of aesthetic outcome by photographic results were 31% (n = 10) excellent, 47% (n = 15) good, 22% (n = 7) regular, and 0% bad. Recalled patients assessed the aesthetic outcome at 25% (n = 8) excellent, 66% (n = 21) good, 9% (n — 3) regular, and 0% bad.