Plastic Surgery in the News

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State Will Pay For PIP Breast Implant Removal, Says Venezuelan Health Minister
Venezuelan Health Minister, Eugenia Sader, has announced that the full costs of removing the Poly Implant Prothèses (PIP) breast implants will be covered by the state. Ms. Sader emphasized that this offer stands for any woman who wishes to have them removed. French authorities have also offered to cover the full costs...
Wed, 28 Dec 2011 19:00:00 +0000

Complications and Risks of Breast Augmentation
There were 364,610 breast augmentation procedures performed in 2005. The top concerns of breast augmentation include the surgery itself, the implants, breast cancer and the risk of anesthesia.Contributor: Cristina Olvera Published: May 24, 2006
Wed, 24 May 2006 14:47:00 +0000

Brigham And Women's Surgeons Describe 3 Successful Full Face Transplants
In March 2011, a surgical team at Brigham and Women's Hospital (BWH) performed the first full face transplantation (FFT) in the United States and went on to complete a total of three FFTs this year...
Wed, 04 Jan 2012 08:00:00 +0000

Tanning Salons Lie About Health Risks Says Congressional Panel
A report compiled by the U.S. House Energy and Commerce Committee slates tanning salons for not making the risks clear to their customers. The committee asked for a thorough investigation to find out whether tanning salons across the country make it clear to their clients the health issues associated with the services they offer...
Wed, 01 Feb 2012 22:00:00 +0000

Erivedge - Treatment For Most Common Form Of Skin Cancer
Basal cell carcinoma is a form of skin cancer caused by regular sun exposure, or other ultraviolet radiation, which starts in the top layer of the skin (epidermis), is usually painless and grows slowly. The U.S. Food and Drug Administration just approved a new drug named Erivedge (vismodegib) for the treatment of adult patients with basal cell carcinoma, the most common type of skin cancer...
Wed, 01 Feb 2012 17:00:00 +0000

FDA Approves Drug For Common Skin Cancer
On Monday, the US Food and Drug Administration approved a new type of drug to treat adult patients with advanced basal-cell carcinoma, the most common type of skin cancer. The drug's generic name is vismodegib and was developed by the US part of Roche Holding AG. It will be sold in the US by Roche's South San Francisco-based Genentech under the brand name Erivedge...
Wed, 01 Feb 2012 08:00:00 +0000

PIP Breast Implants Unsafe, Say German Authorities
German authorities at the BfArM Institute have officially informed the International Society for Aesthetic Plastic Surgery (ISAPS) that the former GfE Medizintechnik GmbH in Germany sold breast implants under the name TiBREEZE from September 2003 to August 2004, which were manufactured with PIP components...
Tue, 31 Jan 2012 18:00:00 +0000

Robotic Surgery With One Small Incision, U.S. First
On Tuesday, December 20th, Santiago Horgan, MD, chief of minimally invasive surgery at UC San Diego Health System was the first surgeon in the United States to remove a diseased gallbladder through a patient's belly button with the aid of a new FDA-approved da Vinci Si Surgical System. With one incision, Horgan removed the gallbladder in 60 minutes...
Tue, 27 Dec 2011 08:00:00 +0000

A Layperson's Psychological Take on Fake Breasts
Food for thought on the real reasons why women get breast augmentation.Contributor: M G Published: Apr 25, 2005
Tue, 26 Apr 2005 03:44:00 +0000

Breast Implants: Saline vs. Silicone and More on Augmentation Surgery
Now ten years after silicone implants were yanked off the market, breast enlargment sugery is on the rise. This article introduces two mothers who had implants and discusses silicone v. saline, sizes, shapes, side effects and pros/cons or the surgery.Contributor: D. S. Ploshay Published: Feb 21, 2006
Tue, 21 Feb 2006 13:33:00 +0000

Answers to Questions on Silicone and Saline Breast Implants
A board-certified plastic surgeon answers your questions.Contributor: D. S. Ploshay Published: May 16, 2006
Tue, 16 May 2006 13:15:00 +0000

What Are Varicose Veins? What Causes Varicose Veins?
Varicose veins are enlarged, swollen, and tortuous (twisting) veins, frequently linked to faulty valves in the vein. They are generally blue or dark purple. People with bulging and/or lumpy varicose veins on their legs may experience aching and heavy limbs. Sometimes, in very severe cases, the varicose veins may rupture, or varicose ulcers may form on the skin...
Tue, 10 Jan 2012 15:00:00 +0000

Visible Signs Of Aging Improved By Pycnogenol (French Maritime Pine Bark Extract) In New Study
Human skin is the body's first line of defense and often mirrors the health, nutritional status and age of a person. Over time, skin shows signs of aging due to the gradual breakdown of collagen and elastin. However, skin can be rebuilt and made healthier no matter one's age...
Thu, 26 Jan 2012 09:00:00 +0000

New Robotic-Assisted Technology Transforms Treatment Of Kidney Tumors
The Porter Robotics Institute (PRI) now offers the latest in advanced surgical robotics available to patients with kidney tumors, allowing surgeons the ability to remove just a portion of the kidney. Porter Adventist Hospital is among a handful of centers in the country with advanced fluorescence imaging technology, called Firefly, and only the second in the region. St...
Thu, 22 Dec 2011 09:00:00 +0000

Silicon Breast Implants Must Be Removed?
In news that sounds more like something from an automotive, or white goods recall, French authorities have announced that a certain type of silicone breast implant can rupture and might cause cancer. The French authorities are in the process of deciding whether to issue a "recall" and recommend up to 30,000 French women have their implants changed or removed...
Thu, 22 Dec 2011 08:00:00 +0000

Brain Development In Tadpoles Affected By Cosmetic Chemical
A new study finds that low concentrations of the chemical methylisothiazolinone has subtle but measurable negative effects on the neural development of tadpoles. The chemical is found in some cosmetics, although the study does not provide any evidence that cosmetics are unsafe for humans...
Thu, 12 Jan 2012 09:00:00 +0000

Botox Affects Other Muscles, As Well As The Intended Ones
According to an investigation published in the January issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS), researchers have discovered that injecting Botox (botulinum neurotoxin type A) affects muscles other than those it's injected into. The study, led by Dr Christiane G...
Thu, 05 Jan 2012 17:00:00 +0000

Treating Crows Feet With Botulinum Neuromodulators
An investigation published Online First by the Archives of Facial Plastic Surgery, one of the JAMA/Archives journals reveals that the onset action of two botulinum neuromodulators both improved the appearance of crow's feet (lateral orbital rhytids) even though one appeared to produce greater improvement than the other...
Thu, 05 Jan 2012 16:00:00 +0000

Scientists Reassess Weight Loss Surgery For Type 2 Diabetes
Weight loss surgery is not a cure for type 2 diabetes, but it can improve blood sugar control, according to a new study published in the British Journal of Surgery...
Thu, 05 Jan 2012 09:00:00 +0000

Manuka Honey Could Be The Answer For Treating And Preventing Wound Infections
Manuka honey could help clear chronic wound infections and even prevent them from developing in the first place, according to a new study published in Microbiology. The findings provide further evidence for the clinical use of manuka honey to treat bacterial infections in the face of growing antibiotic resistance...
Thu, 02 Feb 2012 08:00:00 +0000

Women and Breast Implants
Women sometimes need the breast implant to fullfill their lives. They need them to enhance their body figures.Contributor: C Published: Oct 02, 2005
Sun, 02 Oct 2005 15:51:00 +0000

New Guidelines For Managing Rare Anesthesia Complication At Ambulatory Surgical Centers
As the number of surgical procedures performed outside hospitals continues to increase, ambulatory surgical centers (ASCs) need to develop policies for managing malignant hyperthermia, a rare but serious reaction to anesthetics, according to an expert panel report in the January issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS)...
Sat, 24 Dec 2011 08:00:00 +0000

First-of-its-Kind Surgery Helps Cancer Patient Keep Her Voice
When Sherry Wittenberg was diagnosed with a rare cancer in the cricoid cartilage of her larynx, doctors told her the only way to treat the condition was to remove her voice box. The operation would leave her unable to speak normally and would require her to breathe through a hole in her neck for the rest of her life...
Sat, 17 Dec 2011 10:00:00 +0000

Male Tummy Tucks Up 15% In UK
Britons appear to be tightening their belts in more ways than one: 2011 audit figures from the British Association of Aesthetic Plastic Surgeons (BAAPS) revealed on Monday that the number of men undergoing tummy tucks (abdominoplasty) was 15% higher than in 2010...
Mon, 30 Jan 2012 14:00:00 +0000

Ban Cosmetic Surgery Ads, Regulate The Industry, Urge To UK Government
The British Association of Aesthetic Plastic Surgeons (BAAPS) is calling on the UK government to ban cosmetic surgery advertising and tighten up industry regulations, including carrying annual checks on surgeons. The association has long voiced its objection to the use of "marketing gimmicks" to promote cosmetic surgery and what it sees as the lax regulation of the industry...
Mon, 23 Jan 2012 12:00:00 +0000

St John the Baptist in the Wilderness by Michelangelo Merisi, Called Caravaggio [Beauty]

Mon, 21 Nov 2011 20:55:59 +0000

Multidisciplinary Care of International Patients With Cleft Palate Using Telemedicine [Research Letters]

Mon, 21 Nov 2011 20:55:59 +0000

Trending Topics in Rhinoplasty [Brief Communication]

Mon, 21 Nov 2011 20:55:59 +0000

Current Knowledge and Management of Vascular Anomalies, II: Malformations [Contemporary Review]
Objective To present current information on the diagnosis, pathogenesis, natural history, and treatment of vascular malformations. Method Literature review. Results Vascular malformations are a heterogeneous group of congenital lesions resulting from aberrations of vascular embryogenesis. They are distinct from the vascular tumors with which they are commonly confused in presentation, natural history, and management. Conclusions Multimodality intervention involving medical therapy, laser photocoagulation, and surgery is available for the various types of vascular malformations. Multidisciplinary care is crucial for the evaluation and management of these complicated lesions. Clarification of underlying pathogenesis and molecular biologic mechanisms will provide opportunities for expansion of available treatments.
Mon, 21 Nov 2011 20:55:59 +0000

The Alar-Spanning Suture: A Useful Tool in Rhinoplasty to Refine the Nasal Tip [Surgical Technique]
The alar-spanning suture is a surgical technique used by an experienced rhinoplastic surgeon to address certain nasal tip deformities. Wide nasal tip deformities with strong, convex lower lateral cartilages are best indicated for treatment with this technique. The alar-spanning suture can improve lateral crural position and eliminate dead space by refining and narrowing the supratip, often without requiring extensive dissection or additional strut grafting. We use operative photographs and an intraoperative video to demonstrate the alar-spanning suture technique, which is a useful addition to the armamentarium of any rhinoplastic surgeon.
Mon, 21 Nov 2011 20:55:59 +0000

Clinical and Genetic Characterization of Frontorhiny: Report of 3 Novel Cases and Discussion of the Surgical Management [Original Article]
Objectives To (1) define the nasal, columellar, and lip deformities of 3 patients with characteristics consistent with frontorhiny; (2) illustrate the embryologic correlation of the oronasal findings to the development of the median nasal prominence; (3) report the clinical manifestation in 3 patients from 2 unrelated families; (4) report a novel Y214X mutation in ALX3 ; and (5) describe the surgical reconstruction. Methods In this case series, we report 3 novel cases of frontorhiny from 2 different families. The surgical reconstruction technique is reviewed. Extension of the columellar medial crural cartilage into the upper lip cleft is examined histologically. Signed consent was granted for all patient photographs and specimens, and the study was approved by the institutional review committee of the University of California Davis The genetic sequencing of the ALX3 homeobox gene was performed in 2 of our 3 cases using standard commercially available sequencing kits. The genetic material in our third case was not available for analysis. Results Patients 1 and 2 were brothers from the same family. Both exhibited bifidity of their columella, a widened philtrum, poor nasal tip development, and low hairlines. Genetic sequencing in the 2 brothers confirmed the presence of a novel ALX3 homeobox mutation at the second exon (mutation Y214X). Patient 3 was a 4-year-old girl. She presented with an underdeveloped, widened nasal tip and a bifid columella. Her philtrum was widened and had a left-sided cartilaginous prominence. She also had a widened nasal root. Family history revealed no family members with the same features. Conclusions Frontorhiny represents a new syndromic frontonasal malformation with consistent characteristic features. The genetic abnormality has now been found in 14 different patients. Careful scrutiny and classification of frontonasal deformities will expand our understanding of causes, genetic susceptibility, and treatment options.
Mon, 21 Nov 2011 20:55:59 +0000

Anterior Ethmoidal Artery Septal Flap for the Management of Septal Perforation [Original Article]
Objectives To achieve long-term closure of nasal septal perforations and to describe our surgical technique for repairing septal defects. Methods We describe 11 patients who underwent endoscopic repair of anterior septal perforations with a unilateral septal flap pedicled by the anterior ethmoidal artery. The patients were followed up for a period of 12 to 132 months (median follow-up, 51 months). Results There were no complications after surgery. All cases of septal perforation remained closed for the duration of follow-up. Conclusion Closure of a perforated nasal septum through an endonasal technique can be achieved with a unilateral mucosal flap based on the anterior ethmoidal artery.
Mon, 21 Nov 2011 20:55:59 +0000

Simultaneous Intraoperative Mohs Clearance and Reconstruction for Advanced Cutaneous Malignancies [Original Article]
Background Improved control of cutaneous malignancies using Mohs micrographic pathologic clearance has been well established. However, surgical margin control of advanced and complex cutaneous tumors of the head and neck is commonly performed by far less reliable frozen section margin analysis. Objective To describe a routine and ideal collaboration between dermatologic surgery and facial plastic surgery/head and neck surgery in which the Mohs micrographic method is used intraoperatively to achieve marginal clearance during resection and reconstruction. Methods A single-institution retrospective analysis was performed of patients who underwent intraoperative Mohs micrographic surgery. Intraoperative margins (peripheral and deep) of tissue specimens were analyzed by the Mohs surgeon. Results Twenty-six patients underwent large cutaneous tumor resection using intraoperative Mohs micrographic surgery. Most lesions were basal (48%) or squamous (34%) cell carcinoma. A mean (SD) of 2.1 (0.98) resection layers were required before negative margins were achieved. Conclusions We demonstrate the intraoperative technique and utility of Mohs micrographic analysis via an efficient collaborative effort. Well established for accuracy greater than intraoperative frozen section margin analysis, intraoperative Mohs micrographic surgery provides an optimal method of intraoperative margin assessment of cutaneous malignancies.
Mon, 21 Nov 2011 20:55:59 +0000

Carbon Dioxide Laser Treatment for Lentigo Maligna: A Retrospective Review Comparing 3 Different Treatment Modalities [Original Article]
Objective To assess outcomes in managing primary lentigo maligna through surgical excision, radiation therapy, and carbon dioxide laser ablation. Methods Retrospective case series review of all patients with primary lentigo maligna diagnosed and treated in London, Ontario, Canada, between July 2, 1991, and June 29, 2010. Results Seventy-five patients aged 39 to 93 years (mean age, 64.8 years) were included in the study; 73 patients chose treatment. Twenty-seven patients were treated with surgical excision, 31 patients with radiation therapy, and 15 patients with carbon dioxide laser ablation. The median follow-up times were 16.6 months for surgical excision, 46.3 months for radiation therapy, and 77.8 months for carbon dioxide laser ablation (P < .001). Recurrence rates by treatment modality were 4.2% (1 of 27) for surgical excision, 29.0% (9 of 31) for radiation therapy, and 6.7% (1 of 15) for carbon dioxide laser ablation. Conclusions A trend toward lower recurrence rates with surgical excision and carbon dioxide laser ablation was identified, but the results were not statistically significant. Carbon dioxide laser ablation may have a role as an alternative treatment for lentigo maligna among patients in whom standard treatments, such as surgical excision and radiation therapy, are declined or carry significant morbidity.
Mon, 21 Nov 2011 20:55:59 +0000

Anatomical Comparison of Platysmal Tightening Using Superficial Musculoaponeurotic System Plication vs Deep-Plane Rhytidectomy Techniques [Original Article]
Objectives To quantify the degree of submental platysmal tightening that can be accomplished with superficial musculoaponeurotic system (SMAS) plication vs deep-plane rhytidectomy techniques in a cadaveric anatomical study to help dictate the need for midline platysmal surgery when using different rhytidectomy techniques. Methods The lateral distraction of the medial edge of the platysma muscle was measured during tightening of the SMAS-platysmal complex on 5 cadaver heads. The measurements were taken after the following 3 rhytidectomy techniques: SMAS-platysmal plication, deep-plane rhytidectomy, and extended deep-plane rhytidectomy continuing the flap below the angle of the mandible into the neck with release of the platysma and cervical retaining ligaments. Results The medial edge of the platysma muscle was distracted laterally 427% more with deep-plane rhytidectomy compared with SMAS-platysmal plication (P < .001). Extending the deep-plane rhytidectomy flap into the neck to release the cervical retaining ligaments resulted in 554% greater lateral distraction of the medial edge of the platysma muscle compared with SMAS-platysmal plication (P < .001). This represents 30% greater advancement compared with the traditional deep-plane technique (P = .05). Conclusions Extending a traditional deep-plane rhytidectomy inferiorly to release the lateral platysma and cervical retaining ligaments to the sternocleidomastoid muscle achieves the greatest lateral motion of the midline platysma, theoretically obviating the need for midline platysmal plication except in cases of severe platysmal laxity and banding. Because of the limited platysmal motion during SMAS plication, midline platysmal plication should routinely be used as an adjunct procedure except in cases of no or minimal platysmal laxity.
Mon, 21 Nov 2011 20:55:59 +0000

Hinged Forearm Split-Thickness Skin Graft for Radial Artery Fasciocutaneous Flap Donor Site Repair [Original Article]
Objective To present a modified technique in the harvest and application of split-thickness skin graft (STSG) from the primary flap donor site in forearm fasciocutaneous free flaps. Methods A prospective review was performed on 16 consecutive patients who had undergone a radial forearm free flap procedure for reconstruction of head and neck defects with a hinged forearm STSG used to reconstruct the flap donor site defect. Results Sixteen patients with a mean (SD) defect size of 53.7 (29.9) cm2 underwent the hinged STSG procedure. A hinged STSG was successfully harvested from all patients without disruption. Graft take was greater than 90% in all patients by postoperative day 7. A secondary skin graft donor site was avoided in all but 2 patients. Good color match of the deepithelialized flap with surrounding oral and pharyngeal mucosa was observed. Visible scarring along the graft hinge margin was absent. No bridging scars resulted from the deepithelialized flaps. Conclusions The hinged STSG from the forearm is a reliable method of repairing radial forearm free flap donor site defects and offers the advantages of reduced suture line scarring, minimal STSG disruption, low or no secondary donor site morbidity, and good color match at the donor and recipient flap sites.
Mon, 21 Nov 2011 20:55:59 +0000

Orbicularis Muscle Position During Lower Blepharoplasty With Fat Repositioning [Original Article]
Objective To evaluate intraoperative changes in the position of the orbicularis muscle edge, which defines the tear trough during lower eyelid blepharoplasty with supraperiosteal fat repositioning. Methods Thirty consecutive patients undergoing transconjunctival lower eyelid blepharoplasty with a supraperiosteal fat repositioning technique underwent intraoperative measurement of the elevation of the released orbicularis muscle edge. Using a "dipstick" method, the distance between the midinferior orbital rim and the inferior orbicularis muscle edge, which was previously located below the orbital rim, was measured after fixation of the repositioned orbital fat. Age, associated procedures, length of follow-up, and complications were noted. Results The released orbicularis muscle edge was elevated between 6 and 12 mm above the orbital rim (average elevation, 8.8 mm). All measurements were within 2 mm between the 2 sides for a given patient, with 24 of the cases being within 1 mm. No apparent difference was seen between the muscle elevation achieved with externalized suture fixation of repositioned fat (22 patients) and that achieved with internal suture fixation (8 patients). Conclusions The orbicularis oculi muscle fusion to the maxilla below the arcus marginalis defines the junction between the eyelid and the cheek, and it provides an anchor for the tear trough. The eyelid-cheek interface is significantly elevated with our surgical technique of fat repositioning in the supraperiosteal plane. Elevation of the orbicularis muscle edge may contribute to improved blepharoplasty results in treating the aging midface.
Mon, 21 Nov 2011 20:55:59 +0000

An Internally Controlled, Double-blind Comparison of the Efficacy of OnabotulinumtoxinA and AbobotulinumtoxinA [Original Article]
Objective To compare 2 commercially available botulinum neuromodulators in a randomized, double-blind, split-face study. Methods Ninety patients were treated with 10 U of onabotulinumtoxinA and 30 U of abobotulinumtoxinA for the treatment of lateral orbital rhytids. Patients were assessed live with a validated 5-point photographic scale prior to treatment and at 30 days. Patients were also photographed at each visit. Results AbobotulinumtoxinA demonstrated a statistically significant advantage compared with onabotulinumtoxinA in the treatment of lateral orbital rhytids at maximal contraction, as evaluated independently by the investigator (P  = .01) and patient (P  = .03). AbobotulinumtoxinA was also favored by the patient over onabotulinumtoxinA 67% of the time. While abobotulinumtoxinA seemed to treat lateral orbital rhytids better at rest, as evidenced by the data and photographs, this difference was not statistically significant (P  = .42). Conclusions AbobotulinumtoxinA offers superior efficacy in the treatment of lateral orbital rhytids compared with onabotulinumtoxinA. Further studies are needed to compare the 2 products in different muscle groups and for other indications.
Mon, 21 Nov 2011 20:55:59 +0000

Highlights of Archives of Facial Plastic Surgery [Highlights of Archives of Facial Plastic Surgery]

Mon, 21 Nov 2011 20:55:59 +0000

Pere Borrell del Caso's Escapando de la Critica (Escaping Criticism): Trompe l'oeil and the Emerging Science of Neuroaesthetics [Beauty]

Mon, 19 Sep 2011 19:54:52 +0000

High Dynamic Range Photography for Intraoperative Imaging: How We Do It [COMMENTS AND OPINIONS]

Mon, 19 Sep 2011 19:54:52 +0000

Health Care Reform: Ethical Considerations for Physicians [Ethics and Public Policy]

Mon, 19 Sep 2011 19:54:52 +0000

Cryptotia Repair: A Modern Update to the Trefoil Flap [Surgical Technique]
Cryptotia is a congenital anomaly in which the superior aspect of the helical cartilage is buried beneath the scalp, resulting in an absence of the auriculocephalic sulcus. Treatments have included splinting, skin grafts, and a variety of local flaps. We present a modification of the trefoil flap, initially described by Wesser in 1972. The modifications include wider undermining of the opposing trefoil flap (≤2-4 cm), staggering the closure of the helical apices, and expanding the base of the auricular trefoil flap such that it extends over a larger circumference of the helical rim. The senior author (K.S.) has achieved excellent results with this method and has alleviated the need for skin grafts or local preauricular flaps to close the donor site.
Mon, 19 Sep 2011 19:54:52 +0000

Comprehensive Analysis of the Anterolateral Thigh Flap Vascular Anatomy [Original Article]
Objective The anterolateral thigh (ALT) flap has become a frequently used free flap for head and neck reconstruction. Widespread use has been based on literature of ALT flap thickness performed primarily in Asian populations. To our knowledge, to date there has not been a comprehensive analysis of the anthropomorphic parameters of this flap in the Western population, in which it is often much thicker, thereby potentially limiting its utility. Methods Computed tomographic angiograms of 106 patients were assessed, yielding 196 lower-extremity scans examined for volumetric characteristics and vascular anatomical variations. Results Perforator vessels were located in 88.8% of scans, and most commonly located were a hybrid musculoseptocutaneous vessel (52.3%) followed by septocutaneous (33.9%) and musculocutaneous (13.8%) vessels. The midpoint perforator was located within ±2% of the midpoint of the total thigh length in only 47% of legs. The proximal and distal perforators were located 52.7 and 58.6 mm from the midpoint, respectively. Subcutaneous fat thickness differed significantly by sex, with mean male and female thicknesses of 9.9 mm and 19.9 mm (P < .001), respectively. Thickness increased with increasing body mass index, especially in women. Conclusion This study used computed tomographic angiography to characterize the ALT flap vasculature and thickness, providing a degree of predictability to these 2 highly variable flap characteristics.
Mon, 19 Sep 2011 19:54:52 +0000

Reconstruction of Complex Nasal Dorsal and Sidewall Defects: Is the Nasal Sidewall Subunit Necessary? [Original Article]
Objective To demonstrate that by the extended use of cheek advancement flaps, the need to maintain the nasal dorsal side unit is obviated. Design Retrospective case series. Setting Tertiary care clinic and hospital. Patients Twelve patients aged 48 to 88 years who underwent Mohs micrographic surgery for nasal skin neoplasms, presenting with dorsal sidewall and nasal dorsal cutaneous defects. Intervention All patients underwent nasal reconstruction with adjacent tissue cheek advancement flaps with or without contralateral nasal dorsal and sidewall advancement flaps. Main Outcome Measures Avoidance of ipsilateral nasal sidewall scars to allow a natural-appearing transition between the cheek and nose and avoidance of forehead flap morbidity. Results Satisfactory results were achieved in all but 1 patient who had partial flap necrosis. Conclusions To maintain the nasal dorsal sidewall unit, superior, central dorsal, and nasal sidewall defects have traditionally been reconstructed using a variety of techniques, including skin grafts and regional flaps, such as glabellar flaps and frontal flaps. We demonstrate that creation of the nasal dorsal sidewall unit is often not necessary, and excellent results can be achieved through the expanded use of cheek advancement flaps.
Mon, 19 Sep 2011 19:54:52 +0000

Evaluation of the Midforehead Brow-lift Operation [Original Article]
Objective To examine patients who have undergone midforehead brow-lift to assess the resulting brow position, symmetry, and final scar and overall appearance based on objective evaluations by masked plastic surgeons and laypersons. Methods Twenty-one patients undergoing midforehead brow-lift in a single surgeon's practice were identified with at least 6 months' postoperative photographic documentation. Information was collected concerning patient demographics, the cause of brow ptosis, and the outcome of surgery. Four independent evaluators, including 2 plastic surgeons and 2 laypersons, were recruited to compare preoperative and postoperative photographs for brow symmetry, elevation, and incision scar and overall appearance. Results The midforehead brow-lift was found to offer excellent aesthetic results in all patients, with the mean across all categories being greater than 3.5 on the 4.0-point scale (independent of the reviewer background). The mean overall score was 3.60. No patients received the lowest rating of a poor outcome. Conclusions A review of the literature regarding brow-lifts and current practice patterns is provided. We believe that the midforehead brow-lift should hold a prominent place among the current treatments for the aging upper third of the face.
Mon, 19 Sep 2011 19:54:52 +0000

Long-term Analysis of Surgical Correction of the Senile Upper Lip [Original Article]
Objective A quantitative comparison of immediate and long-term results of surgical correction of the senile upper lip using lip advancement and lip lift. Methods Retrospective review of 30 patients who underwent senile upper lip repair, including lip advancement or lip lift. Digital image analysis was used to standardize each patient's preoperative and postoperative photographs for accurate, objective comparison. Results Lip lift and lip advancement achieve significant improvement in the appearance of the senile upper lip (P < .001). This improvement is sustained during many years (mean, 5 y; P < .001). Using repeated measures analysis of variance, no significant difference was found in the operative group compared with the control group when examining age-related change. Conclusion Lip advancement and lip lift can restore the senile upper lip to a more youthful and natural appearance with sustained long-term benefits.
Mon, 19 Sep 2011 19:54:52 +0000

Extended Infrabrow Excision Blepharoplasty for Dermatochalasis in Asians [Original Article]
Objective To describe extended infrabrow excision blepharoplasty (IBEB), whereby skin excision is extended to a substantial part of intrabrow skin and the intrabrow incision is made perpendicular to the hair shaft. Methods A total of 194 Asian patients with moderate to severe dermatochalasis underwent extended IBEB. The mean width of excised skin at its widest was 12.8 mm (range, 6-22 mm). Results Extended IBEB significantly reduced eyelid laxity but produced a natural-looking eyelid because it did not damage the eyelid framework. With application of eyebrow makeup by women, routine social activity was resumed soon after surgery. Infrabrow scarring became inconspicuous in patients with thick eyebrows after regrowth. Conclusions Extended IBEB is recommended for middle-aged and older Asian women with moderate to severe dermatochalasis. With precise incision and fine suturing, regrowth alleviates eyebrow reduction and scarring among Asians who do not use makeup (male patients and young female patients).
Mon, 19 Sep 2011 19:54:52 +0000

Tensile Characteristics of Costal and Septal Cartilages Used as Graft Materials [Original Article]
Objectives To determine the biomechanical characteristics of septal cartilage (SC) and costal cartilage (CC) taken from fresh cadavers using tensile testing and to establish CC graft material of a suitable thickness (ie, with tensile characteristics closest to those of SC). Methods Grafts of varying thickness were harvested from the central part of the seventh-rib CC and SC of 18 fresh cadavers. Tensile testing was performed with a 0.5-kilonewton load calibrated at 7 mm/min. The results were shown as a force-elongation curve. Results No significant difference according to tensile force was observed between the SC group and the 1.0-mm and 1.5-mm CC groups (P = .09 and P = .32, respectively). However, a significant difference was observed between the SC group and the 2.0-mm CC group (P = .04). Although the strength value of the CC group was 5.03 MPa, the modulus of elasticity was 1.33 MPa. In the SC group, the strength value was 12.42, but the modulus of elasticity was 1.39 MPa. The strength value of the SC group was higher than that of the CC group (P = .001), but the modulus of elasticity value of the CC group was higher than that of the SC group (P = .001). Conclusions From the standpoint of tensile testing for preparing columellar struts, 1.0-mm and 1.5-mm CC have similar characteristics to SC and thus can be used instead of it. However, it is important to determine the thickness of CC by considering the expected characteristics of the established material and the forces that affect the area in the nose where the graft will be placed.
Mon, 19 Sep 2011 19:54:52 +0000

Sonic Rhinoplasty: Histologic Correlates and Technical Refinements Using the Ultrasonic Bone Aspirator [Original Article]
Objective To demonstrate histologic correlates and describe refinements in cosmetic rhinoplasty using the ultrasonic bone aspirator. Methods This retrospective review of 103 consecutive patients undergoing cosmetic rhinoplasty at a tertiary care academic facial plastic surgery practice extends the applications for the ultrasonic bone aspirator to include reducing the nasal spine, glabellar deepening, sculpting of mobile bone fragments after osteotomy, smoothing of bony edges after medial osteotomy, and reducing the convexity of nasal bones. We performed histologic analysis of cartilage samples, and the patient and surgeon subjectively evaluated the aesthetic outcome of the procedure. Results All patients obtained satisfactory outcomes. Seven patients experienced minor complications. One patient had a visible dorsal irregularity, 2 had palpable but not visible dorsal irregularities, 2 had asymmetry of the dorsum, and 2 had underresection of the dorsum. No patients experienced skin or soft-tissue injury. Conclusions The ultrasonic bone aspirator can be a useful adjunct for the cosmetic rhinoplasty surgeon. The ultrasonic bone aspirator permits precise, graded removal of bone without damage to surrounding soft tissue or mucosa. With multiple applications in nasal surgery, the ultrasonic bone aspirator permits refinement of subtle irregularities and asymmetry of the nasal bones. Complications associated with the device are rare.
Mon, 19 Sep 2011 19:54:52 +0000

Prevalence of Occult Nostril Asymmetry in the Oversized Nasal Tip: A Quantitative Photographic Analysis [Original Article]
Objective To objectively determine the prevalence of occult nasal base asymmetry in adults with wide nasal tips using a standard photographic editing program. Methods We performed a retrospective observational study in a private practice, ambulatory care setting. The photographs of 100 randomly selected patients undergoing rhinoplasty who presented with excessive nasal tip width and no apparent nasal base asymmetry were evaluated for occult nostril asymmetry. Patients varied by ethnicity and sex and ranged in age from 16 to 40 years. We excluded patients with discrete nasal base asymmetry, crooked or twisted noses, caudal septal deviation, columellar tilt, a history of craniofacial trauma, or a history of nasal surgery. Measurements were obtained using a standard photographic analysis program. Results On the basal view, the median percentage of asymmetry (95% confidence interval) was 4.91% (4.17%-5.66%); on the frontal view, 4.66% (3.68%-5.62%). On the basal view, 73% of noses were at least 2.5% asymmetric; on the frontal view, 67% (McNemar P = .53). On the basal view, 48% of noses were at least 5% asymmetric; on the frontal view, 50% (McNemar P = .74). On the basal view, 11% of noses were at least 10% asymmetric; on the frontal view, 20% (McNemar P = .11). Conclusions A large percentage of individuals presenting with excessive nasal tip width and no obvious alar size discrepancies have nasal base asymmetry. Moreover, nostril asymmetry is demonstrated from the frontal and basal views with reasonable consistency. In a small subset of study patients, occult nostril asymmetry exceeded 10% of the total nasal base width. We postulate that clinically significant nostril size discrepancies are hidden by excessive tip width, and we speculate that these nostril size discrepancies become more apparent after surgical refinement of the oversized nasal tip, thereby potentially leading to unexpected postoperative cosmetic imperfections and patient dissatisfaction. The apparent frequency of (occult) nostril asymmetry in patients with excessive nasal tip width underscores the importance of nostril size assessment in the preoperative aesthetic analysis. We offer a reliable and convenient method for objective analysis of nasal base symmetry.
Mon, 19 Sep 2011 19:54:52 +0000

Toward Personalized Nasal Surgery Using Computational Fluid Dynamics [Original Article]
Objective To evaluate whether virtual surgery performed on 3-dimensional (3D) nasal airway models can predict postsurgical, biophysical parameters obtained by computational fluid dynamics (CFD). Methods Presurgery and postsurgery computed tomographic scans of a patient undergoing septoplasty and right inferior turbinate reduction (ITR) were used to generate 3D models of the nasal airway. Prior to obtaining the postsurgery scan, the presurgery model was digitally altered to generate 3 virtual surgery models: (1) right ITR only, (2) septoplasty only, and (3) septoplasty with right ITR. The results of the virtual surgery CFD analyses were compared with postsurgical CFD outcome measures including nasal resistance, unilateral airflow allocation, and regional airflow distribution. Results Postsurgery CFD analysis and all virtual surgery models predicted similar reductions in overall nasal resistance, as well as more balanced airflow distribution between sides, primarily in the middle region, when compared with the presurgery state. In contrast, virtual ITR alone produced little change in either nasal resistance or regional airflow allocation. Conclusions We present an innovative approach for assessing functional outcomes of nasal surgery using CFD techniques. This preliminary study suggests that virtual nasal surgery has the potential to be a predictive tool that will enable surgeons to perform personalized nasal surgery using computer simulation techniques. Further investigation involving correlation of patient-reported measures with CFD outcome measures in multiple individuals is under way.
Mon, 19 Sep 2011 19:54:52 +0000

Evaluation of Dynamic Morphologic Changes in the Masseter Muscle in Patients Undergoing Mandibular Angle Sagittal Split Osteotomy: A Report of 130 Cases [Original Article]
Objective To evaluate the dynamic morphologic changes in the masseter muscle after mandibular angle sagittal split osteotomy (MASO). Methods Computed tomographic (CT) examinations were performed on 130 patients treated with MASO before surgery and at 3, 6, 12, and 18 months after surgery. These CT images were stored and a 3-dimensional reconstruction was made for calculating the volume of masseter muscle using Mimics 10.01 software. The cross-sectional area of masseter muscle was evaluated preoperatively and postoperatively using 3-dimensional CT images observed from 3 selected slice levels, which paralleled the Frankfurt horizontal plane. Results Following treatment, the reduction of the volume and cross-sectional area of masseter muscle were calculated. The volume of the masseter muscle was reduced by 28.18%, 39.58%, 33.37%, and 31.18% at 3, 6, 12, and 18 months postoperatively, respectively. The cross-sectional area of 3 slices were reduced, but the sectional area of the lower slice had the sharpest decline, with reductions of 79.27%, 84.39%, 84.02%, and 83.57% at 3, 6, 12, and 18 months postoperatively, respectively. Conclusions The results showed that the masseter muscle undergoes significant atrophy after mandibular osteotomy, and these changes could be considered as a guide for the design and simulation of MASO before surgery.
Mon, 19 Sep 2011 19:54:52 +0000

Highlights of Archives of Facial Plastic Surgery [Highlights of Archives of Facial Plastic Surgery]

Mon, 19 Sep 2011 19:54:52 +0000

Risk Factors Associated With Repair of Orbital and Lateral Skull Defects [Original Article]
Objective To explore the complications and associated risks factors after orbital exenteration and lateral skull base defect repair.Methods Patients who had undergone a reconstruction of their orbital cavity and lateral skull base defects were selected from our departmental database. The outcome of interest was postoperative complications. The risks factors were defined as age, sex, history of radiation therapy, and intracranial involvement (with and without dural involvement). Information was collected on the type of reconstruction used after the orbital cavity repair. The 2 test and logistic regression were used to analyze associations between postoperative complications and the various risks factors.Results Of the 32 identified patients, 19 had intracranial involvement (9 with dural involvement). Twenty-four patients underwent reconstruction with free tissue transfer in the same setting. Reconstruction with free tissue transfer was significantly associated with fewer major postoperative complications (P < .053). There was a trend toward more complications with a history of radiation therapy or intracranial involvement.Conclusions Reconstruction of the orbital cavity and lateral skull base can be challenging, especially if there is a history of radiation therapy and intracranial involvement. Free tissue transfer is a safe and effective method for reconstruction of such defects.
Mon, 19 Dec 2011 20:41:25 +0000

Split-Face Double-blind Study Comparing the Onset of Action of OnabotulinumtoxinA and AbobotulinumtoxinA [Original Article]
Objective To report and discuss the outcome of a prospective, internally controlled, randomized, double-blind, split-face study comparing the onset of action of 2 commercially available botulinum neuromodulators.Methods Ninety individuals with moderate-to-severe lateral orbital rhytids were treated with onabotulinumtoxinA, 10 U, and abobotulinumtoxinA, 30 U, for the treatment of lateral orbital rhytids. Participants were assessed live with a validated 5-point photographic scale before treatment and on days 2, 4, and 6 after treatment. Photographs were taken at each encounter. Statistical analysis was applied to evaluate for any significant difference in onset of action between the 2 products.Results AbobotulinumtoxinA and onabotulinumtoxinA demonstrated statistically significant change from baseline at day 2 in the treatment of lateral orbital rhytids at maximal contraction and rest when evaluated independently by investigator and participant (P < .001). Also at day 2, the improvement with abobotulinumtoxinA was better than that with onabotulinumtoxinA for the primary end point of maximal contraction graded by the investigator, although this did not reach statistical significance (P = .21); by day 4, the greater improvement achieved with abobotulinumtoxinA reached statistical significance (P = .02) and remained superior at day 6 (P = .02). The primary findings were strengthened by similar results in the secondary end points of patient self-grade at maximal contraction and at rest and of investigator grade at rest.Conclusions In conclusion, both abobotulinumtoxinA and onabotulinumtoxinA achieved statistically significant onset of action at day 2. This improvement was seen in all end points, with abobotulinumtoxinA demonstrating a trend toward greater improvement than onabotulinumtoxinA at day 2 and a statistically significant greater improvement at days 4 and 6 when looking at maximal contraction.
Mon, 19 Dec 2011 20:41:24 +0000

Histopathologic Findings of the Orbicularis Oculi in Upper Eyelid Aging: Total or Minimal Excision of Orbicularis Oculi in Upper Blepharoplasty [Original Article]
Objective It is well known that gradual loss of elastic fibers and skin relaxation cause the aging process, but whether changes in the orbicularis oculi muscle may contribute to the aging of the upper eyelid is not known. The aim of the present study was to use histopathologic examination to investigate whether the orbicularis oculi contributes to upper eyelid aging.Methods Full-thickness upper eyelids, which were removed during blepharoplasty using en bloc resection, were stained with hematoxylin-eosin and examined. Eleven patients with oriental eyelid, 14 patients with bilateral dermatochalasia, and 2 patients with facial nerve palsy and contralateral dermatochalasia were included in this study.Results Patients ranged in age from 21 to 73 years (median age, 55.8 years). Histologic results revealed that changes in the aging upper eyelid were mainly in the skin and subcutaneous layers with large masses of deranged elastic fibers in the papillary dermis, which was characterized as solar elastosis.Conclusions Our study revealed that the entire orbicularis oculi muscle layer remained morphologically intact with aging. Moreover, our findings suggests that a minimally invasive surgical approach with muscle sparing in upper blepharoplasty in selected patients could yield good results in terms of cosmetic outcomes and upper eyelid function while minimizing postoperative complications.
Mon, 19 Dec 2011 20:41:23 +0000

No Need to Fear Evidence-Based Medicine [Special Topics]
Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to clinical decision making. The notion seems noble in its purpose, yet there are some apprehensions and misconceptions among physicians, especially those in a predominantly surgical field such as facial plastic surgery. Developing a sophisticated understanding of the inherent biases and limitations of EBM will become increasingly important for the researcher and practicing surgeon as we strive to improve the rigor of our studies and produce noteworthy scientific evidence that improves the health outcomes for our patients.
Mon, 19 Dec 2011 20:41:22 +0000

The Brooding Woman by Paul Gauguin [Beauty]

Mon, 18 Jul 2011 19:56:08 +0000

The C-Ring Complex: Defining the Parameters of Nasal Tip Anatomy [Research Letters]

Mon, 18 Jul 2011 19:56:08 +0000

Deep-Plane Face-lift as an Alternative in the Smoking Patient [Research Letters]

Mon, 18 Jul 2011 19:56:08 +0000

Vacuum-Assisted Closure Therapy for Reconstruction of Soft-Tissue Forehead Defects [Surgical Technique]
We sought to examine the efficacy of vacuum-assisted closure (VAC) therapy for the reconstruction of full-thickness forehead defects and to determine the appropriate therapeutic strategies for its use. Medical records and photographs were reviewed for 3 patients with full-thickness tissue loss of the forehead region treated with a VAC system. All 3 patients had complete formation of healthy granulation tissue with VAC therapy alone. One patient was treated to full reepithelization of her wound; the other 2 patients underwent successful surgical closure after VAC reduction of the defect. The treatment was well tolerated, with no complications. Although this represents an initial study, it seems that the protocol for VAC therapy presented herein is a reliable technique for the repair of forehead defects that provides excellent functional and aesthetic outcomes.
Mon, 18 Jul 2011 19:56:08 +0000

Secondary Reconstruction of Posttraumatic Enophthalmos: Prefabricated Implants vs Titanium Mesh [Original Article]
Objective To compare individually prefabricated computer-assisted designed/computer-assisted manufactured (CAD/CAM) glass-bioceramic implants with nonpreformed titanium meshes for orbital floor reconstruction in secondary correction of enophthalmos. Methods In a nonrandomized, comparative, prospective cohort study, 2 groups of 10 patients received secondary correction of enophthalmos with CAD/CAM implants in one group and titanium meshes in the other. Relative enophthalmometry and exophthalmometry data were assessed preoperatively, at the end of the operation, at day 90 postoperatively, and at day 365 postoperatively. Results In both groups, the globe position improved significantly at the end of the operation (P = .005 in both groups). At day 90, there was a significant tendency toward relapse of enophthalmos in both groups (P = .005 in the CAD/CAM group and P = .008 in the titanium mesh group). However, the globe position did not change significantly between postoperative days 90 and 365 in both groups (P = .57 in the CAD/CAM group and P = .35 in the titanium mesh group). Conclusions Individually prefabricated CAD/CAM glass-bioceramic implants and nonpreformed titanium meshes produce similar results in secondary enophthalmos correction. Because of higher costs, the use of CAD/CAM implants should be confined to selected cases in secondary enophthalmos correction.
Mon, 18 Jul 2011 19:56:08 +0000

A Comparison of Anterior vs Posterior Isolated Mandible Fractures Treated With Intermaxillary Fixation Screws [Original Article]
Objective To compare complication rates after use of intermaxillary fixation (IMF) bone screws for anterior (ie, symphyseal/parasymphyseal) and posterior (ie, body and angle) mandible fractures. Methods A retrospective analysis of isolated mandible fractures treated with intraoperative IMF bone screws at 2 major level 1 trauma centers within the Department of Otolaryngology–Head and Neck Surgery at the University of Minnesota. From January 1, 2003, through January 31, 2006, we accrued 53 patients with 67 isolated mandible fractures treated with intraoperative IMF bone screws. These patients had at least 6 weeks of follow-up. Results Twenty-one patients had anterior mandible fractures and 32 had posterior mandible fractures. In the anterior group, there was 1 incident of wound dehiscence, resulting in a total complication rate of 5%. In the posterior fracture group, there was 1 infection (3%), 4 malunions/malocclusions (12%), and 1 nonunion (3%), for an overall complication rate of 19%. The difference between groups for malocclusion rates (12% vs 0%) was significant (P < .001). Conclusions The IMF bone screw system has a superior speed and safety profile. It produces better occlusion results in anterior mandible fractures and might have a lower overall complication rate compared with arch bars. Given this, IMF bone screws are the preferred modality of intermaxillary fixation in properly selected mandible fractures.
Mon, 18 Jul 2011 19:56:08 +0000

Practical Device for Precise Cutting of Costal Cartilage Grafts to Uniform Thickness [Original Article]
Objectives Costal cartilage is becoming increasingly popular as a graft source for facial reconstruction. However, carving methods have not changed in decades and continue to primarily rely on detailed maneuvers with a scalpel. There are few reports of mechanical devices for shaping costal cartilage, and to our knowledge their accuracy and precision have not been reported. We describe a simple costal cartilage slicing device that facilitates the production of sections having uniform, user-defined thicknesses. Methods The design included laboratory research using 200 porcine and 2 cadaveric human ex vivo costal cartilage slices. A 2-component apparatus was constructed consisting of a mechanism to secure the costal cartilage and a double-bladed device to cut the rib graft through a central cross-section. Optimizing blade characteristics and static forces that secure the cartilage were critical design challenges. The device was used to obtain slices 0.8, 2.1, and 4.1 mm in thickness, with lengths up to 4.0 cm and a width of 1.0 cm. To confirm uniformity, thickness was measured at 8 fixed regions per section using a digital micrometer. Results All costal cartilage slices appeared to be extremely uniform on visual and manual inspection. The absolute difference between the largest and smallest thickness measured for each individual sample ranged from 0.04 to 0.13 mm, 0.06 to 0.14 mm, and 0.10 to 0.21 mm for the 0.8-, 2.1-, and 4.1-mm-thick groups, respectively. Conclusions Our study demonstrates the precision of using a mechanical slicing device to section costal cartilage to a clinically relevant and uniform thickness. This mechanized technology may increase accuracy and reduce carving time required for using costal cartilage tissue in head and neck reconstruction.
Mon, 18 Jul 2011 19:56:08 +0000

Long-term Results of Autologous Periorbital Lipotransfer [Original Article]
Objective To evaluate the long-term aesthetic results in patients treated with autologous periorbital lipotransfer. Methods A retrospective review of 114 consecutive patients during 4 years who underwent autologous periorbital lipotransfer. Of these patients, 99 were identified who had complete photographic and medical records and were therefore included in the study. Patients were placed into 5 groups based on their total length of postoperative follow-up. Periorbital volume augmentation was assessed by 3 independent masked evaluators using a standard aesthetic scale from 0 to 2 (with 0 indicating no improvement; 1, mild improvement; and 2, marked improvement). Interobserver correlation was determined by correlation, and Mann-Whitney tests were used to assess for statistical significance comparing the same patients in each group. Results Scores from the 3 independent evaluators correlated well ( = 0.316); aesthetic improvement was seen in almost all patients (86.4%), who had demonstrated improvement for the first 3 years of follow-up. The degree of improvement decreased each year, and only mild improvement was retained in most patients (68.2%) by the 3-year follow-up point (P = .049). Conclusions Results from most patients who underwent autologous periorbital lipotransfer demonstrated improvement that lasted as long as 3 years. Autologous periorbital lipotransfer remains a valid and effective technique for periorbital rejuvenation and demonstrates long-term potential effectiveness.
Mon, 18 Jul 2011 19:56:08 +0000

Safety, Efficacy, and Utility of Platelet-Rich Fibrin Matrix in Facial Plastic Surgery [Original Article]
Objective To evaluate the clinical safety and efficacy of the use of autologous platelet-rich fibrin matrix (PRFM) in facial plastic surgery. Methods Medical charts of the last 50 patients with at least 3 months of follow-up who were treated by the author with PRFM for aesthetic purposes were reviewed for patient satisfaction, objective clinical results, and adverse events. Results The study cohort of patients was followed up for a mean (SD) of 9.9 (8.0) months (range, 3-30 months). Most patients were treated for deep nasolabial folds, while the volume-depleted midface region, superficial rhytids, and acne scars were other commonly treated areas. The patients underwent an average of 1.6 treatments (range, 1-5 treatments). No patients reported any swelling lasting longer than 5 days, and most noted only minimal bruising lasting for 1 to 3 days. Most patients were satisfied with the results of their treatments, although 1 patient felt that there was limited or no improvement after 2 treatments. Conclusions Autologous PRFM treatment is a well-tolerated, excellent choice for use in the face. Further studies on the precise mechanism of action of PRFM are ongoing.
Mon, 18 Jul 2011 19:56:08 +0000

Modification of Square Face in Men [Original Article]
Background Women with elliptical faces are considered to be aesthetically appealing in Asia. Some men prefer this shape for themselves and choose to have their square-shaped face altered to an elliptical shape. To accomplish this, we perform an ostectomy that includes resection of the mandibular angle, splitting of the lateral cortex, and reduction in the width of the chin. Methods Nineteen men with a square face (aged 22-30 years) underwent ostectomy, including resection of the mandibular angle, splitting of the lateral cortex around the mandibular angle, and reduction of the width of the chin by an intraoral approach. Results The results of the ostectomy were satisfactory 3 to 6 months postoperatively. The bigonial distance was effectively reduced and stable chin contours were achieved. The overall shape of the face was elliptical. There was no microgenia, facial asymmetry, hematoma, infection, or permanent mental nerve injury. Conclusion Ostectomy that includes resection of the mandibular angle, splitting of the lateral cortex, and reduction in the width of the chin is a safe and effective method to modify a man's square-shaped face into a more elliptical appearance.
Mon, 18 Jul 2011 19:56:08 +0000

Platysmectomy: An Effective Intervention for Facial Synkinesis and Hypertonicity [Original Article]
Objectives To describe a procedure to permanently address platysmal synkinesis and hypertonicity and to report changes in quality of life associated with platysmectomy using the Facial Clinimetric Evaluation instrument. Methods Chemodenervation significantly relieves platysmal synkinesis in almost all patients with significant face and neck synkinesis associated with dynamic facial expressions. We recently began to offer platysmectomy as part of a permanent solution to chronic superficial torticollis-like neck symptoms. For a 10-month period, 24 patients underwent the procedure, and preoperative and postoperative Facial Clinimetric Evaluation data were obtained from 21 patients (88%). Results In 19 patients, platysmectomy was performed using local anesthesia without sedation. In the remaining 5 patients, platysmectomy was performed using general anesthesia concurrent with free gracilis transfer for smile reanimation. No intraoperative or postoperative complications occurred. Overall, the patients' quality of life significantly improved after platysmectomy (P = .02). Conclusion Platysmectomy is straightforward and seems effective in treating neck synkinesis associated with chronic hypertonic platysmal activity.
Mon, 18 Jul 2011 19:56:08 +0000

Expanded Polytetrafluoroethylene as Dorsal Augmentation Material in Rhinoplasty on Southeast Asian Noses: Three-Year Experience [Original Article]
Objective To describe the outcomes of dorsal augmentation rhinoplasty with expanded polytetrafluoroethylene (ePTFE) implants in Southeast Asian patients from the Philippines. Methods Retrospective review of 1054 patients. Results Of the 1054 patients, 90.61% were women and 9.39% were men. One thousand eight patients (95.64%) underwent primary rhinoplasty; 46 (4.36%), secondary or revision rhinoplasty. One thousand thirty (97.72%) had desirable and 24 (2.28%) had undesirable outcomes. The most common undesirable outcome was implant deviation (1.04%), followed by a visible ePTFE implant (0.47%). Implant infection occurred in 0.38% of the patients, and 0.38% of the patients were not satisfied with their aesthetic outcome because of the presence of a high nasal bridge. Conclusions We find ePTFE to be an excellent synthetic material with proven outcomes for augmenting the dorsum in rhinoplasty of the Southeast Asian patient. However, prudent use of this material is warranted to avoid undesirable outcomes.
Mon, 18 Jul 2011 19:56:08 +0000

Nasal Airway Preservation Using the Autospreader Technique: Analysis of Outcomes Using a Disease-Specific Quality-of-Life Instrument [Original Article]
Objective To measure the efficacy of a specific midvault reconstruction technique (the autospreader flap) in dorsal reductive rhinoplasty with a validated quality-of-life instrument. Design A prospective observational outcomes study of patients desiring reduction of the nasal dorsum who either (1) had no breathing obstruction, who underwent purely aesthetic rhinoplasty, or (2) had concomitant severe nasal obstruction due to septal deviation, internal valve narrowing, and/or turbinate hypertrophy, who subsequently underwent combined functional and aesthetic rhinoplasty. Preoperative and postoperative evaluation was performed using the Nasal Obstruction Symptoms Evaluation (NOSE) scale. Results Thirty-eight patients completed preoperative and postoperative evaluation. No complications occurred. Patients in the purely aesthetic group were noted to have low preoperative NOSE scores, with no change postoperatively. There was a significant improvement in mean NOSE score postoperatively for the combined functional and aesthetic group (P < .001). Conclusions Midvault reconstruction using the autospreader graft may help prevent postoperative nasal obstruction due to midvault collapse. Combining this procedure with dorsal reduction in functional rhinoplasty patients with traditional airway reconstruction techniques is effective in improving nasal airway function as measured by a patient-based, disease-specific quality-of-life instrument.
Mon, 18 Jul 2011 19:56:07 +0000

Highlights of Archives of Facial Plastic Surgery [Highlights of Archives of Facial Plastic Surgery]

Mon, 18 Jul 2011 19:56:07 +0000

Lateral Crural Turn-in Flap in Functional Rhinoplasty [Original Article]
Objective To use the trimmed cartilage as a support material for both internal and external valves.Methods The lateral crural turn-in flap (LCTF) technique is simply to make cephalic trimming of the lateral crura and turn it into a pocket created under the remaining lateral crus. Twenty-four patients with lateral crura wider than 12 mm and in whom this technique was applied took part in this study. The trimmed cartilage was used to reshape and/or support the lateral crus and the internal valve by keeping the scroll intact. The support and suspension of the lateral crura "sandwich" helped not only to prevent stenosis of the internal valve angle but also to widen it in some cases.Results The LCTF has been used in 24 patients to reshape and/or add structure to the lateral crus with great success. The internal valve was also kept open by keeping the scroll area intact, especially in 1 patient with concave lateral crura in whom this technique helped to widen the internal valve angle.Conclusions This study shows that the LCTF can be used to reshape and add structure to the lateral crus and to suspend the internal valve. Although it is a powerful technique by itself in functional rhinoplasty, it should be combined with other methods, such as spreader flaps/grafts or alar battens, to obtain the maximum functional result.
Mon, 17 Oct 2011 19:41:22 +0000

Larger Osteotomies Result in Larger Ostia in External Dacryocystorhinostomies [Original Article]
Objective To evaluate whether final ostium size is determined by the osteotomy created during dacryocystorhinostomy (DCR).Design Prospective nonrandomized study. Intraoperative measurements of bony osteotomy were taken during external DCR. Endonasal endoscopy with functional endoscopic dye testing and internal ostium photography were performed 3 months after surgery.Results Fifty patients (mean age, 63 years) underwent 55 DCRs. Postoperative nasal endoscopy with functional endoscopic dye testing was performed in 27 cases (49%), and measurements of intranasal ostia were feasible in 24 of them (86%). The mean follow-up time was 7 months (range, 3-12 months). Surgical success was achieved in 25 of 27 patients (93%) who underwent postoperative nasal endoscopy. There was no difference in either the intraoperative osteotomy size or the postoperative ostium size between failed and successful cases. The mean (SD) intraoperative osteotomy size was 256.3 (89.0) mm2, and the mean (SD) postoperative ostium size was 9.6 (6.7) mm2. The intraoperative osteotomy size correlated positively with the postoperative intranasal ostium size (r = 0.45; P = .03, Pearson bivariate correlation).Conclusions Larger osteotomies created during external DCR are correlated with larger postoperative ostia as measured by endonasal endoscopy and image analysis software. There is a trend toward greater success with larger osteotomies; however, failed cases in this series were not associated with smaller-sized intraoperative osteotomies.
Mon, 17 Oct 2011 19:41:21 +0000

Induction of Dermal Collagenesis, Angiogenesis, and Adipogenesis in Human Skin by Injection of Platelet-Rich Fibrin Matrix [Original Article]
Objective To evaluate the histological changes induced in human skin by injection of autologous platelet-rich fibrin matrix (PRFM).Methods Four healthy adult volunteers were included in the study. Platelet-rich fibrin matrix was prepared from 9 mL of autologous blood using a proprietary system (Selphyl; Aesthetic Factors, Wayne, New Jersey) and injected into the deep dermis and immediate subdermis of the upper arms of subjects. Full-thickness skin biopsy specimens were taken from the treated areas over a 10-week period, and the specimens were processed for histological evaluation.Results Findings from histological examination supported the clinical observation of soft-tissue augmentation. As early as 7 days after treatment, activated fibroblasts and new collagen deposition were noted and continued to be evident throughout the course of the study. Development of new blood vessels was noted by 19 days; also at this time, intradermal collections of adipocytes and stimulation of subdermal adipocytes were noted. These findings became more pronounced over the duration of the study, although the fibroblastic response became much less pronounced. No abnormal mitotic figures were observed at any point, and a very mild chronic inflammatory response was noted only at the earliest time points of the study.Conclusions Injection of PRFM into the deep dermis and subdermis of the skin stimulates a number of cellular changes that can be harnessed for use. Coupled with prior in vitro and in vivo studies, we now have a much clearer picture of the cellular effects of PRFM and its potential uses in facial plastic surgery. Further work is planned to more clearly elucidate the potential role of PRFM in aesthetic and reconstructive surgery.Trial Registration clinicaltrials.gov Identifier: <a rel="nofollow" target="_blank" HREF="http://clinicaltrials.gov/show/NCT00956020">NCT00956020</a>
Mon, 17 Oct 2011 19:41:21 +0000

The Four Seasons: Winter, by Francois Boucher [Beauty]

Mon, 16 Jan 2012 20:53:56 +0000

Neck Rejuvenation [Book and Multimedia Review]

Mon, 16 Jan 2012 20:53:56 +0000

The Effect of Rhinoplasty on Perceived Age [Research Letters]

Mon, 16 Jan 2012 20:53:56 +0000

Physician Confidence in Fillers and Neurotoxins: A National Survey [Research Letters]

Mon, 16 Jan 2012 20:53:56 +0000

Zygomaticomaxillary Complex Fractures [Contemporary Review]

Mon, 16 Jan 2012 20:53:56 +0000

New Technique for Medial Canthoplasty That Incorporates Modified V-W Epicanthoplasty [Surgical Technique]
Telecanthus, which is the lateral displacement of the medial canthus, can be a congenital deformity or can occur after facial trauma. Several epicanthoplasty methods have been described, but the orbitonasal angle and appropriate shape cannot be reconstructed in Asians. We solved this problem by using a dog-ear effect. This article describes a new design for epicanthoplasty and its results.
Mon, 16 Jan 2012 20:53:56 +0000

Orthodromic Temporalis Tendon Transfer: Anatomical Considerations [Original Article]
Objectives To define (1) at-risk structures during the orthodromic temporalis tendon transfer and (2) achievable tendon length without temporal releasing incisions or perioral lengthening materials. Methods Ten fresh cadavers provided 20 hemifaces for dissection. Measurements and photographic documentation were used to examine the parotid duct, masseteric artery, inferior alveolar nerve, internal maxillary artery, and mobilized tendon relative to adjacent landmarks. Results The parotid duct was found in a reproducible region posterior to the melolabial crease and inferior to a parotid duct reference line. The masseteric artery was found posterior to the posterior-most attachment of the tendon at its exit from the sigmoid notch (mean, 14.5 mm). The inferior alveolar nerve was found posterior to the anterior edge of the ascending ramus (mean, 18.3 mm). The internal maxillary artery coursed superiorly from posterior to anterior along the medial mandible near the coronoidectomy site. The tendon reached beyond the melolabial crease in 17 of 20 hemifaces (85%). Conclusions The parotid duct reference line and the melolabial crease allow estimation of the parotid duct location. Anatomical relationships between the tendon, parotid duct, neurovasculature, and anatomical landmarks underscore the importance of deliberate soft-tissue retraction and subperiostial elevation to minimize injury. The tendon alone usually provides adequate length for orthodromic suspension.
Mon, 16 Jan 2012 20:53:55 +0000

Intraoperative Suction-Assisted Evaluation of the Nasal Valve in Rhinoplasty [Original Article]
Objective To introduce and analyze suction-assisted analysis of nasal valve strength in functional septorhinoplasty. This is a novel method for helping the surgeon analyze the integrity of a patient's airway during surgery. Methods In this prospective study, 20 patients who underwent functional septorhinoplasty were analyzed. Negative pressure using suction tubing was placed at the nasal sill, and measurements of the amount of maximal depression of the nasal valve were performed in the operating room immediately before incision and immediately after closure of the incisions. Results All 20 patients had an immediate decrease in the deviation of the weakest point of the valve, with a mean change of 2.14 mm. The change on both sides was statistically significant (paired t test, P < .001). This novel method helped the surgeons decide which grafts provided the most immediate structural benefit. Conclusions Structure-based septorhinoplasty can immediately improve the strength of the nasal valve. Suction-assisted analysis of the nasal valve can be a useful "real-time" tool for determining which maneuvers improve the strength of the nasal valve.
Mon, 16 Jan 2012 20:53:55 +0000

Anatomic Variations Found on Dissection of Depressor Septi Nasi Muscles in Cadavers [Original Article]
Objectives To define variations of the depressor septi muscle in Iranians; to provide guidance for modification of this muscle during rhinoplasty in patients with an active muscle and short upper lip; and to correlate our findings with our clinical experience to develop the applied algorithms. Methods This study was conducted by dissecting 82 depressor septi nasi muscles in 41 Iranian cadavers. Origin and insertion points of each muscle were studied. Results Three variations were found in muscle insertion points: periosteal, orbicularis oris, and floating. Forty-four percent of the muscles were inserted into the periosteum of the maxilla (n = 36); 39% of muscles were inserted into the orbicularis oris muscle (n = 32); and 17% were diminutive or floating (n = 14). Periosteal insertion was thicker and stronger than the other variations. In all cadavers, the origin of the muscle was medial crus of alar cartilage and caudal of the nasal septum. Conclusions This cadaveric dissection showed that the percentage of depressor septi muscle insertions is not similar to that found in other surveys. In this study, periosteal insertion of the depressor septi muscle was the most common variation.
Mon, 16 Jan 2012 20:53:55 +0000

Mechanical Analysis of the Effects of Cephalic Trim on Lower Lateral Cartilage Stability [Original Article]
Objective To determine how mechanical stability changes in the lower lateral cartilage (LLC) after varying degrees of cephalic resection in a porcine cartilage nasal tip model. Methods Alar cartilage was harvested from fresh porcine crania (n = 14) and sectioned to precisely emulate a human LLC in size and dimension. Flexural mechanical analysis was performed both before and after cephalic trims of 0 (control), 4, and 6 mm. Cantilever deformation tests were performed on the LLC models at 3 locations (4, 6, and 8 mm from the midline), and the integrated reaction force was measured. An equivalent elastic modulus of the crura was calculated assuming that the geometry of the LLC model approximated a modified single cantilever beam. A 3-dimensional finite element model was used to model the stress distribution of the prescribed loading conditions for each of the 3 types of LLC widths. Results A statistically significant decrease (P = .02) in the equivalent elastic modulus of the LLC model was noted at the most lateral point at 8 mm and only when 4 mm of the strut remained (P = .05). The finite element model revealed that the greatest internal stresses was at the tip of the nose when tissue was flexed 8 mm from the midline. Conclusion Our results provide the mechanical basis for suggested clinical guidelines stating that a residual strut of less than 6 mm can lead to suboptimal cosmetic results owing to poor structural support of the overlying skin soft-tissue envelope by an overly resected LLC.
Mon, 16 Jan 2012 20:53:55 +0000

Auricular Keloids: Combined Therapy With a New Pressure Device [Original Article]
Objective To develop a new, custom-made pressure device that can be used with established designs as an adjuvant therapy for optimized treatment of auricular keloids. Methods Seven patients (4 males, 3 females; mean [SD] age, 22.6 [8.3] years) were treated with surgical excision and corticosteroid injection followed by application of our new auricular pressure device. Results All patients tolerated the adjuvant therapy and wore the device overnight for 5 nights per week. Usage was not interrupted or cancelled. No recurrence was observed during the follow-up period (mean [SD] duration of follow-up, 24 [6] months). All patients were satisfied with the results; none described pruritus, pain, or dysesthesia. Conclusion Overnight usage of the new pressure device seems to be a safe and effective extension of established auricular keloid therapy with the potential for prophylaxis of recurrence.
Mon, 16 Jan 2012 20:53:55 +0000

Nasal Batten Grafts: Are Patients Satisfied? [Original Article]
Objectives To learn how nasal batten grafts affect patients' assessment of their nasal airway patency and to determine the extent to which patients believe batten grafts altered their appearance. Methods A prospective survey study of 18 patients in a tertiary veterans hospital who had nasal airway obstruction (NAO) due to nasal valve collapse was completed. Patients had placement of bilateral polyethylene batten grafts during a 36-month study period. The Nasal Obstruction Symptom Evaluation (NOSE) validated survey was used to measure a patient's subjective postoperative change in nasal airway obstruction. In addition, the patients were asked to rate the extent their appearance had changed. Results All patients presented with complaints of NAO due to nasal valve collapse either in isolation or in combination with another anatomical source of obstruction. The nasal valve collapse was identified by clinical examination. All patients had preoperative photographs. Most patients had a trial with an intranasal stent before opting for surgical implantation of the batten grafts. The results of the NOSE survey demonstrate significant improvement in nasal obstruction. Patients also reported only a minimal change in appearance. There was 1 patient with implant extrusions and only a few implants were removed. Conclusions Nasal airway obstruction due to nasal valve collapse can be effectively treated with polyethylene batten grafts. The implants are well tolerated, and patients report a significant improvement in NAO. There is little risk of implant extrusion, exposure, or intolerance. In addition, patients did not note a significant change to their appearance.
Mon, 16 Jan 2012 20:53:55 +0000

Retrospective Review of Resorbable Plate Fixation in Pediatric Craniofacial Surgery: Long-term Outcome [Archives Classic: A Contemporary Perspective]

Mon, 16 Jan 2012 20:53:55 +0000

The Nasal Valve Dilemma: The Narrow Straw vs the Weak Wall [Commentary]

Mon, 16 Jan 2012 20:53:55 +0000

Highlights of Archives of Facial Plastic Surgery [Highlights of Archives of Facial Plastic Surgery]

Mon, 16 Jan 2012 20:53:55 +0000

Treating Crow's Feet - Botulinum Neuromodulators
An investigation published Online First by the Archives of Facial Plastic Surgery reveals that the onset action of two botulinum neuromodulators both improved the appearance of crow's feet (lateral orbital rhytids), even though one appeared to produce greater improvement than the other...
Mon, 02 Jan 2012 19:00:00 +0000

Saline Implants' Risks, Benefits Essential Info for Health Literate Women
Breast projection is a legitimate wish of some women. They may be aware of the risks and costs of a saline implant. It must be possible for every woman who takes a considered decision to opt for reconstruction surgery, to have her wish fulfilled.Contributor: Jenny Tansey Published: May 27, 2005
Fri, 27 May 2005 21:36:00 +0000

Breast Implant Boss Arrested
The scandal of the faulty, badly made breast implants from French company Poly Implant Prothese (PIP) continues with the arrest of Jean-Claude Mas, 72, who according to police has been held at his home in Six-Fours-les-Plages in the South of France...
Fri, 27 Jan 2012 01:00:00 +0000

New Guidelines For Managing Rare Anesthesia Complication At Ambulatory Surgical Centers
As the number of surgical procedures performed outside hospitals continues to increase, ambulatory surgical centers (ASCs) need to develop policies for managing malignant hyperthermia a rare but serious reaction to anesthetics, according to an expert panel report in the January issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS)...
Fri, 23 Dec 2011 09:00:00 +0000

10 Myths About Breast Cancer Busted
Ten of the most common myths about breast cancer exposed here. Some of them may surprise you, and others you just be aware of.Contributor: Megan Mathews Published: May 19, 2006
Fri, 19 May 2006 10:14:00 +0000

Body Absorbs Breast Implant During Pilates Session
A breast cancer survivor's breast implant was swallowed up by her own body during a Pilates session, resulting in surgical intervention to retrieve it and place it back into the breast, according to an article by doctors at Johns Hopkins' University and published in NEJM (New England Journal of Medicine). The 59-year-old female had undergone a double mastectomy, followed by breast implants...
Fri, 16 Dec 2011 18:00:00 +0000

Less Blood Needed Post-Surgery
Patients need less blood after surgery than is widely thought. A new study comparing two plans for giving blood transfusions following surgery showed no ill effects from postponing transfusion until patients develop signs of anemia or their hemoglobin concentration falls below 8 g/dL...
Fri, 16 Dec 2011 10:00:00 +0000

PIP Breast Implants - UK Dept Of Health Response To Expert Report
According to the Department of Health, their main concern is the wellbeing of women who have had PiP breast implants. For this reason, an expert group led by Professor Sir Bruce Keogh, NHS Medical Director, has been asked to examine all available data and evidence on PiP breast implants...
Fri, 13 Jan 2012 17:00:00 +0000

Faulty PIP And ROFIL Medro Breast Implants - ISAPS Official Statement
Health authorities have discovered during a recent French governmental inspection of breast implants, which were manufactured by PIP and ROFIL Medro since 2001, that most implants are filled with industrial grade silicone instead of medical grade silicone...
Fri, 06 Jan 2012 18:00:00 +0000

Botox Has Effects On Unintended Muscles
According to a study in the January issue of Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society (IARS), Botox (Botulinum neurotoxin type A) has previously unsuspected 'systemic' effects on muscles other than the ones it's injected into...
Fri, 06 Jan 2012 08:00:00 +0000