Pub Date : 2023-07-18DOI: 10.1177/07488068231183209
E. Nuveen, C. Caplin
{"title":"The Struggle to Change: Consolidation for Success and the Future of Cosmetic Surgery","authors":"E. Nuveen, C. Caplin","doi":"10.1177/07488068231183209","DOIUrl":"https://doi.org/10.1177/07488068231183209","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131399766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-17DOI: 10.1177/07488068231186742
Hatem Elfieshawy, Graham Smyth, Monika Jasińska
Inferior breast implant displacement, also known as caudal migration, or bottoming-out, is a known complication of breast augmentation. This leads to a loss of upper pole fullness, a more superiorly located nipple-areolar complex, and an unnatural appearance. Avoiding these complaints has been a longstanding challenge in the field of aesthetics and this technical note suggests a novel solution. This technical note describes the process of preoperative assessment, careful markings, and the use of an autologous lipo-dermal advancement flap that has been designed, mobilized, and rotated to be internally fixated to costal margins and the relevant deep fascial structures at the proposed inframammary fold level. This technique creates a robust partitioning hammock-like structure that stabilizes the breast implant and prevents future caudal displacement. The described technique may be implemented as an independent solution, or as an adjunct to other modalities like biological meshes in revision breast surgery.
{"title":"Autologous Lipo-Dermal Advancement Flap for Inframammary Fold Reconstruction: A Technical Note for Prevention and Management of Caudal Breast Implant Migration","authors":"Hatem Elfieshawy, Graham Smyth, Monika Jasińska","doi":"10.1177/07488068231186742","DOIUrl":"https://doi.org/10.1177/07488068231186742","url":null,"abstract":"Inferior breast implant displacement, also known as caudal migration, or bottoming-out, is a known complication of breast augmentation. This leads to a loss of upper pole fullness, a more superiorly located nipple-areolar complex, and an unnatural appearance. Avoiding these complaints has been a longstanding challenge in the field of aesthetics and this technical note suggests a novel solution. This technical note describes the process of preoperative assessment, careful markings, and the use of an autologous lipo-dermal advancement flap that has been designed, mobilized, and rotated to be internally fixated to costal margins and the relevant deep fascial structures at the proposed inframammary fold level. This technique creates a robust partitioning hammock-like structure that stabilizes the breast implant and prevents future caudal displacement. The described technique may be implemented as an independent solution, or as an adjunct to other modalities like biological meshes in revision breast surgery.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115085827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-17DOI: 10.1177/07488068231186181
Wilbur Hah
New research results were recently unveiled at the May 2023 meeting of the World Association of Gluteal Surgeons (WAGS), which illustrate the enhanced safety of Brazilian butt lifts (BBLs) performed by cosmetic surgeons certified by the American Board of Cosmetic Surgery (ABCS). These data reveal zero fatalities during more than 12 000 conse cutive cases performed by ABCS diplomats, which were performed subsequent to the Florida Board of Medicine’s emergency rule which prohibited dangerous intramuscular fat injection. Ninetyeight percent of the ABCS surgeons (sur geons who practice both in Florida and in other states which have not enacted prohibitions against intramuscular injection) polled reported injecting only in the subcutaneous plane. This finding contrasts with a 2023 article published in the Aesthetic Journal which revealed that 10 out of 11 BBL deaths in the state of Florida occurred at the hands of plastic surgeons certi fied by the American Board of Plastic Surgery and that the other surgeon with a death in Florida during this timeframe was certified in neither cosmetic nor plastic surgery.1 Continuing demand for the BBL has propelled it to become the cosmetic procedure with the fastest growth in recent years. In 2021, the American Society of Plastic Surgeons reported 61 000 BBLs performed. However, experts believe that the actual number could be twice as high given that other surgeons also perform BBLs. It is estimated that Americans spent between $250 million and $750 million US dollars on BBLs annually. Despite its soaring popularity, BBL has not been without its controversies, particularly concerning the risks associated with the procedure. One of the most significant concerns has been cases of mortality resulting from pulmonary fat embolism. The reported mortality ranges from 1 in 3000 to 1 in 20 000.2 There was a decrease in deaths between 2018 and 2020, but a staggering 400% surge in BBLrelated deaths in South Florida in 2021 raised alarm bells within the medical community. This was particularly true of the Florida Board of Medicine, which led the country in BBL safety by prohib iting intramuscular fat injection and requiring that surgeons employ intraoperative ultrasound, the current gold standard in safety for this procedure. At a recent WAGS meeting held in Miami, Dr. Angelo Cuzalina presented a groundbreaking study concerning the safety of BBL procedures.1 This study stands out as it is the first twostage prospective analysis spanning 6 years, exam ining the safety record of BBL surgery, specifically when performed by fellowshiptrained, boardcertified cosmetic surgeons under the ABCS. In the first stage of the study, conducted in 2019, diplo mates of the ABCS were surveyed via email questionnaires. A total of 393 surveys were distributed, with a response rate of 23% as 93 respondents participated. Among them, 63% (or 64 out of 93) reported having performed BBLs, with a total of 22 800 BBLs carried out between 201
{"title":"New Data Show Board-Certified Cosmetic Surgeons Safely Performing Brazilian Butt Lift Surgery","authors":"Wilbur Hah","doi":"10.1177/07488068231186181","DOIUrl":"https://doi.org/10.1177/07488068231186181","url":null,"abstract":"New research results were recently unveiled at the May 2023 meeting of the World Association of Gluteal Surgeons (WAGS), which illustrate the enhanced safety of Brazilian butt lifts (BBLs) performed by cosmetic surgeons certified by the American Board of Cosmetic Surgery (ABCS). These data reveal zero fatalities during more than 12 000 conse cutive cases performed by ABCS diplomats, which were performed subsequent to the Florida Board of Medicine’s emergency rule which prohibited dangerous intramuscular fat injection. Ninetyeight percent of the ABCS surgeons (sur geons who practice both in Florida and in other states which have not enacted prohibitions against intramuscular injection) polled reported injecting only in the subcutaneous plane. This finding contrasts with a 2023 article published in the Aesthetic Journal which revealed that 10 out of 11 BBL deaths in the state of Florida occurred at the hands of plastic surgeons certi fied by the American Board of Plastic Surgery and that the other surgeon with a death in Florida during this timeframe was certified in neither cosmetic nor plastic surgery.1 Continuing demand for the BBL has propelled it to become the cosmetic procedure with the fastest growth in recent years. In 2021, the American Society of Plastic Surgeons reported 61 000 BBLs performed. However, experts believe that the actual number could be twice as high given that other surgeons also perform BBLs. It is estimated that Americans spent between $250 million and $750 million US dollars on BBLs annually. Despite its soaring popularity, BBL has not been without its controversies, particularly concerning the risks associated with the procedure. One of the most significant concerns has been cases of mortality resulting from pulmonary fat embolism. The reported mortality ranges from 1 in 3000 to 1 in 20 000.2 There was a decrease in deaths between 2018 and 2020, but a staggering 400% surge in BBLrelated deaths in South Florida in 2021 raised alarm bells within the medical community. This was particularly true of the Florida Board of Medicine, which led the country in BBL safety by prohib iting intramuscular fat injection and requiring that surgeons employ intraoperative ultrasound, the current gold standard in safety for this procedure. At a recent WAGS meeting held in Miami, Dr. Angelo Cuzalina presented a groundbreaking study concerning the safety of BBL procedures.1 This study stands out as it is the first twostage prospective analysis spanning 6 years, exam ining the safety record of BBL surgery, specifically when performed by fellowshiptrained, boardcertified cosmetic surgeons under the ABCS. In the first stage of the study, conducted in 2019, diplo mates of the ABCS were surveyed via email questionnaires. A total of 393 surveys were distributed, with a response rate of 23% as 93 respondents participated. Among them, 63% (or 64 out of 93) reported having performed BBLs, with a total of 22 800 BBLs carried out between 201","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"236 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133417381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-14DOI: 10.1177/07488068231165900
A. Mowlavi, H. Mirzania, Zachary Sin, Chelsea Sahami
Introduction: High-definition liposuction (HDL) has been coined to identify liposuction results that are superior to traditional liposuction. The HDL Body scale has been previously described to help objectify changes required to achieve HDL results (that range from 2 to 10 score) with the ultimate goal of achieving a near perfect 9 or 10 body score. Materials/Methods: We present the High-Definition (HD) Abdominal Body Scale that is intended to assist with attaining HD abdominal contouring outcomes. High-definition abdominal contouring outcomes require comprehensive correction of abdominal contour concerns as well as creation of abdominal muscle highlights and natural shadows. HD Abdominal Body Scale assigns scores ranging from 2 to 10 with the ultimate goal of achieving a near perfect 9 or 10 body score indicative of HD outcomes. Results: The HD Abdominal Body Scale and subsequent surgical algorithm for HD abdominal contouring and case studies are presented. Discussion: Considerations for achieving HD abdominal contouring outcomes include assessing degree of fat excess, integrity of abdominal muscles, amount of skin redundancy, as well as quality and extent of skin texture changes. Evaluation of these factors provides the premise for determining HD abdominal contouring scores. HD abdominal contouring scores are used to establish proper patient selection, appropriate surgical design, and objective assessment of outcomes. Conclusion: This article presents an abdominal HDL Body Scale that helps expand patient populations who are candidates for HD body contouring. Surgeons’ outcomes may be improved using the HDL body scale and surgical algorithm presented.
{"title":"High-Definition Abdominal Body Scale","authors":"A. Mowlavi, H. Mirzania, Zachary Sin, Chelsea Sahami","doi":"10.1177/07488068231165900","DOIUrl":"https://doi.org/10.1177/07488068231165900","url":null,"abstract":"Introduction: High-definition liposuction (HDL) has been coined to identify liposuction results that are superior to traditional liposuction. The HDL Body scale has been previously described to help objectify changes required to achieve HDL results (that range from 2 to 10 score) with the ultimate goal of achieving a near perfect 9 or 10 body score. Materials/Methods: We present the High-Definition (HD) Abdominal Body Scale that is intended to assist with attaining HD abdominal contouring outcomes. High-definition abdominal contouring outcomes require comprehensive correction of abdominal contour concerns as well as creation of abdominal muscle highlights and natural shadows. HD Abdominal Body Scale assigns scores ranging from 2 to 10 with the ultimate goal of achieving a near perfect 9 or 10 body score indicative of HD outcomes. Results: The HD Abdominal Body Scale and subsequent surgical algorithm for HD abdominal contouring and case studies are presented. Discussion: Considerations for achieving HD abdominal contouring outcomes include assessing degree of fat excess, integrity of abdominal muscles, amount of skin redundancy, as well as quality and extent of skin texture changes. Evaluation of these factors provides the premise for determining HD abdominal contouring scores. HD abdominal contouring scores are used to establish proper patient selection, appropriate surgical design, and objective assessment of outcomes. Conclusion: This article presents an abdominal HDL Body Scale that helps expand patient populations who are candidates for HD body contouring. Surgeons’ outcomes may be improved using the HDL body scale and surgical algorithm presented.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126971079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.1177/07488068231182784
E. Nuveen, C. Caplin
{"title":"The Struggle to Change: Consolidation as the Future of Cosmetic Surgery","authors":"E. Nuveen, C. Caplin","doi":"10.1177/07488068231182784","DOIUrl":"https://doi.org/10.1177/07488068231182784","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116779824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-23DOI: 10.1177/07488068231169247
Nicolas Hayes, Alexander W. Sobel
Self-reported height and weight is commonly used in medical practice for the determination of body mass index (BMI). Self-reported height and weight can be underestimated or overestimated resulting in inaccurate BMI calculations. In our practice the self-reported height and weight are obtained at the time of cosmetic surgery consultation. The purpose of this study is to determine the accuracy of preoperative height, weight, and BMI calculations in patients undergoing liposuction of the abdomen in comparison to measurements obtained by nursing staff the day of surgery. Clinically, these data may affect perioperative risk stratification and preoperative planning with respect to deep venous thrombosis prophylaxis. Using Nextech electronic medical records (EMR) system, charts were reviewed from July 2019 to July 2022. Patients identified as having underwent liposuction of the upper and lower abdomen were reviewed. All patients had been consented for the prescribed procedure. Data extracted included the self-reported height/weight and calculated BMIs obtained at the time of consultation as well as measured height/weight and BMIs from the day of surgery. The study sample included 50 patients (31 women and 19 men), with an average age of 44 ± 11 years (range, 20-71 years). Time from consult to surgery ranged from 2 to 270 days with an average of 58 days. Time of consult (TOC) height average was 169.1 cm (range, 152.4-190.5 cm) versus day of surgery (DOS) height average of 169.5 cm (range, 149-190 cm). Time of consult weight average was 82.4 kg/181.66 lbs (range, 54.5-115.9 kg/120.15-264.89 lbs) versus DOS average of 84 kg/185.19 lbs (range, 53.8-116 kg/118.61-255.74 lbs). Time of consult BMI average was 28.5 kg/m2 (range, 21.1-43.9 kg/m2) with a DOS average of 29 kg/m2 (range, 20.9-47 kg/m2). Height was on average underestimated by 0.03 cm. Weight was on average underestimated by 1.6 kg at the TOC compared with DOS. BMI difference between TOC and DOS had an average underestimate of 0.5 kg/m2. A total of 8 patients upstaged to a higher obesity classification based on DOS BMI calculation. Subgroup analysis of male and female height and weight estimations versus measured data are also reviewed. When averaged the time of consultation height, weight, and BMI correlated with height, weight, and BMIs measured and calculated the day of surgery in patients undergoing liposuction of the abdomen. Sixteen percent of our study population were reclassified to a higher obesity class based on DOS height and weight. For the purposes of accurate perioperative risk management and deep venous thrombosis prophylaxis planning, height and weight should be obtained accurately at the time of consultation or at a preoperative visit within 1 month of surgery.
{"title":"Self-Reported Height and Weight for BMI Calculation Compared With Measured Height, Weight, and BMI in Patients Undergoing Liposuction of the Upper and Lower Abdomen: A Single-Center Retrospective Review","authors":"Nicolas Hayes, Alexander W. Sobel","doi":"10.1177/07488068231169247","DOIUrl":"https://doi.org/10.1177/07488068231169247","url":null,"abstract":"Self-reported height and weight is commonly used in medical practice for the determination of body mass index (BMI). Self-reported height and weight can be underestimated or overestimated resulting in inaccurate BMI calculations. In our practice the self-reported height and weight are obtained at the time of cosmetic surgery consultation. The purpose of this study is to determine the accuracy of preoperative height, weight, and BMI calculations in patients undergoing liposuction of the abdomen in comparison to measurements obtained by nursing staff the day of surgery. Clinically, these data may affect perioperative risk stratification and preoperative planning with respect to deep venous thrombosis prophylaxis. Using Nextech electronic medical records (EMR) system, charts were reviewed from July 2019 to July 2022. Patients identified as having underwent liposuction of the upper and lower abdomen were reviewed. All patients had been consented for the prescribed procedure. Data extracted included the self-reported height/weight and calculated BMIs obtained at the time of consultation as well as measured height/weight and BMIs from the day of surgery. The study sample included 50 patients (31 women and 19 men), with an average age of 44 ± 11 years (range, 20-71 years). Time from consult to surgery ranged from 2 to 270 days with an average of 58 days. Time of consult (TOC) height average was 169.1 cm (range, 152.4-190.5 cm) versus day of surgery (DOS) height average of 169.5 cm (range, 149-190 cm). Time of consult weight average was 82.4 kg/181.66 lbs (range, 54.5-115.9 kg/120.15-264.89 lbs) versus DOS average of 84 kg/185.19 lbs (range, 53.8-116 kg/118.61-255.74 lbs). Time of consult BMI average was 28.5 kg/m2 (range, 21.1-43.9 kg/m2) with a DOS average of 29 kg/m2 (range, 20.9-47 kg/m2). Height was on average underestimated by 0.03 cm. Weight was on average underestimated by 1.6 kg at the TOC compared with DOS. BMI difference between TOC and DOS had an average underestimate of 0.5 kg/m2. A total of 8 patients upstaged to a higher obesity classification based on DOS BMI calculation. Subgroup analysis of male and female height and weight estimations versus measured data are also reviewed. When averaged the time of consultation height, weight, and BMI correlated with height, weight, and BMIs measured and calculated the day of surgery in patients undergoing liposuction of the abdomen. Sixteen percent of our study population were reclassified to a higher obesity class based on DOS height and weight. For the purposes of accurate perioperative risk management and deep venous thrombosis prophylaxis planning, height and weight should be obtained accurately at the time of consultation or at a preoperative visit within 1 month of surgery.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123280037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-16DOI: 10.1177/07488068231175582
L. Martins, Juan Martin Zarate, Ibrahim Fakih-Gomez, N. Fakih-Gomez
Brow position is a key feature to define a fresh and youthful appearance of the periorbital region. Frontotemporal brow lift implies the elevation of both the medial brow and lateral brow and can be performed through an open (coronal), endoscopic, or combined approach. While endoscopic brow lift has the advantage of minimal incisions compared with the open coronal approach, it requires specific equipment, a longer learning curve, and has been associated with high recurrence rates. Herein, the authors’ technique for frontotemporal brow lift is presented, an approach that includes complete access under direct vision to the lateral brow and glabellar area, through 2 limited frontotemporal incisions and a novel method of 3-vectoring suspension to the frontal bone. It has proved to be predictable with long-lasting results.
{"title":"Frontotemporal Brow lift With Suspension to Frontal Bone","authors":"L. Martins, Juan Martin Zarate, Ibrahim Fakih-Gomez, N. Fakih-Gomez","doi":"10.1177/07488068231175582","DOIUrl":"https://doi.org/10.1177/07488068231175582","url":null,"abstract":"Brow position is a key feature to define a fresh and youthful appearance of the periorbital region. Frontotemporal brow lift implies the elevation of both the medial brow and lateral brow and can be performed through an open (coronal), endoscopic, or combined approach. While endoscopic brow lift has the advantage of minimal incisions compared with the open coronal approach, it requires specific equipment, a longer learning curve, and has been associated with high recurrence rates. Herein, the authors’ technique for frontotemporal brow lift is presented, an approach that includes complete access under direct vision to the lateral brow and glabellar area, through 2 limited frontotemporal incisions and a novel method of 3-vectoring suspension to the frontal bone. It has proved to be predictable with long-lasting results.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115313158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-16DOI: 10.1177/07488068231166916
Ehab Akkary, Brett Tomlin, Mohamed Almoukadem, B. Friedberg
Since the mid-1980s, Klein’s tumescent anesthesia has been used routinely in different surgical specialties such as cosmetic surgery, dermatology, vascular surgery, reconstructive plastic surgery, and breast surgery. The tumescent anesthesia technique was developed by Dr Jeffrey Klein, a board-certified dermatologist. The technique was first published in 1987. Tumescent means “swelling.” This technique involves injection of an ultra-dilute lidocaine and epinephrine solution into the surgical planes offering multiple advantages including, but not limited to, postoperative analgesia, reduced blood loss, and avoidance of general anesthesia. The standard liter of Klein’s solution contains lidocaine 1 g, epinephrine 1 mg, and sodium bicarbonate 12.5 mg. Multiple modifications and variations have been implemented and used over the years, an evolution from Klein’s original description. While tumescent anesthesia started in liposuction procedures, its application has now extended into a wider variety of procedures and specialties. In this article, we present a case of tumescent anesthesia in a critically ill general surgery patient who presented with an acute life-threatening surgical emergency. The patient was assessed to be a very high risk for general anesthesia, and after collaborative discussion between the surgical and anesthesia teams and taking informed consent from the patient, the decision was made to proceed with surgery under monitored intravenous sedation with tumescent anesthesia. The patient had an uneventful recovery and survived a very high mortality surgical emergency. He was subsequently discharged back to his nursing home in stable condition. Tumescent anesthesia has become tremendously popular in cosmetic surgery. Tumescent anesthesia allows patients to have surgical procedures in an ambulatory setting, avoid general anesthesia, and allow for better pain control postoperatively. While tumescent anesthesia is used in other specialties, the field of general surgery has not widely adopted tumescent anesthesia. Many general surgeons and anesthesiologists are not familiar with the technique and how to implement it in their practice. It is of utmost importance to understand the pharmacokinetics of tumescent solution and safe implementation. Tumescent anesthesia with monitored anesthesia care is here reported as an alternative to general anesthesia in the care of a moribund patient with multiple comorbidities requiring open abdominal surgery. Close cooperation between the surgeon and the anesthesiologist made the successful conduct of this case possible.
{"title":"Gangrenous Bowel Obstruction Managed With Local Tumescent Anesthesia and MAC","authors":"Ehab Akkary, Brett Tomlin, Mohamed Almoukadem, B. Friedberg","doi":"10.1177/07488068231166916","DOIUrl":"https://doi.org/10.1177/07488068231166916","url":null,"abstract":"Since the mid-1980s, Klein’s tumescent anesthesia has been used routinely in different surgical specialties such as cosmetic surgery, dermatology, vascular surgery, reconstructive plastic surgery, and breast surgery. The tumescent anesthesia technique was developed by Dr Jeffrey Klein, a board-certified dermatologist. The technique was first published in 1987. Tumescent means “swelling.” This technique involves injection of an ultra-dilute lidocaine and epinephrine solution into the surgical planes offering multiple advantages including, but not limited to, postoperative analgesia, reduced blood loss, and avoidance of general anesthesia. The standard liter of Klein’s solution contains lidocaine 1 g, epinephrine 1 mg, and sodium bicarbonate 12.5 mg. Multiple modifications and variations have been implemented and used over the years, an evolution from Klein’s original description. While tumescent anesthesia started in liposuction procedures, its application has now extended into a wider variety of procedures and specialties. In this article, we present a case of tumescent anesthesia in a critically ill general surgery patient who presented with an acute life-threatening surgical emergency. The patient was assessed to be a very high risk for general anesthesia, and after collaborative discussion between the surgical and anesthesia teams and taking informed consent from the patient, the decision was made to proceed with surgery under monitored intravenous sedation with tumescent anesthesia. The patient had an uneventful recovery and survived a very high mortality surgical emergency. He was subsequently discharged back to his nursing home in stable condition. Tumescent anesthesia has become tremendously popular in cosmetic surgery. Tumescent anesthesia allows patients to have surgical procedures in an ambulatory setting, avoid general anesthesia, and allow for better pain control postoperatively. While tumescent anesthesia is used in other specialties, the field of general surgery has not widely adopted tumescent anesthesia. Many general surgeons and anesthesiologists are not familiar with the technique and how to implement it in their practice. It is of utmost importance to understand the pharmacokinetics of tumescent solution and safe implementation. Tumescent anesthesia with monitored anesthesia care is here reported as an alternative to general anesthesia in the care of a moribund patient with multiple comorbidities requiring open abdominal surgery. Close cooperation between the surgeon and the anesthesiologist made the successful conduct of this case possible.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115104192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-29DOI: 10.1177/07488068231171313
N. Fakih-Gomez, Juan Martin Zarate, L. Martins, Luis Miguel Lindo Delgadillo, Ibrahim Fakih-Gomez
Upper blepharoplasty has traditionally involved subtractive approaches with excision of different amounts of skin, muscle, and fat. However, this approach often results in iatrogenic acceleration of the normal volume depletion and bone resorption associated with aging, which leads to deepening of the superior sulcus, A-shape deformity and generalized hollowness. In recent years, the concept of periorbital volume restoration and augmentation has shifted the paradigm toward fat preservation and gland repositioning procedures. Herein, we describe the volumetric contouring concept, a contemporary approach for upper blepharoplasty that includes gland repositioning, suspension of the levator aponeurosis, fat transposition or reposition, and adjunctive filling procedures. This concept seeks for long-term restoration of the eyelid-brow complex by addressing every involutional aspect of the aging process, while treating and preventing hollow eyes and A-shaped deformity. In our experience, this approach has enabled us to attain optimal and long-lasting aesthetic results.
{"title":"Contemporary Upper Blepharoplasty: Volumetric Contouring Concept","authors":"N. Fakih-Gomez, Juan Martin Zarate, L. Martins, Luis Miguel Lindo Delgadillo, Ibrahim Fakih-Gomez","doi":"10.1177/07488068231171313","DOIUrl":"https://doi.org/10.1177/07488068231171313","url":null,"abstract":"Upper blepharoplasty has traditionally involved subtractive approaches with excision of different amounts of skin, muscle, and fat. However, this approach often results in iatrogenic acceleration of the normal volume depletion and bone resorption associated with aging, which leads to deepening of the superior sulcus, A-shape deformity and generalized hollowness. In recent years, the concept of periorbital volume restoration and augmentation has shifted the paradigm toward fat preservation and gland repositioning procedures. Herein, we describe the volumetric contouring concept, a contemporary approach for upper blepharoplasty that includes gland repositioning, suspension of the levator aponeurosis, fat transposition or reposition, and adjunctive filling procedures. This concept seeks for long-term restoration of the eyelid-brow complex by addressing every involutional aspect of the aging process, while treating and preventing hollow eyes and A-shaped deformity. In our experience, this approach has enabled us to attain optimal and long-lasting aesthetic results.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120894313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-23DOI: 10.1177/07488068231166912
Ariel Luksenburg, J. J. Barcia, J. Gaviria, Roberto Sergio, Santiago Palacios, M. Pelosi
The worldwide prevalence of female urinary incontinence (UI) is reported at 55%, and about 27% of UIs are severe. The complications in cases of severe UI treated surgically and the ineffective or incomplete results of prolonged treatments with thermal energies motivated us to develop an innovative treatment. Our hypothesis was based on correcting the descent and/or urethral hypermotility and repositioning the descended bladder urethral junction. We have designed a system for the development of a dense and resistant fibrosis that supports the urethra and can correct the alterations of severe UI, Luksenburg systems procedure, LSG3. A group of 652 women between the age of 46 and 74 years, post-menopausal, with more than 2 vaginal births and severe UI, documented by the clinical presentation and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score index, were enrolled. Originally developed polycaprolactone threads were placed in suburethral space using specific designed tools (LSG3). Immediate results—24 hours (P < .05): 469 patients without clinical UI (72% efficacy), 122 patients with grade 1 UI (drops) (18% improvement), and 59 patients with grade 3 UI (unchanged 9%). Thirty-day results (P < .05): 560 patients without UI (86% efficacy), 58 patients with grade 1 UI (drops) (9% improvement), and 34 patients with grade 3 UI (unchanged 5%). Fifteen-month results (P < .05): 542 patients without UI (83%), 74 patients with grade 1 UI (drops) (11%), and 36 patients with grade 3 UI (6%). No complications or secondary effects were found after the procedure in the 15 months of follow-up. We have developed an innovative system called “suburethral spider web” to treat and cure severe (grade 3) UI in office, as outpatient, that is effective, safe, and cheap.
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