Pub Date : 2022-07-07DOI: 10.1177/07488068221100690
Kelsey A. Roelofs, T. Soriano, Chandra N. Smart, L. Cohen, S. Diniz, Te-Chuan Chen, Kendall Goodyear, Justin N. Karlin, R. Goldberg, D. Rootman
Introduction: The skin pinch technique is generally thought to excise a skin-only specimen, with minimal damage to the underlying orbicularis oculi muscle. The purpose of this study was to assess for the presence and quantity of muscle excised during routine lower eyelid pinch blepharoplasty. Methods and Materials: Horizontal tissue sectioning (Mohs technique) with histologic circumferential peripheral and deep margin assessment was employed to allow for evaluation of the entire deep margin of the pinch specimen. Hematoxylin and eosin slides were examined. The presence of and total surface area of skeletal muscle were calculated. Results: Ten pinch blepharoplasty specimens with a mean surface area of 70.6 ± 29.0 mm2 were evaluated. Overall, 90% (9/10) of specimens had at least 1 quadrant with muscle. On average, 3 ± 3% (range 0%-9%) of the total pinch specimen surface area contained muscle. There was a strong positive correlation between the size of skin excision and the percentage of surface area with muscle (Pearson correlation: 0.942; P < .001). Discussion: In the majority of cases, the amount of muscle excised during pinch blepharoplasty is negligible; however, larger skin excisions may be expected to result in disproportionately greater muscle resection. Conclusions: The lower eyelid pinch blepharoplasty technique is an effective method of excising redundant skin with minimal resection of orbicularis muscle.
{"title":"What’s in a Pinch: A Closer Look at Lower Eyelid Pinch Blepharoplasty","authors":"Kelsey A. Roelofs, T. Soriano, Chandra N. Smart, L. Cohen, S. Diniz, Te-Chuan Chen, Kendall Goodyear, Justin N. Karlin, R. Goldberg, D. Rootman","doi":"10.1177/07488068221100690","DOIUrl":"https://doi.org/10.1177/07488068221100690","url":null,"abstract":"Introduction: The skin pinch technique is generally thought to excise a skin-only specimen, with minimal damage to the underlying orbicularis oculi muscle. The purpose of this study was to assess for the presence and quantity of muscle excised during routine lower eyelid pinch blepharoplasty. Methods and Materials: Horizontal tissue sectioning (Mohs technique) with histologic circumferential peripheral and deep margin assessment was employed to allow for evaluation of the entire deep margin of the pinch specimen. Hematoxylin and eosin slides were examined. The presence of and total surface area of skeletal muscle were calculated. Results: Ten pinch blepharoplasty specimens with a mean surface area of 70.6 ± 29.0 mm2 were evaluated. Overall, 90% (9/10) of specimens had at least 1 quadrant with muscle. On average, 3 ± 3% (range 0%-9%) of the total pinch specimen surface area contained muscle. There was a strong positive correlation between the size of skin excision and the percentage of surface area with muscle (Pearson correlation: 0.942; P < .001). Discussion: In the majority of cases, the amount of muscle excised during pinch blepharoplasty is negligible; however, larger skin excisions may be expected to result in disproportionately greater muscle resection. Conclusions: The lower eyelid pinch blepharoplasty technique is an effective method of excising redundant skin with minimal resection of orbicularis muscle.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115836123","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 : 2022-07-06DOI: 10.1177/07488068221104573
R. Troell
Lip augmentation can be achieved using dermal fillers, biological tissues (fat, fascia, scar tissue, Alloderm), and a permanent soft silastic implant. Patients choosing the permanent lip implant were evaluated for aesthetic outcome, patient satisfaction, complications, and the use of dermal fillers postoperatively. Retrospective review of lip implant augmentation was performed in a single private practice. Analysis of aesthetic outcomes, adverse effects, methodology to determine optimal lip implant size, surgical technique caveats, and the use of dermal fillers before and after lip implant placement was carried out. Aesthetic outcomes and patient satisfaction were assessed by direct patient questioning and surgeon observation. A total of 100 lip implant augmentation patients with 192 implants (92 combined upper and lower lips, 4 upper lip only, 4 lower lip only) were placed by the author between May 2011 and September 2021. From a patient satisfaction standpoint, 97% were happy with the final lip augmentation outcome. There was a complication incidence of 8%, with implant asymmetry the most common. Some patients (7%) underwent dermal fillers, both polymethylmethacrylate to the vermillion border and hyaluronic acid filler to the bulk of the lip to provide additional lip enhancement. Silastic lip implant satisfies the following factors for lip augmentation: precise, accepted by the host, modifiable, natural feel, readily reversible, and permanency. The author’s quantitative method uses primarily the “golden ratio” (1:1.62) as the most impactful metric of size determination of the upper and lower lip followed by two-third incisor dental show. Most patients (94%) used lip dermal fillers prior to surgery to assess satisfaction with lip augmentation. Our results revealed larger lip implant size placement (4- and 5-mm diameter implants) compared with the largest study published. Lip bulk augmentation with hyaluronic acid fillers injected superficial to the implant capsule may be performed safely after permanent lip implant placement to achieve the patients’ desired outcome. It is best to be an advanced filler injector and to use a microcannula for filler placement. The soft silastic lip implant procedure is a simple surgical procedure with a high patient satisfaction rate and low complication rate. Knowledge of lip aesthetic mathematical ratios and degree of dental show is imperative. Additional lip enhancement to lip bulk and vermillion border using both temporary and permanent dermal fillers may be performed safely after permanent lip implant placement to achieve the patients’ desired outcome.
{"title":"Optimizing the Lip Aesthetic Ratio Using Surgically Placed Silastic Implants for Lip Augmentation","authors":"R. Troell","doi":"10.1177/07488068221104573","DOIUrl":"https://doi.org/10.1177/07488068221104573","url":null,"abstract":"Lip augmentation can be achieved using dermal fillers, biological tissues (fat, fascia, scar tissue, Alloderm), and a permanent soft silastic implant. Patients choosing the permanent lip implant were evaluated for aesthetic outcome, patient satisfaction, complications, and the use of dermal fillers postoperatively. Retrospective review of lip implant augmentation was performed in a single private practice. Analysis of aesthetic outcomes, adverse effects, methodology to determine optimal lip implant size, surgical technique caveats, and the use of dermal fillers before and after lip implant placement was carried out. Aesthetic outcomes and patient satisfaction were assessed by direct patient questioning and surgeon observation. A total of 100 lip implant augmentation patients with 192 implants (92 combined upper and lower lips, 4 upper lip only, 4 lower lip only) were placed by the author between May 2011 and September 2021. From a patient satisfaction standpoint, 97% were happy with the final lip augmentation outcome. There was a complication incidence of 8%, with implant asymmetry the most common. Some patients (7%) underwent dermal fillers, both polymethylmethacrylate to the vermillion border and hyaluronic acid filler to the bulk of the lip to provide additional lip enhancement. Silastic lip implant satisfies the following factors for lip augmentation: precise, accepted by the host, modifiable, natural feel, readily reversible, and permanency. The author’s quantitative method uses primarily the “golden ratio” (1:1.62) as the most impactful metric of size determination of the upper and lower lip followed by two-third incisor dental show. Most patients (94%) used lip dermal fillers prior to surgery to assess satisfaction with lip augmentation. Our results revealed larger lip implant size placement (4- and 5-mm diameter implants) compared with the largest study published. Lip bulk augmentation with hyaluronic acid fillers injected superficial to the implant capsule may be performed safely after permanent lip implant placement to achieve the patients’ desired outcome. It is best to be an advanced filler injector and to use a microcannula for filler placement. The soft silastic lip implant procedure is a simple surgical procedure with a high patient satisfaction rate and low complication rate. Knowledge of lip aesthetic mathematical ratios and degree of dental show is imperative. Additional lip enhancement to lip bulk and vermillion border using both temporary and permanent dermal fillers may be performed safely after permanent lip implant placement to achieve the patients’ desired outcome.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123927204","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 : 2022-06-23DOI: 10.1177/07488068221101229
R. Troell, B. Eppley, Shahin Javaheri
Introduction: One of the most requested aesthetic procedures is body contouring using liposuction. Adjunctive procedures using fat grafting can provide enhancement in most body areas, commonly used in both gluteal and hip augmentation. Performing processing and enrichment to optimize fat transfer survival can avoid the use of body implants. When there is insufficient fat for the desired degree of augmentation, silastic implant placement is an alternative treatment. Much has been written in the medical cosmetic literature regarding gluteal and breast implants, but nothing in terms of hip silastic implants. Material and Methods: Hip implant patient selection, the body frame analysis, associated enhancing body contouring procedures, implant design and fabrication, and implant surgical placement are analyzed. In 3 different cosmetic surgery practices, methods of patient analysis and the process of creating a custom hip implant is presented. Techniques and protocols in the use of fat grafting in association with both gluteal and hip implants are elucidated. Results: The minimally manipulating fat maneuvers to increase fat survival are detailed. This paper defines the process of planning, designing, and fabricating a custom hip implant with significant patient input. By definition, patient-specific or custom implants can be any shape, size, and projection. The patient and surgeon provide the implant fabrication company a paper tracing of the surface area of the proposed implant along with the maximum projection. Engineering creates a 2-dimensional drawing using a computational software for intelligent system design or CAD. The implants are fabricated with input from the surgeon on silastic durometer, implant alterations to lower weight and enhance ease of folding for placement, and shape. Caveats and pitfalls in surgical planning, implant design, fabrication, and surgical placement are identified. Discussion: Body contouring using ultrasound liposuction may provide the desired aesthetic result. When augmentation is requested, fat transfer is the preferred initial procedure. If there is an insufficient volume of fat to augment both the buttocks and hip area, hip fat grafting is preferred to avoid a hip alloplastic implant. The reason for this treatment recommendation is to avoid the hip implant with a higher risk profile. Once the indication for the hip implant is confirmed, usually because of either inadequate presence of fat or a desired maximum hip projection that cannot be attained by fat grafting alone, the body shape analysis is finalized. Conclusion: Custom silastic hip implants are designed, fabricated, and surgically placed to provide the patient desired cosmetic hip augmentation.
{"title":"Concepts in Hip Implant Body Contouring: Patient Evaluation & Implant Fabrication","authors":"R. Troell, B. Eppley, Shahin Javaheri","doi":"10.1177/07488068221101229","DOIUrl":"https://doi.org/10.1177/07488068221101229","url":null,"abstract":"Introduction: One of the most requested aesthetic procedures is body contouring using liposuction. Adjunctive procedures using fat grafting can provide enhancement in most body areas, commonly used in both gluteal and hip augmentation. Performing processing and enrichment to optimize fat transfer survival can avoid the use of body implants. When there is insufficient fat for the desired degree of augmentation, silastic implant placement is an alternative treatment. Much has been written in the medical cosmetic literature regarding gluteal and breast implants, but nothing in terms of hip silastic implants. Material and Methods: Hip implant patient selection, the body frame analysis, associated enhancing body contouring procedures, implant design and fabrication, and implant surgical placement are analyzed. In 3 different cosmetic surgery practices, methods of patient analysis and the process of creating a custom hip implant is presented. Techniques and protocols in the use of fat grafting in association with both gluteal and hip implants are elucidated. Results: The minimally manipulating fat maneuvers to increase fat survival are detailed. This paper defines the process of planning, designing, and fabricating a custom hip implant with significant patient input. By definition, patient-specific or custom implants can be any shape, size, and projection. The patient and surgeon provide the implant fabrication company a paper tracing of the surface area of the proposed implant along with the maximum projection. Engineering creates a 2-dimensional drawing using a computational software for intelligent system design or CAD. The implants are fabricated with input from the surgeon on silastic durometer, implant alterations to lower weight and enhance ease of folding for placement, and shape. Caveats and pitfalls in surgical planning, implant design, fabrication, and surgical placement are identified. Discussion: Body contouring using ultrasound liposuction may provide the desired aesthetic result. When augmentation is requested, fat transfer is the preferred initial procedure. If there is an insufficient volume of fat to augment both the buttocks and hip area, hip fat grafting is preferred to avoid a hip alloplastic implant. The reason for this treatment recommendation is to avoid the hip implant with a higher risk profile. Once the indication for the hip implant is confirmed, usually because of either inadequate presence of fat or a desired maximum hip projection that cannot be attained by fat grafting alone, the body shape analysis is finalized. Conclusion: Custom silastic hip implants are designed, fabricated, and surgically placed to provide the patient desired cosmetic hip augmentation.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129678374","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 : 2022-06-22DOI: 10.1177/07488068221105360
P. Tansley, D. Fleming, T. Brown
The practice of cosmetic surgery is of immense interest across the western world. In Australia, its regulation is currently the subject of three separate administrative processes, all due to report by mid-2022. Cosmetic surgery is typically dealt with at a superficial level by the media and sometimes misrepresented by medical commentators. This article details relevant issues for consideration and in relation to their complexities, which may be of interest to readers in other jurisdictions such as the United States.
{"title":"Cosmetic Surgery Regulation in Australia: Who Is to Be Protected—Surgeons or Patients?","authors":"P. Tansley, D. Fleming, T. Brown","doi":"10.1177/07488068221105360","DOIUrl":"https://doi.org/10.1177/07488068221105360","url":null,"abstract":"The practice of cosmetic surgery is of immense interest across the western world. In Australia, its regulation is currently the subject of three separate administrative processes, all due to report by mid-2022. Cosmetic surgery is typically dealt with at a superficial level by the media and sometimes misrepresented by medical commentators. This article details relevant issues for consideration and in relation to their complexities, which may be of interest to readers in other jurisdictions such as the United States.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130318049","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 : 2022-06-22DOI: 10.1177/07488068221104568
A. Mowlavi, Zachary Sin, Stephanie Young, Chelsea Sahami, V. Sharma
Ex vivo liposuction is a novel technique wherein tissues that are preoperatively planned for excision can be liposuctioned in a sterile manner after removal from the patient. Excised tissues are routinely obtained during a tummy tuck or variant, lateral thigh tuck, buttock tuck, brachioplasty, upper body tuck, and medial thigh tuck. These tucking procedures are performed when moderate to severe skin redundancy is present in patients undergoing body contouring. Traditionally, these tissues were first liposuctioned prior to being excised, termed in vivo liposuction. However, we have developed ex vivo liposuction protocols wherein the tissues are liposuctioned after they have been excised off the patient. Routine processing of harvested fat focuses on minimizing blood products in the aspirate prior to injection. This is because blood products are felt to contain pro-inflammatory products that negatively affect fat graft take. We hypothesized that fat collected by ex vivo technique provides a less bloody harvest than fat collected by in vivo technique. We quantitated blood concentrate of ex vivo versus in vivo fat aspirate by comparing the hemolysis index in 14 consecutive patients undergoing high-definition liposuction and body contouring. Comparison of hemolysis index demonstrated significant reduction in blood concentrate in ex vivo versus in vivo fat aspirate. In vivo hemolysis index demonstrated a larger median than ex vivo hemolysis index. These results confirm our clinical observation that fat harvested by ex vivo liposuction is cleaner and less blood-tinged than fat harvested by in vivo liposuction. No patients experienced complications related to fat graft infection nor fat emboli. Ex vivo liposuction has proven a safe and less blood-tinged technique for harvesting fat in patients who require excisional procedures.
{"title":"Ex Vivo Versus In Vivo Liposuction Hemolysis Index in High-Definition Liposuction and Body Contouring","authors":"A. Mowlavi, Zachary Sin, Stephanie Young, Chelsea Sahami, V. Sharma","doi":"10.1177/07488068221104568","DOIUrl":"https://doi.org/10.1177/07488068221104568","url":null,"abstract":"Ex vivo liposuction is a novel technique wherein tissues that are preoperatively planned for excision can be liposuctioned in a sterile manner after removal from the patient. Excised tissues are routinely obtained during a tummy tuck or variant, lateral thigh tuck, buttock tuck, brachioplasty, upper body tuck, and medial thigh tuck. These tucking procedures are performed when moderate to severe skin redundancy is present in patients undergoing body contouring. Traditionally, these tissues were first liposuctioned prior to being excised, termed in vivo liposuction. However, we have developed ex vivo liposuction protocols wherein the tissues are liposuctioned after they have been excised off the patient. Routine processing of harvested fat focuses on minimizing blood products in the aspirate prior to injection. This is because blood products are felt to contain pro-inflammatory products that negatively affect fat graft take. We hypothesized that fat collected by ex vivo technique provides a less bloody harvest than fat collected by in vivo technique. We quantitated blood concentrate of ex vivo versus in vivo fat aspirate by comparing the hemolysis index in 14 consecutive patients undergoing high-definition liposuction and body contouring. Comparison of hemolysis index demonstrated significant reduction in blood concentrate in ex vivo versus in vivo fat aspirate. In vivo hemolysis index demonstrated a larger median than ex vivo hemolysis index. These results confirm our clinical observation that fat harvested by ex vivo liposuction is cleaner and less blood-tinged than fat harvested by in vivo liposuction. No patients experienced complications related to fat graft infection nor fat emboli. Ex vivo liposuction has proven a safe and less blood-tinged technique for harvesting fat in patients who require excisional procedures.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130113147","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 : 2022-06-15DOI: 10.1177/07488068221099153
R. Troell
Introduction: Optimizing the abdomen aesthetic appearance may combine liposculpture, abdominoplasty, and postsurgical noninvasive body sculpting. The abdominoplasty traditional technique highlights abdominal flap undermining. The Avelar or Saldana lipoabdominoplasty’s technique modifications use liposuction and the absence of undermining of the abdominal wall flap. This method maintains abdominal wall vascularization and lessens complications. Two commonly employed liposuction techniques are power-assisted and ultrasound-assisted liposuction. Combining power-assisted technology with the Separation, Aspiration, Fat Equalization (SAFE) liposuction process has improved aesthetic results and reduced complications. Separation, Aspiration, Fat Equalization liposuction process enrolls separation, aspiration, and fat equalization steps. Ultrasound-assisted liposuction advantages include high-definition body sculpting through maximum fat removal and skin tightening with less blood loss and viable fat for grafting. This clinical study evaluated a comprehensive surgical protocol for lipoabdominoplasty designed to minimize complications. In addition, the study assessed aesthetic outcome and complication differences comparing the use of ultrasound-assisted versus power-assisted liposuction. Materials and Methods: This is a retrospective study in a single surgeon’s private cosmetic practice in 2 practice locations in patients undergoing a modified lipoabdominoplasty technique over a 2-year period. Results: Modified lipoabdominoplasty combining power-assisted technology with SAFE liposuction (n = 30) compared to those using ultrasound-assisted liposuction (n = 20) revealed similar complication rates. Surgeon observation revealed better skin contour smoothness, more abdominal definition and skin tightening with less bruising when using ultrasound liposuction. The comprehensive surgical protocol designed to minimize perioperative complications was implemented on each patient and resulted in no medical errors and a low major and minor complication rate. Conclusions: The lipoabdominoplasty surgical protocol provides surgeon’s comprehensive preoperative, intraoperative, and postoperative guidelines to minimize complications. Higher body mass index increased the complication rate. The aesthetic outcome using ultrasound-assisted liposuction appeared to yield better aesthetic sculpted appearance with less bruising compared to power-assisted technology.
{"title":"Lipoabdominoplasty: Comparing Ultrasound-Assisted and Power-Assisted Techniques","authors":"R. Troell","doi":"10.1177/07488068221099153","DOIUrl":"https://doi.org/10.1177/07488068221099153","url":null,"abstract":"Introduction: Optimizing the abdomen aesthetic appearance may combine liposculpture, abdominoplasty, and postsurgical noninvasive body sculpting. The abdominoplasty traditional technique highlights abdominal flap undermining. The Avelar or Saldana lipoabdominoplasty’s technique modifications use liposuction and the absence of undermining of the abdominal wall flap. This method maintains abdominal wall vascularization and lessens complications. Two commonly employed liposuction techniques are power-assisted and ultrasound-assisted liposuction. Combining power-assisted technology with the Separation, Aspiration, Fat Equalization (SAFE) liposuction process has improved aesthetic results and reduced complications. Separation, Aspiration, Fat Equalization liposuction process enrolls separation, aspiration, and fat equalization steps. Ultrasound-assisted liposuction advantages include high-definition body sculpting through maximum fat removal and skin tightening with less blood loss and viable fat for grafting. This clinical study evaluated a comprehensive surgical protocol for lipoabdominoplasty designed to minimize complications. In addition, the study assessed aesthetic outcome and complication differences comparing the use of ultrasound-assisted versus power-assisted liposuction. Materials and Methods: This is a retrospective study in a single surgeon’s private cosmetic practice in 2 practice locations in patients undergoing a modified lipoabdominoplasty technique over a 2-year period. Results: Modified lipoabdominoplasty combining power-assisted technology with SAFE liposuction (n = 30) compared to those using ultrasound-assisted liposuction (n = 20) revealed similar complication rates. Surgeon observation revealed better skin contour smoothness, more abdominal definition and skin tightening with less bruising when using ultrasound liposuction. The comprehensive surgical protocol designed to minimize perioperative complications was implemented on each patient and resulted in no medical errors and a low major and minor complication rate. Conclusions: The lipoabdominoplasty surgical protocol provides surgeon’s comprehensive preoperative, intraoperative, and postoperative guidelines to minimize complications. Higher body mass index increased the complication rate. The aesthetic outcome using ultrasound-assisted liposuction appeared to yield better aesthetic sculpted appearance with less bruising compared to power-assisted technology.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123164380","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 : 2022-05-02DOI: 10.1177/07488068221094452
N. Homer, Justin N. Karlin, Alison H. Watson, Marie B. Somogyi, Emily M. Bratton, R. Goldberg, Tanuj Nakra
Purpose: Facial nerve palsy may lead to significant functional facial and ocular morbidity. Soft tissue resuspension may improve both functional and aesthetic defects. We have adapted a minimally invasive midface suspension, which may be easily combined with routine paretic periocular rehabilitation to optimize outcomes. Methods: A retrospective review of patients with unilateral facial nerve palsy who underwent midcheek release and suture suspension simultaneous with periocular surgical rehabilitation at 2 surgical centers was performed. A temporal incision was made and dissection carried along the deep temporalis fascia to the lateral orbital rim. Dissection was continued subperiosteally along the anterior face of the maxilla to the piriform aperture. In severe cases, a second incision via superior buccal sulcus was utilized to maximize cheek soft tissue mobilization. Through 3 separate stab incisions along the nasolabial fold each end of a 0-0 permanent braided suture on a Keith needle was used to engage and elevate cheek soft tissues, secured at the deep temporalis fascia. Results: Seven patients (mean age 69 years) with unilateral facial nerve palsy and symptomatic facial droop underwent midface suture suspension simultaneous to eyelid reconstruction. With an average follow-up of 8.7 months, all patients demonstrated lasting improvement in facial asymmetry and reported satisfaction with their results. There were no significant postoperative complications. Conclusions: Midfacial static soft tissue resuspension is an effective minimally invasive surgical option for static facial rehabilitation in patients with facial nerve paralysis that can be performed at the time of periocular rehabilitation to enhance functional and aesthetic outcomes.
{"title":"Suture Cheek Suspension Augments Periorbital Aesthetic Rehabilitation in Facial Nerve Palsy","authors":"N. Homer, Justin N. Karlin, Alison H. Watson, Marie B. Somogyi, Emily M. Bratton, R. Goldberg, Tanuj Nakra","doi":"10.1177/07488068221094452","DOIUrl":"https://doi.org/10.1177/07488068221094452","url":null,"abstract":"Purpose: Facial nerve palsy may lead to significant functional facial and ocular morbidity. Soft tissue resuspension may improve both functional and aesthetic defects. We have adapted a minimally invasive midface suspension, which may be easily combined with routine paretic periocular rehabilitation to optimize outcomes. Methods: A retrospective review of patients with unilateral facial nerve palsy who underwent midcheek release and suture suspension simultaneous with periocular surgical rehabilitation at 2 surgical centers was performed. A temporal incision was made and dissection carried along the deep temporalis fascia to the lateral orbital rim. Dissection was continued subperiosteally along the anterior face of the maxilla to the piriform aperture. In severe cases, a second incision via superior buccal sulcus was utilized to maximize cheek soft tissue mobilization. Through 3 separate stab incisions along the nasolabial fold each end of a 0-0 permanent braided suture on a Keith needle was used to engage and elevate cheek soft tissues, secured at the deep temporalis fascia. Results: Seven patients (mean age 69 years) with unilateral facial nerve palsy and symptomatic facial droop underwent midface suture suspension simultaneous to eyelid reconstruction. With an average follow-up of 8.7 months, all patients demonstrated lasting improvement in facial asymmetry and reported satisfaction with their results. There were no significant postoperative complications. Conclusions: Midfacial static soft tissue resuspension is an effective minimally invasive surgical option for static facial rehabilitation in patients with facial nerve paralysis that can be performed at the time of periocular rehabilitation to enhance functional and aesthetic outcomes.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121417975","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 : 2022-04-12DOI: 10.1177/07488068221079101
J. Alford, R. Jackson, C. Lowery
Our patient presents with a unique case of both functional and cosmetic concerns following colectomy for the treatment of Crohn’s disease with subsequent massive weight loss following bariatric surgery. She desires abdominoplasty to address these concerns. Thorough preoperative planning and work up set the ground work for a successful procedure. We’ve shared our intraoperative approach, which has never before been published in the literature. Following her procedure, the patient had a mostly uneventful postoperative course. Her functional and cosmetic concerns were addressed with the procedure. The surgical outcome exceeded her expectations. Patients seeking body contouring surgery following bariatric surgery can be expected to increase. We suspect there may be other patients similar to ours that are experiencing similar functional and cosmetic concerns that can be addressed with cosmetic surgery. Due to the extremely unique nature of this case, we’ve shared our approach in hopes that our success can serve as a resource to other surgeons with similar patients.
{"title":"A Case Report of Cosmetic Abdominoplasty in a Patient With Colostomy Appliance","authors":"J. Alford, R. Jackson, C. Lowery","doi":"10.1177/07488068221079101","DOIUrl":"https://doi.org/10.1177/07488068221079101","url":null,"abstract":"Our patient presents with a unique case of both functional and cosmetic concerns following colectomy for the treatment of Crohn’s disease with subsequent massive weight loss following bariatric surgery. She desires abdominoplasty to address these concerns. Thorough preoperative planning and work up set the ground work for a successful procedure. We’ve shared our intraoperative approach, which has never before been published in the literature. Following her procedure, the patient had a mostly uneventful postoperative course. Her functional and cosmetic concerns were addressed with the procedure. The surgical outcome exceeded her expectations. Patients seeking body contouring surgery following bariatric surgery can be expected to increase. We suspect there may be other patients similar to ours that are experiencing similar functional and cosmetic concerns that can be addressed with cosmetic surgery. Due to the extremely unique nature of this case, we’ve shared our approach in hopes that our success can serve as a resource to other surgeons with similar patients.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"os-23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127767366","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 : 2022-04-09DOI: 10.1177/07488068221088114
T. Brown
Requests for removal of silicone breast implants are increasingly common. Often patients request a capsulectomy in either a total or “en bloc” form. Capsulectomy adds time, cost, and morbidity to removal of implant procedures. This article examines the reasoning given by practitioners for undertaking the procedure, and reviews the literature to examine the validity of those arguments. Except where pathology of the capsule is demonstrable (Breast implant related anaplastic large cell lymphoma, BIR-ALCL), there is currently no indication for prophylactic removal of capsules following removal of breast implants. Given the potential risks, and lack of evidence for the procedure, both patient and surgeons should be aware of the potential consequences.
{"title":"The Case Against Capsulectomies When Removing Silicone Breast Implants","authors":"T. Brown","doi":"10.1177/07488068221088114","DOIUrl":"https://doi.org/10.1177/07488068221088114","url":null,"abstract":"Requests for removal of silicone breast implants are increasingly common. Often patients request a capsulectomy in either a total or “en bloc” form. Capsulectomy adds time, cost, and morbidity to removal of implant procedures. This article examines the reasoning given by practitioners for undertaking the procedure, and reviews the literature to examine the validity of those arguments. Except where pathology of the capsule is demonstrable (Breast implant related anaplastic large cell lymphoma, BIR-ALCL), there is currently no indication for prophylactic removal of capsules following removal of breast implants. Given the potential risks, and lack of evidence for the procedure, both patient and surgeons should be aware of the potential consequences.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129947605","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 : 2022-04-02DOI: 10.1177/07488068221090080
Talon Maningas, H. Ramirez, Kindall Martin
Radiofrequency (RF) microneedling requires minimal downtime; however, patients’ tolerance of the procedural pain can limit cosmetic results. The goal of this study was to determine the patient tolerance of RF microneedling with sufentanil sublingual tablet (SST) 30 μg and topical local anesthetic compared with topical local anesthetic alone. The study was a one-way crossover study of patients undergoing RF microneedling of the face or abdomen. Topical local anesthetic was applied 45 minutes prior to the initial procedure to one side of the face or abdomen (control side), followed by topical local anesthetic and SST administered 45 and 30 minutes, respectively, prior to the procedure on the opposite side (SST-treated side). The primary endpoint was patient completion of the procedure with additional endpoints of Richmond Agitation Sedation Scale scores, patient and provider satisfaction ratings, vital signs, oxygen saturation levels, and adverse events. A total of 51 patients were enrolled averaging 44.8 ± 11.1 (SD) years of age. Forty-five percent of patients successfully completed the control side compared with 96% of patients successfully completing the SST-treated side ( P < .001). Patients were less restless or agitated during the SST-treated side (6%) compared with the control side (51%; P < .001). Patient and provider satisfaction scores were significantly improved with SST ( P < .001). Vital signs remained stable with SST treatment compared with the control side. The SST is a safe and effective sublingual analgesic allowing patients to be awake and alert while increasing patient tolerance of RF microneedling as well as patient and provider satisfaction with the procedure. The SST is a novel analgesic that can be used in office-based settings with appropriate safety equipment available.
{"title":"Novel Sublingual Analgesic Improves Patient Tolerance of Face and Body Radiofrequency Microneedling: A Split Face/Abdomen Study","authors":"Talon Maningas, H. Ramirez, Kindall Martin","doi":"10.1177/07488068221090080","DOIUrl":"https://doi.org/10.1177/07488068221090080","url":null,"abstract":"Radiofrequency (RF) microneedling requires minimal downtime; however, patients’ tolerance of the procedural pain can limit cosmetic results. The goal of this study was to determine the patient tolerance of RF microneedling with sufentanil sublingual tablet (SST) 30 μg and topical local anesthetic compared with topical local anesthetic alone. The study was a one-way crossover study of patients undergoing RF microneedling of the face or abdomen. Topical local anesthetic was applied 45 minutes prior to the initial procedure to one side of the face or abdomen (control side), followed by topical local anesthetic and SST administered 45 and 30 minutes, respectively, prior to the procedure on the opposite side (SST-treated side). The primary endpoint was patient completion of the procedure with additional endpoints of Richmond Agitation Sedation Scale scores, patient and provider satisfaction ratings, vital signs, oxygen saturation levels, and adverse events. A total of 51 patients were enrolled averaging 44.8 ± 11.1 (SD) years of age. Forty-five percent of patients successfully completed the control side compared with 96% of patients successfully completing the SST-treated side ( P < .001). Patients were less restless or agitated during the SST-treated side (6%) compared with the control side (51%; P < .001). Patient and provider satisfaction scores were significantly improved with SST ( P < .001). Vital signs remained stable with SST treatment compared with the control side. The SST is a safe and effective sublingual analgesic allowing patients to be awake and alert while increasing patient tolerance of RF microneedling as well as patient and provider satisfaction with the procedure. The SST is a novel analgesic that can be used in office-based settings with appropriate safety equipment available.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114345915","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}
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