Pub Date : 2021-10-07DOI: 10.1177/07488068211047086
A. Mowlavi, Rebecca L. Van Alstine, Mariam Berri, Samar Arshad, Michael Ablavsky, S. Kachare, B. Wilhelmi
Purpose: Botulinum toxin (BTX) injections are used in cosmetic surgery to efface facial wrinkles. Botulinum toxin relaxes the muscle by preventing the release of the neurotransmitter acetylcholine at the neuromuscular junction located at the posterior muscle surface causing local muscle paralysis. The purpose of this study is to provide anatomic knowledge of muscle belly depths of the frontalis, corrugator supercilii, procerus, and orbicularis oculi muscles in an attempt to improve the efficacy of BTX treatment of glabellar, forehead, and lateral eyelid rhytides. Methods: Six-millimeter punch biopsies were obtained from 7 fresh cadavers. Biopsies were taken from the corrugator supercilii, frontalis, procerus, and orbicularis oculi muscles at the sites of routine BTX injection. Specimens were fixed in formalin, and representative H&E-stained sections were used to measure muscle surface depths by light microscopy equipped with digital camera that includes a digital micrometer. One-way analysis of variance test analyses were used to identify statistical differences between measured muscle depths. Results: The measured anterior muscle depth of the corrugator supercilii, frontalis, procerus, and orbicularis oculi was found to be 4.2 ± 0.6, 3.9 ± 0.6, 2.9 ± 0.4, and 2.3 ± 0.7 mm, respectively. The anterior muscle surface of the corrugator supercilii and frontalis was found to be deeper than that of the procerus and orbicularis oculi (P < .001). The posterior surface depth of the corrugator supercilii, frontalis, procerus, and orbicularis oculi was found to be 6.6 ± 0.8, 5.1 ± 0.7, 4.9 ± 0.7, and 3.8 ± 1.0 mm, respectively. The posterior surface depth of the corrugator supercilii was found to be significantly deeper than that of the frontalis, procerus, and orbicularis oculi (P < .001); the posterior surface depth of the frontalis and procerus was deeper than that of the orbicularis oculi (P < .001). The muscle belly width of the corrugator supercilii, frontalis, procerus, and orbicularis oculi measured 2.5 ± 0.9, 1.1 ± 0.4, 2.0 ± 0.6, and 1.5 ± 0.5 mm, respectively. The corrugator supercilii was found to be thicker than the frontalis and orbicularis oculi, while the procerus was found to be thicker than the frontalis (P < .001). Conclusion: The findings above demonstrate statistical differences in the posterior muscle surface depth of the corrugator supercilii, frontalis, procerus, and orbicularis oculi which can be used clinically to improve BTX injection efficacy when used to efface facial rhytides.
{"title":"Analysis of Facial Muscle Depths to Guide Botulinum Toxin Therapy of the Periocular Region","authors":"A. Mowlavi, Rebecca L. Van Alstine, Mariam Berri, Samar Arshad, Michael Ablavsky, S. Kachare, B. Wilhelmi","doi":"10.1177/07488068211047086","DOIUrl":"https://doi.org/10.1177/07488068211047086","url":null,"abstract":"Purpose: Botulinum toxin (BTX) injections are used in cosmetic surgery to efface facial wrinkles. Botulinum toxin relaxes the muscle by preventing the release of the neurotransmitter acetylcholine at the neuromuscular junction located at the posterior muscle surface causing local muscle paralysis. The purpose of this study is to provide anatomic knowledge of muscle belly depths of the frontalis, corrugator supercilii, procerus, and orbicularis oculi muscles in an attempt to improve the efficacy of BTX treatment of glabellar, forehead, and lateral eyelid rhytides. Methods: Six-millimeter punch biopsies were obtained from 7 fresh cadavers. Biopsies were taken from the corrugator supercilii, frontalis, procerus, and orbicularis oculi muscles at the sites of routine BTX injection. Specimens were fixed in formalin, and representative H&E-stained sections were used to measure muscle surface depths by light microscopy equipped with digital camera that includes a digital micrometer. One-way analysis of variance test analyses were used to identify statistical differences between measured muscle depths. Results: The measured anterior muscle depth of the corrugator supercilii, frontalis, procerus, and orbicularis oculi was found to be 4.2 ± 0.6, 3.9 ± 0.6, 2.9 ± 0.4, and 2.3 ± 0.7 mm, respectively. The anterior muscle surface of the corrugator supercilii and frontalis was found to be deeper than that of the procerus and orbicularis oculi (P < .001). The posterior surface depth of the corrugator supercilii, frontalis, procerus, and orbicularis oculi was found to be 6.6 ± 0.8, 5.1 ± 0.7, 4.9 ± 0.7, and 3.8 ± 1.0 mm, respectively. The posterior surface depth of the corrugator supercilii was found to be significantly deeper than that of the frontalis, procerus, and orbicularis oculi (P < .001); the posterior surface depth of the frontalis and procerus was deeper than that of the orbicularis oculi (P < .001). The muscle belly width of the corrugator supercilii, frontalis, procerus, and orbicularis oculi measured 2.5 ± 0.9, 1.1 ± 0.4, 2.0 ± 0.6, and 1.5 ± 0.5 mm, respectively. The corrugator supercilii was found to be thicker than the frontalis and orbicularis oculi, while the procerus was found to be thicker than the frontalis (P < .001). Conclusion: The findings above demonstrate statistical differences in the posterior muscle surface depth of the corrugator supercilii, frontalis, procerus, and orbicularis oculi which can be used clinically to improve BTX injection efficacy when used to efface facial rhytides.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134158877","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 : 2021-10-05DOI: 10.1177/07488068211051437
{"title":"Corrigendum to “Ten Women Cosmetic Surgeons Comment on Their Cosmetic Fellowship Experiences”","authors":"","doi":"10.1177/07488068211051437","DOIUrl":"https://doi.org/10.1177/07488068211051437","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130004721","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 : 2021-09-28DOI: 10.1177/07488068211045519
J. Petro
{"title":"Book Review: Textbook of Plastic, Reconstructive, and Aesthetic Surgery Volume VI, by Kuldeep Singh","authors":"J. Petro","doi":"10.1177/07488068211045519","DOIUrl":"https://doi.org/10.1177/07488068211045519","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116477112","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 : 2021-09-19DOI: 10.1177/07488068211043740
Nalin Dayal, Joseph B Castellano
Mastopexy has become a widely popularized procedure across the country over the last 20 years. Women have seen the benefits of various forms of breast lifts to correct breast ptosis. While older teachings focused on mastopexy and augmentation as separate, staged procedures, many centers now perform both simultaneously. Our center primarily performs mastopexy procedures with simultaneous augmentation with implants, and we reviewed 260 patient charts to examine complications when compared to mastopexy alone. Complications reviewed include the following: hematoma formation, incision openings, and revision surgeries. Our data showed only minor rates of hematoma formation, incision openings, and revision surgeries with a negligible difference between the 2 groups. Patients in both groups overall had few surgical complications. Patients undergoing mastopexy with simultaneous augmentation had similar rates of complications when compared to patients with mastopexy alone. Many previously believed that simultaneous augmentation with mastopexy would place too much tension on the mastopexy incisions due to the rapid breast volume increase. However, with no significant changes in complications between the groups, it is clear that surgical technique and planning has improved to allow this to be a safely performed single-staged procedure. Overall, we had minimal complications and show that mastopexy with simultaneous augmentation is safe for patients who desire these procedures.
{"title":"Single-Staged Mastopexy With Augmentation: A Retrospective Review of 260 Patients in a Single Surgeon Practice","authors":"Nalin Dayal, Joseph B Castellano","doi":"10.1177/07488068211043740","DOIUrl":"https://doi.org/10.1177/07488068211043740","url":null,"abstract":"Mastopexy has become a widely popularized procedure across the country over the last 20 years. Women have seen the benefits of various forms of breast lifts to correct breast ptosis. While older teachings focused on mastopexy and augmentation as separate, staged procedures, many centers now perform both simultaneously. Our center primarily performs mastopexy procedures with simultaneous augmentation with implants, and we reviewed 260 patient charts to examine complications when compared to mastopexy alone. Complications reviewed include the following: hematoma formation, incision openings, and revision surgeries. Our data showed only minor rates of hematoma formation, incision openings, and revision surgeries with a negligible difference between the 2 groups. Patients in both groups overall had few surgical complications. Patients undergoing mastopexy with simultaneous augmentation had similar rates of complications when compared to patients with mastopexy alone. Many previously believed that simultaneous augmentation with mastopexy would place too much tension on the mastopexy incisions due to the rapid breast volume increase. However, with no significant changes in complications between the groups, it is clear that surgical technique and planning has improved to allow this to be a safely performed single-staged procedure. Overall, we had minimal complications and show that mastopexy with simultaneous augmentation is safe for patients who desire these procedures.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115492514","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 : 2021-09-18DOI: 10.1177/07488068211043980
R. Cristel, Alexander J Caniglia
Introduction: Residency training courses are fundamental to an Otolaryngology (ENT) residency curriculum. Neurotoxin and filler injections have become common during ENT residency, and the outcomes of training courses have not been previously evaluated. We hypothesize that after participating in the course, resident knowledge, skill, and likelihood of using neurotoxin and filler injections in future practice will significantly improve. Materials and Methods: A prospective study was designed among ENT residents undergoing neurotoxin and filler injection educational training courses from April 2019 to November 2020. After the completion of the course and injections, residents completed a self-evaluation to assess their level of knowledge and skill level with neurotoxin and filler injections. Results: The mean number of neurotoxin and filler injections besides within the course was 1.67 and 0.33, whereas during the course was 3.39 (P = .008) and 1.39 (P = .0009), respectively. Resident knowledge, skill, and likelihood of using neurotoxin and filler injections in future practice all significantly improved (P < .05). This study found that a biannual training course for neurotoxin and injectable fillers was an effective strategy at improving resident knowledge, skill, and likelihood of use in future practice.
{"title":"Evaluation of Neurotoxin and Filler Injection Training in Otolaryngology Residency","authors":"R. Cristel, Alexander J Caniglia","doi":"10.1177/07488068211043980","DOIUrl":"https://doi.org/10.1177/07488068211043980","url":null,"abstract":"Introduction: Residency training courses are fundamental to an Otolaryngology (ENT) residency curriculum. Neurotoxin and filler injections have become common during ENT residency, and the outcomes of training courses have not been previously evaluated. We hypothesize that after participating in the course, resident knowledge, skill, and likelihood of using neurotoxin and filler injections in future practice will significantly improve. Materials and Methods: A prospective study was designed among ENT residents undergoing neurotoxin and filler injection educational training courses from April 2019 to November 2020. After the completion of the course and injections, residents completed a self-evaluation to assess their level of knowledge and skill level with neurotoxin and filler injections. Results: The mean number of neurotoxin and filler injections besides within the course was 1.67 and 0.33, whereas during the course was 3.39 (P = .008) and 1.39 (P = .0009), respectively. Resident knowledge, skill, and likelihood of using neurotoxin and filler injections in future practice all significantly improved (P < .05). This study found that a biannual training course for neurotoxin and injectable fillers was an effective strategy at improving resident knowledge, skill, and likelihood of use in future practice.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126545025","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 : 2021-09-14DOI: 10.1177/07488068211044027
Scott Bueno, Blake Nguyen Lam, Mohammed J. Al-Obaidi, T. Schlieve
This case report demonstrates the usage of a bioabsorbable nasal implant (BNI) in conjunction with an aesthetic septorhinoplasty. The authors uniquely chose to use this allograft due to inadequate autologous tissue secondary to previously performed temporomandibular joint arthroplasties. In addition to evaluating our case of a 22-year-old woman who received a BNI with an aesthetic septorhinoplasty, the authors performed a comprehensive literature review on the topic. Spanning 3 databases (Scopus, PubMed, and Cochrane), this review revealed 4 primary studies, totaling 349 patients. Each utilized nasal obstruction symptom evaluation (NOSE) scores to subjectively measure symptomatic improvement. We chose to use the NOSE questionnaire on our patient both preoperatively and postoperatively, in order to help demonstrate subjective improvement. The patient’s functional and aesthetic concerns were addressed in the operating room at Parkland Memorial Hospital under general anesthesia. Notably, the patient had previously had conchal cartilage harvested bilaterally, had insufficient septal cartilage for adequate grafting, and did not desire to undergo costal cartilage harvest. Therefore, all parties agreed to use a BNI to complete the functional component of the patient’s septorhinoplasty. This day-surgery first focused on the aesthetic septorhinoplasty followed by the placement of the BNI bilaterally. Following an uneventful postoperative course, our patient endorsed not only an aesthetic improvement but also an 88% functional improvement based on her NOSE score within 4 months of surgery. The authors were able to successfully integrate functional as well as aesthetic septorhinoplasty techniques under the constraints of having both limited autologous tissue and limited accepted options from the patient. For the patient and provider team, this newer allograft was confirmed to be effective and efficient. With the correct patient selection, this is an excellent adjunct procedure that can be quickly and safely performed either in conjunction with surgical rhinoplasty or as a standalone procedure by facial surgeons.
{"title":"Combining Aesthetic Septorhinoplasty With Bioabsorbable Implants for Nasal Valve Insufficiency","authors":"Scott Bueno, Blake Nguyen Lam, Mohammed J. Al-Obaidi, T. Schlieve","doi":"10.1177/07488068211044027","DOIUrl":"https://doi.org/10.1177/07488068211044027","url":null,"abstract":"This case report demonstrates the usage of a bioabsorbable nasal implant (BNI) in conjunction with an aesthetic septorhinoplasty. The authors uniquely chose to use this allograft due to inadequate autologous tissue secondary to previously performed temporomandibular joint arthroplasties. In addition to evaluating our case of a 22-year-old woman who received a BNI with an aesthetic septorhinoplasty, the authors performed a comprehensive literature review on the topic. Spanning 3 databases (Scopus, PubMed, and Cochrane), this review revealed 4 primary studies, totaling 349 patients. Each utilized nasal obstruction symptom evaluation (NOSE) scores to subjectively measure symptomatic improvement. We chose to use the NOSE questionnaire on our patient both preoperatively and postoperatively, in order to help demonstrate subjective improvement. The patient’s functional and aesthetic concerns were addressed in the operating room at Parkland Memorial Hospital under general anesthesia. Notably, the patient had previously had conchal cartilage harvested bilaterally, had insufficient septal cartilage for adequate grafting, and did not desire to undergo costal cartilage harvest. Therefore, all parties agreed to use a BNI to complete the functional component of the patient’s septorhinoplasty. This day-surgery first focused on the aesthetic septorhinoplasty followed by the placement of the BNI bilaterally. Following an uneventful postoperative course, our patient endorsed not only an aesthetic improvement but also an 88% functional improvement based on her NOSE score within 4 months of surgery. The authors were able to successfully integrate functional as well as aesthetic septorhinoplasty techniques under the constraints of having both limited autologous tissue and limited accepted options from the patient. For the patient and provider team, this newer allograft was confirmed to be effective and efficient. With the correct patient selection, this is an excellent adjunct procedure that can be quickly and safely performed either in conjunction with surgical rhinoplasty or as a standalone procedure by facial surgeons.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128979970","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 : 2021-09-01DOI: 10.1177/0748806820971065
{"title":"Ten Women Cosmetic Surgeons Comment on Their Cosmetic Fellowship Experiences","authors":"","doi":"10.1177/0748806820971065","DOIUrl":"https://doi.org/10.1177/0748806820971065","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130314298","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 : 2021-08-19DOI: 10.1177/07488068211039054
Allison Altman, Zachary Sin, Erik Dan Tran, Jeanie Nguyen, A. Mowlavi
In this study, we explore the changes in the earlobe segments following an extended superficial musculoaponeurotic system (SMAS) face-lift and neck lift. We proposed to delineate the effect of the cheek and neck skin tension vectors on the earlobe based on the amount of excised skin length. A retrospective study identified patients who underwent extended SMAS rhytidectomy performed by the senior author (A.M.) at the Cosmetic Plastic Surgery Institute (CPSI) from 2017 to 2020. A total of 34 North American Caucasians, who had preoperative and postoperative photographs available for comparison, were evaluated. Preoperative and postoperative cephalic (the distance from the intertragal notch to the otobasion inferius, abbreviated as I to O) and caudal earlobe segment (the distance from the otobasion inferius to the subaurale, abbreviated as O to S) heights were collected. The change from the postoperative to preoperative measurements was calculated. The effects of the degree of cheek skin (superior ear [SE]) and neck skin (mastoid peak [MP]) excision lengths were then determined by comparing the change in I to O and O to S. The postoperative attached cephalic segment (15.94 ± 1.02 mm) increased significantly compared with the preoperative attached cephalic segment (12.99 ± 1.03 mm). The postoperative free caudal segment (3.62 ± 0.81 mm) decreased significantly compared with the preoperative free caudal segment (5.44 ± 0.95 mm). The SE median was found to be 3.0 cm and the MP median was found to be 3.5 cm. I to O increased by 3.85 mm for SE ≤3.0 cm compared with only 1.57 mm for SE >3.0 cm. O to S decreased by 2.79 mm for SE ≤3.0 cm compared with only decrease of 0.14 mm for SE >3.0 cm. I to O increased by only 1.67 mm for MP < 3.5 cm. O to S decreased less dramatically by 0.55 mm for MP ≤3.5 cm compared with decrease of 2.39 mm for MP >3.5 cm. These data demonstrate that more aggressive SE >3.0 cm cheek excision lengths resulted in a protective effect on decreasing the free caudal segment of the earlobe. More aggressive excisions of the cheek demonstrate a protective effect on preserving the free earlobe caudal segment, whereas more aggressive neck skin excisions result in higher propensity for loss of the free earlobe caudal segment. In our study, we demonstrate findings observed with clinical observations that a face-lift and neck lift will result in increase in the attached cephalic earlobe segment height (I to O) and a decrease in caudal free earlobe segment height (O to S). These findings may assist plastic surgeons when trying to fine-tune the earlobe aesthetics during face-lift and neck lift. If the patient has a small free hanging earlobe, the more aggressive pull on the cheek flap will result in less reduction in the earlobe hang.
{"title":"The Effect of Extended SMAS Face-lift on Earlobe Ptosis and Pseudoptosis","authors":"Allison Altman, Zachary Sin, Erik Dan Tran, Jeanie Nguyen, A. Mowlavi","doi":"10.1177/07488068211039054","DOIUrl":"https://doi.org/10.1177/07488068211039054","url":null,"abstract":"In this study, we explore the changes in the earlobe segments following an extended superficial musculoaponeurotic system (SMAS) face-lift and neck lift. We proposed to delineate the effect of the cheek and neck skin tension vectors on the earlobe based on the amount of excised skin length. A retrospective study identified patients who underwent extended SMAS rhytidectomy performed by the senior author (A.M.) at the Cosmetic Plastic Surgery Institute (CPSI) from 2017 to 2020. A total of 34 North American Caucasians, who had preoperative and postoperative photographs available for comparison, were evaluated. Preoperative and postoperative cephalic (the distance from the intertragal notch to the otobasion inferius, abbreviated as I to O) and caudal earlobe segment (the distance from the otobasion inferius to the subaurale, abbreviated as O to S) heights were collected. The change from the postoperative to preoperative measurements was calculated. The effects of the degree of cheek skin (superior ear [SE]) and neck skin (mastoid peak [MP]) excision lengths were then determined by comparing the change in I to O and O to S. The postoperative attached cephalic segment (15.94 ± 1.02 mm) increased significantly compared with the preoperative attached cephalic segment (12.99 ± 1.03 mm). The postoperative free caudal segment (3.62 ± 0.81 mm) decreased significantly compared with the preoperative free caudal segment (5.44 ± 0.95 mm). The SE median was found to be 3.0 cm and the MP median was found to be 3.5 cm. I to O increased by 3.85 mm for SE ≤3.0 cm compared with only 1.57 mm for SE >3.0 cm. O to S decreased by 2.79 mm for SE ≤3.0 cm compared with only decrease of 0.14 mm for SE >3.0 cm. I to O increased by only 1.67 mm for MP < 3.5 cm. O to S decreased less dramatically by 0.55 mm for MP ≤3.5 cm compared with decrease of 2.39 mm for MP >3.5 cm. These data demonstrate that more aggressive SE >3.0 cm cheek excision lengths resulted in a protective effect on decreasing the free caudal segment of the earlobe. More aggressive excisions of the cheek demonstrate a protective effect on preserving the free earlobe caudal segment, whereas more aggressive neck skin excisions result in higher propensity for loss of the free earlobe caudal segment. In our study, we demonstrate findings observed with clinical observations that a face-lift and neck lift will result in increase in the attached cephalic earlobe segment height (I to O) and a decrease in caudal free earlobe segment height (O to S). These findings may assist plastic surgeons when trying to fine-tune the earlobe aesthetics during face-lift and neck lift. If the patient has a small free hanging earlobe, the more aggressive pull on the cheek flap will result in less reduction in the earlobe hang.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121744200","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 : 2021-08-13DOI: 10.1177/07488068211032731
A. Mowlavi, Bryce Bash, Shea Skenderian, Zachary Sin
Background: Superior displacement of implants is a common complication in the early postoperative period following breast augmentation surgery. Postoperative breast bands are used during the first 4 weeks to optimize breast implant position following breast augmentation and reconstructive procedures. Although currently available breast bands are effective in maintaining implants in an inferior position, they have been observed to irritate the armpit region. We hypothesized that a modified breast band geometry with cut outs to accommodate the armpit region would provide equal maintenance of desired implant position while providing improved postoperative comfort. Methods: Forty patients who underwent breast augmentation and/or reconstruction were randomly assigned to receive either the traditional breast band or the modified cut out designed breast band following surgery for 4 weeks. Patients rated their breast bands on a 1 to 10 scale regarding (1) comfort, (2) appearance, and (3) overall satisfaction at their routine postoperative visits at 1, 2, and 4 weeks following surgery. Results: The modified breast band scored higher for all factors at 1, 2, and 4 weeks following surgery. The traditional band demonstrated decreasing scores for comfort and overall satisfaction when compared at 4 weeks versus 1 week. There was no change in the modified breast band scores for comfort, appearance, nor overall satisfaction over the same time period. Discussion: This study of 40 patients found that the modified band provides equally effective maintenance of implants in a desired position without compromising comfort and appearance. Patients who used the modified band had a better experience with the band comfort, appearance, and overall satisfaction in comparison to the traditional band. The higher ratings for the cut out band for comfort, appearance, and overall satisfaction were consistent from week 1 to 4. Conclusion: In contrast, the traditional band not only scored lower in comfort, appearance, and overall satisfaction compared to the modified band but also demonstrated significant decrease in the patients’ ratings for comfort and overall satisfaction for the traditional band from week 1 to 4. This study supports the conclusion that a modified cut out breast band design provides an equally effective maintenance of implants in a desired position without compromising comfort, appearance, and overall satisfaction when compared to the traditional band.
{"title":"Modified Breast Band Improving the Postoperative Breast Augmentation and Reconstructive Experience","authors":"A. Mowlavi, Bryce Bash, Shea Skenderian, Zachary Sin","doi":"10.1177/07488068211032731","DOIUrl":"https://doi.org/10.1177/07488068211032731","url":null,"abstract":"Background: Superior displacement of implants is a common complication in the early postoperative period following breast augmentation surgery. Postoperative breast bands are used during the first 4 weeks to optimize breast implant position following breast augmentation and reconstructive procedures. Although currently available breast bands are effective in maintaining implants in an inferior position, they have been observed to irritate the armpit region. We hypothesized that a modified breast band geometry with cut outs to accommodate the armpit region would provide equal maintenance of desired implant position while providing improved postoperative comfort. Methods: Forty patients who underwent breast augmentation and/or reconstruction were randomly assigned to receive either the traditional breast band or the modified cut out designed breast band following surgery for 4 weeks. Patients rated their breast bands on a 1 to 10 scale regarding (1) comfort, (2) appearance, and (3) overall satisfaction at their routine postoperative visits at 1, 2, and 4 weeks following surgery. Results: The modified breast band scored higher for all factors at 1, 2, and 4 weeks following surgery. The traditional band demonstrated decreasing scores for comfort and overall satisfaction when compared at 4 weeks versus 1 week. There was no change in the modified breast band scores for comfort, appearance, nor overall satisfaction over the same time period. Discussion: This study of 40 patients found that the modified band provides equally effective maintenance of implants in a desired position without compromising comfort and appearance. Patients who used the modified band had a better experience with the band comfort, appearance, and overall satisfaction in comparison to the traditional band. The higher ratings for the cut out band for comfort, appearance, and overall satisfaction were consistent from week 1 to 4. Conclusion: In contrast, the traditional band not only scored lower in comfort, appearance, and overall satisfaction compared to the modified band but also demonstrated significant decrease in the patients’ ratings for comfort and overall satisfaction for the traditional band from week 1 to 4. This study supports the conclusion that a modified cut out breast band design provides an equally effective maintenance of implants in a desired position without compromising comfort, appearance, and overall satisfaction when compared to the traditional band.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134315721","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 : 2021-07-31DOI: 10.1177/07488068211032456
Roland Böni, Paul von Waechter-Gniadek
In power-assisted high definition liposuction (PA-HDL), large areas of the body surface are treated, followed by superficial aspiration along definition lines between muscle groups. Both factors can contribute to seroma formation. The purpose of this study was to evaluate if the use of vibration amplification of sound energy at resonance (VASER) prior to PA-HDL would increase the frequency of seroma formation. In this retrospective study, 164 male patients underwent PA-HDL with (n = 82) or without VASER (n = 82). No drains were used. Lymphatic drainage was performed in all patients. Seroma formation was determined by physical examination 1 and 2 weeks postoperatively. The incidence of seroma was 11% (n = 9) in the group with VASER treatment prior to PA-HDL, and 4.9% (n = 4) in the group without previous VASER use. The difference was statistically not significant (P > .05). The most frequent area of seroma formation was at the lower part of the linea semilunaris. PA-HDL has an increased risk of seroma formation, which in our series was mainly located at the lower part of the linea semilunaris. VASER treatment prior to PA-HDL showed a tendency to further increase the risk of seroma formation in an open drainage—no-drains technique, albeit the difference was not statistically significant.
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