Plastic surgery is a general term for operative manual and instrumental treatment which is performed for functional or aesthetic reasons. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with modern plastics.

The principal areas of plastic surgery include two broad fields.

• Reconstructive surgery, including microsurgery, focuses on undoing or masking the destructive effects of trauma, surgery or disease. Reconstructive surgery may include closing defects using skin grafts or with local, regional or distant flaps—that is, by moving tissue from other parts of the body.
• Cosmetic (or aesthetic) surgery is most often performed in order to change features the patient finds unflattering. In many cases, however, there are medical reasons (for example, breast reduction when orthopedic problems are present).

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Fantastic Plastic Surgery Opportunity With Group of Three Surgeons :: Pennsylvania :: CompHealth Inc
Job 658071 Busy Plastic Surgery group is recruiting an experienced Plastic Surgeon to join them Top Salary and benefits for the right candidate Call 1:4 No competition in local region Located in a wonderful
Facial Plastic Surgeon Needed for Excellent Practice Opportunity :: Pennsylvania :: CompHealth Inc
Job 6512599 Require Board Certified / Board Eligible Plastic Surgeon with Fellowship training in craniofacial surgery Employed position Join a surgical team at a 400 bed modern facility Enjoy an established
Metro Area Plastic Surgery With Hand (30%) Opportunity :: Iowa :: CompHealth Inc
Job 6512314 Hospital based surgery group seeks a Plastic Surgeon Unbeatable location - the best that Iowa offers Must be Board Eligible or Board Certified Plastic Surgeon with Hand training or experience

Archives of Facial Plastic Surgery current issue

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

Alar Rim Grafting in Rhinoplasty: Indications, Technique, and Outcomes [Original Article]
Boahene, K. D. O., Hilger, P. A. Objective  To determine the potential indications for placement of cartilaginous alar rim grafts in primary and revision septorhinoplasty. Methods  Retrospective medical chart analysis of all patients undergoing septorhinoplasty from March 2003 through June 2004 in a private facial plastic and reconstructive surgery center and a tertiary teaching hospital. Patients who received alar rim grafts were identified. The indications for placement of the alar rim grafts were deduced from their preoperative evaluation and intraoperative assessment as noted in their comprehensive operative notes. Preoperative and postoperative digital photographs as well as postoperative medical records were analyzed for alar contour, pertinent patient complaints, and complications. Results  During the 15-month study period, 150 patients underwent septorhinoplasty performed by the senior author. Of these patients, 31 received alar rim grafts. The most frequent indications for placement of alar rim grafts were cephalic malposition of the lower lateral cartilage with inadequate alar support (9 patients [29%]), correction of alar flare (9 patients [29%]), and correction of dynamic alar margin collapse (8 patients [26%]). At a mean 6-month follow-up, there were no graft displacements or extrusion. Conclusion  Alar rim grafting is a simple and versatile approach to providing additional support to the external nasal valve and for improving nasal base contour.
Analysis of Patient-Determined Preoperative Computer Imaging [Original Article]
Mahajan, A. Y., Shafiei, M., Marcus, B. C. Objective  To compare patients' goals in aesthetic rhinoplasty with aesthetic ideals by analyzing changes requested through computer imaging during the initial consultation. Methods  The frontal and lateral views of 20 consecutive female rhinoplasty patients were analyzed retrospectively before and after using image manipulation software. Indexes from the frontal view included the ratio of alar base width to dorsal length and the ratio of alar base width to interpupillary distance. On the lateral view, parameters included the nasolabial angle, nasofacial angle, and tip projection (Goode ratio). Ideal parameters were based on descriptions by Powell and Humphreys. Results  The ideal and patient-determined proportions were compared using a paired 2-tailed t test. The mean nasolabial angle falls within the ideal range before and after image manipulation. However, the Goode ratio and the ratio of alar base width to interpupillary distance were statistically similar to ideal values only after image manipulation. The nasofacial angle and the ratio of alar base width to dorsal length showed a trend toward the ideal ratio. Conclusions  Patients' preferences were similar to the ideal in 3 of 5 parameters, and the remaining parameters approached the ideal. These parameters are useful in creating satisfying proportions in aesthetic rhinoplasty and reconstructive surgery within our population. Rather than population-based normative data or ideals based on fashion models or Greek statuary, these are proportions requested by patients. Computer imaging software, used by a growing number of aesthetic surgeons, holds a wealth of data regarding common patient preferences.
The Treatment of Nasal Fractures: A Changing Paradigm [Original Article]
Ondik, M. P., Lipinski, L., Dezfoli, S., Fedok, F. G. Objectives  To compare the efficacy of closed vs open treatment of nasal fractures, and to suggest an algorithm for nasal fracture management that includes closed and open techniques. Methods  Retrospective study of 86 patients with nasal fractures who received either closed treatment (41 patients) or open treatment (45 patients) between January 1, 1997, and December 30, 2007. Fractures were classified as 1 of 5 types. Revision rates were calculated for each group. Preoperative and postoperative photographs were rated, if available, and patients were interviewed about aesthetic, functional, and quality of life issues related to surgical treatment. Results  The revision rate for all fractures was 6%. The revision rate for closed vs open treatment was 2% vs 9%, respectively. Many closed treatment cases were classified as type II fractures, whereas most open treatment cases were classified as type IV fractures. There was no statistical difference in revision rate, patient satisfaction, or surgeon photographic evaluation scores between the closed and open treatment groups when fractures were treated in the recommended fashion. Conclusions  Patients who undergo open or closed treatment have similar outcomes if the surgical approach is well matched to the individual fracture. Our treatment algorithm provided consistent aesthetic and functional results while minimizing the need for revision procedures.
Margin Reflex Distance in Different Ethnic Groups [Original Article]
Murchison, A. P., Sires, B. A., Jian-Amadi, A. Objective  To determine the normal range for eyelid margin reflex distance (MRD) in adults according to their ethnicity, age, and sex. Methods  A prospective study of eyelid measurements in 112 consecutive adult African American, Asian, white, and Latino patients was compared using t test analysis. Measurements of MRD were collected by a single examiner across 5 months. Patients with conditions disposing to eyelid height changes were excluded. Results  The MRD showed statistically significant variance among select ethnic groups. There was no statistical significance between sexes within each ethnic group. Conclusions  Variance in MRD exists among ethnic groups. This information and further data on ethnicity and sex variance of eyelid measurements can be used for both diagnostic purposes and surgical treatment of patients for optimal results.

Aesthetic Plastic Surgery

Announcements
Tue, 03 Nov 2009 14:01:31 -0000
Announcements Content Type Journal ArticleCategory AnnouncementsDOI 10.1007/s00266-009-9430-0 Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Percutaneous Electrothrombosis: A Minimally Invasive Technique for the Treatment of Deep Hemangiomas
Sat, 24 Oct 2009 06:04:37 -0000
Abstract Background  A percutaneous electrocauterization technique for the treatment of deep hemangiomas is introduced as an alternative and minimally invasive treatment mode. Methods  Percutaneous electrothrombosis was applied through a needle-catheter that is a small silicone catheter with a needle guide in it. Thus, it is possible to do needle-point monopolar electrocauterization only at the needle tip because of the insulation of the other parts of the needle by the silicone catheter. By retracting the needle with catheter on it during electrocauterization, electrothrombosis was achieved through and around the channel of the needle, leaving vascularized tissue areas between the channels to perfuse the skin or mucosa covering the hemangioma. Results  This technique was applied as a single treatment or before surgery for the treatment of cavernous hemangiomas to more than 40 patients. However, adequate documentation was found for only 10 patients. After percutaneous electrocauterization of deep hemangiomas, discrete areas of skin necrosis appeared in some patients during the healing period, but the subsequent debridement and surgical excisions were easier because of the thrombosis effect of the technique due to the diffuse denaturation and fibrosis through and around the electrocauterization channels. The follow-up period was 1–13 years. Conclusion  The proposed percutaneous electrocauterization technique for the treatment of deep hemangiomas achieved four effects: (1) volume reduction, (2) bleeding reduction, (3) anesthesia time reduction, and (4) cost reduction. The technique can be defined as a minimally invasive and effective alternative treatment for deep hemangiomas. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9425-xAuthors O. Onur Erol, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul TurkeyO. Ata Uysal, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul TurkeyGalip Agaoglu, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Experience of 1000 Cases on Subfascial Breast Augmentation
Thu, 22 Oct 2009 05:59:23 -0000
Abstract Background  Throughout the years the female breast has been manipulated through aesthetic and reconstructive surgery. Since the 18th century there have been reports of techniques that have tried to increase the volume of the mammary gland. This article demonstrates a technique for increasing the volume of the mammary gland by dissection of the fascia of the pectoralis major muscle. This technique provides long-term results due to the optimized dynamics between the soft tissue and the implant. The subfascial technique is paramount to the subglandular method because primarily it offers better palpable firmness in the periareolar area, a significant decrease in the step effect produced by an excessive projection of the breast, a favorable gravitational pull of the breast, and a considerable reduction in the incidence of capsular contractures. The movement of the implant, postsurgical pain, and bleeding caused by the incision of the pectoralis muscle diminish with this technique. Because of the fascia’s tendency to be preserved, this procedure has the advantage of being able to be applied where previous surgery has been performed; this concedes the subfascial technique a more versatile angle. Methods  In the last 10 years 1000 patients were subjected to subfascial breast augmentation with soft-gel cohesive textured implants. An inframammary incision was used in 95% of the patients and the periareolar incision in 5%. Results  The patient does not suffer from immediate postsurgical pain. Recovery time and the ability to start daily activities is briefer than after the submuscular procedure. A better projection is obtained without the need to use a bigger implant to get the same result because there is no pressure on top of the implant as in the submuscular technique. Conclusion  The subfascial procedure offers a high-grade result for the short and long term and has fewer disadvantages than the submuscular or subglandular technique. Likewise, there are fewer immediate postoperative symptoms and patients have a much better and less painful recovery. The morbidity in these patients is less than with the subglandular and submuscular methods. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9402-4Authors Victor Noe Elizondo Tijerina, Monterrey Nuevo Leon MexicoRodolfo A. Elizondo Saenz, Monterrey Nuevo Leon MexicoJair Garcia-Guerrero, Monterrey Nuevo Leon Mexico Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Silicone Nipple Shields: An Innovative Postoperative Dressing Technique After Nipple Reconstruction
Tue, 20 Oct 2009 15:19:38 -0000
Abstract Background  The newly reconstructed nipple is extremely sensitive to mechanical pressure and shearing forces, which can cause flap necrosis and sloughing of the skin, eventually promoting infection. Current available dressing solutions are cumbersome, inefficient, displeasing, or otherwise not readily obtainable. Methods  In this study, 10 patients with newly reconstructed nipples were instructed to use breastfeeding nipple shields as the sole means of nipple dressing after the reconstruction procedure. Results  No complications were observed overall. Patients reported full adherence to the postoperative dressing regimen as well as ease of use, availability, low costs, and pleasing aesthetic appearance under garments. Discussion  Silicone breastfeeding nipple shields offer an efficient, affable, cheap, widely available, and aesthetically pleasing form of postoperative dressing for reconstructed nipples. Their use may enhance patient compliance with the dressing regimen and lower the postoperative complication rate. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9426-9Authors Oren Weissman, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelAriel Tessone, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelAlon Liran, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelDemetris Stavrou, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelNimrod Farber, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelArie Orenstein, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelJosef Haik, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelEyal Winkler, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan Israel Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Erratum to: Abdominal Fascial Flaps for Providing Total Implant Coverage in One-Stage Breast Reconstruction: An Autologous Solution
Tue, 20 Oct 2009 15:19:37 -0000
Erratum to: Abdominal Fascial Flaps for Providing Total Implant Coverage in One-Stage Breast Reconstruction: An Autologous Solution Content Type Journal ArticleCategory ErratumDOI 10.1007/s00266-009-9420-2Authors Tonguc Isken, Kocaeli University Faculty of Medicine Department of Plastic and Reconstructive Surgery Kocaeli TurkeyMurat Onyedi, Kocaeli University Faculty of Medicine Department of Plastic and Reconstructive Surgery Kocaeli TurkeyHakki Izmirli, Kocaeli University Faculty of Medicine Department of Plastic and Reconstructive Surgery Kocaeli TurkeySahin Alagoz, Kocaeli University Faculty of Medicine Department of Plastic and Reconstructive Surgery Kocaeli TurkeyRyan Katz, Johns Hopkins University School of Medicine Department of Plastic and Reconstructive Surgery Baltimore MD USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X
Breast Augmentation, Antibiotic Prophylaxis, and Infection: Comparative Analysis of 1,628 Primary Augmentation Mammoplasties Assessing the Role and Efficacy of Antibiotics Prophylaxis Duration
Tue, 20 Oct 2009 15:19:37 -0000
Abstract Background  Infections after augmentation mammoplasty are not uncommon, and prophylactic antibiotics are routinely administered to minimize infection. However, there is paucity of information on the relationship between the length of prophylaxis cover and its benefits in primary augmentation mammoplasty. A retrospective analysis of different antibiotic cover regimens, their effectiveness in preventing infections, and the management of infection in established cases is reviewed. Methods  A retrospective chart analysis of periprosthetic infections in primary augmentation mammoplasties performed over the past 10 years was conducted. Periprosthetic infection was determined by the presence of pain, swelling, redness, and discharge. Each breast was taken as an individual unit in 1,628 patients, and data for 3,256 breasts were analyzed. The patients had their augmentation in the partial submuscular plane (214 breasts in 107 patients), the subglandular plane (1,548 breasts in 774 patients), and the muscle-splitting biplane (1,494 breasts in 747 patients). All the patients had soft round cohesive gel silicone implants. Of the 3,256 implants, 3,218 were textured, and 38 were smooth surfaced. The patients received antibiotics as a single intravenous dose of cephalosporin (474 breasts in 237 patients), a single intravenous dose plus an oral dose for 24 h (344 breasts in 172 patients), or a single intravenous dose plus an oral course for 5 days (2,438 breasts in 1,219 patients). Infection was recorded as superficial (e.g., wound breakdown, stitch extrusion, stitch abscess) or deep (periprosthetic). The patients with established periprosthetic infections, determined clinically by the presence of pain, discharge, swelling, and redness of the breasts, were managed either conservatively using antibiotics, passive wound drainage, and healing of the wound with secondary intention or by explantation and replacement after 3 to 4 months. In selected cases of periprosthetic infection, the implants were removed after a course of antibiotics and negative swab cultures. The cavity was washed thoroughly with betadine and saline, and new implants were simultaneously reimplanted. Results  The incidence of infection was lowest with a single perioperative dose of intravenous antibiotic compared with a combination of intravenous and oral antibiotics. Superficial infection was seen in 38 breasts (all unilateral), with an incidence of 1.2%, and periprosthetic infection was observed in 17 breasts (13 unilateral and 2 bilateral), giving an infection incidence of 0.52% (p = 0.002). In patients with a single intravenous dose of antibiotic, superficial and periprosthetic infection was seen in four breasts (0.8%) and no breasts, respectively. The difference was not significant (p = 0.13). The patients receiving a single intravenous antibiotic and a 24-h oral antibiotic had superficial and periprosthetic infection rates of 2.3% (8 breasts) and 0.3% (1 breast), respectively, and the difference between the two sub-groups was significantly higher (p = 0.04). The patients receiving an intravenous antibiotic and 5 days of oral antibiotics had superficial and periprosthetic infection rates of 1.1% (26 breasts) and 0.65% (14 breasts), respectively. The difference between the two subgroups was not significant (p = 0.09). Of the 17 periprosthetic infections in 15 patients (13 unilateral and 2 bilateral), 11 breasts (1 bilateral and 9 unilateral) were treated conservatively using antibiotics, passive drainage, and wound healing with secondary intention. Capsular contracture developed in two of the conservatively treated breasts, requiring capsulotomies with change of implants. Of the six periprosthetic infections in six patients, requiring surgical intervention, two implants were treated using explantation with immediate replacement after a course of antibiotics and a negative culture, and two implants were explanted followed by reimplantation later. One patient had both implants removed after unilateral infection, and no reimplantation was performed. One patient had a bilateral infection. In this case, one implant was explanted and the other was treated conservatively. The patient had bilateral reimplantion 6 months later, and bilateral Baker 4 capsular contracture developed in both breasts within 6 months. No other complications were seen in the patients who underwent surgery. Conclusion  A single dose of intravenous antibiotic is adequate for prophylaxis in breast augmentation surgery, and the extra duration of antibiotic cover does not result in reduced superficial or periprosthetic infections. Infection can be managed in more than one way depending on the nature, degree, and extent of infection. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9427-8Authors Umar Daraz Khan, Re-shape House 2-4 High Street ME 19 6QR West Malling, Kent UK Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

pubmed: 1529-4242

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