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Plastic Surgery jobs

All Plastic Surgery jobs for Tue Feb 7 2012

PLASTIC SURGERY jobs in "45 Minutes North of Chicago, Illinois Plastic Su" - IL

Joining private practice of one Plastic Surgeon. Busy practice Office located 45 Minutes North of Chicago Physician works from 4 area hospitals Option for partnership Ideally would like

PLASTIC SURGERY jobs in "Need for Plastic Surgeon in Oklahoma City" - OK

Joining largest volume practice in the Midwest. Extremely high patient volume. Been in business for 7 years. Has built a new 10 sq ft surgery center. All surgeries are conducted there. Physicians

PLASTIC SURGERY jobs in "Bay City, MI Plastic and Reconstructive" - MI

PLASTIC AND RECONSTRUCTIVE SURGERY BAY REGIONAL MEDICAL CENTER BAY CITY, MI Immediate Full time opportunity Very competitive income guarantee provided by the hospital or hospital employed with excellent

PLASTIC SURGERY jobs in "Southwestern Ohio Plastic Surgeon" - NC

Opportunity to establish private practice and offer much-needed plastic surgery services in southwestern Ohio area serving 120,000. CMH and its physicians have identified Plastic Surgery as a key specialty

Plastic Surgery jobs in "15 minutes to downtown St. Louis" - IL

We are currently representing an excellent opportunity for a Plastic Surgeon. Location is 15 minutes from downtown St. Louis. They are seeking a candidate to join one other in a very busy, and well

PLASTIC SURGERY jobs in "Southern IL Plastic Surgeon" - IL

Seeking a Plastic Surgeon for Illinois Based Regional Medical Center Regional Medical Center in Southern IL is looking to provide Plastic Surgery services. Currently not being provided. Two surgeons

Plastic Surgery jobs in "Northern (HAND SURGERY)" - NM

On behalf of a client located in a great northern New Mexico location - we are seeking a full-time plastic surgeon, with hand fellowship training. The new physician must be BC/BE, and will join

Plastic Surgery jobs in "Central PA/NY Border" - PA

Reference:21011 Specialty: Plastic Surgery, General and Reconstructive Location: Pennsylvania (Central PA/NY Border) J1/H1B: NO Service Area: 1 million BE/BC Plastic Surgeon

Plastic Surgery jobs in "Greater Albany" - NY

Our very prestigious client in the Greater Albany area of NY is seeking two Plastic Surgeons; a Chief of the Division of Plastic Surgery and an Assistant or Associate Professor.

Plastic Surgery jobs in "Oklahoma City" - OK

I would like you to consider joining our practice in your area along withother physicians throughout the U.S. Train at our expense

Plastic Surgery jobs in "White Plains" - NY

Plastic Surgery-New York Plastic Surgery-New York-Physician Needed-Plastic Surgeon Needed in the Hudson Valley area Seeking a Plastic Surgeon in the Hudson Valley

Plastic Surgery jobs in "Minneapolis" - MN

I would like you to consider joining our skin, wound and limb salvage practice Our practice may be a new focus for you and the same is true for most of our physicians. We are the nations leading

Plastic Surgery jobs in " Livingston" - NJ

PLASTIC SURGEON Reflections Center for Skin and Body, a leading aesthetic medical practice with two beautiful offices in Northern New Jersey as well as a satellite in Manhattan overlooking

Plastic Surgery jobs in "Los Angeles" - CA

Seeking Medical Doctor for an etablished practice. Qualification: · Experienced plastic surgery physician or related

Plastic Surgery jobs in "Fall River" - MA

I would like you to consider joining us in our specialty skin and wound practice as we keep up with demand from the growing geriatric population and increasing prevalence of wounds (due to the diabetic

Plastic Surgery jobs in Michigan

All Plastic Surgery jobs in Michigan for Tue Feb 7 2012

Plastic Surgery jobs in "Providence" - RI

General or Plastic Surgeon Needed for our Skin, Wound and Limb Salvage Practice In 22 States Work weekdays only No On-call Full or Part-time Train at our expense

Plastic Surgery jobs in "Lakes Area" - KY

Establish New Solo in 300,000 population service area This is an excellent opportunity for a BE/BC Plastic Surgeon to establish a new solo practice in this large service area that currently has but one

Plastic Surgery jobs in "Harrisburg" - PA

Would you enjoy an opportunity that gave you your weekends and nights back and was also, no on-call? Here at Vohra we take pride in our ability to set national benchmarks, precedence

Plastic Surgery jobs in "Evansville" - IN

Private Practice Opportunity Southern Indiana Medical Cosmetic Center located in Evansville , Indiana is offering a unique opportunity to the

Plastic Surgery jobs in "Scranton" - PA

Please consider joining our exciting skin and wound practice as we keep up with demand from the growing geriatric population and increasing prevalence of wounds (due to the diabetic population) in

Plastic Surgery jobs in "Spokane" - WA

Rockwood Clinic, located in Spokane, WA, is actively recruiting for a dynamic Plastic Surgeon to join our expert team of providers. This busy and well established group is located on the campus of Deaconess

Plastic Surgery jobs in "Fulton" - IL

Heartland Regional Medical Center in Marion, IL is looking to provide Plastic Surgery services. Currently not being provided. Two surgeons in the area without privileges at our hospital. Hospital Employed

Plastic Surgery jobs in "Dallas" - FL

Our practice may be a new focus for you and the same is true for most of our physicians. We are the nation’s leading physician group delivering limb salvage, skin and wound care services at bedside

Plastic Surgery jobs in "Dallas" - FL

Our practice may be a new focus for you and the same is true for most of our physicians. We are the nation’s leading physician group delivering limb salvage, skin and wound care services at bedside

Plastic Surgery jobs in "Denver" - CO

If you are considering new opportunities for 2012 and will be living in one of the areas listed below, please consider joining our skin and wound practice Our practice may be a new focus for you

Plastic Surgery jobs in "Fresno" - CA

Join us in our specialty skin and wound practice. --------------------------------------------------------------------------------------------------------------------------------- Our practice

Plastic Surgery jobs in "Boston" - MA

Weekdays Only / No On-Call: Full Time and Part time available. Our practice may be a new focus for you and the same is true for most of our physicians. We are the nations leading physician group delivering

Plastic Surgery jobs in "Novi" - MI

We are currently seeking plastic surgeons with expertise and training in all aspects of aesthetic plastic surgery. Focusing on breast augmentation, facial and liposuction/body sculpting procedures,

Risk Factors Associated With Repair of Orbital and Lateral Skull Defects [Original Article]

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

Histopathologic Findings of the Orbicularis Oculi in Upper Eyelid Aging: Total or Minimal Excision of Orbicularis Oculi in Upper Blepharoplasty [Original Article]

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

Split-Face Double-blind Study Comparing the Onset of Action of OnabotulinumtoxinA and AbobotulinumtoxinA [Original Article]

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

No Need to Fear Evidence-Based Medicine [Special Topics]

Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to clinical decision making. The notion seems noble in its purpose, yet there are some apprehensions and misconceptions among physicians, especially those in a predominantly surgical field such as facial plastic surgery. Developing a sophisticated understanding of the inherent biases and limitations of EBM will become increasingly important for the researcher and practicing surgeon as we strive to improve the rigor of our studies and produce noteworthy scientific evidence that improves the health outcomes for our patients.

Lateral Crural Turn-in Flap in Functional Rhinoplasty [Original Article]

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

Induction of Dermal Collagenesis, Angiogenesis, and Adipogenesis in Human Skin by Injection of Platelet-Rich Fibrin Matrix [Original Article]

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

Effects of Botulinum Toxin A on Cytokine Synthesis in a Cell Culture Model of Cutaneous Scarring [Original Article]

Objective To evaluate possible botulinum toxin A effects in a cell culture model.Methods In a cell culture model with dermal fibroblasts and microvascular endothelial cells, possible botulinum toxin A effects were evaluated. Cell proliferation and cytokine expression were analyzed using viability assays and enzyme-linked immunosorbent assay techniques.Results Neither cell proliferation nor cytokines and growth factors (interleukin 6, monocyte chemoattractant protein 2, fibroblast growth factor, macrophage colony-stimulating factor, and vascular endothelial growth factor) were affected by botulinum toxin A incubation.Conclusions The present data do not add evidence to suggest a significant therapeutic role of botulinum toxin A injections for cutaneous wound healing beyond chemoimmobilization. Further studies that include patient-specific cells of hypertrophic scars are required to better understand what role botulinum toxin A can play in the treatment of mature scar tissue.

Larger Osteotomies Result in Larger Ostia in External Dacryocystorhinostomies [Original Article]

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

About This Journal [About This Journal]

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

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

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

Nasal Batten Grafts: Are Patients Satisfied? [Original Article]

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

Auricular Keloids: Combined Therapy With a New Pressure Device [Original Article]

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

Mechanical Analysis of the Effects of Cephalic Trim on Lower Lateral Cartilage Stability [Original Article]

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

Anatomic Variations Found on Dissection of Depressor Septi Nasi Muscles in Cadavers [Original Article]

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

Intraoperative Suction-Assisted Evaluation of the Nasal Valve in Rhinoplasty [Original Article]

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

Orthodromic Temporalis Tendon Transfer: Anatomical Considerations [Original Article]

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

Comparison of Effectiveness of Silicone Gel Sheeting With Microporous Paper Tape in the Prevention of Hypertrophic Scarring in a Rabbit Model [Original Article]

Objective To determine the effectiveness of treating scars with microporous paper tape or silicone gel sheeting (SGS) in preventing hypertrophic scarring Methods Forty hypertrophic scars were induced in a validated rabbit ear model. Wounds were randomized and bandaged for 30 days with either SGS (20 wounds), paper tape (20 wounds), or untreated controls (40 wounds). Two outcome measures of hypertrophic scarring included (1) histologic measurement of scar elevation index (SEI) and (2) blinded photograph analysis using a visual analog scale. Results In histologic comparison, no difference in mean (SE) SEI between treatment groups was seen (paper tape group, 1.32 [0.2]; SGS group, 1.41 [0.18]; control, 1.35 [0.23]; P = .51). In photographic analysis, both treatment groups were superior to the control group (P < .01), whereas no difference was seen between the SGS and paper tape groups (P = .88). Conclusions Paper tape and SGS demonstrated equal effectiveness in the prevention of hypertrophic scarring on visual analysis, whereas histologic analysis demonstrated no difference in treatment groups from controls. The effectiveness of paper tape in preventing hypertrophic scarring in humans will require further laboratory and clinical investigation.

Laser Facial Nerve Welding in a Rabbit Model [Original Article]

Objective To assess the feasibility of laser tissue welding for repair of facial nerve injury. Methods In a prospective in vivo animal survival surgery model, rabbit facial nerve injury was followed by either standard suture neurorrhaphy or laser tissue welding using a diode laser (808 ± 1 nm) to weld biological solder. Rabbits were evaluated at 4, 8, 12, and 16 weeks by facial videography and electromyography. Histopathological analysis of the repair was performed at 4 and 16 weeks. Results Videographic analysis demonstrated the laser tissue welding repair trended toward superior outcomes compared with suture neurorrhaphy at all 4 time points. Electrophysiological analysis demonstrated similar or better results, with statistically significant improvement at week 16 (P < .05). Histologic analysis demonstrated no difference in axon organization or extravasation between groups; however, the laser nerve repair created a greater initial inflammatory reaction. An analysis of operative time demonstrated significantly decreased time and ease of use for laser tissue welding. Conclusions This pilot study demonstrates that laser nerve welding may be an expedient, feasible, and safe method for facial nerve repair in a rabbit model. Further experiments with larger numbers are needed to provide additional evidence that laser tissue welding produces a neurorrhaphy that has functional, electrophysiological, and histological results that could rival traditional suture neurorrhaphy.

New Technique for Medial Canthoplasty That Incorporates Modified V-W Epicanthoplasty [Surgical Technique]

Telecanthus, which is the lateral displacement of the medial canthus, can be a congenital deformity or can occur after facial trauma. Several epicanthoplasty methods have been described, but the orbitonasal angle and appropriate shape cannot be reconstructed in Asians. We solved this problem by using a dog-ear effect. This article describes a new design for epicanthoplasty and its results.

Zygomaticomaxillary Complex Fractures [Contemporary Review]

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

The Effect of Rhinoplasty on Perceived Age [Research Letters]

Neck Rejuvenation [Book and Multimedia Review]

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

Comparing the Eyes Depicted in Japanese Portraits of Beautiful Women: The Meiji and Modern Periods

Abstract Background The women portrayed in the bijin-ga of the past, particularly those from the Meiji Period (1868–1912), tended not to show much resemblance to those of women portrayed in the more modern bijin-ga (from after World War II), and such an observation came across as a possible indication that Japanese standards of beauty have changed over the two eras. To examine whether the apparent discrepancy can be interpreted as an actual change in the standards or not, a study was designed with the aim of assigning numeric values to several aspects of the eyes and testing for the presence of a statistically significant difference in each of the aspects between the Meiji bijin-ga and the modern bijin-ga. Methods For this study, 29 Meiji bijin-ga and 36 modern bijin-ga were selected. The eye was chosen as the subject of comparison, and five aspects were categorized and measured: (1) presence or absence of a double fold, (2) eye width, (3) eye height, (4) eyebrow-to-upper lid distance, and (D) corneal diameter. The eye width, the eye height, and the eyebrow-to-upper lid distance were divided by the corneal diameter to derive standardized grounds for comparison. Results The difference in double-fold frequencies between the Meiji bijin-ga (24%) and the modern bijin-ga (36%) was not found to be statistically significant (p = 0.298). There was no difference in the eye width-to-corneal diameter ratio between the Meiji bijin-ga (mean 2.57 ± 0.6) and the modern bijin-ga (mean 2.61 ± 0.85) (p = 0.86). The eye height-to-corneal diameter ratio derived from the Meiji bijin-ga (mean 0.62 ± 0.15) was significantly smaller than that derived from the modern bijin-ga (mean 0.82 ± 0.18) (p = 0.000). The eyebrow to upper lid distance-to-corneal diameter ratio derived from the Meiji bijin-ga (mean 2.21 ± 0.83) was significantly greater than that derived from the modern bijin-ga (mean 1.36 ± 0.78) (p = 0.000). Conclusions The results of the study support the notion that Westernization contributed to bringing about changes in the Japanese standards of beautiful eyes in the context of bijin-ga. However, the fact that the changeover has not occurred in all the categories in question does not indicate that the Occidental characteristics came to be emulated in their entirety. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at http://www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00266-011-9857-yAuthors James J. Lee, Center for East Asian Studies, Stanford University, 450 Serra Mall, Stanford, CA 94305, USAEwart Thomas, Department of Psychology, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Announcements

Announcements Content Type Journal ArticleCategory AnnouncementsPages 1-4DOI 10.1007/s00266-011-9862-1 Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Gluteal Reduction: A New Technique With Tightening, Lifting, and Reshaping Effects on the Buttocks

Abstract Background Currently, patient demand is increased for procedures to improve the form and size of the gluteal region. Although gluteal augmentation and lifting are the most common aesthetic requirements for the gluteal area, some patients need gluteal reduction. Most surgeons reduce the gluteal volume only by liposuctioning the buttocks. This procedure, however, is inadequate when patients do not have good skin quality. Very few techniques have been described for gluteal reduction, and all of them leave noticeable scars that are unacceptable to most patients. The author presents a new technique to reduce, lift, and tighten the gluteal region using well-hidden incisions. Methods Five female patients who requested gluteal reduction were included in this study. Two of these patients had primary gluteal lipodistrophy, and two had excessive gluteal volume as a consequence of liquid silicone injections in the buttocks. The remaining patient had previously undergone gluteal implants, but after pregnancy ended up having very big buttocks and wanted to reduce the gluteal volume. Gluteal reduction was performed using bilateral incisions that began from the sacral triangle and proceeded downward slightly off the gluteal midline to continue along the infragluteal fold. A flap involving the whole gluteal area was dissected superficially to the gluteal fascia. Excess tissue was removed, and wound closure was performed in multiple layers. Results The mean operating time was 210 min, and the volume resected ranged from 550 to 640 g in each of the gluteal areas. No major complications or infections occurred. One of the patients presented with wound dehiscence bilaterally, limited to the central area. This case required wound care for 1 month, after which the wound was closed satisfactorily with the patient under local anesthesia. In all the patients, the gluteal area was reduced, reshaped, and tightened satisfactorily. All five patients were extremely satisfied with the new gluteal shape, the degree of the gluteal reduction, the quality and location of the scars, and the lifting effect associated with this gluteoplasty technique. Conclusion A new technique for gluteal reduction that effectively reduces, tightens, and reshapes the buttocks is presented. Patient acceptance of this surgery is very high because unlike previous gluteal reduction techniques, this procedure leaves well-concealed scars that can be hidden even with the small type of swimsuits used currently. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Innovative TechniquesPages 1-7DOI 10.1007/s00266-011-9863-0Authors Jorge Alirio Mejia, Universidad de Antioquia, Calle 7 sur 42-70 OF 511 Ed Forum, Medellin, Antioquia, Colombia Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Reconstruction of Lower Eyelid Retraction or Ectropion Using a Paranasal Flap

Abstract Background This report aims to describe a paranasal flap technique for reconstruction of lower eyelid retraction and ectropion. Methods After the contracture of the lower eyelid skin or conjunctiva had been thoroughly released, the ipsilateral upper pedicle paranasal flap was designed according to the size of the lower eyelid skin wound. After dissection of the flap, the subcutaneous tissue of the flap was trimmed according to the depth of the wound, the flap was rotated to cover the defect, and an anchor was fixed to the distal aspect of the outer canthus. The secondary defect of the donor area was sutured directly. Results In this study, 67 patients with lower eyelid defects resulting from correction of eyelid retraction and ectropion were reconstructed using paranasal flaps between April 2004 and October 2009. The sizes of the paranasal flaps ranged from 0.6 × 2.2 to 1.5 × 3.5 cm. At the follow-up assessment, the patients could close their eyes easily and completely without lagophthalmos, and neither the upper lips or the nasal ala showed any anatomic deformities. The features of the paranasal flaps, such as skin color, texture, and contour of the repaired tissue, were a good match with the surrounding skin. The suture lines of the donor areas were sheltered well. Conclusions Paranasal flaps were used for effective reconstruction of lower eyelid retraction or ectropion, with achievement of good eyelid function and a good color, contour, and texture match with the surrounding skin. Overall, the functional and cosmetic results were satisfactory. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00266-011-9855-0Authors Chun-Yu Xue, Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433 ChinaHai-ying Dai, Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433 ChinaLi Li, Department of Dermatology, Beijing Military General Hospital, Beijing, 100000 ChinaYi-cun Wang, Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433 ChinaCao Yang, Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433 ChinaJun-Hui Li, Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433 ChinaXin Xing, Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 200433 China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Maxillofacial Reconstruction Using Polyetheretherketone Patient-Specific Implants by “Mirroring” Computational Planning

Abstract In the vast majority of cases, precise symmetric reconstruction of maxillofacial defects remains an unsolved problem for craniofacial surgeons. Computer-designed alloplastic implants have contributed considerably to improvement in the accuracy and reliability of facial rehabilitation, rapidly becoming an irreplaceable part of the surgical armamentarium. In recent years, the subsequently developed new generation of computational technologies has allowed planning to be done by preoperative “mirroring” using the healthy side as a template to fabricate an ideal prosthesis for reestablishment of facial symmetry. Two cases of facial defects are reported, one of the midface and another of the lower face reconstructed using a computer-designed polyetheretherketone (PEEK) patient-specific implant (PSI) technique based on “mirroring” computational planning. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Case ReportPages 1-6DOI 10.1007/s00266-011-9853-2Authors Paolo Scolozzi, Division of Maxillofacial and Oral Surgery, Department of Surgery, University Hospital and Faculty of Medicine, 1211 Genève, Switzerland Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Mammae Erraticae: A Case Report and Reappraisal of the Related Theories

Abstract Extra nipples and breast tissue outside the orthotopic location of the mammary glands are called polythelia and polymastia, respectively. Although the theory of mammary ridge remnants can explain extra breast tissue along the milk line, other locations such as the dorsum of the body still need further discussion. This report describes a 28-year-old Caucasian woman with a perfectly formed breast together with a meningocele in the lumbar region. Kyphoscoliosis and growth retardation were accompanying pathologies. As far as the authors can discern, this is the first case in the literature showing a well-formed breast and dysraphism occurring together. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00266-011-9854-1Authors Orhan Babuccu, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Zonguldak Karaelmas University, 67200 Zonguldak, TurkeyMurat Kalayci, Department of Neurosurgery, Faculty of Medicine, Zonguldak Karaelmas University, 67200 Zonguldak, TurkeyEgemen Turhan, Department of Orthopedics and Traumatology, Faculty of Medicine, Zonguldak Karaelmas University, 67200 Zonguldak, TurkeyBanu Dogan Gun, Department of Pathology, Faculty of Medicine, Zonguldak Karaelmas University, 67200 Zonguldak, TurkeyAhmet Dursun, Department of Medical Genetics, Faculty of Medicine, Zonguldak Karaelmas University, 67200 Zonguldak, Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Monsplasty for Women After Massive Weight Loss

Abstract Background Ptosis with excess skin in the pubic area is a very common deformity in patients after massive weight loss. This deformity requires adequate surgical treatment whether combined with abdominoplasty or not. The enlarged pubogenital area may lead to psychosocial distress and impaired quality of life. Methods A series of 23 women with a mean age of 39.5 years who previously underwent bariatric surgeries and later presented with pubogenital ptosis underwent monsplasty. The preoperative surgical markings and the surgical technique presented are easily reproducible. In this prospective study, the surgical outcomes were assessed by questionnaires applied to the patients, who scored the following parameters: movement dynamics, aesthetic appearance, sexual performance, improved hygiene, and use of clothing items. Results Four of the parameters assessed (movement dynamics, aesthetic appearance, hygiene, and use of clothing items) showed clear improvement, with scores ranging from good to very good. A small percentage of the patients (13%) reported fair improvement in sexual performance. Conclusion The findings showed monsplasty to be a simple and reproducible technique with favorable outcomes and low morbidity rates. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00266-011-9859-9Authors Maíra Marques, Division of Plastic Surgery, University of Sao Paulo School of Medicine, Av. São Gabriel, 201, cj. 704/5, São Paulo, 01435-001 BrazilMiguel Modolin, Division of Plastic Surgery, University of Sao Paulo School of Medicine, Av. São Gabriel, 201, cj. 704/5, São Paulo, 01435-001 BrazilWilson Cintra, Division of Plastic Surgery, University of Sao Paulo School of Medicine, Av. São Gabriel, 201, cj. 704/5, São Paulo, 01435-001 BrazilRolf Gemperli, Division of Plastic Surgery, University of Sao Paulo School of Medicine, Av. São Gabriel, 201, cj. 704/5, São Paulo, 01435-001 BrazilMarcus Castro Ferreira, Division of Plastic Surgery, University of Sao Paulo School of Medicine, Av. São Gabriel, 201, cj. 704/5, São Paulo, 01435-001 Brazil Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

A Technique for Auricular Keloid Core Excision Using a Skin Biopsy Punch

Abstract Background Keloids of the auricular region, resulting from ear piercing or external injury, are a common cosmetic problem. Surgical treatment followed by conservative management often is needed. The “hollowing out method for keloids of the auricle” retains the skin over the keloid lesion to minimize tension on the wound. This is considered to be the appropriate surgical treatment method, but skill is required to remove the keloid and retain the skin with a uniform thickness and appropriate form. Material and Methods Four patients with auricle keloids were included in this study. All the patients were females between the ages of 18 and 29 years (average age, 24.8 years). Keloid core excision using a skin biopsy punch with the patient under local anesthesia was performed for all the patients. Results Use of a skin biopsy punch resulted in a shorter operating time without causing ear deformity. Conclusion The authors report a technique for keloid core excision using a skin biopsy punch and believe it is a useful method Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Innovative TechniquesPages 1-3DOI 10.1007/s00266-011-9858-xAuthors Mari Sunohara, Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine, Asahi 1-4-3, Abeno, Osaka, 545-8585 JapanToshiyuki Ozawa, Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine, Asahi 1-4-3, Abeno, Osaka, 545-8585 JapanTeruichi Harada, Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine, Asahi 1-4-3, Abeno, Osaka, 545-8585 JapanKuniyuki Morimoto, Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine, Asahi 1-4-3, Abeno, Osaka, 545-8585 JapanMasamitsu Ishii, Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine, Asahi 1-4-3, Abeno, Osaka, 545-8585 Japan Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Comparing Breast-Reduction Techniques: Time-to-Event Analysis and Recommendations

Abstract Background Breast reduction is a common procedure used to improve physical and aesthetic factors associated with breast hypertrophy. This study investigated how surgical technique alone affects the risk factors for complications and profiled differences between techniques. Complications were assessed by the use of time-to-event methods. Methods Patient information was extracted from a cohort of 283 patients. Demographic, surgical, and follow-up information was analyzed for patients undergoing surgical procedures using the inferior pedicle Wise pattern (IPWP) and modified Hall-Findlay (MHF) techniques. The patients managed with the IPWP technique were considered control subjects. The failure rates were described using the Kaplan–Meier failure estimator to provide a true estimate of the experienced complication rates. Results Overall, few differences were noted between the groups except for total tissue removed. The overall failure (complication) rate at 6 months was 18.8%, with 9% of all the patients experiencing a major complication that required operative intervention/revision. As expected, the period with the greatest risk of complication was the first month after surgery. Surgical technique, total tissue removed, and age were nonpredictive of complications. Overall, the IPWP group had significantly more total tissue removed than the MHF group (median difference, 227 g; P = 0.002). There was no evidence of a learning curve when an experienced surgeon moved from the one technique to the other. Conclusion At 6 months after surgery, 19% of patients are expected to have experienced a complication. There appears to be few differences in outcomes between the techniques of breast reductions used, and the success or otherwise almost certainly relates to factors independent of surgical technique and includes patient selection, operative skill, and experience. Time-to-event analysis provides a precise assessment and description of the complication profile. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00266-011-9860-3Authors D. J. Hunter-Smith, Department of Plastic and Reconstructive Surgery, Peninsula Health, P.O. Box 52, Frankston, VIC 3199, AustraliaN. R. Smoll, Department of Plastic and Reconstructive Surgery, Peninsula Health, P.O. Box 52, Frankston, VIC 3199, AustraliaB. Marne, Department of Plastic and Reconstructive Surgery, Peninsula Health, P.O. Box 52, Frankston, VIC 3199, AustraliaH. Maung, Department of Plastic and Reconstructive Surgery, Peninsula Health, P.O. Box 52, Frankston, VIC 3199, AustraliaM. W. Findlay, Department of Plastic and Reconstructive Surgery, Peninsula Health, P.O. Box 52, Frankston, VIC 3199, Australia Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

The V-Y Latissimus Dorsi Musculocutaneous Flap in the Reconstruction of Large Posterior Chest Wall Defects

Abstract Posterior chest wall defects are frequently encountered after excision of tumors as a result of trauma or in the setting of wound dehiscence after spine surgery. Various pedicled fasciocutaneous and musculocutaneous flaps have been described for the coverage of these wounds. The advent of perforator flaps has allowed the preservation of muscle function but their bulk is limited. Musculocutaneous flaps remain widely employed. The trapezius and the latissimus dorsi (LD) flaps have been used extensively for upper and middle posterior chest wounds, respectively. Their bulk allows for obliteration of the dead space in deep wounds. The average width of the LD skin paddle is limited to 10–12 cm if closure of the donor site is expected without skin grafting. In 2001 a modification of the skin paddle design was introduced in order to allow large flaps to be raised without requiring grafts or flaps for donor site closure. This V-Y pattern allows coverage of large anterior chest defects after mastectomy. We have modified this flap to allow its use for posterior chest wall defects. We describe the flap design, its indications, and its limitations with three clinical cases. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00266-011-9866-xAuthors T. Christen, Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne, 46 rue du Bugnon, 1011 Lausanne, SwitzerlandN. Koch, Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne, 46 rue du Bugnon, 1011 Lausanne, SwitzerlandC. Philandrianos, Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Marseille, Bourrely Road, North Hospital, 13915 Marseille cedex 20, FranceR. Ramirez, Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Marseille, Bourrely Road, North Hospital, 13915 Marseille cedex 20, FranceW. Raffoul, Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne, 46 rue du Bugnon, 1011 Lausanne, SwitzerlandM. Beldi, Private Practice, 36A avenue de Tourbillon, 1950 Sion, SwitzerlandD. Casanova, Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Marseille, Bourrely Road, North Hospital, 13915 Marseille cedex 20, France Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Comparison of Autogenous Cartilage, Acellular Dermis, and Solvent-Dehydrated Pericardium for the Prevention and Correction of Dorsal Nasal Irregularities: An Experimental Study

Abstract Background Numerous materials have been used for the correction and prevention of dorsal nasal irregularities. Experimental and clinical studies have been useful but have provided insufficient results for several reasons, including the impossibility of obtaining pathologic specimens from aesthetic patients and imprecise experimental models. In this study, an experimental model for rhinoplasty is used for the comparative evaluation of solvent-dehydrated pericardium, acellular dermal matrix, and autogenous ear cartilage as onlay grafts for the prevention and correction of nasal dorsal irregularities. We used an experimental rabbit rhinoplasty model that has a human nose-like osteocartilaginous junction. Thus, our goal is to get a more realistic idea about the features of these three materials. Methods Thirty New Zealand rabbits weighing 2,100–2,550 g were used. The noses of the rabbits were evaluated with computerized tomographic measurements, “pinch” tests were performed for skin properties, and all were photographed before the surgical procedures. They were divided into three groups: Autogenous cartilage grafts were applied after the rhinoplasty operation in group 1, acellular dermal matrixes were used after the rhinoplasty in group 2, and pericardium allografts were used after the rhinoplasty in group 3. The rabbits were followed up for 4 months before they were evaluated by photography, computerized tomography, and “pinch” tests for the skin properties of the nose. Then they were killed for histopathologic evaluation. Adhesion and resorption rates of the onlay grafts were observed and subdermal thickness measurements were made to determine the fate of the grafts as well as their effects on the overlying skin. Results The major advantages of the allografts used in groups 2 and 3 are the ease of obtaining them without any donor site morbidity, shorter operative procedures, and lower distortion rates due to lack of cartilage memory. The results of this study conform to those of previous reports and demonstrate that the used allografts had no adverse effects such as ulceration or extrusion. The evaluation of the internal nasal valve angles before and after the surgical interventions showed that cartilage grafts created a spreader effect as expected, but acellular dermis and solvent-dehydrated pericardium did not. Despite a moderate graft reaction, pericardium or acellular dermis remained intact. None of the materials caused adhesion to the overlying skin. Conclusion The results of this experimental study showed that acellular dermis (AlloDerm®) or solvent-dehydrated pericardium (Tutogen) may be used successfully as an “onlay” graft for dorsal nasal problems compared to autogenous cartilage, which is commonly used for this purpose. There has been more cartilage resorption than thought. This should be considered when overcorrection is performed. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s00266-011-9865-yAuthors Harun Çöloğlu, Plastic and Reconstructive Surgery Clinic, Faculty of Medicine, Baskent University, Adana, TurkeyAfşin Uysal, 1st Plastic and Reconstructive Surgery Clinic, Ankara Training and Research Hospital, Ankara, TurkeyYiğit Özer Tiftikçioğlu, Plastic and Reconstructive Surgery Clinic, Faculty of Medicine, Ege University, İzmir, TurkeyMelike Oruç, Plastic and Reconstructive Surgery Clinic, Bilgi Hospital, Ankara, TurkeyUğur Koçer, 1st Plastic and Reconstructive Surgery Clinic, Ankara Training and Research Hospital, Ankara, TurkeyErhan Coşkun, Plastic and Reconstructive Surgery Clinic, Faculty of Medicine, Baskent University, Adana, TurkeySelma Uysal Ramadan, Department of Radiology, Ankara Training and Research Hospital, Ankara, TurkeyMüzeyyen Hesna Astarcı, Department of Pathology, Ankara Training and Research Hospital, Ankara, Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Randomized, Prospective Study of TissuGlu® Surgical Adhesive in the Management of Wound Drainage Following Abdominoplasty

Abstract Background Wound drainage and seroma formation following abdominoplasty remain significant concerns to both surgeons and patients due to the resulting increased need for patient follow-up and delays in returning to normal function. While a number of approaches are used to reduce wound drainage and seroma formation, there is still no definitive solution. A promising strategy to reduce these complications is the development of an effective method for closing dead space between tissue layers in order to achieve improved patient outcomes. Methods We conducted a multicenter, prospective, randomized trial assessing the use of a lysine-derived urethane adhesive (TissuGlu®, Cohera Medical) in patients undergoing abdominoplasty. Twenty patients were randomized to a treatment group and a control group, with the adhesive applied to the abdominal wall prior to closure of the abdominoplasty flap in the treatment group. Control patients underwent an identical procedure but without application of TissuGlu. Outcome measures included time to drain removal, total wound drainage prior to drain removal, and surgical complications. Results The use of TissuGlu was associated with a trend toward decreased time to drain removal compared to the control group (2.9 ± 1.4 vs. 3.7 ± 1.5 days; P = 0.13). Mean total drain volume also tended to be lower in the treatment versus the control group (208.7 ± 138.2 vs. 303.5 ± 240.8 ml; P = 0.14). There were no differences in adverse events or complication rates between the two study groups. Conclusion The application of TissuGlu in abdominoplasty is safe and may decrease wound drainage and the length of time required for postsurgical drains in abdominoplasty patients. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00266-011-9844-3Authors Klaus J. Walgenbach, Plastic and Aesthetic Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, GermanyHolger Bannasch, Erich-Lexer-Klinik, University Medical Center, Freiburg, GermanyStefan Kalthoff, Rosenpark Klinik, Darmstadt, GermanyJ. Peter Rubin, University of Pittsburgh, Pittsburgh, PA, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

The Effect of Continuous Elastic Outside Distraction on the Expressions of Vascular Endothelial Cell Growth Factor and Microvessel Density in Female Porcine Nipple

Abstract Background We have proposed a method to correct the inverted nipple with good clinical results. The aim of the study presented here is to show the effect of continuous elastic distraction on the expression of vascular endothelial growth factor and microvessel density in the female porcine nipple. This article also explores the probable mechanism correction of inverted nipples. Methods Four female 3-month-old pigs each with 12 nipples were used. Four nipples of each minipig were used as control with the other eight nipples continuously distracted with prefabricated instruments. The nipples were excised at weeks 2, 4, 8, and 12 after distraction. Immunohistochemical staining was performed to observe the expression of vascular endothelial cell growth factor (VEGF) and CD34 in those tissues. The integral optical density of VEGF-positive cells and microvessel density (MVD) were also counted. Results The volumes of the nipples all increased after traction compared with those of the control group. The diameters and heights of the nipples showed significant changes (P < 0.01). In immunohistochemical staining, the expressions of VEGF and CD34 of all distracted groups were positive. The staining intensity of traction groups was moderate and that of the control groups was weakly positive. The integral optical density of VEGF-positive cells and MVD compared with the control group were significantly different (P < 0.01), and there was a significant positive correlation in MVD and VEGF. Conclusion Continuous elastic distraction can promote the expression of some growth factors in nipples. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00266-011-9851-4Authors Bin Zhou, Department of Plastic and Burns Surgery, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan Province, ChinaGuoping Wu, Department of Plastic and Burns Surgery, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan Province, ChinaYanchuan An, Department of Plastic and Burns Surgery, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan Province, ChinaXiaochuan He, Department of Plastic and Burns Surgery, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan Province, ChinaLi Teng, Plastic Surgery Hospital of Peking Union Medical College, Beijing, China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Cryopreservation of Fat Tissue and Application in Autologous Fat Graft: In Vitro and In Vivo Study

Abstract Background Absorption of the autologous fat graft results in repeated harvesting procedures. The cost and complications increase with repeated procedures, but cryopreservation is one way to solve the problem. The aim of this study was to find an optimal temperature at which to store fat tissue with or without cryoprotective agents for long-term use. Methods Fat tissues harvested by liposuction were stored in normal saline, frozen in the freezer following the preset program, and cryopreserved at −20, −80, and −196°C. The other group of fat tissues was stored in hydroxyethyl starch using the same frozen procedure. Two and 7 days after cryopreservation, viability tests were conducted. The fat tissues were injected into nude mice 2 and 4 weeks after cryopreservation. Three months later the fat grafts were harvested for histologic examination. Results No significant differences in cell viability were found in either in vitro or in vivo experiments for the three preserving temperatures. The cryoprotective agent HES did not influence cell viability. Conclusion There were no differences in cell viability among the three temperatures and with the use of a cryoprotective agent. Cryopreservation for salvage management is a clinically practical method. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00266-011-9848-zAuthors Bo-Wen Li, Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Shipai Rd., Taipei, TaiwanWen-Chieh Liao, Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Shipai Rd., Taipei, TaiwanSzu-Hsien Wu, Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Shipai Rd., Taipei, TaiwanHsu Ma, Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, Shipai Rd., Taipei, Taiwan Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

High Transverse Capsuloplasty for the Correction of Malpositioned Implants Following Augmentation Mammoplasty in Partial Submuscular Plane

Abstract Background Breast augmentation is one of the most commonly performed procedures today. The complications are few and can be divided into early or late. Early complications include infection and haematoma often requiring emergency interventions. Capsular contracture and implant malplacement are the most common late complications and both can be treated with an elective procedure. Capsular contracture is easily recognised due to change in the breast’s physical characteristics, shape, and accompanying tenderness. On the other hand, implant malplacement, though more common than capsular contracture, is often undertreated. The aim of this study was how to recognise and treat malpositioned implants in a partial submuscular pocket with or without animation or dynamic deformity. Methods Retrospective data were collected from the pool of revision breast surgeries, and patients with double-bubble deformities and malpositioned implants in the partial submuscular pocket accompanied with varying degrees of dynamic deformity were identified. Results Ten patients with malpositioned implants with varying degrees of animation deformity underwent high transverse capsuloplasty for a new pocket creation. The size of the new implants ranged from 350 to 595 cc. All were treated as day cases. With a follow-up period ranging from 1 to 6 years, all patients had good results and a stable new pocket. No revision was required in any of the procedures performed within a follow-up period of at least 1 year. Conclusion The high transverse capsuloplasty is an extension of an already described technique and can be used in selected patients with malpositioned implants with or without animation deformity following partial submuscular breast augmentation. Large-volume implants should be used with caution in these patients. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s00266-011-9850-5Authors Umar Daraz Khan, Re-shape House, 2-4 High Street, West Malling, Kent, ME19 6QR UK Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Tapia’s Syndrome: An Unexpected but Real Complication of Rhinoplasty: Case Report and Literature Review

Abstract Extracranial involvement of the recurrent laryngeal and hypoglossal nerves, also known as Tapia’s syndrome, is a rare complication of airway management under general anesthesia. We report such a case after an otherwise uncomplicated rhinoplasty. After reviewing the other nine reported cases of Tapia’s syndrome, we found that half of the patients had undergone rhinoplasty or septorhinoplasty. The risk factors, etiology, clinical course, recovery potential, and preventive measures are analyzed and discussed. Although Tapia’s syndrome after rhinoplasty/septorhinoplasty appears to be rare, it should be considered by both the anesthetist and the plastic surgeon, and most importantly, special attention should be paid to preventive strategies. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00266-011-9849-yAuthors Efstathios G. Lykoudis, Department of Plastic Surgery, Ioannina University School of Medicine, University Campus, 45110 Ioannina, GreeceKonstantinos Seretis, Department of Plastic Surgery, Ioannina University School of Medicine, University Campus, 45110 Ioannina, Greece Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Back to the Future: A 15-Year Experience With Polyurethane Foam-Covered Breast Implants Using the Partial-Subfascial Technique

Abstract Background Implants with a polyurethane foam cover have been used by plastic surgeons since Ashley described them in 1970. Overwhelming evidence confirms the benefits of these implants, especially the extremely low incidence of capsular contracture (grades 3 and 4, Baker classification). On the other hand, except for a transient and self-limited rash, there is no evidence that polyurethane implants present more complications than texturized or smooth gel implants. Due to concerns of polyurethane-induced cancer, these implants were withdrawn in United States after approximately 110,000 American women had received them. This fact, together with the probability that these implants will be reintroduced in the United States, suggests that continued monitoring of their long-term safety and effectiveness is mandatory. Methods A retrospective study analyzed the outcomes of 996 implants inserted during a period of 15 years. The incidence of early and late complications was analyzed as well as the aesthetic outcome. Results The complications evaluated included hematoma (0.6%), infection (0.4%), seroma (0.8%), rash (4.3%), wound dehiscence (0%), capsular contracture (0.4%), implant malposition (0.8%), need for revisional surgery (1.2%), implant rupture (0.7%), rippling (1.8%), and polyurethane-related cancer (0%). Regarding the aesthetic outcome, 95% of the patients expressed satisfaction with their final result. Conclusion The polyurethane foam-covered implants have been proven safe for use in breast surgery. They provide the lowest rate of capsular contracture (0.4% in the current study) and excellent aesthetic results. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00266-011-9826-5Authors Jose Abel de la Peña-Salcedo, Institute for Plastic Surgery, Vialidad de la Barranca S/N, Office 490, Huixquilucan, 52763 MexicoMiguel Angel Soto-Miranda, Institute for Plastic Surgery, Vialidad de la Barranca S/N, Office 490, Huixquilucan, 52763 MexicoJose Fernando Lopez-Salguero, Institute for Plastic Surgery, Vialidad de la Barranca S/N, Office 490, Huixquilucan, 52763 Mexico Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Anteriorly Pedicled Retroauricular Flap for Repair of Auricular Defects

Abstract The reconstruction of the auricle is aesthetically very demanding. Various techniques have been used depending on the defect size, the defect location, and tissue involved. For better wound control and result predictability, we developed an anteriorly pedicled retroauricular flap. We used this modified double-full-thickness skin graft in three patients. This anteriorly pedicled flap provides a visible wound surface which makes wound dressing easy. The aesthetic outcome is good and predictable. No major complications were encountered during surgery or the healing phase. All patients were satisfied with the outcome. The described method offers a good option for reconstructing larger auricular defects with local tissue. Content Type Journal ArticleCategory Innovative TechniquesPages 1-5DOI 10.1007/s00266-011-9847-0Authors Maria Barbara Stiller, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, GermanyMarcus Gerressen, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, GermanyAli Modabber, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, GermanyAlbert Rübben, Department of Dermatology, University Hospital Aachen, Aachen, GermanyDieter Riediger, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, GermanyAlireza Ghassemi, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Liposuction and Suspension of the Orbicularis Oculi for the Correction of Persistent Malar Bags: Description of Technique and Report of a Case

Abstract Background The purpose of this study was to present an alternative surgical procedure for the correction of persistent malar bags and to review the literature. Methods A 45-year-old female patient with persistent malar bags, secondary to previous blepharoplasty, was admitted. Liposuction of the edema and suspension of the orbicularis muscle to the temporal region was performed through a lateral canthal incision. Results A successful malar bag removal was demonstrated, exhibiting stable results at the 6-month follow-up. Conclusion Persistent malar bags resulting from previous blepharoplasty may be difficult to correct with conventional treatment. The combination of liposuction and suspension of the orbicularis oculi is proposed as an efficient alternative for the correction of persistent malar bags. Content Type Journal ArticleCategory Innovative TechniquesPages 1-4DOI 10.1007/s00266-011-9838-1Authors Ioannis E. Liapakis, OpsisClinical, Plastic and Reconstructive Surgery, 48 Anogion str, Therissos, 71304 Heraklion, Crete, GreeceEleftherios I. Paschalis, Harvard University Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Improving the Longevity and Results of Mastopexy and Breast Reduction Procedures: Reconstructing an Internal Breast Support System with Biocompatible Mesh to Replace the Supporting Function of the Ligamentous Suspension

Abstract Background The reasons for recurrent ptosis in mastopexy and breast reduction procedures are twofold. First, available surgical techniques do not reconstruct the normal breast anatomy responsible for maintaining breast shape. Second, in many instances the techniques rely on atrophied tissue to provide long-term support. The discovery in 1997 of the ligamentous suspension (the supporting system of the breast) gave rise to the concept that reconstruction of this anatomical structure was needed to ensure a sustained postoperative result. Applying the latest knowledge regarding the structural and vascular anatomy of the breast in the surgical technique and utilizing material other than atrophied breast tissue enabled us to prevent the recurrence of breast ptosis. Methods A surgical technique was developed to replace the supportive function of a failed ligamentous suspension in 112 patients with ptotic breasts. This was done by reconstructing an internal breast-supporting system (IBSS) with biocompatible mesh. Results Satisfactory breast shape, nipple projection, and upper breast fullness was obtained with this technique in mastopexy patients with moderate-sized ptotic breasts. In patients with larger breasts good results were obtained with a simultaneous breast reduction. The longest follow-up is 6 years 3 months. Conclusions With this technique recurrent breast ptosis can be prevented in mastopexy and breast reduction procedures. The results are such that it eliminates the need for silicone prostheses to obtain satisfactory upper-breast fullness. The surgical technique is especially indicated in patients with skin of poor quality or patients with high expectations. Content Type Journal ArticleCategory Original ArticlePages 1-12DOI 10.1007/s00266-011-9845-2Authors Petrus V. van Deventer, Division of Plastic and Reconstructive Surgery, Faculty of Health Sciences, University of Stellenbosch, Tygerberg Campus, Bellville, Western Cape, South AfricaFrank R. Graewe, Division of Plastic and Reconstructive Surgery, Faculty of Health Sciences, University of Stellenbosch, Tygerberg Campus, Bellville, Western Cape, South AfricaElisabeth Würinger, Department of Plastic and Reconstructive Surgery, Wilhelminenspital, Vienna, Austria Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

A Study of Postural Changes After Breast Augmentation

Abstract Background A number of factors, including body mass and one’s mood, may influence posture. Breast augmentation results not only in a significant improvement in body image-related feelings and self-esteem but also in a sudden change in body mass. The aim of this study was to assess postural changes following breast augmentation by studying body position, orientation through space, and center of pressure. Methods Patients with breast hypoplasia who underwent breast augmentation were enrolled. Posture evaluation was performed before and 1, 4, and 12 months after surgery by quantifying the center of mass using the Fastrak™ system and the center of pressure using stabilometry. The Wilcoxon signed-rank sum test was used to compare value modifications. Results Forty-eight patients were enrolled in the study. A retropositioning of the upper part of the body, confirmed by baropodometric analysis, was evident in the early postoperative period. We subsequently observed a reprogramming of the biomechanical system, which reached a state of equilibrium 1 year after surgery, with a slight retropositioning of the head and a compensatory anterior positioning of the pelvis. Conclusion We believe that with respect to posture, the role played by psychological aspects is even more important than that played by changes in body mass. Indeed, hypomastia is often associated with kyphosis because patients try to hide what they consider a deficiency. Following breast augmentation, the discovery of new breasts overcomes the dissatisfaction with the patient’s own body image, increases self-esteem, and modifies posture regardless of the changes in body mass due to the insertion of the implants. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00266-011-9841-6Authors Marco Mazzocchi, Department of Plastic Surgery, University of Perugia, Perugia, ItalyLuca Andrea Dessy, Department of Plastic Surgery, “La Sapienza” University of Rome, Rome, ItalyPierpaolo Iodice, Department of Neuroscience and Imaging, “G. d’Annunzio” University of Chieti, Chieti, ItalyRaoul Saggini, Department of Neuroscience and Imaging, “G. d’Annunzio” University of Chieti, Chieti, ItalyNicolò Scuderi, Department of Plastic Surgery, “La Sapienza” University of Rome, Rome, Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

The Diagnosis and Treatment of Thyroid-Associated Ophthalmopathy

Abstract Background Little is written in the plastic surgery literature about thyroid-associated ophthalmopathy (TAO), a condition that is separate from Graves–Basedow disease and may not be accompanied by hyperthyroidism. Many patients with this disease frequently seek periocular aesthetic reconstruction prior to medical workup. Methods This study presents a comprehensive review of the literature surrounding TAO in order to better understand the prevalence, diagnosis, pathophysiology, and appropriate management of TAO. Results TAO is frequently under- or misdiagnosed by health-care providers. Patients seeking blepharoplasty or other oculoplastic procedures may have underlying TAO, and the prevalence of TAO in patients who have had a blepharoplasty is approximately 3%. This condition occurs five times more often in women than in men. As a product of the relatively high prevalence of this disease and its underdiagnosis, TAO patients may experience perioperative and late complications due to surgery. Conclusion Blepharoplasties performed on TAO patients must be undertaken with care and insight to avoid cosmetic and functional complications. Content Type Journal ArticleCategory ReviewPages 1-11DOI 10.1007/s00266-011-9843-4Authors Daniel J. Gould, Department of Plastic Surgery, Baylor College of Medicine, Houston, TX, USAForrest S. Roth, Department of Plastic Surgery, Baylor College of Medicine, Houston, TX, USACharles N. S. Soparkar, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Subfascial Breast Augmentation: Is There Any Advantage Over the Submammary Plane?

Abstract Subfascial (SF) breast augmentation has been proposed as an alternative to placement of a breast prosthesis in a subpectoral (SP) or direct submammary (SM) plane, producing advantages over both techniques. This study compares complication rates in 200 SF-placed implants with 83 SM implants, undertaken over a 51-month period by a single surgeon. No statistical difference was found in the complication rate or patient satisfaction of one technique over the other. No clinical advantage can be demonstrated by placing breast prostheses behind the pectoral fascia compared to directly behind the breast. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00266-011-9840-7Authors Tim Brown, Suite 2, 8-12 Gibb Street, Berwick, VIC 3806, Australia Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Rhytidoplasty Without Periauricular Scar

Abstract As plastic surgeons, it has always been our goal to reduce the scarring associated with facial plastic surgeries. These scars generally occur on the scalp and in both the pre- and retroauricular areas. In 194 of our patients who underwent rhytidoplasties, we successfully eliminated these retroauricular and preauricular scars. To achieve these results, we did not make periauricular incisions; instead, we made a superior incision, a subcutaneous dissection, and used various surgical maneuvers such as subdermal plication and structural grafting. By utilizing this facelift technique, we were able to eliminate the appearance of periauricular scars associated with facial plastic surgery, reduce complications, achieve natural-looking results, and increase patient satisfaction. Content Type Journal ArticleCategory Innovative TechniquesPages 1-6DOI 10.1007/s00266-011-9837-2Authors Alfonso Riascos, Centro Medico Imbanaco (Laskin), CRA. 39 # 5ª – 91 Piso 3, Cali, Colombia Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Primary Nasal Tip Surgery: A Conservative Approach

Abstract Background Rhinoplasty and rhinoseptoplasty are very important and complex surgical procedures because the nose plays a pivotal aesthetic role in the face and an important functional role in breathing. Mild bulbous, plunging, undefined tips are very common, and tip refining and repositioning often are required surgical procedures. Methods For 97 selected patients, the authors performed their personal technique consisting of a transcartilaginous approach, incomplete vertical interruption, and retrograde undermining of the lower lateral cartilages to improve tip projection and definition. The five aspects analyzed were nasal tip symmetry, nostril symmetry, tip projection, tip definition, and appearance of the nasal tip only. Each parameter was assessed using pre- and postoperative quantification according to a visual analog scale. Postoperative evaluation was performed during a mean follow-up period of 1 year. Results The results at 1 year showed high rates of improvement in tip definition (mean, 7.9 ± 2.4) and nasal tip only evaluation (mean, 6.5 ± 3.1). The patients reported an improvement in nasal tip symmetry (mean, 4.2 ± 3.2), nostril symmetry (mean, 4.5 ± 4.1), and tip projection (mean, 5.8 ± 2.9). Conclusions This simple, safe, and effective technique is proposed for mild bulbous, plunging, undefined, and hypoprojected tips. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00266-011-9839-0Authors Marco Klinger, U.O. Chirurgia Plastica 2, Dipartimento di Medicina Traslazionale, Università degli Studi di Milano, IRCCS Istituto Clinico Humanitas, Via A. Manzoni 56, 20089 Rozzano, Milano, ItalyFabio Caviggioli, Cattedra di Chirurgia Plastica, MultiMedica Holding S.p.A. U.O.C. Chirurgia Plastica, Università degli Studi di Milano, Sesto San Giovanni, Milan, ItalyDavide Forcellini, U.O. Chirurgia Plastica 2, Dipartimento di Medicina Traslazionale, Università degli Studi di Milano, IRCCS Istituto Clinico Humanitas, Via A. Manzoni 56, 20089 Rozzano, Milano, ItalyValeria Bandi, U.O. Chirurgia Plastica 2, Dipartimento di Medicina Traslazionale, Università degli Studi di Milano, IRCCS Istituto Clinico Humanitas, Via A. Manzoni 56, 20089 Rozzano, Milano, ItalyLuca Maione, U.O. Chirurgia Plastica 2, Dipartimento di Medicina Traslazionale, Università degli Studi di Milano, IRCCS Istituto Clinico Humanitas, Via A. Manzoni 56, 20089 Rozzano, Milano, ItalyValeriano Vinci, U.O. Chirurgia Plastica 2, Dipartimento di Medicina Traslazionale, Università degli Studi di Milano, IRCCS Istituto Clinico Humanitas, Via A. Manzoni 56, 20089 Rozzano, Milano, ItalyAngelo Virgilio Pagliari, Unità Operativa di Otorinolaringoiatria, Ospedale di Crema, Crema, ItalyFrancesco Klinger, Cattedra di Chirurgia Plastica, MultiMedica Holding S.p.A. U.O.C. Chirurgia Plastica, Università degli Studi di Milano, Sesto San Giovanni, Milan, ItalyRiccardo Francesco Mazzola, Dipartimento di Scienze Chirurgiche Specialistiche, Università degli Studi di Milano, Milan, Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Fat Grafting Versus Adipose-Derived Stem Cell Therapy: Distinguishing Indications, Techniques, and Outcomes

Abstract With adipose-derived stem cells (ASCs) at the forefront of research and potential clinical applications, it is important that clinicians be able to distinguish them from the fat grafting currently used clinically and to understand how the two approaches relate to one another. At times, there has been confusion in clinically considering the two therapies to be the same. This report is aimed at distinguishing clearly between fat grafting and ASC therapy with regard to the indications, harvesting, processing, application techniques, outcomes, and complications. Findings have shown that autologous fat transfer, a widely used procedure for soft tissue augmentation, is beneficial for reconstructive and cosmetic procedures used to treat patients with volume loss due to disease, trauma, congenital defects, or the natural process of aging. On the other hand, ASCs have been identified as an ideal source of cells for regenerative medicine, with the potential to serve as soft tissue therapy for irradiated, scarred, or chronic wounds. Recent advances in tissue engineering suggest that the supplementation of fat grafts with ASCs isolated in the stromal vascular fraction may increase the longevity and quality of the fat graft. Research suggests that ASC supplementation may be a great clinical tool in the future, but more data should be acquired before clinical applications. Content Type Journal ArticleCategory ReviewPages 1-10DOI 10.1007/s00266-011-9835-4Authors Christina J. Tabit, Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at University of California Los Angeles, 200 Medical Plaza, Suite 465, Los Angeles, CA 90095-6960, USAGinger C. Slack, Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at University of California Los Angeles, 200 Medical Plaza, Suite 465, Los Angeles, CA 90095-6960, USAKenneth Fan, Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at University of California Los Angeles, 200 Medical Plaza, Suite 465, Los Angeles, CA 90095-6960, USADerrick C. Wan, Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at University of California Los Angeles, 200 Medical Plaza, Suite 465, Los Angeles, CA 90095-6960, USAJames P. Bradley, Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at University of California Los Angeles, 200 Medical Plaza, Suite 465, Los Angeles, CA 90095-6960, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Breast Reshaping with Dermaglandular Flaps After Giant Lipoma Removal: Versatility of Oncoplastic Techniques

Abstract Lipomas of the breast are benign lesions that do not raise great interest in the literature and their incidence is unclear. They usually are small, benign soft tissue tumors of fat cells that can be treated by simple excision. Although lipoma is a banal condition, it often causes diagnostic and therapeutic uncertainty. The first reason for this is the normal fatty composition of the breast. Second, it may be difficult to distinguish a lipoma from other benign or malignant lumps. This report presents a rare case involving giant lipoma of the breast that compromised most of the mass of the breast. After resection, the remaining breast was reshaped using multiple dermaglandular flaps to restore the breast mound, and contralateral breast mammaplasty was performed for symmetry. This case is a good illustration of the oncoplastic reconstruction options available after wide local excision. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00266-011-9831-8Authors Stefano Bonomi, Department of Plastic Reconstructive Surgery and Burn Unit, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, MI, ItalyAndré Salval, Department of Plastic Reconstructive Surgery and Burn Unit, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, MI, ItalyFernanda Settembrini, Department of Plastic Reconstructive Surgery and Burn Unit, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, MI, ItalyGaetano Musumarra, Department of Plastic Reconstructive Surgery and Burn Unit, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, MI, ItalyVincenzo Rapisarda, Department of Plastic Reconstructive Surgery and Burn Unit, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, MI, Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Patients Have a Right to Safe Surgery

Patients Have a Right to Safe Surgery Content Type Journal ArticleCategory EditorialPages 1-2DOI 10.1007/s00266-011-9836-3Authors Catherine B. Foss, International Society of Aesthetic Plastic Surgery, 45 Lyme Road, Suite 304, Hanover, NH 03755, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Synergistic Effects of Cryolipolysis and Shock Waves for Noninvasive Body Contouring

Abstract Background Excess body fat, localized adiposity, and cellulite represent important social problems. To date, techniques using radiofrequencies, cavitation and noncavitation ultrasound, and carbon dioxide have been studied as treatments for noninvasive body contouring. Ice-Shock Lipolysis is a new noninvasive procedure for reducing subcutaneous fat volume and fibrous cellulite in areas that normally would be treated by liposuction. It uses a combination of acoustic waves and cryolipolysis. Shock waves, used normally in the treatment of renal calculi and musculoskeletal disorders, are focused on the collagen structure of cellulite-afflicted skin. When used on the skin and underlying fat, they cause a remodeling of the collagen fibers, improving the orange-peel appearance typical of the condition. Cryolipolysis, on the other hand, is a noninvasive method used for the localized destruction of subcutaneous adipocytes, with no effects on lipid or liver marker levels in the bloodstream. The combination of the two procedures causes the programmed death and slow resorption of destroyed adipocytes. Methods In this study, 50 patients with localized fat and cellulite were treated with a selective protocol for the simultaneous use of two transducers: a Freezing Probe for localized fatty tissue and a Shock Probe for fibrous cellulite. Results The procedure significantly reduced the circumference in the treated areas, significantly diminishing fat thickness. The mean reduction in fat thickness after treatments was 3.02 cm. Circumference was reduced by a mean of 4.45 cm. Weight was unchanged during the treatment, and no adverse effects were observed. Histologic and immunohistochemical analysis confirmed a gradual reduction of fat tissue by programmed cell death. Moreover, the reduction in fat thickness was accompanied by a significant improvement in microcirculation, and thus, the cellulite. The safety of the method also has been highlighted because it is accompanied by no significant increase in serum liver enzymes or serum lipids. Conclusion The study aimed to observe the effects of the new technique in the treatment of localized fat associated with cellulite in order to assess adipose tissue alterations, cellular apoptosis, and levels of serum lipid or liver markers. The findings show that the action of Ice-Shock Lipolysis is a safe, effective, and well-tolerated noninvasive procedure for body contouring. In particular, the authors believe that this could be an ideal alternative to liposuction for patients who require only small or moderate amounts of adipose tissue and cellulite removal or are not suitable candidates for surgical approaches to body contouring. Content Type Journal ArticleCategory Original ArticlePages 1-14DOI 10.1007/s00266-011-9832-7Authors G. A. Ferraro, School of Medicine and Surgery, Department of Orthopaedic, Traumatologic, Riabilitative and Plastic-Reconstructive Sciences, Second University of Naples, L. De Crecchio 3, 80138 Naples, ItalyF. De Francesco, School of Medicine and Surgery, Department of Orthopaedic, Traumatologic, Riabilitative and Plastic-Reconstructive Sciences, Second University of Naples, L. De Crecchio 3, 80138 Naples, ItalyC. Cataldo, School of Medicine and Surgery, Department of Orthopaedic, Traumatologic, Riabilitative and Plastic-Reconstructive Sciences, Second University of Naples, L. De Crecchio 3, 80138 Naples, ItalyF. Rossano, School of Medicine and Surgery, Department of Orthopaedic, Traumatologic, Riabilitative and Plastic-Reconstructive Sciences, Second University of Naples, L. De Crecchio 3, 80138 Naples, ItalyG. Nicoletti, School of Medicine and Surgery, Department of Orthopaedic, Traumatologic, Riabilitative and Plastic-Reconstructive Sciences, Second University of Naples, L. De Crecchio 3, 80138 Naples, ItalyF. D’Andrea, School of Medicine and Surgery, Department of Orthopaedic, Traumatologic, Riabilitative and Plastic-Reconstructive Sciences, Second University of Naples, L. De Crecchio 3, 80138 Naples, Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Control of Postoperative Pain with a Wearable Continuously Operating Pulsed Radiofrequency Energy Device: A Preliminary Study

Abstract Background Pulsed radiofrequency energy (PRFE) has long been reported to have a therapeutic effect on postoperative pain. In this study, a portable, wearable, low-energy-emitting PRFE therapy device was used to determine the control of postoperative pain after breast augmentation surgery. Methods The study enrolled 18 healthy women who underwent breast augmentation purely for aesthetic considerations. Postoperative pain after surgery was assessed with a 0- to 10-point visual analog scale (VAS). Baseline pain scores were taken at completion of the operation, and the patients were randomly assigned coded PRFE devices that were either active or placebo devices. For 7 days, VAS scores were recorded twice daily (a.m. and p.m.). Medication use also was logged for 7 days. The PRFE devices were left in place and in continuous operation for the 7 days of the study. Results All the patients tolerated the PRFE therapy well, and no side effects were reported. The VAS scores for the active group were significantly lower on postoperative day 1. By day 7, the baseline VAS remaining in the active group was 7.9% versus 38% in the placebo group. Together with lower VAS scores, narcotic pain medication use was lower in the patient group that received PRFE therapy. Conclusion Postoperative pain is significantly lower with PRFE therapy. According to the findings, PRFE therapy in this form is an excellent, safe, drug-free method of postoperative pain control. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00266-011-9828-3Authors Ian M. Rawe, BioElectronics Corporation, 4539 Metropolitan Court, Frederick, MD 21704, USAAdam Lowenstein, Montecito Center for Aesthetic Plastic Surgery, Santa Barbara, CA, USAC. Raul Barcelo, Genecov Plastic Surgery Group, Dallas, TX, USADavid G. Genecov, Genecov Plastic Surgery Group, Dallas, TX, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Long-Term Complications of Polyethylene Glycol Injection to the Face

Abstract Currently, filling, smoothing, or recontouring the face through the use of injectable fillers is one of the most popular forms of cosmetic surgery. Because these materials promise a more youthful appearance without anesthesia in a noninvasive way, various fillers have been used widely in different parts of the world. However, most of these fillers have not been approved by the Food and Drug Administration, and their applications might cause unpleasant disfiguring complications. This report describes a case of foreign body granuloma in the cheeks secondary to polyethylene glycol injection and shows the possible complications associated with the use of facial fillers. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00266-011-9834-5Authors Hande Altintas, Otorhinolaryngology Department, Acibadem University Kadikoy Hospital, Istanbul, TurkeyMustafa Odemis, Department of Hatay, Antakya Government Hospital Otorhinolaryngology, Antakya, TurkeySelcuk Bilgi, Pathology Department, Acibadem University Istanbul, Istanbul, TurkeyOzcan Cakmak, Otorhinolaryngology Department, Acibadem University Kadikoy Hospital, Istanbul, Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Geometric Incision Design for Reduction Nippleplasty

Abstract Background Nipple hypertrophy is a frequently encountered problem in Asian women. It may be congenital or caused by hormones, breast feeding, or gestation. The hypertrophy has been linked primarily to aesthetics. The nipples of Asian women usually are 6–10 mm in diameter and 5–8 mm in height, and women with nipples larger than 1.5 cm in diameter or height frequently ask for reduction nippleplasty. Methods Women with nipple hypertrophy seeking reductive surgery at the authors’ hospital between 2004 and 2009 were considered for nippleplasty. A new design consisting of three dermal flaps and sparing of the central column was used. This design can reduce the diameter, height, and most importantly, the basal shape of the nipple without compromising neurovascular supply and functions. Results During the aforementioned period, 86 nipples of 43 patients were corrected with this method. All the patients were satisfied with the aesthetic results, preserved lactation, and sensory function. No major complications such as necrosis, infection, or numbness of the nipple occurred. Conclusions This reduction nippleplasty method can be applied for all types of nipple hypertrophy to create a new nipple of the desired height and diameter without significant complications. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00266-011-9833-6Authors Wen-Chen Huang, Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Section 2, Chung-Shan North Road, Taipei, Taiwan, R.O.C.Chia-Meng Yu, Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Section 2, Chung-Shan North Road, Taipei, Taiwan, R.O.C.Yao-Yuan Chang, Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Section 2, Chung-Shan North Road, Taipei, Taiwan, R.O.C. Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Transaxillary Muscle-Splitting Breast Augmentation: Experience with 160 Cases

Abstract Background Muscle-splitting breast augmentation, initially described by Baxter and later popularized by Khan, has proved to be an effective technique in terms of implant coverage, bypassing, and even solving of some issues associated with the dual-plane technique. A muscle-splitting breast augmentation technique recently has been used in combination with mastopexy. However, no reports have described muscle-splitting techniques accomplished by the transaxillary route. Methods A prospective study was conducted to evaluate the outcomes and complications of a novel approach to a specific breast augmentation technique. A total of 160 patients underwent bilateral transaxillary muscle-splitting breast augmentation between October 2007 and July 2010. All the patients were treated on an outpatient basis and received epidural anesthesia. Soft, round, textured, cohesive gel implants ranging in size from 200 to 350 ml were used. Results All the patients recovered quickly. To date, no infection, capsular contracture, rippling, double-bubble deformity, muscle contracture-associated deformities, or implant migration has occurred. Four patients (2.5%) experienced hematomas, all of which resolved before discharge. All the patients were discharged less than 24 h postoperatively and had an aesthetically natural result. Conclusion Transaxillary muscle-splitting breast augmentation, a novel approach to a technique that has been described previously, provides consistent, satisfactory results and good reproducibility. This new approach provides an excellent anatomic final appearance with no risk of displacement, rippling, double-bubble deformity, or contracture-associated deformities. Furthermore, this technique avoids any visible scars on the breast and features a low complication rate. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00266-011-9830-9Authors Rubem Lang Stümpfle, Hospital Moinhos de Vento, Ramiro Barcelos 910/605, Floresta, Porto Alegre, RS 90035-000, BrazilLucas Figueras Pereira-Lima, Hospital Moinhos de Vento, Ramiro Barcelos 910/605, Floresta, Porto Alegre, RS 90035-000, BrazilAndré Alves Valiati, Hospital Moinhos de Vento, Ramiro Barcelos 910/605, Floresta, Porto Alegre, RS 90035-000, BrazilGuilherme da Silva Mazzini, Porto Alegre, Brazil Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Using Multidetector Row Computed Tomography to Evaluate Baggy Eyelid

Abstract Background Baggy eyelids, formed by intraorbital fat herniation in the lower eyelids, are a sign of aging observed in the midface. This study aimed to identify the cause of baggy eyelids by evaluating the relationship between orbicularis oculi muscle thickness, orbital fat prolapse length, and age using multidetector row computed tomography (MDCT). Methods The 34 patients in the study ranged in age from 20 to 79 years. The patients were divided into three age groups: 20–29 years, 30–54 years, and 55–79 years. Orbicularis oculi muscle thickness and orbital fat prolapse length were measured using reconstructed computed tomography (CT) images. Results The orbicularis oculi muscle was found to be significantly thinner in the oldest group. Likewise, orbital fat prolapse was found to be significantly more prominent in the oldest group. A strong and significant negative correlation was found between orbicularis oculi muscle thickness and orbital fat prolapse length (r = −0.78; P < 0.001) and between orbicularis oculi muscle thickness and age (r = −0.77; P < 0.001). A strong and significant positive correlation was found between orbital fat prolapse length and age (r = 0.78; P < 0.001). Conclusions The use of MDCT provides insight into the detailed changes associated with aging that take place within the lower eyelids. This study objectively demonstrated that the major factors associated with baggy eyelids include orbicularis oculi muscle thickness, orbital fat prolapse length, and age. Decreased orbicularis oculi muscle thickness leads to the orbital fat prolapse. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00266-011-9829-2Authors Itsuko Okuda, Department of Diagnostic Radiology, International University of Health and Welfare, Mita Hospital, 1-4-3, Mita Minato-ku, Tokyo, 108-8329 JapanMasahiro Irimoto, Irimoto Medical, 1-12-10-203, Koishikawa, Bunkyo-ku, Tokyo, 112-0002 JapanYasuo Nakajima, Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, JapanShigemi Sakai, Department of Plastic Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3, Mita Minato-ku, Tokyo, 108-8329 JapanKazuaki Hirata, Department of Anatomy, St. Marianna University School of Medicine, 2-16-1, Sugao Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, JapanYukio Shirakabe, Department of Aesthetic Plastic Surgery, Sapho Clinic, 5-17-16, Roppongi, Minato-ku, Tokyo, 106-0032 Japan Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Correction of Inverted Nipple with “Arabesque”-Shape Sutures

Abstract Background Inverted nipples are a common self-concern for many women and also a relatively aesthetic problem for the plastic surgeon. Methods Many techniques for correcting inverted nipples have been reported, but none is totally successful. To avoid recurrence and to attain perfect shape of the nipple, the authors present a minimal-incision technique supported by “arabesque”-shape percutaneous sutures. First, four micro-incisions about 0.5 cm in size, each the circumference of the nipple, are designed horizontally. Second, after sufficient releasing of the loose connective tissue beneath the nipple, two 4/0 PDS sutures are made in perpendicular directions to increase the support and sustain the tissue under the nipple and to close the way the nipple inverts. Results This method was used to correct 22 inverted nipples of 18 patients classified as grade 3 or 4. The entire nipple remained everted and symmetric during a follow-up period of 3 months to 1 year except in two cases of recurrence during the early postoperative period due to a loose knot. Conclusion The described technique is simple, safe, and reliable, providing sustained results over the long-term follow-up period with a high rate of stable eversion and patient satisfaction. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00266-011-9827-4Authors Stamatis Sapountzis, Department of Plastic and Reconstructive Surgery, Seoul National University, Bundang Hospital, 166 Gumiro, Bundang, Seongnam, Gyeonggi 463-707, Republic of KoreaJi Hoon Kim, Department of Plastic and Reconstructive Surgery, Seoul National University, Bundang Hospital, 166 Gumiro, Bundang, Seongnam, Gyeonggi 463-707, Republic of KoreaPham Minh, Department of Plastic and Reconstructive Surgery, Seoul National University, Bundang Hospital, 166 Gumiro, Bundang, Seongnam, Gyeonggi 463-707, Republic of KoreaYoung Soo Hwang, Lael-Clinic, Incheon, Republic of KoreaRong Min Baek, Department of Plastic and Reconstructive Surgery, Seoul National University, Bundang Hospital, 166 Gumiro, Bundang, Seongnam, Gyeonggi 463-707, Republic of KoreaChan Yeoung Heo, Department of Plastic and Reconstructive Surgery, Seoul National University, Bundang Hospital, 166 Gumiro, Bundang, Seongnam, Gyeonggi 463-707, Republic of Korea Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Quality of Life Among Iranian Adults Before and After Rhinoplasty

Abstract Background Despite developments in the therapeutic field of cosmetic surgery, there is a little information about the effects of cosmetic procedures on quality of life (QOL), especially in Iran. Rhinoplasty is one of the most common cosmetic surgeries. This type of surgery has remarkable effects on physical and mental health and also improves nasal functioning. The purpose of this study was to survey QOL among Iranian adults before and after rhinoplasty. Methods In this descriptive and analytical cross-sectional study, from March 2009 to March 2010, data were collected from 75 subjects, 16 years old and above, before and 6 months after rhinoplasty. A trained interviewer interviewed and completed standardized questionnaires investigating QOL, including the SF-36 version 2, NOSE, and Rosenberg questionnaires. Data analysis was conducted using SPSS ver. 16. Results before and after surgery were compared. Results The mean age of the subjects was 26.05 ± 7.78 years, with a median of 24 years. The female-to-male ratio was 4.35:1. In all cases and all questionnaires, QOL was improved after rhinoplasty. Significant differences were observed on the NOSE questionnaire (p = 0.005) and the Rosenberg questionnaire (p = 0.002). On the SF-36 questionnaire, significant differences were observed in four subscales, including physical functioning (p = 0.047), role of emotion (p = 0.01), bodily pain (p = 0.01), and vitality (p = 0.05). Conclusions According to this study, QOL is improved after rhinoplasty in Iranian adult patients. With proper patient selection and a successful operation, improvement of physical and mental health can be expected. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00266-011-9820-yAuthors Mohammad Javad Fatemi, Plastic and Reconstructive Surgery, Hazrat Fateme Hospital, Tehran University of Medical Science, Tehran, IranFateme Rajabi, Social Medicine, Tehran University of Medical Science, Tehran, IranSeyed Jaber Moosavi, Social Medicine, Mazandaran University of Medical Science, Mazandaran, IranMajid Soltani, Burn Research Center, Tehran University of Medical Science, Tehran, Iran Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Lateral Canthoplasty Using the Mitek Anchor System

Abstract Background Lower-eyelid shape and position have important aesthetic and functional implications. While primary canthoplasty is generally a straightforward procedure, secondary canthoplasty can be considerably challenging. This is especially true in the setting of poor periorbital tissues and the resultant lack of a stable platform from which to suspend the canthus. We report the first use of the Mitek device in secondary lateral canthal procedures to remedy this common problem. Methods Twelve patients underwent a total of 19 revision lateral canthoplasties using the mini Mitek suture anchor system. All of the patients had had prior cosmetic and/or reconstructive surgery in the lateral canthal area with resultant canthal malpositioning. To correct this, suture anchors were placed into a 2-mm area of intact bone on the lateral orbital wall, and the lateral canthal tendon was resuspended into proper position. Results In this series, there were no postoperative infections or patient reports of persistent discomfort at the anchor sites. All suture anchors remained in proper position postoperatively, and patients reported satisfaction with eyelid shape and function. Most of the patients reported resolution of their preoperative symptoms. Mean follow-up time was 24.2 months. Conclusion The Mitek suture anchor is an excellent tool for lateral canthoplasty in patients with significant periorbital scarring or suboptimal canthal positioning after multiple cosmetic surgery procedures. It is also a good option for patients with significant soft tissue damage owing to prior surgery, radiation, or trauma in the periorbital field. This technique can be performed quickly through small incisions and requires only a small amount of stable bone for tendon fixation. Results are excellent and the procedure has proven to be safe and effective in our series of patients. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00266-011-9825-6Authors Sophie Bartsich, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medical College, 875 Fifth Avenue, New York, NY 10065, USAKimberly A. Swartz, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medical College, 875 Fifth Avenue, New York, NY 10065, USAHenry M. Spinelli, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medical College, 875 Fifth Avenue, New York, NY 10065, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Extended Abdominoplasty: Applications and a New Classification System for Abdominoplasty

Abstract Background Aesthetic deformities of the abdomen requiring skin resection are usually treated with procedures limited to the abdomen and in some cases with circumferential abdominoplasty. There are some patients who require an intermediate procedure between abdominoplasty and circumferential abdominoplasty; these patients have been neglected in the plastic surgery literature. Methods The medical records of 268 patients who underwent aesthetic procedures of the abdomen between January 2008 and July 2010 were retrospectively reviewed. Patients who had abdominal laxity extending into the flanks and who underwent extended abdominoplasty with liposuction of the back were evaluated. The surgical technique is described and its applications are reviewed. Results Twenty-five patients underwent extended abdominoplasty. All patients were extremely satisfied with the results. Only minor complications occurred. Two patients had marginal skin necrosis and one patient had a wound site infection but all of them had satisfactory resolution of their complications. Conclusion Extended abdominoplasty is a safe procedure with highly satisfactory results that should become common practice in plastic surgery. There is a group of patients who are best served by this procedure and a new classification system of the abdominal contour deformities that includes these patients is needed and is proposed by the authors. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00266-011-9818-5Authors Jorge Alirio Mejia, Universidad de Antioquia, Calle 7 sur 42 – 70 OF 511 Ed Forum, Medellín, Antioquia, ColombiaYesid Alberto Cárdenas Castellanos, Universidad de Antioquia, Calle 3 sur # 43ª 52 OF 907 Ed Ultrabursatiles, Medellín, Antioquia, Colombia Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Small-Wave Incision Method for Linear Hypertrophic Scar Reconstruction: A Parallel-Group Randomized Controlled Study

Abstract Background The usual hypertrophic scar reconstruction methods such as Z- and W-plasties can leave noticeable scars and involve excessive normal skin excision, particularly in long linear hypertrophic scars longer than 10 cm. Thus, we invented and applied the small-wave incision method for patients with linear hypertrophic scars. Methods A total of 40 patients with linear hypertrophic scars were included in this study. The patients were randomly assigned to the linear incision group (n = 20) or the small-wave incision group (n = 20). All scars were mildly hypertrophic, longer than 10 cm, and located in the lower abdominal/suprapubic region. They occurred after Cesarean section or gynecological or abdominal surgery. Patient age and sex, the cause of the scar, and the preoperative and postoperative sizes of the scar were recorded. Postoperative scar size and recurrence were evaluated for 18 months. Mathematical comparisons were also made to multiple linear incision, Z-plasty, planimetric Z-plasty, and W-plasty. Results Postoperative recurrence was 40 and 15% in linear and small-wave groups, respectively (P = 0.77). The main risk factor for recurrence was postoperative size (P = 0.043). Mathematical comparisons revealed that the small-wave method can achieve the same release of tension with the least normal skin excision while making the scar irregular via an accordion effect. Conclusion The small-wave method can meet both the functional and the cosmetic requirements of long linear hypertrophic scar reconstruction while reducing complication risks. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00266-011-9821-xAuthors Chenyu Huang, Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 JapanShimpei Ono, Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 JapanHiko Hyakusoku, Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 JapanRei Ogawa, Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 Japan Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Volume Enhancement of Upper Lip in Secondary Cleft Deformity Using Composite Mastoid Tissue

Abstract Background Secondary cleft lip deformity correction needs thorough assessment and planning to optimize treatment and achieve good results. Deficient volume of the upper lip, which is one of the most common secondary cleft lip deformities, has been addressed in many ways using tissues from local or distant areas. Consideration must be given to safety, easy availability of the tissues, minimum morbidity, and longevity of the results when selecting a procedure. Methods This retrospective study included ten patients with a minimum follow-up of 1 year. Composite mastoid fascia was harvested through a postauricular incision and used to augment deficient lip volume in secondary cleft lip deformities. Clinical assessment and measurement was performed by measuring the vertical height and projection of the deficient upper lip before and after surgery. Results At the end of 1 year the average increase in the vertical height of the vermilion was 27.11% compared to the preoperative readings, with an average loss of 12.81% of increase at 1 year. The lateral projection showed an increase of 23.88% compared to the reading taken before surgery, with a loss of 9.75% at the end of 1 year. The donor site incision was concealed behind the ear and lip incisions were invisible in the long term. There were no major complications. Conclusion This is a good way of augmenting the lip with due consideration given to longevity of the result and minimal morbidity. This method might also by used for permanent cosmetic lip enhancement for those with very thin lips. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00266-011-9822-9Authors Mohan Thomas, Breach Candy Hospital and Research Centre, Mumbai, IndiaJames Allan D’silva, Breach Candy Hospital and Research Centre, Mumbai, IndiaRam Mahadev Chilgar, The Cosmetic Surgery Institute, 169, Lily Villa, St. Andrews Road, Off Turner Road, Bandra (West), Mumbai, 400050 India Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Anatomical Variations of the Upper Lateral Cartilages and Their Implications in Rhinoplasty

Abstract Background Upper lateral cartilage manipulation is often associated with compromise of the middle-third vault. Although the anatomical details of the upper lateral cartilages are of great importance for the maintenance or even the creation of an aesthetically pleasing dorsum with proper respiratory function, the literature includes few studies related to these themes. Thus, this study aimed to evaluate the total length of the upper lateral cartilages and their extension under the nasal bones and caudally, and examine the anatomical variations of the upper lateral cartilages and their implications in rhinoplasty. Method An anatomical study was performed on 32 upper lateral cartilages of 16 fresh adult cadavers. The upper lateral cartilages were measured for total length, cephalad length (overlapped by the nasal bones), and caudal length (caudally to the nasal bones) using a millimeter ruler. The measurements were recorded and analyzed by BioEstat 5.0 software. The statistical tests were performed at the significance level of 0.05. Results A total of 13 male specimens and 3 female specimens with ages ranging between 20 and 60 years were analyzed. The length of the upper lateral cartilage portion under the nasal bones on the right side ranged from 3 to 7 mm (4.62 ± 1.20 mm). On the left side, it ranged from 2 to 7 mm (4.56 ± 1.26 mm). The total length of the upper lateral cartilages ranged from 16 to 28 mm (20.44 ± 3.26 mm) on the right side and 17 to 30 mm (20.75 ± 3.71 mm) on the left side. Conclusion Data from this study confirmed the anatomical variations of the upper lateral cartilages, including the portion lying under the nasal bones. This has important surgical implications given the attention required during spreader graft fabrication in order to maintain dorsal aesthetic lines and proper respiratory function. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00266-011-9824-7Authors Victor Diniz de Pochat, Division of Plastic Surgery, Department of Surgery, HUPES—Federal University of Bahia (UFBA), R. Conselheiro Correia de Menezes, 432, AP. 201, Salvador, BA 40295030, BrazilNivaldo Alonso, Department of Plastic Surgery, Hospital das Clinicas da FMUSP, Sao Paulo, BrazilEmilie B. Ribeiro, Division of Plastic Surgery, Department of Surgery, HUPES—Federal University of Bahia (UFBA), R. Conselheiro Correia de Menezes, 432, AP. 201, Salvador, BA 40295030, BrazilEmanuelle A. da Rocha, Division of Plastic Surgery, Department of Surgery, HUPES—Federal University of Bahia (UFBA), R. Conselheiro Correia de Menezes, 432, AP. 201, Salvador, BA 40295030, BrazilEdinho G. Tenório, Division of Plastic Surgery, Department of Surgery, HUPES—Federal University of Bahia (UFBA), R. Conselheiro Correia de Menezes, 432, AP. 201, Salvador, BA 40295030, BrazilJose Valber Lima Meneses, Division of Plastic Surgery, Department of Surgery, HUPES—Federal University of Bahia (UFBA), R. Conselheiro Correia de Menezes, 432, AP. 201, Salvador, BA 40295030, Brazil Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Effective Wound Closure With a New Two-Component Wound Closure Device (Prineo™) in Excisional Body-Contouring Surgery: Experience in Over 200 Procedures

Abstract Background In excisional body-contouring surgery the surgeon is often confronted with time-consuming closure of long wounds. Recently, a new combination of a self-adhering mesh together with a liquid 2-octyl cyanoacrylate adhesive (Prineo™; Ethicon, Inc., Somerville, NJ, USA) has been introduced to replace intracutaneous running suture. Methods An observational study was undertaken to evaluate the efficacy of the new wound closure device in excisional body-contouring procedures between January 2008 and November 2010. Wound characteristics were recorded in a prospectively maintained database. Results During the study period, 224 procedures in 180 patients were undertaken. Twenty-seven patients had two subsequent operations and four patients had three subsequent operations. Application of the new device was easy and safe and patient satisfaction with the results was generally high. However, intense local allergic reactions were seen in 4 patients (1.8%), which necessitated early removal and topical corticosteroid treatment. Conclusions Prineo™ enables the surgeon to perform a quick and smooth skin closure, especially in long incisions frequently encountered in excisional body-contouring surgery. The application is fast and easy if basic guidelines are respected. Operating time is saved by eliminating the need for time-consuming intracutaneous running sutures. Removal is easy and painless for the patient. However, there is a potential for local allergic adverse effects of which the surgeon must be aware. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00266-011-9819-4Authors Georg M. Huemer, Plastic, Aesthetic & Reconstructive Surgery, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, AustriaManfred Schmidt, Plastic, Aesthetic & Reconstructive Surgery, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, AustriaGudrun H. Helml, Plastic, Aesthetic & Reconstructive Surgery, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, AustriaMaziar Shafighi, Department of Plastic and Reconstructive Surgery, University Hospital Inselspital, 3010 Bern, SwitzerlandKarin M. Dunst-Huemer, Department of Dermatology, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Single-Stage Reconstruction of Skin-involving Nasal Paraffinoma with Pericraniosubgaleal Flap

Abstract Background The removal of a paraffinoma over the nasal bridge may result in thinning and even loss of involved skin as well as a saddle nose deformity. For nasal reconstruction, a variety of techniques using a free graft of autogenous tissue such as fascia, dermofat, or cartilage have been used, either in immediate, single-stage or in delayed, multiphase treatment. However, such reconstructions can be challenging largely due to absorption of the grafted tissue and poor blood supply to the surrounding nasal tissue infiltrated with paraffin. This article reports the successful clinical outcomes of immediate, single-stage reconstructions by wrapping a pericraniosubgaleal flap over the nasal implant after removing a paraffinoma. Methods Eleven patients with a paraffinoma showing a palpable lump, redness, or telangiectasia over the nasal skin were treated between November 1998 and March 2011. The mean follow-up period was 20.1 months. As much of the paraffinoma as possible was removed via a bidirectional approach (open rhinoplasty and frontal hairline incision), and the resulting deformity was reconstructed simultaneously using a pericraniosubgaleal flap and turning it over the sculpted nasal implant (ePTFE; GORE-TEX® in nine cases and silicone in two cases). Results Nine patients (81.8%) were treated successfully without complications and were satisfied with their results. However, the other two patients complained of incomplete removal of the paraffinoma requiring additional removal. Telangiectasia over the nose improved in four out of six patients after surgery. Conclusion Nasal reconstruction using a pericraniosubgaleal flap is one of the most reliable surgical options for treating skin-involving nasal paraffinomas. The advantage of such a method is that a well-vascularized and durable flap, which is resistant to infection, is wrapped over the sculpted nasal implant in a single step. It also reinforces the thinned skin, which makes it easier to form various shapes, producing excellent cosmetic results. Finally, it can also serve as a tolerable graft bed in the case of overlying skin loss. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00266-011-9815-8Authors Seung-Il Chung, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyung Hee University, #1 Hoeki-dong, Dongdaemun-ku, Seoul, 130-702 KoreaYoung-Cheun You, Art Plastic Surgery Clinic, Seoul, KoreaKi-Yup Kim, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyung Hee University, #1 Hoeki-dong, Dongdaemun-ku, Seoul, 130-702 KoreaWon-Yong Yang, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyung Hee University, #1 Hoeki-dong, Dongdaemun-ku, Seoul, 130-702 KoreaSeok-Min Kwon, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyung Hee University, #1 Hoeki-dong, Dongdaemun-ku, Seoul, 130-702 KoreaSang-Yoon Kang, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyung Hee University, #1 Hoeki-dong, Dongdaemun-ku, Seoul, 130-702 Korea Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Coenzyme Q10 Does Not Enhance Preadipocyte Viability in an In Vitro Lipotransfer Model

Abstract Background Autologous fat is an attractive soft-tissue filler in plastic and reconstructive surgery. The success of the procedure relies strongly on the technique of transferring viable preadipocytes. Among other factors, preadipocyte viability is impaired by local anesthetics. Application of coenzyme Q10 is being performed by aesthetic plastic surgeons to enhance the success of lipotransfer. The aim of this study was to evaluate the effect of Q10 on preadipocyte viability with special regard to impairment after lidocaine treatment. Methods Preadipocytes were pretreated with coenzyme Q10 or vehicle control followed by incubation with lidocaine for 30 min. Viability and apoptosis were assessed by FACS analysis and Western blot. Results Coenzyme Q10 did not improve viability nor have any effect on investigated apoptosis parameters. Preadipocyte viability was reduced after lidocaine treatment. Surface binding of annexin V, cleavage of caspase-3, and abundance of subdiploid cells were not detectable though, suggesting that necrosis rather than apoptosis is the cause for reduced preadipocyte viability. Conclusion Our results indicate that Q10 does not improve preadipocyte viability. Preadipocyte cell death induced by lidocaine is not caused by apoptosis but by necrosis, which cannot be prevented by coenzyme Q10. These findings should be taken into account when searching for solutions to improve preadipocyte viability in the context of soft tissue engineering and autologous fat transfer. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00266-011-9823-8Authors Maike Keck, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Währingergürtel 18-20, 1090 Vienna, AustriaMaximilian Zeyda, Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, AustriaSonja Burjak, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Währingergürtel 18-20, 1090 Vienna, AustriaLars-Peter Kamolz, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Währingergürtel 18-20, 1090 Vienna, AustriaHarald Selig, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Währingergürtel 18-20, 1090 Vienna, AustriaThomas M. Stulnig, Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, AustriaManfred Frey, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Währingergürtel 18-20, 1090 Vienna, Austria Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Calf Implants: A 25-Year Experience and an Anatomical Review

Abstract Background Body contouring in the calf region is becoming a more frequently requested procedure. There are several techniques for calf enhancement, including implants, liposuction, and free flaps. Alloplastic augmentation can be performed with several implant types and several layers of pocket dissection. We present our 25 years of experience using the subfascial technique for calf implantation along with an anatomical study to illustrate all the important steps and relevant anatomy of this augmentation technique. Methods The subfascial technique was performed in 25 cadavers, in which the important layers were dissected for high-resolution photos of the surgery to learn about the relevant anatomy of the region. Also, we did a retrospective study of our experience with calf implants, studying the aesthetic outcome, the presence of early complications, and the presence of late complications. Results We performed dissections in 25 cadavers and surgery in 63 patients (126 implants). In our series of patients the final aesthetic index was of 9.8. The early complications were severe postoperative pain (11.11%), infection (0.79%), seroma (21.42%), hematoma (0%), and wound dehiscence (7.14%). The late complications were capsular contracture (Baker grades III and IV) (3.17%), implant rupture (1.58%), implant leaking (0%), implant displacement (3.96%), numbness at the ankle (2.38%), and palpability of the implant (0%). Conclusion The subfascial technique for calf augmentation has complication rates low enough and surgical outcomes good enough to recommend it as the gold standard for alloplastic calf augmentation. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s00266-011-9812-yAuthors Jose Abel de la Peña-Salcedo, Institute for Plastic Surgery, Vialidad de la Barranca S/N, Office 490, 52763 Huixquilucan, Mexico, MexicoMiguel Angel Soto-Miranda, Institute for Plastic Surgery, Vialidad de la Barranca S/N, Office 490, 52763 Huixquilucan, Mexico, MexicoJose Fernando Lopez-Salguero, Institute for Plastic Surgery, Vialidad de la Barranca S/N, Office 490, 52763 Huixquilucan, Mexico, Mexico Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Vacuum-Assisted Breast Implant Insertion in Primary Augmentation Mammaplasty

Vacuum-Assisted Breast Implant Insertion in Primary Augmentation Mammaplasty Content Type Journal ArticleCategory Letter to the EditorPages 1-2DOI 10.1007/s00266-011-9817-6Authors Roberto Bracaglia, Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome RM, ItalyMarco D’Ettorre, Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome RM, ItalyStefano Gentileschi, Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome RM, ItalyDamiano Tambasco, Department of Plastic and Reconstructive Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome RM, Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Surgical Correction of Ambiguous Genitalia in 46-Year-Old Woman

Surgical Correction of Ambiguous Genitalia in 46-Year-Old Woman Content Type Journal ArticleCategory Letter to the EditorPages 1-3DOI 10.1007/s00266-011-9811-zAuthors M. S. Leone, Plastic and Reconstructive Surgery Unit, National Institute for Cancer Research-IST, Largo Rosanna Benzi, no 10, 16132 Genoa, ItalyC. Introini, Surgical Oncology Urology Unit, National Institute for Cancer Research-IST, Genoa, ItalyC. Neumaier, Department of Diagnostic Imaging, National Institute for Cancer Research-IST, Genoa, ItalyP. L. Santi, Plastic and Reconstructive Surgery Unit, National Institute for Cancer Research-IST, Largo Rosanna Benzi, no 10, 16132 Genoa, ItalyM. Massa, Plastic and Reconstructive Surgery Unit, National Institute for Cancer Research-IST, Largo Rosanna Benzi, no 10, 16132 Genoa, Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Rhinoplasty Sizers

Abstract Templates and sizers are used as tools to assist in the design and construction of both structural and artistic works. These templates and sizers are used frequently in the field of aesthetic and reconstructive surgery. The use of a template to assist with construction of cartilage grafts in rhinoplasty allows the surgeon to sculpt by replicating the template model. Templates and sizers are useful and advantageous tools in the rhinoplasty operation. Content Type Journal ArticleCategory Innovative TechniquesPages 1-5DOI 10.1007/s00266-011-9764-2Authors Dennis McMahon, Division of Plastic and Reconstructive Surgery, Stanford University Hospital, Stanford, USAAlex Lin, University of California, San Francisco, USAVikram Reddy, University of California, Davis, USARonald P. Gruber, Stanford University, Stanford, USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Reverse Nasal SMAS-Perichondrium Flap to Avoid Supratip Deformity in Rhinoplasty

Abstract Background Supratip deformity is an iatrogenic convexity that occurs cephalically to the nasal tip. This is also known as “parrot beak” deformity and causes an unnatural appearance of the nose. In the literature there are several explanations of the mechanism of the deformity and methods to correct it. One of the most accepted theories about the cause of supratip deformity is overresection of the caudal dorsum. Healing soft tissues fill in the gap created between the septum and the tip of the lower lateral cartilages, leading to fullness in the supratip area. The lower third and basically distal third of the middle third of the nose include several muscle groups, ligamentous structures, and perichondrium as the subcutaneous soft tissues. Methods With the idea of elevating a reverse-based flap basically from the lower third and the lower third of the middle third of the nose, including the perichondrium and SMAS tissue, we aimed to reduce this gap, which has the potential to accumulate soft tissues that cause supratip fullness. Between December 2008 and July 2010, the reverse nasal SMAS-perichondrium flap was used in 42 primary rhinoplasty patients. Results This flap was used in 42 patients. Follow-up ranged from 3 to 18 months. No early or late complications were noted, such as infection, excessive bleeding, or extended edema. Minor revisions were performed in only two patients with the aim of achieving a smoother nasal dorsum. Conclusions The reverse nasal SMAS-perichondrium flap is a new flap. The results presented here are not long term; however, the preliminary results are promising. The flap should be avoided in cases of thin skin, or at least be used with caution, whereas in thick skin cases it is very safe. Further studies in larger groups are required to better define the advantages and disadvantages of this flap. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00266-011-9814-9Authors Emrah Arslan, Department of Plastic and Reconstructive Surgery, Çanakkale Onsekiz Mart University, Çanakkale Onsekiz Mart University Hospital, Sahil Yolu No. 5 Kepez, 17100 Çanakkale, TurkeyEyuphan Gencel, Department of Plastic and Reconstructive Surgery, Cukurova University, Adana, TurkeyOznur Pekedis, Department of Plastic and Reconstructive Surgery, Ortadogu Hospital, Adana, Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Reoperative Transaxillary Breast Surgery: Using the Axillary Incision to Treat Augmentation-related Complications

Abstract Background The axillary incision for breast augmentation has been an option for patients and surgeons for more than 30 years now. Controlled clinical trials have demonstrated that reoperations continue to be significant (15–24% at 3 years) independent of incision choice. The misbelief that the transaxillary approach is not adequate for reoperations inhibits patients’ and surgeons’ decisions on what incision is best in each case. Methods A retrospective analyses was performed seeking reoperation cases performed from January 2008 to January 2011 that used the same axillary incision as the previous transaxillary augmentation. Data on the cause for the reoperation, time between surgeries, patient age, implant volume, locality of the primary operation, and details regarding the implant type and pocket plane were gathered and analyzed. Results A total of 15 patients and 26 breasts needing reoperation were found in this period. The average time between the first surgery and reoperation was 12 months, average patient age was 36 years, and implant volume ranged from 195 to 360 cc, with an average of 283 cc. Six of these patients were previously operated on by the authors and nine were operated on by other surgeons and came to our service seeking revision. Details regarding the implant type and pocket plane are also given. The main causes for reoperation were capsular contracture (26.9%), size change (15.4%), seroma/hematoma (11.5%), infection (11.5%), axillary banding/scarring (11.5%), lower-pole deformity/high-riding (11.5%), asymmetry (7.7%), and rippling/waviness (3.8%). Conclusion Transaxillary breast augmentation reoperation is feasible if certain principles are followed. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00266-011-9810-0Authors Filipe Volpe Basile, Plastic Surgery Department, Basile Medical Center, Av. Prof Joao Fiusa 2300, Ribeirao Preto, Sao Paulo, Brazil 14024-230Antonio Roberto Basile, Plastic Surgery Department, Basile Medical Center, Av. Prof Joao Fiusa 2300, Ribeirao Preto, Sao Paulo, Brazil 14024-230 Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

A Bellevue Nurse's Tribute to Dr. William Shaw.

A Bellevue Nurse's Tribute to Dr. William Shaw. Plast Reconstr Surg. 2012 Feb;129(2):409e-10e Authors: McGibbon MF PMID: 22286494 [PubMed - in process]

The Uses of the iPhone for the Plastic Surgeon: Friend or Foe?

The Uses of the iPhone for the Plastic Surgeon: Friend or Foe? Plast Reconstr Surg. 2012 Feb;129(2):408e-9e Authors: Amin K, Chandrasena A PMID: 22286493 [PubMed - in process]

Adoption of accreditation council for graduate medical education duty hour requirements.

Adoption of accreditation council for graduate medical education duty hour requirements. Plast Reconstr Surg. 2012 Feb;129(2):407e-8e Authors: Wong MS, Stevenson TR PMID: 22286492 [PubMed - in process]

Should plastic surgeons operate on patients diagnosed with body dysmorphic disorder?

Should plastic surgeons operate on patients diagnosed with body dysmorphic disorder? Plast Reconstr Surg. 2012 Feb;129(2):406e-7e Authors: Azevedo de Brito MJ, Nahas FX, Ferreira LM PMID: 22286491 [PubMed - in process]

Instruments for supermicrosurgery in Japan.

Instruments for supermicrosurgery in Japan. Plast Reconstr Surg. 2012 Feb;129(2):404e-6e Authors: Mihara M, Hayashi Y, Iida T, Narushima M, Koshima I PMID: 22286490 [PubMed - in process]

Antibacterial Analysis of Surgical Adhesives.

Antibacterial Analysis of Surgical Adhesives. Plast Reconstr Surg. 2012 Feb;129(2):402e-404e Authors: Joseph JM, Voldman A, Zoumalan CI, Lisman RD, Iovine NM PMID: 22286489 [PubMed - as supplied by publisher]

A Cautionary Report: Creation of Intraoperative Sparks and Embers from Onyx Embolic Material during Surgical Resection of Arteriovenous Malformations.

A Cautionary Report: Creation of Intraoperative Sparks and Embers from Onyx Embolic Material during Surgical Resection of Arteriovenous Malformations. Plast Reconstr Surg. 2012 Feb;129(2):401e-2e Authors: Mull A, Marshallek F, Tejada J, Flores RL PMID: 22286488 [PubMed - in process]

Simplified negative-pressure wound therapy system for skin graft wounds.

Simplified negative-pressure wound therapy system for skin graft wounds. Plast Reconstr Surg. 2012 Feb;129(2):399e-401e Authors: Li TS, Choong MY, Wu HF, Chung KC PMID: 22286487 [PubMed - in process]

Pedicled anterolateral thigh flap for complex trochanteric pressure sore reconstruction.

Pedicled anterolateral thigh flap for complex trochanteric pressure sore reconstruction. Plast Reconstr Surg. 2012 Feb;129(2):397e-9e Authors: Saint-Cyr M, Uflacker A PMID: 22286486 [PubMed - in process]

The split pedicle groin flap: new refinement in groin flap application and technique for combined thumb and dorsal hand defects.

The split pedicle groin flap: new refinement in groin flap application and technique for combined thumb and dorsal hand defects. Plast Reconstr Surg. 2012 Feb;129(2):396e-7e Authors: Saint-Cyr M, Wong C PMID: 22286485 [PubMed - in process]

Pediatric nailbed repair study: nail replacement increases morbidity.

Pediatric nailbed repair study: nail replacement increases morbidity. Plast Reconstr Surg. 2012 Feb;129(2):394e-6e Authors: Miranda BH, Vokshi I, Milroy CJ PMID: 22286484 [PubMed - in process]

The Use of Ultrasound in Evaluating Flexor Tendons following Surgical Repair.

The Use of Ultrasound in Evaluating Flexor Tendons following Surgical Repair. Plast Reconstr Surg. 2012 Feb;129(2):392e-394e Authors: Nugent N, Coyle J, Barry J, Oʼshaughnessy M PMID: 22286483 [PubMed - as supplied by publisher]

Regenerative surgery for the definitive surgical repair of enterocutaneous fistula.

Regenerative surgery for the definitive surgical repair of enterocutaneous fistula. Plast Reconstr Surg. 2012 Feb;129(2):391e-2e Authors: Scala M, Spagnolo F, Strada P, Santi P PMID: 22286482 [PubMed - in process]

Pectoralis Major Flap with Sternum: Achieving Vascularized Osseous Reconstruction of the Mandible without a Free Flap.

Pectoralis Major Flap with Sternum: Achieving Vascularized Osseous Reconstruction of the Mandible without a Free Flap. Plast Reconstr Surg. 2012 Feb;129(2):389e-91e Authors: Selber JC, Ghali S PMID: 22286481 [PubMed - in process]

A Patient's Quest for Montgomery Glands in a Reconstructed Breast.

A Patient's Quest for Montgomery Glands in a Reconstructed Breast. Plast Reconstr Surg. 2012 Feb;129(2):388e-9e Authors: Sivathasan N, Singh K PMID: 22286480 [PubMed - in process]

Coding System for Computed Tomographic Angiography of Inferior Epigastric Artery Perforators in DIEP Flaps.

Coding System for Computed Tomographic Angiography of Inferior Epigastric Artery Perforators in DIEP Flaps. Plast Reconstr Surg. 2012 Feb;129(2):387e-8e Authors: Al-Dhamin A, Berry R, Prasad V, Martin A, Morris SF PMID: 22286479 [PubMed - in process]

Filling-port complications in becker expanders.

Filling-port complications in becker expanders. Plast Reconstr Surg. 2012 Feb;129(2):386e-7e Authors: Farace F, Faenza M, Sanna M, Campus GV, Rubino C PMID: 22286478 [PubMed - in process]

Septocutaneous gluteal artery perforator flap in lateral decubitus position for breast reconstruction.

Septocutaneous gluteal artery perforator flap in lateral decubitus position for breast reconstruction. Plast Reconstr Surg. 2012 Feb;129(2):385e-6e Authors: Quilichini J, Hivelin M, Matar N, Benjoar MD, Lantieri L PMID: 22286477 [PubMed - in process]

A plea for recipient vascular pedicle versatility in microvascular breast reconstruction: the conundrum of absent internal mammary veins.

A plea for recipient vascular pedicle versatility in microvascular breast reconstruction: the conundrum of absent internal mammary veins. Plast Reconstr Surg. 2012 Feb;129(2):383e-5e Authors: Pradas-Irun C, Azzawi K, Malata CM PMID: 22286476 [PubMed - in process]

An update on oncoplastic surgery.

An update on oncoplastic surgery. Plast Reconstr Surg. 2012 Feb;129(2):382e-3e Authors: Losken A, Ghazi B PMID: 22286475 [PubMed - in process]

Reconstructing large keloids with neodermis: a systematic review.

Reconstructing large keloids with neodermis: a systematic review. Plast Reconstr Surg. 2012 Feb;129(2):380e-2e Authors: Bidic SM, Dauwe PB, Heller J, Brown S, Rohrich RJ PMID: 22286474 [PubMed - in process]

The radial forearm fasciocutaneous free flap for head and neck reconstruction: an examination of the effects of radiation therapy on outcomes.

The radial forearm fasciocutaneous free flap for head and neck reconstruction: an examination of the effects of radiation therapy on outcomes. Plast Reconstr Surg. 2012 Feb;129(2):379e-80e Authors: Hoppe IC, Patel PP, Datiashvili RO PMID: 22286473 [PubMed - in process]

Adrenal Suppression following Steroid Treatment of Infantile Hemangiomas: Expediting the Move toward Propranolol?

Adrenal Suppression following Steroid Treatment of Infantile Hemangiomas: Expediting the Move toward Propranolol? Plast Reconstr Surg. 2012 Feb;129(2):377e-8e Authors: Constantinides J, Prowse P, Gorst C, Didi MA, Liew SH PMID: 22286472 [PubMed - in process]

Full-thickness lower eyelid reconstruction: an easy and reliable method of reinforcing the forehead flap with fascia lata.

Full-thickness lower eyelid reconstruction: an easy and reliable method of reinforcing the forehead flap with fascia lata. Plast Reconstr Surg. 2012 Feb;129(2):376e-7e Authors: Stanizzi A, Grassetti L PMID: 22286471 [PubMed - in process]

The safety of major head and neck surgery in patients taking clopidogrel (plavix).

The safety of major head and neck surgery in patients taking clopidogrel (plavix). Plast Reconstr Surg. 2012 Feb;129(2):375e-6e Authors: Parrett BM, Woo A, Buntic R, Singer M PMID: 22286470 [PubMed - in process]

Construction of the philtral column using palmaris longus tendon.

Construction of the philtral column using palmaris longus tendon. Plast Reconstr Surg. 2012 Feb;129(2):374e-5e Authors: Lim AA, Allam KA, Taneja R, Kawamoto HK PMID: 22286469 [PubMed - in process]

A new z-plasty-based local flap procedure for closure of lateral canthal skin defects.

A new z-plasty-based local flap procedure for closure of lateral canthal skin defects. Plast Reconstr Surg. 2012 Feb;129(2):372e-4e Authors: Mutaf M, Temel M, Günal E PMID: 22286468 [PubMed - in process]

Multiplane hyaluronic Acid rhinoplasty.

Multiplane hyaluronic Acid rhinoplasty. Plast Reconstr Surg. 2012 Feb;129(2):371e-2e Authors: Xue K, Chiang CA, Liu K, Gu B, Li Q PMID: 22286467 [PubMed - in process]