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Western Maryland Seeks Plastic Surgeon :: Maryland :: Enterprise Medical Service

Single Specialty Group is seeking a Plastic Surgeon to join practice. Hours are Monday - Friday, 9a -5p. 1:4 shared call w/mariller facial, plastic surgeon and hand surgeon. 90% Outpatient; 10% Inpatient.

Call for Information :: Illinois :: Inhouse Physician Recruiters Network

The In-House Physician Recruiter Network, composed of over 500 hospital recruiters, represents over 10,000 hospitals and clinics. Our Network's special feature is to showcase outstanding physicians (who

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Wilkes Barre :: Pennsylvania :: Community Health Systems

Wilkes-Barre General Hospital is seeking a board certified/board eligible breast surgeon with a fellowship in breast reconstruction. Contact: Joyce Y. McCuller Email: joyce_mcculler@chs.net Phone:

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Full or Part-Time - No Evenings, No Weekends - No On-call. Our multi-specialty physician group practice of full and part-time physicians delivers skin and wound care services to geriatric patients in

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East :: North Carolina :: Healthcare Recruitment Counselors, LLC

The Division of Plastic Surgery, NC is seeking applicants for appointment at the Assistant or Associate Professor level. Candidates must be BC in General Surgery; BC/BE in Plastic Surgery. Solid clinical

About This Journal [About This Journal]

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

Reconstruction of the Nasal Septum Using Polydioxanone Plate [Original Article]

Objectives To evaluate the usefulness of resorbable polydioxanone plate attached to nasal septal cartilage in external septoplasty, to assess its mechanical stability until healing of cartilage fragments, and to describe the surgical technique and clinical experience. Design External septoplasty with polydioxanone plate has been performed in 396 patients since 1996. Indications were severe septal deformities (usually posttraumatic). Surgery included removal of the quadrilateral cartilage and division into straight fragments, which were sutured to resorbable polydioxanone plate and replaced as a free graft. If the nasal septal cartilage was partly or completely missing because of prior surgery or trauma, the missing cartilage was supplanted with auricular conchal cartilage. The study settings were Medicent Linz, Linz, Austria, and the Ear, Nose, and Throat Department, General District Hospital Steyr, Steyr, Austria. Results Functional and cosmetic outcomes were satisfactory. All patients experienced varying degrees of improvement in nasal blockage. There were no immediate (bleeding, septal hematomas, inflammatory reactions, or necrosis) or long-term (septal perforation, thickening of the nasal septum, or rejection of the implant) complications. Conclusion Use of polydioxanone plate attached to nasal septal cartilage facilitates surgical correction of severe septal deformities and supports the nasal dorsum until healing.

Mandibular Distraction Osteogenesis Used to Treat Upper Airway Obstruction [Original Article]

Objective To evaluate whether mandibular distraction osteogenesis relieves tongue-based airway obstruction in patients with severe micrognathia. Design Retrospective medical review spanning a 7-year period in a tertiary care hospital. The inclusion criterion was defined as micrognathia associated with a severe tongue-based obstruction. The patients included 11 neonates and infants (mean age, 4.3 months) and 2 pediatric patients (mean age, 5.4 years). Two patients had already received tracheotomies, 11 had not. The intervention was bilateral mandibular osteotomies with distraction osteogenesis. The outcome measures were avoidance of tracheotomy and decannulation. Results Ten of 11 patients avoided tracheotomy. Two of 2 patients who had already undergone tracheotomies were successfully decannulated. Conclusion Mandibular distraction osteogenesis is an acceptable treatment alternative to tracheotomy in select pediatric patients with micrognathia and severe tongue-based obstruction.

Temporal Branch of the Facial Nerve and Its Relationship to Fascial Layers [Original Article]

Objectives To eliminate the inconsistency in the nomenclature, to anatomically and definitively describe the topographic relationship of the temporal branch of the facial nerve to the fascial layers and the fat pads, and to create an effective algorithm to define the safest approaches and planes for surgical procedures in this area. Methods The study was performed using 18 hemifacial cadaveric specimens. In 12 hemifacial specimens, the facial halves were coronally sectioned and dissected. In 6 hemifacial specimens, planar dissection was performed layer by layer. Results The temporal branch of the facial nerve that traversed inside the deep layers of the temporoparietal fascia and the superficial musculoaponeurotic system coursed along the zygomatic arch as 1 (14.3%), 2 (57.1%), 3 (14.3%), and 4 (14.3%) twigs in the specimens. The temporoparietal fascia had no attachment to the zygomatic arch and continued caudally as the superficial musculoaponeurotic system. Adhesions were between the temporoparietal fascia and the superficial layer of the deep temporal fascia around the zygomatic arch. In most specimens, the superficial layer of the deep temporal fascia continued as the parotideomasseterica fascia, and a deep layer abutted the posterosuperior edge of the zygomatic arch. Conclusion An easy and safe surgical approach in this area is to elevate the superficial layer deep to the intermediate fat pad directly on the deep layer of the deep temporal fascia descending to the periosteum along the zygomatic arch.

Orbicularis Suspension Flap and Its Effect on Lower Eyelid Position: A Digital Image Analysis [Original Article]

Objective To evaluate changes in lower eyelid position using digital image analysis in patients who have undergone an orbicularis suspension flap combined with blepharoplasty. Methods A total of 68 patients (136 eyes) underwent a lower eyelid orbicularis oculi suspension flap combined with blepharoplasty. Digital image analysis was used to standardize each patient's preoperative and postoperative photographs for accurate objective comparison. The photographs were analyzed for lower eyelid position. Results The mean (SD) preoperative standardized distance from the center of the pupil to the lower eyelid margin (MRD2) in all procedures was 5.53 (0.74) mm. The mean (SD) postoperative standardized MRD2 was 5.22 (1.0) mm. There was a statistically significant difference in MRD2 position such that the postoperative MRD2 position decreased or the lower eyelid position was elevated by an average of 0.31 mm in comparison to the preoperative position (P < .001). Conclusions A well-performed suspension flap can elevate the lower eyelid position to a more natural and anatomically appropriate position. By resuspending the ptotic orbicularis muscle, the suspension flap also reinforces the underlying attenuated orbital septum. Such cases may not achieve the optimum level of rejuvenation if isolated lower eyelid blepharoplasty is performed.

Force Requirements for Artificial Muscle to Create an Eyelid Blink With Eyelid Sling [Original Article]

Objective To determine the force requirements, optimal vector, and appropriate materials of a novel eyelid sling device that will be used to rehabilitate eyelid closure (blink) in congenital or acquired permanent facial paralysis with an artificial muscle. Methods The force required to close the eyelids in human cadavers (n = 6) were measured using a load cell system. The eyelid sling using either expanded polytetrafluoroethylene (ePTFE) or temporalis muscle fascia was implanted. The ideal vector of force and placement within the eyelid for a natural eyelid closure were compared. Results The eyelid sling concept was successful at creating eyelid closure in a cadaver model using an upper eyelid sling attached to the distal tarsal plate. Less force was necessary to create eyelid closure using a temporalis muscle fascia sling (627 ± 128 mN) than for the ePTFE eyelid sling (1347 ± 318 mN). Conclusions The force and stroke required to close an eyelid with the eyelid sling are well within the attainable range of the electroactive polymer artificial muscle (EPAM). This may allow the creation of a realistic and functional eyelid blink that is symmetric and synchronous with the contralateral, normally functioning blink. Future aims include consideration of different sling materials and development of both the EPAM device and an articulation between the EPAM and sling. The biocompatibility and durability studies of EPAM in a gerbil model are under way. The successful application of artificial muscle technology to create an eyelid blink would be the first of many potential applications.

Biomechanical Analysis of Anchoring Points in Rhytidectomy [Original Article]

Objective To quantify tissue tearing force at various anchoring points on the face. Methods This is a prospective anatomic study using 4 fresh cadavers of persons aged 60 to 70 years at the time of death, for a total of 8 sides. Standardized 1-cm distances were measured at the various anchor points, and a single 0 Prolene suture loop was tied at each standardized anchoring point. Steady force was applied perpendicular to the plane of the face with a digital hanging scale. The scale was pulled until the suture ruptured the tissue at the anchoring point. The values at which the tissue ruptured were recorded, averaged, and compared. Results The average tissue force was 7.01 kg for the root of the zygoma vs 3.44 kg for the temporalis fascia (P < .05). The average tissue force was 5.50 kg for infralobular tissue vs 4.09 kg for tissue of the superficial musculoaponeurotic system located 1 cm anterior to the infralobular tissue (P < .05). The force for the fascia of the sternocleidomastoid was 3.89 kg vs 5.57 kg for the mastoid fascia (P < .05). There was a statistically significant difference between vertical bites of the temporalis fascia at 1.90 kg vs horizontal bites of the temporalis at 5.01 kg (P < .05). Conclusion The tissue tearing force varies by location on the face as well as suture orientation.

Bipolar Electrocautery: A Rodent Model of Sunderland Third-degree Nerve Injury [Original Article]

Objective To determine the Sunderland classification of a bipolar electrocautery injury. Methods Twenty-two rats received crush (a reproducible Sunderland second-degree injury) or bipolar electrocautery injury and were evaluated for functional, histomorphometric, and immunohistochemical recovery at 21 or 42 days. Animal experiments were performed between July 3 and December 12, 2007. Axonal regeneration and end plate reinnervation were evaluated in double transgenic cyan fluorescent protein–conjugated Thy1 and green fluorescent protein–conjugated S100 mice. Results Compared with crush injury, bipolar electrocautery injury caused greater disruption of myelin and neurofilament architecture at the injury site and decreased nerve fiber counts and percentage of neural tissue distal to the injury (P =.007). Complete functional recovery was seen after crush but not bipolar electrocautery injury. Serial live imaging demonstrated axonal regeneration at week 1 after crush and at week 3 after bipolar electrocautery injury. Qualitative assessment of motor end plate reinnervation at 42 days demonstrated complete neuromuscular end plate reinnervation in the crush group and only limited reinnervation in the bipolar electrocautery group. Conclusion Bipolar electrocautery injury in a rodent model resulted in a Sunderland third-degree injury, characterized by gradual, incomplete recovery without intervention.

Nimodipine and Acceleration of Functional Recovery of the Facial Nerve After Crush Injury [Original Article]

Objective To establish whether nimodipine, a calcium channel blocker, accelerates or otherwise improves functional recovery of whisking after facial nerve crush injury in the rat. Methods Thirty rats underwent exposure of the left main trunk of the facial nerve followed by a standard crush injury and subsequent quantitative facial movement testing. Animals were randomized into an experimental group (n = 15) and a control group (n = 15). Four days prior to facial nerve manipulation, experimental animals underwent subcutaneous implantation of a nimodipine-secreting pellet. All animals were tested preoperatively and on postoperative days 2, 8 to 17, 20, 22, 24, and 31 using a validated, quantitative whisking kinematics apparatus. Whisks were analyzed for amplitude, velocity, and acceleration. Results Animals receiving nimodipine demonstrated significantly better whisking on 5 days (postoperative days 9, 11 to 13, and 20) compared with control animals (P < .001, P = .003, P = .009, P = .009, and P = .009, respectively; 1-tailed ttest). Overall, the nimodipine-treated animals showed earlier recovery compared with the untreated animals. Conclusions We demonstrate that nimodipine improves recovery of whisking after facial nerve crush. This finding corroborates the semiquantitative findings of others, and provides complete whisking kinematic data on its effects. Given the low adverse effect profile of nimodipine, there may be clinical implications in its administration in patients experiencing facial nerve injury.

The Importance of Primary Rhinoplasty at the Time of Initial Unilateral Cleft Lip Repair [Commentary]

Endoscopic Brow-lift in the Male Patient [Surgical Technique]

Objective To report our experience with the endoscopic brow-lift in male patients at a university-affiliated outpatient surgery center. Methods Retrospective case series. Results From 1995 to 2007, a total of 244 endoscopic brow-lift procedures were performed, 21 of which involved men. Thirteen of the male patients had receding hairlines or some degree of baldness. Two male patients had postoperative complications; 1 male patient had temporal branch neurapraxia that resolved; and 1 male patient had in-office scar revision. Conclusions We have found that the endoscopic brow-lift procedure is well suited for male facial rejuvenation. Furthermore, our combined stair-step approach and suture suspension technique provides consistent results and high satisfaction regardless of the patient's hairline.

Arguing the Ethics of Facial Transplantation [Ethics and Public Policy]

While 7 face transplants have been performed around the world, to date, there remains debate regarding the validity of this procedure. We submit that performing a facial transplant—in the appropriately selected patient—is technically defensible and ethically sound. By outlining the technical and ethical boundaries of the debate, responding to the key arguments against the procedure, and describing its motivations and potential benefits, we state our justification of facial transplantation.

Current Trends in Facial Resurfacing: A Survey of American Academy of Facial Plastic and Reconstructive Surgery Members [Research Letters]

Revision Surgery in Otolaryngology [Book and Multimedia Review]

Atlas of Oculofacial Reconstruction: Principles and Techniques for the Repair of Periocular Defects [Book and Multimedia Review]

Eyelid and Periorbital Surgery [Book and Multimedia Review]

Abstracts: In Other Archives Journals [Abstracts: In Other Archives Journals]

Sir Edward Coley Burne-Jones's Hope [Beauty]

Mondor’s Syndrome: A Clinical Finding on Subfascial Breast Augmentation

Abstract Mondor’s syndrome is a clinical finding that can present in young to middle-age women 7–14 days after subfascial breast augmentation. Three cases of women who presented Mondor’s syndrome after subfascial breast augmentation are reported. The cases were characterized by a tender and painful cord that originates on the middle clavicle line from the inframammary border to the umbilicus scar on the thoracoabdominal wall. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9468-zAuthors Victor Noe Elizondo Tijerina, Monterrey Nuevo Leon MexicoRodolfo A. Elizondo Saenz, Monterrey Nuevo Leon Mexico Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Subfascial Breast Augmentation: A Comprehensive Experience

Abstract Background Subfascial breast augmentation, first performed by Dr. Ruth Graf in 1998, places the implant above the pectoralis muscle but below the pectoralis fascia. Graf documented that this approach resulted in less capsular contracture than subglandular implant placement and a more natural shape while eliminating implant animation with arm movement. In addition, implant edge visibility was decreased compared with subglandular implantation in all but the extremely thin patient. Because of the described benefits and high patient satisfaction, the authors began to perform this technique in 2006. Methods This report presents a comprehensive review of the aforementioned technique by describing a large series of subfascial augmentations (inframammary, periareolar, and endoscopic transaxillary) as primary procedures, secondary procedures, and operations with concurrent use of mastopexy performed by a single surgeon using multiple approaches. A patient satisfaction questionnaire was used in addition to a detailed clinical assessment. Results The results of this procedure were reproducible, controllable, and predictable. The study demonstrated a high degree of patient and surgeon satisfaction with few complications, a low rate of capsular contracture, no evidence of breast animation with arm movement, excellent lower pole coverage, and a brief recovery period. Conclusions Subfascial breast augmentation is a safe, effective procedure allowing for predictable results with excellent shape and longevity. For the properly selected patient, this approach provides the benefits of subglandular and submuscular placement without the disadvantages associated with each. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9466-1Authors Joseph P. Hunstad, The Hunstad Center for Cosmetic Surgery, PA 11208 Statesville Road Huntersville NC 28078 USAL. Shayne Webb, Nirvana Plastic Surgery 1331 44th Ave. North Myrtle Beach SC 29577 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Retightening Revision of a Previous MACS Lift Meloplasty

Retightening Revision of a Previous MACS Lift Meloplasty Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9463-4Authors Brigid Corrigan, Melbourne Institute of Plastic Surgery 253 Wattletree Rd Malvern VIC 3144 AustraliaWilliam McMillan, Melbourne Institute of Plastic Surgery 253 Wattletree Rd Malvern VIC 3144 AustraliaMorris Ritz, Melbourne Institute of Plastic Surgery 253 Wattletree Rd Malvern VIC 3144 Australia Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Carbon Dioxide Therapy in the Treatment of Cellulite: An Audit of Clinical Practice

Abstract Background The clinical practice of using carbon dioxide therapy for localized adiposities was audited over a 4-year period. Methods Patients receiving physical, dietary, or drug concurrent therapy were excluded from the audit. Original measurements in terms of mean ± standard error of the mean (SEM) were compared with those obtained after five sessions. Results This series included 101 women who underwent abdominal therapy. Significant reduction (p < 0.05) in mean upper, mid, and lower abdomen circumference was experienced by all three age groups: respectively, 1.8 ± 0.5, 1.6 ± 0.4, and 2.1 ± 0.3 cm in the 20- to 29-year- old group, 1.6 ± 0.4, 2.3 ± 0.3, and 2.1 ± 0.3 cm in the 30- to 39-year-old group, and 2.0 ± 0.4, 2.5 ± 0.4, and 2.6 ± 0.4 cm in the 40- to 50-year-old group. For 57 women who underwent localized thigh therapy (27 in the 20- to 29-year-old group, 18 in the 30- to 39-year-old group, and 12 in the 40- to 50-year-old group), thigh circumference was significantly reduced in the right versus left thigh: respectively, 1.6 ± 0.3 versus 1.5 ± 0.2 cm, 1.1 ± 0.3 versus 1.1 ± 0.3 cm, 1.6 ± 0.3 versus 1.5 ± 0.4. Weight loss was significant for older women who underwent abdominal therapy: 1.3 ± 0.2 kg in the 30- to 39-year-old group (n = 43) and 1.3 ± 0.2 kg in the 40- to 50 year-old group (n = 29). Older women who underwent thigh therapy also recorded significant weight reduction: 0.9 ± 0.4 kg in the 30- to 39-year-old group (n = 18) and 1.6 ± 0.3 kg in the 40- to 50-year-old group (n = 12). The results for 10 men were not significant. Conclusion These results agree with those reported originally and demonstrate that carboxytherapy is safe and effective. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9459-0Authors Georgia S. K. Lee, TLC Medical Practice Pte Ltd Holland Village Singapore Singapore Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Temperament and Character Traits of Women Admitted for Breast Reduction and Comparison with Body Perception

Abstract Background Reduction mammaplasty improves self-esteem and low body perception. Previous reports comprise either retrospective data or sectional analysis in which women were evaluated postoperatively. Furthermore, temperament and character properties of women applying for breast reduction have not been investigated. This study aimed to compare the temperament and character traits of women admitted for breast reduction surgery with those of healthy volunteers and to investigate the interaction of body perception with temperament and character. Methods The study enrolled 24 patients admitted for reduction mammaplasty and 24 healthy women. The study participants received the Temperament and Character Inventory (TCI) and the Rosenberg Self-Esteem Scale (RSE) questionnaires. The RSE questionnaire was completed again by the patients 6 months after the operation. Results Of the temperament scales, the persistence scale was significantly lower for the patients. Only the reward dependence subscale of the temperament scale was significantly higher for the patients. Self-esteem (RSE) was significantly lower for the patients than for the control subjects preoperatively, whereas, it rose significantly after the operation. The RSE showed a negative correlation with self-directedness and its subscales of being responsible and resourceful. A significant negative correlation also was found between RSE and empathy. Conclusions Women with large breasts try to develop adaptable character properties against chronic troubles. However, the temperament scale of persistence decreases in this process. Similar temperament and character traits of women with and those without large breasts suggest that patients desire breast reduction for functional rather than cosmetic purposes. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9465-2Authors Nurten Turhan-Haktanır, Afyon Kocatepe University Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery Afyonkarahisar TurkeyÖmer Geçici, Akdeniz University Faculty of Medicine, Department of Psychiatry Antalya TurkeyH. Murat Emül, Istanbul University Cerrahpaşa Faculty of Medicine, Department of Psychiatry Istanbul TurkeyAhmet Aşık, Afyon Kocatepe University Faculty of Medicine, Department of Psychiatry Afyonkarahisar TurkeyYavuz Demir, Afyon Kocatepe University Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery Afyonkarahisar TurkeyÖmer Özbulut, Afyon Kocatepe University Faculty of Medicine, Department of Psychiatry Afyonkarahisar Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Scar Prevention Using Laser-Assisted Skin Healing (LASH) in Plastic Surgery

Abstract Background The use of lasers has been proposed for scar revision. A recent pilot clinical study demonstrated that lasers could also be used immediately after surgery to reduce the appearance of scars. The LASH (Laser-Assisted Skin Healing) technique induces a temperature elevation in the skin which modifies the wound-healing process. We report a prospective comparative clinical trial aimed at evaluating an 810-nm diode-laser system to accelerate and improve the healing process in surgical scars immediately after skin closure. Methods Twenty-nine women and 1 man (mean age = 41.4 years; Fitzpatrick skin types I-IV) were included to evaluate the safety and performance of the laser system. The laser dose (or fluence in J/cm²) was selected as a function of phototype and skin thickness. Each surgical incision (e.g., abdominoplasty) was divided into two parts. An 8-cm segment was treated with the laser immediately after skin closure. A separate 8-cm segment was left untreated as a control. Clinical evaluations (overall appearance ratings, comparative scar scale) of all scars were conducted at 10 days, 3 months, and 12 months by both surgeon and patients. Profilometry analysis from silicone replicas of the skin was done at 12 months. Wilcoxon signed-rank test analyses were performed. Results Twenty-two patients were treated using a high dose (80–130 J/cm²) and 8 patients with a low dose (<80 J/cm²). At 12 months in the high-dose group, both surgeon and patients reported an improvement rate of the laser-treated segment over the control area of 72.73 and 59.10%, respectively. For these patients, profilometry results showed a decrease in scar height of 38.1% (p = 0.027) at 12 months for the laser-treated segment versus control. Three patients treated with higher doses (>115 J/cm²) experienced superficial burns on the laser-treated segment, which resolved in about 5–7 days. For the eight patients treated at low dosage (<80 J/cm²), there was no significant difference in the treated segment versus the control segment. No side effects were observed. Conclusion This prospective comparative trial demonstrates that an 810-nm diode laser treatment, performed immediately after surgery, can improve the appearance of a surgical scar. The dose plays a great role in scar improvement and must be well controlled. There is interest in LASH for hypertrophic scar revision. LASH can be used to prevent and reduce scars in plastic surgery. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9469-yAuthors Alexandre Capon, CHRU Service de Chirurgie Plastique et Réparatrice Lille FranceGwen Iarmarcovai, APHM Service de Chirurgie Plastique et Réparatrice Marseille FranceDavid Gonnelli, APHM Service de Chirurgie Plastique et Réparatrice Marseille FranceNathalie Degardin, APHM Service de Chirurgie Plastique et Réparatrice Marseille FranceGuy Magalon, APHM Service de Chirurgie Plastique et Réparatrice Marseille FranceSerge Mordon, INSERM U703, Université Lille Nord de France, Lille University Hospital CHRU 152, Rue du Dr. Yersin 59120 Loos, Lille France Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Retightening Revision of a Previous MACS-Lift Meloplasty

Retightening Revision of a Previous MACS-Lift Meloplasty Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9464-3Authors Patrick Tonnard, Coupure Centrum voor Plastische Chirurgie Coupure Rechts 164 C-D 9000 Gent BelgiumAlexis Verpaele, Coupure Centrum voor Plastische Chirurgie Coupure Rechts 164 C-D 9000 Gent Belgium Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Applied Anatomy of the Nasal Lower Lateral Cartilage: A New Finding

Abstract Background In most references to the nasal anatomy, the shape of the lower lateral cartilage (LLC) is described as a two-dimensional structure. However, the authors have found different forms of LLC in at least 40% of their open rhinoplasty cases during the past 20 years. This cartilage was found to have a three-dimensional hemispheric appearance and to be connected to the upper lateral cartilage (ULC) at the scroll area by an inward limb of this hemisphere. This inward limb may have an important role in producing asymmetry and flare of the nostril. Methods The LLC of 286 patients was evaluated during open rhinoplasty over a 2-year period, with a focus mainly on the shape of this structure, especially at the LLC–ULC junction (scroll area). Results A dome-shaped appearance of the LLC was noted in 40.9% of cases, and 11.5% of cases had bilateral LLC variation. This different anatomic form was seen mostly in patients with a strong bulbous nasal tip, although it was observed less frequently also in patients with narrow nasal tips. Conclusion At least one-third of the LLCs analyzed had a medial wall in addition to the lateral wall, which significantly increased the flare and recoil force of this structure. This makes this cartilage more redundant to reshaping procedures (straightening). Thus, special attention must sometimes be paid to this common anatomic variation to produce symmetric nostrils and to obtain a more aesthetically acceptable alar tip. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-010-9470-5Authors Farhad Hafezi, Iran University of Medical Sciences, St. Fatima Hospital Tehran IranBijan Naghibzadeh, Shahid Beheshty University of Medical Sciences, Loghman Hakim Hospital Tehran IranAmir Hossein Nouhi, Tehran Iran Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Nd:YAG Laser-Assisted Liposuction for an HIV patient

Abstract Active antiretroviral therapy has reduced the mortality of patients with acquired immune deficiency syndrome (AIDS) and increased both the quality of life and the longevity of patients infected with human immunodeficiency virus (HIV). The long-term effects of HIV infection are increasingly observed, particularly changes in fat distribution or “lipodystrophy.” Strategies to prevent, mitigate, or reverse HIV-associated lipodystrophy have been difficult to develop. The medical management of fat redistribution usually is ineffective, and surgical approaches to HIV-associated lipodystrophy have already been described, but major drawbacks include recurrence of the fat accumulation. This report aims to describe the clinical outcomes for a man with buffalo hump who underwent lipolaser-assisted liposuction. This technique obtained a significant reduction in the size of the adiposity and an improvement in the neck’s range of motion. At this writing, after 3 years, the patient is satisfied with his cosmetic and functional results. The authors believe that lipolaser-assisted liposuction using the Smartlipo Deka-Mela neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064-mm-long pulse is effective in reducing the cervicodorsal fat pad. The technique is performed using local anesthesia with low operative risks and minimal surgical trauma. The treated zone shows rapid healing, and the whole procedure requires a day-hospital recovery, thus reducing the costs. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9467-0Authors M. G. Onesti, University of Rome “La Sapienza” Department of Plastic and Reconstructive Surgery Viale delle Provincie 65 00162 Roma ItaliaP. Fioramonti, University of Rome “La Sapienza” Department of Plastic and Reconstructive Surgery Viale delle Provincie 65 00162 Roma ItaliaS. Carella, University of Rome “La Sapienza” Department of Plastic and Reconstructive Surgery Viale delle Provincie 65 00162 Roma ItaliaG. Spinelli, University of Rome “La Sapienza” Department of Plastic and Reconstructive Surgery Viale delle Provincie 65 00162 Roma ItaliaN. Scuderi, University of Rome “La Sapienza” Department of Plastic and Reconstructive Surgery Viale delle Provincie 65 00162 Roma Italia Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Thank You to Reviewers

Thank You to Reviewers Content Type Journal ArticleCategory EditorialDOI 10.1007/s00266-009-9458-1Authors Thomas M. Biggs, 1315 St. Joseph Parkway, Suite 900 Houston TX 77002 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Preoperative Digital Three-Dimensional Planning for Rhinoplasty

Abstract Background This report describes preoperative digital planning for rhinoplasty using a new three-dimensional (3D) radiologic viewer that allows both patients and surgeons to visualize on a common monitor the 3D real aspect of the nose in its inner and outer sides. Methods In the period 2002 to 2008, 210 patients underwent rhinoplasty procedures in the authors’ clinic. The patients were randomly divided into three groups according to the type of preoperative planning used: photos only, a simulated result by Adobe Photoshop, or the 3D radiologic viewer. The parameters evaluated included the number of patients that underwent surgery after the first consultation, the number of patients who asked for a reintervention, patient satisfaction (according to a test given to the patients 12 months postoperatively), the surgical time required for a functional intervention, and the improvement in nasal function by postoperative rhinomanometry and subjective evaluation. Results Computer-aided technologies led to a higher number of patients deciding to undergo a rhinoplasty. Simulation of the postoperative results was not as useful in the postoperative period due to the higher number of reintervention requests. Conclusion The patients undergoing rhinoplasties preferred new technologies in the preoperative period. The advantages of using the 3D radiologic viewer included improved preoperative planning, reduction in intraoperative stress, a higher number of patients undergoing surgery, reduction in postoperative surgical corrections, reduction in surgical time for the functional intervention, a higher rate of improvement in nasal function, a higher percentage of postoperative satisfaction, and reduced costs. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9455-4Authors Fabrizio Moscatiello, Centro Médico Teknon Department of Plastic Surgery Vilana 12 08022 Barcelona SpainJavier Herrero Jover, Centro Médico Teknon Department of Plastic Surgery Vilana 12 08022 Barcelona SpainMiguel Ángel González Ballester, Alma IT Systems Vilana 4B, 4º 1ª 08022 Barcelona SpainEncarna Carreño Hernández, Centro Médico Teknon Department of Plastic Surgery Vilana 12 08022 Barcelona SpainPasquale Piombino, Federico II University of Naples Department of Maxillofacial Surgery Via Pansini 5, Ed 14 80131 Naples ItalyLuigi Califano, Federico II University of Naples Department of Maxillofacial Surgery Via Pansini 5, Ed 14 80131 Naples Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Treatment of Axillary Hyperhidrosis/Bromidrosis Using VASER Ultrasound

Treatment of Axillary Hyperhidrosis/Bromidrosis Using VASER Ultrasound Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9457-2Authors Julio Garcia, 6020 S. Rainbow Las Vegas NV 89118 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Simultaneous Augmentation and Mastopexy: Selecting the Correct Implant

Simultaneous Augmentation and Mastopexy: Selecting the Correct Implant Content Type Journal ArticleCategory DiscussionDOI 10.1007/s00266-009-9441-xAuthors Dennis C. Hammond, Center for Breast and Body Contouring 4070 Lake Drive, Suite 202 Grand Rapids MI 49546 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

The Use of Quilting Suture in Abdominoplasty Does Not Require Aspiratory Drainage for Prevention of Seroma

Abstract Background The formation of seromas after abdominoplasty is a highly prevalent complication that disturbs both the patient and the surgeon. Aspiratory drainage and adhesion sutures (Baroudi suture) are widely used to prevent this complication. This study evaluated the effectiveness of drains in preventing seromas. Methods This retrospective study investigated women submitted to classic abdominoplasty with adhesion sutures. The women were divided into two groups. Group 1 comprised 28 individuals who received no drains, and group 2 consisted of 32 patients that had drains placed. Clinical evaluation of the patients was performed 7 days, 14 days, 1 month, 2 months, 4 months, and 6 months postoperatively. Statistical analysis was accomplished via Fisher’s exact test. Results Group 1 had one case of seroma (3.5%), clinically detected between the first and second postoperative months, whereas group 2 had one case (3.12%) detected 14 days postoperatively. Fisher’s test showed a P value of 1.000 (not statistically significant), for a 95% confidence interval of 0.05 to 14.08 and an odds ratio of 0.8387. Clinical evaluation showed no statistical difference in the incidence of seromas after abdominoplasty with adhesion sutures between the patients who received drains and those who did not. Conclusion The use of adhesion sutures is an effective measure for preventing seromas with no need for additional surgical measures. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9453-6Authors Henrique Lopes Arantes, Santa Cruz Institute of Plastic Surgery Rua Santa Cruz, Number 398, Vila Mariana São Paulo SP CEP 04122000 BrazilRodrigo Gouvêa Rosique, Santa Cruz Institute of Plastic Surgery Rua Santa Cruz, Number 398, Vila Mariana São Paulo SP CEP 04122000 BrazilMarina Junqueira Ferreira Rosique, Santa Cruz Institute of Plastic Surgery Rua Santa Cruz, Number 398, Vila Mariana São Paulo SP CEP 04122000 BrazilJose Marcos Mélega, Santa Cruz Institute of Plastic Surgery Rua Santa Cruz, Number 398, Vila Mariana São Paulo SP CEP 04122000 Brazil Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Transposition of the Malpositioned Nipple-Areola Complex in Breast Reconstruction with Implants

Abstract Background The goal of breast reconstruction after breast cancer is to obtain symmetrical breasts, including the nipple-areola complex. However, in some cases the nipple-areola complex may not be symmetrical even though a symmetrical breast shape has been created. In such cases the nipple-areola complex has been transpositioned, leaving a scar to close the wound or skin graft in the original position. Methods To treat this problem, skin surrounding the areola is removed and two pedicles are created to bear the nipple-areola complex. The nipple-areola complex is then moved to the proposed position and the surrounding circular edge of the skin is closed using a purse-string suture. Results The author performed this technique in three nipple-areolae of two patients. All the nipple-areolae were transposed to the proposed position to create symmetrical breasts without any complications. Conclusion This technique can be used when the malpositioned nipple-areola complex is not too far from the proposed position. The nipple-areola complex can be moved without leaving any scar at the original position of the complex. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9431-zAuthors S. Takayanagi, Mega Clinic 1-18-5 Higashinakajima, Higashiyodogawa-ku Osaka 533-0033 Japan Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Trapezoid Excision Upper Blepharoplasty for Chinese Women with Severe Laxity of Pretarsal Skin

Trapezoid Excision Upper Blepharoplasty for Chinese Women with Severe Laxity of Pretarsal Skin Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9444-7Authors Zhibo Xiao, The Second Affiliated Hospital of Harbin Medical University Department of Plastic Surgery 194 xuefu road Harbin City People’s Republic of ChinaMiaobo Zhang, The Second Affiliated Hospital of Harbin Medical University Department of Plastic Surgery 194 xuefu road Harbin City People’s Republic of China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Skin-Reducing Subcutaneous Mastectomy Using a Dermal Barrier Flap and Immediate Breast Reconstruction with an Implant: A New Surgical Design for Reconstruction of Early-Stage Breast Cancer

Abstract Background The development of skin-sparing mastectomy techniques for early-stage breast cancer has opened a new era in reconstructive breast surgery. Because of improved early diagnoses, the demand for skin-sparing techniques continues to increase more than ever. Methods Between March 2006 and April 2008, skin-reducing subcutaneous mastectomy (SRSM) using the dermal barrier flap technique and simultaneous breast reconstruction with silicone implants was performed for 15 patients (a total of 26 breasts) who had either a diagnosis of early-stage breast cancer or indications for prophylactic mastectomy. Of the 15 patients, 11 underwent bilateral reconstruction. The remaining four patients underwent unilateral reconstruction using SRSM with the dermal barrier flap technique. Results The average age of the patients who underwent SRSM with the dermal barrier flap was 45.7 years. All the patients were discharged from the hospital on postoperative day 1. The mean follow-up period was 12 months, and the recovery time was 35 days. Excellent aesthetic results and uneventful healing were obtained for 23 breasts. Partial nipple–areola necrosis occurred in two breasts. Total skin necrosis in the bilateral nipple–areola and central breast region occurred for one patient who underwent bilateral SRSM. Prosthesis exposure was not observed for any of these patients. Conclusions The authors present their early results with SRSM using the dermal barrier flap and silicone implants for early-stage breast cancer. The dermal barrier flap became a reliable procedure by providing a decreased breast envelope, eliminating the risk of implant exposure, and forming a double layer of dermal tissue at the incision line. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9452-7Authors Yalcin Bayram, Bursa Military Hospital Department of Plastic and Reconstructive Surgery Bursa TurkeyYalcin Kulahci, Haydarpasa Training Hospital Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy and Medical Faculty Selimiye Mah. Tıbbiye Cad., Kadikoy 34668 Istanbul TurkeyCeyhun Irgil, Bursa Breast Surgery Clinic Bursa TurkeyMurat Calikapan, Bursa Oncology Hospital Department of General Surgery Bursa TurkeyNurettin Noyan, Haydarpasa Training Hospital Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy and Medical Faculty Selimiye Mah. Tıbbiye Cad., Kadikoy 34668 Istanbul Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Simultaneous Augmentation and Periareolar Mastopexy: Selecting the Correct Implant

Abstract Background Periareolar mastopexy is a well-described technique for cosmetic improvement of breasts classified as Regnault ptosis grades 1 and 2. However, this technique is used less frequently for cases of grade 3 ptosis. Methods Grades 2 and 3 ptosis were corrected for selected patients using a combination of augmentation with Style 410 shaped, form-stable, highly cohesive, silicone gel implants and periareolar mastopexy. Results In this study, 17 patients were treated. The Style 410 implants used included four different devices: FX (full height, extra-full projection, n = 4), MX (medium height, extra-full projection, n = 1), MF (medium height, full projection, n = 8), and FF (full height, full projection, n = 4). No complications occurred immediately after surgery, and only two cases of capsular contracture Baker grade 2 cases with implant palpability occurred during a mean follow-up period of 18 months. All 17 women were very satisfied with the improvement in their clothed appearance, and 16 were very satisfied overall with their surgery and body image improvements. Conclusions With proper selection of patients and Style 410 breast implants, cases of grade 3 breast ptosis can be managed successfully by the periareolar approach, thus extending the range of cases suitable for this technique. The different shapes of the Style 410 form-stable, silicone gel implants help to recreate the desired natural-looking breast, achieving stable results with minimal complications. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9440-yAuthors Alberto Rancati, Universidad Catolica Argentina Plastic Surgery Instituto Quirurgico Callao, University of Buenos Aires Avenue Callao 1046 PB A (1046) Buenos Aires ArgentinaMaurizio Nava, Fondazione IRCCS Istituto Nazionale dei Tumori Direttore Struttura Complessa di Oncologia Chirurgica Ricostruttiva–Chirurgia Plastica, Plastic Surgery Unit Via Venezian 1 20133 Milano ItalyLuciano Tessari, University of Buenos Aires, Universidad Catolica Argentina Avenue Callao 1046 PB A (1046) Buenos Aires Argentina Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Capsular Flaps for the Management of Malpositioned Implants After Augmentation Mammoplasty

Abstract Among the reasons for reoperation after augmentation mammaplasty is the malpositioned implant, especially a lowered inframammary fold or symmastia, which is difficult to repair. The peri-implant capsule, a physiologic response to a foreign body, is naturally formed and suitable for use as a flap because of its high vascularity. In addition, it is sufficiently tough for suspension of the implant. The authors introduce the idea that the capsular flap is very useful for the correction of symmastia or a lowered inframammary fold. In such situations, the capsular flaps are used to prevent migration of the implant after raising of the inframammary fold or defining of the midline with capsulorrhaphy. This technique successfully corrected the malpositioned implants in this study, and all the patients were satisfied. There was no recurrence of a lowered inframammary fold or symmastia. These findings suggest that the capsular flap should be considered a safe and effective option for the management of malpositioned implants. Content Type Journal ArticleCategory Innovative TechniquesDOI 10.1007/s00266-009-9456-3Authors Gyeol Yoo, The Catholic University of Korea Department of Plastic Surgery, College of Medicine # Yeouido-dong, Yeoungdeungpo-gu Seoul KoreaPaik-Kwon Lee, Apgugeong Avenue Plastic Surgery Clinic 577-6 Sinsa-dong, Gangnam-gu Seoul 135-120 Korea Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Techniques for Labia Minora Reduction: An Algorithmic Approach

Abstract Background Aesthetic reduction of the labia minora has gained popularity, and a number of different techniques have been described. Each procedure has its own set of advantages and disadvantages. However, no algorithm has been defined for pairing the degree of deformity with the optimal surgical procedure. Methods Patients were stratified into one of four groups based on labial size. The surgeon chose one of three reduction techniques based on the degree of labial hypertrophy and the patient’s aesthetic preferences for labial edge color and contour. Three reduction techniques were used including the edge excision technique, the inferior wedge resection technique, and deepithelialization reduction labioplasty. The success of aesthetic reduction was evaluated, as was symptomatic relief. Results The 12 procedures performed included five deepithelialization techniques, four edge excision techniques, and three inferior wedge resection techniques. As reported, 92% of the patients were “very satisfied” with their aesthetic and functional results. The complications were minimal, with three patients experiencing minor wound healing difficulties that resolved spontaneously. One patient who underwent the edge excision technique was “not satisfied” and complained of overreduction. Conclusion The authors found all three techniques for labia minora reduction to be useful in different clinical situations. A novel algorithm is described for matching the optimal surgical technique for each patient based on her degree of hypertrophy and aesthetic goals. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9454-5Authors Warren A. Ellsworth, Baylor College of Medicine, Clinical Care Center Division of Plastic Surgery 6701 Fannin, CC 610.00 Houston TX 77030 USAMort Rizvi, The Methodist Hospital Division of Plastic Surgery Houston TX USAMichael Lypka, The Methodist Hospital Division of Plastic Surgery Houston TX USAMark Gaon, The Methodist Hospital Division of Plastic Surgery Houston TX USABruce Smith, The Methodist Hospital Division of Plastic Surgery Houston TX USABenjamin Cohen, The Methodist Hospital Division of Plastic Surgery Houston TX USATue Dinh, The Methodist Hospital Division of Plastic Surgery Houston TX USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

A New Technique for Gluteal Lifting Using Deepithelialized Dermal Flaps

Abstract Background Gluteal ptosis may result from sagging of redundant skin and fat below the infragluteal fold. The correction of gluteal ptosis and the definition of gluteal prominence can be obtained by several gluteal lifting techniques. We present a new technique to correct gluteal ptosis using deepithelialized dermal flaps. Methods Eight female patients (39 ± 4 years old) with gluteal ptosis were included in the study. Six patients had been previously operated on elsewhere (liposuction, body lift). Gluteal lifting is performed using a crescent-shaped deepithelialized flap. The cranial two-thirds of the flap is sutured to the gluteal fascia, thus creating the new gluteal curvature and the position of the new infragluteal fold. The lower third of the flap is then sutured back toward the two-thirds flap within the first suture line, resulting in a doubling of the deepithelialized area. Results The mean operating time was 100 ± 20 min (range = 75–110 min). There were no complications in the study group. An analysis of postoperative results revealed a very good aesthetic aspect in all patients. All patients showed an improved definition of the infragluteal fold, with a symmetric shape of the gluteal region. All patients judged the outcome as very good. Conclusion The use of a deepithelialized double dermal flap is a safe and new way to obtain excellent results in rejuvenation of the gluteal region. Our technique allows for the creation of a stable and long-lasting infragluteal fold with an aesthetic buttock curvature and a defined border to the thigh region. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9447-4Authors Alexander E. Handschin, Medical School Hannover Department of Plastic, Hand and Reconstructive Surgery Hannover GermanyMarian Mackowski, Mang Medical One Clinics Borsteler Chaussee 55 22453 Hamburg GermanyPeter Maria Vogt, Medical School Hannover Department of Plastic, Hand and Reconstructive Surgery Hannover GermanyTina Peters, Medical School Hannover Department of Plastic, Hand and Reconstructive Surgery Hannover Germany Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

A New Technique for Gluteal Lifting Using Deepithelialized Dermal Flaps

A New Technique for Gluteal Lifting Using Deepithelialized Dermal Flaps Content Type Journal ArticleCategory DiscussionDOI 10.1007/s00266-009-9448-3Authors Sadri Ozan Sozer, Texas Tech University Health Sciences Center Department of General Surgey 4800 Alberta Avenue El Paso TX 79905 USAFrancisco J. Agullo, Texas Tech University Health Sciences Center Department of General Surgey 4800 Alberta Avenue El Paso TX 79905 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Is Breast Augmentation Using Hyaluronic Acid Safe?

Is Breast Augmentation Using Hyaluronic Acid Safe? Content Type Journal ArticleCategory DiscussionDOI 10.1007/s00266-009-9451-8Authors Sebastián Mir-Mir Caragol, Paseo del Perello 12, San Andres del Llavaneras Barcelona 08392 Spain Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Changes in Occlusal Force After Intraoral One-Stage Curved Osteotomy of the Prominent Mandibular Angle

Abstract Background Curved osteotomy of a prominent mandibular angle is widely used in narrowing the width of the lower face, but its influence on occlusal force has not been evaluated. Methods The maximum occlusal forces of five different teeth areas in 20 consecution patients with an average age of 26.5 years were studied. The examinations were performed both before the operation and 6 months afterward. Results The values of maximum occlusal force had reached the preoperative levels or slightly above for the incisor teeth, bilateral premolar teeth, and bilateral molar teeth 6 months after operation. There were no significant differences between the levels before the operation and 6 months afterward (P > 0.05). Conclusion According to the study findings, curved osteotomy of the prominent mandibular angle had no long-term harmful effects on occlusal force. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9439-4Authors Wuyuan Tan, Peking Union Medical College, Chinese Academy of Medical Sciences Craniomaxillofacial Surgical Center, Plastic Surgery Hospital Ba Da Chu Road No. 33, Shi Jing Shan District Beijing 100044 ChinaLai Gui, Peking Union Medical College, Chinese Academy of Medical Sciences Craniomaxillofacial Surgical Center, Plastic Surgery Hospital Ba Da Chu Road No. 33, Shi Jing Shan District Beijing 100044 ChinaMeng Wang, Peking Union Medical College, Chinese Academy of Medical Sciences Plastic Surgery Hospital Beijing ChinaShuang Qiu, Peking Union Medical College, Chinese Academy of Medical Sciences Plastic Surgery Hospital Beijing ChinaYing Chen, Peking Union Medical College, Chinese Academy of Medical Sciences Plastic Surgery Hospital Beijing ChinaFeng Niu, Peking Union Medical College, Chinese Academy of Medical Sciences Plastic Surgery Hospital Beijing ChinaBing Yu, Peking Union Medical College, Chinese Academy of Medical Sciences Plastic Surgery Hospital Beijing ChinaJianfeng Liu, Peking Union Medical College, Chinese Academy of Medical Sciences Plastic Surgery Hospital Beijing China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Is Breast Augmentation Using Hyaluronic Acid Safe?

Abstract Macrolane™, a compound composed of hyaluronic acid, is the newest product to be marketed for breast augmentation. Like many previous breast augmentation products, Macrolane has been authorised for use with very little published scientific data on its safety and efficacy in breast augmentation. This article reviews the evidence available on the safety of using hyaluronic acid and raises concerns with regard to its use as a product for breast augmentation, the technique recommended for its use, and the authorisation process for new implantable medical devices. It is strongly recommended that clinicians review the lack of data on Macrolane before offering it as a treatment option to patients. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00266-009-9450-9Authors Micheal J. McCleave, The Royal Adelaide Hospital Department of Plastic & Reconstructive Surgery North Terrace Adelaide SA 5000 Australia Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Comparison of Surgisis®, AlloDerm®, and Vicryl Woven Mesh® Grafts for Abdominal Wall Defect Repair in an Animal Model

Abstract Background Surgisis® and AlloDerm®, two biosynthetic materials, have been previously used with success in abdominal wall repairs in the setting of contaminated fields. Historically, Vicryl Woven Mesh®, a synthetic material, has also been used in such settings as a temporary bridge for abdominal wall reconstruction. This study compares Surgisis and AlloDerm with Vicryl Woven Mesh with respect to tensile strength, collagen remodeling, and neovascularization using a rat hernia model. Methods A prospective randomized trial of 54 Sprague-Dawley rats were assigned to the Surgisis, AlloDerm, or Vicryl Woven Mesh group with baseline, 30-day, and 60-day end points. A 1.5-cm × 5.0-cm defect was created in the right abdominis rectus muscle and repaired with an underlay bridge graft using the different treatment materials. Tensile strength was measured using an Instron tensiometer. Histologic specimens were evaluated for neovascularization, collagen deposition, and collagen organization at the 30- and 60-day time points. Results Surgisis had significantly greater tensile strength compared to Vicryl Woven Mesh at the baseline time point (0.142 vs. 0.091 MPa, p < 0.05). There were no differences between groups tensile strength at 30 or 60 days postoperatively. The Vicryl Woven Mesh and AlloDerm groups showed increases in tensile strength at 30 days postoperatively versus baseline (p < 0.05). Vicryl Woven Mesh, Surgisis, and AlloDerm all showed increases in tensile strength at 60 days postoperatively compared to 30 days postoperatively and at baseline (p < 0.05). Surgisis and AlloDerm had significantly greater (p < 0.05) amounts of collagen deposition and organization at 30 and 60 days compared to Vicryl Woven Mesh. There was no significant difference between AlloDerm and Surgisis with respect to collagen deposition and organization. Surgisis and AlloDerm showed a significantly greater amount (p < 0.05) of neovascularization than Vicryl Woven Mesh at both time points. In addition, Surgisis had a significantly greater amount (p < 0.05) of neovascularization than AlloDerm at both 30 and 60 days. Conclusion Surgisis has increased baseline tensile strength compared to Vicryl Woven Mesh. Tensile strength in Vicryl Woven Mesh is equal to biosynthetic grafts after tissue incorporation. Biosynthetic grafts showed superior collagen deposition and organization. Surgisis mesh showed increased neovascularization over both AlloDerm and Vicryl Woven Mesh. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9449-2Authors Robert D. Rice, Dwight D. Eisenhower Army Medical Center Department of General Surgery Fort Gordon GA 30905 USAFarhan S. Ayubi, Dwight D. Eisenhower Army Medical Center Department of General Surgery Fort Gordon GA 30905 USAZachary J. Shaub, Dwight D. Eisenhower Army Medical Center Department of General Surgery Fort Gordon GA 30905 USADavid M. Parker, 121 Combat Support Hospital Department of General Surgery Yongsan KoreaPeter J. Armstrong, Dwight D. Eisenhower Army Medical Center Department of General Surgery Fort Gordon GA 30905 USAJohn W. Tsai, Dwight D. Eisenhower Army Medical Center Department of General Surgery Fort Gordon GA 30905 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Can the Pectoral Fascia Integrity Be Preserved During Subfascial Breast Augmentation Through the Axillary Approach?

Abstract Background Although many authors recently have reported good results with subfascial breast augmentation, it still is controversial whether the integrity of the pectoral fascia can be preserved. Some authors think the pectoral fascia will be broken during the operation because it is thin and weak. Therefore, this study aimed to investigate whether the integrity of the pectoral fascia can be preserved during subfascial breast augmentation through an axillary incision without endoscopic assistance. Methods For this study, 10 patients underwent subfascial augmentation mammaplasty through the axillary approach. The technique was used for patients with small or moderate breasts. The pockets were made with the fingers. The area beyond the reach of the fingers was dissected using a breast dissector. Then the pocket and major pectoral fascias were examined with an endoscope. The endoscope was used only to inspect the fascia and major pectoral muscle after the subfascial dissection was completed. The fascia and surgical effects were evaluated. Results The integrity of 11 (55%) of 20 pectoral fascias in 10 patients was preserved during the surgery. Four fascias (20%) were broken at about the fourth intercostal space or at the fifth costa. In five breasts (25%), the superficial layer of the pectoral muscle was split, but the integrity of the fascia was maintained. All the patients except one with asymmetric breasts achieved satisfactory results. There was no active bleeding, hematoma, infection, or fibrous capsule contracture during the follow-up period. Conclusion The integrity of most pectoral fascias (11 + 5 fascias) could be preserved through the axillary approach during subfascial breast augmentation without endoscopic assistance. Even if the lower portion of the pectoral fascia was broken, this did not interfere with the aesthetic outcome or the normal postoperative recovery. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9443-8Authors Lin Jinde, Nanjing Medical University International Plastic and Aesthetic Center Nanjing Jiangsu ChinaChen Xiaoping, Nanjing Medical University International Plastic and Aesthetic Center Nanjing Jiangsu ChinaZhang Wanquan, Nanjing Medical University International Plastic and Aesthetic Center Nanjing Jiangsu ChinaGao Xia, Nanjing Medical University International Plastic and Aesthetic Center Nanjing Jiangsu ChinaXu Ligang, Nanjing Medical University International Plastic and Aesthetic Center Nanjing Jiangsu China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Treatment of Soft Tissue Contour Defects by a Combination of Surgical Subcision with a Beaver Tympanoplasty Blade and Autologous Fat Grafting

Abstract This report describes a technique for treating depressed scars and soft tissue contour deformities. Surgical subcision with a Beaver tympanoplasty blade is undertaken for depressed or adherent scars to release the fibrous attachments beneath the scar before autologous fat grafting. Satisfactory results were observed, with an improvement in surface contour for 16 patients over a 3-year period. The authors recommend the described technique as a safe, minimally invasive, and precise method for subcutaneous dissection of scar tissue before fat injections. Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9442-9Authors Y. S. Lau, Leicester Royal Infirmary Department of Plastic Surgery Infirmary Square Leicester LE1 5WW UKG. J. Offer, Leicester Royal Infirmary Department of Plastic Surgery Infirmary Square Leicester LE1 5WW UK Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

The Nuss Procedure After Breast Augmentation for Female Pectus Excavatum

Abstract Pectus excavatum, the most common congenital chest wall malformation, has a higher incidence among men. Since 1987, when Donald Nuss performed his technique for the first time, the minimally invasive approach has become the most widely used technique for treating pectus excavatum. Few reported studies have focused on the repair of female pectus excavatum. Women with pectus excavatum often present with breast asymmetry that may require breast augmentation, either before or after pectus excavatum repair. To the authors’ knowledge, no reports on the Nuss procedure after breast implant surgery have been published. This report describes the case of a 26-year-old woman who underwent minimally invasive repair after breast implant surgery. The authors believe that for women with severe pectus excavatum, the Nuss procedure should be the first choice for surgical correction. Moreover, for breast implant patients, this technique is absolutely feasible without major complications. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9438-5Authors Giovanni Rapuzzi, Giannina Gaslini Children’s Hospital Division of Pediatric Surgery Largo G.Gaslini 5 16148 Genova ItalyMichele Torre, Giannina Gaslini Children’s Hospital Division of Pediatric Surgery Largo G.Gaslini 5 16148 Genova ItalyMaria Victoria Romanini, Oncological Institute-San Martino Hospital Division of Plastic and Reconstructive Surgery Genoa ItalyRosanna Viacava, Giannina Gaslini Children’s Hospital Division of Pediatric Surgery Largo G.Gaslini 5 16148 Genova ItalyNicola Disma, Giannina Gaslini Children’s Hospital Department of Anaesthesia Largo G.Gaslini 5 16148 Genova ItalyPier Luigi Santi, Oncological Institute-San Martino Hospital Division of Plastic and Reconstructive Surgery Genoa ItalyVincenzo Jasonni, Giannina Gaslini Children’s Hospital Division of Pediatric Surgery Largo G.Gaslini 5 16148 Genova Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Correction of Asymmetric Calf Hypertrophy with Differential Selective Neurectomy

Abstract Contour asymmetry of the legs is a major aesthetic concern among Asian women. This study enrolled 60 patients with asymmetric calf hypertrophy, defined as a differential calf circumference exceeding 0.6 cm. Differential selective neurectomy techniques, which depend on the sizes of the small and large calves, were performed exactly via a 1-cm popliteal wound. The pre- and postoperative mean differences between the larger and smaller calf circumferences at the 1-year follow-up consultation were 1.38 ± 0.65 and 0.42 ± 0.38 cm, respectively (p < 0.01). The reduction was significantly greater in the leg that was initially larger. The procedure was effective in reducing circumference discrepancies so that leg contours were more balanced. All the patients were able to ambulate normally within 5 months after the procedure without disability. The authors posit that differential neurectomy is a safe and reliable technique for the correction of asymmetric calf hypertrophy, with minimal morbidities. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9445-6Authors Tsorng-Harn Fong, Taipei Medical University Department of Anatomy Taipei TaiwanChin-Ho Wong, Singapore General Hospital Department of Plastic Reconstructive and Aesthetic Surgery Singapore SingaporeJeng-Yee Lin, Taipei Medical University Hospital Division of Plastic Surgery, Department of Surgery 252 Wu Hsing Street Taipei 110 TaiwanChuh-Kai Liao, Fu Jen Catholic University Department of Family and Community Medicine, Cardinal Tien Hospital, College of Medicine Taipei TaiwanLi-Yung Ho, National Taiwan University Department of Computer Science and Information Engineering, Institute of Information Science, Academia Sinica Taipei TaiwanFeng-Chou Tsai, Taipei Medical University Hospital Division of Plastic Surgery, Department of Surgery 252 Wu Hsing Street Taipei 110 Taiwan Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

A Clinic Tip for Dressing on the Hair: Avoiding the Sticking of Adhesive Tape

A Clinic Tip for Dressing on the Hair: Avoiding the Sticking of Adhesive Tape Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9446-5Authors Chenyang Ji, Sun Yat-sen Memorial Hospital of Sun Yat-sen University Guangzhou ChinaFuli Min, Sun Yat-sen Memorial Hospital of Sun Yat-sen University Guangzhou ChinaJinming Zhang, Sun Yat-sen Memorial Hospital of Sun Yat-sen University Guangzhou China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Breast Implant Stability in the Subfascial Plane and the New Shaped Silicone Gel Breast Implants

Abstract The author presents his experience with breast augmentation using a next-generation, form-stable, anatomically shaped silicone gel breast implant. Rotation is a potential complication for anatomically shaped breast implants. Anatomically shaped saline implants have been reported to have a rotation rate as high as 14%, while lower rotation rates of 1–2.6% for anatomic cohesive gel silicone implants have been reported. Currently, these implants are limited in the United States to US FDA-approved clinical trials. The author reviews the appropriate surgical techniques to prevent rotation when using these devices. A recent innovation, placement of the superior pole of the implant underneath the superficial fascia of the pectoralis major muscle, is described. Primary and secondary breast augmentations in 241 procedures using the Allergan Style 410 implant resulted in a 0.0% rotation rate. Overall, the anatomic form-stable silicone gel breast implants, when placed subfascially, improve common complications such as capsular contracture and implant rupture with improved aesthetic outcomes and patient satisfaction. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9429-6Authors João Carlos Sampaio Góes, Rua Campos Bicudo, 98-conj. 111 São Paulo SP 04536-010 Brazil Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Management of Upper Abdominal Laxity After Massive Weight Loss: Reverse Abdominoplasty and Inframammary Fold Reconstruction

Abstract Background Central to body contouring after weight loss surgery is treatment of the abdominal region, often through a circumferential abdominoplasty. This procedure, however, neglects the laxity of the lower thoracic/upper abdominal region. A reverse abdominoplasty with reconstruction of a new inframammary fold (IMF) corrects this deformity through removal of excess skin along the IMF. Since 2002, we have performed 88 reverse abdominoplasty procedures within the context of a single or staged total-body lift (TBL). Methods A retrospective chart review of 129 TBL cases indicated that 88 patients had a combined or staged reverse abdominoplasty and circumferential abdominoplasty. Complication rates were noted as localized or generalized. Results Fifty-three of our patients had combined reverse abdominoplasty and circumferential abdominoplasty and 35 had the reverse abdominoplasty during a second stage. The complication rates for both groups were about 5% per patient per procedure with differences that were not statistically significant. Also, the revision rates for reverse abdominoplasty and circumferential abdominoplasty were similar for both groups, indicating patient satisfaction with the procedures. Conclusion In selected patients, effective treatment of the abdominal region demands correction of both the upper and lower abdominal laxity and contour. This can be performed safely, effectively, and reliably by a reverse abdominoplasty with IMF reconstruction independently or simultaneously with circumferential abdominoplasty. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9432-yAuthors Siamak Agha-Mohammadi, 400 Newport Center Drive, Suite 100 Newport Beach CA 92660 USADennis J. Hurwitz, Hurwitz Center for Plastic Surgery Suite 500, 3109 Forbes Avenue Pittsburgh PA 15213 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Scar-Free Technique for Inverted-Nipple Correction

Abstract Background Inverted nipples are associated with aesthetic, functional, and psychological problems. In moderate to severe cases, triangular areolar dermal flap-based methods can effectively correct the condition. A triangular areolar dermal flap supports the nipple base as a result of a hammock-like action and fills the dead space beneath the nipple. However, these flaps leave visible scars on or deform the areola. Methods The authors describe a new technique based on the use of two triangular flaps. Compared with other techniques that use triangular flaps, the described technique does not involve areolar skin. Instead, triangular dermal flaps are elevated under the areolar skin, which overcomes the visible scarring issue. The devised technique has been used to correct 87 inverted nipples of 46 patients at our institute. Results No complications or recurrences were encountered, and resulting scars were almost invisible. All patients were satisfied with their postoperative results. Conclusion The described technique is straightforward and reliable and does not leave visible scars on areolar skin. In particular, it has been found to be especially useful for treating moderately to severely inverted nipples. Content Type Journal ArticleCategory Innovative TechniquesDOI 10.1007/s00266-009-9436-7Authors Kyung-Hee Min, Seoul National University College of Medicine Department of Plastic and Reconstructive Surgery Seoul Republic of KoreaSung-Soo Park, Bong Bong Plastic Surgery Clinic Rothem Building, 5th Floor, Sinsa Dong 591-18 Gang Nam gu, Seoul Republic of KoreaChan-Yeong Heo, Seoul National University College of Medicine Department of Plastic and Reconstructive Surgery Seoul Republic of KoreaKyung-Won Minn, Seoul National University College of Medicine Department of Plastic and Reconstructive Surgery Seoul Republic of Korea Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Augmentation Mastopexy in Muscle-Splitting Biplane: Outcome of First 44 Consecutive Cases of Mastopexies in a New Pocket

Abstract Background Augmentation with mastopexy is a commonly performed procedure and is done either simultaneously or in stages. The augmentation component can be accomplished by placing an implant in the subglandular, partial submuscular, or subfascial plane, and mastopexy can be performed using periareolar, vertical, or Wise pattern markings. These two components are independent of each other and any pocket can be combined with suitable external markings. The muscle-splitting submuscular biplane is a new pocket and is combined with conventional envelope reductions for mastopexy. Methods The submuscular biplane pocket was used in 44 consecutive patients for mastopexy and augmentation using vertical scar and periareolar markings. Of these, 13 had subglandular augmentation in the past. The mean age of the patients was 32.4 years (range = 21–46). Average blood loss was 44 g (range = 10–111 g). Drains were used selectively and the procedure was usually done as a day case. Results The follow-up period of the included cases ranged from 4 months to 3 years. No infection, hematoma, or wound problems were seen. Minor revision was required for periareolar puckering in one case and three had dog-ears after vertical scar mastopexy. One periareolar mastopexy required conversion into a vertical scar as a revision and one vertical scar mastopexy had superficial infection with bilateral minor skin breakdown which responded completely to antibiotics. Conclusion The submuscular biplane technique is a good option for breast augmentation with mastopexy as a single or staged procedure. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9434-9Authors Umar Daraz Khan, Re-shape House, 2-4 High Street, West Malling Kent ME196QR UK Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Novel Administration Technique for Large-Particle Stabilized Hyaluronic Acid-Based Gel of Nonanimal Origin in Facial Tissue Augmentation

Abstract The use of large-particle stabilized hyaluronic acid-based gel of nonanimal origin (NASHA™) for facial aesthetic procedures is widespread and increasing. A panel of experts with extensive clinical experience with NASHA-based gel recently attended an advisory board meeting to develop guidelines for its use in volumetric tissue augmentation. Discussions included details of the blunt-cannula injection technique currently recommended for administration of large-particle NASHA-based gel. With the aim of optimizing patient comfort and control over administration of NASHA-based gel, the panel members explored an alternative, sharp-needle technique. In this article we describe the new technique in detail, together with practical recommendations and precautions. The technique has several advantages over blunt-cannula injection: improved patient comfort, lack of need for a skin incision, increased precision regarding the implant position, and improved control of injection volume. However, the sharp-needle technique requires a high level of skill and a good knowledge of facial anatomy. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9433-xAuthors Woffles Wu, Woffles Wu Aesthetic Surgery & Laser Centre 1 Orchard Boulevard, Suite 09-02, Camden Medical Centre Singapore 249615 SingaporeIan Carlisle, Cabrini Hospital Malvern AustraliaPeter Huang, Rebecca Cosmetic Center Tao Yuan City TaiwanNatalia Ribé, Institut Dra. Natalia Ribé Barcelona SpainRosalba Russo, Xsana Clinique Modena ItalyClaudia Schaar, Transmed Privatklinik GmbH Fachärztin für Plastische und Ästhetische Chirurgie Wiesbaden GermanyAlexis Verpaele, Coupure Centre for Plastic Surgery Ghent BelgiumAnders Strand, University Hospital Uppsala Sweden Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Trauma: A New Pseudogynecomastia Cause

Trauma: A New Pseudogynecomastia Cause Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00266-009-9435-8Authors Songül Erol, Ankara Numune Training and Research Hospital Department of Plastic and Reconstructive Surgery 60. SK. 132/11, Emek Ankara 06510 TurkeyErkan Orhan, Ankara Numune Training and Research Hospital Department of Plastic and Reconstructive Surgery 60. SK. 132/11, Emek Ankara 06510 TurkeyAsuman Sevin, Ankara Numune Training and Research Hospital Department of Plastic and Reconstructive Surgery 60. SK. 132/11, Emek Ankara 06510 TurkeyBülent Erdoğan, Ankara Numune Training and Research Hospital Department of Plastic and Reconstructive Surgery 60. SK. 132/11, Emek Ankara 06510 Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Lipomodeling of Poland’s Syndrome: A New Treatment of the Thoracic Deformity

Abstract Background The severe forms of Poland’s syndrome, with thoracic deformity, were until now very difficult to treat, with treatment involving complex surgery and implant insertion. Results were, in general, inadequate and the appearance unnatural. Our experience with fat transfer for breast reconstruction led us to propose reconstruction of the breast and thorax by serial fat transfer. Methods Our patient had a very severe form of Poland’s syndrome with agenesis of the pectoralis major and latissimus dorsi muscles and lack of fusion of the fourth costal arch. She was treated by fat transfer, or lipomodeling. Lipomodeling was developed in our team in 1998 to augment breast volume after autologous latissimus dorsi flap reconstruction. Because this technique and use of an implant were not possible, we attempted reconstruction by repeated lipomodeling. The patient underwent five sessions at intervals of a few months, the first in August 2001. Results With 6 years of follow-up, the aesthetic, functional, and psychological results exceeded our expectations. In five sessions we were able to reconstruct a breast of natural shape, sensitivity, and consistency, and which was totally accepted by the patient. Mammography, echography, and MRI 1 year later showed a normal breast of fatty type. Conclusion Lipomodeling in Poland’s syndrome is technically feasible. This original description of treatment of the severest form of Poland’s syndrome, with impressive results and at the cost of limited constraints and scar sequelae, opens new perspectives and suggests extensive potential applications of lipomodeling in all disciplines related to the breast. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00266-009-9428-7Authors Emmanuel Delay, University of Lyon, Centre Léon Bérard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceRaphael Sinna, University of Lyon, Centre Léon Bérard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceKaled Chekaroua, University of Lyon, Centre Léon Bérard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceThomas Delaporte, University of Lyon, Centre Léon Bérard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceSebastien Garson, University of Lyon, Centre Léon Bérard Plastic Surgery Department 28 rue Laennec 69008 Lyon FranceGilles Toussoun, University of Lyon, Centre Léon Bérard Plastic Surgery Department 28 rue Laennec 69008 Lyon France Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Announcements

Announcements Content Type Journal ArticleCategory AnnouncementsDOI 10.1007/s00266-009-9430-0 Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 33 Journal Issue Volume 33, Number 6 / November, 2009

Percutaneous Electrothrombosis: A Minimally Invasive Technique for the Treatment of Deep Hemangiomas

Abstract Background A percutaneous electrocauterization technique for the treatment of deep hemangiomas is introduced as an alternative and minimally invasive treatment mode. Methods Percutaneous electrothrombosis was applied through a needle-catheter that is a small silicone catheter with a needle guide in it. Thus, it is possible to do needle-point monopolar electrocauterization only at the needle tip because of the insulation of the other parts of the needle by the silicone catheter. By retracting the needle with catheter on it during electrocauterization, electrothrombosis was achieved through and around the channel of the needle, leaving vascularized tissue areas between the channels to perfuse the skin or mucosa covering the hemangioma. Results This technique was applied as a single treatment or before surgery for the treatment of cavernous hemangiomas to more than 40 patients. However, adequate documentation was found for only 10 patients. After percutaneous electrocauterization of deep hemangiomas, discrete areas of skin necrosis appeared in some patients during the healing period, but the subsequent debridement and surgical excisions were easier because of the thrombosis effect of the technique due to the diffuse denaturation and fibrosis through and around the electrocauterization channels. The follow-up period was 1–13 years. Conclusion The proposed percutaneous electrocauterization technique for the treatment of deep hemangiomas achieved four effects: (1) volume reduction, (2) bleeding reduction, (3) anesthesia time reduction, and (4) cost reduction. The technique can be defined as a minimally invasive and effective alternative treatment for deep hemangiomas. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9425-xAuthors O. Onur Erol, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul TurkeyO. Ata Uysal, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul TurkeyGalip Agaoglu, ONEP Plastic Surgery Science Institute Manolyali Sokak No.15 Levent 34330 Istanbul Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Experience of 1000 Cases on Subfascial Breast Augmentation

Abstract Background Throughout the years the female breast has been manipulated through aesthetic and reconstructive surgery. Since the 18th century there have been reports of techniques that have tried to increase the volume of the mammary gland. This article demonstrates a technique for increasing the volume of the mammary gland by dissection of the fascia of the pectoralis major muscle. This technique provides long-term results due to the optimized dynamics between the soft tissue and the implant. The subfascial technique is paramount to the subglandular method because primarily it offers better palpable firmness in the periareolar area, a significant decrease in the step effect produced by an excessive projection of the breast, a favorable gravitational pull of the breast, and a considerable reduction in the incidence of capsular contractures. The movement of the implant, postsurgical pain, and bleeding caused by the incision of the pectoralis muscle diminish with this technique. Because of the fascia’s tendency to be preserved, this procedure has the advantage of being able to be applied where previous surgery has been performed; this concedes the subfascial technique a more versatile angle. Methods In the last 10 years 1000 patients were subjected to subfascial breast augmentation with soft-gel cohesive textured implants. An inframammary incision was used in 95% of the patients and the periareolar incision in 5%. Results The patient does not suffer from immediate postsurgical pain. Recovery time and the ability to start daily activities is briefer than after the submuscular procedure. A better projection is obtained without the need to use a bigger implant to get the same result because there is no pressure on top of the implant as in the submuscular technique. Conclusion The subfascial procedure offers a high-grade result for the short and long term and has fewer disadvantages than the submuscular or subglandular technique. Likewise, there are fewer immediate postoperative symptoms and patients have a much better and less painful recovery. The morbidity in these patients is less than with the subglandular and submuscular methods. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9402-4Authors Victor Noe Elizondo Tijerina, Monterrey Nuevo Leon MexicoRodolfo A. Elizondo Saenz, Monterrey Nuevo Leon MexicoJair Garcia-Guerrero, Monterrey Nuevo Leon Mexico Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Silicone Nipple Shields: An Innovative Postoperative Dressing Technique After Nipple Reconstruction

Abstract Background The newly reconstructed nipple is extremely sensitive to mechanical pressure and shearing forces, which can cause flap necrosis and sloughing of the skin, eventually promoting infection. Current available dressing solutions are cumbersome, inefficient, displeasing, or otherwise not readily obtainable. Methods In this study, 10 patients with newly reconstructed nipples were instructed to use breastfeeding nipple shields as the sole means of nipple dressing after the reconstruction procedure. Results No complications were observed overall. Patients reported full adherence to the postoperative dressing regimen as well as ease of use, availability, low costs, and pleasing aesthetic appearance under garments. Discussion Silicone breastfeeding nipple shields offer an efficient, affable, cheap, widely available, and aesthetically pleasing form of postoperative dressing for reconstructed nipples. Their use may enhance patient compliance with the dressing regimen and lower the postoperative complication rate. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9426-9Authors Oren Weissman, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelAriel Tessone, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelAlon Liran, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelDemetris Stavrou, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelNimrod Farber, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelArie Orenstein, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelJosef Haik, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan IsraelEyal Winkler, Sheba Medical Center Department of Plastic and Reconstructive Surgery Tel Hashomer, Ramat Gan Israel Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

Erratum to: Abdominal Fascial Flaps for Providing Total Implant Coverage in One-Stage Breast Reconstruction: An Autologous Solution

Erratum to: Abdominal Fascial Flaps for Providing Total Implant Coverage in One-Stage Breast Reconstruction: An Autologous Solution Content Type Journal ArticleCategory ErratumDOI 10.1007/s00266-009-9420-2Authors Tonguc Isken, Kocaeli University Faculty of Medicine Department of Plastic and Reconstructive Surgery Kocaeli TurkeyMurat Onyedi, Kocaeli University Faculty of Medicine Department of Plastic and Reconstructive Surgery Kocaeli TurkeyHakki Izmirli, Kocaeli University Faculty of Medicine Department of Plastic and Reconstructive Surgery Kocaeli TurkeySahin Alagoz, Kocaeli University Faculty of Medicine Department of Plastic and Reconstructive Surgery Kocaeli TurkeyRyan Katz, Johns Hopkins University School of Medicine Department of Plastic and Reconstructive Surgery Baltimore MD USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 33 Journal Issue Volume 33, Number 6 / November, 2009

Breast Augmentation, Antibiotic Prophylaxis, and Infection: Comparative Analysis of 1,628 Primary Augmentation Mammoplasties Assessing the Role and Efficacy of Antibiotics Prophylaxis Duration

Abstract Background Infections after augmentation mammoplasty are not uncommon, and prophylactic antibiotics are routinely administered to minimize infection. However, there is paucity of information on the relationship between the length of prophylaxis cover and its benefits in primary augmentation mammoplasty. A retrospective analysis of different antibiotic cover regimens, their effectiveness in preventing infections, and the management of infection in established cases is reviewed. Methods A retrospective chart analysis of periprosthetic infections in primary augmentation mammoplasties performed over the past 10 years was conducted. Periprosthetic infection was determined by the presence of pain, swelling, redness, and discharge. Each breast was taken as an individual unit in 1,628 patients, and data for 3,256 breasts were analyzed. The patients had their augmentation in the partial submuscular plane (214 breasts in 107 patients), the subglandular plane (1,548 breasts in 774 patients), and the muscle-splitting biplane (1,494 breasts in 747 patients). All the patients had soft round cohesive gel silicone implants. Of the 3,256 implants, 3,218 were textured, and 38 were smooth surfaced. The patients received antibiotics as a single intravenous dose of cephalosporin (474 breasts in 237 patients), a single intravenous dose plus an oral dose for 24 h (344 breasts in 172 patients), or a single intravenous dose plus an oral course for 5 days (2,438 breasts in 1,219 patients). Infection was recorded as superficial (e.g., wound breakdown, stitch extrusion, stitch abscess) or deep (periprosthetic). The patients with established periprosthetic infections, determined clinically by the presence of pain, discharge, swelling, and redness of the breasts, were managed either conservatively using antibiotics, passive wound drainage, and healing of the wound with secondary intention or by explantation and replacement after 3 to 4 months. In selected cases of periprosthetic infection, the implants were removed after a course of antibiotics and negative swab cultures. The cavity was washed thoroughly with betadine and saline, and new implants were simultaneously reimplanted. Results The incidence of infection was lowest with a single perioperative dose of intravenous antibiotic compared with a combination of intravenous and oral antibiotics. Superficial infection was seen in 38 breasts (all unilateral), with an incidence of 1.2%, and periprosthetic infection was observed in 17 breasts (13 unilateral and 2 bilateral), giving an infection incidence of 0.52% (p = 0.002). In patients with a single intravenous dose of antibiotic, superficial and periprosthetic infection was seen in four breasts (0.8%) and no breasts, respectively. The difference was not significant (p = 0.13). The patients receiving a single intravenous antibiotic and a 24-h oral antibiotic had superficial and periprosthetic infection rates of 2.3% (8 breasts) and 0.3% (1 breast), respectively, and the difference between the two sub-groups was significantly higher (p = 0.04). The patients receiving an intravenous antibiotic and 5 days of oral antibiotics had superficial and periprosthetic infection rates of 1.1% (26 breasts) and 0.65% (14 breasts), respectively. The difference between the two subgroups was not significant (p = 0.09). Of the 17 periprosthetic infections in 15 patients (13 unilateral and 2 bilateral), 11 breasts (1 bilateral and 9 unilateral) were treated conservatively using antibiotics, passive drainage, and wound healing with secondary intention. Capsular contracture developed in two of the conservatively treated breasts, requiring capsulotomies with change of implants. Of the six periprosthetic infections in six patients, requiring surgical intervention, two implants were treated using explantation with immediate replacement after a course of antibiotics and a negative culture, and two implants were explanted followed by reimplantation later. One patient had both implants removed after unilateral infection, and no reimplantation was performed. One patient had a bilateral infection. In this case, one implant was explanted and the other was treated conservatively. The patient had bilateral reimplantion 6 months later, and bilateral Baker 4 capsular contracture developed in both breasts within 6 months. No other complications were seen in the patients who underwent surgery. Conclusion A single dose of intravenous antibiotic is adequate for prophylaxis in breast augmentation surgery, and the extra duration of antibiotic cover does not result in reduced superficial or periprosthetic infections. Infection can be managed in more than one way depending on the nature, degree, and extent of infection. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9427-8Authors Umar Daraz Khan, Re-shape House 2-4 High Street ME 19 6QR West Malling, Kent UK Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 34 Journal Issue Volume 34, Number 1 / February, 2010

The New Face of Transplant Surgery: A Survey on Cosmetic Surgery in Transplant Recipients

The New Face of Transplant Surgery: A Survey on Cosmetic Surgery in Transplant Recipients Content Type Journal ArticleCategory DiscussionDOI 10.1007/s00266-009-9416-yAuthors Linda Cendales, Emory University Division of Plastic Surgery and Division of Transplantation, Vascularized Composite Allografts and the Laboratory of Microsurgery, Emory Transplant Center 101 Woodruff Circle, Suite 5105 WMB Atlanta GA 30045 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X Journal Volume Volume 33 Journal Issue Volume 33, Number 6 / November, 2009

A New Postoperative Otoplasty Dressing Technique Using Cyanoacrylate Tissue Adhesives

Abstract There are many techniques for cosmetic surgery of the ears and also many different procedures for postoperative treatment. The postoperative dressing is described as important for a successful outcome. We present our method of postoperative dressing in the form of liquid bonding. Cyanoacrylate tissue adhesives as liquid bonding agents are used for fixation of the pinna at the mastoid area. After 10–14 days the bonding can be easily removed. No huge dressings, tapes, or plasters are necessary. The patients are satisfied with the light dressing; they do not feel ashamed to appear in public. We have found this dressing technique to be simple and economical, especially because of the use of the bonding for skin closure before. It can be used after otoplasty with an anterior or a posterior approach. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9419-8Authors Miriam Vetter, Plastic, Reconstructive and Aesthetic Surgery, Kantonsspital Frauenfeld Frauenfeld SwitzerlandMatthias Foehn, Plastic, Reconstructive and Aesthetic Surgery, Kantonsspital Frauenfeld Frauenfeld SwitzerlandVolker Wedler, Plastic, Reconstructive and Aesthetic Surgery, Kantonsspital Frauenfeld Frauenfeld Switzerland Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Breast Prostheses and Connective Tissue Disease (CTD): Myth or Reality?

Abstract Since their first appearance, breast prostheses have been criticized as being both responsible for and giving rise to systemic disease. The literature contains many reports on the subject, and theories were controversial from the 1980s to the 2000s. The aim of this review was to gather together the most important studies on breast prostheses and systemic disease, with particular attention to connective tissue disease (CTD), in order to verify any relationship between silicone breast implants and the occurrence of pathologies. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00266-009-9422-0Authors F. Bassetto, University of Padova Plastic Surgery Clinic Padova ItalyV. Vindigni, University of Padova Plastic Surgery Clinic Padova ItalyCarlotta Scarpa, University of Padova Plastic Surgery Clinic Padova ItalyA. Doria, University of Padova Institute of Rheumatology Padova Italy Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

Effect of Botulinum Toxin Type A on Transforming Growth Factor β1 in Fibroblasts Derived from Hypertrophic Scar: A Preliminary Report

Abstract Background Hypertrophic scar is a common dermal disease. Numerous treatments are currently available but they do not always yield excellent therapeutic results. Hence, alternatives are needed. Recent basic and clinical research has shown that botulinum toxin type A (BTXA) has antihypertrophic scar properties but the molecular mechanism for this action is unknown. The aim of this study was to explore the effect of BTXA on transforming growth factor β1 (TGF-β1) in fibroblasts derived from hypertrophic scar and further elucidate its actual mechanism. Methods Fibroblasts were isolated from tissue specimens of hypertrophic scar. Fibroblasts were treated with BTXA and the difference in proliferation between treated and nontreated cells was analyzed through the MTT method from the first to the fifth day after treatment. Proteins of TGF-β1 were checked using ELISA in fibroblasts with BTXA and without BTXA from the first to the fifth day. Results The growth of the fibroblast treated with BTXA was obviously slower than that of the fibroblast without BTXA treatment (p < 0.01), which showed that BTXA effectively inhibited the growth of fibroblasts. Proteins of TGF-β1 between fibroblasts with BTXA and fibroblasts without BTXA are statistically significant (p < 0.01). Conclusion These results suggest that BTXA effectively inhibited the growth of fibroblasts derived from hypertrophic scar and in turn caused a decrease in TGF-β1 protein, indicating that BTXA-based therapies for hypertrophic scar are promising and worth investigating further. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9423-zAuthors Zhibo Xiao, Second Affiliated Hospital of Harbin Medical University Department of Plastic Surgery Harbin City People’s Republic of ChinaFengmin Zhang, College of Basic Medical Science, Harbin Medical University Department of Microbiology Harbin City People’s Republic of ChinaWeibin Lin, Second Affiliated Hospital of Harbin Medical University Department of Very Important Patient Harbin City People’s Republic of ChinaMiaobo Zhang, Second Affiliated Hospital of Harbin Medical University Department of Plastic Surgery Harbin City People’s Republic of ChinaYing Liu, Second Affiliated Hospital of Harbin Medical University Department of Plastic Surgery Harbin City People’s Republic of China Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

ArteFill® Permanent Injectable for Soft Tissue Augmentation: I. Mechanism of Action and Injection Techniques

Abstract After more than 25 years of research and development, in October 2006 ArteFill® became the first and only permanent injectable wrinkle filler to receive FDA approval. ArteFill is a third-generation polymeric microsphere-based filler, following its predecessor Artecoll®, which was marketed outside the United States between 1994 and 2006. ArteFill is approved for the correction of nasolabial folds and has been used in over 15,000 patients since its U.S. market introduction in February 2007. No serious side effects have been reported to date according to the FDA’s MAUDE reporting database. ArteFill consists of polymethylmethacrylate (PMMA) microspheres (20% by volume), 30–50 μm in diameter, suspended in 3.5% bovine collagen solution (80% by volume) and 0.3% lidocaine. The collagen carrier is absorbed within 1 month after injection and completely replaced by the patient’s own connective tissue within 3 months. Each cc of ArteFill contains approximately six million microspheres and histological studies have shown that long-term wrinkle correction consists of 80% of the patient’s own connective tissue and 20% microspheres. The standard injection technique is subdermal tunneling that delivers a strand of ArteFill at the dermal–subdermal junction. This strand beneath a wrinkle or fold acts like a support structure that protects against further wrinkling and allows the diminished thickness of the dermis to recover to its original thickness. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9413-1Authors Gottfried Lemperle, University of California, San Diego Division of Plastic Surgery 200 West Arbor Drive San Diego CA 92103 USATerry R. Knapp, 7451 North 63rd Street Niwot CO 80503 USANeil S. Sadick, 911 Park Avenue, Suite 1A New York NY 10075 USAStefan M. Lemperle, 5672 Dolphin Place La Jolla CA 92037 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications

Abstract Patients ask for procedures with long-lasting effects. ArteFill is the first permanent injectable approved in 2006 by the FDA for nasolabial folds. It consists of cleaned microspheres of polymethylmethacrylate (PMMA) suspended in bovine collagen. Over the development period of 20 years most of its side effects have been eliminated to achieve the same safety standard as today’s hyaluronic acid products. A 5-year follow-up study in U.S. clinical trial patients has shown the same wrinkle improvement as seen at 6 months. Long-term follow-up in European Artecoll patients has shown successful wrinkle correction lasting up to 15 years. A wide variety of off-label indications and applications have been developed that help the physician meet the individual needs of his/her patients. Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20 μm to less than 1% “by the number.” Minor technique-related side effects, however, may occur during the initial learning curve. Patient and physician satisfaction with ArteFill has been shown to be greater than 90%. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-009-9414-0Authors Gottfried Lemperle, University of California, San Diego Division of Plastic Surgery 200 West Arbor Drive San Diego CA 92103 USANeil S. Sadick, 911 Park Avenue New York NY 10075 USATerry R. Knapp, 7451 North 63rd Street Niwot CO 80503 USAStefan M. Lemperle, 5672 Dolphin Place La Jolla CA 92037 USA Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X

The Radial Artery Pedicle Perforator Flap: Vascular Analysis and Clinical Implications.

The Radial Artery Pedicle Perforator Flap: Vascular Analysis and Clinical Implications. Plast Reconstr Surg. 2010 Feb 3; Authors: Saint-Cyr M, Mujadzic M, Wong C, Hatef D, Lajoie AS, Rohrich R GOAL:: To determine the location, size, and vascular territory of the radial artery cutaneous perforators. METHODS:: 26 human cadaveric forearms were dissected. All cutaneous radial artery perforators were analyzed for total number, orientation, location, and external diameter. A cluster analysis was performed to determine the overall distribution of perforators. The cutaneous territory of a distally-based pedicled perforator flap was determined using methylene blue injection and 3D CT angiography in 5 flaps. RESULTS:: 639 perforators (399 perforators < 0.5 mm vs. 240 perforators >/= 0.5 mm), were dissected in 26 forearms. Of the 639 radial artery perforators dissected, 328 (51%) perforators were radially distributed, and 311 (49%) were ulnarly distributed. There are two main clusters of clinically relevant perforators at a relative distance of 17.6% and 61.7 % along the radial styloid-to-lateral epicondyle interval. In all cases, >/=2 perforators were found within 2 cm proximal to the styloid. Dye injection of the most dominant distally based perforators revealed a cutaneous territory ranging from 104 cm to 333 cm. The case presented is of a patient with a dorsal hand defect, which was resurfaced with a pedicled perforator flap based on a distal perforator proximal to the radial styloid. CONCLUSIONS:: There are two main clusters of clinically significant radial artery perforators. Increased knowledge of size, location, and cutaneous territory of the radial artery perforators can lead to expanded use of the radial artery forearm flap based on cutaneous perforators alone, without sacrificing the radial artery. PMID: 20134364 [PubMed - as supplied by publisher]

Evaluation of Subciliary Incision Used in Blow Out Fracture Treatment : Pretarsal Flattening After Lower Eyelid Surgery.

Evaluation of Subciliary Incision Used in Blow Out Fracture Treatment : Pretarsal Flattening After Lower Eyelid Surgery. Plast Reconstr Surg. 2010 Feb 3; Authors: Kim YK, Kim JW BACKGROUND:: The skin-muscle flap has been widely used for many years in eyelid surgery. However, lid retraction and pretarsal flattening are considerable cosmetic complications. Furthermore, it has also been reported that damage of the zygomatic branch reduces muscle tone and contributes to the developments of various complications. We investigated whether denervation of the zygomatic branch affects lid retraction and pretarsal flattening in pure blow out fractures. METHODS:: We used 286 unilateral pure blow out fracture patient from January, 2005 to December, 2006. Mean patient age was 35.6 years (9 to 72 years), the male-to-female ratio was 1.7: 1, and mean follow up was 28 months (19 to 40 months). No patients had undergone eyelid operation previously. Eyelid tone was evaluated using the snap test and the lid distraction test. Pretarsal shape was evaluated using photographs, which were presented to three plastic surgeons and six medical students unaware of surgical information. RESULTS:: Increased laxity was found in only 13 patients (4.5%). When viewing photographic comparisons, medical students noticed 10 visible scars (3.5%), 8 pretarsal flattening (2.8%), and 8 eyelid malpositions (2.8%), whereas the plastic surgeons noticed visible scars in 10 cases (3.5%), pretarsal flattening in 10 cases (3.5%) and eyelid malposition in 9 cases (3.1%). CONCLUSIONS:: In this study, it can be inferred that pretarsal flattening may not be a problem associated with skin-muscle flap itself accompanying the denervation of zygomatic branch. Instead, technical expertise, conservation of the buccal branch and meticulous hemostasis are essential for the prevention of complications. PMID: 20134363 [PubMed - as supplied by publisher]

Immediate Soft-Tissue Reconstruction for Complex Defects of the Spine Following Surgery for Spinal Neoplasms.

Immediate Soft-Tissue Reconstruction for Complex Defects of the Spine Following Surgery for Spinal Neoplasms. Plast Reconstr Surg. 2010 Feb 3; Authors: Garvey PB, Rhines LD, Dong W, Chang DW BACKGROUND:: Innovations in surgical approaches and instrumentation for spinal stabilization have allowed radical resections of advanced spinal neoplasms. Wounds that expose instrumentation and vital neural structures can have devastating consequences. In this study, we present a paradigm shift in the way we manage complex wounds of the spine, where immediate, prophylactic muscle-flap reconstruction is provided, particularly for those patients identified to be at high risk for wound healing complications. The purpose of this study was to determine the outcomes of this new prophylactic approach to managing complex spine wounds. METHODS:: We retrospectively reviewed spine tumor patients who underwent immediate reconstruction for complex wounds of the spine from 2004 to 2008. From the prospectively maintained database and medical records, we collected information including reconstructive methods, defect location, patient conditions, complications, and revision surgeries. RESULTS:: Of the 52 patients, 34 patients (65%) had received prior radiation, 17 patients (33%) had prior surgery to the spine, and 44 patients (85%) had spine instrumentation. Overall, 6 patients (12%) had major complications that required surgical intervention. The instrumentation did not need to be removed in any patients. All patients had a closed wound at their last clinic visit. CONCLUSIONS:: Complex wounds of the spine benefit from immediate prophylactic reconstruction with muscle flaps. This approach has a high rate of success in achieving a stable, closed wound while minimizing major wound complications even in the presence of adverse conditions such as prior radiation, prior surgeries, and the presence of hardware. PMID: 20134362 [PubMed - as supplied by publisher]

Retinoic Acid Enhances Osteogenesis in Cranial Suture-Derived Mesenchymal Cells: Potential Mechanisms of Retinoid Induced Craniosynostosis.

Retinoic Acid Enhances Osteogenesis in Cranial Suture-Derived Mesenchymal Cells: Potential Mechanisms of Retinoid Induced Craniosynostosis. Plast Reconstr Surg. 2010 Feb 3; Authors: James AW, Levi B, Xu Y, Carre AL, Longaker MT BACKGROUND:: In utero retinoid exposure results in numerous craniofacial malformations, including craniosynostosis. While many malformations associated with retinoic acid syndrome are associated with neural crest defects, the specific mechanisms of retinoid induced craniosynostosis remain unclear. We utilized the culture of mouse cranial suture-derived mesenchymal cells to probe the potential cellular mechanisms of this teratogen to better elucidate mechanisms of retinoid induced suture fusion. METHODS:: Genes associated with retinoid signaling were assayed in fusing (posterofrontal) and patent (sagittal, coronal) sutures by qRT-PCR. Cultures of mouse suture-derived mesenchymal cells (SMCs) from the posterofrontal suture were established from four-day old mice. Cells were cultured with all-trans retinoic acid (1 and 5 muM); proliferation, osteogenic differentiation, and specific gene expression were assessed. RESULTS:: Mouse sutures were found to express genes necessary for retinoic acid synthesis, binding, and signal transduction, demonstrated by quantitative RT-PCR (Raldh1, Raldh2, Raldh3, Rbp4). These genes were not found to be differentially expressed in fusing as compared to patent cranial sutures in vivo. Addition of retinoic acid enhanced the osteogenic differentiation of SMCs in vitro, including up-regulation of alkaline phosphatase activity, and Runx2 expression. Contemporaneously, cellular proliferation was repressed, as shown by PCNA expression. The pro-osteogenic effect of retinoic acid was accompanied by increased gene expression of several Hedgehog and Bone Morphogenetic Protein ligands. CONCLUSIONS:: Retinoic acid represses proliferation and enhances osteogenic differentiation of suture-derived mesenchymal cells. These in vitro data suggest that retinoid exposure may lead to premature cranial suture fusion via enhanced osteogenesis and Hedgehog and BMP signaling. PMID: 20134361 [PubMed - as supplied by publisher]

A Prospective Analysis of Bony Versus Soft Tissue Reconstruction for Posterior Mandibular Defects.

A Prospective Analysis of Bony Versus Soft Tissue Reconstruction for Posterior Mandibular Defects. Plast Reconstr Surg. 2010 Feb 3; Authors: Hanasono MM, Zevallos JP, Skoracki RJ, Yu P BACKGROUND:: While reconstruction of anterior mandibular oncologic defects with bony free flaps is considered the gold standard, the optimal reconstruction of posterior defects is controversial. Our goal was to compare outcomes using either a vascularized bone flap (VBF) or a soft tissue free flap (STF) for posterior mandibular reconstruction. METHODS:: Data were prospectively collected on 74 patients undergoing posterior mandibular resection including the condyle. RESULTS:: Twenty-four patients underwent VBF reconstruction and 50 patients underwent STF reconstruction. Patients undergoing VBF reconstruction were significantly younger than those undergoing STF reconstruction (47 vs. 62 years, respectively, p=0.0001) and had a significantly lower ASA class (2.6 vs. 3.1, respectively, p=0.001). There were no significant differences in total operative time, intensive care unit stay, or hospital stay. The complication rate was 33% for patients receiving VBF reconstructions and 38% for patients receiving STF reconstruction (p=0.70).Mouth opening averaged 39.8 mm for patients with VBF reconstructions and 46.4 mm for patients with STF reconstructions (p=0.09). Jaw deviation toward the resection side averaged 1.2 mm for VBF reconstructions and 5.3 mm for STF reconstructions (p=0.02). Fifty-six percent of patients with VBF reconstruction tolerate a regular diet, 33% a soft diet, and 11% a pureed diet. Forty-five percent of patients with STF reconstructions tolerate a regular diet, 42% a soft diet, and 12% a pureed diet (p=0.83). CONCLUSIONS:: Carefully selected, good reconstructive results after posterior mandibular resection can be achieved with VBF or STF reconstructions. In appropriate candidates, VBF reconstruction may result in better postoperative occlusion. PMID: 20134360 [PubMed - as supplied by publisher]