Plastic Surgery in the News

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Michael l. bentz, bruce s. bauer, ronald m. zuker (eds): principles and practice of pediatric plastic surgery
Michael L. Bentz, Bruce S. Bauer, Ronald M. Zuker (Eds): Principles and practice of pediatric plastic surgery Content Type Journal ArticleCategory Book ReviewDOI 10.1007/s00238-008-0247-xAuthors Ian Jackson, Institute for Craniofacial and Reconstructive Surgery Fisher Center—Third Floor, 16001 West Nine Mile Road Southfield MI 48075 USA Journal European Journal of Plastic SurgeryOnline ISSN 1435-0130Print ISSN 0930-343X (Source: European Journal of Plastic Surgery)
Wed, 30 Apr 2008 22:27:30 PDT

Dipyrone increases the blood flow of arterial dorsal skin flaps
Dipyrone Increases the Blood Flow of Arterial Dorsal Skin Flaps Content Type Journal ArticleCategory ErratumDOI 10.1007/s00266-008-9168-0Authors S. E. Gülmez, Ankara University Faculty of Medicine Departments of Pharmacology and Clinical Pharmacology, and Plastic and Reconstructive Surgery Ankara 06590 TurkeyS. Serel, Ankara University Faculty of Medicine Departments of Pharmacology and Clinical Pharmacology, and Plastic and Reconstructive Surgery Ankara 06590 TurkeyA. Uluç, Ankara University Faculty of Medicine Departments of Pharmacology and Clinical Pharmacology, and Plastic and Reconstructive Surgery Ankara 06590 TurkeyZ. Can, Ankara University Faculty of Medicine Departments of Pharmacology and Clinical Pharmacology, and Plastic and Reconstructive Surgery Ankara 06590 TurkeyH. Ergün, Ankara University Faculty of Medicine Departments of Pharmacology and Clinical Pharmacology, and Plastic and Reconstructive Surgery Ankara 06590 Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X (Source: Aesthetic Plastic Surgery)  MedWorm Sponsored Message: Find out how you can <a rel="nofollow" target="_blank" href="http://www.medworm.com/rss/medicalsponsorship.php">get your message across here</a> by sponsoring this MedWorm news feed.
Wed, 30 Apr 2008 21:58:08 PDT

CSMG Technologies Subsidiary Live Tissue Connect Technology And Product Performance Will Be Presented At The Central European Congress Of Surgery
CSMG Technologies, Inc., (OTC BB: CTGI) a technology management company, announce its Live Tissue Connect, Inc. (LTC) subsidiary's technology will be present at Central European Congress of Surgery in Prague, Czech. Dr. Robert Tucker M.D. PhD, of the University of Iowa, has had three clinical papers peer reviewed and accepted at a surgical congress. Dr.
Wed, 26 Mar 2008 14:00:00 PDT

Teenager Dies During Breast Surgery
A teenager from South Florida, USA, died last Saturday during an operation to correct asymmetrical breasts and an inverted areola.Two hours into what was supposed to be a routine operation at a plastic surgery facility in Boca Raton, 18-year old Stephanie Kuleba was rushed to Delray Medical Center.
Wed, 26 Mar 2008 03:00:00 PDT

Complications and Risks of Breast Augmentation
There were 364610 breast augmentation procedures performed in 2005 The top concerns of breast augmentation include the surgery itself the implants breast cancer and the risk of anesthesia
Wed, 24 May 2006 07:47:00 PDT

Sensitive Skin A Symptom Of Migraine
"Migraine hurts skin" is the headline in the Daily Mirror. The newspaper describes the symptom of sensitive skin, called allodynia, where sufferers of migraine find combing their hair, wearing jewellery or getting dressed "excruciatingly painful". The newspaper reports that 10% of people in the UK suffer migraine. The Daily Telegraph covers the same story and suggests "two thirds of migraine sufferers reported symptoms of the condition allodynia".
Wed, 23 Apr 2008 05:00:00 PDT

Baby Friendly Bacteria Can Help Prevent Development Of Eczema
Eczema is a distressing condition for both parents and babies - the raw, red skin is painful to see and it is difficult to stop small children from scratching it. At worst, it can mean having to wet wrap wriggly toddlers each day with bandages soaked in moisturisers. It usually starts in the first year of life and affects about 10% of infants. Although most children eventually grow out of it, about half will go on to develop another allergic condition, such as asthma or hayfever.
Wed, 23 Apr 2008 01:00:00 PDT

Long Island Plastic Surgeon Is New ASAPS President

Wed, 07 May 2008 13:00:02 PDT

Misinformation Linking Natural Fats To Obesity And Heart Disease Exposed By Author In New Book
As heart disease and obesity continue to plague the US, many people believe that the recent proliferation of high-fat diets is the major culprit. As a consequence, many people aim to significantly reduce the amount of saturated fats they consume with the hope that they will be slimmer, healthier, and happier. However, many leading researchers in the medical field have found that this is simply not the case.
Wed, 07 May 2008 05:00:00 PDT

Food Made To Appear More Delicious By Gut Hormone
A gut hormone that causes people to eat more does so by making food appear more desirable, suggests a new report in the May issue of Cell Metabolism, a publication of Cell Press. In a brain imaging study of individuals, the researchers found that reward centers respond more strongly to pictures of food in subjects who had received an infusion of the hormone known as ghrelin.
Wed, 07 May 2008 03:00:00 PDT

Appetite Decreased And Weight Loss Promoted By Blocking Brain Enzyme
Imagine being able to tone down appetite and promote weight loss, while improving the body's ability to handle blood sugar levels.That's just what Tony Means, PhD, and his team at the Duke University Medical Center were able to do when they blocked a brain enzyme, CaMKK2, in mice.
Wed, 07 May 2008 03:00:00 PDT

Removing Barriers To Physical Activity In Child Care Centers
At a time when over half of US children (aged 3-6) are in child care centers, and growing concern over childhood obesity has led physicians to focus on whether children are getting enough physical activity, a new study of outdoor physical activity at child care centers, conducted by researchers at Cincinnati Children's Hospital Medical Center, has identified some surprising reasons why the kids may be staying inside.
Wed, 07 May 2008 03:00:00 PDT

Long Island Plastic Surgeon Is New ASAPS President
New York plastic surgeon Alan H. Gold, MD, is the new President of the American Society for Aesthetic Plastic Surgery (ASAPS). The Aesthetic Society, with nearly 2,400 members, is the leading national organization of board-certified plastic surgeons specializing in cosmetic surgery of the face and body. The election of new officers was held on May 4, during the ASAPS 2008 Annual Meeting in San Diego, CA which was attended by plastic surgeons from around the world. Dr.
Wed, 07 May 2008 01:00:00 PDT

Interacting Proteins Identified, Key To Melanoma Development, Treatment
Researchers have discovered how a mole develops into melanoma by showing the interaction of two key proteins involved in 60-70 percent of tumors. The Penn State scientists also demonstrate that therapeutic targeting of these proteins is necessary for drugs to effectively treat this deadly form of cancer.
Wed, 07 May 2008 01:00:00 PDT

Valeant Pharmaceuticals Announces Temporary Stay In Efudex(R) Case
Valeant Pharmaceuticals (NYSE:VRX) announced that Spear Pharmaceuticals has agreed not to market, sell or ship a generic fluorouracil cream 5% pursuant to a stay in Valeant's legal case against the Food and Drug Administration (FDA). The stay will remain in place until May 14, 2008, or until a further order of the Court is issued. On April 11, 2008, the FDA approved an Abbreviated New Drug Application (ANDA) for a fluorouracil cream 5% sponsored by Spear Pharmaceuticals.
Wed, 07 May 2008 01:00:00 PDT

Not All Fat Created Equal
It has long been known that type 2 diabetes is linked to obesity, particularly fat inside the belly. Now, researchers at the Joslin Diabetes Center have found that fat from other areas of the body can actually reduce insulin resistance and improve insulin sensitivity.In a study published in the May issue of Cell Metabolism, a team lead by C. Ronald Kahn, M.D.
Wed, 07 May 2008 00:00:00 PDT

Indoor Tanning Is Not As Safe As You Think - In Fact, It's Totally Out
At age 17, all Meghan Rothschild and Brittany Lietz wanted was a dark tan. They thought it made them look beautiful. But both had no idea that in just three years they would be battling melanoma, the deadliest form of skin cancer. Now Meghan, 24, of Wilbraham, Mass., and Brittany, 23, of Annapolis, Md., are speaking out about their experiences.
Wed, 07 May 2008 00:00:00 PDT

Long island plastic surgeon is new asaps president
New York plastic surgeon Alan H. Gold, MD, is the new President of the American Society for Aesthetic Plastic Surgery (ASAPS). The Aesthetic Society, with nearly 2,400 members, is the leading national organization of board-certified plastic surgeons specializing in cosmetic surgery of the face and body. The election of new officers was held on May 4, during the ASAPS 2008 Annual Meeting in San Diego, CA which was attended by plastic surgeons from around the world. Dr. (Source: Cosmetic Medicine / Plastic Surgery News From Medical News Today)
Wed, 07 May 2008 00:00:00 PDT

Commentary on “surgical management of facial vascular anomalies: role of intraoperative seventh nerve monitoring” by kubiena et al.
Commentary on “Surgical management of facial vascular anomalies: role of intraoperative seventh nerve monitoring” by Kubiena et al. Content Type Journal ArticleCategory Editor's CommentDOI 10.1007/s00238-008-0234-2Authors I. Jackson, Institute for Craniofacial and Reconstructive Surgery 16001 West Nine Mile Road, Third Floor Fisher Center Southfield MI 48075 USA Journal European Journal of Plastic SurgeryOnline ISSN 1435-0130Print ISSN 0930-343X (Source: European Journal of Plastic Surgery)
Tue, 29 Apr 2008 23:23:51 PDT

A new method to quantify the effect after subcutaneous injection of lipolytic substances
Abstract Background  Increasing numbers of patients request lipolytic injection therapy for aesthetic indications. However, only the clinical results of these therapies have been published to date. In most cases, pre- and postprocedure photographs and measurements have been presented. As with every other medical procedure, it is necessary to ensure that the results of lipolytic injections are quantified on an objective and scientific basis with comparable data. Methods  In the past, the size of fat tissue could not be measured properly with conventional ultrasound systems. High-resolution, real-time three-dimensional (RT-3D) ultrasound is a fairly new method for measuring the volume of tissue. Therefore, this study aimed to measure the interscapular fat bodies of New Zealand rabbits before and after lipolytic therapy with Lipostabil®, phosphatidycholine and orciprenalin (Alupent®). Results  The ultrasound-controlled injection of the lipolytic substances into the interscapular fat body ensured a precise injection. The RT-3D ultrasound data were compared with the magnetic resonance imaging (MRI) measurements performed at the same time. The greatest decrease in volume, up to 44%, was measured with orciprenalin (Alupent®). There was a significant correlation between the data from ultrasound imaging and MRI. Conclusion  The data suggest that RT-3D ultrasound imaging could be a simple and fast method for proving the effects on volume size after lipolytic procedures. Of the three investigated substances, orciprenalin (Alupent®) showed the highest lipolytic effect in our animal model. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-008-9158-2Authors S. M. Klein, University of Regensburg Department of Plastic Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyL. Prantl, University of Regensburg Department of Plastic Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyA. Berner, University of Regensburg Department of Plastic Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyS. Schreml, University of Regensburg Department of Plastic Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyT. Schubert, University of Regensburg Institute of Pathology Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyJ. Rennert, University of Regensburg Department of Radiology Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyC. Fellner, University of Regensburg Department of Radiology Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyA. Stopfer, University of Regensburg Department of Plastic Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyP. Angele, University of Regensburg Department of Plastic Surgery Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyA. G. Schreyer, University of Regensburg Department of Radiology Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyC. I. Schreyer, University of Regensburg Department of Radiology Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyS. Feuerbach, University of Regensburg Department of Radiology Franz-Josef-Strauss-Allee 11 93053 Regensburg GermanyE. M. Jung, University of Regensburg Department of Radiology Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X (Source: Aesthetic Plastic Surgery)
Tue, 29 Apr 2008 23:11:31 PDT

Do cosmetic surgeons consider estrogen-containing drugs to be of significant risk in the development of thromboembolism?
Abstract Background  Well-documented evidence shows that estrogen increases the risk of deep vein thrombosis (DVT), and that the effects of DVT are compounded by the stress of surgery and an anesthetic. Methods  This study sought to determine the current views and practice of plastic surgeons regarding combined oral contraceptive and surgery. In the United Kingdom, 285 consultant plastic surgeons were identified, and postal questionnaires were distributed to each surgeon. Results  Of 286 postal questionnaires distributed to consultant plastic surgeons, 53% were returned and analyzed. Most of the surgeons considered combined oral contraceptive and surgery to be a risk factor for DVT, although only 54% discontinued it before surgery. Approximately 50% believed hormone-replacement therapy (HRT) is a risk, but fewer than a one-fourth of surgeons stopped its use before surgery. There was a range of distribution for the length of time HRT was discontinued for surgery. The majority of consultants discontinue HRT use for 5 to 6 weeks before surgery and until full ambulation after surgery. Data retrieved were used to compare documented evidence relating to combined oral contraceptive and surgery and its association with DVT. Conclusion  This survey shows that the management of patients taking estrogen-containing medication before plastic surgery varies, and guidelines regarding this should be sought. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-008-9156-4Authors R. L. Johnson, The Countess of Chester Hospital Department of Plastic Surgery Liverpool Road Chester UKS. J. Hemington-Gorse, The Countess of Chester Hospital Department of Plastic Surgery Liverpool Road Chester UKS. K. Dhital, The Countess of Chester Hospital Department of Plastic Surgery Liverpool Road Chester UK Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X (Source: Aesthetic Plastic Surgery)
Tue, 29 Apr 2008 23:11:31 PDT

Results of long-term follow-up observations of blepharoptosis correction using the palmaris longus tendon
Abstract Background  The frontalis sling procedure is a useful approach for correcting severe blepharoptosis. However, blepharoptosis often recurs after corrective surgery using the tensor fascia lata. Good results without recurrence after a modified Fox method were obtained using the palmaris longus tendon. This study examined the safety and validity of the surgical method using the palmaris longus tendon through long-term follow-up observations. Methods  To reduce the rate of recurrence, the highest point on the pentagon of the Fox method was fixed to the frontalis fascia and frontalis muscle. It was fixed once again to the area 1 cm above the highest point. This approach remarkably reduces the incidence of recurrence by fixing the pentagon of the Fox method not only to the palmaris longus tendon but also to the frontalis fascia and again to the frontalis muscle. A modified Fox method using the palmaris longus tendon was used to treat 16 eyelids of 10 patients. A senior surgeon performed the procedure in all cases under local anesthesia. Results  The mean follow-up period was 51 months (range = 18–86 months). There was no case of blepharoptosis recurrence and a good field of view was secured after surgery. Long-term follow-up revealed that the visual field had been well secured with a mean MRD1 of 3.1 mm. The eyelids were well maintained without any postoperative adverse reaction such as exposure keratitis. Conclusion  The palmaris longus tendon as useful donor material does not lead to recurrence of blepharoptosis, which is often encountered when the tensor fascia lata is used. The modified Fox method using the palmaris longus tendon can be an effective and valid surgical approach that produces both immediate and long-term results. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-008-9165-3Authors SangKeun Park, BK DongYang Plastic Surgery Clinic Seoul Republic of KoreaYongHo Shin, BK DongYang Plastic Surgery Clinic Seoul Republic of Korea Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X (Source: Aesthetic Plastic Surgery)
Tue, 29 Apr 2008 23:11:29 PDT

Tracleer (Bosentan) Receives New Indication In Patients With Systemic Sclerosis And Active Digital Ulcer Disease
Actelion Pharmaceuticals UK Ltd announced that Tracleer® (bosentan), a dual endothelin receptor antagonist, has been approved in the UK and Ireland for the reduction of the number of new digital ulcers (DUs) in patients with systemic sclerosis (SSc) and ongoing DU disease.1DUs are a frequent, extremely painful and disabling complication of SSc2, caused by a reduced blood flow to the fingers and toes.
Tue, 29 Apr 2008 01:00:00 PDT

Cosmetic Plastic Surgery Procedures For Ethnic Patients Up 13 Percent In 2007
Almost a quarter (2,626,700) of cosmetic plastic surgery procedures were performed on ethnic patients in 2007, up 13 percent from last year, including Hispanics, African Americans and Asian Americans, according to statistics released today by the American Society of Plastic Surgeons (ASPS).
Tue, 25 Mar 2008 12:00:00 PDT

Breast Implants Saline vs Silicone and More on Augmentation Surgery
Now ten years after silicone implants were yanked off the market breast enlargment sugery is on the rise This article introduces two mothers who had implants and discusses silicone v saline sizes shapes side effects and proscons or the surgery
Tue, 21 Feb 2006 05:33:00 PST

Answers to Questions on Silicone and Saline Breast Implants
A boardcertified plastic surgeon answers your questions
Tue, 16 May 2006 06:15:00 PDT

Kythera Biopharmaceuticals Announces Second Phase II Clinical Trial With Adipolytic Agent For Reduction Of Submental Fat
Kythera Biopharmaceuticals, Inc. ("Kythera") announced the initiation of a second Phase II clinical trial evaluating its proprietary product, ATX-101, for the reduction of unwanted submental (under chin) fat. This clinical trial is the second in a series of Phase II studies of ATX-101 in aesthetic applications and is aimed at assessing the safety and effectiveness of ATX-101 as a "liposculpting" agent.
Tue, 15 Apr 2008 04:00:00 PDT

Men go body sculpting

Tue, 06 May 2008 13:00:02 PDT

Comparative columellar scar analysis between transverse and inverted-v incision in open rhinoplasty
Abstract Background  Rhinoplasty can be performed using both open and closed approaches. A visible scar on the columella is the major disadvantage of open rhinoplasty. Different columellar incision types have been used in open rhinoplasty. In this retrospective study, we compare transverse and inverted-V columellar incisions with a scar assessment scale. Methods  In this retrospective study, open rhinoplasty was performed on 84 patients between 2001 and 2006. The transverse incision was used on 39 patients (18 males, 21 females). The inverted-V incision was used on 45 patients (21 males, 24 females). The entire surgical procedure was performed by a single surgeon. The columellar incision was closed using 6–0 interrupted polypropylene sutures. All sutures were removed on the fifth postoperative day. With this assessment scale, we observed satisfactory scar, pigmentation, and notching. Results  We compared both groups and found that the inverted-V incision resulted in better scar formation (p < 0.05) and less notching (p < 0.07). Scar pigmentation was found to be irrelevant to the incision technique employed (p < 0.3). Conclusion  As a result of this study we concluded that the inverted-V incision might be a better choice in open rhinoplasty. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00266-008-9170-6Authors Ismail Aksu, Yildirim Beyazit Diskapi Education and Research Hospital Department of Plastic and Reconstructive Surgery Ankara TurkeyHasan Alim, Yildirim Beyazit Diskapi Education and Research Hospital Department of Plastic and Reconstructive Surgery Ankara TurkeyAli Teoman Tellioglu, Yildirim Beyazit Diskapi Education and Research Hospital Department of Plastic and Reconstructive Surgery Ankara Turkey Journal Aesthetic Plastic SurgeryOnline ISSN 1432-5241Print ISSN 0364-216X (Source: Aesthetic Plastic Surgery)
Tue, 06 May 2008 11:10:23 PDT

Getting Obesity Under Control - Australian Medican Association Position Statement On Obesity
The Australian Medical Association called on the food industry to take more responsibility in curbing Australia's obesity epidemic. AMA President, Dr Rosanna Capolingua, said governments should take firm action to encourage the food industry to adopt measures to promote healthy eating.
Tue, 06 May 2008 02:00:00 PDT

Second Genetic Link To Weight And Obesity - New DNA Variants Found That Can Help To Pile On The Pounds
A study of 90,000 people has uncovered new genetic variants that influence fat mass, weight and risk of obesity. The variants act in addition to the recently described variants of the FTO gene: adults carrying variants in both genes are, on average, 3.8 kg (or 8.5 lb) heavier. The variants map close to a gene called MC4R: mutations in this gene are the most common genetic cause of severe familial obesity.
Tue, 06 May 2008 01:00:00 PDT

Clinical Data Demonstrates 5 Year Efficacy And Safety Of Aquamid(R) In Facial Augmentation
Contura International A/S announced that 5-year clinical data for its soft volume filler Aquamid(R) was presented at the annual meeting for the American Society of Aesthetic Plastic Surgery (ASAPS) in San Diego. Aquamid(R) is used to rejuvenate or contour the face, either by restoring lost volume or by adding extra volume where needed. Contura is currently conducting a multicenter, comparative clinical trial of Aquamid(R) in the United States.
Tue, 06 May 2008 00:00:00 PDT

Amylin Pharmaceuticals Initiates Phase 2B Dose-Ranging Clinical Study Of Pramlintide/Metreleptin Combination Treatment In Obesity
Amylin Pharmaceuticals, Inc. (Nasdaq: AMLN) announced the initiation of a Phase 2B clinical study evaluating various dosing combinations of pramlintide, an analog of the natural hormone amylin, and recombinant human leptin (r-metHuLeptin; metreleptin) for the treatment of obesity. The objective of this dose-ranging study is to support dose selection for Phase 3, and to inform the ongoing development of a convenient delivery system for this combination regimen.
Tue, 06 May 2008 00:00:00 PDT

New Studies Support Dermatologists' Recommendation: Self-Exams, Screenings Vital For Detecting Skin Cancer
When detected early, most skin cancers can be successfully treated. In fact, melanoma, the most serious form of skin cancer, is highly curable when found and treated early. The five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent.
Tue, 06 May 2008 00:00:00 PDT

Warning: New Skin Cancer Study Finds Outdoor Workers Are Less Likely To Get Screened For Skin Cancer
While occupational risks are inherent in many jobs, workers who make a living toiling in the sun face an increased threat of skin cancer from repeated overexposure to the sun's harmful ultraviolet (UV) rays. Now, new research finds that workers who need skin exams the most by nature of their occupation -- such as construction, forestry, fishing and farming workers -- are the least likely to get them.
Tue, 06 May 2008 00:00:00 PDT

Recent Advances Make Sunscreen More Effective And Easier To Use
With spring in the air, most of us will be arming ourselves with all the essentials that warm weather brings -- flip flops, shorts, sunglasses, sun hats and, of course, sunscreen. The available options in sunscreen protection have become more plentiful than ever, including formulations offering a smoother application or enhanced protection from ultraviolet (UV) light.
Tue, 06 May 2008 00:00:00 PDT

Senetek PLC Announces Positive Results From Pyratine-6(TM) Clinical Trial In Patients With Acne Rosacea
Senetek PLC (OTC Bulletin Board: SNKTY), a Life Sciences company engaged in the development of technologies that target the science of healthy aging, announced positive study results from a clinical trial of Pyratine-6(TM) in patients with acne rosacea. The findings have been accepted for presentation at the International Investigative Congress of Dermatology at its May 2008 meeting in Kyoto, Japan.
Tue, 06 May 2008 00:00:00 PDT

Surgeon And Laser Pioneer Warns Cosmetic Deregulation Is A Danger For Patients, UK
Consultant Plastic Surgeon and international laser expert David Gault spoke out against the Department of Health's proposal to deregulate laser and Intense Pulsed Light (IPL) devices for 'cosmetic' treatments. Mr Gault who helped develop the first hair-removing laser over 18 years ago and acts as an expert witness in medico-legal cases of 'botched' laser and IPL treatments is particularly concerned that these measures will lead to permanent complications in patients.
Thu, 27 Mar 2008 02:00:00 PDT

Scalp And Neck Melanoma Survival
"Skin cancers on the scalp or neck are more deadly than those elsewhere on the body, a large study has suggested", BBC News reported. The Daily Telegraph also describes the results of a new study that examined the prognosis (chance of survival) of patients who developed a malignant melanoma on their scalp or neck.
Thu, 24 Apr 2008 13:00:00 PDT

FDA Clears Glove Made From New Type Of Latex
The U.S. Food and Drug Administration has cleared for marketing the first device made from a new form of natural rubber latex, guayule latex. The product, the Yulex Patient Examination Glove, is derived from the guayule bush, a desert plant native to the Southwestern United States.Traditional latex gloves are made from the milky sap of a rubber tree, Hevea braziliensis.
Thu, 24 Apr 2008 04:00:00 PDT

Reconstruction Innovations For Breast Cancer Patients Including Partial And Full Mastectomies Examined By ASPS Report
Lumpectomy or breast conservation surgery is the most common type of breast cancer surgery currently performed. A benefit of the surgery is that only part of the breast is removed, but a drawback can be the resulting physical appearance of the breast, which may be disfigured, dented or uneven.
Thu, 24 Apr 2008 03:00:00 PDT

Facelifts Make A Comeback With Boomers In 2007
Despite increasing consumer demand for less invasive procedures for facial rejuvenation, facelifts are making a comeback with female and male baby boomers. According to the latest statistics released by the American Society of Plastic Surgeons (ASPS), facelifts are up 14 percent for patients ages 40 and over, with nearly 116,200 procedures performed in 2007.
Thu, 10 Apr 2008 04:00:00 PDT

Men Of All Ages Turn To Breast Reductions

Thu, 08 May 2008 13:00:02 PDT

Sleeping Too Much Or Too Little Linked To Poor Health Habits, CDC Study
A new study suggests that American adults who usually sleep fewer than 6 hours a night are more likely to have poor health habits than those who sleep 7 to 8 hours. The findings also suggest a similar poor pattern of health behaviours for those who usually sleep 9 hours or more. However, the authors were keen to stress that the finding do not prove that too much or too little sleep causes poor health behaviours, or the other way around.
Thu, 08 May 2008 06:00:00 PDT

Increased Commitment To Prevention A Must, Australia
The Australian Medical Association rejected a think tank report that labels efforts to prevent obesity and chronic diseases a waste of money. The Centre for Independent Studies claims that there is no convincing evidence that preventative health measures work, and Australia's 40-year track record of public health education campaigns have not achieved outcomes.
Thu, 08 May 2008 04:00:00 PDT

Caution Recommended For New Anti-Obesity Drug In Children
A new class of anti-obesity drugs that suppresses appetite by blocking cannabinoid receptors in the brain could also suppress the adaptive rewiring of the brain necessary for neural development in children, studies with mice have indicated. One such drug, rimonabant (trade name Acomplia) has been developed by Sanofi-Aventis and is awaiting approval for use in the U.S., and other pharmaceutical companies are developing similar drugs.
Thu, 08 May 2008 03:00:00 PDT

Picis Launches Total Perioperative Automation Solution In Europe
Picis, the leading provider of information systems for the high-acuity areas of hospitals, has announced the European launch of Picis Total Perioperative Automation suite of products designed to help hospitals increase efficiency, reduce costs and improve the quality of care through every aspect of surgery, which is the most resource- and cost-intensive area in the hospital.
Thu, 08 May 2008 01:00:00 PDT

Obesity Significantly Raises Dementia Risk - Underweight Also Raises Risk
Being obese can increase the risk of Alzheimer's Disease by as much as 80 percent, according to a study in the May issue of Obesity Reviews.But it's not just weight gain that poses a risk. People who are underweight also havean elevated risk of dementia, unlike people who are normal weight or overweight.
Thu, 08 May 2008 01:00:00 PDT

Cynosure's Accolade(TM) Workstation For Pigmented Lesions Receives Korean Regulatory Approval
Cynosure, Inc. (Nasdaq: CYNO), a leading developer and manufacturer of a broad array of light-based aesthetic treatment systems, announced that it has received market approval from the Korea Food & Drug Administration (KFDA) for its flagship Accolade(TM) workstation for the removal of pigmented lesions.
Thu, 08 May 2008 00:00:00 PDT

No Need To Endure Excessive, Embarrassing Sweating
When shaking someone's hand becomes a self-conscious ordeal because of excessive sweating, talk to a care provider. The May issue of Mayo Clinic Health Letter outlines treatment options to help minimize excessive sweating.Called focal hyperhidrosis, this condition most commonly involves excessive daytime sweating of the palms, soles and underarms. It can make typical work and social activities hard to endure.
Thu, 08 May 2008 00:00:00 PDT

Picis launches total perioperative automation solution in europe
Picis, the leading provider of information systems for the high-acuity areas of hospitals, has announced the European launch of Picis Total Perioperative Automation suite of products designed to help hospitals increase efficiency, reduce costs and improve the quality of care through every aspect of surgery, which is the most resource- and cost-intensive area in the hospital. (Source: Cosmetic Medicine / Plastic Surgery News From Medical News Today)
Thu, 08 May 2008 00:00:00 PDT

American Society For Laser Medicine And Surgery Hosts Annual Scientific Conference In Kissimmee, Florida, April 2-6, 2008
The world's top laser experts will gather in Kissimmee, FL, to share innovations in lasers and emerging technologies at the 28th Annual Scientific Conference of the American Society for Laser Medicine and Surgery (ASLMS). "LASER 2008" will be held on April 2-6, 2008, at the Gaylord PalmsTM Resort and Convention Center.
Thu, 03 Apr 2008 04:00:00 PDT

British Cosmetics Doctors Unite Against Laser De-Regulation
The British Association of Cosmetic Doctors the organisation established for the advancement, education and practice of cosmetic dermatology in the UK has warned that the government is putting the public at severe risk with the Department of Health's (DOH) proposals to deregulate lasers and Intense Pulsed Light (IPL) technologies. Members have denounced the proposal by signing a petition asking the prime minister to reject the Department of Health proposals.
Thu, 01 May 2008 01:00:00 PDT

New Genetic Test Helps Women And Doctors Predict Female Hair Loss Before It Starts
Until now, Female Hair Loss has been difficult to predict and diagnose. That changes with today's announcement that HairDX, LLC (http://www.hairdx.com), pioneers of consumer-friendly genetic tests for hair loss, has introduced a screening test using genetic markers strongly associated with Female Hair Loss (Female Androgenetic Alopecia).
Thu, 01 May 2008 01:00:00 PDT

British cosmetics doctors unite against laser de-regulation
The British Association of Cosmetic Doctors the organisation established for the advancement, education and practice of cosmetic dermatology in the UK has warned that the government is putting the public at severe risk with the Department of Health's (DOH) proposals to deregulate lasers and Intense Pulsed Light (IPL) technologies. Members have denounced the proposal by signing a petition asking the prime minister to reject the Department of Health proposals. (Source: Cosmetic Medicine / Plastic Surgery News From Medical News Today)
Thu, 01 May 2008 00:00:00 PDT

Lip Balms And Glosses May Raise Skin Cancer Risk
If you are a regular lip balm or lip gloss user you should perhaps bear in mind that there is a good chance your risk of developing skin cancer is greater, according to researcher, Dr. Christine Brown, Baylor University Medical Center, Dallas. The balms/glosses actually attract the ultraviolet rays. Not only do we have to protect our skin from the sun, says Dr. Brown, but also our lips. In fact, one quarter of all Americans do not appear to use any form of lip protection.
Sun, 27 Apr 2008 09:00:00 PDT

Vanderbilt Burn Expertise To Assist Federal Battlefield Injuries Project
Vanderbilt University Medical Center is one of three clinical sites testing new products to replace burned skin as part of a massive federal grant program announced Thursday. The collaborative effort is expected to boost treatment options for soldiers injured in war zones.The Armed Forces Institute of Regenerative Medicine (AFIRM) consists of two academic groups, or consortiums, working with the U.S.
Sun, 20 Apr 2008 00:00:00 PDT

Women and Breast Implants
Women sometimes need the breast implant to fullfill their lives They need them to enhance their body figures
Sun, 02 Oct 2005 08:51:00 PDT

Delcath Expands Phase III Trial For Metastatic Melanoma To Include University Of Maryland Medical Center
Delcath Systems, Inc. (Nasdaq: DCTH) announced that the Institutional Review Board (IRB) of the University of Maryland Medical Center (UMMC) has approved UMMC's participation in the Phase III study of the Company's Percutaneous Hepatic Perfusion (PHP) System for the isolated, high dose delivery of the anti-cancer agent melphalan to treat inoperable metastatic melanoma in the liver.
Sat, 26 Apr 2008 00:00:00 PDT

Disparities In Use Of Breast Reconstruction May Stem From Lack Of Patient-Provider Discussion
In a new study examining disparities in postmastectomy breast reconstruction, researchers at Brigham and Women's Hospital (BWH) and Dana-Farber Cancer Institute (DFCI) in Boston, Mass., concluded that lack of patient-provider discussion may contribute to socioeconomic, age and race-related inconsistencies in the use of breast reconstruction after mastectomy.
Sat, 05 Apr 2008 08:00:00 PDT

Got Fat?: Plastic Surgeons Review Fat-Melting And Fat-Grafting Procedures
New techniques and devices for surgical and nonsurgical cosmetic enhancement are being introduced at a rapid pace, but do these innovations really deliver what they promise? Are the results of minimally invasive treatments, offering the benefit of little or no downtime, comparable to more
Sat, 03 May 2008 00:00:00 PDT

Doctor Prosecuted For Advertising And Selling An Unlicensed Medicine - 'Fat Jab', UK
The Medicines and Healthcare products Regulatory Agency (MHRA) successfully prosecuted a man from Nottingham at the City of London Magistrates Court on Wednesday 23 April 2008 for illegally possessing with intention to sell and advertising the unlicensed drug, Lipostabil®, for cosmetic purposes.Dr. Dinesh Maini, a GP based at the Lenton Surgery, 266 Derby Road, Nottingham, NG7 1PR, pleaded guilty to three charges and was ordered to pay over Â£10,000 in costs and fines.
Mon, 28 Apr 2008 04:00:00 PDT

A Laypersons Psychological Take on Fake Breasts
Food for thought on the real reasons why women get breast augmentation
Mon, 25 Apr 2005 20:44:00 PDT

REVIEWERS LIST: Thank You to Our Reviewers

Mon, 21 Jan 2008 00:00:00 PST

HIGHLIGHTS OF ARCHIVES OF FACIAL PLASTIC SURGERY: Highlights of Archives of Facial Plastic Surgery

Mon, 21 Jan 2008 00:00:00 PST

ORIGINAL ARTICLE: Surgical Anatomy of the Face: Implications for Modern Face-lift Techniques
Objective  To delineate the anatomic architecture of the melolabial fold with surrounding structures and to elucidate potential implications for face-lift techniques. Methods  A total of 100 facial halves (from 50 cadaveric heads) were studied, including gross and microscopic dissection and histologic findings. Laboratory findings were correlated with intraoperative findings in more than 150 deep-plane face-lift dissections (300 facial halves) performed during the study period. Results  In contrast to previous reports, the superficial musculoaponeurotic system (SMAS) was not found to form an investing layer in the midface. The SMAS, zygomatici muscles, and levator labii superioris alaeque nasi were found to be located in corresponding anatomic layers and to form a functional unit. Additional findings of the present study include the description of 3 structurally different portions of the melolabial fold, of an anatomic space below the levator labii superioris alaeque nasi (sublevator space), and of extensions of the buccal fat pad into the sublevator space and the middle third of the melolabial fold. Conclusions  The findings of the present study may contribute to augment our understanding of the complex anatomy of the midface and melolabial fold. Potential implications for modern face-lift techniques are discussed.
Mon, 21 Jan 2008 00:00:00 PST

ORIGINAL ARTICLE: Clinical Analysis of Surgical Approaches for Orbital Floor Fractures
Objective  To identify the optimal surgical method for managing blowout fractures of the inferior orbital wall by analyzing the location and type of fracture based on computed tomographic findings and medical records. Methods  Medical records of 102 patients with pure inferior blowout fractures who were treated between June 1996 and December 2005 were reviewed regarding fracture type and location and surgical approach. Results  Ocular symptoms persisted in 14 of the 102 cases after surgery, and revision procedures were performed in 11 of those cases. Cases with persistent symptoms were analyzed in terms of fracture location and type of surgery. For anterior orbital floor fractures, symptoms persisted in 2 of the 4 cases treated using a transantral approach, while no symptoms persisted in any of the 15 cases treated using a transorbital approach or in either of the 2 cases treated using a combined approach. For posterior orbital floor fractures, symptoms persisted in 2 of the 31 cases treated using a transantral approach, in 4 of the 6 cases treated using a transorbital approach, and in 1 of the 19 cases treated using a combined approach. For anteroposterior orbital floor fractures, symptoms persisted in 2 of the 5 cases treated using a transorbital approach and in 3 of the 20 cases treated using transantral and combined approaches. Conclusion  Patients with large orbital floor fractures or posterior half fractures of the orbit should undergo surgery via a transantral or a combined approach, while patients with trapdoor fractures or anterior half fractures of the orbit should undergo surgery via a transorbital or a combined approach.
Mon, 21 Jan 2008 00:00:00 PST

ORIGINAL ARTICLE: A New Classification of Lip Zones to Customize Injectable Lip Augmentation
Objectives  To present a new classification of 15 anatomical lip zones used to direct placement of injectable fillers during lip augmentation and to evaluate the new classification's ability to customize lip contour and size. Methods  Study participants were consecutive patients presenting to a facial plastic and reconstructive surgery practice for injectable lip augmentation with a nonanimal-sourced stabilized hyaluronic acid (Restylane; Medicis Aesthetic Inc, Scottsdale, Arizona). A nonrandomized, prospective case series. Results  A total of 137 treatments were performed on lips of 66 patients. The mean (SD) satisfaction score was 4.5 (0.6) on an integral scale of 1 (dissatisfied) to 5 (most satisfied). The mean (SD) persistence until lips returned to preoperative appearance based on patient subjective evaluation was 4.9 (1.5) months. Patients were free of adverse effects. Conclusions  Using a new classification of lip anatomical zones to direct the injection of a nonanimal-sourced stabilized hyaluronic acid has increased my ability to better control lip shape and size in lip augmentation. This technique was met with high patient satisfaction and no adverse effects. Persistence of injected nonanimal-sourced stabilized hyaluronic acid was similar to that seen in other studies.
Mon, 21 Jan 2008 00:00:00 PST

ORIGINAL ARTICLE: Lip Augmentation With Porcine Small Intestinal Submucosa
Objective  To relate our initial experience using an acellular, soft tissue matrix derived from porcine small intestinal submucosa (Surgisis; Cook Biotech Inc, West Lafayette, Indiana) for lip augmentation. Design  A prospective, uncontrolled case series examining the results of lip augmentation using Surgisis in patients presenting to an academic otolaryngology/facial plastic surgery office. Results  Nineteen Surgisis implants were placed in 8 patients. All patients tolerated the procedure and denied unnatural sensations or complications at any interval. Adverse events included transient erythema and 1 case of local cellulitis treated effectively with oral antibiotics. Four patients were satisfied with the procedure and 4 patients requested greater augmentation. Six-month follow-up was reported, and preoperative and postoperative photography was used in all cases. Conclusions  Short-term lip augmentation was achieved in all 8 patients (4 patients had multiple strands placed). This study demonstrates technical ease and early safety. Surgisis should serve as scaffolding for ingrowth of striated muscle of the lip, potentially providing long-term augmentation. This study introduces Surgisis as a novel implant for lip augmentation.
Mon, 21 Jan 2008 00:00:00 PST

ORIGINAL ARTICLE: Augmentation of Nasal Tip Projection Using the Inferior Turbinate: Review of Technique and Evaluation of Long-term Success
Objectives  To introduce the use of inferior turbinate bone as an alternative autograft for augmentation of nasal tip projection and to assess maintenance of nasal tip projection, bone remodeling, graft shaping, and ease of harvesting. Methods  Thirteen consecutive patients in need of increased nasal tip projection underwent closed rhinoplasty during a prospective nonrandomized study in a university teaching hospital setting. An autologous demucosalized inferior turbinate bone graft was used as a columellar strut. Measurements of nasal tip projection were obtained using the Goode ratio. Photodocumentation and lateral soft tissue radiographs were obtained before surgery and between 30 and 38 months after surgery. Results  In all patients, the results were as follows: (1) the inferior turbinate bone graft was easily harvested and molded into the appropriate-sized columellar strut; (2) the immediate postoperative nasal tip projection, as measured by the Goode ratio and visual assessment, was increased; and (3) the tip projections were maintained at the 30-month follow-up examination. Paired t tests revealed a statistically significant difference (P = .001 and P = .009) between preoperative and both immediate and long-term measurements. Comparison of immediate postoperative radiographs with those taken 2 years later demonstrated no remarkable change in appearance of the graft. Conclusions  The interior turbinate bone is a viable graft for augmenting nasal tip projection. Moreover, it maintains tip projection and needs little to no remodeling. The graft is easy to harvest, prepare, and place and can be used without requiring a second operative site.
Mon, 21 Jan 2008 00:00:00 PST

ORIGINAL ARTICLE: Nondestructive Imaging of Live Human Keloid and Facial Tissue Using Multiphoton Microscopy
Objectives  To use multiphoton microscopy to image collagen fibers and matrix structure in nonfixed human keloid tissue and normal human facial skin obtained following surgery and to compare the findings to existing knowledge of normal skin and keloid morphology to determine if this technology is a suitable adjunct for conventional histology. Methods  Epidermis was removed to expose the fibroblast-rich dermal layer that was then imaged using a multiphoton confocal microscope (Zeiss-Meta 510; Carl Zeiss, Jena, Germany). An 800-nm tunable titanium/sapphire femtosecond laser (Mai-Tai; Newport Co Spectra-Physics, Mountain View, California) was used to excite the tissue; second harmonic generation between 397 and 408 nm and autofluorescent signals were collected. Images were obtained using a Plan-Neofluar x40 oil immersion objective lens and a Plan-Apochromat x63 oil immersion lens. Results  Compared with normal skin, keloids showed disorganized collagen fibers arranged in complex swirls and bundles 20 to 30 µm in diameter. Normal tissue showed collagen fibers as distinct, straight strands less than 10 µm in diameter. Differences between normal and keloid tissue were subtle but apparent. Conclusions  The value of imaging living tissue is a significant benefit. Because keloids and hypertrophic scars result from altered collagen metabolism, the development of clinical multiphoton microscopy systems may allow examination of wound healing dynamics in vivo and potentially provides a means to monitor therapy without the need for biopsy or the risk of injury to tissue.
Mon, 21 Jan 2008 00:00:00 PST

ORIGINAL ARTICLE: Eyebrow Position Recognition and Correction in Reconstructive and Cosmetic Surgery
Objectives  To improve (1) recognition of eyebrow ptosis, asymmetry, or deformity and (2) selection of the appropriate surgical technique based on the patient's underlying etiology. Design  Nonrandomized, retrospective study of patients undergoing surgical correction of eyebrow asymmetry. Forty consecutive patients were identified as having asymmetric eyebrow ptosis or deformity. Varying etiologies included those that were congenital, posttraumatic, age-related, iatrogenic, or idiopathic, with or without facial nerve paralysis. Patients underwent a variety of surgical approaches for correction of the eyebrow malposition, including transblepharoplasty, midforehead, coronal, and endoscopic procedures. Preoperative evaluation of patients, identification of patient-specific appropriate surgical technique, and photographs and grading of postoperative results are discussed. Results  All patients had a minimum follow-up period of at least 4 months (mean, 15 months; range, 4 months to 3 years). Preoperative and postoperative photographs were obtained and graded. Complete symmetry was achieved in 8 patients (20%), considerable improvement in 23 patients (57%), modest improvement in 7 patients (18%), and no improvement in 2 patients (5%). No notable postoperative complications were reported. Recommendations for improving results are included. Conclusions  The key to correction of eyebrow ptosis in patients undergoing reconstructive and cosmetic surgery is to first recognize the asymmetry. It is also important to note the effect of reconstructive and cosmetic surgical procedures on eyebrow position in order to limit the need to perform additional procedures to correct resultant eyebrow asymmetries and deformities. Finally, the surgeon must consider which eyebrow-lift technique is optimal for the patient's underlying etiology to improve postoperative results and patient satisfaction.
Mon, 21 Jan 2008 00:00:00 PST

SURGICAL TECHNIQUE: The Anchor Graft: A Novel Technique in Rhinoplasty
We review our use of a modified tip graft that we termed the anchor graft for the correction of nasal tip deformities. This modified infratip shield graft was used to improve alar rim positioning, while simultaneously improving tip projection and/or augmenting infratip fullness. Standardized preoperative and postoperative photographs were taken of each patient. Aesthetic appearance was subjectively judged by the physician and a patient survey. Complications were tabulated. Sixteen patients met the requirements for inclusion in our study. Eleven patients received follow-up for more than 1 year. All patients demonstrated good aesthetic improvement, with only minor complications. No extrusion of the graft was noted. All patients reported a natural-appearing and normal-feeling nose after a minimum follow-up of 6 months. Revision surgery was elected in 4 patients, 2 of whom initially presented as revision cases. The anchor graft is a new technique to aid in cosmetic modification of the nasal tip as well as to improve the functional and aesthetic appearance of the nasal ala and external nasal valve.
Mon, 21 Jan 2008 00:00:00 PST

SURGICAL TECHNIQUE: The Lateral Crural Stairstep Technique: A Modification of the Kridel Lateral Crural Overlay Technique

Mon, 21 Jan 2008 00:00:00 PST

COMMENTARY: More Than a Pretty Face: The Mona Lisa

Mon, 21 Jan 2008 00:00:00 PST

BOOK AND MULTIMEDIA REVIEW: Skin Flaps in Facial Surgery

Mon, 21 Jan 2008 00:00:00 PST

BOOK AND MULTIMEDIA REVIEW: Atlas of Microvascular Surgery: Anatomy and Operative Techniques

Mon, 21 Jan 2008 00:00:00 PST

BEAUTY: Juan Van der Hamen y Leon's Still Life with Sweets and Pottery

Mon, 21 Jan 2008 00:00:00 PST

Armed Forces Multi-Million Dollar Effort To Help Soldiers
A procedure currently performed all over the world for cosmetic purposes might also improve wound healing and limb function for soldiers who are severely hurt and scarred during combat. Dr. Adam Katz, plastic surgeon and researcher at the University of Virginia Health System, will conduct research in this area under the Armed Forces Institute of Regenerative Medicine (AFIRM). White House officials announced the formation of AFIRM, which has received more than $80 million for research.
Mon, 21 Apr 2008 02:00:00 PDT

Considering Weight Loss Surgery? What You Need To Know
According to Centers for Disease Control and Prevention (CDC), 66 percent of all U.S. adults are overweight or obese. Faced with conditions of heart disease, high blood pressure and diabetes, many Americans are shopping for bariatric surgery to help manage these conditions and, in some cases, cure them.What should a consumer look for in a bariatric program? Here are five tips from Nick Nicholson, M.D.
Mon, 21 Apr 2008 00:00:00 PDT

INDEX FOR THIS VOLUME: Index to Volume 9

Mon, 19 Nov 2007 00:00:00 PST

HIGHLIGHTS OF ARCHIVES OF FACIAL PLASTIC SURGERY: Highlights of Archives of Facial Plastic Surgery

Mon, 19 Nov 2007 00:00:00 PST

SPECIAL TOPICS: Cleft Deformities in Zimbabwe, Africa: Socioeconomic Factors, Epidemiology, and Surgical Reconstruction
In the African country of Zimbabwe, a variety of socioeconomic factors have contributed to a lack of specialty care and resources for the indigent population. Although cleft lip and palate has a lower incidence in Africa (0.67 per 1000 births) than in Latin America or Asia, access to reconstructive surgery is often difficult to obtain. A surgical team worked with Zimbabweans at the Harare Central Hospital, Harare, to perform cleft surgery for 39 patients. We review the epidemiology of cleft deformities in Africa, our experience with 39 patients with cleft lip and palate, and the techniques used to address 2 patients with midfacial clefts. To our knowledge, this retrospective case review and epidemiologic literature review is the first review of cleft care in Zimbabwe. Poverty in Zimbabwe, caused in part by the highest inflation rate in the world, has contributed to the emigration of a large number of specialists to other countries. In addition, the health care system is overwhelmed by a high prevalence rate of human immunodeficiency virus (25%), leading to a drastically reduced parental life expectancy (mean life expectancy, 36 years). Primary and secondary cleft lip and palate repairs were completed without complications. Children requiring care beyond the scope of this mission were referred to the Republic of South Africa. The cooperation among the Zimbabwean administration, physicians, and nurses was integral to the organization and successful execution of this reconstructive surgical mission. Ultimately, until the socioeconomic conditions improve in Zimbabwe, training and continuing education of local physicians are imperative to advance the care of children with cleft lip and palate. Published online October 22, 2007 (doi:10:1001/archfaci.9.6.qsp70001).
Mon, 19 Nov 2007 00:00:00 PST

SPECIAL TOPICS: Update on Major Reconstruction of the Head and Neck
Reconstruction of soft-tissue defects in the head and neck is best accomplished using similar composite tissue. In the head and neck, this tissue is usually available in the form of adjacent tissue transfer. The local adjacent tissue resembles the resected tissue in color and composition. In some circumstances, the local tissue is not suitable for transfer. This may be due to previous surgery, exposure to radiation, or a defect that is too large for local tissue transfer. In these cases, free tissue transfer may be needed. Free tissue transfer allows for the replacement of similar composite tissue that has not seen previous treatment. The diversity of sites that may be harvested allows a relatively similar tissue match. This article discusses recent advances in the reconstruction of 3 areas that in the past have presented many problems to the reconstructive surgeon. Total nasal and lip reconstruction have been problematic. In heavily pretreated patients, the reconstruction often results in suboptimal outcomes. Large scalp defects in the setting of previous excisions or irradiation are difficult to reconstruct and rehabilitate. In all of these cases, the ability to transfer composite tissue has improved the functional and cosmetic outcomes.
Mon, 19 Nov 2007 00:00:00 PST

ORIGINAL ARTICLE: Safety of Definitive In-Theater Repair of Facial Fractures
Objective  To determine the safety of definitive in-theater facial fracture repair on American military personnel wounded during Operation Iraqi Freedom. Methods  A retrospective review of all patients with head and neck trauma treated at the 322nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq, from May 7, 2005, through September 18, 2005, was performed. This study focused on the outcomes of wounded American military personnel whose facial fractures were definitively repaired in theater. The criteria used to determine candidacy for definitive in-theater facial fracture repair on American military personnel were (1) the fracture site was exposed through either a soft tissue wound or because of an adjacent surgical approach, (2) treatment would not delay evacuation from theater, and (3) treatment would allow the military member to remain in theater. Results  From May 2005 to September 2005, 207 patients were taken to the operating room and required 388 procedures. A total of 175 patients (85%) were operated on for traumatic injuries, and 52 of these patients required open reduction and internal fixation (ORIF) of a facial fracture. Of the 52 patients who underwent an ORIF, 17 were American military personnel. Of the 17 American patients who were definitively treated for their facial fractures in theater, 16 were contacted and/or followed up on the global military medical database. None of these patients developed an Acinetobacter baumannii infection or had a complication caused by the definitive in-theater ORIF. The range of follow-up was 2 months to 11 months, with a mean of 8.3 months. Conclusions  Definitive repair of facial fractures with ORIF on American military personnel in theater is advised when the aforementioned criteria are observed. An otolaryngologist is a crucial member of the head and neck trauma team.
Mon, 19 Nov 2007 00:00:00 PST

ORIGINAL ARTICLE: Sparing the Eye in Craniofacial Surgery for Superior Nasal Vault Malignant Neoplasms: Analysis of Benefit
Objective  To evaluate orbital and ophthalmologic function following standardized eye-sparing protocol for treating superior nasal vault malignant neoplasms. Design  A retrospective review of patients with sinonasal malignant neoplasms who underwent preoperative radiation therapy with or without chemotherapy and craniofacial resection (CFR) with eye preservation. Pretreatment and posttreatment ophthalmologic evaluations were performed. Results  A total of 59 patients underwent eye-sparing therapy between 1983 and 2005; 36 had invasion of the lamina with or without periorbital resection (61%). The most common abnormality was esthesioneuroblastoma (37 cases; 63%), most of which were Kadish stage C (n = 26). The most common preoperative ophthalmologic findings were motility disturbances (18 cases; 31%), afferent pupillary dysfunction and change in acuity (17 cases; 29%), and proptosis (17 cases; 29%). A total of 36 patients were available for long-term follow-up (mean follow-up, 61 months); 35 of these retained functional vision (97%); and 1 patient had a nonfunctional eye. Conclusions  Standardized treatment for superior nasal vault malignant neoplasms using an eye-sparing CFR remains a sound approach both oncologically and ophthalmologically. Most patients with advanced disease present with ophthalmologic findings, and most posttreatment eye findings are notable only on detailed examination and either resolve spontaneously in the acute-care setting or do not require surgical repair.
Mon, 19 Nov 2007 00:00:00 PST

ORIGINAL ARTICLE: Muller's Muscle Conjunctival Resection for Correction of Upper Eyelid Ptosis: Relationship Between Phenylephrine Testing and the Amount of Tissue Resected With Final Eyelid Position
Objectives  To evaluate the outcome of Müller's muscle–conjunctival resection (MMCR) for correction of upper eyelid ptosis and to explore the relationship between phenylephrine testing, muscle resection, and surgical outcome. Methods  Medical records were reviewed for all patients who underwent MMCR at the Jules Stein Eye Institute, Los Angeles, California, from January 1, 1999, through June 30, 2005. Outcome measures were margin reflex distance-1, ptosis correction after instillation of phenylephrine drops, extent of MMCR, ptosis correction, and eyelid symmetry. Results  In 80 patients who underwent 131 MMCR procedures for correction of upper eyelid ptosis, margin reflex distance-1 increased on average by 1.6 mm (P < .001). In 106 patients (81%), eyelid symmetry equal to or less than 1 mm was achieved (P = .02). Phenylephrine testing underestimated the extent of ptosis correction achieved with MMCR. A weak correlation was found between the extent of MMCR and ptosis correction (r = 0.2; P = .04). Conclusions  Müller's muscle–conjunctival resection is effective for ptosis correction in patients with good levator muscle function; good eyelid symmetry is achieved in most patients. Phenylephrine testing underestimated the ptosis correction achieved with MMCR by 40%. The relationship between MMCR and ptosis correction is complex.
Mon, 19 Nov 2007 00:00:00 PST

ORIGINAL ARTICLE: Lateral Retrocanthal Orbitotomy: A Minimally Invasive, Canthus-Sparing Approach
Objective  To develop and evaluate a minimally invasive technique of lateral orbitotomy that provides improved orbital access with fewer complications. Methods  A cadaver study was undertaken to develop a technique of transconjunctival lateral orbitotomy that preserves the structural integrity of the eyelid support system and provides extended access to the orbit from floor to roof. We then evaluated the procedure in an outcome study of 30 consecutive patients. Results  The cadaver investigations demonstrated that a transconjunctival lateral retrocanthal approach is technically possible and provides improved direct access to the lateral orbit. In the study of 30 consecutive procedures, there were no complications resulting from the surgical access. The wound healing was rapid, without tissue distortion or scars. The exposure was ample for all surgical interventions. Conclusions  Lateral retrocanthal orbitotomy is a new approach that provides extended access to the entire lateral orbit. The technique is rapid and can be extended in a single continuous incision to the medial orbit. The structural integrity of the lateral retinaculum is preserved, which appears to improve the postoperative cosmetic and functional result.
Mon, 19 Nov 2007 00:00:00 PST

ORIGINAL ARTICLE: Endoscopic Repair of Orbital Blowout Fractures: Use or Misuse of a New Approach?
Objective  To evaluate the successes and challenges of endoscopic orbital floor fracture repairs. Methods  We analyzed 53 orbital floor repairs and recorded the indications for surgery, factors that complicated the endoscopic repair or necessitated conversion to an open approach, and outcomes for each. Results  Forty-five procedures were completed endoscopically. Repairs of smaller injuries confined entirely to the medial floor were readily accomplished, particularly when entrapment was the primary indication for surgery. Endoscopic repair became very difficult and often not possible when a large amount of soft tissue was herniated through the floor defect and when dissection medially onto the lamina papyracea and lateral to the infraorbital nerve was required for implant placement. Duration of follow-up was short for some patients, but no adverse trends in outcomes were identified. Conclusions  Blowout fractures can be approached endoscopically. However, the technical challenge of working from below with a telescope tends to increase the difficulty of many repairs without improving results. Most blowout fractures are probably still best treated through an open approach, assuming that the lower eyelid incision is correctly performed.
Mon, 19 Nov 2007 00:00:00 PST

ORIGINAL ARTICLE: Prevention of Lower Eyelid Malposition After Blepharoplasty: Anatomic and Technical Considerations of the Inside-Out Blepharoplasty
Objective  To determine the position of the lower eyelid and lateral canthus after release of the lower eyelid retractors with the "inside-out technique" by measuring the marginal reflex distance 2 (MRD2) and using the lateral canthal rounding scale. Design  Retrospective analysis. Results  Of the 171 patients who underwent inside-out blepharoplasty, 78 were followed up for 3 months. Preoperative MRD2 was 0.942 pixels. Postoperatively, the modified MRD2 was 0.903. Although the score of the modified MRD2 was found to decrease postoperatively, the decrease was not statistically significant (P < .07). The lateral rounding scale reviewed an average preoperative score of 2.04 and a postoperative score of 1.99. There was no statistical difference between pre- and postoperative observations based on a 1-tailed t test. No complications were reported. Conclusion  Using photographic analysis, the study found no difference in lateral canthal shape or MRD2 before and after surgery in patients who underwent inside-out blepharoplasty.
Mon, 19 Nov 2007 00:00:00 PST

ORIGINAL ARTICLE: Injectable Calcium Hydroxylapatite for Orbital Volume Augmentation
Objective  To describe a new method of augmenting orbital volume for anophthalmic enophthalmos correction. Methods  A retrospective medical record review was conducted of 4 consecutive patients who had injectable calcium hydroxylapatite (Radiesse) placed in the extraconal space to augment orbital volume. Results  Four patients were treated with 1 to 2 vials (1.3 mL per vial) of injectable calcium hydroxylapatite. The mean amount of preoperative enophthalmos measured by Hertel exophthalmometry was 4 mm (range, 2-7 mm). The mean follow-up was 57 weeks (range, 45-71 weeks). A reduction of enophthalmos, ranging from 2 to 5 mm (mean, 2.75 mm), was observed when comparing preoperative with postoperative measurements of the anophthalmic orbit with prosthesis in place. All patients demonstrated clinical and aesthetic improvement that was observed to continue at almost 1 year or more postoperatively. In one patient, injection was complicated by a peribulbar hemorrhage related to local anesthesia administration, which resolved without incident. Conclusions  Injectable calcium hydroxylapatite provides a new, safe, simple, cost-effective technique to treat volume deficiency in the anophthalmic orbit. Augmentation achieved with this semipermanent filler has demonstrated a lasting effect in the orbit of 1 year or more with little volume loss. The filler seems to last longer in areas with less movement, blood supply, and lymphatic drainage. Injection can even be performed in an office setting using local anesthesia. The amount of volume replacement can be titrated, and the procedure is repeatable until adequate volume is obtained.
Mon, 19 Nov 2007 00:00:00 PST

SURGICAL TECHNIQUE: The Transcaruncular Approach: Surgical Anatomy and Technique
With a detailed understanding of the pertinent surgical anatomy, the transcaruncular approach provides safe access and excellent exposure of the medial orbit and orbital apex. We herein describe our technique of the transcaruncular approach and delineate the pertinent associated surgical anatomy via dissection, magnetic resonance imaging, and histologic examination. The isolated transcaruncular approach provides exposure of the medial orbital floor from the region of the maxilloethmoidal strut to the orbital roof area superior to the frontoethmoidal suture. When combined with an inferior fornix incision, the transcaruncular approach allows for continuous exposure from the frontozygomatic suture laterally to the frontoethmoidal suture medially. Attention to anatomical details promotes creation of an effective and safe caruncular incision. The conjunctival incision should be ample. The orbital septum should be carefully dissected from the posterior surface of the Horner muscle to minimize fat spillage, and the periosteum should be opened widely at the beginning of surgery.
Mon, 19 Nov 2007 00:00:00 PST

BOOK AND MULTIMEDIA REVIEW: Medicinal Leech Therapy

Mon, 19 Nov 2007 00:00:00 PST

BEAUTY: Gerard David's The Rest on the Flight into Egypt

Mon, 19 Nov 2007 00:00:00 PST

HIGHLIGHTS OF ARCHIVES OF FACIAL PLASTIC SURGERY: Highlights of Archives of Facial Plastic Surgery

Mon, 17 Sep 2007 00:00:00 PDT

ORIGINAL ARTICLE: Transglabellar Subcranial Approach for the Management of Nasal Masses With Intracranial Extension in Pediatric Patients
Objective  To describe the use of the transglabellar subcranial approach for the management of congenital nasal masses in the pediatric population. Methods  Case series. Medical records of 5 patients who underwent resection of congenital nasal lesions via the subcranial approach were reviewed. Results  Five children underwent successful resection of congenital nasal lesions with intracranial extension via the subcranial approach. Lesions resected included nasal dermoids with intracranial extension (n = 3) and encephaloceles (n = 2). Patient age at the time of operation ranged from 13 months to 15 years. All lesions were resected successfully, and there have not been any recurrences. Follow-up has ranged from 1 to 12 years. There has been no apparent negative effect on facial growth in any of these patients. Conclusions  The subcranial approach is an effective technique for the resection of nasal masses with intracranial extension. These lesions have traditionally been managed with lateral rhinotomy, midface degloving, or external rhinoplasty approaches combined with a frontal craniotomy. The subcranial approach offers several advantages over a traditional frontal craniotomy. It provides excellent exposure, minimizes frontal lobe retraction, reduces the likelihood of cerebrospinal fluid leakage, and provides for an excellent cosmetic result. Long-term follow-up in 5 pediatric patients has shown no recurrence or negative effect on craniofacial growth. These factors make the transglabellar subcranial approach a useful and safe technique for the management of nasal lesions with intracranial extension in very young patients.
Mon, 17 Sep 2007 00:00:00 PDT

ORIGINAL ARTICLE: The Role of Nasal Feminization Rhinoplasty in Male-to-Female Gender Reassignment
Objective  To objectively assess the results of rhinoplasty in feminizing the facial profiles of male-to-female transsexual patients undergoing gender reassignment. Methods  Twelve patients underwent nasal feminization as part of male-to-female gender reassignment. Global assessments of facial profile were performed, and nasofrontal, nasolabial, and supratip angles and the Goode ratio were objectively measured. Postoperative and long-term patient satisfaction was assessed. Results  The surgical procedures created more feminine nasal profiles in all patients. The mean ± SD nasofrontal angle changed from 141.6° ± 6.0° to 150.5° ± 5.5° (P < .001). The nasolabial angle changed from 107.4° ± 14.3° to 115.2° ± 11.7° (P < .001), and the supratip angle from 1.7° ± 4.9° to 12.8° ± 5.8° (P < .001). The Goode ratio did not change significantly, remaining on average around 1.64 ± 0.15. In 4 cases, spreader grafts were used to reconstruct the nasal valve, and no cases of valve insufficiency occurred. Conclusions  Rhinoplasty is effective in achieving feminine facial profiles in patients undergoing male-to-female gender reassignment. This requires reducing the overall nasal size and changing nasal angles to those more reminiscent of the female form. Because of the extensive resections often required to modify the nasal form, it is important to pay particular attention to preserving function, which may require concomitant nasal valve reconstruction.
Mon, 17 Sep 2007 00:00:00 PDT

ORIGINAL ARTICLE: Technical Advances in the Correction of Septal Perforation Associated With Closed Rhinoplasty
Objective  To demonstrate technical advances for closing septal perforations that allow the perforation repair to be performed with primary or revisional closed rhinoplasty during the same operation. Methods  We used this technique with closed rhinoseptoplasty in 258 cases of perforations in which the perforation ranged from 1.0 to 3.5 cm in diameter. We repaired the perforation using bilateral intranasal submucoperichondrial and submucoperiosteal advancement flaps with a sandwich graft interposition between. We prepared the sandwich graft using the auricular or septal cartilage and 2 layers of deep temporoparietal fascia. Results  In every case, the septal perforation was corrected along with the closed rhinoseptoplasty and, because this is a conservative approach, the vascularization of the columella and anterior septum was preserved, with an excellent view of all the structures involved. Conclusions  Perforation repair represents a challenge to most surgeons owing to the low rates of successful correction with some techniques. Some of these techniques not only fail to rectify nasal aesthetics and the perforation during the same surgery but also cause undesired aesthetic alterations due to the retraction and rotation of tissues to close the perforation. We have performed this repair since 1989, allowing for closure of the perforation in 257 of 258 patients.
Mon, 17 Sep 2007 00:00:00 PDT

ORIGINAL ARTICLE: Reconstructive Application of the Endotine Suspension Devices
Objective  To illustrate the potential reconstructive opportunities that the Endotine suspension devices can provide for patients with soft tissue ptosis secondary to facial nerve dysfunction, posttraumatic deformity, and postablative deformity. Methods  A review was performed of 23 Endotine midface and eyebrow suspension devices in 10 patients with facial nerve sacrifice, facial trauma, or tumor extirpation. Results  A total of 12 midface and 11 eyebrow suspension devices were used in 10 patients. All patients had improvement in soft tissue support and contour. The mean follow-up time was 10 months (range, 1-24 months). No major complications were noted. One patient had recurrent cellulitis secondary to maxillary sinusitis, and another had recurrent cellulitis that responded to treatment with intravenous antibiotics. The Endotine midface device was resistant to infection and did not require removal in either case. One patient requested revision surgery for resuspension of the eyebrow. Conclusions  The Endotine midface and eyebrow suspension devices have been shown to be excellent methods of fixation in cosmetic eyebrow-lifts and midface-lifts. We have demonstrated that the Endotine device may be a good reconstructive option for patients with soft tissue ptosis in a multitude of scenarios.
Mon, 17 Sep 2007 00:00:00 PDT

ORIGINAL ARTICLE: Effect of FK506 on Functional Recovery After Facial Nerve Injury in the Rat
Objective  To examine the effect of the immunosuppressive agent FK506 on the rate of functional recovery of the rat facial nerve after crush injury. Methods  Forty rats underwent facial nerve crush injury and were randomly assigned to 4 experimental groups: isotonic sodium chloride solution control, FK binding protein 52 (FKBP-52) antibody control, FK506, and FK506 and FKBP-52 antibody. Rats underwent daily recovery testing from postoperative day 9 until postoperative day 21 by videotaping 3 validated variables in this model: blink reflex return, vibrissial fibrillation loss, and return of vibrissial sweeping symmetry. Results  FK506-treated animals demonstrated improved recovery in all 3 variables compared with control animals. The FK506 and FKBP-52 antibody group demonstrated improved recovery of only the return of the blink reflex. Conclusions  FK506 accelerated functional recovery of facial nerve function after crush injury. Neuroregeneration was inhibited by FKBP-52 antibody in the rat midface but not the upper face. FK506 may be a viable adjuvant treatment for facial nerve neurapraxic injury.
Mon, 17 Sep 2007 00:00:00 PDT

ORIGINAL ARTICLE: Prospective Examination of the Efficacy of 2 Topical Over-the-counter Cosmeceutical Creams for Rapid Treatment of Facial Rhytids
Objective  To examine the efficacy of 2 over-the-counter cosmeceutical creams in reducing facial rhytids—Freeze 24/7 Anti-Wrinkle Cream (Freeze 24/7 International LLC, New York, New York) and LiftFusion Micro-Injected M-Tox Transdermal Face Lift (Fusionbeauty, Inc, Boca Raton, Florida)—against placebo (Nutraderm Therapeutic Lotion; Healthpoint, Inc, San Antonio, Texas). Methods  A prospective, blinded clinical trial was performed on 42 subjects, comparing 2 cosmeceutical creams that each represent a class of purported rapid rhytid reduction formulas with placebo. Independent analysis by 2 facial plastic surgeons was performed as well as completion of self-assessment questionnaires by the participants. Results  No complications occurred. Self-evaluation of cream effectiveness was no different for test creams compared with placebo. Neither cream produced substantial reduction of rhytids when examined critically by 2 independent facial plastic surgeons. Stratification by Glogau (photoaging) class did not reveal increased effectiveness based on rhytid severity. Conclusion  Two typical over-the-counter rhytid reduction products are ineffective at substantially reducing facial rhytids.
Mon, 17 Sep 2007 00:00:00 PDT

ORIGINAL ARTICLE: Expanded Applications of the Dorsal Nasal Flap
Objective  To describe new applications for the dorsal nasal flap technique of facial reconstruction. Methods  Retrospective review of surgical records of patients in whom the dorsal nasal flap technique was used. Results  The dorsal nasal flap technique was used in 61 patients to repair defects ranging in size from 12 x 17 mm to 35 x 40 mm. Conclusion  The dorsal nasal flap technique is more versatile than has been traditionally appreciated and can allow single-stage reconstruction of many sizes of defects affecting various areas of the nose.
Mon, 17 Sep 2007 00:00:00 PDT

ORIGINAL ARTICLE: Crushed Cartilage Grafts for Concealing Irregularities in Rhinoplasty
Objective  To assess the clinical outcome of crushed cartilage grafts used to conceal contour irregularities in rhinoplasty. Methods  We reviewed the medical records of 462 patients in whom crushed autogenous cartilage grafts were used, selected from a total of 669 patients in whom rhinoplasty procedures were performed at our institution between June 1, 1999, and June 1, 2006. The grafts were used as slightly, moderately, significantly, or severely crushed. Results  Eight hundred nine cartilage grafts (41 slightly crushed grafts [5%], 650 moderately crushed grafts [80%], and 118 significantly crushed grafts [15%]) were used in 462 patients. Resorption occurred in 11 of the 462 patients (2.4%). All of the resorbed grafts (6 moderately crushed grafts and 5 significantly crushed grafts) had been placed in the dorsal area. The resorption rate of those grafts was lower in the moderately crushed cartilage grafts (6 of 284 grafts [2.1%]) than in the significantly crushed grafts (5 of 38 grafts [13.1%]). There was no resorption of slightly crushed grafts. Conclusions  The degree of crushing applied is important for long-term clinical outcome of autogenous crushed cartilage grafts. Slight or moderate crushing of cartilage creates an outstanding graft material for concealing irregularities and provides both excellent long-term clinical outcome and predictable esthetic results.
Mon, 17 Sep 2007 00:00:00 PDT

SURGICAL TECHNIQUE: Autogenous Nasal Tip Reconstruction of Complex Defects: A Structural Approach Employing Rapid Prototyping
We have sought strategies to enhance our ability to successfully reconstruct the human nose. We present one of our efforts to use current technology to improve our ability to accurately create the subsurface framework on which the success of such an endeavor rests. Our novel approach involves the creation of an intraoperative surgical guide, aided by 3-dimensional laser surface scanning and rapid prototyping. This translucent template is developed through cooperative effort by the patient, anaplastologist, and surgeon working together. It is then custom made, sterilized, and available for use during the procedure. It is placed on the patient's face at critical points during the procedure. The subsurface framework is then painstakingly built in a stable fashion to reflect the dimensions and contour of this guide. It is created in such a manner as to anticipate the effect of the thickness of the forehead flap on the final external dimensions.
Mon, 17 Sep 2007 00:00:00 PDT

BEAUTY: Frank W. Benson's Portrait of My Daughters

Mon, 17 Sep 2007 00:00:00 PDT

HIGHLIGHTS OF ARCHIVES OF FACIAL PLASTIC SURGERY: Highlights of Archives of Facial Plastic Surgery

Mon, 17 Mar 2008 00:00:00 PDT

ORIGINAL ARTICLE: Impact of Cosmetic Facial Surgery on Satisfaction With Appearance and Quality of Life
Objectives  To assess perioperative quality-of-life (QOL) changes in a facial plastic surgery patient population and to ascertain factors determinative of QOL changes. A notable paucity of objective scientific measurements of QOL exists within the facial plastic surgery literature. Methods  A 3-year prospective cohort study. The patient population, which comprised a consecutive series of patients 16 years or older, undergoing cosmetic nasal or facial surgery, was obtained from the senior author's (P.A.A.) private surgical practice. All patients presenting for surgery were offered participation. The main outcome measure was the 59-item Derriford Appearance Scale (DAS59), a valid and reliable instrument assessing psychological distress associated with self-consciousness of facial appearance. Three patient score subgroupings were established: group 1, the DAS59 scores for all patients; group 2, the DAS59 score according to sex; and group 3, the DAS59 score according to the main surgical procedure. Surveys were administered to eligible patients at the final preoperative clinic visit and at 3 months after surgery. Data from the case-control groups were analyzed by a blinded statistician with appropriate t tests. Results  A total of 93 patients were enrolled with a 100% response rate (82 females [88%] and 11 males [12%]). The most common procedures were rhinoplasty (49%) and surgery for the aging face (51%). Marked differences in perioperative QOL were noted across all DAS59 domains for group 1 and for all females in group 2. Male patients in group 2 analysis experienced QOL improvement only from DAS59 domain 2 (General Self-consciousness of Facial Appearance). Rhinoplasty and surgery for the aging face improved patients' QOL but differed with respect to which DAS59 domains were affected. Conclusions  Quality of life was enhanced by facial plastic surgery in this patient population. Male and female patients seem to have different needs to be met from facial cosmetic surgery and correspondingly different areas of improvement in QOL. Rhinoplasty and surgery for the aging face act on different domains of QOL.
Mon, 17 Mar 2008 00:00:00 PDT

ORIGINAL ARTICLE: Botulinum Toxin and Quality of Life in Patients With Facial Paralysis
Objectives  To examine the effect botulinum toxin, a potent neurotoxin that causes temporary paralysis of hyperkinetic musculature, has on the quality of life (QOL) in the patient with facial paralysis. We surveyed patients with facial paralysis, using the previously validated Facial Clinimetric Evaluation QOL instrument, before and then again after therapeutic administration of botulinum toxin for the management of their facial hyperkinesis, and performed pair-wise comparisons to determine the effect on patient QOL. Design  Prospective clinical study at an outpatient facial nerve center. Results  The overall Facial Clinimetric Evaluation score improved from a mean (SD) of 51.7 (20.9) in the pretreatment group to 63.7 (17.8) in the posttreatment group (P < .05). Statistically significant improvements were noted in all subdomain scores, including Facial Movement, Facial Comfort, Oral Function, Eye Comfort, Lacrimal Control, and Social Function (P < .05 for all comparisons). Conclusions  Botulinum toxin has a well-established objective benefit in the control of facial hyperkinesis in patients with facial nerve disorders. This study establishes the associated QOL benefit and reaffirms its important role in the multimodality management of patients with facial nerve disorders.
Mon, 17 Mar 2008 00:00:00 PDT

ORIGINAL ARTICLE: Hockey-Stick Vertical Dome Division Technique for Overprojected and Broad Nasal Tips
Objectives  To discuss overprojected and broad nasal tips, to overview treatment options, and to relate our experience with the hockey-stick technique. Design  A retrospective review (1975-2005) was conducted. Patients were selected from a computerized rhinoplasty database of operative cases. The database was used to extract a subset population that had received the hockey-stick tip procedure and had follow-up data for 1 year or more after surgery. Medical records and photographs were also analyzed in this review of results and complications. Results  The hockey-stick modification of vertical dome division was used in 137 patients (9.9% of the rhinoplasties in the computerized database). Of these, 64 patients had 1 year or more of follow-up. Complications referable to the nasal tip (eg, bossae, persistent tip projection, and alar asymmetry) were seen in 8 patients (13%). Revisions for tip-related problems were performed in 4 patients (6%). Conclusions  The hockey-stick technique is an effective method for nasal tip deprojection and narrowing via an endonasal approach. The length of follow-up in this patient population allows good long-term evaluation of this technique.
Mon, 17 Mar 2008 00:00:00 PDT

ORIGINAL ARTICLE: Epidemiology and Risk Factors for Pathologic Scarring After Burn Wounds
Objective  To describe the clinical characteristics of postburn scars and determine the independent risk factors specific to these patients. While burns may generate widespread and disfiguring scars and have a dramatic influence on patient quality of life, the prevalence of postburn pathologic scarring is not well documented, and the impact of certain risk factors is poorly understood. Methods  A retrospective analysis was conducted of the clinical records of 703 patients (2440 anatomic burn sites) treated at the Turin Burn Outpatient Clinic between January 1994 and May 15, 2006. Prevalence and evolution time of postburn pathologic scarring were analyzed with univariate and multivariate risk factor analysis by sex, age, burn surface and full-thickness area, cause of the burn, wound healing time, type of burn treatment, number of surgical procedures, type of surgery, type of skin graft, and excision and graft timing. Results  Pathologic scarring was diagnosed in 540 patients (77%): 310 had hypertrophic scars (44%); 34, contractures (5%); and 196, hypertrophic-contracted scars (28%). The hypertrophic induction was assessed at a median of 23 days after reepithelialization and lasted 15 months (median). A nomogram, based on the multivariate regression model, showed that female sex, young age, burn sites on the neck and/or upper limbs, multiple surgical procedures, and meshed skin grafts were independent risk factors for postburn pathologic scarring (Dxy 0.30). Conclusion  The identification of the principal risk factors for postburn pathologic scarring not only would be a valuable aid in early risk stratification but also might help in assessing outcomes adjusted for patient risk.
Mon, 17 Mar 2008 00:00:00 PDT

ORIGINAL ARTICLE: Hematoma Rates in Drainless Deep-Plane Face-lift Surgery With and Without the Use of Fibrin Glue
Objective  To determine the rate of hematoma formation in drainless deep-plane rhytidectomy and compare it with the rate using the same technique with the use of fibrin glue. Methods  This is a retrospective review of 605 patients (78 male and 527 female) who, over a 6-year period, underwent deep-plane face-lift surgery (n = 544) or lateral superficial musculoaponeurotic system (SMAS)ectomy (n = 61) by the senior author (S.S.R.) without the use of surgical drains. One hundred forty-six consecutive patients underwent rhytidectomy without fibrin tissue glue, and the following 459 consecutive patients were sprayed with fibrin glue under the flap prior to flap closure. Pressure dressings were used on all patients for 24 hours. Results  None of the patients in either group had major or expanding hematomas requiring operative intervention. In the group of patients treated without fibrin glue (n = 146), there were 5 minor, nonexpanding hematomas, all managed by needle aspiration. This is a minor hematoma rate of 3.4%. In the fibrin glue group (n = 459), there were 2 hematomas, for a rate of 0.4%. Using a Fisher exact test, we found a statistically significant decrease in the hematoma rate from 3.4% to 0.4% (P = .01). Male patients had a higher hematoma rate than female patients, and only men had significantly fewer hematomas when fibrin glue was applied (P = .01). All 7 hematomas were recognized in the first 24 hours after surgery. Of the 7 patients with hematomas, 2 (29%) had emesis in the recovery room despite medication. Conclusions  The use of fibrin glue demonstrates a significant decrease in the rate of hematoma formation. Fibrin glue may benefit male more than female patients. If meticulous hemostasis and pressure dressings are used, drains are not necessary. The prevention and prompt treatment of postoperative nausea may also help prevent hematoma formation.
Mon, 17 Mar 2008 00:00:00 PDT

ORIGINAL ARTICLE: An Anatomical Study of the Nasal Superficial Musculoaponeurotic System: Surgical Applications in Rhinoplasty
Objective  To give a unifying description of nasal muscles and ligaments corresponding to anatomical and surgical findings such as the dermocartilaginous ligament described by Pintanguy in 2001. Methods  In 30 fresh cadavers of white individuals, nasal dissections were performed, divided into 3 different approaches: from radix to nasal tip, from nasal tip to radix, and from midline to lateral. The anatomical and surgical planes of dissection were followed to isolate the nasal superficial musculoaponeurotic system (SMAS). Correlations between the nasal SMAS and the nasal framework were noticed. In 9 specimens, the left nasal wall was resected for histologic examination. Results  The nasal SMAS consists of a unique layer, and it divides at the level of the nasal valve into deep and superficial layers. Each layer has medial and lateral components. The dermocartilaginous ligament corresponds to the deep medial expansion. Both the deep and the superficial medial expansions correspond to the lowering ligaments of the nasal tip; the cephalic rotation of the nasal tip is allowed by their cut. The histological examination showed that the deep lateral expansion is composed of fat. Conclusions  This description of the nasal SMAS explains the relationship between the nasal muscles and ligaments, including the dermocartilaginous ligament described by Pitanguy. Furthermore, it is helpful to surgeons during rhinoplasty.
Mon, 17 Mar 2008 00:00:00 PDT

ORIGINAL ARTICLE: Methicillin-Resistant Staphylococcus aureus-Positive Surgical Site Infections in Face-lift Surgery
Objectives  To determine the incidence of methicillin-resistant Staphylococcus aureus (MRSA)-positive surgical site infections after face-lift surgery and to discuss the screening, prevention, and treatment of such infections. Methods  The patient charts of 780 patients who underwent a deep-plane rhytidectomy between 2001 and 2007 were reviewed for postoperative wound infections. Culture results and sensitivities were recorded. To our knowledge, this is the first study that documents MRSA-positive surgical site infections after face-lift surgery. Results  Five of 780 patients (0.6%) who underwent face-lift surgery by the senior surgeon had postoperative surgical site infections. Four of the 5 patients had cultures that were positive for MRSA. Two of these patients (0.3%) required hospitalization and had collections that had to be opened or drained and developed wound breakdown. Both patients eventually responded to wound care along with intravenous and then oral antibiotic therapy. The other 2 MRSA-infected patients responded to oral antibiotic therapy and local wound care alone. The 2 complicated infections occurred on postoperative days 5 and 8. These 2 patients were the only ones among the 5 patients with positive cultures who had known recent contact with another physician or a hospital. All infections occurred in the year 2006, with 3 patients experiencing infection in the last 4 months of the year. Herein, we describe the incidence and sequelae of MRSA infections and colonization. The 2 major different subsets of MRSA are community-acquired MRSA and health care–associated MRSA. Surgical site infections that are positive for MRSA blur this division, which affects many aspects of the course of disease and treatment. We also discuss strategies for screening, preventing, and treating MRSA surgical site infections. Conclusions  Methicillin-resistant S aureus–positive surgical site infection is an increasingly problematic issue in all surgical fields. In the future, MRSA-positive infections will be more prevalent and will require well-developed screening, prevention, and treatment strategies.
Mon, 17 Mar 2008 00:00:00 PDT

ORIGINAL ARTICLE: Effects of Different Suture Materials on Cartilage Reshaping
Objective  To examine the effects of different suture materials and suturation techniques on cartilage reshaping in a rabbit model. Methods  Twenty-two rabbits were used. Posterior skin flaps were elevated, and 4 cartilage struts were prepared on each auricula. Each strut was bent at its midpoint, and the skin under the bent area was elevated only in 1 side. The strut was sutured either with catgut, polyglactin 910, polydioxanone, or polypropylene sutures. Anteriorly, the suture was passed subcutaneously on 1 side, while transcutaneously on the other. Animals were killed at the first and fourth months. The shape of the struts was macroscopically evaluated. Inflammation and foreign body reaction around the suture were examined under light microscopy. Results  Maintenance of shape with all suture materials was significantly lower in the transcutaneously sutured group than in the subcutaneously sutured group. Because of high rates of suture loss in the transcutaneously sutured group, further evaluations on cartilage tissue were made only in subcutaneously sutured group. Success rate in maintenance of shape was similarly high in the polydioxanone, polyglactin 910, and polypropylene suture groups; however, it was significantly lower in the catgut suture group. Conclusion  Long-lasting absorbable suture materials are as effective as nonabsorbable ones, and the subcutaneous technique is more effective than the transcutaneous technique.
Mon, 17 Mar 2008 00:00:00 PDT