Second Thoughts on First Thoughts.

This article represents the inaugural edition of our new "Second Thoughts on First Thoughts" section with Dr Aly as our featured master surgeon. In this article we will explore the evolution of his now renowned surgical strategies from their birth, through their active tinkering, to their ongoing tweaking, even today. The reader will then come away with a deeper understanding of Dr Aly's "learning curve" and in so doing be spurred forward on their own learning curves.

Evidence-Based Abdominoplasty Review With Body Contouring Algorithm.

Abdominal contour deformities are an aesthetic challenge to the plastic surgeon. Patients present with diverse clinical histories, multiple comorbidities, and unique aesthetic demands. Weight loss, previous pregnancy, and aging are 3 principal indications for abdominoplasty. Bariatric surgery has increased demand for body contouring procedures. This heterogeneous patient cohort means a "one-size-fits-all" abdominoplasty is not appropriate. Precise evaluation, evidence-based decision-making, and artistic acumen are required while balancing patient goals with safe, realistic, and long-lasting aesthetic outcomes. This article reviews surgical options for abdominal body contouring, providing an evidence-based treatment algorithm for selecting the appropriate procedure for each patient to maximize clinical and patient reported outcomes.

Looking at plastic surgery through Google Glass: part 1. Systematic review of Google Glass evidence and the first plastic surgical procedures.

BACKGROUND: Google Glass has the potential to become a ubiquitous and translational technological tool within clinical plastic surgery. Google Glass allows clinicians to remotely view patient notes, laboratory results, and imaging; training can be augmented via streamed expert master classes; and patient safety can be improved by remote advice from a senior colleague. This systematic review identified and appraised every Google Glass publication relevant to plastic surgery and describes the first plastic surgical procedures recorded using Google Glass. METHODS: A systematic review was performed using PubMed National Center for Biotechnology Information, Ovid MEDLINE, and the Cochrane Central Register of Controlled Trials, following modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Key search terms "Google" and "Glass" identified mutually inclusive publications that were screened for inclusion. RESULTS: Eighty-two publications were identified, with 21 included for review. Google Glass publications were formal articles (n = 3), editorial/commentary articles (n = 7), conference proceedings (n = 1), news reports (n = 3), and online articles (n = 7). Data support Google Glass' positive impact on health care delivery, clinical training, medical documentation, and patient safety. Concerns exist regarding patient confidentiality, technical issues, and limited software. The first plastic surgical procedure performed using Google Glass was a blepharoplasty on October 29, 2013. CONCLUSIONS: Google Glass is an exciting translational technology with the potential to positively impact health care delivery, medical documentation, surgical training, and patient safety. Further high-quality scientific research is required to formally appraise Google Glass in the clinical setting.

The error of omission: a simple checklist approach for improving operating room safety.

SUMMARY: The primary goal of patient safety must go hand in hand with the goal of producing reliably good aesthetic and functional results. The implementation of a proactive checklist improves operating room communication and takes the necessary step toward reducing the often neglected errors of omission. These steps are necessary if we are to ultimately achieve our goal of improving safety comprehensively in the operating room.

The pinch blepharoplasty revisited.

BACKGROUND: The prevention of scleral show is truly one of plastic surgery's Holy Grails. This postoperative problem may be considered subtle, but it represents the most common cause of the "operated" look that we all strive to avoid. Of course, the postoperative fear of a true ectropion is all too common. These concerns, borne out in patient results following the traditional skin-muscle technique, are what drove the author to consider the "pinch" blepharoplasty. METHODS: All patients who were candidates for a lower blepharoplasty, primary or secondary, underwent the pinch blepharoplasty. Patients excluded were only those who underwent a carbon dioxide laser resurfacing of the lower eyelid, as no skin excision was planned. RESULTS: Of the 77 blepharoplasties performed, there were no postoperative findings of lower eyelid malposition: no taping was necessary, no significant scleral show was evident, and no ectropion was produced. There was also noticeably less bruising and swelling postoperatively with this technique. Moreover, it was apparent that the crepe-like skin at the lower eyelid was often fully effaced or improved significantly. CONCLUSIONS: The pinch blepharoplasty has proved to be a superior approach to lower eyelid rejuvenation. This series suggests that with this technique significantly more crepe-like skin can be removed with reliably less chance of scleral show.