Nasal sill augmentation: an overlooked concept in rhinoplasty-a technical note and review of the literatures.

BACKGROUND: Nasal sill is one of the components of the alar ring, affecting the esthetic outcomes of rhinoplasty; accordingly, we developed a novel technique to adjust defects in this area and compared it with the available techniques. METHODS: Our technique was based on creating a tunnel access to the nasal sill area through an incision made in the lower third of the columella using the open approach or through a nostril base incision in patients, who underwent alar base reduction, followed by insertion of a cartilaginous graft into the marked defect area. RESULTS: A total number of 54 patients with a defect in the nasal sill area were included in this study. Thirty-one patients underwent open rhinoplasty with the sill approach from the lower third of the columella, while 23 patients underwent rhinoplasty with a nostril base approach for nasal sill augmentation procedure. There were no reports of patient dissatisfaction, infection, bleeding, sensory dysfunction, or remaining asymmetry of the sill area. CONCLUSION: Based on the findings of the present study, this technique can be successfully used in reconstructing the nasal sill area with minimal complications and morbidity.

Injection Lipolysis: A Systematic Review of Literature and Our Experience with a Combination of Phosphatidylcholine and Deoxycholate over a Period of 14 Years in 1269 Patients of Indian and South East Asian Origin.

BACKGROUND: Phosphatidylcholine and deoxycholate (PC-DC) injections have been used as nonsurgical alternatives to liposuction. DC as a constituent for lipolysis has recently been approved by the US Food and Drug Administration. AIM: PC and DC have independently been used in lipolysis. We hereby present a systematic review of literature on injection lipolysis and share our experience of using DC in combination with PC for injection lipolysis. We have retrospectively evaluated the effects of PC-DC treatments in varied age groups, both sexes, and over different target areas. MATERIALS AND METHODS: This study spans over 14 years wherein 1269 patients of different age groups and sex were treated with injection lipolysis with PC-DC combination. The PC-DC cocktail injection was given to all patients for an average four sessions every 4 weeks, and the results were assessed after 8 weeks from the last session. RESULTS: The effects were best appreciated over the face (malar, jawline, and submental areas) and upper arm, whereas average effect was observed on the thighs and around the knees. We have also used lipolysis as a primary modality as well as a touch-up modality following liposuction. The results are better appreciated in primary lipolysis. The need for follow-up sessions (1-2 sessions) of lipolysis and the quantification of results in subsequent sessions reveal that maximal improvement is achieved in the first session. CONCLUSION: PC-DC cocktail used for lipolysis as a local administration is effective for reducing unwanted fat. It shows great efficacy in treating localized fat, especially over the face and bra roll in the women of younger age group (20-30 years).

Lip designing: the need for a beautiful smile: an Indian perspective.

BACKGROUND: Smile is the defining element of the face, its impact holding utmost importance in the perception of feelings. Lip is an integral part for a perfectly perceived smile. The aim of the present manuscript is to present an innovative approach to smile improvement by lip design in Indian context. MATERIALS AND METHODS: Thirty-five patients who had undergone smile design (lip) in the institute were taken up for retrospective analysis. The technique of using fillers for lip augmentation was assessed, and the final result evaluated. RESULTS: Demographic details are presented . We observed that the upliftment of the lips was more visible, and the fillers enhanced the volume resulting in an attractive smile. CONCLUSION: Smile reconstruction has been revolutionized by the new filler materials for volume augmentation of lips. We advocate this novel approach of lip design using fillers to generate a gorgeous smile.

Anatomic and mechanical considerations in restoring volume of the face with use of hyaluronic acid fillers with a novel layered technique.

CONTEXT: Facial fillers have revolutionized the field of cosmetic facial rejuvenation as it has become the prime sought - after rejuvenation procedure offering youthful, 3-dimensional look with minimal invasiveness. Fillers are expensive and need to be redone periodically hence a sound understanding of structural basis on which they are laid is important in reducing the quantity of filler required in each sitting as well as increasing the longevity of results. AIM: The aim of the following study is to analyse a novel method of facial filling "The pillars pyramids and tie beams (PPT)" technique and its advantages over the conventional methods. SUBJECTS AND METHODS: A novel technique of injecting the facial fillers was employed on 67 patients visiting our clinic. These patients were followed-up for a period of 3 years. RESULTS: We observed that the amount of filler material required in initial sitting remains the same, however the frequency of touch up visits is decreased and so is the amount of filler material required for follow-up injections. CONCLUSION: Facial contour remodelling is being revolutionised by the new filler materials for volume augmentation and no uniform consensus has been reached on the techniques currently used in clinical practice. We advocate this novel PPT technique of facial filling in facial rejuvenation to restore a youthful look as a primary goal.

Periprosthetic atypical mycobacterial infection in breast implants: a new kid on the block!

INTRODUCTION: Breast augmentation is one of the most commonly performed cosmetic surgical procedures. Infection in the breast implant surgery can range from simple wound infection to periprosthetic infection usually with skin commensals such as staphylococci. However, with routine use of broad-spectrum antibiotics atypical mycobacterial infections are being increasingly reported. MATERIAL AND METHODS: We studied 12 cases of atypical mycobacterial breast implant infections over a period of 8 years from 2002 to 2010. Six of them were primarily operated at our centre and six referred from elsewhere after implant infection. Age range was 30-40 years and follow-up after secondary surgery ranged from 1 to 5 years. All patients were explanted and started on combination antibiotics namely, clarithromycin, gatifloxacillin and linezolid for 3 months. After a period of 3 months, all patients underwent implant surgery again with the same antibiotic cover for 6 weeks. RESULT: All the secondary implant augmentations were successful. Organisms grown in primary culture were Mycobacterium fortuitum and M. chelonei. All patients were satisfied with the final breast form and size achieved. CONCLUSION: The possibility of an atypical mycobacterial infection should always be at the back of the mind of an alert surgeon to prevent a periprosthetic infection from compromising the final aesthetic result of a breast implant procedure. Diagnosed early and eradicated in time, the final result is not compromised.

Volume enhancement of upper lip in secondary cleft deformity using composite mastoid tissue.

BACKGROUND: Secondary cleft lip deformity correction needs thorough assessment and planning to optimize treatment and achieve good results. Deficient volume of the upper lip, which is one of the most common secondary cleft lip deformities, has been addressed in many ways using tissues from local or distant areas. Consideration must be given to safety, easy availability of the tissues, minimum morbidity, and longevity of the results when selecting a procedure. METHODS: This retrospective study included ten patients with a minimum follow-up of 1 year. Composite mastoid fascia was harvested through a postauricular incision and used to augment deficient lip volume in secondary cleft lip deformities. Clinical assessment and measurement was performed by measuring the vertical height and projection of the deficient upper lip before and after surgery. RESULTS: At the end of 1 year the average increase in the vertical height of the vermilion was 27.11% compared to the preoperative readings, with an average loss of 12.81% of increase at 1 year. The lateral projection showed an increase of 23.88% compared to the reading taken before surgery, with a loss of 9.75% at the end of 1 year. The donor site incision was concealed behind the ear and lip incisions were invisible in the long term. There were no major complications. CONCLUSION: This is a good way of augmenting the lip with due consideration given to longevity of the result and minimal morbidity. This method might also by used for permanent cosmetic lip enhancement for those with very thin lips.

Ethnic rhinoplasty.

This article examines the surgical techniques of rhinoplasty in relation to aesthetic considerations of various ethnic groups. Rhinoplasty in general is challenging, particularly in the ethnic population. When considering rhinoplasty in ethnic patients one must determine their aesthetic goals, which in many cases might deviate from the so-called norm of the "North European nose." An experienced rhinoplastic surgeon should be able to navigate his or her way through the nuances of the various ethnic subsets. Keeping this in mind and following the established tenets in rhinoplasty, one can expect a pleasing and congruous nose without radically violating ethnicity.

Effect of pre-heating composite resin on gap formation at three different temperatures.

AIM: The study aims to evaluate and compare total gap surface area formed after restoration of class II cavities with Filtek Z350 and P60 at room temperature, 37°C and 54°C. MATERIALS AND METHODS: Thirty extracted maxillary and mandibular molars were taken and divided into six groups of five teeth each. Standardized class II cavities were made and were restored with Filtek Z350 and P60, both at room temperature, 37°C and 54°C. Group 1(a) was restored with Filtek Z350 at room temperature, Group 1(b) with Filtek Z350 at 37°C and Group 1(c) with Filtek Z350 at 54°C. Group 2(a) was restored with P60 at room temperature, Group 2(b) with P60 at 37°C and Group 2(c) with P60 at 54°C. After storing the samples in distilled water at room temperature for 48 hours, longitudinal sectioning was done to obtain tooth restoration interface. The interfaces were then examined under compound light microscope with digital output and analyzed using Image J analysis software. RESULTS: The results demonstrated better adaptation and less total gap area formation at 54°C as compared to room temperature and 37°C. CONCLUSIONS: Based on the results of this study, it is suggested that use of P60 is better suited for posterior restorations at 54°C as compared to Filtek Z350 universal nanohybrid at room temperature.

Improved surgical access for facial dimple creation.

As an alternative to blind coring of the soft tissue from the buccal mucosa to the dermis or the placement of transcutaneous sutures, both of which can be associated with untoward side effects, the authors describe a safe and effective method for creating dimples through an open technique that replicates the anatomical basis of a natural dimple.

Surgical complications of lipoplasty--management and preventive strategies.

BACKGROUND: Lipoplasty and its associated complications are well researched and documented. In most articles, the focus has been on the major life-threatening complications of liposuction. Most of these major complications are related to conditions other than surgical trauma per se, namely anaesthesia, hypothermia, long duration of surgery and fluid overload. With the exception of pneumothorax and abdominal perforation, surgical trauma does not cause major complications. Although most surgical complications are classified as minor, they present as major events for patients and the treating physician. All efforts to prevent even minor complications to enhance patient satisfaction are needed. This article presents a review of only the surgical-trauma-related complications of lipoplasty and discusses their management and preventive strategy. METHODS: A review of 200 consecutive cases of lipoplasty, performed between July 2006 and December 2007, including large-volume liposuctions (LVLs) and combined liposuction abdominoplasties, was undertaken. Complications relating only to the surgical trauma of liposuction were analysed. RESULTS: Complications such as hyperpigmentation of access points, postoperative fluid collection, asymmetry, irregularity, external genital swelling and haematoma were noted. Postoperative fluid collection and haematoma required active intervention. Drainage of fluid collection using a liposuction cannula was effective and prevented recurrence and the need for repeated aspirations. Major surgical complications such as pneumothorax and abdominal wall perforations could be avoided by following simple rules. CONCLUSIONS: Major complications related to surgery can be avoided by following well-known safety guidelines. To enhance patient satisfaction, minor complications related to surgical trauma need to be addressed aggressively. This article discusses methods to lower the incidence of most surgical complications.

Anesthesia considerations in large-volume lipoplasty.

BACKGROUND: Large-volume lipoplasty is becoming more common and has been proven to be safe and effective. Large-volume lipoplasty is normally performed with the patient under general anesthesia. Techniques of general anesthesia and fluid management are important factors in improving the safety of large-volume lipoplasty. OBJECTIVE: Certain important considerations in anesthesia and perioperative management can improve outcomes in large-volume lipoplasty. Our objective is to present our protocol and technique for general anesthesia in large-volume lipoplasty METHODS: Large-volume lipoplasty (5 to 18.5 L) was performed on 32 patients under general endotracheal anesthesia. Important considerations included proper selection of patients, low flow of anesthesia gases, prevention of hypothermia, deep vein thrombosis prophylaxis, intraoperative fluid ratio of 1, Foley catheter to monitor urine output, and postoperative overnight or longer monitoring in a well-equipped hospital. Maintaining the endotracheal cuff pressure between 20 to 30 mm of water helped to reduce incidence of sore throat. Addition of lidocaine in wetting solution helped to reduce requirement of general anesthetic agents and as a result, postoperative recovery was faster and more pleasant. RESULTS: Major complications did not occur in any patients. Minor complications encountered were nausea, vomiting, and shivering and occurred in about 25% of patients. All patients were able to walk without support 4 hours after surgery. In spite of minor complications, all patients reported the postoperative recovery to be better than expected. CONCLUSIONS: General anesthesia for large-volume lipoplasty is safe. Postoperative recovery can be made faster and more pleasant by following these recommendations.