Wetting solutions in ultrasound-assisted lipoplasty.

Wetting solutions play a crucial role in traditional lipoplasty by reducing blood loss in the aspirate and diminishing postoperative ecchymosis and edema. From the inception of ultrasound-assisted lipoplasty a "wet environment" has been considered essential for efficient fat emulsification and for control of thermal side effects. This article reviews the historical role of wetting solutions in lipoplasty and examines the risks of their use in an overzealous manner. The authors provide safety guidelines for maximizing the benefits of wetting solutions in traditional and ultrasound-assisted lipoplasty while minimizing their side effects and complications.

Autologous cultured fibroblasts as cellular therapy in plastic surgery.

Autologous cultured fibroblasts serve as injectable protein repair systems for correction of acne scars, rhytids, and other facial scars. The system uses the patient's own cultured fibroblasts to correct contour deformities over time.

Breast cancer in a patient with gynecomastia.

A case of breast carcinoma in the midst of florid gynecomastia in a 20-year-old man is reported. Up to now, only two male patients under the age of 21 with breast malignancy have been described in the literature. In contrast, gynecomastia is a more common condition than generally appreciated. The association of gynecomastia, a rather common condition, and cancer of the male breast, a rather uncommon condition, is examined. Mammography is recommended as part of the workup. A new classification of gynecomastia into true, pseudo, and mixed types is suggested. Recommendations for the role of lipoplasty in the treatment of gynecomastia are made.

Personal experience with ultrasound-assisted lipoplasty: a pilot study comparing ultrasound-assisted lipoplasty with traditional lipoplasty.

Body contouring with traditional suction-assisted lipoplasty is currently the most commonly performed aesthetic surgical procedure. In competent hands, traditional lipoplasty has a low complication rate, a short recovery period, and a high patient satisfaction rate. Body contouring with ultrasound-assisted lipoplasty has recently gained considerable attention, and its proponents have claimed many benefits over the traditional method. This pilot study consists of one surgeon's clinical experience with ultrasound-assisted lipoplasty in 100 cases. In 63 of these patients, ipsilateral traditional lipoplasty and contralateral ultrasound-assisted lipoplasty were done on one or more body areas. These patients were blinded in the study. Complication rates, lipocrits from the aspirate, postoperative ecchymosis, postoperative swelling, patient satisfaction, and surgeon satisfaction were then compared for each patient studied. Ten randomly selected patients were also evaluated by an independent panel of reviewers who compared ecchymosis and swelling in ultrasound-assisted versus traditional lipoplasty-treated areas. Their observations in this subset of 10 patients were subjected to statistical analysis. This initial pilot study failed to prove most of the benefits attributed to ultrasound-assisted lipoplasty by other surgeons. However, the method is an evolving technology, and the authors remain optimistic about the role of ultrasound in body sculpting surgery.

Sideburn reconstruction for postrhytidectomy deformity.

A posteriorly based random-pattern scalp flap is described for the correction of sideburn and temporal alopecia. The procedure can be readily incorporated into a coronal lift operation.

Autologous fibroblasts for treatment of facial rhytids and dermal depressions. A pilot study.

OBJECTIVE: To assess effectiveness of intradermal injections of autologous fibroblasts for the treatment of facial rhytids and dermal depressions. DESIGN: Six-month prospective pilot study. Photographs and silicone molds were taken of a prominent rhytid or dermal depression from each patient prior to treatment and at 6 months after treatment. SETTING: Specialty clinic in academic medical center. PATIENTS: Ten adults (age range, 24-69 years) who each exhibited a prominent rhytid or depressed facial scar. INTERVENTION: A 3-mm postauricular skin biopsy specimen from each participant was sent to Isolagen Technologies, Inc, laboratories, where a fibroblast cell line was developed. Three injection sessions were performed at 2-week intervals; target areas were the study site as well as behind the ear. MAIN OUTCOME MEASURES: Subjective improvement scores were obtained by each patient and 2 clinicians at every follow-up visit. Skin surface topographical features were evaluated with optical profilometry by comparing silicone molds before and after injection. Histological analysis was performed on a biopsy specimen of the postauricular injection site. RESULTS: Nine of 10 patients noted a 60% to 100% improvement with the treatment; clinicians made similar observations. Size reduction of 10% up to 85% of the study site was demonstrated by optical profilometry for every patient. Microscopically, there was evidence of increased thickness and density of dermal-layer collagen. CONCLUSIONS: Intradermal injection of autologous fibroblasts may be an effective treatment option for facial rhytids and depressed scars.

From the panniculus carnosum (PC) to the superficial fascia system (SFS)

There is a renewed interest in the anatomy of the subcutaneous fat. These studies have been stimulated by the recent clinical popularity of liposuction. Attention has been drawn to the superficial fascia system and to its role in wound healing and in skin contraction. What is the origin of this SFS? This article proposes that the panniculus carnosum (except for the platysma) did not disappear in man. Instead, it is present throughout the body as the superficial fascia system. Therefore, the superficial fascia system is nothing else but the evolutionary form of the panniculus carnosum.

Aesthetic rhinoplasty in early adolescence.

Aesthetic rhinoplasty was performed on a small number of select youngsters who were less than 14 years old. During the early years of the clinical study only patients with a significant anatomic deformity and a very strong desire for surgery to correct it were accepted for surgery. There was close postoperative followup. In no case was recurrence of pathology noted and no additional surgery was performed. The psychological benefit that the surgery afforded during puberty, a very critical time in emotional development, was found to be significant.

Lower lid "tarsal fixation" blepharoplasty: a personal technique.

The majority of patients seeking lower-lid blepharoplasty find that a muscle roll under their lower-lid ciliary margin is a desired postoperative feature. Very few prefer a flat postoperative lower lid. In addition to the cosmetic advantage obtained by more closely simulating a youthful lower eyelid, preservation of the pretarsal portion of the orbicularis oculi muscle also has a physiologic value in maintaining lower eyelid tone and support. A method to create this fold, which included placement of tarsal fixation sutures, has been previously described. It was accompanied by prolonged postoperative swelling. In hands other than masterful surgeons, it often resulted in irregular shape and asymmetry. Perhaps this is why the technique never became very popular. The technique described here consists of overlapping two layers of orbicularis oculi muscle over the lower lid tarsal plate. The method is simple, quick, requires no additional sutures, and does not complicate or prolong the postoperative course. The result is that of a soft, even, and natural appearing lower eyelid roll and lower eyelid.

Scarlet red.

Scarlet red-impregnated gauze is commonly used by plastic surgeons on granulating surfaces to promote epithelialization. Its mode of action is not fully understood.

Platysma-SMAS rhytidectomy--a personal modification.

An approach to SMAS-platysma system rhytidectomy is described which has the benefits of deep-layer meloplasty without the undue risk inherent in approaches that widely undermine this system. The technique has been used on 100 consecutive patients with few complications. These include 1 hematoma that required surgical evacuation, 8 minor hematomas, and 4 skin sloughs. There was no facial nerve paralysis or alopecia.

Latissimus dorsi muscle flap in reconstruction of congenitally absent breast and pectoralis muscle.

Reconstruction of a congenitally absent left breast and pectoralis major muscle was performed on a 17-year-old woman by subcutaneous insertion of silicone gel breast and custom-made silicone gel pectoralis major implants. Subsequently, a superior result was obtained using the latissimus dorsi muscle flap and a submuscular prosthesis.

Power-assisted lipoplasty (PAL): A clinical pilot study comparing PAL to traditional lipoplasty (TL).

The subject of this paper is a study designed to compare power-assisted lipoplasty (PAL) to traditional lipoplasty (TL) in 30 patients. PAL was used on one side and TL was used on the matching contralateral body area. In PAL, a cannula powered by medical-grade nitrogen (N(2)) reciprocates between 2000 and 4000 cpm with a 2-mm stroke. The device is commercially offered by MicroAire Surgical Instruments. While there was no difference in the speed of recovery or in the aesthetic quality of the result between the two sides, PAL was found considerably superior as far as ease of fat extraction.