Development and Validation of a Photonumeric Scale to Assess Marionette Lines.

BACKGROUND: A validated scale is needed for objective and reproducible comparisons of marionette lines before and after treatment in clinical studies. OBJECTIVE: To describe the development and validation of a 5-point photonumeric marionette lines scale. METHODS: The scale was developed to include an assessment guide, verbal descriptors, and real and morphed subject images for each scale grade. Intrarater and interrater reliability was evaluated in initial scale validation (web-based review) ( N = 51 ) and live-subject validation ( N = 75 ) studies, each completed during 2 sessions. RESULTS: In the initial scale validation study, intrarater agreement for 2 physician raters was near perfect (weighted kappa = 0.92 and 0.94). Interrater agreement was excellent during sessions 1 and 2 (intraclass correlation coefficients of 0.94 and 0.95, respectively). In the live-subject validation study, intrarater agreement for 3 physician raters showed a strong correlation (mean weighted kappa = 0.77). Interrater agreement was high during live-subject validation sessions 1 and 2 (intraclass correlation coefficients = 0.89 for both sessions). CONCLUSION: This new marionette lines scale is a validated and reliable scale for physician rating of marionette line severity.

Intradermal Botulinum Toxin A on Skin Quality and Facial Rejuvenation: A Systematic Review and Meta-analysis.

Background: Botulinum toxin A (BTxA) has gained popularity as a nonsurgical aesthetic treatment for skin rejuvenation. However, previous studies on intradermal BTxA have shown inconsistent results. This systematic review and meta-analysis with trial sequential analysis aimed to assess the efficacy and safety of intradermal BTxA for facial rejuvenation. Methods: Following PRISMA guidelines, a comprehensive search was conducted in various databases from January 2008 to March 2023. Outcome measures included sebum production, pore size, skin hydration, skin texture, erythema index, facial wrinkles, and facelift. Eligible studies included human-based clinical trials and prospective cohort studies published in English, focusing on healthy populations requiring facial rejuvenation. Two authors independently screened the titles and abstracts, followed by a full-text review to determine study eligibility. Data extraction and quality assessment were performed by two authors using predefined criteria. Results: Ten studies met the inclusion criteria, including five randomized controlled trials and five prospective cohort studies with 153 participants. Studies revealed positive effects of intradermal BTxA on various outcome measures related to facial rejuvenation. These effects included improvements in sebum production, pore size, erythema index, facial wrinkles, skin texture and elasticity, and overall facelift but not skin hydration. All failed to reach the required information size in the trial sequential analysis. Conclusions: Findings suggest positive outcomes in multiple attributes of skin quality and facial rejuvenation. However, more high-quality research is needed to establish definitive conclusions. These findings contribute to the evidence base for nonsurgical aesthetic treatments, emphasizing the importance of ongoing research in this field.

Galea-including forehead flap for lower one-third nasal reconstruction.

The first choice for internal mucosal restoration of the nose is a septal mucosal or vestibular local flap. The forehead flap, raised including the galeal layer, is an alternative option for large nasal defects. It can be used in any difficult situation in which septal or vestibular flaps are not adoptable, such as complete loss of lower one-third. The authors intend to describe the inclusion of galea in the traditional median forehead flap for nasal lining reconstruction. Thirteen patients treated with a forehead flap including galea for lower one-third nasal reconstruction were retrospectively reviewed. No complete flaps necrosis occurred. In 1 case, lining was lost due to infection. In 2 cases a moderate nostril stenosis was observed as late complication. The forehead flap with galea is a good option for large nasal full-thickness defects, involving the lower one-third.

Launois-Bensaude Syndrome: an unusual localization of obesity disease.

BACKGROUND: Launois-Bensaude syndrome is a rare pathology consisting of adipose masses symmetrically distributed mainly in the superior part of the body. Men are especially affected between age of 30 and 60 as well as chronic alcohol abusers. Etiopathogenesis is attributable to mutations or deletions of mitochondrial DNA, and alcohol is a possible cofactor. METHODS: The current treatment of the disease is described based on the authors' experience. Four cases treated in our department are retrospectively reviewed regarding comorbidities and type of surgery performed. RESULTS: A relevant and long-lasting reduction of fat bulges has been obtained in all cases with no major complications except for a mild anemia. CONCLUSION: Launois-Bensaude syndrome causes a functional rather than esthetic concern due to the peculiar localization of fat bulges. Currently, the only effective therapy is surgery, through lipectomy or liposuction of adipose bulges.

Abdominoplasty after weight loss in morbidly obese patients: a 4-year clinical experience.

BACKGROUND: Morbid obesity is associated with various co-morbidities. With the significant weight loss, new dysfunctions arise, and prior body contour disorders start to severely affect the patient's quality of life. The abdominal apron is generally the greater and the first disturbance faced by the post-bariatric patient. METHODS: The authors retrospectively reviewed their clinical experience in the treatment of those disorders through abdominoplasty. The benefits in terms of relief of said disorders and drawbacks in terms of surgical complications are described. RESULTS: 117 abdominoplasties were performed from January 2002 to December 2005 on patients who had lost significant weight. The tissue removed ranged from 400 g to 10,500 g of adipose-cutaneous tissue (mean 2,276.5 g). Mean duration of the procedure was 4 hours and 25 minutes, with a maximum of 7 and a minimum of 2 and 40. Complication rate was 50.43%. CONCLUSION: Abdominoplasty in the post-obese patient is an apparently simple procedure, which in fact causes a high rate of surgical complications. The complication rate is higher than that of cosmetic abdominoplasties. Nevertheless, the improvement in quality of life following such a procedure renders it a fundamental step in the rehabilitation of the formerly obese patient.

Congenital mammary asymmetry. Classification and surgical treatment.

AIM OF THE STUDY: The Authors intend to guide the choice of surgical treatment for mammary asymmetry, according to specific form of asymmetry. MATERIAL AND METHODS: Possible types of symmetryzation surgery are listed. First Author's personal technique is described and some clinical cases are presented. DISCUSSION: Regardless to specific surgical needs for the single case, a generally valid concept is the necessity of a surgical moulding meant to obtain the same volume for both breasts before positioning of implants. This allows a longer lasting symmetry between breasts, as aging modifications bilaterally occur at equal speed if the adipo-glandular structures obtained have the same volume.

The plastic surgeon in the treatment of obesity.

Obesity is an increasingly common disease, whose complex treatment often terminates with the patient's discontinuation of therapies. The authors suggest how to improve a multidisciplinary approach to the obese, to increase compliance with therapy. A characterization of obesity is a helpful initial step. It consists of an accurate anatomic definition of fat distribution, which can more accurately be performed by imaging (U/S, CT, MRI). The patient's obesity should also be identified based on the physical characteristics that we propose. The plastic surgeon's intervention is often required and beneficial in every type of obesity. Many body areas are appropriate for contouring. Apart from providing a gain in esthetic appearance, plastic surgery also results in several benefits for the patient's general health.

Closed rhinoplasty with marginal incision: our experience and results.

Supporters of traditional rhinoplasty and promoters of open rhinoplasty have debated their approaches for many years. From among different possible techniques, a surgeon must always choose the approach that provides the best aesthetic result. The surgeon's experience and artistic sense are essential for the closed technique, whereby most of the corrections are performed without exposing the nasal frame. The open technique allows a greater operating range with a direct view of the nasal structure, resulting in improved precision in modeling the cartilages. However, the absence of intact skin cover exposes the surgeon to a less precise overall aesthetic evaluation. This report highlights the marginal technique, described in 1990 by Guerrerosantos, which uses a two-sided circular incision permitting complete dissection of the alar cartilages and the overhead skin cover of the columella. This approach, together with the extramucous technique, permits complete exposure of the skin and nasal septum without a columella incision. Therefore, the marginal technique is suitable for primary rhinoplasty cases in which complex modeling of the nasal tip and an excellent aesthetic result are required.