RESUMO
Background: The umbilicus detachment and reinsertion in umbilical float mini-abdominoplasty results in its lower position with or without shape distortion. This event creates a stigmatizing look, elongating the upper abdomen and creating variable grades of infra umbilical/pubis bulging. This lack of proportion causes an unpleasant, artificial look, and is very difficult to fix. The study aimed to describe a sequence of abdominoplasty and combined upper abdomen horizontal muscle plications to correct umbilicus malposition after a mini-abdominoplasty. Methods: Over a period of 24 months, 12 patients underwent a liposuction (suction-assisted liposuction) and abdominoplasty with horizontal supraumbilical muscle plication. All patients underwent objective measurements before and after the procedure, using digital image measurements by Mirror Image software, version 6.0 (Fairfield, N.J.). The follow-up evaluation was performed 12 months postoperatively. Statistical analysis was performed using IBM SPSS Statistics V26. Results: Over 24 months, 12 patients (100%), who underwent abdominoplasty combined with horizontal plication in the upper abdominal wall, have shown adequate umbilicus elevation (2.98 ± 0.242 cm; 95% confidence level), restoring the abdominal muscle wall proportion at 12 months follow-up. One patient (8%) had a seroma, and one (8%) had a small muscular hernia (1.5 cm) in the lower abdomen. Conclusions: The combination of abdominoplasty and upper horizontal muscle plication can fix the malpositioned umbilicus, restoring the aesthetic and anatomic proportions in those patients who underwent an umbilical float mini-abdominoplasty.
RESUMO
IMPORTANCE: Postoperative edema and ecchymosis following rhinoplasty are a cause of anxiety for both patients and physicians and can affect the cosmetic results. Corticosteroids have been used to reduce these events. OBJECTIVE: To determine whether preoperative use of dexamethasone sodium phosphate alters the occurrence of edema and ecchymosis following rhinoplasty. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled clinical trial at an institutional referral center among a sample of individuals with rhinomegaly. INTERVENTIONS: Patients were randomized into 2 groups. In group 1, dexamethasone was intravenously injected before surgery. In group 2, normal saline solution was intravenously injected before surgery. MAIN OUTCOMES AND MEASURES: When patients returned at 1 week after surgery, standardized photographs were obtained. The photographs were analyzed by 5 plastic surgeons who were blinded as to whether dexamethasone or normal saline solution had been injected. The plastic surgeons rated the degree of edema and ecchymosis. RESULTS: Forty-two patients participated in the study. Randomization by lottery resulted in 20 patients in group 1 and 22 patients in group 2. Group 1 showed lower rates of postoperative ecchymosis than group 2; the difference of 0.62 (P = .02) reflects less perceived ecchymosis when dexamethasone was administered. Group 1 also showed lower rates of postoperative edema than group 2; the difference of 0.68 (P = .01) reflects less perceived edema when dexamethasone was administered. CONCLUSIONS AND RELEVANCE: Preoperative use of dexamethasone reduced edema and ecchymosis at 7 days after rhinoplasty. Rigorous methods in this trial demonstrate the beneficial effect of preoperative corticosteroid administration in this surgical procedure. LEVEL OF EVIDENCE: 1.