"Scarless" umbilicoplasty: a new umbilicoplasty technique and a review of the English language literature.

Many techniques have been described for umbilicoplasty after abdominoplasty, but none of these techniques seems ideal. In this report, we wish to report a new "scarless" umbilicoplasty technique, which bears many of the characteristics of an ideal technique: it is easy to perform and results in the complete absence of visible scars and with a preferred vertical orientation. The aesthetic results of this technique are subjectively and objectively evaluated as compared with the classic umbilicoplasty and these results are discussed among the English language literature. In the period of 2004 to 2005, a series of 138 female patients have had an abdominoplasty with either the classic umbilicoplasty (n = 31) or with our scarless umbilicoplasty (n = 107). After a follow-up period of at least 3 (of 6) months, a questionnaire was send to all of these patients to evaluate patient satisfaction. Twenty-five patients from the classic umbilicoplasty group responded, 53 patients from the scarless umbilicoplasty group. Age (mean 45 with range, 22-66 years) and body mass index (29 with range, 22-35) did not differ among both groups. Also a random selection of fifteen photos from both groups was analyzed and rated according to the system of Strasser by an independent panel. There were no major complications in both groups, but in the classic group, there were some cases with hypertrophic scarring. Patients who underwent the scarless umbilicoplasty technique graded the appearance of their umbilicus significantly better on shape, depth, hygiene, and scar. No significant differences were found in grading size and wound healing. Objective evaluation of the photos demonstrated significant better results for the scarless umbilicoplasty technique. Based on our subjective and objective analysis we conclude that our new technique of the scarless umbilicoplasty features many of the characteristics of the ideal umbilicoplasty: a rather simple and reliable method for creating a natural looking umbilicus when performing an abdominoplasty.

The best marketing strategy in aesthetic plastic surgery: evaluating patients' preferences by conjoint analysis.

BACKGROUND: To provide the best marketing strategy for a private clinic, knowledge of patients' preferences is essential. In marketing, conjoint analysis has been frequently used to calculate which attributes of a product are most valuable to consumers. METHODS: This study investigates the relative importance of attributes that influence the selection and decision-making process when choosing an aesthetic private clinic, using conjoint analysis. The following attributes were chosen by the senior author (R.W.L.) and a marketing and communications director after a preselection of 25 randomly selected people: relative cost of the procedure, travel time, experience of the plastic surgeon, size of the clinic, method of referral, and online presentation. The attributes were then divided into levels. Using a random factor conducted by SPSS, 18 different scenarios were created and rated online by 150 potential patients before their potential visit or consultation. The patients could rate these scenarios on a scale from 1 to 7 with respect to the likeliness of visiting the clinic. RESULTS: The most important attribute was experience of the surgeon (35.6 percent), followed by method of referral (21.5 percent), travel time (14.2 percent), cost of procedure (12.9 percent), online presentation (9.7 percent), and size of the clinic (6.1 percent). Six of 16 levels gave a negative influence on the decision making. CONCLUSIONS: The authors' study shows that the two most important attributes are the experience of the surgeon and the method of referral and that conjoint analysis is effective in determining patients' preferences. It also shows which levels positively or negatively contribute per attribute.

Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia.

OBJECTIVE: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. BACKGROUND: Long-term results of incisional hernia repair are lacking. Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair. However, many surgeons are still performing suture repair. METHODS: Between 1992 and 1998, a multicenter trial was performed, in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were randomly assigned to suture or mesh repair. In 2003, follow-up was updated. RESULTS: Median follow-up was 75 months for suture repair and 81 months for mesh repair patients. The 10-year cumulative rate of recurrence was 63% for suture repair and 32% for mesh repair (P < 0.001). Abdominal aneurysm (P = 0.01) and wound infection (P = 0.02) were identified as independent risk factors for recurrence. In patients with small incisional hernias, the recurrence rates were 67% after suture repair and 17% after mesh repair (P = 0.003). One hundred twenty-six patients completed long-term follow-up (median follow-up 98 months). In the mesh repair group, 17% suffered a complication, compared with 8% in the suture repair group (P = 0.17). Abdominal pain was more frequent in suture repair patients (P = 0.01), but there was no difference in scar pain, cosmetic result, and patient satisfaction. CONCLUSIONS: Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair. Suture repair of incisional hernia should be abandoned.