Free Diced Cartilage: Tips and Tricks of a Customized Procedure in Rhinoplasty.

Free diced cartilage graft represents a relatively innovative technique with multiple applications. It is conventionally used for smoothening, augmentation, or camouflaging of the nasal dorsum in primary or revision rhinoplasties. The aim of the article was to give some tips and tricks about harvesting and preparation of free diced cartilage to maximize its exploitation and make it easily repeatable, extending the field of application not only to the nasal dorsum but also other sites, such as the tip of the nose.

Abdominal Subcutaneous Mass After Laser-Assisted Lipolysis and Immediate Multiple Treatments with a Dual-Wavelength Laser, Vacuum and Massage Device.

UNLABELLED: Body contouring by means of minimally invasive procedures is a growing trend. Current approaches to body contouring often involve a combination of surgical techniques (eg, laser-assisted liposuction) and a series of noninvasive device-based treatments aimed at accelerating recovery and improving aesthetic outcomes. In this case study, we describe a 38-year-old woman who presented with an abdominal-wall mass that resembled a tumor when assessed with magnetic resonance imaging. Twenty-six months before presenting to our office, the patient had undergone laser lipolysis and a series of treatments with a device that delivered dual-wavelength laser energy and vacuum-assisted massage. To address the patient's concerns, we removed the mass and performed abdominal dermolipectomy. No postoperative complications occurred, and the patient was highly satisfied with the aesthetic outcome. The results of histologic studies indicated that the mass was pseudocystic and fluid-filled, surrounded by a fibrous capsule, and characterized as a foreign-body granuloma. Further analysis is warranted regarding the safety of laser lipolysis without aspiration combined with a device delivering dual-wavelength laser energy and vacuum-assisted massage. LEVEL OF EVIDENCE: 5 Risk.

L-Shaped Lipothighplasty.

BACKGROUND: In addition to the already-known postoperative complications in patients formerly obese, for medial thigh lift, there are many more problematic issues. The main ones are represented as follows: by the frequent downward displacement of the scars that become, in this way, extremely visible; by the distortion of the vulva or scrotal region; by serious and disabling disorders of the lymphatic system; and by the early recurrence of ptosis in this anatomical site. MATERIALS AND METHODS: From 2004 to 2010, 16 patients with moderate to severe laxity of the medial area of the thighs were treated by an L-shaped medial thigh lift after selective liposuction. Ten have been previously treated with biliopancreatic diversion and 6 have been previously treated with gastric bypass. Mean (standard deviation [SD]) height before bariatric surgery was 1.62 (0.08) m, mean (SD) weight was 141.53 (23.12) kg, and mean (SD) body mass index was 57.13 (8.21) kg/m. After the intervention, mean (SD) weight decreased to 81.12 (16.43) kg, whereas mean (SD) body mass index decreased to 31.83 (8.51) kg/m. RESULTS: After L-shaped lipothighplasty, 13 patients (81%) had no complications in the postoperative period. No skin necrosis, hematoma, seroma, or thromboembolic events were reported. Two patients experienced hypertophic scarring and 1 patient had a wound infection because of poor hygienic care. CONCLUSIONS: The medial lifting technique defined as L-shaped lipothighplasty is a valid, fast, and safe technique and can reduce early and late postoperative complications in a critical and troublesome area for the surgeon who is going to correct the deformity.

Postabdominoplasty Wound Dehiscence in Bariatric Patients: Biliopancreatic Diversion Versus Gastric Bypass: A Preliminary Study.

BACKGROUND: Surgical procedures with an extended follow-up and therefore recognized as safe in literature are classified into 2 categories: procedures limiting the introduction of food mechanically (restrictive interventions such as adjustable gastric banding, vertical banded gastroplasty, and sleeve gastrectomy) or functionally (mini gastric bypass or gastric bypass) and procedures limiting absorption (mainly biliopancreatic diversion [BPD]). MATERIALS AND METHODS: Seventy-nine patients who underwent postbariatric abdominoplasty to correct serious flaws resulting from weight loss surgery were included in this retrospective study. Dehiscence of the surgical wound was carefully investigated between the population previously submitted to BPD and gastric bypass. The data were analyzed by correlating the incidence of postoperative dehiscence by Fisher exact test, with a statistical significance level of P<0.05. RESULTS: Among the 42 abdominoplasties after BPD, dehiscence rate was 33% (14 patients), whereas in the group of 37 patients who underwent gastric bypass, the occurrence of dehiscence was 8% (3 patients).The Fisher exact test highlighted previously performed BPD as statistically significant for the onset of postoperative dehiscence (P=0.012). CONCLUSIONS: There is a great need to validate these data on large or multicentric studies. The previous bariatric surgery procedure may play a role similar to so many other widely investigated risk factors such as smoking and body mass index, and some categories of patients should require even more attention in the preoperative, intraoperative, and postoperative management.

Rainbow graft: a technique for the replacement of the lower lateral cartilages, improvement of tip projection, and correction of external nasal valve dysfunction.

Revision rhinoplasties are extremely difficult to perform even for the surgeons mastering nasal surgery. In fact, they must be skilled at adapting surgical strategies to the anatomical changes induced by primary rhinoplasty.We herein describe an original technique using an auricular cartilage graft after 6 revision rhinoplasties.The aforementioned graft succeeded in improving tip support, correct external nasal valve dysfunction and alar pinch, and providing tip definition, projection, and ptosis.In our opinion, rainbow graft is a safe approach in case of severe nasal structural deficiencies, improving both the functional and esthetic results in revision rhinoplasties.

Micro- and macroscopic tissue modifications after bariatric surgery: effects of different procedures-a pilot study.

UNLABELLED: The most effective treatment for morbid obesity has demonstrated to be bariatric surgery. Despite enormous benefits, skin tissue aberrations are inevitable consequences. Our study was focused on micro- and macroscopic modifications in patients who had previously undergone gastric bypass. These preliminary data suggest that tissue alterations, partly responsible for high wound complications rate, may differ among patients undergoing both different and same weight loss procedures. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Triple-plane technique for breast augmentation: solving animation deformities.

UNLABELLED: An unpleasant consequence of subpectoral implant placement is the occurrence of animation deformities during pectoralis muscle contraction. This study aimed to review the results achieved for 524 patients undergoing the triple-plane technique with respect to loss of animation deformities. The evaluation was performed by a group of three plastic surgeons according to the Spear grading system for breast distortion using a 4-point scale. Of the 524 patients evaluated, 351 (67 %) were rated as grade 1 (no distortion), 156 (29.77 %) as grade 2 (mild distortion), 17 (3 %) as grade 3 (moderate distortion), and 0 (0 %) as 4 (severe distortion).The excellent results achieved can be explained by the horizontal sectioning of the major pectoralis muscle at the areola level to the sternal margin. In fact, it determines that superior to sectioning of the muscle, its activity remains normal, with a low degree of dynamic deformities. On the contrary, inferiorly, at the muscular-aponeurotic plane level, no activity is detected, with no resultant animation deformities. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A simple procedure to facilitate chin implants placement via submental approach.

In order to facilitate chin implants placement by submental incision, the use of two threads is described. They are separately passed through the extremities of the implant and inserted into the previously created subperiosteal pocket using a grooved guide. Once the landmarks of dissection have been reached, the tip of the needle exits through the skin just a few centimetres laterally to the augmentation area and, only by pulling the free ends of the threads, the implant can easily be inserted into the pocket and the sutures cut and removed. This procedure was successfully performed in 79 patients of both sexes presenting with deficiencies in the sagittal dimension at the pogonion and in width, laterally to the symphysis. Therefore, in the authors' opinion, the before-described technique could be a useful tool that facial plastic surgeons can employ to facilitate alloplastic chin implants placement, by minimising the invasiveness of the procedure, reducing the operative time, and greatly improving the aesthetic result, without sacrificing the safety of the operation.

SMAS Strip Autograft.

The thinning of the overlying nasal skin and nasal SMAS layer and the variations in nasal bones consistency increase the risk of showing dorsal contour irregularities after osteotomies of this site.The authors present their experience with combined nasal dorsal osteotomies and insertion of a SMAS strip graft, harvested during facelift procedure in 6 aging patients.Postoperative follow-up time ranged from 1 year to 7 years and showed excellent outcomes: no infection, graft migration, or reabsorption was detected.Due to the ease of execution of the procedure and taking into account this graft as an ideal soft-tissue augmentation composed by fat, muscle, and fascia, the SMAS strip autograft represents another viable option for nasal dorsum contouring in the patient presenting also for rhythidectomy.

Patchy areolar hyperpigmentation 6 years after augmentation mastopexy: a case report.

UNLABELLED: A 42-year-old primigravida woman of 20 weeks gestation was referred to the authors for the treatment of a suspected malignant melanoma of her left areola. She had undergone bilateral augmentation mammoplasty with periareolar mastopexy elsewhere 6 years previously. Her history included partial necrosis of her left areola in the immediate postoperative period that required a long time to heal and had resulted in partial areolar depigmentation. Her left areola had a few patches of hyperpigmentation at her presentation to the authors. Specimens removed from eight involved areas showed a tissue diagnosis of benign areolar melanosis. The hyperpigmentation completely disappeared after delivery. This case is reported because of its rarity as well as its nonmalignant and self-resolving nature. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

"Inverted-Y": a modified vest-over-pants abdominoplasty pattern following bariatric surgery.

BACKGROUND: The post-bariatric surgery patient presents several challenges to the surgeon. Correction of skin and subcutaneous redundancy can be difficult, particularly in massive-weight-loss patients with horizontal laxity, upper abdominal or flank laxity, and "double-roll" deformities. The aim of our study was to propose our modification of the "vest-over-pants" abdominoplasty technique to exploit all the advantages of the Planas technique in bariatric surgery patients and to solve the problem of extreme epigastric skin redundancy in difficult abdominal contour cases. METHODS: Sixteen post-bariatric surgery patients (10 females and 6 males, nonsmokers) with moderate to severe epigastric skin laxity were enrolled in the study. They all had undergone a biliopancreatic diversion (BPD) by laparotomy and had undergone this body-contouring procedure from 2006 to 2010. RESULTS: After the inverted-Y abdominoplasty, 12 patients (75 %) had an uneventful recovery. On the other hand, one subject (6.25 %) had a seroma and four (25 %) had wound dehiscence and delayed wound healing. No skin necrosis was reported. In one patient (6.25 %) scar revision in areas that had delayed healing was performed. The addition of a vertical incision has not led to an increased rate of postoperative complications, but the rates are in line with the satisfactory results described with the Planas technique in bariatric surgery patients. In addition, various advantages have been observed compared to traditional vertical resection patterns. CONCLUSION: This case series has quantitative limitations and further investigations are needed. However, this study suggests that inverted-Y abdominoplasty could be a good compromise between the need to minimize complication rates and ensure an optimum aesthetic result and patient satisfaction rate in some abdominal defects in massive-weight-loss patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article.