The Role of Subcutaneous Radiofrequency-Assisted Liposculpture in the Facial Plastic Surgeon's Practice.

Importance: Percutaneous radiofrequency-based skin tightening procedures can offer patients an option to undergo a potential treatment for skin laxity and excess adipose of the face and neck with less downtime, lower cost, and decreased risk of complications compared with more aggressive open procedures such as neck lift, face and neck lift, and platysmaplasty. Observations: FaceTite and AccuTite can safely yet effectively deliver energy into the subdermal space, targeting the dermal collagen network and deeper fascial layer. Ideal candidates have early jowl formation, mild to moderate skin laxity, and submental adiposity. Relevance & Conclusions: From the perspective of facial plastic surgeons, these procedures can enhance the volume of an aesthetic practice by welcoming patients who may not otherwise present for face and neck rejuvenation out of fear from surgery. Furthermore, many of these minimally invasive patients will ultimately return for surgical rejuvenation later in life.

Transcutaneous Radiofrequency Microneedling in the Facial Plastic Surgeon's Practice: A Review.

Importance: Minimally invasive methods for skin rejuvenation are in high demand. A diverse array of minimally invasive devices has been developed for aesthetical purposes and should be considered to help patients achieve their goals. Observations: Radiofrequency (RF) microneedling is a safe and effective intervention for treatment of various aesthetical and dermatological conditions in all skin types. This review highlights Morpheus8 (InMode, Inc., Irvine, CA) and what differentiates it from other similar devices. Conclusions and Relevance: RF microneedling addresses aesthetical and dermatological concerns for a diverse variety of patients in whom surgical intervention may not be desired. Morpheus8 has unique technological properties and advances that make it the preferred device for many practices.

Perceptions of Sound Quality and Enjoyment After Cochlear Implantation.

OBJECTIVES: To characterize the quality and enjoyment of sound by cochlear implant (CI) recipients and identify predictors of these outcomes after cochlear implantation. STUDY DESIGN: Cross-sectional study. SETTING: A tertiary care hospital. METHODS: Surveys based on the Hearing Implant Sound Quality Index were sent to all patients who received a CI at a tertiary care hospital from 2000 to 2019. Survey questions prompted CI recipients to characterize enjoyment and quality of voices, music, and various sounds. RESULTS: Of the 339 surveys, 60 (17.7%) were returned with complete data. CI recipients had a mean ± SD age of 62.5 ± 17.4 years with a mean 8.0 ± 6.1 years since CI surgery. Older current age and age at implantation significantly predicted lower current sound quality (P < .05) and sound enjoyment (P < .05), as well as worsening of sound quality (P < .05) and sound enjoyment (P < .05) over time. Greater length of implantation was associated with higher reported quality and enjoyment (r = 0.4, P < .001; r = 0.4, P < .05), as well as improvement of sound quality (r = 0.3, P < .05) but not sound enjoyment over time. CONCLUSION: Recipients who had CIs for a longer period had improved quality of sound perception, suggesting a degree of adaptation. However, CI recipients with implantation at an older age reported poorer sound quality and enjoyment as well as worsening sound quality and enjoyment over time, indicating that age-related changes influence outcomes of cochlear implantation.

Preoperative Criteria Predict Operative Time Variability Within Tympanoplasty Procedures.

OBJECTIVE: To identify preoperative patient and surgical parameters that predict operative time variability within tympanoplasty current procedural terminology (CPT) codes. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: One hundred twenty eight patients who underwent tympanoplasty (CPT code 69631) or tympanoplasty with ossicular chain reconstruction (69633) by a single surgeon over 3 years. INTERVENTIONS: Procedures were preoperatively assigned a complexity modifier: Level 1 (small or posterior perforation able to be repaired via transcanal approach), Level 2 (large perforation or other factor requiring postauricular approach), or Level 3 (cholesteatoma or severe infection). MAIN OUTCOME MEASURES: Total in-room time (nonoperative time plus actual operative time). RESULTS: Consideration of preoperative parameters including surgical complexity, surgical facility, use of facial nerve monitoring, laser usage, resident involvement, revision surgery, and underlying patient characteristics (American Society of Anesthesiologists [ASA] score, body mass index [BMI]) accounted for up to 69% of surgical time variance. Across both CPT codes, surgical complexity levels accurately stratified operative times (p < 0.05). Total time was longer (by 30.0 min for 69631, 55.4 min for 69633) in Level 3 procedures compared with Level 2, while Level 1 cases were shorter (27.6, 33.9 min). Resident involvement added 25 and 32 minutes to total time (p < 0.02). Nonoperative preparation times were longer (22.1, 15.4 min) in the main hospital compared with ambulatory surgical center (p < 0.001). CONCLUSIONS: There is significant surgical time variability within tympanoplasty CPT codes, which can be accurately predicted by the preoperative assignment of complexity level modifiers and consideration of patient and surgical factors. Application of complexity modifiers can enable more efficient surgical scheduling.

Developmental Anatomy of the Eustachian Tube: Implications for Balloon Dilation.

OBJECTIVE: To describe the developmental anatomy of the eustachian tube (ET) and its relationship to surrounding structures on computed tomography. STUDY DESIGN: Case series with chart review. SETTING: A tertiary care hospital. METHODS: ET anatomy was assessed with reformatted high-resolution computed tomography scans from 2010 to 2018. Scans (n = 78) were randomly selected from the following age groups: <4, 5 to 7, 8 to 18, and >18 years. The following were measured and compared between groups: ET length, angles, and relationship between its bony cartilaginous junction and the internal carotid artery and between its nasopharyngeal opening and the nasal floor. RESULTS: The distance between the bony cartilaginous junction and internal carotid artery decreased with age between the <4-year-olds (2.4 ± 0.6 mm) and the 5- to 7-year-olds (2.0 ± 0.3 mm, P = .001). The ET length increased among the <4-year-olds (32 mm), 5- to 7-year-olds (36 mm), and 8- to 18-year-olds (41 mm, P < .0001). The cartilaginous ET increased among the <4-year-olds (20 mm), 5- to 7-year-olds (25 mm), and 8- to 18-year-olds (28 mm, P < .0001). The ET horizontal angle increased among the <4-year-olds (17°), 5- to 7-year-olds (21°), and 8- to 18-year-olds (23°, P≤ .003), but the ET sagittal angle did not statistically change after 5 years of age. The height difference between the nasopharyngeal opening of the ET and the nasal floor increased among the <4-year-olds (4 mm), 5- to 7-year-olds (7 mm), and 8- to 18-year-olds (11 mm, P < .0001). CONCLUSION: The ET elongates with age, and its angles and relationship to the nasal floor increase. Although some parameters mature faster, more than half of the ET growth occurs by 8 years of age, and adult morphology is achieved by early adolescence.

Cost-effectiveness of CI in developing countries.

PURPOSE OF REVIEW: Cost-effectiveness of cochlear implants is a major concern for expanding these services to low-income and middle-income developing countries. RECENT FINDINGS: Recent studies have applied appropriate methodology to make determination of cost-effectiveness for cochlear implants in developing countries. In addition, important parameters that effect cost-effectiveness have been reviewed in a systematic way. The combination of these new studies along with existing reports of cochlear implant programmes in developing countries allows for a discussion of cost and outcomes determinants that drive cost-effectiveness in these environments. SUMMARY: Cochlear implants are a very cost-effective treatment for profound hearing loss in all high-resource countries and in many low-income and middle-income developing countries. A number of cost considerations affect cost-effectiveness of cochlear implants in developing countries including device cost and device-related expenses such as power consumption and reliability, but also including rehabilitation and access-related expenses. Large-scale programmes confer an advantage for cost-effectiveness, primarily through device-related savings.