Full-Field Erbium:YAG Laser Resurfacing: Complications and Suggested Safety Parameters.

BACKGROUND: Laser skin resurfacing with erbium-doped yttrium aluminum garnet (Er:YAG) lasers is a newer alternative to CO2 laser treatment, and was developed to reduce common complications. Although Er:YAG lasers have been available for years, safety parameters for efficacious resurfacing with these devices have not previously been available. OBJECTIVES: The aim of this study was to utilize one practice's laser treatment settings and outcomes data to identify complication rates for various energies and areas of the face and to offer safe energy/depth parameters for treating each area. METHODS: A retrospective chart review was performed for full-field confluent laser resurfacing patients treated with a Sciton Contour Tunable Resurfacing Er:YAG laser by the senior author. The data were retroactively analyzed with a time range of 8 years (January 2007-December 2015). RESULTS: The overall complication rate for MicroLaserPeels (ablation of 50 µm or less) was 10.1% (20 of 198 treatments) and the rate for deep resurfacing treatments was 26.5% (71 of 268 cases). In MicroLaserPeel treatments the cheek area had the highest complication rate, followed by the forehead, nose, perioral, and eyelid areas, in that order (complication rate range, 0%-9.1%). In deep resurfacing treatments the perioral area had the highest complication rate, 38.6% of 145 cases. This was followed by the lids, cheek, nose, and forehead, in that order (complication rate range, 15.2%-20.9%). There is a correlation between increased depth of ablation and increased rate of complication. CONCLUSIONS: The study confirmed the efficacy of Er:YAG resurfacing and provides guidance for a safer approach to excellent outcomes.

Postoperative Granulomas at Liposuction Incision Sites.

Since most liposuction incisions heal uneventfully, difficult healing in such incisions must be investigated. In the cases of two gynecomastia liposuction patients in which a water-based lubricating gel was used on the liposuction incisions, the incisions failed to heal. For both patients, workup uncovered palisading granulomas at the lateral inframammary fold incision sites several months after otherwise successful surgeries. These two cases are presented and the previous literature is reviewed, with consideration given to the etiology and prevention of such granulomas. LEVEL OF EVIDENCE 5: Risk.

Factors Affecting Lower-pole Stretch after Breast Augmentation.

Breast augmentation surgical planning based on soft-tissue characteristics including the type of lower-pole pocket direction has been described. Objective outcome measures of the effects of some of these choices on postoperative lower-pole settling, including dual-plane dissection type, have been lacking. OBJECTIVE: The aim of this study was to determine whether the type/extent of dual-plane dissection, patient age, or variables in breast implant characteristics affected implant-soft tissue dynamics of the lower pole of the breast enough to cause difference in implant settling during the postoperative period. METHODS: Measurements of nipple-to-inframammary fold distance in primary breast augmentation patients were collected prospectively for 227 female primary breast augmentation patients during postoperative visits over an 8-year period. Changes in this distance during the postoperative period were evaluated for correlation with dual-plane dissection type, patient age, implant fill material, implant size, and implant profile. RESULTS: Increasing dual-plane dissection type did demonstrate a trend toward greater postoperative lower-pole stretch. Only implant profile affected lower-pole stretch, with statistical significance shown in the ultrahigh-profile group. Age, implant fill material, and size of implant did not show any notable effect. CONCLUSIONS: Ultrahigh-profile implants cause significantly more lower-pole stretch postoperatively, whereas increasing dual-plane dissection type appears to have some effect as well. Age, implant material, and size of implant are of less importance over a 6-month period.

The Buccal Fat Pad: A Case Report and Retrospective Case Series.

Buccal fat contributes significantly to the contour of the face, but the contribution of buccal fat is often neglected on examination and in surgery. A case of isolated buccal fat removal is examined. Previous literature relevant to this case is discussed and the author's experience from 10 subsequent lower facial rejuvenation surgeries combined with buccal fat reductions is presented with suggestions.

Anticoagulation therapy in microsurgery: a review.

The advent of microsurgical tissue transfer including replantation greatly has expanded the scope of reconstructive surgery. There are few recent innovations in anticoagulation therapies for microsurgery, however, and anastomotic thrombosis remains an occasional cause of surgical failure. No consensus exists on the ideal anticoagulation protocol for microsurgery. This article reviews major pharmacologic modalities of anticoagulation, delineates the mechanism of action and study of efficacy of each agent, and compares the risks and benefits of popular anticoagulation therapies. Finally, it examines available human outcomes-based data and attempts to provide a glimpse of the future direction of microsurgical anticoagulation research.

Gouty flexor tenosynovitis of the digits: report of three cases.

Gouty tenosynovitis in the hand is a rare entity. To date the limited cases described have involved predominantly extensor tendons in the fingers and flexor tendons in the palm or wrist. Flexor tendon involvement is less common and has been reported only twice to our knowledge distal to the palm. We report 3 cases of extra-articular gout presenting as tophaceous involvement of flexor tendons in the fingers. All cases were treated surgically. These cases are presented to heighten awareness of this rare entity and to provide a setting for a discussion of management.