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1.
Aesthet Surg J ; 2024 Jul 04.
Article in English | MEDLINE | ID: mdl-38963821

ABSTRACT

BACKGROUND: Over the past decade, the use of poly-4-hydroxybutyrate (P4HB) in aesthetic breast surgery has grown in popularity. Published data on long-term outcomes, however, is scarce. OBJECTIVES: The purpose of this study was to assess long-term outcomes when using P4HB in various aesthetic breast procedures. METHODS: A retrospective review of all patients undergoing breast procedures with P4HB performed by the senior author (WPA) between July 2012 and March 2022. All patients with greater than one year of follow-up were evaluated, including demographics, surgical indications, complications, secondary procedures, and patient satisfaction. A Kruskal-Wallis test was performed to assess the stability of satisfaction over time. RESULTS: A total of 248 patients were evaluated. The mean follow-up length was 2.9 years (range, 1-9.3y). The most common surgical indication was breast ptosis, which comprised 68 percent (n=167) of patients. The overall complication rate was 8.0 percent (n=20), with an unplanned reoperation rate of 2.8 percent (n=7). Across the entire study population, the mean satisfaction score was 3.42 out of 4. When satisfaction scores were compared to follow-up length, Kruskal-Wallis test demonstrated no statistical differences (H = 18.2, p = 0.89, df = 2), suggesting stability of satisfaction over time. CONCLUSIONS: This study presents the senior author's entire experience with P4HB across a wide range of aesthetic breast procedures. With an average follow-up length of almost 3 years, P4HB appears to be both a safe and effective tool to support soft tissue in aesthetic breast surgery. Further, high patient satisfaction appears stable.

2.
Aesthet Surg J ; 44(1): 1-8, 2023 Dec 14.
Article in English | MEDLINE | ID: mdl-37409963

ABSTRACT

BACKGROUND: In 2001, Elkwood and Matarasso published an American Society of Plastic Surgeons (ASPS) member survey detailing brow lift practice patterns. Interval changes in practice patterns have not been studied. OBJECTIVES: The previous survey was revised to elucidate current trends in brow lift surgery. METHODS: A 34-question descriptive survey was distributed to a random group of 2360 ASPS members. Results were compared to the 2001 survey. RESULTS: A total of 257 responses were collected (11% response rate; ± 6% margin of error at 95% CI). The most frequent technique for the correction of brow ptosis in both surveys was the endoscopic approach. The use of hardware fixation has increased in endoscopic brow lifting, whereas the use of cortical tunnels has decreased. Although coronal brow lifting has decreased in frequency, hairline and isolated temporal lift have increased. Neuromodulators have replaced resurfacing techniques as the most common nonsurgical adjunct. Frequent use of neuromodulators has risen from 11.2% to 88.5%. Nearly 30% of current surgeons feel that neuromodulators have replaced formal brow lifting procedures to a significant degree. CONCLUSIONS: In comparing the 2001 and current ASPS member survey there has been a clear transition to less invasive procedures over time. Although the endoscopic approach was the most popular means of forehead correction in both surveys, coronal brow lifting has decreased in frequency and the hairline and temporal approaches have increased. Neurotoxins have replaced laser resurfacing and chemical peeling methods as an adjunct, and in some cases replaced the invasive procedure entirely. Possible explanations for these findings will be discussed.


Subject(s)
Plastic Surgery Procedures , Rhytidoplasty , Humans , Rhytidoplasty/methods , Endoscopy/methods , Neurotoxins , Forehead/surgery , Neurotransmitter Agents , Eyebrows
3.
Aesthet Surg J ; 42(9): 971-977, 2022 08 24.
Article in English | MEDLINE | ID: mdl-35350068

ABSTRACT

BACKGROUND: Tranexamic acid (TXA) has rapidly gained popularity in aesthetic surgery. Previous reports have suggested that TXA provides a dry surgical field and significantly reduces operating time during facelift surgery. OBJECTIVES: The aim of this study was to build upon earlier findings by providing a large cohort matched alongside historic controls and more clearly document time saved when performing facelift surgery. METHODS: A retrospective, single-surgeon case-control study was undertaken between July 2016 and October 2021. All patients underwent facelift surgery alone or in combination with fat transfer and perioral chemical peel. All patients received subcutaneous infiltration of 0.5% lidocaine/1:200,000 epinephrine with or without 1 or 2 mg/mL TXA. Patient demographics, TXA dose, surgical time, and minor and major complications were examined. RESULTS: In total 145 consecutive patients were identified: 73 in Group 1 (no-TXA) and 72 in Group 2 (TXA). No differences in terms of gender distribution (P = 0.75), age (P = 0.54), BMI (P = 0.18), frequency of secondary rhytidectomy (P = 0.08), rate of ancillary lipografting (P = 0.44), TXA dose (P = 0.238), and minor complication rate (P = 0.56) were observed. However, mean surgical time in the no-TXA group was 21 minutes longer than in the TXA group (P = 0.016). Six patients (8%) in the no-TXA group experienced minor complications vs 8 patients (11%) in the TXA group. No patients experienced major complications. CONCLUSIONS: Although previous studies have highlighted the potential benefits of TXA in aesthetic surgery, most of the data remain subjective and non-validated. This report adds to the objective body of evidence supporting TXA in facial aesthetic surgery by documenting time saved in the operating room without additional surgical morbidity.


Subject(s)
Antifibrinolytic Agents , Rhytidoplasty , Tranexamic Acid , Antifibrinolytic Agents/adverse effects , Blood Loss, Surgical/prevention & control , Blood Transfusion , Case-Control Studies , Humans , Operating Rooms , Retrospective Studies , Rhytidoplasty/adverse effects , Tranexamic Acid/adverse effects
4.
Scand J Immunol ; 94(5): e13098, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34940993

ABSTRACT

Costimulatory and coinhibitory mechanisms appear to be involved throughout immune responses to control their specificity and level. Many mechanisms operate; therefore, various theoretical models should be considered complementary rather than competing. One such coinhibitory model, pictured in 1971, involves the crosslinking of antigen receptors with inhibitory Fc receptors by antigen/antibody complexes. This model was prompted by observations that the Fc portion of antibody was required for potent suppression of immune responses by antibody. The signal via the antigen receptor wakes up T or B cells, providing specificity, while costimulators and coinhibitors stimulate or inhibit these awoken cells. The recent observations that administration of monoclonal anti-SARS-CoV-2 spike antibodies in early COVID-19 patients inhibits the induction of clinically damaging autoimmune antibodies suggest they may provide negative Fc signals that are blocked in COVID-19 patients. Furthermore, the reduced ability of SARS-CoV-2 antigen to localize to germinal centres in COVID-19 patients also suggests a block in binding of the Fc of antibody bound to antigen on FcγRIIb of follicular dendritic cells. The distinction between self and foreign is made not only at the beginning of immune responses but also throughout, and involves multiple mechanisms and models. There are past beginnings (history of models) and current and future beginnings for solving serious clinical problems (such as COVID-19) and different types of models used for understanding the complexities of fundamental immunology.


Subject(s)
COVID-19/immunology , Models, Immunological , Receptors, Fc/metabolism , SARS-CoV-2/physiology , Animals , Antibodies, Viral/metabolism , Antigen-Antibody Complex/metabolism , Autoantibodies/metabolism , Humans , Immunosuppression Therapy
5.
Aesthet Surg J ; 41(4): 391-397, 2021 03 12.
Article in English | MEDLINE | ID: mdl-32644111

ABSTRACT

BACKGROUND: Rebound bleeding during facelift surgery is a major cause of facelift hematomas. Subcutaneous infiltration of tranexamic acid (TXA) combined with lidocaine and epinephrine was recently retrospectively shown to decrease rebound bleeding. No study has prospectively examined the effect of subcutaneous TXA on intraoperative and postoperative bleeding during facelift surgery. OBJECTIVES: The aim of this study was to prospectively demonstrate that TXA combined with local anesthesia safely reduces the effects of rebound bleeding, reduces operative time, and decreases postoperative drainage. METHODS: This was a prospective, single-surgeon, case-control study performed between July 2019 and March 2020. Thirty-nine patients (35 female and 4 male; mean age, 64.9 years; age range, 49-80 years) underwent facelift surgery alone or in combination with facial rejuvenation procedures. All patients were injected subcutaneously with 1 or 2 mg/mL TXA + 0.5% lidocaine/1:200,000 epinephrine. Patient demographics, TXA dose, time to hemostasis, drain output, and minor and major complications were recorded. RESULTS: The mean time to hemostasis was 6.4 minutes for the left and right sides each. Average postoperative day (POD) 0 drain outputs were 13.9 mL (left) and 10.1 mL (right). Average POD 1 drain outputs were 15.1 mL (left) and 15.6 mL (right). Drains were removed from all patients on POD 1 or 2. There were 2 minor complications (flap necrosis plus infection, marginal mandibular neuropraxia) and no major complications. CONCLUSIONS: TXA safely and effectively decreased bleeding, operating room time, and drain output compared with traditional local anesthetic techniques. Our future goal is to determine if epinephrine can be completely removed from the local anesthetic and replaced with TXA for facelift surgery.


Subject(s)
Antifibrinolytic Agents , Rhytidoplasty , Tranexamic Acid , Aged , Aged, 80 and over , Antifibrinolytic Agents/adverse effects , Blood Loss, Surgical , Case-Control Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Retrospective Studies , Tranexamic Acid/adverse effects
6.
Aesthet Surg J ; 40(6): 587-593, 2020 05 16.
Article in English | MEDLINE | ID: mdl-31504134

ABSTRACT

BACKGROUND: Rebound bleeding as a result of loss of epinephrine effect is a common problem encountered during facelift surgery. Tranexamic acid (TXA) is an anti-fibrinolytic agent whose safety and efficacy in reducing bleeding are well documented. We have found that local infiltration of TXA combined with a lidocaine with epinephrine solution during facelift surgery has been effective in decreasing rebound bleeding and the time required to gain hemostasis. OBJECTIVES: The authors sought to share their local infiltration protocol of TXA combined with epinephrine solution in facelift. METHODS: Patients who underwent facelift received subcutaneous injection of TXA-lidocaine 0.5% solution following the authors' protocol. After completing both sides of the facelift and the submental platysmaplasty, the first and second sides were sequentially closed. The time to gain hemostasis on each side prior to closure was prospectively measured. RESULTS: Twenty-seven consecutive patients who underwent facelift surgery received local infiltration of TXA-lidocaine solution. In 23 of the 27 patients, the time required for hemostasis was prospectively recorded. The mean age was 62.1 years (±9.3) and all were females. The average time spent achieving hemostasis on the right, left, and both sides of the face was 6.5 (±2.7), 6.3 (±2.1), and 12.9 (±4.2) minutes, respectively. The total surgical time saving is approximately 25 to 60 minutes. Although primary facelift [13.6 (± 4.3)] exhibited a longer time of hemostasis compared with the secondary group [10.2 (± 2.8)], this was not statistically significant (P = 0.09). CONCLUSIONS: Local infiltration of TXA with local anesthetic prior to a facelift appears to decrease bleeding, operative time, and postoperative facelift drainage output.Level of Evidence: 4.


Subject(s)
Antifibrinolytic Agents , Rhytidoplasty , Tranexamic Acid , Anesthetics, Local/adverse effects , Antifibrinolytic Agents/adverse effects , Blood Loss, Surgical/prevention & control , Female , Humans , Middle Aged , Rhytidoplasty/adverse effects , Tranexamic Acid/adverse effects , Treatment Outcome
7.
Aesthet Surg J ; 40(12): 1269-1279, 2020 11 19.
Article in English | MEDLINE | ID: mdl-31956904

ABSTRACT

BACKGROUND: The ability to quantitatively analyze how we look at a face and determine if this changes following facial surgery should be of interest to the plastic surgeon. Eye tracking technology (ETT) provides the ability to record where observers fixate when viewing a facial image, enabling quantitative data to be obtained comparing pre- and postoperative changes. OBJECTIVES: The authors sought to investigate ETT as a novel outcome assessment tool, determining if facial rejuvenation surgery shifts attention away from the prominent signs of aging, and if so, where this attention shifts. METHODS: Twenty-five volunteers viewed 32 randomized frontal, oblique, and lateral images of 11 patients pre- and post-facelift. An eye movement monitoring system recorded the observer's eye position, net dwell time, fixation count, fixation time, and revisits into predefined areas of interest. Data were grouped and analyzed by angle and areas of interest. Paired t tests were employed to detect significant differences in pre- and post-images. RESULTS: On frontal images, less dwell time, fixations, and revisits were noted on the bottom third, forehead, perioral region, and neck (P < 0.05). On the lateral view, less visual attention was given to the neck, upper third, and perioral region, with more time in the cheek, nose, and middle third (P < 0.05). On oblique images, less attention was given to the neck and upper lid with more aimed at the middle third of the face (P < 0.05). CONCLUSIONS: ETT provides quantitative data post-facial rejuvenation. Facial aesthetic surgery does alter where observers look when viewing a face, decreasing the time spent inspecting the prominent signs of aging.


Subject(s)
Surgery, Plastic , Attention , Eye-Tracking Technology , Face/diagnostic imaging , Face/surgery , Humans , Technology
8.
J Craniofac Surg ; 30(7): 1960-1965, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31232982

ABSTRACT

INTRODUCTION: Chronic osteomyelitis is characterized by compromised blood supply and eventual osteonecrosis. Definitive treatment requires aggressive resection of affected bone. The resultant defect poses a unique challenge to reconstructive surgeons. Much of the literature on craniofacial osteomyelitis focuses on infection eradication, rather than subsequent reconstruction. This article reports representative cases from our experience with free flap reconstruction for defects secondary to chronic osteomyelitis of the craniofacial skeleton. METHODS/RESULTS: The authors selected 5 of the most difficult reconstructive cases of craniofacial osteomyelitis from our experience in a single tertiary referral institution with a follow-up of at least 6 months. Three of the 5 cases arose in the setting of previous head and neck cancer treated with resection and radiation therapy. One case had a previous surgical craniotomy complicated by osteomyelitis and multiple failed alloplastic reconstructions. The final case was due to multiple gunshots to the head, with subsequent cerebral and cranial abscess (>1000cc). In each case, the defect was successfully treated with free tissue transfer. Two cases required creation of recipient vessels with an arteriovenous loop. CONCLUSIONS: Free tissue transfer provides a versatile and effective tool in the reconstruction of extensive craniofacial osteomyelitis defects. Furthermore, the addition of vascularized tissue can protect against further episodes of osteomyelitis. Finally, arteriovenous loops can be employed successfully when prior radiation and infection of the wound bed precludes the use of local recipient target vessels.


Subject(s)
Craniotomy , Osteomyelitis/surgery , Osteonecrosis/surgery , Plastic Surgery Procedures , Aged , Female , Head and Neck Neoplasms/surgery , Humans , Male , Middle Aged , Wounds, Gunshot/surgery , Young Adult
11.
Plast Reconstr Surg ; 151(1): 158e-166e, 2023 01 01.
Article in English | MEDLINE | ID: mdl-36576831

ABSTRACT

BACKGROUND: Previous studies have compared various attributes of independent and integrated resident applicants and identified criteria for a successful match outcome. Few studies have directly examined the relative desirability of various surgical and nonsurgical specialties from the resident's perspective. To address this, the authors analyzed plastic surgery resident applicants and available positions from 2010 through 2018 and compared these data alongside four surgical and five nonsurgical specialties. METHODS: In this cross-sectional, retrospective review from the San Francisco Match and National Resident Matching Program, year, number of applicants, available positions, and specialty (integrated or independent plastic, general, or orthopedic surgery; neurosurgery; otolaryngology; anesthesiology; emergency, family, or internal medicine; and pediatrics) were examined. RESULTS: From 2010 through 2018, the number of integrated positions increased by 142%, whereas the number of integrated applicants increased only by 14.5%. The number of available independent positions decreased by 32.6%, whereas the number of independent applicants decreased by 43.9%. All surgical subspecialties demonstrated a decrease in applicants relative to positions (range 9.9% to 24.8%). Unlike the surgical specialties, the nonsurgical fields increased both their number of positions (14% to 57.2%) and number of applicants (2.2% to 44.1%). In particular, applicants to emergency, family, and internal medicine increased dramatically (17% to 44.1%). CONCLUSIONS: Applicants to plastic surgery and other surgical residencies changed minimally. The nonsurgical specialties showed a significant increase in the number of applicants, suggesting increasing interest in the nonsurgical fields. Contributing factors may include medical school pressures, lifestyle concerns, and experience with various specialties during medical school. Means of enhancing medical student exposure to plastic surgery are suggested.


Subject(s)
Internship and Residency , Plastic Surgery Procedures , Surgery, Plastic , Humans , Child , United States , Education, Medical, Graduate , Surgery, Plastic/education , Cross-Sectional Studies
12.
Pain Pract ; 12(8): 610-9, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22304620

ABSTRACT

BACKGROUND: Topical analgesics are important products in the armamentarium for pain relief. METHODS AND FINDINGS: This study compared a topical analgesic product containing menthol to the same product with the addition of oxygenated glycerol triesters (OGTs) (also called essential oxygen oil) in 66 healthy adult subjects with acute musculoskeletal pain. Patients were randomized in a single-center, double-blind study to receive mentholated cream (MC) only or MC containing OGTs. Patients self-reported their pain intensity, lifestyle limitations, and evaluation of the mobility of the painful joint or muscle at baseline and three times daily over a seven-day course on a 100-mm visual analog scale (VAS). Patients in both groups experienced statistically significant pain relief on Day 8 over baseline, with the MC plus OGT-treated group reporting statistically significantly greater pain relief than the MC group (P = 0.016). In addition, patients treated with the combination product experienced an incremental decrease in pain during each of the 7 days of treatment in addition, and they had lower VAS scores and greater lifestyle and mobility improvements than the MC group. Both products were well tolerated with no serious adverse events reported and no signs of significant skin reactions in either group. CONCLUSION: Based on this study, a MC containing OGTs is safe, effective, and provided significantly better pain relief than MC alone. The combination of oxygenated glycerol trimesters and MC provided significant pain relief and offered continued improvement in pain relief over time.


Subject(s)
Analgesics/administration & dosage , Glycerol/administration & dosage , Menthol/administration & dosage , Musculoskeletal Pain/drug therapy , Oils, Volatile/administration & dosage , Skin Cream/therapeutic use , Administration, Topical , Adult , Double-Blind Method , Female , Humans , Male
13.
Plast Reconstr Surg ; 149(6): 1096e-1105e, 2022 06 01.
Article in English | MEDLINE | ID: mdl-35383689

ABSTRACT

BACKGROUND: In 2000, Matarasso et al. performed a survey of American Society of Plastic Surgeons members' face lift practice patterns. Since that publication, the aesthetic marketplace has changed dramatically, as have ancillary face lift techniques. In an attempt to detail these changes, we repeated that original survey, adding questions to address more recent technical issues and advances. The goal of this report was to define current face lift practice patterns, compare current patterns to the previous ones, and define recent advances. METHODS: A 38-question survey assessing face lift techniques, perioperative management, complications, and concomitant procedures was electronically distributed to a random cohort of American Society of Plastic Surgeons members. Data were recorded and statistically analyzed utilizing the Pearson chi-square test. RESULTS: A total of 251 forms were returned and analyzed. Details of demographics, face lift techniques, ancillary procedures, perioperative care, and complications are presented. Current results were compared to the previously published society member practice patterns delineated in the 2000 Plastic and Reconstructive Surgery publication. CONCLUSIONS: The basic approach of American Society of Plastic Surgeons members to the face lift operation has not changed dramatically over the past 20 years. The development of operative adjuncts, however, has been positive, including fat grafting techniques, concomitant use of skin resurfacing, and means of minimizing blood loss with tranexamic acid. In certain instances, respondents do not follow evidence-based guidelines for perioperative care. Finally, common complications of practicing members appear to coincide with published retrospective reviews.


Subject(s)
Plastic Surgery Procedures , Rhytidoplasty , Surgeons , Surgery, Plastic , Humans , Practice Patterns, Physicians' , Retrospective Studies , Rhytidoplasty/methods , Surveys and Questionnaires , United States
14.
Aesthet Surg J Open Forum ; 3(1): ojab007, 2021 Jan.
Article in English | MEDLINE | ID: mdl-34212140

ABSTRACT

This article provides a review of available evidence with regard to short-term complications in facelift surgery. The article reviews both the most common complications and less common, but well-described ones. The goal is to offer objective means to minimize postoperative complications and a guide for treatment when they occur.

16.
Front Biosci ; 9: 3019-28, 2004 Sep 01.
Article in English | MEDLINE | ID: mdl-15353334

ABSTRACT

The lymphoid system normally mounts damaging responses to infectious pathogens while avoiding equally damaging responses to self. A notable number of antibodies to self antigens are formed but normally remain at levels below the damaging threshold, only temporarily rising to damaging levels during protective responses against infectious nonself. Many mechanisms regulate the level of autoantibodies and anti-self B cells including deletion, anergy, ignorance for antigen, receptor editing, coinhibition, competition for resources to sustain B cell responses, and apoptotic denouement of damaging responses following the ejection or containment of foreign invaders. While infectious events may encourage immune responses to self antigens, infectious events tend also to strengthen regulatory mechanisms. When regulatory mechanisms do not function properly, abnormal damaging responses to self antigens may occur. While defects in a single regulatory mechanism may result in autoimmunity, this eventuality usually happens only on permissive genetic backgrounds; this indicates that weakness in other regulatory mechanisms may be necessary to result in the emergence of damaging responses to self antigens. The immune system and its regulatory mechanisms are not simple, as one would expect of a homoeostatic process that also has the ability to expand enormously when challenged and to contract rapidly when threats pass. These processes that avoid damaging anti-self B cells are much more complicated than that envisaged in standard two signal models. Simple signals through the B cell antigen-receptor probably encourage B cell survival and receptivity, while other signals (costimulatory or coinhibitory) promote B cell stimulation or non-stimulation/inactivation.


Subject(s)
Antibodies/chemistry , Autoantigens/chemistry , B-Lymphocytes/cytology , B-Lymphocytes/immunology , B-Lymphocytes/metabolism , Immune Tolerance , Animals , Antigen-Presenting Cells , Antigens/chemistry , Apoptosis , Autoimmunity , Humans , Immune System , Receptors, Antigen, B-Cell , Self Tolerance
18.
Eplasty ; 15: ic22, 2015.
Article in English | MEDLINE | ID: mdl-25987945
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