Hemostatic Net in Facelift Surgery: A 5-Year Single-Surgeon Experience.

BACKGROUND: The hemostatic net has been promoted as a safe and effective method to prevent hematoma formation following facelift procedures. To date there is little published evidence to validate the replicability and effectiveness of the technique. OBJECTIVES: This study presents 2 cohorts of facelift patients from a single surgeon's practice to assess the impact of the hemostatic net on hematoma formation. METHODS: The records of 304 patients were reviewed on whom the hemostatic net was placed following a facelift between July 2017 and October 2022. Data were collected and assessed for complications and compared with a control group of 359 patients who underwent a facelift procedure without placement of a hemostatic net by the same surgeon between 1999 and 2004. RESULTS: A total of 663 patients were included. In this retrospective cohort study, analysis of available data showed a significantly reduced hematoma rate of 0.6% in the intervention group compared with 3.9% in the control group (P = .006722). CONCLUSIONS: The use of the hemostatic net is a safe, reproducible, and effective technique in reducing the risk of hematoma in facelift surgery.

A Novel Application of the Hemostatic Net in Aesthetic Breast Surgery: A Preliminary Report.

BACKGROUND: Obtaining optimum breast aesthetics can be challenging in secondary aesthetic breast surgery, particularly with poor-quality skin, when downsizing implants, and in cases where patients will not accept additional mastopexy scars. Most techniques described in these cases rely on internal suturing and capsulorrhaphy, which can lack precision in tailoring the skin over the internal pocket. OBJECTIVES: The aim of this study was to present the authors' experience with utilizing the hemostatic net to help address a range of challenging breast cases in their practices. METHODS: A multicentre retrospective analysis of patients undergoing aesthetic and reconstructive breast surgery between 2019 and 2021 was conducted. A database was established to record patient demographics, indications for surgery, surgical technique, and complications. Following capsulorrhaphy, the hemostatic net was applied in as many rows as required with monofilament sutures and removed 3 to 7 days postoperatively. RESULTS: Twenty-four women (aged 23-67 years) underwent aesthetic or reconstructive breast surgery with the hemostatic net. This approach optimized stabilization of the inframammary fold and redraping of lax skin or irregularities in the skin envelope. At follow-up review, only 1 instance of the net failing to successfully redrape the skin was seen. CONCLUSIONS: The application of the hemostatic net is an option for patients who might otherwise require mastopexy but refuse to accept the scars. The technique has now been extended to primary cases where implant malposition or skin tailoring issues are anticipated, thus securing its place as a part of the surgical armamentarium.

Aesthetic Surgery Practice Resumption in the United Kingdom During the COVID-19 Pandemic.

BACKGROUND: The global COVID-19 pandemic has significantly impacted all aspects of healthcare, including the delivery of elective aesthetic surgery practice. A national, prospective data collection was carried out of the first aesthetic plastic surgery procedures performed during the COVID-19 pandemic in the United Kingdom. OBJECTIVES: The aim of this study was to explore the challenges aesthetic practice is facing and to identify if any problems or complications arose from carrying out aesthetic procedures during the COVID-19 pandemic. METHODS: Over a 6-week period from June 15 to August 2, 2020, data were collected by means of a proforma for aesthetic plastic surgery cases. All patients had outcomes recorded for an audit period of 14 days postsurgery. RESULTS: The results demonstrated that none of the 371 patients audited who underwent aesthetic surgical procedures developed any symptoms of COVID-19-related illness and none required treatment for any subsequent respiratory illness. CONCLUSIONS: No COVID-19-related cases or complications were found in a cohort of patients who underwent elective aesthetic procedures under strict screening and infection control protocols in the early resumption of elective service.

Use of Platelet Preparations in Facial Rejuvenation and Wound Healing Remains Unproven.

UNLABELLED: There is growing interest in the use of platelet derivatives in facial aesthetic surgery and wound healing. Sclafani et al. have concluded from their review of the literature that the vast majority of studies show a significant and measurable effect on facial aesthetic outcomes with the use of these platelet preparations. We suggest that an alternative review of the same literature may well have produced a different set of conclusions. 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.

Giant hemifacial plexiform neurofibroma arising from trigeminal ganglion.

We present a case of a massive hemifacial plexiform neurofibroma. The tumor arose from the right trigeminal ganglion in the middle cranial fossa, involving the 3 divisions of the trigeminal nerve. This affected the whole right side of the face. The principles of management are discussed.

Modified lateral SMASectomy.

BACKGROUND: The modified lateral superficial musculoaponeurotic system (SMAS)-ectomy is an evolution of the technique described by Baker. This modification of the lateral SMASectomy improves and simplifies the procedure by addressing the SMAS and platysma in one surgical procedure. METHODS: A rectangle of SMAS and platysma, parallel to the nasolabial fold (1 cm inferior to the zygomatic arch, 4 to 5 cm below the jaw line, and 3 cm wide), was marked. This plane was undermined anteriorly with blunt dissection, leaving the facial nerve deep to the deep cervical fascia. After excision of the rectangle, the defect was closed, leading to a correction of the neck, jowl, and nasolabial folds. Superolateral elevation of the inferior portion of the flap in particular addresses the problem of neck laxity and platysma redundancy. RESULTS: A total of 359 patients have undergone this procedure performed by the senior author (N.W.). CONCLUSION: This technique gives pleasing, durable results, with minimal morbidity.

The differential fascial glide: a technical refinement in abdominoplasty.

Body contour surgery is in continuous evolution in an attempt to offer better aesthetic results. With greater understanding of the superficial fascial system of the trunk, various suspension procedures have been devised which use the fascial system as an adjunct to complement traditional abdominoplasty techniques. We present a simple technical refinement to the traditional abdominoplasty which uses the superficial fascial system to tighten the flanks and concomitantly shortens the final scar: the differential fascial glide. In this technique the superficial fascia is dissected as a separate layer from the abdominal flap and suspended in an oblique direction towards the midline whilst the abdominal flap is pulled in a downward and lateral direction, thus creating two opposing vectors of pull. This simple technique results in improved flank contour and a shorter scar in patients undergoing classic abdominoplasty.

Versatility of diced cartilage-fascia grafts in dorsal nasal augmentation.

BACKGROUND: Augmentation of the nasal dorsum using autologous cartilage remains an exacting task in rhinoplasty. Precise, long-term control over graft contour and alignment can be difficult to achieve. In an attempt to alleviate these problems, the use of diced cartilage wrapped in a supportive sleeve has recently seen a resurgence of interest. The Turkish delight technique uses Surgicel as the sleeve material, whereas Daniel and Calvert have proposed autologous fascia. METHODS: The objective of this study was to assess the efficacy and reliability of diced cartilage-fascia grafts in the treatment of dorsal nasal volume deficiencies. RESULTS: Over a 2-year period, 20 adult patients underwent nasal augmentation using diced cartilage-fascia grafts. The indications for dorsal grafting were congenital saddling, racial refinement, or iatrogenic or posttraumatic deformities. Apart from one infection, all of the hybrid grafts retained their original volume and had not undergone resorption by a mean time of 16 months postoperatively. A critical analysis of the radix-dorsum aesthetics led to a minor modification of the original technique. CONCLUSION: This series supports the use of diced cartilage-fascia grafts for the correction of difficult dorsal nasal defects with grafting in the 3- to 5-mm range in primary and secondary rhinoplasty.

A standardized digital photography system with computerized eyelid measurement analysis.

BACKGROUND: The authors have developed a slit-lamp mounted digital photography system. This ensures that the patient's head is consistently positioned in the same plane in relation to the camera and generates standardized images of the eyelids, which are then analyzed using commercially available computer measurement software. The aim of this study was to assess the repeatability and reproducibility of this system compared with traditional methods of eyelid measurement. METHODS: Both eyes of 10 patients were photographed and then measured by three clinicians using a handheld ruler for five eyelid parameters (i.e., palpebral aperture, superior marginal reflex distance, inferior scleral show, levator function, and upper eyelid skin crease height). The photographs were then assessed using computer software by the same clinicians (twice by a consultant and once by a clinical fellow and a specialist registrar). At all times, each observer was masked to their colleagues' results. Data were analyzed using Bland-Altman plots. RESULTS: There was a good level of agreement between measurements obtained by computer analysis of digital photographs and measurements obtained by traditional methods. A higher level of reproducibility (interobserver variability) was demonstrated in all digital measurements compared with those obtained by handheld ruler. Repeatability (intraobserver variability) with the digital photograph technique was also high and consistent for each of the five eyelid parameters. CONCLUSIONS: These results suggest that a digital photography system with computer analysis is comparable to, and offers advantages over, traditional methods of measurement. This system offers a simple, standardized, and rapid method of patient assessment with important applications in electronic patient records, audit, and research.

Buckling and hydraulic mechanisms in orbital blowout fractures: fact or fiction?

Since the first description of orbital blowout fractures, there has been much confusion as to their etiology. Two principal mechanisms have been proposed to explain their production, the buckling and the hydraulic mechanisms caused, respectively, by trauma to the orbital rim and the globe of the eye. The aim of this study was to evaluate both mechanisms qualitatively and quantitatively. Our protocol used intact cadavers, quantifiable intraocular pressure, variable and quantifiable force, and quantifiable bone strain distribution with strain gauge analysis. One orbit of each cadaver was used to simulate each of the two mechanisms, allowing direct comparison. Fractures produced by the buckling mechanism were limited to the anterior part of the orbital floor, with strain readings reaching up to 3756 microepsilon. Posteriorly, strain did not exceed 221 microepsilon. In contrast, hydraulic-type fractures were much larger, involving anterior and posterior parts of the floor as well as the medial wall of the orbit. Here, strain exceeded 3756 microepsilon in both parts of the floor. Furthermore, we have demonstrated that the average energy required to fracture the orbital floor by the buckling mechanism is 1.54 J, whereas an average energy of 1.22 J is needed to produce this fracture by the hydraulic mechanism. Our results suggest that efforts to establish one or another mechanism as the primary etiology are misplaced. Both mechanisms produce orbital blowout fractures, with different and specific characteristics. We believe this provides the basis for our reclassification of such fractures.