Postbariatric Brachioplasty with Posteromedial Scar: Physical Model, Technical Refinements, and Clinical Outcomes.

BACKGROUND: Brachioplasty is an increasingly performed procedure following massive weight loss. A visible scar is the main hindrance to this surgery. The aims of the study were to develop a physical model to investigate the ideal location of the surgical incision and to present the authors' technical refinements with the posteromedial scar approach. METHODS: Twenty-four postbariatric patients underwent brachioplasty with posteromedial scar placement, concomitant liposuction, fascial plication, and axillary Z-plasty. Skin specimens were tested and a physical model of the arm was set up to investigate the difference in mechanical stress on the posteromedial and medial scars. The validated Patient and Observer Scar Assessment Scale, the Vancouver Scar Scale, and a questionnaire assessing subjective improvements were administered to patients. Preoperative and postoperative photographs were assessed by three independent plastic surgeons. RESULTS: The physical model showed that stress intensity and distribution along the scar were reduced in the posteromedial location, with smaller scar displacement in the loading simulations. Twenty-three patients healed uneventfully. One (4.1 percent) had a 2-cm dehiscence. Mean Patient and Observer Scar Assessment Scale scores were, respectively, 2 ± 0.76 and 2.13 ± 0.64 in the patients' and observers' questionnaires. The mean Vancouver Scar Scale value was 3.5 ± 1.7. Questionnaires assessing the subjective outcomes showed a mean value of 3.45 ± 0.63 of 4. The surgeons' assessment resulted in a score of 4.5 ± 0.4 of 5. CONCLUSIONS: The physical model demonstrated that the posteromedial scar was subjected to lower mechanical stress and displacement. The reported technical refinements allowed pleasant arm recontouring to be achieved with acceptable scarring and a low incidence of complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Medial thigh lift in post-bariatric patients: Our encouraging experience.

BACKGROUND: A high rate of postoperative complications following inner thigh lift is reported in the medical literature. The authors present the results of a study on the validity of inner thigh contouring, with liposuction and concomitant skin excision, in postbariatric patients. METHODS: This study examined the charts of 46 postbariatric female patients, who underwent medial thigh lift with a 'T' scar technique and concomitant liposuction, between February 2010 and February 2013. Complications were recorded. A questionnaire was administered to the patients at the 1-year follow-up visit. Preoperative and 1-year postoperative photographs were compared, superimposed, and analysed. RESULTS: This study did not observe major systemic complications, haematoma, seroma, infection, skin necrosis, lymphoceles, or lymphoedema. Minor complications were three cases of wound dehiscence and two cases of deepithelialisation. At the 1-year follow-up visit, caudal scar migration, genital distortion, recurrent ptosis, or deformity of the inner thigh contour were not observed. Questionnaires and a comparison of pre- and 1-year postoperative pictures showed encouraging results. CONCLUSIONS: The medial thigh lift technique described and assessed in this article is a straightforward surgical procedure, with considerable functional and aesthetic results. Liposuction, early mobilisation, and appropriate postoperative management are pivotal to reduce postoperative downtime and complications.

Assessment of the 18-month permanence of onlay tip cartilage grafts following rhinoplasty.

Augmentation rhinoplasty requires addition of materials of various natures to reshape the nasal pyramid. Onlay tip grafts are single or multilayered grafts placed horizontally over the alar domes. The aim of the present study was to assess the 18-month permanence of onlay septal cartilage grafts. Twenty-eight patients underwent rhinoplasty with onlay tip cartilage graft, between June 2008 and November 2008 at the Campus Bio-Medico University in Rome, Italy. They were reviewed and photographed 6 months and 18 months postoperatively. Comparison of 6-month and 18-month postoperative pictures was performed with Adobe Photoshop CS. Measurements on pictures were taken with AutoCAD. Comparison of photographs showed no visible difference in nasal tip projection. Comparison of the measurements of tip projection showed a mean reduction of 0.06 mm (0.19%). Considerable stability of nasal tip projection after rhinoplasty with onlay tip grafts was observed postoperatively. Comparison of standardised digital photographs is a valid procedure to assess contour alterations of various anatomical structures after plastic surgery.

Reduction of the opposite breast in patients with a breast reconstructed with an implant: validity of the inverted "T", superior pedicle technique, with an inferiorly-based dermal adipose flap.

We reviewed 28 cases of breasts reconstructed with implants and reduction mammaplasty on the other side for symmetry, with the aim of assessing the stability and aesthetic result in the reduced breasts five years postoperatively. An inverted "T", superior pedicle technique, with an inferiorly-based dermal adipose flap was used in patients who did not have overstretched Cooper's ligaments. At the 5-year follow-up, the sternal notch-to-nipple and inframammary fold-to-nipple distances were measured and the degree of ptosis was evaluated (Regnault's classification). The patients recorded their satisfaction using a verbal numerical rating scale (1-5). The patients' photographs were also sent to 12 plastic surgeons for aesthetic assessment of the reduced breasts (same verbal numerical rating scale). The comparison of the preoperative and postoperative measurements and degrees of ptosis showed reasonable stability at least during a 5-year period. The patients' mean rating of the aesthetic result was 4.3, more than good, and the surgeons' mean rating was 3.4, more than satisfactory.

Digital photography in plastic surgery: how to achieve reasonable standardization outside a photographic studio.

Accurate photographic documentation has become essential in reconstructive and cosmetic plastic surgery both for clinical and scientific purposes. Digital imaging systems currently are popular, being reasonably affordable and much improved in quality. They offer multiple advantages in terms of quality, easy image storage and retrieval. Nevertheless, obtaining standardized, consistent, and relevant digital images is not easy outside a photographic studio. The purpose of this report is to define guidelines for accurate image capture in different anatomic areas, following elementary general criteria based on practical issues beyond the purely theoretical, to obtain reasonable standardization, consistency, and reproducibility.