Ligament Preservation in Open Rhinoplasty: Prospective Analysis.

BACKGROUND: In the open rhinoplasty technique, the soft tissue and ligaments are vulnerable to injury. Reconstruction of the ligaments is not performed routinely. The authors aimed to assess the effect of preservation of the nasal ligaments (ie, scroll, septocolumellar, and Pitanguy ligaments) in open-approach rhinoplasty. METHODS: In this prospective cohort study, 32 patients underwent open rhinoplasty with ligament preservation after receiving precise training on five cadavers. RESULTS: All patients had improved aesthetic and functional outcome in the early postoperative period with long-lasting preservation of tip projection and results. No patient needed secondary revision surgery for tip dropping or malrotation. The objective findings and subjective assessments were satisfying for the patients and surgeons. CONCLUSIONS: Refinements of nasal surgery have no limits. This study suggests that nasal ligament reconstruction, including of the scroll, septocolumellar, and Pitanguy ligaments, could maintain nasal tip projection and rotation for a long time. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Nandrolone decanoate safely combats catabolism in burned patients: A new potential indication after recall.

INTRODUCTION: The hyper-catabolic state is a devastating pathophysiological response to severe injury, infection or burns. Nandrolone decanoate (ND) is a potent anabolic steroid have many clinical indications, but not investigated in burn injuries yet. PATIENTS AND METHODS: A prospective randomized control study included 40 burned patients who were treated in Burn unit from burn injuries ranged from 20 to 40%. Both groups are objectively assessed, clinically and laboratory during treatment period till full recovery from burns' injury. Recall assessment of the drug safety after many years is achieved. RESULTS: ND showed highly significant results supporting its use in combating catabolic insults in burns patient. Both clinical findings and laboratory findings are correlated and highly support the use of ND in burns as new effective and safe long-lasting indication. CONCLUSION: This study results showed preservation of lean body mass and protein partition, as well as the near normal nitrogen balance in burn patients. Study proposes that nandrolone decanoate could be used in safe and effective way to combat hypercatabolic impact in burn injury.

Rhinoplasty Assisted by Endoscopic Septoplasty: Precise Job and an Educational Tool.

BACKGROUND: Septoplasty is a crucial step during rhinoplasty to correct the nose function and nasal aesthetics. The idea is not investigated regarding the educational purposes. Objective of the study is to evaluate the efficiency of endoscopic septoplasty during full job rhinoplasty and to observe its educational benefit. METHODS: Twenty-seven patients who submitted for prospective study of endoscopic septorhinoplasty operation; the analysis involves 16 female patients and 11 males. RESULTS: Endoscopic septoplasty during rhinoplasty showed an efficient illumination and visualization, which improved the precision and has an educational benefit during the reform of the posterior septum, isolated septal spurs, anterior septum, and middle turbinate attachments. CONCLUSION: The procedure allows a precise septal job with excellent visualization of the anterior and posterior septum. It also has an intraoperative educational benefit and helps to soothe the time down of patient's recovery.

Nonmicrosurgical Grafting for Facial Nerve Branches with Permanent Sensational Functional Outcome.

A 49-year-old man underwent intraoperatively modified procedure from superficial to radical parotidectomy with excision of the facial nerve 4 branches, temporal, zygomatic, buccal, and mandibular. We have dissected and harvested the branches of the great auricular nerve to repair the defects of the temporal, zygomatic, buccal, and mandibular nerves without microsurgery aid. The aims of the repair were just to mark the nerve endings, to try autologous grafting, and to avoid neuroma(s) formation, although neuroma(s) formations from motor nerves are rare. We did an immediate temporary nonmicrosurgical nerve grafting, and we have sutured each nerve anastomosis by 2-3 stitches of Prolene 6-0. We have observed facial nerve branches' recovery on the second month, even with radiation therapy, and then gradually more improvements on the third month and then on the sixth month of the follow-up. Finally, the procedure results in permanent sensational functional outcome after 1 year. Because we did not plan a microsurgical repair, this case report does not support any intended nonmicrosurgical procedures for facial nerve repair, but it raises questions for laboratory and animal investigations about the size of Prolene we have used, grip repair taking the epineurium and fascicle in mass closure, and the positive fast functional results. In surgical environments where microscope or microinstruments are lacking, one can still perform primary nerve grafting.

Laser-assisted Lipolysis Burn Safety: Proposed Detailed Parameters with Assessment of Their Efficacy and Safety.

BACKGROUND: Many recent studies have evaluated the clinical safety and efficacy of therapeutic lasers in laser lipolysis, but without detailed description of the safe and effective parameters. PURPOSE: To propose a method for adjusting safe and effective parameters for laser lipolysis. METHODS: Detailed calculations of the safe and effective laser parameters for fat melting are proposed in the study. Amount of energy delivered in joules was calculated based on data from Havenith research. External skin and internal tissues temperatures during the procedure were kept in a recommended range and monitored for safety and efficacy. Prospective statistical study was designed on a series of 300 patients who underwent laser-assisted lipolysis and /or liposuction using 2 different machine manufacturers, delivering 1,064/1,320 nm. RESULTS: All areas submitted to laser-assisted liposuction in this series have resulted in no clinical thermal burns injury to the skin. There was improvement in the bulk of fats, skin tightening, skin textures, and cellulites. CONCLUSION: This study is proposing a simple method for calculations of safe and effective laser lipolysis. Skin burn injury could be highly prevented by following up the proposed detailed basic parameters for laser lipolysis treatment.

Two years' outcome of thread lifting with absorbable barbed PDO threads: Innovative score for objective and subjective assessment.

BACKGROUND: Thread-lifting rejuvenation procedures have evolved again, with the development of absorbable threads. Although they have gained popularity among plastic surgeons and dermatologists, very few articles have been written in literature about absorbable threads. This study aims to evaluate two years' outcome of thread lifting using absorbable barbed threads for facial rejuvenation. METHODS: Prospective comparative stud both objectively and subjectively and follow-up assessment for 24 months. RESULTS: Thread lifting for face rejuvenation has significant long-lasting effects that include skin lifting from 3-10 mm and high degree of patients' satisfaction with less incidence rate of complications, about 4.8%. Augmented results are obtained when thread lifting is combined with other lifting and rejuvenation modalities. CONCLUSION: Significant facial rejuvenation is achieved by thread lifting and highly augmented results are observed when they are combined with Botox, fillers, and/or platelet rich plasma (PRP) rejuvenations.