The Fisher Subunit Anatomical Approach for Cleft Lip Revisions: An Evolution and Case Series.

ABSTRACT: Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with nonanatomic scars and a short upper lip, creating a need for revision. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors' experience, recreating the defect and utilizing the Fisher repair for revision have led to aesthetically pleasing results and less noticeable scars. A database was collected that included all cleft lip revisions performed at a large, comprehensive children's hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons. Data collected included sex, characteristics of the cleft lip, age at initial and index repair, type of initial repair, previous revisions, type of revision with any additional tissue rearrangement, and any nose repair. Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. This study demonstrates a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons' experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.

Plastic Surgery: Beware the Candle Burning at Both Ends.

Background: Plastic surgery dates back to 800 BC, where forehead flaps were used to reconstruct noses in India. Today, it is one of the most romanticized fields in medicine. Due to the influence of social media, there has never been a larger spotlight. Ironically, this spotlight brings a narrowed perception of the scope of plastic surgery. This study aimed to assess the scope through the eyes of the average American to identify gaps in knowledge to better represent the field. Methods: A series of questions were developed under survey methodologists and administered by Qualtrics. Responses were gathered, and data were analyzed to assess the public's knowledge of plastic surgery's scope. Results: Two thousand five hundred responses were obtained, balanced across demographics similar to that of the United States. The US population has a poor understanding of the scope of plastic surgery and how to obtain board certification. Conclusions: This survey demonstrates a gap in awareness of plastic surgery as a field and the scope outside aesthetic procedures dramatized by the media. There remains no clear understanding of the qualifications of plastic surgeons or the provider makeup of the field of cosmetic surgery. Subspecialties proved to be overlooked, and knowledge of board certification was sparse. Further effort is needed to educate both the public and patients of the scope of plastic surgery, so that they might seek and gain access to appropriate treatment in the most efficient manner to optimize outcomes regarding the form and function of the body.