The use of buflomedil in reduction mammaplasty for a previously irradiated breast: a case report.

In recent years, lumpectomy combined with breast irradiation and chemotherapy, as a part of conservation therapy for breast cancer, has well-established results. Little has been published on reduction mammoplasty for breast-irradiated patients. These patients have increased risks of nipple necrosis, wound complications, and delayed healing. Breast reduction techniques that rely on minimum skin undermining combined with the use of buflomedil may prevent major postoperative complications in breast-irradiated patients. Buflomedil was administered intraoperatively and for 14 days after the procedure. The use of buflomedil in reduction mammaplasty for a previously irradiated breast patient has not been heretofore described. The case of a 58-year-old woman who underwent bilateral breast reduction after breast conservation therapy is reported.

[Facial surgery for rejuvenation]. / Chirurgie faciale de rajeunissement.

Aging brings about anatomical changes that are undesirable. Senescence is consequently one of the most powerful stimuli for aesthetic surgery. The face, responsible for the myriad expressions of human experience, is constantly subject to exposure and also suffers from the perennial action of environmental factors and gravity. Frequently, the face is the main focus of anxiety in individuals who have attained a certain age, presenting skin flaccidity and loss of tone, marked lines of expression and fat deposits. Expectations of both the patient and the surgeon, regarding facial aesthetic surgery, have increased considerably over the last two decades with the advent of newer procedures and equipment. While experience allows the surgeon a better selection of techniques, at the same time he must be knowledgeable in details of different surgical approaches and variations to attain the best result for each individual case. The anatomy of the aging face should be examined carefully for a personalized treatment plan. Currently, a satisfactory result of an aesthetic facial procedure is obtained when signs of an operation are undetectable and no anatomical landmarks have been altered. The bond created between the patient and surgeon will be frustrated if there remain signs that reveal the "secret" that surgery was performed.

"Train surfers": analysis of 23 cases of electrical burns caused by high tension railway overhead cables.

The term "train surfers" describes a group of adolescents from the outskirts of the city of Rio de Janeiro, who are compelled by the overcrowded railway trains to travel on the roofs of the wagons. Collision with electrical high-tension wires is a relatively frequent occurrence, causing extensive and complex injuries. This study analyzes this clinical and surgical phenomenon which has caused over 100 fatalities in more than 200 registered accidents over the past 10 years.

Evaluation of body contouring surgery today: a 30-year perspective.

Concepts of beauty have been continuously evolving throughout the history of mankind. The voluptuous figures that were idealized by artists in the past have been substituted by slimmer forms. Medical advances in this century have permitted safe and efficient surgical correction of contour deformities. Until recently, these alterations were mostly hidden under heavy clothing or were accepted reluctantly. Current fashion trends generally promote body-revealing attire. The media frequently encourage the importance of fitness and good health, linking these qualities with youthfulness and beauty. The subliminal and the overt message is that these are necessary and desirable requirements for social acceptance and professional success.

Facial cosmetic surgery: a 30-year perspective.

Although traits that are specific to different social and cultural groups may express the uniqueness in what humans regard as beautiful, the quest for beauty itself is universal. It is intrinsically related to the search for harmony as a means of achieving intimate well being. Inevitably, aging brings changes that are undesirable. The face, because of its exposure and expression and the constant action of gravity, is frequently the main focus of anxiety in individuals who have attained a certain age because their face has flaccid skin, marked lines of expression, and fat deposits. Motivations for surgery for the aging face are generally deeply hidden and include personal, social, and professional factors. These motivations might not be perceived or investigated by the surgeon who, in turn, will not have done a complete and precise diagnosis. This evaluation is the most valuable tool for determining the most favorable procedure for each patient.

Contour surgery in the patient with great weight loss.

Obesity can be defined as a chronic disease in which there is excess of body adiposity, leading to severe secondary health problems. This metabolic pathology shortens life-span and is a main cause of diabetes, atherosclerosis, systemic arterial hypertension, and reduction of pulmonary function, among others. The plastic surgeon is involved with the obese patient under two circumstances: either the patient is currently overweight and requests reduction of excess adipose tissue, or has suffered a great weight loss and desires correction of one, or more, contour deformities. In either case, planning demands a close preoperative analysis and careful preparation of the patient, execution of a meticulous surgical routine, and close postoperative follow-up. In this article, various body contour deformities will be addressed, showing the senior author's strategy in treating the obese patient that has achieved the loss of considerable weight.

The round-lifting technique.

Aging of the face is a frequent complaint in today's youth-oriented society. Competition and successfulness, in social and professional circles, are intimately related to how a person reflects, in his or her physical appearance, an inner well-being. Regardless of chronologic age, it is imperative that the surgeon perform a problem-oriented, detailed analysis of the face and each subunit so that specific conditions can be individually assessed as they apply to the harmonic balance of the whole. It is generally assumed that the most common source of unfavorable results following a rhytidectomy is patient dissatisfaction. This fact stresses the importance of correctly identifying the patient's expectations. Therefore, perhaps as important as the technical procedure is a correct diagnosis of the deformity and a thorough interpretation of the psychological motivations of each patient. The real goal of treatment is to reestablish the patient's inner well-being and to balance how he or she interprets this self-image in relation to the external world, without denoting that a facial rejuvenation procedure has been done.

CO2 laser peeling associated with the 'round lifting' technique.

This paper evaluates the use of CO2 laser peeling as an isolated procedure or associated with the 'round lifting' technique for correction of the aging face. This technique, as described by the senior author, allows for the treatment of signs of facial aging while maintaining anatomical structures. The article reviews the philosophy and evolution of the classical surgical procedures in an overall experience of 7477 patients operated on at the Ivo Pitanguy Clinic, and emphasizes how the CO2 laser resurfacing has enhanced the aesthetic result in selected cases.

Numerical modeling of facial aging.

Facial aging is a biological phenomenon. Skin properties change with time, and gravity and facial expressions exert mechanical deformation. Knowledge of these alterations may suggest ways to reverse them by identifying the corresponding distortional forces. The aim of this study was to determine a pattern of change for parameters of the face during the aging process, based on the numerical fitting of measures from a sample of patients. The first aspect of this study was to define adequate facial parameters and means of measuring them. Subsequently, each parameter was defined individually, and these data were analyzed as a set. The sample for the research was restricted to a group of 40 white female patients with a history of limited exposure to the sun, with ages ranging from 25 to 65. The reason for choosing this sample was the availability of frontal pattern photographs at different ages. The parameters for each patient were measured at two different ages. A strong correlation was found between age and behavior of the parameters. This aging model can be verified qualitatively by comparing photographs of a patient with manipulated photographs simulating aging. The quantitative verification of the model was done through the comparison of the measured and the predicted parameters.

Rejuvenation of the brow.

Aging of the upper face is a frequent complaint in patients seeking a more youth appearance. Sometimes muscle dynamics are excessively forceful and cause marked lines of expression relatively early in life. Regardless of chronologic age, it is imperative that the surgeon perform a problem-oriented, detailed analysis of the face and each subunit, so that imperfections can be individually assessed as they apply to the harmonic balance of the whole face. Various factors, such as degree of eyebrow ptosis, vertical dimension of the forehead, preexisting scars, and level of hairline, will determine the best approach to surgical correction of the aging brow. In the authors' opinion treatment of the forehead, when done together with a rhytidectomy, requires previous blocking of the cervicofacial flaps so as not to distort important anatomic landmarks when traction is applied to the frontal flap, respecting the patient's desire for a natural aesthetic result.

Surgical treatment of hemangiomas of the nose.

The approach to a rapidly growing vascular tumor is determined by a number of objective and subjective factors. As a rule, treatment of a hemangioma in an infant is usually delayed, in the expectation that involution will be complete. While most hemangiomas are harmless vascular marks, some may grow to become large, infiltrating masses. Local factors that influence treatment decision making include volume, ulceration, secondary infection, and bleeding of the tumor. Hemangiomas situated on the nose are distinguished from other locations by a few but important aspects and may demand a more aggressive position from the surgeon. An important consideration is the potential for aplasia of the delicate nasal cartilages that are undergoing development, due to the mass effect of the tumor. Nasal tip hemangiomas are slow to regress, and contour deformities result from the fibrofatty tissue that invariably remains even after total involution. More importantly, hemangiomas of the nasal region are particularly prone to causing great social distress to the parents, who will request prompt treatment for such a visible, deforming lesion. A definite solution that ensures removal of affected tissue and preservation of anatomy seems to be the best treatment for these tumors. In this article, the experience of the senior author (IP) in treating hemangiomas located on the nose is reviewed. The elliptical midline incision over the nasal dorsum described in the text was developed to address three important aspects: an expedient procedure to treat a highly disfiguring disease; an open access to allow for complete resection and, at the same time, allow for the correction of underlying cartilaginous disruption; and placement of a scar in an anatomic location proven to be very satisfactory aesthetically, permitting access for secondary procedures for better definition of nasal contour. Careful patient selection for this surgical procedure is emphasized.

The surgical importance of the dermocartilaginous ligament of the nose.

The dermocartilaginous ligament of the nose, as first described by the senior author, has been shown to influence the equilibrium of the dorsum-tip relationship. In some noses, this is manifested by a residual convexity after routine rhinoplastic management of the osteocartilaginous structures. The anatomic findings are reported, and surgical considerations are analyzed. A system of classification based on the thickness of the ligament has been shown to be helpful in the intraoperative evaluation of this structure.

Body contouring.

Body contour surgery concerns the correction of diverse morphological abnormalities of the body which may occur due to various acquired and congenital etiologies. The concept of surgical body sculpting has achieved widespread recognition and acceptance because it safely alters such deformities yielding functionally aesthetic results. Several factors account for the current popularity of body contouring. Foremost among them, is the considerably increased exposure of the body which is seen in most modem cultures, particularly in warm climates. In no other period in the history of western civilization have men and women been so revealingly attired. In addition, today's competitive society strongly encourages the maintenance of a lean athletic body, as a symbol of good health, youth and vigor. The reality of achieving this physical ideal becomes increasingly less likely because of current sedentary lifestyles and dietary excesses. These factors combine to create a disturbing disequilibrium between an individual's desired condition and his actual state. Regular adherence to proper diet and exercise must be stressed, but unfortunately some of these deformities remain resistant to the most sincere of such efforts. Subsequently, there are increasingly greater numbers of people who seek surgical correction for specific abnormalities. Body contour surgery is also an important reconstructive tool in the correction of extremely lax skin in obese patients who have recently undergone dramatic weight loss.

[Tissue expanders in plastic surgery of the head and neck. Indications and use]. / Gewebeexpander in der plastischen Kopf- und Halschirurg. Indikation und Anwendung.

Tissue expansion allows a functional as well as an aesthetic reconstruction of local defects and thus corresponds to the actual state of the art in plastic surgery.-Tissue expansion provides tissue of the same quality for the repair of defects without leaving deformities on the donor site. It creates local flaps with skin of the same texture, colour and preserved sensitivity.-The use of tissue expanders has grown enormously during the last few years.-A higher rate of complications on the cheek and on the neck must be taken into account.

[Facial burns--treatment of sequelae]. / Gesichtsverbrennungen--Behandlung der Spätfolgen.

The treatment of the sequelae of facial burns is still a controversial subject. The authors present a retrospective study of 1516 cases between 1967 and 1987. They suggest a more conservative approach of the therapy in purely aesthetic lesions. Therefore, they wait for the "softening" of the scars and start an operative treatment after the maturation of the collagen connective tissue. Functional sequelae have to be treated earlier according to their dimension and according to the aesthetic units affected.

Surgical treatment of macrocheilia.

The authors report 27 cases of macrocheilia, discussing each cause individually. They classify macrocheilia according to its etiology, emphasizing the importance of an accurate diagnosis in treating the disease. The operative technique indicated for each cause is discussed. The technique basically consists of a fusiform resection, which may include a larger or smaller amount of lip tissue depending on the disease process. The incision may be interrupted at the mid-lip and W-plasty or lateral Z-plasties may be used to avoid the formation of dog ears.

Prominent ears--Pitanguy's island technique: long-term results.

Through the analysis of 300 cases of prominent ears operated by Pitanguy's technique with a follow-up of 1-15 years we observed the preservation of the aesthetic aspect as well as the cephaloauricular angle. We call attention to its easy performance and almost no incidence of early or late complications.