Evaluation of anatomical and round breast implant aesthetics and preferences in Dutch young lay and plastic surgeon cohort.

BACKGROUND: Literature remains inconclusive on the attractiveness and natural aspect of anatomical breast implants, and thus far, studies have failed to demonstrate the visible difference in implants that are in practice compared to those that are round. This study was undertaken to evaluate (1) whether lay and professional participants can distinguish between breasts augmented with either round or anatomical breast implants and (2) their opinion with regard to naturalness and attractiveness of these augmented breasts. METHODS: Twenty breast augmentations (10 anatomical and 10 round implants), each depicted by two postoperative pictures, were scored by 100 lay participants and 15 plastic surgeons. Implant volume ranged from 275 to 400 g. Ptotic or malformed breasts were excluded. Finally, they had to score the most natural, unnatural, attractive, and unattractive breast shapes on a schematic depiction of breast types with varying upper poles. RESULTS: The rate of correct implant identifications was 74.0% (1480/2000 observations, p < 0.001) in the lay and 67.3% (202/300 observations, p < 0.001) in the surgeon cohort. Breasts with anatomical implants were rated as significantly more natural (3.3 ± 1.0 vs. 2.6 ± 1.0, p < 0.001 and 3.3 ± 1.0 vs. 2.2 ± 0.9, p < 0.001, respectively) and more attractive (3.1 ± 1.0 vs. 2.6 ± 1.0, p < 0.001 and 3.6 ± 0.9 vs. 2.7 ± 0.9, p < 0.001, respectively) versus round implants by both lay participants and surgeons. Participants preferred breasts with a neutral or slightly negative upper pole contour. CONCLUSION: Participants were able to distinguish between the results achieved with either anatomical or round textured Allergan breast implants and found augmented breasts with the anatomical implants more natural and attractive.

The effect of eyelid cooling on pain, edema, erythema, and hematoma after upper blepharoplasty: a randomized, controlled, observer-blinded evaluation study.

BACKGROUND: The purpose of this study was to investigate the efficacy of eyelid cooling to reduce postoperative pain, edema, erythema, and hematoma after upper blepharoplasty. METHODS: After bilateral upper blepharoplasty in 38 consecutive patients, one eyelid per patient was randomized for cooling with an ice pack, and the other eyelid was left uncooled. Pain was scored by the patients using a visual analogue scale (0 to 10) 1 hour and 1 day after surgery. Degree of edema, erythema, and hematoma were scored by the patients on a four-point rating scale (no, minimal, moderate, or severe) 1 hour, 1 day, 1 week, and 2 months after surgery. Light photography was obtained 1 week after surgery for scoring the degree of bruising on a four-point rating scale by a blinded observer. RESULTS: Pain did not differ between cooled and uncooled eyelids on the day of surgery. However, pain in cooled eyelids was significantly lower 1 day after surgery (p = 0.046), yet absolute pain scores were low (median, 0 and 0.5, on a scale of 10). Edema, erythema, or hematoma did not differ between cooled and uncooled eyelids on any of the time points studied. CONCLUSIONS: Cooling of eyelids after upper blepharoplasty does not reduce edema, erythema, or hematoma of the eyelids, but reduces pain 1 day after surgery. However, because the degree of pain seems clinically irrelevant and because the majority of patients indicate that they have no preference for cooling over noncooling, eyelid cooling after upper blepharoplasty as a rule of thumb can be abandoned. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Improved upper blepharoplasty outcome using an internal intradermal suture technique: a prospective randomized study.

OBJECTIVE: To assess whether a suture technique in upper blepharoplasty may be the cause of differences in the occurrence of suture abscess formation and focal inflammation. MATERIALS AND METHODS: A Level I, randomized controlled trial. The upper blepharoplasty wound was closed with a running intradermal suture. External intradermal suturing implied that this suture was started by initially passing it through the intact skin adjacent to the wound. In contrast, internal intradermal suturing meant the intradermal suture was not started in the adjacent skin but simply within the wound itself. One week and 6 weeks after surgery, the presence of suture abscesses and focal inflammation was assessed at the entrance and exit of the sutures. RESULTS: After 1 week, 12 abscesses (40.0%) were found at the medial side of the externally sutured upper eyelids and 4 abscesses (13.3%) in the internally sutured upper eyelids (p = .02). The presence of erythema and edema after 1 week was also significantly lower in internally sutured upper eyelids (p = .02). CONCLUSION: In this series, the method of starting the suture (internal vs external) at the medial side of an upper blepharoplasty wound was associated with a statistically significant reduction in the incidence of medial wound inflammation and suture abscess formation at a 1-week follow-up.

The purse-string reinforced SMASectomy short scar facelift.

BACKGROUND: Over the last two decades, short scar facelifts, often referred to as "mini" facelifts, have gained popularity. We use a purse-string reinforced (PRS) superficial musculoaponeurotic system rhytidectomy (SMASectomy) shortscar facelift that combines a SMASectomy in the vertical direction and suspension sutures in order to improve structural facial support. In the case of visible platysma bands and/or local fat deposition, liposuction (frequently followed by an anterior plastysmaplasty procedure) was added to correct features that are not consistently correctable using only a short scar facelift. OBJECTIVE: This study retrospectively analyzes our experience with a new type of short scar facelift technique that combines both a superficial musculoaponeurotic system rhytidectomy (SMAS-ectomy) and suspension sutures with a thorough approach to the anterior surface of the neck. METHODS: Over a period of three years, the PRS short scar facelift was performed in 137 patients with a mean age of 55 years (range 23-79 years). In almost half of the patients, the PRS short scar facelift was preceded by a separate treatment of the anterior neck contour by liposuction (67/137 patients; 49%). In two-thirds of these patients (42/67 patients), this liposuction was followed by an anterior plastymaplasty. RESULTS: Most patients (129/137; 94%) were satisfied or very satisfied with their results at the end of the follow-up period. Eight patients were not satisfied: five because of higher expectations, two because of insufficient improvement of the plastysma bands (which had not been treated by a plastysmaplasty procedure), and one because of the improper recognition of midface sagging (which had not been treated and was not properly discussed preoperatively). In the case of plastysma bands, platysmaplasty (n = 42) did improve the presence of these bands. There were no major complications in this series: 1 case had temporary neuropraxia of a buccal branch, which resolved after two months; two cases had hematoma, requiring evacuation on the outpatient clinic after one week; two cases with traction dimpling in the neck over the sternocleidomastoid region required late surgical revision; and one case had hypertrophic scarring in the preauricular area. CONCLUSIONS: The PRS technique is a short scar facelift technique that is both simple and safe. Complications are uncommon and usually minor. However, in the presence of platysma bands and/or local fat deposition, an anterior neck procedure-liposuction and/or anterior platysmaplasty-should be incorporated in order to optimize the results.

Statements on the safety of permanent soft tissue fillers in Europe.

Increasing reported complications associated with permanent soft tissue fillers have led the national medical societies and governmental institutes in Europe to send out warnings regarding their use. Regulation and legislation for the introduction of new products and the use of existing products are necessary to guarantee patient safety.

Bipolar coagulation-assisted orbital (BICO) septoblepharoplasty: a retrospective analysis of a new fat-saving upper-eyelid blepharoplasty technique.

BACKGROUND: Upper eyelid blepharoplasty generally is performed as a combination of excess skin reduction and fat resection. Fat resection can in the long term result in a hollow orbit. Therefore, treatment of the lax orbital septum, in combination with skin reduction, seems a more preferable approach than fat resection. The authors describe a technique of upper-eyelid blepharoplasty: a combination of excess skin reduction and shortening of the stretched lax orbital septum by means of bipolar coagulation. This procedure is called bipolar coagulation-assisted orbital septoblepharoplasty, ie, BICO septoblepharoplasty. The aim of this retrospective study is to report on our initial experience with this technique. METHODS: We retrospectively analyzed 296 patients in whom an upper-eyelid blepharoplasty was performed during the past 4 years using the BICO septoblepharoplasty technique: first, excess skin is removed, then a small rim of orbicularis muscle is excised to expose the bulging orbital septum, and finally, before closure of the wound, bipolar coagulation of the exposed orbital septum is performed. This results in shrinkage of the septum and thus in repositioning of the pseudoherniated fat pads. RESULTS: At discharge from follow-up, which varied from 9 weeks (72% of the patients) up till 2 years after surgery (28% of the patients), in all patients ultimately a satisfactory result was achieved and ultimately all were satisfied or very satisfied with the result of the procedure. There were only 3 patients with minor complications: 1 patient with a slightly retracting scar, which resolved spontaneously, and 2 patients with slight asymmetry requiring additional skin resection. CONCLUSIONS: BICO septoblepharoplasty of the upper eyelid seems to be an effective way to treat blepharochalasia of the upper eyelid; the bipolar coagulation of the orbital septum will lead to shrinkage of the septum, thereby repositioning the prolapsing medial and central fat pads. Secondary fibrosis will reinforce the orbital septum postoperatively.