"Nonsurgical Rhinoplasty in Patients of African Descent: A Retrospective Review".

BACKGROUND: There is a paucity of research on non-surgical rhinoplasty in the population of African descent. In this group, underlying anatomy and aesthetic ideals vary, necessitating differences in the consultation process and in treatment. We present a case series from a single clinician's practice performing non-surgical rhinoplasty on patients of African descent. METHODS: A retrospective chart review was completed on eligible patients who received non-surgical rhinoplasty treatment with hyaluronic acid filler injections by the first author (A.H.) from March 2018 to February 2021. Demographic variables, indications for treatment, patient-reported outcomes and adverse events were reviewed. We also share the first author's technique for non-surgical rhinoplasty in this patient cohort. RESULTS: A total of 487 patients of African descent or mixed race including African descent were included in this study. The most common indications for treatment were lack of bridge definition (63.9%); excessive alar width (61.6%); and a bulbous tip (61.6%). Median filler volume was 0.6ml (range 0.3-2.1ml) at the initial treatment visit. There were no reported cases of infection, vascular occlusion, or necrosis. CONCLUSIONS: This study is the first to illustrate the effectiveness and safety profile of non-surgical rhinoplasty in a population of African descent. Anatomic variations and the desire for racially congruent results must be acknowledged to ensure satisfactory outcomes.

Consensus Recommendations on the Use of Hyaluronic Acid-Based Fillers for Nonsurgical Nasal Augmentation in Asian Patients.

BACKGROUND: Nonsurgical nasal augmentation using dermal fillers such as hyaluronic acid is increasing in popularity because of its less invasive nature and shorter downtime compared with traditional surgery. However, the complexity of the nasal vasculature makes it a high-risk procedure without proper training. Appropriate patient and product selection and safer standardized injection techniques are warranted to minimize complications and to achieve reproducible aesthetic results. In this article, recommendations for nonsurgical nasal augmentation using hyaluronic acid fillers are outlined, with focus on the dorsum, tip, and columella. METHODS: A consensus meeting was conducted to develop recommendations on nonsurgical nasal augmentation in Asian patients using hyaluronic acid-based fillers. Literature review was performed using PubMed and Google Scholar. Relevant studies were included to formulate recommendations. Consensus statements were graded using the criteria outlined by the Grading of Recommendations Assessment, Development and Evaluation Working Group. RESULTS: Nonsurgical nasal augmentation is an advanced procedure that warrants in-depth knowledge of the nasal anatomy. The panel recommends thorough preinjection assessment and counseling to fully align the patient's expectations with aesthetic goals. Injections must be deep and at the level of the periosteum or perichondrium to minimize risk of intravascular injection. Aliquots of hyaluronic acid must be introduced using slow, low-pressure, and low-volume injections. Optimal aesthetic effect is achieved with hyaluronic acid dermal fillers that are highly elastic, cohesive, and with good adaptability to their environment. CONCLUSIONS: Hyaluronic acid injections are safe and effective in nonsurgical nasal augmentation. In-depth knowledge of vascular anatomy and proper injection techniques using suitable products are necessary to achieve aesthetic goals safely. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

The Nonsurgical Rhinoplasty: A Retrospective Review of 5000 Treatments.

BACKGROUND: Nonsurgical rhinoplasty with injectable dermal fillers has become an increasingly popular alternative to surgical procedures, in view of its relative low cost, convenience and rapid recovery, and low risk profile. The safety and efficacy of nonsurgical rhinoplasty remains a relatively contentious and ambiguous matter, given that there are few large-scale series reporting results or complications. This study reports the experience of a single clinician performing nonsurgical rhinoplasty in the largest cohort to date. METHODS: Patient demographics, indications, treatment details, and outcomes of patients treated between March of 2016 and January of 2019 were reviewed. The nonsurgical rhinoplasty technique described previously by Harb was used using hyaluronic acid dermal filler. RESULTS: Nonsurgical rhinoplasty was performed in 5000 patients. The commonest indication was dorsal hump (44 percent). Swelling and erythema were self-limiting side effects encountered in approximately half of patients. Infection was seen in two patients, and localized skin necrosis was observed in three patients. CONCLUSIONS: Nonsurgical rhinoplasty is a safe procedure with positive aesthetic results when performed by an experienced clinician. Knowledge of nasal anatomy, comprehensive training, and use of appropriate materials are key in ensuring safety and results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Pelvic and buttock hypoplasia reconstructed with anatomical breast implants.

Radiation therapy is used in the management of a number of childhood cancers and can have significant effects on skeletal growth. We present the case of a 35-year-old woman who developed a hypoplastic pelvis and buttocks following radiotherapy for rhabdomyosarcoma of the vagina at the age of 2. At the age of 25, the patient underwent bilateral buttock augmentation with a two-stage reconstruction using tissue expansion followed by definitive augmentation with anatomical breast implant insertion. The patient continues to have a satisfactory outcome 10 years following reconstruction, having undergone a single uplift procedure and exchange of implants through the original incision 9 years postoperatively. This case represents a unique reconstructive challenge to plastic surgeons and was successfully managed with a novel approach.

Training in bilateral breast reduction and breast augmentation: the results of a supra-regional audit.

INTRODUCTION: Bilateral breast reduction (BBR) and bilateral breast augmentation (BBA) represent ideal training procedures. This study prospectively audited BBR and BBA training opportunities at six plastic surgery units. METHODS: Operative numbers and training opportunities were audited at 6 plastic surgical units in the south west region. RESULTS: The results demonstrated considerable variations in training opportunities between different hospitals. In some cases, trainees did not operate on a single BBR or BBA, despite relatively high overall operative numbers. These differences did not relate to trainee seniority or patient demographics. CONCLUSION: The variations and deficiencies in training opportunities identified in this study may be due to a number of factors, such as local attitudes to training, external pressure on operative lists and the EWTD restrictions. These findings are unlikely to be confined to one region and should encourage wider audit of training provision.

A case of fulminant portal pyemia complicating hemicolectomy for polyps: literature review and case report.

INTRODUCTION: Portal pyaemia is a rare phenomenon that can complicate a variety of pathologies and surgical procedures. It has a predilection for elderly and immunocompromised patients. DISCUSSION: We present a review of the related literature and report an exceptional case of fulminant portal pyaemia, with an atypical presentation in a patient with few typical risk factors, complicating an elective surgical procedure for benign disease. CONCLUSION: Portal pyaemia is a condition which can lead to acute overwhelming sepsis and carries a high mortality. It should be considered a differential in abdominal sepsis when no overt abdominal source is found.

Primary omental mesothelioma: a rare but important differential diagnosis in previous asbestos exposure.

Primary omental mesothelioma is a malignant tumour of the mesothelial cells of the omentum, related to asbestos exposure. It is an extremely rare condition that presents both diagnostic and therapeutic challenges. We present a review of the related literature and report on a fatal case of primary omental mesothelioma in a 70 year old man, presenting with a painful abdominal mass. Radiological imaging was not diagnostic but useful in excluding other pathologies. Diagnosis relied on specific immunohistochemical analysis. The difficulty in diagnosis and management and the advanced stage of disease meant that prognosis was very poor. Our patient died within 3 weeks of diagnosis.