Patients' perceptions of cosmetic surgery at a time of globalization, medical consumerism, and mass media culture: a French experience.

BACKGROUND: The global popularity of cosmetic surgery, combined with mass media attention on medical consumerism, has resulted in misinformation that may have negatively affected the "collective image" of aesthetic practitioners. OBJECTIVES: The authors assess patients' perceptions of cosmetic surgery and analyze their decision-making processes. METHODS: During a 2-year period, 250 consecutive patients presenting to either of 2 public hospitals for cosmetic surgery treatment were asked to complete a 7-item questionnaire evaluating their knowledge of opinions about, and referring practices for, aesthetic procedures. Patients undergoing oncologic, postbariatric, or reconstructive procedures were not included in the study. RESULTS: After exclusion of 71 cases for refusal or incompletion, 179 questionnaires were retained and analyzed (from 162 women and 17 men). Overall, repair (70.4%), comfort (45.3%), and health (40.8%) were the words most frequently associated with cosmetic surgery. Quality of preoperative information (69.3%), patient-physician relationship (65.4%), and results seen in relatives/friends (46.3%) were the most important criteria for selecting a cosmetic surgeon. Moreover, 82.7% of patients knew the difference between cosmetic surgery and cosmetic medicine. CONCLUSIONS: Although potential patients appear to be more educated about cosmetic surgery than they were several years ago, misinformation still persists. As physicians, we must be responsible for disseminating accurate education and strengthening our collaboration with general practitioners to improve not only our results but also the accuracy of information in the mass media.

Abdominoplasty after major weight loss: improvement of quality of life and psychological status.

Abdominoplasty provides a reconstructive but rarely aesthetic cosmetic solution after major weight loss. Few articles document quality of life (QOL) issues and the psychological impact of abdominoplasty on obese patients. We report a retrospective study of 41 abdominoplasties performed after an average weight loss of 40.2 kg. Data were obtained through review of patient medical files, double-blind surgical and psychological examinations, and two specifically designated questionnaires used to assess pre-abdominoplasty body perception and QOL, post-body contouring perception of improvement, and psychological status. To date, 14 patients have regained >10 kg; 84.6% have improved QOL; 86.5% have improved psychological status; 74% have better sexual relations; 53.9% admit liking their body; 76.9% are satisfied with the results of abdominoplasty; and 96.1% would be willing to undergo abdominoplasty again. Anterior dermolipectomy improves both QOL and psychological status. Provision of patient education, multidisciplinary management, and long-term follow up are necessary to obtain satisfactory results.

Functional and aesthetic outcome of a complex upper-limb reconstruction after criminal caustic injection.

Extensive upper-limb injuries are usually secondary to accidental partial or complete avulsions or massive burns. Caustic injections are an exceptional etiology, with terrible lesions that present therapeutic challenges and major aftereffects. We report the case of a 41-year-old patient presenting with a large and deep anterior necrosis of the upper-limb anterior tissues, after a criminal intravenous injection of caustic soda on the inner side of his left elbow. Reconstruction methods consisted of a homolateral latissimus dorsi pediculated flap, a humeroulnar vascular bypass, a medial nerve autograft, and a secondary palliative Brand 1 procedure. Final functional and aesthetic results, obtained after long-term physiotherapy, were unexpectedly good. In conclusion, reconstructive surgery of such major lesions cannot be considered without a multidisciplinary approach. Moreover, patients have to be well informed about the necessity of multiple surgical interventions, the risk of major handicap, and the unpredictable nature of the final outcome.

"Bleeding polyp" of the nasal septum: an uncommon lesion in adults.

Inflammatory hemangioma of the nasal septum, known as "bleeding polyp," is an uncommon lesion in adults. We report the case of a 20-year-old woman who presented with left nasal hemangioma revealed by unilateral epistaxis and obstruction. The patient had a medical history of septoplasty performed 5 years earlier. This benign tumor can be spontaneous or posttraumatic and occurs in young postpubertal adults or patients over 40 years of age, without a sex preponderance. The site of origin is most frequently the cartilaginous septum. The appearance and clinical signs often mimic malignancy, and a biopsy for histologic confirmation of the diagnosis is crucial. The capillary hemangioma is more frequently observed than the cavernous type. This tumor does not present spontaneous involution, and treatment is based on a surgical excision including the mucosa and the underlying perichondrium, after computed tomographic and/or nuclear magnetic resonance examination.