Umbilical Lift: A Simple Effective Procedure to Rejuvenate the Umbilicus.

The umbilical lift procedure is a useful technique for improving the skin laxity in the upper umbilicus, which is commonly seen in patients with umbilical piercings who have had children or with aging.

The British Association of Aesthetic Plastic Surgeons (BAAPS) Gluteal Fat Grafting Safety Review and Recommendations.

Superficial gluteal lipofilling is a fat grafting procedure performed to correct a trochanteric depression and buttock deflation. Brazilian butt lift (BBL) is a gluteal lipofilling procedure traditionally associated with exaggerated appearance and intramuscular fat transfer. The risk of mortality from fat embolism in BBL was previously reported as being 1:2500. The actual risk was later estimated to be nearer 1:15,000, which is similar to the mortality risk in abdominoplasty. There is increasing evidence regarding the safety of subcutaneous gluteal lipofilling. This has principally been related to new technologies, surgical techniques, and training being developed to avoid intramuscular injection of fat. The efficacy and benefits of intraoperative ultrasound for guiding the subcutaneous placement of fat and avoiding inadvertent deep lipofilling have been demonstrated. Other serious risks and complications must be considered in addition to mortality. These include hypothermia, sepsis, skin necrosis, and poor aesthetic results, as well as the much-publicized risk of fat embolism. Complications are better controlled and managed in strictly regulated healthcare settings. Patients seeking surgery at unregulated facilities or via medical tourism are deemed to be at higher risk of being exposed to these serious complications and/or inadequate subsequent management.

3D Printed Anchoring Sutures for Permanent Shaping of Tissues.

Sutures are one of the most widely used devices for adhering separated tissues after injury or surgery. However, most sutures require knotting, which can create a risk of inflammation, and can act as mechanically weak points that often result in breakage and slipping. Here, an anchoring suture is presented with a design that facilitates its propagation parallel to the suturing direction, while maximizing its resistive force against the opposite direction of external force to lock its position in tissues. Different microstructures of suture anchors are systematically designed using orthogonal arrays, and selected based on shape factors associated with mechanical strength. 3D printing is used to fabricate different types of hollow microstructured suture anchors, and optimize their structure for the effective shaping of tissues. To define the structural design for fixing tissues, the maximum force required to pull 3D printed anchors in different directions is examined with tissues. The tissue reshaping function of suture anchors is further simulated ex vivo by using swine ear, nose, and skin, and bovine muscle tendon. This study provides advantages for building functional sutures that can be used for permanently reshaping tissues with enhanced mechanical strength, eliminating the need for knotting to improve surgical efficiency.

Presenting concerns and surgical management of secondary rhinoplasty.

BACKGROUND: Secondary rhinoplasty is a challenging surgical procedure, and patients seeking this procedure tend to be difficult to please. However, psychological and functional improvements in patients and high satisfaction rates are achievable with secondary rhinoplasty. OBJECTIVES: The authors reviewed a series of secondary rhinoplasties and tabulated patient concerns, underlying deformities, and corrective surgical procedures. METHODS: The authors conducted a retrospective review of 109 patients for whom the senior author (B.M.) performed secondary rhinoplasty from 2009 to 2012. Concerns causing the patients to seek surgery and management of the secondary procedures were described. RESULTS: The mean patient age at time of surgery was 33.2 years (range, 18-61 years), and most patients (71.6%) were women. The mean number of previous procedures was 1.6 (range, 1-8). Chief presenting concerns were asymmetry (36.7%), large tip (24.8%), and breathing difficulties (22.0%). The most common clinical findings were nostril asymmetry (33.9%), septal deviation (32.1%), overresection (26.6%), and tip asymmetry (26.6%). CONCLUSIONS: Patients seeking secondary rhinoplasty present with various concerns. Preoperative identification of the underlying problems and determination of the techniques required to correct them are important to successful secondary procedures. LEVEL OF EVIDENCE 4: Therapeutic.

The evidence behind noninvasive body contouring devices.

The demand for body contouring is rapidly increasing, and interest in noninvasive approaches has also grown. The author reviewed the evidence base behind the currently available devices and methods for nonsurgical body contouring. There is little high-level evidence in the present literature to support the effectiveness of any of these devices.

Cosmetic surgery growth and correlations with financial indices: a comparative study of the United Kingdom and United States from 2002-2011.

BACKGROUND: Over the past 10 years, there has been significant fluctuation in the yearly growth rates for cosmetic surgery procedures in both the United States and the United Kingdom. OBJECTIVES: The authors compare cosmetic surgical procedure rates in the United Kingdom and United States with the macroeconomic climate of each region to determine whether there is a direct relationship between cosmetic surgery rates and economic health. METHODS: The authors analyzed annual cosmetic surgery statistics from the British Association of Aesthetic Plastic Surgeons and the American Society for Aesthetic Plastic Surgery for 2002-2011 against economic indices from both regions, including the gross domestic product (GDP), consumer prices indices (CPI), and stock market reports. RESULTS: There was a 285.9% increase in the United Kingdom and a 1.1% increase in the United States in the number of procedures performed between 2002 and 2011. There were significant positive correlations between the number of cosmetic procedures performed in the United Kingdom and both the GDP (r = 0.986, P < .01) and CPI (r = 0.955, P < .01). Analysis of the US growth rates failed to show a significant relationship with any indices. UK interest rates showed a significant negative correlation (r = -0.668, P < .05) with procedures performed, whereas US interest rates showed a significant positive correlation. CONCLUSIONS: Data from the United States and United Kingdom suggest 2 very different growth patterns in the number of cosmetic surgeries being performed as compared with the economy in each region. Economic indices are accurate indicators of numbers of procedures being performed in the United Kingdom, whereas rates in the United States seem independent of those factors.

Online marketing strategies of plastic surgeons and clinics: a comparative study of the United Kingdom and the United States.

The cosmetic surgery market is a rapidly growing sector of healthcare, and the use of marketing strategies is now an integral part of any cosmetic surgery practice. In this study, the authors review 50 Web sites from practitioners in London and New York to quantify the utilization of online marketing, comparing results between the United Kingdom and the United States.

The evidence for reducing the pain of administration of local anesthesia and cosmetic injectables.

Administration of injections, whether local anesthetic or cosmetic injectable, can result in significant distress and discomfort to patients. This review explores factors that can alleviate anxiety and pain associated with injections including cosmetic injectables. We highlight that many techniques used to reduce pain have only been reported based on anecdotal evidence and small series. The techniques that have been reported to reduce pain, by randomized controlled trials, include pretreatment with topical local anesthetic agents and combined cosmetic injectables with local anesthetics.