Evolution of Full Facial Feminization Surgery: Creating the Gendered Face With an All-in-one Procedure.

Facial feminization surgery (FFS) has recently gained popularity to enhance the female facial profile and promote a real transformation of the male to female face in transgender patients. The term involves overlapping of the surgical procedures devoted to feminization and represents a dual and reversible procedure unique in plastic and reconstructive surgery. Indeed, FFS envisages modifications of the hard and soft tissues and is both reductive and augmentative. For these reasons, full FFS (F-FFS) is used by surgeons with special expertise in FFS. This study describes a novel approach to F-FFS performed in a single surgery and thus renamed, de facto, all-in-one and representing its most recent evolution. Forty-nine consecutive nonrandomized patients underwent FFS at a private clinical practice (Face Surgery Center, Parma, Italy) between January 2003 and December 2017. Following a retrospective review according to specific inclusion criteria, the authors identified 9 patients aged 19 to 33 years (mean age, 21 years) who underwent all-in-one F-FFS. Patients were discharged the day after surgery with written postoperative care instructions. No reports of wound infection/dehiscence or nerve/vessel damage were recorded. Patients typically returned to work within 30 days following surgery. The mean operative time was 281 minutes (range, 245-305 minutes). The evolved all-in-one F-FFS provides a further step technically (overlapping several procedures) in terms of surgical outcome (higher satisfaction rate) and reduced overall costs and low morbidity.

A New Hybrid Technique for Performing a Safer Bilateral Sagittal Split Osteotomy: Combining Reciprocating Saw and Piezoelectric Devices.

The sagittal split osteotomy (SSO) is an indispensable tool in the correction of dentofacial abnormalities. In elective orthognathic surgery, it is important that surgeons inform patients about the risk of complications related to inferior alveolar nerve damage and unfavorable split. The purpose of this article is to describe a novel, hybrid technique to SSO by combining a reciprocating saw and piezoelectric devices with several advantages over traditional "pure" methods (osteotomies performed by reciprocating saw or piezoelectric devices only) in terms of precision, rapidity, easier splitting, and decreased complications related to inferior alveolar nerve damage and bad split with reduced overall morbidity. The level of evidence was Level IV, therapeutic study.

Metastatic Squamous Cell Carcinoma of the Lower Lip: Analysis of the 5-Year Survival Rate.

OBJECTIVES: The author analyse the impact of extracapsular lymph node spread and bone engagement in the ipsilateral neck of patients suffering squamous cell carcinoma (SCC) of the lower lip. METHODS: The data of 56 neck dissections performed in patients suffering SCC of the lower lip between January 2000 and December 2008 were retrospectively analysed. Statistical analysis was performed with the Kaplan-Meier life table method, and the survival rate was investigated with the log rank statistic and significance test. The values were considered statistically significant at p<0.05. RESULTS: Nine patients took advantage from simultaneous treatment of tumor and prophylactic neck dissection (level I-III), reaching 100% survival rate. Patients suffering metastasized disease, who received radical neck dissection at the time of tumor treatment, presented 83.3% survival rate. Patients who underwent previous surgery and radiotherapy presented worse prognosis although radical neck dissection in case of extra-capsular spread only (24.7%) and osseous engagement (22.2%). CONCLUSION: Prophylactic neck dissection (level I-III) is recommended in T3-T4 N0 SCC. Simultaneous treatment of tumor and cervical lymph nodes provides a better prognosis as respect to delayed nodal management. Extra-capsular spread with or without bone engagement represents independent risk factor responsible for high mortality rate of SCC of the lower lip.

Siliconomas of the lower limb: Tumour-like excision and reconstruction.

BACKGROUND: Silicone oil injection can cause several complications including pain, cellulitis, abscesses, skin compromise, migration, embolism and multiorgan failure. Oil-infested tissue excision remains the solely treatment to prevent such complications. OBJECTIVES: The authors evaluate tumor-like excision of the oil-infested tissue as a treatment for patients experiencing silicone injections in the lower limbs, to both preserve aesthetic appearance and solve further risk of complication from silicone. METHODS: Between January 2004 and January 2011 a total of 12 consecutive, nonrandomized female patients underwent surgical management of siliconoma of the lower limb. The mean age was 41-years, range from 22 to 61 years and all patients didn't referred comorbidities. Eight siliconomas were located on the leg and 4 were on the thigh. The mean area of siliconoma was 35 cm2, range from 25 to 60 cm2. Each patient was evaluated by ultrasonography and EchocolorDoppler of the soft tissue and in order to achieve a "staging" of siliconoma. RESULTS: Healing was uneventful in all cases. Three patients (25%) suffering hypertrophic scarring underwent further injection of corticosteroids to improve hypertrophic scars quality. Two patients (16.6%) required a further session of structural fat grafting to improve thigh's profile. All patients were satisfied with the cosmetic results and indispositions requiring medical therapy disappeared. CONCLUSIONS: Tumor-like excision and immediate reconstruction appears to be a safe and consistent surgical option that preserves aesthetic appearance for patients victims of illegal oil silicone injection of the lower limbs.

Lipomodeling: An Innovative Approach to Global Volumetric Rejuvenation of the Hand.

BACKGROUND: Rejuvenation of the hand, particularly the dorsum, has garnered increased attention because of its unique aesthetic importance. Various methods have been advocated for achieving optimal aesthetic results. OBJECTIVES: The authors describe their experience applying lipotransfer to total hand rejuvenation, including rejuvenation of the radial and ulnar aspects of the fingers. METHODS: The authors conducted a retrospective review of 22 women who underwent global hand rejuvenation by lipotransfer. Aesthetic outcomes were assessed objectively by serial photography and subjectively by patient self-assessments. RESULTS: No major postoperative complications were observed. Of 22 patients, 21 indicated that they were "satisfied" or "very satisfied" with the procedure. Plastic surgeons noted improvement in the aesthetic appearance of the hands after treatment. CONCLUSIONS: Global hand rejuvenation should aim to restore volume and reduce skin laxity to reverse the signs of extrinsic aging. The fingers represent almost 50% of the length of the hand and should be included in treatments to achieve optimal aesthetic outcomes. LEVEL OF EVIDENCE: 4 Therapeutic.

Successful combined approach to a severe Fournier's gangrene.

We present a case of a successful reconstruction of a severe Fournier's gangrene (FG) involving the scrotum, the perineum, the right ischial area and extended to the lower abdomen. There are many different surgical techniques to repair and reconstruct the defect following debridement in FG. The authors treated this complex wound using negative pressure wound therapy (NPWT), dermal regeneration template and a split-thickness skin graft. Complete recovery was achieved and no major complications were observed. The patient showed a satisfying functional and aesthetic result.

Esthetic restoration in progressive hemifacial atrophy (Romberg disease): structural fat grafting versus local/free flaps.

BACKGROUND: Progressive hemifacial atrophy, also called Parry-Romberg disease, is a craniofacial disorder that typically involves the subcutaneous layer of 1 side of the face. Autologous reconstruction is achieved through various techniques, including autologous grafting of fatty tissue, the use of pedicled flaps, and free tissue transfer based on microvascular anastomoses. Thus far, a systematic literature review devoted to compare different surgical techniques has not been published. METHODS: The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were identified by performing a systematic search on Medline, Ovid, Embase, the Cochrane Database, Current Contents, PubMed, Google, and Google Scholar. RESULTS: The initial search resulted in 871 articles through online access on July 2013. Sixty-six articles were included and fully reviewed for data extraction of the surgical procedures and divided into the following 4 groups: pedicled flaps, free flaps, structural fat grafting, and conjoint treatment (free flaps plus lipofilling). CONCLUSIONS: The therapeutic management of progressive hemifacial atrophy is based on the severity of the disease. Except for minor degrees of atrophy, for which lipofilling can satisfy the requirements, vascularized fatty tissue is essential for long-term contour correction. Microsurgical transfer of buried flaps can be considered the most effective surgical treatment of middle and severe Romberg disease in long-term correction, complication rate, and reoperative rate.

Through-and-through Nasal Reconstruction with the Bi-Pedicled Forehead Flap.

BACKGROUND: Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction. METHODS: Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia. RESULTS: Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary. CONCLUSIONS: This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.