A new technique for creating a neo-umbilicus in abdominoplasty.

BACKGROUND: The umbilicus is an essential feature of the abdomen. In this article, we describe a new technique for creating a neo-umbilicus in abdominoplasty. METHODS: Thirty consecutive women underwent abdominoplasty with our new technique for recreating the navel. The new navel is created at the midpoint between the xiphoid process and pubic symphysis by defatting a cylinder of fat tissue as far as the dermis that is then sutured to the rectus muscle to enable it to "take" in the same way as a total skin graft and form a hollow, which will be the new navel. Patients were divided into three groups according to BMI (group A < 25; group B 25-29.9; group C ≥ 30). Results were rated on a scale of 0-10 by external observers and by the patients. Complications were recorded. RESULTS: Groups B and C obtained median scores of 10/10 from both the external raters and patients (range 1), while group A obtained median scores of 6/10 and 7/10, respectively (ranges 6 and 5). CONCLUSIONS: Our new technique presents a series of advantages: it allows the positioning of the new navel in any location, it does not create periumbilical scarring, and it can be used in cases in which the original pedicle and vascularization of the navel cannot be preserved. It appears to achieve good aesthetic results and high levels of satisfaction among patients; however, it is less effective in very thin patients whose navel remains flat due to the lack of adipose tissue.

Endoscopic management of osteomas of the forehead.

Transcutaneous resection is the most common technique for the removal of facial lesions. In recent years, endoscopic techniques have been used in aesthetic surgery of the face, and have achieved good results. We know of few descriptions of this approach. We describe 9 patients who had endoscopic removal of osteomas of the forehead through a single 3 cm incision of the midline, which was concealed 2 cm behind the hairline.

Cheek mucosa territories perfused by perforators from the facial artery.

The cutaneous areas perfused by the cutaneous perforators of the facial artery have been well defined. However, the oral mucosal areas perfused by perforators of the facial artery have not been described. We studied 20 hemifaces from 10 cadavers. Perforators between the branching off sites of the labial arteries larger than 0.5 mm were selected and their diameters were measured; the distance between their exit point over the facial artery and the branching-off point from the superior labial artery was also measured. The selected perforators were injected with 1 ml of diluted ink. Both labial arteries were ligated to limit the study to the mucosal perforators from the facial artery. Seventy-four perforators from 20 hemifaces were studied; the mean diameter was 0.58 mm and the mean number per artery was 3.7. The total stained area, a triangle-shaped zone on the cheek, was determined. The more constant perforators larger than 0.5 mm were localized next to the branching-off site of the superior labial artery. With this information, flaps based on the mucosal perforators from the facial artery could be designed.

Cortical tibial bone graft for nasal augmentation: donor site short scar.

The nose is the central part of the face and the most prominent facial feature. Augmentation rhinoplasty is one of the most exciting and arduous techniques for plastic surgeon and patient. Fourteen cases of augmentation rhinoplasty with cortical tibial bone graft are presented. An endonasal approach was used in 13 cases and an open approach in one case, with a donor site short scar (1.5 cm) in every case. The average follow up was 2 years and no significant bone resorption was observed. No remarkable complications or complications requiring surgery were noted during the follow up. The cosmetics results have been gratifying.

Rejuvenecimiento periorbitario no invasivo / Non-invasive periorbital rejuvenation

Cirujanos plásticos y médicos estéticos se esfuerzan por lograr resultados satisfactorios y estéticos que mejoren o suavicen el paso del tiempo a nivel facial, con un especial interés o énfasis en el área periorbitaria. Un gran número de pacientes consultan para mejorar esta zona, pero por diferentes motivos desean que los procedimientos que se les realicen sean poco invasivos y con resultados rápidos, permitiéndoles así incorporarse lo antes posible a sus actividades cotidianas. Es fundamental el conocimiento de las proporciones faciales y periorbitarias para lograr resultados naturales. El objetivo de la técnica que proponemos es lograr una bioestimulación local de la piel, restaurar los volúmenes y reducir las arrugas de expresión o dinámicas, consiguiendo así una apariencia relajada y juvenil en el paciente (AU)

Plastic surgeons and aesthetic doctors are making an effort to reach positive aesthetic results. Their aim is to soften the effects of age on facial features stressing in the periorbital area. Many patients come to improve their facial image on this area, but they are asking for non-invasive and fast procedures to keep on their daily life. It is indispensable the knowledge of facial and periorbital proportions to achieve a more naturaleffect. The aim of the technique exposed is to achieve a local bioestimulation on skin, to restore volumes and to reduce expression and dynamical wrinkles. The expected result is a relaxing, youthful appearance (AU)

Uso de factores de crecimiento plaquetar unidos a injertos de grasa para lipofiling facial en ritidectomía / Use of fat grafts enriched with platelet growth factors for facial lipofiling in ritidectomy

Presentamos una serie de pacientes a los que hemos realizado infiltraciones de grasa enriquecida con Factores de Crecimiento Plaquetario (F.C.P.) como único procedimiento. Igualmente presentamos casos donde las infiltraciones van acompañadas con otros procedimientos (liftingtemporal, lifting cérvico-frontal, etc.). También usamos el plasma rico en F.C.P. en forma de coágulo para rellenar el surco de la cuenca orbitaria (“Tear Through”),y como mesoterapia facial enriquecida con nutrientes. El objetivo de este trabajo es presentar una revisión detallada de los pasos a seguir para la realización de éste procedimiento, que van desde la simple extracción de sangre para la posterior obtención de F.C.P. hasta la técnica de infiltración de grasa enriquecida con dichos factores a nivel facial. Con esta técnica de enriquecimiento de la grasa hemos logrado tener mejores resultados y con mayor permanencia. Evaluando los postoperatorios de pacientes sometidos a este procedimiento, hemos observado que el volumen infiltrado en áreas como la región malar, se mantiene entre un 90% a 95%. En otras áreas como labios y surcos nasogenianos (áreas de gran movilidad), solo permanece entre el 50% a 60% del volumen infiltrado (AU)

We present a serie of patients with facial fat infiltration enriched with platelet-derived growth factors, some of them associated to other surgical procedures (temporal lifting, cervico-frontal lifting, etc.) We explain how to use this platelet – rich plasma to fill the tear – through and as a facial mesotherapy. Our purpose is to present a detailled review of our method: since blood extraction to the last obtention of the platelet – derived growth factors and the use of this plasma combined with fat infiltration in the facial area. With this methodology we have got better and more permanent results. We have evaluated 90-95 % fat grafts survival in malar region. In other facial areas such as lips or nasogenian folds (big movement areas), we only report about 50 to 60% fat graft survival (AU)

Our algorithm for nasal reconstruction.

Nasal reconstruction is always challenging for plastic surgeons. Its midfacial localisation and the relationship between convexities and concavities of nasal subunits make impossible to hide any sort of deformity without a proper reconstruction. Nasal tissue defects can be caused by tumor removal, trauma or by any other insult to the nasal pyramid, like cocaine abuse, developing an irreversible sequela. Due to the special characteristics of the nasal pyramid surface, the removal of the lesion or the debridement must be performed according to nasal subunits as introduced by Burget. Afterwards, the reconstructive technique or a combination of them must be selected according to the size and the localisation of the defect created, and tissue availability to fulfil the procedure. An anatomical reconstruction must be completed as far as possible, trying to restore the nasal lining, the osteocartilaginous framework and the skin cover. In our department, 35 patients were operated on between 2000 and 2002: three bilobed flaps, five nasolabial flaps, two V-Y advancement flaps from the sidewall, three dorsonasal flaps modified by Ohsumi, 19 paramedian forehead flaps, three cheek advancement flaps, three costocondral grafts, two full-thickness skin grafts and two auricular helix free flaps for alar reconstruction. All flaps but one free flap survived with no postoperative complications. After 12-24 months of follow-up, all reconstructions remained stable from cosmetic and functional point of view. Our aim is to present our choice for nasal reconstruction according to the size and localization of the defect, and donor tissue availability.

Hip and buttock implants to enhance the feminine contour for patients with HIV.

The antiretroviral therapy for patients with human immunodeficiency virus (HIV) causes lipodystrophy, or a change in the distribution of body. Treatment for the facial changes is well addressed and covered in the recent literature, but female patients also report changes in their buttocks and lower limbs. There is no treatment for the lower limb deformity, but plastic surgeons can do something for the buttock. The authors propose a classification for the deformities of these patients and a new solution to improve the contour of this area and to reduce the social impact of deformity on women with HIV. This consists of placing two silicone implants, in the buttock and on the hip, to give a rounder appearance. The authors think that hip implants may be indicated also for gender reassignment surgery and for women with masculine features.

Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps.

Soft tissue heel defects reconstruction represents a challenge for plastic surgeons because of the poor availability of regional tissue to perform the reconstruction. We divide the heel on the anterior or weight-bearing heel and the posterior or non-weight-bearing heel. Our preferences are the fasciocutaneous instep flap for anterior heel defects and the reverse sural flap for posterior heel defects. We have performed 11 reconstructions of the heel. The complications were total necrosis of 1 instep flap in a previously irradiated patient and 1 case of partial tip necrosis in a reverse sural flap. Functional recovery has been very satisfactory for both procedures. Regional island flaps are for us the first therapeutic option because the skin is similar to the lost one and less time consuming than a free-flap reconstruction.

Forehead flag flap.

We present a modification of the Okada and Maruyama's flap for forehead reconstruction, based solely on the supratrochlear vessels. The flap is raised extra-periosteally but in the area of the pedicle the periosteum is included in the flap to protect the vessels. The flap is advanced and rotated to cover full thickness defects on the contralateral hemi-forehead, like a flag on its flagpole. We have treated six patients with large malignant tumours of the forehead which required excision including the periosteum. The flap survived in all cases and no necrosis was observed in any. The main advantage of this flap is that it is relatively straightforward to raise, being a good solution in selected cases (elderly patients). The main disadvantages of this flap are that the supraorbital nerve is sacrificed and some distortion of the eyebrows occurs.

Los marcadores biológicos en el envejecimiento. El entendimiento de la expresión genética / Biomarkers of aging. Understanding gene expresión

El autor enfatiza la temática respecto a los marcadores biológicos: qué son, para qué sirven y cómo el profesional puede obtener, de forma objetiva, los datos biológicos que expresen 1a situación biológica del individuo en un momento determinado respecto a su envejecimiento. Enumera los distintos marcadores biológicos objetivos ( 1a situación hormonal, procesos inmunológicos, metabolismo óseo, cerebral, nivel del pH) así como los subjetivos ( esperanza de vida, salud de la familia e individual, la importancia de los factores ambientales, personales y su actitud ante la vida), analizando los distintos sistemas de obtención de datos. Establece una diferenciación entre los marcadores biológicos modificables y los que no lo son. Asimismo, analiza los procesos de reparación del ADN y los tratamientos que pueden condicionar una mejoría en este proceso. Finalmente, expone los cuatro puntos esenciales en los que el cirujano plástico puede actuar con el fin de retrasar o modificar positivamente el proceso natural del envejecimiento (AU)

Los radicales libres. Sistema inmunitarlo y envejecimiento / Free radicals. Inmune system and aging

El autor expone la importancia de los radicales libres de oxigeno (RLO) en el sistema oxidativo. Explica los mecanismos de la producción de los mismos, su origen y formación tanto a nivel del ADN (que condicionaría una proteogénesis alterada, al actuar directamente sobre la doble hélice del mismo), en las moléculas lipídicas (que sufrirían un proceso de peroxidación con la consiguiente alteración de las mismas) en las proteínas, en la membrana celular y en los lisosomas. Asimismo, repasa tanto las condiciones biológicas como ambientales en las que pueden producirse estos RLO, así como los sistemas de los que se dispone en la actualidad para luchar contra los mismos y neutralizarlos parcialmente (AU)

Cálculo de la Edad Biológica en el Tratamiento Antiaging / Biologic Age Measurement for Antiaging therapies

Los autores presentan una nueva fórmula para contrastar la mejoría en el tratamiento antienvejecimiento, partiendo de un test de anamnesis y modificándolo según un factor de corrección de década, otro basado en el estrés oxidativo y tres factores importantes dentro de las costumbres de nuestro país como son el tabaco, el alcohol y el colesterol de baja densidad de lipoproteínas (AU)

The authors present a new formula to evaluare the improvernent after an antiaging treatment. lt is based on an anamnesis test and modified by a decade correction oxidative factor and three factors irnportant in our culture such as smoking, alcohol and colesterol of low density lipoproteis (AU)

Protocolo Médico en la Terapia del Antienvejecimiento. La Importancia de los Radicales libres / Medical Protocol in Antiaging therapy. Importance of Free Radicals

En este trabajo presentamos las teorías actuales del envejecimiento dando especial importancia al efecto de los radicales libres y las causas que los aumentan que pueden estar a nivel mental, dietético y hormonal. Exponemos los tratamientos basados en ejercicio físico, control del estrés y medicación (AU)

In this paper we present the actual theories for antiaging, specially on behalf the effect of free radicals and causes that increase their presence such as mental, diet and hormone. We also explain the treatment based on physical activity, stress control and medication (AU)

[Applications of the CO2 laser scalpel in surgery]. / Aplicaciones del bisturí Láser CO2 en cirugía.

The use of CO2 Laser in different surgical fields is presented. Different cutting powers for each tissue are shown as well. Advantages of the CO2 Laser such as less pain, haemorrhage, inflammation, fibrosis, edema. . ., have also assessed. According to its characteristics, we find it specially indicated in oncologic surgery, hemophilia and in highly vascularized tissues. It is also very useful when operating cavities with a difficult surgical approach, because of its reflective property.