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1.
Clin Plast Surg ; 49(1): 191-195, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782136

RESUMO

Nonsurgical rhinoplasty is increasing in popularity, and when used appropriately, can be less costly and have less downtime than surgical rhinoplasty. It can offer patients a means of seeing how they would feel about a surgical rhinoplasty later. Injection can be safe but patients should still be counseled regarding the rare, possible risks of tissue loss and potentially irreversible tissue ischemia and irreversible blindness. Treatment with hyaluronidase can be partially effective when signs and symptoms are caught early; however, avoidance is still the best medicine along with seeking an experienced, qualified rhinoplasty plastic surgeon.


Assuntos
Rinoplastia , Humanos , Isquemia , Nariz/cirurgia
3.
Plast Reconstr Surg ; 148(4): 927-929, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34550952
5.
Aesthet Surg J Open Forum ; 3(1): ojab008, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33824950

RESUMO

Background: Chemical peels are an exceedingly popular cosmetic treatment with a wide variety of suppliers, each with its own online health resource describing the procedure. With increasing reliance on the internet for medical information, it is crucial that these resources provide reliable information for patients to make informed decisions. Objectives: The aim of this study was to examine popular chemical peel resources and determine if those that offered chemical peel treatments (Sales) had lower readability, quality of information, and technical features compared with those that did not (Scholarly). Methods: The term "chemical peel" was searched in July 2020 and the top 50 websites were retrieved for analysis. Each resource's readability, quality, and technical features were measured through 8 readability formulas, the DISCERN and Health on the Net Code (HONcode), and 2 website performance monitors. Results: The 50 websites were analyzed with an average Fry readability score of 13th grade. Scholarly websites displayed higher readability than Sales (Flesch Reading Ease 54.4 > 47.4, P = 0.047 and Coleman-Liau Index 10.6 < 11.7, P = 0.04). Scholarly resources surpassed Sales both in quality (DISCERN 56.4 > 39.7, P < 0.001 and HONcode 11.8 > 9.5, P = 0.032) and technical features (WooRank 76.9 > 68.6, P = 0.0082). Conclusions: The average readability of chemical peel resources is too difficult, and their quality must be improved. Scholarly resources exhibited higher readability, quality, and technical features than Sales websites.

6.
Plast Reconstr Surg Glob Open ; 9(1): e3353, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33552813

RESUMO

A hands-on facial fracture simulation course can be an important adjunct teaching modality in resident education and training, enhancing both resident confidence and competence in treatment of facial fractures. In this study, 11 plastic surgery residents participated in a surgical wet laboratory and lecture focusing on operative management of facial fractures. Pre- and post-course questionnaires were administered as clinical knowledge assessments. Pre-course, 40% of participating residents reported feeling comfortable with facial fracture management (>5 of 10) and 50% of residents achieved competence on clinical assessment (scoring >50%). Following the simulation course, these same assessments were re-administered. Post-course, comfortability with fracture management increased to 100% among participating residents, and 90% of residents scored >50%, demonstrating improvement in clinical competency.

7.
Ann Plast Surg ; 86(6): 726-730, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33074836

RESUMO

ABSTRACT: Breast augmentation is among the most commonly performed cosmetic procedures in the United States. As these patients age or develop comorbidities, surgeons across many other disciplines will inevitably encounter these patients in their own practices. Consequently, surgeons must be aware of the potential interactions between breast implants and devices commonly used in their fields. This case, the second of its kind encountered by our own department, describes a woman who suffered one such interaction: migration and coiling of a ventriculoperitoneal shunt around her breast implant. A systematic review was conducted to characterize breast-related ventriculoperitoneal shunt complications reported in the literature and generate an algorithm for management of the most commonly reported scenarios. Recognition of potential complications will aid surgeons in appropriate operative planning and prevention of these adverse events.


Assuntos
Implante Mamário , Implantes de Mama , Mamoplastia , Mama , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Feminino , Humanos , Estados Unidos , Derivação Ventriculoperitoneal/efeitos adversos
9.
Ann Plast Surg ; 80(1): 54-58, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28930782

RESUMO

INTRODUCTION: Despite the advances in cutaneous melanoma management, the false-negative rates (FNRs) of sentinel lymph node biopsy (SLNB) are still high. These rates are dependent not only on the technique but also on definitional terms and percentage of head/neck melanoma (highest false-negative SLNB). Fluorescence imaging technology is well acquainted in plastic surgery and other specialties. Having demonstrated that fluorescence-assisted SLNB is effective in melanoma, we are interested in determining its FNR. METHODS: We obtained institutional review board approval to follow up prospectively all patients with cutaneous melanoma who underwent radioisotope/fluorescence-assisted SLNB with the intent to capture 100 negative SLNB patients. Inclusion criteria were as follows: (1) National Comprehensive Cancer Network criteria; (2) an SLNB report; (3) at least 24 months of follow-up in the negative SLNB group. The outcome variables were FNR and adjusted FNR of SLNB, considering the criterion standard of assessing the accuracy of SNLB. The FNR was defined as the proportion of patients with false-negative SLNB to patients with true-positive and false-negative SLNB [false negative/(false negative + true positive)]. Adjusted FNR refers to the previously described false-negative SLNB, but in the absence of local/in-transit recurrence or distant metastases. Furthermore, false-negative incidence (false-negative/negative SLNB patients) was also calculated. Length of follow-up was date of surgery to the date of last follow-up/death. RESULTS: A total of 125 participants, with 52.0% being male and 48.0% being female, were included. One hundred patients had an SLNB negative for metastases, whereas the rest had positive SLNB results. Median follow-up time of the cohort and that of the negative SLNB group were 36.7 (2.6-58.5) and 37.9 (24.0-58.5) months, respectively. A relatively high number (24.8%) of head/neck melanoma were included. We identified 2 cases of false-negative SLNB, with one having in-transit metastases. Thus, the FNR and adjusted FNR were 7.4% and 3.7%, respectively. The false-negative incidence and adjusted false-negative incidence were 2.0% and 1.0%, respectively. CONCLUSIONS: This is the first prospective study examining the FNR of fluorescence-assisted SLNB for patients with cutaneous melanoma. Our study reveals that this technique has one of the lowest FNRs published, especially considering the large percentage of participants with head/neck melanoma involved.


Assuntos
Melanoma/patologia , Imagem Óptica , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/patologia , Adulto , Idoso , Reações Falso-Negativas , Feminino , Seguimentos , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia
10.
J Craniofac Surg ; 28(3): 693-695, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28468150

RESUMO

BACKGROUND: Craniofacial teams employ multidisciplinary clinics to optimize patient care. Different clinic formats exist among teams. Formats include providers rotating from room to room as separate specialties, patients rotating from room to room to either separate specialties or as 1 group, as well as providers rotating together as 1 group. Surveys were used to study family preferences between the different formats and to compare them with trends of national practices. METHODS: Families of the authors' team clinic patients were surveyed from November 2012 to February 2013, after a clinic format change from patients moving between rooms to see providers, to providers moving between rooms to see patients. This survey focused on patient satisfaction, clinic format preference, and their perception of efficiency. A second, national survey was distributed to 161 American craniofacial teams approved by the American Cleft Palate-Craniofacial Association to survey clinic formats, provider satisfaction, and experience with other formats. Institutional survey data were tabulated as percentages and further analyzed using the Mann-Whitney Test. The national survey data was then tabulated and compared with authors' institutional results. RESULTS: Thirty-nine of 54 (72.2%) families responded to the institutional survey. Providers moving between rooms were associated with greater patient satisfaction (mean 4.8 of 5, 5 being most satisfied) (0<0.0001), shorter perceived clinic time (76.9%), and an increased sense of comfort (84.6%). The difference in satisfaction rates was statistically significant (P <0.0001) between the primary clinic formats of providers rotating (mean of 4.8) and patients rotating (mean of 2.4).The national survey had 93 responses of 161 (57.7%). 54.9% of respondents have providers rotating between examination rooms, and 32.3% have patients moving between rooms. Other formats included the entire team moving as a group between rooms (10.8%) and specialties sitting together in 1 room while patients rotate (9.7%). Respondents were satisfied with current formats (mean 4.24 of 5, 5 being most satisfied). 22.2% had tried a different format previously. CONCLUSION: The most common American cleft and craniofacial clinic format is providers moving between rooms; however, all formats have high provider satisfaction. At our institution, patients prefer when providers move between rooms. Our study suggests that clinic formats do not need to be standardized, and the clinic format utilized should be tailored to the individual needs of the institution.


Assuntos
Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Bucais/normas , Satisfação do Paciente , Procedimentos Cirúrgicos Reconstrutivos/normas , Sociedades Médicas , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Inquéritos e Questionários , Estados Unidos
11.
J Plast Reconstr Aesthet Surg ; 70(6): 752-758, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28286041

RESUMO

BACKGROUND: We report the long-term outcome analysis of 12 patients who underwent two-stage abdominal wall reconstruction using combined submuscular tissue expansion and anterior components separation (CS) technique. METHODS: Outcome measures were (1) the patients were assessed for the presence or absence of recurrence; (2) patient-reported outcomes on physical functioning in relation with the abdominal wall reconstruction were evaluated using the SF 36-item health survey. RESULTS: The mean age, average expansion volume, and mean time expansion were 37.5 years, 1250 cc, and 9.5 weeks, respectively. The average soft tissue deficiency size was 15.5 (width) × 19.5 (length) cm2. The average fascial defect was 17 (width) × 21.5 (length) cm2. No mesh-assisted technique was required. Primary closure was obtained in all. The average follow-up was 39.6 months. Hernia recurrence was noted in one patient (8.3%). All 12 patients completed the SF 36-item health survey. Moreover, 75% of the patients reported 100%, indicating "Not limited in vigorous activities," and 25% indicated "limited a little." All patients reported 100% "not limited at all" in lifting or carrying groceries, climbing several flights of stairs, climbing one flight of stairs, bending, kneeling, stooping, walking more than a mile, walking several blocks, walking one block, bathing, or dressing. CONCLUSIONS: Parietal laxity obtained with tissue expansion increases the possibility of direct closure of the fascial layer, skin, and subcutaneous tissue components. Combined use of tissue expansion and CS may result in favorable long-term outcomes as evidenced by patient-reported physical functioning data and low rate of hernia recurrence.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Expansão de Tecido/métodos , Atividades Cotidianas , Adulto , Feminino , Seguimentos , Herniorrafia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Expansão de Tecido/efeitos adversos , Resultado do Tratamento
12.
J Craniofac Surg ; 27(1): 258-63, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26751427

RESUMO

BACKGROUND: The current study was performed to elucidate changes in growth factor expression over time in critical-sized calvarial defects in rats from infancy to skeletal maturity. MATERIALS AND METHODS: Critical-sized parietal defects of 5, 6, and 8 mm were created in postnatal day 6 (P6), postnatal day (P20), and postnatal day (P84) adult rats, respectively. Dura was harvested at 3, 7, or 14 days after surgery, and serial micro-computed tomography imaging was performed through 12 weeks postoperatively. Absolute quantitative polymerase chain reaction was performed for Bone Morphogenic Protein-2 (BMP-2), Fibroblast Growth Factor-2 (FGF-2), Insulin-like Growth Factor-1 (IGF-1), and Transforming Growth Factor-ß1 (TGF-ß). RESULTS: The P6 (6-d-old) rats showed the greatest difference in gene expression between the dura derived from the defect side and the dura derived from the control side, demonstrating significant differences in TGF-ß1, BMP-2, IGF-1, and FGF-2 at various time intervals. Absolute gene expression in the defect dura was highest in the P6 rats and declined with age. Significant differences were noted at limited time points in the P20 rats for TGF-ß1 and BMP-2 as well as in the P84 rats for TGF-ß1. TGF-ß1 was the only gene studied that showed significant differences at postoperative days 3, 7, and 14 in varying age groups. CONCLUSIONS: The P6 rats have a higher osteogenic potential accompanied by a more vigorous alteration in growth factor expression compared with the P20 or P84 rats. Decrease in BMP-2 and FGF-2 as well as relative increase in TGFß-1 messenger RNA were observed in healing defects. These data provide valuable insight into the mechanism of healing of critical-sized defects and may be of use to engineer factor-releasing implants to correct skull defects.


Assuntos
Envelhecimento/genética , Doenças Ósseas/fisiopatologia , Peptídeos e Proteínas de Sinalização Intercelular/genética , Osteogênese/genética , Osso Parietal/fisiopatologia , Animais , Doenças Ósseas/genética , Proteína Morfogenética Óssea 2/genética , Dura-Máter/química , Fator 2 de Crescimento de Fibroblastos/genética , Expressão Gênica , Imageamento Tridimensional/métodos , Fator de Crescimento Insulin-Like I/genética , Masculino , Osso Parietal/química , RNA Mensageiro/genética , Ratos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos , Fator de Crescimento Transformador beta/genética , Fator de Crescimento Transformador beta1/genética , Cicatrização/genética , Microtomografia por Raio-X/métodos
13.
Plast Reconstr Surg ; 134(6): 1306-1311, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25415096

RESUMO

BACKGROUND: The Global Burden of Disease ranks migraine headache among the most disabling of conditions, and in the United States, migraine headache is one of the top five causes of visits to the emergency room. As migraineurs turn to surgical treatment for relief, it is unknown how migraine frequency influences outcomes. METHODS: In total, 488 patients prospectively completed the migraine headache questionnaires preoperatively and at least 11 months postoperatively. Patients were grouped into three cohorts based on migraine frequency of one to 14 per month (episodic), 15 to 29 per month (chronic), or at least daily (daily). Statistics were performed with paired t tests, linear regression, and analysis of variance with Tukey's honestly significant difference test. RESULTS: All groups experienced a significant benefit from surgery in terms of frequency, duration, and severity of migraine headache, and Migraine Headache Index. Patients experienced significantly different final outcomes based on their frequency cohort with respect to duration (p = 0.02), frequency (p < 0.0001), and Migraine Headache Index (p < 0.0001). However, when the preoperative score is controlled for, the only significant difference between cohorts occurred in Migraine Headache Index among daily migraineurs compared with episodic (p = 0.0003) and chronic (p = 0.0008) migraineurs. No other significant findings persisted. CONCLUSIONS: All cohorts, regardless of their frequency of migraine headache, achieved significant improvement in frequency, duration, severity, and Migraine Headache Index. The groups also achieved statistically different final outcomes, but no group benefits more than the other when improvement is quantified, and patients can expect similar relative improvement.


Assuntos
Transtornos de Enxaqueca/cirurgia , Período Pré-Operatório , Índice de Gravidade de Doença , Doença Crônica , Seguimentos , Humanos , Modelos Lineares , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
14.
Plast Reconstr Surg ; 134(2): 294-300, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25068328

RESUMO

BACKGROUND: The optimal strategy for correction of significant nasal angulation in patients with unilateral coronal synostosis remains controversial. The authors report a novel technique for correction of significant nasal angulation in these patients, in which dissection of the nasal bones is limited to the site of the osteotomy, maintaining continuity with the soft-tissue envelope and the nasal cartilages. METHODS: Seven successive patients with unilateral coronal synostosis and nasal deviation of greater than 6 degrees by computed tomographic analysis were evaluated. Three patients were treated using ex vivo repositioning in which the nasal bones were freed completely from the surrounding soft-tissue envelope, and four patients were treated with in vivo repositioning by performing a subperiosteal dissection only where required for lateral nasal osteotomies without separating the nasal bones from the cartilaginous framework of the nose. Nasal angulation was calculated using clinical photographs and three-dimensional computed tomography preoperatively and at 1-year follow-up. RESULTS: Mean nasal angulation was reduced from 9.5 degrees to 2.5 degrees by computed tomographic analysis (p<0.001) and from 6.9 degrees to 1.9 degrees by photographic analysis (p<0.01) 1 year postoperatively. There was no significant difference in outcome between patients who underwent ex vivo or in vivo repositioning. CONCLUSIONS: Primary surgical correction of significant nasal angulation in patients with unilateral coronal synostosis can be achieved with less dissection and disruption of soft-tissue relationships than previously described without compromise in efficacy. The authors' technique for osteotomy of the nasal bones preserves nasal architecture, minimizes periosteal dissection, and may theoretically reduce the potential for growth disruption. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Craniossinostoses/cirurgia , Rinoplastia/métodos , Adolescente , Criança , Pré-Escolar , Craniossinostoses/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Lactente , Osteotomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Aesthetic Plast Surg ; 38(1): 83-89, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24399148

RESUMO

Prominent ear is the most common deformity of the external ear. The major causes can be an underdeveloped antithetical fold, concha hypertrophy, and prominence of the ear lobule. Since Ely's first aesthetic correction of the prominent ear in 1881, more than 200 different techniques have been described, but the choice of procedure still remains the surgeon's preference. This report presents the laterally based posterior auricular dermal flap technique as an adjunct to the conventional cartilage-sparing otoplasty. An elliptical skin incision was planned according to the classic prominent ear correction technique. Instead of the excision, skin was deepithelialized. From the inferior border of the incision, the dermal flap was incised and elevated in a medial-to-lateral direction. The posterior auricular dermal flap was used to support and cover the suture material. This method was used in the treatment of 17 consecutive patients. After a follow-up period of 6-32 months (mean 16 months), the patients were evaluated in terms of the recurrence and suture line problems. No suture line problems or recurrences were observed at the end of the follow-up period. Use of the posterior auricular dermal flap both prevents suture extrusion and decreases recurrences. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Técnicas Cosméticas , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Retalhos Cirúrgicos , Técnicas de Sutura , Suturas , Adolescente , Adulto , Criança , Pré-Escolar , Falha de Equipamento , Feminino , Humanos , Masculino , Prevenção Secundária , Adulto Jovem
16.
Plast Reconstr Surg ; 132(4): 933-943, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24076684

RESUMO

BACKGROUND: Secondary cleft nasal deformity in children of primary school age can result in permanent impact to a child's self-esteem. The ideal technique and timing of addressing the deformity remain controversial, as harvest of septal cartilage affects nasal growth and limits future options. METHODS: Fifty-three patients underwent secondary cleft nasoplasty with resorbable plate placement as a columellar strut. All patients had standardized preoperative and postoperative photographs. Basilar photographs were analyzed for height and width of each nostril, height and width of the nose, and deviation of the nasal tip from midline. RESULTS: In unilateral clefts, improvements in nostril width, nostril height, tip height, and tip deviation were found to be statistically significant in early postoperative photographs; improvements in nostril height, tip height, and tip deviation remained statistically significant in late photographs. In patients with bilateral clefts, improvements in nostril height and tip height were found to be significant in early postoperative photographs, with improvement in nostril height remaining significant in the long term. Partial plate exposure limited to the columellar base occurred in five patients (9.4 percent), successfully treated in the clinic setting with no loss of nasal tip support. CONCLUSIONS: The authors provide quantitative data regarding nasal outcomes following secondary cleft nasoplasty using resorbable plates for tip support. Significant long-term improvements in nasal appearance are possible using this technique with minimal complications. In those patients presenting with cleft nasal deformity at primary school age, the use of resorbable plates can improve nasal symmetry and spare native cartilage and thereby reduce the potential for nasal growth disturbance. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Implantes Absorvíveis , Fenda Labial/cirurgia , Septo Nasal/cirurgia , Rinoplastia/métodos , Adolescente , Criança , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Masculino , Cartilagens Nasais/crescimento & desenvolvimento , Cartilagens Nasais/patologia , Cartilagens Nasais/cirurgia , Septo Nasal/crescimento & desenvolvimento , Septo Nasal/patologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
17.
Plast Reconstr Surg ; 132(6): 1551-1556, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24005368

RESUMO

BACKGROUND: This study maps the course of the lesser occipital nerve and its potential compression sites in the posterior scalp. METHODS: Twenty sides of 10 fresh cadaveric heads were dissected. Two fixed anatomical landmarks were used: the y axis was the vertical midline in the posterior scalp through the midline of the cervical spine. The x axis was a horizontal line drawn between the most anterosuperior points of the external auditory meatus. A topographic map of the lesser occipital nerve and its potential compression points was created. RESULTS: The lesser occipital nerve emerged from the posterior border of the sternocleidomastoid muscle at an average of 6.4 ± 1.4 cm lateral to the y axis and 7.5 ± 0.9 cm caudal to the x axis. Branches of the occipital artery were found to interact with the lesser occipital nerve in 11 of the 20 hemiheads (55 percent). The mean location of the artery-nerve interaction was 5.1 ± 0.9 cm lateral to the y axis and 2 ± 1.45 cm caudal to the x axis. Two patterns of artery-nerve interaction were seen: a single site of artery crossing over the nerve in nine of 20 hemiheads (45 percent) and a helical intertwining relationship in two of 20 of hemiheads (10 percent). A fascial band was identified to compress the lesser occipital nerve in four of 20 hemiheads (20 percent). CONCLUSION: This anatomical study traced the lesser occipital nerve as it courses through the posterior scalp and mapped its potential decompression sites.


Assuntos
Descompressão Cirúrgica , Transtornos de Enxaqueca/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Nervos Espinhais/anatomia & histologia , Nervos Espinhais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Cadáver , Vértebras Cervicais/inervação , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/etiologia , Síndromes de Compressão Nervosa/complicações , Couro Cabeludo/inervação
18.
Plast Reconstr Surg ; 132(5): 1085-1092, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23924651

RESUMO

BACKGROUND: The purpose of this study was to identify the specific components of facial aging secondary to smoking, by comparing standardized photographs of identical twins with different smoking histories. METHODS: During the Twins Days Festival in Twinsburg, Ohio, from 2007 to 2010, 79 pairs of twins were identified, in which only one twin smokes or where one twin smoked at least 5 years longer than his or her counterpart. Questionnaires were obtained and standardized photographs were taken by professional photographers. A panel of three blinded judges analyzed the twins' facial features and graded wrinkles using the validated Lemperle Assessment Scale, and ranked age-related facial features on a four-point scale. RESULTS: Smoking twins compared with their nonsmoking counterparts had worse scores for upper eyelid skin redundancy, lower lid bags, malar bags, nasolabial folds, upper lip wrinkles, lower lip vermillion wrinkles, and jowls. Lower lid hyperpigmentation in the smoking group fell just short of statistical significance. Transverse forehead wrinkles, glabellar wrinkles, crow's feet, and lower lip lines accentuated by puckering did not have a statistically significant differences in scores. Among twins with greater than 5 years' difference in smoking duration, twins who had smoked longer had worse scores for lower lid bags, malar bags, and lower lip vermillion wrinkles. CONCLUSIONS: This study details the specifics of facial aging brought on by smoking, which primarily affects the middle and lower thirds of the face. It also demonstrates that a 5-year difference in smoking history can cause noticeable differences in facial aging in twins. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Face/patologia , Envelhecimento da Pele/patologia , Fumar/efeitos adversos , Adolescente , Adulto , Idoso , Doenças em Gêmeos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Gêmeos Monozigóticos , Adulto Jovem
19.
Plast Reconstr Surg ; 132(1): 78-82, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23806911

RESUMO

BACKGROUND: Dietary supplement use is common in the United States. Some herbal supplements may cause coagulopathy, hypertension, or dry eyes. The goal of this study is to reveal the incidence of herbal supplement use in the cosmetic surgery population. METHODS: A retrospective chart review of 200 patients undergoing facial cosmetic surgery performed by a single surgeon was performed. Variables studied included patient age, sex, surgical procedure, herbal medication use, and intraoperative variables. Exclusion criteria were age younger than 15 years, noncosmetic procedures such as trauma, and incomplete preoperative medication form. Patients were subdivided into the supplement user group (herbal) and the supplement nonuser group (nonherbal). Statistical analysis included descriptive statistics, t test, and chi-square analysis. RESULTS: The incidence of supplement use was 49 percent in the 200 patients; 24.5 percent of patients used only vitamins or minerals, 2.5 percent of patients used only animal- and plant-based (nonvitamin/mineral) supplements, and 22 percent of patients used both types of supplements. In the herbal group, patients used an average of 2.8 supplements. The herbal and nonherbal groups differed significantly in sex (herbal, 89.8 percent female; nonherbal, 77.5 percent; p < 0.04) and age (herbal, 51.4 years; nonherbal, 38.5 years; p < 0.001). CONCLUSIONS: Herbal supplement use is prevalent in the facial cosmetic surgery population, especially in the older female population. Considering the potential ill effects of these products on surgery and recovery, awareness and careful documentation and prohibiting the patients from the consumption of these products will increase the safety and reduce the recovery following cosmetic procedures.


Assuntos
Blefaroplastia , Suplementos Nutricionais/estatística & dados numéricos , Minerais/farmacologia , Preparações de Plantas/farmacologia , Rinoplastia , Ritidoplastia , Vitaminas/farmacologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Fitoterapia/métodos , Fitoterapia/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
20.
Plast Reconstr Surg ; 131(1): 159-167, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23271525

RESUMO

BACKGROUND: Symptomatic dryness of the eyes is a most common blepharoplasty complication. The authors reviewed the medications and herbal products that may potentiate this complication. METHODS: The MEDLINE and PubMed databases were searched for the years 1991 to 2011. Search terms included "dry eye syndrome," "keratitis sicca," "keratoconjunctivitis sicca," "ocular side effects," "herbal supplements," "herbals and dry eye," "dry eye risk factors," "etiology of dry eye," "drugs side effects," "drugs and dry eye," "dietary supplements," "ocular toxicity," and "tear film." References from herbal product reviews and eligible medication reports were searched for additional articles. A manual search was also conducted based on citations in the published literature. RESULTS: Of 232 articles found to be related to dry eye syndrome and possible risk factors, 196 were excluded because they did not discuss medications or herbal products as risk factors in dry eye syndrome. Thirty-six articles that examined the pathophysiology and risk factors of dry eye were included. Nine books were reviewed that contained some information regarding the association of medications and herbal products with dry eye. These agents were then categorized based on mechanism of action and usage. Medications listed include antihistamines, decongestants, antidepressants, anticonvulsants, antipsychotics, antiparkinson drugs, beta-blockers, and hormone replacement therapy. The three main herbal products that contribute to dry eye are niacin, echinacea, and kava. There was a strong association between anticholinergic alkaloids and dry eye. CONCLUSION: This study identifies the medications and herbal products that should be considered when a patient undergoes blepharoplasty and complains of symptoms associated with dryness of the eyes.


Assuntos
Blefaroplastia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Síndromes do Olho Seco/induzido quimicamente , Preparações de Plantas/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Síndromes do Olho Seco/etiologia , Humanos , Fatores de Risco
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