1
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Cazzato V, Ellis C, Makris S. 'Magic cosmetic fillers': Appearance-enhancement effects on self-face recognition. PLoS One 2024; 19:e0305580. [PMID: 38870257 PMCID: PMC11175468 DOI: 10.1371/journal.pone.0305580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
People naturally exhibit a self-serving bias which can be observed in their tendency to judge their own physical attractiveness more favourably than that of others. Despite this positive self-perception, minimally invasive cosmetic injectable procedures for facial rejuvenation and enhancement are becoming increasingly common. It remains unclear, however, whether recognizing an altered version of one's own face, enhanced cosmetically, correlates with a positive view of cosmetic surgery and excessive preoccupations about physical characteristics perceived as defects (body dysmorphic concerns). In this study, 30 healthy female participants, aged 18-24 years (Mage = 21.1 years, SD = 1.6), engaged in a face recognition task during which their faces were digitally morphed with that of gender-matched unfamiliar women who had undergone cosmetic enhancements, specifically lip and cheek fillers. The duration of exposure to these modified faces varied with short (500 msec) and long (2000 msec) viewing periods. Participants were asked to identify whether the digital morphs represented themselves or the other woman. Self-reports regarding acceptance of cosmetic surgery and dysmorphic concerns were collected. Participants PSE indicated a tendency towards self-bias under short presentation times, shifting towards the other as presentation times lengthened. Interestingly, this effect was associated with greater acceptance of cosmetic surgery and higher body dysmorphic concerns. This study underscores the importance of understanding how perceptions of others' physical appearances can influence self-recognition and attitudes towards cosmetic surgery, which may have both positive and potentially harmful implications.
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Affiliation(s)
- Valentina Cazzato
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Messina, Italy
| | - Charlotte Ellis
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Stergios Makris
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
- Arts and Wellbeing Research Centre, Edge Hill University, Ormskirk, United Kingdom
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Bin Rubaian NF, Elfaki AM, Almuhaidib SR, Aldulijan FA, Qasim RS, Nagshabandi KN, Al-Ojail HY, Alsubaie SS. Aesthetic Procedures and Psychological Wellbeing in Saudi College Students: An In-Depth Exploration. Clin Cosmet Investig Dermatol 2024; 17:1365-1376. [PMID: 38881698 PMCID: PMC11178093 DOI: 10.2147/ccid.s462841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024]
Abstract
Purpose Minimally invasive aesthetic procedures are widely popular among the youth. Despite their prevalence, there is a significant gap in the research concerning the relationship between these procedures and psychological wellbeing, as well as an insufficient exploration of the barriers and motivators influencing their adoption, this study aims to address these gaps. Methods This cross-sectional study has utilized a secure online survey directed at Saudi university students as the target population. The survey was consisting of 18-item electronic questionnaire including of 4 parts (demographical data, history of psychological illness and screening of current psychological wellbeing using WHO-5 well-being tool, history of doing cosmetic procedure, or willingness to do in the future, barriers and motivators to do cosmetic procedures), and it was distributed across multiple social media platforms. Results A total of 8443 college students completed the study questionnaire. Exactly 1096 (13%) of the students underwent a cosmetic procedure. The most reported procedures were laser hair removal (9.1%), filler (5.3%), skin boosters (2.8%), and Botulinum toxin A injections (Botox) (2.6%). The most ranked motivators were being painless, with no side effects (8.8 out of 10), followed by being free (8.0 out of 10) and enhancing self-confidence (7.4 out of 10). Conclusion No significant difference recorded at the overall psychological well-being score between who underwent cosmetic procedures and who did not.
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Affiliation(s)
- Nouf F Bin Rubaian
- Department of Dermatology, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | - Fajar A Aldulijan
- Department of Family Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Eastern Province, Saudi Arabia
| | - Raghda S Qasim
- Department of Dermatology, Dammam Medical Complex, Dammam, Saudi Arabia
| | - Khalid Nabil Nagshabandi
- Department of Dermatology, College of Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | | | - Shayma S Alsubaie
- King Fahad University of Petroleum and Mineral, Interdisciplinary Research Center for Finance and Digital Economy, Dhahran, Saudi Arabia
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Liao CD, Zhao K, Nikkhahmanesh N, Bui DT. Decreasing Seroma Incidence Following Abdominoplasty: A Systematic Review and Meta-Analysis of High-Quality Evidence. Aesthet Surg J Open Forum 2024; 6:ojae016. [PMID: 38585023 PMCID: PMC10995621 DOI: 10.1093/asjof/ojae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Background Seroma formation is the most common complication of abdominoplasties. Many preventive interventions have been proposed, but none have been recognized as a definitive solution, partly due to varying levels of evidence (LOE) in the literature. Objectives We aimed to analyze seroma prevention methods supported by high-level evidence. Methods The PubMed database was queried through August 2023. Primary articles of interest included randomized controlled trials (RCTs), prospective comparative studies, and meta-analyses of these studies. The LOE for each article was determined according to the American Society of Plastic Surgeons Rating Scale. The "seroma occurrence ratio," or ratio of seroma events in the interventional group to respective control group, was calculated to compare incidence rates between techniques. Results Twenty articles and 9 categories of techniques were analyzed. Study designs included 10 RCTs, 2 prospective cohort studies, 7 prospective comparative studies, and 1 retrospective randomized study. The use of progressive-tension and quilting sutures had the most data supporting a statistically significant reduction in seroma (occurrence ratio 0.306, P < .001). Tissue adhesives and preservation of Scarpa's fascia were also well reinforced (0.375, P < .01 and 0.229, P < .011, respectively), while increasing the number of drains was not (P = .7576). Meta-analysis demonstrated that compared with 2 drains alone, alternative techniques were more effective at reducing seroma occurrence (pooled risk ratio 0.33, 95% CI, 0.11-0.99). Conclusions This review highlights multiple seroma prevention techniques for abdominoplasty investigated in recent high-quality literature. We suggest future randomized comparative studies of the various seroma prevention methods to fully ascertain their efficacy following abdominoplasty. Level of Evidence 1
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Affiliation(s)
- Christopher D Liao
- Corresponding Author: Dr Christopher D. Liao, 100 Nicolls Rd #271, Stony Brook, NY 11794-8191, USA. E-mail:
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Kohan J, Vyas K, Erotocritou M, Khajuria A, Tehrani K. High-Intensity Focused Electromagnetic (HIFEM) Energy With and Without Radiofrequency for Noninvasive Body Contouring: A Systematic Review. Aesthetic Plast Surg 2024; 48:1156-1165. [PMID: 37957393 DOI: 10.1007/s00266-023-03730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Emsculpt Neo (EmSculpt NEO Device, BTL Industries, Inc.) is a FDA-cleared noninvasive body contouring treatment for increasing muscle tone and/or reducing fat. The device uses high-intensity electromagnetic energy to stimulate muscle contractions and to build muscle mass (Emsculpt) or a combination of electromagnetic energy with radiofrequency (Emsculpt NEO) to produce a synergistic effect of building muscle mass and reducing fat. In this study, we conduct a high-quality systematic review to evaluate outcomes for Emsculpt and Emsculpt NEO treatments for noninvasive body contouring. METHODS An electronic search was performed of the PubMed, MEDLINE, Embase, and Web of Science databases using the key terms "High intensity focused electromagnetic therapy; HIFEM; Emsculpt; Emsculpt NEO; BTL Industries." The search included all articles published in English through January 2023. Inclusion criteria included articles noninvasive body contouring and reporting at least one outcome of interest (clinical or patient-reported outcomes). Methodological quality and risk of bias were assessed using the GRADE criteria. Articles involving applications other than for body contouring, animal studies, and review articles were excluded. RESULTS Of the 159 articles identified in the initial search strategy, 51 met relevance based on abstract screening. Fifteen clinical studies were identified, including Emsculpt (n=11) and Emsculpt NEO (n=2). The typical protocol involved four treatments given over a 2-4-week period (range 3-8 treatments) with increase to 100% intensity setting and 1-6-month follow-ups. No complications were reported. Abdominal measurements were obtained using imaging were reported in eight studies. Treated areas included the buttocks (n=4), thighs (n=3), arms or calves (n=1), and abdomen (n=11). For abdominal contouring, mean reductions of fat thickness were 5.5 mm, muscle thickness of 2 mm, and rectus diastasis improvement of 3.0 mm. No studies reported weight change before and after treatment. All studies with patient-reported outcomes report high patient satisfaction. Two studies report marginal or no benefit of treatment. Certain studies failed to report comorbidities or demographic characteristics other than age and sex, which precludes analysis of specific subgroups that may benefit from treatment. Furthermore, certain studies failed to address how missing data or the final study population was analyzed. CONCLUSION This systematic review reports on currently published evidence regarding the efficacy and safety of Emsculpt and Emsculpt NEO for body contouring. High-quality level data reporting with patient-reported outcomes will optimize shared decision-making and informed consent. LEVEL OF EVIDENCE II Therapeutic study. 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 .
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Affiliation(s)
- Joshua Kohan
- The Robert Larner MD College of Medicine at The University of Vermont, Burlington, Vermont, USA.
- , New York, USA.
| | - Krishna Vyas
- Aristocrat Plastic Surgery and MedAesthetics, New York, New York, USA
| | - Marios Erotocritou
- Kellogg College, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ankur Khajuria
- Kellogg College, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Tehrani
- Aristocrat Plastic Surgery and MedAesthetics, New York, New York, USA
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Anker AM, Lenhard J, Klein SM, Felthaus O, Prantl L, Ruewe M. Standard doses of Triamcinolone do not affect fibroblast cell migration of abdominoplasty patients in-vitro1. Clin Hemorheol Microcirc 2023; 85:307-314. [PMID: 36502314 DOI: 10.3233/ch-229106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent studies have demonstrated that local application of corticosteroids reduces wound exudation following abdominoplasty and other reconstructive surgical procedures. On the other hand, corticosteroids might provoke wound healing disturbances due to their immunosuppressive effects. OBJECTIVE The main objective of this study was to gain further information about the impact of the corticosteroid triamcinolone on cell migration in abdominoplasty patients. METHODS An in-vitro scratch assay wound healing model was applied to observe cell migration of fibroblasts cultured with nutrient medium containing human seroma aspirate±triamcinolone. RESULTS There were no significant differences regarding cell migration when fibroblasts were incubated with triamcinolone + seroma containing culture medium compared to seroma containing culture medium without triamcinolone. CONCLUSIONS The performed in-vitro study suggests that triamcinolone does not decelerate fibroblast cell migration which is considered as a surrogate of wound healing.
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Affiliation(s)
- Alexandra M Anker
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Regensburg, Germany
| | - Jasmin Lenhard
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Regensburg, Germany
| | - Silvan M Klein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Regensburg, Germany
| | - Oliver Felthaus
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Regensburg, Germany
| | - Marc Ruewe
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Regensburg, Germany
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The Jaws Brachioplasty: An Original Technique: Improving Aesthetic Outcomes in Arm Lift Procedures. J Clin Med 2022; 11:jcm11175038. [PMID: 36078966 PMCID: PMC9457159 DOI: 10.3390/jcm11175038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: The increase in the number of bariatric surgery procedures has led plastic surgeons to look for new approaches to improve outcomes of body-contouring surgeries. A major concern in brachioplasty is the scarring process. Here, we propose a novel technique to minimize the incidence of pathological or unsatisfactory scars from brachioplasty. A video of the entire procedure is provided. (2) Methods: From January 2016 to August 2020, we performed the “Jaws” brachioplasty on 16 post-bariatric patients. We evaluated the effectiveness of the technique through pre- and postoperative assessments by patients and surgeons, the Vancouver Scar Scale, and the detection of major and minor complications within 12 months of follow-up. (3) Results: Thirteen patients were female and three were male, with a mean age of 32.5 ± 6.8 years (range: 22–47 years). The BODY-Q© Arms Section scores improved significantly, with no incidence of major or minor complications over 1 year of follow-up, and favorable aesthetic outcomes. (4) Conclusions: We believe that the “Jaws” technique is a valid contribution to post-bariatric surgery, as it aims to solve specific aesthetic problems of scarring from brachioplasty. The small number of patients does not allow the comparison of our original technique to others previously described in the literature.
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Salari N, Fatahi B, Bartina Y, Kazeminia M, Heydari M, Mohammadi M, Hemmati M, Shohaimi S. The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2821-2836. [PMID: 34080041 DOI: 10.1007/s00266-021-02365-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abdominoplasty is one of the most common cosmetic surgeries performed worldwide. Seroma is also the most common local complication associated with abdominoplasty, which increases care costs, reduces patient satisfaction, and has serious complications for patients. Results of previous studies report different levels of seroma prevalence after abdominoplasty. The aim of this study is to standardize the statistics of the prevalence of seroma after abdominoplasty using meta-analysis. METHODS In this systematic review and meta-analysis study, data from studies conducted on the global prevalence of seroma after abdominoplasty was extracted using the keywords "Prevalence, Epidemiology, Complications, Abdominoplasty, Seroma, and Lipo abdominoplasty" in the databases of Science, Scientific Information Database, MagIran, Embase, Scopus, PubMed, Web of Science, and Google Scholar search engine without time limit until October 2020. The random-effects model was used to analyze the eligible studies, and the heterogeneity of the studies was investigated with the I2 index. Data analysis was performed using Comprehensive Meta-Analysis software (Version 2). RESULTS In reviewing 143 studies (five studies related to Asia, 55 studies related to Europe, three studies related to Africa, and 80 studies related to the Americas) with a total sample size of 27834 individuals, the global prevalence of seroma after abdominoplasty was obtained as 10.9% (95% CI: 9.3-3.6.6%) and the highest prevalence of seroma was related to the Europe continent with 12.8% (95% CI: 10.15-3.9%). The results from meta-regression showed a declining trend in the global prevalence of seroma after abdominoplasty with an increase in the sample size, age of study participants, and the year of study (p < 0.05). CONCLUSIONS This study shows that the prevalence of seroma after abdominoplasty is high globally. Therefore, physicians and specialists must consider its importance and take the controlling and treatment measures seriously. LEVEL OF EVIDENCE III 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behnaz Fatahi
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yalda Bartina
- Department of Translation Studies, Faculty of Literature, Istanbul University, Istanbul, Turkey
| | - Mohsen Kazeminia
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mahvan Hemmati
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
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Safety and efficacy of gluteal contouring based on stromal enriched lipograft in 194 patients. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Pacifico M, Kanapathy M, Dancey A, MacQuillan A, Ross G, Mosahebi A. Summary document on safety and recommendations for aesthetic liposuction: Joint British Association of Aesthetic Plastic Surgeons (BAAPS)/British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) expert liposuction group. J Plast Reconstr Aesthet Surg 2021; 75:941-947. [PMID: 34776388 DOI: 10.1016/j.bjps.2021.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/22/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
Liposuction is one of the commonest surgical aesthetic procedures performed worldwide. Despite being perceived to be a technically simple procedure, poor patient selection, sub-optimal technical execution or sub-optimal peri‑operative management could lead to significant harm. This guidance was produced on behalf of the British Association of Aesthetic Plastic Surgeons (BAAPS) and British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) by the expert liposuction group. The guidance is based on the evidence available in the literature along with specialist expert opinion in aesthetic liposuction to provide plastic surgeons with consensus recommendation. The aim is to identify best practice to maximise the safety of patients. This article summarises current practices and safety considerations and outlines recommendations covering various aspects of patient care.
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Affiliation(s)
- Marc Pacifico
- Purity Bridge, 19 Mount Ephraim, Tunbridge Wells, Kent TN4 8AE, United Kingdom.
| | - Muholan Kanapathy
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London WC1E 6BT, United Kingdom.
| | - Anne Dancey
- Parkway Hospital, 1 Damson Parkway, Solihull B91 2PP, United Kingdom.
| | | | - Gary Ross
- University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London WC1E 6BT, United Kingdom.
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Che DH, Xiao ZB. Gluteal Augmentation with Fat Grafting: Literature Review. Aesthetic Plast Surg 2021; 45:1633-1641. [PMID: 33216176 DOI: 10.1007/s00266-020-02038-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The buttock is the second sex feature of the human body, and the graceful buttock curve gives people confidence. Although the safety of gluteal augmentation with autologous fat grafting is still controversial, the proportion of operations is increasing year by year. PURPOSE To provid a comprehensive and detailed review of the literature on gluteal augmentation with fat grafting. METHODS A comprehensive review of the published literature through September of 2020 was performed in PubMed database, with the search terms "gluteal augmentation," "buttock augmentation," "Brazilian buttock lift," "fat grafting," "fat transfer," "gluteal AND aesthetic," "gluteal AND anatomy." RESULTS A total of 64 articles were included. On the basis of the information obtained, surgical recommendations are proposed to achieve buttocks as close as possible to aesthetic standard and improve surgical safety. CONCLUSION With a good grasp of the anatomical structure of the buttocks, complications can be reduced. At the same time, based on the theoretical basis of buttock aesthetics, better postoperative results can be obtained. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- De-Hui Che
- Department of Plastic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Zhi-Bo Xiao
- Department of Plastic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China.
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Toplu G, Altinel D. Genital Beautification and Rejuvenation with Combined Use of Surgical and Non-surgical Methods. Aesthetic Plast Surg 2021; 45:758-768. [PMID: 32997240 DOI: 10.1007/s00266-020-01980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
AIM In female genital rejuvenation and beautification, interest and demand for combined surgical and non-surgical methods are increasing. This study presents the results of our labia minora reduction technique and a vulvovaginal rejuvenation and beautification concept, where a combination of fat injection into the mons pubis and labia majora, if necessary, combined with fractional carbon dioxide (CO2) laser is used. PATIENTS AND METHODS Genital rejuvenation and beautification were performed on 37 patients between January 2014 and January 2019. Postoperative follow-up for 1 year to obtain data on the satisfaction of surgical and non-surgical procedures was performed. RESULTS Of the 37 female patients included in the study, 33 (94.5%) were satisfied or very satisfied with their postoperative appearance. Thirty (80%) patients were satisfied or very satisfied with functional results. CONCLUSION The described genital beautification and rejuvenation technique combines different aesthetic female genital surgery techniques and non-surgical noninvasive procedures. These procedures, like other plastic surgeries and procedures, are designed for the subjective improvement of the patients' appearance and feelings. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Gaye Toplu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Univeristy of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Dincer Altinel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Univeristy of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
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Demographic and Cultural Differences in the Acceptance and Pursuit of Cosmetic Surgery: A Systematic Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3501. [PMID: 33777604 PMCID: PMC7990019 DOI: 10.1097/gox.0000000000003501] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Abstract
Worldwide, the numbers of cosmetic procedures continue to climb. However, cosmetic surgery (CS) continues to be plagued by negative stigmatization. This study reviews the literature to identify how attitudes toward CS vary by sex, age, race, culture, and nationality, and aims to determine how other factors like media exposure interact with demographics to influence how well CS is accepted. Methods A PRISMA-guided systematic review of the literature was conducted to identify all English-language papers reporting on CS or plastic surgery acceptance, attitudes, or stigmatization, specifically examining for data on age, sex, race/ethnicity, culture, and media influence. Results In total, 1515 abstracts were reviewed, of which 94 were deemed pertinent enough to warrant a full-text review. Among the potential demographic predictors of CS acceptance, the one with the most supportive data is sex, with women comprising roughly 90% of all CS patients in virtually all populations studied and consistently exhibiting greater CS knowledge and acceptance. Culturally, the pursuit of beauty through CS is a universal phenomenon, although different countries, races, and cultures differ in how willingly CS is embraced, and in the aesthetic goals of those choosing to have it. In countries with culturally diverse societies like the United States, non-Hispanic Whites continue to predominate among CS patients, but the number of CS patients of other races is rising disproportionately. In this trend, social media is playing a major role. Conclusion Healthcare practitioners performing cosmetic procedures need to consider demographic and cultural differences of the patients in order to enhance their understanding of their patients' aesthetic goals and expectations.
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Bakhshaee M, Poursadegh M, Irani M, Yazdanpanah MJ, Fayyazi Bordbar MR, Rasoulian B. Post-Rhinoplasty Acne, Frequency and Role Players. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2020; 32:319-325. [PMID: 33014909 PMCID: PMC7515625 DOI: 10.22038/ijorl.2020.41593.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction Acne is a common complain among post rhinoplasty patients. While rhinoplasty is done for aesthetic reasons and acne expressively affects the individual’s appearance, we aimed to study its incidence and role players. Materials and Methods: A descriptive cross-sectional study was performed on 152 (143 females and 9 males) patients admitted for rhinoplasty during January 2016 to March 2017. Patients were examined by a dermatologist prior to surgery and 7, 30 and 90 days after rhinoplasty using the Global Acne Grading System and responded to a list of questions on the probable risk factors of acne. Psychological status was examined by the perceived stress scale-14 and the Hospital Anxiety and Depression Scale. Results: The patients' mean age was 28.9±3.82 yrs. Mild and moderate acne were observed in 21.7% (n=33) of the cases in the preoperative visit. The incidence of mild and moderate acne was 36.1%, 42.8% and 23% after 7, 30 and 90 days of surgery, respectively. One week after rhinoplasty, acne manifested in 14.9% of cases with no history of acne. Mean age significantly differed between those with and without post-surgical acne at all post-surgical visits (P> 0.001 and P=0.001 and P=0.015, respectively). Hospital anxiety and depression and perceived stress levels were significantly higher in patients who presented with acne on the first post-surgical visit compared to those with no acne presentations (P=0.04 and P=0.02, respectively). Conclusion: External psychological stress may be the main role player in post-rhinoplasty acne. Consultation or referral of patients to an experienced psychologist is highly recommended for a better outcome and fewer complications.
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Affiliation(s)
- Mehdi Bakhshaee
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Poursadegh
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Irani
- Department of Otorhinolaryngology-Head & Neck Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Bashir Rasoulian
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Composite Face Lifting: The Combination of Stromal Enriched Lipograft With Face Minilift and Upper and Lower Blepharoplasty: A Review of 210 Cases. Ann Plast Surg 2020; 85:e20-e23. [PMID: 32694458 DOI: 10.1097/sap.0000000000002465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Face rejuvenation is increasingly challenging because patients request minimally invasive surgery; rapid surgical course and recovery; and fast, tangible, and long-term results. Rejuvenation of face often requires surgery to multiple areas, that is, the lateral face, the midface, the neck, and periorbital areas, in addition to the emerging procedures of face volumizing and biostimulation through fat injection. At our institution, a systematic approach comprising all of these procedures has been developed, with consistent results. OBJECTIVE The aim of this study was to describe the combination of blepharoplasty, minilift, and Stromal Enriched Lipograft (SEL) for thorough rejuvenation of face and neck regions. METHODS A prospective study was performed to evaluate outcomes and patient satisfaction with composite face lifting, comprising upper and lower blepharoplasties, minilift, and SEL in 210 patients between 2009 and 2018. Overall improvement after the procedure was rated on a scale of 1 to 5, where 1 is "poor," 2 is "fair," 3 is "good," 4 is "very good," and 5 is "excellent." The evaluation was expressed at 6 months postoperatively by the patient. RESULTS The amount of SEL transplanted varied from 22 to 56 mL per side (mean, 41). There were no cases of liponecrosis, infection of the grafted area, or pulmonary embolism. More than 85% of patients expressed a very good to excellent evaluation of the result obtained. No one expressed a degree of satisfaction less than good. CONCLUSIONS Composite face lifting seems as a safe and effective combined procedure for the rejuvenation of face. Face harmony not only depends on redraping tissues toward a more natural, tense, and young conformation, but also on restoring volumes and improving the quality of the redraped tissues. More research is necessary, but the preliminary encouraging impression is that the composite face lifting is capable of addressing all issues, the necessity of correcting laxity, filling volumes, and improving the quality of cutaneous tissues.
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Akgul Y, Kenkel JM. Commentary on: Cell-Free Fat Extract Increases Dermal Thickness by Enhancing Angiogenesis and Extracellular Matrix Production in Nude Mice. Aesthet Surg J 2020; 40:914-916. [PMID: 32077917 DOI: 10.1093/asj/sjaa001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yucel Akgul
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX
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Severe and massive necrosis following high definition power-assisted liposuction: a case report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01678-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Schuetzenberger K, Pfister M, Messner A, Garhöfer G, Hohenadl C, Pfeiffenberger U, Schmetterer L, Werkmeister RM. Cutaneous optical coherence tomography for longitudinal volumetric assessment of intradermal volumes in a mouse model. Sci Rep 2020; 10:4245. [PMID: 32144359 PMCID: PMC7060266 DOI: 10.1038/s41598-020-61276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Clinical evaluation of skin lesions requires precise and reproducible technologies for their qualitative and quantitative assessment. In this study, we investigate the applicability of a custom-built dermatologic OCT system for longitudinal assessment of intradermal volumes in a mouse model. The OCT, based on an akinetic swept laser working at 1310 nm was employed for visualization and quantification of intradermal deposits of three different hyaluronic acid-based hydrogel formulations - one commercial and two test substances. Hydrogels were applied in 22 BALB/c mice, and measurements were performed over a six-month time period. All hydrogels increased in volume within the first weeks and degraded steadily thereafter. The half-lifes of the test hydrogels (27.2 ± 13.6 weeks for Hydrogel 1, 31.5 ± 17.2 weeks for Hydrogel 2) were higher in comparison to the commercially available HA hydrogel (21.4 ± 12.0 weeks), although differences were not significant. The sphericity parameter was used for evaluation of the deposit geometry. While on the injection day the sphericities were similar (~0.75 ± 0.04), at later time points significant differences between the different test substances were found (T24: PRV 0.59 ± 0.09, Hydrogel 1 0.70 ± 0.11, Hydrogel 2 0.78 ± 0.07; p ≤ 0.012 for all pairs). This study shows the applicability of OCT imaging for quantitative assessment of the volumetric behavior of intradermal deposits in vivo.
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Affiliation(s)
- Kornelia Schuetzenberger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
| | - Martin Pfister
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
- Institute of Applied Physics, Vienna University of Technology, Wiedner Hauptstr. 8-10, 1040, Vienna, Austria
| | - Alina Messner
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Garhöfer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christine Hohenadl
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
- Croma Pharma GmbH, Cromazeile 2, 2100, Leobendorf, Austria
| | - Ulrike Pfeiffenberger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
| | - Leopold Schmetterer
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Singapore Eye Research Institute, 20 College Road Discovery Tower Level 6, The Academia, Singapore, 169856, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Dr, Singapore, 636921, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Institute of Ophthalmology, 4031, Basel, Switzerland
| | - René M Werkmeister
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria.
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Stability of Hyaluronic Acid Fillers After Insulated Microneedle Radiofrequency Treatment. Dermatol Surg 2019; 45:1213-1216. [DOI: 10.1097/dss.0000000000001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fasola E, Bosoni D. Dynamic Quadripolar Radiofrequency: Pilot Study of a New High-Tech Strategy for Prevention and Treatment of Vulvar Atrophy. Aesthet Surg J 2019; 39:544-552. [PMID: 30052757 DOI: 10.1093/asj/sjy180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The well-being of the vulva and a woman's quality of life are strongly correlated. Dynamic quadripolar radiofrequency (DQRF), one of the newest nonsurgical light- and energy-based vulvar rejuvenation technologies, has been demonstrated to be an effective option in aesthetic gynecology. OBJECTIVES The aim of this study was to perform qualitative and semiquantitative evaluations of short-term changes in vulvar aesthetics to illustrate the efficacy of an accelerated DQRF vulvar rejuvenation program in women with mild to moderate vulvar atrophy. METHODS Twenty women with mild to moderate vulvar atrophy were prospectively screened and evaluated. Serial photographs documented the aesthetic impact of DQRF on the vulvar area over the 2-month study period. The overall aesthetic improvement was rated on a Global Aesthetic Improvement Scale modified to create a 10-point semiquantitative rating tool. Complications and side effects were recorded. RESULTS All women successfully underwent 3 planned DQRF procedures spaced 7-10 days apart. Signs and symptoms of vulvar atrophy and the range of aesthetic judgments of the vulvar area were improved in most women after the first DQRF session, and improvements in vulvar aesthetics were persistently highly significant 1 month after the end of the DQRF rejuvenation program. No complications or side effects occurred. CONCLUSIONS Improvements in the signs and symptoms of vulvar atrophy by DQRF rejuvenation of the labia majora confirm the efficacy and safety of this technically simple outpatient procedure. In women with mild to moderate atrophy, a rapid rejuvenation program of closely spaced sessions achieved significant improvements. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Elena Fasola
- Microsurgeon and General Secretary of the Italian Association of Functional and Esthetic Gynecology (AIGEF), Milan, Italy
| | - David Bosoni
- Collaborator, Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, Section of Obstetrics and Gynaecology, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Vandeputte J. Real-world Experience with Volume Augmentation using Cohesive Polydensified Matrix Hyaluronic Acid Gel: A Retrospective Single-center Analysis of 110 Consecutive Patients with Medium- to Long-term Follow-up. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2018; 11:30-39. [PMID: 30666277 PMCID: PMC6334831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: Hyaluronic acid (HA) volumizer injection into subcutaneous and deep tissue layers is increasingly used for nonsurgical volume loss correction. Information on optimal techniques, safety, and medium- to long-term satisfaction is limited. This study evaluated cohesive polydensified matrix® HA volumizer CPM-26 (Modélis® Shape or Belotero® Volume) across different indications. Design: This study was a retrospective chart review and included a patient questionnaire given at six months posttreatment and during long-term assessment (mean: 3.2 years). Setting: This study was conducted in a Belgian single-site plastic surgery practice. Participants: Consecutive patients (n=110, aged 19-74 years, 81% female) receiving single/ multiple injections with CPM-26 between 2010 and 2016 were included. Measurements: Procedural details and safety outcomes, patient estimates of satisfaction and adverse events, and Global Aesthetic Improvement Scale (GAIS) score were considered. Results: Participants received 601 injections over 189 sessions. The most common sites for volumizing injection were the lateral midface, deep prejowl sulcus, and anterior midface. In six participants, the injection site was the penis (8, 1.3%). Questionnaire data were provided by 81 patients. At six months, 94.9 percent (74/78) were satisfied with outcomes, while, at long-term assessment (mean: 3.2 years), 74.9 percent (54/73) were satisfied. Conclusion: Deep CPM-26 injection improved appearance and was reported as beneficial by two-thirds of patients at long-term assessment. Local adverse events were minor, transient, and infrequently required treatment.
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Affiliation(s)
- Joan Vandeputte
- Dr. Vandeputte is a Fellow of the European Board of Plastic, Reconstructive, and Aesthetic Surgery and a plastic surgeon in private practice and at Oudenaarde General Hospital in Belgium
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Spriggs M, Gillam L. "I Don't See That as a Medical Problem": Clinicians' Attitudes and Responses to Requests for Cosmetic Genital Surgery by Adolescents. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:535-548. [PMID: 30341676 DOI: 10.1007/s11673-018-9878-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
Labiaplasty is a form of genital surgery to reduce large or protruding labia minora. Internationally, the rates of this surgery among women and girls is increasing and is viewed as a worrying trend. Currently, the main clinical strategy is to reassure adolescents that they are normal by talking about the variation of labia size and appearance and showing pictures demonstrating the wide range of normal female genital appearance. For the most part, policy documents recommend against labiaplasty in adolescents, claiming that it is medically non-essential surgery. In this paper, we contrast findings from our interviews with clinicians with the existing literature and policy documents and we point out areas needing more thought. This is qualitative research using semi-structured interviews. We set out to find out on what basis clinicians decide how to treat or manage adolescent patients seeking labiaplasty. We interviewed clinicians who are likely to be approached by under-eighteens requesting labiaplasty. We use interpretive content analysis and thematic analysis to analyse the data. Our findings support the emphasis on education and reassurance as the first step for all patients, but other issues that have not figured previously in the literature that would alter clinical strategies for managing patients emerge as well. Key findings are that reassurance does not always work and that the distinction between functional and appearance concerns is not a solid foundation in itself for deciding whether surgery is ethically appropriate. We conclude that the distinction between functional and appearance concerns is not ethically relevant. It is open to different interpretations and is not regarded by all clinicians as the definitive factor in relation to surgery. The focus of clinicians should be on relieving distress whatever the cause. Appearance reasons may sometimes justify surgery but, also, functional reasons may sometimes not be sufficient justification for surgery.
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Affiliation(s)
- Merle Spriggs
- Children's Bioethics Centre, Royal Children's Hospital (Melbourne), Flemington Road, Parkville, Victoria, 3052, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia.
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.
| | - Lynn Gillam
- Children's Bioethics Centre, Royal Children's Hospital (Melbourne), Flemington Road, Parkville, Victoria, 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia
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Akgul Y, Constantine R, Bartels M, Scherer P, Davis K, Kenkel JM. Utility of Adipocyte Fractions in Fat Grafting in an Athymic Rat Model. Aesthet Surg J 2018; 38:1363-1373. [PMID: 29722790 DOI: 10.1093/asj/sjy111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Multiple processing and handling methods of autologous fat yield to variations in graft retention and viability, which results in unpredictable clinical outcomes. OBJECTIVES This study aims to understand the skin effects of fat graft preparations that contain a varying ratio of free-lipid and stem-cell-bearing stromal vascular fractions (SVF). METHODS Lipoaspirates from consenting patients were processed into emulsified fat and then SVF and adipocyte fractions (free-lipid). SVF enriched with 0%, 5%, and 15% free-lipid were grafted along the dorsum of athymic rats. The xenografts were collected 45 days after grafting and then prepped for immunostaining. RESULTS Xenografts resulted in viable tissue mass under the panniculus carnosus of rats as confirmed with human specific markers. A low percentage of human cells was also detected in the lower reticular dermis. Although grafts with SVF formed adipocytes of normal architecture, grafts formed with free-lipid alone resulted in large lipid vacuoles in varying sizes. Among graft preparations, SVF with 10% free-lipid resulted in much-developed adipocyte architecture with collagen and elastin. Compared with SVF alone grafts, SVF with free-lipid had higher CD44 expression, suggesting a localized immune response of adipocytes. CONCLUSIONS Current studies suggest that SVF enriched with approximately 10% free-lipid provides the best conditions for fat graft differentiation into viable fat tissue formation as well as collagen and elastin production to provide mechanical support for overlaying skin in an athymic rat model. Additionally, application of this therapeutic modality in a simple clinical setting may offer a practical way to concentrate SVF with free-lipid in a small volume for the improvement of clinical defects. LEVEL OF EVIDENCE 5
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Affiliation(s)
| | - Ryan Constantine
- Departments of Plastic Surgery, Internal Medicine, and Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mason Bartels
- Departments of Plastic Surgery, Internal Medicine, and Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Philipp Scherer
- Departments of Plastic Surgery, Internal Medicine, and Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathryn Davis
- Departments of Plastic Surgery, Internal Medicine, and Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey M Kenkel
- Departments of Plastic Surgery, Internal Medicine, and Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX
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Duteille F, Perrot P, Bacheley MH, Stewart S. Eight-Year Safety Data for Round and Anatomical Silicone Gel Breast Implants. Aesthet Surg J 2018; 38:151-161. [PMID: 29040345 DOI: 10.1093/asj/sjx117] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The safety and efficacy of all medical devices, including breast implants, is important and consistent performance is best shown by undertaking long-term clinical and vigilance studies. Local complications such as capsular contracture and rupture are risks often associated with breast implant surgery. OBJECTIVES The authors investigate and evaluate the safety and performance of Eurosilicone's (Eurosilicone S.A.S, Apt Cedex, France) Cristalline Paragel breast implants at 8 years postimplantation. METHODS In this prospective clinical study, 995 Eurosilicone textured cohesive Cristalline Paragel mammary implants were implanted in 526 women undergoing augmentation and reconstructive surgery at 17 centers across France. Complications were recorded at 3 months and annually thereafter for 8 years. Descriptive statistics were used and key complications were analysed using the Kaplan-Meier method. RESULTS Capsular contracture was reported in 8.5% of implants across all cohorts through 8 years. The Kaplan-Meier risk of capsular contracture (Baker Grade III/IV) per implant was 8.4% in the primary augmentation cohort and 18.0% in the primary reconstruction cohort. Eight implant ruptures were identified by surgeon examination during this follow-up period. The Kaplan-Meier risk of rupture occurring within 8 years postimplantation, across all cohorts, was 1.4% per patient and 0.9% per implant. Actual implant removal rate (explantation/exchange) was 6.0% and 13.8% for primary augmentation and primary reconstruction, respectively. Actual rates of local complications including infection and seroma were low with risk rates of 0.6% and 0.2% by subject. CONCLUSIONS This multicenter clinical study involving Eurosilicone's silicone gel breast implants in both round and shaped profiles demonstrates an excellent safety and efficacy profile through 8 years.
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Affiliation(s)
- Franck Duteille
- Principal Investigator, Centre des Brûlés, Immeuble Jean Monnet, Centre Hospitalier Universitaire, Nantes, France
| | - Pierre Perrot
- Clinical Investigator, Centre des Brûlés, Immeuble Jean Monnet, Centre Hospitalier Universitaire, Nantes, France
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Suijker J, Troncoso E, Pizarro F, Montecinos S, Villarroel G, Erazo C, Cisternas JP, Andrades P, Benítez S, Sepúlveda S, Danilla S. Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results for the Body-QoL® Cohort. Aesthet Surg J 2018; 38:279-288. [PMID: 29117298 DOI: 10.1093/asj/sjx090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Body contouring surgery (BCS) is becoming increasing popular for aesthetic and reconstructive purposes, particularly among patients with massive weight loss (MWL). However, data on quality of life (QoL) following the surgery are limited, especially long-term QoL. OBJECTIVES The authors evaluated the effect of BCS on QoL and the durability of this effect over time. METHODS QoL was measured with the Body-QoL® instrument at 3 time points among consecutively treated patients: the day before BCS, 1 to 9 months postoperatively (short term), and 1 to 2.7 years postoperatively (long term). Total Body-QoL scores were compiled, as were scores for the instrument's main domains: body satisfaction, sex life, self-esteem and social performance, and physical symptoms. Scores were examined for the entire study population and separately for the cosmetic and MWL cohorts. RESULTS Fifty-seven of the 112 patients participated in the short-term assessment and 84 in the long-term assessment. Total Body-QoL scores increased significantly (P < 0.0001), from 44.0 ± 14.1 preoperatively to 85.5 ± 17.5 short-term postoperatively and to 84.4 ± 12.7 long-term postoperatively. Scores for the 2 postoperative assessments did not differ significantly. Similar results were observed for scores on each separate domain. Although preoperative scores were lower for the MWL cohort than the cosmetic cohort (33.9 ± 15.6 vs 46.1 ± 12.8; P = 0.0002), they improved substantially after BCS, approaching scores for the cosmetic cohort. CONCLUSIONS QoL increases significantly after BCS. This favorable outcome remained stable throughout long-term follow-up and was true for the cosmetic and MWL cohorts. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Jaco Suijker
- Resident, Department of General Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - Francisca Pizarro
- Medical Students, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Sofia Montecinos
- Medical Students, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Galia Villarroel
- Medical Students, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Cristian Erazo
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Juan Pablo Cisternas
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Patricio Andrades
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Susana Benítez
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Sergio Sepúlveda
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Stefan Danilla
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
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Rodrigues MA, Ferreira LM, de Carvalho Calvi EN, Nahas FX. Preoperative Respiratory Physiotherapy in Abdominoplasty Patients. Aesthet Surg J 2018; 38:291-299. [PMID: 29040352 DOI: 10.1093/asj/sjx121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND After abdominoplasty, patients experience decreased ventilatory function and increased intra-abdominal pressure (IAP). Breathing exercises are used during the pre- and postoperative periods of several abdominal surgeries to prevent or minimize postoperative complications. OBJECTIVES The aim of this study was to assess the effect of preoperative respiratory physiotherapy on the outcome of abdominoplasty patients. METHODS Thirty-three patients were divided into 2 groups. The control group (n = 18) received no preoperative intervention. The intervention group (n = 15) performed breathing exercises during the preoperative period, including incentive spirometry, diaphragmatic breathing, shortened expiration, and sustained maximal inspiration. Respiratory physiotherapy started one week before surgery. Breathing exercises were performed daily. They were performed 3 times weekly in the presence of a physiotherapist and patients were instructed to carry on the exercises at home on days without physiotherapy sessions for three sets of 20 repetitions each. Patients were assessed by spirometry and IAP measurements. RESULTS No significant difference in spirometry was found between groups. However, patients in the intervention group had lower IAP at the start of surgery and at all time points (P = 0.010) compared with controls. CONCLUSIONS Preoperative respiratory physiotherapy had no impact on spirometry, but may have contributed to reduce IAP intraoperatively. LEVEL OF EVIDENCE 2
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Chang PC. Computer-Assisted Planning and 3D Printing-Assisted Modeling for Chin Augmentation. Aesthet Surg J 2017; 38:1-10. [PMID: 29117294 DOI: 10.1093/asj/sjx071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients are frequently not satisfied with the outcome of chin augmentation. OBJECTIVES We report the use of three-dimensional (3D) imaging and printing to design custom fit porous polyethylene chin implants. METHODS Patients requesting chin augmentation received 3D computed tomography (CT) imaging of the facial area. Patients could select the chin contour they desired by viewing 3D images of their face and chin. A 3D mandible replicate was printed from the CT data, and used to sculpt the inner surface of the implant to match the shape of the mandible, and the outer surface to match the contour the patient desired. Implants were placed with a 2 cm mucosal incision. The primary outcome was patient satisfaction with the cosmetic result at 6 months postoperatively. RESULTS From April 2014 to March 2015, 107 females and 22 males (mean age, 29.7 years) received chin augmentation using 3D imaging and printing to create a custom fit porous polyethylene implant. No major complications (eg, infection, nerve injury) occurred. At 1 month, five of the 124 patients who returned for follow up were not satisfied; however, became satisfied after a minor adjustment procedure. All of the 78 patients that returned for the 6 month follow up were satisfied with the cosmetic result. No implant displacement, skin numbness, or infection was noted during the 6 months of follow up. CONCLUSIONS Three-dimensional imaging and printing can be used to produce custom fit porous polyethylene chin implants that results in minimal complications and a very high satisfaction rate. LEVEL OF EVIDENCE 4.
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Pingel J, Nielsen MS, Lauridsen T, Rix K, Bech M, Alkjaer T, Andersen IT, Nielsen JB, Feidenhansl R. Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures. Sci Rep 2017; 7:14746. [PMID: 29116170 PMCID: PMC5677119 DOI: 10.1038/s41598-017-14997-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/20/2017] [Indexed: 12/30/2022] Open
Abstract
Botulinum-toxin A (BoNT/A) is used for a wide range of conditions. Intramuscular administration of BoNT/A inhibits the release of acetylcholine at the neuromuscular junction from presynaptic motor neurons causing muscle-paralysis. The aim of the present study was to investigate the effect of high dose intramuscular BoNT/A injections (6 UI = 60 pg) on muscle tissue. The gait pattern of the rats was significantly affected 3 weeks after BoNT/A injection. The ankle joint rotated externally, the rats became flat footed, and the stride length decreased after BoNT/A injection. Additionally, there was clear evidence of microstructural changes on the tissue level by as evidenced by 3D imaging of the muscles by Synchrotron Radiation X-ray Tomographic Microscopy (SRXTM). Both the fibrillar and the non-fibrillar tissues were affected. The volume fraction of fibrillary tissue was reduced significantly and the non-fibrillar tissue increased. This was accompanied by a loss of the linear structure of the muscle tissue. Furthermore, gene expression analysis showed a significant upregulation of COL1A1, MMP-2, TGF-b1, IL-6, MHCIIA and MHCIIx in the BoNT/A injected leg, while MHVIIB was significantly downregulated. IN CONCLUSION The present study reveals that high dose intramuscular BoNT/A injections cause microstructural damage of the muscle tissue, which contributes to impaired gait.
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Affiliation(s)
- Jessica Pingel
- Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark.
| | | | | | - Kristian Rix
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
| | - Martin Bech
- Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Tine Alkjaer
- Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Ida Torp Andersen
- Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bo Nielsen
- Center for Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - R Feidenhansl
- Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
- European XFEL, Hamburg, Germany
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Ardehali B, Fiorentino F. A Meta-Analysis of the Effects of Abdominoplasty Modifications on the Incidence of Postoperative Seroma. Aesthet Surg J 2017; 37:1136-1143. [PMID: 28482000 DOI: 10.1093/asj/sjx051] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Seroma is the most common complication of abdominoplasty. Certain modifications to abdominoplasty may reduce the risk of seroma. OBJECTIVES The authors evaluated the incidence of seroma for 3 abdominoplasty techniques: preservation of Scarpa's fascia, placement of progressive tension (or quilting) sutures, and application of fibrin glue. METHODS In this systematic review and meta-analysis, the Cochrane Library, MEDLINE, Embase, and the International Clinical Trials Registry Platform (World Health Organization) were searched to identify studies of patients who underwent abdominoplasty with seroma as a potential "outcome." RevMan 5.3 was utilized for data management, statistical analyses, and graph preparation. RESULTS Fifteen studies (1824 total patients) met the criteria for inclusion in this review. The overall risk of bias was high, mainly owing to the nonrandomized nature of most studies. Abdominoplasty with preservation of Scarpa's fascia or placement of progressive tension sutures was associated with a significantly reduced incidence of seroma compared with that of standard abdominoplasty (P < 0.0001 and P < 0.0002, respectively). Abdominoplasty with application of fibrin glue was similar to standard abdominoplasty in terms of seroma development. CONCLUSIONS Placement of progressive tension sutures or preservation of Scarpa's fascia during abdominoplasty may reduce the likelihood of postoperative seroma. Application of fibrin glue has no impact on seroma formation. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Ben Ardehali
- Dr Ardehali is a Consultant Plastic and Reconstructive Surgeon, St George’s Hospital NHS Foundation Trust, London, United Kingdom. Dr Fiorentino is a Statistician and Research Fellow, Imperial College Trial Unit and Department of Surgery, Imperial College, London, United Kingdom
| | - Francesca Fiorentino
- Dr Ardehali is a Consultant Plastic and Reconstructive Surgeon, St George’s Hospital NHS Foundation Trust, London, United Kingdom. Dr Fiorentino is a Statistician and Research Fellow, Imperial College Trial Unit and Department of Surgery, Imperial College, London, United Kingdom
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Weissler JM, Carney MJ, Yan C, Percec I. The Value of a Resident Aesthetic Clinic: A 7-Year Institutional Review and Survey of the Chief Resident Experience. Aesthet Surg J 2017; 37:1188-1198. [PMID: 29044363 DOI: 10.1093/asj/sjx103] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the evolving plastic surgery training paradigm, there is an increasing emphasis on aesthetic surgery education during residency. In an effort to improve aesthetic education and to encourage preparation for independent practice, our institution has supported a resident-run aesthetic clinic for over two decades. OBJECTIVES To provide insight into the educational benefits of a resident-run cosmetic clinic through longitudinal resident follow up and institutional experiential review. METHODS A retrospective review was conducted to identify all clinic-based aesthetic operations performed between 2009 and 2016. To capture residents' perspectives on the cosmetic resident clinic, questionnaires were distributed to the cohort. Primary outcome measures included: volume and types of cases performed, impact of clinic experience on training, confidence level performing cosmetic procedures, and satisfaction with chief clinic. Unpaired t tests were calculated to compare case volume/type with level of confidence and degree of preparedness to perform cosmetic procedures independently. RESULTS Overall, 264 operations performed by 18 graduated chief residents were reviewed. Surveys were distributed to 28 chief residents (71.4% completion rate). Performing twenty or more clinic-based procedures was associated with higher levels of preparedness to perform cosmetic procedures independently (P = 0.037). Residents reported the highest confidence when performing cosmetic breast procedures when compared to face/neck (P = 0.005), body/trunk procedures (P = 0.39), and noninvasive facial procedures (P = 0.85). CONCLUSIONS The continued growth of aesthetic surgery highlights the need for comprehensive training and preparation for the new generation of plastic surgeons. Performing cosmetic procedures in clinic is a valuable adjunct to the traditional educational curriculum and increases preparedness and confidence for independent practice.
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Affiliation(s)
- Jason M Weissler
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Martin J Carney
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Chen Yan
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ivona Percec
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
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Kaoutzanis C, Winocour J, Gupta V, Ganesh Kumar N, Sarosiek K, Wormer B, Tokin C, Grotting JC, Higdon KK. Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients. Aesthet Surg J 2017; 37:1175-1185. [PMID: 28398469 DOI: 10.1093/asj/sjx062] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postoperative hematomas are one of the most frequent complications following aesthetic surgery. Identifying risk factors for hematoma has been limited by underpowered studies from single institution experiences. OBJECTIVES To examine the incidence and identify independent risk factors for postoperative hematomas following cosmetic surgery utilizing a prospective, multicenter database. METHODS A prospectively enrolled cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major hematomas requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis was used to identify potential risk factors for hematomas including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. RESULTS Of 129,007 patients, 1180 (0.91%) had a major hematoma. Mean age (42.0 ± 13.0 years vs 40.9 ± 13.9 years, P < 0.01) and BMI (24.5 ± 5.0 kg/m2 vs 24.3 ± 4.6 kg/m2, P < 0.01) were higher in patients with hematomas. Males suffered more hematomas than females (1.4% vs 0.9%, P < 0.01). Hematoma rates were higher in patients undergoing combined procedures compared to single procedures (1.1% vs 0.8%, P < 0.01), and breast procedures compared to body/extremity or face procedures (1.0% vs 0.8% vs 0.7%, P < 0.01). On multivariate analysis, independent predictors of hematoma included age (Relative Risk [RR] 1.01), male gender (RR 1.98), the procedure being performed in a hospital setting rather than an office-based setting (RR 1.68), combined procedures (RR 1.35), and breast procedures rather than the body/extremity and face procedures (RR 1.81). CONCLUSIONS Major hematoma is the most common complication following aesthetic surgery. Male patients and those undergoing breast or combined procedures have a significantly higher risk of developing hematomas. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Christodoulos Kaoutzanis
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
| | - Julian Winocour
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
| | - Varun Gupta
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
| | - Nishant Ganesh Kumar
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
| | - Konrad Sarosiek
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
| | - Blair Wormer
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
| | - Christopher Tokin
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
| | - James C Grotting
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA. Private practice, Duluth, GA. Division of Plastic Surgery, University of Alabama, Birmingham, AL; Aesthetic Surgery Journal
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Jabbour S, Kechichian E, Hersant B, Levan P, El Hachem L, Noel W, Nasr M. Labia Majora Augmentation: A Systematic Review of the Literature. Aesthet Surg J 2017; 37:1157-1164. [PMID: 28449124 DOI: 10.1093/asj/sjx056] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Currently, there is no standardized approach for labia majora augmentation and controversies still exist regarding this subject. OBJECTIVES This systematic review aimed to assess the evidence in the literature regarding labia majora augmentation. METHODS On November 20, 2016, we conducted an online search of published articles in the Medline, Embase, and Cochrane databases. All articles describing labia majora augmentation were included in this review. RESULTS Nine studies were selected for inclusion in the systematic review. Only 2 studies were prospective trials. The most commonly used technique was fat grafting with a total of 4 articles and 183 patients. The mean total injected fat volume ranged from 18 mL to 120 mL per session. Two articles described hyaluronic acid injection techniques. The total injected volume of hyaluronic acid ranged from 2 to 6 mL per session. Three articles used surgical techniques for labia majora augmentation. All included articles did not report any major or life-threatening complications. All techniques demonstrated high satisfaction rates. CONCLUSIONS Labia majora augmentation appears to be a safe, efficient technique with a high satisfaction rate and no reported major complications. However, further randomized controlled trials are warranted. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Samer Jabbour
- Department of Plastic and Reconstructive Surgery, Saint-Joseph Hospital, Paris, France. Department of Dermatology, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor, Creteil, France. Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut, Lebanon. Department of Plastic and Reconstructive Surgery, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Elio Kechichian
- Department of Plastic and Reconstructive Surgery, Saint-Joseph Hospital, Paris, France. Department of Dermatology, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor, Creteil, France. Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut, Lebanon. Department of Plastic and Reconstructive Surgery, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Barbara Hersant
- Department of Plastic and Reconstructive Surgery, Saint-Joseph Hospital, Paris, France. Department of Dermatology, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor, Creteil, France. Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut, Lebanon. Department of Plastic and Reconstructive Surgery, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Philippe Levan
- Department of Plastic and Reconstructive Surgery, Saint-Joseph Hospital, Paris, France. Department of Dermatology, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor, Creteil, France. Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut, Lebanon. Department of Plastic and Reconstructive Surgery, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Lena El Hachem
- Department of Plastic and Reconstructive Surgery, Saint-Joseph Hospital, Paris, France. Department of Dermatology, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor, Creteil, France. Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut, Lebanon. Department of Plastic and Reconstructive Surgery, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Warren Noel
- Department of Plastic and Reconstructive Surgery, Saint-Joseph Hospital, Paris, France. Department of Dermatology, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor, Creteil, France. Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut, Lebanon. Department of Plastic and Reconstructive Surgery, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Marwan Nasr
- Department of Plastic and Reconstructive Surgery, Saint-Joseph Hospital, Paris, France. Department of Dermatology, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon. Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor, Creteil, France. Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut, Lebanon. Department of Plastic and Reconstructive Surgery, Faculty of Medicine Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
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Commentary on: "Gluteal Augmentation with Silicone Implants: A New Proposal for Intramuscular Dissection". Aesthetic Plast Surg 2017; 41:1146-1147. [PMID: 28374290 DOI: 10.1007/s00266-017-0834-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
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Hammond SE, Al-Bayati A, Joumblat N, Salgado CJ. Mycobacterium Chelonae Infection of the Buttocks Secondary to Lipofilling: A Case Report and Review of the Literature. Aesthetic Plast Surg 2017; 41:1150-1154. [PMID: 28526906 DOI: 10.1007/s00266-017-0890-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/25/2017] [Indexed: 02/07/2023]
Abstract
Mycobacterium chelonae is a nontuberculous mycobacterium, classified as a Runyon type IV mycobacterium. In relation to humans, it is most commonly associated with tissue trauma or pulmonary infections. The majority of medical reports describe finding M. chelonae in the surgical setting, attributing infection to inadequate sterilization of surgical equipment. Symptoms are often nonspecific and include pain, erythema, and draining subcutaneous nodules and skin lesions. Therefore, the diagnosis of M. chelonae is often difficult to establish without prior suspicion of the disease, but can be confirmed with culture. We will describe the case of a 40-year-old female who contracted M. chelonae infection of the buttocks after abdominal liposuction and gluteal fat injection. We will describe her symptomatology, diagnosis, and successful treatment with surgical excision and antibiotics. 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 .
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Klatsky SA, Mohan R. The History of ASAPS on its 50th Anniversary. Aesthet Surg J 2017; 37:1082-1084. [PMID: 28520910 PMCID: PMC5846699 DOI: 10.1093/asj/sjx069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Stanley A Klatsky
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Klatsky is Editor Emeritus of Aesthetic Surgery Journal
| | - Raja Mohan
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Dr Klatsky is Editor Emeritus of Aesthetic Surgery Journal
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Yeslev M, Gupta V, Winocour J, Shack RB, Grotting JC, Higdon KK. Safety of Cosmetic Surgery in Adolescent Patients. Aesthet Surg J 2017; 37:1051-1059. [PMID: 28398472 DOI: 10.1093/asj/sjx061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 01/21/2023] Open
Abstract
Background Limited surgical literature currently exists that evaluates postoperative complications after cosmetic surgery in adolescents. Objectives The purpose of this study was to determine the incidence of major postoperative complications in adolescent patients undergoing cosmetic surgery and compare their complication rates to older patients. Methods A prospective cohort of patients undergoing cosmetic surgical procedures between 2008 and 2013 was identified from the CosmetAssure database. Demographics, clinical characteristics, surgical procedures, and major complications in adolescent patients (age 10-19 years) and older patients (≥20 years old) were compared. Risk factors analyzed included age, gender, body mass index, smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Results Overall, 3519 adolescents and 124,409 older patients underwent cosmetic surgical procedures. The adolescent cohort contained more men (20.0% vs 6.0%, P < 0.01), lower mean body mass index (22.6 ± 4.1 vs 24.4 ± 4.6, P < 0.01), lower prevalence of diabetes (0.8% vs 1.9%, P <0.01), and fewer smokers (5.9% vs 8.3%, P < 0.01) compared to the older patient cohort. Most commonly adolescent patients underwent breast followed by face and body procedures. Overall adolescent patients demonstrated a lower incidence of major postoperative complications compared to older patients after single (0.6% vs 1.5%, P < 0.01) and combined (1.2% vs 3%, P = 0.03) cosmetic procedures. Adolescent patients had lower complications rates after face, breast, and body procedures compared to the older cohort. The most common postoperative complications in adolescent patients were hematoma (0.34%) and infection (0.28%). Conclusions Cosmetic surgical procedures in adolescent patients are safe with a lower rate of major postoperative complications compared to older patients. Level of Evidence 2.
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Affiliation(s)
- Max Yeslev
- Department of Plastic Surgery, The South Permanente Medical Group, Atlanta, GA
| | - Varun Gupta
- Department of Plastic Surgery, Vanderbilt University, Vanderbilt, TN
| | - Julian Winocour
- Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA
| | - R Bruce Shack
- Erlanger Heath System, the University of Tennessee at Chattanooga, Chattanooga, TN
| | - James C Grotting
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL
- Aesthetic Surgery Journal
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University, Vanderbilt, TN
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Guney K, Sezgin B, Yavuzer R. The Efficacy of Vibration Anesthesia on Reducing Pain Levels During Lip Augmentation: Worth the Buzz? Aesthet Surg J 2017; 37:1044-1048. [PMID: 29025227 DOI: 10.1093/asj/sjx073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Lip augmentation procedures have increased drastically in the last years as patients seek to enhance the shape and size of their lips with dermal fillers. One of the main concerns faced with these procedures is the pain inflicted through injections. On the other hand, many different techniques have been introduced for the reduction of pain while performing office-based minimal invasive procedures. Objectives This study aims to determine the analgesic effect of vibration anesthesia during lip augmentation procedures and to evaluate its overall effect on the comfort of patients. Methods A split-lip study was designed in a randomized fashion for 25 lip augmentation patients who received hyaluronic acid fillers with or without with a concurrent vibration stimulus on either half of their lips. Patients were asked to score the pain that they felt during lip injections on a scale from 0 to 10 (0 being no pain and 10 being the worst pain ever felt) for either lip half. The pain scores were then analyzed for significance. Results The overall pain score on the vibration-assisted side was 3.82 ± 1.73 while the pain score for the side with no vibration was 5.6 ± 1.76 (P < 0.001). Twenty-three patients (92%) felt less pain with the addition of vibration while, interestingly, 2 patients (8%) stated that they felt an increase in pain levels on the vibration-treated side. Conclusions Vibration devices can be a safe and effective tool for lowering pain levels in patients undergoing lip augmentation with hyaluronic acid fillers. Level of Evidence 2.
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Affiliation(s)
- Kirdar Guney
- Dr Guney is a plastic surgeon in private practice in Istanbul, Turkey. Dr Sezgin is a Plastic Surgeon and Clinical Specialist, and Full Faculty Member; and Dr Yavuzer is a Visiting Professor, Koç University School of Medicine, Istanbul, Turkey
| | - Billur Sezgin
- Dr Guney is a plastic surgeon in private practice in Istanbul, Turkey. Dr Sezgin is a Plastic Surgeon and Clinical Specialist, and Full Faculty Member; and Dr Yavuzer is a Visiting Professor, Koç University School of Medicine, Istanbul, Turkey
| | - Reha Yavuzer
- Dr Guney is a plastic surgeon in private practice in Istanbul, Turkey. Dr Sezgin is a Plastic Surgeon and Clinical Specialist, and Full Faculty Member; and Dr Yavuzer is a Visiting Professor, Koç University School of Medicine, Istanbul, Turkey
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Vieira BL, Dorfman R, Turin S, Gutowski KA. Rates and Predictors of Readmission Following Body Contouring Procedures: An Analysis of 5100 Patients From The National Surgical Quality Improvement Program Database. Aesthet Surg J 2017; 37:917-926. [PMID: 28200103 DOI: 10.1093/asj/sjx012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospital readmissions can be a major contributor to increased healthcare costs and are a salient current topic in healthcare. There is a paucity of large, prospective studies that evaluate rates and risk factors of readmission within the aesthetic subset of plastic surgery. OBJECTIVES The authors propose to determine the rates of unplanned readmission following body contouring procedures and to analyze the predictors associated with it. METHODS The 2011 and 2012 National Surgical Quality Improvement Program Database was queried for body contouring procedures using the appropriate Current Procedural Terminology codes. The rate of unplanned readmission, preoperative risk factors, comorbidities, and medical and surgical postoperative complications data were analyzed using multivariate regression models to determine predictors of readmission after these procedures. RESULTS We identified 5100 patients who underwent body contouring procedures, of which 142 (2.8%) experienced an unplanned readmission. Forty-eight per cent of readmitted patients experienced at least one surgical complication, and 23.9% experienced at least one medical complication. Multivariate regression analyses identified several independent predictors of unplanned readmission: increasing age (odds ratio [OR] 1.018 per year, P = 0.039), bleeding disorders (OR 3.674, P = 0.039), increased operative time (each additional hour conferring a 20% increased risk), surgical complications (OR 19.179, P < 0.001), and medical complications (OR 10.240, P < 0.001). CONCLUSIONS The unplanned readmission rate for body contouring procedures is low overall (2.8%). We identified age, bleeding disorders, operative duration, and postoperative complication as independent risk factors for unplanned readmission. These data can help guide preoperative risk stratification and future interventions in high-risk patient populations. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Brittany L Vieira
- Ms Vieira is a Medical Student, Mr Dorfman is a Research Fellow, and Dr Turin is a Resident, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr Gutowski is an Adjunct Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Illinois – Chicago, Chicago, IL
| | - Robert Dorfman
- Ms Vieira is a Medical Student, Mr Dorfman is a Research Fellow, and Dr Turin is a Resident, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr Gutowski is an Adjunct Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Illinois – Chicago, Chicago, IL
| | - Sergey Turin
- Ms Vieira is a Medical Student, Mr Dorfman is a Research Fellow, and Dr Turin is a Resident, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr Gutowski is an Adjunct Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Illinois – Chicago, Chicago, IL
| | - Karol A Gutowski
- Ms Vieira is a Medical Student, Mr Dorfman is a Research Fellow, and Dr Turin is a Resident, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr Gutowski is an Adjunct Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Illinois – Chicago, Chicago, IL
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Kamali P, Lin SJ. Commentary on: Rates and Predictors of Readmission Following Body Contouring Procedures: An Analysis of 5100 Patients From The National Surgical Quality Improvement Program Database. Aesthet Surg J 2017; 37:927-929. [PMID: 28333261 DOI: 10.1093/asj/sjx041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Parisa Kamali
- From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Samuel J Lin
- From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Parsa FD, Cheng J, Stephan B, Castel N, Kim L, Murariu D, Parsa AA. Bilateral Breast Reduction Without Opioid Analgesics: A Comparative Study. Aesthet Surg J 2017; 37:892-899. [PMID: 28333299 DOI: 10.1093/asj/sjx038] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast reduction has traditionally been performed under general anesthesia with adjunct opioid use. However, opioids are associated with a wide variety of adverse effects, including nausea, vomiting, constipation, postoperative sedation, dizziness, and addiction. OBJECTIVES This study compares bilateral breast reduction using a multimodal opioid-free pain management regimen vs traditional general anesthesia with adjunct opioids. METHODS A total of 83 female patients were enrolled in this study. Group 1 includes a retrospective series of 39 patients that underwent breast reduction via general anesthesia with adjunct opioid use. This series was compared to 2 prospective groups of patients who did not receive opioids either preoperatively or intraoperatively. In group 2, twenty-six patients underwent surgery under intravenous sedation and local anesthesia. In group 3, eighteen patients underwent surgery with general anesthesia. All patients in groups 2 and 3 received preoperative gabapentin and celecoxib along with infiltration of local anesthetics during the operation and prior to discharge to the Post-Anesthesia Care Unit (PACU). Primary outcome measures included the duration of surgery, time from end of operation to discharge home, postoperative opioid and antiemetic use, and unplanned postoperative hospitalizations. RESULTS When compared to group 1, groups 2 and 3 experienced a shorter time from end of operation to discharge home (P < 0.05), fewer unplanned hospital admissions (P < 0.05), and highly significant decrease in postoperative opioid use (P < 0.001). CONCLUSIONS This multimodal approach allows patients to safely undergo opioid-free bilateral breast reduction either under local or general anesthesia as an outpatient. This method resulted in significantly less morbidity, use of opioids postoperatively, as well as unplanned hospital admissions compared to "traditional" breast reduction under general anesthesia with the use of opioids. LEVEL OF EVIDENCE 3.
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Wall S, Del Vecchio D. Commentary on: Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force. Aesthet Surg J 2017; 37:807-810. [PMID: 28486673 DOI: 10.1093/asj/sjx080] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Simeon Wall
- Dr Wall is a Plastic Surgeon in private practice, and an Assistant Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and an Assistant Clinical Professor, Division of Plastic Surgery, LSU Health Sciences Center at Shreveport, Shreveport, LA. Dr Del Vecchio is a plastic surgeon in private practice in Boston, MA
| | - Daniel Del Vecchio
- Dr Wall is a Plastic Surgeon in private practice, and an Assistant Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and an Assistant Clinical Professor, Division of Plastic Surgery, LSU Health Sciences Center at Shreveport, Shreveport, LA. Dr Del Vecchio is a plastic surgeon in private practice in Boston, MA
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Fouché JJ, Van Loghem JAJ, Thuis J, De Heer LM, van Oijen MGH. Left/Right Pain Asymmetry With Injectable Cosmetic Treatments for the Face. Aesthet Surg J 2017; 37:708-714. [PMID: 28333175 DOI: 10.1093/asj/sjw214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pain is processed and experienced differently on the left (L) and right (R) sides of the body; however, L/R pain asymmetry with cosmetic treatments of the face has not been evaluated. OBJECTIVES The authors compared patient ratings of L/R facial pain during and immediately after injectable cosmetic treatments. METHODS In this cross-sectional multicenter pragmatic study, pain levels were evaluated for 302 patients who underwent facial treatments with botulinum toxin (BTX) and/or impermanent soft-tissue filler (STF). Patients indicated pain intensity on each side of the face with a visual analogue scale (VAS; 0, no pain; 10, worst pain). RESULTS Combined mean VAS scores for BTX and STF treatments (L, 3.79 vs R, 3.42), and individual scores for BTX (L, 3.60 vs R, 3.30) or STF (L, 4.22 vs R, 3.69) treatments were significantly different, with pain rated as worse on the L side of the face (all P < 0.01). When treatments were performed first on the L side, patients rated the overall experience as significantly less painful than when treatments were begun on the R side. BTX treatments with a 29-gauge (G) needle were significantly more painful than with a 33-G needle. CONCLUSIONS To lessen pain with injectable facial treatments, the authors recommend placing the first injection on the L side of the face and, when possible, employing a high-G needle. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Jacobus Johannes Fouché
- Drs Fouché, Van Loghem, and Thuis are aesthetic surgeons in private practice in Amsterdam, Netherlands. Dr De Heer is a Cardiothoracic Surgeon Registrar, Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Netherlands. Dr Van Oijen is an Associate Professor, Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Netherlands
| | - Jani Adriaan Jochem Van Loghem
- Drs Fouché, Van Loghem, and Thuis are aesthetic surgeons in private practice in Amsterdam, Netherlands. Dr De Heer is a Cardiothoracic Surgeon Registrar, Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Netherlands. Dr Van Oijen is an Associate Professor, Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Netherlands
| | - Job Thuis
- Drs Fouché, Van Loghem, and Thuis are aesthetic surgeons in private practice in Amsterdam, Netherlands. Dr De Heer is a Cardiothoracic Surgeon Registrar, Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Netherlands. Dr Van Oijen is an Associate Professor, Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Netherlands
| | - Linda Marije De Heer
- Drs Fouché, Van Loghem, and Thuis are aesthetic surgeons in private practice in Amsterdam, Netherlands. Dr De Heer is a Cardiothoracic Surgeon Registrar, Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Netherlands. Dr Van Oijen is an Associate Professor, Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Netherlands
| | - Martijn G H van Oijen
- Drs Fouché, Van Loghem, and Thuis are aesthetic surgeons in private practice in Amsterdam, Netherlands. Dr De Heer is a Cardiothoracic Surgeon Registrar, Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Netherlands. Dr Van Oijen is an Associate Professor, Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Netherlands
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Kaoutzanis C, Gupta V, Winocour J, Layliev J, Ramirez R, Grotting JC, Higdon K. Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures. Aesthet Surg J 2017; 37:680-694. [PMID: 28430878 DOI: 10.1093/asj/sjw243] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Liposuction is among the most commonly performed aesthetic procedures, and is being performed increasingly as an adjunct to other procedures. OBJECTIVES To report the incidence and risk factors of significant complications after liposuction, and to determine whether adding liposuction to other cosmetic surgical procedures impacts the complication risk. METHODS A prospective cohort of patients who underwent liposuction between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major complications requiring emergency room visit, hospital admission, or reoperation within 30 days of the operation. Univariate and multivariate analysis evaluated risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, and combined procedures. RESULTS Of the 31,010 liposuction procedures, only 11,490 (37.1%) were performed as a solitary procedure. Liposuction alone had a major complication rate of 0.7% with hematoma (0.15%), pulmonary complications (0.1%), infection (0.1%), and confirmed venous thromboembolism (VTE) (0.06%) being the most common. Independent predictors of major complications included combined procedures (Relative Risk (RR) 4.81), age (RR 1.01), BMI (RR 1.05), and procedures performed in hospitals (RR 1.36). When examining specifically other aesthetic procedures performed alone or with liposuction, combined procedures had a higher risk of confirmed VTE (RR 5.65), pulmonary complications (RR 2.72), and infection (RR 2.41), but paradoxically lower hematoma risk (RR 0.77) than solitary procedures. CONCLUSIONS Liposuction performed alone is a safe procedure with a low risk of major complications. Combined procedures, especially on obese or older individuals, can significantly increase complication rates. The impact of liposuction on the risk of hematoma in combined procedures needs further investigation. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Christodoulos Kaoutzanis
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Varun Gupta
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Julian Winocour
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - John Layliev
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Roberto Ramirez
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C. Grotting
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Kent Higdon
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
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Gabriel A, Maxwell GP. Commentary on: Aesthetic Breast Surgery and Concomitant Procedures: Incidence and Risk Factors for Major Complications in 73,608 Cases. Aesthet Surg J 2017; 37:528-530. [PMID: 28333267 DOI: 10.1093/asj/sjx042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Allen Gabriel
- From the Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - G. Patrick Maxwell
- From the Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA
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Oranges CM, Tremp M, di Summa PG, Haug M, Kalbermatten DF, Harder Y, Schaefer DJ. Gluteal Augmentation Techniques: A Comprehensive Literature Review. Aesthet Surg J 2017; 37:560-569. [PMID: 28203698 DOI: 10.1093/asj/sjw240] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Many studies of gluteal augmentation techniques have been published in recent decades, including case reports, retrospective and prospective case series, and multicenter survey reviews. However, to date, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques. Objectives The authors performed a comprehensive literature review to determine outcomes and complications of gluteoplasty techniques, including patient satisfaction. Methods A search on PubMed/Medline was performed for clinical studies involving gluteal augmentation techniques. A priori criteria were used to review the resulting articles. Results Fifty-two studies, published from 1969 through 2015, were included - representing 7834 treated patients. Five gluteal augmentation techniques were identified from these studies: gluteal augmentation with implants (n = 4781), autologous fat grafting (n = 2609), local flaps (n = 369), hyaluronic acid gel injection (n = 69), and local tissue rearrangement (n = 6). The overall complication rates of the most commonly utilized techniques were: 30.5% for gluteal augmentation with implants, 10.5% for autologous fat grafting, and 22% for local flaps. Patients' satisfaction was reported as consistently high for all the five techniques. Conclusions Implant-based gluteal augmentation is associated with high patients' satisfaction despite a high complication rate, while autologous fat grafting is associated with the lowest complication rate yet including serious major complications such as fat embolism. Local flaps and local tissue rearrangements are the ideal procedures in case of massive weight loss patients. A paucity of data is available for hyaluronic acid gel injections, which appear to be effective but temporary and expensive. Level of Evidence 4
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Affiliation(s)
- Carlo M Oranges
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Mathias Tremp
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Pietro G di Summa
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Yves Harder
- Division of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano (ORL), Breast Centre of Switzerland (CSSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
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Affiliation(s)
- Jeffrey S Dover
- Associate Clinical Professor of Dermatology, Yale University School of Medicine, New Haven, CT, USA
- Adjunct Associate Professor of Dermatology, Brown Medical School, Providence, RI, USA
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Abstract
During the late 1960s and early 1970s, Alan Scott showed that intramuscular injections of botulinum toxin (BoNT) corrected nonaccommodative strabismus without resorting to surgery. The UK doctors who trained with Scott soon realized the significant potential offered by BoNT type A as a therapeutic option for several difficult-to-treat diseases. This led to a collaboration between these pioneering clinicians and the Centre for Applied Microbiology and Research at Porton Down, United Kingdom, and, in turn, to the development and commercialization of abobotulinumtoxinA as Dysport (Dystonia/Porton Down; Ipsen Biopharm Ltd., Wrexham, UK). Dysport was approved in Europe for the treatment of specific dystonias in December 1990 and now has marketing authorizations in 75 countries. Since then, the use of BoNT in therapeutic and aesthetic indications has grown year-on-year, and continues to expand well beyond Scott's initial aim. For example, ongoing trials are assessing potential new indications for BoNT-A, including acne and psoriasis. Furthermore, a growing number of other BoNT products, often termed "biosimilars," together with innovative formulations of well-established BoNT types, are likely to reach the market over the next few years. This review focuses on the history of Dysport to mark the 25th anniversary of its first launch in the United Kingdom.
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Affiliation(s)
- Gary D Monheit
- Dermatologist, Departments of Dermatology and Ophthalmology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andy Pickett
- Director and Founder of Toxin Science Limited, Wrexham, UK
- Adjunct Professor at the Botulinum Research Center, Institute of Advanced Sciences, Dartmouth, MA, USA
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Couto RA, Lamaris GA, Baker TA, Hashem AM, Tadisina K, Durand P, Rueda S, Orra S, Zins JE. Age as a Risk Factor in Abdominoplasty. Aesthet Surg J 2017; 37:550-556. [PMID: 28333178 DOI: 10.1093/asj/sjw227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Recent studies reviewing large patient databases suggested that age may be an independent risk factor for abdominoplasty. However, these investigations by design considered only short-term major complications. Objectives The purpose of this investigation was: (1) to compare the safety of abdominoplasty in an elderly and younger patient population; (2) to determine the complication rates across all spectrums: major, minor, local, and systemic; and (3) to evaluate complications occurring both short and long term. Methods Abdominoplasty procedures performed from 2010 to 2015 were retrospectively reviewed. Subjects were divided into two groups: ≤59 years old and ≥60 years old. Major, minor, local, and systemic complications were analyzed. Patient demographics, comorbidities, perioperative details, adjunctive procedures were also assessed. Results A total of 129 patients were included in the study: 43 in the older and 86 in the younger age group. The median age of The elderly and young groups was 65.0 and 41.5 years, respectively (P < .001). No statistically significant differences in major, minor, local, or systemic complications were found when both age groups were compared. Major local, major systemic, minor local, and minor systemic in the elderly were 6.9%, 2.3%, 18.6%, and 2.3%, while in the younger patients were 9.3%, 4.7%, 10.5%, and 0.0%, respectively (P > .05). Median follow-up time of the elderly (4.0 months) was no different than the younger (5.0 months) patients (P > .07). Median procedure time in the elderly (4.5 hours) was no different than the younger group (5.0 hours) (P = .4). The elderly exhibited a greater American Society of Anesthesiologist score, median body mass index (28.7 vs 25.1 kg/m2), and number of comorbidities (2.7 vs 0.9) (P < .001). Conclusions There was no significant difference in either major or minor complications between the two groups. This suggests that with proper patient selection, abdominoplasty can be safely performed in the older age patient population. Level of Evidence 2.
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Affiliation(s)
- Rafael A. Couto
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Gregory A. Lamaris
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Todd A. Baker
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Ahmed M. Hashem
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Kashyap Tadisina
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Paul Durand
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Steven Rueda
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Susan Orra
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - James E. Zins
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
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Gupta V, Yeslev M, Winocour J, Bamba R, Rodriguez-Feo C, Grotting JC, Higdon KK. Aesthetic Breast Surgery and Concomitant Procedures: Incidence and Risk Factors for Major Complications in 73,608 Cases. Aesthet Surg J 2017; 37:515-527. [PMID: 28333172 DOI: 10.1093/asj/sjw238] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Major complications following aesthetic breast surgery are uncommon and thus assessment of risk factors is challenging. Objectives To determine the incidence and risk factors of major complications following aesthetic breast surgery and concomitant procedures. Methods A prospective cohort of patients who enrolled into the CosmetAssure (Birmingham, AL) insurance program and underwent aesthetic breast surgery between 2008 and 2013 was identified. Major complications (requiring reoperation, readmission, or emergency room visit) within 30 days of surgery were recorded. Risk factors including age, smoking, body mass index (BMI), diabetes, type of surgical facility, and combined procedures were evaluated. Results Among women, augmentation was the most common breast procedure (n = 41,651, 58.6%) followed by augmentation-mastopexy, mastopexy, and reduction. Overall, major complications occurred in 1.46% with hematoma (0.99%) and infection (0.25%) being most common. Augmentation-mastopexy had a higher risk of complications, particularly infection (relative risk [RR] 1.74, P < 0.01), than single breast procedures. Age was the only significant predictor for hematomas (RR 1.01, P < 0.01). Increasing age (RR 1.02, P = 0.03) and BMI (RR 1.09, P < 0.01) were risk factors for infection. Concomitant abdominoplasty was performed in 4162 (5.8%) female patients and was associated with increased risk of complications compared to breast procedures or abdominoplasty performed alone. Among men, correction of gynecomastia was the most common breast procedure (n = 1613, 64.6%) with a complication rate of 1.80% and smoking as a risk factor (RR 2.73, P = 0.03). Conclusions Incidence of major complications after breast cosmetic surgical procedures is low. Risk factors for major complications include increasing age and BMI. Combining abdominoplasty with any breast procedure increases the risk of major complications. Level of Evidence 2.
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Affiliation(s)
- Varun Gupta
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Max Yeslev
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julian Winocour
- Plastic Surgery Fellow, Division of Plastic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ravinder Bamba
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - James C Grotting
- Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL, USA
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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