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Muacevic A, Adler JR, Khan MM, Basireddy PR. ECG Changes Occurring During Chest Liposuction for Gynecomastia - Artifacts or a Cause for Concern? Cureus 2022; 14:e32850. [PMID: 36694503 PMCID: PMC9867793 DOI: 10.7759/cureus.32850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
Currently, liposuction alone or combined with various methods of gland excision has become the standard of care in the surgical management of gynecomastia. Although liposuction is considered a safe and straightforward method of body contouring, serious complications related to the procedure, including deaths, have been reported in the literature. We report the occurrence of ECG artifacts intra-operatively while performing chest liposuction under general anesthesia. Patients may receive unnecessary and potentially dangerous therapeutic interventions if these ECG artifacts are not identified correctly. A careful and rational evaluation of the patient and the ECG by the clinician can accurately identify these pseudo-abnormalities and avoid unnecessary therapies.
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Plath M, Sand M, Cavaliere C, Plinkert PK, Baumann I, Zaoui K. How to predict the outcome of septorhinoplasty? A normative study of ROE and FROI-17 scores. ACTA OTORHINOLARYNGOLOGICA ITALICA 2021; 41:327-335. [PMID: 34533536 PMCID: PMC8448188 DOI: 10.14639/0392-100x-n1291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
Objective Normative values of patient-reported outcome instruments are needed to identify good candidates for rhinoplasty. Rhinoplasty Outcome Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory-17 (FROI-17) are disease-specific questionnaires that evaluate quality of life in patients undergoing rhinoplasty. Methods The reference cohort contained 1,000 participants, selected from a non-probability panel. Normative ROE and FROI-17 scores from this reference cohort were compared with ROE and FROI-17 scores from a patient cohort before (n = 104) and 6 (n = 55) and 12 months (n = 32) after septorhinoplasty. Results Mean FROI-17 scores (± SD) were: overall score, 20.8 ± 17; nasal symptoms, 16.8 ± 7; general symptoms, 24.8 ± 22; and self-confidence, 16.4 ± 21. The ROE total score was 73.1 ± 16. Normative values differed significantly from the preoperative ROE and FROI-17 scores of septorhinoplasty patients (p < 0.01). Except for the FROI-17 general score at 12 months postoperatively (p = 0.004), there were no significant differences between normative ROE/FROI-17 and septorhinoplasty scores postoperatively, indicating that they returned to normalcy. Conclusions Normative scores for ROE and FROI-17 provide a reference point from which to identify patients who are most likely to benefit from rhinoplasty.
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Affiliation(s)
- Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Sand
- GESIS-Leibniz-Institute for the Social Sciences, Mannheim, Germany
| | - Carlo Cavaliere
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Karim Zaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Cheng F, Dai S, Wang C, Zeng S, Chen J, Cen Y. Do Breast Implants Influence Breastfeeding? A Meta-Analysis of Comparative Studies. J Hum Lact 2018; 34:424-432. [PMID: 29932861 DOI: 10.1177/0890334418776654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Aesthetic breast implant augmentation surgery is the most popular plastic surgery worldwide. Many women choose to receive breast implants during their reproductive ages, although the long-term effects are still controversial. Research aim: We conducted a meta-analysis to assess the influence of aesthetic breast augmentation on breastfeeding. We also compared the exclusive breastfeeding rates of periareolar versus inframammary incision. METHODS A systematic search for comparative studies about breast implants and breastfeeding was performed in PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, Scopus, and Web of Science through May 2018. Meta-analysis was conducted with a random-effects model (or fixed effects, if heterogeneity was absent). RESULTS Four cohorts and one cross-sectional study were included. There was a significant reduction in the exclusive breastfeeding rate for women with breast implants compared with women without implants, pooled relative risk = 0.63, 95% confidence interval [0.46, 0.86], as well as the breastfeeding rate, pooled relative risk = 0.88, 95% confidence interval [0.81, 0.95]. There was no evidence that periareolar incision was associated with a reduction in the exclusive breastfeeding rate, pooled relative risk = 0.84, 95% confidence interval [0.45, 1.58]. CONCLUSION Participants with breast implants are less likely to establish breastfeeding, especially exclusive breastfeeding. Periareolar incision does not appear to reduce the exclusive breastfeeding rate.
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Affiliation(s)
- Fengrui Cheng
- 1 Department of Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shuiping Dai
- 1 Department of Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chiyi Wang
- 1 Department of Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shaoxue Zeng
- 1 Department of Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Junjie Chen
- 1 Department of Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ying Cen
- 1 Department of Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Abdelhafez AH, Taha O, Abdelaal M, Al-Najim W, le Roux CW, Docherty NG. Impact of Abdominal Subcutaneous Fat Reduction on Glycemic Control in Obese Patients with Type 2 Diabetes Mellitus. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - Osama Taha
- Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt
| | - Mahmoud Abdelaal
- Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, United Kingdom
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, United Kingdom
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Neil G. Docherty
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Purnell CA, Klosowiak JL, Cheesborough JE, Park E, Bandy A, Dumanian GA. Resolution of Cosmetic Buttock Injection-induced Inflammatory Reaction and Heart Failure after Excision of Filler Material. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1079. [PMID: 27826475 PMCID: PMC5096530 DOI: 10.1097/gox.0000000000001079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/19/2016] [Indexed: 11/25/2022]
Abstract
We present a case of a 66-year-old woman who developed heart failure and severe inflammatory reaction after the illicit cosmetic injections of polymethyl-methacrylate or polyacrylamide hydrogel from a primary care provider. After medical optimization, an en bloc excision of all injectable materials and gluteus muscle was performed, which resulted in exposure of bilateral sciatic nerves. Within 10 days, the patient's heart failure resolved and inflammatory state improved. This is the first known report of heart failure due to buttock injections and subsequent improvement after surgery.
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Affiliation(s)
- Chad A Purnell
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.; and Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Julian L Klosowiak
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.; and Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jennifer E Cheesborough
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.; and Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Eugene Park
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.; and Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Andrew Bandy
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.; and Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Gregory A Dumanian
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.; and Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Makhoul R, Noël W, Royer E, Szwebel J, Levan P. [Treatment of malar mounds by direct excision]. ANN CHIR PLAST ESTH 2015; 61:136-40. [PMID: 26321309 DOI: 10.1016/j.anplas.2015.07.008] [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: 04/11/2015] [Accepted: 07/24/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The treatment of malar mounds is challenging. We report a case series of direct excision of malar mounds and review the existing literature. MATERIAL AND METHODS The procedure is carried out under local anesthesia with light sedation. A pinch test allows to estimate the width of the resection. The skin is resected, and if needed, some of the sub-orbicularis oculi fat. The orbicularis muscle is not closed, and the skin is closed in two layers. RESULTS Eight patients were treated by the same surgeon between January and December 2013. The ages ranged from 41 to 74, with an average of 53. The patients were highly satisfied. The results were considered excellent for 5 patients and good for 3. There were no complications, in particular no scleral show, no ectropion, and no hematoma. CONCLUSION Direct excision of malar mounds is simple, efficient, and reproducible. The scars are most often inconspicuous, in particular in the elderly.
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Affiliation(s)
- R Makhoul
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - W Noël
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - E Royer
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - J Szwebel
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - P Levan
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
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Yeslev M, Gupta V, Winocour J, Shack RB, Grotting JC, Higdon KK. Safety of Cosmetic Procedures in Elderly and Octogenarian Patients. Aesthet Surg J 2015; 35:864-73. [PMID: 25911627 DOI: 10.1093/asj/sjv053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The proportion of elderly patients in North America is increasing. This has resulted in an increased number of elderly patients undergoing cosmetic procedures. OBJECTIVES The purpose of this study was to determine the incidence of postoperative complications in elderly patients (age ≥65) undergoing elective aesthetic plastic surgical procedures compared with younger patients. METHODS A total of 183,914 cosmetic surgical procedures were reviewed using the prospectively enrolled cohort of patients in the CosmetAssure database. Comorbidities and postoperative complications in elderly and younger patient groups were recorded and compared. A separate analysis of postoperative complications was performed in the octogenarian subgroup (age ≥80). RESULTS A total of 6786 elderly patients who underwent cosmetic procedures were included in the study. Mean ages (±standard deviation) in elderly and younger patients were 69.1 ± 4.1 and 39.2 ± 12.5 years, respectively. The elderly patient population had more men, a higher mean body mass index (BMI), a higher prevalence of diabetes mellitus (DM), and fewer smokers compared with the younger patients. The overall postoperative complication rate was not significantly different between elderly and younger patients. When stratified by type of cosmetic procedure, only abdominoplasty was associated with a higher postoperative complication rate in elderly compared with younger patients. The most common postoperative complications in elderly patients were hematoma and infection. The overall postoperative complication rate in octogenarians was 2.2%, which was not significantly different from the younger population. CONCLUSIONS Cosmetic procedures in elderly patients, including octogenarians, remain safe with an acceptable complication rate compared to younger patients.
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Affiliation(s)
- Max Yeslev
- Drs Yeslev, Gupta, and Winocour are Plastic Surgery Fellows, Dr Shack is a Professor and Chairman, and Dr Higdon is an Assistant Professor, Department of Plastic Surgery, Vanderbilt University, Nashville, Tennessee. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Varun Gupta
- Drs Yeslev, Gupta, and Winocour are Plastic Surgery Fellows, Dr Shack is a Professor and Chairman, and Dr Higdon is an Assistant Professor, Department of Plastic Surgery, Vanderbilt University, Nashville, Tennessee. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Julian Winocour
- Drs Yeslev, Gupta, and Winocour are Plastic Surgery Fellows, Dr Shack is a Professor and Chairman, and Dr Higdon is an Assistant Professor, Department of Plastic Surgery, Vanderbilt University, Nashville, Tennessee. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - R Bruce Shack
- Drs Yeslev, Gupta, and Winocour are Plastic Surgery Fellows, Dr Shack is a Professor and Chairman, and Dr Higdon is an Assistant Professor, Department of Plastic Surgery, Vanderbilt University, Nashville, Tennessee. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C Grotting
- Drs Yeslev, Gupta, and Winocour are Plastic Surgery Fellows, Dr Shack is a Professor and Chairman, and Dr Higdon is an Assistant Professor, Department of Plastic Surgery, Vanderbilt University, Nashville, Tennessee. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - K Kye Higdon
- Drs Yeslev, Gupta, and Winocour are Plastic Surgery Fellows, Dr Shack is a Professor and Chairman, and Dr Higdon is an Assistant Professor, Department of Plastic Surgery, Vanderbilt University, Nashville, Tennessee. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, and is CME/MOC Section Editor for Aesthetic Surgery Journal
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8
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Noels EC, Lapid O, Lindeman JHN, Bastiaannet E. Breast implants and the risk of breast cancer: a meta-analysis of cohort studies. Aesthet Surg J 2015; 35:55-62. [PMID: 25568234 DOI: 10.1093/asj/sju006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The popularity of cosmetic breast augmentation and the incidence of breast cancer have been increasing worldwide. It has been hypothesized that the risk of breast cancer may be greater among patients who have undergone cosmetic breast implantation. OBJECTIVES The authors performed a meta-analysis of the available literature on the risk of breast cancer among women with cosmetic breast implants. METHODS The study was designed as a meta-analysis of observational studies. A systematic search of the English literature (published by August 28, 2013) was conducted in PubMed and EMBASE. Eligible reports were those that included relative risk (RR; the increased or decreased risk of breast cancer associated with breast implants) or the standardized incidence ratio (SIR) of the observed number of cases of breast cancer to the expected number of cases among patients that previously underwent cosmetic breast augmentation. RESULTS Seventeen studies representing 7 cohorts were selected. Some of these were follow-up reports of previously published studies; in such cases, only the most recent reports were included in the meta-analysis. Summary SIR and RR rates and the corresponding 95% confidence intervals (CIs) were calculated with a random-effects (SIR) or fixed-effects (RR) model. The overall SIR estimate was 0.69 (95% CI, 0.56-0.85), and the overall RR, based on 4 studies, was 0.63 (95% CI, 0.56-0.71). CONCLUSIONS Finding of this meta-analysis suggest that women who have undergone cosmetic breast implantation do not have an increased risk of breast cancer.
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Affiliation(s)
- Eline C Noels
- Dr Noels is a researcher and Dr Lapid is a plastic surgeon in the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lindeman is a senior researcher in the Department of Vascular Surgery, and Dr Bastiaannet is an epidemiologist and senior researcher in the Department of Surgery and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Oren Lapid
- Dr Noels is a researcher and Dr Lapid is a plastic surgeon in the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lindeman is a senior researcher in the Department of Vascular Surgery, and Dr Bastiaannet is an epidemiologist and senior researcher in the Department of Surgery and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan H N Lindeman
- Dr Noels is a researcher and Dr Lapid is a plastic surgeon in the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lindeman is a senior researcher in the Department of Vascular Surgery, and Dr Bastiaannet is an epidemiologist and senior researcher in the Department of Surgery and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Bastiaannet
- Dr Noels is a researcher and Dr Lapid is a plastic surgeon in the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lindeman is a senior researcher in the Department of Vascular Surgery, and Dr Bastiaannet is an epidemiologist and senior researcher in the Department of Surgery and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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9
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Nadeau MH, Gould DJ, Macias LH, Spring MA, Stevens WG. Superior pedicle technique of reduction mammaplasty: a stepwise approach. Aesthet Surg J 2015; 35:94-104. [PMID: 25568240 DOI: 10.1093/asj/sju011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Numerous surgical options for breast reduction have been described, but in the current healthcare environment, efficiency is of the utmost importance. In this Featured Operative Technique, the authors describe an efficient, reproducible, and simple method for minimal to moderate reduction mammaplasty that utilizes a superior pedicle. The surgical maneuvers were developed and conveyed to the senior author (W.G.S.) by Dr John Bostwick. This approach preserves superior and medial breast fullness while providing appropriate resection of the breast parenchyma to ameliorate symptoms and produce a smaller, lifted breast with a more youthful appearance. The surgical technique maintains a reliable blood supply to the nipple-areola complex (NAC) from the internal mammary artery and its perforators, and involves minimal transposition of the NAC. The authors reviewed the charts of 62 consecutive patients who underwent this procedure and found the complication rate to be 11.3%. Complications included 1 hematoma, 1 standing cone deformity, 3 soft-tissue infections, 8 incisional breakdowns, and 1 unilateral necrosis of the NAC.
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Affiliation(s)
- Meghan H Nadeau
- Dr Nadeau is a fellow in the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles. Dr Gould is a resident and Drs Macias and Spring are Clinical Assistant Professors of Surgery in the Division of Plastic and Reconstructive Surgery at the University of Southern California in Los Angeles. Dr Stevens is Clinical Professor of Surgery and Director of the Division of Plastic and Reconstructive Surgery at the University of Southern California and is Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles
| | - Daniel J Gould
- Dr Nadeau is a fellow in the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles. Dr Gould is a resident and Drs Macias and Spring are Clinical Assistant Professors of Surgery in the Division of Plastic and Reconstructive Surgery at the University of Southern California in Los Angeles. Dr Stevens is Clinical Professor of Surgery and Director of the Division of Plastic and Reconstructive Surgery at the University of Southern California and is Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles
| | - Luis H Macias
- Dr Nadeau is a fellow in the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles. Dr Gould is a resident and Drs Macias and Spring are Clinical Assistant Professors of Surgery in the Division of Plastic and Reconstructive Surgery at the University of Southern California in Los Angeles. Dr Stevens is Clinical Professor of Surgery and Director of the Division of Plastic and Reconstructive Surgery at the University of Southern California and is Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles
| | - Michelle A Spring
- Dr Nadeau is a fellow in the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles. Dr Gould is a resident and Drs Macias and Spring are Clinical Assistant Professors of Surgery in the Division of Plastic and Reconstructive Surgery at the University of Southern California in Los Angeles. Dr Stevens is Clinical Professor of Surgery and Director of the Division of Plastic and Reconstructive Surgery at the University of Southern California and is Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles
| | - W Grant Stevens
- Dr Nadeau is a fellow in the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles. Dr Gould is a resident and Drs Macias and Spring are Clinical Assistant Professors of Surgery in the Division of Plastic and Reconstructive Surgery at the University of Southern California in Los Angeles. Dr Stevens is Clinical Professor of Surgery and Director of the Division of Plastic and Reconstructive Surgery at the University of Southern California and is Director of the University of Southern California-Marina del Rey Aesthetic Surgery Fellowship Program in Los Angeles
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Brockhoff HC, Morris CD, Throckmorton GS, Finn R. Anatomic analysis of the conchal bowl cartilage. J Oral Maxillofac Surg 2014; 72:2248-55. [PMID: 25438278 DOI: 10.1016/j.joms.2014.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/21/2014] [Accepted: 04/21/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE The conchal bowl is a portion of auricular cartilage commonly used as an autologous graft for various maxillofacial procedures. Few studies have attempted to describe the anatomy of this region in detail, particularly in relation to the curvature of the conchal bowl. The present study has provided detailed information about the anatomy of the auricular cartilage in the conchal bowl region that could assist in the surgical design of graft harvesting. MATERIALS AND METHODS A total of 35 pairs of cadaver ears without gross deformity (15 male, 20 female; aged 39 to 99 years) were dissected to completely expose the cartilage skeleton. Each cartilage was stabilized, and the conchal bowl was mapped. The starting reference point was defined as the intersection of the lateral border of the antihelix and the superiormost aspect of the inferior crux. A prefabricated grid was then used to imprint a 4 × 5 matrix of pinpoint ink spots on the surface of each cartilage, with 6-mm increments between each spot. The grid's y and x axes were then aligned with the landmarks above. Next, a MicroScribe 3-dimensional digitizer (ghost3d.com) was used to capture the 3-dimensional coordinates for each point on the ear's surface and the coordinates were transferred into an Excel spreadsheet. After digitization, a Boley gauge was used to measure the thickness of the cartilage at each premarked spot. The gathered data points and measurements were examined to describe our parameters of interest (ie, depth, thickness, and curvature). RESULTS The average maximum conchal bowl depth was 10.5 ± 3.0 mm in the female ears and 10.7 ± 2.5 mm in the male ears. In general, the conchal bowl depth at each point did not differ significantly between the males and females. The mean cartilage thickness ranged from 0.77 to 1.79 mm (mean 1.15 ± 0.26) in the females and 0.95 to 1.45 mm (mean 1.25 ± 0.23) in the males. Both genders showed an increase in the conchal bowl depth from inferiorly to superiorly and from posteriorly to anteriorly. The cartilage thickness also increased from posteriorly to anteriorly; however, the exact shape is complex. CONCLUSIONS A detailed understanding of the facial anatomy is important in the practice of facial surgery. The results we have presented will provide surgeons with information on the overall dimensions, thickness, and curvature of the conchal bowl that could allow more advantageous donor site selection.
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Affiliation(s)
- Hans C Brockhoff
- Resident, Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center-Parkland, Dallas, TX.
| | | | - Gaylord S Throckmorton
- Professor Emeritus, Department of Anatomy and Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rick Finn
- Director, Section of Oral and Maxillofacial Surgery, Dallas Veteran's Affairs Medical Center, and Faculty, Department of Cell Biology and Neuroscience, University of Texas Southwestern Medical Center, Dallas, TX
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11
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Hein RE, Constantine RS, Cortez R, Miller T, Anigian K, Lysikowski J, Davis K, Reed G, Trussler A, Rohrich RJ, Kenkel JM. An alternative outpatient care model: postoperative guest suite-based care. Aesthet Surg J 2014; 34:1225-31. [PMID: 25270544 DOI: 10.1177/1090820x14546161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients recovering from outpatient surgery are responsible for managing their pain, managing ambulation, and even implementing thromboembolism prophylaxis after discharge. Because of the importance of postoperative care to prevent complications, a model of care that helps a patient transition to independent self-care could provide optimal results. OBJECTIVES The authors investigated the safety and morbidity rate for patients who underwent body contouring procedures and overnight care at an attached, nurse-staffed guest suite facility. METHODS A retrospective review was conducted of 246 patients who underwent major body contouring and who stayed at least 1 night in the guest suite facility. Major complications included a return to the operating room within 48 hours, major wound infection, and unplanned hospitalization within 48 hours. Minor complications included any postsurgical effect necessitating unplanned physician intervention within the first 30 days. Univariate analyses correlating patient characteristics and complication rates were conducted, as well as comparison of complication rates among same procedures reported in the literature. RESULTS The complication rate (major and minor complications) was 25.20%. Surgical site infection occurred in 8.13% of patients. The most common wound complication was erythema around the incision site (12.20%). Death, deep vein thrombosis, or pulmonary embolism did not occur. Comparison with relevant results reported in the literature indicated a significant reduction in the occurrence of postoperative venous thromboembolism. CONCLUSIONS Patient education after surgery is essential to healing and adequate care. The guest suite model provides improved care and education for the patient and family postsurgery by addressing some of the known risk factors of plastic surgery. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Rachel E Hein
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Ryan S Constantine
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Robert Cortez
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Travis Miller
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Kendall Anigian
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Jerzy Lysikowski
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Kathryn Davis
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Gary Reed
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Andrew Trussler
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Rod J Rohrich
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Jeffrey M Kenkel
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
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Abdelaal MM, Aboelatta YA. Comparison of Blood Loss in Laser Lipolysis vs Traditional Liposuction. Aesthet Surg J 2014; 34:907-12. [PMID: 24871303 DOI: 10.1177/1090820x14536904] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Laser-assisted liposuction has been associated with reduced blood loss. However, this clinical finding has not been evaluated objectively. OBJECTIVES In this study, the authors objectively estimated the blood loss volume associated with laser lipolysis vs traditional liposuction in various anatomic regions. METHODS In this prospective study, 56 patients underwent equal amounts of traditional and laser-assisted liposuction at 2 contralateral anatomic sites. Blood loss volumes were calculated from the lipoaspirates by measuring hemoglobin and red blood cell content. The data were analyzed statistically with repeated-measures analysis of variance and the Mann-Whitney U test. RESULTS Laser lipolysis can reduce blood loss by more than 50% compared with traditional liposuction. Laser lipolysis resulted in significant reductions in mean blood loss volumes in the abdomen, flanks, back, and breast. CONCLUSIONS The authors provide objective evidence that laser lipolysis significantly reduces blood loss compared with traditional liposuction. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Mohammed Mahmoud Abdelaal
- Drs Abdelaal and Aboelatta are Associate Professors, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Yasser Abdallah Aboelatta
- Drs Abdelaal and Aboelatta are Associate Professors, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Lapid O, Noels EC, Meijer SL. Pathologic Findings in Primary Capsulectomy Specimens: Analysis of 2531 Patients. Aesthet Surg J 2014; 34:714-8. [PMID: 24809359 DOI: 10.1177/1090820x14531144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND After breast augmentation, additional operations are often needed for revision or explantation. Although the surgeon may elect to leave the capsule in situ during these procedures, excised capsule tissue may be examined histopathologically for cancer cells. OBJECTIVES The authors assessed pathologic findings from breast implant capsules submitted for histopathologic examination and evaluated whether it is oncologically safe to leave capsule tissue in situ. METHODS The authors searched PALGA, the nationwide histopathology and cytopathology data network and registry in the Netherlands, for primary capsulectomy specimens excised between 2003 and 2012. The authors applied a sensitive search strategy with low specificity that included female and breast as the sex and anatomic location keywords, and wildcards were used to detect different spellings. Cases were excluded if previous examinations showed compatibility with a history of breast cancer, prophylactic mastectomy, or prophylactic oophorectomy. The pathologic reports were manually reviewed for relevance, and each case's diagnosis was registered. A total of 6803 reports were available, representing 4948 patients; 2574 reports from 2531 patients were included in this study. The median age of patients was 51.2 ± 12.0 years (range, 15-88 years). RESULTS Invasive carcinoma was detected in 4 patients (0.16%). Four patients (0.16%) had ductal carcinoma in situ, and 1 patient (0.04%) had lobular carcinoma in situ. Metaplasia was noted in 51 patients (2.0%), calcifications in 375 (14.6%), and silicone in 701 (27.2%). CONCLUSIONS The incidence of occult invasive or in situ carcinoma in capsulectomy specimens of patients with no previous breast pathology is low. Therefore, it appears oncologically safe to leave capsule tissue in situ. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Oren Lapid
- Dr Lapid is a plastic surgeon and Dr Noels was a medical student in the Department of Plastic, Reconstructive and Hand Surgery
| | - Eline C Noels
- Dr Lapid is a plastic surgeon and Dr Noels was a medical student in the Department of Plastic, Reconstructive and Hand Surgery
| | - Sybren L Meijer
- Dr Meijer is a pathologist in the Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Constantine RS, Davis KE, Kenkel JM. The effect of massive weight loss status, amount of weight loss, and method of weight loss on body contouring outcomes. Aesthet Surg J 2014; 34:578-83. [PMID: 24676143 DOI: 10.1177/1090820x14528208] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The impact of massive weight loss (MWL) on body contouring procedures and outcomes has not been firmly established in the literature. OBJECTIVE The authors investigate the correlations between MWL status, the method of achieving MWL, and the amount of weight lost with wound-healing complications after body contouring procedures. METHODS The charts of 450 patients (124 of whom had undergone MWL) who underwent body contouring procedures including abdominoplasty, brachioplasty, thighplasty, breast mastopexy/reduction, lower bodylift, bodylift, buttock lift, and liposuction were reviewed. MWL patients were classified as having achieved weight loss through diet and exercise, gastric banding or sleeving, or gastric bypass. Postoperative complication data were collected, including cases of infection, delayed wound healing, seroma, hematoma, dehiscence, and overall wound problems. Odds ratios (OR) were estimated using 4 multivariate logistic regression models. RESULTS MWL status was a significant predictor of wound problems (OR, 2.69; P < .001). Patients with 50 to 100 lbs of weight loss did not have a significantly increased risk of wound problems (OR, 1.93; P = .085), while patients with over 100 lbs of weight loss did (OR, 3.98; P < .001). Gastric bypass (OR, 3.01; P = <.001) had a higher risk correlation than did diet and exercise (OR, 2.72, P = .023) or restrictive bariatric surgery (OR, 2.31; P = .038) as a weight loss method. Patients who lost over 100 lbs demonstrated increased risk of complications if they had gastric bypass or restrictive procedures. CONCLUSIONS MWL was a significant risk factor for wound complications in the body contouring population. Method and amount of weight loss were also significant factors in predicting complications.
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Abstract
Blepharoplasty, the most common aesthetic eyelid procedure, sometimes involves a challenging patient subgroup: those who present with malar edema, malar bags, and festoons. In this review article, the authors describe the relevant anatomy in festoon development, discuss the pathophysiological basis of this condition spectrum, outline clinical examination basics, summarize various surgical approaches for treatment and propose an algorithm for their application, and describe the most common postsurgical complications.
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Affiliation(s)
- Dzifa S Kpodzo
- Dr Kpodzo is the former ASAPS Scholar at Paces Plastic Surgery, Atlanta, Georgia, and Assistant Professor of Surgery in the Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
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Few JW. Book Review: Botulinum Toxin: Procedures in Cosmetic Dermatology Series. Aesthet Surg J 2013. [DOI: 10.1177/1090820x13500299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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