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Lisiecki JL, Chiodo MV, Rohrich RJ. Neuromodulator Injection for Gummy Smile. Plast Reconstr Surg 2024; 153:555e-557e. [PMID: 37159908 DOI: 10.1097/prs.0000000000010644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
SUMMARY Neuromodulators have become a treatment of choice for the management of excess gingival show, or "gummy smile." There have been many proposed algorithms for the optimal placement and dosage of neuromodulator to inject in these locations. The authors aim to clarify these points and provide surgeons with a reliable way to manage the gummy smile that results from hyperactive muscles of the midface.
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Boyd CJ, Chiodo MV, Lisiecki JL, Wagner RD, Rohrich RJ. Systematic Review of Capsular Contracture Management following Breast Augmentation: An Update. Plast Reconstr Surg 2024; 153:303e-321e. [PMID: 36877620 DOI: 10.1097/prs.0000000000010358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics and minimizing subsequent recurrence of capsular contracture. As new data emerge, close review of the data are merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture. METHODS A systematic review of the MEDLINE, Embase, and Cochrane Database of Systematic Reviews databases was conducted to characterize the surgical management of capsular contracture in revision breast augmentations. The primary endpoint was capsular contracture recurrence rate. RESULTS The review was conducted in November of 2021. Primary search revealed 14,163 results. Initial screening by title left 1223 articles. Abstract review left 90 articles for full-text review, of which 34 were ultimately included and were all observational in nature. CONCLUSIONS Capsular contracture management remains an important topic, with limited high-level evidence for establishing clear evidence-based treatment guidelines. Although more evidence is required to assess the effects of capsulectomy, implant exchange, and plane change, these appear to be useful mechanisms for reducing recurrent capsular contracture. There is more evidence regarding the use of acellular dermal matrix, although this still requires long-term follow-up studies. New developments regarding textured implants limit the revision breast augmentation surgeon to smooth devices.
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Affiliation(s)
- Carter J Boyd
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone
| | | | | | - Ryan D Wagner
- Division of Plastic Surgery, Baylor College of Medicine
| | - Rod J Rohrich
- Dallas Plastic Surgery Institute
- Division of Plastic Surgery, Baylor College of Medicine
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Lisiecki JL, Chiodo MV, Rohrich RJ. Revision Rhinoplasty Finesse with Digital Osteotomies. Plast Reconstr Surg 2024; 153:106-107. [PMID: 36877619 DOI: 10.1097/prs.0000000000010362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
SUMMARY Revision rhinoplasty is a finesse procedure requiring careful consideration of all of its requisite steps. Lateral osteotomies are required in many cases and, in the setting of prior lateral osteotomies, can often be recreated with digital pressure alone, without the use of an osteotome. The advantages of doing so include decreased dead-space creation and preservation of attachments between the skeleton and overlying soft tissue.
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Rohrich RJ, Lisiecki JL, Chiodo MV. Refinements in Component Dorsal Reshaping in Primary Rhinoplasty. Plast Reconstr Surg 2023; 152:828e-833e. [PMID: 36728200 DOI: 10.1097/prs.0000000000010215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
SUMMARY Dorsal reduction and reshaping is an essential part of many rhinoplasty procedures. The steps of component dorsal reduction have been well established. The authors describe refinement of the dorsal reshaping process to improve the quality and consistency of results.
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Chiodo MV, Lisiecki JL, Rohrich RJ. Management of the Post Hemangioma Nose - 5 Key Rhinoplasty Components. Plast Reconstr Surg 2023; Publish Ahead of Print:00006534-990000000-02023. [PMID: 37379459 DOI: 10.1097/prs.0000000000010895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Hemangiomas of the nasal tip are a relatively uncommon presentation of a common tumor. While optimal medical and surgical management of nasal tip infantile hemangiomas has been described and debated extensively in the literature, to our knowledge, there is no report of secondary aesthetic and functional rhinoplasty in these patients at skeletal maturity until now. This special topic provides an excellent example of the five key technical elements to revision rhinoplasty in the skeletally mature patient with history of nasal tip infantile hemangioma.
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Affiliation(s)
| | | | - Rod J Rohrich
- Dallas Plastic Surgery Institute, Dallas, Texas
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
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Chiodo MV, Lisiecki JL, Rohrich RJ. Neuromodulator Finesse for Masseter Hypertophy and Bruxism. Plast Reconstr Surg 2023; Publish Ahead of Print:00006534-990000000-01924. [PMID: 37224448 DOI: 10.1097/prs.0000000000010746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A particularly prominent mandibular angle or a hypertrophied masseter muscle can result in an excessively wide facial appearance which is often less aesthetically pleasing, especially for women. Though normally a benign condition and strictly an aesthetic concern, a hypertrophied masseter can also cause pain, bruxism, and headaches. Neuromodulator for masseter reduction and treatment of bruxism has become first line. Here we provide the senior author's anatomic approach to neuromodulator injection of the masseter with a corresponding video of the injection technique.
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Affiliation(s)
| | | | - Rod J Rohrich
- Dallas Plastic Surgery Institute, Dallas, Texas
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
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Jalalabadi F, Lisiecki JL, Chiodo MV, Rohrich RJ. Lip Lifting: The Missing Link in Central Facial Rejuvenation. Plast Reconstr Surg 2023; Publish Ahead of Print:00006534-990000000-01882. [PMID: 37220218 DOI: 10.1097/prs.0000000000010735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The lip lift is a powerful yet finesse operation in the realm of facial rejuvenation. In an era of booming non-surgical lip augmentation, the astute plastic surgeon must identify which patients will end up with a dreaded unnatural appearance should they receive volume enhancement alone in pursuit of central facial and perioral rejuvenation. In this paper, we review the ideal youthful lips, the characteristics of the aged lip and indications for lifting. We present our preferred surgical technique, the underlying principles that it respects, and adjunct procedures to optimize results in central facial rejuvenation.
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Affiliation(s)
| | | | | | - Rod J Rohrich
- Dallas Plastic Surgery Institute, Dallas, Texas
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
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Rohrich RJ, Lisiecki JL, Chiodo MV. Differential Fat Grafting to Address Facial Asymmetry in Facelifting. Plast Reconstr Surg 2023; Publish Ahead of Print:00006534-990000000-01883. [PMID: 37220215 DOI: 10.1097/prs.0000000000010737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The modern facelift is a complex operation involving the repositioning of tissues and the refilling of volume atrophy. Preoperative analysis is key to the successful diagnosis of aging changes. Facial asymmetry is universal, and must be recognized and incorporated into surgical planning. In this paper, we address the role of fat grafting to manage facial aging in the setting of facial asymmetry.
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Wagner RD, Lisiecki JL, Chiodo MV, Rohrich RJ. Longevity of ptosis correction in mastopexy and reduction mammaplasty: A systematic review of techniques. JPRAS Open 2022; 34:1-9. [PMID: 36061406 PMCID: PMC9428726 DOI: 10.1016/j.jpra.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022] Open
Abstract
Background Mastopexy and reduction mammaplasty are commonly performed procedures in plastic surgery with many variations in incision pattern, pedicle design, and additional support maneuvers. Aesthetically pleasing on table results are widely accomplished; however, the longevity of the outcome and sustained correction of ptosis or pseudoptosis is not universal. A systematic review of mastopexy and reduction mammaplasty procedures was performed to investigate which techniques provided the greatest long-term correction of ptosis. Methods A broad search of the literature was performed using the PubMed database from inception to December of 2021. Study characteristics, number of patients, number of breasts, technique, outcome, and average follow-up time were extracted for analysis. Study quality was assessed using the Newcastle–Ottawa Scale when applicable. Results The primary search yielded 1123 articles. After two levels of screening, 24 articles were identified for analysis. This included 16 case series, seven cohort studies, and one randomized controlled study. From these studies, 1235 patients and 2235 breasts were analyzed. The majority of articles reported on a change in the nipple to inframammary fold and sternal notch to nipple distances. Conclusions In the analytical studies, superior and superomedial pedicles tended to provide greater long-term stability than inferior pedicles. Mesh, dermal suspension flaps, and muscular slings showed promise in providing additional support over standard techniques. No single procedure is ideal for all patients; however, this systematic review provides a valuable description of techniques and long-term outcomes to guide surgical planning.
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Daar DA, Bekisz JM, Chiodo MV, DeMitchell-Rodriguez EM, Saadeh PB. Hematoma After Non-Oncologic Breast Procedures: A Comprehensive Review of the Evidence. Aesthetic Plast Surg 2021; 45:2602-2617. [PMID: 33864116 DOI: 10.1007/s00266-021-02276-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hematoma after non-oncologic breast surgery is a common concern requiring expeditious treatment. The purpose of this study is to perform an evidence-based review of perioperative factors that may contribute to hematoma in non-oncologic breast procedures. METHODS A comprehensive literature review was performed of non-oncologic breast procedures: breast augmentation, single-stage augmentation-mastopexy, mastopexy, and reduction. In total, 28 studies highlighting incidence and potential risk factors for hematoma were included; overall level of evidence was established regarding each perioperative factor examined and hematoma rate. RESULTS The hematoma rate in breast augmentation ranges from 0.2 to 5.7%. There is inconclusive evidence to support an association between pocket choice or incision location and hematoma rate (Level III) and no evidence of an association between implant type and hematoma (Level V). Single-stage augmentation-mastopexy may have a lower hematoma rate than augmentation alone (Level II). Hematoma may increase the risk of capsular contracture (Level III). In breast reduction, the hematoma rate ranges from 1.0 to 9.3%. Evidence of an association between incision choice and hematoma rate is inconclusive (Level III). Use of epinephrine-containing solution, pedicle choice, and resection weight do not appear to affect hematoma rate (Level V, II, and II, respectively). The use of postoperative drains and ketorolac do not affect the incidence of hematoma (Level I and III, respectively). Intraoperative hypotension may increase the risk of hematoma after breast reduction (Level III). CONCLUSIONS Breast hematomas are not uncommon complications. Current literature lacks ample evidence for risk factors for hematoma after non-oncologic breast procedures, warranting further, high-powered investigations. 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)
- David A Daar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
| | - Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Michael V Chiodo
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Evellyn M DeMitchell-Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Pierre B Saadeh
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 East 41st Street, New York, NY, 10017, USA
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Robertson KJ, Mendez BM, Bruce WJ, McDonnell BD, Chiodo MV, Patel PA. Le Fort III Distraction With Internal vs External Distractors. Cleft Palate Craniofac J 2018; 55:721-727. [DOI: 10.1177/1055665617754460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study compares the change in midface position following Le Fort III advancement using either rigid external distraction (group 1) or internal distraction (group 2). We hypothesized that, with reference to right-facing cephalometry, internal distraction would result in increased clockwise rotation and inferior displacement of the midface. Design: Le Fort III osteotomies and standardized distraction protocols were performed on 10 cadaveric specimens per group. Right-facing lateral cephalograms were traced and compared across time points to determine change in position at points orbitale, anterior nasal spine (ANS), A-point, and angle ANB. Setting: Institutional. Patients, Participants: Twenty cadaveric head specimens. Interventions: Standard subcranial Le Fort III osteotomies were performed from a coronal approach and adequately mobilized. The specified distraction mechanism was applied and advanced by 15 mm. Main Outcome Measure(s): Changes of position were calculated at various skeletal landmarks: orbitale, ANS, A-point, and ANB. Results: Group 1 demonstrated relatively uniform x-axis advancement with minimal inferior repositioning at the A-point, ANS, and orbitale. Group 2 demonstrated marked variation in x-axis advancement among the 3 points, along with a significant inferior repositioning and clockwise rotation of the midface ( P < .0001). Conclusion: External distraction resulted in more uniform advancement of the midface, whereas internal distraction resulted in greater clockwise rotation and inferior displacement. External distraction appears to provide increased vector control of the midface, which is important in creating a customized distraction plan based on the patient’s individual occlusal and skeletal needs.
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Affiliation(s)
- Kevin J. Robertson
- Division of Plastic and Maxillofacial Surgery, Royal Children’s Hospital of Melbourne, Melbourne, Victoria, Australia
| | - Bernardino M. Mendez
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William J. Bruce
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | | | - Michael V. Chiodo
- Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY, USA
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Frey JD, Poudrier G, Chiodo MV, Hazen A. Research Disparities in Female-to-Male Transgender Genital Reconstruction: The Charge for High-Quality Data on Patient Reported Outcome Measures. Ann Plast Surg 2017; 78:241. [PMID: 28177977 DOI: 10.1097/sap.0000000000000996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jordan D Frey
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY
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