Modified Approach of Double Papillae Laterally Positioned Flap Technique using Alloderm® for Root Coverage

Cosmetic concern is on increase in dental patients these days resulting in more demand for periodontal plastic surgical procedures. Gingival recession is one of the common problems which impairs aesthetic and may result in hypersensitivity and increase chances of root caries. Several plastic procedures are available to correct the defect. Double papilla laterally positioned flap combined with Alloderm has been used to cover single tooth class I recession site as adequate width of keratinized gingiva is present on adjacent teeth. The technique has resulted in 80% of root coverage.

Central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections

We report 2 cases of central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections and a literature review. The 2 patients were two healthy women, in which cosmetic facial injections with autologous fat and filler were performed, respectively. The patients had no light perception at the final visit and their conditions led to memory retrieval disturbance in case 1 and right arm weakness, dysarthria, facial palsy, and ophthalmoplegia in case 2. Neuroimaging showed multifocal small infarctions in the ipsilateral frontal lobe with occlusion of the ophthalmic artery in case 1 and multiple infarctions in the ipsilateral anterior and middle cerebral artery territories with subsequent hemorrhagic transformation in case 2. Poor visual prognosis and neurological complications can occur in healthy adults undergoing cosmetic facial injection, and all patients should be informed of this risk before the procedure.

Adsorption of polyelectrolytes and polyelectrolytes-surfactant mixtures at surfaces: a physico-chemical approach to a cosmetic challenge

The use of polymer and polymer - surfactant mixtures for designing and developing textile and personal care cosmetic formulations is associated with various physico-chemical aspects, e.g. detergency and conditioning in the case of hair or wool, that determine their correct performances in preserving and improving the appearance and properties of the surface where they are applied. In this work, special attention is paid to the systems combining polycations and negatively charged surfactants. The paper introduces the hair surface and presents a comprehensive review of the adsorption properties of these systems at solid-water interfaces mimicking the negative charge and surface energy of hair. These model surfaces include mixtures of thiols that confer various charge densities to the surface. The kinetics and factors that govern the adsorption are discussed from the angle of those used in shampoos and conditioners developed by the cosmetic industry. Finally, systems able to adsorb onto negatively charged surfaces regardless of the anionic character are presented, opening new ways of depositing conditioning polymers onto keratin substrates such as hair.

Comparison of three skin closure methods in knee mid-anterior incisions

BACKGROUND

Few clinical trials have studied the functional and cosmetic outcomes using different closure techniques for surgical incisions. Since wound and rupture closure methods may influence the healing process and cosmetic outcome, the present study aims at comparing three different suture techniques.

METHODS

In a clinical trial, sixty patients with an anterior cruciate ligament rupture were studied. At the end of the operation and after subcutaneous tissue closure, the skin incision was divided into three equal parts. Each part was randomly sutured using one of three techniques: simple, vertical mattress, or semisubcuticular suture techniques. After six months follow-up, we take a picture of the healed wound in each individual. The cosmetic outcome was rated and evaluated by three Orthopedic Surgeons according to the visual analogue scale (zero to 10). During the study, wounds were followed up for inflammation, infection, or discharges.

RESULTS

There were no significant differences between cosmetic results of different suturing methods. The mean and standard deviation of VAS scores for three different observer were 5.62±1.39, 5.62±1.13, 5.65±1.29 in the simple suture; 6.05±1.33, 6.13±1.01, 5.93±1.02 in the vertical mattress technique and 5.72±1.82, 5.81±097 and 5.77±0.99 in the semisubcutaneous method. Overall agreements between observers were weak to moderate. Slight superiority of the semisubcuticular sutures were not statistically significant.

CONCLUSIONS

The methods used for suturing an anterior midline incision of the knee does not seem to affect the final cosmetic outcome. The concept of different surgeons from a favorable cosmetic result could totally differ.

Ocular damage secondary to lights and lasers: How to avoid and treat if necessary

An armamentarium of the latest light and laser technologies are used by physicians of different disciplines to address a variety of aesthetic challenges in the periocular region and throughout the body. If improperly used, these modalities can inflict serious ocular injury on the patient, support personnel, and operator. It is paramount that providers involved in operating these technologies be knowledgeable about the physical and clinically relevant properties of the unit being used. This involves training in the proper utilization, appropriate treatment parameters, and safety measure for each. Selection of the appropriate eye protection is particularly important for both the patient and the personnel. It is also imperative for the laser operator to understand the range of potential ocular complications associated with the cosmetic use of lasers and lights, to recognize the signs and symptoms associated with ocular damage, and to provide efficient first aid measures should damage ensue. Possible ocular complications related to the cosmetic use of lasers and lights range from mild eyelid swelling and erythema to potentially blinding macular injury. Ocular injury may also be inflicted by the improper selection or placement of eye protection. A complete ophthalmologic evaluation and timely management of potential complications is mandated when there is any concern for ocular injury.

Bone-anchored hearing aid: why do some patients refuse it?

OBJECTIVE

Bone-anchored hearing aid (BAHA™) is a proven tool to improve hearing. Nevertheless, there are patients who are candidates for BAHA™ implants that end up refusing the surgery. The objective of this study is to review our BAHA™ experience with particular emphasis on reasons behind the refusal of some candidates.

METHODS

A prospective cohort of 100 consecutive new candidates referred to The BAHA™ program in a tertiary health care center. Candidates' demographics, hearing status, Co-morbidities and audiometeric tests were all recorded. Patients' acceptance or refusal was noted alongside the reasons to refuse BAHA™.

RESULTS

100 new candidates were seen for BAHA™ assessment, 10 patients were excluded due to incomplete data. There were 68 children and 22 adults. Unilateral Conductive Hearing Loss was the most common reason for consultation (40%), followed by unilateral SNHL (23.3%). Aural Atresia was the commonest clinical finding (36.6%). The commonest reason for refusal was social acceptance by the parents due to concern with cosmesis.

CONCLUSION

The main reason of BAHA™ surgery refusal, in otherwise eligible candidates, is related to cosmesis. Patients with congenital anomalies were the most likely candidates to accept BAHA™ implants.

Direct determination of mercury in cosmetic samples by isotope dilution inductively coupled plasma mass spectrometry after dissolution with formic acid

A new method was proposed for the accurate determination of mercury in cosmetic samples based on isotopic dilution (ID)-photochemical vapor generation (PVG)-inductively coupled plasma mass spectrometry (ICP MS) measurement. Cosmetic samples were directly dissolved in formic acid solution and subsequently subjected to PVG for the reduction of mercury into vapor species following by ICP MS detection. Therefore, the risks of analyte contamination and loss were avoided. Highly enriched (201)Hg isotopic spike is added to cosmetics and the isotope ratios of (201)Hg/(202)Hg were measured for the quantitation of mercury. With ID calibration, the influences originating from sample matrixes for the determination of mercury in cosmetic samples have been efficiently eliminated. The effects of several experimental parameters, such as the concentration of the formic acid, and the flow rates of carrier gas and sample were investigated. The method provided good reproducibility and the detection limits were found to be 0.6 pg mL(-1). Finally, the developed method was successfully applied for the determination of mercury in six cosmetic samples and a spike test was performed to verify the accuracy of the method.

Patient and parental scar assessment after single incision versus standard 3-port laparoscopic appendectomy: long-term follow-up from a prospective randomized trial

BACKGROUND

Single site laparoscopy for appendectomy is a technique with several case series suggesting a cosmetic advantage, but without prospective comparative data. We conducted a prospective, randomized trial comparing single site laparoscopic appendectomy to the standard 3-port approach, including scar assessment at early and long-term follow-up.

METHODS

Enrolled patients over 12years old and parents of patients less than 12years old were asked to complete the validated Patient Scar Assessment Questionnaire (PSAQ) at early follow-up around 6weeks and by phone after 18months. The PSAQ consists of 4 scored subscales: Appearance, Consciousness, Appearance Satisfaction, and Symptom Satisfaction. Each subscale has a set of questions with a 4-point categorical response (1=most favorable, 4=least favorable). The sum of the scores quantifies each subscale.

RESULTS

Early questionnaires were obtained from 98 3-port and 100 single-site patients with the single-site approach producing superior overall scar assessment (P=0.003). By telephone follow-up, questionnaires were completed by 49 3-port and 56 single-site patients at a median of 25 (18-32) months. In this longer-term follow-up, overall scar assessment was not significantly different between groups (P=0.06).

CONCLUSION

Patients or parents express superior scar assessment with the single site approach at early follow-up, but this difference disappears in the long-term.

Mesotherapy for local fat reduction

Mesotherapy, which is the injection of substances locally into mesodermally derived subcutaneous tissue, developed from empirical observations of a French physician in the 1950s. Although popular in Europe for many medical purposes, it is used for local cosmetic fat reduction in the United States. This paper reviews manuscripts indexed in PubMed/MEDLINE under 'mesotherapy', which pertains to local fat reduction. The history of lipolytic mesotherapy, the physiology of body fat distribution, the mechanism of action of different lipolytic stimulators and their increased efficacy in combination are reviewed. Mesotherapy falls into two categories. Lipolytic mesotherapy using lipolytic stimulators requires more frequent treatments as the fat cells are not destroyed and can refill over time. Ablative mesotherapy destroys fat cells with a detergent, causes inflammation and scarring from the fat necrosis, but requires fewer treatments. The historic and empiric mixing of sodium channel blocking local anaesthetics in mesotherapy solutions inhibits the intended lipolysis. Major mesotherapy safety concerns include injection site infections from poor sterile technique. Cosmetic mesotherapy directs the area from which fat is lost to improve self-image. Studies were of relatively small number, many with limited sample sizes. Future research should be directed towards achieving a Food and Drug Administration indication rather than continuing expansion of off-label use.

Recent expansions in an emergent novel drug delivery technology: Emulgel

Emulgel is an emerging topical drug delivery system to which if more effort is paid towards its formulation & development with more number of topically effective drugs it will prove a boon for derma care & cosmetology. Emulgels are either emulsion of oil in water or water in oil type, which is gelled by mixing it with gelling agent. Incorporation of emulsion into gel increases its stability & makes it a dual control release system. Due to lack of excess oily bases & insoluble excipients, it shows better drug release as compared to other topical drug delivery system. Presence of gel phase makes it a non greasy & favors good patient compliance. These reviews give knowledge about Emulgel including its properties, advantages, formulation considerations, and its recent advances in research field. All factors such as selection of gelling agent, oil agent, emulsifiers influencing the stability and efficacy of Emulgel are discussed. All justifications are described in accordance with the research work carried out by various scientists. These brief reviews on formulation method have been included. Current research works that carried out on Emulgel are also discussed and highlighted the wide utility of Emulgel in topical drug delivery system. After the vast study, it can be concluded that the Emulgels appear better & effective drug delivery system as compared to other topical drug delivery system. The comprehensive analysis of rheological and release properties will provide an insight into the potential usage of Emulgel formulation as drug delivery system.

Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial

STUDY OBJECTIVE

To compare cosmetic satisfaction with laparoendoscopic single-site surgery (LESS) compared with multi-port surgery.

DESIGN

Randomized controlled trial (Canadian Task Force classification I).

SETTING

University hospital.

PATIENTS

Twenty women who underwent laparoscopically-assisted vaginal hysterectomy (LAVH) via LESS or multi-port surgery.

INTERVENTIONS

Laparoendoscopic single-site surgery or multi-port surgery.

MEASUREMENT AND MAIN RESULTS

Cosmetic satisfaction was assessed using the Body Image Questionnaire at baseline and at 1, 4, and 24 weeks after surgery. Of the 20 LESS procedures, 1 was converted to multi-port surgery because of severe adhesions, and 1 woman assigned to undergo multi-port surgery was lost to follow-up. The 2 surgery groups did not differ in clinical demographic data and surgical results or postoperative pain scores at 12, 24, and 36 hours. Compared with the multi-port group, the LESS group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p < .01).

CONCLUSION

Compared with multi-port surgery, LESS is not only a feasible approach with comparable operative outcomes but also has an advantage insofar as cosmetic outcome.

Optimizing injectable poly-L-lactic acid administration for soft tissue augmentation: The rationale for three treatment sessions

BACKGROUND

The availability and variety of different injectable modalities has led to a dramatic increase in soft tissue augmentation procedures in recent years. Injectable poly-L-lactic acid (PLLA) is a synthetic, biodegradable polymer device approved in the United States for use in immunocompetent patients as a single regimen of up to four treatment sessions for correction of shallow to deep nasolabial fold contour deficiencies and other facial wrinkles. Injectable PLLA is also approved for restoration and/or correction of signs of facial fat loss (lipoatrophy) in individuals with HIV.

METHODS

The present article provides an overview of previous studies with injectable PLLA, and specifically focuses on the number of recommended treatment sessions and intervals between treatment sessions. The authors also provide two case studies to support their recommendations for an average of three treatment sessions.

RESULTS

Although the specific mechanisms remain hypothetical, injections of PLLA are believed to cause a cascade of cellular events that lead to collagen repair and subsequent restoration of facial volume. Because the development of a response to injectable PLLA is gradual and its duration of effect is long lasting, sufficient time between treatment sessions should be allocated to avoid overcorrection.

CONCLUSION

Studies of injectable PLLA support the hypothesized mode of operation, and the experience and clinical recommendations of the authors that suggest that three treatment sessions are an optimal regimen for use of injectable PLLA in the majority of patients.