Small-incision orbicularis-levator fixation technique: a modified double-eyelid blepharoplasty for treating trichiasis in young Asian patients

Upper-eyelid trichiasis often occurs with a single puffy eyelid or shallow eyelid crease in young Asian patients. This study presents a novel modified trichiasis correction method to simultaneously treat trichiasis and create a natural eyelid crease. It combines the modified small-incision debulking procedure and the orbicularis-levator fixation technique. The eyelash lift angle (LA), body curl angle (BCA) and end curl angle (ECA) were quantitatively analysed. A total of 90 patients (152 trichiasis eyelids) were followed up for approximately 22 months. The LA changed from 24.32° ± 9.21°-54.12° ± 10.32° in the nasal section of the eyelid (section 1), from 21.03° ± 11.34°-52.03° ± 10.56° in the middle section of the eyelid (section 2) and from 23.31° ± 8.12°-63.15° ± 8.43° in the temporal section of the eyelid (section 3). All patients were satisfied with the eyelid-fold appearance. In conclusion, for young Asian patients with upper-eyelid trichiasis, the small-incision orbicularis-levator fixation technique is able to acquire a stable up-curved position of the eyelashes and satisfactory aesthetic results.

Treatment of cellulite using a 1440-nm pulsed laser with one-year follow-up

BACKGROUND

Cellulite is characterized by a thickened hypodermal fat layer, along with hypodermal fat lobules that extend upward into the dermis, expanding and stretching the fibrous septae that separate the fat lobules. Eventually, the septae sclerose, contract, and harden, holding the skin at an inflexible length while the surrounding tissue continues to expand.

OBJECTIVES

The author evaluates the efficacy, safety, and duration of clinical benefit associated with a pulsed laser that delivers 1440-nm energy to the dermal-hypodermal interface for the treatment of cellulite. The changes in the dermal structure that affect the appearance of cellulite are also examined.

METHODS

Ten healthy women with cellulite on their thighs enrolled in a prospective Institutional Review Board-approved study conducted in the author's private plastic surgery clinic. Patients received a single treatment with a 1440-nm pulsed laser. Energy was delivered to the subdermal tissue through a fiber that was designed for side firing and enclosed in a cannula. Treatment addressed the thickened hypodermal fat layer, hypodermal fat lobules that extended upward into the dermis, and fibrous septae by thermal subcision.

RESULTS

The mean age of the patients was 47 years ± 5.4 years. Mean skin thickness (as shown by ultrasound) and skin elasticity were shown by objective measurements to increase significantly at one, three, six, and 12 months. Subjective physician and subject evaluations indicated improvement, high subject satisfaction, and minimal adverse effects.

CONCLUSIONS

In this study, a single treatment with the 1440-nm pulsed laser improved the appearance of cellulite, an improvement that persisted through at least one year of follow-up with minimal adverse effects.

Three-dimensional radiofrequency tissue tightening: a proposed mechanism and applications for body contouring

The use of radiofrequency energy to produce collagen matrix contraction is presented. Controlling the depth of energy delivery, the power applied, the target skin temperature, and the duration of application of energy at various soft tissue levels produces soft tissue contraction, which is measurable. This technology allows precise soft tissue modeling at multiple levels to enhance the result achieved over traditional suction-assisted lipectomy as well as other forms of energy such as ultrasonic and laser-generated lipolysis.

Xenotransplantation of breast cancers

Three experimental systems based on mouse models are currently used to study breast cancer: transgenic mice, carcinogen-induced models, and xenografts of breast cancers. Each of these models has advantages and limitations. This chapter focuses on xenotransplantation of breast cancers and reviews the techniques used so far in establishing this model, the advantages and limitations compared to other experimental systems, and finally, the technical questions that remain to be answered.

The high-superior-tension technique: evolution of lipoabdominoplasty

Because abdominoplasty is associated with complications such as seroma and necrosis as well as epigastric bulging and a suprapubic scar located too high, the demand for this procedure is not as high as it otherwise might be. However, although these negative effects were common many years ago, their incidence has decreased dramatically with modern abdominoplastic techniques. One approach using a combination of abdominoplasty and liposuction or lipoabdominoplasty has resolved many of the problems faced with earlier techniques, offering aesthetically pleasing results and excellent reliability. The keys to successful lipoabdominoplasty, first developed as the high-superior-tension technique, are extensive liposuction, preservation of lymphatic trunks, preaponeurotic epigastric dissection, major muscle fascia plication, two high-tension paraumbilical sutures, hypogastric tension sutures, and closure of the dead spaces. The most recent updates to this technique are described in this article.

Malar fat pad repositioning in facelifting: a simple technique of suspension and fixation

BACKGROUND

Aging in the malar fat pad is mainly caused by ptosis of the fibroadipose layer. In the lower level of the face, atrophy or osseous rotation may contribute to the signs and symptoms of facial aging.

OBJECTIVES

The senior author (CYC) describes his simple technique of suspension and fixation of the malar fat pad and the jowl during facial rejuvenation surgery.

METHODS

Ten patients underwent facial rejuvenation, the technique of which consists of sustaining and elevating the ptotic malar tissue and the jowl with four slings of monofilament nylon suture. The sutures are fixed medially in an artificial orifice dissected on the frontal process of the maxilla, above the alar groove. The sutures are distributed evenly on the face, directly supporting the jowl, the malar fat pad, and the periorbital tissue. Laterally, the loops are fixed under tension on the temporal fascia and the periosteum of the lateral orbital rim. The vector of tissue displacement is upward and concentric, opposing the vector of the aging process, and the fixation is consistent.

RESULTS

Postoperative complications included moderate and transitory pain; patients reported no major complications or recidivisms during the follow-up period of two years. Results showed aesthetic improvement for all patients.

CONCLUSIONS

The present technique has proven simple and effective in a small cohort over two years. A longer follow-up period with more patients would be valuable in further documenting the procedure.

Assessment of carprofen and buprenorphine on recovery of mice after surgical removal of the mammary fat pad

The purpose of this study was to determine the level of pain elicited by mammary fat pad removal surgery and the effects of postoperative analgesics on recovery. Female FVB mice were anesthetized, and mammary fat pad removal was performed. After surgery, mice received carprofen, buprenorphine, a combination of carprofen and buprenorphine, or saline treatment. Additional mice received anesthesia but no surgery or treatment. Food and water intake, body weight, wheel running activity, and a visual assessment score were recorded daily for 4 d after surgery and compared with presurgical findings. Corticosterone metabolites in fecal samples were analyzed at 12 and 24 h postsurgically and compared with baseline values. All surgical groups had significantly decreased food intake at 24 h, with a return to baseline by 48 h. The combination treatment resulted in a significantly decreased water intake and body weight at 24 h. All surgical groups had significantly decreased wheel running activity at 24 h only. The visual assessment scores indicated mild pain for all surgical groups, with the buprenorphine treated mice showing the highest pain index scores, as compared with nonsurgical controls. Fecal corticosterone metabolite levels did not differ significantly between any of the groups or across time. The parameters used in this study did not indicate that administration of these analgesic regimens improved recovery as compared with that of saline-treated mice. Care should be taken when using visual assessment scores to evaluate pain in mice, given that analgesics may have side effects that inadvertently elevate the score.

Tension-free primary closure with autologous platelet gel versus Vivostat- for the definitive treatment of chronic sacrococcygeal pilonidal disease

OBJECTIVE

A randomized clinical trial was performed in patients with chronic or recurrent pilonidal sinus (PS) comparing primary closure coupled with random application of in house autologous platelet gel or produced by means of Vivostat- in order to assess whether a standardized product had an impact on the wound healing process.

PATIENTS AND METHODS

Between June 2006 and June 2009, 100 patients (82 males, 18 females: median age 30 years; range, 16-51 years) underwent wide excision of the pilonidal area with midline tension-free closure and were randomly given either the in house autologous platelet gel (Group 1) or the Vivostat- gel (Group 2).

RESULTS

Group 2 patients had shorter wound healing time (8 vs. 10 days; p<0.0001), time to return to full activity (11 vs. 16 days: p<0.0001), less uncomplicated fluid collections (120 vs. 190 ml: p<0.0001), and fewer postoperative wound complications (1/50=2% vs. 5/50=10%, p<0.001). After a median follow-up of 21 months (range: 4-40 months), two recurrences were detected in Group 1.

CONCLUSION

The standardized production of platelet gel by means of the Vivostat- system guarantees the reproducibility of the procedure and its use was correlated with an improved outcome, with a high degree of patient satisfaction and better cosmetic results.

An unusual growth of ovarian cystic teratoma with multiple floating balls during pregnancy: a case report

We report a case of ovarian cystic teratoma with an important growth during pregnancy and the sonographic appearance of intracystic multiple, mobile, polygonal structures called intracystic "fat balls." Due to the rapid growth of the lesion, which exceeded 15 cm in diameter, a right oophorectomy was performed. Histopathologic diagnosis confirmed the mature cystic teratoma. The presence of floating balls composed of keratin and fat is rarely seen but is pathognomonic of mature cystic teratomas. Growth of a teratoma during pregnancy is a rare condition.

Penis ligaments: their use in "increasing" the size of the penis in penile augmentation procedures. Anatomical description in human cadavers and clinical results of a phalloplasty series

AIM

To present in human cadavers the anatomical basis of penis lengthening operations and reproduce this technique in a group of patients.

MATERIALS OF STUDY

Penis ligaments in ten human cadavers were identified and dissected releasing the penis from its fixation to pubic arch. The same technique was applied to a group of forty patients that demanded a penis lengthening operation.

RESULTS

The dissection of penis ligaments increases the distance pubic bone-tip of the penis for 3.1 +/- 0.6 cm. In patients, the increase in length 12 months post-operatively was 3.5 +/- 1.3 cm (2.3-5.1 cm) flaccid and 1.8 +/- 1.4 cm (1.4-3.2 cm) erect. There was a statistically significant difference (p < 0.005) between preoperative and postoperative status. The overall satisfaction rate was 67.5%.

DISCUSSION

Cadavers study shows that this technique offers significant mobilization of the penis with a 3 cm gain, while on living tissue it has similar results. Anatomical parameters that might influence the final outcome of the operation are the length (antero-posterior dimension) of the pubic arch (corresponds to the length of the ligament), its angle with the horizontal level, the amount of the fatty tissue in the pubic area and the angle of the repositioning of the penis.

CONCLUSIONS

Division of ligaments of the penis increases its apparent length. Significant anatomical parameters are the length of the pubic arch, its angle with the horizontal level, the amount of the fatty tissue in the pubic area and the angle of the repositioning of the penis.

The eyelids in Thyroid Orbitopathy

Eyelid involvement in Thyroid Orbitopathy (TO) is very common. In the early stages of inflammatory TO, edema and injection of the eyelids may warn the physician of the development of severe TO and the need for anti-inflammatory treatment. Lid retraction is the commonest sign of TO and in many cases is the presenting symptom of Graves' disease and its orbital involvement. In the past several decades many surgical approaches have been suggested to deal with upper and lower lid retraction in the easiest, most predictable and reproducible manner. The different manifestations of TO in the eyelids are summarized and some of the common surgical approaches of correcting lid retraction practiced today are presented.

Orbital decompression in thyroid related orbitopathy

Thyroid related orbitopathy is the most common extra-thyroid manifestation of Graves' disease. Most patients suffer from mild ocular discomfort and local eye symptoms; however sight threatening conditions such as optic neuropathy or corneal exposure can occur. Orbital decompression allows orbital tissue expansion with globe repositioning. It is effective in alleviating pressure symptoms such as pain and compressive neuropathy. Surgery should be offered to patients with cosmetic disfigurement and functional disability.

Orbital fat decompression for Graves' orbitopathy: a literature review

Thyroid eye disease manifests as orbital inflammation resulting in extraocular muscle enlargement and orbital fat proliferation. This causes exophthalmos, ocular motility impairment and eyelid retraction. Numerous surgical procedures have been introduced for correction of exophthalmos by removal of bony walls. The limited success and high complication rate of the early methods lead to the evolution of an alternative procedure for reduction of retrobulbar volume by removal of intraorbital fat. The indications for this procedure extended from orbital decompression to compressive optic neuropathy with satisfactory results. The moderate complication rate and the fact that orbits with predominant muscle enlargement respond purely to this technique leads to the evolution of a combined procedure with orbital fat removal and bony wall decompression. The scattered published evidence comprising retrospective case series highlights the need for prospective controlled clinical trials in order to improve patient care and clinical practice.

Optimal waist-to-hip ratios in women activate neural reward centers in men

Secondary sexual characteristics convey information about reproductive potential. In the same way that facial symmetry and masculinity, and shoulder-to-hip ratio convey information about reproductive/genetic quality in males, waist-to-hip-ratio (WHR) is a phenotypic cue to fertility, fecundity, neurodevelopmental resources in offspring, and overall health, and is indicative of "good genes" in women. Here, using fMRI, we found that males show activation in brain reward centers in response to naked female bodies when surgically altered to express an optimal (approximately 0.7) WHR with redistributed body fat, but relatively unaffected body mass index (BMI). Relative to presurgical bodies, brain activation to postsurgical bodies was observed in bilateral orbital frontal cortex. While changes in BMI only revealed activation in visual brain substrates, changes in WHR revealed activation in the anterior cingulate cortex, an area associated with reward processing and decision-making. When regressing ratings of attractiveness on brain activation, we observed activation in forebrain substrates, notably the nucleus accumbens, a forebrain nucleus highly involved in reward processes. These findings suggest that an hourglass figure (i.e., an optimal WHR) activates brain centers that drive appetitive sociality/attention toward females that represent the highest-quality reproductive partners. This is the first description of a neural correlate implicating WHR as a putative honest biological signal of female reproductive viability and its effects on men's neurological processing.

Updates and advances in liposuction

Liposuction has evolved tremendously over the past three decades. Since its introduction by Illouz it has progressed into one of the most popular procedures in plastic surgery. The objective of this CME is to provide a foundation of knowledge with respect to anatomy, physiology, preoperative, intraoperative, and postoperative management of patients scheduled to undergo liposuction. A review of both the immediate and delayed complications related to liposuction is addressed, as well as relevant surgical site-specific pearls for patients undergoing liposuction. Finally a summary of the various operative techniques available for surgeons is discussed along with information related to relevant emerging technology in body contouring.

Pericardial fat necrosis: a review and update

A previously healthy middle-aged person presents with excruciating left-sided chest pain of 6 hours' duration. The pain has come on abruptly, without warning, and is located in the lower part of the chest anteriorly. It radiates to the neck and left shoulder and worsens on deep inspiration. The patient appears seriously ill, with tachypnea, tachycardia, and diaphoresis. Otherwise, the physical examination is unremarkable. The electrocardiogram shows sinus tachycardia. Results of conventional blood studies and the chest radiograph are within normal limits. Three days later, a follow-up chest radiograph shows a 3.5 x 4-cm mass adjacent to the left side of the heart near the diaphragm.

Aesthetic blepharoplasty

Blepharoplasty is one of the most demanding aesthetic procedures, and relevant anatomical knowledge of the eyelid and surrounding area is essential. The pathophysiology of ageing in these sites results in varied clinical features. In upper blepharoplasty, lateral brow lift is a necessary adjunctive procedure. Access through the upper blepharoplasty incision is used to adjust retro-orbicularis oculi fat, for glabellar myotomy, and lateral canthopexy. In lower blepharoplasty, the traditional approach is to use a skin and muscle flap, but skin-only flaps are being reported increasingly. Septal reset and plication of the orbicularis oculi is recommended instead of excision of fat. The aim is improvement of cosmesis with no signs of the procedure.

A new approach for adipose tissue treatment and body contouring using radiofrequency-assisted liposuction

A new liposuction technology for adipocyte lipolysis and uniform three-dimensional tissue heating and contraction is presented. The technology is based on bipolar radiofrequency energy applied to the subcutaneous adipose tissue and subdermal skin surface. Preliminary clinical results, thermal monitoring, and histologic biopsies of the treated tissue demonstrate rapid preaspiration liquefaction of adipose tissue, coagulation of subcutaneous blood vessels, and uniform sustained heating of tissue.

Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue manipulation device

BACKGROUND

Most post-pubertal women exhibit cellulite, particularly in the thigh and buttock regions. The prevalence of cellulite has led to many attempts at treatment, including a variety of topical solutions, massage-based therapies, and surgical techniques--most with suboptimal clinical effects. The purpose of this controlled study was to evaluate a novel combination device involving radiofrequency, infrared light, and mechanical tissue manipulation for the treatment of cellulite.

METHODS

Twenty adult women (ages 25-57 years) of various skin phototypes (I-V), and with moderate bilateral thigh and buttock cellulite, received eight biweekly treatments to a randomly selected side (the contralateral side serving as a non-treated control). A combined bipolar radiofrequency, infrared light, and mechanical suction-based massage device was applied at 20 watts RF, 20 watts IR (700-1500 nm) light, and 200 millibar vacuum (750 mmHg negative pressure). Patients were evaluated using standardized digital photography and circumferential leg measurements at baseline, prior to each treatment session, and at one, three, and six months after the final treatment. Clinical improvement scores of comparable photographs using a quartile grading scale (0 = or < 25%, 1 = 25%-50%, 2 = 51%-75%, 3 = or >75% improvement) were made independently by two masked medical assessors after the series of treatments. Final post-treatment body weight and patients' subjective evaluations were recorded.

RESULTS

Ninety per cent (18/20) of patients noticed overall clinical improvement, and 17 of these 18 patients reported that they would pursue treatment of the contralateral thigh. Side effects were limited to transient erythema in most patients, and bruising was observed in 2/20 patients after the first couple of treatment sessions, but not as the treatment series progressed. Clinical improvement scores averaged 1.82 (corresponding to approximately 50% improvement) after the series of treatments. Circumferential thigh measurements were reduced by 0.8 cm on the treatment side.

CONCLUSIONS

Cellulite can be significantly and safely reduced with the use of a noninvasive device that combines bipolar RF, infrared light, and mechanical massage. The effects of treatment appear to be prolonged, but maintenance treatments may be necessary to further enhance the clinical results achieved.

Where endoscopy fails: indications and experience with the frontal sinus fat obliteration

BACKGROUND

With the event of angled endoscopes, image guidance and the rapidly improving endoscopic techniques the previously used osteoplastic frontal sinus fat obliteration (ISO) becomes more and more a second line treatment option. The objective of our study is to describe the up-to-date indications for FSO based on our own experience.

METHODS

Retrospective analysis including follow-up visits of 77 patients with frontal sinus fat obliteration at our clinic between 1991 and 2006 was undertaken and descriptive statistics were drawn.

RESULTS

Thirty-six cases were operated by FSO as a first-line treatment, 41 had previous surgery. Eighty percent of all patients showed no postoperative residual complaints. Two patients required revision surgery. General complication rate was 36.4%, however these consisted in the vast majority of cases (90%) of minor complications.

CONCLUSIONS

FSO still remains a valuable operation for specific indications. FSO is the gold standard for repeatedly failed endoscopic procedures. The operation should also target the following indications as a first-line treatment: large/lateral osteomas, malignant disease, lateral mucoeceles, most fractures of the posterior sinus wall with CSF-leak, osteomyelitis, pathologies in small underdeveloped sinuses with narrow floor. It is associated with minimal complications and a good outcome.

[Procedure for calculating the volume of the orbital fat to be removed at decompressive surgery in patients with endocrine ophthalmopathy]

The paper gives data of computed tomography in 100 patients (148 orbits) with edematous exophthalmos (lipogenic and mixed types). There is a relationship of the higher degree of exophthalmos to the increased orbital soft tissue contents. A procedure is described for the individual calculation of the amount of removed orbital fat during compressive operations, which considers both the individual features of the anatomic structure and existing exophthalmos.

Removal of exogenous triglycerides in subjects with massive obesity before and after jejunoileal shunt operation

The fractional removal rate of exogenous triglycerides (TG) in 12 obese subjects with a mean body weight of 132+/-5 kg (S.E.M.) has been studied before a jejunoileal shunt operation. The study was repeated postoperatively at stable body weights 30-54 months later. The weight loss ranged from 13 to 65 kg (mean weight reduction 27%). In 8 patients, 0.3-6.0 kg of skin and subcutaneous tissue were removed surgically for cosmetic reasons during the weight reduction period. Serum cholesterol fell from 220+/-8 to 141+/-11 mg/100 ml (p less than 0.001). The serum TG reduction was not significant, 1.80+/-0.25 before and 1.50+/-0.19 mmol/l after operation. The fractional removal rate of exogenous TG, determined by the intravenous fat tolerance test (IVFTT) with the Intralipid fat emulsion, was not significantly changed. The IVFFT k2 value was 3.5+/-0.5%/min before and 4.3+/-0.6 after surgery (p greater than 0.05). Previous studies have shown that a major part of Intralipid is removed initially in skeletal muscle. The unchanged fractional removal rate of Intralipid, despite the marked reduction in the amount of adipose tissue, supports the concept that the adipose tissue may play a minor role in the initial elimination of exogenous TG from the bloodstream.