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Chen Q, Li P, Zhao Q, Tu T, Lu H, Zhang W. Occurrence and treatment of peripheral nerve injuries after cosmetic surgeries. Front Neurol 2023; 14:1258759. [PMID: 38020669 PMCID: PMC10659089 DOI: 10.3389/fneur.2023.1258759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Although non-invasive and minimally invasive aesthetic procedures increasingly dominate the cosmetic market, traditional plastic surgery remains the most effective improvement method. One of the most common complications in plastic surgery, peripheral nerve injuries, though has a low incidence but intrigued plastic surgeons globally. In this article, a narrative review was conducted using several databases (PubMed, EMBASE, Scopus, and Web of Science) to identify peripheral nerve injuries following cosmetic surgeries such as blepharoplasty, rhinoplasty, rhytidectomy, breast surgeries, and abdominoplasty. Surgery-related nerve injuries were discussed, respectively. Despite the low incidence, cosmetic plastic surgeries can cause iatrogenic peripheral nerve injuries that require special attention. The postoperative algorithm approaches can be effective, but the waiting and treatment processes can be long and painful. Preventive measures are undoubtedly more effective than postoperative remedies. The best means of preventing disease is having a good understanding of anatomy and conducting a careful dissection.
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Affiliation(s)
- Qiang Chen
- Department of Hand & Reconstructive Surgery, Center for Plastic & Reconstructive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Pengfei Li
- Department of Plastic and Aesthetic Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - QingFang Zhao
- Department of Plastic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tian Tu
- Department of Plastic and Aesthetic Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Lu
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Musmarra I, Aguilar P, Struk S, Couteau C, Tresallet C, Quilichini J. Vertical Body Lift: Surgical Technique and Comparison with the Inferior Body Lift Technique. Plast Reconstr Surg 2023; 152:507e-517e. [PMID: 36780353 DOI: 10.1097/prs.0000000000010291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Patients with massive weight loss have excessive skin laxity along both vertical and transverse axes. Vertical body lift (VBL) is a body-contouring technique addressing both excesses, promoting not only body lifting but also a tightening effect. The aim of this study was to describe the authors' VBL surgical technique and its potential clinical applications. In addition, they present their experience among postbariatric surgery patients to compare surgical aspects and outcomes of VBL and the classic inferior body lift (IBL) technique. METHODS The authors reviewed data on 140 consecutive postbariatric surgery patients who underwent a body lift procedure between January of 2018 and March of 2020. The patients were divided into two groups: the VBL group and the IBL group. Patient demographics, operative details, and postoperative outcomes were compared between groups. RESULTS Of the 140 patients included in the study, 92 underwent IBL and 48 underwent VBL. There were no statistically significant differences between groups for surgical duration (IBL, 192 minutes; VBL, 193 minutes), hemoglobin decrease (IBL, 2.32 g/dL; VBL, 2.11 g/dL), hospital length of stay (IBL, 5.4 days; VBL, 5.7 days), or complication rate (IBL, 32%; VBL, 31%). CONCLUSIONS The authors' study shows comparable operative details and postsurgical outcomes between the VBL and classic IBL techniques. In their experience, VBL is a reliable and reproducible technique that can improve aesthetic and functional outcomes in a subpopulation of approximately one-third of patients with massive weight loss. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Isidoro Musmarra
- From the Service de Chirurgie Plastique, Reconstructrice et Esthétique, Centre Hospitalier R. Ballanger
- Hôpitaux Universitaires Paris Seine-Saint-Denis, CHU Avicenne
- Faculté de Médecine Paris XIII
- Università degli Studi di Palermo, Azienda Ospedaliera Cannizzaro
| | - Paola Aguilar
- From the Service de Chirurgie Plastique, Reconstructrice et Esthétique, Centre Hospitalier R. Ballanger
- Hôpitaux Universitaires Paris Seine-Saint-Denis, CHU Avicenne
| | - Samuel Struk
- From the Service de Chirurgie Plastique, Reconstructrice et Esthétique, Centre Hospitalier R. Ballanger
- Hôpitaux Universitaires Paris Seine-Saint-Denis, CHU Avicenne
| | - Claire Couteau
- From the Service de Chirurgie Plastique, Reconstructrice et Esthétique, Centre Hospitalier R. Ballanger
- Hôpitaux Universitaires Paris Seine-Saint-Denis, CHU Avicenne
| | - Christophe Tresallet
- Hôpitaux Universitaires Paris Seine-Saint-Denis, CHU Avicenne
- Faculté de Médecine Paris XIII
| | - Julien Quilichini
- From the Service de Chirurgie Plastique, Reconstructrice et Esthétique, Centre Hospitalier R. Ballanger
- Hôpitaux Universitaires Paris Seine-Saint-Denis, CHU Avicenne
- Faculté de Médecine Paris XIII
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Jin J, Zhang T, Xiong X, Chen H, Jiang Y, He S. A prospective study of chronic postsurgical pain in elderly patients: incidence, characteristics and risk factors. BMC Geriatr 2023; 23:289. [PMID: 37173634 PMCID: PMC10182592 DOI: 10.1186/s12877-023-04006-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Due to the continued growth of surgical procedures in older adults and the significant impact of chronic postsurgical pain (CPSP), it is crucial to improve our understanding of the occurrence of CPSP as well as the appropriate prevention and treatment. We therefore conducted this study to determine the incidence, characteristics and risk factors of CPSP in elderly patients at both 3 and 6 months after surgery. METHODS Elderly patients (aged ≥ 60 years) undergoing elective surgery in our institution between April 2018 and March 2020 were prospectively enrolled in this study. Data on demographics, preoperative psychological well-being, intraoperative surgical and anesthesia management, and acute postoperative pain intensity were collected. At 3 and 6 months after surgery, patients received telephone interview and completed the questionnaires regarding chronic pain characteristics, analgesic consumption, and interference of the pain with activities of daily living (ADL). RESULTS A total of 1065 elderly patients were followed up for 6 postoperative months and included in final analysis. At 3 and 6 months after operation, the incidence of CPSP was 35.6% [95% confidence interval (95% CI) 32.7 - 38.8%] and 21.5% (95% CI 19.0% - 23.9%), respectively. CPSP cause negative impacts on patient's ADL and most particularly on mood. Neuropathic features were found in 45.1% of the patients with CPSP at 3 months. At 6 months, 31.0% of those with CPSP reported that the pain had neuropathic features. Preoperative anxiety [3 months: Odds ratio (OR) 2.244, 95% CI 1.693 to 2.973; 6 months: OR 2.397, 95% CI 1.745 to 3.294], preoperative depression (3 months: OR 1.709, 95% CI 1.292 to 2.261; 6 months: OR 1.565, 95% CI 1.136-2.156), orthopedic surgery (3 months: OR 1.927, 95% CI 1.112 to 3.341; 6 months: OR 2.484, 95% CI 1.220 to 5.061), higher pain severity on movement within postoperative 24 h (3 months: OR 1.317, 95% CI 1.191 to 1.457; 6 months: OR 1.317, 95% CI 1.177 to 1.475) were associated with a higher risk for CPSP independently at both 3 and 6 months after surgery. CONCLUSIONS CPSP is a common postoperative complication in elderly surgical patients. Preoperative anxiety and depression, orthopedic surgery, and greater intensity of acute postoperative pain on movement are associated with an increased risk for CPSP. It should be kept in mind that developing psychological interventions to reduce anxiety and depression and optimizing the management of acute postoperative pain will be effective in reducing the development of CPSP in this population.
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Affiliation(s)
- Juying Jin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China.
| | - Ting Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Xianwei Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Huan Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Yiling Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Shuangyu He
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
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Aitzetmüller MM, Raschke L, Klietz ML, Kueckelhaus M, Hirsch T, Wiebringhaus P, Harati K. After weight loss, what skin removal procedure has the most effect using Body Q metrics? Surg Obes Relat Dis 2022; 18:1049-1056. [DOI: 10.1016/j.soard.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/10/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
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Body Contouring Surgery Improves Physical Activity in Patients After Massive Weight Loss-a Retrospective Study. Obes Surg 2020; 30:146-153. [PMID: 31444775 DOI: 10.1007/s11695-019-04145-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to compare physical activity (PA) in patients who had undergone massive weight loss (MWL), before and after body contouring procedures. METHODS All patients undergoing body contouring surgery after MWL between 2007 and 2017 with a minimum follow-up of 6 months after the last procedure were included in this retrospective study. Excluded were those with a body mass index > 35 kg/m2 and those with comorbidities leading to impaired PA. Quality of life (QOL) was assessed using the Moorehead-Ardelt QOL Questionnaire II. Evaluation of PA was obtained with the International Physical Activity Questionnaire (IPAQ) short form and the Freiburg PA Questionnaire. Functional impairment during exercise was analyzed using a self-designed functional impairment score (FIS). RESULTS In the 45 patients completing the survey (37 female, 8 male), an improvement in QOL (p < 0.001) and PA scored by the IPAQ (p = 0.017) was found. The Freiburg PA Questionnaire showed no difference in PA before and after body contouring surgery (p = 0,274). Furthermore, scores of the FIS indicated a decrease of functional impairment during physical activity after body contouring surgery (p < 0.001). CONCLUSION Body contouring improves QOL and PA in patients after massive weight loss. The results of our study confirm the important role of plastic surgery in the treatment and maintenance of health of patients with former obesity.
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Giordano S, Uusalo P, Oranges CM, di Summa PG, Lankinen P. Local anesthetic pain catheters to reduce opioid use in massive weight loss patients undergoing abdominoplasty: A comparative study. J Plast Reconstr Aesthet Surg 2019; 73:770-776. [PMID: 31864888 DOI: 10.1016/j.bjps.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 09/22/2019] [Accepted: 11/22/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Abdominoplasty is a common procedure for anatomical restoration of the lower abdominal skin, with a continuously increasing annual number of procedures performed. The significance of postoperative pain management is of crucial importance from a patient's perspective and to ensure the achievement of the aimed clinical outcome. We evaluated the efficacy of local pain pump catheters (PPCs) on massive weight loss patients undergoing body-contouring abdominoplasty. METHODS Primary abdominoplasty procedures after massive weight loss performed from 2009 to 2014 were retrospectively reviewed. The patients were divided into two groups according to the use of the PPC. The primary outcome measure was the amount of opioid use calculated as morphine equivalents. The secondary outcome measures were the length of hospital stay (LOS) and early postoperative complications within 30 days of surgery. RESULTS A total of 61 patients were included in the study: 24 patients in the PPC group and 37 patients in the conventional abdominoplasty analgesia (CAA) group. No significant differences between the study groups were found with regard to demographics, operative time, and resection weight. A significantly decreased use of opioids was observed after using PPC versus control (14.0 ± 13.9 mg vs. 74.6 ± 73.3 mg, p < 0.001). Similarly, the LOS was shorter in the PPC group (3.1 ± 1.1 days vs. 3.8 ± 1.0 days, p = 0.023). There was a similar rate of complications in both groups (45.8% vs. 40.5%, p = 0.622). The most common complication was seroma formation (25.0% vs. 18.5%, p = 0.315). CONCLUSION The use of local anesthetic pain catheters in abdominoplasty may be associated with a decreased use of opioids and might result in a shorter hospital stay on massive weight loss patients. Further studies are needed to validate this treatment modality.
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Affiliation(s)
- Salvatore Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland.
| | - Panu Uusalo
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Carlo M Oranges
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Pietro G di Summa
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Petteri Lankinen
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
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Chopra K, Kokosis G, Slavin B, Williams E, Dellon AL. Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury. Aesthet Surg J 2019; 39:1427-1435. [PMID: 30346489 DOI: 10.1093/asj/sjy284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature. OBJECTIVES The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery. METHODS A literature review was performed utilizing the PubMed database to identify painful complications of brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery. RESULTS Title and abstract review followed by application of inclusion and exclusion criteria resulted in 20 clinical studies for this review, including lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear, and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; and intercostobrachial nerve after breast surgery. CONCLUSIONS Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be employed in patients with persistent pain after aesthetic surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Karan Chopra
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Georgios Kokosis
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Benjamin Slavin
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Eric Williams
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - A Lee Dellon
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD
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Refractory Knee Osteoarthritis: Adipose-Derived Stromal Cells Versus Bone Marrow Aspiration Concentrate. PM R 2019; 10:524-532. [PMID: 29776486 DOI: 10.1016/j.pmrj.2018.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 02/07/2023]
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Abstract
Chronic postsurgical pain affects between 5 and 75% of patients, often with an adverse impact on quality of life. While the transition of acute to chronic pain is a complex process-involving multiple mechanisms at different levels-the current strategies for prevention have primarily been restricted to perioperative pharmacological interventions. In the present paper, we first present an up-to-date narrative literature review of these interventions. In the second section, we develop several ways by which we could overcome the limitations of the current approaches and enhance the outcome of our surgical patients, including the better identification of individual risk factors, tailoring treatment to individual patients, and improved acute and subacute pain evaluation and management. The third and final section covers the treatment of established CPSP. Given that evidence for the current therapeutic options is limited, we need high-quality trials studying multimodal interventions matched to pain characteristics.
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Affiliation(s)
- Arnaud Steyaert
- Department of Anesthesiology, Acute and Transitional Pain Service, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Patricia Lavand'homme
- Department of Anesthesiology, Acute and Transitional Pain Service, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Abstract
BACKGROUND Opioid misuse occurs commonly among obese patients and after bariatric surgery. However, the risk of new persistent use following postbariatric body contouring procedures remains unknown. METHODS The authors examined insurance claims from Clinformatics Data Mart (OptumInsight, Eden Prairie, Minn.) between 2001 and 2015 for opioid-naive patients undergoing five body contouring procedures: abdominoplasty/panniculectomy, breast reduction, mastopexy, brachioplasty, and thighplasty (n = 11,257). Their primary outcomes included both new persistent opioid use, defined as continued prescription fills between 90 and 180 days after surgery, and the prevalence of high-risk prescribing. They used multilevel logistic regression to assess the risk of new persistent use, adjusting for relevant covariates. RESULTS In this cohort, 6.1 percent of previously opioid-naive patients developed new persistent use, and 12.9 percent were exposed to high-risk prescribing. New persistent use was higher in patients with high-risk prescribing (9.2 percent). New persistent use was highest after thighplasty (17.7 percent; 95 percent CI, 0.03 to 0.33). Increasing Charlson comorbidity indices (OR, 1.11; 95 percent CI, 1.05 to 1.17), mood disorders (OR, 1.27; 95 percent CI, 1.05 to 1.54), anxiety (OR, 1.41; 95 percent CI, 1.16 to 1.73), tobacco use (OR, 1.22; 95 percent CI, 1.00 to 1.49), neck pain (OR, 1.23; 95 percent CI, 1.04 to 1.46), arthritis (OR, 1.30; 95 percent CI, 1.08 to 1.58), and other pain disorders (OR, 1.36; 95 percent CI, 1.16 to 1.60) were independently associated with persistent use. CONCLUSIONS Similar to other elective procedures, 6 percent of opioid-naive patients developed persistent use, and 12 percent were exposed to high-risk prescribing practices. Plastic surgeons should remain aware of risk factors and offer opioid alternatives. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Nestor M, Andriessen A, Berman B, Katz BE, Gilbert D, Goldberg DJ, Gold MH, Kirsner RS, Lorenc PZ. Photobiomodulation with non-thermal lasers: Mechanisms of action and therapeutic uses in dermatology and aesthetic medicine. J COSMET LASER THER 2017; 19:190-198. [PMID: 28328287 DOI: 10.1080/14764172.2017.1293828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Non-thermal laser therapy in dermatology, is a growing field in medical technology by which therapeutic effects are achieved by exposing tissues to specific wavelengths of light. OBJECTIVES The purpose of this review was to gain a better understanding of the science behind non-thermal laser and the evidence supporting its use in dermatology. METHODS A group of dermatologists and surgeons recently convened to review the evidence supporting the use of non-thermal laser for body sculpting, improving the appearance of cellulite, and treating onychomycosis. RESULTS The use of non-thermal laser for body sculpting is supported by three randomized, double-blind, sham-controlled studies (N = 161), one prospective open-label study (N = 54), and two retrospective studies (N = 775). Non-thermal laser application for improving the appearance of cellulite is supported by one randomized, double-blind, sham-controlled study (N = 38). The use of non-thermal laser for the treatment of onychomycosis is supported by an analysis of three non-randomized, open-label studies demonstrating clinical improvement of nails (N = 292). CONCLUSIONS Non-thermal laser is steadily moving into mainstream medical practice, such as dermatology. Although present studies have demonstrated the safety and efficacy of non-thermal laser for body sculpting, cellulite reduction and onychomycosis treatment, studies demonstrating the efficacy of non-thermal laser as a stand-alone procedure are still inadequate.
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Affiliation(s)
- Mark Nestor
- a Center for Clinical and Cosmetic Research, Center for Clinical Enhancement , Aventura, Miami , Florida , USA.,b University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Anneke Andriessen
- c Andriessen Consultants, Medical Director , Malden , Netherlands.,d Radboudumc, Radboud Academie , Nijmegen , Netherlands
| | - Brian Berman
- a Center for Clinical and Cosmetic Research, Center for Clinical Enhancement , Aventura, Miami , Florida , USA.,e Department of Dermatology and Cutaneous Surgery , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Bruce E Katz
- f Department of Dermatology , Icahn School of Medicine at Mt Sinai , New York , New York , USA
| | - Dore Gilbert
- g Newport Dermatology and Laser Associates , Newport Beach, Newport Beach, USA.,h Department of Dermatology , University of California , Irvine , USA
| | - David J Goldberg
- i Skin Laser & Surgery Specialists, Director , Westwood , Massachusetts , USA
| | | | - Robert S Kirsner
- b University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Paul Z Lorenc
- k Lorenc Aesthetic Plastic Surgery Center , New York , New York , USA.,l Lenox Hill Hospital, New York , New York , USA
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