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Kinney BM, Boyd CM. Remodeling of facial soft tissue induced by simultaneous application of HIFES and synchronized radiofrequency provides nonsurgical lift of facial soft tissues. J Cosmet Dermatol 2024; 23:824-829. [PMID: 38235951 DOI: 10.1111/jocd.16165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/06/2023] [Revised: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND The application of radiofrequency (RF) and HIFES on the body provides improvement in skeletal muscle tissue, reduction in fatty tissue, reorganization of connective tissue, and skin texture improvement. However, overall facial appearance relies on both skin and underlying structures, specifically muscles and connective tissue which have to be treated as one unit to achieve proper care while preserving fatty layers that define youth facial appearance. AIMS The aim of this study is to find whether the effect of novel RF + HIFES is safe and can induce the lifting of soft tissue and overall improvement in facial appearance. METHODS In this study, 21 subjects were enrolled. The therapy was administered in four 20-min treatments on the forehead and cheeks. Photographs were evaluated by a Global Aesthetic Improvement Score (GAIS) and linear measurements of facial tissue lifting at 1- and 3-month follow-ups. Volumetric changes in the cheek area were investigated as well. The patients' satisfaction, safety, and comfort were documented throughout the study. RESULTS The data indicated improvement in overall facial appearance, and 23% of average lifting was found in brows (p = 3.14 × 10-12 ) and cheeks (p = 6.00 × 10-15 ). The assessment of digital photographs showed an improvement in 100% of patients at 3-month follow-up. The treatments were safe, accompanied by high therapy comfort and subject satisfaction of 98%. CONCLUSIONS The treatment by simultaneous RF and HIFES technology produces significant changes to the overall facial appearance, characterized by the lifting of facial tissues.
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Affiliation(s)
- Brian M Kinney
- USC Keck School of Medicine, Los Angeles, California, USA
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2
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TerKonda SP, TerKonda AA, Sacks JM, Kinney BM, Gurtner GC, Nachbar JM, Reddy SK, Jeffers LL. Artificial Intelligence: Singularity Approaches. Plast Reconstr Surg 2024; 153:204e-217e. [PMID: 37075274 DOI: 10.1097/prs.0000000000010572] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/21/2023]
Abstract
SUMMARY Artificial intelligence (AI) has been a disruptive technology within health care, from the development of simple care algorithms to complex deep-learning models. AI has the potential to reduce the burden of administrative tasks, advance clinical decision-making, and improve patient outcomes. Unlocking the full potential of AI requires the analysis of vast quantities of clinical information. Although AI holds tremendous promise, widespread adoption within plastic surgery remains limited. Understanding the basics is essential for plastic surgeons to evaluate the potential uses of AI. This review provides an introduction of AI, including the history of AI, key concepts, applications of AI in plastic surgery, and future implications.
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Affiliation(s)
- Sarvam P TerKonda
- From the Division of Plastic and Reconstructive Surgery, Mayo Clinic Florida
| | - Anurag A TerKonda
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine in St. Louis
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine in St. Louis
| | - Brian M Kinney
- Division of Plastic Surgery, University of Southern California
| | - Geoff C Gurtner
- Division of Plastic and Reconstructive Surgery, Stanford University
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Kent DE, Jacob C, Kinney BM. Retrospective analysis of high-intensity focused electromagnetic procedure synchronized with radiofrequency energy for visceral fat reduction. J Cosmet Dermatol 2023; 22:2485-2491. [PMID: 37154787 DOI: 10.1111/jocd.15784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/20/2023] [Accepted: 04/09/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Visceral adipose tissue (VAT), present in the abdominal cavity, oftentimes contributes to an unpleasant aesthetic appearance and can be correlated with serious health issues. High-intensity focused electromagnetic field (HIFEM) technology with synchronized radiofrequency (RF) was recently used for abdominal body shaping through subcutaneous fat reduction and muscle growth. AIM This study aimed to assess the effect of HIFEM + RF technology on VAT tissue. METHODS Data of 16 men and 24 women (22-62 years, 21.2-34.3 kg/cm2 ) from the original study were retrospectively reviewed. All subjects received three 30-min HIFEM + RF abdominal treatments once weekly for three consecutive weeks. The VAT area was measured in the axial plane of MRI scans at two levels: L4-L5 vertebrae and 5 cm above this level. The VAT was identified, segmented, and calculated, yielding total area in square centimeters per scan at both specified levels. RESULTS By thoughtful review of the subject's post-treatment MRI scans, no other changes in the abdominal cavity were found except for VAT. The evaluation showed a VAT reduction of 17.8% (p < 0.001) on average at 3-month follow-up, maintaining the results up to 6 months (-17.3%). Averaging the values obtained from both measured levels, the VAT, occupied an area of 100.2 ± 73.3 cm2 at the baseline. At the 3-month follow-up, the subjects achieved an average reduction of 17.9 cm2 , preserving the results at 6 months (-17.6 ± 17.3 cm). CONCLUSION This retrospective analysis of MRI images objectively documented the effect of HIFEM + RF abdominal therapy on VAT. The data indicates considerable VAT reduction without serious adverse events following the HIFEM + RF procedure.
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Affiliation(s)
- David E Kent
- Skin Care Physicians of Georgia, Macon, Georgia, USA
| | - Carolyn Jacob
- Chicago Cosmetic Surgery and Dermatology, Chicago, Illinois, USA
| | - Brian M Kinney
- USC Keck School of Medicine, Los Angeles, California, USA
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Jeffers LLC, Sacks JM, Kinney BM. Technology Innovation and Disruption in Plastic Surgery: Intelligence Quotient, Emotional Quotient, and Technology Quotient. Plast Reconstr Surg 2023; 152:236-238. [PMID: 37382920 DOI: 10.1097/prs.0000000000010269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
SUMMARY This article is an introduction to the new PRS Tech Disruptor Series, the culmination of work originating from the Technology Innovation and Disruption Presidential Task Force. Our technology quotient is important to our success as individuals and as a specialty society. The goal of this new series is to address the broader concepts in technology as they relate to plastic surgery and thus enhance the technology quotient of readers and, in turn, of the specialty and specialty society. Critical topics related to technology, their current and future impact on plastic surgery, and the opportunities and barriers in research, education, and advocacy will be addressed. The intent is for readers to engage in dialogue and think outside the box about the current and future impact of technology.
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Affiliation(s)
- Lynn L C Jeffers
- From private practice
- CommonSpirit/Dignity Health St John's Hospitals
| | - Justin M Sacks
- the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine in St. Louis
| | - Brian M Kinney
- the Division of Plastic Surgery, Keck USC School of Medicine
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5
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Henn D, Trotsyuk AA, Barrera JA, Sivaraj D, Chen K, Mittal S, Mermin-Bunnell AM, Chattopadhyay A, Larson MR, Kinney BM, Nachbar J, TerKonda SP, Reddy S, Jeffers L, Sacks JM, Gurtner GC. Robotics in Plastic Surgery: It's Here. Plast Reconstr Surg 2023; 152:239-249. [PMID: 37382921 DOI: 10.1097/prs.0000000000010270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
SUMMARY Although robotic surgery has been routinely established in other surgical disciplines, robotic technologies have been less readily adopted in plastic surgery. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, most reconstructive procedures, including microsurgery, have continued to necessitate an open approach. Recent advances in robotics and artificial intelligence, however, are gaining momentum and have shown significant promise to improve patient care in plastic surgery. These next-generation surgical robots have the potential to enable surgeons to perform complex procedures with greater precision, flexibility, and control than previously possible with conventional techniques. Successful integration of robotic technologies into clinical practice in plastic surgery requires achieving key milestones, including implementing appropriate surgical education and garnering patient trust.
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Affiliation(s)
- Dominic Henn
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
- Department of Plastic Surgery, University of Texas Southwestern Medical Center
| | - Artem A Trotsyuk
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | - Janos A Barrera
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | - Dharshan Sivaraj
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | - Kellen Chen
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
- Department of Surgery, University of Arizona
| | - Smiti Mittal
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | - Alana M Mermin-Bunnell
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | - Arhana Chattopadhyay
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | - Madelyn R Larson
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
| | | | | | | | - Sashank Reddy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University
| | | | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine
| | - Geoffrey C Gurtner
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University
- Department of Surgery, University of Arizona
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Nachbar JM, Kinney BM, Sacks JM, Gurtner GC, TerKonda SP, Reddy SK, Jeffers LL. Cybersecurity and Technical Patient Privacy Protection. Plast Reconstr Surg 2023; Publish Ahead of Print:00006534-990000000-01887. [PMID: 37220229 DOI: 10.1097/prs.0000000000010740] [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
Plastic surgery offices are subject to a wide variety of cybersecurity threats, including ransomware attacks that encrypt the plastic surgeon's information and make it unusable, as well as data theft and disclosure attacks that threaten to disclose confidential patient information. Cloud-based office systems increase the attack surface and do not mitigate the effects of breaches that can result in theft of credentials. Although employee education is often recommended to avoid the threats, a single error by a single employee has often led to security breaches, and it is not reasonable to expect that no employee will ever make an error. A recognition of the two most common vectors of these breaches, compromised email attachments and surfing to compromised websites, allows the use of technical networking tools to both prevent email attachments from being received and to prevent employee use of unsanctioned and potentially compromised websites. Further, once compromised code is allowed to run within the office network, that code must necessarily make outbound connections to exploit the breach. Preventing that outbound traffic can mitigate the effects of a breach. However, most small office network consultants design firewalls to only limit incoming network traffic and fail to implement technical measures to stop the unauthorized outbound traffic that is necessary for most network attacks. Detailed techniques are provided which can be used to direct IT consultants to properly limit outbound network traffic as well as incoming email attachments, with more information at https://officenetworksecurity.com.
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Affiliation(s)
| | - Brian M Kinney
- Division of Plastic Surgery, University of Southern California; Beverly Hills, CA
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine in St. Louis; St. Louis, MO
| | - Geoff C Gurtner
- Section of Plastic Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Sarvam P TerKonda
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Florida; Jacksonville, FL
| | - Sashank K Reddy
- Department of Plastic Surgery; Johns Hopkins University; Baltimore, MD
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Kinney BM, Bernardy J, Jarošová R. Novel Technology for Facial Muscle Stimulation Combined With Synchronized Radiofrequency Induces Structural Changes in Muscles Tissue: Porcine Histology Study. Aesthet Surg J 2023:7072379. [PMID: 36883601 DOI: 10.1093/asj/sjad053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND With age, facial muscles lose the ability to complete contractions properly resulting in limitation of facial expressions, fat shifting, and leading to skin creases and wrinkling. OBJECTIVES The aim of this study was to determine the effects of the novel high intensity facial electromagnetic stimulation (HIFES) technology combined with synchronized radiofrequency on delicate facial muscles, using an animal porcine model. METHODS Eight (n = 8, 60-80 kg) sows were divided into the active group (n = 6) and the control group (n = 2). The active group underwent four 20-minute treatments with radiofrequency (RF) and HIFES energies. The control group was not treated. Histology samples of muscle tissue were collected by a punch biopsy (6 mm in diameter) from the treatment area of each animal at baseline, 1-month, and 2-month follow-up. The evaluation included staining of the obtained tissue slices with hematoxylin and eosin (H&E) and Masson's Trichrome to determine the changes in muscle mass density, number of myonuclei, and muscle fibers. RESULTS The active group showed muscle mass density increase (by 19.2%, p < 0.001), together with elevated numbers of myonuclei (by 21.2%, p < 0.05) and individual muscle fibers, which increased from 56.8 ± 7.1 to 68.0 ± 8.6 (p < 0.001). In the control group, no significant changes were seen in any of the studied parameters throughout the study (p > 0.05). Finally, no adverse events or side effects were observed in the treated animals. CONCLUSIONS The results document favorable changes after the HIFES + RF procedure at the level of the muscle tissue, which may be of great importance in terms of maintenance of facial appearance in human subjects.
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Affiliation(s)
- Brian M Kinney
- Clinical associate professor of plastic surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Jan Bernardy
- Clinical researchers, Veterinary Research Institute, Brno, Czechia
| | - Rea Jarošová
- Clinical researchers, Veterinary Research Institute, Brno, Czechia
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Sforza M, Hammond DC, Botti G, Hedén P, Quirós MC, Munhoz AM, Kinney BM, Corduff N. Corrigendum to: Response to "Clarification About 'Expert Consensus on the Use of a New Bioengineered, Cell-Friendly, Smooth Surface Breast Implant'". Aesthet Surg J 2021; 41:NP1354. [PMID: 31905400 PMCID: PMC8438642 DOI: 10.1093/asj/sjz298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sforza M, Hammond DC, Botti G, Hedén P, Quirós MC, Munhoz AM, Kinney BM, Corduff N. Corrigendum to: Expert Consensus on the Use of a New Bioengineered, Cell-Friendly, Smooth Surface Breast Implant. Aesthet Surg J 2021; 41:1106. [PMID: 31067295 PMCID: PMC8361341 DOI: 10.1093/asj/sjz125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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10
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Sforza M, Botti G, Hedén P, Zacheddu R, Munhoz AM, Mayo F, Kinney BM, Hammond DC, Corduff N, Morelli HU, Stavrou D, Centeno J. Erratum to: Response to: Nano-Surface Implants: Indications and Limitations. Aesthet Surg J 2021; 41:984. [PMID: 33904904 PMCID: PMC8279308 DOI: 10.1093/asj/sjab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sforza M, Botti G, Hedén P, Zacheddu R, Munhoz AM, Mayo F, Kinney BM, Hammond DC, Corduff N, Morelli HU, Stavrou D, Centeno J. Response to: Nano-Surface Implants: Indications and Limitations. Aesthet Surg J 2021; 41:NP1143-NP1146. [PMID: 33693485 PMCID: PMC8279306 DOI: 10.1093/asj/sjaa297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | - Alexandre Mendonça Munhoz
- Department of plastic surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Brian M Kinney
- Division of Plastic Surgery, Keck School of Medicine, University of Southern California, Beverly Hills, CA, USA
| | - Dennis C Hammond
- Plastic and Reconstructive Surgery Spectrum Health/Michigan State University Plastic Surgery Integrated Residency Partners in Plastic Surgery, Grand Rapids, MI, USA
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Kent DE, Kinney BM. Cover Image. J Cosmet Dermatol 2021. [DOI: 10.1111/jocd.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Scuderi N, Fanelli B, Fino P, Kinney BM. Comparison of 2.5% agarose gel vs hyaluronic acid filler, for the correction of moderate to severe nasolabial folds. J Cosmet Dermatol 2021; 20:1512-1519. [PMID: 33533155 PMCID: PMC8248355 DOI: 10.1111/jocd.13962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
Background Agarose gel filler is a natural hydrocolloid with a three‐dimensional structure similar to the extracellular matrix, with gel formed by hydrogen bonds and electrostatic interactions rather than through chemical cross‐linking or polymerization. Objective To determine efficacy and safety of 2.5% agarose gel filler for the correction of nasolabial folds. Methods In this split‐face study, efficacy, safety, and usability of 2.5% agarose gel were compared to those of NASHA‐L. Assessments included the nasolabial fold (NLF) Wrinkle Severity Rating Scale (WSRS), Global Aesthetic Improvement Scale (GAIS [blinded investigator]), subject satisfaction, safety (adverse events), and usability. Results Sixty‐six subjects were treated, and 46/66 (66.7%) were available for evaluation at 3 months, when mean change in WSRS was identical for both products (−1.1 ± 0.4 for 2.5% agarose; −1.1 ± 0.4 for NASHA‐L). Scores for each product remained similar across all time points and began to return to baseline between 7 and 8 months. GAIS score followed a similar pattern, rising between months 7 and 8 (2.7 ± 0.6 for 2.5% agarose at month 7‐3.3 ± 0.5 at month 8 and 2.7 ± 0.6 for NASHA‐L at month 7‐3.3 ± 0.5 at month 8). Ultrasound confirmed the longevity of both fillers between 7 and 8 months. All adverse events were transient in nature and resolved within 15 days. Most events were mild in nature, and the number of events was similar between the two fillers. Conclusion Treatment with 2.5% agarose gel resulted in improvement that persisted for between 7 and 8 months. The treatment effect was equivalent to NASHA‐L.
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Affiliation(s)
- Nicolò Scuderi
- Department of General and Plastic Surgery, University of La Sapienza, Rome, Italy, Italy
| | - Benedetta Fanelli
- Plastic Surgery Unit, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Pasquale Fino
- Department of Experimental Medicine, University of La Sapienza, Rome, Italy
| | - Brian M Kinney
- Division of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kent DE, Kinney BM. The effect of high-intensity focused electromagnetic procedure on visceral adipose tissue: Retrospective assessment of computed tomography scans. J Cosmet Dermatol 2021; 20:757-762. [PMID: 33543566 PMCID: PMC7986109 DOI: 10.1111/jocd.13952] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND High levels of visceral adipose tissue (VAT) are associated with abdominal obesity and increased risk of metabolic deterioration. Recent studies showed that intensive physical exercise results in the reduction of subcutaneous and visceral fat. AIMS This study investigates the effect of supramaximal muscle contractions induced by a HIFEM procedure for abdominal VAT changes. METHODS Computed tomography (CT) scans of 22 subjects (47.3 ± 8.4 years, BMI of 23.5 ± 3.5 kg/m2 ) who received 8 HIFEM treatments of the abdomen (2-3 days apart) were retrospectively evaluated for the changes in VAT. The CT scans were obtained at baseline and 1 month after the last treatment. The transverse slices at umbilical, infraumbilical, and supraumbilical levels were used to determine the cross-sectional area (CSA) of VAT through a semi-automated segmentation method. RESULTS Analysis of the CSA revealed a significant (P = .004) and uniform reduction of the abdominal VAT area by 14.3% (-16.7 cm2 ) from 110.6 ± 69.0 cm2 to 93.9 ± 54.6 cm2 . In general, a higher relative improvement was seen infraumbilically (17.1%), followed by supraumbilical (15.5%) and umbilical (10.7%) levels. The reduction of VAT was strongly correlated to the reduction of subcutaneous fat (r(17) = 0.66; P = .002). A decrease in VAT volume contributed to the overall aesthetic enhancement visible on digital photographs. CONCLUSIONS The outcomes indicate that HIFEM technology has a positive effect on VAT. However, further studies are necessary to validate these outcomes and to clarify the exact mechanism of a VAT reduction. Based on our results, the HIFEM procedure may be a beneficial treatment option for patients with high VAT deposits.
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Affiliation(s)
| | - Brian M Kinney
- Division of Plastic Surgery, University of Southern California, Beverly Hills, CA, USA
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15
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Kinney BM, Kent DE. MRI and CT Assessment of Abdominal Tissue Composition in Patients After High-Intensity Focused Electromagnetic Therapy Treatments: One-Year Follow-Up. Aesthet Surg J 2020; 40:NP686-NP693. [PMID: 32103232 DOI: 10.1093/asj/sjaa052] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Several studies investigating high-intensity focused electromagnetic (HIFEM) treatments have recently been published. However, due to the novelty of the procedure, long-term data are still missing. OBJECTIVES The aim of this study was to evaluate changes in abdominal tissues on average 1 year after a series of HIFEM treatments, to determine the long-term durability of patients' original body responses. METHODS Magnetic resonance imaging (MRI) or computed tomography (CT) scanning were performed on 21 patients a mean of 332.6 [88.5] days after their original HIFEM treatment series. The scans were evaluated by a blinded radiologist for abdominal muscle thickness, subcutaneous fat changes, and abdominal separation. The results were compared with the MRI/CT-assisted measurements taken at baseline and 6-week follow-up. Correlations between collected data sets were calculated and tested. The incidence of any adverse events related to earlier treatments was monitored. RESULTS When comparing the 1-year follow-up measurements with the baseline, the MRI/CT-assisted calculations revealed mean reductions of 14.63% (2.97 [2.11] mm) in fat, 19.05% (1.89 [0.88] mm) in muscle thickening, and 10.46% (1.96 [1.71] mm) in diastasis recti. All changes were significant (P < 0.05) and not related to weight fluctuations (P > 0.05). The baseline width of diastasis positively correlated with the degree of improvement at follow-up. No adverse events were reported. CONCLUSION The HIFEM-induced muscle hypertrophy, fat reduction, and reduction in abdominal separation were maintained 1-year posttreatment. This suggests long-term durability of the original bodily response, which needs to be verified by continuing follow-up of this group and by further studies. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Brian M Kinney
- Clinical Associate Professor of Plastic Surgery, USC Keck School of Medicine, Los Angeles, CA
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Gold MH, Kinney BM, Kaminer MS, Rohrich RJ, D’Amico RA. Cover Image. J Cosmet Dermatol 2020. [DOI: 10.1111/jocd.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Michael Atlan
- APHP Hopital Tenon, Université Pierre et Marie Curie Paris VI, Maitre de conférence des Universités Praticien Hospitalier, Paris, France
| | - Brian M Kinney
- Keck School of Medicine, Division of Plastic Surgery, University of Southern California, Beverly Hills, CA, Costa Rica
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Gold MH, Kinney BM, Kaminer MS, Rohrich RJ, D'Amico RA. A multi-center, open-label, pilot study of allograft adipose matrix for the correction of atrophic temples. J Cosmet Dermatol 2020; 19:1044-1056. [PMID: 32176417 DOI: 10.1111/jocd.13363] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Autologous fat grafting (AFG) and synthetic fillers are currently used in esthetic and reconstructive surgery. Challenges in AFG include inconsistent graft retention, donor site morbidities, insufficient harvest, and excessive harvesting times. An allograft adipose matrix (AAM) has been developed as an off-the-shelf alternative to AFG and synthetic fillers. AIMS To evaluate the clinical safety and retention of an AAM over 24 weeks after treatment of bilateral atrophic temples. PATIENTS/METHODS Ten subjects (nine females, one male, aged 47-69 years) with temple atrophy were enrolled in the IRB-approved study. AAM (Renuva® , MTF Biologics, Edison, NJ) was injected (<3 mL) bilaterally into the atrophic temples of each subject. Volume retention, global improvement, and safety were evaluated at 1, 4, 8, 12, 16, 20, and 24 weeks. Biopsy specimens were obtained for adipogenic and angiogenic histological evaluation. RESULTS The mean temple volume improved over the baseline and was retained throughout the study period. Fullness (measure of volume) increased immediately from 0 pretreatment to 2.8 post-treatment (scale 0-4 = none-maximum). Fullness varied from 0.8 to 2.2 from weeks 1 through 12 and was 2.7-3.0 from weeks 16-24, around 75% increase from baseline. Furthermore, skin tone, smoothness, texture, and overall appearance also improved with 71% of subjects being satisfied to very satisfied with the results. Adverse events were minimal and histology revealed native tissue incorporation and remodeling. CONCLUSION AAM is safe and well tolerated, provides at least 6-month volume retention, improves skin quality, and supports adipose tissue remodeling after treatment into temples.
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Affiliation(s)
- Michael H Gold
- Tennessee Clinical Research Center, Nashville, Tennessee
| | - Brian M Kinney
- Keck School of Medicine, University of Southern California, Beverly Hills, California
| | - Michael S Kaminer
- Yale School of Medicine, Skin Care Physicians, Inc, Chestnut Hill, Massachusetts
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Kinney BM, Kanakov D, Yonkova P. Histological examination of skin tissue in the porcine animal model after simultaneous and consecutive application of monopolar radiofrequency and targeted pressure energy. J Cosmet Dermatol 2020; 19:93-101. [PMID: 31794139 PMCID: PMC7004092 DOI: 10.1111/jocd.13235] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The cosmetic appearance of skin is substantially influenced by the organization of connective fibers and underlying subcutaneous tissue. It has been previously documented that radiofrequency and pressure energies alone are able to improve skin appearance; however, detailed histological evaluation should be done to determine their synergistic effect. AIMS This histological study investigates the difference between simultaneous and consecutive application of monopolar radiofrequency with targeted pressure energy on porcine skin. METHODS In a total of four weekly abdominal treatments, simultaneous emission of the energies was applied to two pigs (12 minutes per session); additionally, two pigs were treated consecutively (12 + 12 minutes per session). The 5th pig served as a control subject. Biopsies were obtained at baseline, after the 4th treatment, and at 1-month follow-up. Primary outcomes were to document changes of dermal and hypodermal tissues. RESULTS In the treated subjects, the amount of collagen and elastin fibers increased significantly (P < .001). At follow-up, simultaneous application showed a significantly higher increase in collagen and elastin fibers (by 59% and 64%, respectively), when compared to consecutive. Thickness of the dermis increased more in the pigs treated simultaneously (+848.8 µm/50.17%; P < .001). Treated tissue also showed the upper part of dermis to be rich in blood vessels and better organized interlobular septa in hypodermis. No significant change was observed in the control subject. CONCLUSION Simultaneous application produces significantly more profound changes, when compared to consecutive treatment. Further research is needed but our findings represent a new potential treatment of various skin conditions like cellulite or laxity.
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Affiliation(s)
- Brian M. Kinney
- Division of Plastic SurgeryThe University of Southern California Keck School of MedicineBeverly HillsCAUSA
| | - Dian Kanakov
- Department of Internal Noninfectious DiseasesFaculty of Veterinary MedicineTrakia UniversityStara ZagoraBulgaria
| | - Penka Yonkova
- Department of Veterinary Anatomy, Histology and EmbryologyFaculty of Veterinary MedicineTrakia UniversityStara ZagoraBulgaria
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Kinney BM, Kanakov D, Yonkova P. Cover Image. J Cosmet Dermatol 2020. [DOI: 10.1111/jocd.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sforza M, Hammond DC, Botti G, Hedén P, Chacón Quirós M, Munhoz AM, Kinney BM, Corduff N. Response to "Clarification About 'Expert Consensus on the Use of a New Bioengineered, Cell-Friendly, Smooth Surface Breast Implant'". Aesthet Surg J 2019; 39:NP540-NP542. [PMID: 31617876 PMCID: PMC6853640 DOI: 10.1093/asj/sjz235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Marcos Sforza
- Corresponding Author: Prof Marcos Sforza, Plastic Surgery Department, Dolan Park Hospital, Stone Lane, B60 1LY, Bromsgrove, United Kingdom. E-mail:
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Kaufman‐Janette J, Taylor SC, Cox SE, Weinkle SH, Smith S, Kinney BM. Efficacy and safety of a new resilient hyaluronic acid dermal filler, in the correction of moderate-to-severe nasolabial folds: A 64-week, prospective, multicenter, controlled, randomized, double-blind and within-subject study. J Cosmet Dermatol 2019; 18:1244-1253. [PMID: 31444861 PMCID: PMC7384057 DOI: 10.1111/jocd.13100] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/24/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Injectables that behave similarly to native tissue and preserve facial expressiveness represent a new frontier in aesthetic medicine. A range of fillers made of high molecular weight hyaluronic acid (HA) chains with low crosslinking have been specifically developed to complement facial dynamics. AIMS The efficacy and safety of one of these resilient HA fillers, and its noninferiority to an effective comparator available in the US, were tested in the treatment of dynamic wrinkles. METHODS A 15-month, prospective, multicenter, controlled, randomized, double-blind, within-subject (split-face) clinical trial was conducted on 140 subjects with moderate-to-severe nasolabial folds (NLF). Study endpoints included improvement on a proprietary Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale, according to Blind Live Evaluators (BLE), subjects, and treating investigators (TI). Subject perception was evaluated with FACE-Q and satisfaction scales. RESULTS The per-protocol population included 88 subjects (92% women) of all Fitzpatrick phototypes, with a mean age of 57 years. WSRS improvement was significantly greater with the resilient HA than its comparator over 15 months, including at week 24 (primary endpoint), as rated by BLE and TI. Results demonstrated the noninferiority of the resilient HA filler to its comparator. Aesthetic improvement and subject satisfaction were durably high, with an overall trend toward higher scores for the resilient HA filler. Both treatments were safe and well tolerated. CONCLUSION The resilient HA filler made of long chains lightly crosslinked is at least equivalent to a well-established comparator for the correction of NLF in subjects of diverse skin phototypes.
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Affiliation(s)
| | - Susan C. Taylor
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | | | - Stacy Smith
- California Dermatology & Clinical Research InstituteEncinitasCAUSA
| | - Brian M. Kinney
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
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Sforza M, Hammond DC, Botti G, Hedén P, Chacón Quirós M, Munhoz AM, Kinney BM, Corduff N. Expert Consensus on the Use of a New Bioengineered, Cell-Friendly, Smooth Surface Breast Implant. Aesthet Surg J 2019; 39:S95-S102. [PMID: 30958549 PMCID: PMC6460429 DOI: 10.1093/asj/sjz054] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although general guidelines are available for established silicone gel breast implants, the unique characteristics of the latest Motiva implants warrant specific guidelines. OBJECTIVES This study aimed to generate consensus recommendations and summarize expert-based advice to better understand current surgical practices and to establish guidelines for surgeons transitioning from other implant devices to the Motiva implants. METHODS A survey was compiled by 12 plastic surgeon experts in aesthetic and reconstructive breast surgery and 1 biotechnology scientist, and distributed to 36 plastic surgeons to establish a consensus on the use of these devices. Surgical techniques, complication rates, and implant selection were among the topics discussed. RESULTS The experts agreed on 3 core principles regarding the use of Motiva Round and Ergonomix implants. Firstly, the dissected pocket needs to be close fitting and steps must be taken to prevent expansion of the pocket. Secondly, implant selection must be individualized. Finally, surgical planning and technique must be carefully considered. When questioned about problems they had ecountered, 84.6% of the experts agreed that they experienced fewer overall complications and 76.9% confirmed reduced capsular contracture rates with these devices. Overall, 84.6% of the experts favored selecting Motiva Ergonomix implants over Round implants to achieve a more natural look. In addition, 92.3% of the experts agreed that Motiva implants, due to their innovative technology, reduce the risk of anaplastic large-cell lymphoma. CONCLUSIONS This international consensus of leading practitioners will assist plastic surgeons with patient selection, preoperative planning, and surgical technique. These recommendations are designed to optimize surgical outcomes, resulting in lower overall complication rates, more natural-looking breasts, and highly satisfied patients.
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Affiliation(s)
- Marcos Sforza
- Responsible for the Elective Internship in Plastic Surgery, Dolan Park Hospital, UK
- Examiner of the Royal College of Surgeons
| | - Dennis C Hammond
- Associate Program Director of Plastic and Reconstructive Surgery, Spectrum Health/Michigan State University Plastic Surgery, Grand Rapids, MI
| | | | - Per Hedén
- plastic surgeon in private practice in Stockholm, Sweden
| | | | - Alexandre Mendonça Munhoz
- Chief of the Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Professor of Plastic Surgery, Division of Plastic Surgery, Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
- Director of the Plastic Surgery Division, Hospital Moriah, São Paulo, Brazil
| | - Brian M Kinney
- Plastic Surgeon, Keck School of Medicine, Division of Plastic Surgery, University of Southern California, Beverly Hills, CA
| | - Niamh Corduff
- plastic surgeon in private practice in Geelong, VIC, Australia
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Kinney BM, Lozanova P. High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: Safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. Lasers Surg Med 2019; 51:40-46. [PMID: 30302767 PMCID: PMC6585690 DOI: 10.1002/lsm.23024] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study introduces an initial evaluation of a novel High-Intensity Focused Electromagnetic (HIFEM) technology. The primary goal is to quantify any effects the treatments may have on abdominal tissues, as well as to establish hypotheses for future research of this technology. METHODS Twenty-two patients received four abdominal treatments using the EMSCULPT device (BTL Industries Inc., Boston, MA). Anthropometric evaluations were recorded and digital photographs were taken at baseline, at 2 months, and at 6 months post-treatments. The MRI without contrast determined by vertertebras T12 and S1 (FIESTA and FSPRG sequences) was used to measure dimensions in coronal cross-sectional images of abdominal muscle and fatty tissues, in order to assess any anatomical changes induced by the application. RESULTS Analysis of the same MRI slices verified by tissue artefacts showed a statistically significant (all P < 0.0001) average 18.6% reduction of adipose tissue thickness, 15.4% increase in rectus abdominis muscle thickness, and 10.4% reduction in rectus abdominus separation (diastasis recti) as measured from the medial border of the muscle 2 months post-treatment. More significant improvements were observed in patients with BMI 18.5-24.9 (classified as "normal"). MRI data from 6-month follow-up suggest the changes can be preserved in longer term. Tape measurements showed on average 3.8 cm subumbilical circumference reduction. The weight of the subjects did not change significantly (average -0.5 lb; P > 0.05). No adverse events were reported. CONCLUSIONS MRI, considered as a highly precise diagnostic method, revealed simultaneous muscle growth, fat reduction and reduced abdominal separation at 2 months and at 6 months post treatments, unrelated with dieting. Further research should investigate the exact physiological processes which stand behind the tissue changes observed in this study. Lasers Surg. Med. 51:40-46, 2019. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Brian M. Kinney
- University of Southern California Division of Plastic SurgeryBeverly HillsCalifornia
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Kinney BM, Andriessen A, DiBernardo BE, Bloom J, Branson DF, Gentile RD, Goldberg DJ, Lorenc PZ, Nestor M, Wu D. Use of a controlled subdermal radio frequency thermistor for treating the aging neck: Consensus recommendations. J COSMET LASER THER 2017; 19:444-450. [PMID: 28665165 DOI: 10.1080/14764172.2017.1343952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A new temperature-controlled device has been used as a percutaneous radio frequency probe to treat lax submental and other facial areas. It has significant advantages over other esthetic devices as it provides the dual benefit of fat lipolysis and skin tightening. Our goal here is to present consensus recommendations for treating the aging neck. METHODS A panel of 11 expert physicians convened in Dallas, Texas, on October 15, 2016 to arrive at a consensus on the best current practice for submental skin tightening and contour improvement. Prior to the meeting, a comprehensive review of the literature was performed and a survey was sent to esthetic dermatologists and plastic surgeons who were queried about various aspects of neck rejuvenation. RESULTS The literature search revealed 10 different technologies for neck rejuvenation evaluated in double-blind (n = 2) and single-blind (n = 1) clinical trials and other clinical evaluations (n = 21). The survey was sent via an email to 1248 individuals and was completed by 92 respondents. Review of the data and discussion by meeting attendees generated eight consensus recommendations. DISCUSSION Subdermal monopolar radio frequency represents an effective means for disrupting fat volume and skin tightening of the face, neck, and jawline. For suitable patients, this treatment can be used to achieve significant esthetic improvements.
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Affiliation(s)
- Brian M Kinney
- a Department of Plastic Surgery, USC School of Medicine , Beverly Hills , CA , USA
| | - Anneke Andriessen
- b Radboudumc, Radboud Academie , Nijmegen , Netherlands.,c Andriessen Consultanta , Malden , Netherlands
| | - Barry E DiBernardo
- d Surgery, Plastic Surgery Division , University of Medicine & Dentistry of New Jersey , Montclair , NJ , USA
| | - Jason Bloom
- e Main Line for Laser Surgery , Ardmore , OK , USA
| | - Dennis F Branson
- f Aesthetic, Plastic and Reconstructive Surgery , Fayetteville , NY , USA
| | - Richard D Gentile
- g Facial Plastic & Aesthetic Laser Center & The MIA Center , Boardman , OH , USA
| | | | - Paul Z Lorenc
- i Lorenc Aesthetic Plastic Surgery Center , New York , USA.,j Lenox Hill Hospital , New York, NY , USA
| | - Mark Nestor
- k School of Medicine, Dermatology and Cutaneous Surgery, University of Miami , Miami , FL , USA.,l Center for Cosmetic Enhancement and Center of Cosmetic Research , Aventura , FL , USA
| | - Douglas Wu
- m Cosmetic Laser Dermatology , San Diego , CA , USA
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Kinney BM. Less haste, more speed: evaluating human growth hormone for normal, healthy, aging adults. Aesthet Surg J 2004; 24:47-8. [PMID: 19336133 DOI: 10.1016/j.asj.2003.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
The worldwide search for the ideal soft tissue filler material continues. The authors focus on the stringent safety and efficacy requirements for soft tissue fillers and provide an overview of the current natural and synthetic materials. (Aesthetic Surg J 2001;21:469-471.).
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Kinney BM. Body contouring with external ultrasound. Plastic Surgery Educational Foundation DATA Committee. Device and Technique Assessment. Plast Reconstr Surg 1999; 103:728-9. [PMID: 9950568 DOI: 10.1097/00006534-199902000-00060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kinney BM. External fatty tissue massage (the "endermologie" and "silhouette" procedures). Plastic Surgery Educational Foundation DATA Committee. Plast Reconstr Surg 1997; 100:1903-4. [PMID: 9393494 DOI: 10.1097/00006534-199712000-00044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Turk AE, Ishida K, Kobayashi M, Narloch J, Kinney BM, Verity MA, Roy RR, Edgerton VR, Miller TA, Lieber RL, Botte MJ. The Effects of Dynamic Tension and Reduced Graft Size on Muscle Regeneration in Rabbit Free Muscle Grafts. Plast Reconstr Surg 1991. [DOI: 10.1097/00006534-199108000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Turk AE, Ishida K, Kobayashi M, Narloch J, Kinney BM, Verity MA, Roy RR, Edgerton VR, Miller TA. The effects of dynamic tension and reduced graft size on muscle regeneration in rabbit free muscle grafts. Plast Reconstr Surg 1991; 88:299-309; discussion 310. [PMID: 1852824] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a study of 28 adult New Zealand White rabbits, the influence of tension and size on muscle regeneration in tibialis anterior free muscle grafts (without vascular anastomoses) was examined 6 months after transplantation. Three laboratory models were studied: (1) whole dynamic (WD) graft (allowing ankle excursion and, therefore, variable dynamic physiologic tension), (2) whole static (WS) graft (constant, fixed length and, thus, only isometric tension), and (3) longitudinally sliced (reduced radius) dynamic (SD) model. Bilateral orthotopic grafts of the tibialis anterior muscle were performed in 24 rabbits (eight animals in each of the three different model groups). Controls consisted of normal tibialis anterior muscle from four age-matched rabbits. All tibialis anterior muscle grafts were examined histologically (fiber counts) and functionally (determined by in situ contractile properties under maximal stimulation conditions). The WD grafts demonstrated a significantly higher number of regenerated fibers per muscle cross section (4819 +/- 589) than the WS (2221 +/- 603) or SD (1919 +/- 732) grafts. The amount of tetanic tension in the WD grafts was 35 percent of the control and twice as much as that of the WS grafts (WD 1.0 +/- 0.2 kg versus WS 0.5 +/- 0.4 kg; p less than 0.05). The SD grafts produced approximately one-third as much maximum tetanic tension as the WD grafts (0.3 +/- 0.1 kg versus 1.0 +/- 0.2 kg), demonstrating that the amount of recovery was similar in these two dynamic models, since only the longitudinal middle third of the muscle was grafted in the SD model. Free muscle grafts under dynamic tension, which allows excursion, have shown a greater amount of muscle-fiber regeneration and restoration of function compared with a graft with fixed length. The positive effect of dynamic mechanical tension on small autogenous free muscle grafts (without vascular anastomoses) is clinically significant in the reconstruction of facial and hand neuromuscular deficits when blood vessels are not available for reanastomosis. Future studies using the tibialis anterior WD and SD transplant models will strengthen our understanding of the events of spontaneous revascularization and skeletal muscle regeneration.
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Affiliation(s)
- A E Turk
- Research Service, Veterans Administration Medical Center, West Los Angeles, Calif
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Abstract
As the use of rigid internal fixation of the facial skeleton has become routine in adults, many craniofacial surgeons have expanded its use to the pediatric population. The effects of miniplate and screw fixation on subsequent craniofacial growth, however, have not been examined. Using 6-week-old rabbits as an experimental model, miniplates were placed across the right coronal suture. Calvarial changes were measured by direct osteometry on dry skull preparations. Compared with the control group, a significant reduction in growth was noted across the plated suture and adjacent bones. Because secondary growth disturbances can be produced with the use of these fixation devices, their use in the pediatric population should be viewed cautiously.
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Affiliation(s)
- J I Resnick
- Division of Plastic Surgery, University of California School of Medicine, Los Angeles
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