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Robenpour M, Fuchs Orenbach S, Hadash-Bengad R, Robenpour O, Heller L. The Wide Suture Suspension Platysmaplasty, a revised technique for neck rejuvenation: A retrospective cohort study. J Cosmet Dermatol 2021; 20:3603-3609. [PMID: 33583136 DOI: 10.1111/jocd.14001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Restoration of an esthetic neck contour is an integral component of facial rejuvenation. The corset platysmaplasty and the suture suspension neck lift were introduced by Feldman in 1990 and by Giampapa in 1995, respectively. Both techniques are routinely used in current practice with satisfactory and long-lasting results. However, some patients who have undergone the suture suspension platysmaplasty report long-term discomfort, excessive neck tightening, and recurrence of deformity. OBJECTIVE To achieve an improvement in the Cervicomental (CM) angle and other parameters in patients with a difficult neck and to reduce the probability of long-term discomfort, excessive neck tightening, and a recurrence of deformity. The author developed a new technique that includes a very wide suture suspension with no interlocking. We hereby present a revised suture suspension technique-The Wide Suture Suspension Platysmaplasty. METHODS Between the years 2015 and 2017, the senior author performed 286 face and neck rejuvenation surgeries with or without blepharoplasty. Of these cases, 35 patients with a heavy neck were chosen for the new Wide Suture Suspension Technique. This was a single surgeon retrospective cohort study. Patients were photographed in a lateral view preoperatively and 6 months postoperatively. Pre- and postoperative photographs were compared in four measured parameters: the cervicomental angle, the jowl angle, the horizontal distance between the mentum and the cervicomental angle and the vertical distance between the mentum and the cervicomental angle. RESULTS The Wide Suture Suspension Platysmaplasty resulted in pleasing esthetics, with minimal complications in patients with difficult necks. The cervicomental angle decreased by 42° (P < .0001), the jowl angle increased by 12° (P < .0001), the horizontal distance between the mentum and the cervicomental angle rose by 12.4% and the vertical distance between the mentum and the cervicomental angle was reduced by 34.5%. CONCLUSION The Wide Suture Suspension Platysmaplasty resulted in improved esthetics, as demonstrated by objective measurements. None of the patients in this series had any secondary intervention during the follow-up period. Particularly in the case of a difficult neck, surgeons should consider this technique.
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Affiliation(s)
- Manoocher Robenpour
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Shir Fuchs Orenbach
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Reut Hadash-Bengad
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ophir Robenpour
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Lior Heller
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
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Hadash-Bengad R, Hajaj E, Klein S, Merims S, Frank S, Eisenberg G, Yakobson A, Orevi M, Caplan N, Peretz T, Lotem M, Cohen JE. Immunotherapy Potentiates the Effect of Chemotherapy in Metastatic Melanoma-A Retrospective Study. Front Oncol 2020; 10:70. [PMID: 32117727 PMCID: PMC7033746 DOI: 10.3389/fonc.2020.00070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 11/05/2019] [Accepted: 01/15/2020] [Indexed: 01/25/2023] Open
Abstract
Melanoma survival increased with targeted- and immunotherapy agents, yet most patients ultimately progress and require salvage therapy. In our experience, some progressive disease patients on immune-checkpoint inhibitors (ICIs) demonstrate deep and sustained responses to chemotherapy. We hypothesized that ICIs improve the response to subsequent chemotherapy in metastatic melanoma. We conducted a retrospective study to compare the efficacy of chemotherapy given with prior immunotherapy, to its efficacy given without it. We measured progression free survival (PFS), overall survival, and response rate. Immune-monitoring was performed on sequential peripheral blood mononuclear cell samples taken from a chemotherapy-responsive patient. The chemotherapy post-immunotherapy group (CpI) included 11 patients, the chemotherapy without prior immunotherapy (CNPI) group included 24 patients. Median PFS was 5.2 months in the CpI vs. 2.5 months in the CNPI groups; HR 0.37 [95% Confidence interval (CI) 0.144–0.983], P = 0.046. Immune-monitoring showed an increased proportion of CD8+ cells, with elevated PD-1 and CD69 expression, while on chemotherapy, as compared with all-time points on ICIs, suggesting immune-activation. Immunotherapy potentiates the effect of chemotherapy in metastatic melanoma possibly through activation of CD8+ T cells.
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Affiliation(s)
- Reut Hadash-Bengad
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Emma Hajaj
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shiri Klein
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Merims
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Stephen Frank
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Eisenberg
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexander Yakobson
- Department of Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Marina Orevi
- Department of Nuclear Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadia Caplan
- Division of Radiology and Medical Imaging, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lotem
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonatan E Cohen
- Sharett Institute of Oncology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Wohl Institute for Translational Medicine, Hadassah Medical Center, Jerusalem, Israel
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