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Stein MJ, Shah N, Harrast J, Zins JE, Matarasso A, Gosain AK. Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. Aesthetic Plast Surg 2024; 48:793-802. [PMID: 38302713 DOI: 10.1007/s00266-023-03841-x] [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: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND This study evaluates change in practice patterns in facelift surgery based on a 15-year review of tracer data collected by the American Board of Plastic Surgery as part of the Continuous Certification process. METHODS Tracer data for facelift was reviewed from 2006 to 2021. The 15-year collection period was divided into an "early cohort (EC)" from 2006 to 2014 and a "recent cohort (RC)" from 2015 to 2021. RESULTS Of 3400 facelifts (1710 EC/1690 RC) performed, 18% were done in hospital and 76% were done in an accredited office facility. Ninety one percent of patients were female with an average age of 61 years. There was an increase in the number of secondary facelifts (4% EC vs 18% RC; p < 0.001) and an increased number of patients concerned about volume loss/deflation (25% EC vs 37% RC; p < 0.001). The surgical approach to the SMAS involved plication (40%), flaps (35%), SMASectomy (22%) and MACS lift (6%). One percent of facelifts were subperiosteal and 8% skin-only. Significantly more surgeons used the lateral SMAS flap (14% EC vs 18% RC, p < 0.005), while less used an extended SMAS flap (21% vs 18%; p = 0.001) and MACS lift (10% EC vs 6% RC; p = 0.021) techniques. The concomitant use of facial fat grafting is becoming more common (15% EC vs 24% RC, p = 0.0001). CONCLUSIONS A 15-year review of ABPS tracer data provides an excellent venue for the objective assessment of the current status of facelift surgery, and key changes in practice patterns during that time. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Michael J Stein
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Nikhil Shah
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital of Northwestern Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA
| | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alan Matarasso
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital of Northwestern Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA.
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Coombs DM, Sinclair NR, Kochuba A, Grow J, Couto RA, Matarasso A, Zins JE. Practice Patterns: An American Society of Plastic Surgeons (ASPS) Member Survey, 2000 and 2020-How Much Has Brow Lifting Changed? Aesthet Surg J 2023; 44:1-8. [PMID: 37409963 DOI: 10.1093/asj/sjad207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/11/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND In 2001, Elkwood and Matarasso published an American Society of Plastic Surgeons (ASPS) member survey detailing brow lift practice patterns. Interval changes in practice patterns have not been studied. OBJECTIVES The previous survey was revised to elucidate current trends in brow lift surgery. METHODS A 34-question descriptive survey was distributed to a random group of 2360 ASPS members. Results were compared to the 2001 survey. RESULTS A total of 257 responses were collected (11% response rate; ± 6% margin of error at 95% CI). The most frequent technique for the correction of brow ptosis in both surveys was the endoscopic approach. The use of hardware fixation has increased in endoscopic brow lifting, whereas the use of cortical tunnels has decreased. Although coronal brow lifting has decreased in frequency, hairline and isolated temporal lift have increased. Neuromodulators have replaced resurfacing techniques as the most common nonsurgical adjunct. Frequent use of neuromodulators has risen from 11.2% to 88.5%. Nearly 30% of current surgeons feel that neuromodulators have replaced formal brow lifting procedures to a significant degree. CONCLUSIONS In comparing the 2001 and current ASPS member survey there has been a clear transition to less invasive procedures over time. Although the endoscopic approach was the most popular means of forehead correction in both surveys, coronal brow lifting has decreased in frequency and the hairline and temporal approaches have increased. Neurotoxins have replaced laser resurfacing and chemical peeling methods as an adjunct, and in some cases replaced the invasive procedure entirely. Possible explanations for these findings will be discussed. LEVEL OF EVIDENCE: 4
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James I, Kochuba A, Grow JN, Ho I, Calobrace MB, Movassaghi K, Zins JE. Trends in Aesthetic Surgery Fellowship Training: An Analysis of Supply and Demand. Aesthet Surg J 2023; 44:95-101. [PMID: 37431878 DOI: 10.1093/asj/sjad208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/13/2023] [Accepted: 07/09/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Aesthetic surgery fellowship applications were consolidated under the San Francisco Match in 2018. The impact of these changes on aesthetic program and applicant numbers had not yet been investigated. OBJECTIVES In this study we sought to evaluate changes in programs, positions, applications, match rates, and fill rates since aesthetic surgery joined the San Francisco Match. We also aimed to compare these trends to craniofacial surgery, microsurgery, and hand surgery fellowships over this same time period. METHODS San Francisco and National Resident Matching Program (NRMP) match data for aesthetic, craniofacial, microsurgery, and hand fellowships were obtained from 2018 to 2022, and the number of applications, positions, programs, and successful matches were evaluated. RESULTS The number of aesthetic fellowship positions increased from 17 to 41 (141%) over the period studied. This resulted in increased match rates and more unfilled positions. Over the same period, fellowship positions for craniofacial, hand, and microsurgery increased by 3.4%, 6%, and 2.5% respectively. There was no increase in applications to any postgraduate subspecialty, nor was there any change in the number of residents pursuing fellowship. Similarly, there was no change in the percentage of fellowship-bound residents applying to any given discipline. CONCLUSIONS The increase in aesthetic fellowship programs and positions did not generate an increase in applications. Applications to other plastic surgery subspecialties also failed to increase. Unlike aesthetic fellowships, their program numbers have remained stable. Given the limited fellowship applicant pool, our focus should be on enhancing the quality of existing aesthetic programs rather than continuing to increase the number of aesthetic positions. LEVEL OF EVIDENCE: 3
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Meyers A, Jin A, Kwiecien GJ, Gatherwright J, Khetarpal S, Zins JE. Platelet-Rich Plasma for Treatment of Hair Loss Improves Patient-Reported Quality of Life. Aesthetic Plast Surg 2023; 47:1528-1534. [PMID: 36637490 DOI: 10.1007/s00266-022-03224-8] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND While numerous studies have demonstrated enhanced hair growth following platelet-rich plasma (PRP) treatments in patients with male and female pattern hair loss, no study has demonstrated its impact on quality of life (QoL) using a validated tool. OBJECTIVE This prospective study aimed to assess the psychological impact of PRP treatment for hair loss. METHODS PRP scalp injections were repeated monthly for the first 3 months, then quarterly for 1 year, and annually thereafter. HAIRDEX 48, a validated scale assessing QoL for patients with alopecia, was administered before PRP and at each visit. Scores were interpolated on a 0-100 scale: 0 representing highest QoL, 100 lowest, and compared using paired t-tests. RESULTS Ninety-two patients receiving PRP were analyzed. Mean age was 48.2 ± 17.4 years and 55% were male. Patients had an average of 4 ± 2 treatments; most (60%) had ≥4. Thirty patients (33%) completed both pre- and post-PRP questionnaires. Prior to PRP, 61% tried minoxidil, 16% finasteride, and 1% hair transplant. Total HAIRDEX scores improved from a mean of 23.2 ± 15.4 to 19.7 ± 11.3 after 3-5 months after PRP (p < 0.001). There were also decreases in symptoms (10.0 ± 12.0 vs. 9.6 ± 10.8, p < 0.001), functioning (16.1 ± 18.1 vs. 13.3 ± 12.6, p < 0.001), and emotions domains (37.7 ± 24.1 vs. 32.2 ± 18.9, p < 0001). For stigmatization and self-confidence domains, improvements from pre-PRP were significant at 3-5 months (21.2 ± 16.8 vs. 17.4 ± 12.1; p < 0.001 and 24.8 ± 17.7 vs. 20.9 ± 15.5; p < 0.001, respectively) and >6 months (18.9 ± 13.9; p < 0.001 and19.5 ± 18.6; p = 0.008, respectively). CONCLUSIONS PRP improves QoL and is an effective part of multimodal therapy for hair loss. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Abigail Meyers
- Department of Plastic Surgery, A60, Cleveland Clinic, Cleveland, OH, USA
| | - Alison Jin
- Department of Plastic Surgery, A60, Cleveland Clinic, Cleveland, OH, USA
| | | | - James Gatherwright
- Department of Plastic Surgery, A60, Cleveland Clinic, Cleveland, OH, USA
| | | | - James E Zins
- Department of Plastic Surgery, A60, Cleveland Clinic, Cleveland, OH, USA.
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Coombs DM, Kwiecien GJ, Sinclair NR, Jin A, Zins JE. Local Infiltration of Tranexamic Acid During Facelift Improves Operating Room Efficiency: A Matched Patient Study. Aesthet Surg J 2022; 42:971-977. [PMID: 35350068 DOI: 10.1093/asj/sjac067] [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: 01/19/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has rapidly gained popularity in aesthetic surgery. Previous reports have suggested that TXA provides a dry surgical field and significantly reduces operating time during facelift surgery. OBJECTIVES The aim of this study was to build upon earlier findings by providing a large cohort matched alongside historic controls and more clearly document time saved when performing facelift surgery. METHODS A retrospective, single-surgeon case-control study was undertaken between July 2016 and October 2021. All patients underwent facelift surgery alone or in combination with fat transfer and perioral chemical peel. All patients received subcutaneous infiltration of 0.5% lidocaine/1:200,000 epinephrine with or without 1 or 2 mg/mL TXA. Patient demographics, TXA dose, surgical time, and minor and major complications were examined. RESULTS In total 145 consecutive patients were identified: 73 in Group 1 (no-TXA) and 72 in Group 2 (TXA). No differences in terms of gender distribution (P = 0.75), age (P = 0.54), BMI (P = 0.18), frequency of secondary rhytidectomy (P = 0.08), rate of ancillary lipografting (P = 0.44), TXA dose (P = 0.238), and minor complication rate (P = 0.56) were observed. However, mean surgical time in the no-TXA group was 21 minutes longer than in the TXA group (P = 0.016). Six patients (8%) in the no-TXA group experienced minor complications vs 8 patients (11%) in the TXA group. No patients experienced major complications. CONCLUSIONS Although previous studies have highlighted the potential benefits of TXA in aesthetic surgery, most of the data remain subjective and non-validated. This report adds to the objective body of evidence supporting TXA in facial aesthetic surgery by documenting time saved in the operating room without additional surgical morbidity. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Alison Jin
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - James E Zins
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Hernandez CA, Zins JE, Dutton JW. Commentary on: Quantitative Mobility of the Face and its Relevance for Surgical and Nonsurgical Aesthetic Facial Procedures. Aesthetic Plast Surg 2022; 46:2246-2247. [PMID: 35922670 DOI: 10.1007/s00266-022-03004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Claudia A Hernandez
- Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - James Walter Dutton
- Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Abstract
This article discusses the physiology of brow ptosis and compares how depressor muscle alteration combined with wide subperiosteal undermining leads to its correction. A detailed description and a series of videos illustrate the endoscopic technique. Long-term before and after photographs demonstrate the efficacy of the procedure. Pitfalls and flaws in technique leading to less-than-ideal outcomes are described.
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Affiliation(s)
- James E Zins
- Section of Cosmetic Surgery, Cleveland Clinic Department of Plastic Surgery, Desk A 60, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Demetrius M Coombs
- Cleveland Clinic Department of Plastic Surgery, Desk A 60, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Zins JE, Grow J, Cakmakoglu C. Brow Anatomy and Aesthetics of the Upper Face. Clin Plast Surg 2022; 49:339-348. [PMID: 35710149 DOI: 10.1016/j.cps.2022.03.001] [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] [Indexed: 11/03/2022]
Abstract
The surgical approach to the brow has changed perhaps more than any other facial esthetic procedure in the past 20 years. Understanding the functional anatomy of the upper face is the best means of maximizing results and minimizing untoward events in this region. The surgical and clinical correlation is addressed in detail in this article. Cadaver and intraoperative photographs are used to illustrate critical points. Armed with the details of this anatomy, the reader will best be able to best individualize surgical treatment.
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Affiliation(s)
- James E Zins
- Section of Cosmetic Surgery, Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jacob Grow
- Southern Indiana Aesthetic and Plastic Surgery, 2450 NorthPark, Suite B, Columbus, Indiana 47203, USA
| | - Cagri Cakmakoglu
- Cleveland Clinic Department of Plastic Surgery, 9500 Eucllid Avenue, Cleveland Ohio 44195, USA
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10
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Dutton JW, Chang IA, Zins JE. The Hairline Brow Lift. Clin Plast Surg 2022; 49:349-356. [DOI: 10.1016/j.cps.2022.01.004] [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: 11/03/2022]
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Zins JE. More Than a Brow Lift: The Importance of Brow Shape. Clin Plast Surg 2022; 49:ix-x. [DOI: 10.1016/j.cps.2022.03.003] [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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12
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Zins JE, Dutton JW. Commentary on: A Systematic Review and Meta-Analysis Evaluating the Impact of Tranexamic Acid Administration in Aesthetic Plastic Surgery. Aesthet Surg J 2022; 42:559-561. [PMID: 34922333 DOI: 10.1093/asj/sjab420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
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13
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Chang IA, Wells MW, Zheng DX, Mulligan KM, Wong C, Scott JF, Zins JE. A Multimetric Readability Analysis of Online Patient Educational Materials for Submental Fat Reduction. Aesthetic Plast Surg 2022; 46:712-718. [PMID: 35037081 PMCID: PMC8761512 DOI: 10.1007/s00266-021-02675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/07/2021] [Indexed: 11/24/2022]
Abstract
Background Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction. Methods Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales. Results Analysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8–59.2), representing a “difficult” level of reading. Mean readability grade levels (range 9–13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health. Conclusions Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
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Zins JE, Dutton JW. Invited Discussion on: Re-evaluating the Effect of Preoperative Tranexamic Acid on Blood Loss and Field Quality During Rhinoplasty: A Randomized double-blinded controlled Trial. Aesthetic Plast Surg 2022; 46:1321-1322. [PMID: 34981155 DOI: 10.1007/s00266-021-02679-5] [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] [Received: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022]
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Frautschi RS, Orfahli LM, Zins JE. Reflecting on Your Reflection: Examining the Effect of a Non-Reversing Mirror on Self-Perception. Aesthet Surg J 2021; 41:NP1989-NP1993. [PMID: 33843982 DOI: 10.1093/asj/sjab179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Photographic images can clash markedly with patients' self-perception. Individuals are more familiar with their mirror image, where their facial asymmetries are reversed. A non-reversing mirror (NRM) allows patients to see their dynamic non-reversed image and familiarize themselves with how they appear in photographs and to others. OBJECTIVES The aim of this study was to explore the effect that a NRM has on facial self-perception and investigate whether a NRM changes an individual's goals when considering cosmetic surgery. METHODS Individuals (n = 30) filled out portions of the FACE-Q questionnaire after inspecting their reflections in a NRM and in a standard mirror for 30 seconds each. After these two inspections had been completed, investigators asked qualitative questions comparing the 2 mirrors. Wilcoxon signed-rank test, Mann-Whitney U test, and Pearson's chi-squared test were used to analyze the differences. RESULTS Participants scored significantly better on the FACE-Q Age Appraisal and Appearance-Related Psychosocial Distress scales when looking in a standard mirror vs a NRM (P = 0.007 and 0.001, respectively). Qualitatively, most reported that their faces seemed less symmetric and less balanced (73% and 53%, respectively) in the NRM. Overall, 83.3% reported seeing a qualitative difference in their appearance, with 30% endorsing that looking in the NRM had changed their facial aesthetic goals. CONCLUSIONS A NRM can bridge between the familiarity of the patient's reversed reflection and their less-familiar, non-reversed true image. It may serve as a useful physician-patient communication tool when discussing goals and expectations for facial aesthetic procedures.
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Affiliation(s)
- Russell S Frautschi
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lynn M Orfahli
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Zins JE, Grow JN. Invited Discussion on: Preauricular Aging-A 3 Point Grading System to Guide Treatment in Facial Rejuvenation. Aesthetic Plast Surg 2021; 45:2188-2189. [PMID: 33903932 DOI: 10.1007/s00266-021-02323-2] [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] [Received: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
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Hashem AM, Couto RA, Surek C, Swanson M, Zins JE. Facelift Part II: Surgical Techniques and Complications. Aesthet Surg J 2021; 41:NP1276-NP1294. [PMID: 33558887 DOI: 10.1093/asj/sjab081] [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: 11/13/2022] Open
Abstract
Although previous publications have reviewed face and necklift anatomy and technique from different perspectives, seldom were the most relevant anatomical details and widely practiced techniques comprehensively summarized in a single work. As a result, the beginner is left with a plethora of varied publications that require sorting, rearrangement, and critical reading. A recent survey of US plastic surgery residents and program directors disclosed less facility with facelift surgery compared with aesthetic surgery of the breast and trunk. To this end, 4 of the widely practiced facelift techniques (ie, minimal access cranial suspension-lift, lateral-SMASectomy, extended-SMAS, and composite rhytidectomy) are described in an easy review format. The highlights of each are formatted followed by a summary of complications. Finally, the merits and limitations of these individual techniques are thoroughly compared and discussed. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ahmed M Hashem
- Department of Plastic Surgery at Cairo University, Cairo, Egypt
| | | | | | - Marco Swanson
- Department of Plastic Surgery at Case Western University, Cleveland, OH, USA
| | - James E Zins
- Department of Plastic Surgery at Cleveland Clinic Foundation, Cleveland, OH, USA
- Facial Surgery co-section editor for Aesthetic Surgery Journal
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Kochuba AL, Surek CC, Ordenana C, Vargo J, Scomacao I, Duraes E, Zins JE. Anterior Approach to the Neck: Long-Term Follow-Up. Aesthet Surg J 2021; 41:861-870. [PMID: 32436583 DOI: 10.1093/asj/sjaa099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The anterior or submental necklift has been well described. Long-term results have been demonstrated in patients with minimal, mild, and moderate skin excess. It relies on the skin's unique ability to contract once separated from its attachments and further enhances the surgical result with treatment of the intermediate layer- subplatysmal fat, anterior digastric, submandibular gland, and platysma. Treatment of this layer differentiates this operation from liposuction and offers benefits beyond liposuction alone. OBJECTIVES The authors sought to assess the long-term success of the anterior necklift for neck rejuvenation and determine its utility in patients with severe cervicomental angles. METHODS This was a single-surgeon, retrospective review of patients who underwent an isolated anterior necklift with no additional procedures between 1998 and 2017. Pre- and postprocedure photographs were scrambled and examined by independent evaluators grading the change in cervicomental angle based on the Knize scale. The reduction in apparent age was calculated utilizing the validated apparent age assessment scale. RESULTS Twenty-seven patients were evaluated (42% mild and 58% moderate to severe necks preoperatively). The average follow-up was 24.7 months. There was an average 3.6-year age reduction and 1.0-grade improvement in all patients. In moderate to severe necks, there was a 3.9-year age reduction and 1.4-grade improvement in the cervicomental angle following surgery. CONCLUSIONS This study demonstrates the effectiveness of the operation in improving the cervicomental angle and reducing the overall apparent age of patients, even more so in severe cases. The operation is an option for patients who desire neck improvement but are unwilling to undergo a facelift. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | - Carlos Ordenana
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - James Vargo
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Isis Scomacao
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Eliana Duraes
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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Frautschi RS, Zins JE. Commentary on: How Does Wearing a Facecover Influence the Eye Movement Pattern in Times of COVID-19? Aesthet Surg J 2021; 41:NP1125-NP1126. [PMID: 33942059 PMCID: PMC8135967 DOI: 10.1093/asj/sjab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Russell S Frautschi
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Surek CC, Kochuba AL, Said SAD, Cho KH, Swanson M, Duraes E, McBride J, Drake RL, Zins JE. External Approach to Buccal Fat Excision in Facelift: Anatomy and Technique. Aesthet Surg J 2021; 41:527-534. [PMID: 31965150 DOI: 10.1093/asj/sjaa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Masculinization of the face is a common finding in facelift patients. It is attributed to deflation and decent of the midface-jowls coupled with skin laxity. Fullness is evident lateral to the jowl in a small percentage due to prominent buccal fat pad (BFP). OBJECTIVES The authors sought to examine the anatomy of the BFP, triangulate the prominent BFP with surgical landmarks, and describe an external approach to excise the BFP during facelift surgery. METHODS Eighteen cadaveric dissections were performed. Facelift flap was elevated and the prominent buccal extension of the BFP protruding through the superficial-musculo-aponeurotic-system was identified. Measurements were taken from the BFP to surgical landmarks: zygomatic arch, tragus, and gonial angle. The locations of the facial nerve, parotid duct, and vascular pedicle relative to the BFP were calculated. RESULTS BFP was 4.1 cm inferior to the zygomatic arch, 7.5 cm anterior the tragus, and 4.5 cm medial the gonial angle. The middle facial artery supplied the BFP on the inferior-lateral quadrant in 61% and inferior-medial quadrant in 39% of specimens . In all specimens, the parotid duct traversed the BFP superiorly, and the buccal branches of the facial nerve traversed the capsule superficially. CONCLUSIONS The buccal extension of the BFP can pseudoherniate in the aging face. Excision may improve lower facial contour. Measurements from facial landmarks may help surgeons identify the buccal extension of the BFP intraoperatively. The surgeon must be careful of the vascular pedicle, parotid duct, and the facial nerve. The external approach safely excises buccal fat during facelift dissection while avoiding intraoral incisions and unnecessary contamination. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Christopher C Surek
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew L Kochuba
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ki-Hyun Cho
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Marco Swanson
- Division of Plastic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Eliana Duraes
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer McBride
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Richard L Drake
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Kochuba AL, Coombs DM, Kwiecien GJ, Sinclair NR, Zins JE. Prospective Study Assessing the Effect of Local Infiltration of Tranexamic Acid on Facelift Bleeding. Aesthet Surg J 2021; 41:391-397. [PMID: 32644111 DOI: 10.1093/asj/sjaa198] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rebound bleeding during facelift surgery is a major cause of facelift hematomas. Subcutaneous infiltration of tranexamic acid (TXA) combined with lidocaine and epinephrine was recently retrospectively shown to decrease rebound bleeding. No study has prospectively examined the effect of subcutaneous TXA on intraoperative and postoperative bleeding during facelift surgery. OBJECTIVES The aim of this study was to prospectively demonstrate that TXA combined with local anesthesia safely reduces the effects of rebound bleeding, reduces operative time, and decreases postoperative drainage. METHODS This was a prospective, single-surgeon, case-control study performed between July 2019 and March 2020. Thirty-nine patients (35 female and 4 male; mean age, 64.9 years; age range, 49-80 years) underwent facelift surgery alone or in combination with facial rejuvenation procedures. All patients were injected subcutaneously with 1 or 2 mg/mL TXA + 0.5% lidocaine/1:200,000 epinephrine. Patient demographics, TXA dose, time to hemostasis, drain output, and minor and major complications were recorded. RESULTS The mean time to hemostasis was 6.4 minutes for the left and right sides each. Average postoperative day (POD) 0 drain outputs were 13.9 mL (left) and 10.1 mL (right). Average POD 1 drain outputs were 15.1 mL (left) and 15.6 mL (right). Drains were removed from all patients on POD 1 or 2. There were 2 minor complications (flap necrosis plus infection, marginal mandibular neuropraxia) and no major complications. CONCLUSIONS TXA safely and effectively decreased bleeding, operating room time, and drain output compared with traditional local anesthetic techniques. Our future goal is to determine if epinephrine can be completely removed from the local anesthetic and replaced with TXA for facelift surgery. LEVEL OF EVIDENCE: 2
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22
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Zins JE, Grow JN. Commentary on: Endovascular Hyaluronidase Application Through Superselective Angiography to Rescue Blindness Caused by Hyaluronic Acid Injection. Aesthet Surg J 2021; 41:356-357. [PMID: 33150934 DOI: 10.1093/asj/sjaa278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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23
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Sinclair NR, Coombs DM, Kwiecien G, Zins JE. How to Prevent and Treat Complications in Facelift Surgery, Part 1: Short-Term Complications. Aesthet Surg J Open Forum 2021; 3:ojab007. [PMID: 34212140 PMCID: PMC8240741 DOI: 10.1093/asjof/ojab007] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/21/2022] Open
Abstract
This article provides a review of available evidence with regard to short-term complications in facelift surgery. The article reviews both the most common complications and less common, but well-described ones. The goal is to offer objective means to minimize postoperative complications and a guide for treatment when they occur.
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Affiliation(s)
- Nicholas R Sinclair
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Demetrius M Coombs
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Grzegorz Kwiecien
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Zins JE, Grow JN. Invited Discussion on: Efficacy of Topical Tranexamic Acid (Cyclokapron) in "Wet" Field Infiltration with Dilute Local Anesthetic Solutions in Plastic Surgery. Aesthetic Plast Surg 2021; 45:340-342. [PMID: 33241463 DOI: 10.1007/s00266-020-02042-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic Desk A60, 9500 Euclid Ave, Cleveland, OH, 44195-5243, USA.
| | - Jacob Nathaniel Grow
- Department of Plastic Surgery, Cleveland Clinic Desk A60, 9500 Euclid Ave, Cleveland, OH, 44195-5243, USA
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Frautschi RS, Dawlagala N, Klingemier EW, England HS, Sinclair NR, Zins JE. The Use of Eye Tracking Technology in Aesthetic Surgery: Analyzing Changes in Facial Attention Following Surgery. Aesthet Surg J 2020; 40:1269-1279. [PMID: 31956904 DOI: 10.1093/asj/sjaa008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ability to quantitatively analyze how we look at a face and determine if this changes following facial surgery should be of interest to the plastic surgeon. Eye tracking technology (ETT) provides the ability to record where observers fixate when viewing a facial image, enabling quantitative data to be obtained comparing pre- and postoperative changes. OBJECTIVES The authors sought to investigate ETT as a novel outcome assessment tool, determining if facial rejuvenation surgery shifts attention away from the prominent signs of aging, and if so, where this attention shifts. METHODS Twenty-five volunteers viewed 32 randomized frontal, oblique, and lateral images of 11 patients pre- and post-facelift. An eye movement monitoring system recorded the observer's eye position, net dwell time, fixation count, fixation time, and revisits into predefined areas of interest. Data were grouped and analyzed by angle and areas of interest. Paired t tests were employed to detect significant differences in pre- and post-images. RESULTS On frontal images, less dwell time, fixations, and revisits were noted on the bottom third, forehead, perioral region, and neck (P < 0.05). On the lateral view, less visual attention was given to the neck, upper third, and perioral region, with more time in the cheek, nose, and middle third (P < 0.05). On oblique images, less attention was given to the neck and upper lid with more aimed at the middle third of the face (P < 0.05). CONCLUSIONS ETT provides quantitative data post-facial rejuvenation. Facial aesthetic surgery does alter where observers look when viewing a face, decreasing the time spent inspecting the prominent signs of aging.
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Affiliation(s)
| | | | | | | | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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26
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Matarasso A, Zins JE. Abdominoplasty. Clin Plast Surg 2020. [DOI: 10.1016/s0094-1298(20)30033-x] [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: 10/24/2022]
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Matarasso A, Zins JE. Abdominoplasty: State-of-the-Art. Clin Plast Surg 2020; 47:ix-x. [PMID: 32448480 DOI: 10.1016/j.cps.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alan Matarasso
- Hofstra University/Northwell School of Medicine, 1009 Park Avenue, New York, NY 10028, USA.
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA.
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Couto RA, Charafeddine A, Sinclair NR, Nayak LM, Zins JE. Local Infiltration of Tranexamic Acid With Local Anesthetic Reduces Intraoperative Facelift Bleeding: A Preliminary Report. Aesthet Surg J 2020; 40:587-593. [PMID: 31504134 DOI: 10.1093/asj/sjz232] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Rebound bleeding as a result of loss of epinephrine effect is a common problem encountered during facelift surgery. Tranexamic acid (TXA) is an anti-fibrinolytic agent whose safety and efficacy in reducing bleeding are well documented. We have found that local infiltration of TXA combined with a lidocaine with epinephrine solution during facelift surgery has been effective in decreasing rebound bleeding and the time required to gain hemostasis. OBJECTIVES The authors sought to share their local infiltration protocol of TXA combined with epinephrine solution in facelift. METHODS Patients who underwent facelift received subcutaneous injection of TXA-lidocaine 0.5% solution following the authors' protocol. After completing both sides of the facelift and the submental platysmaplasty, the first and second sides were sequentially closed. The time to gain hemostasis on each side prior to closure was prospectively measured. RESULTS Twenty-seven consecutive patients who underwent facelift surgery received local infiltration of TXA-lidocaine solution. In 23 of the 27 patients, the time required for hemostasis was prospectively recorded. The mean age was 62.1 years (±9.3) and all were females. The average time spent achieving hemostasis on the right, left, and both sides of the face was 6.5 (±2.7), 6.3 (±2.1), and 12.9 (±4.2) minutes, respectively. The total surgical time saving is approximately 25 to 60 minutes. Although primary facelift [13.6 (± 4.3)] exhibited a longer time of hemostasis compared with the secondary group [10.2 (± 2.8)], this was not statistically significant (P = 0.09). CONCLUSIONS Local infiltration of TXA with local anesthetic prior to a facelift appears to decrease bleeding, operative time, and postoperative facelift drainage output. Level of Evidence: 4.
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Affiliation(s)
- Rafael A Couto
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Ali Charafeddine
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Cummins AJ, Surek CC, Charafeddine AH, Scomacao I, Duraes E, Zins JE. Facelift Surgery Following Superficial Parotidectomy: Is it Safe? Aesthetic Plast Surg 2020; 44:354-358. [PMID: 31980862 DOI: 10.1007/s00266-019-01608-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/18/2019] [Accepted: 12/27/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients who have previously undergone superficial parotidectomy may also seek facelift surgery for facial aging and rejuvenation. These patients present unique challenges compared to a standard facelift patient. Most concerning is the location of facial nerve branches, which may be superficial and displaced. In addition, significant contour deformities and abnormal scar patterns may be present. The purpose of the study is to review our series of patients and assess potential morbidity and safety of facelift surgery in superficial parotidectomy patients. METHODS A retrospective case series was performed reviewing all patients who underwent facelift surgery following superficial parotidectomy from 2000 to 2017. Data were collected for: postoperative facial nerve deficit, soft tissue contour and scar deformities, facelift technique, ancillary soft tissue augmentation procedures and pre- and postoperative photographs. An evidence-based treatment algorithm to address specific problems in this patient population was developed. RESULTS A total of seven patients were identified who underwent facelift surgery following parotidectomy. Patients underwent one of the standard SMAS procedure on the non-parotidectomy side, and surgical modifications were made to address the parotidectomy side; soft tissue augmentation was performed in two patients. Precautions to identify the facial nerve and prevent injury, including nerve monitoring and stimulation, were utilized in all seven patients. No permanent postoperative facial nerve injury was noted. CONCLUSION Facelift following superficial parotidectomy was safely performed in all cases. Special consideration should be given to contour deformities, facial nerve location and scar placement. However, if approached properly, these patients can still be considered as suitable candidates for facelift surgery. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Andi J Cummins
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Ali H Charafeddine
- Department of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Isis Scomacao
- Department of Plastic Surgery, Cleveland Clinic Foundation, A60 Crile Building, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Eliana Duraes
- Department of Plastic Surgery, Cleveland Clinic Foundation, A60 Crile Building, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, A60 Crile Building, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Alghoul MS, Vaca EE, Mioton LM, Zins JE. The Functional Anatomy of the Deep Facial Fat Compartments: A Detailed Imaging-Based Investigation. Plast Reconstr Surg 2020; 145:870e-871e. [PMID: 32221247 DOI: 10.1097/prs.0000000000006706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mohammed S Alghoul
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Elbert E Vaca
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lauren M Mioton
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - James E Zins
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
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31
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Ordenana C, Dallapozza E, Said S, Zins JE. Objectifying the Risk of Vascular Complications in Gluteal Augmentation With Fat Grafting: A Latex Casted Cadaveric Study. Aesthet Surg J 2020; 40:402-409. [PMID: 31665218 DOI: 10.1093/asj/sjz237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fat transfer is the most popular means of gluteal augmentation. However, this procedure may be complicated by pulmonary fat embolisms (PFEs). Of 135 PFEs out of 198,857 cases reported by the Aesthetic Surgery Education and Research Foundation task force, 32 were fatal, contributing to the mortality risk of this procedure being as high as 1:2351. OBJECTIVES The aim of this study was to generate an anatomic map of the 3-dimensional location and variability in size of the gluteal region vessels. METHODS Twenty cadaveric gluteal regions were dissected. The aorta, venae cavae, popliteal, and saphenous veins were cannulated and injected with colored latex. Dissection was performed subcutaneously, in the gluteus maximus (GM), and submuscularly to evaluate the number and vascular distribution of all the vessels. Vessels were mapped on an XYZ axis. RESULTS The subcutaneous plane, containing 25 vessels on average, had the smallest vessel diameters (artery, 0.9 [0.3] mm; vein, 1.05 [0.22] mm). The GM vein diameter was 1.3 [0.3] mm. Branches of the inferior gluteal vessels had arterial and venous calibers of 2.2 [0.04] mm and 3.5 [0.99] mm, respectively. Superior gluteal artery and vein branches were 1.8 [0.2] mm and 3.85 [1.9] mm in diameter, respectively. Superior and inferior gluteal vein diameters were 7.61 [2.24] mm and 13.65 [6.55] mm, respectively. CONCLUSIONS The deeper and more medial planes of the gluteal region house larger, more prominent vessels. This research objectifies and is consistent with recommendations made by various recent task force reports to limit fat transfer to the subcutaneous plane.
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Affiliation(s)
- Carlos Ordenana
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Sayf Said
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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32
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Zins JE, Kochuba AL. Commentary on: Optimal Facelift Vector and its Relation to Zygomaticus Major Orientation. Aesthet Surg J 2020; 40:357-358. [PMID: 32004375 DOI: 10.1093/asj/sjz350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Andrew L Kochuba
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
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33
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Hashem AM, Couto RA, Duraes EFR, Çakmakoğlu Ç, Swanson M, Surek C, Zins JE. Facelift Part I: History, Anatomy, and Clinical Assessment. Aesthet Surg J 2020; 40:1-18. [PMID: 30843042 DOI: 10.1093/asj/sjy326] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In this article, the authors aim to thoroughly describe the critical surgical anatomy of the facial layers, the retaining ligamentous attachments of the face, and the complex three-dimensional course of the pertinent nerves. This is supplemented with clarifying anatomic dissections and artwork figures whenever possible to enable easy, sound, and safe navigation during surgery. The historic milestones that led the evolution of cervicofacial rejuvenation to the art we know today are summarized at the beginning, and the pearls of the relevant facial analysis that permit accurate clinical judgment and hence individualized treatment strategies are highlighted at the end. The facelift operation remains the cornerstone of face and neck rejuvenation. Despite the emergence of numerous less invasive modalities, surgery continues to be the most powerful and more durable technique to modify facial appearance. All other procedures designed to ameliorate facial aging are either built around or serve as adjuncts to this formidable craft.
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Affiliation(s)
- Ahmed M Hashem
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Rafael A Couto
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | | | - Marco Swanson
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Chris Surek
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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34
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Zins JE, Charafeddine AH. Facelift. Clin Plast Surg 2019. [DOI: 10.1016/s0094-1298(19)30070-7] [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: 10/26/2022]
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Abstract
An aesthetically pleasing neck contour remains the cornerstone for facial rejuvenation. In this article a detailed description of the anatomy pertaining to the necklift surgery is provided, with supplemental cadaver video dissections going over the most common and novel necklift techniques.
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Affiliation(s)
- Ali H Charafeddine
- Center for Plastic & Reconstructive Surgery, 5333 McAuley Drive, Suite 5001, Ypsilanti, MI 48197, USA
| | - Rafael A Couto
- Cleveland Clinic Foundation, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA.
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37
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Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA.
| | - Ali H Charafeddine
- Center for Plastic and Reconstructive Surgery, 5333 McAuley Drive, Suite 5001, Ypsilanti, MI 48197, USA.
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Surek CC, Said SA, Perry JD, Zins JE. Retrobulbar Injection for Hyaluronic Acid Gel Filler-Induced Blindness: A Review of Efficacy and Technique. Aesthetic Plast Surg 2019; 43:1034-1040. [PMID: 31065750 DOI: 10.1007/s00266-019-01388-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/13/2019] [Indexed: 11/30/2022]
Abstract
While blindness after hyaluronic acid gel filler injection occurs only very rarely, it represents a devastating complication for the patient and the surgeon. Retrobulbar injection with hyaluronidase is the only known potential means of reversing this adverse event. However, positive outcomes remain anecdotal. We have attempted to review the current literature regarding possible efficacy and detail the indications and technique to be utilized, if hyaluronidase retrobulbar injection is to be attempted. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Christopher C Surek
- Plastic Surgery Department, University of Kansas Health System, Kansas City, KS, USA
| | - Sayf A Said
- Plastic Surgery Department, Cleveland Clinic, 9500 Euclid Ave, A60, Cleveland, OH, 44195, USA
| | - Julian D Perry
- Cole Eye Institution, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - James E Zins
- Plastic Surgery Department, Cleveland Clinic, 9500 Euclid Ave, A60, Cleveland, OH, 44195, USA.
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Zins JE, Sinclair NR. Commentary on: Age and Gender Differences of the Frontal Bone: A Computed Tomographic (CT)-Based Study. Aesthet Surg J 2019; 39:711-713. [PMID: 30668836 DOI: 10.1093/asj/sjy337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
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40
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Zins JE, Couto RA. Commentary on: Longitudinal Assessment of Aesthetic Plastic Surgery Training in the United States: The Effect of Increased ACGME Case Log Minimum Requirements. Aesthet Surg J 2019; 39:NP83-NP84. [PMID: 30561499 DOI: 10.1093/asj/sjy306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James E Zins
- Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Rafael A Couto
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Abstract
Background A number of authors have proposed retrograde arterial embolism as the responsible mechanism for filler-induced blindness. However, no previous human study has substantiated this proposed mechanism. Objectives The aim of this study was to investigate the pathophysiology of filler-induced blindness using a fresh cadaver perfusion technique. Methods A fresh cadaver head perfusion model that simulates both physiologic blood pressure and flow rate of the carotid artery, ophthalmic artery, and supratrochlear artery was used. The common carotid artery was cannulated and the internal jugular vein exposed for open venous drainage. A plasma-based perfusate was circulated through the cadaver head, which was connected to a perfusion system consisting of a roller pump, preload reservoir, and pressure monitor. The hyaluronic acid filler mixed with methylene blue was injected into the cannulated superficial branch of the supratrochlear artery. Cadaver dissection, angiographic study, and histology were used to investigate filler-induced blindness. Results Cannulation of the superficial branch of the supratrochlear artery was successful in all six cadavers. Emboli to the ophthalmic artery was successfully demonstrated in the three out of 6 fresh cadaver heads. The C-arm angiogram documented a cut-off sign in the ophthalmic artery due to hyaluronic acid filler emboli. An average intravascular volume of the intraorbital part of the supratrochlear artery was 50.0 µL. The average depth of location of the superficial branch of the supratrochlear artery from the epidermal surface was 1.5 mm. Conclusions Our cadaveric study demonstrated that retrograde hyaluronic acid filler emboli to the ophthalmic artery could be produced by the cannulation of the supratrochlear artery. The superficial location of the supratrochlear artery, the rich vasculature surrounding it, and the variability in the anatomy make this possible.
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Affiliation(s)
- Ki-Hyun Cho
- Department of Plastic Surgery and the Cerebrovascular Center Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Edoardo Dalla Pozza
- Department of Plastic Surgery and the Cerebrovascular Center Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Gabor Toth
- Department of Plastic Surgery and the Cerebrovascular Center Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Bahar Bassiri Gharb
- Department of Plastic Surgery and the Cerebrovascular Center Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - James E Zins
- Department of Plastic Surgery and the Cerebrovascular Center Neurological Institute, Cleveland Clinic, Cleveland, OH
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Abstract
After massive weight loss, deflation of the tissues and loss of skin elasticity in the face and neck can result in the appearance of accelerated facial aging. Surgical facial rejuvenation can be successfully performed with several modifications. Proper preoperative counseling and expectation management regarding staged or ancillary procedures is recommended. Wide undermining of the face and neck, and extended postauricular incisions are required to allow for mobilization of excess skin and access to the mobile superficial musculoaponeurotic system (SMAS). Fat transfer into the deep malar compartment for midface volumizing is helpful. Treatment of the SMAS and platysma are universally necessary.
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Affiliation(s)
- Joshua T Waltzman
- Private Practice, Waltzman Plastic and Reconstructive Surgery, 3828 Schaufele Avenue, #360, Long Beach, CA 90808, USA.
| | - James E Zins
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA
| | - Rafael A Couto
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA
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Frautschi RS, Duraes EF, Tadisina KK, Couto RA, Zins JE. Apparent Age is a Reliable Assessment Tool in 20 Facelift Patients. Aesthet Surg J 2018; 38:347-356. [PMID: 29040425 DOI: 10.1093/asj/sjx143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the literature is replete with favorable facelift results, there are few validated facial rejuvenation outcome measures. Apparent age (AA), a visual estimate of age by objective observers, has been utilized in several studies; although attractive, AA lacks validation. OBJECTIVE The aim of this study is to examine the reliability of AA, highlighting the importance of the exclusive use of validated outcome measures in future studies. METHODS Ten blinded reviewers assessed pre- and postoperative photographs of 32 patients who underwent facelift. Each reviewer completed 3 surveys at 3-month intervals composed of 40 randomly ordered photos; totaling 1200 photographs assigned an AA. The intra-class correlation coefficient was classified as "excellent," "good," "fair," or "poor." The accuracy of assigned AA, agreement within 5 years, and reduction in AA were also evaluated. RESULTS The mean difference of preoperative true age from assigned AA was 2.74 ± 4.36 years. Forty-three percent of raters were within 5-years (±2.5) of the mean. Intra-rater reliability preoperatively and postoperatively were 0.77 (95% CI, 0.82-0.72) and 0.75 (95% CI, 0.79-0.71), respectively. Inter-rater reliability preoperatively was 0.98 (95% CI, 0.99-0.96), while postoperatively was 0.95 (95% CI, 0.99-0.95). Mean AA reduction was 5.23 ± 2.81, with an intra-rater reliability 0.15 (95% CI, 0.03-0.34) and inter-rater reliability 0.65 (95% CI, 0.84-0.38). CONCLUSION Using current statistical measures and analysis, AA is an acceptable tool for pre- and postoperative facial evaluation when assessed by a group of 10 reviewers. Therefore, apparent age represents a reliable and valid objective observer assigned measure for evaluation of facelift outcomes.
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Affiliation(s)
| | | | | | | | - James E Zins
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
- Facial Surgery Section Editor for Aesthetic Surgery Journal
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Pozza ED, D'Souza GF, DeLeonibus A, Fabiani B, Gharb BB, Zins JE. Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up. Aesthet Surg J 2017; 38:101-109. [PMID: 29117293 DOI: 10.1093/asj/sjx079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/05/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While prevalent in everyday life, smartphones are also finding increasing use as a medical care adjunct. The use of smartphone technology as a postoperative cosmetic surgery adjunct for care has received little attention in the literature. OBJECTIVES The purpose of this effort was to assess the potential efficacy of a smartphone-based cosmetic surgery early postoperative follow-up program. Specifically, could smartphone photography provided by the patient to the plastic surgeon in the first few days after surgery allay patient's concerns, improve the postoperative experience and, possibly, detect early complications? METHODS From August 2015 to March 2016 a smartphone-based postoperative protocol was established for patients undergoing cosmetic procedures. At the time of discharge, the plastic surgeon sent a text to the patient with instructions for the patient to forward a postoperative photograph of the operated area within 48 to 72 hours. The plastic surgeon then made a return call/text that same day to review the patient's progress. A postoperative questionnaire evaluated the patients' postoperative experience and satisfaction with the program. RESULTS A total of 57 patients were included in the study. Fifty-two patients responded to the survey. A total of 50 (96.2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed to detect early complications in 3 cases. The physician was able to address and treat the complications the following day prior to the scheduled clinic follow up. CONCLUSIONS The smartphone can be effectively utilized by the surgeon to both enhance the patient's postoperative experience and alert the surgeon to early postoperative problems. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Gehaan F D'Souza
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Anthony DeLeonibus
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Brianna Fabiani
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Facial Surgery Section Editor for Aesthetic Surgery Journal
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Richards BG, Schleicher WF, D’Souza GF, Isakov R, Zins JE. The Role of Injectables in Aesthetic Surgery: Financial Implications. Aesthet Surg J 2017; 37:1039-1043. [PMID: 29025237 DOI: 10.1093/asj/sjx136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The plastic surgeon competes with both core and noncore physicians and surgeons for traditional cosmetic procedures. In 2007, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) joined efforts to form a Cosmetic Medicine Task Force to further analyze this trend. Objectives Our objective is to document and quantify the patient capture and total collections generated in a single surgeon's practice exclusive from Botulinum Toxin A and filler injections over a 10-year period. We subsequently identified the effect and importance that fillers and Botulinum Toxin A have on an active cosmetic practice. Methods A retrospective chart review of all male and female patients who received Botulinum Toxin A or soft tissue filler injections (noninvasive aesthetic treatment) in a single surgeons practice from January 2004 to December 2013 was undertaken. Only those patients new to the practice and who were exclusively seeking out Botulinum Toxin A or fillers were included in the study. Chart review then identified which of these selected patients ultimately underwent invasive aesthetic surgery during this 10-year period. Noninvasive and invasive aesthetic surgery total collections were calculated using billing records. Results From January 2004 to December 2013, 375 patients entered the senior surgeon's practice specifically requesting and receiving noninvasive aesthetic treatments. Of these 375 patients, 59 patients (15.7%) subsequently underwent an aesthetic surgery procedure at an average of 19 months following initial noninvasive aesthetic treatment. Of these 375 patients, 369 were female and 6 were male. The most common initial invasive aesthetic procedure performed after injectable treatment included 22 facelifts (18.5%), 21 upper eyelid blepharoplasties (17.6%), and 15 endoscopic brow lifts (12.6%). Total collections from noninvasive aesthetic sessions and invasive surgery combined represented US$762,470 over this 10-year span. This represented US$524,771 and US$396,166 in total collections for injectables and surgery respectively. Conclusions Noninvasive aesthetic surgery is a critical part of a plastic surgery practice. A measurable and significant number of patients who sought out a single plastic surgeon exclusively for noninvasive treatment ultimately underwent traditional invasive cosmetic surgical procedures.
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Affiliation(s)
- Bryson G Richards
- Dr Richards is a plastic surgeon in private practice in Las Vegas, NV. Dr Schleicher is an Attending Surgeon, University Hospital Medical Group, Cleveland, OH. Dr D’Souza is an Aesthetic Fellow, Dr Isakov is an Attending Surgeon, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH. Dr Zins is also Facial Surgery Section Editor for Aesthetic Surgery Journal (ASJ)
| | - William F Schleicher
- Dr Richards is a plastic surgeon in private practice in Las Vegas, NV. Dr Schleicher is an Attending Surgeon, University Hospital Medical Group, Cleveland, OH. Dr D’Souza is an Aesthetic Fellow, Dr Isakov is an Attending Surgeon, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH. Dr Zins is also Facial Surgery Section Editor for Aesthetic Surgery Journal (ASJ)
| | - Gehaan F D’Souza
- Dr Richards is a plastic surgeon in private practice in Las Vegas, NV. Dr Schleicher is an Attending Surgeon, University Hospital Medical Group, Cleveland, OH. Dr D’Souza is an Aesthetic Fellow, Dr Isakov is an Attending Surgeon, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH. Dr Zins is also Facial Surgery Section Editor for Aesthetic Surgery Journal (ASJ)
| | - Raymond Isakov
- Dr Richards is a plastic surgeon in private practice in Las Vegas, NV. Dr Schleicher is an Attending Surgeon, University Hospital Medical Group, Cleveland, OH. Dr D’Souza is an Aesthetic Fellow, Dr Isakov is an Attending Surgeon, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH. Dr Zins is also Facial Surgery Section Editor for Aesthetic Surgery Journal (ASJ)
| | - James E Zins
- Dr Richards is a plastic surgeon in private practice in Las Vegas, NV. Dr Schleicher is an Attending Surgeon, University Hospital Medical Group, Cleveland, OH. Dr D’Souza is an Aesthetic Fellow, Dr Isakov is an Attending Surgeon, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH. Dr Zins is also Facial Surgery Section Editor for Aesthetic Surgery Journal (ASJ)
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47
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Hashem AM, Waltzman JT, D'Souza GF, Cakmakoglu C, Tadisina KK, Kenkel JM, Zins JE. Resident and Program Director Perceptions of Aesthetic Training in Plastic Surgery Residency: An Update. Aesthet Surg J 2017; 37:837-846. [PMID: 28333253 DOI: 10.1093/asj/sjw275] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 11/13/2022] Open
Abstract
Background This is the third survey exploring the quality of cosmetic training in plastic surgery residency. We focused on determining: (1) the applied modalities and extent of resident exposure; and (2) resident confidence in performing variable cosmetic procedures. Objectives To analyze trends in resident exposure and confidence in aesthetic plastic surgery procedures from the standpoint of program directors (PDs) and residents. Methods The survey was developed and e-mailed to 424 residents enrolled in the ASAPS Residents Program and 95 PDs. Both independent and integrated programs were included. The questions were posed in a five-point ranking format. Univariate statistical analysis was used to examine all aspects. The results were analyzed in relation to our previous surveys in 2008 and 2011. Results Thirty-three PDs (34.7%) and 224 (52.8%) residents responded. Residents felt most confident with abdominoplasty, breast reduction, and augmentation-mammaplasty. Facial aesthetic procedures, especially rhinoplasty and facelift, were perceived as "challenging." The three most preferred modalities of aesthetic education were, in descending order, residents' clinic, staff cosmetic patients, and cadaver dissections. Both residents and PDs felt a need for more training especially in facial procedures. Only 31.5% of residents who planned to focus on cosmetic surgery felt ideally prepared integrating cosmetic surgery into their practice (compared to 50% in previous surveys). Conclusions Despite improvements observed from 2008 to 2011 published surveys, there are still challenges to be met especially in facial cosmetic procedures. It is suggested that resident clinics and cadaver courses be universally adopted by all training programs.
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Affiliation(s)
- Ahmed M Hashem
- Cairo University, Cairo, Egypt.Aesthetic Surgery Journal (ASJ). ; ASJ
| | | | - Gehaan F D'Souza
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Cagri Cakmakoglu
- Dr Lufti Kirdar Training and Research Hospital, Istanbul, Turkey
| | | | - Jeffrey M Kenkel
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Aesthetic Surgery Journal
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48
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Zins JE, D’Souza GF. Commentary on: Characterization of the Cervical Retaining Ligaments During Subplatysmal Facelift Dissection and its Implications. Aesthet Surg J 2017; 37:502-503. [PMID: 28388702 DOI: 10.1093/asj/sjx043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James E. Zins
- From the Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. Dr Zins is Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Gehaan F. D’Souza
- From the Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. Dr Zins is Facial Surgery Section Editor for Aesthetic Surgery Journal
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Couto RA, Lamaris GA, Baker TA, Hashem AM, Tadisina K, Durand P, Rueda S, Orra S, Zins JE. Age as a Risk Factor in Abdominoplasty. Aesthet Surg J 2017; 37:550-556. [PMID: 28333178 DOI: 10.1093/asj/sjw227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Recent studies reviewing large patient databases suggested that age may be an independent risk factor for abdominoplasty. However, these investigations by design considered only short-term major complications. Objectives The purpose of this investigation was: (1) to compare the safety of abdominoplasty in an elderly and younger patient population; (2) to determine the complication rates across all spectrums: major, minor, local, and systemic; and (3) to evaluate complications occurring both short and long term. Methods Abdominoplasty procedures performed from 2010 to 2015 were retrospectively reviewed. Subjects were divided into two groups: ≤59 years old and ≥60 years old. Major, minor, local, and systemic complications were analyzed. Patient demographics, comorbidities, perioperative details, adjunctive procedures were also assessed. Results A total of 129 patients were included in the study: 43 in the older and 86 in the younger age group. The median age of The elderly and young groups was 65.0 and 41.5 years, respectively (P < .001). No statistically significant differences in major, minor, local, or systemic complications were found when both age groups were compared. Major local, major systemic, minor local, and minor systemic in the elderly were 6.9%, 2.3%, 18.6%, and 2.3%, while in the younger patients were 9.3%, 4.7%, 10.5%, and 0.0%, respectively (P > .05). Median follow-up time of the elderly (4.0 months) was no different than the younger (5.0 months) patients (P > .07). Median procedure time in the elderly (4.5 hours) was no different than the younger group (5.0 hours) (P = .4). The elderly exhibited a greater American Society of Anesthesiologist score, median body mass index (28.7 vs 25.1 kg/m2), and number of comorbidities (2.7 vs 0.9) (P < .001). Conclusions There was no significant difference in either major or minor complications between the two groups. This suggests that with proper patient selection, abdominoplasty can be safely performed in the older age patient population. Level of Evidence 2.
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Affiliation(s)
- Rafael A. Couto
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Gregory A. Lamaris
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Todd A. Baker
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Ahmed M. Hashem
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Kashyap Tadisina
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Paul Durand
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Steven Rueda
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - Susan Orra
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
| | - James E. Zins
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. Dr Zins is the Facial Surgery Section Editor for Aesthetic Surgery Journal
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Frautschi RS, Hashem AM, Halasa B, Cakmakoglu C, Zins JE. Current Evidence for Clinical Efficacy of Platelet Rich Plasma in Aesthetic Surgery: A Systematic Review. Aesthet Surg J 2017; 37:353-362. [PMID: 28207031 DOI: 10.1093/asj/sjw178] [Citation(s) in RCA: 21] [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: 01/14/2023] Open
Abstract
Background Platelet rich plasma (PRP) has attracted attention in a number of surgical fields due to a wide variety of potential clinical benefits. Yet PRP has not gained wide popularity in aesthetic surgery as a result of uncertainty surrounding objective clinical evidence. Objectives We aim to describe the current applications, define preparation and activation, explore effectiveness, and propose a classification system to facilitate comparisons across studies. Methods A comprehensive review of the literature regarding the use of platelet rich plasma in aesthetic surgery was performed. Data gathered included: PRP application, study type, subject number, centrifugation, anticoagulation, activation, PRP composition, and outcomes. Results Thirty-eight reports were identified. Applications included injection into aging skin (29%), scalp alopecia (26%), lipofilling (21%), fractional laser (13%), and facial surgery (11%). The majority of studies (53%) were case series without controls. Leucocytes were sparsely defined (32%). The concentration of injected and/or baseline platelets was rarely clarified (18%). The mechanism of activation was described in 27 studies (71%), while anticoagulation was uncommonly elucidated (47%). While most studies (95%) claim effectiveness, objective measures were only utilized in 17 studies (47%). Conclusions Current studies produce context-dependent results with a lack of consistent reporting of PRP preparation, composition, and activation in aesthetic applications, making meaningful meta-analysis unrealistic. Thus the method of PRP preparation warrants increased attention. We recommend a set of descriptors, FIT PAAW (described below), to produce scientifically grounded conclusions, facilitating a clearer understanding of the situations in which PRP is effective. Level of Evidence 4
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Affiliation(s)
| | - Ahmed M Hashem
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Brianna Halasa
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - James E Zins
- Facial Surgery Section Editor for Aesthetic Surgery Journal
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