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Response to: Studying Dynamics of Mid-face Lifting During Hyaluronic Acid Filler Injection Using Ultrasound Imaging. Aesthetic Plast Surg 2023; 47:2677-2678. [PMID: 37069349 DOI: 10.1007/s00266-023-03356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
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Light-Guided Percutaneous Neck Rejuvenation With Division of Platysma Bands and Suture Suspension: A Multicenter Retrospective Study. Aesthet Surg J 2023; 43:393-404. [PMID: 36342786 PMCID: PMC10053652 DOI: 10.1093/asj/sjac287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Traditional invasive suture suspension techniques have proven efficacy and durability. A previously described percutaneous placement of a neck suspension suture with light guidance has transformed this into a minimally invasive technique. This novel technique provides a major advance for minimally invasive neck rejuvenation. OBJECTIVES The authors sought to describe their experience with light-guided percutaneous neck rejuvenation over the past 4.5 years, including technique, patient selection, safety profile, and expected outcomes. METHODS Data were retrospectively reviewed for all patients who underwent the procedure with 5 surgeons across 4 aesthetic plastic surgery practices from January 2018 through May 2022. Inclusion criteria were mild to moderate neck laxity, prominent anterior platysma bands, and desire to improve neck contour. Patients undergoing concurrent skin incision >5 mm (ie, open rhytidectomy or platysmaplasty) were excluded. RESULTS A total of 391 patients meeting criteria were identified during the study period. No hematomas were documented. Four patients (1%) developed infection at the suture site, 1 resolving on antibiotics and 3 requiring suture removal. Eighteen (4.6%) developed recurrent platysmal bands, and 7 (1.8%) had residual loose skin. Four (1%) experienced transient marginal mandibular neuropraxia. Mean length of follow-up time was 240 days. CONCLUSIONS Light-guided percutaneous suture suspension is a safe and viable option for improving neck contours. Although it does not address extensive skin laxity or excess submental fat, it can be combined with energy-based tissue tightening, submental liposuction, or skin excision. In selected patients, this minimally invasive procedure provides predictable results with a low risk of complications. LEVEL OF EVIDENCE: 3
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Commentary on: Cryptocurrency: The Future of Plastic Surgery Payments? Aesthet Surg J 2022; 42:1350-1352. [PMID: 35727294 DOI: 10.1093/asj/sjac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Commentary on: Hyaluronic Acid Compound Filling Plus Mesotherapy vs Botulinum Toxin A for the Treatment of Horizontal Neck Lines: A Multicenter, Randomized, Evaluator-Blinded, Prospective Study in Chinese Subjects. Aesthet Surg J 2022; 42:NP242-NP243. [PMID: 35289354 DOI: 10.1093/asj/sjab411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Invited Discussion on: "Complications and Disasters After Minimal Invasive Tissue Augmentation with Different Types of Fillers: A Retrospective Analysis". Aesthetic Plast Surg 2022; 46:1398-1399. [PMID: 35157119 DOI: 10.1007/s00266-022-02780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
Abstract
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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1470-nm Radial fiber-assisted liposuction for body contouring and facial fat grafting. J Cosmet Dermatol 2022; 21:1514-1522. [PMID: 35106886 PMCID: PMC9303361 DOI: 10.1111/jocd.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/31/2021] [Accepted: 01/06/2022] [Indexed: 12/01/2022]
Abstract
Background Laser‐assisted liposuction using 1470‐nm radial fiber emits light energy preferentially absorbed by water, yielding a rapid and localized contouring and tightening effect, with minimal scarring. When collected under appropriate conditions, extracted fat samples can be exploited as autologous filling material in liposculpturing procedures. Objectives To assess the 6‐month contouring efficacy of 1470 radial fiber‐assisted liposuction and the volumetric enhancement effect of the harvested tissue in facial fat grafting. Methods Twenty subjects underwent liposuction (BeautiFill, Alma Lasers, Inc.) of lower abdominal or outer thigh fat. In seven subjects, harvested samples were grafted into facial regions. Treatment safety, body weight, blinded evaluator‐assessed aesthetic improvements, and subject‐rated satisfaction were monitored for 6 months. Abdominal and facial fat thickness were assessed by magnetic resonance imaging (n = 5) within 3 months of treatment. Results One‐month posttreatment, most subjects ranked improvements good/excellent (88%) and skin tightening satisfactory/very satisfactory (92%), with >70% of subjects providing similar scores 6‐month posttreatment. Blinded evaluators noted improved/very much improved aesthetic appearance (87%). Harvested tissue injected as a facial filler (21.0 ± 5.2 ml) led to a 0.63 ± 0.12 mm increase in facial fat thickness, observed by MRI, within 3 months. Six months postfilling, the majority of subjects (83%) were satisfied with the outcome. All procedures were well‐tolerated. Conclusions A single 1470 nm radial fiber‐assisted abdominal and thigh liposuction session provided for effective and durable reduction of adipose tissue deposits, with appreciable skin tightening and aesthetic improvements. The gentle harvesting method yielded viable filler material, which was well‐retained in facial regions for up to 6 months.
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Abstract
Suction-assisted lipectomy (or "liposuction") is a fundamental technique for all plastic surgeons, and like many procedures in aesthetic surgery, its applications are continuing to evolve. With the rapid introduction of new technologies, many plastic surgeons are left with questions about how these new devices work, what results to expect, and how to best apply these technologies in their practice. We recognized that there is a need for unbiased recommendations to guide surgeons on how to approach current liposuction devices (as well as their adjuncts) and how to use them effectively for their patients. Using available literature and personal experience, we answer the most common questions that we hear from our plastic surgery colleagues.
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Invited Discussion on: A Prospective Study Determining Patient Satisfaction with Combined Cryolipolysis and Shockwave Therapy Treatment for Non-Invasive Body Contouring. Aesthetic Plast Surg 2021; 45:2326-2327. [PMID: 33768306 DOI: 10.1007/s00266-021-02239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/14/2021] [Indexed: 11/24/2022]
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Bipolar Radiofrequency as an Adjunct to Face and Body Contouring: A 745-Patient Clinical Experience. Aesthet Surg J 2021; 41:685-694. [PMID: 33388742 DOI: 10.1093/asj/sjaa417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Radiofrequency (RF) technology has ushered in a new paradigm in body contouring for patients with mild to moderate skin laxity who desire fat removal without exacerbating skin laxity issues. A bipolar internal RF device, used as an adjunct to liposuction, has been found to be simpler and more accurate than previous technologies. OBJECTIVES The aim of this study was to review the authors' clinical experience with bipolar RF-assisted liposuction (RFAL). METHODS We conducted a review of our large experience with bipolar RFAL, evaluating the nuances from appropriate patient selection and specific treatment areas. The review covered 745 patients treated from January 2017 to January 2020 at 2 centers. A retrospective chart review was performed of the first and last 50 patients treated at each center (for a total of 100 patients in each group) to assess trends in outcomes and adverse events. RESULTS Results were generally excellent from physician evaluation, and overall patient satisfaction was high (96%). The two most common adverse events were temporary swelling (9%) and nodules (8.5%). Selected examples of a variety of cases are reviewed. CONCLUSIONS The ability to tighten skin with a minimally invasive tool adds much to the contemporary approach to the body-contouring patient with skin laxity. Adverse events were minimal and greatly decreased after an initial short learning curve. Bipolar RFAL is a strong addition to our surgical armamentarium and has become an essential tool for our practices. LEVEL OF EVIDENCE: 4
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Characterizing the Microbiome of the Contracted Breast Capsule Using Next Generation Sequencing. Aesthet Surg J 2021; 41:440-447. [PMID: 32291435 DOI: 10.1093/asj/sjaa097] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Recent work suggests that bacterial biofilms play a role in capsular contracture (CC). However, traditional culture techniques provide only a limited understanding of the bacterial communities present within the contracted breast. Next generation sequencing (NGS) represents an evolution of polymerase chain reaction technology that can sequence all DNA present in a given sample. OBJECTIVES The aim of this study was to utilize NGS to characterize the bacterial microbiome of the capsule in patients with CC following cosmetic breast augmentation. METHODS We evaluated 32 consecutive patients with Baker grade III or IV CC following augmentation mammoplasty. Specimens were obtained from all contracted breasts (n = 53) during capsulectomy. Tissue specimens from contracted capsules as well as intraoperative swabs of the breast capsule and implant surfaces were obtained. Samples were sent to MicroGenDX Laboratories (Lubbock, TX) for NGS. RESULTS Specimens collected from 18 of 32 patients (56%) revealed the presence of microbial DNA. The total number of positive samples was 22 of 53 (42%). Sequencing identified a total of 120 unique bacterial species and 6 unique fungal species. Specimens with microbial DNA yielded a mean [standard deviation] of 8.27 [4.8] microbial species per patient. The most frequently isolated species were Escherichia coli (25% of all isolates), Diaphorobacter nitroreducens (12%), Cutibacterium acnes (12%), Staphylococcus epidermidis (11%), fungal species (7%), and Staphylococcus aureus (6%). CONCLUSIONS NGS enables characterization of the bacterial ecosystem surrounding breast implants in unprecedented detail. This is a critical step towards understanding the role this microbiome plays in the development of CC. LEVEL OF EVIDENCE: 4
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Invited Discussion on: Development and Usability of a Virtual Reality-Based Filler Injection Training System. Aesthetic Plast Surg 2020; 44:1843-1844. [PMID: 32747983 PMCID: PMC7397957 DOI: 10.1007/s00266-020-01890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 11/17/2022]
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Invited Discussion on: The Effect of Hyaluronidase on Depth of Necrosis in Hyaluronic Acid Filling-Related Skin Complications. Aesthetic Plast Surg 2020; 44:1786-1787. [PMID: 32500320 DOI: 10.1007/s00266-020-01796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/28/2022]
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Response to "Comments on 'Characterizing the Microbiome of the Contracted Breast Capsule Using Next Generation Sequencing'". Aesthet Surg J 2020; 40:NP587. [PMID: 32539145 DOI: 10.1093/asj/sjaa125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Invited Discussion on: A Meta-analysis-Based Assessment of Intense Pulsed Light for Treatment of Melasma. Aesthetic Plast Surg 2020; 44:953-954. [PMID: 32198640 DOI: 10.1007/s00266-020-01671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
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Commentary on: Noninvasive Induction of Muscle Fiber Hypertrophy and Hyperplasia: Effects of High-Intensity Focused Electromagnetic Field Evaluated in an In-Vivo Porcine Model: A Pilot Study. Aesthet Surg J 2020; 40:575-576. [PMID: 31904822 DOI: 10.1093/asj/sjz314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Novel Injection Technique for Malar Cheek Volume Restoration. Aesthetic Plast Surg 2018; 42:1393. [PMID: 29344684 DOI: 10.1007/s00266-017-1053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/06/2017] [Indexed: 11/26/2022]
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Multi-Center Pilot Study to Evaluate the Safety Profile of High Energy Fractionated Radiofrequency With Insulated Microneedles to Multiple Levels of the Dermis. J Drugs Dermatol 2016; 15:1308-1312. [PMID: 28095540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this multi-center pilot study, the safety pro le of high intensity focused radiofrequency (RF) delivered to the dermis was evaluated for safety in the treatment of the aging neck and face. A newly designed insulated microneedle system delivers a signi cant coagulative thermal injury into the dermis while sparing the epidermis from RF injury. Thirty- ve healthy subjects from seven aesthetic practices were evaluated, and data from each were incorporated in this case report. The subjects received a single treatment using settings that delivered the highest RF energies suggested from the new recommended protocols. The depth of thermal delivery was adjusted before each pass and all subjects received a minimum of two to three passes to the treated areas. Before and after photographs along with adverse effects were recorded. This case report demonstrates the ability to deliver significant RF thermal injury to several layers of the dermis with insulated microneedles safely with little injury to the epidermis and minimum downtime.
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Abstract
Minimally invasive devices are a departure from standard laser therapies, because energy is delivered directly below the skin through a 1-mm incision. Lasers can affect such tissues as fat for enhanced disruption, coagulation of small blood vessels, and skin tightening at the right temperatures. Minimally invasive radiofrequency devices can tighten skin but can also improve neck muscle laxity. These devices can achieve results not possible with traditional external devices and, because the skin is not penetrated with energy, a much improved healing profile is seen as well.
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Does Implant Insertion with a Funnel Decrease Capsular Contracture? A Preliminary Report. Aesthet Surg J 2016; 36:550-6. [PMID: 26672104 DOI: 10.1093/asj/sjv237] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Capsular contracture remains a common and dreaded complication of breast augmentation. The etiology of capsular contracture is believed to be multi-factorial, and its causes may include biofilm formation due to implant/pocket contamination with skin flora. It has been shown that insertion funnel use reduces skin contact and potential contamination by 27-fold in a cadaver model. After incorporating the funnel into our surgical protocols, we anecdotally believed we were experiencing fewer capsular contractures in our augmentation practices. OBJECTIVES The purpose of this study was to test the hypothesis that capsular contracture related reoperation rates decreased after insertion funnel adoption using data from multiple practices. METHODS At seven participating centers, we retrospectively reviewed the surgical records from March 2006 to December 2012 for female patients who had undergone primary breast augmentation with silicone gel implants. Group 1 consisted of consecutive augmentations done without the insertion funnel, and Group 2 consisted of consecutive augmentations done with the insertion funnel. The primary outcome variable was development of grade III or IV capsular contracture that led to reoperation within 12 months. RESULTS A total of 1177 breast augmentations met inclusion criteria for Group 1 and 1620 breast augmentations for Group 2. The rate of reoperation due to capsular contracture was higher without use of the insertion funnel (1.49%), compared to Group 2 with funnel use (0.68%), a 54% reduction (P = 0.004). CONCLUSIONS The insertion funnel group experienced a statistically significant reduction in the incidence of reoperations performed due to capsular contracture within 12 months of primary breast augmentation.
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High Definition Body Sculpting: Art and Advanced Lipoplasty Techniques. Aesthet Surg J 2015. [DOI: 10.1093/asj/sjv048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
BACKGROUND Aesthetic breast augmentation can be fraught with postoperative complications, particularly capsular contracture (CC), skin surface irregularities, and implant or inframammary fold malposition. Similar complications have been addressed successfully in reconstructive breast surgery with acellular dermal matrix (ADM) products. OBJECTIVE The authors present their initial experience with porcine ADM (PADM) in aesthetic breast augmentation. METHODS Retrospective chart review was performed for 93 consecutive patients (179 breasts) who underwent revisionary cosmetic breast augmentation with or without mastopexy between May 2009 and September 2012. Porcine ADM (Strattice; Lifecell Corp, Branchburg, New Jersey) was placed bilaterally in 74 patients and unilaterally in 19 patients. All patients were operated upon by 1 surgeon (J.N.P.). Product use description and complications were recorded, including infection, extrusion, CC, and implant malposition. RESULTS Average follow-up was 12 months (range, 1-39 months). There were 2 major complications (1.6% of breasts): an infection in 1 breast that required implant explantation approximately 2 weeks postoperatively and an extrusion that required PADM removal. Two additional patients had high-riding implants resulting from folded PADM that required revision; both cases were corrected by excising the folded PADM segment. Seven other patients required office procedures to correct minor imperfections. Two CC recurrences were suspected (1 patient) in the 76 breasts that underwent capsulectomy and PADM placement. CONCLUSIONS Porcine ADM demonstrated great utility as an adjunct in revisionary cosmetic breast surgery. The product helped to provide good aesthetic outcomes with low complication rates. Prospective, randomized trials may prove helpful in defining the role of PADM further in these challenging cases.
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Abstract
Today, laser therapy is standard treatment for a wide variety of dermatologic complaints. From skin rejuvenation to the management of complex vascular malformations, laser treatment has proved to be an effective, innovative solution to once-challenging dilemmas. However, laser application in those with darker complexions remains a topic of great concern. Although contemporary devices may use longer-wavelength lasers and cooling devices to isolate target tissues within patients with high levels of epidermal melanin, significant risk remains. Today's laser surgeon must have a thorough understanding of patient concerns, lesion character and response to treatment, as well as the unique needs of those with darker skin. In this article, we discuss critical issues in patient assessment, proper evaluation of common skin complaints, and laser therapy use for a variety of lesions in the ethnic population.
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The medical spa: an opportunity or nightmare? Facial Plast Surg 2010; 26:45-9. [PMID: 20119903 DOI: 10.1055/s-0029-1245064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Nonsurgical cosmetic procedures have become increasingly common and important to plastic surgery practices. Many physicians have either opened a medical spa or have thought about integrating a medical spa into their aesthetic practices. The authors (plastic surgeon and marketing professional) have shared their views on opening a medical spa and the trials they went through. This article describes the positives and negatives of opening a spa from construction through personnel.
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Abstract
BACKGROUND Light chemical peels and microdermabrasion have enjoyed recent popularity for the treatment of mild photoaging. However, clinical improvement from these modalities is often minimal from both a patient's and physician's perspective. Erbium:YAG lasers have been effective in treating mild to moderate photoaging, but the need for either regional or general anesthesia, as well as the significant post-treatment recovery period has limited its use. OBJECTIVE We sought to utilize a very low fluence approach to erbium:YAG laser resurfacing, with topical anesthesia, to ascertain its efficacy in treating mild to moderate photoaging. METHODS A total of 250 subjects aged 28-80 years with skin types 1-4 and mild to moderate facial rhytids were treated with topical anesthesia and subsequently one pass of a 2940 nm erbium:YAG laser, using between 5 and 17.5 J/cm2. In addition, 58 of the treated facial subjects underwent neck resurfacing with fluences between 5 and 15 J/cm2 and eight treated facial subjects underwent upper chest resurfacing at fluences of 5-7 J/cm2. A single treatment was received by 246 subjects; four subjects were treated a second time after a 1-month interval. RESULTS Most subjects completely re-epithelialized by 3-4 days; healing time was depth dependent. Most subjects were able to start skin care regimens within 1-2 weeks after the procedure. Results were judged to be excellent in individuals with thin skin and good in subjects with thicker skin. CONCLUSIONS One pass of low fluence erbium:YAG resurfacing, under topical anesthesia, was effective for the treatment of mild to moderate photoaging.
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Abstract
LEARNING OBJECTIVES The reader is presumed to have a basic understanding of the use of lasers in plastic surgery and laser physics. After reading this article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination on the basis of material covered in this article. The examination begins on page 435. BACKGROUND Nonablative resurfacing, also referred to as subsurface or dermal remodeling, is a recently introduced technology for restoring damaged collagen without injuring or removing the overlying epidermis. To date there have been no published comparisons or reviews of these laser systems. OBJECTIVE The authors review the mechanisms of action of currently available nonablative laser technologies and published data on their performance. METHODS Literature concerning nonablative laser technology published between 2000 and 2002 was reviewed by use of Medline searches. Data on technical specifications were obtained from the manufacturers. RESULTS Significant improvement in skin elasticity and photodamage with few or no complications was noted after treatment with most of the systems reviewed. However, the results were generally more subtle than those achieved with ablative lasers. CONCLUSIONS Nonablative technology is currently at the forefront of skin rejuvenation. Data on long-term results must await several more years of accumulated clinical treatment. Improvement in skin quality, tone, and texture can be expected, but patients and physicians who expect nonablative laser treatment results to be similar to those achieved by ablative techniques may be disappointed. (Aesthetic Surg J 2002;22:427-434.).
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The RSVP facelift: a highly vascular flap permitting safe, simultaneous, comprehensive facial rejuvenation in one operative setting. Aesthetic Plast Surg 2000; 24:313-22. [PMID: 11084693 DOI: 10.1007/s002660010054] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study describes our effort to develop a reliably safe method for combining currently available treatment modalities in an effort to obtain comprehensive facial rejuvenation in one operative setting. Detailed evaluation of 101 available consecutive patients, their per- and postoperative photos and charts was undertaken. Five groups of patients were studied: (1) traditional facelift with wide subcutaneous undermining and SMAS plication. (2) Similar traditional facelift with regional laser resurfacing. (3) RSVP (rejuvenation with sparing of vascular perforators) facelift. Subcutaneous undermining stops 3 cm lateral to the nasolabial fold to preserve the rich angular/facial arterial supply and venous drainage, still permitting lateral SMASectomy or SMAS plication. Subcutaneous neck undermining is discontinuous, the posterior dissection being limited to that which is necessary for identification of the posterior edge of the platysma and its plication to the mastoid and SCM muscle. The anterior dissection is limited to that necessary for anterior platysmal repair leaving intact a vertical subcutaneous non-undermined zone 4-6 cm in width, preserving the submental perforating artery. If indicated, gentle liposuction with a fine cannula is performed through this area. (4) RSVP facelift and regional laser resurfacing. (5) RSVP facelift with total facial laser resurfacing. Mean follow-up was 13.6 months, minimum 6 months. There were no additional major complications associated with the addition of laser resurfacing or fat grafting to the RSVP group. The patients with laser resurfacing were pleased with their result, and estimated that their apparent age had been reduced by a mean of 10.4 years, compared with 6.6 years for the non-lased group. We conclude that the RSVP flap is a hardy, vascular flap permitting simultaneous laser resurfacing, fat grafting, and other adjunctive procedures without significant fear of flap loss.
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Lasers, facelifting, and the future. Clin Plast Surg 2000; 27:293-9. [PMID: 10812528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Variable-pulse width ER:YAG laser resurfacing. Clin Plast Surg 2000; 27:263-71, xi. [PMID: 10812525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
New resurfacing laser systems have been introduced that offer the ablative capacity of Er:YAG lasers with the ability to add controlled degrees of thermal effect to provide collagen tightening and hemostasis. This article discusses the current systems available and offers comparisons to short-pulse Er:YAG and carbon dioxide lasers. A histologic study and initial clinical results are presented and discussed.
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Preface. Clin Plast Surg 2000. [DOI: 10.1016/s0094-1298(20)32703-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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MacGyver Midface. Plast Reconstr Surg 1999; 103:2081-2. [PMID: 10359278 DOI: 10.1097/00006534-199906000-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Facial skin resurfacing using the carbon dioxide laser has become an increasingly popular procedure. Improvements in carbon dioxide laser technology have made the procedure simpler and more reliable. However, difficulties in the postoperative period can lead to patient morbidity and physician anxiety. Common problems such as prolonged erythema, hyperpigmentation, acne, milia, dermatitis, and infection can be controlled or avoided with proper postoperative care. Less common sequela such as hypertrophic scarring and prolonged healing are often a results of errors committed in the postoperative period. The authors have performed laser resurfacing in almost 2100 patients in the last 4 years. Changes in the postoperative regimen to include no pretreatment, use of semipermeable dressings, antiviral and antibacterial prophylaxis, and early treatment with sunscreens and bleaching agents have made for a smoother recovery with more predictable results.
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Endoscopically assisted supraorbital nerve neurolysis and correction of eyebrow asymmetry. Plast Reconstr Surg 1997; 100:755-8; discussion 759-60. [PMID: 9283579 DOI: 10.1097/00006534-199709000-00036] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Laser resurfacing as an adjunct to endoforehead lift, endofacelift, and biplanar facelift. Ann Plast Surg 1997; 38:315-21; discussion 321-2. [PMID: 9111888 DOI: 10.1097/00000637-199704000-00002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Laser resurfacing is a wonderful technological advance at improving the quality of aged skin. Physicians have been reluctant to perform full facial resurfacing at the time of rhytidectomy due to risk of flap slough. Newer endoscopic-assisted subperiosteal techniques allow hardy flaps without significant blood supply interruption. Since September 1995 we have performed 26 full facial resurfacings at the time of rhytidectomy or brow lift using the Coherent 5000C carbon dioxide laser. Standard settings and densities were used. Twelve patients underwent full endoscopic facelift; 5 patients, extended endoforehead lift; 8 patients, biplanar rhytidectomy; and 1 patient, standard rhytidectomy prior to immediate laser resurfacing. An additional 2 patients underwent endoscopic forehead lift and forehead resurfacing. There were three herpes infections, one in the endoscopic group, one in the biplanar group, and one in the standard rhytidectomy patient. There were 2 patients with minor skin slough in our early experience with the biplanar group. Full facial resurfacing at the time of rhytidectomy provides a one-stage rejuvenation of skin and deeper layers, and can be performed safely. However, only experienced laser practitioners should attempt resurfacing over undermined flaps.
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Abstract
A 91-year-old man presented with a 9.0 x 7.0 cm exophytic mass on the dorsum of the right foot, surrounded by a scaling hyperkeratotic plaque-like lesion that had been present for many years. He had similar long-standing hyperkeratotic plaque-like lesions on both legs. Histopathologic examination of the exophytic mass revealed a well-differentiated squamous cell carcinoma surrounded by an eccrine syringofibroadenoma (ESFA). Histochemistry, immunohistochemistry and electron microscopy support this diagnosis. To our knowledge, this is the only reported case of ESFA being intimately associated with a malignant neoplasm.
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Subperiosteal minimally invasive laser endoscopic rhytidectomy: the SMILE facelift. Aesthetic Plast Surg 1996; 20:463-70. [PMID: 8929322 DOI: 10.1007/bf00449248] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Current concepts of total facial rejuvenation involve a comprehensive integrated approach to achieve a balanced youthful appearance. Recently introduced endoscopic-assisted techniques allow us to rejuvenate the face through small, remote incisions. Previously, we have considered only young patients with good skin turgor as candidates for minimally invasive procedures, but the advent of the resurfacing laser has allowed us to expand our indications for single stage minimal access rejuvenation. Full facial immediate laser resurfacing at the time of standard rhytidectomy has been avoided due to risk of flap necrosis. Subperiosteal minimally invasive endoscopic assisted techniques do not substantially interfere with facial blood supply. We can now perform endoscopic-assisted full facelifts combined with immediate laser resurfacing to reposition the tissues in a more youthful position and then tighten the skin envelope. Extended endoscopic-assisted subperiosteal forehead lift is performed through three to five scalp incisions; subperiosteal midface lift is performed through a crow's foot or intraoral incision. Cervicoplasty, if needed, is performed through a small submental incision. Full face laser resurfacing is done using a Coherent Ultrapulse laser. To date we have performed eleven subperiosteal minimally invasive laser endoscopic (SMILE) rhytidectomies. There has been no evidence of flap necrosis with this technique. Postoperative recovery has been no different from patients treated only by full face resurfacing, except perhaps for the slight increase in early facial edema. We believe the SMILE facelift is a viable alternative to standard techniques. The limitations of this procedure still need to be elucidated.
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Abstract
Endoscopic-assisted surgery allows remote incision placement and provides an illuminated, magnified operative field. We have applied these principles to perform neurolysis of the zygomaticotemporal nerve and removal of a fixation wire under endoscopic control in a patient with pain and tenderness at the site of a previous zygomatic arch fracture. Endoscopic assistance aided dissection by placing the incision in a hidden, unscarred area.
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The severely twisted nose. Treatment by separation of its components and internal cartilage splinting. Clin Plast Surg 1996; 23:327-40. [PMID: 8726431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adequate treatment of the deviated nose requires a detailed evaluation of the deformity present. A new method of component separation with internal cartilage splinting has been used with success to correct the severely deviated nose. The separation of the components allows detection and correction of all areas of cartilage deviation. The internal cartilage splinting allows long-term support and avoidance of mid-vault collapse.
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Abstract
Endoscopic techniques have revolutionized current surgical techniques and have now been introduced to plastic surgery. Advantages of endoscopic assistance include direct visualization, hidden scars, and decreased morbidity. We sought to implement endoscopic techniques to recontour the facial skeleton and avoid the disadvantages of open procedures. A standard video system and endoscopic instrumentation including a 4-mm 30-degree endoscope and a power bur were used. Cadaveric dissections were performed before clinical use. Using endoscopic assistance, the frontal bone of a 42-year-old Korean woman with bony deformities was visualized and sculpted using a power bur. An uneventful postoperative course ensued. This case illustrates the feasibility of using endoscopic techniques in forehead recontouring and sets the stage for further work in malar and mandible recontouring.
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