The American Journal of Cosmetic Surgery

This work reviews the current state of patient-reported outcomes research in periocular cosmetic plastic surgery.

A systematic review of the English-language medical literature from January 1946 through March 2013 was conducted for patient-reported outcomes measures used in periocular cosmetic plastic surgery patient populations. These measures were assessed for adherence to minimum standards recommended by the International Society for Quality of Life Research.

Thirteen outcome measures were identified. Upper-lid blepharoplasty was the only procedure for which an instrument, the Blepharoplasty Outcomes Evaluation, had been formally developed in the target patient group (periocular cosmetic surgery), and that met or exceeded minimum standards of reporting. Nine formally developed instruments were identified in the following applications: general facial cosmetic surgery (instruments that may be applied to periocular surgery, which are not restricted to any single facial intervention or anatomic region), chemodenervation, filler, and skin treatment. Of these, 5 instruments met minimum standards.

Few well-developed, patient-reported outcomes measures targeted at periocular cosmetic patients exist at this time.

Fibromatosis is a rare benign neoplasm that infrequently presents in the head and neck. Although it has no metastatic potential, its ability to infiltrate and invade organs and vital structures can lead to significant morbidity and even death. Clinically, fibromatoses manifest as painless, firm, often rapidly growing masses fixed to underlying bone and soft tissue. Although the precise etiology is unknown, genetic mutations or hormonal levels may be a causative factor. Interestingly, trauma and surgical incisions may be associated in up to 25% of cases.

A 44-year-old woman was treated for submental lipomatosis and platysmal banding via submental liposuction and platysmaplasty. Within the following weeks, a firm, nontender, freely-movable nodule was noted, and biopsy was returned as fibromatosis.

Because of the rapid progression and location of the tumor, this neoplasm was classified as aggressive fibromatosis. Our patient required surgical resection with close follow-up. Although reported in the head and neck prior to this case, this is the only case to our knowledge arising clinically after cosmetic surgery.

Although the exact etiology is unknown, there is a strong suspicion that either the surgery itself may have been the causative factor enabling the normal reparative fibroblasts to differentiate into tumor cells or a preexisting, but not clinically apparent tumor, may have been stimulated by the procedure. Judicious follow-up and prompt diagnosis led to early treatment, which in turn decreased the potential for severe morbidity.

Muscle wasting is a known complication of HIV and the highly active antiretroviral therapy (HAART) therapy employed to treat HIV/AIDS. To date, there has been no good solution for patients suffering from muscle wasting in the anterior thigh region. We have developed a custom silicone prosthesis to help those who suffer from inadequacy of the anterior thigh/quadriceps.

A custom-designed silicone prosthesis was placed via an incision in the anterior thigh beneath the fascia of the quadriceps muscle to augment the anterior thigh.

A single patient underwent quadriceps augmentation with a semisolid silicone prosthesis and has had an excellent cosmetic result 3 months postoperatively.

Because of HIV or HAART therapy, a patient may suffer from wasting in the legs, and placement of a silicone prosthesis may help to restore a patient's confidence and improve the cosmetic appearance of the anterior thigh/quadriceps region. This procedure may have application in the realm of non-HIV patients seeking cosmetic augmentation of the anterior thigh, and further research is warranted.

A 52-year-old woman presented with delayed-onset nodules in the malar and glabellar regions approximately 16 months after undergoing facial augmentation via injection of an unknown substance in China. Medical records for the procedure were not available. The authors performed an investigative review of fillers used abroad to determine possible treatment options for the patient. After discussion with general plastic surgeons in China, a treatment plan was initiated.

Computed tomography of the head with 3-dimensional reformatting was performed to characterize the nature and extent of the interventions performed. The study revealed significant amounts of a subdermal substance in the malar and glabellar regions.

A cycle of treatment was performed involving the injection of lidocaine, triamcinolone, and fluorouracil into the affected areas accompanied by interspersed daily massage. The regimen proved effective, and there was clear reduction in the size and inflammation of the nodules.

The modern age of facial rejuvenation features an increasing array of soft tissue fillers available to physicians performing facial augmentation. The expansion of available filling agents and the rising costs of domestic health care have resulted in an increase in the number of patients seeking elective cosmetic procedures abroad, and patients presenting with complications from cosmetic tourism are increasingly a part of the modern aesthetic practice. Maintaining a solid awareness of current usage trends of injectable filling agents and a thorough understanding of the management options for delayed-onset nodules are essential for mitigating complications from soft tissue fillers of unknown provenance.