The American Journal of Cosmetic Surgery

Over the years, liposuction has been the standard treatment for localized fatty deposit. Lipolysis is a controversial procedure based generally on phosphatidylcholine and deoxycholate injection. The purpose of this study was to compare the efficacy of cholanic acid Aqualyx with the efficacy of liposuction in women with moderate submental fatty collection.

A prospective randomized study of 30 women with moderate submental fatty collection. Half of the subjects were treated with cholanic acid Aqualyx and the other half with liposuction. Responses were assessed clinically and statistically.

Although the lipolysis group showed a better response, it is difficult to conclude that adipocytolisis leads to greater fat reduction compared with liposuction.

Laser resurfacing of the lower eyelids is a popular option for rejuvenation. Lower eyelid synechia (adhesions) can occur with laser skin resurfacing, but literature searches for this topic failed to show any dedicated articles addressing this complication.

The author routinely performs more than 120 procedures per year involving high-fluence, high-density, multipass CO₂ laser skin resurfacing to the lower eyelids (which includes full-face and periorbital treatment combined). This article discusses the author's clinical experience dealing with lower eyelid synechiae. Health Insurance Portability and accountability Act guidelines as well as the World Medical Association Declaration of Helsinki regarding ethical principles for medical research were followed.

Lower eyelid synechiae are an uncommon complication in the reepithelialization phase of laser resurfacing. If recognized and treated early, permanent tissue adhesion is rare; if allowed to totally reepithelialize; however, permanent deformity may occur.

Laser resurfacing remains a popular option for rhytid effacement, skin tightening, and dyschromia improvement of the lower eyelids whether performed as an isolated procedure or as part of full-face laser resurfacing. Lower eyelid synechiae are an uncommon but potential complication that can lead to permanent disfigurement if not diagnosed and treated early in the healing period after laser treatment. All physicians and staff that perform laser resurfacing should be familiar with the early diagnosis and early treatment of lower eyelid synechiae.

Abdominoplasty can be a major and difficult procedure for patients. They can have prolonged postoperative pain and difficulty moving and eating. These difficulties can increase the time patients are in the postoperative unit, increase costs, and decrease overall patient satisfaction. This retrospective study compared the recovery time for patients who did and patients who did not receive intravenous (IV) acetaminophen before abdominoplasty.

Twenty-seven patients were randomly selected for the study. The 12 patients chosen as a control group were given a standard pain regimen without IV acetaminophen. Fifteen patients were given the standard pain regimen, including preoperative IV acetaminophen. The total time in the postanesthesia care unit was recorded from entry to the area to the patients' leaving the facility. The Aldrete score was used for discharge criteria, and the time was recorded once the patient scored 10 out of 10 and had good pain control.

The average recovery time for the control group was 117 minutes. The average recovery time for the IV. acetaminophen group was 83 minutes for an improvement in discharge time of 34 minutes. The number of patients discharged from the facility within 90 minutes of arriving in the postoperative care unit increased from 33% to 73%.

Compared with patients given standard medical therapy, patients in the preoperative IV acetaminophen group improved discharge times, and more patients were discharged within 90 minutes of arriving in the postoperative care unit.

The purpose of the study was to determine the rate of postoperative surgical-site infections following blepharoplasty by comparing patients using topical antibiotic ointment and those using topical lubricating ointment without antibiotic.

In an observational, cohort study, 2 similar groups of patients were evaluated for rates of allergic reactions and postoperative infections. For 15 months, 384 consecutive patients, (171 men, 213 women; age range = 38 to 87 years; mean age = 69.2 years), underwent bilateral upper eyelid blepharoplasty. Postoperatively, patients applied bacitracin ophthalmic ointment twice a day for 7 days. Patients with a known allergy to bacitracin were excluded. For the subsequent 9 months, a second cohort of 158 patients, (64 men, 94 women; age range = 30 to 96 years; mean age= 69.3 years) used sterile Refresh PM ophthalmic ointment twice a day for 7 days. All patients had surgery at 1 of 2 fully accredited surgery centers. Both cohorts underwent identical betadine preparations, and all procedures were performed under sterile conditions with full gloves, gowns, and drapes. Surgical technique, instruments, and suture materials were consistent in both groups. Patients were seen 1 week following surgery.

In the bacitracin group, 14 of 384 (3.65%) patients had an allergic reaction to the ointment characterized by bilateral erythema, swelling, and itching without any evidence of purulent material along the incision line. In 1 patient (0.26%) a positive culture indicated infection with a methicillin-sensitive Staphylococcus species. In the group using Refresh PM, 10 of 158 (6.3%) patients had a culture-positive surgical-site infection characterized by erythema and purulent material along the incisions. All but 1 infection was bilateral. All cultures grew community-acquired methicillin-resistant Staphylococcus aureus. The study was discontinued in light of the high incidence of infection.

In these very similar age-matched cohorts, a lower rate of infection (P < .001) was identified in patients using topical antibiotic ointment postoperatively.

Patients diagnosed with symptomatic capsular contracture or with safety concerns for the implant are often reluctant to accept the operation of implant exchange, choosing instead removal without exchange or taking other options to rebuild their breasts. These patients may benefit from augmenting the overlying soft tissue of the breasts with autologous fat grafting (AFG) after removing the prosthesis if the aesthetic appearance of their breasts is an issue. A retrospective analysis of patients receiving AFG for breast augmentation after implant removal was performed. The outcomes in these patients were compared with those of the patients receiving AFG for breast augmentation as their first breast surgery during the same period.

Between March 2011 and November 2013, 27 patients receiving AFG after breast implant removal (BIR) were assigned to group A and 325 patients who underwent AFG for breast augmentation without preexisting implant by the same surgeon were assigned to group B. Objective evaluation was made by measuring the change in the difference of breast circumference (BCD) and breast thickness measured by ultrasonography taken before and after the treatment. Aesthetic evaluation was performed using a 5-point Likert-type scale for patient satisfaction and comparing preoperative and postoperative digital photographs for physician satisfaction.

Relative to group B, patients in group A were older and had higher complication rates, including infection, fat necrosis, indurations, and calcifications (P < .05). The changes in BCD and breast thickness between the 2 groups were of no clinical significance. The reoperation rate in group A was significantly higher (P < .05).

The number of postoperative complications of AFG for breast augmentation was found to be higher in patients after BIR. The optimal timing of AFG in the patients after BIR should be further studied if 2-stage augmentation with fat grafting is to be performed. Reoperation with fat grafting to the breasts should be considered if patients expect to have the original volume of their breasts restored.

The umbilical scar is the only scar that is culturally accepted and whose dysmorphia or absence catches people's attention. Studies have discussed numerous umbilicus reconstruction techniques but not any for repositioning the umbilicus during or after liposuction. In this study, we will introduce a technique called “umbilicosliding” that is used to prevent or correct a defect known as the “sad umbilicus” without visible scarring.

A retrospective study was conducted from 2010 to 2014 in which 32 patients fulfilled the inclusion criteria. Preoperative and postoperative photographs were analyzed by two plastic surgeons that were not on the team at the time of the procedures. Patients were recalled and surveyed about results.

The external assessment of aesthetic outcome by photographic results were 31% (n = 10) excellent, 47% (n = 15) good, 22% (n = 7) regular, and 0% bad. Recalled patients assessed the aesthetic outcome at 25% (n = 8) excellent, 66% (n = 21) good, 9% (n — 3) regular, and 0% bad.

The rhino filler is a relatively recent complementary technique to rhinoplasty. The filler provides good results in certain selected cases, camouflaging irregularities of the dorsum and tip. This study aims to evaluate the Italian technique for the modification of the tip, a seemingly trivial but very effective technique. In selected cases, it is possible to successfully modify the tip of the nose using a simple double injection of filler within a few seconds.

A total of 212 subjects were treated with filler in a single session. The patients were carefully selected, and each presented to varying degrees and in different ways with the tip of the nose projected and/or turned downward. The goal of the treatment is to provide greater projection and an upward lift of the tip. Follow-up visits evaluated the result, degree of patient satisfaction, and adverse reactions.

Of the patients, 79.2% claimed to be completely satisfied, 11.3% moderately satisfied, and 9.5% had no observable improvement. When evaluated photographically, 92.4% demonstrated improvement.

The technique has inherent limitations. It cannot change the structure of bone or cartilage, and it can correct only with an increase. For this reason, it is essential to select patients carefully. This study reported no major adverse events, and this is encouraging.

This technique standardizes the reshaping of the tip with injectable fillers, reducing the number of injections to 2 boluses, by becoming a safer treatment, easier carrying, quick, well tolerated, economical, durable, and with maximum results.

A new technique of minimally invasive orbicularis myectomy is described. A study is presented to show its efficacy in relieving spasms in benign essential blepharospasm and to note any complications resulting from it.

In a prospective clinical, interventional study conducted at oculoplastics department of a tertiary care center, 25 consecutive cases (50 eyes) of benign essential blepharospasm were included, from January 2012 to December 2014. The patients consisted of 19 women and 6 men between the ages 28 and 66 years (mean age, 52 years). After a thorough history, a complete ophthalmological examination, and assessment of functional disability, they received appropriate therapy for triggering factors such as dry eyes, meibomitis, blepharitis, and trachoma for 1 month, after which a minimal orbicularis myectomy of both the upper and lower lids was performed simultaneously under local anesthesia by a single surgeon. The cases were followed up after 1 week, 1 month, 3 months, 6 months, and 1 year.

Six cases (24%) needed simultaneous brow suspension; 4 cases (16%) had blepharoplasty for dermatochalasis. Postoperatively, ecchymosis of lids was noted in 13 cases (52%) and lid swelling in 3 cases (12%). No lad lag, lid asymmetry, or corneal exposure was seen in any case. Three cases needed frontalis suspension for apraxia of upper lids, which was done 1 month postoperatively. Patient satisfaction was 100%, with improved functional disability.

Minimal orbicularis myectomy was found to be effective in providing a long-term relief of spasms and was not associated with any complications. However, proper patient selection is mandatory.