The American Journal of Cosmetic Surgery

We report the case of a patient who developed keloid scarring associated with Mammostat-induced skin trauma during reduction mammoplasty. A 32-year-old patient consulted for breast hypertrophy and developed from the fourth postoperative month significant keloid scars on skin shears caused by dermal stretching techniques used during de-epithelialization. The Mammostat-related scars were keloid, while those found on old skin incisions were only enlarged and slightly hypertrophic. We followed up this patient for 7 years. During this time, she received the following local treatments: scar kneading, silicone dressings, intralesional injections of corticosteroids, and potent dermocorticosteroids. After balancing the benefit/risk ratio of a possible revision surgery for resection and plasty of her keloid scars, we opted for therapeutic abstention. In patients at high risk of keloids, we recommend a soft de-epithelialization causing no skin shear, performed by manual tensioning of the dermis.

The preservation of healthy human body and function for every patient should be the goal of all health practitioners. Dentistry is not an exception to this philosophy. In past few decades, the improvements of scientific method and technology has led to a better understanding of oral microflora and dental materials resulted in the shifting of caries management method from G. V. Black’s “extension for prevention” to the modern “minimally invasive” approach in dentistry. The minimally invasive approach to dental caries establishes a proper doctor-patient relationship, thus empowering and educating the patient to take responsibility for their own dental health. The proper sequence of caries management should be the introduction of preventive strategies such as oral hygiene instructions, reminialization regiments, and risk assessments followed by minimal surgical interventions. Using the laser technology in the aspect of surgical intervention has many clinical advantages. Some of the clinical benefits include its selectivity for carious tissue, reduction of needs for local anesthesia, decontamination effect of preparation surfaces, minimal thermal stimulus to pulp chamber, increase in surface adhesion for composite materials, and other soft tissue applications. The combination of caries prevention program, disease control, risk assessment, and laser technology application on the surgical intervention significantly reduces the long-term restorative needs and thus preserves more healthy natural tooth structures, which complement the concept of minimally invasive dentistry. In cosmetic surgery, the same rules apply. The same laser types are used as well.

Autologous adipose-derived stromal vascular fraction (SVF) has been proposed as a remedy for a number of inflammatory, autoimmune, and degenerative conditions. This procedure had mainly been evaluated in veterinary medicine and outside the United States when this study was initiated. This study looks at adverse events to evaluate safety as its primary objective and secondarily follows efficacy of SVF as deployed through intra-articular injections and intravenous infusions for a variety of orthopedic and non-orthopedic conditions. We hypothesized that autologous SVF deployment using a specialized surgical processing system (the CSN Time Machine® system, trademark name for the MediKhan Lipokit/Maxstem system; MediKhan, Los Angeles, California) was safe (ie, minimally acceptable adverse events) and that clinical efficacy could be demonstrated. This was a prospective case series. After institutional review board approval, 1698 SVF deployment procedures were performed between 2011 and 2016 by us and other affiliates with our same system trained by us as a nearly closed sterile surgical lipotransfer procedure on 1524 patients with various degenerative, inflammatory, and autoimmune conditions with a majority involving the musculoskeletal system. All outcome test data were collected in an online database over a 5-year period. Our study shows a very low number of reported adverse events and a reduction in pain ratings after 6 months or more across a variety of musculoskeletal diseases and improvements in a variety of other degenerative conditions. Our system for producing adipose-derived SVF therapy for our patients was safe and benefits could be measured for a long time after SVF deployment. Further controlled long-term studies for specific disease conditions with large patient populations are necessary to further investigate the benefits observed.

This study was designed to compare 2 common techniques for anesthesia prior to facial filler injections to determine which anesthetic method resulted in less pain during filler injections and which was preferred for future treatments. Via a randomized, prospective, split-face design, one side was treated with topical lidocaine gel and the contralateral received nerve block injection(s) to the infraorbital and/or mental nerve with local anesthetic. Hyaluronic acid (HA) filler was used to treat cosmetic deformities of the nasolabial folds, upper, and/or lower lips. Patients were surveyed to quantify the subjective pain during (1) preprocedural anesthesia and (2) injection of HA filler. At 1 week, patients reported which side was perceived as less painful, and his or her future treatment preference. Forty-eight participants (46 women and 2 men) were enrolled. In all, 77% perceived the filler injections with anesthetic block(s) as less painful, 21% recorded injections on the side pretreated with topical anesthesia as less painful, and 2% perceived no difference. Of all participants, 56% preferred local anesthetic injections for future treatments, 33% chose topical anesthesia, and 10% (5 of 48) had no preference. Patients rated the treatment of HA injections after anesthetic block(s) as the least painful method. Although more than half of the patients preferred this modality, the posttreatment survey suggests that there may be other factors contributing to patients’ preferences.

A nonthermal laser device is approved for noninvasive body circumference reduction and temporary improvement in the appearance of cellulite. Another noninvasive device based on the principle of manual lymph drainage is approved for body circumference reduction and improving the appearance of cellulite. This pilot study evaluated the effectiveness of combining these treatments for reducing body circumference. Healthy men and women (N = 27), 22 to 70 years of age with a body mass index of 25 to 40 kg/m², inclusive, seeking to improve the appearance of their waist, hips, and upper abdomen, were enrolled. The laser device consists of 6 independent, variable frequency lasers emitting a 532-nm green light with a mean power output of 17 mW (Erchonia Verjú Laser System; Erchonia Corporation, Melbourne, Florida). The lymphatic drainage system is a pressure therapy intended for body contouring and cellulite reduction applications and for reducing edema (Green PRESS 8 Lymphatic Drainage System; Iskra Medical, Podnart, Slovenia). Participants received 12 treatments, one every 3 to 4 days over a 6-week period. Each session included a 30-minute nonthermal laser treatment (15 minutes each to front and back) followed by a 30-minute treatment with the lymphatic drainage system. To evaluate comparability of the combined devices treatment with the nonthermal laser treatment, individual study success for the nonthermal laser alone was a 3.0-inch (7.62 cm) decrease in combined baseline hips, waist, and upper abdomen circumference at the end of the study. A 50% increase in combined hips-waist-upper abdomen circumference measurement following combined treatments was considered a clinically meaningful improvement over the use of nonthermal laser alone. Individual study success was achieved by 17 participants (63.0%), exceeding the preestablished overall study success criteria of 60% in comparison with nonthermal laser treatment alone. The mean (SD) combined body circumference decreased from 112.3 (13.7) inches at baseline to 108.5 (13.8) inches at the end of the study, a mean decrease of 3.9 (2.7) inches (P < .0001). One-way analysis of variance tests for changes in total body circumference measures at weeks 4, 8, and 12 were significantly less than baseline (for each, P < .01); however, the study failed to achieve a 50% decrease in combined hips-waist-upper abdomen circumference measurement following application of combined treatments versus nonthermal laser alone. Additional treatment with a manual lymphatic drainage system does not improve the effectiveness of a nonthermal 532-nm green laser for reducing hips, waist, and upper abdomen circumference.

Ensuring adequate intraoperative hemostasis is crucial in avoiding serious complications of rhytidectomy surgery such as hematoma formation and skin flap necrosis. Charring of bipolar electrocautery arms can lead to ineffective hemostasis, frequent wiping to ensure hemostatic efficacy and prolonged operative time. We investigate the impact of a commercially available antistick coating solution (Electro Lube) on intraoperative wiping frequency of bipolar electrocautery arms and operative time for rhytidectomy procedures. Fifty patients undergoing rhytidectomy were prospectively enrolled in a randomized, split-face study. All patients enrolled were seen and evaluated in a private facial plastic and reconstructive surgery practice, and were operated on by a single surgeon in either an accredited ambulatory surgical center under deep, intravenous sedation or in a monitored office setting under light, oral sedation. Electro Lube was utilized to coat bipolar electrocautery arms for one side of the rhytidectomy procedure on each patient, letting the contralateral side serve as control. Total number of wipes to clean the cauterizing arms of the bipolar cautery per procedure was counted, and operative time, from skin incision to skin trimming, was measured. Total wipe count in the intervention group (n = 50) was 13 (0.26 wipes/procedure) versus 47 in the control group (n = 50) (0.94 wipes/procedure), a difference that was found to be statistically significant (P = .0013). Average operative time in the intervention group was 27.52 minutes versus 28.35 minutes in the control group. This difference was also found to be statistically significant (P = .043). The use of Electro Lube to coat bipolar electrocautery arms may have clinical utility to simplify and reduce intraoperative wiping and shorten operative time in rhytidectomy procedures and other cosmetic or reconstructive procedures where frequent use of bipolar electrocautery to maintain intraoperative hemostasis is crucial.