Anthony E. Brissett

Keloids: Pathogenesis, Clinical Features, and Management

Cutaneous wound healing is a complex response to skin injury. Deregulation of this process can lead to excessive scar formation, as seen in keloids. Keloids are common skin lesions that are difficult to treat and are associated with high recurrence rates despite the large number of available treatment options. With increased knowledge of the disease process and further scientific advancements, future approaches will hopefully improve keloid treatment. In this article, we review the epidemiology, genetic basis, etiology, clinical features, pathogenesis, and management of keloids.

Ethnic Trends in Facial Plastic Surgery

The appearance of patients seeking cosmetic surgery is changing to reflect our multicultural society. Integral to addressing the desires of a cross-cultural patient population is an understanding of ones perception of race, ethnicity, and culture. Race is an objective description, whereas ethnicity is a subjective description of a persons social group. Culture, on the other hand, defines the behaviors, beliefs, and values of a group. How a person perceives their place within these groups affects his or her self-image and approach to cosmetic surgery. These cultural perceptions are important, as patients of Asian, Hispanic, and African descent make up the fastest growing groups that desire cosmetic surgery. Factors contributing to this trend include population growth, especially within multicultural communities, improvements in social status, and increasing disposable income, combined with a positive perception of cosmetic surgery. Surgical philosophies have also changed, shifting from the perspective of racial transformation, defined as the use of a common set of surgical goals for all ethnicities, toward a view of racial preservation, with the goal of preserving ones racial and ethnic features.

HIV-Associated Facial Lipoatrophy: Establishment of a Validated Grading Scale

Objective: HIV‐associated lipodystrophy is considered a sequela of highly active antiretroviral treatment. We describe the characteristics, possible etiology, and pathophysiology of HIV‐associated lipodystrophy and facial lipoatrophy and establish a validated grading scale for HIV‐associated facial lipoatrophy using evidence‐based techniques.

The aging African-American face.

With the desire to create a more youthful appearance, patients of all races and ethnicities are increasingly seeking nonsurgical and surgical rejuvenation. In particular, facial rejuvenation procedures have grown significantly within the African-American population. This increase has resulted in a paradigm shift in facial plastic surgery as one considers rejuvenation procedures in those of African descent, as the aging process of various racial groups differs from traditional models. The purpose of this article is to draw attention to the facial features unique to those of African descent and the role these features play in the aging process, taking care to highlight the differences from traditional models of facial aging. In addition, this article will briefly describe the nonsurgical and surgical options for facial rejuvenation taking into consideration the previously discussed facial aging differences and postoperative considerations.

Laser Skin Treatment in Non-Caucasian Patients

The demand for facial rejuvenation and cosmetic procedures is rising among all ethnicities and skin types. The authors present a review of lasers and how to select a laser based on skin type and the treatment goals of laser resurfacing: skin laxity, dyschromia, hair removal, keloid, and hypertrophic scarring. In addition, they discuss preprocedural and postprocedural considerations, potential complications, and their management to maximize patient outcomes and minimize risk.

Increased in vitro differentiation of fibrocytes from keloid patients is inhibited by serum amyloid P.

Keloid scarring is a form of fibroproliferative dermal wound healing characterized by growth beyond the confines of the original wound. Fibrocytes, derived from peripheral blood mononuclear cells and inhibited by serum amyloid P (SAP), have been linked to other fibroproliferative diseases. We hypothesized that peripheral blood mononuclear cells of keloid formers have a higher propensity to differentiate into fibrocytes and are more resistant to the effects of SAP. To test this hypothesis, plasma was isolated from peripheral blood samples of keloid (n = 10) and age/sex/race‐matched control (n = 10) subjects, and SAP levels were measured by enzyme‐linked immunosorbent assay. Equal numbers of peripheral blood mononuclear cells were also isolated from these samples and fibrocytes cultured in serum‐free media with increasing concentrations of SAP. No difference in plasma SAP levels was found between keloid and control subjects. In the absence of SAP, keloid patients (n = 7) had almost 20 times more fibrocytes than controls (n = 7) in culture (median: 1,087 cells vs. 60 cells; p < 0.01). SAP inhibited the differentiation of keloid fibrocytes in vitro, although a higher concentration of SAP was needed when compared with controls (20 μg/mL keloid vs. 5 μg/mL control). Fibrocytes may contribute to the pathogenesis of keloids, and SAP has potential as a therapeutic agent in the prevention of these lesions.

Tip nuances for the nose of African descent.

Patients of African descent are seeking rhinoplasties today more than ever. As a result, the rhinoplasty surgeon must be aware of the ethnic, cultural, anatomic, and surgical issues pertaining to this patient population. In this article, the nuances of rhinoplasty as it pertains to the nasal tip in patients of African descent are discussed.

Creation of a head and neck Keloid quality of life questionnaire.

Create a head‐and‐neck keloid quality of life (QOL) questionnaire. Demonstrate the reliability of the keloid‐specific QOL scale according to test‐retest and internal consistency standards.

Utility of Post-reduction Radiographic Analysis of Mandible Fractures

Objectives: Recognize that immediate post-reduction films: 1) Have a significant associated cost; 2) Do not alter management. Methods: A retrospective review of the medical record was performed on patients with mandible fractures operated on by the otolaryngology-head and neck surgery service between November 1, 2010, and November 30, 2012, at a level 1 county hospital. The post-operative imaging modalities were determined as well as if any changes in care were initiated by that image. Those patients who did have repeat imaging were evaluated to determine what led to the second image and what action was taken. Results: Fifty-seven patients met inclusion criteria. Fifty-five patients (96.5%) had a post-reduction image with 45 (79.0%) having a computed tomography (CT;

SF-12® for Head-and-Neck Keloid Patients: Preliminary Results towards Creating a Keloid-Specific Scale

1,965) and 10 (17.5%) having a Panorex (