Carrie S. Stern

Human fat grafting alleviates radiation skin damage in a murine model.

Background: Autogenous fat grafting has been observed to alleviate the sequelae of chronic radiodermatitis. To date, no study has replicated this finding in an animal model. Methods: The dorsa of adult wild-type FVB mice were shaved and depilated. The dorsal skin was then distracted away from the body and irradiated (45 Gy). Four weeks after irradiation, 1.5-cc fat or sham grafts were placed in the dorsal subcutaneous space. Gross results were analyzed photometrically. The animals were euthanized at 4 and 8 weeks after fat or sham grafting and their dorsal skin was processed for histologic analysis. Results: Hyperpigmentation and ulceration were grossly improved in fat-grafted mice compared with sham-grafted controls. This improvement manifested histologically in a number of ways. For example, epidermal thickness measurements demonstrated decreased thickness in fat-grafted animals at both time points (20.6 ± 1.5 &mgr;m versus 55.2 ± 5.6 &mgr;m, p = 0.004; 17.6 ± 1.1 &mgr;m versus 36.3 ± 6.1 &mgr;m, p = 0.039). Picrosirius red staining demonstrated a diminished scar index in fat-treated animals at both time points as well (0.54 ± 0.05 versus 0.74 ± 0.07, p = 0.034; and 0.55 ± 0.06 versus 0.93 ± 0.07, p = 0.001). Conclusion: Fat grafting attenuates inflammation in acute radiodermatitis and slows the progression of fibrosis in chronic radiodermatitis.

The Evolution of Photography and Three-dimensional Imaging in Plastic Surgery

Summary: Throughout history, the technological advancements of conventional clinical photography in plastic surgery have not only refined the methods available to the plastic surgeon, but have invigorated the profession through technology. The technology of the once traditional two-dimensional photograph has since been revolutionized and refashioned to incorporate novel applications, which have since become the standard in clinical photography. Contrary to traditional standardized two-dimensional photographs, three-dimensional photography provides the surgeon with an invaluable volumetric and morphologic analysis by demonstrating true surface dimensions both preoperatively and postoperatively. Clinical photography has served as one of the fundamental objective means by which plastic surgeons review outcomes; however, the newer three-dimensional technology has been primarily used to enhance the preoperative consultation with surgical simulations. The authors intend to familiarize readers with the notion that three-dimensional photography extends well beyond its marketing application during surgical consultation. For the cosmetic surgeon, as the application of three-dimensional photography continues to mature in facial plastic surgery, it will continue to bypass the dated conventional photographic methods plastic surgeons once relied on. This article reviews a paradigm shift and provides a historical review of the fascinating evolution of photography in plastic surgery by highlighting the clinical utility of three-dimensional photography as an adjunct to plastic and reconstructive surgery practices. As three-dimensional photographic technology continues to evolve, its application in facial plastic surgery will provide an opportunity for a new objective standard in plastic surgery.

Mixed Reality with HoloLens: Where Virtual Reality Meets Augmented Reality in the Operating Room

Summary: Virtual reality and augmented reality devices have recently been described in the surgical literature. The authors have previously explored various iterations of these devices, and although they show promise, it has become clear that virtual reality and/or augmented reality devices alone do not adequately meet the demands of surgeons. The solution may lie in a hybrid technology known as mixed reality, which merges many virtual reality and augmented realty features. Microsoft’s HoloLens, the first commercially available mixed reality device, provides surgeons intraoperative hands-free access to complex data, the real environment, and bidirectional communication. This report describes the use of HoloLens in the operating room to improve decision-making and surgical workflow. The pace of mixed reality–related technological development will undoubtedly be rapid in the coming years, and plastic surgeons are ideally suited to both lead and benefit from this advance.

Abstract 29: Improving Decision Making in Breast Reconstruction Through Use of a Validated Picture Option Grid

METHODS: A retrospective review of 560 patients undergoing outpatient breast plastic surgery procedures was conducted. Patients received 1) no preoperative analgesia (n=333), 2) intraoperative IV acetaminophen (n=78), 3) preoperative oral acetaminophen and gabapentin (n=95), or 4) preoperative oral acetaminophen, gabapentin and celecoxib (n=54). Outcomes included PACU narcotic use, pain scores, PACU length-of-stay, rescue anti-emetic use and 30-day complications.

A Novel Approach to Surgical Markings Based on a Topographical Map and a Projected 3D Hologram.

Purpose: Surgical markings play a crucial role in planning plastic surgery procedures.[1, 2] Despite the importance of markings as a guide, these surgical markings are often imprecise. [3] Herein we describe a novel approach to lipostructure, guided by a computer-based roadmap. A digital 3D topographical surgical map is created using 3D photography and analytic software and then projected as an image onto the patient in the OR during surgery. This concept can be applied to most soft tissue procedures in plastic surgery.

A Novel 3D Analysis of Arcus Marginalis Release for Midface Rejuvenation.

PURPOSE: Many experts believe the arcus marginalis plays a critical role in tear-trough deformity.1-5 Arcus marginalis release (AMR) is performed with fat repositioning to soften the lidcheek junction and achieve a more youthful midface contour. The following study used 3D photography and computer analysis to document changes in the tear-trough and midface contour in response to AMR with malar lipostructure.

3D Topographical Surface Changes of the Malar Region in Response to Compartmental Volumization of the Deep Medial and Lateral Cheek.

INTRODUCTION: Given the widespread use of facial fi llers, and identifi cation of distinct facial fat compartments1,2, a better understanding of 3D surface changes in response to volume augmentation is needed. The malar region is one such area commonly treated with autologous fat grafting or fi llers in which it is important to understand how compartmental volumization relates to topographical change.3,4