Dwight A. Scarborough

EXTRACORPOREAL PHOTOCHEMOTHERAPY IN PROGRESSIVE SYSTEMIC SCLEROSIS

Background. Extracorporeal photochemotherapy, an immune‐modulating form of therapy, has been shown to be effective in the treatment of autoimmune diseases. We evaluated the effects of extracorporeal photochemotherapy in the treatment of patients with progressive systemic sclerosis (pss).

Surgical Pearl: Intralesional electrodesiccation of sebaceous hyperplasia ☆ ☆☆ ★

From the Division of Dermatology, Department of Internal Medicine, Ohio State University Hospitals. Reprints are not available from the authors. J Am Acad Dermatol 2000;42:127-8. Copyright

The Use of Conscious Sedation for Outpatient Dermatologic Surgical Procedures

Background. Dermatologic surgery has undergone increasing levels of sophistication over the past few decades. Commensurate with this demand, an established anesthesia technique called conscious sedation has been employed. Objectives. Methods for performing office‐based conscious sedation are described. Recommendations are made regarding prerequisites for conscious sedation in an office setting, patient selection, complications management, and postoperative discharge requirements. Conclusion. The goals of anesthesia are to provide for patient safety and comfort, to increase patient acceptance of the procedure, and to enhance the surgeons efficiency and satisfaction.

The Occurrence of Breast Enlargement in Females following Liposuction

* Clinical Assistant Professor of Medicine, Division of Dermatology, Ohio State University Hosptials, Columbus, Ohio t Clinical Assistant Professor of Medicine and Dermatology, Columbia University College ofPhysicians and Surgeons, New York, New York T he advent of liposuction surgery has facilitated the reconfiguration of body morphology by the removal of adipose tissue. The study of fat patterning and its relationship to health has been of medical interest in recent years. We observed the occurrence of breast enlargement in 16 of 30 female patients who underwent liposuction surgery. A subset of 16 patients had> 1000 cc fat extracted, 12 of whom experienced subsequent breast enlargement. Steady-state or a positive caloric energy balance in conjunction with estrogens appear to playa key role in this development. Our preliminary observations may suggest that liposuction-induced morphologic changes may predicate other metabolic contingencies, and further evaluation is warranted.

Surgical intervention for the aging face. Combination of mini-face-lifting and superficial carbon dioxide laser resurfacing.

background. Patients seeking facial rejuvenation often would benefit from a combination of face‐lifting and laser resurfacing. Fear of skin slough has prevented the study of this issue. objective. We report our experience utilizing a combination of simultaneous cervicofacial rhytidectomy and carbon dioxide (CO2) laser resurfacing, and summarize the results of a survey completed by each patient. methods. Forty patients underwent the combination treatment. Patients were followed and asked to respond to a questionnaire 12 months postprocedure regarding their surgical experience. results. Our survey revealed an overall degree of satisfaction. Reported complications included transient swelling, redness, pigmentary alteration, and numbness. One patient experienced minimal slough in a nonresurfaced site. conclusions. The control of depth of thermal damage with the CO2 UltraPulse laser allows for precision in its combined application along with face‐lifting. In the area of the flap, one pass at low power settings is safe in our experience and results in an improved cosmetic result.

Breast Enlargement after Liposuction

* Clinical Assistant Professor ofMedicine, Columbia University, College of Physicians and Surgeons, New York, New York t Clinical Assistant Professor ofMedicine, Ohio State University, Columbus, Ohio 43210 W e report the observations of five women of various ages who underwent liposuction surgery. The only common feature is a 5to 7-lb weight gain postliposuction procedure. These five women have reported the development of breast enlargement.

A Technique for Square Plug Hair Transplantation

* Assistant Clinical Professor of Medicine & Dermatology, Columbia University, College of Physicians and Surgeons, New York, New York. t Assistant Clinical Professor of Medicine, Division of Dermatology, Ohio State University Hospitals. Columbus, Ohio. H air transplantation has become the most popular cosmetic operative procedure for men. The most commonly used surgical method of transplanting hair has been the round punch graft. The square plug is obtained by use of a surgical tool manufactured by Tiemann & Co. We have found each plug to contain 10-30% more surface area compared to a conventional round plug, which confirms the finding of Coiffman. 3 We will outline this technique. Most men or women with an area of significant androgenic alopecia and good donor hair in the occipital or temporal scalp are candidates for hair transplantation. Hair transplantation for male pattern baldness has become increasingly popular during the past 20 years. It is the most common cosmetic procedure performed on males. Hair transplantation as a cosmetic procedure was launched with the classic paper in which Orentreich described the results of transplanting punch grafts into areas of alopecia. The most commonly used surgical method of transplanting hair remains the round punch graft. We will describe a technique that employs square punch grafts. 2

Midface lift using a minimally invasive technique and a novel absorbable suture.

BACKGROUND Midface rejuvenation is a minimally invasive procedure designed to correct early ptosis of the cheeks and deepening nasolabial folds. Implementation of this technique requires a detailed understanding of the anatomy of this region in addition to recognizing the vectors of change that occur over time as one matures. Finally, aesthetic competence and requisite surgical skills are required to restore the midface in a minimally invasive fashion. OBJECTIVE To describe a new minimally invasive approach to facial rejuvenation using a novel absorbable suture with segmented stabilizers that allows for a superolateral reversal of the senescent changes of the midface. METHODS In a case series study, 30 patients with aging changes of the midface signed informed consent to have this procedure done. An incision was made in the preauricular area, followed by hydrodissection with tumescent anesthesia and blunt dissection with the aid of a 4‐mm spatula cannula. Two angiocatheters (14GA 3.25 IN, 2.1 × 83 mm, 14 gauge) were tunneled through the malar fat pad and pierced the skin just lateral to the nasolabial fold. The angiocatheter was then removed and the suture tethered to facilitate the proper amount of lifting entirely in the subcutaneous supra‐SMAS plane and anchored superolaterally to the temporalis fascia. The segmented stabilizers anchored themselves in multiple directions but ultimately lifted the tissues of the midface. RESULTS AND CONCLUSION This technique uses the multidirectional segmented stabilizers of the Monograms to counteract the downward displacement of the malar fat pad while simultaneously softening the nasolabial fold. This is a minimally invasive technique that addresses the multiple factors involved in the senescent changes of the midface. Proper patient selection, good aesthetic judgment, and surgical competence are required to restore the midface in a minimally invasive fashion. The objective of this study was to report a novel approach to midfacial rejuvenation using the Monograms. This cross‐hatched suture achieves simultaneous malar fat pad elevation and nasolabial fold effacement. The midface lift adds another vital dimension to panfacial augmentation. The authors have indicated no significant interest with commercial supporters.

A Novel Specialized Suture and Inserting Device for the Resuspension of Ptotic Facial Tissues: Early Results

BACKGROUND In the past decade, the popularity of minimally invasive procedures for facial rejuvenation has increased. OBJECTIVE To describe a new specialized suture, and its associated technique, used to elevate sagging tissues of the face and neck. METHODS A detailed description of the technique and the results obtained in 20 patients in whom we have used this novel approach. Attention was given to appropriate patient selection. The primary focus was on the correction of the jowl, jawline, and neck subunits. It involves the percutaneous introduction of a novel 3‐0 polypropylene suture that has 10 absorbable hollow cones along its axis that are equally interspersed with knots. Once the absorbable cones are resorbed into the surrounding tissues, the non‐absorbable suture component can be removed without compromising the aesthetic outcome. RESULTS All patients demonstrated improvement in these areas, with minimal complications. One patient required resuspension using the open technique. (Excessive ptotic tissue was later excised for an optimal cosmetic result.) CONCLUSION The suture and technique described in this article provide a major contribution to the correction of ptosis of facial tissues. When done in conjunction with other procedures, such as neck and jowl microliposuction, this technique has proven to be a useful addition to facial rejuvenation. The authors have indicated no significant interest with commercial supporters.

Otoplasty for the Treatment of Protuberant Ears

The goal of otoplasty is to make the protuberant ears less apparent by restoring them to a normal form and position while maintaining symmetry. The authors describe the history of otoplasty and discuss anatomy and development of the ear, indications for otoplasty of protuberant ears, anatomical causes of protuberant ears, preoperative considerations, and postoperative care complications. The surgical techniques are discussed for correction of protuberant ears that involve treatment of underdeveloped antihelical fold, conchal prominence and/or anterolateral rotation, prominent helix, and protruding earlobe.