Giselle Prado

Ocular Pain and Impending Blindness During Facial Cosmetic Injections: Is Your Office Prepared?

Soft tissue filler injections are the second most common non-surgical procedure performed by the plastic surgeon. Embolization of intravascular material after facial injection is a rare but terrifying outcome due to the high likelihood of long-term sequela such as blindness and cerebrovascular accident. The literature is replete with examples of permanent blindness caused by injection with autologous fat, soft tissue fillers such as hyaluronic acid, PLLA, calcium hydroxyl-apatite, and even corticosteroid suspensions. However, missing from the discussion is an effective treatment algorithm that can be quickly and safely followed by injecting physicians in the case of an intravascular injection with impending blindness. In this report, we present the case of a 64-year-old woman who suffered from blindness and hemiparesis after facial cosmetic injections performed by a family physician. We use this case to create awareness that this complication has become more common as the number of injectors and patients seeking these treatments have increased exponentially over the past few years. We share in this study our experience with the incorporation of a “blindness safety kit” in each of our offices to promptly initiate treatment in someone with embolization and impending blindness. The kit contains a step-by-step protocol to follow in the event of arterial embolization of filler material associated with ocular pain and impending loss of vision.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Resolution of Post-Surgical Hypergranulation Tissue with Topical Aluminum Chloride

Hypergranulation is the extension of granulation tissue beyond the required amount to close a tissue defect. We report our experience using aluminum chloride to treat a series of two patients with hypergranulation tissue. Both patients had lengthy treatment courses after Mohs surgery with growth of hypergranulation tissue that resolved once aluminum chloride was placed on the wound. Aluminum chloride is a useful hemostatic agent frequently employed in dermatology. It is a readily available and low-cost option for management of hypergranulation after dermatologic procedures. Chronic wounds are a common treatment challenge for clinicians. Due to its affordability and availability, clinicians may consider topical aluminum chloride when managing post-surgical hypergranulation tissue.

Assessment of Clinician Accuracy for Diagnosing Melanoma Based on Electrical Impedance Spectroscopy Score Plus Morphology Versus Lesion Morphology Alone

8. Duffin KC, Yeung H, Takeshita J, et al. Patient satisfaction with treatments for moderate-to-severe plaque psoriasis in clinical practice. Br J Dermatol. 2014;170(3):672-680. 9. Weinstein GD, Koo JY, Krueger GG, et al. Tazarotene cream in the treatment of psoriasis: two multicenter, double-blind, randomized, vehicle-controlled studies of the safety and efficacy of tazarotene creams 0.05% and 0.1% applied once daily for 12 weeks. J Am Acad Dermatol. 2003;48(5):760-767. 10. Gupta SK, Singh KK, Lalit M. Comparative therapeutic evaluation of different topicals and narrow band ultraviolet B therapy combined with systemic methotrexate in the treatment of palmoplantar psoriasis. Indian J Dermatol. 2011 Mar; 56(2):165-170.

Autologous Fat Transfer to Buttocks

This chapter describes in detail the surgical steps involved in performing the Brazilian butt lift or autologous fat transfer to the buttocks. Buttock augmentation has been gaining increasing popularity, particularly in certain ethnic groups (Semin Plast Surg 23(3):232–43, 2009). Buttock augmentation can be achieved with either implants or autologous fat. The advantage of autologous fat is that there is minimal risk of infection and no risks of implant malposition, rotation, or extrusion (Clin Plast Surg 33(3):449–66, 2006). Another advantage of autologous fat transfer is that fat is removed from less desirable areas such as the abdomen, flanks, back, and/or thighs (Surg Innov 21(3):327–36, 2014). There is risk of fat necrosis or fat absorption (failed take) (Plast Reconstr Surg 124(1):272–80, 2009). The key area to suction is the lumbosacral triangle (the “V” zone). This alone gives the visual illusion of a prominent buttock. This fat is harvested using standard tumescent liposuction techniques and then separated by gravity or centrifuge (Clin Plast Surg 33(3):449–66, 2006). This “pure fat” is devoid of oil, blood, and tumescent fluid. There are four basic buttock shapes: the “A” shape, “V” shape, “round” shape, and “square” shape (Clin Plast Surg 33(3):333–46, 2006). The “A” shape is considered the most attractive, and the goal of this surgery is to convert the other buttock shapes to an “A” shape.

Abstract: The Use of the Laser Level to Ensure Symmetry in Aesthetic Breast Surgery.

IntroductIon: Although reconstruction with adipofascial anterolateral thigh flap (ALTA) is commonly recommended treatment alternative for the extremity defects there are a few studies published in the literature. In this study it was aimed to show the advantageous and disadvantageous of ALTA flap due to experiences that we got from 9 patients at whom superficial extremity defects were reconstructed with ALTA flap.

Aesthetic Procedures for Increased Lip Volume: Hyaluronic Acid Fillers in Nonsurgical Lip and Eye Rejuvenation Techniques

Patients often present for lip augmentation to correct the loss of volume and signs of aging commonly perceived with perioral aging, including but not limited to decreased vermillion showing, blunting of the Cupid’s bow, less visible white roll, vertical rhytids, marionette lines, formation of a mentalis crease, and deep nasolabial folds. Hyaluronic acid (HA) is popular filler for temporary lip augmentation (effects last 3–6 months) due to its hygroscopic properties and resulting natural appearance. Additionally, they have desirable safety profiles due to the reversibility by enzymatic degradation using hyalurodinase. Keeping in mind the important anatomy of the perioral region and its vascular supply and nerve innervation is essential to a successful procedure with good cosmetic results. This chapter includes detailed guidelines and a technique for injecting. Physicians should consult with patients as to their preferences for a desired look, but carefully manage expectations to avoid disappointments. HA fillers are well tolerated and rarely result in adverse reactions for patients. Commonly experienced reactions can include local inflammation, tenderness, and bruising. HA fillers are an effective first-line treatment option for patients who want to augment and revitalize their lips.