Joshua Waltzman

Anthropometric and aesthetic analysis of the Indian American woman's face☆

BACKGROUND This is the first study defining the facial anthropometric and aesthetic measurements in Indian American women (IAW). METHODS This is a prospective cohort study involving evaluation of facial photographs. Frontal, lateral and basal photographs were taken of IAW (n=102), and 30 anthropometric measurements were determined. Proportions were compared with published North American white women (NAWW) norms. Judges (n=6) evaluated the photographs for aesthetics using a visual analogue scale. Attractive IAW (top 15%) were compared with average IAW (remaining 85%) and average NAWW. All completed a facial self-esteem survey. RESULTS There were significant differences between IAW and NAWW in 25 of 30 facial measurements. Six measurements correlated with aesthetic scores: intercanthal distance, mouth width, nasolabial angle, midface height 2, ear length and nasal height. Attractive IAW had nine measurements approximating NAWW features, 15 measurements similar to average IAW values and two measurements distinct from both average IAW and average NAWW. Attractive IAW had higher facial self-esteem scores than average IAW. CONCLUSIONS Facial measurements in IAW are much different from NAWW, and these results will assist in preoperative planning. Several features are correlated with attractiveness in IAW: larger and wider-set eyes, a smaller midface, a smaller nose with greater tip rotation, smaller ears and a larger mouth. Attractive IAW display many measurements typical of average IAW and several measurements that reflect average NAWW values. These results contribute to concepts of transcultural aesthetics--for a minority ethnic group, facial beauty appears to be an assimilation of deep-rooted ethnic features with prevailing cultural traits and aesthetic standards.

Review of Over-the-Counter Topical Scar Treatment Products

Postsurgical, traumatic, and burn scars can be painful, pruritic, erythematous, raised, and cosmetically unacceptable. Although a number of over-the-counter products are available to treat symptomatic scars, the peer-reviewed data on the clinical efficacy of these products are limited and/or controv

Impaired Lung Vascular Endothelial Growth Factor in Extremely Premature Baboons Developing Bronchopulmonary Dysplasia/Chronic Lung Disease

Background Preterm infants exposed to O2 with mechanical ventilation often develop bronchopulmonary dysplasia (BPD), a form of chronic lung disease (CLD). The pathogenesis of BPD/CLD involves dysmorphic microvasculature and disrupted alveolarization. This may be due to impaired vascular endothelial growth factor (VEGF) and VEGF receptor expression. Methods To examine the ontogeny of VEGF and VEGF receptors in baboon lungs from 125 to 185 (term) days gestation and to determine whether exposure to O2 and mechanical ventilation alter these ontogenic profiles, we examined lung specimens from three O2-exposed groups: (1) animals delivered at 125 days gestation and exposed to O2 for 14 days as needed; (2) animals delivered at 140 days gestation and exposed to O2 for 10 days as needed; and (3) animals delivered at 140 days gestation and exposed to 100% O2 for 10 days. Lungs from gestational age-matched controls were also examined at 125, 140, 160, 175, and 185 (term) days. Results VEGF189 was the most abundant splice variant in the lungs at all stages of development. Extremely premature baboons developing BPD/CLD had higher lung VEGF121 messenger ribonucleic acid (mRNA) expression. However, transcripts for VEGF189, VEGF165, and VEGF receptors (Fms-like tyrosine kinase-1 [Flt-1], kinase-insert domain receptor [KDR]/fetal liver kinase-1 [Flk-1], and neuropilin 1) were suppressed in the BPD models. Conclusions We conclude that impaired VEGF and VEGF receptor mRNA expression in lungs from extremely premature baboons developing BPD/CLD may contribute to dysmorphic microvasculature and disrupted alveolarization.

What Patients Look for When Choosing a Plastic Surgeon: An Assessment of Patient Preference by Conjoint Analysis

The knowledge of patient preference is crucial for plastic surgeons to determine optimal marketing strategies. Conjoint analysis is a statistical technique whereby research participants make a series of trade-offs. Analysis of these trade-offs reveals the relative importance of component attributes. This study will evaluate the relative importance of attributes that influence the selection and decision-making process when choosing a plastic surgeon. A questionnaire consisting of 18 plastic surgeon profiles was rated by 111 patients. Attributes analyzed were as follows: travel distance, number of years in practice, board certification status, method of referral, office décor, and procedure cost. A traditional full-profile conjoint analysis was performed. Subjects consisted of 10 men and 101 women (n = 111). Median age was 51 years (range, 19–72). The “mean importance” of the attributes are as follows: board certification status, 39.7%; method of referral, 23.5%; distance from home to office, 13.2%; office décor, 9.0%; number of years in practice, 7.5%; and cost of procedure, 7.2%. Internal validity checks showed a high correlation (Pearson ρ = 0.995; P < 0.001). This pilot study demonstrates that conjoint analysis is a very powerful tool for market research in the health care system. The level of importance for each attribute reliably helps plastic surgeons to understand the preferences of their patients, thus being able to improve marketing strategies for private practices and institutions. The present study indicates that the most important attributes were board certification and method of referral.

Novel cryoprecipitate for wound healing and skin grafts in rats.

The authors sought to evaluate the ability of locally administered enhanced cryoprecipitate (eCryo) to improve the wound healing of split thickness skin grafts (STSG) and their donor sites. An STSG (5 × 5 cm) was harvested on the back of 30 rats and divided into four areas that were then treated in one of the following groups: A: ‘standard’ dressing without STSG; B: eCryo without STSG; C: eCryo with STSG coverage and D: STSG alone. Macroscopic and histological assessments (histomorphometric grading scale and cellular composition) were evaluated at days 7, 14, 21 and 28 for wound healing. All wound beds as well as STSGs healed well without any complications. Eighty per cent of the STSG showed a histological graft take of >75% after 28 days. There were no statistically significant differences of macroscopic or histological results between the groups at any time point. Preparation of eCryo is easy and effective. Its use as an adhesive for STSGs is safe and shows similar results as controls. The theoretical benefits of eCryo did not show significant differences. Possible reasons as well as important findings for future research on wound healing are discussed.

271 ONTOGENY OF VASCULAR ENDOTHELIAL GROWTH FACTOR, INSULIN-LIKE GROWTH FACTOR-I, AND GROWTH HORMONE IN THE RAT VITREOUS FLUID, RETINAL HOMOGENATES, AND SYSTEMIC CIRCULATION: RELATIONSHIP TO PHYSICAL GROWTH AND RETINAL DEVELOPMENT

Vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF)-I, and growth hormone (GH) are important regulators of physical growth and have been shown to play key roles in retinal angiogenesis and development. In premature infants, low serum IGF-I and high GH levels in the early postnatal period were reported to be associated with severe retinopathy of prematurity (ROP). We examined the ontogenic profile of VEGF, IGF-I and GH in rat vitreous fluid, retinal homogenates and systemic circulation from birth to 21 days postnatal age (weaning, P21). Sprague Dawley rats (litter size =15 pups) were sacrificed at P0, P7, P14 and P21 (3 litters/group). At sacrifice, the pups were weighed and measured for linear growth (nose to tail length). Vitreous fluid, retinal homogenates, and serum were analyzed for VEGF, IGF-I and GH by enzyme immunoassay. VEGF levels were 10-fold higher in the vitreous (pg/mL) than serum (pg/mL) at all stages of development. Vitreous and serum VEGF levels progressively declined at P7, P14 and P21 (p≤0.05 to p≤0.001) compared to term, however in the retinal homogenates, VEGF levels (pg/mg protein) increased with the highest concentration at P21 (p≤0.05 vs term). Vitreous IGF-I levels were decreased at P7 through P14 (p≤0.05) compared to term. Vitreous GH levels were 10-fold lower than serum levels and were decreased at P14 and P21 (p≤0.001) compared to P7. Despite a trend for increasing IGF-I and decreasing GH in retinal homogenates, no appreciable changes were detected with advancing postnatal age. Similarly, serum IGF-I levels increased with postnatal age (P14 and P21: p≤0.05 vs term), whereas serum GH levels were decreased at P7 (p≤0.05), P14 (p≤0.01), and P21 (p≤0.01) compared to term. In rats, retinal development occurs postnatally by P14. Our data demonstrate that during normal retinal development, VEGF, IGF-I and GH decrease in the vitreous; and VEGF and IGF-I increase, while GH decreases in the retinal homogenates. A quite different ontogenic pattern is noted in the systemic circulation. VEGF and GH decrease, while IGF-I increases with advancing physical growth. We therefore conclude that any future therapy for ROP should consider changes occurring in the eye rather than the systemic compartment.

466 A SINGLE COURSE OF ANTENATAL BETAMETHASONE INCREASES MATRIX METALLOPRPTEINASE-2 IN MATERNAL BLOOD AND PLACENTA

A single course of antenatal betamethasone (B) is administered to women with threatened preterm delivery to advance fetal lung maturation. Lung maturation is associated with increased breakdown and remodeling of the lung basement membrane and extracellular matrix. These processes are regulated by matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) which are present in the fetomaternal membranes of the placenta. We examined the effects of a single course of antenatal B on maternal and placental MMPs and TIMPs. A prospective pilot study of three groups of pregnant patients was conducted. Group I (n=21): women who were antenatally treated with a single course of B, and who delivered ≤36 weeks gestation; Group II (n=7): untreated women who delivered ≤36 weeks (preterm controls); and Group III (n=15): untreated women who delivered ≥38 weeks (term controls). Group I was subdivided into women delivering: a) ≤2 weeks (IA, n=13); and b) ≥2 weeks (IB, n=8) post B treatment. Maternal blood and placental samples were collected at the time of delivery for MMP-2, MMP-9, TIMP-1 and TIMP-2 levels. Placental levels were standardized using total cellular protein levels. Maternal MMP-2 levels (ng/mL) were significantly lower in Group II (14.5±1.2, p≤0.05) than Groups IA (17.9±0.67) IB (18.4±0.6), and III (18.2±0.83). Maternal MMP-9 and TIMP-1 remained unchanged. Maternal TIMP-2 was suppressed in Group IA (38.6±10.0, p≤0.05) and Group II (38.5±4.5, p≤0.05) compared to Group III (83.7±12.3), however, in Group IB, the levels were increased (65.0±7.9, p≤0.01) compared to Groups IA and II. As a result, a higher MMP-2 to TIMP-2 ratio was noted in Group IA (0.54±0.06, p≤0.01) than Groups IB (0.32±0.04) and III (0.33±0.04); and a lower ratio was noted in Group IB (0.32±0.04, p≤0.05) than Group II (0.40±0.04). In the placenta, MMP-2 levels were increased in Group IA (117.3±3.9, p≤0.05) compared to Groups II (100.8±6.0) and III (104.5±3.7). Interestingly, TIMP-1 levels were 10-fold higher in maternal blood than placenta, whereas TIMP-2 levels were 2-fold greater in placenta than maternal blood. Data are mean±SEM. A single course of antenatal B acutely enhances maternal and placental MMP-2 synthesis and maternal MMP-2/TIMP-2 ratio. Increased MMP-2 activity may result in increased collagen breakdown, and suggests a mechanism for Bs effect on fetal lung maturation. Decreased MMP-2 by 2 weeks post B treatment reflects abatement of the effects of antenatal B known to occur by 7-10 days.