Karan Mehta

Current Trends in Facial Rejuvenation: An Assessment of ASPS Members' Use of Fat Grafting during Face Lifting.

Background: Fat grafting can be used to improve the results of face lifting. The extent to which plastic surgeons use fat grafting in their face-lift practices is unknown. The goals of this study were to understand the current use of fat grafting during facial rejuvenation surgery and identify the most common techniques used. Methods: A 28-item questionnaire was formulated for distribution to a randomized cohort of American Society of Plastic Surgeons members. Data were collected and statistically analyzed using Pearson chi-square and Fisher’s exact tests. Results: A total of 309 questionnaires were collected. The questionnaire revealed that 85.2 percent of respondents use fat grafting during face lifts. Currently, the most common techniques used include abdominal harvest, centrifuge processing, blunt cannula injection without pretunneling, and placing less than 0.1 cc per pass. The deep central malar, lower lid cheek junction, and nasolabial folds are the most commonly injected areas. Conclusions: Combining surgical repositioning of fat with fat grafting offers surgeons a greater degree of aesthetic control for correcting contour in the aging face. Although there is controversy regarding the best method to surgically reposition fat, there is a growing consensus that volume augmentation is preferred by most face-lift surgeons.

Residency characteristics that matter most to plastic surgery applicants: a multi-institutional analysis and review of the literature.

PurposeThe National Residency Matching Program Match is a very unique process in which applicants and programs are coupled to each other based on a ranking system. Although several studies have assessed features plastic surgery programs look for in applicants, no study in the present plastic surgery literature identifies which residency characteristics are most important to plastic surgery applicants. Therefore, we sought to perform a multi-institutional assessment as to which factors plastic surgery residency applicants consider most important when applying for residency. MethodsA validated and anonymous questionnaire containing 37 items regarding various program characteristics was e-mailed to 226 applicants to New York University, Albany, University of Michigan, and University of Southern California plastic surgery residency programs. Applicants were asked to rate each feature on a scale from 1 to 10, with 10 being the most important. The 37 variables were ranked by the sum of the responses. The median rating and interquartile range as well as the mean for each factor was then calculated. A Wilcoxon signed rank test was used to compare medians in rank order. ResultsA total of 137 completed questionnaires were returned, yielding a 61% response rate. The characteristics candidates considered most important were impressions during the interview, experiences during away rotations, importance placed on resident training/support/mentoring by faculty, personal experiences with residents, and the amount of time spent in general surgery. The characteristics candidates considered least important were second-look experiences, compensation/benefits, program reputation from Internet forums, accessibility of program coordinator, opportunity for laboratory research, and fellowship positions available at the program. ConclusionsApplicants value personal contact and time spent in general surgery when selecting residency programs. As the number of integrated programs continues to grow, programs will benefit from learning what factors their applicants value most.

Inferior Turbinate Hypertrophy in Rhinoplasty: Systematic Review of Surgical Techniques

Background: Inferior turbinate hypertrophy is often encountered by plastic surgeons who perform rhinoplasty. Many treatment options are available to treat the inferior turbinate. The objective of this study was to systematically review outcomes of available techniques and provide guidance to surgical turbinate management. Methods: A MEDLINE search was performed for means of treating inferior turbinate hypertrophy. Studies selected focused on treatment of the inferior turbinate in isolation and excluding patients with refractory allergic rhinitis, vasomotor rhinitis, or hypertrophic rhinitis. Results: Fifty-eight articles were identified, collectively including the following surgical treatments of inferior turbinate hypertrophy: total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryotherapy, electrocautery, radiofrequency ablation, and turbinate outfracture. Outcomes and complications were collected from all studies. Procedures such as turbinectomy (partial/total) and submucosal resection showed crusting and epistaxis at comparatively higher rates, whereas more conservative treatments such as cryotherapy and submucous diathermy failed to provide long-term results. Submucosal resection and radiofrequency ablation were shown to decrease nasal resistance and preserve mucosal function. No literature exists to support the belief that turbinate outfracture alone is an effective treatment for turbinate hypertrophy. Conclusions: Treatment of inferior turbinate hypertrophy is best accomplished with modalities that provide long-lasting results, preservation of turbinate function, and low complication rates. Submucosal resection and radiofrequency ablation appear to best fulfill these criteria. Turbinate outfracture should only be considered in combination with tissue-reduction procedures.

Abstract 103: primed mesenchymal stem cells prevent endothelial activation and improve allograft perfusion following transplantation.

PurPose: Endothelial activation following ischemia-reperfusion injury (IRI) in transplantation triggers the inflammatory cascade, compromising allograft perfusion. Additionally, IRI is a critical factor that contributes to the incidence and severity of both acute and chronic rejection. We have previously demonstrated that mesenchymal stem cells (MSCs) can be seeded into allografts ex vivo where they take up residence in the perivascular space. While conventional expansion of MSCs produces an innate immunomodulatory phenotype, conditions that enhance this phenotype may be utilized to attenuate endothelial failure following ischemic insult during transplantation. We hypothesized that expansion under hypoxic conditions or with inflammatory cytokines primes the immunosuppressive functions of MSCs and improves allograft perfusion subsequent to ex vivo delivery.

Abstract 4: Site Specific Targeting of PUMA Induced ROS Prevents Radiation Injury via a Smad3 Independent Mechanism.

PurPose: Although radiation therapy is an instrumental tool in the treatment of numerous cancers, it is hampered by its detrimental effects on the skin. Namely, impaired wound healing, fibrosis and scarring often requiring surgical intervention. Previously, we have demonstrated that radiation induced PUMA expression and subsequent ROS overproduction is a critical factor in the development of cutaneous fibrosis. However, it is unclear whether this effect is dependent on SMAD3 expression, a central fibrosis pathway. Here, we investigate the downstream molecular mechanism for radiation protection with PUMA knock down in cutaneous radiation injury.

Abstract: Matching into Plastic Surgery

population. Several risk factors have been associated with the development of CTS including, age, body mass index (BMI), pregnancy, and wrist morphology. A single study has identified sleep position as a causative factor in the development of CTS. Our study evaluates the influence of age on the report of nighttime paresthesias and further examines the relationship between sleep position and reports of hand paresthesias.

Platelet Rich Therapy for Facial Rejuvenation: A Systematic Review of the Literature.

www.PRSJournal.com 145 M oday, O cber 19 CONCLUSIONS: The greater the extent of youthfulness the patient achieves, the longer the result will last. The anatomy and surgical approach into the Facial Release Zone will be demonstrated with emphasis on safety to the branches of the facial nerve. The positive aspects are 1) Maximum rejuvenation, 2) Predictable results, 3) Longer lasting, and 4) Avoidance of facelift stigmata. The drawbacks are length of surgery time and limited margin of error due to the proximity of facial nerve branches.

Abstract 152: pharmacologic inhibition of phosphodiesterase 5 as a strategy to improve outcomes in microvascular surgery.

results: PHD2 knockdown in diabetic mouse fibroblasts resulted in enhanced expression of multiple angiogenic factors compared to control shRNA-treated fibroblasts. Diabetic skin wounds treated with PHD2 shRNA were observed to close within 14 ±0.47 days while control shRNA-treated wounds closed at 18 ±1.36 days. Finally, perfusion of ischemic hindlimbs with PHD2 shRNA resulted in decreased muscle necrosis histologically and no distal digit tip necrosis.

Abstract 129: Phosphodiesterase Type 5 Inhibition Enhances The Angiogenic Profile Of Adipose-derived Stem Cells.

ConClusion: Our findings suggest that incorporating paclitaxel in fat grafts for breast reconstruction following primary breast surgery is a viable option for decreasing the risk of local recurrence. 4OH tamoxifen can also be incorporated in fat grafting with ER-positive breast cancer patients. An in-vivo model employing lipoaspirate and cancer cells to test encapsulated chemotherapeutics is currently being developed with encouraging results. Taken together, incorporating encapsulated chemotherapeutic drugs in autologous fat grafts for breast reconstruction procedures is a feasible therapeutic option for breast cancer survivors. 129 Phosphodiesterase type 5 inhibition enhances the angiogenic Profile of adipose-derived Stem cells