Kian Karimi

Progressive nodular histiocytosis: a case report with literature review, and discussion of differential diagnosis and classification.

Histiocytoses are a heterogeneous group of disorders which are difficult to categorize because of overlapping clinical and microscopic features, and incompletely understood mechanisms of cellular origin and triggers of proliferation. Progressive nodular histiocytosis (PNH) is a rare non‐Langerhans cell histiocytic (NLH) disorder. We present the case of a 34‐year‐old woman with PNH, who has involvement of the back, head and neck, face, and uniquely, extensive involvement of the posterior pharynx and larynx, which has shown progressive worsening and deformity over a 7‐year course. Clinically it is best classified as PNH, although it microscopically closely resembles juvenile and adult xanthogranulomatosis. This study reinforces the concept that the NLH is a closely related group of disorders, possibly representing a spectrum of a single underlying process.

Isolated congenital absence of the left lower lateral cartilage.

Introduction: Congenital defects of the nasal cartilaginous skeleton are rare, yet clinically relevant, entities that are important to recognize prior to operative repair Methods: A 47 year old woman was referred to our institution for lifelong leftsided nasal airway obstruction. On physical examination, a complete absence of the left lower lateral cartilage was suspected. Hypothesis: Complete congenital absence of the lower lateral cartilage Results: External approach rhinoplasty confirmed the above hypothesis, and reconstruction was performed with autologous septal cartilage. Conclusions: Careful history and physical examination is important in preoperative planning of nasal surgery. External rhinoplasty approach Isolated complete absence of left lower lateral cartilage identified (Figure 2a) Septal cartilage harvested Septal extension graft replaced the left medial crura Lateral crural strut graft replaced the left lateral crura Shield graft to orient and help reconstitute the tip Left domal onlay graft to emphasize left tip highlight Patient pleased with functional and aesthetic outcome Surgical Approach and Results 1. Losee JE, Kirschner RE, Whitaker LA, et al. Congenital nasal anomalies: a classification scheme. Plast Reconstr Surg 2004;113:676-689. 2. Bilkay U, Tokat C, Ozek C. Reconstruction of congenital absent columella. J Craniofac Surg 2004;15(1): 60-63. 3. Mavili ME, Akyurek M. Congenital isolated absence of the nasal columella: reconstruction with an internal nasal vestibular skin flap and bilateral labial mucosa flaps. Plast Reconstr Surg 2000;106(2):393 -399. 4. Yilmaz MD, Altunas A. Congenital vomeral bone defect. Am J Otolaryngol 2005;26(1):64-66. 5. Klinger M. Caviggioli, Klinger F, et al. Isolated congenital absence of the nasal bones and aesthetic surgical correction: managing and case report. Aesth Plast Surg 2005;29(4):246-249. References 47 year old otherwise healthy Latin American female Lifelong left sided nasal airway obstruction No prior facial trauma or surgery Exam showed mild septal deviation, profound nostril asymmetry, and the absence of any palpable cartilage within left side of the nasal tip (Figure 1) Case Presentation Figure 2a. Complete absence of lower lateral cartilage on the left. Figure 2b. Surgical repair with septal extension, lateral crural strut, and domal onlay grafts. Isolated, non-syndromic cases of absent nasal structures is exceedingly rare. No previous reports exist of isolated absence of a lower lateral cartilage. May occur after fusion of mesenchymal components by 10th week of gestation from vascular accident or pressure phenomenon. Despite its rarity, this anomaly reinforces the importance of careful pre-rhinoplasty analysis and familiarity with principles of open structure rhinoplasty. Conclusions Introduction History and physical examination are crucial to appropriate pre-operative planning of functional and cosmetic rhinoplasty Externally, special attention is paid to the characteristics of the skin-soft tissue envelope, the nasal bones, middle nasal vault, and the lower lateral cartilages. Internally, examination of the septum, the internal and external nasal valves, nasal sidewalls, inferior turbinates and the nasal mucosa. Congenital anomalies of the nose can be responsible for nasal airway obstruction and are present in 1/20,000 to 1/40,000 births Figure 1. Asymmetry of external nose noted with basal and frontal views.

The Spectrum of Isolated Congenital Nasal Deformities Resembling the Cleft Lip Nasal Morphology

OBJECTIVE To define the intrinsic (hypoplasia) and extrinsic (deformational) contributions to congenital nasal deformities and the potential of a carrier state for orofacial clefting. METHODS Retrospective case series. RESULTS The factors affecting 4 congenital nasal deformities are postulated after contrasting the patients characteristics. CONCLUSIONS The spectrum of congenital nasal deformities includes those that resemble the cleft lip nasal deformity, but careful inspection is needed for proper classification. Classifying congenital nasal deformities can be difficult in part due to the highly variable normal range. The most minor form of the typical unilateral cleft lip nasal deformity is the microform cleft. The potential of an isolated cleft lip nasal deformity without obvious cleft lip has been previously suggested to represent a carrier state for orofacial clefting. Definitive genetic studies and continued anthropometric documentation in relatives of patients with orofacial clefts are needed if we are to uncover previously unidentified associations, and a potential carrier state.

Ethical Considerations in Aesthetic Rhinoplasty: A Survey, Critical Analysis, and Review

Although the practice of medicine is built on a foundation of ethics, science, and common sense, the increasing complexity of medical interventions, social interactions, and societal norms of behavior challenges the ethical practice of aesthetic surgeons. We report a survey of the opinions, practices, and attitudes of experienced and novice facial plastic surgeons. The survey consisted of 15 clinical vignettes addressing ethical quandaries in aesthetic rhinoplasty. The vignettes are based on the experience and observations of the senior author (P.A.A.) over nearly 30 years of practice and teaching. Fellowship directors and facial plastic surgery fellows of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed anonymously. Five of the 15 vignettes demonstrated significant differences between the responses of the fellowship directors and the fellows. No single vignette had a unanimous consensus in either group. Aesthetic rhinoplasty surgeons encounter ethical issues that should be reflected on by both experienced and inexperienced facial plastic surgeons, preferably before being faced with them in practice. We present a practical approach to ethical issues in clinical practice. Our survey can also be used as a stimulus for further discussion and teaching.

Nasopharyngeal amyloidosis: a case report.

Nasopharygeal amyloidosis is a rare entity described in the otolaryngology literature. It is usually isolated and does not represent a manifestation of systemic disease. Herein we discuss the first reported case of incidentally discovered nasopharyngeal amyloidosis leading to the diagnosis of systemic disease. A patient presented to the otolaryngology clinic with complaints of otalgia and eustachian tube dysfunction. He was noted to have a unilateral middle ear effusion and subsequent nasolaryngoscopy demonstrated a right nasopharyngeal mass at the eustachian tube orifice--this was biopsied and shown to be nasopharyngeal amyloidosis. Amyloidis is a condition which entails the abnormal deposition of proteins in tissue (local) and organs (systemic) throughout the body secondary to an alteration in the secondary structure of the protein into an insoluble form, termed amyloid. Amyloidosis in the head and neck most often presents in the larynx (60%), followed by the trachea (9%), orbit (4%), and nasopharynx (3%). The vast majority of these lesions represent isolated amyloidosis, which is not associated with a shortened lifespan or the sequelae associated with systemic disease. Treatment of local disease is typically excision followed by routine surveillance for recurrence. Treatment of systemic disease is complex, and should be managed by a Hematologist/Oncologist. Amyloidosis can be associated with malignancy, thus proper workup is important even when isolated lesions are discovered.

Patient Analysis and Selection in Aging Face Surgery

Advances in health, increased awareness of preventative medicine, and evolution have led to an increasingly older population worldwide. Surgical aesthetic facial rejuvenation has become increasingly popular, more accessible, and has lost much of the stigma that it once carried. This review will discuss proper patient analysis and selection for aging face surgery, including medical, anatomic, and psychosocial factors that are involved. Although the novice facial plastic surgeon typically focuses on facial analysis and operative techniques in aging face surgery, we caution that the patients expectations, psychosocial comorbidities, and perioperative interpersonal experiences are the most important factors that yield patient satisfaction, which is the prime outcome that is meaningful in elective cosmetic surgery.

Laryngeal Involvement in Progressive Nodular Histiocytosis: A Case Report

Progressive nodular histiocytosis (PNH) belongs to an exceedingly rare family of benign proliferative skin disorders known as non-Langerhans cell histiocytoses (NLCHs). Since initial description as progressive nodular histiocytoma by Taunton et al 1 in 1978, there have been only a handful of case reports describing this rare entity. In the past, there has been a great deal of confusion in classifying the various histiocytoses owing to the rarity in which they were encountered as well as to the tremendous overlap, both clinically and histologically, observed between these diseases. 2 The lesions encountered in this family of diseases are generally benign; however, in the case reported herein, the involvement of the larynx led to partial airway obstruction, a clinical occurrence previously undescribed (to our knowledge).

Microcannula Utilization for Injectable Facial Fillers: Standard of Care?

The microcannula technique has become an increasingly popular method for injecting cosmetic fillers. Previous studies have illustrated that the microcannula technique allows filler to be injected with less pain, swelling, and essentially no bruising. This study is a retrospective clinical series examining 247 patients who have undergone dermal filler injections using the microcannula technique from 2011 to 2016 with a single injector, Kian Karimi. The purpose of this study is to assess the frequency of adverse events associated with injections such as bruising and swelling. All 666 recorded patient visits from 2011 to 2016 were analyzed using electronic medical records based on the criteria that the patients had cosmetic filler using the microcannula technique by the surgeon investigator. Of the 666 filler treatments using the microcannula technique, 3 treatments (0.5%) produced adverse events on the day of service, and 32 treatments (4.8%) produced adverse events at 2-week follow-up. In total, 5.4% of treatments produced adverse events. At the 2-week follow-up, 5.7% of treatments using the 25-gauge microcannula produced adverse events (P = .830); 3.9% of treatments using the 27-gauge microcannula produced adverse events (P = .612]). Only 3 patients were treated with the 30-gauge microcannula, and 1 patient reported adverse events on the day of service. None of the treatments using the 30-gauge microcannula produced adverse events at the 2-week follow-up (P = .160). The data support that the microcannula technique is a safe and effective alternative to hypodermic needles for the injection of dermal filler to minimize common adverse events.

A single-center, pilot study evaluating a novel TriHex peptide- and botanical-containing eye treatment compared to baseline

Topical treatments containing tripeptide and hexapeptide (TriHex technology) have been proven to contribute to youthful skin by clearing the extracellular matrix and stimulating collagen and elastin production.

Technique for Nonsurgical Lifting Procedures Using Polydioxanone Threads

Although surgical techniques are effective for correction of sagging tissues of the midface and lower third, nonsurgical or “minimally invasive” modalities have become popular in the United States and have seen an increase in demand over the past several years.1 Threads have been used to perform lifting procedures for more than 3 decades, dating back to the Aptos thread technique described in 1998, which used permanent polypropylene threads to lift tissues of the midface and jowls.2 The experience with “thread lifting” in the United States has been poor. The Contour Threadlift system (Surgical Specialties Corp) was approved by the US Food and Drug Administration (FDA) in 2005. Composed of polypropylene, these were used to perform thousands of thread lifting procedures. The procedures resulted in high rates of complications and patient dissatisfaction, and the threads were difficult to remove. Multiple studies also looked at the results and complication rates of these threads and discouraged physicians from using them.3,4 These threads were eventually removed from the market, leaving both patients and aesthetic physicians with a negative impression of thread use for lifting. Recently, a subcutaneous and knotless technique with polydioxanone (PDO) has been described for office-based lifting of the soft tissues of the skin and body.5 This method, popular in many countries worldwide, has not previously been used or described in the United States. Polydioxanone is a safe and reliable suture; it has been used in the United States and worldwide for more than 3 decades and currently holds FDA indication for approximation of the soft tissues of the face and body.