Mario Goisis

Reconstruction of the orbital walls in surgery of the skull base for benign neoplasms

Surgery for benign neoplasm extending into the orbital roof requires immediate reconstruction to avoid complications, which include transmission of the cerebral pulse to the globe, bulbar dystopia, diplopia, and fibrosis of the oculomotor muscles. Many alloplastic materials have been employed for such reconstruction, but currently most authors agree that autologous bone graft is the best option. Using calvarial bone in adults and split ribs in children, we have operated on eight patients for fibrous dysplasia (five cases), neurofibroma (two cases), or meningioma (one case). After a median follow-up period of two years and six months, good morphology of the orbit was maintained with no ocular symptoms.

Fibrous dysplasia of the orbital region: Current clinical perspectives in ophthalmology and cranio-maxillofacial surgery

Purpose: To describe the multidisciplinary diagnosis and treatment of patients with orbital fibrous dysplasia, a slowly progressive disease that may lead to asymmetry, disfigurement, and functional ocular problems. Methods: Ten patients with orbital fibrous dysplasia underwent bifrontal craniotomy through a coronal flap, with the removal of the supraorbital arch and dysplastic process involving the anterior and middle base of the skull. Four patients underwent superior orbital fissure and optic nerve canal decompression. Reconstruction was performed by using an autologous bone graft for both the adults and children, in whom a rib graft was preferred. The mean follow-up was 53.2 ± 18.3 months (range, 14 to 94 months). The patients’ preoperative status and postoperative status were compared. Results: The immediate and long-term morphologic and aesthetic results were good in all cases. All of the patients complained of some degree of diplopia during the immediate postoperative period, but the problem spontaneously resolved within 1 to 6 months in all but one case. No postoperative reduction in visual function was observed in the patients who underwent optic nerve decompression. The only reported complication was the irregular reabsorption of regrafted dysplastic bone in one patient. Conclusions: A multidisciplinary approach to orbital fibrous dysplasia is fundamental for treatment planning and execution.

Is Hyaluronic Acid Gel a Good Option for Breast Augmentation

To the Editor: Although nonanimal stabilized hyaluronic acid (NASHA) has not been approved for use in breast augmentation by the Federal Drug Administration (FDA), a great number of patients have been treated by this approach in Europe, South Korea, and Japan. To stimulate discussion about this procedure, which is becoming very common, we report our experience. In the past 19 months, 207 patients underwent breast augmentation with NASHA gel in our clinic using Macrolane VRF 30 (Q-Med AB, Uppsala, Sweden). The material is implanted using a minimally invasive procedure with the patient under local anesthesia. This approach results in a shorter recovery time than traditional surgical methods. Macrolane gave satisfactory natural-appearing cosmetic results for the majority of breasts treated (Fig. 1). As hyaluronic acid is degraded naturally and gradually, possible problems associated with permanent fillers, such as the permanency of technical errors or migration, are not applicable. Nevertheless, three major questions emerged from our experience. The first question relates to the duration and cost of Macrolane. Macrolane is a resorbable material, and the study of Heden et al. [1] published in Aesthetic Plastic Surgery showed 30% to 50% resorption at 12 months. Our echographic measurements showed a 60% rate of resorption at 1 year. Consequently, a second treatment usually was performed 9 months after the first treatment. The necessity of a touch-up increases the cost of breast augmentation with NASHA gel, which is as expensive as a single surgical treatment with a prosthesis after three or four touch-ups. The second question relates to the radiologic evaluation of patients. Macrolane is a new material that constitutes a diagnostic challenge for radiologists. Indeed, the appearance of NASHA gel may mimic a cyst on mammography and sonography [1]. Therefore, it is important that radiologists become familiar with the spectrum of imaging findings for Macrolane. In particular, to make an accurate diagnosis for these patients, it is important to send them to reference radiologic centers. The last open question is related to posttreatment adverse events. We did not experience any complications so severe that they required surgical removal of the product. Nevertheless, we had a high rate of minor complications. In particular, 47% of the patients had multiple lumps that disappeared completely within 30 days of treatment in 92% of the cases (Fig. 2). For seven patients, the lumps were removed by direct aspiration. Baker 2 and 3 capsule formation developed in 10 of the treated breasts. The treatment of the capsule required external manipulation (closed capsulotomy) for seven breasts and capsulotomies with a blunt cannula for three breasts. In conclusion, NASHA gel for breast volume augmentation is an interesting treatment, but the three open questions require additional studies.

Gluteal Augmentation and Remodeling

Gluteal augmentation and remodeling are generally sought by patients who desire a fuller buttock or curvier appearance. Gluteal contour defects are common and may be related to a deficiency in gluteal mass, loss of fat in the buttock area, or in the shape of the lower spine.

Fillers in Aesthetic Medicine

The pursuit of beauty and the effort to reverse the effects of ageing dates back to many centuries. Facial volume depletion and facial rhytids are a natural and inevitable part of ageing.