Reza Nassab

The Evidence Behind Noninvasive Body Contouring Devices

The demand for body contouring is rapidly increasing, and interest in noninvasive approaches has also grown. The author reviewed the evidence base behind the currently available devices and methods for nonsurgical body contouring. There is little high-level evidence in the present literature to support the effectiveness of any of these devices.

Cosmetic surgery growth and correlations with financial indices: a comparative study of the United Kingdom and United States from 2002-2011.

BACKGROUND Over the past 10 years, there has been significant fluctuation in the yearly growth rates for cosmetic surgery procedures in both the United States and the United Kingdom. OBJECTIVES The authors compare cosmetic surgical procedure rates in the United Kingdom and United States with the macroeconomic climate of each region to determine whether there is a direct relationship between cosmetic surgery rates and economic health. METHODS The authors analyzed annual cosmetic surgery statistics from the British Association of Aesthetic Plastic Surgeons and the American Society for Aesthetic Plastic Surgery for 2002-2011 against economic indices from both regions, including the gross domestic product (GDP), consumer prices indices (CPI), and stock market reports. RESULTS There was a 285.9% increase in the United Kingdom and a 1.1% increase in the United States in the number of procedures performed between 2002 and 2011. There were significant positive correlations between the number of cosmetic procedures performed in the United Kingdom and both the GDP (r = 0.986, P < .01) and CPI (r = 0.955, P < .01). Analysis of the US growth rates failed to show a significant relationship with any indices. UK interest rates showed a significant negative correlation (r = -0.668, P < .05) with procedures performed, whereas US interest rates showed a significant positive correlation. CONCLUSIONS Data from the United States and United Kingdom suggest 2 very different growth patterns in the number of cosmetic surgeries being performed as compared with the economy in each region. Economic indices are accurate indicators of numbers of procedures being performed in the United Kingdom, whereas rates in the United States seem independent of those factors.

Twitter for plastic surgeons.

Integrated plastic surgery programs were not included. Data were obtained from the Accreditation Council for Graduate Medical Education (www.acgme. org) Web site for academic year 2010/2011. There were 17 programs with one resident per year (24 percent), 37 programs with two residents per year (53 percent), 11 programs with three residents per year (16 percent), and four programs with four residents per year (6 percent). Programs with two residents per year were the most common, accounting for 53 percent of all plastic surgery residency programs (chart 1). Of the 17 programs with one resident per year, 16 had a 3-year approval cycle and one had a 4-year approval cycle, for an average of 3.06 years. Of the 37 programs with two residents per year, 30 had a 5-year approval cycle, one had a 4-year approval cycle, and six had a 3-year approval cycle, for an average of 4.24 years. Of the 11 programs with three residents per year, one had a 6-year cycle, five had a 5-year cycle, one had a 4-year cycle, and four had a 3-year cycle, for an average of 3.45 years. Of the four programs with four residents per year, three had a 5-year cycle and one had a 3-year cycle, for an average of 4.5 years (Fig. 1). There is a suggested correlation with program accreditation cycle length and program size. Programs with only one resident per year have the shortest accreditation cycle. Larger programs have longer accreditation cycles, which is evidence of support for larger programs. These differences, although very suggestive, were not statistically significant. The number of years of accreditation approval was analyzed as an ordinal categorical variable. The null hypothesis was that there would be no significant relationship between the number of residents per year or total residents and the number of years of accreditation approval. Data were analyzed using ordinal logistic regression with weighted least squares estimation. Frequency tables were analyzed using Fisher’s exact test. A value of p 0.05 was used for statistical significance. It appears that smaller programs may not be at a statistically significant disadvantage for program accreditation compared with larger programs in plastic surgery. This is comforting and reassuring and validates the fairness of the Residency Review Committee, at least in plastic surgery. DOI: 10.1097/PRS.0b013e31824aa0bc

Presenting Concerns and Surgical Management of Secondary Rhinoplasty

BACKGROUND Secondary rhinoplasty is a challenging surgical procedure, and patients seeking this procedure tend to be difficult to please. However, psychological and functional improvements in patients and high satisfaction rates are achievable with secondary rhinoplasty. OBJECTIVES The authors reviewed a series of secondary rhinoplasties and tabulated patient concerns, underlying deformities, and corrective surgical procedures. METHODS The authors conducted a retrospective review of 109 patients for whom the senior author (B.M.) performed secondary rhinoplasty from 2009 to 2012. Concerns causing the patients to seek surgery and management of the secondary procedures were described. RESULTS The mean patient age at time of surgery was 33.2 years (range, 18-61 years), and most patients (71.6%) were women. The mean number of previous procedures was 1.6 (range, 1-8). Chief presenting concerns were asymmetry (36.7%), large tip (24.8%), and breathing difficulties (22.0%). The most common clinical findings were nostril asymmetry (33.9%), septal deviation (32.1%), overresection (26.6%), and tip asymmetry (26.6%). CONCLUSIONS Patients seeking secondary rhinoplasty present with various concerns. Preoperative identification of the underlying problems and determination of the techniques required to correct them are important to successful secondary procedures. LEVEL OF EVIDENCE 4: Therapeutic.

Fibrosis of diced cartilage wrapped in fascia in rhinoplasty.

The management of the over resected dorsum in rhinoplasty remains a challenge and there exist a number of techniques to address this with varying results and consequences. The techniques that have been described for dorsal augmentation and camouflage include dorsal cartilage grafts, diced cartilage and costal cartilage. The use of costal cartilage is an established technique for correction of saddle nose deformities and reconstruction, however, warping of this graft has long been considered a problem. When less augmentation is required, the use of diced cartilage has been well described. The method of how the diced cartilage is wrapped remains an issue of contention. Erol presented a large series of patients undergoing the ‘Turkish delight’ procedure that involved diced cartilage wrapped in Surgicel. This paper showed very promising long-

Patient support groups for facial disfigurements

Operation Smile was founded in 1982 by a plastic surgeon William Magee. This is an international organisation whose volunteers repair childhood facial deformities in areas where provision of these services would otherwise not be likely. In 2007, they provided 9334 surgeries on children across the world. Operation Smile invest in the creation of foundations in countries. These foundations recruit local medical volunteers, train physicians and raise funds for children with facial deformities. Operation Smile is a registered charity and funding is primarily through donations and fundraising.

Online resources for lymphoedema.

the reconstructed breast footplate. The abdominal closures are frequently tight and usually lower the inframammary folds. It is particularly pronounced in the patients with lower BMIs. Failure to elevate the inframammary folds will create unaesthetic low and flat reconstructed breasts and further exaggerate the volume deficits in these women. Consequently, reconstruction of inframammary folds should be performed before the completion of the flap inset and after the provisional closure of the abdominal wound. In summary, breast reconstruction results can be enhanced by meticulous attention to detail during flap inset (Figure 2). Planning of the lateral flap extension to increase its volume, in-folding the flap to improve shape and projection, multipoint suspension to the chest wall along the upper and lateral perimeter of the breast footplate, routine elevation of the inframammary fold, and lateral reduction of mastectomy pocket, are useful maneuvers that should be

A comparative study of postoperative patient-controlled analgesia use in latissimus dorsi and muscle-sparing latissimus dorsi flaps in breast reconstruction.

175e A Comparative Study of Postoperative Patient-Controlled Analgesia Use in Latissimus Dorsi and Muscle-Sparing Latissimus Dorsi Flaps in Breast Reconstruction Sir: T latissimus dorsi has been the workhorse flap in breast reconstruction for several decades. The flap has a high reliability but is becoming less frequently used because of the recognized limitations of this flap. These disadvantages include functional impairment such as reduced shoulder mobility and strength. The rate of seroma formation has also been reported to be high with traditional latissimus dorsi flaps. We describe the use of the muscle-sparing latissimus dorsi flap within our unit for breast reconstruction. Our technique is a modification of a number of different techniques that have been described previously.1 The lateral segment (6 to 8 cm) of the latissimus dorsi is raised incorporating the descending branch of the thoracodorsal artery and thoracodorsal artery perforators. This is similar to the muscle-sparing latissimus dorsi type II flap as described by Hamdi.2 Our flap includes a fascial envelope, similar to the extended latissimus dorsi flap, that allows full implant coverage and placement of the implant in the prepectoral plane.1 We undertook a retrospective study comparing the muscle-sparing latissimus dorsi and latissimus dorsi flaps over a 2-year period. All muscle-sparing latissimus dorsi procedures were performed by one surgeon and the latissimus dorsi procedures were performed by three surgeons. During this period, 43 patients underwent surgery; 21 of the patients underwent muscle-sparing latissimus dorsi flap surgery and 22 of the patients underwent latissimus dorsi flap surgery. The muscle-sparing latissimus dorsi flap group comprised 15 unilateral and six bilateral reconstructions. The latissimus dorsi group consisted of 20 unilateral and two bilateral cases. The mean age for all patients was 51.9 years. The majority of cases (81.4 percent) were delayed reconstructions. We reviewed patient drug charts for total patient-controlled analgesia use postoperatively. This was then adjusted for patient weight to allow comparison. Total postoperative donor-site drainage was also noted. Statistical analysis was performed using independent samples t tests to allow comparison of the muscle-sparing latissimus dorsi and latissimus dorsi flap groups. There was no statistical difference in operative times for unilateral latissimus dorsi and muscle-sparing latissimus dorsi flap reconstructions (latissimus dorsi, 4.80 hours; muscle-sparing latissimus dorsi, 4.53 hours). There was a statistically significant difference in the mean total patient-controlled analgesia use between the unilateral latissimus dorsi and muscle-sparing latissimus dorsi flap reconstructions (0.935 mg/kg versus 0.498 mg/kg, respectively; p < 0.05) (Table 1). There was also a significant difference in terms of postoperative drainage using the two techniques (Table 2). This consequently translates to a shorter hospital stay in the Stefan J. Cano, Ph.D. Clinical Neurology Research Group Plymouth University Peninsula School of Medicine and Dentistry Plymouth, United Kingdom