Samer Jabbour

Botulinum Toxin for the Treatment of Excessive Gingival Display: A Systematic Review

BACKGROUND To date, no standardized minimally invasive approach for the treatment of excessive gingival display exists. OBJECTIVES This systematic review aims to assess the evidence in the literature regarding the role of botulinum toxin injection in the management of gummy smile. METHODS All publications through December 2014 and pertaining to the subject were electronically searched in PubMed, Embase, Scopus, and Web of Science, and the bibliographies of retrieved articles were manually screened. RESULTS Out of 33 articles, 29 were discarded based on exclusion criteria. Although all 4 selected articles were in line with a role for botulinum toxin injection in the treatment of gummy smiles and the importance of targeting the levator labii superioris alaeque nasi muscle, studies differed in the type and the dose of toxin administered and the technique adopted. CONCLUSIONS Injection with botulinum toxin is a novel, safe, and cosmetically effective treatment for gummy smile when performed by experienced practitioners. However, further randomized controlled trials are warranted. LEVEL OF EVIDENCE 4: Therapeutic.

Does the Addition of Progressive Tension Sutures to Drains Reduce Seroma Incidence After Abdominoplasty? A Systematic Review and Meta-Analysis

Background Progressive tension sutures (PTS) are commonly utilized to reduce postoperative seroma in abdominoplasty. However, current evidence regarding PTS in abdominoplasty is limited to small series and the findings of single institutions. Objectives The authors reviewed the available literature concerning the effects of PTS and drains on seroma formation following abdominoplasty, and summarized the different techniques that have been described to date. Methods We conducted a systematic review of the Medline, Embase, and Cochrane databases. We identified randomized controlled trials (RCTs) and observational studies in which the numbers of patients who had postoperative seroma were indicated. We applied the Cochrane Collaborations tool for assessing the risk of bias. Results Seven studies were included (three RCTs and four retrospective studies). Patients who had PTS and drains following abdominoplasty had a significantly lower rate of postoperative seroma than those who had drains only. The mean surgical time difference between the two groups was 23 minutes. There was no difference in postoperative seroma rate in patients who had PTS and drains placed following abdominoplasty compared to those who had PTS only. Conclusions Addition of PTS to drains reduces the risk of postoperative seroma in standard abdominoplasty. More RCTs with larger sample sizes and better comparability are warranted to confirm with more confidence the impact of PTS in abdominoplasty. Level of Evidence 2![Graphic][1] Therapeutic [1]: /embed/inline-graphic-1.gifBackground Progressive tension sutures (PTS) are commonly utilized to reduce postoperative seroma in abdominoplasty. However, current evidence regarding PTS in abdominoplasty is limited to small series and the findings of single institutions. Objectives The authors reviewed the available literature concerning the effects of PTS and drains on seroma formation following abdominoplasty, and summarized the different techniques that have been described to date. Methods We conducted a systematic review of the Medline, Embase, and Cochrane databases. We identified randomized controlled trials (RCTs) and observational studies in which the numbers of patients who had postoperative seroma were indicated. We applied the Cochrane Collaborations tool for assessing the risk of bias. Results Seven studies were included (three RCTs and four retrospective studies). Patients who had PTS and drains following abdominoplasty had a significantly lower rate of postoperative seroma than those who had drains only. The mean surgical time difference between the two groups was 23 minutes. There was no difference in postoperative seroma rate in patients who had PTS and drains placed following abdominoplasty compared to those who had PTS only. Conclusions Addition of PTS to drains reduces the risk of postoperative seroma in standard abdominoplasty. More RCTs with larger sample sizes and better comparability are warranted to confirm with more confidence the impact of PTS in abdominoplasty. Level of Evidence 2

Comparison of microwave ablation, botulinum toxin injection, and liposuction-curettage in the treatment of axillary hyperhidrosis: A systematic review

Background: Primary focal axillary hyperhidrosis is a disorder of excessive sweating that can strongly impact quality of life. Objective: The objective if this study was to compare microwave ablation (MA), botulinum toxin (BT) injection, and liposuction-curettage (LC) in the treatment of primary axillary hyperhidrosis based on subjective and objective criteria. Methods: A systematic review of the literature published in French or English between 1 January 1991 and 1 February 2015 was completed using PubMed and Embase databases. Results: 16 of 775 articles were selected based on relevance and criteria of inclusion and exclusion. The three methods proved to be efficient and safe; however, MA and BT had better results when compared to LC in the short term. Both MA and LC showed longer lasting results when compared to BT. However, in the long term, MA was superior to LC. Conclusion: MA, LC, and BT injections are safe and efficient minimally invasive alternatives for the treatment of axillary hyperhidrosis. Well-designed randomized controlled trials are needed to further compare the efficacy of these techniques.

Effect of Tissue Adhesives on Seroma Incidence After Abdominoplasty: A Systematic Review and Meta-Analysis.

BACKGROUND Tissue adhesives (TAs) are widely utilized in abdominoplasty to reduce postoperative seroma. However, current literature regarding TAs in abdominoplasty is limited to small studies and the findings of single institutions. OBJECTIVES The authors reviewed the current literature regarding the effects of TAs on seroma formation and other endpoints following abdominoplasty, and summarized the types of TAs and application techniques that have been described to date. METHODS A systematic review of the Medline, Embase, Web of Science, and Cochrane databases was conducted to identify randomized controlled trials (RCTs) in which the numbers of patients who experienced seroma after abdominoplasty were indicated. The Cochrane Collaborations tool for assessing risk of bias was applied. RESULTS Seven studies were included in a descriptive review, 5 of which were RCTs. Data from the 5 RCTs were pooled for a meta-analysis. Patients who received TAs following abdominoplasty had a similar incidence of seroma compared with patients who did not receive TAs. However, the total drainage volume was significantly lower for patients who received TAs. CONCLUSIONS There is a paucity of high-quality evidence to support the delivery of TAs to prevent seroma formation after abdominoplasty. Well-designed RCTs are needed to assess with confidence the overall effects of TAs in abdominoplasty. LEVEL OF EVIDENCE 2 Therapeutic.

Labia Majora Augmentation: A Systematic Review of the Literature.

Background Currently, there is no standardized approach for labia majora augmentation and controversies still exist regarding this subject. Objectives This systematic review aimed to assess the evidence in the literature regarding labia majora augmentation. Methods On November 20, 2016, we conducted an online search of published articles in the Medline, Embase, and Cochrane databases. All articles describing labia majora augmentation were included in this review. Results Nine studies were selected for inclusion in the systematic review. Only 2 studies were prospective trials. The most commonly used technique was fat grafting with a total of 4 articles and 183 patients. The mean total injected fat volume ranged from 18 mL to 120 mL per session. Two articles described hyaluronic acid injection techniques. The total injected volume of hyaluronic acid ranged from 2 to 6 mL per session. Three articles used surgical techniques for labia majora augmentation. All included articles did not report any major or life-threatening complications. All techniques demonstrated high satisfaction rates. Conclusions Labia majora augmentation appears to be a safe, efficient technique with a high satisfaction rate and no reported major complications. However, further randomized controlled trials are warranted. Level of Evidence 4.

Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection

Background: The “Nefertiti lift” consists of injecting the platysmal bands and the inferior border of the mandible with botulinum toxin. No clinical trial has evaluated its effect on the different lower face and neck aging components, and little is known about the clinical characteristics that predict treatment success. Methods: Patients were injected with abobotulinumtoxinA along the inferior border of the mandible and into the platysmal bands. Using standardized preinjection and postinjection photographs, the jowls, marionette lines, oral commissures, neck volume, and platysmal bands at maximal contraction and at rest were assessed with validated photonumeric scales. In addition, the overall appearance of the lower face and neck was evaluated by the Investigators and Subjects Global Aesthetic Improvement Score. Pain and patient satisfaction rates were also evaluated. Results: Thirty patients were injected with a mean dose of 124.9 U of abobotulinumtoxinA per patient. Platysmal bands at rest and with maximal tension reached a statistically significant improvement. The other components showed a tendency for improvement but did not reach statistical significance; 93.3 percent of investigators and patients rated the overall results as improved, and 96.6 percent of patients were satisfied with their results. When comparing the patients who improved the most to all the other patients, they had lower preinjection region-specific scores. Conclusions: The Nefertiti lift can be used on its own or in conjunction with other rejuvenating procedures. It is particularly helpful in younger patients with platysma muscle hyperactivity and retained skin elasticity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm.

BACKGROUND Chondrodermatitis nodularis helicis (CNH) is an idiopathic benign inflammatory painful condition of the ear. Still, to date, no study has yet evaluated nor compared treatments regarding their safety and efficacy. OBJECTIVE The objective of this study is to review all available treatment modalities of CNH that were described in the literature, compare their efficacy and propose a treatment algorithm. METHODS AND MATERIALS A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. Articles studying the management of CNH that reported data on the cure rates were included in this review. RESULTS A total of 29 studies were included in the review. The 3 most commonly reported treatments for CNH are surgery, pressure relief, and topical nitroglycerin. Surgery has higher cure rate (82%) compared with pressure relief treatment (37%) or nitroglycerin (51%) (p < .0001). Surgery should be considered as the first-line treatment for CNH. Second-line treatments include nonsurgical therapies, particularly nitroglycerin and pressure relief techniques, alone or in combination. Third-line treatments include newer or less studied methods. CONCLUSION Among the treatment modalities, surgery showed the highest cure rates. Adequately designed randomized controlled trials are warranted to compare newer therapeutic methods.

Abstract: Lower Body Lift in the Massive Weight Loss Patient

videos was 13.1 (SE = .18) out of a possible 26. The videos found under the search “nose reshaping” had the lowest mean score (10.24 SE = .74) while “eyelid surgery” and “buttock lift” had the highest (14.36 SE = .83, 14.36 SE = .70). Videos with physician authorship, (59% of included videos), were found to have a higher mean EQIP score and video views than those posted by patients.. Whether the search term used was the appropriate medical terminology for the procedure or a non-expert description, such as “otoplasty” versus “ear surgery,” influenced how many of the top 50 videos were relevant to plastic surgery and the average EQIP score for that search.

Botulinum Toxin for Eyebrow Shaping: A Systematic Review

BACKGROUND Currently, there is no standardized approach for eyebrow shaping with botulinum toxin, and controversies still exist regarding this subject. OBJECTIVE The objective of this systematic review is to summarize and compare all the published data regarding eyebrow shaping with botulinum toxin. METHODS On March 10, 2017, an online search of published articles in the Medline, Embase, and Cochrane databases were conducted. All articles that used objective measurements to quantify the eyebrow changes after botulinum toxin injection were included in this review. RESULTS Eleven studies were selected for inclusion with a total of 585 patients. All the included studies used onabotulinumtoxin A. Seven studies injected both the lateral and the medial eyebrow depressors, 2 studies injected the lateral depressors alone, and 2 studies injected the medial depressors alone. The highest elevation was observed in the lateral brow (0.4–4.8 mm). Bruising and headache were the most frequently reported complications, and only 5 cases of eyelid ptosis were noted. CONCLUSION Botulinum toxin injection for eyebrow shaping is a noninvasive, safe, and reproducible procedure. Eyebrow reshaping can be achieved by targeting different muscle groups. However, further randomized controlled trials are warranted.

Smartphone-Based Patient Education in Plastic Surgery

Background Internet use for health information has dramatically increased in the past decade. Mobile medical applications (MMAs) could be a useful tool to improve postoperative patient education and care. The objective of this study is to evaluate the impact of an MMA on patient care in plastic surgery. Methods An MMA was developed to improve postoperative plastic surgery patients care. All patients who underwent surgery at our plastic surgery department between August and November 2014 and were willing to download the MMA were included. Two to 4 weeks after the procedure, the patients were asked to fill a questionnaire that assessed the content, design, and efficacy of the application. Results Sixty patients were included. The patients reported that their questions regarding the postoperative management were addressed by the application with a mean score of 4.1 over 5. Most patients would recommend the application to other plastic surgery patients with a mean score of 4.6 over 5. The application prevented 12 patients (20%) from calling the plastic surgeon or the emergency department. Conclusions A smartphone application can optimize the plastic surgery patient care. It can provide additional information allowing the patients to get involved in their own medical care.