Seyhan Çenetoğlu

Facial resurfacing in Xeroderma pigmentosum with monoblock full-thickness skin graft

A case of xeroderma pigmentosum with multiple skin tumors on the face that was treated with total excision and replacement of face skin except the eyelids with a monoblock full-thickness abdominal skin graft is reported. The quality and tumor-free features of the monoblock full-thickness skin graft in xeroderma pigmentosum are indicated. Despite the increased morbidity of the donor region, the radical surgical approach advocated here has improved the prognosis in the case reported.

Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face

The combination of chemical peeling and dermabrasion for the improvement of facial wrinkles, acne, posttraumatic scars, and abnormal pigmentation was first described by Dupont in 1972 and Horton in 1984. We have been using the combined technique since 1972, and we have obtained more satisfying results than by using these techniques independently. The purpose of this paper is to summarize the results obtained using the combined technique of chemical peeling and dermabrasion and to emphasize a simple method of postoperative care that can be applied after any physical or chemical rejuvenation technique. Whereas the combined technique takes advantage of depth-controlled surgery, less bleeding, less postoperative pain, less risk of local and systemic complications, and longer lasting results, the covering of the wound with one layer of fine mesh gauze is another advantage that provides easy postoperative care.

Histologic Profiles of Breast Reduction Specimens

Abstract. Reduction mammaplasty is one of the most common procedures performed by plastic surgeons all around the world. This procedure is performed for aesthetic or reconstructive purposes, but also offers the opportunity to examine all resected breast tissue histopathologically. The purpose of this study was to evaluate the histologic diagnoses of the reduction mammaplasty specimens retrospectively and to determine the incidence of breast lesions in otherwise asymptomatic and healthy women. Therefore, 149 patients who had undergone reduction mammaplasty were reviewed with regard to their histologic diagnoses. We found that 61% of these women have pathologic alterations in at least one of their breasts, so each patient who requests a breast reduction surgery should be evaluated carefully and the specimens should be handled with particular care.

The Effect of Microneedle Thickness on Pain During Minimally Invasive Facial Procedures: A Clinical Study

BACKGROUND Minimally invasive procedures are becoming increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. The choice of needle for minimally invasive procedures can be a major factor in the patients comfort level, which in turn affects the physicians comfort level. OBJECTIVES In this comparative study, the authors assessed levels of pain and bruising after participants were injected with 30-gauge or 33-gauge (G) microneedles, which are commonly used for minimally invasive injection procedures. METHODS Twenty healthy volunteers were recruited for this prospective study. Eight injection points (4 on each side of the face) were determined for each patient. All participants received injections of saline with both microneedles in a randomized, blinded fashion. Levels of pain and bruising were assessed and analyzed for significance. RESULTS The highest level of pain was in the malar region, and the lowest level was in the glabella. Although all pain scores were lower for the 33-G microneedle, the difference was significant only for the forehead. Because most minimally invasive procedures require multiple injections during the same sitting, the overall procedure was evaluated as well. Assessment of the multiple-injection process demonstrated a significant difference in pain level, favoring the 33-G needle. Although the difference in bruising was not statistically significant between the 2 needles, the degree of bruising was lower with the 33-G needle. CONCLUSIONS For procedures that involve multiple injections to the face (such as mesotherapy and injection of botulinum toxin A), thinner needles result in less pain, making the overall experience more comfortable for the patient and the physician. LEVEL OF EVIDENCE 3.

Proper timing of breast reduction during the menstrual cycle.

Breasts are known to show cyclic changes in accordance with the menstrual cycle, and speculations have been made regarding the ideal timing of breast surgery in this extent, but the clinical evidence to support global acceptance and application is lacking. This study was designed to establish the relationship of intraoperative bleeding and postoperative drainage with the menstrual period of 35 reduction mammaplasty patients. The results indicate that both perioperative blood loss and postoperative drainage were significantly reduced when breast reduction is performed during the periovulatory phase compared with the perimenstrual phase. The authors strongly recommend the interval between days 8 and 20 of the menstrual cycle as a more convenient period to perform breast reduction. Drains may be avoided during this period, but they are preferred if the surgery is done during the perimenstrual phase.

Distally based lateral and medial leg adipofascial flaps : Need for caution with old, diabetic patients

Background: Reconstruction of defects around the ankle region has always been challenging for plastic surgeons. Distally based lateral and medial leg adipofascial flaps are among the flaps of choice for coverage of this difficult region. Presented here is the authors’ clinical experience with these flaps, particularly emphasizing the complicated attempts in diabetic patients. Methods: Seven skin defects around the ankle were reconstructed with lateral and medial leg adipofascial flaps. The lowermost perforators of the peroneal or posterior tibial artery were identified preoperatively, and a straight incision through skin only was made proximal to this perforator. With the skin flaps reflected, the adipofascial flap was than raised in the subfascial plane. The perforators to be retained in the base were located and the flap was then turned over to cover the defect, followed by application of a split-thickness skin graft over the flap. The donor site was closed primarily. Results: The ages of the patients ranged from 25 to 80 years, and the size of the flaps ranged from 3 × 5 cm to 7 × 10 cm. Four defects were reconstructed with lateral leg adipofascial flaps, and medial leg adipofascial flaps were used in three. Two flaps healed uneventfully. Partial or total graft loss and partial flap necrosis were observed in five patients, four of whom were diabetic. Conclusions: Leg adipofascial flaps offer a valuable option for repair of defects around the ankle in many cases. However, adipofascial flaps should be used with caution in old, diabetic patients and, when performed, the probability of a second or third procedure should be considered.

Topical lignocaine gel for split-thickness skin graft donor-site pain management.

urethra and a dorsal skin-lined socket for a removable prosthesis. Ann. Plast. Surg. 16: 235, 1986. 4. He, Q. L., Lin, Z. H., Liu, Q., et al. One-stage penis reconstruction with the abdominal fasciocutaneous flap based on the double arteries. Chin. Med. J.(Engl.) 100: 255, 1987. 5. Hage, J. J. Phalloplasty (Letter). Br. J. Plast. Surg. 45: 487, 1992. 6. Harashina, T. Reconstruction of the penis with a free deltoid flap (Letter). Br. J. Plast. Surg. 45: 254, 1992.

Vascularized double-sided preputial island flap with W flap glanuloplasty for hypospadias repair.

&NA; Hypospadias surgery is one of the most challenging surgical interventions that still need further refinements for increased success rates. During the last 5 years, we operated on 26 mid‐penile or proximal hypospadias cases by using vascularized double‐sided preputial island flap and W flap glanuloplasty to achieve superior functional and aesthetic results. Follow‐up period of the patients revealed a 92.3 percent success rate with a single operation. Two cases developed fistula, which was located at the proximal anastomosis site. However, they were repaired in a second sitting without any additional problem. The basic aim in hypospadias surgery is the correction of chordee, reconstruction of urethra, and sufficient ventral penile skin coverage in one stage with minimal complication. The use of vascularized tissue for urethral reconstruction and ventral coverage is believed to have a superior healing capacity with better functional and cosmetic outcome. On the other hand, adding W flap glanuloplasty to this technique avoids the risk of meatal stenosis. We conclude that by combining the two above‐mentioned techniques, it is possible to cope better with this devastating congenital deformity.

A Severe Acute Hypersensitivity Reaction after a Hyaluronic Acid with Lidocaine Filler Injection to the Lip

A 27-year-old woman requesting lip augmentation presented to our clinic (Figs. 1, ​,2).2). She had not been treated previously with any dermal filler. She was generally healthy and had no signs of active soft tissue infection, cheilitis, or herpes simplex lesions around her perioral area and face. She was not using any medication or herbal supplements (such as vitamin E, ginseng, ginger, or ginkgo biloba). Overall, she seemed to be an ideal candidate for lip augmentation using fillers. Before injection, written informed consent was obtained from the patient. According to standard procedure, EMLA (AstraZeneca PLC, London, UK) cream and cooling packs were applied to the perioral area ten minutes prior to injection. Mucosal and skin preparation was carried out with chlorhexidine gluconate. An Food and Drug Administration (FDA)-approved filler, consisting of 1 mL (0.5 mL per lip) of 24 mg/mL hyaluronic acid (HA) with 0.3% lidocaine (Juvederm Ultra Plus XC, Allergan, Irvine, CA, USA), was injected into the upper and lower vermilion border and vermilion. Retrograde fashion linear threading and serial puncture methods were used with a 30-gauge needle. The procedure was finished with a gentle massage to blend and smooth the region, and cooling packs were reapplied. Fig. 1 A twenty-seven-year old woman presented requesting lip augmentation. Fig. 2 A progressive lip edema occurred within minutes following injection with hyaluronic acid and lidocaine. Everything was normal upon the completion of the filler injection, but a progressive edema arose on the injection site within minutes. Lip volume increased 3-4 fold during the first hour, and swelling progressed during the first 12 hours after the injection (Fig. 3). The patient was monitored for approximately 2 hours and treated with intravenous antihistamines (a slow infusion of 2 mL of 45.5 mg/2 mL pheniramine maleate). She was closely followed for any sign of respiratory distress or systemic reaction until the reaction was clearly confined. Systemic findings such as hypotension, changes in consciousness, generalized rash, tongue and pharynx edema, dyspnea, or dysphagia were not observed. The edema did not spread outside the injection area and remained localized to the lips. After 3 hours follow-up, she was sent home with oral antihistamines (5 mg desloratadine 2 time/day). Ointments were applied for lubrication to avoid lip fissures and cold compression was continued. The edema started to resolve 48 hours after the start of the reaction and was completely resolved by the seventh day. The patient was worried about her lips after the initial treatment, but ultimately was satisfied enough that she requested another filler session. Before the first session, we examined the patient carefully and asked about her experiences with any previous lidocaine injections such as those that occur during dental treatments, but she did not mention any kind of allergic reaction. Likewise, she had an uneventful rhinoplasty operation one year before this procedure. Fig. 3 Edema was almost completely resolved at 7 days post-injection. HA fillers have a low hypersensitivity profile rate compared to other soft tissue fillers, ranging from 0.6% to 0.8% [1]. Generally, reactions are mild to moderate, self-limited, and continue for less than seven days. However, Leonhardt et al. [2] reported a rare case of severe local hypersensitivity. They observed a sudden swelling of the lips after a HA filler injection. Their patient was treated with steroids and valacyclovir for herpes prophylaxis and reaction was almost completely improved in four days. Recently, FDA-approved fillers containing HA and lidocaine have become available, with the goal of increasing patient comfort. Although there are only a few studies comparing pure HA fillers and fillers containing HA and lidocaine, the available results reveal no significant differences in the safety, efficacy, and longevity between the two treatments, while less procedural pain has been associated with the use of a filler containing HA and lidocaine [3]. The present report is the first case of a severe angioedema-type acute hypersensitivity reaction to a filler containing HA and lidocaine. In the present case, this acute reaction could be secondary to HA, lidocaine, EMLA cream, or simply due to the repeated punctures of the needle. Although no immunological tests were performed because the patient did not consent, the patients previous medical history indicates that HA hypersensitivity was more probable than other possible causes of the reaction. Although hypersensitivity reactions can often be treated by topical tacrolimus, intralesional steroids, systemic steroids, or antihistamines, the most commonly used drugs are steroids [4]. However, antihistamines are also frequently indicated in cases of hypersensitivity and they lead successful results. We preferred antihistamines in the treatment of this case and a satisfactory result was obtained. In light of our case and the similar cases in the literature, it seems that lips may have a greater tendency to swell and to show more severe reactions compared to other regions of the face. The high regional blood flow found in the lips may be the reason for this tendency. However, previous review articles about filler complications do not mention a higher possibility of hypersensitivity reactions following lip augmentation [5]. Once an allergic reaction has been observed after procedures involving artificial fillers, autologous lip augmentation options such as fat grafting become the first choice for future use in these patients.

The Inhibitory Effect of Platelet-Rich Plasma on Botulinum Toxin Type-A: An Experimental Study in Rabbits

BackgroundCombination treatments of botulinum toxin type-A and other rejuvenation agents or instruments are gradually becoming more popular. After observing a high incidence of therapy failure following simultaneous applications of botulinum toxin type-A and platelet-rich plasma mesotherapy, we aimed to investigate whether PRP has an inhibitory effect on botulinum toxin type-A.MethodsTwenty-four New Zealand white rabbits were divided into 4 groups, and the anterior auricular muscle and overlying skin were used for injections. Groups I and II both received onabotulinumtoxinA intramuscular injections. In addition, autologous platelet-rich plasma mesotherapy was performed in Group I while Group II received saline mesotherapy. Group III was designed as the in vitro mixture group in which onabotulinumtoxinA and platelet-rich plasma were mixed and then administered intramuscularly. Group IV received saline within the mixture instead of platelet-rich plasma. The contralateral ears of all the rabbits served as control and were only treated with onabotulinumtoxinA. Visual evaluation of ear positions and electroneuromyographic studies were done prior to all procedures and at day 14. Anterior auricular muscles were harvested at day 14 and were evaluated with quantitative real-time PCR.ResultsVisual and electroneuromyographic studies revealed less onabotulinumtoxinA activity in Groups I and III. When platelet-rich plasma was administered through skin mesotherapy, onabotulinumtoxinA activity failure was more severe in comparison with direct contact. No significant difference in SNAP-25 mRNA expression through quantitative real-time PCR was observed between groups.ConclusionAlthough we could not explain the exact mechanism underlying this interaction, platelet-rich plasma applications result in less onabotulinumtoxinA muscle paralysis activity.No Level AssignedThis journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.