Stephen P. Daane

Analysis of methods for reporting severe and mortal lipoplasty complications.

During the past 2 years, media attention has focused on catastrophic outcomes associated with liposuction. A critical review of the lipoplasty literature was undertaken to determine the incidence of severe and mortal complications. Reported lipoplasty complications and patient outcome studies published in the English literature through January 1, 1999, were reviewed. From these and from ASPRS questionnaire surveys of experienced, board-certified plastic surgeons, it is apparent that (1) plastic surgeons do not often voluntarily report severe and mortal complications (either as case reports or in self-reported series), and (2) while survey studies provide the most accurate estimate of complications due to lipoplasty, they are subject to an underreporting bias because they exclude complications occurring in the hands of residents and junior attendings. The mortality from lipoplasty procedures is higher than the 0.003 to 0.02% reported in the literature and may be as high as 0.1%.

Subperiosteal midface lifting: A simplified approach

A simplified approach to subperiosteal midface lifting with suspension is described, which has been performed on 75 patients since 1986. In comparison with standard facelifting, this technique results in long-lasting vertical resuspension of ptotic midfacial tissues. To date there has been a high rate of patient satisfaction with no cases of nerve injury or hematoma. There is a rare incidence of minor complications.

Human skin allograft used to treat open wounds after club foot release.

The inversion deformity of club foot is characterized by shortened ligaments and tendons on the medial side of the foot. The condition, when refractory to castings, is treated easily by operative intervention with neutralization of the foot and ankle. Closure of the resulting incision creates tension on the skin that is well tolerated in most children. Correction of severe deformities leaves incisions that will not close primarily, leaving tendons and neurovascular structures exposed on the posteromedial aspect of the foot. Free tissue transfer or spontaneous secondary closure are 2 options that have drawbacks. Application of human skin allograft affords protection to underlying tissue while allowing granulation tissue formation and wound contraction. Subsequent skin autograft and secondary skin contraction and epithelialization provide satisfactory wound closure with normal foot contour and preservation of ankle correction. Complete healing is achieved by the time cast immobilization is discontinued 6 weeks after surgery.

Indications, Psychological Issues and Selection of Patients in Aesthetic Surgery

Personal identity is the definition of an individual in relation to himself and others. The body represents one of the fundamental aspects of personal identity, as for each individual it is unique; it is the manner of communicating with the world and can be considered either in an objective or in a subjective way. “I am my body” or “I see and feel my body as tall, short, thin etc.”

Botulinum Toxin: BOTOX®

Botulinum toxin type A (“Botox,” Allergan Inc., Irvine CA) [1] was first quantified and used clinically by ophthalmologist Dr. Alan B. Scott [2] of San Francisco, California. Dr. Scott published the first reports using Botulinum toxin type A for the treatment of blepharospasm, strabismus, and glabellar frown lines in the early 1980s. The FDA approved Botox in December 1989 as an orphan drug for the treatment of strabismus, hemifacial spasm, and blepharospasm.

Anti-Aging: An Overview

Although the masterminds of humanity (Michelangelo, Goethe, Picasso, and Newton) all lived past 80 years of age and led productive lives without the help of modern medicine [1], human life expectancy only recently increased from 47 years in 1900 to 80 years in 2000. The U.S. Census Bureau projects [2] that by 2040 a minimum of 1.3 million people would reach the age of 100. We have gained more years in life expectancy in the recent century than the dawn of mankind, likely due to improvements in medical technology, sanitation, and vaccinations. With or without the help of medicine, the maximum average life span of a human being has been projected to be between 85 and 95 years. Several theories have been proposed to explain the biological mechanism of aging, but among these the “telomere hypothesis” that originated about 40 years ago has continued to gain support through research: This theory suggests that cellular aging occurs due to a loss of telomeric DNA due to incomplete replication or degradation of DNA ends. When a certain length of telomere is reached, the cell evokes the Hayflick limit and stops cell division [3].

Upper Eyelid Blepharoplasty

According to the American Society of Plastic Surgery surveys, upper eyelid blepharoplasty yields the highest satisfaction rate of any plastic surgery procedure. The attractiveness of this procedure is the short length of the operation, the ability to perform the operation under local anesthesia, the relatively brief recovery time (time away from work), and inconspicuous scarring due to the location of the incisions.