Susana Benitez

Full-face carbon dioxide laser resurfacing: a 10-year follow-up descriptive study.

Background: The purposes of this study were to retrospectively compare the 1-, 5-, and 10-year cosmetic outcomes of full-face carbon dioxide laser resurfacing using the SilkTouch technology, and analyze its advantages, disadvantages, and long-term results. Methods: Photographic results of full-face carbon dioxide laser resurfacing were evaluated after 1, 5, and 10 years. Statistical analysis considered surgeon and patient satisfaction based on a predetermined cosmetic visual analogue scale. Patients and two plastic surgeons unfamiliar with the cases evaluated objective postresurfacing results using Beausang’s grading system and a modified wrinkle assessment scale. Results: One hundred fifty-nine patients were treated and 46 patients completed 1-, 5-, and 10-year follow-up. Combined aesthetic procedures to the full-face carbon dioxide resurfacing were transcutaneous upper lid/lower lid transconjunctival blepharoplasty and endoscopic brow lifts in 15 patients. After 1 year, some relapse occurred, but the overall aesthetic result remained very good. At 5 and 10 years, respectively, 32 and 20 percent of the sample maintained good-quality skin texture; 22 and 19 percent achieved correction of skin pigmentation without scars; and 88 and 98 percent needed correction of recurrent rhytides, jowling, and redundant skin. Permanent hypopigmentation was found in four cases (8.7 percent). Conclusions: The authors’ early experience with the carbon dioxide laser was excellent, but after 1 year, they noticed lines of demarcation between treated and nontreated skin or persistent erythema. After 5 and 10 years, advantages were maintenance of good skin texture, ablation of fine wrinkles, and long-term correction of skin pigmentation. Disadvantages included permanent hypopigmentation of the mandible-neck junction, telangiectasia, and possible accentuation of skin redundancy.

Nonresective shrinkage of the septum and fat compartments of the upper and lower eyelids: a comparative study with carbon dioxide laser and Colorado needle.

Background: The purpose of this article is to describe an alternative nonresective treatment of the fat-septum component of the eyelids during blepharoplasty, using shrinkage desiccation with two low-energy modalities: a carbon dioxide laser and a low-range grid of electrocautery with a Colorado microdissection needle. Methods: Thirty-six patients underwent a four-lid blepharoplasty. During surgery, after exposure (not opening) of the septum and assessment of the amount of bulging by gentle globe compression, a grid spray of electrocautery (right eye) and carbon dioxide laser (left eye) was applied over the entire septum until shrinkage and correction of the bulging was achieved. Preoperative, postoperative day 15, and 1-year follow-up photographs were evaluated using an objective grading system by blinded surgeons. For statistical analysis, the Wilcoxon matched-pairs signed-ranks test was used, with p < 0.05 indicating statistical significance. Results: All the patients completed the 15-day evaluation, but only 32 completed the 1-year follow-up. No major eye or eyelids complications were observed. There were no statistical differences in surgical time and postoperative pain on either side. In this study, laser fat-septum shrinkage achieved substandard results compared with electrocautery when analyzed as a continuous variable, but it did not influence the categorical Strasser scale final result in the short- and long-term follow-up. Conclusions: The method described is simple and safe, and provides a subtle but long-lasting, adequate result. No statistical clinical differences were observed between the electrocautery and laser fat-septum shrinkage techniques.

Abdominoplasty: The use of polypropylene mesh to correct myoaponeurotic-layer deformity

The aponeurotic layer is a very important element to consider during abdominoplasty. For most patients, a simple midline plication is enough to obtain good results. However, for in patients with severe aponeurotic laxity, some other maneuvers must be performed. The purpose of this study was to evaluate the use of polypropylene mesh in this group of patients. We analyzed the results for 20 patients in whom three types of mesh anchoring were used on the basis of intraoperative findings. Adequate long-term follow-up results were obtained, with no recurrence of rectus diastases, as shown by ultrasonography.

Suction-assisted lipectomy fails to improve cardiovascular metabolic markers of disease: a meta-analysis.

BACKGROUND The purpose of this study was to determine whether suction-assisted lipectomy (SAL) decreases the incidence of early cardiovascular disease risk factors or its biochemical and clinical risk indicators. METHODS A systematic review of the literature was performed by conducting a predefined, sensitive search in MEDLINE without limiting the year of publication or language. The extracted data included the basal characteristics of the patients, the surgical technique, the amount of fat extracted, the cardiovascular risk factors and the biochemical and clinical markers monitored over time. The data were analysed using pooled curves, risk ratios and standardised means with meta-analytical techniques. RESULTS Fifteen studies were identified involving 357 patients. In all of the studies, measurements of predefined variables were recorded before and after the SAL procedure. The median follow-up was 3 months (interquartile range (IQR) 1-6, range 0.5-10.5). The mean amount of extracted fat ranged from 2063 to 16,300 ml, with a mean ± standard deviation (SD) of 6138 ± 4735 ml. After adjusting for time and body mass index (BMI), leptin and fasting insulin were the only markers that were significantly associated with the amount of aspirated fat. No associations were observed for high sensitive C-reactive protein (hCRP), interleukin-6 (IL-6), adiponectin, resistin, tumour necrosis factor-α (TNF-α), Homeostasis Model of Assessment (HOMA), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, free fatty acids or systolic blood pressure. CONCLUSIONS Based on the results of our analysis, we conclude that there is no evidence to support the hypothesis that subcutaneous fat removal reduces early cardiovascular or metabolic disease, its markers or its risk factors.

Liposuction and lipoinjection treatment for congenital and acquired lipodystrophies in children.

Background: The purpose of this clinical study was to establish liposuction and lipoinjection as a noncosmetic procedure in children to correct lipodystrophies. Methods: Liposuction, fat injection, or a combination of both was performed on 30 patients between 1994 and 2006 at Roberto del Rio Hospital or Clinica Alemana, Santiago, Chile. Liposuction was indicated in patients with excessive amounts of fatty tissue or tumor-like swelling. Combined liposuction and lipoinjection was performed on patients with deficit and excess in soft tissues. Lipoinjection was used for patients with soft-tissue insufficiencies. Samples of fat obtained by liposuction were submitted to histopathologic examination. Traditional tumescent technique was used for liposuction. The supernatant obtained by simple filtration was used for fat injection. Short- and long-term postoperative follow-up included registration of complications and assessment of aesthetic and functional outcome. The kappa test was used for statistical analysis. Results: Thirty patients, nine boys and 21 girls, were operated on, with an average age of 11 years (range, 4 to 17 years). A total of 43 procedures were performed: 27 liposuctions, 10 lipoinjections, and six combined procedures. Average hospital stay was 1.1 days. Of a total 20 patients who underwent liposuction, six required revision. Histopathologic study showed 19 lipomatoses and one lipoblastomatosis. Cosmetic outcomes based on Strasser scale were as follows: six excellent, 19 good, four mediocre, and one poor. Conclusions: Liposuction and lipoinjection as sole or combined procedures are safe methods for the pediatric population. They are well tolerated, with a low rate of complications and satisfactory aesthetic results.

Vascular diameter determining the magnification for a microvascular anastomosis.

The purpose of this study was to determine the association between vascular diameters and amount of magnification and to assess the influence of the magnification media on the microanastomosis quality and permeability. Sixty arterial microanostomoses were distributed into three groups: group I (diameter 1.5 mm), group II (1.5 to 2.5 mm), and group III (> 2.5 mm). The models used were carotid artery of Sprague-Dawley rats and carotid and abdominal artery of wild rabbits. In each group, 10 anastomoses were performed with 2.5 x loupes and 10 with 10 x microscope. The total time of anastomosis, the quality of the anastomosis (Gorman scale), and 24-hour permeability rate were measured. The total anastomotic time and quality had statistical differences for the microscope by analyzing the total sample and group I only. The global permeability was 83% for the microscope and 40% for the loupe. The same result was observed in group I but no differences were observed in the other groups. The histology and the survey showed similar results. Microanastomoses performed under a microscope (10 x) were performed in less time, were of better quality, and had higher permeability rates when compared with those performed under a loupe (2.5 x). In vessels < 1.5 mm, these differences were statistically significant but in vessels > 1.5 mm no differences were observed.

Clinical trial evaluating the results of breast reduction with ancillary lipoplasty.

BACKGROUND Suction-assisted lipoplasty (SAL) may be used in breast reduction either alone or as an adjunct to standard reduction mammaplasty procedures. Although adequate results have been attained through breast reduction with ancillary lipoplasty, the safety of this procedure has not been evaluated. OBJECTIVE The purpose of this study was to evaluate outcomes in breast reduction surgery complemented with lipoplasty of the breast area. METHOD A prospective, randomized double-blinded trial with 2 study groups was designed. A total of 25 patients were included in the control group (without SAL) and 25 in the active group (with SAL). Lipoplasty of the breast area was performed using the tumescent technique. Neither lipoplasty of the surrounding breast area nor other surgical procedures were performed. The primary outcome measure was the complication rate; the secondary outcomes were the clinical data from the patient and the surgical and aesthetic results. For comparison of paired variables, linear or logistic regression models were used with an alpha level of 5% for statistical significance. RESULTS The 2 groups were comparable with respect to sex, body mass index, comorbidities and smoking habits, but the active group (with SAL) was younger (P = .351). The overall complication rate was higher in the group that underwent reduction mammaplasty with SAL (18% vs. 6%, P = .0324), in which a higher incidence of dehiscence and tissue necrosis was observed. There were no differences with respect to aesthetic outcome. CONCLUSIONS In this study, breast reduction with ancillary lipoplasty resulted in a higher rate of complications when compared to reduction mammaplasty with no lipoplasty. Caution must be used when applying SAL in the pedicle, under the nipple-areola complex, or in the pillars during a standard reduction mammaplasty.

Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results for the Body-QoL® Cohort

Background Body contouring surgery (BCS) is becoming increasing popular for aesthetic and reconstructive purposes, particularly among patients with massive weight loss (MWL). However, data on quality of life (QoL) following the surgery are limited, especially long-term QoL. Objectives The authors evaluated the effect of BCS on QoL and the durability of this effect over time. Methods QoL was measured with the Body-QoL® instrument at 3 time points among consecutively treated patients: the day before BCS, 1 to 9 months postoperatively (short term), and 1 to 2.7 years postoperatively (long term). Total Body-QoL scores were compiled, as were scores for the instruments main domains: body satisfaction, sex life, self-esteem and social performance, and physical symptoms. Scores were examined for the entire study population and separately for the cosmetic and MWL cohorts. Results Fifty-seven of the 112 patients participated in the short-term assessment and 84 in the long-term assessment. Total Body-QoL scores increased significantly (P < 0.0001), from 44.0 ± 14.1 preoperatively to 85.5 ± 17.5 short-term postoperatively and to 84.4 ± 12.7 long-term postoperatively. Scores for the 2 postoperative assessments did not differ significantly. Similar results were observed for scores on each separate domain. Although preoperative scores were lower for the MWL cohort than the cosmetic cohort (33.9 ± 15.6 vs 46.1 ± 12.8; P = 0.0002), they improved substantially after BCS, approaching scores for the cosmetic cohort. Conclusions QoL increases significantly after BCS. This favorable outcome remained stable throughout long-term follow-up and was true for the cosmetic and MWL cohorts. Level of Evidence 4

Use of aerosolized bovine-prepared fibrin glue for skin fixation after primary open rhinoplasty: a prospective randomized and controlled trial.

BackgroundFibrin glue has been used in diverse areas of plastic surgery. To the authors’ knowledge, no clinical controlled trial studies have reported its use for open rhinoplasty.MethodsA prospective, randomized, masked clinical trial was designed to demonstrate that aerosolized bovine-prepared fibrin glue used in open rhinoplasty controls skin fixation (flap movement), edema, hematomas, ecchymosis, bleeding, and cosmetic results 1 and 12 months postoperatively. The results were reviewed by two blinded plastic surgeons who assessed postoperative photographs using the Strasser score. Other items such as columella scar, pain, surgery/recovery time, and patient satisfaction also were evaluated.ResultsA computer system was used to randomize 22 consecutive open primary rhinoplasties. Cosmetic analysis did not differ significantly between the group redraped with fibrin glue and the control group. Patient satisfaction was the only outcome that significantly favored the active group. None of the other items or adverse events significantly differed between the two groups, including operative time and pain.ConclusionsFibrin glue is believed to reduce bleeding and to improve the adherence of tissues. The only statistical difference in this study favored the patient satisfaction cosmetic score of the group that received fibrin glue.