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Abstract Introduction Edema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons. Objective We conducted this systematic review and meta-analysis to determine the effect of preand postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis. Methods A comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of preor postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software. Results Nineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo −0.82, 95% CI (−1.37, −0.26), and -0.95, 95% CI (−1.32, −0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone. Conclusion This comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.
Resumo Introdução O edema e a equimose no pós-operatório da cirurgia plástica facial constituem um problema preocupante para pacientes e cirurgiões. Considera-se que a administração de corticosteroides diminua o período de recuperação e reduza essas complicações. Os dados sobre a eficácia da administração de corticosteroides permanecem controversos entre os cirurgiões. Objetivo Fizemos essa revisão sistemática e metanálise para determinar o efeito da administração de corticosteroides nos períodos pré- e pós-operatório sobre as complicações pós-operatórias em pacientes submetidos à cirurgia reconstrutiva facial apoiada em diferentes análises de subgrupos. Método Foi feita uma busca abrangente de artigos nos bancos de dados PubMed, Cochrane Central, Scopus e Ebsco até outubro de 2019. Incluímos todos os ensaios clínicos cujos pacientes foram submetidos a qualquer tipo de cirurgia plástica facial para estudar o efeito dos corticosteroides nas complicações pós-operatórias. Fizemos a análise de subgrupos de acordo com os tipos e as doses de preparação de corticosteroides, além de uma análise de subgrupos de uso de corticosteroides pré ou pós-operatório. Todas as análises estatísticas foram feitas no software RevMan. Resultados Dezenove estudos foram incluídos nesta revisão sistemática, mas apenas 10 deles foram elegíveis para a metanálise. Os escores de edema periorbital e equimoses reduziram significantemente no grupo de corticosteroides em comparação com o placebo: -0,82, IC95% (-1,37, -0,26) e -0,95, IC95% (-1,32, -0,57), respectivamente. Essas diferenças significantes não se mantiveram nos dias 3 e 7. Doses menores de corticosteroides (8 mg e 10 mg) foram associadas a menores diferenças no escore médio de edema e equimoses palpebrais superiores e inferiores, enquanto as doses mais altas foram associadas a diferenças maiores. Além disso, o corticosteroide pré-operatório reduziu significantemente o sangramento intraoperatório quando comparado ao placebo para doses maiores > 50 mg por dia (p < 0,0001), mas não para 8 mg de corticosteroide (p = 0,06). O uso de corticosteroides no pós- e pré-operatório foi associado a uma diminuição maior de edema e equimoses do que no pré-operatório isoladamente. Conclusão Esta metanálise abrangente confirma um benefício estatisticamente significante do uso de corticosteroides no pré-operatório. Além disso, a manutenção dos esteroides no pós-operatório está associada à redução das complicações em longo prazo. Doses mais altas de corticosteroides estão associadas a uma redução mais significativa no edema e nas equimoses, mas estudos adicionais são recomendados para determinar os efeitos colaterais pós-operatórios como infecção do sítio cirúrgico e atraso na cicatrização.
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@#Shared decision making (SDM) refers to two-way communication between doctors and patients. SDM helps surgeons decide the most suitable treatment plan for patients based on the medical evidence and the preferences of patients. A standardized clinical process and decision assistant tools, such as verbal tools, graphic tools, and patient decision aids, can help the shared decision-making work effectively. Since the sense of facial aesthetics is individual and there are multiple treatment options in plastic surgery, facial aesthetic surgery is suitable for the application of SDM. In addition, medical service centers can also meet the personalized needs of patients, provide high-quality medical services for patients and achieve better treatment results with SDM. SDM has not been introduced into the clinical practice of maxillofacial plastic surgery in China, and its development is facing many difficulties, such as the lack of decision aid tools, the limited time of diagnosis, and the lack of doctor-patient communication. Research and development of standard SDM clinical implementation path guides and decision aid tools will be beneficial to the application and development of SDM in the field of maxillofacial plastic surgery in China.
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Resumen Introducción: La región periorbitaria es la primera en exhibir los efectos del envejecimiento, siendo el exceso de piel del párpado superior el signo más frecuente. Actualmente las técnicas quirúrgicas de blefaroplastia superior son más conservadoras, logrando resultados estéticos satisfactorios y naturales. La técnica con realce de volumen es una técnica poco agresiva en la cual se respeta el músculo y grasa periorbitaria. Objetivo: Describir la técnica de blefaroplastia superior con realce de volumen, sus beneficios y resultados estéticos. Material y Método: Estudio descriptivo retrospectivo. Se analizaron pacientes sometidos al procedimiento entre agosto de 2016 y octubre de 2017. Resultados: Se describe la técnica quirúrgica. Se operaron 56 pacientes con un promedio de edad de 57 años. 75% correspondían a sexo femenino. Se utilizó anestesia local en 59% pacientes. Se complementó con otras cirugías en un 57%. De éstas 19% corresponden a rinoplastías, 31% a frontoplastías, 47% a blefaroplastias inferiores, entre otras. No se presentaron complicaciones intraoperatorias ni postoperatorias mayores. Conclusión: La técnica de blefaroplastia superior con realce de volumen es una técnica conservadora con excelentes resultados estéticos y funcionales. Al conservar el músculo orbicular y los tejidos blandos subyacentes se genera un aumento de volumen en la zona del supratarso, realzando la belleza de la región periorbitaria.
Abstract Introduction: The periorbital region is the first to exhibit the effects of aging. The excess of skin on the upper eyelid is the most frequent sign. Nowadays upper blepharoplasty techniques are more conservative, achieving satisfactory aesthetic results. The volume enhancement technique is a non-aggressive technique in which muscle and periorbital fat are preserved. Aim: Describe the upper blepharoplasty with volume enhancement technique, its benefits and aesthetic results. Material and Method: The surgical technique is described. Retrospective descriptive study. Patients studied were between august 2016 and october 2017. Results: 56 patients underwent surgery with an average age of 57 years. 75% were female. 59% were performed under local anesthesia. 57% had complementary surgeries. These were rhinoplasties (19%), frontoplasty (31%), lower blepharoplasty (47%) among others. There were no mayor intraoperative or postoperative complications. Conclusion: The upper blepharoplasty with volume enhancement technique is a conservative technique with excellent aesthetic and functional outcomes. By preserving the orbicularis muscle and the underlying soft tissues, a volume increase is achieved in supra tarsal area, enhancing the beauty in the periorbital region.
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Humans , Male , Female , Surgery, Plastic/methods , Minimally Invasive Surgical Procedures , Blepharoplasty/methods , Aging , Epidemiology, DescriptiveABSTRACT
Abstract Introduction Facial plastic and reconstructive surgery (FPRS) is a key part of the curriculum for otolaryngology residents. It is important to gain an understanding of the breadth of exposure and level of competence residents feel with these concepts during their residency. Objective To determine the level of FPRS exposure and training otolaryngology residents receive during their residency. Methods A survey was emailed to all Accreditation Council for Graduate Medical Education (ACGME) accredited otolaryngology residents. The survey aimed to find the level of exposure to FPRS procedures otolaryngology residents get and how confident they feel with their training in cosmetic FPRS. Results A total of 213 residents responded to the survey for an overall response rate of 13.4%. There was an even mixture of residents from all postgraduate year (PGY) levels, with 58% of respondents being male. Almost all (98%) of the residents felt FPRS was important to otolaryngology residency training. Exposure to procedures varied with 57% performing or assisting with cosmetic minor procedures, 81% performing or assisting with cosmetic major procedures, and 93% performing or assisting with reconstructive procedures. Only 49% of residents felt their programs either very or somewhat adequately prepared them in cosmetic facial plastic surgery. Conclusion There was a wide variability in the FPRS procedure exposure. Most residents felt procedures were a vital part of otolaryngology residency training, but not all were able to participate in them. Only half of the residents felt well-prepared in cosmetic procedures.
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Objective To analyze the clinical efficacy of PRF-mixed autogenous fat granules transplantation for facial contour modification,and to discuss the methodology for improving fat preservation rate after facial fat transplantation.Methods 60 cases were divided randomly into two groups with 30 cases each:mixed treatment group of PRF and autologous fat granules (mixed group),and simple autologous fat granules transplantation group (control group).According to the different defect parts of facial contour,the mixture of proper amount of autologous fat granules and PRF harvested from venous blood via once centrifugation separation autologous transplanted to the cases in mixed group,PRF not added to the cases in control group,then the recent and long-term effect,complications,safety,and patient satisfaction were observed.Results The facial shape was stable 6 months after operation,the face of all cases was more full,and facial proportion was more harmonious than before operation.12 months of follow-up study was performed in all 60 cases,there was no fat embolism,infection,necrosis and other complications.The satisfaction rate was 96.7％ in mixed group and 80％ in control group after primary operation respectively.There were significant differences between the two groups.Conclusions Autologous transplantation of fat granule mixed with PRF has important application value in facial contour modification and facial rejuvenation.It is easy to be operated,and can achieve high fat preservation rate,stable long term effect and no obvious complication;the cases performed sufficient amount mixture of transplantation can get ideal cosmetic effect.
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Abstract Introduction Norms and patterns of nasal esthetics are essential for an adequate preoperative evaluation and surgical programming. The esthetic nasal patterns used are a blend of artistic beauty ideals and tracings in models and celebrities. Because they do not consider population measures, they vary according to the period, and allow a discrepancy between the surgeon's preference and the patient's real desire for rhinoplasty. Not all populations wish to obtain an esthetic result according to these values, but prefer a natural result, that is, one with some of the nasal characteristics of the population to which they belong to. The Brazilian population lacks population studies to evaluate its nose measurements. Objective (1) To evaluate the anthropometric measures of Caucasian noses of people living in the city of Curitiba (state of Paraná), and to compare them to the ideal esthetic pattern of the literature; (2) To compare them between genders. Methods This is a prospective cohort study involving 100 Caucasian volunteers at a tertiary hospital in Southern Brazil. Through the frontal and lateral view photos, intercanthal distance, alar distance, nasal dorsum length, nasofrontal angle, nasolabial angle, and nasal tip projection (Goode's method) were obtained. A statistical analysis was performed to compare the measures obtained between genders and with the ideal patterns. Results Comparing the results obtained with those predicted by the esthetic ideals, the sample presented: similar nasolabial angle (p = 0.07), alar width greater than intercanthal distance (p < 0.001), higher nasal tip projection (p < 0.001), larger width-length ratio (p < 0.001), and more obtuse nasofrontal angle (p < 0.001). The nasofrontal angle (p = 0.0008) and the tip projection (p = 0.032) were statistically different between the genders. Men had a smaller nasofrontal angle, and a larger Goode's ratio. Conclusion Except for the nasolabial angle, the measures obtained in the population sample differed from the published esthetic ideals. Comparing the genders, men had a sharper nasofrontal angle, and higher tip projection than women.
Resumo Introdução Normas e padrões de estética nasal são essenciais para uma adequada avaliação pré-operatória e programação cirúrgica. Os padrões estéticos nasais usados são uma mistura dos ideais artísticos de beleza e traçados em modelos e celebridades. Por não considerar medidas populacionais, variam conforme o período e permitem uma discrepância entre o desejo do cirurgião e o real desejo do paciente com a rinoplastia. Nem todas as populações desejam obter um resultado estético conforme esses valores, mas um resultado natural, ou seja, com algumas das características nasais da população a que pertencem. A população brasileira carece de estudos populacionais que avaliam as suas medidas nasais. Objetivo 1) Avaliar as médidas antropométricas de narizes caucasianos da cidade de Curitiba (Paraná) e compará-los com o padrão estético ideal da literatura; 2) Compará-los entre os sexos. Método Estudo prospectivo, coorte, envolveu 100 voluntários caucasianos em um hospital terciário no Sul do Brasil. Através de fotografias na vista frontal e lateral, foram obtidas: distância intercantal, distância alar, comprimento do dorso nasal, ângulo nasofrontal, ângulo nasolabial e projeção da ponta nasal (método do Goode). Análise estatística foi realizada para comparar as medidas obtidas: entre os gêneros e com os padrões ideais. Resultados Comparando os resultados obtidos com o apregoado pelos ideais estéticos, a amostra apresentou: ângulo nasolabial similar (p = 0,07), largura alar maior do que distância intercantal (p < 0,001), maior projeção da ponta nasal (p < 0,001), relação largura-comprimento maior (p < 0,001) e ângulo nasofrontal mais obtuso (p < 0,001). Diferiram estatisticamente entre os sexos o ângulo nasofrontal (p = 0,0008) e a projeção da ponta (p = 0,032). Homens apresentaram o ângulo nasofrontal menor e a razão de Goode maior. Conclusão Com exceção do ângulo nasolabial, as medidas obtidas na amostra populacional diferiram dos ideais estéticos publicados. Na comparação dos sexos, homens apresentaram um ângulo nasofrontal mais agudo e uma projeção da ponta maior do que as mulheres.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Anthropometry/methods , Nose/anatomy & histology , White People , Esthetics , Reference Standards , Rhinoplasty/standards , Brazil/ethnology , Sex Factors , Prospective Studies , Lip/anatomy & histologyABSTRACT
Objective:To evaluate the effect of continuing care in facial plastic operation .Method:Select 120 patients who had aesthetic plastic surgery in our hospital during the period from January to July in 2014 and ran-domize them into the observation group (60 cases)and the control group (60 cases).The control group merely re-ceive conventional treatment .The observation group is employed continuing care based on conventional treatment . Results:The satisfaction of two groups has no significant difference a week after operation (P>0.05).Six months after operation , the satisfaction of the observation group is obviously higher than that of the control group .The difference is statistically different ( P<0 .0001 ) .The anxiety level of the observation group is obvious lower than that of the control group and the difference is Statisticallydifferent ( P<0 .0001 ) .Conclusion: Based on the hu-manistic care, carry on the continuing care could considerately improve the satisfaction of patients in clinic facial plastic surgery and is one of the most important solution of preventing medical disputes ;mean while , it is also one of the most effective stress reduction measures which makes the patients feel humanized nursing .
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Objective To investigate the preventive effect of thin foam dressings(Allevyn Thin)combined with ice compress on facial plastic postoperative swelling and to summarize the nursing key points.Methods Sixty patients after facial plastic surgeries in our department were randomly divided into the observation group and the control group with 30 cases in each group.In the control group,ice packs wrapped with sterile gauze were placed on the patients’ wound dressings postoperatively and fixed properly for 30 to 40 minutes with an interval of 30 minutes,6 to 10 times a day for 72 hours postoperatively.In the observation group,thin foam dressing was stick to the wounds,followed by ice compress as in the control group.The facial swelling degrees of both groups were compared on day 3 and day 7 postoperatively.Result The swelling degree in the observation group was significantly smaller than that of the control group(P<0.01).Conclusion Thin foam dressings combined with ice compress can effectively improve the postoperative early swelling of patients receiving facial plastic surgery and therefore it is worthy of clinical popularization and application.