Clinical Anatomy in Aesthetic Gluteal Contouring.

Despite the acceptance of gluteal augmentation procedures into today's mainstream of plastic surgery procedures, clinical anatomy continues to play a critical role in improving outcomes in aesthetic gluteal contouring. In this rapidly growing and evolving field, avoiding complications is imperative for the continuing advancement and acceptance of this group of procedures into the armamentarium of every plastic surgeon. This article highlights the clinically relevant anatomy important to improving patient satisfaction and avoiding complications.

Autologous Gluteal Augmentation with the Moustache Transposition Flap Technique.

Massive weight loss patients and aesthetic patients can present with significant gluteal contour abnormalities. Gluteal ptosis, skeletal deformities, severe platypgia, and a paucity of donor fat for autologous transfer are common problems. Excisional procedures are used to treat massive-weight-loss contour abnormalities. These procedures present an opportunity to address severe gluteal deformities using autologous tissue augmentation. With a working knowledge of the relevant anatomy, sound surgical technique, and meticulous postoperative care, autologous gluteal autoaugmentation with circumferential body lift/excisional buttock lift using the "Moustache" flap technique will enhance massive weight loss body contouring outcomes and improve patient satisfaction.

Surgisis acellular collagen matrix in aesthetic and reconstructive plastic surgery soft tissue applications.

Tissue engineering in aesthetic and reconstructive plastic surgery remains an elusive goal. The advent of Surgisis extracellular collagen matrix and its performance characteristics suggest that the use of a bioengineered tissue substitute can meet some of our reconstructive requirements. Incorporation and replacement by host tissue with minimal allergic or immune response seems to be achievable today. The ability to engineer the device, the ready availability of substrate, and its cost effectiveness support the use of Surgisis in aesthetic and reconstructive plastic surgery applications. Future product innovations and engineering seem promising. The permanent role of Surgisis in aesthetic and reconstructive plastic surgery will be determined by its documented long-term performance.

Management of contaminated autologous grafts in plastic surgery.

BACKGROUND: Contamination of autologous grafts unfortunately occurs in plastic surgery, but the literature provides no guidance for management of such incidents. METHODS: American Society of Aesthetic Plastic Surgery members were asked to complete an online survey that asked about the number and causes of graft contaminations experienced, how surgeons dealt with the problem, the clinical outcomes, and patient disclosure. RESULTS: Nineteen hundred surgeons were asked to participate in the survey, and 223 responded. Of these, 70% had experienced at least 1 graft contamination incident, with 26% experiencing 4 or more. The most frequently reported reason for graft contamination was a graft falling on the floor (reported by 75%). Nearly two thirds of the contaminated grafts related to craniofacial procedures. Ninety-four percent of grafts were managed with decontamination and completion of the operation. The most common method of decontamination was washing with povidone-iodine, but this practice is contrary to recommendations in the literature. Only 3 surgeons (1.9%) said a clinical infection developed following decontaminated graft use. Patients were not informed in 60% of graft contamination incidents. The survey results and review of the literature led to development of algorithms for the management of inadvertent graft contamination and patient disclosure. CONCLUSIONS: Although autologous grafts do become contaminated in plastic surgery, the overwhelming majority can be safely decontaminated and produce minimal or no clinical sequelae. The algorithms presented are intended to serve as guides for prevention of contamination events or for their management should they occur.

Gluteal contouring surgery in the massive weight loss patient.

This article describes some of the salient anatomic issues, a classification system, surgical techniques, and a decision-making algorithm available for contouring the gluteal region in the patient who has sustained massive weight loss (MWL). The gluteal deformities encountered in patients who have lost a massive amount of weight are unprecedented in body-contouring surgery, and plastic surgeons need uncommon techniques when contouring and augmenting the gluteal region in these patients. A better understanding of the anatomy and a new surgical armamentarium can improve the cosmetic results of gluteal contouring, and, thereby, enhance patient satisfaction in this challenging population.

Clinical anatomy in aesthetic gluteal body contouring surgery.

This article describes some of the major anatomical issues that confront plastic surgeons when contouring and augmenting the gluteal region. A better understanding of anatomy can improve the cosmetic results of gluteal augmentation and thereby enhance patient satisfaction. More importantly, this knowledge can reduce the risks of complications, some of which may have long-term adverse effects.

Autologous gluteal augmentation with circumferential body lift in the massive weight loss and aesthetic patient.

Massive weight loss (MWL) patients have unique and severe gluteal deformities that demand alternative body contouring solutions because they are rarely candidates for gluteal implants. Techniques for autologous gluteal augmentation (AGA) with circumferential body lift (CBL) are offered as a solution to this problem. Experience with these techniques will allow surgeons to extend AGA to other aesthetic patients presenting with flattened buttocks. Flap indications, surgical planning, techniques,results, complications, and postoperative management are discussed.

Gluteal aesthetic unit classification: a tool to improve outcomes in body contouring.

The author analyzes the aesthetics of gluteal contouring, combining the contributions of other experts with his unique classification system that divides the gluteal region into 8 distinct aesthetic units. He advises that careful anatomic analysis and surgical technique, as well as communication with patients to determine their aesthetic preferences, are essential to positive outcomes.

Combination volume rejuvenation therapy of the face: fat, fillers, and Botox.

The author uses combination volume rejuvenation therapy (CVRT) in patients who desire facial rejuvenation with minimal downtime. He describes how the combined use of relatively large doses of multiple injectables-including fat, pharmaceutical soft tissue fillers, and Botox-permits simultaneous volume rejuvenation of most facial areas with or without excisional surgery.

DMSO: applications in plastic surgery.

The authors point out that dimethyl sulfoxide (DMSO) increases tissue perfusion and may effectively treat or prevent ischemia in flaps. They recommend application of topical DMSO every 4 to 6 hours, until blood flow improves, to areas that show signs of ischemia or less than adequate perfusion. Other potential cosmetic surgery uses of DMSO include areas of skin care, pain relief, and treatment of keloids.

Initial results from an online breast augmentation survey.

BACKGROUND: Data have been lacking to answer many questions raised in the clinical literature and by the US Food and Drug Administration with regard to patient satisfaction with breast implants, informed consent, the impact of augmentation on quality of life, repeat operations, and other issues related to breast augmentation. OBJECTIVE: The authors conducted an online survey of women with and without breast implants to collect data on key issues related to breast augmentation. METHODS: A survey including 177 questions was posted on the Web site www.implantinfo.com for 6 months, from August 2001 to February 2002. The survey was aimed at women who had undergone augmentation and those who were considering augmentation but had not yet undergone surgery. The raw data were analyzed by Data Harbor (Chicago, IL), an independent data management and technology development company with experience in managing large, complex medical databases. RESULTS: The survey was completed by 4011 women, including 2273 who had received breast implants and 1738 who were considering augmentation. Among the key findings: More than half of the women who had undergone breast augmentation and those who were considering the procedure thought about the decision for at least 3 years before proceeding. Most women who underwent breast augmentation (88%) were satisfied with the results, and 93% said they would recommend the procedure to friends or family members. Nearly all women who received implants thought the surgery improved their overall appearance (92%) and self-confidence (82%) but said it did not result in significant changes in their marriage/dating activities, careers, or social lives. At least 92% said their surgeons had answered their questions and listened to their concerns, and more than 75% said they remembered being informed of the risks of surgery. The percentage of women with breast pain was greater among women with implants than among those without. However, other physical symptoms, such as those associated with rheumatologic diseases, were more common among women considering augmentation. Respondents with implants did not smoke at levels higher than comparable women in the general population and were not major consumers of alcohol. CONCLUSIONS: The Online Breast Augmentation Survey provides a wealth of previously unavailable data on women who have undergone or who are considering breast augmentation. The data indicate that women consider breast augmentation carefully, that they are well informed by their physicians before surgery, and that they are generally happy with the results.

Initial report from an online breast augmentation follow-up survey.

BACKGROUND: The first Online Breast Augmentation Survey (Aesthetic Surg J 2004;24:117-135) reported on women who had undergone or who were considering breast augmentation with regard to motivation for surgery, patient satisfaction with results, and other issues. The Food and Drug Administration and others have also raised questions concerning informed consent, follow-up, health insurance, and related issues dealing with breast augmentation. OBJECTIVE: An Online Breast Augmentation Follow-Up Survey was designed to collect data from women who had undergone breast augmentation with regard to informed consent, follow-up, complications and problems following breast augmentation, and health insurance. METHODS: The survey comprised 56 questions, many of which were presented in a multiple-part format. Women who visited the Web site www.implantinfo.com and who had undergone breast augmentation were invited to participate in the survey. An independent research firm, Industry Insights, Inc. (Columbus, OH), assisted with the final design and collected and analyzed the data. RESULTS: The survey was posted from April 8-June 30, 2003. Surveys were submitted by 1350 women. Ninety-two percent of respondents said that surgeons asked them to return for regular follow-up during the first postoperative year. Ninety percent said they would return to the original surgeon if a problem developed. Almost all respondents (94%) said that they had been informed by the surgeon, the surgeon's staff, or both of specific problems or complications that might be associated with breast implants and augmentation; 89% said that the information they received was adequate. Eighty percent said they complied with the surgeon's recommendations for follow-up visits, although compliance declined after the first postoperative year. The survey also showed that most women who undergo breast augmentation seek out information about the procedure before surgery from independent sources, in most cases from Web sites. Eighty-eight percent of respondents said they were involved in some way in deciding on implant size; 88% said they were satisfied with breast size after surgery. Fourteen percent of respondents reported additional implant-related surgery after the original augmentation. CONCLUSIONS: Our data indicate that almost all patients are advised to return for follow-up visits, that most comply with their surgeons' recommendations for follow-up in the first postoperative year, and that the main reason for noncompliance is an absence of problems with implants. The survey also indicates that patients receive adequate informed consent from the surgeon or the surgeon's staff and that they also seek out information on their own. Finally, the data suggest that women who have undergone augmentation have a realistic appreciation of the problems involved and are willing to tolerate minor complications.

Breast augmentation with bilateral deepithelialized TRAM flaps: an alternative approach to breast augmentation with autologous tissue.

Since the 1980s, many patients have benefited from the use of the transverse rectus abdominis musculocutaneous (TRAM) flap for postmastectomy reconstruction. In addition to cancer reconstruction, this technique has recently been used to treat patients with breast implant intolerance and for reconstruction after siliconoma resection. However, physicians and patients alike believe that such an extensive procedure should not be used for aesthetic purposes, and to the authors' knowledge, no study has been reported on the use of pedicled TRAM flaps for aesthetic augmentation mammaplasty. In the past several years, a number of the authors' patients have requested simultaneous breast augmentation and abdominoplasty. These patients objected to the use of prosthetic implants because of potential complications such as implant failure, capsular contracture, wrinkling, and palpability. Therefore, from 1995 to 2000, the authors performed 14 cases of bilateral breast augmentation with deepithelialized, pedicled TRAM flaps. In this series, the donor-site complication rate was similar to that of the traditional TRAM flap. Surprisingly, no cases of complete or partial flap loss were clinically detected. The only complaints were pedicle bulges at the costal margins. These patients were all extremely satisfied with the results. It was concluded that the TRAM flap is safe for augmentation in a subset of carefully selected women with hypoplastic or atrophic breasts. The authors discuss patient selection, technique, and their experience with this method of breast augmentation.

Botulinum toxin a for managing focal hyperhidrosis.

According to the authors, Botox is a safe, rapid, and effective treatment for focal hyperhydrosis with uniformly good results, few complications, and high patient satisfaction. Studies have shown that the therapeutic effect persists for 8 to 9 months on average.