The effect of tranexamic acid on blood loss in liposuction: a randomized controlled study.

Background: Liposuction is one of the most common procedures in the practice of plastic surgery. Since it evolved, continuous modifications have been to decrease blood loss so that patients are hemodynamically stable intra- and postoperatively. Tranexamic acid (TXA) has long been used for its antifibrinolytic properties that were beneficial in reducing blood loss, rate of transfusion, and hemoglobin drop in major trauma and surgeries. Its use in plastic surgery, however, is still limited. In this study, we aim to illustrate the effect of intravenous (IV) and local infiltration of TXA on blood loss in liposuction surgery. Methods: Between April 2019 and April 2021, 90 patients who requested liposuction for various body parts were randomly allocated into 3 equal groups: control group, IV TXA, and local infiltration of TXA. A sample was taken from infranatant and sent for hematocrit calculation. Volume of blood in lipoaspirate was then calculated. Patients were assessed for blood loss and postoperative bruising. Results: Volume of blood loss in lipoaspirate was considerably lower in the TXA groups, with 60% decrease in blood loss for the local TXA group in comparison with the control group. TXA has also been shown to markedly decrease bruising tendency in postoperative liposuction patients. Conclusions: TXA can be used to decrease blood loss in large-volume liposuction, modify the need for blood transfusion intra- and postoperative, and improve the results of liposuction procedure without the need for multiple sessions. Level of evidence: Level II, Risk/Prognostic Study.

Facial Anthropometry and Analysis in Egyptian Women.

Human facial analysis can be considered both an art and a science, and is used extensively to measure soft tissue proportions. Remarkable changes exist in anthropometric measures due to changes over centuries of geographical, genetic, and environmental factors, as well as waves of migration causing facial proportions to vary among the different ethnic groups. The purpose of this study was to establish facial soft tissue norms for the Egyptian female population between the ages of 18 and 50, as well as several age-related changes in facial measurements that are described fairly scarcely in the literature. Methods: A prospective study was carried out on 300 Egyptian women between June 2019 and December 2020. All were volunteers and between 18 and 50 years old. Facial measurements were obtained by both direct (caliper-based) and indirect (3D Crisalix software) anthropometric analysis. Anthropometric measurements used in the study included seventeen facial measurements derived from different anthropometric soft tissue landmarks from each subject and eight measurements for analysis. Results: Our results were able to describe the average facial and nasal measurements of the Egyptian female population, as well as the horizontal and vertical analysis of facial proportions. We also determined similarities with other Middle Eastern female measurements, with subtle differences in facial width and nasal height and width compared with Turkish and Iranian women. Conclusions: The current study is valuable because it delivers facial anthropometric measures for Egyptian female faces. This can provide a database for a multitude of uses, including operative planning, postoperative measurements, and forensic and ergonomic purposes.

Postoperative Cutaneous Manifestations as the First Presentation of COVID-19 Infection or a Postvaccination Sequel.

Since its first emergence, coronavirus disease 2019 (COVID-19) took the world by surprise, causing more than two million deaths and 100 million infections to date. The virus's most prevalent clinical symptoms have become well known, yet the rarer symptoms, on the other hand, need to be more widely recognized. Various studies have reflected the possibilities of potential skin lesions being the presenting signs of COVID-19 infection. Acquaintance with the cutaneous presentations of COVID-19 may help in early diagnosis and management of infected patients. Herein we report two cases that presented for plastic surgical interventions in which skin manifestations were the first indicators of COVID-19 infection or postvaccination sequel. The cases were operated upon in different hospitals by different surgical teams.

Consensus Opinions on Facial Beauty and Implications for Aesthetic Treatment in Middle Eastern Women.

BACKGROUND: Middle Eastern women worldwide increasingly seek aesthetic treatment to enhance their beauty and improve self-esteem, but literature describing standards of beauty across the Middle East are scarce. Knowledge of facial anthropometry and Middle Eastern subregional beauty preferences and aesthetic weaknesses are key to develop an effective facial enhancement strategy that does not jeopardize ethnic identity or facial harmony. METHODS: Dermatologists and plastic surgeons from 8 Middle Eastern countries who had 7.5-25 (mean 13.5) years of experience in aesthetic medicine examined female Middle Eastern beauty in 4 geographic subregions: the Gulf (comprising Bahrain, Kuwait, Saudi Arabia, and the United Arab Emirates), Iran, Lebanon, and Egypt. They developed consensus opinions regarding facial beauty, aesthetic deficiencies, and injectable treatment solutions. RESULTS: Facial anthropometry differs between Middle Eastern and Western women, and also within the region. Although subregional differences are seen, beauty is generally recognized by an oval or round face; temple fullness; pronounced, elevated, arched eyebrows; large almond-shaped eyes; well-defined, laterally full cheeks; a small, straight nose; full lips; a well-defined jawline; and a prominent, pointed chin. The relative prominence of the nose necessitates attention to the lips and the shape and projection of the chin. Aging is often accompanied by midface sagging that leads to increased heaviness in the lower facial third. CONCLUSIONS: Middle Eastern beauty is characterized by striking eyes, defined cheeks, and full lips. These consensus opinions inform aesthetic practitioners who treat Middle Eastern women worldwide about their aesthetic ideals and the implications for treatment.

Low-level versus high-level placement of gold plates in the upper eyelid in patients with facial palsy.

BACKGROUND: Lagophthalmos is a condition that results from facial paralysis causing functional as well as esthetic problems. This condition can be treated by a range of techniques, including tarsorrhaphy, facial slings, and canthopexies. Gold plates provide a solution for temporary or permanent lagophthalmos resulting from facial paralysis. This study discusses the use of gold plates in the treatment of lagophthalmos but with the introduction of gold plates in two different positions in the upper lids. METHODS: Group 1 (38 eyes) had a low level of placement (2 mm from the lid margin) of gold plates, while Group 2 (23 eyes) had a high level of placement (5 mm from the lid margin). RESULTS: Noticeable bulge was seen in 18.4% of Group 1 eyes compared with 13% in Group 2, and migration of the plate occurred in 2.6% and 0% of eyes in Group 1 and Group 2, respectively, as well as ptosis (7.8% and 4.3%) and conjunctival perforation (0% and 4.3%). The degree of improvement of eyelid closure, keratopathy, and visual acuity were the same for both techniques. CONCLUSION: Placement of gold plates at a higher level could avoid some of the drawbacks of lower level placement of these plates, such as upper eyelid bulge and ptosis, especially given the thinning of the eyelids and orbicularis muscles that occurs in facial palsy.