The Jaws Brachioplasty: An Original Technique: Improving Aesthetic Outcomes in Arm Lift Procedures.

(1) Background: The increase in the number of bariatric surgery procedures has led plastic surgeons to look for new approaches to improve outcomes of body-contouring surgeries. A major concern in brachioplasty is the scarring process. Here, we propose a novel technique to minimize the incidence of pathological or unsatisfactory scars from brachioplasty. A video of the entire procedure is provided. (2) Methods: From January 2016 to August 2020, we performed the "Jaws" brachioplasty on 16 post-bariatric patients. We evaluated the effectiveness of the technique through pre- and postoperative assessments by patients and surgeons, the Vancouver Scar Scale, and the detection of major and minor complications within 12 months of follow-up. (3) Results: Thirteen patients were female and three were male, with a mean age of 32.5 ± 6.8 years (range: 22-47 years). The BODY-Q© Arms Section scores improved significantly, with no incidence of major or minor complications over 1 year of follow-up, and favorable aesthetic outcomes. (4) Conclusions: We believe that the "Jaws" technique is a valid contribution to post-bariatric surgery, as it aims to solve specific aesthetic problems of scarring from brachioplasty. The small number of patients does not allow the comparison of our original technique to others previously described in the literature.

The Regenerative Effects of Botulinum Toxin A: New Perspectives.

Background: Botulinum Toxin A (BTX-A) has been found to improve blood flow perfusion. This study aimed to find in literature the use of BTX-A in Plastic Surgery and in particular its use to improve blood flow perfusion.Methods: We read the article "Effects of Botulinum Toxin A on the blood flow in expanded rat skin" and starting from this article we searched in the literature all the articles talking about the use of BTX-A to improve blood flow perfusion.Results: BTX-A increase the expression of VEGF, CD-31 and INOS. Moreover BTX-A selective suppress sympathetic neurons of the cutaneous microcirculation. We found 13 studies that confirm the effects of Botulinum Toxin A in improving blood flow perfusion of cutaneous and myocutaneous flaps.Conclusion: We think that in the future we could start to use BTX-A in these fields of plastic surgery, but we really need to understand good dosages and standardize them, see which are the effects on long-term outcomes, and put on randomized trials providing high-level evidence about the range of dosages in which we are safe to use BTX-A and asses the risk-benefit ratio in humans and the cost-benefit ratio.

To Keep or Not to Keep? The Hamletic Umbilical Dilemma: Preservation versus Reconstruction of the Umbilicus in Vertical Abdominoplasty.

(1) Background: The role of the umbilical scar and its repositioning remains one of the most important surgical steps in the execution of any type of abdominoplasty, including those involving "inverted-t" or "fleur de lys" incisions. A consequence of this is a surgeon's Hamletic dilemma: to keep or not to keep the original umbilical scar? (2) Methods: A retrospective observational study was conducted on all patients undergoing "T-inverted" abdominoplasty at the Department of Plastic Surgery of the Santa Maria alle Scotte University Hospital, Siena, between January 2018 and December 2020. Twelve months after the surgery we submitted to all patients the U-score questionnaire about their feelings about their umbilicus's appearance. Patients could assign a score from 1 (very dissatisfied) to 4 (very satisfied) to each of the five items of the score. (3) Results: The average of the scores attributed by the nine patients in whom the navel was preserved is 13 (Range 10-17), while in patients on whom a navel reconstruction was performed, the mean score is 16.8 (Range 12-20). The mean score of patients with a reconstructed umbilicus is, therefore, statistically higher than that of the other group of patients (t-value = 3.88, p = 0.000374) with an average increase of 3.8 points. (4) Conclusions: We can state that the reconstruction of a new navel is the right answer to the Hamletic dilemma in patients having undergone vertical or anchor abdominoplasty.