Clinical Efficacy of a Topical Compounded Formulation in Male Androgenetic Alopecia: Minoxidil 10%, Finasteride 0.1%, Biotin 0.2%, and Caffeine Citrate 0.05% Hydroalcoholic Solution.

Androgenetic alopecia is the most common form of hair loss. This condition affects both men and women causing significant psychological distress and a decrease in the quality of life. The objective of this study was to investigate the clinical efficacy and patient satisfaction of a topical compounded formulation (minoxidil 10%, finasteride 0.1%, biotin 0.2%, and caffeine citrate 0.05% hydroalcoholic solution) in male androgenetic alopecia patients. A total of five individual, prospective case studies were conducted in the private hair transplant practice of Dr. James C. Marotta. Patients were provided with the topical formulation and instructed to apply a measured 1-mL dose to the entire frontal, parietal, and occipital scalp, twice daily for 6 months. Patients visited the practice periodically (90 days, 120 days, and 180 days post-treatment) for clinical evaluation, photographic assessment, and measurement of their treatment satisfaction by the Men's Hair Growth Questionnaire. By the end of the study, at 180 days, the dermatologist-in-charge concluded that the topical treatment was successful for all five patients. Although moderate, the clinical improvements were visually noticeable as most patients had thicker, more voluminous hair; improved scalp coverage; and improved general hair appearance. These results were consistent with the photographic assessment, which demonstrated a global average increase of +1.05 in the patients' hair density. According to the patients' self-assessment, the topical compounded formulation was effective following 3 months and 6 months of continuous treatment. At 120 days, the patients' satisfaction was neutral or negative, which was likely due to negligible differences in the patients' hair growth and appearance in 90 days compared to 120 days. The results from this study suggest that the new hair-loss topical solution may be considered a safe and effective treatment option in male AGA patients.

Intraoperative Endoscopic Suction-Assisted Evaluation of the Nasal Valve.

IMPORTANCE: The study sought to identify a new method for measuring internal nasal valve patency. OBJECTIVE: To determine whether intraoperative endoscopic suction-assisted evaluation of the internal nasal valve is a useful technique to assess internal nasal valve area and function. DESIGN, SETTING, AND PARTICIPANTS: A study of 20 patients undergoing cosmetic and functional septorhinoplasty from May 1 through October 31, 2012, at a private surgical practice was performed. A follow-up study was performed 3 years postoperatively on 7 patients. A photograph of the internal nasal valve was taken endoscopically with and without suction preoperatively, postoperatively, and at 3-year follow-up. Measurement of the internal nasal valve surface areas was then performed by an evaluator masked to patient groupings. MAIN OUTCOMES AND MEASURES: Outcome measures were surface area of the internal nasal valve as measured by standardized, endoscopic photography preoperatively, postoperatively, and at 3 years with and without suction and Nasal Obstruction Symptom Evaluation (NOSE) scale scores at 3 years comparing preoperative and postoperative symptoms. RESULTS: Among the 20 patients studied, 13 were female and the mean age was 26 years. No difference was found in the observed static surface area of the internal nasal valve comparing preoperative and postoperative values (72 418 vs 76 973 square pixels, P = .58). No difference was found in the observed static surface area of the internal nasal valve comparing preoperative (56 426 square pixels) and postoperative (60 011 square pixels) values (P = .58). No difference was found in the observed surface area of the internal nasal valve under negative pressure comparing preoperative (54 194 square pixels) and immediate postoperative (58 325 square pixels) values (P = .97). At 3 years, the resting surface area of the internal nasal valve was not increased with an internal nasal valve surface area mean of 56 426 square pixels preoperatively and 84 352 postoperatively (P = .09). The surface area of the internal nasal valve was increased when exposed to negative sniff pressures in the 3-year follow-up by 45% (P = .03). The surface area measured a mean of 47 683 square pixels preoperatively and 85 612 square pixels at the 3-year mark under negative pressure. CONCLUSIONS AND RELEVANCE: The study outlines a novel technique for measuring internal nasal valve surface area and compliance preoperatively and postoperatively. Surgery on the internal nasal valve has a greater effect on the dynamic function of the internal nasal valve (ie, stiffness that can be accounted for by a mere increase in nasal valve size when measured endoscopically). The study lays the groundwork for future studies using this technique. LEVEL OF EVIDENCE: 4.

Lower eyelid aesthetics after endoscopic forehead midface-lift.

OBJECTIVE: To assess and quantitate the immediate effect of endoscopic forehead midface-lift on infraorbital hollowing and lower eyelid skin excision. METHODS: Twenty-five patients who underwent an endoscopic forehead midface-lift with a lower eyelid blepharoplasty or lower eyelid blepharoplasty without a midface-lift between January 1, 2005, and May 15, 2005, were included in the study. Preoperative and immediate postoperative measurements of the vertical height of the lower eyelid were taken in all patients. The change in the vertical height of the lower eyelid after endoscopic forehead midface-lift with blepharoplasty was compared with the change in lower eyelid height after either transconjunctival or lower eyelid skin pinch blepharoplasty or skin muscle flap blepharoplasty alone. The amount of lower eyelid skin excised after endoscopic forehead midface-lift with blepharoplasty was compared with both transconjunctival or lower eyelid skin pinch blepharoplasty and skin muscle flap blepharoplasty when a midface-lift was not performed. RESULTS: The average change in the vertical height of the lower eyelid after the endoscopic forehead midface-lift was 5 mm. Lower eyelid blepharoplasty alone, whether transconjunctival with skin pinch or skin muscle flap, did not affect the vertical height of the lower eyelid. The change in the vertical height of the lower eyelid with midface surgery over blepharoplasty alone was statistically significant (P < .001). The average amount of lower eyelid skin excised after endoscopic forehead midface-lift and lower eyelid skin pinch was 7.0 mm compared with 5.5 mm for both the transconjunctival lower eyelid skin pinch and the skin muscle flap techniques. The difference in skin excision when a midface-lift was performed compared with blepharoplasty alone was statistically significant (P = .008). CONCLUSIONS: The endoscopic forehead midface-lift can reduce the vertical height of the lower eyelid by an average of 5 mm and allows more skin excision over blepharoplasty alone. The endoscopic forehead midface-lift is a powerful tool for decreasing the vertical height of the lower eyelid, lessening infraorbital hollowing, and improving dermatochalasis.

Pitfalls of midface surgery.

The endoscopic forehead midface lift is perhaps the most powerful tool has been made available to the facial aesthetic surgeon in the last 10 years. Although this technique can reap the greatest rewards, it is also fraught with the greatest peril. A difficult dissection, prolonged period of edema, and numerous other pitfalls have tempered enthusiasm among facial aesthetic surgeons for this powerful technique. Nonetheless, the midface lift can be performed both safely and effectively. Through careful analysis of the pitfalls of midface surgery, one can adopt principles that help prevent or minimize potential complications. Such an approach can maximize the surgical benefit to the patient and lessen the anxiety surrounding the procedure for the patient and surgeon alike.

Efficacy of resorbable plates for reduction and stabilization of laryngeal fractures.

We evaluated the efficacy of resorbable reconstruction plates (polylactic acid copolymer) for the open reduction and stabilization of displaced laryngeal fractures. Both MacroPore and Leibinger reconstruction plates were used with equal ease of application in 3 adult male patients. We found the plating system to be especially effective for the reduction of comminuted cricoid fractures. Adequate skeletal stabilization allowed early resumption of phonatory and respiratory function without long-term intraluminal stenting for skeletal support. No complications of hematoma, seroma, or infection were experienced. Resorbable plates appear to be relatively safe and useful for internal fixation of both cartilaginous and ossified parts of the larynx, allowing rapid rehabilitation and return of function.