Breast Reduction in Behçet's Disease: A Case Report.

Behçet's disease (BD) is an inflammatory systemic vasculitis manifested by uveitis and oral and genital aphthae. There have been no reported cases in the literature about reduction mammoplasty or large flap surgeries in BD. A 55-year-old female with a 16-year history of BD was presented to our clinic for reduction mammoplasty. The patient was taking colchicine and had records of uveitis and oral and genital aphthae. Colchicine treatment was stopped one week before surgery and restarted one week later. Reduction mammoplasty was performed with the inferior pedicle technique. On the first day after surgery, mild hyperemia and induration were observed around the incision line, worsening over the next 48-72 hours with the appearance of serous discharge at the vertical suture line and inverted T incision. Minimal wound dehiscence developed on the seventh day, and a small superficial necrosis developed at the lower part of the vertical suture on the 15th day. Between days 30 and 45, the necrotic tissue sloughed off, and the wound closed with epithelialization. In conclusion, patients with BD may experience prolonged inflammation, small skin necroses around the incision line, and delayed wound healing post surgery, although acceptable scar maturation can eventually be achieved.

High Superficial Musculoaponeurotic System Lamellar Facelift Under Local Anesthesia.

PURPOSE: Patients, nowadays, prefer easy, low-risk, day-case procedures under local anesthesia for facial rejuvenation. Therefore, they favor facelift operations applied under local anesthesia. MATERIALS AND METHODS: A total of 160 patients who underwent high superficial musculoaponeurotic system (SMAS) lamellar facelift under local anesthesia between 2010 and 2020 were included in this study. Patients operated under general anesthesia were excluded from this study. High SMAS lamellar facelift under local anesthesia was performed in all patients, consisting of 145 women and 15 men without any additional disease aged between 38 and 65 years. About 140 of these patients underwent primary facelift, whereas 20 of them had undergone SMAS plication more than 10 years ago. Lidocaine was used as a local anesthetic and the patients were not sedated. The duration of the operation was 80 minutes on average. The patients were left to rest for 1 hour after the operation and then sent home until their follow-up every other day for the first week. RESULTS: This study shows that high SMAS facelift operations for the mid-face can easily be performed under local anesthesia under operating room conditions without sedation. However, an important point to keep in mind is that although the results of this surgery satisfy the patients, the outcomes do not entirely match the expectations from total face and neck lift performed under general anesthesia. High SMAS facelift with local anesthesia should be considered as an alternative for patients who do not want to undergo general anesthesia or who are at risk of undergoing general anesthesia. Especially during the COVID-19 pandemic, local anesthesia was considered much safer for the patients.Level of evidence: Level V.

Harvesting Split Costal Cartilage Graft in Revision Rhinoplasty Without Disturbing the Costal Integrity.

BACKGROUND: Graft use is inevitable in some primary and secondary rhinoplasty cases with cartilage or bone deficiency. Although rib graft is one of the best graft sources, it has several disadvantages. The purpose of this study is to minimize the risks of using rib grafts. MATERIAL AND METHODS: Between 2018 and 2020, a total of 21 patients aged between 25 and 55 have undergone revision rhinoplasty under general anesthesia with a split cartilage graft of central origin. A 3-4-mm-thick bridge was left at the superior and inferior edges of the donor area, and the graft was harvested from the central region without disrupting the costal integrity. A special retractor was placed between the perichondrium and the rib at the posterior of the costa to prevent damage to the pleura while cutting the rib. The previously marked grafts were cut in the donor area and harvested ready for use. The harvested grafts were used as spreader, strut, alar rim and nasal valve grafts. RESULTS: None of the patients had complications due to rib graft harvesting. After the operation, pain in the donor region and analgesic requirement of these patients were less compared to the patients with full-layer grafts. CONCLUSIONS: The grafts taken from the center of the costa without breaking its integrity seem quite suitable for revision rhinoplasty surgeries. This technique prevents various morbidities and enables patients to have a more comfortable postoperative period. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Harvest of Rib Graft for Rhinoplasty in Breast Implant Patients.

Combined cosmetic surgeries are advantageous to patients, requiring only 1 anesthesia administration and the loss of fewer working days. There is no previous study reporting on a submuscular implant placement with the simultaneous reconstruction of a nose deformity using a rib graft. Reconstructions of nose deformities through a rib graft, augmentation mammoplasty, and augmentation mastopexy were performed on 4 female patients (who were 19, 23, 24, and 27 years old) between 2006 and 2016. The patients were taken for operations under general anesthesia. First, the rib graft was taken and the breast implant was placed to prevent contamination. An inframammary incision was made, the skin and the subcutaneous layers were passed, and the pectoral muscle fascia was accessed for the rib graft in all 3 patients. After the perichondrium was dissected, an osteochondral graft was harvested at full thickness. The remaining sharp edges were rasped to avoid damaging the silicone. The perichondrium and the periosteum were sutured edge-to-edge, and the donor area was closed. The harvested grafts were used to produce a spreader graft, a nasal valve graft, an onlay graft, and an L-strut graft. In the early period, no seroma, hematoma, or infections were experienced. There were no ruptures, leakages, capsules, or deformities during the 2- to 10-year follow-up. Primary and secondary rhinoplasties requiring a rib graft can be safely performed simultaneously with a breast implant, provided that the rib stumps are closed with a thick protective layer.

Nipple Dimensions After Augmentation Mammoplasty, Mastopexy and Reduction Mammoplasty: A Comparative Clinical Study.

BACKGROUND: Nipple hypertrophy is a rare aesthetic problem. Ideal nipple dimensions are 6-8 mm, while nipples larger than 10 mm are considered hypertrophic. PATIENTS AND METHODS: A total of 24 female patients, aged between 22 and 53 years, with a nipple diameter or height greater than 10 mm, underwent augmentation mammoplasty (AM), augmentation mastopexy (AUM) and reduction mammoplasty (RM) operations. The patients were divided into three groups according to the type of surgery containing equal numbers of patients. Group I underwent AM, Group II underwent AUM and Group III underwent RM surgery. Preoperative and 1-year post-operative nipple dimension measurements were performed, and the results were compared. RESULTS: There was no significant difference between the preoperative nipple volumes among the groups (p > 0.05). There was no significant difference between preoperative and post-operative nipple volumes in Group I (p > 0.05). The difference between preoperative and post-operative nipple volumes in Group II and Group III was significant (p < 0.05). When post-operative dimension comparisons were taken into consideration, there was a significant difference between Group I compared to Group II and Group III (p < 0.05); however, the difference between Group II and Group III was not significant (p > 0.05). CONCLUSIONS: Since there will be no reduction in nipple size during the post-operative period in AM patients, hypertrophic nipple can be reduced in the same session. However, in patients with AUM or RM, if the reduction in nipple size is not sufficient, it is more convenient to perform the nipple reduction operation 1-year post-surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Prominent Ear Recurrence in Different Age Groups.

AIM: Although many prominent ear deformity (PED) surgery techniques have been described to date, there have been few comprehensive studies evaluating the recurrence rates in different age groups. Previous studies have focused either on the young or the elderly. The present clinical study compares recurrence rates among patients of different age groups undergoing PED repair and discusses cartilage morphology. PATIENTS AND METHODS: A total of 380 patients with a mean age of 24.2 years underwent PED repair surgery between 2001 and 2019. The patients were divided into five subgroups according to age. Group I (5-10 years) was composed of 44 patients, Group II (10-20 years) was composed of 47 patients, Group III (20-30 years) was composed of 166 patients, Group IV (30-40 years) was composed of 90 patients, and Group V (over 40 years) was composed of 33 patients. The cephaloauricular angle (CAA) and the distance between the helix (upper, middle, lower) and mastoid were measured and recorded prior to surgery. The patients were all treated with three concha-mastoid sutures to achieve concha reduction and to narrow the cephaloauricular angle. The anterior aspect of the cartilage was thinned with a rasp, and an antihelix was created using non-absorbable sutures in patients with an inadequate antihelix. RESULTS: The CAA and the upper pole-mastoid distance were measured immediately after surgery and at 15 days, 3 and 6 months after surgery. Recurrence was observed in a total of 18 patients, with PED recurring in one patient in Group I (2.3%), three patients in Group II (6.38%), 10 patients in Group III (6.8%), three patients in Group IV (3.3%) and one patient in Group V (3.03%). Although the difference in the recurrence rate among the age groups would appear to be clinically significant, the difference was not significant, statistically. Clinically, the differences among the groups could be attributed to intragroup numerical differences. CONCLUSIONS: In the present study, no significant relationship was identified between the patient age and recurrence rate. Although PED repair is recommended in the preschool period, prominent ear repairs can be carried out in any age group, although the degree of cartilage scoring should differ depending on the age group. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effect of Hyaluronidase on Depth of Necrosis in Hyaluronic Acid Filling-Related Skin Complications.

AIM: In this clinical study, 16 female patients with vascular compression and occlusion-related ischemia and skin necrosis after hyaluronic acid filling injection were analyzed retrospectively. Dose, timing, and efficacy of hyaluronidase use in skin necrosis are discussed. PATIENTS AND METHODS: In a total of 841 cases, aged between 18 and 60 years, hyaluronic acid filling injections were performed. All patients were followed up for 3-24 months. Filling injected areas include nasolabial (391 cases), lip (225 cases), glabella-forehead (90 cases), infraorbital (46 cases), malar region (25 cases), chin (24 cases), and nose (40 cases). Skin complications occurred in four cases during the application and in 12 cases 6-24 h after the procedure. Only palliative treatment was performed in six cases, while hyaluronidase was used in 10 cases in addition to palliative treatment. Hyaluronidase injection was performed 30 s after filling injection in four cases and 6-24 h after the injection in the remaining six cases. A total of 1500 units of hyaluronidase was applied to each case in average. RESULTS: Recovery period of the patients who received palliative treatment only lasted 40-60 days. The area of necrosis was limited in these patients who did heal well only with some change of pigmentation and no obvious scar. In the patient group who received hyaluronidase in addition to palliative treatment, a large necrosis area was observed at the same time in four patients. Despite the hyaluronidase treatment in this group, recovery period was 20-90 days. The affected and necrosis areas were large. The cause of ischemia depended both on occlusion and on compression. While four patients healed with a scar, the remaining 12 patients healed without any significant scar. CONCLUSIONS: Hyaluronidase injection provides earlier recovery of limited skin necrosis. Immediate hyaluronidase injection allows small damage to heal in a short time; however, it does not completely eliminate large necrosis, although it limits the necrotic area. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prominent Ear Correction With Anterior Rasping.

PURPOSE: Prominent ear deformity is usually characterized by antihelical fold deficiency, concha hypertrophy and earlobe deformity. MATERIALS AND METHODS: Between 2000 and 2018, 375 otoplasty patients aged 6 to 58 who underwent surgery in our clinic were included in this study. Among these 375 cases, 25 were unilateral and 350 were bilateral. As surgical techniques anterior rasping, concha-mastoid sutures and concha-scaphoid sutures were used. The average cephaloauricular angle, the upper pole-mastoid distance and the distance between the middle 1/3 of the ear and mastoid was measured preoperatively and postoperatively. Postoperative measurements were made on the 15th day, 3rd month and the 6th month after the surgery. The approximate follow-up period ranged from 6 months to 18 years. RESULTS: Concha-mastoid sutures can be used not only to reduce the concha but also to adjust the proportion between the width and height of the ear. Attenuation of the cartilage by rasping provides homogeneous thinning of the cartilage and prevents deformation. In all age groups, relapse and angle changes were observed in the first 6 months. After 6 months, there were no cases of recurrence or angle changes.

Measurement of Warping Angle in Human Rib Graft: An Experimental Study.

BACKGROUND: The purpose of this study was to determine the warping angle of the costal cartilage in vivo. METHODS: A nasal framework reconstruction with a rib graft was performed in a total of 130 patients. After the cartilage specimens were prepared, the remaining grafts were used for study. The angle of warping in all grafts was measured at 0, 30, and 60 minutes; after 24 hours; and after 1 week. Eight subgroups of graft thicknesses from central and peripheral groups, determined according to the perichondral distance of the grafts, were evaluated, and the warping angles of 48 osteochondral and chondral grafts were measured individually. Three-way analysis of variance was used to compare the change in warping over time to detect differences in the grafts. RESULTS: Significant differences were not observed in the 1- to 3-mm-thick grafts of peripheral and central origin before 30 minutes (p > 0.05), although significant differences were observed in these groups for all time points after 30 minutes (p < 0.05). In central and peripheral grafts thicker than 4 mm, a significant warping angle was not observed (p > 0.05). In central origin grafts thinner than 1 mm, significant differences were not observed in the warping angle (p > 0.05), although they were observed in the same grafts of peripheral origin (p < 0.05). Peripheral origin grafts thicker than 1 mm showed warping in the direction of the perichondrium (p < 0.05), whereas central origin grafts thinner than 1 mm showed warping angle irregularities. CONCLUSION: Interlocking stresses are very important in rib grafts when balanced cross-sectional carving occurs from the peripheral to the central areas. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Augmentation Mastopexy with a Dermal Encapsulated Round or Anatomic Autoprosthesis.

INTRODUCTION: Several factors, such as aging, pregnancy, and weight loss, reduce the elasticity of the breast tissue, and ptosis occurs. Due to aging and gravity, it is not possible to completely prevent breast ptosis. The goal is to delay the recurrence of ptosis as much as possible. PATIENTS AND METHODS: This study included 20 female patients aged 25-55 years. The patients who underwent surgery had different levels of ptosis. Although the patients wanted their breasts to be lifted and an increase in projection, they did not want implants to be used. For this reason, autologous flaps were prepared from the patients, and these flaps were called autoprosthesis flaps. The flap donor area (FA) boundaries consisted of the inframammary fold at the bottom, the medial and lateral pillar legs at the two sides and the lower margin of the areola at the top. The skin on the FA was de-epithelialized. A hand dermatome was used to ensure that the extracted skin was not too thick because the rest of the dermal skin would form the cover of the planned autoprosthesis flap. Before surgery, the autoprosthesis flap baseline width, projection, and shape (round or anatomic) were planned for each patient. The autoprosthesis flap was prepared as a central pedicle, and the dermal layer, which was 1 cm wider than the flap, was then attached over the autoprosthesis flap to the pectoral muscle fascia with at least 10 sutures in the recipient area. For a round autoprosthesis flap, the flap base diameter was 10-12 cm on average, whereas for an anatomic autoprosthesis flap, the width of the flap was 10-12 cm and the height was 12-14 cm. Autoprosthesis flap projections varied from 4 to 6 cm. RESULTS: Because of the autoprosthesis flap, breast projection was more prominent, even in the lying position. All the patients were very satisfied with their size, shape, projection, and natural appearance. In particular, the image in the lying position was very similar to a mastopexy performed with an actual breast implant; thus, sagging was not observed. CONCLUSION: In augmentation mastopexy patients who do not want implants, upper pole filling and adequate breast projection can be easily achieved with this method. The potential risks of capsule formation, implant rejection, and implant rupture were not observed with this technique. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hair Transplantation in Migraine Headache Patients.

BACKGROUND: Migraine headache is a primary neurologic disease affecting millions of people worldwide. As a consequence, quality of life is diminished, productivity suffers (through loss of work force), and treatment costs are substantial. The occurrence rate in the general population is quite high, with women accounting for 3 of every 4 cases. METHODS: Between January 2011 and May 2012, a total of 221 patients received hair transplants. Another 590 patients underwent hair transplantation between June 2012 and December 2016. Initially (first interval), patients were not questioned on migraine headaches in preoperative visits, but questioning was regularly done thereafter. Overall, 150 patients given transplants in the first period were surveyed by phone regarding preoperative migraine headaches. Aside from the 1 incidental discovery, no other instances of migraine emerged. Headache origins were occipital-frontal in 2 patients, occipital-temporal in 2 patients, and occipital-temporal-frontal in the 2 others. Donor/receiver areas in hair transplantation and migraine trigger zones shared locations. Headache frequencies ranged from 4 to 8 days per month (average, 6 days), and pain scores were 5-8 (10 being highest). Duration of pain was 3-5 hours (average, 4 hours). All six patients had used various medications, such as triptans, ergot, and nonsteroidal anti-inflammatory drugs, before hair transplantation. The 1 female patient was a 32-year-old seeking treatment for alopecia, with a 6-year history of migraine headaches. The male patients presenting with androgenetic alopecia (grade 4-5 by Norwood classification) had 6- to 20-year migrainous histories. RESULTS: After hair transplantation, each migraine sufferer was checked once in the first month and then once every 3 months. Those who could not appear in person after the first year were evaluated by phone every 3 months. Migraine headaches had ceased in all 6 patients, none of whom used medical treatments for migraines thereafter. The postoperative improvement each patient experienced was dramatic (P < 0.001). Overall, the mean intensity of headaches declined from 6.6 ± 1.47 to 0, on an analog scale of 1-10 (P < 0.001); and mean headache frequency was reduced from 5.83 ± 1.03/month to 0/month (P < 0.001). Likewise, the migraine pain index fell from a mean of 149.33 ± 19.21/month to mean of 0/month (P < 0.001). CONCLUSIONS: This report details 6 patients who experienced abatement of migraine headache symptoms following hair transplantation. The positive effects of hair transplantation on migraine headache and potential mechanisms of action are also discussed.

Incidence and Classification of Chest Wall Deformities in Breast Augmentation Patients.

Although chest wall deformities (CWDs) are seen four times more often in males than in females, most patients who consult plastic surgery clinics in our country are females. Breast augmentation and augmentation mastopexy were performed with a total of 812 breast implants in 406 patients. Forty-three of these patients had various CWDs. The CWD patient ages ranged from 18 to 43 years. Patients were observed for 6 months to 8 years (mean of approximately 3 years). Pectus excavatum (PE) was present in 22 patients, pectus carinatum (PC) in five patients, Poland syndrome (PS) in two patients, sunken chest deformity (SCD) in three patients, barrel chest deformity (BCD) in five patients, body builder deformity (BBD) in three patients, and long upper chest wall (LCW) in three patients. None of the patients had functional or cardiac deformities. A total of 86 round, anatomically textured gel implants in various profiles were used within a range of implant volumes for all patients. There were no serious complications in the 43 CWD patients. The frequency of CWDs in the total population of 406 patients was approximately 10.6%. PE was present in 51% (22/43) of the patients with CWDs. The deformity rates among patients who underwent augmentation mammoplasty were as follows (%): PE, 5.4; PC, 1.23; PS, 0.5; SCD, 0.73; BCD, 1.23; BBD, 0.73; and LCW, 0.73. The three most common deformities observed in this study were PE, PC, and BCD. The least common deformity was PS. Patients with CWDs should be carefully evaluated preoperatively, and all the associated measurements and calculations must be meticulously performed. The implant selection may differ according to the deformity pattern. For example, in patients with PE, prostheses with larger base diameters cover the deformity better. Although high-profile prostheses are preferred on the affected side in cases of PS and SCD, low- or middle-profile prostheses are preferred on the opposite side. Despite this common consensus, there was an asymmetry of approximately 1 cm between the sides, as observed postoperatively. However, the patients did not express dissatisfaction with this situation. Low-profile prostheses should be preferred for PC and BCD protruding CWDs because asymmetry becomes more prominent and over-projection occurs more frequently in cases of high-profile prostheses. The BBD projection is also a problem. For this reason, high-profile prostheses should be preferred in these patients. It is possible to obtain satisfactory results by using appropriate breast implants in patients with CWDs. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Osseous-Cartilaginous Spreader Graft and Nasal Framework Reconstruction.

Revision rhinoplasties and saddle nose deformities usually require grafting for reconstruction. Between January 1, 2000, and January 1, 2017, autologous rib grafts were used in 127 secondary and tertiary rhinoplasty patients [(57/127 females) and (70/127 males)]. Osseous-cartilaginous rib grafts (OCRGs) were divided into three parts (i.e., 1/3 upper peripheral, 1/3 central, and 1/3 lower peripheral). The harvested OCRGs were also shaped as vertical strips using a number 11 scalpel blade. These OCRGs were shaped to form the L-strut cartilaginous graft (LSCGs), osseous-cartilaginous spreader grafts (OCSGs), osseous-cartilaginous onlay grafts, nasal valve grafts (NVGs), and lower lateral cartilaginous grafts (LLCGs). The upper peripheral portion of the rib was usually used as an onlay graft for dorsal reshaping. The shape of this part was minimally convex after being cut from the main graft, and the convex shape was very appropriate for use as an onlay graft. The middle portion of the graft that consisted of the osseous and cartilaginous structure was used for the OCSGs. The middle portion of the graft that contained only cartilage was used for the LSCGs, NVGs, and LLCGs. OCRGs were used for the dorsal, alar, septal, upper lateral, and columellar struts for all patients. OCSGs were used for all of the septal grafts to provide further stability. In the nasal valve failure patients, the rib cartilage was fixed onto the lower lateral and upper lateral cartilage and was sutured using polyglactin to improve nasal valve function. One edge of the graft was sutured over the septum, and the other edge was positioned against the maxillary crest to allow for air flow at the nasal valve. After an OCSG was sutured to the septum, a flat and smooth dorsum was shaped before the dorsal onlay graft was placed and fixed. The bone fragments of the grafts that consisted of spreader and onlay grafts were tied to the radix nasi bone without any space. After 6 months of follow-up, a minimally warping defect was apparent in 8 patients but none of these patients requested another surgery. The analysis of the questionnaire responses revealed that >90% of the patients were satisfied with the outcome of the procedure. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Late postoperative massive bleeding in septorhinoplasty: A prospective study.

BACKGROUND: There are various complications that can occur in septorhinoplasty, most of which are related to postoperative failure to achieve the desired aesthetic result. However, there are also many other complications, including postoperative bleeding, which is one of the most common nonaesthetic-related complications. OBJECTIVE: The present study was a prospective analysis involving a total of 750 septorhinoplasty patients, and included individuals who experienced massive bleeding after postoperative day 8. RESULTS: The incidence of bleeding was 2% among all patients. One percent of cases with bleeding occurred between postoperative days 8 and 14. None of the patients exhibited an abnormality in preoperative or postoperative coagulation tests. Mean blood loss was approximately 1 unit. In all patients, clots in the nose were cleaned, bleeding was subsequently controlled by placement of a polyvinyl alcohol sponge tampon soaked in adrenalin and tranexamic acid, and intravenous administration of 250 mg tranexamic acid in isotonic saline solution. This treatment was sufficient for all cases. None of the patients expereinced recurrent bleeding nor did they require a blood transfusion. CONCLUSION: Late bleeding in septorhinoplasty is rare. It may be prevented by completely filling the nasal cavity so that there is no dead space between the septal mucosal membranes and the drainage opening. If bleeding occurs, it can be treated by placement of a tampon soaked in adrenalin and tranexamic acid plus intravenous administration of 250 mg tranexamic acid.

HISTORIQUE: Plusieurs complications peuvent survenir après une septorhinoplastie. La plupart sont liées à l'incapacité d'obtenir le résultat esthétique souhaité après l'opération. Il existe toutefois de nombreuses autres complications, y compris les hémorragies postopératoires, qui font partie des complications les plus courantes à ne pas être liées à l'esthétisme. OBJECTIF: La présente analyse prospective portait sur 750 patients ayant subi une septorhinoplastie et incluait des personnes qui avaient subi une hémorragie massive huit jours après l'opération. RÉSULTATS: L'incidence d'hémorragie s'élevait à 2 % pour l'ensemble des patients. Un pour cent des cas d'hémorragie se sont produits entre le huitième et le quatorzième jour suivant l'opération. Aucun patient ne présentait d'anomalie selon les tests de coagulation préopératoires ou postopératoires. La perte de sang moyenne s'élevait à environ une unité. Chez tous les patients, les caillots dans le nez ont été nettoyés, le saignement a été contrôlé par l'insertion d'un tampon d'alcool polyvinylique en éponge, imbibé d'adrénaline et d'acide tranexamique, et par l'administration intraveineuse de 250 mg d'acide tranexamique dans du sérum physiologique isotonique. Ce traitement a suffi dans tous les cas. Aucun des patients n'a souffert d'hémorragie récurrente ni n'a dû subir de transfusion. CONCLUSION: L'hémorragie tardive est rare après une septorhinoplastie. Pour l'éviter, on peut remplir complètement la cavité nasale, pour combler tout l'espace entre les muqueuses du cartilage triangulaire et l'ouverture de drainage. Pour traiter un saignement, on peut insérer un tampon imbibé d'adrénaline et d'acide tranexamique et administrer 250 mg d'acide tranexamique par voie intraveineuse.

Autoaugmentation Mastopexy Modification Prevents Bottoming-Out Deformity and Areola Distortion: A Preliminary Report.

BACKGROUND: Ptotic breast deformity results from involution of breast parenchyma and leads to a loss of volume, along with a converse laxity of the skin envelope. As the breast tissue descends inferiorly with gravity, there is an apparent volume loss in the upper pole and the central breast, and the lower pole becomes fuller and often wider. This study presents modifications for a well-known mastopexy technique which provides not only autoaugmentation for the breast but also suspension for the breast parenchyma and reduces bottoming-out deformity, and also obtains a regular areola shape in all types of breasts. PATIENTS AND METHODS: The modifications involve 2-4 cm subareolar crescentic incisions for regular areolas and cylindrical excision of the recipient area in the superior medial and lateral pillars for wide flaps in medium and large-size breasts. RESULTS: The present study included 63 female patients, with an average body mass index of 25.5 ± 2.0 kg/m(2), aged 26-47 years (average 35 years). The author performed vertical scar mastopexy and augmented the breasts with a distal-based flap of deepithelialized dermoglandular tissue inserted beneath the breast parenchyma of a superior-based nipple-areolar complex pedicle. CONCLUSIONS: In this study, modifications included subareolar crescentic incisions and cylindrical excisions in the superior medial and lateral pillar regions. This technique produced satisfactory results for all types of breasts in terms of good breast shape, natural image at the upper pole of the breast, good projection, and reduced bottoming-out deformity. This simple modified technique maintained the size of the breasts and avoided augmentation by breast implants. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Follicular Unit Extraction Hair Transplantation with Micromotor: Eight Years Experience.

OBJECTIVE: Follicular unit extraction (FUE) has been performed for over a decade. Our experience in the patients who underwent hair transplantation using only the FUE method was included in this study. METHODS: A total of 1000 patients had hair transplantation using the FUE method between 2005 and 2014 in our clinic. RESULTS: Manual punch was used in 32 and micromotor was used in 968 patients for graft harvesting. During the time that manual punch was used for graft harvesting, 1000-2000 grafts were transplanted in one session in 6-8 h. Following micromotor use, the average graft count was increased to 2500 and the operation time remained unchanged. Graft take was difficult in 11.1 %, easy in 52.2 %, and very easy in 36.7 % of our patients. CONCLUSIONS: The main purpose of hair transplantation is to restore the hair loss. During the process, obtaining a natural appearance and adequate hair intensity is important. In the FUE method, grafts can be taken without changing their natural structure, there is no need for magnification, and the grafts can be transplanted directly without using any other processes. Because there is no suture in the FUE method, patients do not experience these incision site problems and scar formation. The FUE method enables us to achieve a natural appearance with less morbidity.

Comparison of Various Rhinoplasty Techniques and Long-Term Results.

BACKGROUND: Various techniques are used in rhinoplasty. These techniques can be classified under transcolumellar approaches and endonasal procedures. Open rhinoplasty without transcolumellar incision (ORWTI) procedure can be described as a combination of these two techniques. METHODS: In this study, we present patients who underwent nasal surgery utilizing one of these three techniques between 1999 and 2013 and discuss some modifications to the techniques. RESULTS: Of a total of 1526 patients, 1131 were operated on with open rhinoplasty with transcolumellar incision, 219 were operated on with ORWTI, and 176 were operated on using the endonasal approach. With an average follow-up period of approximately 4 years, 4 % of the patients required revision. The patient satisfaction rate was more than 90 % for all of these techniques. CONCLUSIONS: The endonasal approach is an appropriate choice for select patients due to the lower chance of complications and a shorter procedure time. With open rhinoplasty with the transcolumellar incision technique, the type of surgery can be more easily controlled, however, extended nasal tip edema and columellar scar are some of the disadvantages of this method. ORWTI allows a patient to avoid these disadvantages and provides a more controlled procedure, similar to the open method.

Cold injury from liquid petroleum gas.

Cold injury by liquid petroleum gas is produced by evaporation that causes damage by cold to vital structures. We present two cases of exposure to pressurised liquid petroleum gas during an industrial accident.