Iridium(III)-based minor groove binding complexes as DNA photocleavage agents.

Transition metal complexes containing the qtpy ligand (2':4,4'':4',4'''-quaterpyridyl) are known to be DNA intercalators or minor groove binders. In this study, new tricationic iridium(III) complexes of qtpy are reported. Both [Ir(bpy)2(qtpy)]3+1 and [Ir(phen)2(qtpy)]3+2 display good water solubility as chloride salts. The complexes possess high-energy excited states, which are quenched in the presence of duplex DNA and even by the mononucleotides guanosine monophosphate and adenosine monophosphate. Further studies reveal that although the complexes bind to quadruplex DNA, they display a preference for duplex structures, which are bound with an order of magnitude higher affinities than their isostructural dicationic RuII-analogues. Detailed molecular dynamics simulations confirm that the complexes are groove binders through the insertion of, predominantly, the qtpy ligand into the minor groove. Photoirradiation of 1 in the presence of plasmid DNA confirms that this class of complexes can function as synthetic photonucleases by cleaving DNA.

Liposuction-Augmentation Mammaplasty.

BACKGROUND: The female breast loses superior fullness and becomes more ptotic over time. Women often present to their plastic surgeon requesting reversal of this evolution. While liposuction alone has been proven to lift the breast, no solution combining augmentation and liposuction has been reported. OBJECTIVES: Herein, we introduce a technique called liposuction-augmentation mammaplasty (LAM) that can achieve "scarless" lifting or simply volume equalization prior to inserting same-sized implants. We then compare its safety and efficacy to two gold-standard techniques with similar aims, mastopexy-augmentation mammaplasty (MAM) and reduction-augmentation mammaplasty (RAM). METHODS: A retrospective 3-year chart review was conducted on 359 patients (652 breasts) undergoing LAM (n = 125), MAM (n = 188), and RAM (n = 46). Patient demographics, operative details, and revisions were documented. Degree of lift was measured on pre- and postoperative photographs using sternal notch-to-nipple distances (SN-N). Statistical differences were assessed between the groups. RESULTS: The LAM group's mean age and OR time (37 years, 46 minutes) were significantly lower than those of MAM (43 years, 90 minutes) and RAM (42 years, 106 minutes). Mean BMIs and revision rates were uniform between the LAM and MAM groups (24, 2.5%), but significantly higher for RAM (28, 4.6%). Aspirate volumes and resection weights averaged 151 cc and 307 g (left breast) and 173 cc and 298 g (right breast). Minimum follow up was 12 months. The LAM group's mean SN-N reduction (~6%) was statistically significant, albeit much lower than MAM (~16%) and RAM (~22%). CONCLUSIONS: LAM is a safe, facile, reliable solution for the ptotic, fatty breast. Patients can direct their volumetric outcome and enjoy lower costs and shorter downtime.

Five-year Experience with Perma Facial Implant.

SUMMARY: Augmentation cheiloplasty is becoming an increasingly popular aesthetic procedure despite current methodologies having met with disappointment among surgeons and patients. The goal of this study was to examine the benefits and drawbacks of 1 device in particular-Perma Facial Implant (PFI). The senior authors (P.R. and S.W.H.) performed 832 consecutive PFI lip augmentations with excellent results based on photographic documentation, patient satisfaction surveys, unbiased surgeon ratings, and low complication rates. In addition to augmenting thin lips, PFIs hide excess dentition and improve vermilion rhytids and pout. Contrary to alternatives, they are both permanent and reversible. However, they do not level out asymmetries or benefit razor-thin lips without prior lifting or mucosal advancement.

Thermal capsulorrhaphy: a modified technique for breast pocket revision.

BACKGROUND: Scant attention has been paid to breast capsule revision after augmentation mammaplasty. Dissatisfaction with traditional techniques prompted the senior authors to develop a thermal capsulorrhaphy (TC) technique to obliterate excess breast pocket space using ball cautery followed by barbed suture closure. OBJECTIVES: The authors propose a new periprosthetic technique for pocket closure, present a corresponding guide for surgical and postoperative management, and provide results of their retrospective review. METHODS: Medical records were reviewed for all patients who underwent TC after cosmetic augmentation mammaplasty during a 5-year period, for whom clinical photographs were available from at least 1 year postoperatively. Operating details and complications were documented. Outcomes were rated a success, partial success, or failure, based on analysis of the photographs. RESULTS: Of the 157 TC cases (41 unilateral, 58 bilateral) with a mean follow-up of 2 years, 141 (90%) outcomes were successful, 4 (2%) were partially successful, and 12 (8%) had failed. There were 16 complications: 10 over- or undercorrections and 1 episode each of hematoma, capsular contracture, slight deformity, nipple sensitivity, exposed suture knot, and suture abscess. CONCLUSIONS: The efficacy of TC derives from the symbiosis of stitches and heat: capsulorrhaphy reinforces apposition of the damaged walls, and cautery contracts and thickens the capsule, thus reducing dead space and improving suture purchase. Initially popularized in shoulder surgery, TC is even better suited for breast pocket closure due to superior visibility and maneuverability, more aggressive practices, and the lack of similar complications. Postoperative stabilization and guideline compliance are essential to successful revision. LEVEL OF EVIDENCE: 4.

The endonasal lip lift: personal technique.

Given the shortcomings of current methods to shorten the cutaneous upper lip, the senior authors modified the traditional subnasal lip lift with endonasal flaps, performing 311 such lifts over a 15-year period. Ideal surgical candidates are adults with tall philtra, negligible dental show, and no maxillary abnormalities. Benefits of the procedure include improved scar appearance and pout, absence of tension in visible areas, increased dental and vermilion display, and minimal scar migration (ie, loss of lift). Moreover, caudal rhinoplasty procedures are facilitated via the same incision sites. Undercorrection, sill widening, and alar distortion are mostly avoidable (or at least corrigible) complications. Nasal sill disruption, however, remains an inevitable drawback that may be minimized through meticulous technique.

Analysis and classification of the upper lip aesthetic unit.

BACKGROUND: Disharmonies of the upper lip aesthetic unit generally stem from tall ergotrids and/or thin lips. Comprehension and correction of such defects has been stifled by a lack of metrics and organized systems of diagnosis and treatment. METHODS: The philtral-labial score was devised to better analyze the upper lip region. Measurements were made with Adobe Photoshop CS6, and computations were performed on a standard calculator. A retrospective medical records review identified 908 patients of the senior authors' (P.R. and S.W.H.) practices who underwent perioral rejuvenation between January 1, 2001, and July 31, 2012. Two hundred patients were randomly selected and assessed for disharmonies in three surveys that sequentially built on data points provided. RESULTS: When preoperative anteroposterior and lateral photographs, dental show measurements, and philtral-labial scores were available, diagnostic concordance between the authors approached 100 percent. Pattern analysis resulted in a classification system (labral classification system), designating patients as either type 0 (no defects), type 1 (thin upper lip), type 2 (long philtrum), or type 3 (both) defects. Characteristic dental show values, philtral-labial scores, and suggested treatments were paired with each type. CONCLUSIONS: The labral classification system and its associated analytical tools serve as useful references in consultation, simplify discussion of patients with upper lip defects, furnish a practical alternative to complex algorithms, enable documentation of changes, and facilitate analysis of large sample sizes. When implemented judiciously, the tools described in this article will help surgeons confidently address upper lip problems by streamlining accurate diagnosis and guiding proper treatment.