Nasal Filling in Plastic Surgery Practice: Primary Nasal Filling, Nasal Filling for Post-rhinoplasty Defects, Rhinoplasty After Hyaluronidase Injection in Dissatisfied Nasal Filling Patients.

BACKGROUND: Nasal filling has gained popularity in plastic surgery practice and strengthened the surgeon's hand. Mild deformities of the nose can be treated with nasal filling instead of rhinoplasty, or small contour irregularities following surgical rhinoplasty can be corrected by dermal filler injections. It is a significant advantage of hyaluronic acid (HA) fillers that they can be dissolved with hyaluronidase in case of the patient dislikes the appearance and desires a surgical rhinoplasty. However, there is no publication about when rhinoplasty surgery can be performed safely after hyaluronidase injection. OBJECTIVES: In this case series, we shared our experiences with nasal filling in plastic surgery practice under three headings: primary nasal filling, nasal filling for post-rhinoplasty defects and rhinoplasty after hyaluronidase injection in dissatisfied filling patients. We presented our nasal filling technique, indications, result analysis and also our rhinoplasty experiences we performed at different times after hyaluronidase injection. METHODS: Nasal filling patients from July 2015 to March 2020 were divided and analyzed in three groups: (a) Primary nasal filling was provided to 62 patients, (b) nasal filling for post-rhinoplasty defect was provided to 18 patients, and (c) rhinoplasty after hyaluronidase injection was performed in five patients who are not satisfied with results. The duration between hyaluronidase and rhinoplasty operation was, respectively, 6 months, 3 months, 3 months, 2 months and 1 week. RESULTS: (a) In primary nasal filling, 57 patients were fully satisfied, two patients were satisfied, and three patients were dissatisfied with results. Results were stable up to at least 6 months (Range 6-14 months). (b) In nasal filling for post-rhinoplasty defects, all patients were fully satisfied with results. Results were stable for at least 12 months (Range 12-36 months). (c) In rhinoplasty after hyaluronidase injection, any filling residue was not observed, and there were no complications. The postoperative results were satisfactory. CONCLUSION: Nasal filling with hyaluronic acid represents an excellent alternative for patients who do not wish to undergo a rhinoplasty or a revision rhinoplasty procedure. HA filler can be dissolved easily with hyaluronidase if the patient does not like the result, and we think that rhinoplasty can be performed safely at least one week later from hyaluronidase treatment. 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 .

Metatarsal artery perforator-based propeller flap.

Soft-tissue defects of the distal foot that involve an exposed tendon and bone demonstrate a reconstructive challenge for plastic surgeons. This report investigates the feasibility and reliability of metatarsal artery perforator (MAP)-based propeller flap for reconstruction of the distal foot soft-tissue defects. Between July 2011 and June 2012, six patients underwent distal foot reconstruction with seven MAP-based propeller flaps. Five flaps were based on the third metatarsal artery and two flaps were based on the first metatarsal artery. The flap size ranged from 4 × 2 cm to 8 × 4 cm. All flaps completely survived. Two patients developed transient distal venous congestion, which subsided spontaneously without complications. There were no donor site complications. All patients were ambulating without difficulty within the first month of surgery. MAP-based propeller flaps can be used to repair the distal foot soft-tissue defects, providing sufficient skin territory and excellent esthetic and functional recovery.

Comparing various surgical delay methods with ischemic preconditioning in the rat TRAM flap model.

Both surgical delay and ischemic preconditioning (IP) have been shown to be effective in improving the survival of flaps. We used a variety of flap delay methods and IP to increase the surviving area of the transverse rectus abdominis musculocutaneous (TRAM) flap in rats, and the results are compared in between. A 6-× 3-cm-sized TRAM flap in 40 Wistar rats was allocated into five groups. Group 1: TRAM flap was elevated from nondominant pedicle, and the flap was sutured to the original bed. Group 2: Left superior deep epigastric vessels (SDEV) were cut; 1 week later, TRAM flap was elevated. Group 3: Only skin incision was done; 1 week later, TRAM flap was elevated. Group 4: Skin incision was done, and the left SDEV were cut; 1 week later, TRAM flap was elevated. Group 5: TRAM flap was elevated; IP was performed using three cycles of 10 minutes of repeated ischemia/reperfusion (I/R) periods, and the flap was sutured to the original bed. The surviving area of the flap was statistically significant between the control and groups 2, 4, and 5 (p < 0.001), and groups 4 and 2 were superior to group 5. Although preconditioning has been intensively studied for the last two decades and partly provided its beneficial effects in I/R injury, we determined the IP increased the surviving area of the TRAM flap but not effective as much as surgical delay method.