Can Cosmetics' Advertisements Be An Indicator of Different Perceptions of Beauty Amongst Countries?

INTRODUCTION: Concepts of beauty are different amongst different cultures and civilizations. The objective of this study was to evaluate beauty perceptions through cosmetic advertisements in an effort to further appreciate beauty understanding amongst lay people in various parts of the world. To achieve these objectives, we reviewed cosmetics' advertisements to study whether the concept of beauty varies amongst different countries. MATERIALS AND METHODS: We used the keywords "cosmetics" and "advertisements" in YouTube search engine in all existing languages in Google translator and came up with advertisements from 18 countries. The faces of the models were compared against Marquardt® beauty mask template in order to have a mean to objectively test symmetry with a mathematical computer model. The weak point of our study is that we can present no model photographs due to General Data Protection Regulation. RESULTS: Advertisements retrieved in total were 257. Characteristics with no statistically significant difference (SSD) amongst models in different parts of the world were: symmetry (p = 0.187), high cheek bones (p = 0.325), small noses (p = 0.72), thin jaws (p = 0.98), lush hair (p = 0.54), clean and smooth skin (p = 0.367), and white toothed smile (p = 0.235). Characteristics with SSD were: in Latin America, USA, and Australia tanned models and fuller lips were preferred (p < 0.001), whilst in Asia milky white skin models and small mouth were preferred. Age ratio (p = 0.022) was lower amongst models in Southeast Asia compared to American, European, Indian, Australian, and Arab models. Arab and Southeast Asia women had intense eyebrows (p < 0.001) and used artificial eyelashes. CONCLUSIONS: All the common characteristics noted by the two independent surgeons (GAS and LP) referred to symmetry, youthfulness, and health. Differences noticed reflected cultural influences in the perception of beauty. 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 .

A 6-year experience in flat helix correction with a simple procedure.

OBJECTIVE: To present our 6-year experience in flat helix correction with a simple procedure. Among the many different congenital ear deformities lies the flat helix. The correction of this anomaly must be considered owing to its significance to the overall shape and appearance of the auricle. METHODS: Our surgical method is based on a geometrical approach, with radiating beveled incisions of the helical cartilage and subsequent overlapping and suturing of small triangular cartilaginous flaps. The method was applied in 15 patients over 6 years and was combined with correction of prominent ears in 9 cases. RESULTS: Curling of the helix was achieved in all cases. A step deformity detected in 2 initial cases led to minor technique modification. No recurrences were recorded during the follow-up period (mean follow-up, 32 months). All patients were satisfied with the aesthetic outcome. CONCLUSIONS: The method applied is a relatively simple and reliable procedure that allows the restoration of the curvilinear shape of the helix. It can be performed under local anesthesia (along with any other procedure that a prominent ear may require), causes no visible scars, and delivers consistently effective results.

Reconstruction of the hypopharynx with the anterolateral thigh flap: defect classification, method, tips, and outcomes.

BACKGROUND: The authors retrospectively reviewed their experience over the past 5 years with reconstructions of hypopharyngeal defects using anterolateral thigh flaps. The purpose of the study was to present a modified classification of defects, the method and tips used, and outcomes and morbidities. METHODS: From 2002 to 2007, 55 anterolateral thigh flaps were harvested for reconstruction of hypopharyngeal defects after tumor ablation in 54 patients. Patient age ranged from 38 to 77 years (average, 54 years). In 24 cases, free flaps were used for reconstruction of circumferential defects; in 28 cases, they were used to reconstruct partial defects; and in three cases, they were used to reconstruct circumferential and skin defects. RESULTS: Total flap loss occurred in one patient and partial flap loss occurred in three patients. Strictures occurred in three patients and fistulas occurred in 10. In one case, arterial occlusion was noticed postoperatively. The arterial anastomosis was revised and the flap was salvaged. In another case, venous occlusion was noticed. The vein was reanastomosed with a vein graft and the flap was salvaged. Postoperatively, seven patients tolerated a regular diet. The donor site was skin grafted in five cases, closed with reverse anterolateral thigh in one case and with retrograde V-Y advancement flap in one case, and closed primarily in the rest. There were no donor-site complications. CONCLUSION: Reconstruction of the hypopharynx with the anterolateral thigh flap offers versatility in the coverage of large and complex defects and is associated with minimal donor-site morbidity.

Buried anterolateral thigh flap for pharyngoesophageal reconstruction: our method for monitoring.

BACKGROUND: A noninvasive method for monitoring in cases of pharyngoesophageal defects reconstruction with the anterolateral thigh flap is presented. METHODS: Seventeen patients underwent reconstruction from 2005 to 2007. In 16 patients, the distal stump of the descending branch of lateral circumflex femoral artery (LCFA) was left on the skin surface covered with a transparent film dressing and monitoring was performed by direct observation of the pulsation. In the 17th patient, the pedicle emerged from the transverse branch of the LCFA and dissection of the distal stump for monitoring was impossible; therefore, he was excluded from the study. RESULTS: Cessation of the pulsation of the stump was noticed immediately postoperatively in 1 patient because of occlusion of the arterial anastomosis and in a second case 15 hours postoperatively due to a neck hematoma that caused collapse of the vein of the pedicle. Both flaps were salvaged. CONCLUSION: The proposed method of monitoring is simple, reliable, costless, and easily interpreted by the nursing staff.

A new combined "interrupted-continuous" microvascular anastomotic technique. Experimental study and clinical application.

A new combined interrupted-continuous microvascular anastomotic technique is introduced, using four interrupted stay stitches and continuous suturing in between. Its efficacy is compared with the simple interrupted and continuous techniques. Microanastomoses were performed in the femoral artery and vein of rats. The patency, anastomosis time, and blood loss from the suture line of all anastomoses were recorded. Also, the sites of all anastomoses were harvested and histologically examined for lumen stenosis, media regeneration, and endothelial lining. Experimentation findings showed 100% patency rate in all groups. The combined and the continuous techniques were significantly faster and watertight compared with the simple interrupted. The only difference in pathology findings was the development of significant lumen stenosis in vein anastomoses performed with the continuous technique, compared with the other two techniques. The combined technique was clinically used in 16 free flap transfers and ensured 100% patency in all arterial and vein anastomoses, as well as survival of all flaps. In conclusion, the combined technique was found to be fast and easy to perform and ensured the same patency rate as the simple interrupted and continuous techniques. It also diminished the lumen stenosis effect of the continuous technique in vein anastomoses. Therefore, we suggest its use in both experimental studies and clinical cases.

New pure motor nerve experimental model for the comparative study between end-to-end and end-to-side neurorrhaphy in free muscle flap neurotization.

The present study demonstrates a new experimental model to compare the efficacy of end-to-end and end-to-end neurorrhaphy in free muscle flap neurotization. Forty animals were used, divided into four equal groups named A, B, C and D. The peripheral stump of the thoracodorsal nerve was stitched end-to-end in groups A and C and end-to-side in groups B and D to the long thoracic nerve. Free functional muscle transfer was simulated by putting vascular clamps to the thoracodorsal artery (FD SS8R, F: 15 to 20 g) and vein (FD SS6R, F: 10 to 15 g) for 60 minutes and transecting and then restitching the origin and insertion of the latissimus dorsi muscle. Electromyographic and histological studies were performed 150 days following completion of the experiment. The results could indicate the possibility that end-to-side neurorrhaphy might be used in free functional muscle transfer as an alternative to end-to-end neurorrhaphy. We believe that the proposed experimental model is useful for the comparative study between end-to-end and end-to-side neurorrhaphy in free muscle flap neurotization, as these are pure motor nerves and innervate synergistic muscles, are in close approximation, and have similar diameters.

Alopecia associated with birth injury.

BACKGROUND: Alopecia after birth-related caput succedaneum is an extremely rare complication. CASE: The case of a child with permanent alopecia due to birth-related caput succedaneum is presented. After delivery with vacuum extraction, caput succedaneum at the left occipitoparietal region of the neonate's head was noted, which subsided within a week, leaving a circular necrotic crust and finally a circular bald area. At age 4, the child was referred at a tertiary center for the management of alopecia. Treatment initially consisted of the expansion of the hair-bearing skin adjacent to the bald area, which was excised at a second stage and covered with the expanded skin. A pleasing esthetic result was achieved. CONCLUSION: Neonatal alopecia is a rare birth-associated complication. Premature rupture of the membranes, prolonged second stage of the labor, and prolonged vacuum extraction time may be important features in the pathogenesis of this complication. In case of permanent alopecia, excellent esthetic results can be achieved with the use of reconstructive plastic surgery techniques.

The conjoint medial circumflex femoral perforator and gracilis muscle free flap: anatomical study and clinical use for complex facial paralysis reconstruction.

BACKGROUND: [corrected] The aim of this study was to establish the anatomic basis of the conjoint medial circumflex femoral perforator and gracilis muscle flap and to expand the use of this flap in complex facial paralysis reconstruction. METHODS: An anatomic study was initially undertaken to record the existence, consistency, and diameter of musculocutaneous perforators emanating from the proximal third of the gracilis muscle to provide blood supply to the overlying fascia, subcutaneous fat, and skin. In a total of 20 clinical cases of gracilis muscle harvesting, the aforementioned anatomical data were recorded during flap dissection. At least one musculocutaneus perforator, consisting of one artery and two accompanying veins (vein caliber > 0.3 mm) was found in 95 percent of cases. RESULTS: The anatomical study was followed by successful use of the conjoint flap for reconstruction of longstanding facial palsy accompanied by a soft-tissue defect of the cheek. In the first stage, cross-face nerve grafting was performed. In the second stage, free transfer of the conjoint flap, consisting of the proximal third of the gracilis muscle and the overlying subcutaneous fat, was performed to the face. The only connection between the two components of the conjoint flap was one musculocutaneous perforator. When the flap was inset, the muscle was used for facial reanimation and partial obliteration of the soft-tissue defect, while the subcutaneous fat was used to obliterate the rest of the defect. CONCLUSION: The proposed technique ensured symmetry of the face, on both rest and animation, and obliteration of the cheek deformity.

The anatomic basis of the gracilis perforator flap.

Another perforator flap, the gracilis perforator flap, has recently been added to the armamentarium of reconstructive surgeons. A detailed study of the anatomy of this flap was undertaken in this study. Forty-seven dissections were performed in cadavers and clinical cases of gracilis muscle harvesting for various reconstructive reasons. According to our findings, at least one musculocutaneous perforator of large calibre was found in the majority of the dissections performed (87%), emanating from the proximal third of gracilis. All the perforators were located within a radius of 7 cm from the point of entrance of the gracilis main vascular pedicle. In their majority, they emanated proximal to that point (83%) from the middle part (anteroposterior axis) of the muscle (62%). The intramuscular course of the perforators was easily followed and few muscular branches were encountered, before they joined the main vascular pedicle. A sensory branch of the anterior obturator nerve, accompanying the perforators, was occasionally found (29%). Finally, a superficial vein, branch of the greater saphenous, was always found within the skin territory of the flap in all dissections performed in cadavers.