Redraping of the fat and eye lift for the correction of the tear trough.

INTRODUCTION: Tear trough deformity is very difficult to correct. It can appear at relatively young age and it deepens over the years due to laxity and loss of structural support. We describe a technique for the correction of tear trough deformity and mid-face laxity by means of redraping blepharoplasty and lateral "eye lift". MATERIALS AND METHODS: Upper lid markings were made and removal of the excess skin was employed. The herniated fat was removed from the nasal fat pad. Using a subciliary incision the dissection was completed at the level of the orbital rim and the fat was repositioned with 5-0 Monocryl (poliglecaprone 25, Ethicon) sutures at the inner canthus to correct the tear trough. Subsequently, a canthopexy performed to secure the lower eyelid. We then dissected the cheek over the periosteum of the zygomatic bone-arch and the flap was suspended through a tunnel at the periosteum of the upper-lateral orbit by 5-0 Monocryl (poliglecaprone 25, Ethicon) suture. RESULTS: Thirty-five procedures were performed between 2009 and 2013. Patients were followed for at least one year. Successful correction of the tear trough deformity with middle face elevation was achieved in all patients. Sclera show was noted in 7 patients but resolved over 3-6 months period with no surgical intervention. Diplopia was noted in 1 patient probably due to oedema and was released 4 weeks after the operation. The oedema was prolonged (more than 1.5 month) in 10 patients probably due to the lymphatic stasis. Conjunctivitis was also noted in 2 patients and was released by conservative treatment. CONCLUSION: Our technique of redraping blepharoplasty and mid-face lift describes a relatively new approach for the correction of the tear trough deformity and middle face laxity. It shows stable results for up to 4 years although longer follow-up is needed to confirm the stability of the correction.

Silicone lymphadenopathy after breast augmentation: case reports, review of the literature, and current thoughts.

BACKGROUND: Silicone lymphadenopathy after implantation of silicone breast implants is a foreign body reaction due to the release or migration of silicone into the tissues surrounding the breast implant. METHODS: For the study, 14 cases of silicone lymphadenopathy were identified from the authors' files. Four patients had been implanted before 2000 and had various types of implants. The remaining 10 patients all were implanted between 2006 and 2009, and all had Poly Implant Prothèse (PIP) implants. In addition to an analysis of the authors' own cases, a thorough bibliographic search was initiated to identify all reports of lymphadenopathy related to silicone breast implants. RESULTS: The implant age of the four patients implanted before 2000 was 12-34 years (mean, 17.25 years). The implant age of the 10 patients implanted after 2000 was 2-6 years (mean 3.45 years). The literature search identified 29 papers with case reports of silicone lymphadenopathy published between 1978 and 2012, with a total of 175 cases. Usable data were extracted from 164 of the 175 cases. Of these patients, 159 were implanted before (and including) the year 2000 and had a mean age of 11 years at presentation or explantation, and 5 of these patients were implanted after the year 2000 and had a mean age of 4.6 years at presentation or explantation . After inclusion of the authors' own cases, the mean age of the implants at presentation or explantation was 10.56 years in a total of 178 cases. Of these patients, 163 were implanted before (and including) the year 2000 and had a mean age of 11.16 years at presentation or explantation, and 15 of these patients were implanted after the year 2000 and had a mean age of 4.06 years at presentation or explantation. CONCLUSIONS: Current breast implant technology has minimized the release of silicone gel due to rupture or bleeding of silicone and its migration into the surrounding tissues, thus reducing the rate of silicone lymphadenopathy in the last 10 years. The PIP implant scandal highlights the fact that disregard for the implant manufacturing technologies and standards in favor of higher profits increased rupture rates and gel diffusion, leading to increased local complication rates. Silicone lymphadenopathy is a foreign body reaction that does not warrant treatment unless it is symptomatic or interferes with breast cancer detection. 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 .

Aesthetic reconstruction of the tuberous breast deformity: a 10-year experience.

BACKGROUND: Tuberous breast deformity is a developmental aberration of the breast whereby a constricting ring on the base of the breast prevents its expansion on the horizontal and/or the vertical axis. This leads to the well-known "tuberous" appearance of the breast, causing a herniation of the breast tissue toward the nipple-areola complex due to the increased pressure. Several techniques have been proposed to correct this deformity, but the aesthetic results have generally been poor. OBJECTIVE: The authors present their theory on the etiology of the deformity, which has been further substantiated by their histological series of patient findings over the course of 10 years. They also present their technique and experience in treating 22 patients (41 breasts) over the past 10 years. METHODS: Twenty-two women (41 breasts) with tuberous breast deformity were treated in the authors' private clinic over the past 10 years. Treatment protocol included a periareolar incision followed by a reconstruction of the breast tissue through transection of the constricting ring and formation of two breast pillars, which were folded toward one another to provide the missing volume on the inferior part of the breast. A silicone breast implant could also be placed subglandularly or submuscularly for additional volume. The oversized nipple areola complex was addressed via a donut-type periareolar excision. RESULTS: Bruising and swelling commonly resulted from application of this technique, but this is a predictable postoperative symptom. In terms of complications, there was one case of hematoma on the right breast of a bilateral reconstruction, which had to be evacuated. No patients had skin necrosis or loss of nipple sensation. The same patient who developed a hematoma developed a Baker III case of capsular contracture in the same breast. One patient developed asymmetry but refused revision. All scars were confined to the periareolar margin and were virtually invisible. CONCLUSIONS: The authors propose a technique that is simple and yields consistently good results for the treatment of tuberous breast deformity. This technique has the added advantage of not disturbing the lactiferous ducts, thus preserving normal breast function. Patients who have been treated by the authors with this method over the past 10 years have experienced good postoperative results with few complications, and it provides a strong alternative to the existing but varied techniques for addressing the deformity.

Effect of povidone iodine on silicone gel breast implants in vitro: implications for clinical practice.

Irrigation of breast implants and breast implant pockets with various solutions, including povidone iodine, has been a common practice among plastic surgeons for many years. Recent reports of potential weakening of silicone tubing have led the Food and Drug Administration to pronounce any contact of povidone iodine with breast implants a contraindication. An in vitro experimental study was undertaken to assess the effect of povidone iodine on the physical properties of silicone breast implant shells. Identical specimens were obtained from the shells of silicone breast implants according to published standards. The specimens were randomly assigned to eight groups of five and incubated in various solutions of decreasing concentration of povidone iodine (10% to 0.01%), and a control group (0.9% saline) was used. The containers were stored in a warming cabinet at 37 degrees C for 4 weeks. Testing of the specimens for tensile strength following 4 weeks of incubation showed no significant difference among any of the groups, including the control group. In addition, no correlation was shown between the concentration of the solution used and the tensile strength of the specimens.

Aesthetic reconstruction of the tuberous breast deformity.

The tuberous breast deformity is a rare entity affecting young women bilaterally or unilaterally. The deformity is characterized by a constricting ring at the base of the breast, which leads to deficient horizontal and vertical development of the breast with or without herniation of the breast parenchyma toward the nipple-areola complex and areola enlargement. Several methods have been put forward to correct the deformity, but most of these fail to address the issue of the constricting ring and subsequently yield results that are not aesthetically satisfactory. A new approach to the treatment of the deformity is presented, which consists of a periareolar approach and rearrangement of the inferior part of the breast parenchyma by division of the constricting ring, thus creating two breast pillars. These pillars are allowed to redrape, and in cases of volume deficiency, a silicone breast implant is placed in a subglandular pocket. The procedure is completed by a donut-type excision to address the size of the nipple-areola complex. The technique has used on 11 patients (21 breasts) with excellent aesthetic results.

Treatment of bilateral severe eyelid burns with skin grafts: an odyssey.

Eyelid burns occur in about 10% of thermal injuries and pose a considerable challenge for the reconstructive surgeon. A consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. A case of severe bilateral eyelid burns was treated with full- and split-thickness skin grafts. The patient was first operated at 2 years post-injury, and a total of 5 operations in 5 years were necessary to address recurrent ectropion of both upper and lower eyelids.