Fotografía digital; una guía sencilla de actualización / Digital photography; a complete up-date guideline

La fotografía digital se encuentra en un periodo en el que tecnológicamente ha sufrido un gran avance; no sólo las cámaras de hoy capturan imágenes increíbles con muy poca luz, sino que también esta tecnología se ha abaratado hasta estar al alcance de todos. En el campo de la Cirugía Plástica, el llevar un expediente digital fotográfico del paciente quirúrgico de manera ordenada es crucial para poder seguir su evolución. Resulta por lo tanto indispensable estandarizar el lugar y la técnica empleados para fotografiar a los pacientes y así poder obtener imágenes de mayor credibilidad y confiabilidad a lo largo del tiempo. En este trabajo, presentamos una guía de actualización entendible, sencilla, pero a la vez completa, de fotografía digital en base a revisión bibliográfica combinada con la experiencia personal. Creemos que estos conocimientos básicos de fotografía, iluminación y cómputo son necesarios para la práctica diaria de nuestra especialidad (AU)

Digital photography is at its best; computer technology has made a great leap forward. Today digital cameras not only capture incredible images requiring a minimum of light source, but also technology and brand's competition has helped reduce retail price tags so now almost anyone can afford one. The use of digital images helps plastic surgeon to follow up patients' evolution over time. It is essential to have a good standardized and consistent way of taking the before, after and follow-up pictures to achieve credibility and trust images in the future. This article is a simple yet complete guideline of digital photography based on the latest literature and personal experience. In order to achieve a good electronic medical record of standardized digital images, it is necessary to have basic computer and photography skills; therefore it is a must to be familiarized with different gears special features available in the market today, in order to select the most appropriate one for our own specific needs (AU)

Uso y actualización de lipoinjertos en Cirugía Plástica Estética y Reconstructiva / Use and update of lipografts in Plastic Aesthetic nd Reconstructive Surgery

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Nuevo enfoque para el tratamiento del lóbulo auricular expandido: técnica quirúrgica y clasificación / New approachment for the treatment of the expanded ear lobe: surgical technique and classification

Las expansiones del lóbulo auricular son cada vez más populares en la población joven, dejando defectos muy notorios que al llegar a la edad adulta requieren reparación. Recientemente se han descrito dos técnicas para solucionar este problema, pero desde nuestro punto de vista, provocan un acortamiento secundario de la oreja. Por esta razón, diseñamos una reparación con dos colgajos, uno medial y otro lateral, donde uno de ellos funciona rellenando el defecto y el otro cubriéndolo; de esta manera evitamos el acortamiento de la oreja y del lóbulo. Además proponemos una nueva clasificación de los defectos del lóbulo auricular (AU)

Earlobe expansions are becoming increasingly popular among young people, leaving very noticeable defects that on reaching adulthood require repair. Recently, two techniques have been described to solve this problem, but in our view, they lead to a shortening of the ear. For this reason we design a repair with two flaps, one medial and one lateral, in which one works by filling the defect and the other covers; so we avoid the shortening of the ear lobe. Furthermore, we propose a new classification of defects in the earlobe (AU)

Long-term outcome of autologous fat transplantation in aesthetic facial recontouring: sixteen years of experience with 1936 cases.

Fat grafts have become an important and necessary procedure in the field of plastic surgery. The author presents experiences with two types of patients: older people with thin facial soft tissues, in whom the combination of lifting and lipoinjection gives good results; and patients with progressive hemifacial atrophy caused by Parry-Romberg's syndrome in whom normal or almost normal facial contour can be achieved. The longterm survival of fat grafts is presented. This procedure has been used by the author for the past 16 years.

Challenging the limits: build your own reliable double microvascular clamps.

This report describes the detailed construction, experimental basis, and clinical application of a reliable double microvascular clamp that can be built from inexpensive parts that are readily available. Twenty-five clinical free-tissue transfers were performed using this clamp with an acceptable free-flap survival rate.

Frontalis musculocutaneous island flap for coverage of forehead defect.

The use of the frontalis musculocutaneous flap as a pedicle island flap offers some advantages in frontal reconstruction. It can be used for immediate reconstruction following the ablation of a small or moderate area, even after harvesting of the frontal flap for nasal reconstruction. Because of its intact lateral bundle, it has the potential to carry some sensory innervation, albeit minimal, to the reconstructed area. We have found the frontalis musculocutaneous flap, when used as a pedicle island flap, to be an adaptable and dependable alternative flap for repairs after small or moderate resections in the frontal region. This flap could be performed immediately and in one stage, have a low morbidity rate, and allow a rapid aesthetic restoration; and, it is easy to perform. In two cases, we have observed some degree of venous congestion in the island during the early postoperative period but with success in final healing. The experience demonstrates that this flap should be considered as another valuable tool in reconstructive efforts directed at the forehead. We propose a novel method for the forehead reconstruction using the frontalis musculocutaneous island flap. A case is presented that demonstrates the use of this flap for repair in a depressed frontal defect.

Gluteus augmentation with fat grafting.

This study presents the authors' experience with gluteus augmentation with autologus fat grafts and liposuction methods, having recorded the evolution of gluteus reshaping with autologus intramuscular fat graft injections for the past 5 years. Preoperative shape is discussed and patient evaluations, operative techniques, postoperative management, and longterm results are emphasized.

Simultaneous rhytidoplasty and lipoinjection: a comprehensive aesthetic surgical strategy.

Fat autografting is an accepted technique in the treatment of depressions or augmenting thin soft tissues. Aging soft tissues become thin, among them the subcutaneous fat layer, muscles, and fasciae, and these tissues in addition become flaccid. Therefore, to get better results in rejuvenation plastic surgery, a good alternative is the combination of lifting the flaccid tissues and thickening the thin soft tissues with a lack of contour and definition, which enhances the aspect of the entire face and neck. For 10 years in our practice, we have been combining rhytidoplasty (which includes systematizing superficial musculoaponeurotic system and platysma plication) with lipoinjection, placing thin rolls of autologous fat into the facial and cervical muscles, or at least under the fasciae. The results reveal a very high success rate with few minor complications. Proper diagnosis, patient selection, and adequate surgical technique produce predictable and favorable aesthetic results. A concurrent retrospective study of 357 consecutive patients who underwent simultaneous rhytidoplasty and lipoinjection was conducted over a 10-year period (1985 to 1995). The purpose of this article is to show our experience with this method, including long follow-up observations.

Cartilaginous behavior in nasal surgery: a comparative observational study.

Cartilaginous autografts, either from the ribs, auricular concha, nasal septum, or even the alar cartilages, are some of the most widely used materials in nasal surgery. Nevertheless, no comparative study exists on these four cartilages in which their physicoelastic properties are analyzed based on their histological architecture and their function within the organism. The studies that do exist on structure and classification of cartilages differ widely. In this study, cartilage specimens obtained from the nasal septum, rib, auricular pavilion, and alar of 7 fresh cadavers were analyzed. They were subjected to special tincturing to be able to histologically observe their architecture, cellularity, intercellular substance, the relationship between cellularity and intercellular substance, the primary components of the matrix, and the distribution of fibers. Many similarities were found among the septal, costal, and alar cartilages. All three exhibit little cellularity and much intercellular substance. The intercellular substance is made up of homogeneously distributed collagen fibers. Auricular cartilage has many cells and little intercellular substance, being made up of irregularly distributed elastic fibers. On the basis of these findings, we propose a simpler classification and make recommendations for the use of these four cartilages in nasal surgery.

Deep planed torso-abdominoplasty combined with buttocks pexy.

This new procedure was created for aesthetic purposes with the intention of creating a longer and more slender waist and at the same time treating neighboring areas. This procedure also is used to raise or change the position of a previous abdominoplasty scar. In addition it is also beneficial for treating gestation sequelae of the torso-abdominal wall, ptosis of the abdomen, vertical and horizontal enlargements of the musculoaponeurotic system, lipodystrophy, stretch marks, rhytidosis of the inguinal region, and ptosis of the external quadrant of the gluteous and the external trochanter area in one surgical procedure. It is not always necessary to apply the entire procedure to each case. The deep planed torso-abdominoplasty offers a broader selection of techniques for creating aesthetic contouring of the torso-abdominal wall, flanks, inguinal region, and outer thighs. It also creates pexy of the external quadrant of the gluteous region.

Autologous fat grafting for body contouring.

In trying to achieve symmetry and better contour of the back torso and middle third of the body, the combination of liposuction and lipoinjection is rapidly becoming the procedure of choice. Its versatility makes it suitable for most body contour deformities. The indications and operative and postoperative techniques are detailed in this article. Fat graft long-term survival is presented. This procedure has been used by the author during the past 12 years.

Long-term survival of free fat grafts in muscle: an experimental study in rats.

In this study, we showed both macroscopically and microscopically the viability of the autotransplanted fat placed intramuscularly in long-term follow-up. The study was performed on 120 Wistar rats during a 12-month period. The fat grafts were obtained from either the inguinal region or preurinary bladder cavity. Rats were divided into six groups. In group 1, the fat was injected in thin rolls in the frontal subcutaneous layer. In group 2, the fat was injected in thin rolls in the gluteus superficialis, biceps femoris, gastrocnemius, and semitendinosus muscles. In group 3, 6 mm x 2 mm fat strips were placed subcutaneously in the frontal region. In group 4, the same dimension of fat strips were placed in the gluteus superficialis and biceps femoris muscles. In group 5, large cystic spaces of fat were injected subcutaneously in the frontal region, and in group 6, large cystic spaces of fat were injected intramuscularly. Rats at 3, 6, 9, and 12 months after fat grafting were sacrificed in order to carry out the macroscopic observations. The results showed clinical and microscopic success in groups 2 and 4, and problems and failure with the remaining groups.

Autoantibodies in Parry-Romberg syndrome: a serologic study of 14 patients.

OBJECTIVE: To determine autoantibody profiles of patients with Parry-Romberg syndrome (PRS). METHODS: Antinuclear antibodies (ANA) in 14 patients with PRS were studied by indirect immunofluorescence (IIF), immunodiffusion and immunoblotting. Antinative DNA antibodies and rheumatoid factor (RF) were also analyzed. RESULTS: ANA were positive in 8 patients (57%). The patterns of staining included nucleolar, nuclear speckled and homogeneous. Anticentromere antibodies were observed in 2 and antihistone antibodies in 3 sera. Rheumatoid factor was found in 5 (36%) sera. Antinative DNA or antibodies that precipitated rabbit thymus extract were not found in any patients. CONCLUSION: The serologic abnormalities observed in this study suggests that autoimmunity could play a pathogenic role in PRS.

Nose and paranasal augmentation: autogenous, fascia, and cartilage.

The up-to-date plastic surgeon should consider using augmentation rhinoplasty with relative frequency. In selected cases, for improving the face integrally, it is desirable to augment the paranasal area. In the author's hands, grafts of cartilage and fascia are the preferred tissues, based on the experience of many years. Fascia can be used alone or combined, and in the last few years we have used it alone quite often. A temporoparietal fascia graft has great versatility in the correction of a number of nasal deformities. A depressed nasal dorsum can be augmented by utilizing fascia grafts. A depressed nasal radix can be corrected successfully by utilizing fascia grafts. Submucosal placement of strips of fascia has proved to be an effective method of reconstructing the roof of the middle cartilaginous vault. For augmenting the nasal dorsum when it is a case of primary rhinoplasty, the author prefers the use of fascia alone, but if the patient is having a secondary rhinoplasty, then the graft of fascia and cartilage combined is preferred.

Open rhinoplasty without skin-columella incision.

For the last 4 years, the author has been using the open lower cartilaginous vault rhinoplasty, making an external cutaneous incision on the columella. After observing the improved results in patients with nasal tip, lateral crura, and medial crura difficulties, the author widely recommends the use of this procedure in selected patients. In addition to multiple advantages which have been reported useful in open-tip rhinoplasty in the past, the author has contributed two additional advantages: that it avoids scarring columella skin and that it can be extended to cope with defects of the entire lower cartilaginous vault. Disadvantages are some residual edema in some patients over a 6-months period and prolongation of operating time.

Cheek and neck sculpturing: simultaneous buccal fat pad removal and subcutaneous cheek and neck lipoplasty.

A combined procedure removing the buccal fat pad by excision and the subcutaneous fat of the cheek and neck by lipoplasty is described; this results in an improved contour in both the cheeks and neck. The technique has been applied in 28 patients of various ages without complications and with satisfactory results. Both the immediate results of the operation and the results noted 1 year or more after the operation are very satisfactory. Excellent results have been noted for nine young patients, and good results were obtained in 19 older patients. A review is given of the findings previously reported in the literature. At present, we are inclined to believe that removal of the buccal fat pad and lipoplasty of the subcutaneous fat of the cheeks and neck offers more improvement than either procedure alone. It is hoped that this combined procedure will give a solution to the troublesome problem of chubby cheeks and lead to a method of safely recontouring the cheek to a more youthful and beautiful appearance.