Concha-Type Microtia: New Surgical Incision.

BACKGROUND: Reconstruction of auricles for conchal-type microtia is challenging but rewarding. Many plastic surgeons consider autogenous rib cartilage as the standard material for framework fabrication. A healthy, scar-free skin envelope and a defined cartilaginous framework are also critical to successful ear reconstruction. OBJECTIVES: The aim of this study was to improve the outcome of the reconstruction and minimize complications by proposing a new surgical incision. METHODS: Thirty-three patients who underwent auricular reconstruction of concha-type microtia of various etiologies with the new skin flap incision between 2017 and 2022 were included in the study. Patients' clinical data, detailed surgical techniques, and postoperative care were recorded. RESULTS: Thirty-three patients (21 male, 12 female) were enrolled in the study. The mean age of the patients was 21.51 years at the time of reconstruction. The microtia was on the right side in 17 cases, on the left side in 12 cases, and 4 cases were bilateral; 12 cases were traumatic amputations of the helical component of the auricle, 11 cases were deformities after a burn, and 10 cases were congenital. The mean follow-up time was 17.43 months. A good initial projection without obvious scarring on the anterior surface of the auricle was achieved, with an overall complication rate of 5.42%. CONCLUSIONS: The surgical incision recommended in the study improves the final aesthetic result of the technique without any additional surgical risk.

Investigating the Safety of Multiple Body Contouring Procedures in Massive Weight Loss Patients.

INTRODUCTION: Deformities after massive weight loss are usually severe and affect many parts of the body, negatively impacting patients' social and intimate lives. A common request of patients after massive weight loss is to treat more than one anatomical area in one surgical procedure. Advantages include a single recovery period, lower surgical costs, and faster patient satisfaction. Disadvantages may include increased need for blood transfusions, longer hospital stay, and increased risk of common complications. OBJECTIVE: The main objective of the study is to compare operative risk, hospital length of stay, complication rate, and patient satisfaction in MWLP according to the number of surgical procedures performed in the same surgical setting. PATIENTS AND METHODS: This is a retrospective case-control study of 653 MWLP who underwent multiple contouring procedures simultaneously in a single surgical procedure. All patients underwent surgery between 2016 and 2020. The patients studied were divided into 4 groups according to the number of anatomical areas operated on. RESULTS: A total of 1254 body contouring procedures were included in the study. Follow-up time ranged from 13 to 41 months, with a mean of 17 months. The mean age in the study was 33 years old. Women accounted for 78% of the studied population and men accounted for 22%. The overall complication rate (major and minor) was 105 cases (16.07%) in all groups CONCLUSION: Patient satisfaction was highest in patients who underwent 2-3 procedures within the same surgical setting compared to patients who underwent +3 procedures. Nevertheless, this is clinically insignificant. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

"Post Bariatric Male Chest Re-shaping Using L-shaped Excision Technique".

BACKGROUND: Male chest deformity after massive weight loss is complex and challenging to treat because of differing grades of excessive parenchyma/fat ptosis, nipple malposition, over-stretched skin, ill-defined infra-mammary fold, and prominent axillary rolls. Patients are eager to restore balanced upper body dominance. Two fundamental techniques are used for large breasts with moderate to poor skin elasticity; (1) the inferior pedicle Wise skin pattern and (2) double incision with free nipple graft technique.The author presents his experience in treating such severe breast deformities, besides correcting the prominent axillary rolls using an L-shaped mastectomy excision. MATERIALS AND METHODS: Between March 2017 and December 2020, 55 consecutive patients were treated surgically for male chest re-contouring using the L-shaped mastectomy technique. Ages ranged from 20 to 57 years (median, 31 years). The average body mass index (BMI) was 29. The average follow-up period was 17 months (13-44 months). RESULTS: Fifty-one patients (92.8%) reported greater levels of postoperative satisfaction with their results owing to lack of any major complication and minimal minor complications (two cases of minor ischemia that healed spontaneously, two small hematomas, two small seromas, and four hypertrophic scars). CONCLUSION: The L-shaped excision is a useful procedure for severe grade gynecomastia with an atypical presentation in the form of complex chest deformity and prominent axillary roll after massive weight loss patients. The technique is associated with minor complications that are treated in an office setting. The technique preserves normal pigmentation and sensitivity of the nipple-alveolar complex. 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 .

Aesthetic Nonexcisional Arm Contouring.

BACKGROUND: Surgical excision remains the gold-standard therapy for arm skin laxity. However, many patients refuse surgical treatment for fear of the prominent long scars associated with brachioplasty. OBJECTIVES: The objective of the study was to compare the aesthetic outcome of 2 energy-assisted liposuction arm-contouring techniques, radiofrequency-assisted liposuction (RFAL; Group A) and Renuvion helium subdermal coagulation (Group B), with a control group treated with VASER-assisted liposuction (VAL) alone (Group C). METHODS: This is a randomized controlled study of 176 patients seeking arm contouring, who were treated between February 2017 and December 2020. All of the patients underwent VAL, followed by either RFAL (53 patients, Group A) with the BodyTite RF platform or subdermal coagulation (66 patients, Group B) with the Renuvion platform; 57 patients in the control group (Group C) received VAL alone. Patient data, marking techniques, operative details, complications (and tips and tricks to avoid them), and aesthetic outcomes were recorded and tabulated. Surgical team, third-party, and patient satisfaction surveys were conducted 6 months postoperatively. RESULTS: The study included 176 patients (153 female and 23 male) with a mean age of 32 years (range, 20-59 years). All patients were followed up for a minimum of 6 months. In total, 96 (80.6%) patients reported their satisfaction with the overall technique. An independent plastic surgeon considered the result good to excellent in 97 of 119 cases of the studied group. CONCLUSIONS: The umbrella of nonexcisional arm contouring can be extended to include treatment of difficult cases of arm laxity with energy-producing machines. The procedure can achieve a reduction in fat deposits and significant improvements in skin laxity.

Severe Gynecomastia: New Technique Using Superior Pedicle NAC Flap Through a Circumareolar Approach.

UNLABELLED: : Gynecomastia is defined as benign proliferation of glandular breast tissue in men. Gynecomastia causes considerable emotional discomfort because of limitation of everyday activity especially in young men. Surgical treatment of gynecomastia significantly contributes to an increase in social activity and an improvement of social acceptance and emotional comfort, and thus significantly improves satisfaction from personal life in men who underwent this intervention. Various surgical techniques were suggested to treat gynecomastia, but most of them end with visible scars especially in severe degree gynecomastia. The aim of many plastic surgeons is to advocate new techniques treating severe gynecomastia (grade II B and III according to Simon et al) with less visible scars. OBJECTIVE: The author proposed a new technique combining both surgery and liposuction for treating grade II B and III gynecomastia using only circumareolar approach. AIM: This study evaluates aesthetic results after surgery and assessment of the incidence of early and late postoperative complications. METHOD: The patient was marked preoperatively while standing. Under general anesthesia, ultrasound-assisted liposuction of the periglandular area and de-epithelialization of excess skin were performed. A superiorly based nipple areola complex flap was created based on the subdermal plexus. The excess glandular tissue was resected through the lower half of the circle of the de-epithelialized area. Closure of the wound was done after insertion of 14-French redivac. RESULTS: This treatment protocol was applied to 27 patients, 18 to 53 years of age, from February 2008 till now. Among these patients, 4 were classified as type IIB and 23 as type III. Follow-up ranged from 3 months to 4 years. Complications were the following: 1 hematoma, 1 wound dehiscence, 1 loss of nipple areola complex, 2 cases of hypertrophied scars, and 3 minor aesthetic problems near areolae. CONCLUSIONS: A new periareolar approach for correction of severe-grade gynecomastia permits broad resection of excess skin and submammary tissue while avoiding unattractive scars on the patient's chest.

Periosteal Flap Technique for Elevation of the Pinna in Microtia.

IMPORTANCE: For optimal aesthetic construction of the auricle in patients with severe microtia, it is important to construct an exquisite framework and place it in the correct natural position. In addition to its accurate vertical and sagittal positioning, normal elevation is of utmost importance because this determines the auricular width from the common anterior view in interpersonal communication. Many techniques have been described to stabilize the constructed auricle in the elevated position. Some of the techniques are prone to relapse (eg, simple skin transplantation), while others are intricate (eg, using cartilage, huge pedicled flaps, and free skin grafts). OBSERVATIONS: The objective of the study was to describe a simple and reliable periosteal flap technique and present our experience in 158 patients with complete unilateral or bilateral ear deformity (with possible defects of the external auditory meatus) who were operated on between February 3, 2005, and August 27, 2012. Principles of the technique include elevating the framework from the posterior aspect, stabilizing it with autogenous rib cartilage, covering this with a novel periosteal flap, and skin grafting. CONCLUSIONS AND RELEVANCE: The periosteal flap technique proved to be straightforward and reliable. All flaps had unrestricted microcirculation. Good and stable projection of the auricle was achieved in all patients.