The Impact of COVID-19 on Plastic Surgery Residents Across the World: A Country-, Region-, and Income-level Analysis.

BACKGROUND: The COVID-19 pandemic has upended graduate medical education globally. We investigated the COVID-19 impact on learning inputs and expected learning outputs of plastic surgery residents across the world. METHODS: We administered an online survey capturing training inputs before and during the pandemic and retrieved residents' expected learning outputs compared with residents who completed their training before COVID. The questionnaire reached residents across the world through the mobilization of national and international societies of plastic surgeons. RESULTS: The analysis included 412 plastic surgery residents from 47 countries. The results revealed a 44% decline (ranging from - 79 to 10% across countries) and an 18% decline (ranging from - 76 to across 151% countries) in surgeries and seminars, respectively, per week. Moreover, 74% (ranging from 0 to 100% across countries) and 43% (ranging from 0 to 100% across countries) of residents expected a negative COVID-19 impact on their surgical skill and scientific knowledge, respectively. We found strong correlations only between corresponding input and output: surgeries scrubbed in with surgical skill (ρ = -0.511 with p < 0.001) and seminars attended with scientific knowledge (ρ = - 0.274 with p = 0.006). CONCLUSIONS: Our ranking of countries based on their COVID-19 impacts provides benchmarks for national strategies of learning recovery. Remedial measures that target surgical skill may be more needed than those targeting scientific knowledge. Our finding of limited substitutability of inputs in training suggests that it may be challenging to make up for lost operating room time with more seminars. Our results support the need for flexible training models and competency-based advancement. 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 http://www.springer.com/00266 .

Parry-Romberg syndrome treatment with fat transfer and a new bleaching formula.

Parry-Romberg syndrome is a hemifacial atrophy which can be complicated by melasma. We present two cases of Parry-Romberg syndrome, treated by fat transfer and bleaching of the skin using a modified "Kligman's formula." The atrophy, as well as the skin dyschromia, improved, and the results were stable.

Complications of Fat Transfer for Breast Augmentation.

Autologous fat grafting is quite common for breast augmentations as well as for reconstructive breast surgery. Coleman has described the surgical technique of fat grafting. Fat is harvested, and after centrifugation and refinement, blunt infiltration cannulas are used to place the fat through small incisions. The grafted tissue is placed in small aliquots with each withdrawal of the cannula. In order to achieve an aesthetically pleasing contour of the breast, the fat should be layered into different levels from the chest wall to the skin. However, autogenous lipotransfer if not performed lege artis might lead to complications such as fat necrosis, calcification, formation of encapsulated fatty masses (cystic lesions), lymphadenopathy, disfigurement of breast contouring, hypersensitive breasts, itchy nipples. A 36-year old female patient, presented with multiple palpable cystic lesions, disrupted breast contouring, asymmetry, hypersensation and pain during examination, 6 months after autologous fat grafting for breast augmentation elsewhere. The patient had ultrasound and MRI screening, which revealed the multiple bilateral cysts formation in the breast tissue. Surgical removal of the large lesions was performed, and specimens were sent for pathology and cytology consideration and screening. A few months after surgical removal of these lesions and after symptoms subsided, breast augmentation was performed with silicone implants. An aesthetically pleasing result together with relief of the patient's initial symptomatology was achieved. 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 .

Wound healing after laser skin resurfacing: the effect of a silver sulfadiazine-hyaluronic acid-containing cream under an occlusive dressing.

INTRODUCTION: Occlusive dressings promote wound healing after laser skin resurfacing. Our goal was to evaluate whether a cream containing hyaluronic acid-silver sulfadiazine could improve this process. METHODS: Ten guinea pigs received laser resurfacing on the skin of their backs. Polyurethane foam film adhesive dressing was applied. A cream containing hyaluronic acid-silver sulfadiazine was applied under the dressing over half of the wound. Skin biopsies were taken at days 2, 4, 7 and 9 and examined by a pathologist blinded to the study. RESULTS: Re-epithelialization appeared to occur faster in the cream-treated areas, together with a lower level of acute inflammation in the early phase of the healing process. CONCLUSIONS: The cream containing silver sulfadiazine/hyaluronic acid seems to improve wound healing after laser skin resurfacing in guinea pigs. The clinical application of this finding on humans should be assessed.

Laser-assisted blepharoplasty and inferior lateral retinaculum plication: skin contraction versus skin traction.

Blepharoplasty is one of the most commonly performed operations in plastic surgery, especially among middle-aged patients. Ablative lasers, especially the carbon dioxide laser, assist in tissue cutting and hemostasis. These lasers also offer skin resurfacing with its unique advantages despite the prolonged downtime. The authors present their laser-assisted blepharoplasty experience and the recent addition of one simply performed, inferior lateral retinaculum plication to the procedure (single suture traction technique, SSTT). Hence, the need for laser skin resurfacing of the lower eyelid has been reduced due to the skin traction applied, avoiding the long period required for resolution of erythema and potential hyperpigmentation. Furthermore, the tightening effect on the canthal ligament offers a more youthful look to the surgically treated eye.

Hair induction after laser-assisted hair removal and its treatment.

BACKGROUND: Laser hair removal is a relatively safe procedure with limited side effects. Hair induction has been previously scarcely reported. OBJECTIVE: We sought to report the incidence of this strange side effect in a large number of patients treated for hair removal and to follow its course and treatment. METHODS: We conducted retrospective analysis of the files of all patients who underwent laser hair removal during the time period from May 1998 until May 2005 in a private institution in Athens, Greece. RESULTS: Hair induction occurs predominantly on the face and neck of female patients of Mediterranean ancestry with darker skin types. The percentage is quite low (4.5%). Laser treatment of the induced hair reduces the problem. LIMITATIONS: No control groups could be obtained in this study. Furthermore, the natural course of hair induction could not be studied because it was always treated or patients were lost to follow-up. CONCLUSIONS: Hair induction is a rare side effect of laser hair removal occurring in selected populations and body areas; however, it responds well to laser treatments.

Development of terminal hair following skin lesion treatments with an intense pulsed light source.

Laser and other light sources have been used to treat vascular and pigmented skin lesions and to remove tattoos and unwanted hair, with varying degrees of success and various side effects. It has not yet been reported that hair growth can occur as a side effect of such treatments. In this paper two cases are presented, one port wine stain and one tattoo, that were each treated several times with an intense pulsed light source (IPLS) for removal. Terminal hair, not present before treatment, partially developed in treated areas of both lesions. Local inflammatory reactions are believed to trigger such outcomes.

Intense pulsed light is effective in treating pigmentary and vascular complications of CO(2) laser resurfacing.

Prolonged erythema and hyperpigmentation are frequently encountered side effects of laser skin resurfacing. The author has found intense pulsed light to be effective in the treatment of erythema and hyperpigmentation resulting from laser skin resurfacing in the periorbital area. (Aesthetic Surg J 2002;22:489-491.).