Non-surgical Rhinoplasty with Hyaluronic acid Fillers: Predictable Results Using Software for the Evaluation of Nasal Angles.

BACKGROUND: There is a relative lack of evidence on optimal products and techniques for nose treatment with hyaluronic acid (HA) fillers. This study assessed the efficacy and safety of nasal reshaping with Vycross HA fillers, using a free software (Face Master) to measure facial parameters. METHODS: This was a prospective, open-label, single-center study of consecutive adult patients treated in the nose (bony and cartilaginous dorsum and/or columella) with VYC-20 or VYC-17.5. A maximum of 1 mL of filler was used. All patients (except one) had at least 12 months of follow-up. RESULTS: Sixty-two patients were enrolled (57 females; 5 males) with a mean age of 29.0 ± 9.2 years. A mean of 0.55 ± 0.22 mL of filler (range 0.2-1.0 mL) was injected during initial treatment; 12 patients required touch-up with 0.15 ± 0.08 mL of filler (range 0.1-0.3 mL). Using Face Master, mean nasofrontal angle increased from 143.6 ± 6.3° pre-treatment to 147.3 ± 6.7° post-treatment (mean change 3.7 ± 2.8°), and mean nasolabial angle increased from 85.3 ± 6.1° to 88.5 ± 6.1° (mean change 3.2 ± 2.6°). Mean patient satisfaction (0-10 scale) increased from 2.4 ± 1.7 pre-treatment to 9.4 ± 0.8 post-treatment (mean improvement 7.1 ± 2.1). Complications were minor and transient: pain, n = 3 (4.8%); edema, n = 3 (4.8%); hematoma, n = 2 (3.2%). CONCLUSIONS: Non-surgical nasal reshaping with VYC-20 or VYC-17.5 appeared to be efficacious and safe; Face Master objectively demonstrated meaningful changes in key nasal angles. 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.

Bleeding in Plastic-Aesthetic Surgery: A Prognostic Pathway with Clinical Application.

One of the potential complications of aesthetic surgery is bleeding. Given the high surgical activity carried out in our center and the variety of interventions performed, the risk of bleeding is not negligible: A clinical practice that could reduce this postsurgical complication is necessary. The goal of this article is to value effectiveness of a bleeding score obtained through the evaluation of anamnestic data. The study was divided into two steps. The preliminary data consist in the creation of a form for the evaluation of the bleeding score based on literary data. Subsequently, the first step was put on a retrospective study on 163 patients who underwent aesthetic surgery from January 2013 to July 2017. In the second step, the bleeding score was introduced in clinical practice, submitting the form to 223 patients operated on from September 2017 to September 2018. Retrospective results showed that patients with a low bleeding index had no hemorrhagic complications. One patient of three with a medium-high bleeding score showed a hemorrhagic complication in the postoperative course. The prospective study showed that in three patients with an index between 4 and 7, the level II panel analysis confirmed a medium risk of incurring bleeding episodes during or after the surgery. One patient in 223 obtained a bleeding index of 9: This patient was not operated on and he was sent to the reference center for further investigation. This routine will help to recognize, manage, and prevent hemorrhagic complications of aesthetic surgery.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.

Standardized Practice Reduces Complications in Breast Augmentation: Results with the First 290 Consecutive Cases Versus Non-standardized Comparators.

BACKGROUND: Several systematic methods for breast augmentation have been published, providing key principles and technical steps for minimizing complications and optimizing patient satisfaction. The aim of this study was to compare complication rates in patients receiving a breast augmentation performed using a structured, standardized approach versus comparator patients operated on without a standardized approach. METHODS: This was a single-center, retrospective review of 290 consecutive breast augmentations performed between October 2016 and September 2017 based on a standardized technique (Randquist's "five P's" combined with Adams' 14-point plan), and 235 comparators who underwent breast augmentations prior to standardization between April 2014 and September 2016. All study subjects were females aged ≥ 18 years, undergoing bilateral breast augmentation, either alone or in the context of augmentation mastopexy or implant replacement. Various implant ranges were used before standardization; most (94.8%) of the standardized procedures used Natrelle® devices. Follow-up lasted for ≥ 12 months. RESULTS: Significantly fewer patients in the standardized surgery group experienced complications (14.5%, n = 42) compared with the non-standardized group [29.4%, n = 69; Chi square = 6.57; degrees of freedom (df) = 1; p = 0.01041]. Complication rates were also significantly lower in the standardized surgery group for each of the three types of breast augmentation surgery assessed separately. Reoperation rates with standardized and non-standardized surgery were 4.1% (n = 12) and 11.9% (n = 28), respectively (Chi square = 6.4; df = 1; p = 0.01145). Patient satisfaction was increased post-surgery in both groups. CONCLUSIONS: The use of a structured, standardized approach to breast augmentation reduced the risk of postoperative complications. 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 .

Superficial ulnar artery perforator flap.

Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions.

Lower limb trauma and posttraumatic stress disorder: a single UK trauma unit's experience.

INTRODUCTION: The incidence and factors influencing posttraumatic stress disorder (PTSD) in victims of severe lower extremity injuries are largely unknown. We studied a cohort of patients treated in a specialist centre to try and elucidate these unknowns. MATERIALS AND METHODS: The Posttraumatic Stress Disorder Checklist Scale (PCL-S) was used as a reliable and reproducible patient-reported outcome measure (PROM) assessing all patients for PTSD. Sixty patients were included in the study. This was a prospective analysis of the progression of the PCL-S scores. The data were analysed using a non-parametric Wilcoxon test. RESULTS: Sixty patients were recruited into the study cohort. We found that the incidence in this cohort of PTSD was 30%. We found that age had an influence on outcome. Those who were 50 years old or over had a significantly lower incidence of PTSD according to the PCL-S scores and appeared to recover from it significantly more effectively. CONCLUSIONS: Up to a third of patients suffering from a severe lower extremity injury will develop PTSD. Patients of the younger age group are more severely affected and will need psychological support to overcome their distress.

Microvascular free-flap transfer for head and neck reconstruction in elderly patients.

BACKGROUND: With the increase in life expectancy, the incidence of head and neck cancer has grown in the elderly population. Free tissue transfer has become the first choice, among all the reconstructive techniques, in these cases. The safety and success of micro vascular transfer have been well documented in the general population, but its positive results achieved in elderly patients have received less attention. METHODS: We retrospectively studied 28 patients over the age of 60 years. The aim of this paper was to study the success rate of free tissue transfer and investigate the complication incidence in this patient population. RESULTS: Twenty-eight free flaps were performed to reconstruct medium to large cervico-facial surgical defects in six years. No difference was noted between success and complication rates observed between general and elderly population. CONCLUSION: This study indicates that free-flap technique for head and neck reconstruction could be considered a safe option in elderly patients when a good pre-operative general status is present.

Use of Macrolane VRF 30 in emicircumferential penis enlargement.

BACKGROUND: Penis enlargement is increasingly in demand. Methods for penis enlargement can be classified into surgical, nonsurgical (filling), and mechanical. Each method has shown only relatively successful results. A new formulation of injectable, stabilized, hyaluronic acid (HA)-based, nonanimal gel is available that may have applications for this use. OBJECTIVES: The authors propose a new technique for emicircumferential-injection filling of the penis and assess the safety and efficacy of this procedure compared with lipofilling. METHODS: The authors retrospectively reviewed the charts of 83 patients who underwent penis enlargement with either their HA-injection technique or lipofilling between December 2007 and July 2011. Safety, efficacy, and patient satisfaction were assessed. RESULTS: The circumferential enlargement obtained from both techniques ranged from 3.2 to 4.5 cm, with a decrement during erection. In all patients, the increase in penis length ranged from 1.8 to 3.6 cm. No complications were seen in patients treated with HA, whereas 8 patients treated with lipofilling developed granuloma, and another experienced fat necrosis. The vast majority (n = 72) of patients reported being "very satisfied" with the results. CONCLUSIONS: The ideal technique for penis enlargement should be nonsurgical, with a satisfactory and predictable result, a low rate of complications, and long-term stability. Emicircumferential enlargement with HA filler meets these requirements. However, results have been durable but not definitive, and repeated treatment (with associated costs) is necessary.

Versatility of the posterior auricular flap in partial ear reconstruction.

BACKGROUND: The posterior auricular flap alone has always been popular because of its prompt availability, its rich vascularity, and the ease of closing the donor-site defect primarily. METHODS: Fifty-seven patients with partial ear defects covered with posterior auricular flaps during the period between 2002 and 2007 were reviewed. In the authors' series, posterior auricular flaps were harvested based on a simple random vascularization and tailored to reach almost any defect of the ear by a simplified and standardized approach. RESULTS: The authors propose a simple nomenclature after grouping the flaps according to skin paddle type, pedicle type, pedicle base, flap transfer method, and flap movement; they present a standardized algorithm with which to choose the flap design for a given defect from this group. CONCLUSIONS: The authors contribute three new flap designs to enhance the versatility of the posterior auricular flap. These are the superiorly and inferiorly based twisted island flaps and the posterior auricular propeller flap.