Comparison of Clinical Outcomes of CO2 Laser-Assisted Blepharoplasty Using Two Different Methods.

PURPOSE: Numerous methods have been developed for blepharoplasty, including carbon dioxide (CO2) laser-assisted blepharoplasty. Although the superiority of CO2 laser compared with the scalpel for blepharoplasty has been proposed, to the best of our knowledge, no study has compared the clinical outcomes of blepharoplasty with the CO2 laser alone versus the combined use of a scalpel and CO2 laser. PATIENTS AND METHODS: In the present randomized clinical trial, 21 healthy patients underwent bilateral upper eyelid blepharoplasty. For each patient, an initial skin incision was made using the CO2 laser (setting, continuous emission; ultrapulse mode; 3 W of power) on 1 side and a scalpel on the other side. The remaining blepharoplasty steps were conducted using the CO2 laser (setting, continuous emission; 9 W of power) in both groups. The patients were evaluated on postoperative days 1, 3, 7, 14, and 30 using the postoperative repair criteria, including edema and ecchymosis. The Manchester scar scale was used to evaluate the results at 60 days after surgery. RESULTS: Our comparison of the 2 methods showed no significant differences at 1 month after surgery using the evaluation criteria. The scar index was not significantly different after 60 days, despite lower scores in the scalpel group. CONCLUSIONS: In upper eyelid blepharoplasty, making an initial incision with a scalpel, followed by use of a laser provides advantages similar to those found by performing the entire procedure with a CO2 laser alone.

Pyoderma Gangrenosum After Facelift and Otoplasty Surgery: Case Presentations and Literature Review.

PURPOSE: Pyoderma gangrenosum (PG) is an uncommon autoimmune, neutrophilic, ulcerative skin condition of uncertain etiology believed to result from dysregulation of the immune system. Although this entity is well recognized by dermatologists, other specialists are less familiar with diagnosis and treatment. This report describes a severe PG reaction to an elective cosmetic facelift, which is believed to be the second reported case of PG after facelift surgery. A second case after otoplasty surgery is described. MATERIALS AND METHODS: An unusual presentation of PG after cervicofacial rhytidectomy (facelift) is presented and discussed with a review of the literature. RESULTS: The present case was a rare complication after facelift surgery and followed the natural progression of PG. Delayed diagnosis and treatment extended the disease process. CONCLUSIONS: PG can mimic other surgical complications and delay diagnosis and treatment. This case is believed to represent the second reported incidence of PG after elective facelift surgery.

Rhytidectomy in Patients with Cochlear Implants.

As the incidence of rhytidectomy and cochlear implantation increases, so does the likelihood that an individual patient will undergo both procedures over their lifetime. This is particularly relevant as the US population not only ages but ages well. The purpose of this paper is to describe cochlear implants and to characterize pre-, intra-, and postoperative considerations of rhytidectomy in patients with cochlear implants. A thorough understanding of the relevant anatomy and physiology is crucial to the avoidance of potentially serious complications in patients with cochlear implants.

Neurotoxin waste from drawing product through the vial stopper.

Botulinum toxin injection is the most common cosmetic surgery procedure in the world. Current technique requires reconstitution that can produce product waste resulting in significant loss of profit as well as inaccuracy of actual units injected. By random sampling of "used empty" vials, it was shown that an average of 5 units are potentially wasted by the conventional methods of drawing up the product with a needle through the stopper of an inverted vial. Depending on the pricing and dilution of the product, this can result in a profit loss of $50 to $60 per vial, which can quickly add up to tens of thousands of dollars in a busy practice. Removing the stopper, tilting the vial, and aspirating the last residual with a small gauge needle can result in significant savings. Finally, this residual was calculated at a five-percent loss, which results in an inaccuracy of actual units delivered.

Esthetic removal of head and neck nevi and lesions with 4.0-MHz radio-wave surgery: a 30-year experience.

PURPOSE: The cosmetic removal of facial nevi and related lesions is a frequent patient request of cosmetic surgeons. Many patients live with esthetically bothersome lesions, unaware that scar-free or minimal scar treatment modalities are available. MATERIALS AND METHODS: The author has used a protocol of treating thousands of nevi and related benign lesions with 4.0-MHz radio-wave ablation during the past 30 years. A review of this technique is presented with substantiation by before and after images. Indications, diagnosis, and complications also are reviewed. RESULTS: Conservative ablation of nevi and benign lesions of the face and neck can be predictably removed with minimal and frequently imperceptible scarring. CONCLUSION: Facial surgeons see multiple patients on a daily basis requesting the removal of nevi and other benign lesions of the face and neck. Many patients are misinformed by experienced practitioners that the resulting scar will be worse than the lesion. This unfortunate dictum has been disproved hundreds of times by the author's treatment using 4.0-MHz radio-wave surgery to ablate benign lesions of the face and neck, with excellent cosmetic results. Even if practitioners do not offer this treatment, they should be aware that it exists and offer patients exposure to this modality.

Facial rejuvenation using neurotoxins and injectable fillers.

Dentistry has seen numerous paradigm shifts over the past 100 years, but perhaps the most dramatic has been the transition from treating oral diseases to prevention and esthetics. Minimally invasive injectable esthetic treatments have become a popular treatment choice in our society. This paper reviews some of the most common injectable aesthetic treatments with an emphasis on dental-related applications. Over the past 30 years, dentistry and its specialties have progressively embraced cosmetic techniques; the scope of oral and maxillofacial surgery now includes cosmetic facial surgery. The safe and effective administration of injectable fillers and neurotoxins requires a command of head and neck anatomy and physiology, pain control, and injection expertise, which puts dentistry in an optimal position for providing these treatments.