Light-Guided Percutaneous Neck Rejuvenation With Division of Platysma Bands and Suture Suspension: A Multicenter Retrospective Study.

BACKGROUND: Traditional invasive suture suspension techniques have proven efficacy and durability. A previously described percutaneous placement of a neck suspension suture with light guidance has transformed this into a minimally invasive technique. This novel technique provides a major advance for minimally invasive neck rejuvenation. OBJECTIVES: The authors sought to describe their experience with light-guided percutaneous neck rejuvenation over the past 4.5 years, including technique, patient selection, safety profile, and expected outcomes. METHODS: Data were retrospectively reviewed for all patients who underwent the procedure with 5 surgeons across 4 aesthetic plastic surgery practices from January 2018 through May 2022. Inclusion criteria were mild to moderate neck laxity, prominent anterior platysma bands, and desire to improve neck contour. Patients undergoing concurrent skin incision >5 mm (ie, open rhytidectomy or platysmaplasty) were excluded. RESULTS: A total of 391 patients meeting criteria were identified during the study period. No hematomas were documented. Four patients (1%) developed infection at the suture site, 1 resolving on antibiotics and 3 requiring suture removal. Eighteen (4.6%) developed recurrent platysmal bands, and 7 (1.8%) had residual loose skin. Four (1%) experienced transient marginal mandibular neuropraxia. Mean length of follow-up time was 240 days. CONCLUSIONS: Light-guided percutaneous suture suspension is a safe and viable option for improving neck contours. Although it does not address extensive skin laxity or excess submental fat, it can be combined with energy-based tissue tightening, submental liposuction, or skin excision. In selected patients, this minimally invasive procedure provides predictable results with a low risk of complications.

Classification of Newborn Ear Malformations and their Treatment with the EarWell Infant Ear Correction System.

BACKGROUND: A single practice's treatment protocol and outcomes following molding therapy on newborn ear deformations and malformations with the EarWell Infant Ear Correction System were reviewed. A classification system for grading the severity of constricted ear malformations was created on the basis of anatomical findings. METHODS: A retrospective chart/photograph review of a consecutive series of infants treated with the EarWell System from 2011 to 2014 was undertaken. The infants were placed in either deformation or malformation groups. Three classes of malformation were identified. Data regarding treatment induction, duration of treatment, and quality of outcome were collected for all study patients. RESULTS: One hundred seventy-five infant ear malformations and 303 infant ear deformities were treated with the EarWell System. The average age at initiation of treatment was 12 days; the mean duration of treatment was 37 days. An average of six office visits was required. Treated malformations included constricted ears [172 ears (98 percent)] and cryptotia [three ears (2 percent)]. Cup ear (34 ears) was considered a constricted malformation, in contrast to the prominent ear deformity. Constricted ears were assigned to one of three classes, with each subsequent class indicating increasing severity: class I, 77 ears (45 percent); class II, 81 ears (47 percent); and class III, 14 ears (8 percent). Molding therapy with the EarWell System reduced the severity by an average of 1.2 points (p < 0.01). Complications included minor superficial excoriations and abrasions. CONCLUSION: The EarWell System was shown to be effective in eliminating or reducing the need for surgery in all but the most severe malformations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Selected outcomes of thumb replantation after isolated thumb amputation injury.

PURPOSE: The aim of this study was to assess thumb survival, pinch strength, grip strength, and need for secondary surgery in patients undergoing thumb replantation after isolated thumb amputation injury. METHODS: We conducted a retrospective review of 52 consecutive isolated thumb replantations performed over a 4.5-year period. Charts were reviewed for mechanism of injury, level of amputation, and surgical technique. Primary outcomes of interest included survival and secondary surgery (eg, tenolysis, neurolysis) rates. Functional outcome was assessed by pinch and grip strengths after a mean follow-up period of 10 months from the initial injury. RESULTS: The overall thumb survival rate was 92% (48 of 52). One hundred percent of Zone I injuries (13 of 13), 94% of zone II injuries (29 of 31), and 75% of zone III injuries (6 of 8) survived; overall survival was 94% in sharp injuries (32 of 34), 89% in avulsion injuries (8 of 9), and 89% in crush injuries (8 of 9). Secondary surgery was performed in 18 patients with increasing need across the 3 zones (0%, 42%, and 63%, respectively; p for trend = .002). Pinch and grip strengths of 17 patients after an average follow-up period of 10 months were significantly worse after crush/avulsion injuries (p = .007 and .07, respectively) and injuries requiring joint intervention (p = .004 and .02, respectively); grip strength was also found to be negatively associated with increasing zone of injury. CONCLUSIONS: This retrospective study shows that a high rate of survival can be achieved after thumb replantation using current techniques. In addition, the need for secondary surgery is strongly related to zone of injury, with zone I injuries requiring the least amount of secondary surgery. Finally, pinch and grip strengths may be worse after crush or avulsion injuries and injuries requiring joint intervention. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The measure of face-lift patient satisfaction: the Owsley Facelift Satisfaction Survey with a long-term follow-up study.

BACKGROUND: Patient satisfaction is a major factor in determining success in aesthetic surgery. To the authors' knowledge, a long-term study measuring patient satisfaction with face-lift surgery has not been published. The authors' study was designed to measure patient satisfaction with the overall experience of a face lift and to assess the patient's level of satisfaction 10 to 15 years after surgery. METHODS: Three hundred ninety-four consecutive patients were identified who had face lifts performed by the senior author (J.Q.O.) between January 1, 1994, and January 1, 1999. Contact was achieved with 146 patients (37 percent), and 131 patients (90 percent) agreed to participate by completing a four-page survey. Eighty-nine patients (68 percent) returned the survey. RESULTS: One year after face-lift surgery, 87 patients (97.8 percent) described the improvement of their facial appearance as very good or beyond expectations. After an average follow-up of 12.6 years, 61 patients (68.5 percent) rated their current degree of improvement as very good or beyond expectations, and 61 patients (68.5 percent) felt 10 or more years had been added to their youthful appearance. Thirty-four patients (31 percent) indicated disappointment in some aspect of the face lift. CONCLUSIONS: This work assesses the long-term satisfaction of face-lift patients who had a superficial musculoaponeurotic system-platysma face lift. The results suggest a high degree of satisfaction following face-lift surgery at short-term and long-term follow-up. The authors recognize that recall bias may be present when recalling the satisfaction at 1 year postoperatively. We present the survey questionnaire as a template for future research in face-lift patients.

Successful replantation of the ear as a venous flap.

Successful microvascular ear replantation is well described, and often involves the use of arterial inflow anastomoses with leeches and systemic anticoagulation to augment outflow. Failed replantation attempts have also been published, with most of the failures attributed to venous drainage problems. A case of successful replantation of an ear is presented using a single 0.5-mm arteriovenous anastomosis, as no suitable artery could be identified in the amputated part. Postoperatively, dextran and leech therapies were employed to promote adequate venous drainage. We report a 100% successful ear replantation using a single arterialized vein as the inflow. In situations where no adequate artery is identifiable in the amputated part, an arteriovenous anastomosis may be a suitable alternative.

Simultaneous coverage of two separate dorsal digital defects with a syndactylizing venous free flap.

We report a case of a 58-year-old patient who sustained multiple finger injuries on the right hand. After thorough debridement, two dorsal defects of the middle and ring fingers were covered simultaneously with a single arterialized venous free flap from the right forearm. The flap was used to create a dorsally syndactylized digit which survived completely and was subsequently divided longitudinally. With early flap division, excellent functional and cosmetic result was achieved. We consider the syndactylized venous free flap with early division as a useful option for simultaneous coverage of separate dorsal digital defects.

Tinea capitis: current concepts in clinical practice.

Tinea capitis is a common infection, particularly among young children in urban regions. The infection often is seen in a form with mild scaling and little hair loss, a result of the prominence of Trichophyton tonsurans (the most frequent cause of tinea capitis in the United States). T. tonsurans does not fluoresce under Wood light, unlike the common tinea capitis-causing fungal organisms seen in Europe and many other countries, which emit a green fluorescence. However, T. tonsurans, like other fungi, also may less often produce an intense inflammatory reaction, which is suggestive of an acute bacterial infection.