The American Journal of Cosmetic Surgery最新文献

{"title":"Periareolar Mastopexy: A Historical Appraisal of Technique and Further Technical Refinements Toward Reliable, Lasting, and Reproducible Results","authors":"K. Lie, D. Hodgkinson","doi":"10.1177/07488068241228732","DOIUrl":"https://doi.org/10.1177/07488068241228732","url":null,"abstract":"Since its first description in 1976, periareolar mastopexy has attained a negative perception due to perceived high rates of unsatisfactory outcomes. The 2 main reported problems are (1) periareolar scar widening and (2) poor breast shaping. It is the author’s experience that with appropriate refinements in surgical technique based on sound anatomical and surgical underpinnings, good breast shaping and areolar aesthetics can be reliably achieved. This article describes innovations in the technique to improve outcomes, followed by a description of our own technique and refinements over the senior author’s 40-year journey. A literature review of technical refinements in periareolar mastopexy surgical technique was undertaken. Suggested refinements from various authors were then placed in the context of the senior author’s own clinical experience and evolution of technique over 40 years. Representative case studies from the author’s personal series are then presented to illustrate technical pearls and results. Four illustrative cases are discussed, along with a comprehensive description of the senior author’s technique and underlying principles. Early techniques of periareolar mastopexy were plagued by poor breast shaping and areolar distortion. Progressive refinements in technique over the last 50 years have steadily improved surgical outcomes. By combining various published refinements into a single operation, it is now possible to reliably achieve good aesthetic outcomes and avoid previous problems, as shown by the author’s own case series.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"23 49","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140408875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Lip Lift: The Sashimi Technique","authors":"Nabil Fakih-Gomez, David Dominguez-Medina, Cristina Muñoz-Gonzalez, Ibrahim Fakih-Gomez","doi":"10.1177/07488068231215114","DOIUrl":"https://doi.org/10.1177/07488068231215114","url":null,"abstract":"The lip lift surgery has emerged as one of the most highly sought-after procedures within the realm of cosmetic clinical practices. While indirect techniques have undergone numerous modifications and garnered extensive attention over time, there has been a notable dearth of published information concerning direct techniques. In this article, we present 3 refined modifications to the direct lip lift technique. These enhancements encompass an upgraded marking design based on the clinical anatomy of the oral commissure, a full-thickness skin excision while preserving the integrity of the orbicularis oris muscle, and an improved intradermal skin suturing technique. In our experience, we found that by methodically implementing these techniques, we have successfully minimized the visibility of scars along the vermilion border. Concurrently, we have achieved effective lip eversion while preserving its natural fullness. These modifications to the technique have emerged as a result of an evolutionary process aimed at rectifying the limitations of previous methods. Consequently, these adaptations have empowered us to more seamlessly integrate the direct lip lift technique into our clinical practice.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"64 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138945822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indirect Lip Lift With Modified Suspension Technique to Pyriform Ligament","authors":"Nabil Fakih-Gomez, Cristina Muñoz-Gonzalez, David Dominguez-Medina, Ibrahim Fakih-Gomez","doi":"10.1177/07488068231216569","DOIUrl":"https://doi.org/10.1177/07488068231216569","url":null,"abstract":"The lip lift procedure has witnessed a surge in popularity in recent years due to its remarkable ability to bring about a substantial transformation in facial appearance through a minor surgical intervention. The primary objective of the procedure is to diminish the height of the philtrum, consequently enhancing the visibility of the teeth while leaving behind a minimal visible scar along the upper lip vermilion border. In this article, a series of refined modifications to the conventional subnasal technique are introduced. The approach entails the removal of a skin strip while preserving a subcutaneous cuff. This method incorporates central and laterally vectored deep-plane sub-superficial muscular aponeurotic system (SMAS) advancement flaps, complemented by suspensions to the pyriform ligament. Furthermore, a sliding closure technique is introduced through the cuffs, and an enhanced skin suturing method is implemented. These substantial enhancements to the procedure result in a lasting elevation of the lip and a reduction in the visibility of unfavorable scarring. These modifications have emerged through an evolutionary process, driven by the pursuit to improve scar outcomes. The surgical techniques applied in this method effectively address the primary limitations of previous approaches, consistently yielding aesthetically pleasing results over the long term.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"216 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Vitro Analysis of Dissolution of 18 HA-based Dermal Fillers with Tailored Hyaluronidase Dosing to Achieve Urgent Reversal of Vascular Complications","authors":"Sahitya Reddy, Marisa Mihori, S. Rostami","doi":"10.1177/07488068231210181","DOIUrl":"https://doi.org/10.1177/07488068231210181","url":null,"abstract":"Hyaluronidase (HYAL), a hyaluronic acid-degrading enzyme, is commonly used “off-label” as part of the gold standard management of hyaluronic acid (HA) dermal filler complications. It is paramount that injectors be cognizant to diagnose and treat filler complications, particularly vascular emboli, where there may be a narrow window for timely treatment. There is a paucity of studies, however, that provide HYAL dosage guidelines in the setting of acute vascular obstruction that are specific to each of the 18 reversible HA-based dermal fillers commercially available on the current US market. Differences in resistance to HYAL degradation is based on variation in cross-linking technique, concentration of HA, and cohesive properties that each filler may possess. This in vitro study investigates optimal dosage parameters of HYAL to achieve gross dissolution of every reversible HA-based filler commercially available to better improve outcomes after filler-induced vascular complications. Standardized in vitro analysis using 0.5-mL aliquots of all 18 commercially available HA-based fillers included all Restylane products (Lyft, Restylane-L, Silk, Refyne, Defyne, Kysse, Contour), Juvederm products (Volbella, Vollure, Voluma, Ultra XC, Ultra Plus XC), Revanesse products (Versa+, Lips+), Teoxane products (RHA 2, RHA 3, RHA 4), and Belotero. Hylenex, recombinant human HYAL, was used in 150 IU increments for total quantities of either 300, 450, 600, or 750 IU to achieve timed assessment of the gross dissolution of filler using photographic and videographic documentation. Inert dye was used to improve filler visibility against the HYAL. Mechanical integration of HYAL into the filler mimicked massage technique commonly implemented to incorporate HYAL into the perivascular soft tissue to help relieve a filler-induced vascular obstruction. The cross-linking technology utilized by each HA-filler manufacturer played a significant role in the readiness of filler dissolution with HYAL. Fastest dissolution times ranged from 11 seconds to approximately 32 minutes, with a strong correlation with Restylane products dissolving the fastest, followed by Juvederm & Revanesse products. The slowest to achieve gross dissolution were Belotero and the RHA series. All 18 HA-based fillers achieved complete gross dissolution within the first 32 minutes, however, due to differences in cross-linking technology and molecular properties, there was large variation in in vitro HYAL-induced degradation that can be extrapolated clinically to help reverse urgent vascular obstruction. This may also help beginner injectors strategically choose the HA-based dermal fillers that have the fastest degradation response to HYAL. Further in vivo studies are necessary to integrate these into clinical practice.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"6 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138980236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Blepharoplasty With Fat Transposition and Three-Vector Suspension Technique","authors":"Nabil Fakih-Gomez","doi":"10.1177/07488068231213410","DOIUrl":"https://doi.org/10.1177/07488068231213410","url":null,"abstract":"The aging appearance of the lower eyelids is multifactorial, involving changes in the skin, orbital fat, orbicularis muscle, soft tissue of the midface, tear trough, and tear valley. Traditional techniques of lower blepharoplasty are based on transcutaneous or transconjunctival approaches with skin removal, followed by adjunctive procedures, such as canthal suspension, fat resection, or repositioning. However, these approaches can hardly achieve excellent transitions simply because they do not effectively address every age-related issue affecting the lower eyelid. Conversely, the approach presented herein, focuses on blending the lid-cheek junction by means of skin resection, fat transposition, and three periosteal suspension vectors, including canthal, skin-muscle flap, and sub-orbicularis oculi fat (SOOF) suspensions. It provides adequate volume restoration in the tear trough and tear valley, along with enhanced support and stability to the eyelid with canthopexy, double muscle flap, and SOOF suspension. The aim of this article is to provide a detailed step by step description of this technique along with the results of 269 patients who underwent this procedure from 2019 to 2023. This technique offers a safe and effective solution for lower eyelid aging, yielding long-lasting aesthetic results with excellent transitions.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"1 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138981911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review: What Happened To You? Conversations on Trauma, Resilience, and Healing by Bruce D. Perry and Oprah Winfrey","authors":"Eve Bluestein, Isaac Bluestein","doi":"10.1177/07488068231213323","DOIUrl":"https://doi.org/10.1177/07488068231213323","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139259751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Safe and Simple Method of Augmentation Mastopexy","authors":"Tong Le, Michael John Higgs","doi":"10.1177/07488068231200092","DOIUrl":"https://doi.org/10.1177/07488068231200092","url":null,"abstract":"Introduction: Combining breast augmentation with mastopexy has historically been considered challenging, with concerns about complications and suboptimal aesthetic outcomes. However, recent data suggest that the combined procedure can be performed safely and effectively. Materials and Method: This article presents a technique for augmentation mastopexy that aims to minimize complications and is safe to perform. The technique focuses on preserving a robust blood supply, minimizing lower breast contour bottoming out, maintaining upper pole fullness, reducing the risk of recurrent ptosis, minimizing scar burden, and avoiding periareolar scar widening. Precise preoperative and intraoperative markings are crucial for achieving long-lasting results. The use of tailor tacking and marking the vertical excess with the patient in an upright position provides a reliable method for determining the amount of soft tissue resection required. Results: The results are shown in the postoperative photographs at 10 days, 1 month, and 3 months, respectively. These are compared with the preoperative photographs of the patient’s features. Discussion: The technique incorporates the use of an implant placed in the dual-plane subpectoral pocket to address upper pole flatness and provide structural support in the lower pole. The article emphasizes the importance of preserving Cooper’s ligaments during skin resection to maintain the supportive role of the skin. Vertical wedge resection of the lower pole is employed to reconstruct the breast cone and create a strong vertical fibrous band, which contributes to the long-term shape and support of the breast. The article also discusses techniques to mitigate nipple-areolar complex widening and emphasizes the importance of patient selection based on specific criteria. Conclusion: Overall, the authors present a safe and simple technique for augmentation mastopexy that aims to achieve long-lasting results with minimal complications. The authors advocate for careful patient selection and adherence to their methodology, which incorporates principles of preserving blood supply, maintaining breast contours, and minimizing scar burden.","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135253570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in Facelift Surgery Instrumentation: Modifications to Trepsat Spatula-Tipped Facelift Scissors—A Letter to the Editor","authors":"Hatem Elfieshawy","doi":"10.1177/07488068231203242","DOIUrl":"https://doi.org/10.1177/07488068231203242","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135483218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WITHDRAWAL – Administrative Duplicate Publication: “Editorial: The Struggle to Change: Consolidation as the Future of Cosmetic Surgery”","authors":"","doi":"10.1177/07488068231200761","DOIUrl":"https://doi.org/10.1177/07488068231200761","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134950161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who’s on First","authors":"J. Petro","doi":"10.1177/07488068231190478","DOIUrl":"https://doi.org/10.1177/07488068231190478","url":null,"abstract":"","PeriodicalId":297650,"journal":{"name":"The American Journal of Cosmetic Surgery","volume":"219 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114683178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}