The micropulsed 1444-nm neodymium-doped lipolysis laser exhibits favorable characteristics for novel application in facial contouring. The study described herein is the first clinical report of laser-assisted facial contouring (LAFC). We retrospectively reviewed records of 478 LAFC patients (mean age 52) who underwent contouring of 1278 individual mid- and lower facial treatment sites over 18 months. Along with clinical assessment, study parameters evaluated among "original" and "modified" (where protocol updates included deep dermal soft tissue coagulation as an optional step) protocol groups included laser power, pulse energy, and total energy delivery as well as lipoaspirate volume at each treatment site. Mean power and pulse energy were similar (within 5%) and total energy use was greater (70% higher for mid- and lower face) in the original protocol group. Lipoaspirate volume was similar for both groups for the midface (within 10%) but elevated in the modified protocol group for the lower face (40% higher). Treatment complications were observed in 47 of 363 treatment sites (13%) in the original and in 12 of 915 treatment sites (1%) in the modified protocol group with the majority (63%) of the complications comprising over- versus undercorrections of desired tissue contour. Clinical efficacy varied with improvements of mid- and/or lower facial contour ranging from marginal to subtle to very apparent. LAFC as detailed herein is a novel treatment modality that enables selective soft tissue removal for greater precision in three-dimensional contouring of the face. Protocol modifications based on laboratory and observed tissue photothermodynamics have improved LAFC safety.
To evaluate and compare past and present hair replacement techniques of standard grafts, minigrafts, micrografts, scalp reduction, scalp flaps, strip harvesting, and punch harvesting procedures with regard to aesthetic improvement, effectiveness, postoperative pain, and complications.Design: Three hundred surveys were mailed randomly to patients who had undergone hair replacement over the last 3 decades. The questionnaire asked patients to rate the level of postoperative results and complications in several comparison groups with regard to the following factors: itching, pain, swelling, scarring, bleeding, altered sensation, poor growth, color and texture, infection, hairline, and natural appearance. Each factor was rated by the patients on a scale of 0 to 3 (0, none [best]; 1, minimal; 2, moderate; and 3, worst [severe]).Setting: Private facial plastic surgery practice.Methods: A hypothesis about each set of survey questions was formed based on general trends in patient responses, also known as the null hypothesis; 2 tests were conducted for each of the survey questions to determine the statistical trend with a certain level of confi-dence. The weighted arithmetic mean of the expected response was used for the varying number of patients responding to each question. Using the 2 test, the formulated hypotheses can be accepted or rejected based on the observed and expected responses.Results: Between 1981Between -1990Between and 1991Between -1996, there was a reduction of 38 percentage points in the number of standard graft procedures performed, an increase of 31 percentage points in the number of minigraft procedures, and an increase of 48 percentage points in the number of micrograft procedures. The complication rate was 31% lower for minigraft procedures compared with standard graft procedures and 29% lower for micrograft procedures compared with minigraft procedures. The complication rate was 59% lower for strip harvesting procedures compared with punch harvesting procedures.Conclusions: Newer hair replacement techniques have improved aesthetic results, with lower morbidity and complication rates. These improvements are responsible for the increase in the level of satisfaction of patients undergoing hair replacement surgery today.
Follicular unit transplantation (FUT) is the culmination of decades of refinement and evolution of hair transplantation techniques. Hair naturally grows in groups of one to four individual follicles separated by intervening soft tissue. These clumps or groups of hairs are termed FOLLICULAR UNITS. FUT uses microscopic dissection to separate these units for transplantation in a fashion that most closely resembles naturally occurring hair. FUT has grown to become recognized by many prominent hair restoration surgeons as the state-of-the-art method of hair replacement surgery for both male and female pattern alopecia. Although larger punch grafts, scalp flaps, and alopecia reductions may play a role in certain cases, FUT achieves results that are difficult to differentiate from naturally occurring hair. The central attributes of the technique are the provision of natural-appearing hairlines with reasonable density together with low morbidity and minimal "downtime." Nevertheless, the technique is only as effective as the technician, and results are heavily dependent on the forethought of the architect.
A patient presenting to a facial plastic surgeon with lower eyelid aging often has accompanying midface descent. Many surgical options exist to address these deformities. Blepharoplasty techniques include both the transcutaneous skin-muscle flap as well as the transconjunctival approach. The midface can be addressed via a multitude of techniques, including percutaneous suspension of the malar fat pad, deep plane dissections, subperiosteal and endoscopic midface lifts, and transorbital approaches. Patients who have some midface ptosis but do not meet the standard criteria for formal midface lifting, or who want to avoid the extended recovery associated with such techniques, could benefit from less invasive procedures. We propose the extended skin muscle blepharoplasty to address midface descent and lower lid aging to patients as an alternative to formal midface lifting. The extended skin muscle blepharoplasty is an excellent technique for patients with orbicularis hypertrophy, skin redundancy, a tear trough deformity, and premalar ptosis, as it addresses each of these deformities with minimal downtime. Results for patients with mild but visible midface descent are gratifying.
IMPORTANCE Recognizing the perceptual threshold for artificial-appearing lips is important to avoid an undesirable outcome of treatment. OBJECTIVE To characterize the quantitative measurements for the perceptual threshold of artificial-and unnatural-appearing lips. DESIGN, SETTING, AND PARTICIPANTS Photographs of a female model's lips were digitally altered incrementally in 5 sets of features (the upper lip, lower lip, upper and lower lips, and shape of the Cupid's bow). From December 1, 2013, to January 30, 2014, participants viewed the photographs in random sequence using an online survey and responded to 2 questionnaires after each photograph. The participants were prompted to respond whether each altered photograph of the lips appeared to have received any cosmetic treatment, and whether the lips looked attractive and natural or artificial and unnatural. The measurement of each lip at which 50% of the observers perceived the lips as being treated and 50% of the observers perceived the lips as being artificial was determined. The difference in these 2 measurements was defined as dTA 50 , which represents the threshold differential between the perception of treated lips and artificial lips for 50% of the observers. MAIN OUTCOMES AND MEASURES Survey responses of the participants to the appearance of the lips in the photographs. RESULTS A total of 98 participants (76 females and 22 males; mean age, 42 years) provided usable responses to the survey. Each area of the lips had a unique quantitative measurement at which the observers perceived the lips as being treated and artificial. Enhancement of the upper lip alone had a narrower margin for artificial appearance (dTA 50 , 0.9 mm) compared with enhancement of both the upper and lower lips (dTA 50 , 1.5 mm). Any alteration to the Cupid's bow resulted in the narrowest margin for artificial appearance (dTA 50 , 0.3 mm). The difference in the perceptual threshold between the age of the observers was the most significant for the upper lip. CONCLUSIONS AND RELEVANCE The perceptual threshold for treated and/or artificial appearance is unique for each area of the lips. LEVEL OF EVIDENCE NA.
To compare the efficacy and safety of two different second-generation ablation devices, Novasure impedance control system and microwave endometrial ablation (MEA), in cases of abnormal uterine bleeding (AUB). Materials and Methods: This is a randomized controlled trial that took place in a single Gynecological Department of a University Hospital. Sixty-six women with dysfunctional uterine bleeding (DUB), unresponsive to medical treatment, were included in the trial. The ratio of women allocated to bipolar radio-frequency ablation or MEA was 1:1. Follow-up assessments were carried out at three and 12 months post-ablation. The present main outcome measure was amenorrhea rates 12-months post-treatment. Results: The rate of amenorrhea at 12months post-ablation was significantly higher in women treated by Novasure (25/33; 75.8%) as compared to those treated by MEA (8/33; 24.2%) (rate difference: +51.5%, 95% CI: +27.8 to +67.7). Conclusion: In women with DUB, endometrial ablation with Novasure bipolar radiofrequency impedance-controlled system is associated with increased rates of amenorrhea at 12-months post-treatment as compared to the MEA method.
Findings support the contention that the Silastic midfacial malar implant is a safe and effective alloplastic alternative to treat malar hypoplasia and facial asymmetry. The complication and revision rates are acceptable. Relative technical ease of insertion makes malar augmentation an excellent adjunct for rhytidectomy and rhinoplasty.
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