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The pain felt during botulinum toxin type-A injections and the troubled and distressed treatment it induces is common and well known for the patient and the doctor applying the treatment. This problem is further intensified on the patients who have needle phobia. The effect of ice application on the treatment zone before botulinum toxin type-A treatment on the pain felt during injections is investigated. Totally, 24 patients who underwent botulinum toxin type-A treatment in upper face region for esthetic purposes are included in the study. Ice was applied 5 minutes before the injections on the right lateral orbital zones (crow's feet area) of the patients, whereas on their left sides, toxin was injected without applying any ice. All the drugs were diluted by normal saline; 5 U of active botulinum toxin type-A was used in each diziem (0.1 mL). Total injection number was determined both in right and left areas as 8. Visual analog scale (VAS) was used for pain intensity and evaluation. On the side where ice was applied, the treatment was completed in 1 session and lasted shorter when compared with that of the control side. However, the average VAS values defining the pain that the patients felt in their right and left sides were found as 1.1 and 5.9, respectively. The clinical findings obtained indicated that pain is significantly reduced on the side where ice is applied. The statistical significance of the test results were evaluated by Student's t test, and the difference between VAS values was found statistically significant (P = 0.000).

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Pain is a side effect of botulinum toxin type-A (BTX-A) injections. The efficiency of the preservative-containing saline solution used as the "dilution solution" for controlling the pain felt during multiple injections in different areas has been investigated by a prospective, randomized, single-blinded, controlled study. A total of 93 patients were divided into three groups for the study. All the patients were given BTX-A. Of these 93 patients, 60 received injections in the upper face, 15 in the neck, and 18 in the axillary regions. The visual analog scale (VAS), a single-dimension pain intensity rating scale, was used to evaluate pain perception. The average VAS values for pain sensation experienced by the groups were 1.2 of 10 points for the upper face area in the experimental group (n = 60) and 4.5 point for the control group. In the neck region (n = 15), the respective scores were 0.6 in the experimental group and 3.9 in the control group. Finally, in the axillary region (n = 18), the respective values were 0.9 and 5.1. The authors conclude that the preservative-containing saline solution significantly decreased pain perception during BTX-A injections (p = 0.000).

Circumcision is probably one of the first plastic surgery operations that has been used for centuries. The aim of this study was to apply the bilamellar tissue (skin and mucosa) obtained from circumcision to various defects and to evaluate the clinical results. During the last 2 years, 19 patients have been operated, and the skin and mucosal grafts were applied individually or simultaneously. The etiology was trauma for the whole series of patients (12 burns and 7 strap injuries). In 15 patients the defect was localized to the hand whereas in 4 patients it was located on the dorsum of the foot. In 10 patients, mucosa and skin graft were applied to the same defect as a single, compact layer. In 9 patients, skin and mucosa were applied separately to multiple defects. Using these methods, comparative evaluation of the consequences of prepuce mucosal and skin graft applications could be made. Four obvious differences were observed: (1) in mucosal grafts, early graft edema that resolves spontaneously after 48 hours; (2) better adaptation of the mucosal grafts to the recipient bed; (3) hyperpigmentation in both graft types, but the skin part was slightly darker than the mucosa; and (4) less secondary contraction was seen in mucosal grafts. The results were evaluated in light of the authors' knowledge of the prepuce as an alternative full-thickness donor site. The relative differences in the dual anatomic structure of mucosa and skin, and the role of circumcision as a medical, cultural, and religious application in some societies are discussed.

This study was carried out to observe the isolated effects of pedicle torsion on island skin flaps, without further damaging the pedicle. Twelve adult male Sprague-Dawley rats, weighting 240 to 300 gr, were used, and hexagonal flaps with edges measuring 1.5 cm and pedicles measuring 1 cm in length were raised in the inguinal region. The animals were divided into two groups. In Group A, flaps were re-sutured to the donor beds without any rotation. In Group B, flaps were rotated 360 degrees, applying the same degree of torsion to their pedicles before re-suturing. After 7 days, the percentage of surviving skin areas of the flaps was determined by planimetry, and transverse sections of the flaps and pedicles were taken and evaluated in terms of signs of arterial or venous insufficiency. Statistically significant differences between the groups were determined by analyses using the multiple comparisons test. Pedicle torsion in Group B did not affect flap viability, both macroscopically and microscopically. The presented study shows that 360-degree torsion applied to the pedicle of the flap in this model had no effect on flap viability.

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Plastic surgery must achieve the best cosmetic results, and it helps to consider certain skin lines. Aging and scars can cause the face to become lined, and we have noticed various facial lines among patients or their relations who have come to our outpatient clinic. These lines are sometimes single and there are sometimes 2-3 parallel lines generally in the same area of the face, such as the lateral orbital, temporal, frontal, and buccal regions. After detailed evaluation, we concluded that these oblique or horizontal wrinkles were caused by the position in which they slept. All of them slept prone, with their faces buried in the pillow, which over many years has caused wrinkling of the skin. We think therefore that sleeping position should be considered as an aetiological factor in the formation of wrinkles. The lines that should be taken into consideration during operation are Langer's lines, or relaxed skin tension lines, but not sleep lines. Here we describe the possible aetiology of sleep lines on the face.