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Honolulu, HI, United States

Wagenblast A.L.,Cand. Med | Laessoe L.,Plastic Surgery | Printzlau A.,Bodylift Center
Journal of Plastic Surgery and Hand Surgery | Year: 2014

In the affluent part of the world, there is an increasing occurrence of obesity with Body Mass Index (BMI) above 40, which has resulted in an increasing number of operations such as gastric bypass (GB). After massive weight loss there will often be a need for subsequent plastic surgical correction, since some of the patients will experience problems due to excess skin. Foreign studies estimate that ~ 30% of all bariatric surgery patients will at some point seek plastic surgical correction of excess skin. The aim of this study is to investigate to what extent the GB patients themselves consider plastic surgery for removal of excess skin, and their reasons and motivations for this. The investigation was performed as an anonymous questionnaire handed out to 150 patients at the 1-year standard consultation for GB patients at a private hospital. The questionnaire contained information about demographic data, patient habits, earlier or present comorbidity, physical problems, psychological problems, and cosmetic problems due to excess skin. Also, it contained information about what anatomical area bothered the patient the most. One hundred and thirty-eight patients responded to the questionnaire, and the investigation showed that 89.9% of the patients had a wish for plastic surgery for several different reasons. This patient demand showed to have no correlation to age, gender, smoking habits, or earlier comorbidity. © 2014 Informa Healthcare. Source

Hallam M.-J.,Plastic Surgery | Lo S.,Royal Infirmary | Mabvuure N.,Brighton Medical School | Nduka C.,Queen Victoria Hospital
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013

Background: There are concerns that current trainees may be lacking operative experience in aesthetic and functional breast surgeries. Reduced exposure to such cases during training may stem from rationing, EWTD compliance, and an increasingly consultant-led service. These issues are examined in a single NHS hospital, with analysis of trends over time, and are contrasted with the changes that have occurred in a related private hospital. Methods: A single NHS hospital trusts database was retrospectively analysed for all aesthetic breast surgeries from 2005 to 2011, noting the total number of cases and the grade of the principal surgeon. The analysis was repeated in a related private sector hospital in the same catchment area. Results: A statistically significant drop of 55% of NHS aesthetic breast surgeries performed in 2011 compared to 2005 was demonstrated with an increasing trend for consultant led procedures. The NHS caseload decline was matched by a corresponding increase of 57% within the private sector. Conclusions: Current trainees in plastic surgery face a significant reduction in operative exposure to aesthetic breast surgeries compared to their predecessors due to the EWTD working hours, surgical rationing policies, and an increasingly consultant led service. Approaches to maintaining training standards are discussed. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Source

Rauso R.,Centro Polispecialistico Santa Apollonia | Gherardini G.,Plastic Surgery | Parlato V.,The Second University of Naples | Amore R.,The Surgical Center | Tartaro G.,The Second University of Naples
Aesthetic Plastic Surgery | Year: 2012

Background: Facial lipoatrophy is most distressing for HIV patients in pharmacologic treatment. Nonabsorbable fillers are widely used to restore facial features in these patients. We evaluated the safety and aesthetic outcomes of two samples of HIV+ patients affected by facial wasting who received different filling protocols of the nonabsorbable filler Aquamid ® to restore facial wasting. Methods: Thirty-one HIV+ patients affected by facial wasting received injections of the nonabsorbable filler Aquamid for facial wasting rehabilitation. Patients were randomly divided into two groups: A and B. In group A, the facial defect was corrected by injecting up to 8 ml of product in the first session; patients were retreated after every 8th week with touch-up procedures until full correction was observed. In group B, facial defects were corrected by injecting 2 ml of product per session; patients were retreated after every 8th week until full correction was observed. Results: Patients of group A noted a great improvement after the first filling procedure. Patients in group B noted improvement of their face after four filling procedures on average. Local infection, foreign-body reaction, and migration of the product were not observed in either group during follow-up. Conclusion: The rehabilitation obtained with a megafilling session and further touch-up procedures and that with a gradual build-up of the localized soft-tissue loss seem not to have differences in terms of safety for the patients. However, with a megafilling session satisfaction is achieved earlier and it is possible to reduce hospital costs in terms of gauze, gloves, and other items. © 2011 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery. Source

Menick F.J.,Plastic Surgery
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2012

The anatomy and aesthetics of the nose never change and are similar for cosmetic and reconstructive rhinoplasty. The disciplines differ in the cause of injury, which determines the site and degree of damage, the subsequent deformity, and the therapeutic approach to repair. The cosmetic surgeon modifies the bony-cartilaginous framework to support and mould the overlying skin. A thick, scarred or large skin envelope may limit the expected result but cannot be altered. When severe scarring or necrosis occurs after a cosmetic rhinoplasty or filler injection, missing external skin and internal lining become a controlling factor in achieving nasal shape and must be replaced in exact dimension and border outline, guided by the principles of aesthetic nasal reconstruction. This paper illustrates the use of a 3 stage forehead flap and anatomic reconstruction of the tip cartilages to repair a full thickness necrosis of the tip after a cosmetic filler injection. An overview of presentation and treatment of this complication is presented with reconstructive guidelines to direct the surgeon to successful repair. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Source

Botti G.,Plastic Surgery | Botti C.,Plastic Surgery
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2014

In the last few years, surgery of the ageing face seems to have shifted from tissue uplifting and tightening to mere fi lling. We do not agree with this trend. We are positive that ageing brings about 2 basic phenomena: on one hand bone and fat volume reduction, whilst on the other a deterioration of the skin lining (elastosis) leading to an increase in its compliance and extension. We therefore deem of the utmost importance to couple soft tissue fi lling with indispensable tightening and repositioning together with resection of overabundant skin. For what concerns the midface area in particular, we suggest to resort to 3 diff erent lifting techniques, according to the kind of defect to be treated. It is important to take the right pulling vector into consideration as well as the need of skin excess removal. The procedures can be tailored to suit any peculiar need such as malar bag, lower lid border malposition, tear trough deformity, etc. Diff erent cases will be taken into consideration as examples of the various indications and techniques. © Georg Thieme Verlag KG Stuttgart. New York. Source

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