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Seminars in Plastic Surgery May 2021Breast augmentation is consistently one of the most commonly performed aesthetic operations every year. Unfortunately, revision rates following primary augmentation... (Review)
Review
Breast augmentation is consistently one of the most commonly performed aesthetic operations every year. Unfortunately, revision rates following primary augmentation remain as high as 36%. There are several causes for revision breast augmentation; however, the most common and challenging of these include capsular contracture, implant malposition, and ptosis of the aging breast following augmentation. Successful management of these problems requires knowledge on how to best treat the implant and capsule with the corresponding soft tissue simultaneously. While surgical management is important, understanding the pathological causes of these entities during the primary operation can reduce the need for revision. This article utilizes the most up-to-date literature to review the appropriate clinical evaluation and surgical management of these complex cases.
PubMed: 34121945
DOI: 10.1055/s-0041-1727272 -
Indian Journal of Ophthalmology Sep 2022Different techniques for lateral canthal suspension have been used in the management of various eyelid malpositions. We describe a simplified technique for lateral... (Review)
Review
PURPOSE
Different techniques for lateral canthal suspension have been used in the management of various eyelid malpositions. We describe a simplified technique for lateral canthal suspension and review its outcome along with a review of existing variations.
METHODS
We conducted a retrospective chart review of 28 eyelids in 22 patients who underwent simplified lateral canthal suspension. Demographics, symptoms at presentation, and associated eyelid malposition were noted. We evaluated the palpebral fissure and margin-reflex distance 2 (MRD2) on the preoperative and final postoperative photographs by using MEEI FACE-gram software. We also reviewed existing literature on different surgical management options for comparison.
RESULTS
At three-month postoperative follow-up, presenting symptoms resolved in all cases. The average postoperative decease in palpebral fissure was 0.73 mm (P = 0.018) and the average decrease of the MRD2 was 1.02 mm (P = 0.0003). Recurrence occurred by three months in one eyelid (4%) with ectropion due to moderate eyelid laxity, and this case was managed with tarsal strip procedure. One patient (5%) who had bilateral surgery had asymmetric lower eyelid position and one patient (5%) had persistent edema of the operated eyelid for six months.
CONCLUSION
This simplified canthal suspension is a simple and effective technique that tightens the lateral canthal tendon and improves the lower eyelid position. It can be used in various mild-to-moderate eyelid laxities and has favorable operative characteristics compared with many existing techniques.
Topics: Ectropion; Eyelids; Humans; Plastic Surgery Procedures; Retrospective Studies; Suture Techniques; Tendons
PubMed: 36018130
DOI: 10.4103/ijo.IJO_3126_21 -
Aesthetic Surgery Journal Apr 2024Implant malposition is a well-recognized complication when using prosthetic implants in the breast for both reconstructive and aesthetic indications. However, to date,...
BACKGROUND
Implant malposition is a well-recognized complication when using prosthetic implants in the breast for both reconstructive and aesthetic indications. However, to date, no objective classification system has been described.
OBJECTIVES
This study presents a prospective trial of an objective and reproducible classification system for implant malposition formulated using retrospective data from a large cohort of patients with implant malposition.
METHODS
The authors retrospectively analyzed the degree of medial/lateral and inferior/superior implant malposition relative to their optimal position within the breast footprint in a series of 189 breasts (n = 100 patients). An objective classification system for implant malposition was devised and then applied to a prospective cohort of 53 breasts in 28 patients with implant malposition.
RESULTS
The degree of malposition in a single or combination of axes was categorised according to the distance from the ideal breast footprint and measured in centimeters (cms). The classification system incorporated the axis of malposition and distance to generate a treatment decision-making guide. Cases of Grade 1 malposition did not warrant surgical intervention, whilst surgical correction was warranted in all Grade 3 cases.In the combined patient cohort (n = 242 breasts, 128 patients), lateral, inferior, medial and superior displacement ranged between grades 1-3. There was no inter-observer variability in the grades assigned to nine out of ten patients in the prospective group.
CONCLUSIONS
We have created a simple and reproducible classification system for implant malposition that allows surgeons to objectively record the extent of malposition, guides surgical decision-making and can be used to document the results of any intervention.
PubMed: 38621023
DOI: 10.1093/asj/sjae084 -
Oman Journal of Ophthalmology 2021Ozurdex is one of the most commonly inserted intravitreal steroid implants in cases of posterior uveitis and recalcitrant macular edema in cases of diabetic retinopathy...
Ozurdex is one of the most commonly inserted intravitreal steroid implants in cases of posterior uveitis and recalcitrant macular edema in cases of diabetic retinopathy and vascular occlusions. Here we report accidental malpositioning of this implant in patellar fossa.
PubMed: 34084039
DOI: 10.4103/ojo.OJO_292_2019 -
Journal of Oral and Maxillofacial... Jun 2022Fractures of the infraorbital rim (IOR) are often undertreated with a resultant compromise of facial esthetics and function. The purpose of this research was to identify...
PURPOSE
Fractures of the infraorbital rim (IOR) are often undertreated with a resultant compromise of facial esthetics and function. The purpose of this research was to identify types of IOR fractures related clinical findings and assess post-treatment outcomes.
METHODS
A retrospective cohort study was implemented involving all patients treated for IOR fractures during an 18-month period. Data consisted of treatment records, pretreatment and post-treatment photographs, and computed tomographic (CT) scans. The types of fractures were matched to the treatment instituted. The type of fracture was the independent variable, while the dependent variables were (i) clinical findings such as lid and globe malposition, tethering of facial skin, diplopia, and infraorbital nerve paresthesia, and (ii) treatment outcome assessed by surgeon and patient. Data were analyzed statistically to study frequencies, proportions, and associations using SPSS (v26, IBM, Armonk, NY).
RESULTS
Forty-three patients (41 males and 2 females) with IOR fractures were treated between July 2019 and January 2021. The age range was 18 to 50 years. The etiology for trauma in all patients was a motor vehicle accident. Fifty-one fractures were classified into 6 types based on CT presentation. The single line fracture (concomitant with other bones) was the most prevalent (58.8%), while globe malposition was the most common clinical finding (35.8%). Lid malposition, globe malposition, and tethering of facial skin were associated with the type of IOR fracture (P = .04, P = .02, and P = .01, respectively). Excellent outcomes were scored in 32 and 25 fractures by the surgeon and patients, respectively, (P = .015 and P = .003). The inter-rater agreement between the surgeon and patient was significant (Kappa = 0.680; P < .001).
CONCLUSIONS
Clinical findings in IOR fractures are dependent on the fracture type. Treatment of fractures based on their CT presentation produces effective management of signs/symptoms and improved treatment outcomes.
Topics: Adolescent; Adult; Diplopia; Female; Humans; Male; Middle Aged; Orbital Fractures; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 35123938
DOI: 10.1016/j.joms.2022.01.002 -
Facial Plastic Surgery Clinics of North... Nov 2019The pinched nasal tip deformity often results as sequelae of prior nasal surgery. Conventional tip surgery techniques that overemphasize tip narrowing often deform the... (Review)
Review
The pinched nasal tip deformity often results as sequelae of prior nasal surgery. Conventional tip surgery techniques that overemphasize tip narrowing often deform the lateral crura and weaken support for the alar margin. The pinched nasal tip is characterized by the demarcation between the nasal tip and the alar lobule, isolating the tip from the surrounding nasal subunits. Lateral crural strut grafts with or without repositioning offer the surgeon a powerful maneuver that can help correct this functional and aesthetic deformity and restore a natural appearance to the nasal tip.
Topics: Humans; Hyaline Cartilage; Nose; Nose Deformities, Acquired; Preoperative Period; Rhinoplasty; Tissue and Organ Harvesting
PubMed: 31587767
DOI: 10.1016/j.fsc.2019.07.004