Gallery of Cosmetic Surgery

Author: Kevin Sadati, DO, et al

Abstract

A 60-year-old man presented with Malignant Fibrous Histiocytoma (MFH) of the oropharnx extending to nasopharynx and larynx, and causing severe upper airway obstruction requiring emergency tracheotomy. Ten years previously, this patient had undergone right partial glossectomy and segmental mandibulectomy, followed by 50 Gy radiation in 33 sessions for squamous cell carcinoma of the right tongue base. This MFH tumor was so aggressive that changes in its volume were visually distinguishable during physical examination over a two-week hospital stay. Histological evaluation revealed 7 mitotic figures per high power field. Although radiation-induced MFH is rare in the head and neck, recent medical literature reports a rise in its incidence. This has been attributed to increased effectiveness of head and neck cancer therapy, prolonging patients’ survival. Since MFH is a late complication of irradiation therapy appearing at an average of 10 years following treatment, it is important for physicians treating head and neck cancer to be alert for this long-term post radiation complication and to continue following patients ever after apparent “cure” of their head and neck neoplasm.

Two types of medical schools and medical degrees are available:

• Doctor of Medicine (MD) degree: A doctor of medicine attends a four-year medical school and learns allopathic or traditional medical theory and practice. In traditional medical practice, diseases and health are evaluated and treated based primarily on symptoms or attributes associated specifically with the health condition.
• Doctor of Osteopathic Medicine (DO) degree: A doctor of osteopathy attends a four-year osteopathic school and learns holistic medicine as well as traditional medicine. The focus of holistic medicine is evaluating illnesses and health in the context of the "whole patient."

This is review of the authors technique for lifting the subcutaneous fat of the cheek during face lifting procedures, which seems to offer long-lasting improvement of malar area. They describe a modification of the extended SMAS tightening technique that successfully deals with malar fat pads without increasing complications with aesthetically pleasing results. Several reports discuss how best to reposition the malar fat pad and at what level to perform the dissection. The problem of the malar fat pad has been approached in a variety of ways, including excision, curettage, undermining, and direct or indirect suspension techniques. The sagging of the malar fat pad over the mostly fixed tissue of the nasolabial folds produces a deepening of these structures. The downward migration of the fat pad produces hollowness in the midfacial and infraorbital areas that creates the aging mid face. Descent of the malar fat pad also contributes to the mid-face portion of the jowls.

For complete article review please refer to: clinics in plastic surgery: volume 24. Number 2. April 1997

Published in The American Journal of Cosmetic Surgery   Vol. 26, No. 1,2009

Litrature Review by Suzan Obagi, MD, and Sharleen St. Surin-Lord, MD

Source: PLASTIC AND RECONSTRUCTIVE SURGERY VOLUME 122 (4), OCTOBER 2008

Infrabrow Excision Blepharoplasty: Applications and Outcomes in Upper Blepharoplasty in Asian Women. Y. S. Kim, T. S. Roh, W. M. Yoo, K.-C. Tark, and J. Kim. Pages 1199-1205.

The authors provide several case reports where they address the shortcomings of upper eyelid blepharo­plasty in Asian women using infrabrow excisions to avoid an unnatural operated appearance. They attrib­ute this appearance to suturing of thin pretarsal skin to a thicker upper flap, with thicker excision width, leading to accentuation of the overhanging appearance of the upper flap on the crease line. There is also the issue of exacerbation of lateral hooding (the primary reason for repeat blepharoplasty) with overzealous lateral skin and muscle excision. The authors also explain that in an Asian eyelid with no crease, lid crease creation at the time of blepharoplasty brings about a significant change in periorbital expression and general appearance of the aged patient. The infrabrow technique alleviates lid redundancy through excision of infrabrow skin, subcutaneous tissue, and orbital orbicularis, unlike the upper lid or suprabrow techniques.

Published in The American Journal of Cosmetic Surgery   Vol. 26, No. 1,2009

LITERATURE REVIEWS by SUZAN OBAGI, MD, AND SHARLEEN ST. SURIN-LORD, MD

Source: PLASTIC AND RECONSTRUCTIVE SURGERY VOLUME 122 (4), OCTOBER 2008

 Evaluation of Age-Related Infraorbital Fat Herniation through Computed Tomography. Y.-S. Chen, T.-H. Tsai, M.-L. Wu, K.-C. Chang, and T.-W. Lin. Pages 1191-1198.

In this two-part, retrospective study, authors seek to determine the actual occurrence of herniation in lower lid fat and its relation to aging by using data of orbital and facial computed tomography from 167 patients. This was achieved by evaluating curvature and protrusion of lower eyelid fat and its changes in different age groups (Part I) as well as fat herniation in relation to the position of the globe (Part II). All orbital and facial computed tomographic scans obtained from the Far Eastern Memorial Hospital in Taipei, Taiwan between 1/2/2005 to 3/1/2006 were retrieved and axial and sagittal slices acquired at 3-mm intervals were used for analysis.

Litrature Reviews by Suzan Obagi, MD, and Sharleen St. Surin-Lord, MD published in 

The American Journal of Cosmetic Surgery   Vol. 26, No. 1,2009

Source: PLASTIC AND RECONSTRUCTIVE SURGERY VOLUME 122 (4), OCTOBER 2008

Scars: A Review of Emerging and Currently Available in scar Therapies. R. G. Reish and E. Eriksson. Pages 1068-1078.

The authors review the stages of wound healing, and the role of cytokines, growth factors, and extracellular matrix components in wound healing. Currently available and emerging scar-reducing therapies are discussed in this review. Emerging therapies utilizing the TGF-p superfamily, COX-2 inhibitors and NSAIDS, collagen inhibitors, ACE Inhibitors, minocycline and gene therapies are discussed.

Men are particularly concerned about minimizing scars, hair displacement, and avoiding the appearance of tightness. If thin individuals with sagging skin represent an excellent indication for a facelift, one should always be very cautious when asked to do a facelift in an elderly male with a heavy round face. Despite all efforts, an initial satisfactory result often deteriorates after 6 months or 1 year. Liposuction is a useful adjunct in fatty patients, but its use should be rather conservative in the cheeks and especially the jowls. Once the superficial musculoaponeurotic system (SMAS) and skin have been lifted up, most of the previous fat excess observed in the jowls spreads upwards and disappears, and excessive suctioning can be responsible for unsightly depressions. At the central neck level, undermining is first performed from a 5-mm incision in the skin, being careful to leave a little layer of fat under the skin, and aspirating upwards with a 4-mm cannula. The lateral cervical liposuction is performed only after the SMAS elevation, to be sure to leave a layer of fat over the rim of the mandible.

The American Journal of Cosmetic Surgery   Vol. 27, No. 2,2010

Introduction and Origins

In recent years, botulinum toxin has emerged as one of the most versatile therapeutic agents in all of med­icine. For more than 20 years, facial cosmetic surgeons have used botulinum toxin A (Botox, Allergan, Irvine, Calif) for the treatment of facial rhytides. New cos­metic applications have since emerged, but perhaps even more explosive has been the number of noncos-metic conditions treated by botulinum toxin A (BTXA). In 2008, worldwide sales of Botox reached US$1.3 billion in worldwide sales. Nearly half of this was used in noncosmetic applications (see Table). BTXA is now approved by the US Food and Drug Adminis­tration for the treatment of blepharospasm, strabismus, cervical dystonia, and glabellar rhytides. Other uses of BTXA, including most of the uses discussed in this article, are considered off-label. The use of BTXA for glabellar folds, crow's feet, forehead rhytides, chin rhytides, and forehead wound healing has demon­strated efficacy in double-blind, placebo-controlled studies.¹"⁴ Other cosmetic uses discussed here are based on noncontrolled studies or case reports.

Book authors: Albert Losken and Moustapha Hamdi

Publisher: Quality Medical Publishing, Inc., St Louis, Mo, 2009

The American Journal of Cosmetic Surgery   Vol. 27, No. 1,2010

This textbook is a cooperative venture between Dr Losken, who practices at the Emery University School of Medicine in Georgia, and Dr Hamdi, a professor at Gent University Hospital in Belgium. Other contributors include cosmetic, plastic, reconstructive, and oncologic surgeons from throughout the world. This book is the result of a recent interdisciplinary international breast conference. The conference, attended by breast specialists from multiple disciplines around the world, provided, in an easy to read organized format, information and knowledge about oncoplastic surgery not previously categorized. The term oncoplastic surgery refers to a relatively new approach to breast cancer and other oncologic problems that coordinates oncologic and reconstructive techniques.

LOWER LID AGING

Midfacial aging becomes noticeable in the later third and early fourth decade. Isolated hereditary lower eyelid fat prolapse can occur much earlier. The lower eyelid complex blends seamlessly with the midface and lower eyelid rejuvenation comprehensively includes midfacial and or nasojugal augmentation.

Lower eyelid aging changes are consistent and similar to upper eyelid aging. Dermatochalasia from aging and actinic damage is manifested by excess and "crinkly" lower eyelid skin. This skin is among the thinnest in the body and can be 0.2 mm thick, making it very susceptible to aging changes. As with the upper lids, the lower orbital septum weakens with age and allows prolapse or protrusion of the three lower fat pads. This in itself produces sausage shaped fat that makes patients look older and tired. The actual protruding fat can cast shadows (especially in overhead light) along the inferior orbital rim, which compounds the old and tired look. Compounding the dark circle look are true color changes from actinic or hereditary pigmentation or hemosiderin leakage. The aging changes in skin, fat, muscle and connective tissues produces an accentuated nasojugal groove producing the teartrough deformity. Suspensory laxity changes the position of the canthi and can produce canthal rounding, ectropion and scleral show.

Full article is available on SURGE magazine July 2011