The American Journal of Cosmetic Surgery

To evaluate the efficacy of platelet-rich plasma in promoting wound healing and preventing seroma formation, a 30-patient study was conducted between January 2001 and May 2003. The intent of the study was to evaluate the use of platelet-rich concentrate on patients undergoing either full abdominoplasty (4 patients) or crescent tuck abdominoplasty (miniabdominoplasty) surgery. This series of patients was contrasted with a 100-patient study with similar surgery accomplished between 1990 and 2000 and previously reported at the 17th International Congress of the French Society of Aesthetic Surgery and the 5th International Congress of the Society of Lipo-Plasty. In addition, during the 30-patient study, there were 6 patients studied who did not receive platelet-rich concentrate. Those 6 patients were also compared with the 30-patient platelet-concentrate group.

The platelet concentrate was prepared from 54 mL of blood drawn from the patient at the time of surgery. The anticoagulated volume of 60 mL was processed using a uniquely designed centrifuge system manufactured by Harvest Technologies (Plymouth, Mass). The separation process yielded 10 mL of platelet-rich plasma (PRP). This volume was combined with 1 mL of calcium thrombin in a spray that was applied to the surgical site. The calcium thrombin was used to activate the platelets and fibrinogen to form fibrin chains in order to achieve an immediate hemostatic seal on the tissue beds. The calcium thrombin was prepared by adding 5 mL of 10% calcium chloride to 5000 units of bovine thrombin. Only 1 mL of this mixture was used in the procedure. Prior to the application of the platelet concentrate/calcium thrombin to the tissue beds, absolute hemostasis is accomplished and both beds are blotted as dry as possible. Both the top and bottom layer are sprayed with approximately 4.5 mL of platelet concentrate/calcium thrombin. The tissue layers were approximated and the skin surface rolled to express any fluid from the location of the sutures. Sutures were then placed and the remaining PRP/calcium thrombin mixture was sprayed along the suture line. The formal abdominoplasty was done without liposuction in the upper or epigastric area of the abdomen. The crescent tuck abdominoplasty used was the same as the previous 100-patient series.

No seromas were found in the 30 patients studied as compared with a 7% seroma rate in the previous 100-patient series and 2 out of 6 of the patients who had abdominoplasty during the same time as the 30-patient group developed seromas. Anecdotally, the wounds seemed to heal much more rapidly with more esthetically pleasing incisions.

The addition of platelet-rich plasma is now easily applied at the surgical site with a very easily usable technology that does not require expensive or complicated equipment. The application of platelet-rich plasma as a natural fibrin matrix delivers growth factors to the wound and seems to promote more rapid healing.

Otoplasty enhances the quality of human life by offering the opportunity to correct prominent ears, a common deformity that has significant negative impact on the psychosocial well-being of many patients.

We describe a simple extended skin excision technique that addresses various cosmetic ear abnormalities by stabilizing conchal position during healing while facilitating the curvature of the antihelix by creating skin tension and thus relying less on suture fixation. The key technical aspects of this procedure and short- and long-term results are discussed.

Twenty-two patients underwent otoplasty from 1997 to 2000. On follow-up, patients were very satisfied with the results of the procedure. A small percentage did suffer some minor complications.

This otoplasty technique provides long-term natural cosmetic results with generally low risk and morbidity, making it an ideal addition to the armamentarium of the cosmetic surgeon.

A traditional platysmaplasty almost always results in hardening and scarring at the submental region. In an attempt to avoid these complications, the author has developed a technique for serially notching the platysma bands.

Patients demonstrate their platysma bands so that they can be marked with a distance of 3–4 cm between every incision. After injecting local anesthesia with epinephrine 1 mL to each incision site, a stab incision is made with a number 11 blade horizontal to the platysma band. Multiple incisions are necessary for a better result. The skin must be pinched together with the muscle between the thumb and index finger. The notching is done with an electrocautery and needle and repeated at the sites marked along the muscle. The wounds are covered with sterile dressings.

Serial notching of platysma bands was performed on 102 patients (10 men [9.8%] and 92 women [90.2%]). Only 5 hematomas (5%) were observed. Apart from the cases of hematoma, the other 97 cases were satisfactory (98%). In 78 cases (76.5%), the doctors also performed an S-lift or a facelift and witnessed better results. In most of the cases (80 cases, 81%), a submental liposuction was also necessary.

This technique alone, or combined with liposuction of the neck and with surgeries of the mid to lower face such as posterior necklift, S-lift, short scar facelift, or a conventional facelift, will eliminate platysma bands, especially in older patients. Since using this technique, we have not been required to perform platysma plication (platysmaplasty). This kind of notching of the platysmal bands is mainly done with liposuction. No special and expensive instruments are required, recovery time is very short, scarring is minimal and the sutures can be removed after a few days. If multiple and serial incisions and notching are done, no depressions and retracted muscles will be palpable or visible. It causes no major swelling and bruising of the neck. Also, only 1 case of hematoma was observed and there were no other complications. This technique is a very good adjuvant to a neck or lower facelift in older patients and in some younger patients Type I, II, and III).

The most common complication after a liposuction is the residual (leftover) fat and hollows. Postliposuction irregularities have been commonly corrected with autologous fat injections, but without any long-term results. In the procedure described below, the fat is shifted under the skin from the surrounding tissues into the hollow without any suctioning, air contact, or injecting.

The procedure is performed in the following stages: (1) marking the skin while the patient is standing; (2) local anesthestizing of the skin; (3) tumescent technique; (4) loosening the fat with a Becker cannula; (5) shifting; and (6) fixation of the shifted fat.

This technique has been applied to 82 patients over a period of 7 years. The rate of satisfaction was 88% (72 patients). Some cases with large imperfections had to be liposhifted more than once (5 cases, 14%). In 8 cases (9.8%), the results were not that satisfactory, and 2 cases (2.4%) did not respond to this treatment. The most common complication was hematoma due to fat loosening (5 cases, 6%).

Liposhifting is a very promising method for the elimination of larger irregularities on the skin and the underlying tissue caused by liposuction. It is only helpful in the extremities and in the abdominal wall. It is safe because any contamination of the fat transplant via air contact is avoided; it is practical because it does not need any special training or instruments. The irregularities due to liposuction still remain a main problem of the process.

While use of botulinum A toxin (Botox Allergan, Inc, Irvine, Calif) injections for cosmetic use is generally considered safe and efficacious, uncommon side effects can occur. We present the case of a 52-year-old woman that experienced eyelid ptosis following botulinum toxin injections in the glabellar and forehead regions.

The patient received botulinum toxin injections in a standard fashion to the glabellar, forehead, and lateral canthal regions. A total of 32 units (0.8 mL of botulinum A toxin diluted to 40 units/mL) was used.

Five days following botulinum toxin injections, the patient experienced unilateral eyelid ptosis, which was successfully treated with apraclonidine 0.5% eyedrops (Iopidine, Alcon Labs, Ft Worth, Tex) to the affected side. Resolution of the ptosis occurred within 1 week of initiating treatment.

Although eyelid ptosis can be an undesirable sequela of botulinum toxin injections for cosmetic purposes, measures can be undertaken to avoid this adverse effect. Fortunately, unintended effects from botulinum toxin are temporary. Ptosis can be ameliorated with apraclonidine eyedrops.

The pixie ear is usually considered an undesired outcome following cervicofacial rhytidectomy procedures, and several techniques for prevention and correction have been previously described in the literature. However, on occasion a patient may prefer the aesthetics of the pixie ear and request it be restored or created. We present the case of a 68-year-old woman who desired restoration of bilateral pixie ears.

Described is a simple technique that can be rapidly performed in the office under local anesthesia to achieve the pixie ear look.

A favorable aesthetic outcome recreating pixie ears was accomplished to the satisfaction of the patient without complication.

It is imperative to discuss the desired final cosmetic appearance of the ears in preoperative consultation for cervicofacial rhytidectomy. Although a pixie ear is not the typically desired aesthetic result, some patients may prefer it to the more traditional free-hanging earlobe.