The American Journal of Cosmetic Surgery

The QuickLift is a modification of the S-lift that varies from the S-lift primarily in the shape of the incision, the areas of undermining, the method of plication, and the vector of advancement. Two negative aspects of the purse-string plication technique used with the original QuickLift were an intraoperative bulging centrally that required trimming and minimal midface improvement. In 1 of the 85 patients reported in the original article, the aforementioned complication became noticeable as a slight bulge once swelling subsided.

Instead of using 1 large oval-shaped purse string for plication, a firmly anchored small oval-shaped purse-string is encircled by a larger purse-string, with the latter purse-string modified to provide improved advancement of the midface.

The encircling double purse-string plication technique not only reduces the bulging effect of the deep tissues, but also provides stronger soft tissue support because of increased suture placement and anchoring sites. The cosmesis in the midface is improved over the former technique.

A new variation of the originally described QuickLift plication technique reduces bulging of the deep tissues while simultaneously providing stronger superficial musculoaponeurotic system support to the neck, jowls, and midface. Blunt undermining or liposuction of the neck and/or jowl with a small submental tuck further enhances the result.

Cellulite has always been a difficult condition for patients and cosmetic physicians to treat. Even if improvement is made in the appearance of cellulite, no machine or topical treatment exists that can provide long-term results in the treatment of cellulite. We evaluated a technique that increases lymphatic drainage and vascular permeation to assist in decreasing the appearance of cellulite.

Sixteen female patients underwent 12 treatments with a device called Triactive, which has a triple-pronged mechanism of action consisting of low-level suction, diode laser, and contact cooling. We measured results by waist, hip, and thigh circumference as well as elasticity, thermography, and blinded photograph evaluations.

We found a small decrease in hip and thigh circumference as well as an increase in elasticity of the treated cellulite. Evaluation of the photographs yielded an overall 21% average improvement in the appearance of cellulite. There was no change in thermography data after treatments. Results were not present at 1 month.

The Triactive offers a method to temporarily decrease the appearance of cellulite. It appears that treatments must be continued to maintain results. Further study and larger patient groups are needed before this treatment can be recommended above other available treatments.

In the last thirty years, various techniques of face-lifting have been developed. Many of these operations require a long recovery. With the increased public awareness of cosmetic surgery, the demand for effective procedures with minimal downtime and quicker recovery is on the rise. We set out to examine a technique of facial rejuvenation with barbed sutures, originally described by Dr M.A. Sulamanidze, and its effectiveness.

Twenty-seven patients were treated with the APTOS sutures for facial ptosis from May 2002 to October 2003. The patients were followed for 3 to 28 months. The areas treated were the brows, cheeks, jowls and neck. Digital images were taken at each preoperative and postoperative visit. Almost all of the cases (25 of 27) were performed under local anesthesia. The results were evaluated at each postoperative visit by the patients and the surgeons.

Two hundred and eighty-two sutures were placed in the 27 patients. The malar area was the most commonly treated (88.9% of patients) section of the face. The brows and jowls were the second most common area of treatment (40.7%). The neck was the least common area of treatment (29.6%). The patients' mean age was 50.9 years. The average follow-up time was 18.6 months. The results were evaluated by the patients and the surgeons based on a subjective rating of improvement when compared to the preoperation pictures in the specific area of treatment. Overall patient improvement rating was highest in the malar region, at 55%, compared to a doctor improvement rating of 40%. Pearson correlation analysis showed that the patient's perceived degree of improvement was directly correlated (P < 0.01) with the patient's overall satisfaction. The most common reason for dissatisfaction was patient disappointment with longevity of results. Complications encountered during the study were suture extrusion, bruising, pain, asymmetry, dimpling of skin, and visible suture tracts.

Placement of barbed sutures into the soft tissues of the face for facial lifting is a developing technique. The APTOS lift, as advocated by Dr Sulamanidze, is a limited procedure that is indicated primarily in patients with mild to moderate ptosis who are seeking a subtle improvement in their appearance that is temporary and requires minimal downtime. It is not a replacement for a facelift. When patients are properly informed and educated about the benefits and limitations of this procedure, the chances that they will be satisfied is much higher.

When satisfactory correction of facial deformities and asymmetries are unobtainable by dental orthopedics alone, maxillomandibular surgery or double-jaw surgery is often indicated. As orthognathic surgery has been refined, it has become evident that some problems are beyond treatment in a single jaw. The purpose of this study was to present a review of the literature on the etiology, clinical assessment procedures, radiographic diagnostic techniques, and surgical treatments for mandibular and facial asymmetry. A photographic case report is also presented.

Literature review and case report.

The indications for bimaxillary surgery are severe deformities untreatable in one jaw, deformities of both jaws, unfavorable movement prone to relapse, and complex 3D movements where single-jaw surgery would be a functional/cosmetic compromise.

The most important aspects of maxillomandibular surgery are not the surgery itself but understanding the indications and the treatment plan, and maintaining stable reference during surgery. Combining osteotomies of the maxilla and mandible is complicated and perhaps associated with increased morbidity. However, when indicated, the combined osteotomy offers more surgical options and better results without functional or cosmetic compromises than single-jaw osteotomy.

Many men (∼36–40%) have some form of breast enlargement or swelling, called gynecomastia. The condition may make these men self-conscious about the feminine appearance of their chests in public. Classic removal, with direct excision of the glandular tissue and fat, has been the treatment for gynecomastia in the past. The purpose of this retrospective surgical review and discussion is to compare various treatment modalities for gynecomastia that have been used in our practice over time, and then to present a protocol for the procedure that is the most successful in terms of highest patient satisfaction and lowest revision rate.

A retrospective surgical review of 700 gynecomastia liposuction treatment regimes, including open and closed techniques employing liposuction with manual, ultrasonic, power, and rotary cannulas is presented.

Comparisons of various treatment modalities used by the authors in over 700 cases demonstrate the advantage of hypertumescent infiltration of the dense tissue of the male breast before liposculpture. The aesthetic result is more satisfactory for several reasons: (1) scarring is minimal, (2) neurovascular damage to the delicate areola or surrounding tissue is avoided, (3) the surgeon is allowed to sculpt the tissue rather than just remove it, and (4) a more “normal” looking chest without the periareolar scar is created.

Many men with gynecomastia need diet, exercise, and counseling. We have found that many of these men have high levels of free estrogen accompanied by total testosterone under 300 ng/dL. This endocrine pathological scenario is exacerbated by obesity. If the patients continue to be overweight after treatment, their upper torsos will gradually become feminized again. Thus, our patients are encouraged to follow a high-protein and low-fat diet with caloric restriction and to vigorously exercise so that their results will last.

Surgical treatment can successfully treat gynecomastia in male patients and leave very little scarring. Postoperative diet and exercise will also dramatically improve patients' appearance and self-esteem.