The American Journal of Cosmetic Surgery

In 2014, nearly 15.1 million people chose to undergo elective cosmetic procedures. Cosmetic surgical procedures all involve risks, compromises, and complications. Regardless of a physician’s efforts to limit complications, spontaneous wound opening or wound dehiscence remains one of the most common to occur. Cosmetic surgery, perhaps more than any other subspecialty of medicine, walks a precarious balance of tension in effort to reduce laxity and elevate ptotic tissues. Historically, dehiscence with wound exposure more than 6.0 hours after spontaneous wound opening is managed conservatively with proper cleansing and dressing changes, with or without empiric antibiotics. Our research sought to determine whether delayed primary closure of a cosmetic wound dehiscence is a safe and viable option to improve patient care and satisfaction. A retrospective case evaluation, patients survey, and statistical evaluation revealed improved satisfaction with delayed primary closure of dehiscent wounds.

The purpose of the study is to evaluate the differences between patients who access an oculoplastic practice via the Internet from patients who are referred by other physicians or patients. A retrospective chart review of sequential patients who accessed an oculoplastic practice via the Internet from July 1, 2008, to June 30, 2014, was reviewed. A comparison group of the next sequential chart number after each Internet patient was also reviewed. One hundred eighty-nine Internet patients and 165 non-Internet patients were identified. The average age of the Internet patients was 52 years (range, 19-82 years) and non-Internet patients was 51.8 years (range, 1-82 years). The Internet patients were more likely to be female. (P < .0001). The average income per household of the Internet patients was $61,415 as compared with the non-Internet patients at $54,389 (P = .003); they were also more likely to have private insurance (87% vs. 61%, respectively) (P < .01). A surgical procedure was more likely to be performed in the Internet group (71%) versus the non-Internet group (58%) (P = .003). Internet patients were more likely to have cosmetic and/or functional procedures (P < .0001). Postoperative visits (P = .001) and phone calls (P = .03) were significantly higher for Internet patients. The patients who accessed the practice via Internet were most likely to be a middle-aged female and reside in zip codes with higher household incomes. They were more likely to undergo cosmetic surgery and averaged more postoperative visits and phone calls.

As the population ages, the incidence of herpes zoster otherwise known as shingles increases. The occurrence of zoster in facial cosmetic patients may be increasing. We experienced the complication of reactivation of the herpes virus presenting as herpes ophthalmicus after injection with dermal fillers. An extensive literature review was undertaken to identify other cases of zoster after facial procedures. We were able to identify only 1 other case similar to ours. The literature addressed viral prophylaxis for herpes simplex but there is little discussed about the need of prophylaxis for zoster. We were able to identify a potential for an increase in the incidence of zoster as the aging population is seeking more invasive corrective treatments. A subsequent rise in zoster is reported correlating with the use of childhood vaccination for varicella. It is postulated that low levels of exposure provide some protective effect through antigen exposure. Without that exposure, patients are at higher risk of reactivation as the varicella vaccination was not available at the time. Consensus appears to be lacking on how to appropriately prophylax patients for risk of zoster reactivation.