The American Journal of Cosmetic Surgery

The Circles of Prominence, A New Theory on Beauty: Ideal Distances in the Eyes, Nose, Ears and Lips. The Circles of Prominence (COP) theorizes that the width of the iris serves as an ideal for multiple distances and shapes within the face. We wanted to test if the iris width (IW) dictates: 1.) the aesthetic ideal distance between eyelid margin and bottom of the eyebrow; 2.) the aesthetic ideal width of the nasal bridge and tip; 3.) the aesthetic ideal height of the upper lip; 4.) the aesthetic ideal height of the lower lip; 5.) and the aesthetic ideal distance the ear extends from the side of the face. This was a subjective survey to test these distances to find the ideal. The data supports that the ideal distance for eyebrow height, nasal bridge & tip width, and lower lip height are all 1 IW as predicted by the COP. The ideal height of the upper lip was statistically found to be ½ IW. The ideal distance that the ear extends from the side of the face was split between ½ IW and 1. As predicted, the data supports the idea that the Iris width serves as the ideal distance or shape for many elements in the face.

Hypertrophic and atrophic scars are typically thought to be at opposite ends of the pathological healing process, and, as a consequence, cosmetic treatments have tended to be varied and disparate. This article, however, presents data from a pilot study that illustrates a coherent and unified approach can be used for the effective treatment of both scar types. This method studies the use of a precision microneedling device using mixed length needles. This is used in conjunction with the application of topical, pharmaceutical-grade creams consisting of retinoic acid, antioxidants, anti-inflammatory agents, and sea sponge collagen. Data and examples are presented that show good skin remodeling for both types of scars.

Surgeons performing lower eyelid blepharoplasties continue to seek an efficient method and predictable outcome to restore the aesthetic ideal of the lower eyelid and cheek junction. Current popular methods frequently fall short. Three patients were chosen as examples from the senior author’s past 30 years of practice where they desired improvement in the aesthetic appearance of their lower eyelids. They were treated with a combination of transconjunctival blepharoplasty, fat grafting, and 88% phenol peel. The preoperative and postoperative photos of the patients were analyzed by the patient and senior author. Having undergone the methods described for treatment, all selected patients reported significant improvement with their postoperative appearance. Minimal complications were reported and are mentioned below. No surgical revisions were requested, and the results were stable over an acceptable period of time with an average follow-up time of 2 years. Two of the 3 patients chosen had a follow-up time of at least 8 years. Transconjunctival lower eyelid blepharoplasty when combined with fat grafting and phenol peeling offers a treatment modality to restore the aesthetic ideal of the lower eyelid and cheek junction and, in our hands, is superior to other methods previously described.

Postoperative nausea and vomiting (PONV) is a major patient dissatisfier in aesthetic ambulatory surgical patients. Limited data exist demonstrating single surgeon reduction in PONV after utilizing modern pharmacologic techniques for analgesia and PONV chemoprophylaxis for patients who receive general anesthesia. In our study, multimodal analgesia included pregabalin, oxycontin, ketamine, and opioids; PONV chemoprophylaxis included transdermal scopolamine, diphenhydramine, dexamethasone, and ondansetron. A treatment arm of 36 patients undergoing aesthetic breast surgery was evaluated prospectively and compared with a retrospective control group of 47 patients who underwent similar procedures in the prior year. The aggressive screening for PONV risk factors preoperatively and preemptive treatment resulted in an overall reduction in PONV rate from 31.9% to 5.6%.

We report a technique used to achieve successful repair of 2 large septal perforations in a patient with graft versus host disease, chronic use of corticosteroids, and chronic use of immunosuppressive medications. A multilayered interposition graft was constructed out of temporal fascia and flexible polydioxanone plates and placed between the mucoperichondrial flaps. Due to large size of the perforations and poor tissue quality, no attempt at mucosal closure of the perforations was made. Instead, silicone sheets were placed for 52 days to facilitate healing. Complete healing of both perforations sites was obtained along with resolution of the patient’s symptoms. The described technique provided an optimal surgical outcome in the setting of multiple large septal perforations, graft versus host disease, chronic corticosteroids, and chronic immunosuppressive medications.

Repeated hyaluronic acid (HA) filler rhinoplasty can produce “bottoming out” effect. This effect produces cosmetically displeasing widening of the dorsal aesthetic line. This article demonstrates use of Hyalase to recreate a cosmetically satisfying dorsal aesthetic line.