The American Journal of Cosmetic Surgery

Telogen effluvium is the most common cause of transient, nonscarring, diffuse alopecia. In its acute form, it triggers profound anxiety in our patients, and if not allayed with a confident diagnosis, it inevitably cascades to physical and psychological stress. Numerous possible factors have been implicated as a causation of telogen effluvium, yet concrete evidence in their support is still lacking. However, the role of stress as a causative factor must not be overlooked. As cosmetic surgeons, we unwillingly induce stress on our patients, especially through the many facial rejuvenation procedures we perform. Herein, we present a severe case of telogen effluvium status post endoscopic repair of functional brow ptosis. We attempt to aid readers so that they may make an accurate diagnosis and hopefully implement effective intervention, and if possible, prevention.

The objective of this study was to examine YouTube videos related to rhinoplasty created by both physicians and nonphysicians in order to determine the content of the videos, the selected topics of discussion, and other important parameters. A cross-sectional analysis was performed. YouTube videos that resulted when the search term “rhinoplasty” was entered were identified during the first 15 days of October 2014. The search was carried out daily during this time, and the first 20 unchanged videos were included in this analysis. Authorship, length of video, objective, total views, and type of video were recorded. Ten videos (50%) were physician based, 8 were patient based (40%), and 2 (10%) were television programs. Ten videos (50%) were longer than 10 minutes and 8 (40%) had greater than 100 000 views. The majority of videos (85%) aimed to provide didactic information on the rhinoplasty operation or intended to provide a perspective on the operation from an actual patient. Mann-Whitney U tests and Kruskal-Wallis tests were used to compare physician-based Web sites against those with other authorship with threshold of significance < .05 with no significant difference found between the groups. Videos submitted by practicing physicians were inherently different than those submitted by patients. While videos submitted by physicians concentrated primarily on the actual operation, videos submitted by patients were focused mainly on what they experienced during their procedure. The lack of safeguards on the quality or accuracy of videos posted on the popular Web site YouTube may lead to a possibility for misinformation to the consumer. It would likely be prudent for specialty bodies and organizations to submit high-quality videos to provide the best and most up-to-date information possible.

Pterygium is a frequent conjunctival abnormality in outdoor workers. Genetic background factors are involved. In this study, the authors report their experience in utilizing a rotatory conjunctival flap (RCF) under local anesthesia. A retrospective analysis was conducted of all patients undergoing the proposed technique by one surgeon from 2010 to 2016. Preoperative and postoperative photographs at the longest follow-up visit were used for analysis. A total of 76 patients underwent RCF in an office setting. The average follow-up time was 9 months (range, 6 months to 4 years). All patients were satisfied with the result. One patient required a conjunctival granuloma excision. Additional advantages include the ease of operation, cost, conjunctival preservation for glaucoma filtering surgery, and a short execution time.

The endoscopic approach is an alternative treatment to direct excision of benign forehead tumors. Prior publications describe the technique and outcomes. Our study assumes a quality improvement perspective, focusing on patient satisfaction with decision making and scar outcomes. This is a retrospective case series study of adult patients who underwent endoscopic removal of benign forehead tumors at Kaiser Permanente Oakland from 2006 to 2016. Data were collected pertaining to surgical outcomes, patient satisfaction using validated instruments. Thirty adult patients were included. Mean operating time was 60 minutes. Forehead tumors included osteomas and a variety of soft tissue lesions. Transient complications included hypoesthesia, seroma, and frontalis weakness. A recurrence of an epidermal inclusion cyst occurred. Patients reported nearly complete satisfaction with decision making and scar outcomes. Endoscopic removal of benign forehead tumors is a safe and effective treatment. Patient satisfaction with decision making and the scar is excellent. Further studies are needed to compare the endoscopic approach to direct excision. The surgeon should offer the endoscopic approach and appropriate counseling to the patient with a benign forehead tumor.

Reverse mastopexy is a novel secondary surgical technique applied to patients who have previously undergone skin-sparing mastectomies with reconstruction. Benefits of this procedure include a natural contour to the reconstructed breast with greater breast mound projection, enhanced superior medial fullness, and reduced contour irregularities. Aesthetic improvement to the breast is appreciated with scar relocation to the inframammary fold. Nipple areolar reconstruction can then be performed in surgically undisturbed tissue. Eleven patients from January 2015 through January 2016 who underwent reverse mastopexy were included in our retrospective cohort review. A total of 22 reverse mastopexies were performed at a single institution by a single surgeon. Demographics included age (25-65 years), body mass index (25.5-41.4), and previous breast radiation (3 of 11). All the reverse mastopexies were performed secondarily to mastectomy with reconstruction to improve cosmesis. One patient had undergone unilateral autologous breast reconstruction with a latissimus dorsi flap; the remainder of the women had implant-based reconstruction. Initial short-term follow-up occurred at 1 week, 2 weeks, 1 month, and 2 months after the reverse mastopexy was performed. Follow-up phone survey revealed that all women were satisfied with their aesthetic outcomes (average preoperative vs postoperative satisfaction score: 3.9 vs 9.2; range: 0-10). Complications include localized suture abscess (n = 2), dermatologic reaction to the Dermabond skin closure tape (n = 1), and mild cellulitis 4 weeks after the procedure that resolved with oral antibiotics (n = 1). “Red-breast” syndrome was appreciated in 1 patient. No patient required reoperation. Reverse mastopexy improved cosmetic appearance and patient satisfaction in our population. Few options exist for secondary breast contouring after mastectomy with reconstruction. In comparison with fat grafting, reverse mastopexy is a single operation with predictable results without the potential to cause harvest site irregularities. In addition, reverse mastopexy offers improved scar location to the inframammary fold, which improves tissue bed quality for future nipple areolar reconstruction. Further study for long-term durability and satisfaction is indicated.

Opioid-induced constipation (OIC) is a commonly experienced side effect of those utilizing narcotic pain medication. The current treatment for OIC commonly consists of stool softeners and bowel stimulants which often leads to abdominal bloating and discomfort ultimately resulting in uncomfortable bowel movements and loose stools. We present a novel approach to the treatment of acute OIC after abdominoplasty in patients taking narcotic pain medication utilizing a well-known medication currently approved by the Food and Drug Administration for the treatment of OIC in adult patients with chronic noncancer pain.