The American Journal of Cosmetic Surgery

The direct supraciliary brow lift is an effective procedure to treat brow ptosis, limited by risk of a cosmetically undesirable scar. We performed a comprehensive literature review of direct supraciliary brow lift techniques and provide a summary of the key considerations. The optimal direct brow lift is initiated with thoughtful incision design and a carefully beveled supraciliary incision. Subcutaneous tissue debulking and wound edge undermining optimize wound eversion and approximation. A layered meticulously executed skin closure is essential for optimal cosmesis. The senior author’s personal technique, incorporating these concepts, is described and illustrated. We reviewed 76 patients (141 brows) who underwent our refined technique. At the time of final follow-up visit (average 4.9 months), 72 patients (94.7%) reported complete satisfaction with results. Adverse outcomes were found in 4 patients (5.3%) and included transient paresthesias (n = 3) and hypertrophic scarring (n = 1). Postoperative care routinely included the use of topical steroids and additional treatment with microneedling and 5-fluorouracil in 2 patients (2.6%) to optimize healing. The direct supraciliary brow lift is a minimally invasive and effective procedure to correct brow ptosis and may yield excellent cosmesis when key principles are utilized.

Transversus abdominis plane (TAP) block is a relatively new technique used to provide analgesia to the anterolateral abdominal wall following abdominal procedures. Transversus abdominis plane blocks can be performed using a blind/landmark technique or with ultrasound guidance. We report a 49-year-old woman who received a successful wireless ultrasound-guided TAP block during an abdominoplasty. Our case illustrates the potential advantages of a wireless ultrasound-guided TAP block versus a landmark-guided TAP block during an abdominoplasty. It also serves to promote the use of wireless ultrasound imaging when performing a TAP block to minimize risks of the procedure and achieve better pain control postoperatively. Further studies are needed to confirm the added value that ultrasound provides.

There is a large body of literature dedicated to patient selection in plastic surgery. Much of this, however, is dedicated to the recognition of patients with body dysmorphia, those psychologically unfit for surgery, and those who have medical conditions that make the risk of complications unacceptably high. There is, however, little in the way of recognition and management of patients with chronic pain issues. With opioid misuse and dependence on the rise, the likelihood of plastic surgeons encountering patients who have obvious or occult opioid dependence issues has increased. In this case report and review of literature, we aim to present an evidence-based approach to the diagnosis and management of plastic surgery patients with a known opioid dependence.

Gluteal fat grafting (or autologous fat transfer to the buttocks) is one of the fastest growing procedures in plastic surgery. However, as the popularity of the procedure has grown, so has the number of fatalities and complications. Fatalities are mainly linked to fat embolism, which can occur when fat is injected into the gluteal muscles, instead of subcutaneously. The use of wireless ultrasound imaging during the procedure can help reduce the chances of intramuscular fat injection and improve patient safety. Here, we present a 36-year-old female underwent circumferential liposuction with autologous fat transfer to the bilateral buttocks. From liposuction, 3500 mL of fat was harvested and 1000 mL of fat was injected into each buttock with wireless ultrasound guidance. We identified the subcutaneous plane where fat was to be injected, avoided penetrating the muscular fascia, and observed (in real-time) fat being introduced into the subcutaneous tissue. Wireless ultrasound-guided gluteal fat grafting is an effective and reliable method of visualizing the anatomy of the gluteal region and preventing intramuscular injection of fat. The technology is readily available, very user-friendly and serves as a great learning tool. Based on our positive experience using ultrasound guidance, larger comparative studies should be conducted to confirm its value.

Subcutaneous emphysema refers to the abnormal presence of free gas within the subcutaneous tissue. Its cause can be broadly classified into 3 main causes: (1) infection by gas-forming microorganisms, (2) visceral perforation of luminal organs, and (3) spontaneous alveolar rupture. We report a case of a 48-year-old lady who developed extensive subcutaneous emphysema after undergoing VASER-assisted liposuction and J-Plasma^® therapy at a local cosmetic clinic. The patient was admitted to our tertiary plastic surgery department where she was managed conservatively and discharged at day 3 without any complications. Subcutaneous emphysema is a known but rare complication of liposuction. While subcutaneous emphysema is usually self-limiting, fatal complications can occur. As such, patients considering these procedures should be informed of its risks and benefits to allow them to make an informed decision. This report highlights the importance of meticulous surgical technique in liposuction and its postoperative assessment.

Several reports have been published wherein intradermal filling with nanofat has been used for skin rejuvenation, texture improvement and scar treatment. A study was conducted between August 2017 and August 2018 which included 20 female patients having wrinkles, hyperpigmentation, erythema, and enlarged pores. Lidocaine cream, local infiltration with lidocaine or sedation was used in accordance with the patient’s convenience. Nanofat was injected intradermally in all the facial regions. All patients filled a questionnaire at sixth month post treatment which consisted of questions regarding pain, bumps area and resolution, grade of improvement of skin (wrinkles, smoothness, wrinkles, pores and redness), recovery of donor area, time to reincorporate to normal routine, nanofat-time efficacy and recommendation of the treatment. Patients undergoing it with sedation had less bruising and pain. Lateral thigh as the donor area had less pain in the recovery period. The residual bumps persisted for more time in non-mobile areas while average time to disappear was 3.6 weeks. Patients started to notice the change after nanofat injections at about 1.12 months later. The improvement was noticed for smoothness of skin (100% patients), wrinkles (40% patients), pore size reduction (15% patients), improvement in redness (10% patients). The effect of nanofat was felt by patients for an average time of 3.85 months. All the patients were satisfied and recommended it. No major complications were reported. Nanofat treatment is safe and it conveys beneficial effects on skin rejuvenation as per the post-operative skin texture changes and the satisfaction of patients.

The objective of this study was to document a patient’s evaluation after breast augmentation using BREAST-Q. The study was conducted in a private cosmetic surgery setup among female patients undergoing breast augmentation silicone implant surgery or fat transfer. All the surgeries were performed by a single surgeon under general anesthesia. Three parameters of BREAST-Q were noted preoperatively and after 9months. All the data were analyzed statistically. The mean age of the patients was 28.6 years. The average implant volume was 331 mL (range, 250-455 mL). The patients undergoing fat transfer had an average of 391.7 mL (range, 295-450 mL) injected on each side. There was a statistically significant difference noted in the scores preoperatively and postoperatively. The use of validated survey instruments plays an important role in improving patient-reported outcomes. Breast augmentation with fat transfer was shown to have higher patient satisfaction using BREAST-Q.

There are many treatments for neck laxity and fullness, both invasive and noninvasive. The purpose of this study was to evaluate the effectiveness of combined infrared, radiofrequency, mechanical massage, and suction therapy in performing contour changes in the submental and lateral neck regions. This was a single-center, prospective cohort study in which 30 patients were treated with a session of combined infrared, radiofrequency, mechanical massage, and suction therapy once a week for 4 weeks. Follow-up was performed at posttreatment months 1, 3, and 6. Both subjects and investigators completed submental fat grading scales and lateral neck and jowl linear analog scales. Exclusion criteria included history of soft tissue augmentation, cosmetic injections, ablative or nonablative skin resurfacing, or surgical procedures in the lower facial region, as well as weight gain or loss exceeding 10 pounds during the study period. There was a significant difference between mean ± SD neck and jowl investigator scores at day 0 and month 6, which were 5.6 ± 0.9 and 4.4 ± 1.0, respectively (P < .05). Mean investigator submental fat score at day 0 was 1.9 ± 0.7 vs 1.5 ± 0.6 (P = .04) at month 6. Differences between mean patient neck and jowl and submental fat scores were also statistically significant between day 0 and month 6. At day 0, the mean patient neck and jowl score was 4.7 ± 0.8 vs 3.2 ± 1.1 at month 6 (P < .05), and at day 0, the mean patient submental fat score was 2.2 ± 0.5 vs 1.8 ± 0.6 at month 6 (P < .05). Combined infrared, radiofrequency, mechanical massage, and suction therapy provides an effective, noninvasive treatment modality for improving contour of the lateral neck and submentum.