The focus of modern face-lifting has shifted from isolated superficial musculoaponeurotic system ... more The focus of modern face-lifting has shifted from isolated superficial musculoaponeurotic system (SMAS) manipulation to providing necessary volume restoration and overall facial shaping. Volume deflation is a major component of facial aging but cannot be corrected solely by rhytidectomy. This article presents a detailed overview of facial fat compartment anatomy and examines its role in facial rejuvenation. A good understanding of facial fat compartment anatomy cannot be overemphasized. In combination with methodical preoperative visual analysis, this allows surgeons to target the specific areas that have undergone deflation with fat grafting before selective SMAS manipulation.
Background:The use of heterotopic vascularized lymph node transfer (HVLNT) for the treatment of l... more Background:The use of heterotopic vascularized lymph node transfer (HVLNT) for the treatment of lower extremity lymphedema is still evolving. Current techniques, either place the lymph nodes in the thigh without a skin paddle or at the ankle requiring an unsightly and often bulky skin paddle for closure. We explored the feasibility of doing a below-knee transfer without a skin paddle using the medial sural vessels as recipient vessels and report our experience in 21 patients.Methods:A retrospective review of all patients who underwent HVLNT to the medial calf was performed. Postoperative magnetic resonance angiography (MRA) and lymphoscintigraphy (LS) were analyzed to assess lymph node viability and function after transfer.Results:Twenty-one patients underwent HVLNT to the medial calf. Postoperative imaging was performed at an average of 11 months after surgery. Thirteen patients had postoperative MRA, of whom 12 demonstrated viable lymph nodes. Seven patients underwent postoperative LS, of whom three demonstrated uptake in the transferred nodes. In the other four patients, the injectate failed to reach the level of the proximal calf.Conclusion:We provide proof of concept that HVLNT to the lower leg using the medial sural vessels without a skin paddle can result in viable and functional lymph nodes in the setting of lower extremity lymphedema.
Summary: The purpose of this Special Topic article is to present the current state of scientific ... more Summary: The purpose of this Special Topic article is to present the current state of scientific evidence related to the safety of silicone breast implants. There is presently overwhelming evidence to support the safety of silicone breast implants. Ultimately, the decision to obtain, keep, or remove breast implants is the choice of the patient. If a patient chooses to have her breast implants removed, it is important to find a board-certified plastic surgeon with expertise in breast surgery. Ongoing studies are strongly encouraged in all areas, from cancer detection to autoimmune disease, as we strive for improved patient safety, patient awareness, and patient education. To the best of our body of scientific knowledge to date, there have not been any concrete or evidence-based studies or peer-reviewed data concerning the formation of a new syndrome: “silicone implant illness.” Silicone breast implants are used in nearly 300,000 breast augmentation and 100,000 breast reconstruction operations annually in the United States. 1 Silicone gel–filled implants were first approved by the U.S. Food and Drug Administration in 1962. Since that time, few medical devices have been studied as closely for their safety and associated adverse outcomes. Despite multiple generations of implant shells and gel fillers, the basic components remain as originally designed. 2,3
Background An increasing number of aesthetic surgery procedures are being performed in an ambulat... more Background An increasing number of aesthetic surgery procedures are being performed in an ambulatory fashion in office-based settings. Postoperative monitoring of these patients has historically required paid private-duty nurses measuring vital signs, encouraging ambulation, and monitoring overall comfort level. Recently, advancements in nanotechnology have permitted high-acuity data acquisition of multiple clinical parameters that can be transmitted to the surgeon's mobile device in a continuous fashion. Objective The aim of this study was to describe the authors’ early experience with this emerging artificial intelligence technology in the postoperative setting. Methods Twenty-three consecutive patients underwent radiofrequency-assisted liposuction and Brazilian butt lift surgery, and were placed in a monitoring garment, SimpleSense (Nanowear Technologies, Brooklyn, NY) postoperatively. The primary outcome was device usability, reflected by compliance with wearing the device and completeness of data collection. Results During the first 48 hours, 91% of patients wore the device for more than 12 hours per day. Only 39% were compliant with postoperative positioning. No postoperative events were detected. Conclusions The quality of data collected enables detection of clinical derangements and can alert the surgeon in real time, prompting interventions such as drug administration, position changes, or presentation to the emergency room. Level of Evidence: 4
The authors introduce the technique of reverse lymphatic mapping for vascularized lymph node tran... more The authors introduce the technique of reverse lymphatic mapping for vascularized lymph node transfer. This physiologic technique allows one to identify which lymph nodes drain the trunk as opposed to the extremity, to minimize the risk of iatrogenic lymphedema. A prospective study of patients undergoing vascularized lymph node transfer using the reverse lymphatic mapping technique was conducted. Patients received technetium injections in the first and second webspaces of the foot and intradermal indocyanine green injections in the lower abdomen. Lymphatic vessels were traced to the lymph nodes draining the lower abdomen that were harvested; a gamma probe was used to localize lymph nodes draining the lower extremity, which were avoided. In cases of vascularized axillary lymph node transfer, technetium was injected into the hand and indocyanine green was injected into the back and lateral chest. Ten-second counts were recorded of the lymph node flap and the sentinel node draining the extremity for comparison. Thirty-five patients underwent vascularized lymph node transfer (19 groin and 16 axillary lymph node transfers) guided by reverse lymphatic mapping. Follow-up time was 1 to 30 months. Mean 10-second count using the gamma probe for all lymph node flaps was 88.6 (SD, 123; median, 39); mean 10-second count of extremity sentinel nodes was 2462 (SD, 2115; median, 2000). On average, 10-second signal strength of the lymph node flap was 6.0 percent that of the extremity sentinel node. Reverse lymphatic mapping guides vascularized lymph node flap harvest based on physiologic drainage patterns of the trunk and limb that may minimize the risk of iatrogenic lymphedema. Therapeutic, IV.
The focus of modern face-lifting has shifted from isolated superficial musculoaponeurotic system ... more The focus of modern face-lifting has shifted from isolated superficial musculoaponeurotic system (SMAS) manipulation to providing necessary volume restoration and overall facial shaping. Volume deflation is a major component of facial aging but cannot be corrected solely by rhytidectomy. This article presents a detailed overview of facial fat compartment anatomy and examines its role in facial rejuvenation. A good understanding of facial fat compartment anatomy cannot be overemphasized. In combination with methodical preoperative visual analysis, this allows surgeons to target the specific areas that have undergone deflation with fat grafting before selective SMAS manipulation.
Background:The use of heterotopic vascularized lymph node transfer (HVLNT) for the treatment of l... more Background:The use of heterotopic vascularized lymph node transfer (HVLNT) for the treatment of lower extremity lymphedema is still evolving. Current techniques, either place the lymph nodes in the thigh without a skin paddle or at the ankle requiring an unsightly and often bulky skin paddle for closure. We explored the feasibility of doing a below-knee transfer without a skin paddle using the medial sural vessels as recipient vessels and report our experience in 21 patients.Methods:A retrospective review of all patients who underwent HVLNT to the medial calf was performed. Postoperative magnetic resonance angiography (MRA) and lymphoscintigraphy (LS) were analyzed to assess lymph node viability and function after transfer.Results:Twenty-one patients underwent HVLNT to the medial calf. Postoperative imaging was performed at an average of 11 months after surgery. Thirteen patients had postoperative MRA, of whom 12 demonstrated viable lymph nodes. Seven patients underwent postoperative LS, of whom three demonstrated uptake in the transferred nodes. In the other four patients, the injectate failed to reach the level of the proximal calf.Conclusion:We provide proof of concept that HVLNT to the lower leg using the medial sural vessels without a skin paddle can result in viable and functional lymph nodes in the setting of lower extremity lymphedema.
Summary: The purpose of this Special Topic article is to present the current state of scientific ... more Summary: The purpose of this Special Topic article is to present the current state of scientific evidence related to the safety of silicone breast implants. There is presently overwhelming evidence to support the safety of silicone breast implants. Ultimately, the decision to obtain, keep, or remove breast implants is the choice of the patient. If a patient chooses to have her breast implants removed, it is important to find a board-certified plastic surgeon with expertise in breast surgery. Ongoing studies are strongly encouraged in all areas, from cancer detection to autoimmune disease, as we strive for improved patient safety, patient awareness, and patient education. To the best of our body of scientific knowledge to date, there have not been any concrete or evidence-based studies or peer-reviewed data concerning the formation of a new syndrome: “silicone implant illness.” Silicone breast implants are used in nearly 300,000 breast augmentation and 100,000 breast reconstruction operations annually in the United States. 1 Silicone gel–filled implants were first approved by the U.S. Food and Drug Administration in 1962. Since that time, few medical devices have been studied as closely for their safety and associated adverse outcomes. Despite multiple generations of implant shells and gel fillers, the basic components remain as originally designed. 2,3
Background An increasing number of aesthetic surgery procedures are being performed in an ambulat... more Background An increasing number of aesthetic surgery procedures are being performed in an ambulatory fashion in office-based settings. Postoperative monitoring of these patients has historically required paid private-duty nurses measuring vital signs, encouraging ambulation, and monitoring overall comfort level. Recently, advancements in nanotechnology have permitted high-acuity data acquisition of multiple clinical parameters that can be transmitted to the surgeon's mobile device in a continuous fashion. Objective The aim of this study was to describe the authors’ early experience with this emerging artificial intelligence technology in the postoperative setting. Methods Twenty-three consecutive patients underwent radiofrequency-assisted liposuction and Brazilian butt lift surgery, and were placed in a monitoring garment, SimpleSense (Nanowear Technologies, Brooklyn, NY) postoperatively. The primary outcome was device usability, reflected by compliance with wearing the device and completeness of data collection. Results During the first 48 hours, 91% of patients wore the device for more than 12 hours per day. Only 39% were compliant with postoperative positioning. No postoperative events were detected. Conclusions The quality of data collected enables detection of clinical derangements and can alert the surgeon in real time, prompting interventions such as drug administration, position changes, or presentation to the emergency room. Level of Evidence: 4
The authors introduce the technique of reverse lymphatic mapping for vascularized lymph node tran... more The authors introduce the technique of reverse lymphatic mapping for vascularized lymph node transfer. This physiologic technique allows one to identify which lymph nodes drain the trunk as opposed to the extremity, to minimize the risk of iatrogenic lymphedema. A prospective study of patients undergoing vascularized lymph node transfer using the reverse lymphatic mapping technique was conducted. Patients received technetium injections in the first and second webspaces of the foot and intradermal indocyanine green injections in the lower abdomen. Lymphatic vessels were traced to the lymph nodes draining the lower abdomen that were harvested; a gamma probe was used to localize lymph nodes draining the lower extremity, which were avoided. In cases of vascularized axillary lymph node transfer, technetium was injected into the hand and indocyanine green was injected into the back and lateral chest. Ten-second counts were recorded of the lymph node flap and the sentinel node draining the extremity for comparison. Thirty-five patients underwent vascularized lymph node transfer (19 groin and 16 axillary lymph node transfers) guided by reverse lymphatic mapping. Follow-up time was 1 to 30 months. Mean 10-second count using the gamma probe for all lymph node flaps was 88.6 (SD, 123; median, 39); mean 10-second count of extremity sentinel nodes was 2462 (SD, 2115; median, 2000). On average, 10-second signal strength of the lymph node flap was 6.0 percent that of the extremity sentinel node. Reverse lymphatic mapping guides vascularized lymph node flap harvest based on physiologic drainage patterns of the trunk and limb that may minimize the risk of iatrogenic lymphedema. Therapeutic, IV.
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