Can a neck lift trigger orthostatic hypertension and tremors?

Autoregulatory mechanisms ensure relatively small fluctuations of blood pressure with postural changes in healthy people. Although orthostatic hypotension is well recognized and commonly encountered, there are only a few reports of orthostatic hypertension. Most of the reported cases of orthostatic hypertension were related to excessive venous pooling, with an initial drop in cardiac output followed by overcompensation with an excessive release of catecholamines, or to nephroptosis with orthostatic activation of the renin-angiotensin system. We describe a 44-year-old woman with normal supine blood pressure and severe orthostatic hypertension who did not demonstrate an initial decrease in cardiac output and had normal plasma and urinary catecholamines and renin release. Pharmacological tests of autonomic nervous system function showed an increased pressor sensitivity to norepinephrine (11 to 14 times normal), normal sensitivity to isoproterenol, diminished baroreceptor reflex sensitivity, and exquisite sensitivity to alpha-adrenergic blockers. This unusual case of orthostatic hypertension appears to be secondary to vascular adrenergic hypersensitivity.

Carotid-cardiac baroreflex: Relation with orthostatic hypotension following simulated microgravity and implications for development of countermeasures

Role of tranexamic acid (TXA) in plastic and reconstructive surgery: A national perspective

Reference values of indices of spontaneous baroreceptor reflex sensitivity

Serendipity in Ultimate Neck Lift Correction

The global COVID-19 pandemic reshaped many components of modern health care practice. Before the pandemic, research was beginning to demonstrate the impact of self-facing cameras, selfie images, and webcams on patient interest in head and neck (H&N) aesthetic surgery. We sought to determine temporal changes in patient interest in aesthetic surgery of the H&N as compared with the rest of the body because of COVID-19, and the subsequent surge in Web-conferencing and telecommunication. The 2020 Plastic Surgery Trends Report produced by the American Society of Plastic Surgeons was used to identify the 5 most common aesthetic surgical procedures performed on the H&N and the rest of the body for 2019: blepharoplasty, face lift, rhinoplasty, neck lift, cheek implant, and breast lift, liposuction, tummy tuck, breast augmentation, and breast reduction, respectively. Google Trends filters, which provide relative search interest for greater than 85% of Internet searches, were applied to gauge interest from January 2019 to April 2022. Relative search interest and mean interest were plotted as a function of time for each term. Our findings demonstrate a sharp decline in online aesthetic surgery interest in March 2020, coinciding with the beginning of the COVID-19 pandemic for both the H&N and the rest of the body. Search interest increased shortly after March 2020 and reached values greater than those of the prepandemic year (2019) in 2021 for rest of the body procedures. After March 2020, there was a brief, sharp increase in search interest for rhinoplasty, neck lift, and facelift, whereas patient interest in blepharoplasty increased more gradually. There was no increase in search interest for H&N procedures as a result of COVID-19 when using the mean values of the included procedures, although current interest has returned to prepandemic levels. The COVID-19 pandemic caused a disruption of normal trends in aesthetic surgery interest, with a sharp decline in search interest in March 2020. Afterward, there was a sharp increase in rhinoplasty, face lift, neck lift, and blepharoplasty interest. Patient interest in blepharoplasty and neck lift has remained elevated compared with 2019. Interest in rest of the body procedures has returned to and even surpassed prepandemic levels.

In this study, the extent of racial diversity in images of breast-related plastic surgery published literature was investigated to better understand disparities that exist in breast surgery. The lack of racial diversity in images of skin color in surgery literature can perpetuate implicit bias and stereotypes. Implicit bias can affect the way patients are evaluated, diagnosed, and treated. The visual aspects of plastic surgery make a lack of diversity in imagery especially impactful on patient care and outcomes. Published medical images and graphics depicting human skin were analyzed across 4 major plastic surgery journals. Up to 4 years were chosen a priori to evaluate from each journal and represented the initial year of color image publication, the year of study initiation (2016), and representative years for a given decade (2000 and 2010). Images and graphics were tabulated, rated by Fitzpatrick scale and categorized into "White" or "non-White." Data were evaluated with pair-wise and linear regression statistics. Of the 2774 images and 353 graphics that met inclusion criteria, only 184 (8.18%) images and 9 graphics (6.34%) depicted non-White skin. Temporal analysis showed that there is an increased diversity of images published since 2010 with 0% of images being non-White before and 7.3% to 10.3% after 2010. International and multi-national authors tended to publish more non-White images. There is insufficient racial diversity visually represented in the breast-related plastic surgery literature with a small degree of progress made towards more equitable imagery over time. Increasing awareness of image content, and the need for equitable visual representation may allow for improved racial diversity in surgical literature.

Background: Neck rejuvenation is a cornerstone of facial aesthetic surgery, addressing issues such as skin laxity, submental fat, and platysmal banding. While neck lift surgery offers structural support and long-term correction, neck liposuction presents a minimally invasive alternative with quicker recovery. There remains limited comparative data on the long-term outcomes and patient satisfaction associated with these two techniques in South Asian populations, particularly in Balochistan and Islamabad. Materials and Methods: A prospective, comparative study was conducted from March 2022 to March 2023 at Bolan Medical Complex (Quetta) and a private surgical center in Islamabad. A total of 80 patients were enrolled—40 underwent neck lift surgery (Group A) and 40 underwent neck liposuction (Group B). Patient selection was based on clinical indication, anatomical evaluation, and patient preference. Standardized tools including the Visual Analog Scale (VAS), FACE-Q, and WHOQOL-BREF were used to assess satisfaction and quality of life at baseline, 3 months, and 12 months postoperatively. Statistical analysis was performed using SPSS 25.0, with one-way ANOVA and Pearson correlation applied. A p-value <0.05 was considered statistically significant. Results: Group A demonstrated significantly higher satisfaction scores at 12 months (VAS: 8.7 ± 0.9) compared to Group B (VAS: 7.1 ± 1.2; p<0.001). FACE-Q satisfaction scales also favored the neck lift group. WHOQOL-BREF revealed notable improvements in psychological and social domains in Group A. One-way ANOVA confirmed statistical significance across all metrics, and a moderate positive correlation (r=0.41; p<0.01) was found between aesthetic satisfaction and QoL improvements. Conclusion: Neck lift surgery yields superior long-term aesthetic outcomes and quality of life improvements compared to neck liposuction. These findings highlight the importance of individualized treatment planning and long-term patient counseling in facial cosmetic surgery. Keywords: Neck lift, Neck liposuction, Aesthetic surgery, Patient satisfaction, FACE-Q, WHOQOL-BREF, Balochistan, Islamabad

Dr. Hinderer passed away on January 1, 2007, at his home in Madrid. He was 82 years old. Born in Madrid of German parents in the renowned district of Chamberí, he always lived his life to the fullest in both the German and Spanish cultures. The outbreak of World War II found him in boarding school in Germany, and in 1941, he joined the armed forces at the tender age of 17, fighting on the front line for 3 years. Among other battles, he fought in Stalingrad and, later, as an officer, in the famous battle of the Ardennes, suffering severe injuries. Awarded the Iron Cross in 1945, he returned to Madrid more mature than his years, due to the harsh experiences he had endured during the war. He used to say, “What doesn't destroy you makes you stronger.” Dr. Hinderer studied at the Faculty of Medicine at the Complutense University of Madrid, obtaining his degree in 1950. He continued his training in plastic surgery there and at the University of Dusseldorf. As a result of his uncountable professional successes, Dr. Hinderer was everything in plastic surgery, including professor of plastic surgery at the Complutense University, chief editor of Spanish Plastic Surgery (now known as Ibero-Latinamerican Plastic Surgery), and founder and editor of the journal Aesthetic Plastic Surgery. His contribution and experience helped develop these journals into the well-known publications they are today. Undeniably, his major roles were as eighth general secretary of the International Confederation of Plastic Reconstructive and Aesthetic Surgery and as president of the International Plastic, Reconstructive, and Aesthetic Surgery Foundation. Dr. Hinderer was honest, hard working, and disciplined. Blair Rogers called him the “indefatigable Hinderer,” and Tom Biggs used to say to his residents, “If you think you have found a new surgical technique, revise your bibliography, because either it is of no importance or you will probably find that Hinderer has already published it!” Ulrich was a great lecturer and published hundreds of articles in which he described original surgical techniques in plastic surgery (articles on congenital anomalies, otoplasty, hypospadias, and so on) and aesthetic surgery (such as lifting, mammaplasty, and blepharoplasty). A tireless doctor, plastic surgeon, founder of many scientific societies worldwide, and editor of national and international journals, his legacy is as valuable as it is unforgettable. We will remember him as a great human being and an excellent professional; he leaves us an entire life dedicated to medicine, showing true vocation until the last days of his life. Right now, he is probably discussing new surgical techniques with other great contributors, such as Tagliacozzi, Langenbeck, Dieffenbach, Sanvenero-Roselli, González Ulloa, Salvador Castañares, and others, and he is almost certainly trying to create a Society of Plastic and Aesthetic Surgery in heaven! Rest in peace, “Uncle Uli.”Figure: Dr. Ulrich T. Hinderer Meise, 1924 to 2007.

CONSORT

Optimal cervicomandibular contour often necessitates management of subplatysmal structures, including the submandibular glands (SMGs). Partial SMG excision may enhance neck definition but remains controversial because of concerns regarding bleeding and other potential complications. The LigaSure Exact Dissector (Medtronic, Minneapolis, MN) is a bipolar vessel-sealing device that has been adopted by some surgeons for SMG management during aesthetic neck surgery. To evaluate the short-term safety and postoperative complication profile of partial SMG excision using the LigaSure Exact Dissector during aesthetic neck lift surgery. A retrospective observational case series was conducted of patients undergoing partial SMG excision as part of primary neck lift procedures between August 2023 and January 2025. All SMG excisions were performed using the LigaSure Exact Dissector. Patient demographics and postoperative complications were recorded. Outcomes were analyzed descriptively, with a minimum follow-up of 3 months (mean follow-up, 5 months). Of 123 neck lift procedures, 80 patients (65%) underwent bilateral partial SMG excision. Mean age was 58.7 years (range, 34-73 years); 57 patients (71%) were female and 23 (29%) male, with a mean body mass index of 24.5. Complications included seroma in 3 patients (3.75%), minor hematoma in 1 patient (1.25%), and transient lower-lip weakness in 4 patients (5%), all resolving within 8 weeks. No permanent nerve injury, sialoma, infection, or xerostomia occurred. Partial SMG excision using the LigaSure Exact Dissector was associated with a low rate of short-term complications. These findings suggest the technique can be safely performed in appropriately selected patients undergoing aesthetic neck lift surgery. Further comparative studies are warranted. 4 (Therapeutic).

So You Want to Be an Evidence-Based Plastic Surgeon? A Lifelong Journey.

Our Experience of Hormone Replacement Therapy To Optimize Aesthetic Surgery Results

Plastic and reconstructive surgeons face increasing competition clinically, especially in aesthetic surgery. Otolaryngologists, dermatologists, oral surgeons, and ophthalmologists, as well as physicians in other subspecialties, are increasingly turning to aesthetic surgery. There is little doubt that the attractive revenue stream from aesthetic surgery underlies the current clinical landscape involving so many different specialties competing in the same arena. The "discretionary medicine" or "cash business" aspect of aesthetic surgery stands in stark contrast to the eroding reimbursement by insurance carriers for reconstructive surgery. As with any business, attractive margins draw competition, and eventually the supply-and-demand principles of economics will reduce margins. Given this clinical reality, is there a competitive advantage strategy for plastic and reconstructive surgeons? The answer is yes. Innovation is the sustainable competitive advantage for plastic surgeons, as it has been since plastic surgery became a specialty. It is critically important that plastic and reconstructive surgery residents and fellows understand how integral this competitive advantage is when they finish their training. It is a daunting and oftentimes discouraging time when a plastic surgeon finishes his or her training and starts a practice. Because of the very nature of aesthetic surgery, it is difficult to build a practice with the stiff competition from other specialties. Simply being a board-eligible or board-certified plastic surgeon does not distinguish our "brand" in the minds of aesthetic surgery patients. While this reality may describe the first year of practice for many plastic surgeons, it stands in marked contrast to the competitive advantage these same surgeons enjoyed as chief residents in plastic surgery. Simply put, the plastic surgery chief resident is probably the most innovative clinical problem-solver in the hospital in which he or she works. When the neurosurgeon needs tissue coverage or calvarial reconstruction, when the orthopedic surgeon has exposed hardware or bone, when the thoracic surgeon needs help closing the chest wall or when a sternal wound breaks down, when the general surgeon needs help with an abdominal wall closure reconstruction, whom do they consult? The answer is usually plastic surgery, oftentimes through the chief resident. The specialties that compete so aggressively with our recently trained plastic surgeons are usually not the answer for the wide variety of clinical problems that plastic surgery chief residents solve on an everyday basis. There is a lesson here. Innovation, whether it be clinical or through research, has distinguished plastic surgeons historically and will continue to do so in the future. Innovation for plastic surgeons is analogous to the research and development pipeline of a big pharmaceutical or biotechnology company. We must not forget that innovation makes plastic surgery different and distinctive—the very definition of what strategy is all about. We cannot simply hang a shingle and build an aesthetic practice, because it is difficult to distinguish ourselves easily in the competitive aesthetic surgery arena. Our strategy should continue to emphasize innovation within plastic surgery. Microsurgery, craniofacial surgery, hand surgery, breast reconstruction, and myocutaneous flaps are examples of how plastic surgery innovation has introduced and advanced clinical care. Most of these innovations were initially published in this Journal (Table I), helping to fuel further innovation and refinement in the new field of plastic surgery. Plastic surgeons developed innovative approaches to solve clinical challenges. Driving these clinical advances were research efforts. Taking clinical problems to the laboratory and developing solutions that are translated back to the operating room is the ideal translational research paradigm.TABLE I: Selected Advances in Plastic Surgery Published in Plastic and Reconstructive SurgeryPlastic surgeons should continue to invest time, effort, and resources to maintain a robust, innovative pipeline. Clinical advances in scar reduction and skin remodeling, cell-based strategies for tissue engineering, and regenerative medicine will lead to innovative therapies for plastic surgeons. These new techniques (as well as products) pioneered by plastic surgeons will continue to distinguish us clinically, in both aesthetic and reconstructive surgery. In addition to building large clinical practices, other potential derivatives from this investment in innovation could include intellectual property with substantial revenue streams. In particular, for the Plastic Surgery Educational Foundation, Plastic Surgery Research Council, American Society of Plastic Surgeons, and American Society for Aesthetic Plastic Surgery, these revenue streams could further promote investments in both clinical care and research. In summary, plastic surgeons should remember that we are innovative problem-solvers and that this differentiates us in a competitive aesthetic market. We must not forget our broad-based training, and we must continue to invest in research that translates into novel therapies. Innovation is our sustainable competitive advantage in a highly competitive and fragmented clinical market. Similarly, our Journal must advance in tandem with innovation in the field, as it has done in the past. That is why we are instituting PRS' Advance Online, to more rapidly disseminate peer-reviewed information and stimulate further innovation in plastic surgery. Additional innovations and changes in the Journal—both in print and especially on-line—will parallel changes in the specialty as a whole. While these innovations will certainly provide a different look and feel to the Journal, each is primarily intended to be a tool in service to the reader in order to advance plastic surgery. They will enable the reader to receive the most up-to-date information in the most technologically advanced and useful formats. Enhanced videos will provide real-time windows into operating rooms; the traditional method of telling how a technique is done will be augmented by showing how on the Web site with these videos. Exploiting Web publication will not only enable the rapid delivery of information but also provide plastic surgeons with a peer-reviewed forum for a scholarly rapid response to the changes in medicine that are taking place much more rapidly than they have in the past. In the end, as plastic surgeons, we must not forget our roots. Origins matter.

Sir: Reliable photographic documentation is fundamentally based on photographic documentary standards that were defined decades ago.1,2 In this article, we raise the question of whether articles published in the top plastic surgery journals adhere to these standards. We analyzed all publications showing photographic documents published in Plastic and Reconstructive Surgery (Lippincott Williams & Wilkins), the Journal of Plastic, Reconstructive & Aesthetic Surgery (Elsevier) and Aesthetic Plastic Surgery (Springer) in 1 year. Overall, 249 publications with patient photographs were analyzed keeping the following photographic documentary standards in view (Table 1).Table 1: Number of Articles Split into Anatomical Regions with Correct Standardized Photographic Documentation Camera angles: Obvious deviations from the standard camera angles described previously1,3 were marked as faulty. Special emphasis was put on comparability between preoperative and postoperative photographs. Posing position: Obvious deviations from the standard posing position described previously1,3 were marked as faulty. In case of differing photographic documentary standards such as the upper limb positioning in breast photographic documentation, each standard was accepted as correct, provided that the standard was consistent between preoperative and postoperative photographs. Background: Each type of monochrome background was accepted. Clothes: Absence of any piece of clothing in the photographed area was assessed as correct. Hairdo: Hair hiding parts of the face, especially the forehead, was marked as faulty. Jewelry: Absence of any piece of jewelry including watches, glasses, and hearing devices was assessed as correct. Makeup: Each obvious makeup product including lash mascara and lipstick was marked as faulty. Mimic: Each visible tension of the mimic muscles, especially smiling, was assessed as a deviation from the photographic documentary standards. Photographic section: For facial photography, we analyzed whether attention was paid to the minimal photographic section, in particular, whether the whole face, and not only close-ups, was photographed. The most important element of photographic documentation is the patient positioning and the angles of photography. Slight deviations from the standards, in particular, differences between preoperative and postoperative photographs, lead to severe distortions of the result. This point has been demonstrated by photographs of a “photographic neck lift” and a “photographic rhinoplasty.”4,5 Facial photographic documentation is most challenging. Any deviation from complete relaxed mimic musculature would clearly affect the result of the photographic documentation. Although it is not easy to detect deviations from the standard mentioned above, we still observed them in 11.3 percent of the publications. Moreover, we were astonished that in one-third of all publications, facial photographic documents with obvious makeup are shown. Of course, photographic documentary standards with regard to absence of any jewelry and clothes are more a matter of taste. Nevertheless, we observed gross negligence of style in photographic documents of the buttock with the pants partly pulled down, of the abdomen with the patient wearing over-the-knees boots, and of a patient's face with colored contact lenses with different colors in different photographs. Although standards of photographic documentation were established years ago, there appears to be a lack of adherence to them in general practice. The importance of following the standards cannot be emphasized enough (Fig. 1).Fig. 1.: Percentages of articles with deficient photographic documentation in the different categories.Stefan Riml, M.D. Agnieszka T. Piontke Lorenz Larcher, M.D. Peter Kompatscher, M.D. Department of Plastic, Aesthetic, and Reconstructive Surgery Academic Teaching Hospital Feldkirch Feldkirch, Austria