Aesthetic Units Research Articles

Aesthetic Unit Boundary Approach to Large Fibroadenoma Resection.

Fibroadenomas are the most common benign breast tumors in adolescents. Surgical excision is indicated when the tumor becomes large or symptomatic. Multiple approaches have been described. However, unsightly scars, excess skin, and breast asymmetry are common challenges after tumor resection. The aims of our study were to describe a concentric circumareolar approach combining the round-block technique and geometric principles in the management of large benign breast tumors. This was a retrospective review of pediatric patients who have undergone excision of large fibroadenoma with concentric circumareolar approach from June 2007 to May 2017. Preoperatively, the excess skin that needed to be resected was marked based on geometric principles. Under general anesthesia, circumareolar deepithelialization of the excess skin and tumor resection were performed. Purse-string suture technique was used to achieve the proper nipple-areola complex size. Satisfactory breast symmetry and minimal scarring were achieved in all 6 patients. One patient developed a small seroma, which resolved spontaneously without intervention. Concentric circumareolar approach can be used to resect large benign breast tumors while concealing the scar along the aesthetic unit boundary of the breast. The cosmetic outcome and recovery were promising. The approach is simple to execute, highly reproducible, and less dependent on intuition.

Forehead flap setting in facial aesthetic units reconstruction

Forehead flap setting in facial aesthetic units reconstruction

Principles of Reconstruction After Mohs Surgery

Reconstruction of cutaneous defects is a key component following completion of extirpative surgery, with a primary aim of restoring form and function to sensitive regions of the face and scalp. We review flap physiology, defect analysis, and reconstructive options in the reconstructive ladder, and describe key principles in unit reconstruction. An overview of time-honored principles and techniques including healing by second intention, skin grafting, and local flaps is described. More contemporary techniques such as the use of perichondrium-cutaneous composite grafts, and multi-layered reconstruction of complex nasal defects including the use of forehead flaps are succinctly discussed. This concise review hopes to highlight key nuances in defect analysis, decision-making processes in choice of reconstruction, and considerations when performing reconstruction on various aesthetic units of the face and scalp.

Fat Grafting Volume Restoration to the Brow and Temporal Regions.

Primary manifestations of facial aging are the reduction in subcutaneous tissue volume, especially the atrophy of fat as well as bone volume depletion which directly contribute to loss of support and laxity of the skin. Depressions and hollows develop with a visible disruption of the cosmetic facial aesthetic units resulting in harsh shadows. This is especially evident in the eyebrow and temporal regions which accentuate the appearance of brow ptosis and a hollow, almost cadaveric look to the temple. Restoration of volume to these areas has been shown to rejuvenate the upper face creating a softer, fuller, and more youthful appearance. Fat grafting by itself or in combination with upper facial surgical procedures plays a major role in the restoration of youthful facial qualities in this region.

Działalność dydaktyczna Zakładu Edukacji Estetycznej i Studiów nad Kulturą

This article is a presentation of the didactic activity of the Aesthetic Education and Cultural Studies Unit. It presents a variety of didactic classes taught currently by the members of the Unit, starting from the study programme of the Art and Media Education specialisation, through obligatory and optional classes addressed to students of the Faculty of Education, to general university courses for students of other faculties and students of foreign universities.

Valcer kao jedan od prostora groteske u delima Alfreda Šnitkea

Humour, as one of the most vital phenomena of human nature and culture, has maintained the status of a special category, which evades being defined accurately. Esti Sheinberg thinks that a prerequisite for experiencing a musical piece as comic is the existence of certain incongruity among its meaningful units. She considers musical irony, satire, parody and the grotesque as correlatives of semantic ambiguities, which use two or more layers of meaning. She emphasises irony as a structural prototype for all other modes of ambiguity. Regarding irony as a phenomenon based on mutually excluding components of semantic opposites, Sheinberg makes a distinction in relation to the grotesque, which originates as a result of juxtaposition of aesthetic units, when contradictory semantic pairs are formed. The irresolvable ambiguity of the grotesque is the result of acceptance, not negation of all aspects of the representing subject. The hyperbolical nature of the grotesque in music is manifested through heightening the extreme within the framework of given parameters, while the exaggerations are noted as such in relation to the standard perceived as a human body and voice. The Dance of Death brings to the fore one of the most significant features of the grotesque - the acknowledgement and accumulation of contradiction, with no tendency to their conciliation. The selected compositions for this study are the examples of macabre waltzes in Alfred Schnittke's opus. After their analysis, a certain level of incompatibility among the meaningful elements of the piece has been located and determined, as well as the relationship between the form and content, and the level of deviation from the set norm. Taking into account the importance of the relationship between the body and movement in general and the grotesque, the significant part of the paper is devoted to Hatten's theory of musical gesture.

Essentials of facial local flaps in respecting aesthetic units when reconstructing skin lesions

Essentials of facial local flaps in respecting aesthetic units when reconstructing skin lesions

Le lifting cervical : évolutions récentes

The neck is an aesthetic unit for which a rejuvenation request is sometimes very targeted or ore often encompassed in a global surgical project of face-lift. To obtain a long lasting outcome, the plastic surgeon has to make a full, detailed, and exhaustive analysis of the neck in order to choose the best indication within the multiple surgical tools. A full clinical examination is the key point, every aspects are outlined. The numerous surgical choices are described, illustrated, and sometimes revisited in the light of targeted anatomical studies. A didactic and graduated way is used to explain the recent evolutions of the surgical tools of the cervical lifting. Complications and insufficiencies in outcomes must be identified and explained. Finally, we illustrate this development by clinical cases. The surgical improvement of the cervical region is, for us, centered on the reconstruction of a cervical retaining structure: the Cervico-Mandibular Angle Suspensor (CMAS) ligament. This element makes it possible to understand and integrate the large number of technical proposals for cervical lifting.

Abstract: Camouflage of Scarring Alopecia By Using Follicular Unit Transplantation

INTRODUCTION: Scarring alopecia usually results from trauma, burn and previous surgery in the aesthetic units of head and neck.1,2,3,4Various treatment options that anti-scar ointments, laser treatments and scar revisions surgeries have been used for treatment of these scars. However, it is difficult to destroy the existing scar with these treatment methods; it is not possible to treat alopecia. In this study, we present our result about the camouflage of the scarring alopecia with follicular unit transplantation in the head and neck area. METHODS: Between 2015 and 2016 years, 27 patients who were treated for scaring alopecia after 13 trauma (4 scalp, 2 sideburn, 3 eyebrows and 4 beard) and 14 cleft lip repair(6 unilateral, 8 bilateral) were included in the study. Firstly the recipient areas were assessed for scar width and maturity, the number of needed donor grafts, the angle and direction of the existing hair around scar. The occipital and post auricular scalp area were selected as donor sides for scalp, sideburn and eyebrow scars. If there were adequate follicular unit in the submental beard region, it was selected as donor side for moustache and beard scar; if were not, scalp was selected again. Two teams that extraction and implantation worked together for shortening the duration of ischemia. Çeviri hatasýAll patients were discharged on the same day with analgesics and antibiotics. The patient was called for control at the 2nd week, 1st, 3rd, 6th, 12th months and digital photographs were taken. Graft survival and patient satisfaction were assessed with Photoshop program and the patient satisfaction scale (1: not satisfied, 0: neutral, 1: moderate,2: good, 3: very satisfied) at postoperative 1 year. RESULTS: There were no major complications in the early postoperative period, transient edema due to tumescence infiltration and pain responding to simple analgesia. In the late period, one epidermal inclusion cyst developed, treated with excision. Mean survival rate of grafts was 86%. 20 patients were very-well satisfied (3), 7 were good (2). CONCLUSION: The scarring alopecia is a challenging problem to deal with affects the social and psychological condition of the patient in the aesthetic units.2,3 Focal unit extraction technique(FUE) hair and beard transplantation is an easy, low cost, minimally invasive and alternative treatment with high success and satisfaction rate in scar camouflage.2,4 Reference Citations: 1. Umar S. Use of beard hair as a donor source to camouflage the linear scars of follicular unit hair transplant. J Plast Reconstr Aesthet Surg. 2012 Sep;65(9):1279–80. 2. Barr L, Barrera A. Use of hair grafting in scar camouflage. Facial Plast Surg Clin North Am. 2011 Aug;19(3):559–68. 3. Epstein J. Facial hair restoration: hair transplantation to eyebrows, beard, sideburns, and eyelashes. Facial Plast Surg Clin North Am. 2013 Aug;21(3):457–67. 4. Barrera A. The use of micrografts and minigrafts in the aesthetic reconstruction of the face and scalp. Plast Reconstr Surg. 2003 Sep;112(3):883–90.

A novel technique using a subcutaneously pedicled islanded prolabial flap for the secondary correction of bilateral cleft lip and nasal deformity.

Context:The bilateral cleft lip and nose deformity frequently requires lip revision surgery at the time of secondary rhinoplasty. The goal is to achieve an adequate philtrum with a well-shaped Cupid's bow, white roll alignment and a central vermilion tubercle.Aims:We have devised a new technique of using prolabial tissue tailored as an island of skin based on a subcutaneous pedicle for the secondary reconstruction of the philtral aesthetic unit in patients with bilateral cleft lip nasal deformity.Settings and Design:This technique was used in 21 patients from March 2012 to August 2015. All patients had undergone primary lip repair at other institutions and required lip revision with simultaneous rhinoplasty.Subjects and Methods:The objective criteria considered in the post-operative evaluation by the authors included improvement of philtral ridge projection, symmetry of philtral column and nasal sill and white roll continuity. The ten individual parameters were given a score from 1 to 4 (with 1 = lowest and 4 = highest for each individual parameter) and the total score was rated as 31–40 = excellent, 21–30 = good, 11–20 = fair and 0–10 = Poor. The patients' overall satisfaction was assessed at 6 months postoperatively to record their impression of the aesthetic improvement after our procedure.Results:The follow-up period ranged from 6 months to 3 years. The prolabial flap had no post-operative complications. The authors' assessment judged 15 (71.4%) patients as having an excellent outcome and 6 (28.5%) patients as having a good outcome. All patients expressed subjective satisfaction with the post-operative appearance of their upper lip and rated their results as improved and overall satisfaction scoring was high.Conclusions:This technique is a new addition to the repertoire of procedures which already exist for the correction of bilateral cleft lip nose deformity. It is safe, reliable and has a good aesthetic outcome with no significant morbidity.

Prefabricated maxillofacial and excessively expanded cervical skin flap for aesthetic unit reconstruction in the cheek

Objective To explore a method for repairing the appearance and function of the cheek aesthetic unit. Methods A single volume of 100 ml to 150 ml of tissue expander was implanted at the lower edge of the injury area on the cheek. The first injection was performed 5 days after the operation and twice a week after the injection. It took an average of about 4 months to complete the expansion, with 3-5 times over-expanded. The lesions were resurfaced with the expanded flaps, and long-term follow-up was observed for flap survival. Results 17 cases of cheek lesions had been successfully reconstructed, with the color, texture of the expanded flaps well matched to the surrounding skin after 3-12 months follow-up. The facial expression functions and configurations were satisfied. Conclusions Excessive expansion of the prefabricated skin flap of the jaw and neck can repair the cheek aesthetic unit successfully, which is a practical method and meets the needs of aesthetic unit repair. Key words: Cheek; Aesthetic unit; Skin flap; Tissue expander

Prognostic factors in head and neck melanoma according to facial aesthetic units.

Head and neck melanoma is a clinical challenge. Indeed, cutaneous head and neck melanoma shows a worse prognosis in comparison to melanomas of other body sites. Although the emphasis on facial cosmetic preservation plays a pivotal role in comparison to other body areas, specific Facial Aesthetic Units (FAU) could also play a key role in the prognostic evaluation of the malignancy. The aim of the current study was to evaluate the general outcome and clinicopathological features of head and neck melanoma and to detect prognostic differences according to each FAU. The Kaplan-Meier product was used to calculate survival curves, while Cox proportional-hazard regression was performed to evaluate the predictive value of each FAU. A total of 221 head and neck melanoma patients was included in our analysis. In the nasal FAU, we found a high rate of local recurrence, which affected significantly disease-free survival. The worse prognosis was observed in melanoma of the scalp, which showed a greater tendency to skip metastases in internal organs. Moreover, we found that scalp showed a low incidence of non-melanoma skin cancers, if compared to other FAU, highlighting that the scalp local milieu might play a more prominent role in melanoma biology than chronic UV exposition. Although FAUs have an aesthetic function, they could also play a role in the evaluation and follow-up of melanoma.

Upper Lip Reconstruction

Reconstruction of an aesthetically acceptable and functional upper lip requires a careful consideration of the transverse and vertical soft tissue, muscle, and skin deficiency. This review focuses on the reconstructive aspects of the upper lip. The functional anatomy of the upper lip is considerably complex and includes paired muscles in addition to the orbicularis, elevators of both the upper lip and commissure. The muscular action of facial expression recruits different sets of these paired muscles. Unlike the aesthetic uniform appearance of the lower lip commissure to commissure, the upper lip aesthetics can be divided into a central, philtrum unit, and a lateral upper lip unit. The lateral unit can be further subdivided into medial and lateral elements, with the medial more fixed and less mobile because of attachments superiorly at the alar sill and base. Reconstruction of the philtrum is best accomplished with an Abbe flap. Methods to reconstruct the lateral unit hinge on location, medial versus lateral, and defect size. A conceptual approach to successful reconstruction of upper lip defects entails the use of a classification based on the aesthetic unit, appropriate selection of the reconstructive option for a particular defect driven by location and size, and careful consideration given to a final result in harmony both transversely and vertically with the lower lip and the remainder of the midface.

Free flaps in scar treatment.

Introduction:Scar management needs defined concepts and an algorithm to restore functional and aesthetic units. After an unsuccessful conservative treatment, surgical measures provide a vast spectrum of possibilities for remediation. The spectrum of possibilities consists of excision and Z-plasty, regional flaps, vascularized pedicled flaps, tissue expansion, and finally free tissue transfer. Severe scarring and highly destructed tissues with inferior functional and aesthetic units can be effectively treated with radical excision and free flap reconstruction. The complexity of flap architecture and tissue qualities allows for an individualized approach. Specific attention should be paid to the long-term consequences of severe scarring with progressive loss of functionality.Materials and methods:We worked out the most common surgical approaches and treatment algorithm for a stepwise and effective approach. Part of this algorithm is a seven-step surgical approach.Results:This article provides modern plastic and reconstructive surgery concepts with an algorithm for scar management.Discussion:The treatment of scars follows an algorithm with the level of complexity of techniques adjusted to the individual case and the conditions. Disabilities induced by scarring can lead to further functional loss. In these cases, surgical strategies have to be considered.

Refining the extended circumflex scapular flap for neck burn reconstruction: A 30-year experience

Neck burn sequelae remain a major challenge for the reconstructive surgeon. To achieve satisfactory functional and aesthetic results, the anterior neck aesthetic unit must be covered as a single unit. In cases where free flaps are required, harvesting a flap of sufficient size can cause major donor site morbidity. In 1994, we published our favorable 6-year experience of reconstructing neck burn sequelae with an extended circumflex scapular flap (ECSF). Since then, we have made several modifications to the technique, resulting in improved long-term functional and aesthetic results. Herein, we present our 30-year, 150-patient experience with the ECSF flap for the treatment of anterior neck burn sequelae. We retrospectively reviewed the records of 150 consecutive patients who underwent ECSF procedure for neck resurfacing performed or supervised by the senior author from 1986 to 2015. All cases were assessed for function, aesthetics, satisfaction, and complications. A total of 160 ECSFs were used in 150 patients. Ninety-nine patients were available for updated follow-up [1-30 years (mean, 15.3)]. At the last follow-up, 92 patients regained full range of motion, and 90 patients had acceptable cervicomental angle (<110°). The mean patient satisfaction score was 4.8/5. Nine flaps (5.6%) failed completely and were successfully replaced. Twenty-two patients (15%) had distal necrosis of the flap. Fifteen of these 22 patients underwent complementary flaps to replace the necrotic area, and all 15 patients regained full range of motion. For neck burn sequelae, the ECSF provides safe and effective long-term functional and aesthetic results with minimal donor site morbidity.

Occupational stress of anesthesia: Effects on aging

BackgroundAnesthesiology has been identified as a stressful specialty. Chronic psychological stress may lead to biological aging and skin aging. Study objectiveThe primary outcome was to measure physical health and emotional well-being. Secondary outcomes include skin aging analysis, telomere shortening in anesthetists. DesignThis is a prospective observational study. SettingsUniversity of Alexandria. PatientsStudy was carried out on 366 ASA I–II physicians 30–50yr. InterventionsPhysicians were categorized into two equal groups, Group A (183) were anesthesia physicians and Group B (183) were physicians in less stressful specialties (laboratory specialties). Subgroup analysis was performed comparing 10years' intervals from (30–40) and from (40–50). MeasurementsPhysical health and emotional well-being were evaluated. All physicians were exposed to validated assessment scales for the upper face and the lower face for skin aging analysis. Blood sampling were drowned from all physicians during their working hours for analysis of telomere length, markers of oxidative stress. ResultsThe two studied groups showed comparable demographic data and years of work. Physical health score and emotional health score showed higher values in Group A than Group B. Upper and lower face aesthetic unit summary score showed higher values in Group A than Group B. Telomere (TTAGGG) repeats for terminal restriction fragments (TRF) of Group A individuals revealed a significant decrease of TRF compared to Group B (p=0.001*). ConclusionBiological and skin aging is evident in anesthetists who are chronically exposed to occupational stress, with obvious shorter telomere length, higher lower and upper face scores, and free radicals.

Reconstruction of Skin Defects on the Mid and Lower Face Using Expanded Flap in the Neck.

The reconstruction of major burn and other deformities resulting from significant soft tissue deficits of the face is a continuing challenge for surgeons. In the study, the authors introduce our 5-year experiences using expanded flap in the neck for reconstruction on the mid and lower face. From 2008 and 2013, 12 tissue expanders were used in 12 patients for face resurfacing. The operation consisted of 2 steps. In the first step, the expander was placed subcutaneously under the skin of the neck and they were expanded timely to create adequate superfluous skin and soft tissue. In the second step, the expanded flap was transferred to reconstruct the defects on the mid and lower face after excision of the lesions. All 12 patients with lesions on the mid and lower face underwent successful facial resurfacing with the described technique in the last 5 years. The follow-up ranged from 6 to 24 months. Flaps did not shrink after the operations, and subsequent contractures did not recur. The cervicomental angle appeared normal. All flaps survived well except 2 patients developed slight necrosis at the distal edge and no other major complication was observed. Esthetic outcomes were rated to be very good in 10 patients (83.3%) and good in 2 patients (16.7%). The application of expanded flaps in the neck is proved to be an effective way of repairing facial defects on the mid and lower face. The technique is remarkably reliable in resurfacing the peripheral facial esthetic units.

Lipostructure Plus Platelet Rich Plasma Injections for Enophthalmos Treatment in Patients Carrying Prosthetic Eye- Safety and Efficacy

Purpose: To describe one-year functional and aesthetic outcomes in patients with post-enucleation enophthalmos who underwent lipostructure plus platelet-rich plasma injections. Materials and Methods: 26 patients treated with orbital lipostructure and three platelet rich plasma injections at 1, 2 and 6 months after surgery were retrospectively assessed. Photographs of all patients were taken preoperatively and at 1 and 12 months after surgery. The area of each eye lid esthetic unit/subunit was calculated, both in frontal and profile images. Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, Illinois, USA). Paired t-test was used to compare the unit/subunit areas before and after surgery. Differences were considered significant when P &lt;0.05. Results: Comparing baseline to 1-month images, an improvement of the enophthalmos appearance was observed in all patients. Analysis of each single esthetic units was performed, with an overall unit area reduction of 19.8%. Comparing the two postoperative images, the overall amount of resorption was 12.75%. The surgical procedure appeared to be well tolerated in all cases. Minor complications regarding the lower eyelid were recorded in 6 cases. Conclusions: lipostructure plus platelet rich plasma injections proved to be a valid and effective option for the treatment of post enucleation socket syndrome.

Discriminative Thresholds in Facial Asymmetry: A Review of the Literature.

Facial symmetry is intimately correlated with attractiveness. Perfect facial symmetry is disconcerting and a degree of facial asymmetry is considered normal. There is a lack of data on the limits of normality across facial subunits. This systematic review aims to establish categories of facial asymmetry perception for facial aesthetic units by establishing a discriminative threshold of "deformity perception" across facial subunits and a threshold for intervention (unacceptable asymmetry). A review of the literature was performed across Medline and Embase databases using OvidSP. All prospective studies evaluating the perception of progressive facial asymmetry in laymen or clinicians using a two- or three-dimensional model were included. Studies that did not evaluate rates of perception at varying degrees of asymmetry were excluded as these did not allow for the identification of a perceptive threshold. Each facial feature possesses a unique threshold of perception defined by an abrupt, statistically significant increase in detection. Asymmetry of the eyelid position at rest is the most sensitive facial feature (perceptive threshold, 2 mm) (P < 0.02). This is followed by deviations of the oral commissure (3 mm) (P < 0.001), brow position (3.5 mm) (P < 0.001), nasal tip deviation (4 mm) (P < 0.001), and chin deviation (6 mm) (P < 0.001). Desire for surgery for worsening deformities beyond the intervention threshold is characterized by an exponential, rather than linear, correlation. Categories of facial asymmetry perception establish a framework to counsel patients with facial asymmetries, and are a valuable adjunct to clinical judgment in the management of static and dynamic facial deformities.

Retrospective Analysis of Facial Dog Bite Injuries and Surgical Management at Plastic Surgery Centre: 10 Years' Experience, Vilnius University Hospital, Lithuania

Introduction: Facial dog bites injuries are high risk of contamination, complex and cosmetic outcome is at its great importance. Methods: 81 consecutive patients (46 adults and 35 children) treated for facial dog bite injuries at Plastic and Reconstructive Surgery Centre of Vilnius University Hospital, Lithuania between 1993 and 2012 were retrospectively reviewed. The following information recorded: age, number of facial aesthetic units involved, tissue loss, the duration between injury and surgical repair, type of repair, and complications. We divided patients in to two groups for analysis of the results. Patients with one facial aesthetic unit involved and patients with more than one aesthetic unit involved. Results: First group of the 54 patients (38 adults and 16 children) with one facial aesthetic unit involved. 47 out of 54 wounds were with tissue loss, 7 out of 54 bite wounds without tissue loss. All 7 wounds without tissue loss were directly repaired. Out of 47 wounds with tissue loss 2 were directly repaired, 2 left to heal by secondary intention and 43 required reconstruction surgery with composite graft, skin graft, local or regional flaps. 76% of repairs were performed within 24hours from the injury. 7 complications (13%) were recorded. 1 wound infection after direct closure and 6 out of 7 (86%) complications were composite graft loss. Second group of 27 patients (8 adults and 19 children) with more than one facial aesthetic unit involved. All 14 cases without tissue loss underwent primary closure. Out of 13 wounds with tissue loss 1 repaired directly, 12 required reconstructive surgeries. In this patient group were 5 complications (19%). Conclusions: Children are more likely to sustain injury to multiple facial aesthetic units following dog bite. Direct repair of facial dog bite injuries is safe.