Plastic Procedures Research Articles

Zoom Boom or Bust? Understanding Post-Pandemic Interest in Facial Plastic Surgery via Google Trends.

To understand post-pandemic interest in plastic surgery procedures via Joinpoint analysis of Google Trends search data. Google Trends was used to quantify search volumes from January 2019-December 2022 for select cosmetic face and body procedures in the United States. A keyword analytic tool (Keywords Everywhere) extracted absolute search volumes (average monthly searches). Joinpoint analysis assessed search trends over time reported as monthly percentage change (MPC). All procedures queried, including a non-cosmetic control (cataract surgery), demonstrated expected declines at the start of the COVID-19 pandemic. Blepharoplasty, face lift, neck lift, and Botox demonstrated statistically significant increase in search volumes that remained elevated relative to pre-pandemic levels. Rhinoplasty, fillers, and abdominoplasty interest increased initially followed by return to pre-pandemic levels by the end of 2022. The remainder of search terms did not show a clear temporal associated with COVID-19 lockdowns. The "Zoom Boom" appears to be a real phenomenon reflected by sustained increase in public interest in relation to facial plastic procedures. NA Laryngoscope, 2024.

Use of Intravenous Tranexamic Acid in Patients Undergoing Plastic Surgery: Implications and Recommendations per a Systematic Review and Meta-Analysis.

With increasing interest in aesthetic plastic procedures, the event of blood loss has compromised patients' safety and satisfaction. Tranexamic acid (TXA) is a drug used for the reduction of blood loss during surgical procedures. This systematic review aims to evaluate the clinical efficacy and safety of TXA in aesthetic plastic surgery for the reduction of bleeding and related complications. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. The medical subject headings (MeSH) keywords used for data extraction were ("TXA," OR "tranexamic acid,") AND ("plastic surgery," OR "aesthetic surgery," OR "rhinoplasty," OR "blepharoplasty,") AND ("blood loss" OR "bleeding" OR "TBL") AND ("Edema" OR "ecchymosis"). A combination of these MeSH terms was used in the literature search. The timeline of research was set from 2015 to January 2024. A total of 7380 research articles were identified from the above-mentioned databases, and only 13 research articles met the inclusion criteria. There was a significant difference in total blood loss (TBL) among patients who had undergone plastic surgery procedures while on TXA as compared to a placebo (mean difference = -6.02; Cl: -1.07 to -0.16; p > 0.00001), and heterogeneity was found (degrees of freedom (df) = 9; I2 = 97%). Only two studies reported the average ecchymosis scores after TXA among interventions in comparison to the placebo group. This review provides evidence that TXA lowers TBL, ecchymosis, edema, and anemia during cosmetic surgery without significantly increasing thromboembolic consequences.

THE USE OF A MODIFIED DEEPITHELIALISED FREE GINGIVAL GRAFT IN THE TREATMENT OF GINGIVAL RECESSIONS ASSOCIATED WITH INTERPROXIMAL BONE LOSS. CASE REPORT

The prevalence of gingival recessions is very high, and it increases with age. The gingival recessions occur frequently in populations both with high and low standards of dental care. Gingival recessions are surgically treated to improve aesthetics, reduce root hypersensitivity. Recently, the coronally advanced flap is more frequently used, displacing the free gingival graft and the laterally positioned flap. Connective tissue graft or a deepithelialised free gingival graft is often used in combination with coronally advanced flap. It has been stated, that periodontal plastic procedures may predictably determine complete root coverage in multiple Miller class I and II recessions. According to the treatment of multiple Miller class III recessions, there is lack of evidence by clinical trials in the literature. It should be considered, that dealing with multiple recessions can be associated with different limitations in the same surgical area, such as interproximal bone loss, larger avascular surface, position of the teeth, high muscle and frenulum attachments, etc. There is a quite big difference in the literature according to the data of complete root coverage percentage. Another problem is dealing with black triangles because of interproximal bone loss. Of course, patients expect not only recession closure, but also papillary reconstruction. But it is very hard to predict a complete root coverage at Miller class III recession and papillary reconstruction at the same time. The purpose of this clinical report is to evaluate the effectiveness of the coronally advanced flap in combination with modified deepithelialised free gingival graft (MDFGG). The scalloped form of the deepithelialised free gingival graft in combination with the coronally advanced flap helped to solve two problems simultaneously: recession closure and papillary reconstruction. The results lead to further researches for the treatment of Miller class III and IV recessions, and also papillary reconstruction techniques.

Are Gender-Affirming Plastic Surgeons Adequately Compensated? An Analysis of Relative Value Units.

Gender-affirming surgery (GAS) has a complicated history within US health care. As GAS procedures and reimbursement availability continue to uptrend, the present study aims to investigate whether compensation is equitable between GAS procedures and general plastic surgery procedures. The National Surgical Quality Improvement Program database was queried for all surgeries performed by plastic surgeons from 2016 to 2020. Cases were assigned to the GAS or non-GAS cohort using ICD-10 codes. Duplicate Current Procedural Terminology (CPT) codes were removed for analysis. Operative time, total wRVUs, wRVUs per hour (wRVU/h), reoperation/readmission rate, and number of concurrent procedures were compared between the cohorts. A total of 132,319 non-GAS and 3,583 GAS were identified. After duplicate CPT removal, 299 cases (21 unique CPTs) remained in the GAS cohort and 20,022 (37 unique CPTs) in the non-GAS cohort. Operative time was higher in the GAS cohort (262.9 vs 120.7 min, P < 0.001), as were total wRVUs (59.4 vs 21.6, P < 0.001). Reoperation/readmission rate (7.0% vs 6.0%) and wRVU/h (15.8 vs 15.1) were not significantly different (all P > 0.05). There was a positive correlation between total operative time and total wRVUs (P < 0.001) and a negative correlation between total operative time and wRVU/h (P < 0.001). Proportional wRVUs are allocated to gender affirming plastic procedures. However, the RVU scale does not allocate proportional wRVUs to longer operative times for both GAS and general plastic surgeries. Compensation for gender affirming plastic surgeries is higher than that of general plastic surgeries; however, there is no difference in wRVUs per hour on comparison.

A case of successful treatment of arterial and biliary complications in a patient after liver transplantation

In April, 2018, a 57-year old patient with cirrhosis of the liver (Child-Turcotte-Pugh B class) during the outcome of viral hepatitis B and C was performed Transjugular Intrahepatic Portosystemic Shunt (TIPS); and in June, 2018 – liver transplantation (LТ) from a deceased donor by Piggyback technique. In the postoperative period, abscesses in the left and right lobes of the liver and thrombosis of the hepatic artery thrombosis (HAT) were noticed. Balloon dilatations of biliary stricture with changes of biliary drainage were made during the period of 2 years. In May, 2022, according to the results of angiography, hepatic artery and its branches were seen up to segmental level that meant natural revascularization. Considering the low efficiency of the balloon plastic procedures carried out, there was formed trihepaticojejunostomy on the loop of the small intestine disconnected according to Roux-en-Y. The follow-up period is one and a half years; there are no signs of cholangitis and biliary hypertension.There is no unified scheme of treatment for vascular and biliary complications in the clinics engaged in LТ, because every technique has both advantages and disadvantages. The idea of choice between intervention revascularization, transplantation and surgical reconstruction in the treatment of arterial thrombosis still remains incompletely understood.

Penile prosthesis with contemporary plastic procedures in obese patients: complication and satisfaction rates in a day-case surgery setting

Penile prosthesis with contemporary plastic procedures in obese patients: complication and satisfaction rates in a day-case surgery setting

Anesthesia for office-based facial plastic surgery procedures.

The objective of this study is to provide a state-of-the-art review on the use of anesthetics for in-office facial plastic procedures. A search was performed on PubMed, Embase, Web of Science, and Cochrane Review using the keywords "anesthesia," "office-based procedures," "local anesthesia," "facial plastics," "oral sedation," "moderate sedation," and "deep sedation." Over the past few decades, the shift toward in-office invasive procedures has increased patient convenience and decreased hospital resource utilization. Many tools exist to reduce patient anxiety and discomfort in an office-based setting. With proper patient selection and technique, facial plastic surgeons can adequately anesthetize patients to perform Mohs reconstruction, cutaneous excisions, blepharoplasty, face-lifts, and other in-office procedures.

Equipping your facial plastic clinic for office-based procedures.

Office-based procedures can be a fulfilling part of the facial plastic practice with the right tools, personnel, and preparation. Equipping the clinic for office-based procedures has several unique considerations that ultimately impact its success. It is important to strategize preemptively regarding what treatments will be offered and the respective equipment that will allow the safe, cost-effective, and high-quality delivery of those treatments. Most procedures in the office-based setting are cosmetic in nature and there are often overlapping treatment modalities that target similar outcomes. Patient selection and counseling is a crucial step in preparing for office-based procedures in the effort to maximize patient satisfaction. Nearly all the most common facial plastic procedures can be delivered in the office-based based setting under local anesthesia and moderate sedation, depending on the expertise of the surgeon. To enable these and other categories of treatments, there are certain expensive pieces of technology that one might consider for their office-based practice and other fundamental supplies that are necessary for almost all practices. Though the initial investment in equipment can be costly, this article also discusses more affordable alternatives or third-party sales of devices and equipment. The field of facial plastic surgery is very dynamic and having both peer and mentorship networks is invaluable in navigating some of the financial decisions discussed herein. This article also briefly covers personnel, training, and accreditation considerations.

The I-STOP Program and Narcotic Prescriptions Following Facial Reconstructive Plastic Surgeries.

To explore the effect of e-prescribing requirements on narcotic dispersion in New York State. Slicer Dicer was used to identify patient records based on CPT codes. We investigated the influence of New York State e-prescribing requirements on narcotic dispersion following five common facial plastics procedures. Slicer Dicer was used to identify patient records based on CPT codes.We then looked at narcotic prescription rates following those surgeries between March 2014 and March 2018 at an academic institution. Overall, between March 2014 and March 2018, 76.1% of the sample received a narcotic prescription following a facial reconstructive plastic surgery. Patients who underwent rhinoplasty were most likely to receive a prescription for postoperative narcotics. The implementation of ISTOP, CPT code, use of non-narcotic adjuvant, and insurance type were each significantly associated with prescription of postoperative narcotics. Surgery time and age in years were significantly associated with prescription of postoperative narcotics. Ultimately, when controlling for the aforementioned clinical and sociodemographic variables included in the study, those who underwent surgery after the implementation of ISTOP were 42.8% less likely to receive a prescription for postoperative narcotics, aOR = 0.572, 95% CI 0.356, 0.919, p = 0.021. New York State's ISTOP program has succeeded in reducing the number of postoperative narcotic prescriptions following facial plastic reconstructive surgeries at this academic institution. However, opioid medications can still be utilized for postoperative analgesia when clinically appropriate. 3 Laryngoscope, 134:1208-1213, 2024.

Office-based facial plastics procedures: Neuromodulators.

Botulinum toxin is a potent neuromodulator commonly used for cosmetic applications in the clinic. In this article, we reviewed the various formulations of botulinum toxin type A commercially available in the United States, as well as clinical pearls for preprocedural planning, common in-office injections, and management of complications.

Cost and value of office-based facial plastic and reconstructive surgery procedures.

This chapter will provide an overview of factors affecting the cost of office-based procedures in Facial Plastics and Reconstructive Surgery (FPRS), and will discuss the value of office-based interventions. An in-depth literature review was conducted using multiple primary and secondary sources. Literature from multiple disciplines was included in the review, including otolaryngology, anesthesiology, surgery, public health, and economics. A wide variety of procedures can be performed in an FPRS office. Large upfront costs to the office include laser, electrocautery and surgical equipment. These investments will yield an initial negative cost margin until sufficient case volume is achieved. It is often in the best interest of the patient to perform a procedure in-office and avoid the facility and anesthesia fees associated with a surgical center or hospital. Costs and reimbursements vary greatly across regions and facilities. Additionally, overall cost depends on payer mix, procedures performed, and productivity of the practice. The scarcity of literature on this topic as it applies specifically to FPRS indicates that further research is needed to elucidate the value of common facial plastics procedures in an office-based setting.

Evaluation of pathogen distribution and antimicrobial resistance in breast plastic surgery infection.

The demand for mammaplasty has increased in recent years, and infection remains one of the common and serious post-operative complications. In this study, we analyzed the pathogen distribution and antibiotic susceptibility of breast plastic surgery infections, and compared the differences in pathogenic species between surgical procedures. The number of each species was counted in the microbial samples of breast plastic surgery infections in Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2011 to December 2021. The in vitro antibiotic sensitivity testing data were analyzed using WHONET 5.6 software. The surgical techniques, the period of infection, and other details were gathered in accordance with the clinical data. There were a total of 42 cases included, and 43 different types of pathogenic bacteria, mostly gram-positive bacteria, were found. CoNS (13/43) and Staphylococcus aureus (22/43) made up the majority. The most prevalent of the five Gram-negative bacteria was Pseudomonas aeruginosa. Results of drug sensitivity tests indicate that S. aureus is highly sensitive to vancomycin, cotrimoxazole, and linezolid, whereas CoNS is highly sensitive to vancomycin, linezolid, and chloramphenicol. Both of these bacteria show high resistance to erythromycin and penicillin. Breast augmentation, breast reconstruction, and breast reduction surgery were the most frequently associated breast surgery procedures in this study with infections, with the highest number of infections occurring following breast augmentation with fat grafting, breast reduction surgery, and breast reconstruction with autologous tissue. Various breast plastic surgery procedures have different common pathogens of infection, but the most prevalent are CoNS and S. aureus. Additionally, the majority of the infections in this study were in the early stages. Gram-positive bacteria were the predominant cause of breast plastic surgery infections, and the types of infection strains, the period of infection onset, and the antibiotic susceptibility of prevalent strains varied between breast plastic procedures.

Comparative Evaluation of Antibacterial Efficacy of Cetylpyridinium Chloride and Chlorhexidine Gluconate Mouthwashes after Periodontal Surgery - A Randomized Clinical Study

Background: Periodontitis affects 20-50 percent population is and has various systemic interrelationship. Treatment of periodontal disease requires a holistic approach. Prevention of bacterial accumulation at surgical site is crucial to minimize post-operative complications. The principal cause of post-surgical infection is bacterial colonization due to the wicking effect of the sutures. Despite numerous factors, pathogenic biofilm formation continues to play a crucial role in disease progression. Hence, a comprehensive approach with the goals of infection control, periodontal tissue regeneration, and function restoration becomes a necessity. In this study, we assessed the antibacterial efficacy of Chlorhexidine (CHX) and Cetylpyridinium Chloride (CPC) mouthwashes after periodontal surgery. Material and Methods: In this single-centric, prospective, randomized study, patients undergoing various periodontal surgeries including flap procedures, crown lengthening, resective osseous surgeries, implant placement and periodontal plastic procedures following placement of simple interrupted sutures using monofilament PTFE sutures to reduce the wicking effect. Patients included were &gt;18 years of age, while those with any systemic diseases, pregnant and lactating women, smokers or any other deleterious habits, immune and mental disorders, unwilling to participate were excluded from the study. A total of 46 patients were randomized using envelope method to either one of the two types of mouthwashes CHX or CPC for 10 days post-periodontal surgeries and the sutures were removed after 10 days for CFU analysis. Results: Out of total 46 participants more than half were males (26) and the mean age of participants was 32.53 years (range 18-65 years). Maximum periodontal surgeries were flap procedures (21) and crown lengthening (15) while remaining included osseous surgery (5), perioplastic procedures (3) and implant procedures (2). There was a statistically significant difference seen for the values between the groups. Group I CPC had average CFU count (Mean 1.2x1010) Group II CHX had (Mean 1.2x108) The p value of Mann-Whitney U test was &lt;0.01. Conclusion: Though the bacterial load was reduced by both types of mouthwashes, our study observed better antibacterial effectivity with CHX as compared to CPC. The findings of the study also highlighted the importance of careful adjuvant therapies regardless of the type of periodontal surgery. Keywords: Periodontal surgery, Cetylpyridinium chloride, Chlorhexidine gluconate, mouthwashes, periodontitis, biofilm, Plaque, Wound healing.

VACUUM ASSISTED CLOSURE THERAPY IN MANAGEMENT OF CHRONIC NONHEALING ULCER IN TERTIARY CARE CENTRE -A RANDOMIZED CONTROLLED STUDY

Background: Chronic non healing Ulcers pose a signicant and challenging health as well as economic problem, as it needs long term surgical and nursing care whether it is a Burn wound, Diabetic ulcer or pressure ulcer. Ulcers are also susceptible to complications like infection and thus sepsis and limb loss. Vacuum-assisted closure (VAC) is an alternative method of wound management, which uses the negative pressure to prepare the wound for spontaneous healing or by lesser reconstructive options. All this improves the possibility of primary closure of wounds and reduce the need for plastic procedures. To study about wound healing using Vacuum Assisted clos Aim: ure therapy in management of non-healing ulcer in tertiary care centre. 50 patients who are admitted with chronic foot ulcers Methods: in General surgery department, Kanyakumari medical college are included during the study period from July 2022-march 2023. The patients are randomized in to two group with 25 patient on conventional therapy and 25 patients as study group with V.A.C. The results were tabulated and analysed. Out of 25 non healing ulcer patients, in more Results: than 92 percent patients (23patients) granulation tissue was achieved by VAC dressing at the end of 5th Week. All 23 cases were discharged, 2 cases were followed by split skin graft and only one case was amputated .No mortality .However in the control group only 19 patients were healed, 4 cases went for amputation and there were two mortality. The V.A.C impact on Microbial ora is very signicant and duration of hospital stay is also signicant . VAC therapy appears to be an effective and feasible alternat Conclusion: ive method in the management of chronic non-healing ulcers

Accessory columellas: A case series on surgical method and short-term postoperative course.

Accessory columellas are rare congenital anomalies characterized by skin appendage in the columella of the nostril. Case reports are scattered, but there are few descriptions about the clinical features and surgical course. In this study, 3 patients with 4 lesions were identified (2013-2020). They were morphologically classified, and the accompanying nose deformity, surgical procedure, and postoperative course were examined. According to the morphologic classification, 1 lesion was of the sessile-lobed type, 2 lesions were of the sessile-nodular type, and 1 lesion was of the pedunculated-ovoid type. In terms of accompanying nose deformities, 1 lesion had a wide nasal columella, and 1 lesion had an enlarged left nostril due to a depression at the base of the lesion. Simple ablations were performed in 2 of the lesions, and plastic procedures were performed in the 2 lesions with an accompanying nose deformity. As in our cases, accessory columellas may have a variety of appearances and accompanying deformities. The surgical procedure must be considered according to the case. In addition, any changes due to growth must be observed and taken into consideration when they are reoperated.

Comparative evaluation of patient response and appearance after being treated for gingival hyperpigmentation with various surgical techniques involving the use of diamond bur, scalpel, laser and, electrocautery technique: A case series

The gingival colour is important in facial beauty of individual. Excessive melanin deposition is ultimate cause of ginigival hyperpigmentation. The degree of pigmentation varies from person to person and is determined by variety of factors, particularly melanoblastic activity. Gingival depigmentation is an periodontal plastic procedure in which hyperpigmented gingiva can be removed by various techniques. The technique selection should primarily be based on clinical experience and individual preferences, with primary indication of demand for improved esthetics. Each technique has its own advantages and disadvantages. Re-pigmentation after gingival depigmentation is important point of which clinicians should be aware. The present case series describes four treatment modalities and their outcomes in patients.

Black Triangle and Vitiated Esthetic Vis-à-Vis Management: A Review

Along with functional periodontal health, esthetic demand is increasing among patients. Creating a perfect smile through periodontal plastic procedures or multidisciplinary approaches involving orthodontic, restorative, and prosthetic specialties is a real challenge in esthetic dentistry. “Black triangle” is one of the common causes that can compromise esthetic. Black triangle is open gingival embrasure cervical to interproximal contact. Its presence may also cause problem in phonetic and retention of food debris. This article discusses the definition, causes, classification, prevalence, and various approaches in handling the case of black triangle.

Treatment of Multiple Gingival Recessions Using Modified Tunnel Technique with V-reverse Sutures: A Report of Three Cases

The clinical case series presents a minimally invasive modified tunnel procedure with autogenous connective tissue graft (CTG) using a V-reverse sutures to treat multiple gingival recessions. In periodontal and peri-implant plastic procedures, proper graft and flap stabilization are crucial in the outcomes. The coronally advanced flap allows for better access with the possibility of suturing the graft to the de-epithelialized papillae of the periosteum; there is little evidence with using the V-reverse sutures technique in stabilizing the graft and the flap when performing tunnel techniques (TUN). The following case series presents a minimally invasive modified tunnel procedure with autogenous CTG using V-reverse sutures to treat gingival recessions. Three patients with Miller Class I maxillary buccal gingival recessions defects were selected for this study. All subjects were treated with the minimally invasive modified tunnel technique with autogenous subepithelial CTG. V-reverse sutures technique was performed to further improve the stability of the graft at the recipient site. Clinical parameters, including mean recession depth and root coverage esthetic score (RES), were recorded at baseline, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1-year postoperative follow-up visits. At the 1-year follow-up, complete root coverage was achieved in multiple gingival recessions defect sites. In conclusion, this technique represents an alternative treatment for Miller Class I gingival recessions defects with clinical and esthetically satisfactory outcomes. Combining the advantages of V-reverse sutures and CTG in the treatment of gingival recessions is feasible and noninvasive.

Major and minor risk factors for postoperative abdominoplasty complications: A case series

BackgroundAlthough abdominoplasty is a safe and popular surgery, it is associated with a higher complication rate than other body contouring procedures. Therefore, identifying predictive factors of major and minor complications in patients who have undergone abdominoplasty is necessary to achieve better treatment outcomes after major weight loss. MethodsThis retrospective study analyzed the medical records of patients who underwent abdominoplasty between January 2016 and December 2019. The inclusion criteria were patients aged >18 years who underwent abdominoplasty as the only surgical procedure and had adequate follow-up. Other patients were excluded from the study. Statistical evaluation was performed using SPSS 20.0; statistical significance was set at a P-value of <0.05. ResultsThe study included a total of 152 patients, of whom 146 (96.1%) were women and 6 (3.9%) were men. The mean patient age was 41.1 ​± ​9.8 years. Comorbidities were reported in 67 patients (44.07%). A direct proportional relationship was observed between the weight of the resected tissue and occurrence of general complications (P=0.01), and the presence of comorbidities increased the occurrence of minor (P=0.04) and major complications (P=0.01). ConclusionAbdominoplasty is an aesthetic surgical plastic procedure, and its application has increased over the years. Despite its popularity, patient safety requires further attention due to the high risk of complications. It is essential to study all risk factors.

Including Mean Stress in the Effective Equivalent Stress of the ASME BPVC Elastic–Plastic Fatigue Method

Abstract This work provides a novel method for including mean stress in the American Society of Mechanical Engineers (ASME) Boiler Pressure Vessel Code (BPVC) elastic–plastic fatigue procedure. Typically, the mean stress is accounted for by adjusting the stress-life cycle curve. A new approach is provided by adjusting the effective equivalent stress range with a mean stress correction. This approach is advantageous because this adjustment can be made at each cycle and efficiently implemented in the computation. This new approach allows for fatigue analysis of large-scale models, such as full spacecraft assemblies or a semi-truck trailer. The proposed method is verified by predicting the fatigue life of a test coupon and compared to experimental results.