Plastic Surgery Clinic Research Articles

Screening for body dysmorphic disorder among patients pursuing cosmetic surgeries in Saudi Arabia.

Objectives:To determine the prevalence of positive screening of body dysmorphic disorder (BDD) among patients seeking cosmetic surgeries in plastic surgery and oculoplastic surgery clinics.Methods:The survey of this cross-sectional study was self-administrated and distributed among adults pursuing cosmetic surgeries in plastic surgery and oculoplastic surgery clinics at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between March 2019 and March 2020. The BDD questionnaire was validated, and a highly sensitive and specific tool was used to identify patients with BDD. Ethical approval was granted by the Research Ethics Committee. All analytic studies were performed using IBM SPSS, version 24.Results:A total of 344 patients participated in this study with a mean age of 39.66 ± 13.76 years. Of these, 296 (86%) were women and 298 (86.6%) were Saudi. The prevalence of positive screening for BDD was 19.2%. The most commonly requested procedures were abdominoplasty (21.2%) and skin lesion removal (21.2%). Smoking was found to be significantly associated with BDD with 21.2% of smokers having it (p<0.010).Conclusion:Body dysmorphic disorder was unrecognized among patients pursuing cosmetic surgeries. One-fifth of patients requesting cosmetic procedures are potential cases of BDD requiring psychiatric evaluation and treatment. We recommend implementing screening protocols to identify cases before surgical plans.

Editorial for JCD—October 2020

Welcome to the October 2020 edition of the Journal of Cosmetic Dermatology. We know that we are all continuing in strange and uncharted times. We want to start by saying that we hope everyone, no matter where in the world you are, is safe and healthy. That includes not only you but your families, your staff, and your friends. Navigating through COVID-19 has for many been the most challenging challenge that any of us have ever encountered. We hope that everyone is doing well, during what I like to call these weird and crazy times. We all miss our past normal. I am sure that when we return to whatever that was, we will for sure never take simple things like eating in restaurants or traveling on airplanes for granted. While many have seen their own communities “opening up,” we still must realize that this virus is still all around us. Until there is a safe and effective vaccine that can provide long-standing immunity, we need to be on our guards each and every day. To that end, we remain hopeful that our colleagues working on vaccines and therapeutics, can one day soon, be able to develop something that helps rid us of this invisible killer. We hope that you enjoy this issue of JCD—full of interesting, exciting, and thought provoking studies. We hope, in the end, makes you a better clinical physician. We have started each of the past several issues with articles related to COVID-19. We have chosen six articles that we think need to be in print. Starting with Wang et al discussing Suggestions for Maintaining the Functioning of Plastic Surgery Clinics during COVID-19 Pandemic. We all are doing our best to “function” during this pandemic; here are some important tips. This is followed by Altunisik et al discussing Views and Experiences of Dermatologists in Turkey Regarding Teledermatology during the COVID-19 Pandemic. Teledermatology and telemedicine itself has become extremely popular during this pandemic; this important paper reviews it’s usage in Turkey and how it is being utilized. Next, Veraldi et al review Seborrheic Dermatitis and Masks. Obviously, mask wearing has become standard for most and with it, we are seeing an increase in cutaneous diseases, which can be attributed to the use of that mask. Jakhar et al discuss Increased Usage of Smartphones during COVID-19: Is That Blue Light Causing Skin Damage? The concept of blue light from smartphones is a very important topic at this time and in this paper, and this is discussed. Altunisik et al review the Relationship between Hand Hygiene and Cutaneous Findings during COVID-19 Pandemic. And last, Goldust et al also tackle hand washing with Hand Eczema Due to Frequent Hand Washing in Combat with COVID-19. We need to be aware that hand washing, although mandatory during COVID-19, may lead to an increase in skin concerns. Also in this JCD issue, we are showcasing some of the incredible review articles that we have received. The first of these is Andriessen et al reviewing The Role of a Shelf-Ready, Human-Derived, Soft Tissue Injectable Adipose Matrix for Facial Volume Correction. This is a fascinating new soft tissue adipose matrix which is making great strides in the US market at this time. This is followed by Al-Niami et al reviewing Botulinum Toxin Complications in Registered and Off-Label Aesthetic Indications. Understanding complications is critically important to everyone using injectable toxins, and this article is a wonderful addition to this subject matter. Next, Wanitphakdeedecha et al discuss Antibody-Induced Botulinum Treatment Failure: A Review and Novel Management Approach; another very important paper for us to understand. This is followed by Salum et al with their article Deoxycholic Acid in the Submental Fat Reduction: A Review of Properties, Adverse Events, and Complications. Deoxycholate has been a popular therapy for use in fat reduction; this paper is a must for those interested in this field. And finally, Vinshtok and Cassuto discuss Biochemical and Physical Actions of Hyaluronic Acid Delivered by Intradermal Jet-Injection Route. This fascinating technology may become something very special in the near future. Plus, there are many fascinating articles throughout the rest of this issue of JCD. Please read through, please see the myriad of learning opportunities that exist in this journal. And please, let us know your feedback on how we are doing, good and bad. So please everyone stay safe and healthy. Protect yourself, your families, your loved ones, and your community. Let’s return someday to what normal used to be and prepare so that nothing like COVID-19 ever occurs again.

Analysis of the clinical and aesthetic results of facial dimple creation surgery.

BackgroundDimples on the cheeks can make the smile look more cheerful and attractive. Therefore, some people who do not have dimples may choose to undergo dimple creation surgery. Although dimple surgery is quite common, those desiring this procedure often lack information about it. Therefore, we conducted the present study to share our surgical tips and clinical experiences regarding safe dimple creation surgery.MethodsThis study included 2,048 patients who underwent dimple creation surgery at our plastic surgery clinic between April 2010 and June 2014. These patients were selected from those who displayed no scarring from injury or tumor removal in the central face during the presurgical evaluation. Medical records were used to identify the age and sex of each patient, the location of dimple creation, any postoperative complications, reoperation, and the reason for reoperation.ResultsOf the 2,048 patients, 159 (7.7%) underwent reoperation. The reason for reoperation was undercorrection in 78 cases (49.0%), disappearance of the dimple in 62 cases (38.9%), and overcorrection in nine cases (5.6%). Five patients (3.1%) had their stitches removed to eliminate the created dimple because they changed their minds, and five patients (3.1%) had their stitches removed because of infection. No patients reported complications after reoperation, and no other complications, such as hyperpigmentation or foreign body reaction, were observed.ConclusionsSafe surgery with minimal complications and satisfying cosmetic results can be achieved via accurate knowledge of the relevant anatomy and its relationship with dimples, as well as appropriate surgical methodology.

Increased Incidence of Ophthalmologic Findings in Children With Concurrent Isolated Nonsyndromic Metopic Suture Abnormalities and Deformational Cranial Vault Asymmetry.

The purpose of this project was to study the incidence of ophthalmologic findings which are known to be risk factors for amblyopia in children who have coexisting metopic suture abnormalities and deformational plagiocephaly (DP) and brachycephaly (DB). Institutional Review Board-approved retrospective study reviewing records of a consecutive cohort of children under 2 years of age with metopic suture abnormalities and cranial vault asymmetries seen in both the plastic surgery and ophthalmology clinics from 2007 to 2017. Institutional tertiary care center with all care in plastic surgery under the senior author and the standard of care accepted in pediatric ophthalmology under one of two ophthalmologists. After application of exclusion criteria, 76 children diagnosed with metopic suture abnormalities and DP/DB were included in the study. Patients with severe trigonocephaly, other suture involvement, syndromic diagnoses, and primary ocular disorders were excluded. Describe the incidences of refractive errors (astigmatism, hyperopia, and myopia), anisometropia, strabismus, and amblyopia within the study population. In our patient population, the rates of amblyopia (17.1%) and strabismus (15.8%) are higher than the general pediatric population rates of 1.5% to 1.8% and 2.4% to 3.6%, respectively. Overall, 47.4% had significant refractive error: 28.9% with astigmatism, 15.8% with hyperopia, 5.3% with myopia, and 10.5% with anisometropia. In our patient population, children with coexisting metopic suture abnormalities and DP or DB had significant risk for amblyopia, strabismus, and refractive errors.

The Public's Awareness and Willingness to Undergo Plastic Surgery Procedures during the COVID-19 Pandemic.

Background:In March 2020, the Saudi Ministry of Health implemented mitigation measures to control the Coronavirus Disease 2019 (COVID-19) pandemic, including media campaigns, a nationwide lockdown, and closures of plastic surgery clinics. The aim of this study was to explore the public’s knowledge of COVID-19, their willingness to undergo cosmetic surgery during the pandemic, and the factors influencing their decisions.Methods:An internet-based cross-sectional survey was conducted. We collected data on demographic information, knowledge about COVID-19, and willingness to undergo cosmetic procedures. Participants also completed the cosmetic procedure screening questionnaire to assess body dysmorphic disorder.Results:The sample included a total of 1643 participants (women, n = 1002; 61%). A total of 613 (37.3%) participants were aged between 30 and 40 years. The majority (n = 1472; 89.6%) referred to official government accounts for information regarding COVID-19. Most participants (n = 1451; 88.3%) felt that the pandemic was serious, and 1387 (85%) said they would not leave home to undergo cosmetic procedures during the outbreak. Being women, the presence of body-image concerns, and higher cosmetic procedure screening questionnaire scores were associated with an increased willingness to undergo cosmetic procedures.Conclusions:This is the first study to explore the public’s willingness to undergo cosmetic procedures during the COVID-19 pandemic. The public was well educated about the pandemic, via government actions. This was reflected in participants who wished to undergo a cosmetic plastic procedure; we identified factors associated with an increased willingness to undergo procedures, which may help design awareness initiatives.

Evaluation of Aesthetic and Functional Outcomes After Open Rhinoplasty: A Quasi-experimental Study by the Aid of ROE and RHINO Questionnaires.

Rhinoplasty is one of the common plastic surgery procedures which has a high rate in Iran. There are several tools for assessing the outcomes and quality of life after this surgical procedure which rhinoplasty outcome evaluation (ROE) questionnaire and rhinoplasty health inventory and nasal outcomes are two of them. The aim of this study was to investigate the aesthetic and functional outcomes of rhinoplasty by the aid of ROE and RHINO scales in patients who presented to a referral center in Iran. This prospective, quasi-experimental study was performed on patients who referred to the plastic surgery clinic of Imam Khomeini hospital complex during 2017 to 2019 and underwent open rhinoplasty. ROE and RHINO questionnaires were filled by patients before and 6months after the surgery. Surgical outcomes and aesthetic satisfaction rate were evaluated in different age groups, genders and educational levels. The data were analyzed by version 21 of SPSS software. ROE score increased from 51.27 ± 10.54 to 79.6 ± 9.67 (P < 0.001). In addition, RHINO score increased from 64.13 ± 11.43 to 83.36 ± 11.03 (P < 0.001). The most common satisfaction factors among patients in this study were "nose feels more natural" in 62% of patients and "tip rotation is good" in 32% of patients. Furthermore, the most common causes of dissatisfaction in patients were "nose too wide" in 25% of patients and "tip bulbous" in 25% of patients. ROE and RHINO scales are effective for assessing rhinoplasty outcomes. The satisfaction rate of rhinoplasty is high in Iran and is related to the natural shape of the nose in addition to the tip rotation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Unilateral Nasal Obstruction Causes Symptom Severity Scores Similar to Bilateral Nasal Obstruction.

The objective of this paper is to investigate the differences between unilateral and bilateral nasal obstruction with subjective symptomatology in nasal obstruction. This is a retrospective chart review of prospectively collected data of patients with nasal obstruction presenting to a facial plastic and reconstructive surgery clinic for evaluation and treatment. Patient demographics including age and gender were recorded along with nasal physical exam findings. These included internal valve narrowing (IVN), external valve narrowing, internal valve collapse, external valve collapse, and septal deviations (inferior and superior). Findings were reported for the left, the right, and both sides. Nasal valve and septal findings were recorded on 3- and 4-point Likert scales, respectively, for each side of the nose. A total of 1,646 patients were included in the study. On univariate analysis, a significant correlation was seen between Nasal Obstruction Symptom Evaluation (NOSE) scores and all individual exam findings (p < 0.001). On multiple linear regression, total, left, and right septal deviation (p < 0.001, p = 0.001, p = 0.007, respectively) and total, left, and right IVN (p < 0.001, p = 0.003, p < 0.001) were all predictive of an increased NOSE score. Patients with unilateral septal deviation or internal nasal valve narrowing have symptoms of nasal obstruction similar to those with bilateral nasal obstruction. Unilateral and bilateral septal deviation and internal nasal valve narrowing are predictive of having an increased NOSE score. Unilateral nasal obstruction should be recognized and treated as a cause for severe symptomatic nasal obstruction despite a normal contralateral nasal exam.

Il Miele Medicale nella pratica clinica: la nostra esperienza in 75 casi trattati

Presso la Struttura Organizzativa Dipartimentale (S.O.D.) Clinica di Chirurgia Plastica e Ricostruttiva di Ancona sono stati trattati con miele medicale consecutivamente, nell’arco di 24 mesi, 75 pazienti affetti da lesioni cutanee croniche. Nell’articolo vengono descritti gli ottimi risultati ottenuti in termini di riduzione dei tempi di guarigione delle lesioni trattate, e vengono descritte le caratteristiche chimiche e fisiche del miele medicale che ne spiegano in forma scientifica l’azione.

Man with facial rash.

A 43-year-old male presented to the emergency department (ED) with a rash to his right cheek 4 days after hyaluronic acid filler injections by a non-credentialed beautician. Examination was notable for serpiginous, violaceous erythema with overlying yellow crusting to the right mid-face and involvement of the nasal tip. Patient did not have vision complaints at this time. Accidental facial arterial cannulation with dermal filler injections can cause occlusion and embolization. Risks of embolization may depend on practitioner experience, injection pressure, rate of filler injection, and location of injection.1 On ED presentation, emergent dermatology and/or plastic surgery consult is required. There are serious adverse effects including tissue necrosis, blindness, or neurologic deficits.2, 3 Of all blood vessels affected, the ophthalmic artery was significantly associated with irreversible blindness. There are 2 common fillers used, autologous fat injections and hyaluronic acid. Autologous fat injection is more associated with vascular complications than is hyaluronic acid and has been reported to have more severe outcomes with higher rates of permanent blindness. Ophthalmology consult is required if the patient endorses vision changes or there are signs of skin involvement in the V1 distribution. Neurology consult is required if the patient endorses neurologic complaints. Treatment involves direct injection of hyaluronidase within and around the affected vessel, with multiple injections diffusely across the affected skin. Additional treatments include nitroglycerin paste and oral aspirin.4 Oral antibiotics should be considered if fat necrosis is present. Once blindness occurs, rates of full recovery are low so initial precautions during filler placement, including slow injection rates with low pressure, are crucial. The patient received hyaluronidase injections and nitroglycerin paste and started on oral aspirin and antibiotics. After a 3-month follow-up in plastic surgery clinic, the patient reported full recovery of the rash with no other sequelae.

Research update of effects of adipose tissue and component transplantation on scar treatment

Scar is a kind of skin fibroproliferative disease characterized by excessive repair of skin tissue and disorganized deposition of extracellular matrix resulting from deep dermal injury caused by burns or trauma. Scar is accompanied by symptoms such as itching and pain, which could lead to appearance damage and psychological disorders, and is one of the common diseases in burns and plastic surgery clinics. Currently, transplantation of adipose tissue and components is considered as one of the most cutting-edge treatments for scar. Adipose components transplantation includes transplantation of nanofat, adipose-derived stem cell matrix gel, stromal vascular fraction, and adipose-derived stem cell. More and more studies showed that adipose tissue and components possess the functions of tissue regeneration, extracellular matrix remodeling, and anti-fibrosis, which could improve the appearance and symptoms of scar by local transplantation. Therefore, this paper reviews the effects of adipose tissue and components transplantation on scar treatment, aiming to provide theoretical reference for adipose treatment of scar.

Treatment of chronic wounds with polyurethane sponges impregnated with boric acid particles: A randomised controlled trial.

The objective of this study was to investigate the effectiveness of the sponge with boric acid particles combined with the negative pressure wound treatment (NPWT) system for chronic wounds with tissue defects. Our study was designed as a prospective randomised study. One hundred patients who were planned to have NPWT due to chronic wounds were included in this study from Orthopaedics and Traumatology and Plastic Surgery clinics. Patients were divided into two groups. In the first group, a new method, boric acid impregnated sponge, combined with the NPWT system, was used, and in the second group, sponge with silver nitrate was used. Besides the wide-broad spectrum antibacterial properties of silver nitrate, the antimicrobial, angiogenetic, and epithelial effects of boric acid were aimed to investigate by macroscopically and histopathologically. Thirty-six patients in the silver nitrate group and 44 patients in the boric acid group completed the study. A decrease in wound size and granulation was observed in both groups. Macroscopically, a decrease in wound size reduction, epithelialization and granulation were more prominent in the first group in which boric acid impregnated sponge was used than the second group in which silver sponge was used. Moreover, microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1. In this clinical study, the broad-spectrum antimicrobial properties of boric acid and its positive effect on the cells responsible for wound healing were found to be more pronounced compared to silver nitrate sponges. A combination of boric acid sponges with the NPWT system may be an alternative method for chronic wounds.

Notes on a visit to a children’s clinic for reconstructive and plastic surgery in Belgrade (Serbia)

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4371 The Role of B Cells in Keloid Formation

OBJECTIVES/GOALS: Recent studies indicate B cells are involved in dermal fibroblast activation and collagen deposition in the skin. However, B cell distribution in epidermal and dermal layers is unknown. Here, We aim to characterize the distribution of B cells residing in normal skin and keloidal scars. METHODS/STUDY POPULATION: One abdominal normal skin sample and two keloid samples (ear and shoulder) were obtained from the University of Colorado Biorepository Core Facility and from the Plastic Surgery Clinics. Five micron sections from formalin-fixed paraffin-embedded samples were prepared for multiplex fluorescence immunohistochemistry by the Human Immunology &amp; Immunotherapy Initiative. We stained for CD20+, CD19+, and DAPI. Slides were imaged using Vectra®3 scanning system from PerkinElmer. Images were analyzed in InForm®Tissue Finder, phenotpr, phenoptrReports by Akoya biosciences. RESULTS/ANTICIPATED RESULTS: We found a significant increase in the percentage of CD20+ and CD19+ B cells in keloid skin compared to normal skin tissue (14.50% and 14.20% vs 6.47% and 7.56% of the total cells), respectively. Interestingly, we found that in the epidermis of keloid skin CD20+ cell were more abundant (14.46%) whereas in the epidermis normal skin CD20+ cells were less predominant (5.14%). In the dermis of keloid skin, CD20+ and CD19+ were in equal proportions (13%) whereas in normal skin CD19+ cells were more predominant (10.44%) compared to CD20+ cells (7.04%). Dual positive B cells, CD19+/CD20+ cells, were more abundant in keloid dermis (11.06%) compared to normal skin dermis (1.24%). DISCUSSION/SIGNIFICANCE OF IMPACT: B cells are involved in fibroblast activation in diseases such as scleroderma and rheumatoid arthritis. With the increase of CD19+/CD20+ B cells in keloids, the role of B cells in keloid pathogenesis warrants further study. CD27 staining may determine if these are activated or follicular B cells.

The Bilobe Flap for Nasal Reconstruction.

Repair of nasal defects is technically challenging due to inelastic nasal skin and unforgiving nasal geometry. The bilobe flap is a double transposition flap that can transpose skin from cephalad to caudad to repair defects of the lower third of the nose. However, pincushioning may complicate this flap, yielding untoward aesthetic outcomes. We review our single surgeon series of patients who underwent bilobe flap reconstruction of nasal defects, and describe our surgical technique to minimize pincushioning and poor aesthetic outcomes. This was a retrospective chart review of patients who underwent bilobe flap reconstruction of nasal defects at a tertiary referral facial plastic and reconstructive surgery clinic between January 1, 2010 and February 12, 2019. All postoperative clinic notes were analyzed for complications, reports of unfavorable cosmetic outcome, and rates of revision procedures. Surgical technique is described. In the analysis, 125 patients were included, of whom 84 (67%) patients were women, and the mean (standard deviation) age was 60.7 (12.5) years. Complications were reported in 20 (16%) patients, including scars, pincushioning, and nasal obstruction. Five patients underwent revision surgery (4%), including scar revision and z-plasty. Pincushioning was reported in four patients (3.2%), of whom three underwent scar revision procedures. One patient had alar notching requiring correction. There was no statistically significant association between ear cartilage graft and complications (p = 0.84) or requirement of intervention (p = 1.0). Univariate and multivariate logistic regression did not show statistically significant association between size of the defect and the presence of complications (p > 0.05). The bilobe flap is an excellent transposition flap for the repair of small nasal tip defects. By adequately thinning the transposition flap of excess subcutaneous tissue prior to inset, rates of poor aesthetic outcomes, revision procedures, and pincushioning are minimized.

Clinic Reopening Post-Coronavirus Disease 2019: Precaution of a Plastic Surgery Clinic in China

Sir, The coronavirus disease 2019 (COVID-19) is highly contagious, and over the past several months it has spread rapidly around the world. The main objectives for us due to this outbreak are to control and eliminate the contagious sources, reduce new confirmed cases, and prevent further transmission.1 As a private clinic, we effectively prevented the further transmission of COVID-19 and balanced the deficits after shutdown, so we would like to offer our experience in precaution when reopening clinics. The clients of our clinic are those who want to take plastic surgery and treat cosmetic skin disease. When the government announced a lockdown in Wuhan on January 23 due to the outbreak of COVID-19, to prevent the wide spread of virus around the country, the regular spring festival holiday had to be extended for >6 weeks. Our clinic is located in Hangzhou, Southeast China, where there are a large number of internet companies. Therefore, we can easily use online social media as a tool to function and manage our clinic during the shutdown and provide online consultation services for our clients. The clinic was officially approved to open on February 24 when the epidemic in Hangzhou was under control. At that moment, the situation of the virus outbreak around the world, as well in some parts of China, was still unpredictable. To guarantee the safety of our staff and clients, we conducted a strict infection prevention process in our clinic (Fig. 1).Fig. 1.: Infection prevention process during post-COVID-19 period.Apart from the standard prevention procedures described above, considering the anesthesia-related risk and the adequate time needed after operation for proper cleaning and air changing,2,3 we developed a staged process to provide reservations for different medical services. Stage 1: From February 24 to March 1, we only received reservations for consultation, skin care, or injection procedures. Stage 2: From March 1, we started to do some small surgeries under local anesthesia, such as double eyelid surgery. Stage 3: Since the virus outbreak situation became better in the whole country and especially in our city, from March 27, we started to open all the surgery reservation options within a limited amount. As a result, there have been no confirmed or suspected cases of the COVID-19 in our clinic. Among all the patients who tried to make an onsite reservation, we declined 7% of them because they might have had a travel history, had virus contact, or taken public vehicles. The number of onsite consultation also reduced 32.8% compared with that in the same period last year. Although the total number of consultations, including online discussions, increased by 20.7%, optimistically, our average profits per day show a steady growth during the staged process. The average daily profit during the second stage is 17.4% more than that in the first stage, and the profit during the third stage is 34.6% more than that in the second stage. As for independent clinic owners like us, the priority in this COVID-19 epidemic period is the health and safety of patients and staff. However, balancing the deficit caused by the shutdown and quarantine is also one of our major goals after reopening. Based on our cautious strategy described above, we have temporarily achieved the goal of gradually making profits. In conclusion, we have shared the precautions taken during the gradual opening process and how we solved the subsequent problems after shutdown. As a Chinese plastic surgery clinic, we surmounted the crisis by mid-April. Therefore, we hope our experience can help more independent clinics to overcome the COVID-19 crisis. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Microvascular nose reconstruction after extended tumor resection.

&lt;b&gt;Introduction:&lt;/b&gt; The nose is the central and probably the most important organ of the face. In view of the three-dimensional shape and variety of tissues, reconstructive surgery after tumor resection in this anatomical region requires the surgeon's knowledge of anatomy. &lt;br&gt;&lt;b&gt;Materials and Method:&lt;/b&gt; In the years 2010-2019, 48 patients were treated in the Oncological and Reconstructive Surgery Clinic for extended nasal tumors, which required the use of free microvascular flaps after resection for functional and aesthetic supply of anatomical structures of the nose. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; In 48 patients, a total of 92 free microvascular flaps were used for nasal reconstruction including: radial forearm free flap in 24 patients, radial forearm free flap with radial bone in 14 patients, auricular free flap in 16 patients, radial forearm free flap in combination with auricle free flap in 7 patients, double auricular free flap in 6 patients, radial forearm free flap in combination with double auricular free flap in 4 patients. Total necrosis of the free flap was noted in 4 cases, partial in 6 patients. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; The presented surgical techniques using microvascular free flaps constitute a recognized method of treatment and should be used in everyday surgeon practice. The results demonstrated in this article allow to obtain optimal functional and aesthetic effects.

Autoimmune syndrome induced by adjuvants after breast enhancement with polyacrylamide hydrogel: a study in Poland

Autoimmune syndrome induced by adjuvants (ASIA) is the spectrum of diseases in which the substances considered inert to the body induce autoimmune reactions and inflammation. Some of the biomaterials recently used in plastic surgery, such as silicone or polyacrylamide hydrogel (PAAG) seem to trigger clinical features of ASIA. The aim of this study was to assess the incidence of these features within a group of women after breast augmentation with PAAG. As many as 30 consecutive patients (26–59 years, mean age 39.5) referred to the Clinic of Plastic Surgery after breast enhancement with PAAG were examined. The validated criteria of ASIA syndrome were employed. Descriptive statistics were chosen based on the distribution of variables. The research was approved by the Bioethical Committee of the Centre of Postgraduate Medical Education in Warsaw, Poland. Within the studied group, 50% of patients (n = 15) fulfilled ASIA diagnostic criteria. Apart from local complications, we encountered various general symptoms, among which fever (n = 13, 43.3%), tingling and numbness of upper extremities (n = 10, 33.3%) and chronic fatigue (n = 9, 30%) were the most common. These symptoms were present on an ambulatory visit, before qualification to the operation of hydrogel removal. All patients undergoing surgical PAAG removal (n = 8) declared alleviation or complete resolution of the symptoms. Polyacrylamide hydrogel breast filling, although limiting the invasiveness of the procedure in relation to silicone breast implants, also carries the risk of developing ASIA symptoms. The removal of PAAG may bring improvement in some cases.

Characterization of immune cells found in keloid versus normal skin tissue

Abstract Keloids are abnormal scar formation that extends beyond the confines of the original injury. Immune cell infiltration is associated with keloid pathogenesis, but the exact mechanisms remain unknown. We aim to characterize the immune profile of keloid skin compared to normal skin in order to further understand the role of specific immune subsets in keloid formation. One abdominal normal skin sample and five keloid samples (four ear and one shoulder) were obtained from the Plastic Surgery clinics and the University of Colorado Biorepository Core Facility. Paraffin-embedded samples were stained with CD19+, CD20+, CD3+, CD8+ and FoxP3+ by the Human Immunology and Immunotherapy Initiative. The multiplex immunohistochemistry slides were scanned using Vectra 3 (PerkinElmer, MA, US) and captured images were analyzed with InForm Tissue Finder, phenotpr, and phenoptrReports (Akoya Biosciences, CA, US). CD20+ and CD19+ B cells were significantly increased in keloid tissue compared to normal skin (14.50% and 14.20% vs 6.47% and 7.56%), respectively. In contrast, no significant difference was observed in the percentage of CD3+ and CD8+ cell subsets in keloids compared to normal skin (12.92% and 4.98% vs 8.19% and 4.04%), respectively. Moreover, there was a significant increase in FoxP3+ positive cells found in keloid scars (9.68%) compared to normal skin (2.89%). Further studies examining the role of B cells and FoxP3+ cells in keloid pathogenesis are warranted.

Social Media Impact on a Plastic Surgery Clinic During Shutdown due to COVID-19 in China.

Facial Plastic Surgery & Aesthetic MedicineVol. 22, No. 3 Viewpoints: COVID-19Free AccessSocial Media Impact on a Plastic Surgery Clinic During Shutdown due to COVID-19 in ChinaLu Wang, Ruicheng Gong, Sa Yu, and Huan QianLu WangStarbody Plastic Surgery Clinic, Hangzhou, Zhejiang, PR China.†These authors contributed equally to this work.Search for more papers by this author, Ruicheng GongStarbody Plastic Surgery Clinic, Hangzhou, Zhejiang, PR China.†These authors contributed equally to this work.Search for more papers by this author, Sa YuStarbody Plastic Surgery Clinic, Hangzhou, Zhejiang, PR China.Search for more papers by this author, and Huan Qian*Address correspondence to: Huan Qian, MD, Department of Plastic Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, 88 Jiefang Road, 310009, Hangzhou, PR China, E-mail Address: huanqian@zju.edu.cnDepartment of Plastic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China.Search for more papers by this authorPublished Online:15 May 2020https://doi.org/10.1089/fpsam.2020.0173AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail A growing number of plastic surgeons have started to realize that social media can exert a positive impact on their clinic marketing, and they have been gradually integrating social media into their many ways to reach patients.12 However, the clinic operation is by no means entirely dependent on social media.3 Our plastic surgery clinic is located at Hangzhou in the southeast of China, where many Internet companies, such as Alibaba and NetEase, are based. Statistically, our clinic paid less than 20% of its time and staff resource on social-media management, with direct online consultations accounting for only 10%.However, when Wuhan City announced its shutdown on January 23 due to the outbreak of COVID-19, with increasingly more diagnosed cases across the country, our Spring Festival holiday, which was originally stipulated from January 22 to February 2, was extended to an unknown date. Thus, new social media strategies were taken into consideration immediately, making us pay fully attention to online social media–based consultation, targeting nonprofit education to raise public credibility and identify potential customers. We have started an inclusive response to different social media platforms since January 23 (see Fig. 1).Fig. 1. New social media strategies during the COVID-19 outbreak.Thus, during the shutdown, we have developed new ways to communicate with beauty seekers using social media, gaining growing feedback online (Table 1). Our official reopening was on March 1 when the COVID-19 outbreak in our city had been brought under control. We began with strict health screening processes, which remain in place now, including declining treatment of patients whose health is uncertain or patients who live further away. Based on previous social media–based influence, we have gained more public credibility and more patients online. Despite the 6-week shutdown, the clinic's profit from March 1 to March 30 is 22.8% more than over the same period last year after the Spring Festival holiday (from February 14 to March 16, 2019), along with 30.7% more operations. Among these, those operations that were decided based on online consultation accounted for 58.8% of all surgery. The number of online consultations has reduced by 32.8%, but the total number of consultations, including the online consultation, has increased by 20.7%. The online consultations make up 44.3% of all consultation. Our analysis indicates that post-epidemic transformation in social media and retaliatory spending are mainly responsible for this increase.Table 1. Data from Weibo (Chinese Twitter) and Live Broadcast on Soyoung and WeChat 2020.1.23–2020.3.30Same time last yearData from Weibo (Chinese Twitter)The highest numbers of one post being read50,0005092The lowest numbers of one post being read2,125764Numbers of increasing followers70052Numbers of people asking for consultation (with assistant)2125 2020.2.17–2020.3.30Same time last yearLive broadcast on Soyoung (Chinese online plastic surgery platform)Cumulative time of live broadcast (hours)460Total numbers of people who watched46,6810Numbers of increasing followers4140Numbers of people asking for consultation (with assistant)600 2020.2.1–2020.3.30Same time last yearUsing WeChat for online consultation with doctorsNumbers of online consultation with doctor from Weibo460Numbers of online consultation with doctor from Soyoung150Total610During the COVID-19 epidemic, people all over the country had to stay at home or in medical isolation. More beauty seekers had to shift to online resources to meet their requirements, including shopping, education, consultation, and so on. This trend will likely continue due to the newly recognized benefits, and social media will be highly incorporated into our daily clinic operation. Furthermore, we have established a new staff structure to adapt better to this work, and more data will be collected and analyzed in the future.In conclusion, we have shared the entire process of how social media helped to address the shutdown crisis in a Chinese plastic surgery clinic, along with the subsequent benefits. It is hoped that this will help more clinics overcome the COVID-19 pandemic together.Author Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.

The Correlation of Aesthetic Plastic Surgery With Sexual, Social, and Romantic Life in Cyprus.

During the 21st century, the interest in cosmetic surgery has dramatically increased. Aesthetic plastic surgery can improve self-esteem and self-confidence, enhancing appearance, social relations, and sexual life. This study aimed to investigate the correlation of aesthetic plastic surgery with sexual, social, and romantic lives in Cyprus. Questionnaire data from 128 cosmetic surgery patients, from a plastic surgery clinic in Nicosia, were obtained approximately 1 week before and 3 months after surgery. The questionnaire was developed by the authors for the purpose of this study and consisted of measures on body image, social life, relationships, and sexuality. Pre- and postoperative values were compared. The majority of participants were women (81.9%), and respondents' mean age was 35.35 years. One of 2 participants reporting had undergone breast augmentation (47.6%). One of 2 participants reported feeling self-confidence after treatment, and the majority of respondents reported a positive influence in all 3 realms: sex life (54.7%), social life (64.4%), and romantic relationship (49.5%). Those who underwent breast augmentation were 4 times more likely to report that their sex life had been positively affected than those who did not undergo breast augmentation. The study provides evidence of improvement in an individual's satisfaction with his or her body image and self-confidence after cosmetic surgery. The study demonstrates the positive impact of cosmetic surgery to social life and relationships, especially breast augmentation surgery to sexuality.