Preoperative Photographs Research Articles

Patient Preferences and Satisfaction of Nipple Areola Reconstruction with Three-Dimensional Tattoo in the Setting of Bilateral Implant Based Breast Reconstruction

Background: Patients undergoing mastectomy for breast cancer treatment can have three-dimensional nipple areola complex (NAC) tattoos as part of their reconstructive journey. The generally accepted size and position of the NAC is noted in the literature, however, patients may have different preferences. Methods: All patients undergoing NAC tattoos were given the option to pick the size of the tattoo and location on their chest. Post-procedure measurements were obtained as well as BREAST-Q surveys to examine patient satisfaction. Results: In 104 patients, average NAC tattoo diameter was 3.62 cm (±0.45), average sternal notch to nipple was 19.53 cm (±2.66) and average nipple to inframammary fold was 8.59 cm (±2.64). On multivariable analysis, areola tattoo diameter was found to be significantly larger in patients with larger size implants ( P = .02), and Asian women ( P = .04). On multivariable analysis, sternal notch to nipple was significantly greater in patients with higher BMI ( P = .04). In patients with pre-operative photos for comparison, post-tattoo size and position of the NAC reconstruction, was significantly smaller and higher on the chest compared to their pre-operative values with an average NAC diameter of 3.60 cm (±0.46) ( P < .001), sternal notch to nipple of 19.45 cm (±2.87) ( P < .001), and nipple to inframammary fold of 8.89 cm (±2.80) ( P < .001). Sexual well-being significantly improved with an average score of 53 (±25) after micropigmentation. Conclusions: This study shows women prefer small areola size with a higher position compared to classic values, and these values may be influenced by race, BMI and implant size. Additionally, sexual well-being is improved after NAC reconstruction.

Quality and Consistency of Rhinoplasty Photos on Social Media: Prevalence of Potentially Misleading Before-and-After Images.

Introduction: There is significant variability in how rhinoplasty results are presented on social media. This study aims to evaluate the quality and consistency of preoperative and postoperative rhinoplasty photos on the social media platform Instagram. Methods: Instagram was queried on April 4, 2024 using the search term #rhinoplastybeforeandafter. Posts meeting our inclusion criteria were analyzed for inconsistencies in background, makeup, use of personal photo, and variations in face size between preoperative and postoperative images. Account demographics and time since surgery were also noted. Results: A total of 888 sets of before-and-after rhinoplasty photos were included, with nearly all (n = 882) posted by surgeon accounts. Of the posts analyzed, 23.7% had a ≥10% face size discrepancy, and 5.1% had a ≥10% face rotation discrepancy. Only 35.7% of posts were considered "high quality," with no significant photo discrepancies between postop and preop images and with postoperative time interval reported. Conclusion: Instagram before-and-after rhinoplasty photos evaluated in this study exhibited significant heterogeneity in quality and consistency regarding image background, image source, face size, face rotation, and brightness. Surgeons should prioritize consistency between preoperative and postoperative photos when sharing their results to minimize the potential for misleading the public.

Social Perceptions of Preoperative and Postoperative Photographs of Patients With Syndromic Craniosynostosis Undergoing Le Fort III Advancement

In patients with syndromic craniosynostosis and midface hypoplasia, the Le Fort III osteotomy is a surgical intervention that alleviates nasopharyngeal obstruction and improves facial features that influence societal perceptions of a patient’s attractiveness and interpersonal characteristics. This study determines how perceptions of personality traits, expressed emotion, interpersonal experiences, and expected life achievements and experiences changed in pediatric patients with syndromic craniosynostosis and midface hypoplasia undergoing Le Fort III osteotomy with distraction osteogenesis. The goal of this study is to help quantify the significance of surgical interventions on these perceived social parameters to guide preoperative education and manage expectations with patients and their families.

Lateral Rectangular Flap for Augmenting Vermilion Deficiency in Unilateral Cleft Lip Repair

Background and Objective: Cleft lip and palate are common congenital anomalies that require precise management with main component of repairing lip is the aesthetic outcome. Using lateral rectangular flap is a new method to optimize the medial vermilion deficiency. The goal of this study is to evaluate the efficacy of lateral rectangular flap for augmenting medial vermilion deficiency in unilateral cleft lip repair.Methods: This is a clinical trial was conducted in Rizgary Teaching Hospital and several private hospitals in Erbil, Iraqi Kurdistan Region from June 2021 to June 2023. A total of 18 patients with unilateral, complete and incomplete, isolated cleft lip and cleft lip and palate were included. Preoperative and postoperative photos were documented. Outcomes were analyzed up to one year following the repair.Results: The included patients had either isolated cleft lip (44.4%) or cleft lip and palate (55.6%). Cleft side was right (38.9%) or left (61.1%). Cleft was incomplete in only 2 patients (11.1%) and complete in 16 patients (88.9.%). No early postoperative complications were reported; however 5 patients complained of scar later after surgery. Outcome evaluation score for Cubid’s bow was 1 for 5 patients and 2 for 13 patients. On the other hand, score for lateral vermilion deficiency was 2 for all patients. No significant association was detected between patients’clinical data and the type of cleft. Conclusion: We found that lateral rectangular flap for augmenting medial vermilion deficiency in unilateral cleft lip repair was effective with excellent surgical outcome and minimal patients’ morbidity.

Quantifying the Effect of the Cross‐Facial Nerve Graft on the Nonparalyzed Side

AbstractObjectiveThe cross‐facial nerve graft (CFNG) is employed in facial reanimation surgery to restore neural connectivity from the nonparalyzed side of the face to the paralyzed side, facilitating spontaneous smiling. Typically, the sural nerve, due to its length, serves as the donor graft. Implantation involves functional facial branch transection to provide graft input. However, impact of this transection on a patient's smile has not been conclusively quantified.Study Setting & DesignTertiary Care Academic Medical Center; retrospective chart review.MethodsIn a chart review of patients from 2018 to 2022, 15 patients with unilateral flaccid facial paralysis who underwent CFNG were identified. Demographic and clinical data were collated including medical history and operative details. Emotrics software was used to compare preoperative and postoperative photographs by measuring smile parameters. Percent change was analyzed via Student's T‐test.ResultsA zygomatic branch was sacrificed in 8/15 (53%) surgeries and a buccal branch in 4/15 (27%) surgeries. When evaluating smile angle, dental show, upper lip height deviation, and commissure excursion for open and closed smiles, the average relative change for the nonparalyzed side was 3.4%, 2.8 mm, 12.5%, 3.0 mm, and 1.9% respectively. When comparing these metrics preoperatively and postoperatively in the functional side, there was no statistically significant difference (P = .13, P = .65, P = .33, P = .36, P = .64).ConclusionThere was no significant difference in our assessment of smile after facial branch transection in CFNG, suggesting the impact on a patient's smile may be negligible. Additional studies are needed to characterize qualitative impact on patients and result generalizability.

Utilization of Text-to-Image Artificial Intelligence Model in Preoperative Counseling for Lip Lift Procedures

Summary: Text-to-image models powered by artificial intelligence (AI) offer a promising tool for enhancing patients' comprehension of cosmetic surgery outcomes and providing personalized visual forecasts of their appearance after the procedure. This study explores the efficacy of text-to-image AI models, specifically DALL·E2, in improving preoperative counseling for patients undergoing lip lift procedures. Preoperative photographs of four patients, who had given their consent, were processed using DALL·E2, which allows users to modify specific areas of an image and input text descriptions to visualize anticipated changes. We successfully demonstrated the ability of DALL·E2 to generate accurate visual predictions within a short timeframe of two minutes. Selected images provided realistic expectations of the postoperative appearance, aiding in better patient understanding and expectation management.

Long-Term Outcomes of Nonsyndromic Isolated Unilateral Lambdoid Craniosynostosis

This study combined qualitative and quantitative approaches to evaluate outcomes of isolated nonsyndromic unilateral lambdoid synostosis at the Children's Hospital of Philadelphia. Volumetric, linear, and angular analyses were performed on long-term postoperative and normal control scans. Preoperative and postoperative clinical photographs were evaluated for the presence of dysmorphic frontofacial features. Among 26 included patients, median age of surgery was 10 months and mean postoperative follow-up was 5.9±5.7 years. Two (7.7%) patients underwent secondary cranial vault procedures. At most recent follow-up, 2 (7.7%) subjects reported intermittent headaches. Twenty (90.9%) of 22 patients were assigned Whitaker grade I. Among 9 subjects with long-term imaging at age 11.5±5.3, posterior vault asymmetry, posterior fossa deflection angle, cranial base angle, and ear position asymmetry all remained greater than in the control group. Of subjects included in the frontofacial feature analysis (n=10), 50% had resolution of all dysmorphic frontofacial features present preoperatively. Overall, most subjects who underwent PVR did not require revisional surgery and had good outcomes both aesthetically and functionally. Despite residual abnormalities in the cranial base and posterior vault, most had resolution of parietal bossing and facial scoliosis. Ear position asymmetry was the most common dysmorphic feature at long-term follow-up.

PtosisDiffusion: a training-free workflow for precisely predicting post-operative appearance in blepharoptosis patients based on diffusion models.

This study aims to develop a diffusion-based workflow to precisely predict postoperative appearance in blepharoptosis patients. We developed PtosisDiffusion, a training-free workflow that combines face mesh with ControlNet for accurate post-operative predictions, and evaluated it using 39 preoperative photos from blepharoptosis patients. The performance of PtosisDiffusion was compared against three other diffusion-based methods: Conditional Diffusion, Repaint, and Dragon Diffusion. PtosisDiffusion demonstrated superior performance in subjective evaluations, including overall rating, correction, and double eyelid formation. Statistical analyses confirmed that PtosisDiffusion achieved the highest overlap ratio (0.87 0.07) and an MPLPD ratio close to 1 (1.01 0.10). The model also showed robustness in extreme cases, and ablation studies confirmed the necessity of each model component. PtosisDiffusion generates accurate postoperative appearance predictions for ptosis patients using only preoperative photographs. Among the four models tested, PtosisDiffusion consistently outperformed the others in both subjective and statistical evaluation.

Quantitative Evaluation of the Effects of Blepharoplasty on Visual Field, Corneal Changes, and Cosmetic Appearance.

Blepharoplasty is an important eyelid surgical procedure, involving aesthetic and functional changes to the eyelids. The aim of this study is to investigate the effects of upper eyelid blepharoplasty on changes in the visual field, corneal changes, and cosmetic appearance. This study was performed with preoperative and postoperative facial photographs of 32 patients who underwent bilateral blepharoplasty. Marginal reflex distance (MRD1), percentage of corneal exposure area (CEA), and brow height (BH) were obtained from photographs. intraocular pressure (IOP) and ocular biometric parameters were also obtained. The morphometric and ocular parameters obtained from preoperative, postoperative first-month, and postoperative third-month patients were compared using repeated measures ANOVA test. Significant differences in MRD1, CEA, and BH were observed between preoperative, postoperative first-month, and postoperative third-month patients. Improvements were observed in left axis and right corneal astigmatism axis measurements in the postoperative third month compared with preoperative measurements, and the positive change was statistically significant (P=0.020, P=0.036). Upper eyelid blepharoplasty could provide satisfactory functional and aesthetic outcomes by contributing to the improvement of pseudoptosis and reduction in eyebrow height postoperatively.

The perspectives of laypeople, prosthodontists, orthodontists, and general dentists regarding the efficacy of different types of photographs in revealing the orthodontic treatment results

Aim: This study assessed the perspectives of laypeople, prosthodontists, orthodontists, and general dentists regarding the efficacy of different photographs in revealing the orthodontic treatment results. Methods: In this cross-sectional study, one Cl I and one Cl III orthodontic patient were selected by consensus of several orthodontists, and their preoperative and postoperative photographs were shown to 125 raters in 4 groups of laypeople, prosthodontists, orthodontists, and general dentists. The raters were asked to rate the clarity of the impact of treatment shown on each photograph using a 100-mm visual analog scale (VAS). Results: In the Cl I malocclusion patient, the frontal smiling view acquired the highest score among extraoral photographs, followed by the profile view and frontal view at rest (P<0.001). Of intraoral photographs, the frontal view of occlusion acquired the highest score, followed by the maxillary occlusal view, mandibular occlusal view, and left and right views of occlusion (P<0.001). In the Cl III patient (orthosurgery), the profile view acquired the highest score among extraoral photographs, followed by the frontal smiling view and frontal view at rest (P<0.001). Of intraoral photographs, the frontal view of occlusion acquired the highest score, followed by the left and right occlusal views, maxillary occlusal view, and mandibular occlusal view (P<0.001). Conclusion: For patients with intraoral intra-arch changes, the frontal smiling view extraoral photograph and frontal occlusal view intraoral photograph best revealed the results. In patients with additional facial and extraoral changes, the extraoral profile view and intraoral frontal occlusal view best revealed the treatment results.

Change in Brow Position After Upper Blepharoplasty With or Without Internal Browpexy.

Only upper blepharoplasty can cause a change in the eyebrow position, so browpexy can be combined with blepharoplasty in selected patients. There are many brow lifting techniques, both surgical and nonsurgical, and internal browpexy is one of the most widely used surgical brow lifting techniques. The purpose of this study was to evaluate the change in brow position after upper blepharoplasty with or without internal browpexy using preoperative and postoperative photographs. Patients who underwent upper blepharoplasty by a single surgeon at Dokuz Eylul University Hospital between 2018 and 2022 were retrospectively evaluated. A total of 48 patients, 30 of whom underwent upper blepharoplasty only and 18 of whom underwent upper blepharoplasty combined with internal browpexy, were examined to present the change in brow position postoperatively. Preoperative and postoperative photographs were analyzed using the ImageJ program and the proportional changes in brow height were shown. The first group, which only underwent upper blepharoplasty only, consisted of 30 patients (62.5%), all female; the second group, which underwent upper blepharoplasty and internal browpexy, consisted of 18 patients (37.5%), all female. The change at the midpupil level was determined as a 6.13% decrease in the first group and a 2.99% increase in the second group; at the brow peak level, this change was a 6.2% decrease in the 1st group and a 4.38% increase in the 2nd group. In cases of dermatochalasis, blepharoplasty alone can cause a shortening of the distance between the eyebrow and the upper eyelid groove and an unaesthetic appearance. Internal browpexy is an easy-to-apply technique that allows stabilization of the eyebrow after skin excision and a small amount of elevation.

Component Restoration in the Unilateral Intermediate Cleft Lip Rhinoplasty: Technique and Outcomes

Abstract Background The intermediate cleft tip rhinoplasty is performed in childhood to address residual tip asymmetries during the most critical period of psycho- social development. The authors describe and evaluate long-term outcomes of that approach for the unilateral cleft lip and palate patient based on the concept of individual restoration of each abnormal anatomical component. Methods This was a prospective comparative study in which the technique results were compared to age-matched unilateral cleft lip and palate control patients (n = 20). A separate group of unilateral cleft lip and palate patients who did not undergo intermediate cleft tip rhinoplasty were reviewed as control patients. Photographs of control patients were age-matched to each time point in the intermediate cleft tip rhinoplasty group. Technique of rhinoplasty was through an open approach. It was depending on restoration of the three main nasal cleft components; cartilage malposition, cartilage weakness and vestibular lining deficit. The authors here didn’t use cutaneous graft routinely to compensate the vestibular lining deficit. Instead, fine and complete dissection of the cleft side lower lateral cartilage from its vestibular lining before any cartilage repositioning. Standardized preoperative and postoperative basal view photographs were assessed at four time points: preoperatively (time 0), immediately postoperative (time 1), 3- 6 months (time 2), and more than 1 year postoperatively if available (time 3). Assessments of control and intermediate cleft tip rhinoplasty patients was carried out using four photo- morphometric relationships: Alar symmetry Nasal tip protrusion to alar base width, Cleft nostril dimensions, and Non-cleft nostril dimensions. Results Preoperative (time 0) baseline comparison between the study and the control groups showed significant differences regarding the nostril dimensions at the cleft side (P value 0.027) and alar symmetry (P value 0.000) denoting more severe deformity in the study group compared to the control group. At time 1, the study showed significant improvement regarding the alar symmetry (P value 0.000), and nasal tip protrusion (P value 0.004), while the changes regarding nostril dimension at the cleft side were non-significant (P value 0.057). At time 2, the study added significant improvement regarding the nostril dimensions at the cleft side (P value 0.049) that may reflect the importance of follow-up and using the nostril silicon retainer. At all times no significant changes regarding the nostril measures at non-cleft side were noticed. Conclusion The modified component restoration technique for the unilateral intermediate cleft lip rhinoplasty improves nasal relationships regarding alar symmetry, nostril dimensions at the cleft side, and nasal tip protrusion.

Clinical Significance of Pose Estimation Methods Compared with Radiographic Parameters in Adolescent Patients with Idiopathic Scoliosis.

Human pose estimation, a computer vision technique that identifies body parts and constructs human body representations from images and videos, has recently demonstrated high performance through deep learning. However, its potential application in clinical photography remains underexplored. This study aimed to establish photographic parameters for patients with adolescent idiopathic scoliosis (AIS) using pose estimation and to determine correlations between these photographic parameters and corresponding radiographic measures. We conducted a study involving 42 patients with AIS who had undergone spinal correction surgery and conservative treatment. Preoperative photographs were captured using an iPhone 13 Pro mounted on a tripod positioned at the head of an X-ray tube. From the outputs of pose estimation, we derived five photographic parameters and subsequently conducted a statistical analysis to assess their correlations with relevant conventional radiographic parameters. In the sagittal plane, we identified significant correlations between photographic and radiographic parameters measuring trunk tilt angles. In the coronal plane, significant correlations were found between photographic parameters measuring shoulder height and trunk tilt and corresponding radiographic measurements. The results suggest that pose estimation, achievable with common mobile devices, offers potential for AIS screening, early detection, and continuous posture monitoring, effectively mitigating the need for X-ray radiation exposure. Level of Evidence: 3.

Premaxillary Graft with Costal Cartilage in Rhinoplasty: A Technique to Support the Nasal Tip.

Rhinoplasty is an ever-evolving field, with innovative techniques continually being developed to enhance both aesthetic and functional outcomes for patients. Increasingly, research has focused on the integral role of the facial skeleton in providing nasal support and projection. Central to the structural integrity of the nose is the maxillary bone, which occupies a pivotal position in the midface. The objective of this study is to assess the outcomes of patients who underwent rhinoplasty involving the placement of a premaxillary graft fashioned from costal cartilage. The study aims to evaluate the graft's tolerance, stability, and potential complications. The patient cohort comprised individuals who underwent open approach rhinoplasty with premaxillary insufficiency, necessitating the placement of a costal cartilage graft anterior to the nasal spine, performed by the same surgeon between 2021 and 2022. A total of 38 patients, consisting of 5 men and 33 women aged between 18 and 58years, were operated on during this period. Consistent maintenance of tip support was observed across all cases. Among the 33 patients, 20 were randomly chosen for a comparative assessment of the nasolabial angle in preoperative and postoperative profile photographs, demonstrating a statistically significant improvement. No complications such as graft displacement, scarring, extrusion, or infections were reported. The use of a premaxillary graft with costal cartilage appears to be a viable, well-tolerated option with favorable long-term outcomes. 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 .

The Efficacy of Populus euphratica and Myrtus communis Herbal Mouthwash on Gingivitis in Pediatric Patients Diagnosed Clinically and with Photometric CIELab Analysis: An In Vivo Randomized Double-blind Clinical Study.

Children are more prone to develop gingivitis as a result of deficient oral hygiene, morphological variance, and a diet that encourages the growth of pathogenic oral bacteria. The purpose of this randomized, double-blind clinical study is to compare the therapeutic effect of an herbal mouthwash made of decoction and ethanolic extract of Populus euphratica and Myrtus communis to that of chlorhexidine (CHX) mouthrinse. In this study, 60 patients aged between 8 and 10 years were divided into four groups, each with 15 patients. The first group was treated with a mouthwash made of ethanolic herbal extract, the second group was treated with a mouthwash made of herbal decoction, the third group was treated with CHX mouthwash (0.12%) (positive control), and the fourth group was treated with a placebo made with colored distilled water (negative control). Clinical parameters gingival index (GI) and plaque index (PI) were evaluated at the start, 1, and 2 weeks from ensuing the treatment. Preoperative and postoperative photographs of the maxillary anterior sextant were recorded to evaluate CIELab coordinates to monitor color changes. One-way analysis of variance (ANOVA) with Tukey's honest significant difference (HSD) post hoc tests were used for data assessment. Significant reductions in GI and PI were found among the tested groups (p < 0.05). A significant reduction in a* value was observed, while L* value showed a significant increase between baseline and posttreatment (p < 0.05). Herbal-based mouthwash of Populus euphratica and Myrtus communis, whether prepared by boiling or ethanolic extraction, reduced gingival inflammation significantly and has a lot of potential for treating and preventing periodontal disease in young children. Digital photography is a reliable supplementary approach for diagnosing and monitoring gingival inflammation in pediatric patients. Mohamed-Ali SF, Jasim AA, Mahmood MAK, et al. The Efficacy of Populus euphratica and Myrtus communis Herbal Mouthwash on Gingivitis in Pediatric Patients Diagnosed Clinically and with Photometric CIELab Analysis: An In Vivo Randomized Double-blind Clinical Study. Int J Clin Pediatr Dent 2024;17(8):918-924.

A Study on Septoplasty and Functional Septorhinoplasty in Children.

Surgical techniques that are safe and effective in adults can produce bad results in children. The study was done To present the results of septoplasty and functional septorhinoplasty (FSR) in children in order to restore the anatomy and function of the nose. In a prospective study done in a tertiary care hospital between May, 2016 and November, 2022, twenty-five children (14 males and 11 females) aged 8 to 14 years having significant nasal obstruction due to deviated septum with or without external nasal deviation were included in this study. Septoplasty was done in 16 patients and FSR was done in 9 patients by endonasal technique. Surgical outcomes were evaluated by comparing preoperative and postoperative photographs, NOSE scores, anterior rhinoscopy and subjective satisfaction. The follow-up period ranged from 15 to 90 months with a mean follow-up period of 43 months. Out of the 25 patients, the mean NOSE scores preoperatively and postoperatively were 72 and 22 (a significant improvement of mean 50.00 with p-value of < 0.05). Anterior rhinoscopy postoperatively showed that 19 patients (76%) had a straight septum while 6 patients (24%) had some residual deviation. Subjective patient satisfaction was "much improved" in 13 (52%) patients, and "improved" in 12 (48%) patients. In photographic evaluation of 9 patients with external nasal deviation the result was very good in 3, good in 5 and average in 1 patient. Septoplasty and FSR in children resulted in significant improvements in nasal airway and external nasal deviation.

Long-term photogrammetric outcomes of midface advancement in Apert syndrome: are we nearing normal?

The aesthetic goals of midface surgery in Apert syndrome are to correct the multi-planar midface deficiency and normalize facial ratios. This study characterizes the long-term photogrammetric outcomes of midface advancement in Apert syndrome. Patients with Apert syndrome who underwent midface distraction from 2000 to 2023 were retrospectively reviewed. Soft tissue measurements were applied to preoperative (T0), short-term postoperative (T1), and long-term postoperative (T2) photographs. Long-term changes were compared between subcranial and transcranial procedures, segmental and non-segmental osteotomies, and individual techniques. Frontal facial dimensions at time T2 were compared to age- and sex-matched normal controls from the NIMH-ChEFS face database. Twenty patients had postoperative follow-up of T1 = 0.6 ± 0.4 and T2 = 4.7 ± 1.1years and were compared to 40 normal controls. From time T0 to T2, middle facial third height increased (26.1 ± 3.0% to 27.8 ± 2.6%, p = 0.026), canthal tilt improved (- 7.6° ± 3.7° to - 3.9° ± 4.4°, p < 0.001), and facial convexity increased (182.9° ± 6.2° to 167.9° ± 8.6°, p < 0.001). From time T1 to T2, facial convexity flattened (159.4° ± 10.1° to 167.9° ± 8.6°, p < 0.001). Compared to controls, patients at time T2 had shorter middle facial third height (27.8 ± 2.6% vs. 32.0 ± 1.9%, p < 0.001) and reverse canthal tilt (- 3.9° ± 4.4° vs. 5.4° ± 2.6°, p < 0.001). A tailored treatment approach to the Apert midface yields varying degrees of resolution of central midfacial shortening, canthal tilt, and facial concavity at 5years postoperatively. A slight reduction in facial convexity over time, likely reflecting pseudorelapse in the setting of sagittal overcorrection, should be anticipated. Greater utilization of segmental osteotomies may bring facial third ratios and canthal tilt closer to normal morphometric values.

Treatment of the Hypertrophic Nipple in Breast Augmentation.

Background: Disproportionately large nipples with respect to the areola and the breast can result in physical and psychological problems for the patient. When a breast augmentation is performed, the nipple is projected forward by the implant, creating an optical appearance of being more projected and bigger in size with respect to the areola. A successful nipple reduction should be able to reduce its diameter and projection to achieve a good esthetic result, preserving its sensitive and lactation functions simultaneously. Objectives: The purpose of this study is to describe our technique and results of nipple reduction in context of breast augmentation. Methods: We carried out a retrospective cohort of patients in which a simultaneous breast augmentation and nipple reduction was performed by the Plastic and Reconstructive surgery Department of the German Hospital (Deutsches Hospital), in Buenos Aires, Argentina, between January 2016 and June 2022. Our technique consisted of a circumferential resection of skin at the base of the nipple followed by a wedge resection of the inferior portion of the nipple. The results were evaluated by comparing preoperative and postoperative photographs. Results: We included 17 patients. No patient presented nipple necrosis, wound dehiscence, hypertrophic scarring or permanent loss of sensation. Lactation could not be evaluated in the postoperative follow-up. Esthetic results were satisfactory in all patients. Conclusions: We described our surgical technique, which allows the treatment of the hypertrophic nipple addressing the anteroposterior projection and diameter independently. In turn, it preserves the sensory. The implantation of the scars at the base of the nipple and its inferior surface achieved discreet scars and a good esthetic result with high satisfaction rates in our patients. Level of evidence: Level IV, retrospective cohort.

Scalp Reconstruction With Free Tissue Transfer Using Descending Branch of Lateral Circumflex Femoral Vessels as Interposition Graft.

Despite the rich blood supply to the scalp, postoperative skin necrosis at the surgical site sometimes occurs, and unresolved defects often present a significant challenge for the surgeon. When planning a free flap for scalp reconstruction, distant anastomoses may be necessary if local recipient vessels are unavailable due to previous surgery. This study presents the authors' treatment strategy, which includes extending the pedicle length with arteriovenous bundle interposition grafts. Two patients who experienced surgical wound necrosis after bypass surgery for moyamoya disease underwent reconstruction for skin and soft tissue coverage. To evaluate the altered anatomical structures after the previous surgery, three-dimensional computed tomography angiography was performed, and preoperative photos were taken to accurately measure the expected defect. The surgical strategy was designed to accommodate their unique conditions, utilizing an arteriovenous interposition graft, which included 2 stages of microvascular anastomoses, for pedicle lengthening. The procedure successfully bridged the gap between distant recipient vessels and the extensive defect, and the wounds healed without major complications such as venous congestion or total flap loss. Both patients were satisfied with the surgical outcomes. Arteriovenous bundle interposition grafts can be a useful option for patients with complex scalp defects who lack local recipient vessels. The use of an anterolateral thigh flap with artery-to-artery anastomosis, utilizing the lateral circumflex femoral artery from the opposite side in this study, offers many advantages compared with traditional pedicle lengthening tools utilizing vein-to-artery anastomosis.

Clinical Efficacy of Mechanical Micronized Fat-Assisted Fat Grafting on Temporal Depression.

Temporal concavities result from reduced subcutaneous fat and bone structure variations, impacting facial aesthetics. Filling treatments, including autologous fat grafts, synthetic fillers, and biological materials, are used for enhancement. Autologous fat grafting is promising but limited by unpredictable fat absorption and nonstandardized procedures. This study aims to assess the clinical effectiveness of mechanical micronized fat in combination with autologous granular fat grafting for lipofilling in the correction of temporal deformities. Patients (n = 37, mean age = 37.48) with temporal concavity caused by aging and Inherently inadequate capacity were enrolled and divided into control group (n = 10) and study group (n = 9) according to different fat grafts. Control group received pure autologous granular fat, with an average volume of approximately 19.30 mL. In contrast, the study group used mechanical micronized fat along with autologous granular fat co-injection through an 18G needle with an average injection volume of about 18.89 mL. All autologous fat collected from patients' abdominal and thighs. Information, including postoperative clinical efficacy scored by various plastic surgeons for the comparison of preoperative and postoperative photos of patients, patient satisfaction, and complications between the two groups, was documented. Additionally, changes in patients' quality of life were evaluated using the FACE-Q scale. Six months after surgery, the efficacy of temporal filling in the study group (6.69 ± 0.64) was higher than the control group (6.37 ± 0.67) (P = 0.0048). The patient satisfaction was more prominent in the study group (6.28 ± 0.87) than in the control group (5.80 ± 0.71) (P = 0.0449). Differences between above two observation indicators were statistically significant (P < 0.05). The FACE-Q scale items, which assess psychological health, social functioning, and early life impact, showed higher scores in the study group both before the surgery (psychological health: 59.22 ± 3.53, social functioning: 64.75 ± 3.15) and 6 months after the surgery (psychological health: 69.44 ± 4.50, social functioning: 75.33 ± 3.81, early life impact: 74.21 ± 0.70) (P > 0.05). Notably, only one micronodule formation was detected among all patients. Mechanical micronized fat combined with autologous granular fat improve the clinical effect of treating concavity in temporal region, which is worthy of further promotion and application.