Short Scar Research Articles

Against the “visible” short scar face lift

According to the author, the short scar face lift seeks to eliminate the retroauricular scar by exerting a vertical pull on the cheek, but residual excess skin frequently remains below the ear lobe. More importantly, this vertical elevation of the cheek creates significant skin excess at the temporal level. To eliminate this excess, a precapillary temporal skin excision is usually performed. A potentially obvious temporal scar is thus created in a very visible part of the face. In this article, the author outlines his views on the drawbacks of the short scar face lift and advocates a different technique, using a vertical retroauricular incision, with the goal of avoiding the disadvantages of the short scar approach.

What do Patients Think About Minimally Invasive Total Hip Arthroplasty?

The introduction of minimally invasive techniques for hip replacement into clinical practice has been driven by the perceived benefits of smaller incisions, shorter in-patient stays and faster rehabilitation. This may be at the cost of higher complication rates. The purpose of this study was to explore the opinions and priorities of patients in relation to these techniques. A cross-sectional survey was performed in an elective out-patient setting. Of 44 patients approached, 36 agreed to participate. From most important to least important, patients rated the following items in order: 'rate of complications'; 'implant survival'; 'length of rehabilitation'; 'time in hospital' and 'length of scar'. Despite this, 21 of 35 (60%) responders stated they would accept the offer of minimally invasive techniques if made. Patients appear to prioritise long-term outcomes and low complication rates over the shorter scars, reduced in-patient stay and reduced rehabilitation times potentially offered by minimally invasive hip arthroplasty. Despite this, the technique remains popular among patients.

The third suture in MACS-lifting: making midface-lifting simple and safe

The minimal access cranial suspension (MACS)-lift is a short scar rhytidectomy with vertical purse string suture suspension of the facial tissues. It exists in a simple and extended version. The simple MACS-lift achieves a vertical lifting of neck and lower half of the face with two purse string sutures. The action of a third, malar suture gives additional correction of the middle third of the face, and results in the extended MACS-lift. To draw attention to the power and advantages of the 'third' malar suture in the extended MACS-lift in achieving volumetric restoration of the midface, softening of the nasolabial fold and enhancing support of the lower eyelid. The core principle of this technique is the use of strong purse string sutures in a pure antigravitational direction for correction of the ageing neck and lower two-thirds of the face. In a simple MACS-lift the neck is corrected by a first narrow vertical purse-string suture. The volume of jowls and cheeks is repositioned in a cranial direction with a second, slightly oblique purse string suture. To achieve better control over the midface an extended MACS-lift is performed by adding a third malar vertical purse string suture between the paracanthal area and the malar fat pad. 557 MACS-lift procedures have been performed by the two senior authors, of which 183 were simple and 374 extended. A retrospective review of this technique revealed high patient satisfaction, only one major complication and a minor complication rate of 6%. Both versions of the technique deliver a vertical vector correction of sagged facial features. The third suture restores the volume of the midface and malar mound and provides strong support of the lower eyelid. The third suture in the MACS-lift short scar rhytidectomy produces a natural midface lifting through a short scar, with adequate softening of the nasolabial fold and good support of the lower eyelid.

The differential fascial glide: A technical refinement in abdominoplasty

Body contour surgery is in continuous evolution in an attempt to offer better aesthetic results. With greater understanding of the superficial fascial system of the trunk, various suspension procedures have been devised which use the fascial system as an adjunct to complement traditional abdominoplasty techniques. We present a simple technical refinement to the traditional abdominoplasty which uses the superficial fascial system to tighten the flanks and concomitantly shortens the final scar: the differential fascial glide. In this technique the superficial fascia is dissected as a separate layer from the abdominal flap and suspended in an oblique direction towards the midline whilst the abdominal flap is pulled in a downward and lateral direction, thus creating two opposing vectors of pull. This simple technique results in improved flank contour and a shorter scar in patients undergoing classic abdominoplasty.

300 MACS-Lift Short Scar Rhytidectomies: Analysis of Results and Complications

300 MACS-Lift Short Scar Rhytidectomies: Analysis of Results and Complications

"Doughnut" Excision for Difficult Scar Revision

A newly designed doughnut excision technique difficult scar revision was proved to be suitable and effective for those moderate-sized scar in pen- joint or high skin tension regions. In the initial stage, the eccentric scar tissue is excised, leaving some residual scar tissue in the central area. In the final stage, the residual scar is completely removed if necessary. The procedure has been utilized for fifteen cases and the results revealed the following advantages as compared to conventional fusiform excision method: 1) a shorter final scar length; 2) an avoidance of linear scarring and, therefore applicability to joint surface; 3) a shorter total treatment period because of more scar tissue removal in initial stage; 4) a more desirable, smooth final appearance, even if the final central scar is not removed, because of the non-linear scar.

Minimal-Scar Breast Reduction and Mastopexy

Classic breast reduction and mastopexy techniques leave a vertical scar, but are difficult to apply in cases requiring a large amount of breast tissue removal. This report describes a new breast reduction technique using a vertical incision for resections involving less than 600 g of tissue removal and an inverted T incision for larger resections. Results for the new technique are reported. For 800 women, the reported technique was used for reduction mammaplasty (n=640) and mastopexy (n=160). Peridural anesthesia was used for 90% of the patients, and general anesthesia for 10%. The minimum follow-up period was 6 months for 90% of the patients. All the patients underwent mammary x-ray and ultrasonography before surgery. A short scar was obtained for all the patients. A new intervention for breast reduction was chosen by 16 patients (2%). For all the patients followed, the immediate results (projection of the areola and upper pole) remained unaltered at a late follow-up evaluation. There were no cases of infection or seroma. Hematoma occurred in 8 patients who underwent unilateral breast reconstruction, and 16 patients experienced temporary reduced sensitivity. The new technique was effective in leaving a short scar and maintaining immediate results in the long term. Liposuction limited to the lateral chest wall prevented complications associated with breast tissue.

300 MACS-lift short scar rhytidectomies: analysis of results and complications

Between November 1999 and April 2004, 300 MACS-lifts (Minimal Access Cranial Suspension–lifts) were performed. Starting from the idea of suspension of sagged soft tissues with permanent purse-string sutures, a new comprehensive approach to facial rejuvenation was developed, in which the vertical vector appeared to be essential.The neck is corrected by extended submental liposuction and strong vertical traction on the lateral part of the platysma by means of a first vertical purse-string suture. The volume of the jowls and the cheeks is repositioned in a cranial direction with a second, slightly-oblique purse-string suture. The descent of the midface is corrected by suspending the malar fat pad in a nearly vertical direction.The skin excess generated by these actions is redraped in a pure vertical direction and excised at the temporal hairline and the paracanthal region. As no horizontal pull on the skin is exerted, a retro-auricular incision becomes obsolete. The result is a pure antigravitational lifting procedure, which produces a natural facial rejuvenation through a short scar.

Modified Burow's advancement flaps for two circular adjoining cutaneous defects: The 8-to-S-plasty

The traditional method to close two closely approximated cutaneous defects (i.e., a figure "8"-shaped defect) sacrifices healthy skin and does not give optimal aesthetic results. We report a case with modified Burow's advancement flaps describing less sacrificed skin and shorter scars. Modified Burow's advancement flaps ("8"-to-"S" plasty) were applied, sparing two Burow skin triangles. Application of that modified operation technique leads to shorter scars in comparison to traditional Burow's advancement flaps. A modified technique is presented here for skin defects shaped like an "8"--namely, two similar round and adjoining lesions. The suture line after closing resembles an "S". With this 8-to-S plasty no additional incisions are necessary.

Direct Closure of Round Skin Defects: A Four-Step Technique with Multiple Subcutaneous and Cutaneous ???Figure-of-8??? Sutures Alleviating Dog-Ears

Excisional biopsies of rounded lesions are performed daily by surgeons. The objective of this article is to establish a surgical technique for direct closure of circular and elliptical defects without the need for additional excision of dog-ears. A four-step technique based on multiple cutaneous and subcutaneous "figure-of-8" sutures is presented. When correctly placed, these sutures can equally distribute the excess tissue along the scar and alleviate dog-ears. The results of the 65 presented cases show that this technique yields short scars and saves healthy skin. A significant reduction of the length-to-width ratio and the arc-to-scar length ratio is obtained. Direct closure of a circular or elliptical defect without stipulating a 3:1 length-to-width ratio is feasible. Among the advantages of the technique are that no excessive healthy tissue is removed and that the scar length is reduced. The long-term outcome is a scar that is thin, linear, flat, and concealed in the body structure.

Superomedial Pedicle Reduction with Short Scar

Reduction mammaplasty combining a superomedial pedicle with a circumareolar/vertical pattern skin excision avoids an inferior pedicle that can interfere with vertical scar technique, yet it is flexible enough to allow for a short transverse skin excision. This technique is suitable for small to moderate-size reductions.

Mammaplasty with L–incision

Background The cutaneous sequelae resulting from mastopexy and reduction mammaplasty are serious drawbacks for patients, particularly young women, and physicians who are dissatisfied with extensive postoperative scarring. Objective The author reports on an L-incision technique that involves a base resection with an upper transposition of the nipple-areolar complex (NAC) to yield good shape and projection, short scars, and preservation of lactation. Methods Preoperative markings were made to aid estimation of the amount of breast tissue to be excised, to establish anatomic landmarks ensuring breast symmetry, and to position the scars. Breast reduction was performed by means of perpendicular excision of the lower pole and transverse amputation of the base from the pectoral aspect of the breast. In wider breasts, a vertical keel was excised to decrease the circumference of the base. In mastopexy, the lower pole was preserved as a superiorly based flap and used to fill the upper pole. The new site of the NAC was marked bilaterally, slightly lower than the apex of the new mammary cone, with the downward rotation of the breast during the early postoperative period taken into consideration. Results The described L-incision procedure was performed in more than 500 patients between 1996 and 2003, with good results and a low rate of complications. Nipple sensitivity was generally preserved unless lesions of the lateral branches of the intercostal nerves were present. No lactation problems were reported by the 9 patients who breastfed babies after undergoing surgery. Twenty-seven patients underwent revision procedures to correct scar hypertrophy, areolar enlargement, asymmetry, persistent ptosis, or correction of “dog-ear.” Conclusions The L-incision technique is a safe, reliable procedure that results in good breast shape and projection with inconspicuous scars. It can be used in a wide variety of applications, including correction of breast hypertrophy, ptosis, and asymmetries.

Benefits and pitfalls of vertical scar breast reduction

A quality assurance study was undertaken three years after beginning the vertical scar breast reduction technique. We examined the rate of early and late complications (major and minor) and compared these to the formerly used inverted-T scar and L scar breast reduction techniques. Inverted-T scar breast reductions have an early complication rate of up to 20% and a late complication rate of 20–30%. Our vertical scar breast reduction is a modified Lassus technique, incorporating a geometrically based and measurable preoperative marking of the breast, a superior pedicle, a central breast resection, an intraoperative positioning of the nipple-areola complex, and occasionally a periareolar skin resection. In the time span examined (September 1998–December 2001) 153 patients could be included in the study. The resection weight per breast ranged from 60 to 1262 g (mean 390±210 g, median 380 g). The early complication rate (hematoma, seroma, wound dehiscence, wound infection and necrosis) was 21.6%. Of these cases, 19.6% were minor complications. The late complication or imperfection rate was evaluated very strictly using the standardized, extended scheme of Ferreira (problems of volume, shape, symmetry, areola, scars and position of the breast on the thorax) and was 26%. Major late complications necessitating a reoperation occurred in 11.1% of cases. These complication rates compare well to those of other vertical breast reduction techniques and T scar reductions in our own clinic and in the literature. Given that the vertical scar breast reduction method also results in shorter scars and a significantly better, long-lasting breast projection, this technique is clearly justified to remain the standard method at our clinic.

Short Inframammary Scar Mammaplasty with an Upper and Lower Pole???Encircling Skin Resection: The Bipolar Technique

Short Inframammary Scar Mammaplasty with an Upper and Lower Pole???Encircling Skin Resection: The Bipolar Technique

Tools for characterization of Escherichia coli genes of unknown function.

Despite the power of sequencing and of emerging high-throughput technologies to collect data rapidly, the definitive functional characterization of unknown genes still requires biochemical and genetic analysis in case-by-case studies. This often involves the deletion of target genes and phenotypic characterization of the deletants. We describe here modifications of an existing deletion method which facilitates the deletion process and enables convenient analysis of the expression properties of the target gene by replacing it with an FRT-lacZ-aph-P(lac)-FRT cassette. The lacZ gene specifically reports the activity of the deleted gene and therefore allows the determination of the conditions under which it is actively expressed. The aph gene, encoding resistance to kanamycin, provides a selectable means of transducing a deleted locus between strains so that the deletion can be combined with other relevant mutations. The lac promoter helps to overcome possible polar effects on downstream genes within an operon. Because the cassette is flanked by two directly repeated FRT sites, the cassette can be excised by the Flp recombinase provided in trans. Removing the cassette leaves an in-frame deletion with a short scar which should not interfere with downstream expression. Replacements of yacF, yacG, yacH, yacK (cueO), yacL, ruvA, ruvB, yabB, and yabC made with the cassette were used to verify its properties.

A personal technique: mammaplasty with J scar.

Mastopexy and reduction mammaplasty techniques have evolved with time, pursuing the aim of an effective and reliable technique that produces a well-shaped breast and reduces the amount of scarring. The authors believe that the L mammaplasty achieves the best results in terms of a short scar and a good, stable shape. They present their technique of a modified L mammaplasty with a resulting scar in the shape of a J, which implies a central breast resection with the nipple-areola complex transposed on a superior pedicle. The correct execution of the preoperative markings and the shaping of the gland tissue are mandatory to obtaining the desired result. The technique has been used during the past 7 years on 326 patients, providing satisfactory results with short scars and virtually no complications.

Endoscopic correction of pectus excavatum.

Endoscopic surgery is minimally invasive and can be used to achieve superior cosmetic results. Conventional correction of pectus excavatum results in a long scar. Correction by use of endoscopic surgery involves a smaller skin incision. In this study, endoscopic correction of pectus excavatum was performed in 20 cases. A small transverse skin incision was made above the xyphoid process. A wide area beneath the pectoralis major muscle was dissected under endoscopic visualization. Subperichondrial resection was performed under direct visualization when possible. Subperichondrial resection of the third or fourth rib was performed under endoscopic visualization. Ravitch's chondrotomy of the second or third rib was performed under endoscopic visualization. Endoscopy was also useful for sternal elevation, with minimal risk of pleural perforation. Kirschner wire was inserted percutaneously under the sternum to prevent postoperative paradoxical respiration. In all cases, the postoperative course was uneventful. The advantages of endoscopic pectus excavatum correction are a short scar, control of bleeding, safe dissection of the pleura from the sternum without the risk of pleural perforation, and ease of sternal elevation without injury to the intramammary vessels. However, the endoscopic operation is long and is not useful in adults because subperichondrial resection in adults is difficult to perform.

Short Scar Periareolar Inferior Pedicle Reduction (SPAIR) Mammaplasty/Mastopexy: How I Do It Step by Step

-Recent advances in the technique of breast reduction have focused on reducing the amount of cutaneous scar. Reported here is a short scar operative strategy, which is applicable to everything from cases of simple breast ptosis requiring mastopexy, to cases of breast reduction of more than 1000 g. The operation bases the blood supply to the nipple and areola on an inferior pedicle, controls shape with aggressive internal suturing, and manages the excess skin envelope with a combined periareolar and vertical pattern. The operative technique is straightforward and the results have been consistent and reproducible. The shape of the breast is rounder and fuller than with other techniques, and the breast is resistant to excessive postoperative settling or bottoming out. It is recommended as an excellent option for management of the excessively large or ptotic breast.

Temporal facelift and corrugator resection.

On a path analogous to other surgical disciplines, the progression of facial cosmetic surgery has trended toward shorter scars and less invasive techniques. This article outlines an approach to facelifting that limits the scar to the temporal scalp, preauricular area, and retroauricular sulcus. It will enable the reader to identify those patients who are candidates for a less invasive procedure compared with the conventional facelift approach. Specifically, the temporal facelift addresses the lateral brow, the middle one third of the face, and the upper neck. In addition, this article examines the various and current methods for treatment of the glabellar area of the forehead. Medical and surgical options are outlined for the correction of those rhytids induced by corrugator and procerus muscle activity.

Circumvertical reduction mastoplasty

Background: Circumvertical reduction mastoplasty combines periareolar and vertical techniques for the treatment of large breast hypertrophies. Objective: The advantage of circumvertical reduction mastoplasty over the periareolar technique is the occurrence of fewer wrinkles. Its advantage over the vertical technique is a shorter scar that does not extend beyond the new inframammary crease. Methods: In this technique, the areola is transposed attached to the gland and glandular removal is performed as a wedge excision in the lower quadrant and inferior portions of the lateral and medial quadrants. Liposuction is rarely required but may be useful at the end of the procedure and in cases with small asymmetries. Results: Once the surgery is complete, a uniform and harmonious distribution of wrinkles is observed. Postoperative follow-up of 62 patients, ranging from 1 to 6 years, revealed resections of up to 1000 g per breast. All results were satisfactory. Conclusions: Circumvertical reduction mastoplasty offers a reliable and easily performed approach to breast reduction, which is appropriate for removal of between 400 and 1000 g per breast.