Visible Scars Research Articles

A Case of Nasal Dermoids Removed Via the Open Rhinoplasty Approach

Nasal dermoids are congenital midline nasal lesions that occur along with encephaloceles and gliomas. They can cause both deformity of nasal structure and intracranial infection as they grow. Treatment for these lesions is be concerned with two aspects, the complete removal of the lesions and making the surgical scar cosmetically acceptable. To that goal, many surgical approaches such as vertical incision, transverse incision, lateral rhinotomy and open rhinoplasty have been introduced. A 12-month male child presented with palpable mass at nasal root. The mass was easily movable, non-compressible and did not present fistula. A well-defined cystic mass without intracranial extension was found on the computerized tomography scans. Open rhinoplasty approach was opted for according to the guardians’ preference to avoid visible facial scar, and the lesions were completely resected. The pathologic examination confirmed the lesion to be nasal dermoids. The columellar scar was negligible and there was no recurrence at 5 year-follow up after surgery.

Rac1 inhibition regenerates wounds in mouse fetuses via altered actin dynamics

Mammalian wounds leave visible scars, and there are no methods for complete regeneration. However, mouse fetuses regenerate their skin, including epidermal and dermal structures, up to embryonic day (E)13. This regeneration pattern requires the formation of actin cables in the wound margin epithelium; however, the molecular mechanisms are not fully understood. Rac1 alters actin in cells and is involved in the formation of filopodia. We investigated whether actin remodeling and skin regeneration patterns can be reproduced through the regulation of Rac1 signaling. Rac1 expression was downregulated in E13 wounds and upregulated after E15 when scars remained. NSC23766, a Rac1-specific inhibitor, altered actin dynamics at the cell margin from filopodia formation to cable formation and inhibited the migration of mouse epidermal keratinocyte, PAM212, by Rac1 signaling suppression. NSC23766 suppressed Rac1 activity and completely regenerated the fetal mouse wounds, even at E14, by changing actin dynamics. Knocked-out Rac1 transgenic mice experienced delayed epithelialization of wounds with suppressed epidermal migration in adults; however, in fetuses, complete wound regeneration via Rac1 signal suppression was observed. Therefore, Rac1 suppression in the wound epidermis can achieve regenerative wound healing in fetuses and may be a potential candidate for healing scars.

Breast Cancer Survivors' Perceptions of Mastectomy Reconstruction: A Comparative Analysis of Medical Tattooing Impact on Aesthetics.

Studies indicate that physical appearance changes affect a significant proportion of breast cancer survivors, often leading to post-surgical distress. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on aesthetic outcomes from the patient perspective. This study examined how breast cancer survivors evaluated the cosmetic and decision satisfaction of other patients who made various cosmetic intervention choices post-mastectomy. Breast cancer survivor support networks (n = 180) across 20 states agreed to share information about the online survey to their members. Participants (n = 251) rated the cosmetic outcome and decision satisfaction of images depicting other patients who had received mastectomy with three types of intervention: reconstruction alone, medical tattooing alone (flat closure), and reconstruction and medical tattooing combined. A factorial MANOVA produced significant within-subjects effects indicating participants consistently rated images of patients with a combination of reconstruction and medical tattooing highest in cosmetic quality, lowest in scar visibility, and highest in treatment decision satisfaction. The findings suggest that medical tattooing serves as a valuable complementary cosmetic intervention, with many survivors expressing interest and recognizing potential benefits once informed about the option. However, the study's limitations, such as the need for a more diverse range of patient images for evaluation, should be acknowledged. Future research should address these gaps by incorporating photographs of patients across varying demographics, including age, body weight, disease severity, and surgical procedures, to minimize bias. Despite these limitations, this study highlights the significant role that medical tattooing can play in enhancing aesthetic outcomes after surgery, particularly from a patient-centered perspective. 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 https://link.springer.com/journal/00266 .

Minimally Invasive Video-Assisted Surgery for Concomitant Ascending Aorta and Aortic Valve Replacement via Right Infra-Axillary Thoracotomy.

This study aims to assess the safety, efficacy, and esthetic outcomes of an innovative 4 cm right infra-axillary incision approach for concomitant ascending aorta and aortic valve replacement (AAR and AVR), with a specific focus on achieving optimal surgical outcomes while ensuring minimal visible scarring. We retrospectively examined all elective cases of concomitant AAR and AVR surgery performed at our institution from July 2021 to June 2023. Exclusions encompassed emergency surgery, acute type A aortic dissection, active aortic valve endocarditis, redo cardiac surgery, the necessity for concurrent mitral valve replacement, or left ventricular assist device implantation. We collected and analyzed perioperative data for the patients. The study comprised 24 consecutive patients. Cardiopulmonary bypass time and aortic cross-clamp time averaged 215.0 (interquartile range [IQR], 38.0) and 158.0 (IQR, 37.0) min, respectively. No instances of reoperation due to postoperative bleeding or need for permanent pacemaker implantation were recorded. Initial 24-h postoperative drainage volume averaged 186.9 ± 76.9 mL. Average follow-up duration was 21.7 ± 6.2 months (range, 5 to 30 months). Throughout short-term follow-up, no occurrences of valve dysfunction, paravalvular leak, cardiovascular events necessitating readmission, or mortality were observed. The right infra-axillary incision approach effectively yields secure, successful, and cosmetically pleasing outcomes for concomitant AAR and AVR. Further research and comparisons are warranted to validate these findings.

Submental/submandibular intubation: a journey from past to future.

In 1986, Altemir published the first article on submental intubation as an alternative to tracheostomy for managing difficult airways. This review provides an overview of submental/submandibular intubation, covering its development, techniques, and clinical outcomes. Initially devised to address difficult airways in oral and maxillofacial surgery, the technique has since evolved. Recent advancements include focused surgical incisions, ultrasound-guided imaging, and the use of improved procedural tools like the Seldinger technique. Clinical trials have demonstrated that submental/submandibular intubation is generally more efficient and quicker than tracheostomy in trauma patients. One of its key advantages is the absence of visible scarring, along with a less invasive recovery process. However, the technique has some limitations, including risks of infection, bleeding, and scarring, which require further investigation to optimize its application. While submental/submandibular intubation remains a valuable method for managing difficult airways, ongoing refinement and evaluation are necessary to maximize its clinical utility. This technique presents an excellent alternative in specific surgical scenarios and offers a simplified solution where other intubation methods may be unfeasible.

CLINICAL ADVANTAGES OF LAPAROSCOPIC CHOLECYSTECTOMY: EFFECTS ON RECOVERY AND PATIENT SATISFACTION OVER THE OPEN APPROACH

Cholecystectomy is a surgical procedure aimed at removing the gallbladder, and is commonly used in the treatment of conditions such as symptomatic cholelithiasis and various gallbladder-related diseases. With advances in surgical techniques, laparoscopic cholecystectomy has become the preferred approach in many cases, replacing the conventional open technique. The objective of this integrative review is to analyze the advantages of laparoscopic cholecystectomy compared to conventional surgery, focusing on aspects such as recovery time, postoperative pain, complications, costs, and aesthetic results. The methodology included searches in databases such as PubMed, Scopus, and SciELO, covering studies published in the last 20 years. Inclusion criteria included systematic reviews, clinical trials, and observational studies that compared both surgical approaches. The results indicate that laparoscopic cholecystectomy offers significantly shorter recovery times, allowing patients to quickly return to daily activities. Additionally, this technique is associated with reduced levels of postoperative pain and a lower rate of complications, such as infections and hernias. The aesthetic results are also superior, with less visible scars. Although the initial costs of laparoscopy may be higher, the cost-effectiveness analysis suggests that in the long run, it may be more cost-effective due to the reduction in length of hospital stay and postoperative care. This review provides a comprehensive overview of the benefits of laparoscopic cholecystectomy and its implications for clinical practice and public health.

Indocyanine Green Angiography-Assisted Pure Hemi-Periareolar Incision Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction.

Although pure hemi-periareolar incisions for mastectomy can prevent visible scarring, nipple-areolar complex (NAC) necrosis is a potential risk. Superficial-arterial inflow of the NAC can be evaluated by indocyanine green angiography (ICG-A). This study evaluated the impact of ICG-A assisted periareolar incision on NAC necrosis during nipple-sparing mastectomy (NSM) and direct-to-implant (DTI) breast reconstruction. Between December 2018 and November 2021, lateral hemi-periareolar incisions for NSM were routine. After that time, ICG-A-assisted hemi-periareolar incisions were performed between December 2021 and Sept. 2023. The location of the main arterial inflow was evaluated during preoperative ICG-A and the periareolar incision was planned to avoid disruption. NAC necrosis in the ICG-A-assisted and blind-incision groups was compared using univariate and multivariate analyses. A total of 202 breasts were analyzed including 80 breasts from 75 patients in the ICG-A-assisted group and 122 breasts from 115 patients in the blind-incision group. On preoperative ICG-A, superficial-arterial inflow was observed in 67 of 80 (83.75%) breasts. Perfusion of the nipple without superficial-arterial inflow (base-perfusion pattern) was observed in 13 breasts (16.25%). The main arterial inflow was most common in the upper-medial direction at the areolar margins (65.67%). The full-thickness NAC necrosis rate in the ICG-A-assisted incision group was significantly lower than that in the blind-incision group (2.5% vs. 13.1%, p = 0.010). Multivariate analysis demonstrated that ICG-A-assisted incisions significantly reduced the risk of NAC necrosis (odds 0.155, p = 0.030). ICG-A-assisted pure hemi-periareolar incisions reduced NAC necrosis in DTI breast reconstructions.

Enhancing Athletic Recovery: Scar Treatment Using Microneedling, Dermal Fillers, and Lasers

Introduction and purpose: Scars represent a prevalent skin irregularity encountered by a significant portion of the population. Beyond merely impacting physical appearance, they can also contribute to the onset of depression and anxiety disorders, which may hinder athletic recovery. The treatment landscape for scars is diverse, spanning non-invasive to invasive procedures. This literature review endeavors to explore scar management, particularly focusing on methodologies involving microneedling, dermal fillers, and laser interventions. By examining these innovative approaches, we aim to provide insights into their efficacy and implications for clinical practice, with a particular emphasis on facilitating a faster return to sport and optimal athletic performance. Material and methods: The literature was conducted using "Pub Med" and "Google Scholar" databases with the keywords „scars”, „microneedling”, „dermal fillers”, „lasers” Brief description of the state of knowledge: Scar therapy using microneedling, dermal fillers, and lasers has shown high effectiveness and significantly improves the lives of patients undergoing treatment. Results and conclusions: Treating scars using microneedling, dermal fillers, and laser therapy has led to significant enhancements in both physical functioning and psychological well-being among patients with visible scars. These procedures exert their efficacy by promoting collagen synthesis and facilitating skin regeneration, thereby ameliorating skin redness, erythema, and scar tissue formation. However, it's important to note that the effectiveness of these interventions varies depending on factors such as the type and depth of the scar, as well as the age of the patient.

Evaluation of electrophotobiomodulation as a recent tool in the armamentarium of treatment of fingertip injuries

BackgroundTraditional reconstructive options of fingertip injuries are technically difficult, usually need donor site skin grafting, leave visible scars, and need a protracted period of finger immobilization resulting in joint stiffness. Electro-photobiomodulation (EPBM), is the process of combining intense pulsed light and radiofrequency to modify tissues to help the body heal itself, lower inflammation, and promote wound healing.Patients and methodsThis study included 60 patients presented with fingertip injuries. Patients were randomly divided into two groups. Group 1 includes patients who were treated by EPBM. Group 2 includes patients who were treated by cross finger flap (CFF). Six months after complete healing, evaluation was performed for aesthetic and functional outcome and patient satisfaction.ResultsCompared to group 2 patients, group 1 patients had statistically significant better sensory outcome, better total active motion of affected digits, grip strength, patient satisfaction, healing time, and plastic surgeon general aesthetic evaluation and also, they had statistically significant less adverse events and cold intolerance with absent donor site pain and deformity.ConclusionEPBM is safe and effective treatment of fingertip injuries which shortens the healing time, produces the best aesthetic and functional result while avoiding donor site morbidity of the traditional reconstructive options.

Eyebrow reconstruction by simple elliptical excision with beveled incision – A case series of twelve patients

Patients seeking reconstructive facial surgery desire aesthetically pleasing outcomes with minimal visible scarring. For scalp incisions, bevelled angle of 45° is typicallypreferred to preserve hair follicles. However, no consensus exists regarding the ideal incision angle for the brow area. This observational study analyzed the surgical outcomes of 12 patients with eyebrow defects treated using a simple elliptical excision with a bevelled incision, addressing various indications such as posttraumatic scars, post-burn scars, and tumors. Outcomes were evaluated using the Physician Global Esthetic Improvement Scale at 7 days and 3 months post-surgery. At 7 days, 50% of patients showed very good improvement, and the other 50%showed moderate improvement. By 3 months, 33% of patients exhibited exceptional improvement, 50% showed very good improvement, and 17% demonstrated moderate improvement. This study concludes that direct excision and approximation with an angled incision along the hair follicle direction provide favorable aesthetic results for eyebrow reconstruction.

Feasibility and safety of preauricular incision for extracapsular dissection in benign parotid tumors.

Parotidectomy techniques continuously evolve to improve outcomes while minimizing morbidity. This study investigates the rationale behind developing and evaluating the feasibility and safety of extracapsular dissection (ECD) via preauricular incision for benign parotid tumors in the anterior or superior part of the parotid gland. The preauricular approach is developed to address the increasing demand for minimally invasive techniques that prioritize both functional and aesthetic outcomes. Minimizing visible scarring and preserving facial nerve function offers a compelling solution for patients seeking optimal cosmetic results without compromising surgical efficacy. Patient assessments included cosmetic contentment, functional repercussions, and disease management throughout the follow-up. Eight patients underwent ECD via the preauricular approach, demonstrating favorable outcomes with preserved facial nerve function and minimal complications. This study highlights the potential of the preauricular approach as a preferred option for managing benign parotid tumors in the anterior or superior parotid region, emphasizing aesthetic outcomes and preserving gland function. IV.

Comparison of Aesthetic Results of Mercedes-Y Versus Inverted-V Incision for Umbilical Reconstruction: A Randomized Clinical Trial.

The appearance and position of navel which are considered as a marker for overall abdominal aesthetics, are important for the final results of abdominal surgeries. However, reconstructing and improving its appearance have been a challenge in plastic surgery. In this study, we aimed to compare satisfaction of the patients and the plastic surgery professors with the aesthetic results of the two methods of umbilical reconstruction: Mercedes (Y) incision versus inverted-V incision. This is a randomized clinical trial performed on umbilicoplasty patients following abdominoplasty, breast reconstruction, or abdominal flap surgery whom referred to our center. They were divided into two equal groups of twenty patients with Mercedes (Y) incision and patients with inverted-V incision. The results of surgery were compared three months after the surgery by the opinions of patients, plastic surgery professors, and unbiased observers. The average scores of patients, professors, and observers showed that Mercedes (Y) had significantly higher scores compared to inverted-V incision in terms of position, size, shape, natural appearance, and the overall satisfaction. Surgical complications including stenosis, necrosis, and wound dehiscence were not statistically different in our small sample size. In this study, Mercedes (Y) incision was preferred by all of the groups in all five parameters that were assessed including size, shape, position, natural appearance, and overall satisfaction. The simplicity of the Y incision with less visible scar makes it a suitable method for further investigations with a larger sample size. Level of Evidence I 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 .

Aesthetic Approaches to Zygomatic Fracture Management: Achieving Optimal Outcomes With Minimal Scarring.

The zygomaticomaxillary complex is integral to facial aesthetics and is frequently involved in facial fractures. These injuries often necessitate surgical intervention, with open reduction and internal fixation being the standard treatment. This article presents a novel philosophy for managing zygomatic fractures, emphasizing the "Scarless Surgery" technique. The authors' approach prioritizes minimal osteosynthesis material and fixation points while utilizing the least visible surgical access. For isolated zygomatic arch fractures, an intraoral technique is preferred, whereas the frontozygomatic suture is approached through an upper eyelid crease for optimal aesthetic outcomes. The zygomaticomaxillary buttress is accessed through a vestibular mucosal incision and the infraorbital rim benefits from a transconjunctival approach. The findings suggest that fewer fixation points can still yield satisfactory stability and cosmetic results, aligning with literature supporting the efficacy of 1 and 2-point fixations. This modern technique not only minimizes visible scarring but also conforms to the contemporary push for minimally invasive surgical methods. The authors' experience and the existing literature support the efficacy of this approach, reinforcing its viability as a standard practice in the surgical management of facial trauma.

Accessory Axillary Breast Management: Is Primary Skin Excision Necessary?

AbstractAxillary breasts are a common entity with a reported incidence of 2 to 6% in women and 1 to 3% in men. They are more common amongst Asians than Caucasians, namely amongst South East Asians and Indians, with the highest incidence amongst Japanese. While modalities like CoolScupting™, Kybella™ injections, and BodyTite™ have been used by surgeons for management of axillary breasts, the most effective treatment for this condition remains surgical management involving a combination of liposuction of the axillary breast with excision of the gland and skin. In the author's experience, primary skin excision always leaves a long visible scar that widens over time, at times leading to contractures and restricted axillary movements even when closure looks tension free on the table. Any skin excess is best dealt with secondarily. The author uses a modified protocol without any primary skin excision in axillary breast management to achieve excellent results with minimal scars.

The Impact of Scars After DIEP-Flap Breast Reconstruction on Satisfaction and HR-QoL: A Cross-Sectional Study Comparing BREAST-Q Scores.

Although deep inferior epigastric perforator (DIEP) flap breast reconstruction is the most widely used technique for autologous breast reconstruction, this technique leads to large scars in visible areas on breast and abdomen. So far, limited studies have thoroughly addressed the impact of breast and abdominal scars on satisfaction and Health-related Quality of Life (HR-QoL). This research aimed to determine whether women with no/minor scar symptoms after undergoing DIEP-flap breast reconstruction differ in satisfaction and perceived HR-QoL from women with symptomatic scars. In this cross-sectional survey study, women who had previously undergone DIEP-flap breast reconstruction completed an online survey. Patient-reported scar quality was assessed with the Patient and Observer Scar Assessment Scale (POSAS), and satisfaction and HR-QoL with BREAST-Q. Independent-samples t-tests were conducted to compare BREAST-Q scores between women with no/minor scar symptoms (POSAS overall opinion score 1-3) and women with symptomatic scars (POSAS overall opinion score 4-10). A total of 248 women completed the survey. Women with scar symptoms had significantly worse BREAST-Q scores on 'Satisfaction with breasts,' 'Physical well-being,' 'Psychosocial well-being' and, 'Sexual well-being' compared to women with no/minor scar symptoms (p ≤ 0.001). After DIEP-flap breast reconstructions, women with symptomatic breast and abdominal scars had a clinically relevant and statistically significant lower degree of satisfaction and HR-QoL compared to women who had no/minor scar symptoms. We therefore recommend to explicitly and repeatedly address inevitability of visible scars after DIEP-flap breast reconstruction, aiming to improve preoperative patient selection and post-operative expectation management. 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 .

Indications and technique for transoral thyroid gland and parathyroid gland surgery

The conventional Kocher collar incision is the standard access to the thyroid and parathyroid glands. Although the incision length has been significantly shortened in recent years with this approach, there is increasing interest among patients in asurgical technique without visible scars in the décolleté. Transoral endoscopic thyroid gland surgery via the vestibular approach (TOETVA) is amodern technique that can be learned relatively quickly and leaves no visible scars because it is carried out exclusively through anatural orifice (natural orifice transluminal endoscopic surgery, NOTES). For retrieval of larger specimens, the transoral approach can be combined with aretroauricular access and thus covers alarger range of indications. The indications must be strictly followed, analogous to conventional surgery. Once the transoral access has been established, the operation is carried out as in open surgery but strictly from cranial to caudal. The classical complications are comparable to the results of conventional surgery. Specific complications include perioral, mandibular or cervical dysesthesia and hypesthesia.

Comprehensive Guide to Transoral Endoscopic Thyroidectomy Vestibular Approach: Step-by-Step Technique

AbstractTransoral endoscopic thyroidectomy vestibular approach (TOETVA) is a minimally invasive surgical technique that offers safety comparable to conventional open thyroidectomy, with the added benefit of superior cosmetic outcomes due to the absence of visible scars. This innovative approach is gaining popularity worldwide as an alternative for patients seeking thyroid surgery without postoperative scarring. TOETVA involves positioning the patient supine with slight neck extension under general anesthesia. The procedure uses three trocars placed via midline and lateral incisions, with a 10-mm 30-degree laparoscope for visualization. Preoperative care includes cleaning the surgical area and administering intravenous antibiotics to prevent infection. The technique mirrors conventional thyroidectomy but utilizes standard laparoscopic instruments. It emphasizes the precise identification and preservation of critical anatomical structures, such as the cricoid cartilage, thyroid isthmus, trachea, carotid artery, superior laryngeal nerve, and recurrent laryngeal nerve. The use of an energy device and careful dissection help minimize bleeding and reduce nerve injury risks. Superior pole management and meticulous handling of the thyroid lobe ensures optimal outcomes. The growing popularity of TOETVA indicates a shift toward minimally invasive thyroid surgery, with TOETVA emerging as a leading method. This paper provides a comprehensive overview of the procedure, highlighting its benefits and critical aspects of its successful implementation.

Periareolar approach in video-assisted thoracoscopic surgery for right middle lobectomy: a novel technique

BackgroundUniportal thoracoscopic right middle lobectomy (RML) poses greater technical challenges than other lobectomies. Although two-port thoracoscopy offers convenience, it results in heightened surgical trauma and scarring. The periareolar incision is rarely used in lobectomy while known for its cosmetic advantages. This study presents the periareolar access (combining a periareolar port and a 1-cm port) for video-assisted thoracoscopic surgery (VATS) in RML, comparing it with the traditional uniportal technique in both male and female patients.MethodsEighty patients who underwent RML were randomly divided into two groups: the periareolar VATS (PV) approach (n = 40) and the uniportal VATS (UV) approach (n = 40) from August 2020 to February 2023. All patients were followed up for 1 year and clinical data were collected and analyzed.ResultsNo significant differences in complications, blood loss, duration of chest tube placement, and length of postoperative hospital stay were observed between two methods. However, the PV group exhibited significantly shorter operative time, reduced postoperative visible scarring and lower visual analogue scores (VAS) for postoperative pain (P < 0.05). Additionally, the PV group demonstrated significantly higher cosmetic and satisfaction scores at the 6-month postoperative assessment (P < 0.05). Notably, breast ultrasound follow-up revealed two cases injuries of the mammary glands in female patients, and sensory function of most nipple and areola remained intact except two cases in all PV group patients.ConclusionsPeriareolar VATS emerges as a promising alternative approach for RML, providing clear benefits in pain management and cosmetic outcomes, while maintaining safety and convenience.Graphical

Robotic-assisted neck dissection

The neck dissection has had several evolutions in the last decades, most recently with the addition of the robotic neck dissection to the head and neck surgeon's arsenal. The robotic neck dissection has emerged as a viable option for patients and offers a minimally invasive approach to the cervical lymphatic system. The major advantage includes the avoidance of a visible neck scar, while its limitations include increased operative time and cost. After several iterations, the retro-auricular/modified facelift incision has developed into the surgical approach of choice, offering excellent cosmesis while securing oncologic effectiveness. In this chapter we describe this approach in detail.

Pilot Safety Study of a Microfabricated Device for Anterior Stromal Puncture to Treat Corneal Epithelial Disease in the Optical Axis.

Anterior stromal puncture is an inexpensive and widely used technique at the slit lamp to treat recurrent corneal erosions (RCE), common sequelae of corneal abrasions, trauma, and epithelial basement membrane dystrophies (EBMDs). The purpose of this study was to determine safety of a novel anterior stromal micropuncture device (termed a "plexitome") for use in the optical axis of the cornea. We performed an IRB-approved clinical pilot study on 45 patients with diverse corneal pathologies to determine the safety of the plexitome device and examined corneal healing responses clinically for a minimum of 30 days after treatment. Follow on efficacy data was collected for treated patients with RCE.Micropuncture treatment was performed either through loose epithelial tissue or after debridement using a cotton tip at the slit lamp. After "imprinting," patients were treated with topical medications including antibiotics, hypertonic saline/ointment, bandage contact lenses, and/or patching according to the treating physician's routine care for the condition. Micropuncture using the "plexitome" device did not create visible scars in the corneal stroma of the 45 patients treated and followed for at least 30 days. Photographic evidence of imprinting was seen at in 1 patient at 30 days. There were no significant adverse events associated with treatment. Micropuncture of the cornea using the "plexitome" device does not create optically evident anterior stromal scarring after treatment. Micropuncture using the device may be an effective way of treating RCE and other corneal manifestations of EBMD in the optical axis, which is not currently possible using standard anterior stromal puncture methods.