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PubMed1983

Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation.

Between May, 1973 and December, 1980, 78 Stage I and II breast carcinomas in 76 patients were treated by biopsy and radiotherapy with curative intent. With a maximum follow-up of 10 years, a minimum of 2 1/2 years and a median follow-up of 3 1/2 years, a loco-regional control rate of 97% was obtained. Cosmetic results and treatment complications were studied. Patient characteristics, tumor size, excisional biopsy technique, axillary staging procedure and radiotherapy techniques were analyzed and all found to be important factors affecting cosmesis and complications. The most common complications included transient breast edema observed in 51% of patients, breast fibrosis (usually mild) seen in 23% of the population, axillary hematoma or seroma formation in 15%, mild arm edema in 14% and basilic vein thrombosis in 10% of patients. The causes of these and other less frequent complications are discussed. The overall cosmetic result was excellent in 78%, satisfactory in 18% and unsatisfactory in 4% of patients. Recommendations for improving cosmetic results minimizing complications are made. In our prospective trial, the high loco-regional control and good cosmesis supports the use of excisional biopsy and radiation therapy in patients with Stages I and II breast carcinoma.

Adenocarcinoma↗
PubMed1985

Breast retraction assessment: an objective evaluation of cosmetic results of patients treated conservatively for breast cancer.

Breast Retraction Assessment (BRA) is an objective evaluation of the amount of cosmetic retraction of the treated breast in comparison to the untreated breast in patients who receive conservative treatment for breast cancer. A clear acrylic sheet supported vertically and marked as a grid at 1 cm intervals is employed to perform the measurements. Average BRA value (+/- standard deviation) in 29 control patients without breast cancer was 1.2 cm (+/- 0.7 cm). Average BRA value in 27 patients treated conservatively for clinical Stage I or II unilateral breast cancer was 3.7 cm (+/- 2.1 cm). BRA values in breast cancer patients ranged from 0.0 to 8.5 cm. Statistical analysis revealed that tumor size, employment of adjuvant chemotherapy and use of separate radiation lymph node fields were not factors in breast retraction. Patients who received a local radiation boost to the primary tumor bed site had statistically significantly less retraction than those who did not receive a boost. Patients who had an extensive primary tumor resection had statistically significantly more retraction than those who underwent a more limited resection. In comparison to qualitative forms of cosmetic analysis, BRA is an objective test that can quantitatively evaluate factors which may be related to cosmetic retraction in patients treated conservatively for breast cancer.

Adult↗
PubMed1987

Conservative breast cancer treatment: analysis of cosmetic results and the role of concomitant adjuvant chemotherapy.

Fifty-eight patients conservatively treated for T1 breast cancers are analyzed for cosmetic outcome; 17 had concomitant adjuvant combination chemotherapy (cyclophosphamide, adriamycin, 5 fluorouracil). The results are evaluated by clinical criteria and a quantitative measurement by use of light field projection at 33 months median follow-up. Surgery consisted of lumpectomy and axillary dissection; radiotherapy was given to the breast only except for additional internal mammary irradiation in central and medial lesions. (50 Gy whole breast, 64 Gy electron/photon boost). Questionnaires are used for inquiry on patient experience: 88% of the patients experienced a good to excellent cosmetic outcome. According to the panel only 64% show a good to excellent cosmesis. Panel-scores on asymmetry are compared with quantitative measurements. More esophagitis and probably a higher degree of fibrosis in the boost area is found in the chemotherapy group. No differences in cosmetic outcome, complication rates, and patient experiences are seen. Results are compared with published data.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable, and nonabsorbable sutures.

The objective of this study was to compare the 9- to 12-month cosmetic outcome of facial lacerations closed with rapid-absorbing gut suture (RG), octylcyanoacrylate (OC), or nylon suture (NL). We hypothesized that no important differences would exist between these methods. This prospective, randomized study enrolled consecutive patients with facial lacerations when experienced physician assistants were on duty for wound closure. Patients returned at 9 to 12 months for cosmetic evaluation. Two blinded physicians performed visual analog cosmesis scale (VACS) scoring, and the patient completed a VAS satisfaction score. One hundred forty-five patients were enrolled. Nine-month follow up occurred in 84 patients. The maximum difference within each evaluator's set of scores was 3.6 mm, well below the minimum clinically important difference (MCID) of 10 to 15 mm. We did not detect clinically important differences in cosmetic outcome at 9 to 12 months in patients with facial lacerations closed with RG, OC, or NL, although RG or OC could be preferred to eliminate follow-up visits for suture removal.

Adult↗
PubMed2005

Oncological and cosmetic outcomes of oncoplastic breast conserving surgery.

BACKGROUND: Breast-conserving surgery and radiotherapy is firmly established as a good and safe option for most women with early breast cancer. The important outcome measures of breast conservation are survival, local recurrence, cosmesis and patient satisfaction. Partial breast reconstructive techniques may improve cosmesis and patient satisfaction without compromising the oncological outcomes. METHODS: A search of the Medline and Pubmed databases of studies on breast conserving surgery where partial breast reconstructive techniques were employed. The keywords used were breast conserving surgery, oncoplastic breast surgery, partial breast reconstruction and reduction mammoplasty. The oncological and cosmetic outcomes of these studies were analysed. RESULTS: Studies on partial breast reconstructive techniques often lack oncological outcomes and long-term results are not available. On intermediate follow-up (up to 4.5 years) local recurrence rates vary from 0 to 1.8% per year. Cosmetic failure rates vary from 0 to 18%. To date, detailed studies are small and outcome measures vary. CONCLUSIONS: Breast surgeons should be aware of the range of surgical techniques that may enhance the aesthetic results of breast-conserving surgery as well as expand the indications for its use. There is a need for routine assessment of oncological and cosmetic outcomes and long-term results of partial breast reconstructive techniques in relation to these outcomes are awaited.

Breast Neoplasms↗
PubMed2005

Ptosis repair for the cosmetic surgeon.

The cosmetic surgeon must be familiar with the evaluation and management of the ptotic eyelid. A small amount of unrecognized preoperative eyelid ptosis can seem obtrusive if it is unmasked after blepharoplasty. As such, ptosis repair is an important adjunctive procedure in cosmetic eyelid surgery. This article describes the basics behind the two most common procedures to correct eyelid ptosis. Cosmetic eyelid surgeons should familiarize themselves with these procedures or work in conjunction with an ophthalmic plastic surgeon who can assist in addressing this common eyelid malposition.

Blepharoplasty↗
PubMed2006

Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery.

Body dysmorphic disorder (BDD) is a somatoform disorder characterized by an excessive concern with an imagined or slight defect in appearance. BDD has been particularly studied in cosmetic surgery settings. The object of the present study is to investigate the relationship between personality disorders and dysmorphic symptoms in a group of 66 patients seeking cosmetic surgery. Assessment instruments included the following: a semistructured interview for demographic and clinical characteristics; the Structured Clinical Interview for DSM-IV, the Hamilton Depression and Anxiety Rating Scales, and the Body Dysmorphic Disorder Yale - Brown Obsessive--Compulsive Scale (BDD - YBOCS). A multiple regression analysis was performed using the BDD - YBOCS score as a continuous dependent variable. The severity of dysmorphic symptoms (BDD - YBOCS score) was significantly related to two factors: the number of diagnostic criteria for schizotypal and paranoid personality disorders. The results suggest that the presence of a psychopathological reaction to imagined defects in appearance in subjects pursuing a surgical correction is associated with the severity of schizotypal and paranoid personality disorders. Preoperative assessment could help to define the clinical profile of patients in cosmetic surgery settings.

Adult↗
PubMed1986

Long-term followup of cosmetic appearance and genital function in male epispadias: review of 70 patients.

In male patients who undergo surgery for epispadias the major postoperative complaint often concerns the cosmetic appearance of the penis and the failure to correct the dorsal chordee rather than the urinary incontinence. In the past straightening and lengthening of the penis were not given adequate consideration, and penile elongation was limited to release of dorsal skin chordee only. Recently, however, additional penile length has been achieved by partial mobilization of the crura of the corpora cavernosa from the pubic rami. In a series of 70 patients penile lengthening and urethroplasty were performed separately or were combined as a 1-stage procedure with full thickness grafts or preputial flaps. The recent use of hair-bearing groin flaps has provided excellent skin coverage for the large dorsal defect at the penoabdominal angle. A satisfactory cosmetic appearance of the external genitalia, with a straight penis angulated downward in the standing position, was achieved in 67 per cent of the patients. Normal erectile function was preserved in all patients, 80 per cent of whom have had a straight penis with erection and satisfactory intercourse. Of the patients 29 are married and 19 have fathered children. Meticulous attention to the technical aspects of reconstructive surgery usually can result in a gratifying cosmetic appearance, normal genital function and preservation of fertility potential in most patients.

Adolescent↗
PubMed1990

Factors influencing cosmetic outcome of conservative surgery and radiotherapy for breast cancer.

Increasing acceptance of conservative therapy for early breast cancer has made the cosmetic outcome of the treated breast an important endpoint for evaluation. A number of interrelated patient, tumor, and treatment factors will determine the ultimate cosmetic outcome. Attention to surgical and radiotherapeutic technique should lead to good to excellent overall cosmetic results in the majority of patients.

Biopsy↗
PubMed2001

Objective cosmetic and anatomical outcomes at adolescence of feminising surgery for ambiguous genitalia done in childhood.

There are few, if any data on the long-term outcome of feminising genital surgery for children with ambiguous genitalia. We present a retrospective study of cosmetic and anatomical outcomes in 44 adolescent patients who had ambiguous genitalia in childhood and underwent feminising genital surgery. Cosmetic result was judged as poor in 18 (41%) of these patients. 43 (98%) of 44 needed further treatment to the genitalia for cosmesis, tampon use, or intercourse. 23 (89%) of 26 of genitoplasties planned as one-stage procedures required further major surgery. This information must be available to parents and clinicians planning such surgery. Cosmetic genital surgery in infancy needs to be reassessed in the light of these results.

Adolescent↗
PubMed1987

Corneal ulcers associated with cosmetic extended wear soft contact lenses.

In 52 patients with a history of using cosmetic extended wear soft contact lenses, corneal ulcers developed requiring admission to Wills Eye Hospital between January 1, 1982, and June 30, 1986. A retrospective study was conducted to determine the contact lens history, clinical presentation, culture and sensitivity results, and final visual acuity of these patients. Pseudomonas organisms were isolated in 75% of culture-positive cases. The final visual acuity was 6/60 or less in 12% of all cases and 25% of the Pseudomonas ulcers. Patients and practitioners must be aware of this vision-threatening problem in patients wearing cosmetic extended wear lenses. The pathogenesis of corneal ulcers in contact lens patients has not been established. There may be an inherent increased risk in the use of extended wear, compared to daily wear, soft contact lenses for cosmetic purposes.

Adolescent↗
PubMed1996

Functional and cosmetic reconstruction of the facial lower third associated with placement of the transmandibular implant system.

PURPOSE: Conventional preprosthetic procedures have typically focused on improvement of denture base stability and retention and have ignore patients' concerns about facial appearance and articulation difficulties. Soft tissue procedures have been developed, combined with insertion of the transmandibular implant (TMI) system through a submental incision, for functional and cosmetic reconstruction of the lower face to improve speech and facial esthetics, and prevent gingival hyperplasia along the lateral posts of the implant. PATIENTS: The surgical procedure was evaluated in 146 patients with slight, moderate, severe, and extreme mandibular atrophy classified according to the proportion of muscle origin loss on the edentulous mandible. Preoperative, 3-month, and 1-year postoperative full-face and profile photographs were taken. Patients also were questioned about their satisfaction with their facial appearance and speech at these intervals. Gingival hyperplasia along the TMI posts was scored as present or absent. RESULTS: Satisfaction with the soft tissue reconstruction in 146 patients treated according to this protocol was high, with almost every patient describing the positive comments they had received from their friends and relatives. Postoperatively, none of the patients requested a temporary denture to use during the 12-week incorporation period, although this was a common cosmetic and speech concern preoperatively. Gingival hyperplasia secondary to muscle pull was controlled satisfactorily. CONCLUSIONS: With the described technique for placement of the TMI system, not only is masticatory function improved, but also the lower third soft tissues of the face are functionally and cosmetically reconstructed to the satisfaction of the patients.

Adipose Tissue↗
PubMed1997

On cosmetically treated hair--aspects and pitfalls of interpretation.

Popular hair cosmetic treatments like bleaching or permanent waving were found to affect the stability of incorporated drugs and to cause alterations of the fibers at an ultrastructural level. This may result in a partial or complete loss of drug substances, depending on the particular drug molecule and on its concentration prior to the cosmetic treatment. Moreover, from literature, there is some evidence that drug molecules are not only incorporated into the growing fiber by passive diffusion from blood into the matrix cells and melanocytes, but that the substances enter the hair also via perspiration such as sweat and sebum. Since permed and bleached hair shows an enhanced sorption capacity, the risk of false positives or an unusually high drug concentration in cosmetically treated hair was under investigation. Virgin, permed, mildly as well as severely bleached tresses were exposed to artificial sweat or sebum containing cocaine, benzoylecgonine, 6-acetylmorphine, morphine and codeine (500 ng/g). Except codeine, the concentrations measured by GC/MS were very small and quite close to the detection limit indicating a minor importance of drug uptake into hair fiber from the endogenous-exogenous shunt via sebum or sweat. From the results it is concluded that an increased risk of false positive results in hair analysis on bleached and permanent waved hair fibers does exist, but is not particularly severe.

Drug Interactions↗
PubMed1999

Thymectomy in myasthenia gravis via video-assisted infra-mammary cosmetic incision.

We describe the technique, the benefits and the drawbacks of an original video-assisted thymectomy (VAT), performed through an inframammary cosmetic incision and median sternotomy in myasthenia gravis (MG) patients. This procedure is clinically valuable and cosmetically satisfactory so as to be very well accepted by patients, especially by young women. We report a review of 71 MG patients treated between 1993 and 1997. A clinical remission was obtained in 48 (80%) out of 60 patients who had been followed for at least 12 months from surgery. Fifty-three of these patients (93%) judged their cosmetic results to be excellent or good.

Esthetics↗
PubMed2002

The lateral canthus in cosmetic surgery.

Normally contoured eyelid fissures will enhance the appearance of patients who undergo cosmetic eyelid surgery. The shape and integrity of the lateral canthal structures frequently affect the configuration of the eyelid fissure. Undetected canthal abnormalities may lead to untoward postoperative functional and cosmetic results. An understanding of the etiology and detection of lateral canthal pathology and the treatment of the lateral can thus as a functional unit in cosmetic surgery will enable the plastic surgeon to avoid these complications and enhance surgical results.

Blepharoplasty↗
PubMed2002

Multiple color changes following laser therapy of cosmetic tattoos.

OBJECTIVE: To emphasize the wisdom of small test areas when treating cosmetic tattoos and the need for multiple laser systems. METHODS: A 48-year-old woman requested removal of permanent makeup (cosmetic tattoos) of her eyebrows and around her lips. Physical examination revealed a brown tattoo of both eyebrows and dark red lip liner around both lips. A test area was performed on the red tattoo of the lips. A frequency-doubled Nd:YAG laser (532 nm, 2.0 J/cm2, 2 mm spot size) was used for the lip area, while the same laser at 1064 nm, 3.9 J cm2, 2 mm spot size was utilized for the eyebrows. The lip area immediately turned black. The patient returned for follow-up 1 month later; the black ink on the lip was treated with the same laser at 1064 nm, 3 mm spot size, 4.2 J/cm2, with satisfactory resolution in two monthly treatments. Both brown eyebrow turned bright orange and were treated with 532 nm, 3 mm, 3.0 J/cm2. One month later the eyebrows were a mixture of yellow ink and dark green. The yellow area was treated with 532 nm, 3 mm, 2.3 J/cm2, while the dark green was treated with the 1064 nm, 3 mm spot size, 4.2 J/cm2. One month later little improvement was noted, so Q-switched ruby laser at 694 nm, 6 mm spot size, 16 J/cm2 was utilized. An additional four monthly treatments were given utilizing a combination of both ruby and 532 nm ND:YAG lasers for green and yellow pigment, respectively. RESULTS: Significant but incomplete resolution of the tattoo ink was achieved. CONCLUSION: Multiple laser systems are needed to remove cosmetic tattoos. Test areas must be done before treatment.

Eyebrows↗
PubMed2002

Eleven pearls for cosmetic earlobe repair.

Earlobe repair is a common request in cosmetic facial surgery. Earlobe tears result from a variety of traumatic situations. A resurgence in body piercing and multiple facial and ear piercings is occurring in college-aged individuals. This increase in piercing will bring more piercing-related complications to the cosmetic surgeon. The author has outlined 11 surgical pearls to provide improved cosmetic results in the repair of torn earlobes. Also described is immediate repiercing of the earlobe at the time of the surgical repair. Preventive practices to decrease earring and earlobe trauma are also reviewed.

Dermatology↗
PubMed2002

Reduction of conchal enlargement and/or anterolateral rotation: otoplasty by the cosmetic dermatologic surgeon.

BACKGROUND: Otoplasty is the correction of protuberant ears. One of the most common malformations responsible for prominauris is conchal enlargement and/or anterolateral rotation. The surgical technique we utilize for the correction of this type of auricular malformation is not unlike the removal of auricular skin and cartilage frequently performed by dermatologic surgeons in the treatment of cutaneous malignancies of the ear. OBJECTIVE: To introduce the reduction of conchal enlargement and/or anterolateral rotation for the correction of protuberant ears into the armamentarium of the cosmetic dermatologic surgeon. METHODS: We describe in detail the development and anatomy of the ear along with indications, preoperative considerations, surgical technique, postoperative care, and potential complications for this type of cosmetic surgery. RESULTS: The technique described herein is an effective approach in the surgical management of protuberant ears that are caused by conchal enlargement and/or anterolateral rotation. CONCLUSION: With proper patient selection, thorough knowledge of this step-by-step surgical approach to otoplasty, and some prior surgical experience involving the skin and cartilage of the external ear, the successful correction of protuberant ears is well within the scope of the cosmetic dermatologic surgeon's practice.

Ear, External↗