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Onychomycosis: beyond cosmetic distress.

Onychomycosis, or fungal infection of the nail, is the most common nail disease affecting children (although to a lesser extent) as well as adults. The distress it provokes is not only of a cosmetic kind; it may impair the quality of life. The different clinical types of onychomycosis should be differentiated from similar-looking nail diseases. As far as therapy is concerned, the appearance of new antifungal drugs in the 1990s makes our job easier, but it does not allow us to cure 100% of the patients. Relapses still exist. The aim of this article is to help dermatologists achieve a tailor-made treatment for their patients. The clinical type, the compulsory mycological investigations, the age of the patient, his medical history (drug intake), as well as the use of nail cosmetics, must be considered.

Humans↗

The causes and prevention of poor cosmetic results from injection of fluid silicone.

A 15-year experience with fluid silicone in augmentation of facial tissue while proving that highly desirable cosmetic improvement may be had, has also produced information relative to the cause and prevention of adverse results. The principles of correct technique and the causes of poor cosmetic results are presented. Appropriate graphic illustrations are presented.

Face↗

Cosmetic principles in surgery on the face.

Excisions from the face are performed to cure diseases and to remove blemishes. Satisfactory cosmetic appearances can be achieved in most cases, even when large defects result from the excisions, if the surgeon employs cosmetic surgical principles and techniques in the repairs. Some esthetic concepts and artful methods are presented to illustrate this feasibility.

Adult↗

The running locked intradermal suture. A cosmetically elegant continuous suture for wounds under light tension.

A new suture technique, the running locked intradermal suture, is introduced. The suture is continuous and buried, and is designed for closing simple elliptical wounds under light tension in which a good cosmetic result is desired. It is used in conjunction with a topical antibiotic and a transparent dressing. This technique reduces the dermal dead space, achieves close approximation of the epidermal wound edges, has a good cosmetic appearance soon after surgery, reduces necessary postoperative wound care, reduces the risk of wound infection in clean surgical wounds, and obviates suture removal. Three examples of its application on the face are presented. It is compared with frequently used standard wound closure methods are discussed.

Aged↗

Spontaneous healing of Mohs wounds of the cheek: a cosmetic assessment.

BACKGROUND: Facial defects after Mohs surgery may be closed at the time of surgery, shortly thereafter, or allowed to heal spontaneously. Selection of appropriate management options requires accurate prediction of the final cosmetic result. OBJECTIVE: To determine the relative merits of treatment options for facial defects resulting from Mohs surgery. METHODS: We prospectively and retrospectively analyzed outcomes for 132 wounds of the cheek resulting from Mohs surgery and allowed to heal spontaneously. The cheek was delineated into topographic areas and the wound location, size, and depth were recorded. Patients were observed intermittently, and a final evaluation of cosmesis was made after > or = 6 months. RESULTS: Most wounds in the nasolabial fold and preauricular areas healed with excellent results and half the wounds in the medial area of the cheek healed with good or excellent results. Central and mandibular areas of the cheek healed unpredictably, and results were unsatisfactory for most of these wounds. CONCLUSION: Final cosmetic results of Mohs surgery in the cheek area can be predicted on the basis of location, size, and depth of the wound, enabling physicians to knowledgeably select the most suitable treatment option.

Adult↗

Clinical indications and injection technique for the cosmetic use of botulinum A exotoxin.

BACKGROUND: Some wrinkles and unsightly facial expressions are due to overactivity of the underlying facial musculature. Botulinum A exotoxin reversably paralyses selected muscles. Botulinum toxin has been used to correct facial cosmetic concerns. OBJECTIVES: This paper describes the authors' experience with the cosmetic use of botulinum toxin. The areas that can be treated, the appropriate technique for each area and special considerations such as dose, dilution, and relevant anatomy are discussed. RESULTS: Our results have been published previously and are referenced in this paper. CONCLUSIONS: Botulinum toxin is safe and effective in the management of some facial lines and wrinkles. Its use is associated with a high degree of patient and physician satisfaction.

Botulinum Toxins, Type A↗

Oculoplastic experience with the cosmetic use of botulinum A exotoxin.

BACKGROUND: Botulinum toxin is a neuromuscular blocking agent produced by the bacterium Clostridium botulinum. It has been used as a therapeutic agent in ophthalmology for over 18 years. OBJECTIVE: To present the cosmetic use of botulinum toxin in oculoplastic surgery. METHODS: We present our experience with botulinum toxin as a cosmetic agent. RESULTS: Botulinum toxin was successful in treating hyperfunctional lines of the face and neck. CONCLUSIONS: Botulinum toxin is a safe and effective method of treating dynamic lines of the face and neck.

Botulinum Toxins, Type A↗

Use of ultra-high frequency electrosurgery (radiosurgery) for cosmetic surgical procedures.

BACKGROUND: Electrosurgery has been used for many decades in medicine. Some machines generate ultra-high frequency current waveforms (radiosurgery), which minimize collateral tissue damage. OBJECTIVE: Personal experience using radiosurgery in the performance of cosmetic surgery is related in the narrative form to offer the reader a "how we do it" perspective. CONCLUSION: Radiosurgery facilitates the performance of blepharoplasty, face lifting, hair restoration surgery, abdominoplasty, nasal reduction sculpturing of rhinophyma, and minor cosmetic procedures. Collateral heat damage is minimal allowing rapid healing and aesthetically pleasing scars.

Dermatologic Surgical Procedures↗

The use of skin expansion to repair cosmetic defects in animals.

Skin expansion was used in three horses, one heifer, and one dog to aid in the repair of cosmetic defects. Skin expansion was produced by inserting an expandable silicone device subcutaneously and gradually inflating the device with saline. Skin expansion allowed skin to be mobilized and sutured over cosmetic defects without excessive tension. A successful outcome was achieved in four of the five cases reported here. In one animal, two attempts to create a pocket for a silicone prosthesis failed because the expanders ruptured. Complications included implant failure, wound dehiscence, and exposure of an expander. Skin expansion can be used to enable closure of skin defects in areas where skin tension usually precludes repair by local transposition.

Animals↗

Cosmetic results of a ventrally based advancement flap for closure of total ear canal ablations in 6 cats: 2002-2003.

OBJECTIVE: To report the outcome of a modified total ear canal ablation (TECA) technique to maintain normal ear carriage in cats. STUDY DESIGN: Case series. ANIMALS: Six cats with external ear canal disease. METHODS: Medical records were reviewed to identify cats in which a modified TECA using a single pedicle advancement flap was used to maintain normal ear carriage. Signalment, histopathologic diagnosis, complications, and outcome were retrieved. Owners were contacted to document long-term outcome. RESULTS: Modified TECA procedures (7) were performed in 6 cats. Normal ear carriage was present immediately after surgery and was preserved at follow-up interview. Owners were satisfied with cosmetic appearance. Histopathologic diagnosis of excised ear masses included ceruminous gland adenocarcinoma (2 cats), ceruminous gland adenoma (2 cats, 3 ears), and inflammatory polyp (2 cats). CONCLUSIONS: Modification of the TECA skin incision preserved normal ear carriage in all cats. Owners were satisfied with overall outcome and with cosmetic result. Rate and nature of complications were similar to previously published data. CLINICAL RELEVANCE: A simple modification of the TECA skin incision to create a single pedicle advancement flap maintains normal ear carriage in cats.

Animals↗

A cosmetic approach for pectoral pacemaker implantation in young girls.

Pectoral placement of pacemaker generators, combined with use of a redundant intravascular lead portion, reduces the need for endocardial lead advancement during growth in children. While the use of small generators and submuscular pockets has contributed to cosmetic acceptability, the conventional subclavicular incision may occasionally form a keloid scar that is unacceptable in young girls. A modified implantation technique was used in five girls (age 2.6-13.3 years) during implantation of VDD (n = 2), VVIR (n = 2), and DDDR (n = 1) pacemakers. A 5-cm incision was made in the axilla along the line of the pectoralis major and dissection was continued below the muscle to create a pocket for the generator. Subclavian vein puncture was performed from the axillary incision and beneath the pectoralis major muscle using standard or extra long needles with a needle guard. Peel away sheaths were used for lead positioning. The generator was placed in the submuscular pocket and the wound closed with absorbable sutures. At follow-up, pacemaker function was excellent and neither the scars nor pacemakers were visible from the front. In conclusion, the axillary incision with direct subclavian vein puncture from below the pectoralis major muscle offers the advantages of pectoral pacemaker implantation through a single cosmetic incision.

Adolescent↗

Cosmetic surgery and the motivation for health and beauty.

Cosmetic surgery, powerful in its potential to address human tragedies of severe disfigurement or congenital malformities, is increasingly viewed as a means of creating a culturally "ideal" physical appearance. The popularity and acceptability of this motivation for cosmetic surgery confronts practicing nurses with value and attitude choices, which can substantively alter the nature and focus of nursing care approaches to those who elect such surgery.

Beauty↗

Central retinal artery occlusion following cosmetic blepharoplasty.

A case is presented of a 70-year-old white male who underwent a bilateral cosmetic lower lid blepharoplasty with fat removal. He subsequently developed a right orbital haemorrhage which resulted in the occlusion of the central retinal artery. The patient had no light perception with his right eye for approximately 1 hour, but vision was eventually restored to 20/20 after emergency therapeutic measures. There are many possible causes of visual loss following blepharoplasty, with orbital haemorrhage being the most common. Visual loss secondary to blepharoplasty can be prevented in the preoperative, intraoperative, and postoperative phases of surgery. Blindness as a complication of cosmetic blepharoplasty can be reversible if recognised early and treated appropriately. These facts must be kept in mind by all surgeons who perform blepharoplasties.

Aged↗

Long-term cosmetic outcome and toxicity in patients treated with quadrantectomy and radiation therapy for early-stage breast cancer.

Breast conservation treatment followed, if useful, by adjuvant therapy is the treatment of choice in early breast cancer. Late cosmetic outcome and toxicity are important in comparing conservative treatment to mastectomy. We reviewed the records of 225 patients treated from 1981 to 1988 with a median follow-up of 74 months (range 12-156 months). Cosmetic results, either reported by the physician (82.4%) or by the patients themselves (81.5%), were generally excellent or good, and tended to decline with time (69 and 75.5%, respectively). Toxicity was mild with arm edema (14.6%) being the most frequent symptom. No severe toxicities were observed. We conclude that overall cosmesis has been acceptable in this series and that a low rate of long-term toxicity can be expected with this conservative approach.

Breast Neoplasms↗

Cosmetic surgery as an antecedent of life change.

Of 42 patients who underwent cosmetic surgery, 4 patients, who gave no indication of an impending life change before surgery, obtained a legal separation or divorce 3-6 months later. These 4 patients had had strong parental domination and hostile relationships with younger siblings; they had a need for success on their own terms and for the rapid closure of potential conflict. The authors suggest that such patients are undergoing significant identity changes that become conscious only after cosmetic surgery, which tests out their shift from passivity and withdrawal to activity and participation.

Adult↗

Management of blindness in the practice of cosmetic surgery.

Blindness (amaurosis) as a complication of cosmetic surgery is not common, but has been reported in cases of blepharoplasty, as well as in connection with facial injection of various substances, including collagen. The anatomic and pathophysiologic basis for embolization of the retinal artery is presented, and the literature regarding thromboembolic, spasmodic, and vaso-obliterative etiologic factors in amaurosis is reviewed. It is recommended that ocular examination be carried out prior to both injection of materials into the face and blepharoplasty. The treatment of this most serious complication is reviewed in detail. Finally, it is suggested that the surgeons who practice cosmetic surgery be aware of this complication and the current treatment modalities.

Adult↗

Does concomitant chemoradiotherapy influence cosmetic outcome in conservative treatment of breast cancer?

PURPOSE: To evaluate retrospectively factors influencing the cosmetic outcome after conservative treatment for breast cancer. MATERIAL AND METHODS: From 1988 until 1992, 164 patients were treated with conservative surgery (quadrantectomy) and radiotherapy with 60Co (50 Gy on the whole breast) plus 10 Gy on the surgical bed (300 kV photons) for T1-T2 breast cancers; 46 patients (28%) received concomitant adjuvant chemotherapy (CMF schedule). Cosmesis evaluation was carried out after 24 to 108 months (median, 38 months). A logistic regression analysis was performed to identify independent variables influencing the aesthetic outcome. P values of 0.05 or less were considered significant. RESULTS: Univariate analysis showed that T2 versus T1 (P = 0.0102), lower quadrants site (P = 0.0002) and concomitant adjuvant chemotherapy (P = 0.0009) produced a worse aesthetic outcome. Multivariate analysis confirmed the same factors: tumor size (P = 0.0020), tumor site (P = 0.0150) and concomitant chemotherapy (P = 0.0024). CONCLUSIONS: The significant negative influence on the cosmetic outcome of concomitant adjuvant chemotherapy implies questions about the timing of radiotherapy and chemotherapy in breast cancer conservative treatment.

Adult↗