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Five patients developed diplopia following cosmetic blepharoplasty. While temporary diplopia and visual disturbances are known to occur following this type of surgery, the persistence of diplopia with demonstrable muscle imbalance is not common. We encountered ocular motility complications involving the inferior or oblique muscle, inferior rectus muscle, and superior oblique tendon.
We have examined three patients with cosmetically objectionable prominent veins in the lower eyelids. Segmental interruption of the vessels through multiple skin incisions has proved to be a satisfactory treatment.
The collection of information concerning a patient's history is every bit as important in the evaluation of candidates for cosmetic surgery as it is in any other branch of medicine. Consequently, a self-administered questionnaire was developed to save time and to ensure thoroughness. The questionnaire helps elicit a patient's motivations and expectations, and also satisfies some of the requirements of the legal doctrine of informed consent. A particularly noteworthy feature of the form is the "Personal Inventory" section, which attempts to "red flag" patterns of psychogenic conditions in prospective patients.
A study was undertaken to test the validity of the belief that lacrimal apparatus injury is common in patients who undergo a cosmetic rhinoplasty. Dacryocystography was done in 15 patients immediately following the lateral osteotomy, and there was no evidence of lacrimal sac injury or extravasation of the dye in any patient.
The many-faceted reasons for patient dissatisfaction with the results of cosmetic procedures are discussed within a broad context, encompassing causative, preventive, and management factors. Psychological manifestations as they relate to patient expectations and disappointments are exposed. The author recommends that the surgeon adopt an affirmative, rather than a defensive, approach to the problem.
A dorsal nasal cyst is a rare complication of cosmetic rhinoplasty. The cause of this complication is unknown; however, entrapment of nasal mucosa and subsequent growth through osteotomy sites are thought to be the basis for formation of these masses. We describe two patients with these dorsal nasal cysts and provide a review of the English-language literature. The maintenance of mucosal integrity together with the meticulous removal of debris from the operative site may prevent postrhinoplasty nasal cysts.
In 9 cases of human adjuvant disease, 4 cases of scleroderma (3 progressive systemic sclerosis and 1 localized morphea) were observed. Seven to 19 years after injection of foreign substances into the breasts or nose for cosmetic purposes, some patients developed human adjuvant disease. In one case the foreign substances were removed by bilateral mastectomy with no discernible effects on the patient's clinical course. Histopathologic findings of the removed breasts demonstrated foreign body granulomas with calcification. The injected substance was identified as a mixture of liquid and solid paraffin. Human adjuvant disease might be caused by prolonged hypersensitization activated by the injected foreign materials which act as an adjuvant.
Connective tissue disease has been reported to occur following cosmetic surgery with injection of the foreign substances paraffin and silicone (human adjuvant disease). The clinical findings in 18 such patients and a review of 28 additional cases from the Japanese literature are presented. The patients were classified into 2 major groups: group I consisted of 24 patients with definite connective tissue disease--12 with scleroderma, including 8 with progressive systemic sclerosis (PSS), 6 with rheumatoid arthritis, 5 with systemic lupus erythematosus, and 1 with polymyositis; group II consisted of 22 patients with human adjuvant disease with some symptoms, signs, and laboratory abnormalities suggestive, but not diagnostic of a connective tissue disease. The occurrence of PSS is approximately three-fold greater than expected for all women believed to have undergone such surgery, and PSS developed primarily in individuals injected with paraffin. Prolonged exposure to the injected substance may play a role in the induction of these immunologic disorders.
Twenty-four dyes currently or previously used in the food, drug, cosmetic, and textile industries were tested in the in vitro rat hepatocyte primary culture/DNA repair (HPC/DR) assay and, to a limited extent, in the in vivo/in vitro HPC/DR assay. The positive control, Solvent Yellow 3 (o-aminoazotoluene), and five other dyes (4-dimethylaminobenzeneazo-1-naphthalene, 4-dimethylaminobenzeneazo-2-naphthalene, Direct Blue 53, Acid Blue 9, and 4-dimethylaminostilbene) induced DNA repair in rat hepatocytes both in vitro and in vivo, while 13 of the dyes (Food Red 1, Food Red 5, Food Orange 4, Food Red 7, Acid Red 14, Acid Red 27, Pigment Red 53, Acid Yellow 23, Food Black 1, Food Green 3, Acid Red 51, Acid Blue 74, and Natural Red 4) did not produce any detectable DNA repair in either the in vitro or in vivo/in vitro assays. Direct Blue 14 had weak activity in vitro but none was detected in vivo. In contrast, Solvent Yellow 5 was not active in vitro, but produced a weak positive response in vivo. Negative responses were also obtained for Solvent Yellow 14 and Acid Green 5 in the in vitro assay, whereas the responses produced by these dyes in the in vivo/in vitro assay were judged to be equivocal. An equivocal response was also obtained for Direct Red 28 in the in vivo/in vitro assay as well as in the in vitro assay. These findings provide information about the potential genotoxicity of a number of dyes for which previous genotoxicity data has been inconsistent or inadequate. For some dyes (eg, Solvent Yellow 5), discrepancies between the results obtained in the in vitro and in vivo/in vitro assays may implicate a role for intestinal microflora in their metabolic activation.
The usual radiologic postoperative appearance of the bony nasal pyramid following a typical cosmetic rhinoplasty is demonstrated, and possible atypical sequelae are discussed. More specifically, the sites of the osteotomies performed as part of this surgical procedure are diagrammatically illustrated. It is believed that because of the increasing popularity of rhinoplastic operations, it is timely to acquaint radiologists with the postsurgical stigmata which, though minor, might be erroneously interpreted as resulting from accidental trauma or other pathologic processes. Beyond academic considerations, potential medicolegal implications also exist. A brief historical overview is included.
Cosmetic and psychologic morbidity was evaluated by patients' self-assessment in 42 patients who underwent breast conserving therapy (BCT) and 48 patients who underwent mastectomy with immediate breast reconstruction (MIBR). Although sexual adjustment and fear of cancer recurrence were not significantly different between the two groups, body image was rated as significantly better in the BCT group. Additionally, in the MIBR group, nine patients expressed concern about abdominal or back scars and 15 related abdominal or back pain. Eighty-three percent of the BCT group indicated BCT as a future choice of treatment, whereas only 38% of the MIBR group indicated MIBR as a future choice of treatment. Therefore, body image and patients' satisfaction were thought to have been improved by BCT, but psychologic morbidity was the same in both groups.
The optical sectioning property of the confocal microscope offers a breakthrough from the classic observation of the hair in a scanning electron microscope (SEM). Confocal microscopy requires minimal sampling preparation, and the hair can be observed in its natural environment with less damage than by other microscopic methods such as SEM. While used in the reflection mode, the true morphology of the cuticle and the various exogenous deposits at the surface can be identified and quantified. This relatively noninvasive, nondestructive technique is routinely used by us to monitor the efficiency of cleansing shampoos, to assess the homogeneity of layering polymers, and to evaluate the changes they induce in the optical properties of the hair surface in terms of opacity, transparency, and brilliancy. A second important field of investigation uses the fluorescence channel which reveals the internal structure of the hair. Fluorescent probes (rhodamine and its derivatives) demonstrate the routes of penetration and outline the geometry of cortical cells and of the medulla according to their lipophilic or hydrophilic properties. A volume rendering of a hair cylinder provides a better understanding of the interrelationships between cuticle cells, cortical cells, and the medullar channel. This recent technology is becoming an invaluable tool for the cosmetic assessment of the hair.
An evaluation of the psychological and cosmetic morbidity of 31 patients who had undergone breast conserving treatment (BCT group) and 71 patients who had undergone radical mastectomy (RM group) revealed that 85% and 73%, respectively, were satisfied with their operative results. BCT appeared superior to RM in relation to body image, with 93% of the BCT group indicating BCT as a future choice of treatment, whereas only 35% of the RM group indicated RM as a future choice of treatment. For 59% of the BCT patients, the results were considered excellent or good by a physician, but fear of recurrence was frequently expressed by both groups even though an early stage of breast cancer had been significantly more common in the BCT group than the RM group. Sexual adjustment was the same in both groups. Body image was thus concluded to have been improved by BCT rather than RM, but psychological morbidity was essentially the same in both groups.
The measurement of chloride activity was studied with Cl- -sensitive ion-exchanger microelectrodes (ISE) in calibrated test solutions stained with commonly used renal test dyes (e.g. Lissamine green SF) or other food or cosmetic dyes. Renal test dyes impair measurements of Cl- activity due to their anionic substitution and were found to increase electrode resistance. Cationic food dyes did not interfere with the Cl- reading of ISE although electrode resistances were increased, too.
One of the medical specialties most vulnerable and suit-prone is cosmetic plastic surgery. Societal factors playing a role in this include the growing emphasis on personal gratification and youth and the tendency to insist on redress if things go wrong. Furthermore, studies of the conflicts between doctors and patients show that many difficulties have their roots in the quality of interaction between doctor and patient and in the attitudes and behavior of the surgeon in the course of the relationship, both pre- and postoperatively. Other factors affecting the vulnerability of plastic surgeons include their ability to conduct an effective patient interview with attention paid to non-verbal cues and the image of plastic surgery projected through advertisements, publications, and the media.
In a series of 1149 cases of cosmetic surgery of the breast performed from 1973 to 1989, early diagnosis of breast cancer in 34 cases was possible by relying mainly on the use of mammography for the diagnosis. It is strongly recommended that a policy of mandatory preoperative mammography be implemented so that all patients can be protected from a lethal disease that has a far better prognosis when detected early.
Although thick skin is generally considered a disadvantage in cosmetic surgery of the nasal tip, responsible for the supra tip deformity known as "polly beak" and other aesthetic defects, there are surgical guidelines that can greatly reduce the occurrence of these problems, the most interesting of which is grafting. On the contrary, thick skin could even be considered an advantage, if it masks amputated cartilaginous margins following any dome-sectioning technique.
OBJECTIVE: Since we developed the procedure in 1996, we have now performed 100 pediatric open heart operations using a lower midline skin incision and a minimal sternotomy approach. METHODS AND RESULTS: To elucidate the benefits of this approach, we analyzed these 100 cases retrospectively. There was no death, and no major complication, caused by this approach, and the resulting scarring in each patient is difficult to be seen under a common undershirt. CONCLUSION: This review shows that the technique of a lower midline skin incision and minimal sternotomy approach is a safe reliable and cosmetically advantageous method for a pediatric cardiac operation.