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PubMed2001

Body mass index: risk predictor for cosmetic day surgery.

Body mass index (BMI; weight per unit surface area) is the scientific yardstick by which overweight is gauged relative to the population norm. The contrary association between obesity and diabetes or hypertension is only too well known. Less appreciated is the heightened sensitivity to respiratory depressants such as sedatives and analgesics in the obese (BMI >/= 30) and the increased incidence of sleep apnea in the morbidly obese (BMI >/= 35)-either or both of which raise the risk of cosmetic surgery when sedation or anesthesia is contemplated. Guided by the BMI, a gender-independent measure of fatness, the surgeon now can inform the patient of her or his relative operative risk and offer an objective rationale for advising overnight hospitalization rather than office-based day surgery. The BMI is readily calculated when height and weight are expressed in metric units, much less so when measured in foot-pound units. In fact, the calculations are sufficiently cumbersome that the BMI remains underused in U.S. office surgery. The author's complimentary "BMI Calculator"-an Excel workbook available on-line to society members-is designed so that office staff need enter only height (in feet and inches) and weight (in pounds) to print the BMI for the patient's permanent record. The BMI places patient weight relative to height in proper perspective for aesthetic surgery, whether with sedation or under general anesthesia. The BMI ought to be as routine a part of the preoperative assessment as blood pressure or hemoglobin content.

Adult↗
PubMed1991

Cosmetic blepharoplasty.

Performing flawless cosmetic blepharoplasty surgery requires attention to many details. A proper medical work-up with establishment of patient rapport and preoperative photographic documentation should begin the evaluation. The surgical correction of concomittant brow position abnormalities should be considered. Resection of the brow fat pad is useful in recontouring bulky brows and redefining the superior sulci. Upper lid tissue resection needs to be individualized with skin resection, skin muscle resection, and lipocontouring of the suborbicularis muscle as well as with Burows triangles and "W" plasties. Lower lids may be handled by skin flap resection alone, myocutaneous flaps resection, or a combination of both. Lateral tarsal suspension avoids lower skin retraction.

Documentation↗
PubMed2002

Advances in cosmetic oculoplastic surgery.

According to the American Society for Aesthetic Plastic Surgery, in the year 2000 over 5.7 million cosmetic surgical and nonsurgical procedures were performed in the United States. This was a 25% increase above the total number performed in 1999. The most popular of these procedures was botulinum toxin injection, followed by chemical peels and microdermabrasion. As the field of plastic and reconstructive surgery changes, so does the scope of the oculoplastic surgeon. This review article summarizes those developments in aesthetic surgery that are recent additions to the practice of aesthetic oculoplastic surgery. It highlights the most recent literature discussing brow and midface lifts, skin lasers, microdermabrasion, upper and lower blepharoplasty, chemical peels, botulinum toxin, and fat sculpturing.

Blepharoplasty↗
PubMed2004

A surgical method to preserve testicular function and restore cosmetic appearance in hypogonadal men.

PURPOSE: Maintenance of spermatogenesis in hypogonadotropic hypogonadal patients is possible and is an objective to be actively pursued. Gonadotropin releasing hormone and gonadotropin/ testosterone therapy can develop and maintain sex characteristics and spermatogenesis such that even small gonads should be preserved. An empty scrotum, like any other congenital or acquired condition compromising the size of the genitalia, can produce serious psychosexual problems and have an extremely negative effect on normal social life. MATERIALS AND METHODS: In 2 adolescents affected by Kallmann's syndrome with testes of infantile volume 1 gonad was transferred to the contralateral hemiscrotum and replaced by an adult testicular prosthesis. RESULTS: There were no postoperative complications. The cosmetic results were considered satisfactory by the patients and their parents. CONCLUSIONS: When possible and when there is no risk of physiological repercussions, every effort should be made to normalize the appearance of the genital area for strong psychological reasons.

Adolescent↗
PubMed2002

Cosmetic surgery in times of recession: macroeconomics for plastic surgeons.

Periods of economic downturn place special demands on the plastic surgeon whose practice involves a large amount of cosmetic surgery. When determining strategy during difficult economic times, it is useful to understand the macroeconomic background of these downturns and to draw lessons from businesses in other service industries. Business cycles and monetary policy determine the overall environment in which plastic surgery is practiced. Plastic surgeons can take both defensive and proactive steps to maintain their profits during recessions and to prepare for the inevitable upturn. Care should also be taken when selecting pricing strategy during economic slowdowns.

Economics↗
PubMed2003

Self-reported diseases and symptoms by rupture status among unselected Danish women with cosmetic silicone breast implants.

Epidemiologic evidence does not support an association between silicone breast implants and connective tissue or other rheumatic diseases. However, a recent study has suggested that women with ruptured implants may be at increased risk of developing fibromyalgia. An analysis of adverse health outcomes according to breast implant rupture status was conducted in 238 unselected Danish women with cosmetic silicone breast implants. Ninety-two of the women had definite implant rupture, and 146 had intact implants as determined by magnetic resonance imaging. Before undergoing imaging, the women provided blood samples and completed a self-administered questionnaire. Women with ruptured implants overall, and the subgroup with extracapsular ruptures (n = 23), were compared with women with intact implants regarding a number of self-reported diseases and symptoms and the presence of specific autoantibodies, such as antinuclear antibodies, rheumatoid factor, and cardiolipin immunoglobulin G and M antibodies. Overall, there were no differences in the occurrence of self-reported diseases or symptoms or in the presence of autoantibodies between women with intact implants and women with ruptured implants, including extracapsular rupture. The only exception was capsular contracture, which was reported six times more frequently by women with extracapsular ruptures than by women with intact implants (OR, 6.3; 95 percent CI, 1.7 to 23.5). In conclusion, this study of unselected women with silicone breast implants could establish no association between silicone implant rupture and specific diseases or symptoms related to connective tissue disease or other rheumatic conditions, except for an excess of capsular contracture among women with extracapsular rupture.

Adult↗
PubMed2004

Early experience with an anatomical soft cohesive silicone gel prosthesis in cosmetic and reconstructive breast implant surgery.

Recently, an anatomic breast implant filled with soft cohesive silicone gel was introduced by Mentor Medical Systems onto the European market. This study reports the early experience of a single surgeon with this implant. All patients who received a Contour Profile Gel (CPG) implant from March 2001 to October 2002 were studied. Patient satisfaction with breast shape and consistency was assessed using linear analogue scales with a maximum score of 10. Thirty-five patients received CPG implants for cosmetic (10 patients, 20 breasts) and reconstructive (25 patients, 31 breasts) surgery purposes. Patients were satisfied with their breast shape (mean score: 8.3). Eighty-five percent of the breasts were rated as soft (score >/=6). No serious esthetic complications such as implant malposition or significant capsular contracture were observed. Anatomic soft cohesive gel implants provide excellent results in selected cases. They are well accepted by patients and not associated with an increased rate of complications.

Adult↗
PubMed2004

Functional and cosmetic results of fingertip replantation: anastomosing only the digital artery.

In fingertip amputations, conventional stump plasty provides an almost acceptable functional result. However, replanting fingertips can preserve the nail and minimize loss of function. We investigated the functional and cosmetic results of fingertip replantation at the terminal branch of the digital artery. Outcomes were nailbed width and distal-segment length; sensory recovery; and range of motion (ROM) of thumb-interphalangeal (IP) or finger-distal interphalangeal (DIP) joints, and total active motion (TAM) of the replanted finger. Of 15 fingertips replanted after only arterial anastomosis, 13 were successful, and 12 were studied. After a median of 1.3 years, mean nailbed widths and distal-segment lengths were 95.4% and 93.0%, respectively, of the contralateral finger. Average TAM and ROM of the thumb-IP or finger-DIP joints were 92.0% and 83.0% of normal, respectively. Semmes-Weinstein results were blue (3.22 to 3.61) in 4 fingers and purple (3.84 to 4.31) in 8; the mean result from the 2-point discrimination test was 5.9 mm (range, 3 to 11 mm). Thus, amputated fingertips should be aggressively replanted.

Adult↗
PubMed2006

A portal to validated websites on cosmetic surgery: the design of an archetype.

There has recently been an increase in the usage of the Internet as a source of patient information. It is very difficult for laypersons to establish the accuracy and validity of these medical websites. Although many website assessment tools exist, most of these are not practical.A combination of consumer- and clinician-based website assessment tools was applied to 200 websites on cosmetic surgery. The top-scoring websites were used as links from a portal website that was designed using Microsoft Macromedia Suite.Seventy-one (35.5%) websites were excluded. One hundred fifteen websites (89%) failed to reach an acceptable standard.The provision of new websites has proceeded without quality controls. Patients need to be better educated on the limitations of the Internet. This paper suggests an archetypal model, which makes efficient use of existing resources, validates them, and is easily transferable to different health settings.

Internet↗
PubMed2004

Differences in patient and transplant professional perceptions of immunosuppression-induced cosmetic side effects.

BACKGROUND: A two-part study was initiated to compare kidney transplant patient and transplant professional perceptions regarding immunosuppression-related physical changes and their impact on transplant recipients. METHODS: Parallel surveys were developed and administered to transplant patients and active transplant clinicians. RESULTS: Eighty percent of surveyed patients reported immunosuppression-induced hirsutism, gingival hyperplasia, acne, alopecia, or cushingoid facies. Hirsutism (94%) and gingival hyperplasia (51%) occurred more frequently in cyclosporine patients (p < 0.01); alopecia (30%) occurred more frequently in tacrolimus patients (p < 0.01). Patient reported incidence of physical changes significantly exceeded observations by professionals for every condition (p < 0.01), however 84.4% of affected patients reported feeling "happy to endure" changes "for the sake of having a transplant." Patients also reported emotional and social effects due to physical changes, an outcome underestimated by transplant professionals (p < 0.01). Patients and professionals communicated about physical changes; however, more than half of affected patients believed communication occurred "rarely/never" while over half of the professionals believed communication occurred "every visit/most of the time." Although most physicians believed changes could be addressed, doctors recommended treatment for less than half of the affected patients. When recommended therapy changes were pursued, treatments were effective in the majority of cases. CONCLUSIONS: Incidence of immunosuppression-related physical changes is high and somewhat dependent on drug regimen. Although patients seem willing to accept cosmetic changes for the sake of having a transplant, physical changes have a psychosocial impact that is underestimated by clinicians. Immunosuppression-related physical changes remain underaddressed; effective interventions offer opportunities for improved care.

Alopecia↗
PubMed1991

Granulomatous tissue reaction following cosmetic eyebrow tattooing.

We report a case of epithelioid granuloma which occurred at the site of a previous cosmetic eyebrow tattooing. A biopsy specimen showed the organized appearance of epithelioid cell granulomas containing little pigment as well as occasional giant cells, mainly of Langhans' type, thus showing the characteristic features of granulomatous hypersensitivity. With the use of energy dispersive X-ray microanalysis and inductively coupled plasma spectrometry, the presence of copper, iron, cobalt, and chromium was demonstrated.

Coloring Agents↗
PubMed1991

The cosmetic effects of submucous resection.

A prospective assessment of the complications of submucous resection is presented. Preoperative photographs were taken and a post-operative assessment was carried out at a minimum time of 2 years by questionnaire and photographs. No examples of significant cosmetic changes were found.

Esthetics↗
PubMed1999

Penile elongation and thickening--a myth? Is there a cosmetic or medical indication?

Penile lengthening and thickening techniques can be performed in different ways for treatment of congenital penile hypoplasia and dysmorphophobia in terms of aesthetics or function. Particularly for penile lengthening, a combination of surgery and stretcher device is suggested. Surgery for lengthening comprises three different stages: suture with plane alternating edges of the pubo-penile skin, infrapubic lipectomy, and section of the suspensory ligament. Our approach to penile thickening differs depending on whether dysmorphophobia is related to aesthetics or function. While pericavernosal apposition of autografts is suggested in the first case, a technique developed by the authors is performed in the latter, which comprises bilateral longitudinal incision of the corpora cavernosa and enlargement of the tunica albuginea by means of saphenous grafts. The endothelial lining, which constitutes the internal surface of the veins, is highly compatible with the endothelium of the corpora cavernosa; therefore, the incidence of postoperative subareolar fibrosis and occlusive vein pathology is lower than after surgery performed with techniques using grafts of other material. The described procedure did not cause postoperative complications in terms of infection, wound healing and cosmetic appearance. All subjects resumed regular sexual activity after 4 months without any disturbance or functional limitation. Diametrical measurements at the 9-month follow-up revealed an increase of 1.1-2.1 cm. The reliability and efficiency of these procedures are strongly influenced by factors other than technical problems; however, expert diagnosis and psychological consultation in the case of dysmorphophobia will confirm and specify the indications.

Humans↗
PubMed1984

Some preliminary psychological observations on narcissism, the cosmetic rhinoplasty patient and the plastic surgeon.

From the point of view of the clinical psychologist, one important dimension of the psychological experience of the typical cosmetic rhinoplasty (CR) patient that has been underemphasized in the psychological and plastic surgery literature is the patient's narcissism. The author's aim is to facilitate the plastic surgeon's understanding and management of these patients by putting the disparate aspects of their behaviour into a unifying theoretical framework. A total of 41 CR patients from the UK, who had been referred through the National Health Service, were interviewed, psychologically tested and clinically assessed at varying times before and after surgery. A control group of patients undergoing wisdom teeth extractions were also interviewed and tested. The CR patient's narcissism was manifest, for example, in their self-absorption, inadequate self-esteem and fantasies of ideal beauty which was observed in his/her pre- and postoperative behaviour. Some suggestions on the management of the CR patient with narcissistic problems are offered to surgeons and hospital staff in order to maximize the clearly beneficial psychological and behavioural effects of CR.

Adult↗
PubMed2004

Body dysmorphic disorder and cosmetic dermatology: more than skin deep.

Body dysmorphic disorder (BDD) is relatively common in cosmetic practise, yet it remains under-recognized. BDD patients are unnaturally concerned with minimal or non-existent flaws, most commonly in the skin (e.g. facial acne or scarring) and hair (e.g. hair loss). Many patients develop social avoidance and suffer occupational or academic impairment. More severely ill patients may become housebound or even attempt suicide. Despite the minimal or non-existent nature of the perceived appearance flaws, patients with BDD may request dermatological treatments such as isotretinoin or dermabrasion. Although treatment outcome has received little investigation, it appears that most patients are dissatisfied with dermatological treatment and, even if the outcome is objectively acceptable, they do not worry any the less about their appearance afterwards. In contrast, a majority of patients respond to serotonin reuptake inhibitors or cognitive behavioural therapy. Treatment of these patients is best given by an experienced health professional. This may be a mental health professional or a dermatologist with an interest in psychological medicine.

Journal Article↗
PubMed2002

Cosmetic and medical causes of hair weathering.

To experts in any aesthetic field, scalp hair has 'life'. But in any scientific sense it is a dead structure made up of highly organized and orientated keratinized fibres and fibrils; and these can be modified by cosmetic procedures to give a seemingly infinite variety of beautiful and exciting styles. As the hair grows away from the scalp it degenerates or 'weathers' to some degree and this can be exaggerated by physical and chemical procedures such as overzealous brushing, bleaching, permanent waving and tricotillomania.

Hair↗
PubMed2005

A retrospective study of the efficacy of intense pulsed light for the treatment of dermatologic disorders presenting to a cosmetic skin clinic.

BACKGROUND: One hundred seven patients presenting to a cosmetic skin clinic were treated with intense pulsed light (IPL) over a 12-month period. The main categories of patients offered treatment were those with vascular problems such as rosacea, facial telangiectasia, and spider nevi; pigmentation disorders such as solar damage, lentigines, and hyperpigmentation; and assorted problems such as scarring and poikiloderma. METHODS: Each patient who entered into the study had the full medical history taken and a dermatologic assessment. Polaroid photographs were taken and the images used for comparison before and after treatment. Outcomes were assessed by physicians' global assessment and a patients' postal questionnaire. Patients were treated with a Lumina IPL (Lynton Lasers Ltd) using a multiple pulsing facility with variable interpulse spacing, incorporating a 585-nm head. Fluence levels varied between 10 and 40 J/cm(2), although the average fluence over all patients was 25 J/cm(2). The delay was set between 10 and 30 ms and two to four pulses were used. Results Excellent results were seen in 80% of patients treated. There was a high patient satisfaction rate and low prevalence of side effects. CONCLUSIONS: IPL has been shown to provide a safe and effective noninvasive treatment for a wide range of dermatologic disorders and is suitable for wider use in primary care.

Journal Article↗
PubMed2005

Capillaroscopy and videocapillaroscopy assessment of skin microcirculation: dermatologic and cosmetic approaches.

BACKGROUND: Different noninvasive bioengineering techniques exist to study the microvasculature of the skin and the dynamics of the microcirculation. The goal of these techniques is to visualize the skin capillary circulation easily and directly. Indeed, this information is irreplaceable to study the physiology and physiopathology of the skin capillary circulation efficiently. AIMS: Capillaroscopy and video-capillaroscopy techniques are presented with different methods to study the capillary structure of the skin. METHODS: The methods presented in this work include image processing analysis combining morphology, statistics, geometry, and neural network detection designed to quantify the microcirculation and to follow its evolution. To illustrate the combination of these techniques and methods, different examples of their application are described, in dermatology (hypertension, venous insufficiency, age-related changes) as well as in cosmetology (rosacea and erythrosis assessment). CONCLUSION: The determination of structural or dynamic changes in the cutaneous microcirculation belongs to the noninvasive techniques of the biometrological domain. Thus, every capillary modification resulting from topical cosmetic products, or chemical agents can be observed. In pathology, numerous conditions can be better examined with this system. Associated with the potential of numerical image analysis, capillaroscopy techniques will probably extend their application fields to the assessment of the influence of arterial and venous diseases on the skin nutritional circulation.

Journal Article↗