The Minimal Facelift: Liposuction of the Neck and Jowls

We have used blunt liposuction for removing excess fat from the neck and jowls since 1983 with generally good results and few complications. Under local anesthesia with Valium and ketamine sedation and the use of the super-wet technique, and by using special precautions to avoid the complications of prominent platysmal bands, wrinkling of the neck, and salivary gland prominence, carefully performed liposuction to the neck and jowls has been shown to be a safe and dependable procedure with good results, and may delay or obviate the need for a facelift.     

应用医用电子去脂机行颈部脂肪抽吸临床效果观察

目的：探讨医用电子去脂机行颈部脂肪抽吸的临床效果以及安全性。方法：共收治就医者87例，按其要求分别对颈前区、颈项部等进行电子去脂术，针对每位就医者手术治疗前后颈围测量及照片的对比，进行临床效果的评估。结果：全部病例均取得了明显的治疗效果，术后无反弹，术中损伤小，就医者无明显痛苦，手术无并发症发生。结论：应用医用电子去脂机行颈部脂肪抽吸，操作简单，安全可靠，治疗效果显著，就医者易接受。     

Breast Enlargement Observed After Power Liposuction: A Retrospective Review

BACKGROUND: After undergoing power liposuction to various body areas, a significant number of subjects reported an increase in their breast size that occurred spontaneously several months after their procedure. OBJECTIVE: To establish the incidence of breast enlargement among subjects who underwent power liposuction and to identify variables that are associated with the phenomenon. METHODS: A retrospective chart review and patient interview were performed from among 73 subjects who had undergone power liposuction at our center. Variables such as age, original weight, volume of aspirated fat, estrogen supplements, amount of weight loss or gain, and body areas aspirated were compared between those who experienced breast enlargement and those who did not. RESULTS: Thirty-four percent of the subjects (25 of 73) reported an increase in breast size. Of this group, 32% (8 of 25) reported an increase in cup size of one or more. Variables associated with the cohort who experienced breast enlargement included larger volume of fat aspiration and liposuction in the abdomen and hip location. CONCLUSION: Breast enlargement was observed in 34% of the subjects after power liposuction either in the form of a larger bra cup size or a subjective feeling of increased fullness. We hypothesize that an altered androgen to estrogen ratio after liposuction may be responsible for this change.     

The Benefits of Powered Liposuction Versus Traditional Liposuction: A Paired Comparison Analysis

BACKGROUND: There is much debate about the safety of liposuction as well as the efficacy and risk:benefit ratio of newer devices used in this procedure. OBJECTIVE: To determine if there are any benefits in terms of safety and efficacy of power reciprocating cannulas compared to traditional manual liposuction cannulas. METHODS: Patients served as their own controls in a paired comparison analysis of power liposuction cannulas and traditional liposuction cannulas. RESULTS: Power cannulas significantly reduced procedure times, intraoperative pain, and surgeon fatigue, and increased the amount of fat aspirated per minute. Power cannulas also decreased postoperative pain, ecchymoses, and edema, as well as resulting in higher patient satisfaction scores. CONCLUSION: Power liposuction cannulas produce significantly faster recovery times for patients, allow faster procedure times, and reduce surgeon fatigue, resulting in safer and more precise surgery. A lower incidence of touch-up procedures is likely due to these benefits.     

Liposuction of Neck and Jowls: Five-Incision Method Combining Machine-Assisted and Syringe Aspiration

BACKGROUND: Liposuction of the jowl region is difficult from a single submental incision and must be done conservatively in order to avoid overresection of fat. The neck region may be suctioned much more completely. OBJECTIVE: A new method for liposuction of the neck and jowls that uses five incisions and that combines syringe suctioning of the jowls and machine-assisted suctioning of the neck has been developed. METHODS: The neck was suctioned from submental and infra-auricular incisions. The jowls were suctioned from the infra-auricular and additional infrajowl incisions. RESULTS: This method has been used on 68 patients over a 3-year period. Three additional patients underwent syringe liposuction of only the jowls. Volumes of fat aspirated from bilateral jowls were consistently nearly equal. The incidence of adverse events was low. CONCLUSION: This method enables conservative removal of jowl fat and thorough removal of neck fat, with a low incidence of adverse sequalae.     

Infected Aneurysms of Neck and Limb Arteries: A Retrospective Multicenter Study

Infected aneurysms (IA) of neck and limb arteries are uncommon. This report describes the results of a retrospective study undertaken by the University Association for Surgical Research (AURC) to evaluate etiology, bacteriology, location, diagnostic features, and therapeutic methods associated with IA. A total of 58 IA in 52 patients were reviewed. The lesion was located in a lower extremity artery in 47 patients (81%), internal carotid artery in 7 (12%), and upper extremity artery in 4 (6%). Eleven patients had multilocular aneurysm (21%). Symptoms of local infection were observed in 43 patients (82.6%). Rupture or splitting was the presenting manifestation in 13 patients (25%). Primary IA following bacteremia or septicemia without endocarditis was the most common type of IA observed in 34 patients (65.3%). Twelve patients (23%) presented mycotic IA secondary to bacterial endocarditis. In the remaining six patients (11.5%), IA resulted from direct contamination or spreading from a contiguous infection site. Surgical treatment included ligation of the artery without reconstruction in 19 patients and exclusion bypass in 33 patients. The duration of antibiotic treatment ranged from 15 days to 3 months. No recurrence of aneurysm was observed but three patients developed bypass infection. Primary IA was associated with high mortality due to severe septicemia.     

Influence of Surgical Margins on the Outcome of Breast Cancer Patients: A Retrospective Analysis

Objective

Breast-conserving surgery has become the preferred treatment for early breast cancer. Yet the question of what constitutes a ‘safe margin’, in terms of impact on patient outcome, remains unanswered. Our aim was to address this knowledge gap by determining the prevalence of positive and narrow margins after breast-conserving surgery, and evaluating how margin status impacted local recurrence and overall survival.

Materials and Methods

We collected data about all women who underwent breast-conserving cancer surgery in our department between 2002 and 2011, focusing on patient and tumor characteristics, the distance from the tumor to the surgical margin, therapies administered, and outcome (measured in terms of local recurrence and overall survival). Data were analyzed by R (version 3.0.1), considering p < 0.05 as significant. Multivariate analyses were also performed.

Results

Of 1,192 women who received breast-conserving surgery, 264 were considered for widening; 111 of these patients had positive margins and 153 narrow (where narrow was defined as less than 5 mm). Widening was performed for 38 % of these patients (99/264) and mastectomy for 27 % (70/264), while 36 % (95/264) had no further surgery and were simply followed-up. Our multivariate analysis confirmed that local tumor recurrence and overall survival were not significantly influenced by margin status, either at initial surgery, or (for those patients with initially positive margins) at secondary margin-widening surgery. However, the following were found to be significantly correlated with local recurrence: tumor multifocality, high expression of Ki-67/Mib-1, comedo-like necrosis, and non-axillary lymph node positivity (p < 0.05).

Conclusions

We found the status of resection margins and the management of infiltrated or narrow margins to have no significant influence on local tumor recurrence rates or on overall patient survival. Instead, biological factors connected with tumor aggressiveness seem to play the most important role in breast cancer prognosis, independent of surgical radicality.     

Combined Use of Ultrasound-Assisted Liposuction and Limited-Incision Platysmaplasty for Treatment of the Aging Neck

BACKGROUND: Many techniques have been introduced for the surgical treatment of the aging neck. In this study the combination therapy of ultrasound-assisted liposuction and limited-incision platysmaplasty for cervicofacial rejuvenation is presented. METHODS: Fifteen female patients (age = 43-75 years) were treated for grade II-III (n = 2), III (n = 6), and grade IV (n = 7) cervicomental angle deformity. The outcome of surgery was retrospectively evaluated by a panel. RESULTS: Ultrasonic energy was applied for an average of 2 min (range = 45 s-6.5 min). The mean aspiration volume was 125 ml. No immediate or delayed adjuvant skin reduction was needed in any of the patients. No complications were encountered in this series. After treatment significant improvement of the cervicomental angle was observed. CONCLUSION: For treatment of all grades of the aging neck we advocate the combination of UAL and limited-incision platysmaplasty. This combination therapy has little morbidity and leads uniformly to significant improvement of the cervicomental angle.     

Combination Surgical Lifting with Ablative Laser Skin Resurfacing of Facial Skin: A Retrospective Analysis

BACKGROUND: Cutaneous aging is manifested by rhytides, dyschromias, and skin laxity. Ablative laser skin resurfacing can effectively improve many signs of skin aging; however, the photoaged patient with facial laxity often requires a surgical lifting procedure in order to obtain optimal results. Concerns with delayed or impaired wound healing has led to reluctance to perform both procedures simultaneously. OBJECTIVE: To report the clinical results and side effect profiles after concomitant surgical facial lifting procedures and ablative carbon dioxide or erbium:YAG laser resurfacing in a series of patients. METHODS: A retrospective analysis and chart review was performed in 34 consecutive patients who underwent combination CO(2) or erbium:YAG laser skin resurfacing and surgical lifting procedures, including S-lift rhytidectomy, blepharoplasty, and brow lift. Side effects and complication rates were tabulated. RESULTS: The side effect profile of the combined surgical-laser procedures was similar to that reported after a laser-only procedure. The most common side effect was transient hyperpigmentation which occurred in 20.6% of treated patients. None of the patients experienced delayed reepithelialization, skin necrosis, or prolonged healing times. CONCLUSIONS: Concurrent laser skin resurfacing and surgical lifting of facial skin maximizes aesthetic results without increased incidence of adverse effects. Patients benefit from the consolidation of anesthesia and convalescent times as well as enhanced global clinical outcomes.     

A Retrospective Analysis of Surgical Treatment in Patients With Symptomatic Hallux Rigidus: Long-Term Follow-Up

The objective of this retrospective study was to analyze the long-term clinical outcomes and patient satisfaction of operative care in patients with symptomatic hallux rigidus. Seventy-seven patients (94 feet) underwent cheilectomy, Keller resection arthroplasty, or arthrodesis between 1990 and 2000. All were invited to return for follow-up evaluation after a minimum of 2 years (mean, 7 years). The average patient age was 53 years (range, 22-77 years). Outcomes were assessed by questioning and examining the patients and by evaluating radiographs according to the Regnauld's classification system. Overall patient satisfaction was good; average visual analogue and American Orthopedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scores were 1.8 and 81, respectively. Eighty-seven percent stated they would undergo the same procedure again. After cheilectomy, the average visual analogue score was 1.4 for grade I and 2.3 for grade II, and rating scale scores were 87 and 82, respectively. There were comparable results for the Keller resection arthroplasty where visual analogue scores were 0.4 and 1.6, respectively, while AOFAS scores were 94 and 83, respectively. Average visual analogue scores and AOFAS scores in grade III patients after a Keller procedure and an arthrodesis were 2.3; 87 and 2.0; and 73, respectively. In the arthrodesis group, 4 patients required revision because of complications. Cheilectomy is a good choice for patients with grade I and II hallux rigidus because it is a safe and simple joint-preserving procedure. For end-stage hallux rigidus without preexistent metatarsalgia, the Keller procedure was favored over arthrodesis of the first metatarsophalangeal joint.     

Surgical Approaches and Hemiarthroplasty Outcomes for Femoral Neck Fractures: A Meta-Analysis

Background

The lateral approach (LA), posterior approach (PA), and anterior approach (AA) are conventional surgical access routes for hemiarthroplasty in proximal femoral fractures. This meta-analysis assesses and compares the outcomes and attempts to identify the best approach for hemiarthroplasty in the treatment of proximal femoral fractures.