Evolving Clinical Experiences in Aesthetic Hip Implant Body Contouring.

Background: Hip augmentation increases the hip width utilizing fat transfer and/or subcutaneous implants, creating a more feminine hourglass shape. Custom hip implant surgery requires proper patient selection, correct body frame analysis, appreciation of hip aesthetics, understanding surgical anatomy, optimal aesthetic planning, a favorable implant design and fabrication, skilled surgical implant placement, diligent postoperative patient care, and proper complication management.

Objectives: The authors sought to evaluate the pioneering clinical experience with cosmetic custom hip silastic implants.

Chin Reshaping in Profileplasty: Augmentative and Reductive Strategies.

After studying this article, the reader should be able to understand how various implants, osteotomies, and reductive tissue techniques affect the aesthetic outcomes of chin reshaping surgery. The roles of standard versus custom chin implants, the operative steps and indications for a bony genioplasty and the techniques for chin reduction are described with emphasis on proper patient selection and avoiding their common complications.

Forehead/Brow Reduction or Augmentation with Custom Implants for Enhanced Facial Profileplasty.

After studying this article, the reader should be able to understand the basic concepts of aesthetic reshaping of the forehead and the different methods to make those upper facial contour changes. The operative techniques for bony forehead and brow bone reduction and biomaterials for forehead and brow bone augmentation are described. Innovations in bony reduction and implant augmentation methods are emphasized.

Mandibular Angle Implants.

After studying this article, the reader should be able to understand the two basic types of implants for aesthetic augmentation of the jaw angles and the aesthetic goals in using them. The operative steps for surgical placement are described with emphasis on avoiding the common complications of jaw angle implants. The indications for the use of standard versus custom jaw angle implants are also described.

Postoperative Care in Facial Implants.

Facial augmentation is a growing field, secondary to the appreciation of the changes seen in the facial skeleton with aging and the growing acceptance/popularity of facial fat grafting and facial fillers. In addition, it plays a significant role in patients with congenital facial deficiencies as well as those interested in facial feminization/masculinization surgery. Several facial implants are discussed in this article including classic facial implants such as malar, submalar, chin, and prejowl implants as well as newer facial implants such as mandible, temporal, forehead, and skull implants.

Pediatric pyoderma gangrenosum: is it just big wounds on little adults?

Background: Pyoderma gangrenosum (PG) is an uncommon, ulcerative, cutaneous condition, often caused by surgical trauma that can masquerade as a pyogenic disease process requiring debridement and antibiotics. Treatment is, however, medical, with delay leading to significant morbidity. In addition, medical workup for coincident disorders has been suggested.

Utility of Tongue Stitch and Nasal Trumpet in the Immediate Postoperative Outcome of Cleft Palatoplasty.

Background: Postoperative airway obstruction is a feared complication following cleft palate repair. The aim of this study was to evaluate the effectiveness of tongue stitches and nasal trumpets that have been used in an attempt to prevent this complication.

Methods: An 8-year (2005 to 2013) retrospective review of palatoplasties performed at a tertiary care center was conducted.

Facial dog bite injuries in children: treatment and outcome assessment.

Dog bite injuries to a child's face are not an infrequent occurrence. They may require primary and revisional surgery. All result in permanent facial scars.

Surgical pocket location for gluteal implants: a systematic review.

Background: The safest pocket location for gluteal augmentation surgery using implants still is unknown. This study conducted a systematic review to derive evidence-based recommendations concerning the safest type of pocket location (sub-muscular, subfascial, intramuscular, or intramuscular XYZ method) for silicone implants in terms of acute and long-term complication rates.

Methods: Articles from medline that met predetermined criteria were included in the study.

Nonorthodontic orthognathic surgery.

Orthognathic surgery for occlusal improvement commonly requires preoperative and postoperative orthodontic treatments to fine-tune intercuspation. This report focuses on the feasibility, treatment goals, and outcomes of orthognathic surgery in a series of patients with congenital dentofacial anomalies who were considered ineligible for or noncompliant with orthodontic treatment. Despite suboptimal occlusal outcomes, the orthognathic procedures resulted in tangible benefits for the patients.

Adipose stromal cells and platelet-rich plasma therapies synergistically increase revascularization during wound healing.

Background: The authors examined the efficacy of adipose stem cells, when supplied either alone or in platelet-rich fibrin gels, to improve wound healing.

Methods: A porcine full-thickness wound model was used to compare six topical treatments: platelet-poor plasma; platelet-rich plasma; autologous adipose stem cells plus platelet-poor plasma; autologous adipose stem cells plus platelet-rich plasma; allogeneic adipose stem cells containing green fluorescent protein plus platelet-poor plasma; and saline (control). One week after isolation, adipose stem cells were applied to full-thickness wounds on the paraspinal and thoracic regions of three pigs (44 wounds per pig; each treatment was applied to eight separate wounds).

Body contouring with solid silicone implants.

Background: Body-contouring implants are becoming increasingly popular and more accepted and requested for aesthetic purposes. These implants must be placed in a safe and reproducible plane of anatomic dissection for a successful long-term outcome. Poor implant placement techniques result in greater complications such as asymmetry, implant migration, capsular contracture, and infection.

Craniosynostosis: a single institution's outcome assessment from surgical reconstruction.

Purpose: A retrospective review of a single institution's 20-year experience of complications and reoperation rates after surgery for primary craniosynostosis correction.

Methodology: A retrospective chart review of all patients (n = 376) undergoing primary surgery for craniosynostosis was conducted. The charts were analyzed for diagnosis, sex, syndromic involvement, age at operation, type of fixation, complications, and reoperations.

Surgical cephalometrics: applications and developments.

Learning Objectives: After studying this article, the participant should be able to: 1. Describe the historical origins of modern cephalometry. 2.

Mandibular coronoid hyperplasia in pediatric patients.

Bilateral coronoid hyperplasia is a relatively rare condition in the pediatric population and yet may be an unrecognized cause of limited mouth opening in children. There are multiple theories as to the causes of the hyperplasia, which include temporalis hyperactivity, hormonal stimulus, and genetic inheritance. The resulting excess growth of the coronoids results in impingement on the zygomatic processes leading to mandibular hypomobility.

Bioabsorbable plate and screw fixation in orthognathic surgery.

This paper describes the author's 10-year experience in using resorbable polymeric plates and screws in select cases of orthognathic surgery as well as a comprehensive review of all published reports on this technology for similar applications.

An experimental study of heat adaptation of bioabsorbable craniofacial meshes and plates.

Intraoperative heating of bioabsorbable plates and mesh panels to above the glass transition temperature is commonly performed to assist their adaptation to bone. Some studies suggest that once heat-adapted, such implants under certain conditions tend to partially revert to their preadapted shape, termed a "memory effect." We investigated this phenomenon by using heat-adapted 82:18 poly-L-lactic acid:polyglycolic acid copolymer mesh panel and plate specimens with a glass transition temperature of 57 degrees C.

In vitro characteristics of a bioabsorbable suspension screw and suture system for endoscopic brow lift surgery.

The time requirement for endoscopic subperiosteal brow lift fixation is as little as 10-14 days. Many types of bioabsorbable fixation have been applied to this procedure, including bioabsorbable suture coupled with a bioabsorbable bone anchor, with excellent outcomes. Typically, the anchor and suture materials differ, each having their own hydrolytic strength loss profile.

Platelet-rich plasma: a review of biology and applications in plastic surgery.

Healing of hard and soft tissue is mediated by a complex array of intracellular and extracellular events that are regulated by signaling proteins, a process that is, at present, incompletely understood. What is certain, however, is that platelets play a prominent if not deciding role. Controlled animal studies of soft and hard tissues have suggested that the application of autogenous platelet-rich plasma can enhance wound healing.

The effect of high temperature intraoperative molding on bioabsorbable PLLA-PGA craniofacial fixation.

Bioabsorbable internal fixation has become an established part of the surgeons' armamentarium. There are several unique aspects of bioabsorbable polymers that can enhance their versatility. One of these is the application of heat to adapt the implant.

Injectable soft-tissue fillers: clinical overview.

Learning Objectives: After studying this article, the participant should be able to: 1. Know the composition and biology of injectable fillers. 2.

Treatment of nasopharyngeal stenosis by prosthetic hollow stents: Clinical experience in eight patients.

Objective: A series of nasopharyngeal appliance designs is presented that represents our evolving experience over a 20-year period in the adjunctive use of prosthetic stents in the surgical correction of nasopharyngeal stenosis.

Design: Retrospective assessment of effectiveness of two nasopharyngeal stenosis hollow stent designs in a consecutive series of patients for relief of nasal obstructive symptoms.

Setting: Tertiary academic medical center, Craniofacial Program at Children's Hospital.

Stability of craniofacial PLLA/PGA copolymer bioabsorbable screws.

The behavior of bioabsorbable plates and screws after implantation is a dynamic process that results in dimensional changes of the devices after surgery. Bioabsorbable plates frequently are recognized as changing because of their size, but bioabsorbable screws are less appreciated in this regard. How bioabsorbable screws may change after placement and whether their manufacturing method has an influence on size and shape after implantation needs further study.