Finesse in Primary Open Rhinoplasty.

Rhinoplasty remains one of the most technically demanding operations in plastic surgery, and it continues to be one of the top 5 aesthetic surgical procedures performed. The focus of this article is open rhinoplasty, the central focus of the practice of the senior author (R.J.

Pitanguy Ligament Preservation in Structural Precision Rhinoplasty.

The Pitanguy ligament is a crucial structure in nasal tip support and in maintaining the integrity of the soft tissue envelope of the nose. In this cadaveric study, we dissected out the Pitanguy ligament on a series of fresh human cadaver specimens to better elucidate the structure of the ligament and its fate in open rhinoplasty. The Pitanguy ligament can act as a tethering force to the nasal tip when reshaping the nasal tip.

Efficacy of Mepliex Ag Versus Xeroform As A Split-Thickness Skin Graft Donor Site Dressing: Bad Habits Die Hard.

Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site.

Predicting Organometallic Intermediates in the Surface-Assisted Ullmann Coupling of Chrysene Isomers.

On-surface polymerization of functional organic molecules has been recently recognized as a promising route to persistent low-dimensional structures with tailorable properties. In this contribution, using the coarse-grained Monte Carlo simulation method, we study the initial stage of the Ullmann coupling of doubly halogenated chrysene isomers adsorbed on a catalytically active (111) crystalline surface. To that end, we focus on the formation of labile metal-organic precursor structures preceding the covalent bonding of chrysene monomers.

Order-Disorder Transition of Two-Dimensional Molecular Networks through a Stoichiometric Design.

Materials with disordered structures may exhibit interesting properties. Metal-organic frameworks (MOFs) are a class of hybrid materials composed of metal nodes and coordinating organic linkers. Recently, there has been growing interest in MOFs with structural disorder and the investigations of amorphous structures on surfaces.

Management of the Posthemangioma Nose: 5 Key Rhinoplasty Components.

Hemangiomas of the nasal tip are a relatively uncommon presentation of a common tumor. While optimal medical and surgical management of nasal tip infantile hemangiomas has been described and debated extensively in the literature, to our knowledge, there is no report of secondary aesthetic and functional rhinoplasty in these patients at skeletal maturity, until now. This special topic article provides an excellent example of the 5 key technical elements to revision rhinoplasty in the skeletally mature patient with a history of nasal tip infantile hemangioma.

Structural Quantification of the Surface-Confined Metal-Organic Precursors Simulated with the Lattice Monte Carlo Method.

The diversity of surface-confined metal-organic precursor structures, which recently have been observed experimentally, poses a question of how the individual properties of a molecular building block determine those of the resulting superstructure. To answer this question, we use the Monte Carlo simulation technique to model the self-assembly of metal-organic precursors that precede the covalent polymerization of halogenated PAH isomers. For this purpose, a few representative examples of low-dimensional constructs were studied, and their basic structural features were quantified using such descriptors as the orientational order parameter, radial distribution function, and one- and two-dimensional structure factors.

Neuromodulator Finesse for Masseter Hypertrophy and Bruxism.

A particularly prominent mandibular angle or a hypertrophied masseter muscle can result in an excessively wide facial appearance, which some individuals may find less aesthetically pleasing. Although normally a benign condition and strictly an aesthetic concern, a hypertrophied masseter can also cause pain, bruxism, and headaches. Neuromodulator for masseter reduction and treatment of bruxism has become first-line treatment.

Beyond Alar Base Resection: Contouring of the Alar Rim and Base.

Summary: Alar base surgery is approached with hesitancy and is often avoided by many surgeons because of inexperience and a lack of understanding. However, with a thorough knowledge of the anatomy and dynamic nature of the lower third of the nose, alar base resection can achieve favorable and reproducible results. Beyond correcting alar flare, an appropriately diagnosed and performed alar base procedure serves to contour both the alar rim and the alar base.

Lip Lifting: The Missing Link in Central Facial Rejuvenation.

The lip lift is a powerful yet finesse operation in the realm of facial rejuvenation. In an era of increased popularity of nonsurgical lip augmentation, the astute plastic surgeon must identify which patients will end up with an unnatural appearance should they receive volume enhancement alone in pursuit of central facial and perioral rejuvenation. In this article, the authors review the ideal youthful lip appearance, characteristics of the aged lip appearance, and indications for lifting.

Differential Fat Grafting to Address Facial Asymmetry in Face Lifting.

The modern face lift is a complex operation involving the repositioning of tissues and the refilling of volume atrophy. Preoperative analysis is key to the successful diagnosis of aging changes. Facial asymmetry is universal, and must be recognized and incorporated into surgical planning.

Neuromodulator Injection for Gummy Smile.

Neuromodulators have become a treatment of choice for the management of excess gingival show, or "gummy smile." There have been many proposed algorithms for the optimal placement and dosage of neuromodulator to inject in these locations. The authors aim to clarify these points and provide surgeons with a reliable way to manage the gummy smile that results from hyperactive muscles of the midface.

Systematic Review of Capsular Contracture Management following Breast Augmentation: An Update.

Background: Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics and minimizing subsequent recurrence of capsular contracture. As new data emerge, close review of the data are merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture.

Revision Rhinoplasty Finesse with Digital Osteotomies.

Revision rhinoplasty is a finesse procedure requiring careful consideration of all of its requisite steps. Lateral osteotomies are required in many cases and, in the setting of prior lateral osteotomies, can often be recreated with digital pressure alone, without the use of an osteotome. The advantages of doing so include decreased dead-space creation and preservation of attachments between the skeleton and overlying soft tissue.

Refinements in Component Dorsal Reshaping in Primary Rhinoplasty.

Dorsal reduction and reshaping is an essential part of many rhinoplasty procedures. The steps of component dorsal reduction have been well established. The authors describe refinement of the dorsal reshaping process to improve the quality and consistency of results.

Finesse Buccal Fat Pad Excision.

The buccal fat pad has long been noted for its complex anatomy and its significance to facial aesthetics. Its bulk is mostly deep facial fat immediately superficial to the buccinator muscle. The buccal fat pad has a main body and four extensions: buccal, pterygoid, superficial temporal, and deep temporal.

Learners' Responses to a Virtual Cadaver Dissection Nerve Course in the COVID Era: A Survey Study.

 Virtual education is an evolving method for teaching medical learners. During the coronavirus disease 2019 pandemic, remote learning has provided a replacement for conferences, lectures, and meetings, but has not been described as a method for conducting a cadaver dissection. We aim to demonstrate how learners perceive a virtual cadaver dissection as an alternative to live dissection.

Longevity of ptosis correction in mastopexy and reduction mammaplasty: A systematic review of techniques.

Background: Mastopexy and reduction mammaplasty are commonly performed procedures in plastic surgery with many variations in incision pattern, pedicle design, and additional support maneuvers. Aesthetically pleasing on table results are widely accomplished; however, the longevity of the outcome and sustained correction of ptosis or pseudoptosis is not universal. A systematic review of mastopexy and reduction mammaplasty procedures was performed to investigate which techniques provided the greatest long-term correction of ptosis.

Innovation in Delivering a Live, Virtual Cadaver Dissection Course.

The availability of advanced telecommunication technology and the social restrictions introduced by a global pandemic have compelled the medical community to explore new avenues of surgical education. Although cadaver courses have long been a fundamental method for learning surgical anatomy and improving operative preparedness, the COVID-19 pandemic has made traditional dissections less practical. The need for quality virtual learning experiences motivated the authors to design and assess the feasibility of organizing a live, virtual upper extremity peripheral nerve cadaver dissection course.

Theoretical Modeling of the Metal-Organic Precursors of Anthracene-Based Covalent Networks on Surfaces.

Surface-assisted fabrication of molecular network architectures has been a promising route to low-dimensional materials with unique physicochemical properties and functionalities. One versatile way in this field is the Ullmann coupling reaction of halogenated organic monomers on catalytically active metallic surfaces. In this work, using the coarse-grained Monte Carlo simulations, we studied the on-surface self-assembly of metal-organic precursors preceding the covalent Ullman-type linkage of tetrahalogenated anthracene building blocks.

Fatigue Life of Austenitic Steel 304 Bolts Strengthened by Surface Treatment with Graphene Oxide Layer and Surface Shot Peening.

This paper presents the results of investigations of the effect of graphene oxide and surface shot peening on the mechanical properties and fatigue life of bolts made of austenitic 304 steel. An innovative method for the uniform deposition of graphene oxide on screws is presented. The process involved activating the surface using plasma and then performing graphene oxide deposition using centrifugal force and vacuum drying.

Quantitative anatomy of primary ossification centres of the lateral and basilar parts of the occipital bone in the human foetus.

Background: Computed tomography (CT)-based quantitative analysis of primary ossification centres in the cranium has not been carried out to date due to the limited availability of the foetal human material. Detailed morphometric data about the development of primary ossification centres in human foetuses may be useful in the early detection of developmental defects. Understanding the growth and development of the occipital bone is crucial in assessing the normal and pathological development of the cranial base, and the cranium as a whole.

How to Host a Virtual Educational Conference.

Virtual education is a promising tool for expanding surgical training and continuing education. The authors present their preferred platforms for virtual surgical education, and discuss security and privacy concerns. Maintaining communication and keeping sessions engaging require special consideration when education is done virtually.

Traditional Anthropometrics versus Computerized Photograph Manipulation in Rhinoplasty Planning.

Background: Rhinoplasty planning requires meticulous forethought and is a source of challenge to surgeons. Traditional anthropometric analyses aim to use measurements and ideal ratios to determine the appropriate changes in nasal measurements such as length and tip projection. More recently, computerized photograph manipulation has been adopted as a means to demonstrate to patients the planned changes in a rhinoplasty and improve communication and patient confidence.

Opioid Prescribing Habits and Pain Management Among Aesthetic Plastic Surgeons.

Background: The opioid epidemic continues to worsen in the USA. Post-operative opioid prescriptions contribute to development of opioid use disorders, with studies showing 6% of plastic surgery patients developing new persistent use. Prescribing by surgeons is often excessive, and plastic surgery patients only consume about half of their opioid prescriptions.