Epidural bupivacaine administration after infiltration of liposomal bupivacaine for transversalis fascia plane block: A case report.

Extended-release liposomal bupivacaine is frequently used in surgical infiltration for postoperative pain control. The manufacturer recommends against subsequent local anesthetics within 96 hours. We administered epidural bupivacaine one day after local liposomal bupivacaine infiltration for staged hemipelvectomy without symptoms of LAST.

Alloplastic Facial Implants.

As the face ages, there is thinning of the epidermis, volume loss and rearrangement of the soft tissues, and malabsorption of the skeletal framework. It is essential to have a thorough understanding of the aging process for successful facial augmentation and rejuvenation. Alloplastic implants can be used to provide a long-lasting solution for augmentation of skeletal deficiencies, restoration of facial irregularities, and rejuvenation of the face.

Telemedicine in the Intensive Care Unit: Improved Access to Care at What Cost?

Health systems across the United States are adopting intensive care unit telemedicine programs to improve patient outcomes. Research demonstrates the potential for decreased mortality and length of stay for patients of these remotely monitored units. Financial models and studies point to cost-effectiveness and the possibility of cost savings in the face of abundant startup costs.

Insights into the Functional Anatomy Behind the PREEMPT Injection Paradigm: Guidance on Achieving Optimal Outcomes.

Objective: To provide clinically relevant insights on the identification of the muscles and techniques involved in the safe and effective use of onabotulinumtoxinA for chronic migraine prophylaxis.

Background: Although guidance on the use of onabotulinumtoxinA for chronic migraine is available, based on the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical program, clinical experience has shown that insufficient understanding of the anatomy and function of the head and neck muscles may lead to undesirable outcomes and suboptimal efficacy.

Design/methods: Each muscle involved in the standardized PREEMPT injection paradigm is reviewed with a thorough description of each muscle's anatomy (ie, muscle description and location, innervation, vascular supply) and function.

The role of fillers in facial implant surgery.

Alloplastic facial implants and injectable fillers are currently used for facial rejuvenation and augmentation. Their respective roles in augmentation and volume replacement of the chin and midface are discussed. Treatment goals, patient selection, procedures, and patient recovery are detailed.

Zonal analysis of facial asymmetry and its clinical significance in facial plastic surgery.

Objectives: To describe common patterns of facial asymmetry and to augment the facial analysis paradigm for improved preoperative counseling and surgical planning.

Methods: We conducted a frontal photographic analysis of 50 patients who were seeking various types of facial cosmetic surgical procedures. The horizontal zonal thirds of the face were analyzed, and the bilateral data points were compared in regard to brow height, width of midface at maximum distance, malar eminence height,nasal alar height, and mandible width measured from the oral commissure to the gonial angle.

Facial rejuvenation and volumization using implants.

Whereas traditional concepts of facial aging focus on the descent of soft tissue secondary to gravitational effects, it is now well established that volumetric changes involving different levels of soft tissue loss reveal craniofacial skeletal deficiencies that, together, contribute to the changes evident in the aging face. Thus, effective facial rejuvenation requires a comprehensive paradigm that identifies and addresses all anatomic elements involved in the aging process. Contemporary practices in facial rejuvenation have expanded far beyond the rhytidectomy procedure to involve deeper and more fundamental levels of dissection for the purpose of elevating and replacing volume.

Method of injection of onabotulinumtoxinA for chronic migraine: a safe, well-tolerated, and effective treatment paradigm based on the PREEMPT clinical program.

Chronic migraine (CM) is a prevalent and disabling neurological disorder. Few prophylactic treatments for CM have been investigated. OnabotulinumtoxinA, which inhibits the release of nociceptive mediators, such as glutamate, substance P, and calcitonin gene-related peptide, has been evaluated in randomized, placebo-controlled studies for the preventive treatment of a variety of headache disorders, including CM.

Midface alloplastic augmentation in the Asian and Latino patient.

The population of the United States is becoming increasingly more diverse as there is an ever expanding influx of various ethnic groups and races that comprise the general population. As a result, the singular concept of Nordic beauty that dominated the United States media throughout the middle of the twentieth century has given way to a more diverse multiracial aesthetic. There is also a growing trend in aesthetic surgery toward ethnic feature preservation and avoidance of a "westernized" look that was more popular in previous years.

Custom-designed facial implants.

Accurate correction and restoration of facial contour defects have historically posed arduous challenges for reconstructive and aesthetic surgeons, but technological innovations in the design and manufacture of facial prostheses have significantly improved the precision, fit, and reliability of these restorative devices. This article discusses the experience with and benefits obtained by the use custom implants created using CT imaging and computer-aided design and manufacture.

Malar and submalar augmentation.

Over the past four decades, revolutionary improvements in the design and manufacture of facial implants have broadened the application of midface augmentation. The contemporary practice of facial rejuvenation reflects a 20-year culmination of rapid advances made in the understanding and treatment of midface aging. This article highlights the practice of malar and submalar augmentation: when and how it should be used.

Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins.

Objective: To evaluate the presence of imprinted facial lines in identical twin sisters, one of whom had received botulinum toxin type A (Botox) treatment in the forehead and glabellar region regularly for 13 years and one of whom had not. Crow's feet were also compared.

Methods: One twin received Botox in the forehead and glabellar region (approximately 2 to 3 times each year over the past 13 years) and in the crow's feet (twice in past 2 years).

The use of custom-designed midfacial and submalar implants in the treatment of facial wasting syndrome.

Facial wasting syndrome is part of a lipodystrophy that occurs as a complication of highly active antiretroviral therapy. The loss of subcutaneous fat in the cheeks and temples results in a hollow-eyed, bony, emaciated appearance that is characteristic of the results of treatment of human immunodeficiency virus. Cessation of therapy results in a rebound in viral load and subsequent morbidity.

Treatment of migraine headache with botulinum toxin type A.

Migraine is a common headache disorder with profound implications on patients' quality of life and the overall health care system. Traditional treatment options have been less than optimal and many migraine patients lack confidence in over-the-counter and prescribed medications. BTX-A has shown promise as an efficacious, well-tolerated, long-lasting preventive therapy.

Botulinum toxin type A (BOTOX) for treatment of migraine.

An open-label study and 2 double-blind, placebo-controlled studies have provided supporting evidence of botulinum toxin type A (BTX-A) as an effective, well-tolerated treatment for migraine. Observed durations of benefit were consistent with known properties of BTX-A. Findings suggest that response may vary by features of preinjection headaches, such as migraine frequency.