Dr. Larry Weinstein In the News New Jersey

New Jersey Plastic Surgeon In The News

Plastic Surgery | Minutes: Dr. Larry Weinstein and Dr. Rod J. Rohrich
“Dr. Weinstein Helps to Answer Three Critical Questions Regarding Breast Augmentation”

Plastic Surgery News
Teen battles obesity and loses 100 pounds and gets improved image with the help of plastic surgery. www.cnn.com

People in the News




We proudly announce the 2014 Wall of Distinction Ceremony honoring Dr. Weinstein for his research in Plastic Surgery and his Humanitarian missions bringing smiles to children’s faces in India.

The ceremony will be held at:

Madison High School
Sunday, April 27, 2014


Study reassesses results of plastic surgery.

The Los Angeles Times (2/21, Brown) reports, “It turns out plastic surgery really does make you look younger,” according to a study published online Feb. 20 in the Archives of Facial Plastic Surgery. The Times adds, “Hoping to come up with ‘an objective measure of surgical success’ — and not have to depend solely on patient-reported satisfaction to assess the success of cosmetic surgery procedures — the researchers…asked first-year medical students to view pictures of 60 patients (54 women and six men, age 45 to 72)” who had undergone plastic surgery. “Of the surgical patients, 22 had facelifts and neck lifts only, 17 also had surgery on their upper and lower eyelids and 21 had the first two procedures as well as forehead lifts.”

The raters of the “before” and “after” photographs “consistently estimated patients’ post-surgery age at about a mean of 8.9 years younger than their actual age,” the Washington Post (2/21, Huget) “The Checkup” blog reports. “Overall, patients looked a mean of 7.2 years younger after surgery.” However, “the results varied according to the procedures patients underwent. Those who had only face-lift and neck-lift looked a mean of 5.7 years younger than they actually were, and those who had those two procedures and work on their upper and lower eyelids looked 7.5 years younger than they were.”

Bloomberg News (2/21, Tirrell) points out, “Americans spent almost $10.7 billion on cosmetic procedures in 2010, according to the American Society for Aesthetic Plastic Surgery. The most common surgeries that year were breast augmentation, at 318,123, liposuction, at 289,016, and blepharoplasty, or eyelid surgery, at 152,123.” The study authors said their “study offers objective evidence of cosmetic surgery’s success and may help doctors when counseling patients.” Also covering the story are MedPage Today (2/21, Bankhead) and HealthDay (2/21, Dotinga).

Note: Many patients I have helped over the years look more then 10 years younger then they did before surgery.

Dr. Weinstein named one of New Jersey’s best beauty doctors in the March 2010 edition of NJ Savvy

Best Doc

Best Doc

Surgery potentially best option for severe migraine headaches — University Hospitals Case Medical Center researchers provide study results at ASPS conference

CLEVELAND – The disability from migraine headaches is an enormous health burden affecting over 30 million Americans.

In newly released research, 79 migraine sufferers were followed for at least five years after having undergone detection of migraine “trigger sites” and surgery. The new data finds promising outcomes for treating trigger sites surgically for migraine headaches resulting in elimination of pain for those afflicted with the condition.

Since the surgery, 10 of the 79 patients required additional surgeries for newly detected trigger sites and were disregarded from the final analysis. Sixty-one of the remaining 69 patients (88 percent) have maintained the initial positive response to the surgery. Twenty patients (29 percent) reported elimination of migraines entirely, 41 patients (59 percent) noticed a significant decrease, and only eight patients (11 percent) experienced less than 50 percent improvement or no change.

This new data provides strong evidence that surgical manipulation of one or more migraine trigger sites can successfully get rid of (cure) or reduce the frequency, duration, and/or intensity of migraine headaches with lasting results.

Bahman Guyuron, MD, Chairman of Plastic Surgery at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, and an internationally recognized leader in the field of plastic surgery, will present new five-year research data that could potentially reveal a cure for migraine headaches on October 24, 2009, at the American Society of Plastic Surgeons annual meeting in Seattle.

“Migraine headaches are extremely disabling and this surgical option offers hope for migraine sufferers,” says Dr. Guyuron. “Combined with the previous studies, this new five-year data has provided strong evidence that severe migraine headaches and their painful symptoms can be successfully treated with surgery with lasting results.”

The impetus behind Dr. Guyuron’s eight migraine headache research projects was his observation close to a decade ago that many patients who had undergone forehead rejuvenation noticed a disappearance in migraine symptoms following surgery.

For patients who suffer frontal migraine headaches, Dr. Guyuron removes the corrugator supercilii (frowning) muscle group in the forehead that is suspected to be a trigger point for headaches, compressing nerves and causing nerve inflammation. Temple migraine headaches are treated by removing a small branch of the trigeminal nerve. For those patients who suffer from occipital (back of the head) migraine headaches, a small piece of muscle encasing the nerve is removed and replace with a soft tissue flap. When the headaches are located behind eyes and are triggered by weather change, he works on the nose septum and surrounding structures. Dr. Guyruon has performed more than 1,000 of these procedures on more than 450 patients, since each patient has 2.5 trigger sites in average. Analysis of more recent results demonstrates a significantly higher elimination rate.

Note: Dr. Guyaron is a member of our Maxillofacial society, we have found a number of patients that benefit from Botox as well. The procedure can be done endoscopically through minimal incisions with great aesthetic cosmetic results.

Larry Weinstein, MD FACS

Decreasing expander breast infection: A new drain care protocol
JD Murray, ET Elwood, GE Jones, R Barrick, J Feng

BACKGROUND: Risk factors for expander reconstruction infection are well known. However, drain use as a risk factor for the development of infection is unclear. OBJECTIVE: To review a simple method for drain use to help reduce rates of infection in expander breast reconstruction.

METHODS: Two hundred consecutive single-surgeon (JDM) immediate first-stage expander breast reconstructions were retrospectively reviewed. The records were reviewed for history and physical examination, intraoperative technique, perioperative management, adjuvant therapy, and outcome with respect to expander infection necessitating premature explantation within the first eight weeks. Infection was defined on clinical basis, with or without culture positivity. All expanders (Mentor, USA) were the same model (textured, port-integrated and biodimensional). Two consecutive series of reconstructions were then created. The first series included 177 reconstructions while the second series included 23 reconstructions. Unlike the first series, the second series introduced a protocol in which all reconstructions received mupirocin 2% cream to the drain sites and all drains were removed at the end of the first week. Additionally, in the second series, all expanders were secluded from direct in vivo contact with the closed suction drain either by the use of an intervening Alloderm sling (LifeCell Corporation, USA, 15 of 23 breasts) or by subdermally tunnelling the drain superficial to an adequate fatty subcutaneous layer (eight of 23 breasts).

RESULTS: Patients who developed infection in the first series and all patients in the second series shared statistically the same level of aggregate risk factors (P=0.531). The infection rate (5.65%, 10 infections in 177 breasts) in the first series was statistically greater than in the second series (0%, 0 in 23 breasts, P=0.001).

CONCLUSIONS: The present study found that percutaneous closed suction drains do serve as an increased risk for expander infection. However, early results indicate that in vivo protection of the expander with Alloderm or subdermal tunnelling, topical antibiotic ointment use and early drain removal may significantly reduce expander infection. Note: Any drain requires care. It is a potential source of bacterial contamination. Cleansing with Betadine and applying Bacitracin oitment has been successful in my practice in avoiding drain site infections.

Incidence of Alarplasty in Primary and Revision Rhinoplasty in a Private Practice Setting
Benjamin E. Saltman, MD; Steven J. Pearlman, MD
Arch Facial Plast Surg. 2009;11(2):114-118.

Objective: To evaluate the incidence of alarplasty in primary and revision rhinoplasty during a 3-year period.

Methods: We conducted a retrospective medical record review of patients undergoing primary and revision rhinoplasty between January 1, 2004, and December 31, 2006. Patients were divided into the following categories: primary or revision rhinoplasty, alarplasty, and ethnicity. The incidence of alarplasty was calculated and compared for primary vs revision rhinoplasty and for ethnicity. Statistically significant differences were confirmed using the 2 test.

Results: A total of 168 patients underwent rhinoplasty with minimum follow-up of 6 months; 116 patients had primary rhinoplasty and 52 revision rhinoplasty. All alarplasties were bilateral. Of 50 alarplasties performed, 35 were in the primary group and 15 in the revision group. The incidence of alarplasty was 30.2% in the primary group and 28.8% in the revision group. Nonwhite patients had a higher overall incidence of alarplasty (63.0%) than did white patients (25.4%). Each ethnic category identified had a higher incidence of alarplasty than the white group.
Conclusions Alarplasty is an important technique in rhinoplasty. The high incidence of alarplasty in revision rhinoplasty procedures suggests that alarplasty is underused by many surgeons currently performing rhinoplasty. One should consider alarplasty for all patients’ noses, not just those of nonwhite ethnic rhinoplasty patients.

Note:Most patients I have seen over twenty years have required some reduction of the alars to achieve a best outcome.

Larry Weinstein, MD FACS

Correction of the High Female Hairline
Alexander L. Ramirez, MD; Kevin H. Ende, MD; Sheldon S. Kabaker, MD
Arch Facial Plast Surg. 2009;11(2):84-90.

Objectives: To review a technique and to make quantitative analyses of the senior author’s 20-year experience with his preferred technique to correct the high female hairline.

Methods: A retrospective review of 29 female patients who underwent the hairline-lowering procedure performed by the same surgeon (S.S.K.). We analyzed preoperative and postoperative standardized photographs by taking measurements from the medial and lateral canthi to the anterior hairline. Facial height, from the menton to the hairline, was also measured. We calculated mean values and then used a 2-tailed, paired t test to evaluate for statistical significance. Patients also underwent evaluation for satisfaction, complications, and aesthetic result. We reevaluated the measurements from the profile view and compared them with the original data.

Results: The photographed midfrontal hairline position was vertically lowered on average 1.3 cm in patients who underwent a single-stage procedure (P < .001). In retrospect, the analysis was flawed compared with clinical experience. Therefore, the profile views were evaluated, and the correlating true curvilinear advancement was an average of 2.1 cm. Three complications occurred, including 1 major effluvium, 1 minor effluvium, and 1 scar that required revision. Patient satisfaction was extremely high.

Conclusions: Advancement of the female hairline by incorporating an irregular trichophytic incision and a posterior scalp advancement flap is an effective and safe technique that has been used by the senior author for more than 2 decades. The average advancement was 2.1 cm in this study. The technique is immediately effective, well tolerated by patients, and associated with minimal complications. Although it is associated with a potentially visible incision, this technique can be used to make the scar virtually invisible.Note: This is one of the alternatives I use for brow lifting, hooded eyelids or high hairline corrections. In the past 20 years with very natural results.

Larry Weinstein, MD FACS

The Lateral Tarsal Strip Mini-Tarsorrhaphy Procedure
M. Reza Vagefi, MD; Richard L. Anderson, MD
Arch Facial Plast Surg. 2009;11(2):136-139.

The lateral canthus normally sits 1 to 2 mm higher than the medial canthus. With time, aging and gravity produce inferior displacement of the canthus. Numerous eyelid disorders can also result in lower eyelid or lateral canthal tendon laxity or malposition, requiring horizontal eyelid tightening or canthal repositioning. The lateral tarsal strip procedure has proven to be a useful technique in addressing these problems. Care must be taken when suspending the tarsal strip to the lateral orbital rim to preserve the almond shape of the lateral canthal angle. If mild to moderate upper eyelid laxity is present, suspension of the strip can result in upper eyelid overhang with lower eyelid and eyelash imbrication. We describe the lateral tarsal strip mini-tarsorrhaphy procedure that overcomes this problem. The technique provides excellent functional and aesthetic results and adds to the versatility of a time-tested procedure. Note: This is one method of alleviating ectropion.

Larry Weinstein, MD FACS

Patients Who Gave Up Smoking Before Surgery Had Half As Many Complications Afterwards

ScienceDaily (Mar. 17, 2009) — More than a third of patients who took part in an eight-week smoking cessation programme before and after planned surgery were able to give up and most of them were still smoke free after a year, according to new research.They also experienced half as many complications after surgery as the patients who did not receive help to give up smoking, with 21 per cent experiencing problems as opposed to 41 per cent. Researchers randomly assigned 117 patients who were due to undergo general or orthopaedic surgery to an intervention and control group.

“The intervention group attended weekly meetings or received telephone support and were provided with free nicotine replacement therapy, while the control group just received standard pre-operative care” says lead author Dr Omid Sadr Azodi from the Karolinska Institute in Stockholm, Sweden.

“Patients were then assessed at regular intervals before and after surgery and after 12 months.”

“One interesting thing to emerge from the study was the high refusal rate. A further 76 patients declined to take part in our research because they were unwilling to give up smoking or were stressed by their forthcoming surgery.”

Key findings from the study included:

  • Twenty of the patients in the intervention group (36 per cent) abstained from smoking for the minimum period of three weeks before their operation and four weeks after surgery, compared with one patient in the control group (two per cent). The figures peaked at 58 per cent one week before surgery.
  • People in the intervention group were more than twice as likely to be smoke free at 12 months than those in the control group. Eighteen of the intervention group (33 per cent) were still smoke free and nine members of the control group had given up (15 per cent).
  • Patients with a lower level of nicotine dependence – who scored less than four on the zero to ten Fagerstrom scale – were 3.4 times more likely to be smoke free at 12 months.
  • Those with a high body mass index – of more than 30 – were 3.3 times more likely to be smoke free after 12 months.
  • Being employed increased the long-term success rate to 2.3, but marital status, education and living with a smoker had no significant bearing on abstinence rates at 12 months.
  • The majority of the patients who took part completed the study – 87 per cent of the intervention group and 84 per cent of the control group.
  • Just over half of the 117 patients (53 per cent) were male and the average age was 56. Their average body mass index was just over 25. Median smoking levels were ten to 20 cigarettes a day and the median time since patients started smoking was just over 35 years. Just over a third (36 per cent) had a nicotine dependency score of less than four.

As well as the medical condition they were receiving surgery for, 15 per cent suffered from depression, 12 per cent from chronic obstructive pulmonary disease, nine per cent from chronic heart disease and two per cent from diabetes.

“Smokers are prone to developing a number of complications after surgery, ranging from impaired wound and bone healing to life-threatening pulmonary and cardiovascular problems” says Dr Sadr Azodi. “This is why it is so important to find feasible, financially attractive and effective ways to help patients stop smoking before surgery.”

“Our study shows that providing support in the run up to surgery enabled a third of the patients who took part in the study to remain smoke free after a year.”

“Lower nicotine dependence levels were significantly associated with long-term abstinence and we believe that high levels should be classed as a chronic disorder. Our intervention was for a fairly intense eight-week period, but we recognise that people with higher levels of dependency may need longer to help them stop smoking before surgery.”

Quantitative analysis of normal smile with 3D stereophotogrammetry – an aid to facial reanimation
Published online: 19 December 2008
A.R. Sawyer, M. See, C. Nduka
DOI: 10.1016/j.bjps.2008.08.062
Journal of Plastic, Reconstructive & Aesthetic Surgery,

A technique for applying Biobrane to the face as a single sheet
Published online: 19 December 2008
A.F. Bhatti, J.K. O’Neill, R. Almasharqah, T.S. Burge
DOI: 10.1016/j.bjps.2008.10.017
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Subacute hematoma after augmentation mammaplasty: case report
Published online: 19 December 2008
Marwan W. Nasr, Henri A. Stephan, Fadi H. Sleilati, Nabil E. Hokayem
DOI: 10.1016/j.bjps.2008.11.020
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Stable coverage of a cervico-thoracic defect with an extended lower trapezius myocutaneous flap
Published online: 17 December 2008
Filip B. Stillaert, Koen Van Landuyt
DOI: 10.1016/j.bjps.2008.08.066
Journal of Plastic, Reconstructive & Aesthetic Surgery,

A new instrument for achieving a natural nasofrontal angle
Published online: 17 December 2008
Erdem Tezel, F. Nihal DurmuÅŸ
DOI: 10.1016/j.bjps.2008.08.021
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Salvage of infected tissue expanders using a new continuous irrigation method with intermittent aspiration
Published online: 17 December 2008
Akiyoshi Kajikawa, Kazuki Ueda, Yoko Katsuragi, Shoko Iida
DOI: 10.1016/j.bjps.2008.09.027
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Laparoscopic hernia repair compromising rectus abdominis muscle flap for perineal reconstruction despite initial patent vessels
Published online: 17 December 2008
K. Khan, R.S. Uppal, B. Soin, J.M. Gilbert
DOI: 10.1016/j.bjps.2008.11.013
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Osteogenesis of the construct combined BMSCs with ?-TCP in rat
Published online: 17 December 2008
Mingyu Zhang, Kunzheng Wang, Zhibin Shi, Huaqing Yang, Xiaoqian Dang,
Wei Wang
DOI: 10.1016/j.bjps.2008.11.017
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Re-defining pseudoptosis from a 3D perspective after short scar-medial pedicle reduction mammaplasty
Published online: 17 December 2008
Kevin H. Small, Oren M. Tepper, Jacob G. Unger, Naveen Kumar, Daniel L.
Mihye Choi, Nolan S. Karp
DOI: 10.1016/j.bjps.2008.11.023
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Platysma-mastoid suture to prevent ear lobule deformity following facelift
Published online: 17 December 2008
J.J. Stanek, MG Berry
DOI: 10.1016/j.bjps.2008.11.049
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Dual mesh–muscle pocket with/without abdominal lift for immediate implant-based breast reconstruction after skin-sparing mastectomy
Published online: 17 December 2008
Reto Wettstein, Badwi Elias, Annick Bächle, George Vlastos, Yves Harder
DOI: 10.1016/j.bjps.2008.11.043
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Superior Orbital Fissure Syndrome After Repair of Maxillary and Naso-orbito-ethmoid Fractures: A Case Study
Published online: 17 December 2008
Toshihiro Fujiwara, Ken Matsuda, Tateki Kubo, Koichi Tomita, Kenji
Yano, Ko
DOI: 10.1016/j.bjps.2008.11.052
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Hypafix® versus Mefix®
Published online: 17 December 2008
Nakul G. Patel, Sinclair Gore, Odhran P. Shelley
DOI: 10.1016/j.bjps.2008.11.061
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Sural perforator flap for reconstructive surgery in the lower leg and the foot: a clinical study of 86 patients with post-traumatic osteomyelitis
Published online: 15 December 2008
N. Tajsi?, R. Winkel, R. Hoffmann, H. Husum
DOI: 10.1016/j.bjps.20
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Free myocutaneous latissimus dorsi flap transfer in total knee arthroplasty
Published online: 15 December 2008
R. Hierner, P. Reynders-Frederix, J. Bellemans, J. Stuyck, W. Peeters
DOI: 10.1016/j.bjps.2008.07.038
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Treatment of rhinophyma with ultrasonic scalpel: case report
Published online: 15 December 2008
Stefania Tenna, Pierluigi Gigliofiorito, Marika Langella, Carlo Carusi,
DOI: 10.1016/j.bjps.2008.11.006
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Intraoperative hemodynamic evaluation of the delay phenomenon in TRAM flaps
Published online: 15 December 2008
L. O’Halloran, C.N. Verheyden, M. O’Toole
DOI: 10.1016/j.bjps.2008.11.010
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Multiple zone 2 flexor tendon injuries: an act of self-harm?
Published online: 15 December 2008
Jennifer Tseng, Samuel V. Bartholomew, Michael S. Wong
DOI: 10.1016/j.bjps.2008.11.012
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Patient satisfaction with aesthetic outcome after bilateral prophylactic mastectomy and immediate reconstruction with implants
Published online: 15 December 2008
Jessica Gahm, Göran Jurell, Åsa Edsander-Nord, Marie Wickman
DOI: 10.1016/j.bjps.2008.11.014
Journal of Plastic, Reconstructive & Aesthetic Surgery,

An integrated fat grafting technique for cosmetic facial contouring
Published online: 15 December 2008
Yun Xie, DanNing Zheng, QingFeng Li, Bin Gu, Kai Liu, GuoXiong Shen,
Lee L.Q. Pu
DOI: 10.1016/j.bjps.2008.11.016
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Management of a rare ulcerated erythema nodosum in a patient affected by chron’s disease and tuberculosis
Published online: 15 December 2008
Alessandra Campa, Davide Lazzeri, Anna Brafa, Massimiliano Calabrò,
Nisi, Cesare Brandi, Carlo D’Aniello
DOI: 10.1016/j.bjps.2008.11.024
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Treatment of posterior thigh radiation ulcer by a simple and easy technique of transferring island pedicled vastus lateralis muscle flap
Published online: 15 December 2008
Shih-Hsin Chang, Ta-jui Chiu, Kwang-Yi Tung, Hung-Tao Hsiao
DOI: 10.1016/j.bjps.2008.11.031
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Reduction of the hypertrophic nipple following total skin sparing mastectomy
Published online: 15 December 2008
Mahlon A. Kerr-Valenti
c, Jayant P. Agarwal
DOI: 10.1016/j.bjps.2008.11.032
Journal of Plastic, Reconstructive & Aesthetic Surgery,

On innovations in plastic surgery
Published online: 15 December 2008
Hemant Mehta
DOI: 10.1016/j.bjps.2008.11.028
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Interhemispheric lipoma associated with frontal subcutaneous lipoma
Published online: 17 November 2008
Delphine Mitilian, Delphine Haddad, Marion Lenoir, Sabah Boudjemaa, Marie-Paule Vazquez, Arnaud Picard
DOI: 10.1016/j.bjps.2008.06.072
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Is breast reduction a functional or a cosmetic operation? Proposal of an objective discriminating criterion
Published online: 17 November 2008
Giovanni Nicoletti, Silvia Scevola, Angela Faga
DOI: 10.1016/j.bjps.2008.06.069
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Bimaxillary reconstruction with vascularised and non-vascularised fibula
Published online: 17 November 2008
Xiao-feng Shan, Zhi-gang Cai, Jie Zhang, Jian-guo Zhang
DOI: 10.1016/j.bjps.2008.06.088
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Management of axillary dermatolipodystrophy following massive reduction mammaplasty
Published online: 17 November 2008
Adam J. Oppenheimer, Christopher J. Pannucci, Amy K. Alderman
DOI: 10.1016/j.bjps.2008.06.092
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Re: Gigantomastia – a classification and review of the literature
Published online: 17 November 2008
A. Mojallal, M. Moutran, E. Martin, F. Braye
DOI: 10.1016/j.bjps.2008.07.014
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Diffuse-type giant cell tumour of the tendon sheath of the proximal forearm
Published online: 17 November 2008
N. Kandamany, P.J. Mahaffey
DOI: 10.1016/j.bjps.2008.07.041
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Reconstruction of the perioral and perinasal defects with facial artery perforator flaps
Published online: 17 November 2008
Mustafa Erol Demirseren, Kamran Afandiyev, Candemir Ceran
DOI: 10.1016/j.bjps.2008.07.037
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Reconstruction of a composite anterior mandibular defect with horizontal sliding osteotomies and an osteocutaneous forearm free flap: a case report
Published online: 17 November 2008
B. Bianchi, C. Copelli, S. Ferrari, A. Ferri, A.A. Palumbo, E. Sesenna
DOI: 10.1016/j.bjps.2008.07.028
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Dual innervation method using one-stage reconstruction with free latissimus dorsi muscle transfer for re-animation of established facial paralysis: simultaneous reinnervation of the ipsilateral masseter motor nerve and the contralateral facial nerve to improve the quality of smile and emotional facial expressions
Published online: 17 November 2008
Yorikatsu Watanabe, Tanetaka Akizuki, Tsuyoshi Ozawa, Kei Yoshimura, Kaori Agawa, Tomoyuki Ota
DOI: 10.1016/j.bjps.2008.07.025
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus
Published online: 17 November 2008
Tahsin Oguz Acartürk, Cem K Parsak, Gürhan Sakman, Orhan Demircan
DOI: 10.1016/j.bjps.2008.07.017
Journal of Plastic, Reconstructive & Aesthetic Surgery,

New thoracodorsal artery perforator (TAPcp) flap with capillary perforators for reconstruction of upper limb
Published online: 17 November 2008
Isao Koshima, Mitsunaga Narushima, Makoto Mihara, Takuya Iida, Koichi Gonda, Gentaro Uchida, Masahiro Nakagawa
DOI: 10.1016/j.bjps.2008.07.020
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Reflexive contraction of the levator palpebrae superioris muscle to involuntarily sustain the effective eyelid retraction through the transverse trigeminal proprioceptive nerve on the proximal Mueller’s muscle: verification with evoked electromyography
Published online: 17 November 2008
Ryokuya Ban, Kiyoshi Matsuo, Yoshiro Osada, Midori Ban, Shunsuke Yuzuriha
DOI: 10.1016/j.bjps.2008.07.021
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Surgical tip – Aesthetically precise, simple template for nasal reconstruction
Published online: 17 November 2008
S. Saour, C.M.J. Healy
DOI: 10.1016/j.bjps.2008.07.022
Journal of Plastic, Reconstructive & Aesthetic Surgery,

‘Radicoat’-meshed Acticoat™ allows exudate to drain
Published online: 17 November 2008
James Henderson, Radoslaw Bielecki, Bruce Philp
DOI: 10.1016/j.bjps.2008.07.023
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Technical Tip: a simple method of securing the kidney dish to the surgical drapes
Published online: 17 November 2008
S. Saour, P.-N. Mohanna
DOI: 10.1016/j.bjps.2008.07.024
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Anatomy of the motor nerve to the gracilis muscle and its implications in a one-stage microneurovascular gracilis transfer for facial reanimation
Published online: 17 November 2008
A. Rodríguez Lorenzo, S. Morley, A.P. Payne, C.J. Tollan, D.S. Soutar
DOI: 10.1016/j.bjps.2008.08.010
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Evaluation of the 4-stitch-eversion technique for end-to-end anastomoses on rat aortas
Published online: 17 November 2008
Jan F. Cornelius
DOI: 10.1016/j.bjps.2008.07.035
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Preoperative Preparation of the Umbilicus
Published online: 17 November 2008
Mamoru Kikuchi, Kenji Yano, Ko Hosokawa
DOI: 10.1016/j.bjps.2008.08.012
Journal of Plastic, Reconstructive & Aesthetic Surgery,

A novel method of applying Biobrane to facial burns
Published online: 17 November 2008
Nicholas C. Smith, Katerina Anesti, Graig Mckinnon
DOI: 10.1016/j.bjps.2008.08.042
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Erythromycin sclerotherapy in the management of seroma
Published online: 17 November 2008
A.S. Ali-Khan, A. Orlando, J. Kenealy
DOI: 10.1016/j.bjps.2008.08.016
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Reinserting the central slip – A novel method for treating boutonniere deformity in rheumatoid arthritis
Published online: 17 November 2008
Andreas Fox, Norbert Kang
DOI: 10.1016/j.bjps.2008.08.055
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Cutaneous leiomyosarcoma arising in a tattoo – ‘a tumour with no humour’
Published online: 17 November 2008
Christopher C. West, Andrew N. Morritt, Lee Pedelty, David GK. Lam
DOI: 10.1016/j.bjps.2008.09.021
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Anterior Rectus sheath repair with porcine collagen (Permacol™) in patients undergoing breast reconstruction with free abdominal flaps
Published online: 17 November 2008
A.J. Ramsden, V. Allen, J.M. O’Donoghue
DOI: 10.1016/j.bjps.2008.08.072
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Spontaneous hip disarticulation associated with severe pressure sore ulceration
Published online: 17 November 2008
Patrick D. Cole, Yoav Kaufman, Daniel A. Hatef, Frank J. Gerow, Larry H. Hollier
DOI: 10.1016/j.bjps.2008.08.073
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Self–harm and the surgeon
Published online: 14 November 2008
A. Abood, S. Jain, J. Zhong
DOI: 10.1016/j.bjps.2008.07.019
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Letter to Editor
Published online: 14 November 2008
AEK Deliaert, RRWJ van der Hulst
DOI: 10.1016/j.bjps.2008.08.015
Journal of Plastic, Reconstructive & Aesthetic Surgery,

The Sandwell incision for Dupuytren’s fasciectomy: a technical tip
Published online: 14 November 2008
Derick Amith Mendonca, Jagdeep Rai, Eleonore Breuning
DOI: 10.1016/j.bjps.2008.08.028
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Freeman-Sheldon syndrome: a functional and cosmetic correction of microstomia
Published online: 13 November 2008
Andri Neumann, Pieter F. Coetzee
DOI: 10.1016/j.bjps.2008.06.064
Journal of Plastic, Reconstructive & Aesthetic Surgery,

An explosion in the mouth caused by a firework
Published online: 13 November 2008
Giovanni Di Benedetto, Luca Grassetti, William Forlini, Aldo Bertani
DOI: 10.1016/j.bjps.2008.06.074
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Scars: A Review of Emerging and Currently Available Therapies.


Plastic & Reconstructive Surgery. 122(4):1068-1078, October 2008.
Reish, Richard G. M.D.; Eriksson, Elof M.D., Ph.D.


Background: With the investigation and potential introduction of several novel scar-reducing therapies to the market within the next several years, it is germane to review both the pathophysiology of scarring and the safety and efficacy of currently available and emerging therapeutic agents.

Methods: An extensive review of the English-language literature was conducted using the MEDLINE database.

Results: A comprehensive review of the pathophysiology of scarring and scar management, including both emerging and currently available therapies, was completed. Current clinical studies are limited by small sample sizes, lack of well-designed controls, and lack of standardized scar outcome measurement parameters.

Conclusions: A prominent challenge in the study of scar management is the paucity of well-designed, large, randomized, controlled studies examining existing scar-reducing techniques. The greatest improvement in scar-reducing protocols likely entails a polytherapeutic strategy for management. Further investigation into the role of inflammation in scarring is paramount to the development of improved scar-reducing agents. There is a need for large controlled trials using a polytherapeutic strategy that combines existing and novel agents to provide a standardized evidence-based evaluation of efficacy.

© 2008 American Society of Plastic Surgeons Note: Control of scars is a constant vigilant interest of plastic surgeons. The redness of wounds takes 6 months to mature and improve, the thickness of a wound can take longer and may improve with external modalities.

Larry Weinstein MD FACS
Chester, NJ USA

Injectable fillers for facial rejuvenation: a review
Published online: 27 October 2008
Donald W. Buck, Murad Alam, John YS Kim
DOI: 10.1016/j.bjps.2008.06.036
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Complications of otoplasty: a literature review
Published online: 27 October 2008
G.C. Limandjaja, C.C. Breugem, A.B. Mink van der Molen, M. Kon
DOI: 10.1016/j.bjps.2008.06.043
Journal of Plastic, Reconstructive & Aesthetic Surgery,

Use of 2-Octyl-Cyanoacrylate Skin Adhesive (Dermabond) for Wound Closure following Reduction Mammaplasty: A Prospective Randomized Intervention Study.


Plastic & Reconstructive Surgery. 122(1):10-18, July 2008.
Nipshagen, Martine D. M.D.; Hage, J Joris M.D., Ph.D.; Beekman, Werner H. M.D., Ph.D.


Background: 2-Octyl-cyanoacrylate skin adhesive may be used for surgical wound closure. However, its use in plastic surgery has not been properly assessed.

Methods: The authors conducted a prospective, randomized, controlled clinical intervention study in which the scar characteristics after use of skin adhesive were compared with those after suture closure. Bilateral reduction mammaplasty was performed in 50 patients. The method of closure (sutures versus skin adhesive) applied to each breast was determined randomly, using each patient as her own control. Scars were assessed by the patient and by a blinded panel, at 1 week, 6 weeks, and 6 months after surgery, using a visual analogue scale, the modified Hollander Wound Evaluation Scale, and the Patient and Observer Scar Assessment Scale.

Results: Both patients and panelists expressed an overall preference for the adhesive side as of 1 week after surgery. Patients’ visual analogue scale scores for scar comfort and scar appearance and panelists’ visual analogue scale scores for aesthetic outcome were significantly better for the adhesive side after 6 weeks and 6 months (p < 0.05), as was the total Hollander Wound Evaluation Scale score of the panelists after 6 weeks (p < 0.02). The total Patient and Observer Scar Assessment Scale score after 6 months was significantly better for the adhesive side according to the patients (p < 0.01), but not according to the panelists (p = 0.11).

Conclusion: The authors conclude that 2-octyl-cyanoacrylate is a sound alternative for wound closure.

© 2008 American Society of Plastic Surgeons

Note: Tissue glues are an alternative to sutures close to or over the skin. Most plastic surgeons as Dr. Weinstein use subcuticular sutures with steristrips as an effective method of wound closure. The Quill suture maybe a method more favorable to wound healing.

Larry Weinstein, MD FACS

Unusual Distribution of the Lower Body Fatty Tissue: Classification, Treatment, and Differential Diagnosis.
Aesthetic Surgery – Annals of Plastic Surgery. 61(1):2-8, July 2008.

El-Khatib, Hamdy A. MD – Abstract: Unusual fat distribution of the lower part of the body is clinically characterized by massive symmetric and diffuse fat deposition in the trochanters, groins, buttocks, hips, and lower extremities, which contrasts sharply with the normal upper part of the body. The massive lipomatoses of the lower part of the body can be classified into 3 types: type 1, the familial symmetrical lipomatosis that affects the groins, trochanters, hips, buttocks, and thighs; type 2, the bilateral peritrochanteric familial lipomatoses; and type 3, the unilateral peritrochanteric lipomatosis. This unusual adiposity runs in families and predominantly exists in the Mediterranean region, and seems, however, to be common in North Africa. It is rarely reported in the literature. In this regard, a differential diagnosis is presented regarding the lipomatosis and lipodystrophies-described syndromes to familiarize plastic surgeons with these unique deformities.

Between 2000 and 2006, 50 women with abnormal diffuse fat deposits in the lower part of the body were investigated and treated with conventional liposuction; patients’ ages ranged between 20 to 46 years.

Laboratory examination includes the serum concentrations of lipoprotein, cholesterol, triglycerides, uric acid, fasting glucose, and other routine laboratory tests. Endocrinologic tests include serum estradiol and testosterone levels, and thyroid function tests.

Histologic examination of the lipoaspirate was performed. All cases were treated with liposuction. For type 1 cases liposuction was performed in stages; the maximum amount of lipoaspirate per setting was 3,000 to 4,000 mL, and for type 2 and type 3 a single stage liposuction was undertaken.

Laboratory examination showed normal values and routine parameters were within normal limits. Endocrinologic investigations revealed no abnormalities and histologic examination of lipoaspirate showed normal subcutaneous fatty tissue. The esthetic outcome of all individuals was satisfactory.

Abnormal swelling of the lower half of the female body caused by deposition of subcutaneous fat is determined by heredity and seems to be common in North Africa. It is often accompanied by a psychological reaction due to the disturbed body image. A clinical classification is reported in the current study. The traditional liposuction is the treatment of choice for these esthetic deformities.

Note: There are many women of different ethnic backgrounds with excess fatty tissue of the lower extremities and buttocks. I have found
liposuction always to be effective treatment in healthy patients.

Larry Weinstein,MD FACS

Maturation of the Human Scar: An Observational Study.

Plastic & Reconstructive Surgery. 121(5):1650-1658, May 2008.
Bond, Jeremy S. M.R.C.S. (Ed.); Duncan, Jonathan A. L. M.R.C.S.(Ed.); Sattar, Abdul Ph.D.; Boanas, Adam B.Sc.; Mason, Tracey Ph.D., C.Stat.; O’Kane, Sharon B.Sc. (Hons.), Ph.D.; Ferguson, Mark W. J. D.D.S., Ph.D.


Background: The natural history of scar maturation in humans has never been formally described from either a clinical or a histologic standpoint.

Methods: The maturation of incisional scars was observed in 58 healthy male volunteers who each had 2 x 1-cm incisional wounds created on the inner aspect of both upper arms. The resulting scars were photographed digitally at monthly intervals for 12 months and excised for histologic analysis at specific time points. All histologic specimens were stained using Masson’s trichrome and reviewed together with the corresponding digital clinical scar images to produce macroscopic and microscopic descriptions of the maturation process.

Results: Three distinct groups, each displaying a different rate of longitudinal progression of scar maturation, were identified from within the study group. The majority of volunteers belonged to a “representative” subset but distinct “poor” and “excellent” subsets were also identified. The poor subset invariably contained volunteers younger than 30 years of age, whereas the majority of the excellent subset comprised subjects older than 55 years of age.

Conclusions: Scar maturation occurs as a series of defined macroscopic and microscopic stages over the course of 1 year. The rate of scar maturation varied within the study group, with older subjects (>55 years) displaying accelerated maturation, whereas a prolonged high turnover state and a retarded rate of maturation were observed in younger subjects (<30 years).

© 2008 American Society of Plastic Surgeons

Note: Estrogen and other hormonal influences cannot be underestimated in their effects on wound healing. Older patients do better then younger patients. Maturation of scars can take 2 years. Redness can last 2 years as well.

Larry Weinstein, MD FACS
Chester, New Jersey

The Retaining System of the Face: Histologic Evaluation of the Septal Boundaries of the Subcutaneous Fat Compartments.


Plastic & Reconstructive Surgery. 121(5):1804-1809, May 2008.
Rohrich, Rod J. M.D.; Pessa, Joel E. M.D.


Background: Because the concept of subcutaneous fat compartments has many significant implications for cosmetic and reconstructive surgery, it is important to verify the original findings and validate the concept. The authors studied the histology of the septal boundaries between several adjacent fat compartments.

Methods: Eighteen hemifacial cadaver specimens were used (five male and four female cadavers; age range, 39 to 87 years). Tissue marking dye was injected into the central forehead and the medial, middle, and lateral temporal cheek compartments. Dye was allowed to diffuse for 4 hours until a skin blush was noted, at which point dye-setting solution was injected to fix the dye. En bloc transverse specimens were harvested and stored in formalin overnight. Standard histologic processing was performed.

Results: Each compartment partitioned dye in a consistent and reproducible manner. A fibrous condensation of connective tissue formed the diffusion barriers. These septa originated from underlying fascia and inserted into the dermis of the skin. A septal barrier originated from the fascia of the frontalis muscle, so these septal barriers are not necessarily related to the superficial musculoaponeurotic system but can occur anywhere between superficial fascia and skin.

Conclusions: These findings support the concept that subcutaneous fat is compartmentalized, specifically by fascial condensations that travel from superficial fascia to dermis. These septa form an interconnecting framework that limits shearing forces on the face. This framework provides a “retaining system” for the human face. Implicit in this concept is the suggestion that the face ages three dimensionally, with separate compartments changing relative to one another by both position and volume.

© 2008 American Society of Plastic Surgeons

The Influence of Forehead, Brow, and Periorbital Aesthetics on Perceived Expression in the Youthful Face.


Plastic & Reconstructive Surgery. 121(5):1793-1802, May 2008.
Knoll, Bianca I. M.D.; Attkiss, Keith J. M.D.; Persing, John A. M.D.


Background: The purpose of this study was to characterize the relative influence of eyebrow position and shape, lid position, and facial rhytides on perceived facial expression as related to blepharoplasty, with a specific focus on the perception of tiredness.

Methods: A standardized photograph of a youthful upper face was modified using digital imaging software to independently alter a number of variables: brow position/shape, upper/lower lid position, pretarsal show, and rhytides. Subjects (n = 20) were presented with 16 images and asked to quantify, on a scale from 0 to 5, the presence of each of seven expressions/emotions as follows: “surprise,” “anger,” “sadness,” “disgust,” “fear,” “happiness,” and “tiredness.”

Results: Statistically significant values for tiredness were achieved by changes of increasing and decreasing the pretarsal skin crease, lowering the upper eyelid, and depressing the lateral brow. Happiness was perceived by elevation of the lower lid or the presence of crow’s feet. Brow shape had a greater influence than absolute position on perceived expression. Elevation of the lateral brow was perceived as surprise, whereas depression of the medial brow and rhytides at the glabella were perceived as anger and disgust. Elevation of the medial brow elicited a minimal increase for sadness.

Conclusions: This study showed that the perception of tiredness is most affected by the length of pretarsal lid height (e.g., ptosis). Surprisingly, simulating the skin resection of an upper blepharoplasty results in a paradoxical increase in the perception of tiredness as well. Modifications of brow contour elicit profound changes in perceived facial mood to a greater degree than absolute brow position.

© 2008 American Society of Plastic Surgeons

Outcome Analysis of Combined Lipoabdominoplasty versus Conventional Abdominoplasty.


Plastic & Reconstructive Surgery. 121(5):1821-1829, May 2008.
Heller, Justin B. M.D.; Teng, Edward B.S.; Knoll, Bianca I. M.D.; Persing, John M.D.


Background: Abdominoplasty and liposuction have traditionally been separate procedures. The authors performed a retrospective cohort study to evaluate the outcomes of a novel single-stage approach combining extensive lipoplasty with a modified transverse abdominoplasty.

Methods: One hundred fourteen patients were evaluated for abdominal contouring. Patients were categorized into four groups: group I (n = 20) received abdominal liposuction only, group II (n = 33) traditional W-pattern incision line abdominoplasty, group III (n = 30) modified transverse incision abdominoplasty, and group IV (n = 31) combined procedure involving widely distributed abdominal liposuction accompanied by inverted V-pattern dissection abdominoplasty. Wound complications, patient satisfaction, and revision rates were compared statistically.

Results: Group I (liposuction alone) experienced an overall complication rate of 5 percent; two patients were dissatisfied (10 percent) and underwent further revision with full abdominoplasties. Group II (traditional W-pattern abdominoplasty) had a complication rate of 42 percent, a dissatisfaction rate of 42 percent, and a revision rate of 39 percent. By comparison, group III (modified low transverse abdominoplasty) had a complication rate of 17 percent, a dissatisfaction rate of 37 percent, and a revision rate of 33 percent. Group IV (combined liposuction plus abdominoplasty) had significantly lower complication, dissatisfaction, and revision rates (9, 3, and 3 percent, respectively).

Conclusions: Modified transverse abdominoplasty combined with extensive liposuction and limited paramedian supraumbilical dissection produced fewer complications and less dissatisfaction than did traditional abdominoplasty. This may be attributable to a reduced tension midline closure in the suprapubic region, less lateral undermining in the upper abdomen, and greater preservation of intercostal artery blood flow to the flap.

© 2008 American Society of Plastic Surgeons

Wound Infections in Aesthetic Abdominoplasties: The Role of Smoking.


Plastic & Reconstructive Surgery. 121(5):305e-310e, May 2008.
Araco, Antonino M.D.; Gravante, Gianpiero M.D.; Sorge, Roberto M.D.; Araco, Francesco M.D.; Delogu, Daniela; Cervelli, Valerio M.D.


Background: In this prospective study, the authors followed patients who underwent aesthetic abdominoplasty to determine the influence of smoking on the occurrence of postoperative wound infections.

Methods: Patients who underwent aesthetic abdominoplasty were considered eligible for the study. The authors excluded postbariatric patients, those with ongoing clinical infections, those receiving a recent antibiotic course, and those with systemic diseases such as arteriosclerosis and diabetes mellitus. Smokers were advised to quit smoking at least 4 weeks before surgery.

Results: Starting in February of 2004, the authors enrolled 84 patients. Postoperative infections were present in 13 patients (15.5 percent) and were superficial in 10 (77 percent). All but one occurred in smokers. These had a certain number of cigarettes smoked per day, years of smoking, and higher estimated overall number of smoked cigarettes when postoperative infections were present. The relative risk of smoking on infections was 12. A cutoff value of approximately 33,000 overall cigarettes smoked determined 3.3 percent false-positive and 0 percent false-negative rates.

Conclusions: Smoking is an important issue in aesthetic surgery that needs to be accurately addressed during the preoperative interview. In the future, the analysis of smoke-related, easy-to-gather variables such as the estimated overall number of cigarettes smoked until surgery could help stratify patients according to their risk of manifesting infections.

© 2008 American Society of Plastic Surgeons
Friday, March 14th 2008

Barbed Sutures: A Review of the Literature.


Plastic & Reconstructive Surgery. 121(3):102e-108e, March 2008.
Villa, Mark T. M.D.; White, Lucile E. M.D.; Alam, Murad M.D.; Yoo, Simon S. M.D.; Walton, Robert L. M.D.

Background: Despite substantial mention in the popular press, there is little in the plastic surgery or dermatology literature regarding the safety, efficacy, longevity, or complications of barbed suture suspension procedures. The authors review the literature to estimate several clinical parameters pertaining to barbed thread suspensions.

Methods: The authors performed a MEDLINE search using the keywords “barbed and suture,” “thread and suspension,” “Aptos,” “Featherlift,” and “Contour Thread.”

Results: The authors identified six studies that met their criteria of addressing midface elevation with barbed thread suspension. These detected some adverse events, but most of these were minor, self-limited, and of short duration. Less clear are the data on the extent of the peak correction and the longevity of effect. Objective outcome measures and long-term follow-up data were not provided in a systematic manner in the few available studies.

Conclusions: Suspension of the aging face with barbed sutures offers the promise of a minimally invasive technique with diminished adverse events. The technique is in its infancy, but it has potential to be a useful and effective clinical tool as further innovations are made in the clinic and laboratory.

© 2008 American Society of Plastic Surgeons

Friday, February 10th 2008
Nonsurgical Treatment of Cicatricial Ectropion with Hyaluronic Acid Filler.

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