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BACKGROUND: Every region of the face may bear the signs of aging. Treating isolated areas without adequate anatomical knowledge can lead to incomplete or artificial-looking results and decrease patient satisfaction. Here, we describe a technique for complete rejuvenation, coined the "Full SMAS" technique, by addressing the anatomical continuity of the SMAS-Platysma to the deep-plane suspension of the face. OBJECTIVES: This study aims to evaluate the contribution of endoscopic techniques combined with traditional facelift and neck lift procedures. The evaluation is conducted on procedures treating from the frontal and temporal regions of the superior part of the face to its mid and lower parts, including the cervical region. METHODS: The treatment of the three sub-SMAS layers of the face was performed using endoscopy for repositioning the frontal region and midface. This procedure involves frontal and zygomatic-masseter ligament release, open treatment of the lower subplatysmal section, and the complete release of the retaining ligaments of the face and approach to the jowl. RESULTS: One hundred sixty-one patients underwent the Full SMAS technique, leading to long-lasting results, low complication rates, and high patient satisfaction. CONCLUSIONS: The Full SMAS is a systematic technique that provides complete facial rejuvenation by combining an endoscopic approach for the temporal and midface regions with traditional open approaches for the lower face and neck. Treating the temporal and midface regions using minimally invasive techniques (endoscopy) reduces the possibility of permanent nerve injuries, provides smaller scars, and creates more natural, long-lasting results.

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The endoscopic approach for forehead rejuvenation and brow lift has many advantages. It provided excellent exposure for release of periorbital soft tissues combined with endoscopic magnification, shorter scars, and reduced risk of alopecia and scalp sensory changes compared with the traditional open coronal brow lift. The technique has improved over the last 15 years with better fixation devices, a better understanding of the longevity, and decreased complications of the procedure. The endoscopic brow lift offers the patient a much easier and safer solution for the aging forehead, active wrinkles from corrugator and frontalis hyperactivity, and the ptotic, asymmetric brow.

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The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the "lessons learned" with the COVID-19 pandemic. In this paper, the board-certified core aesthetic physicians classified these recommendations into four generalized areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies. Proactive strategies are provided in each of these categories that, if implemented, may alleviate the processes involved with an efficient office closure and reopening process including, in the case of COVID-19, methods to reduce the risk of transmission to doctors, staff, and patients. These strategies also include being prepared for emergency-related notifications of employees and patients; the acquisition of necessary equipment and supplies such as personal protective equipment; and the maintenance and accessibility of essential data and contact information for patients, vendors, financial advisors, and other pertinent entities.J Drugs Dermatol. 2021;20(1):10-16. doi:10.36849/JDD.5803.

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Cryolipolysis is a nonsurgical body contouring procedure that involves cooling of fat cells to induce lipolysis while sparing surrounding structures. Plastic surgery practices are increasingly incorporating noninvasive aesthetic procedures (eg, cryolipolysis, fillers, radiofrequency, ultrasound) to offer their patients a wider range of aesthetic treatment options. Here, we report insights from 8 plastic surgeons with regard to cryolipolysis best practices from a clinical perspective and the impact of integrating this noninvasive body contouring procedure into a plastic surgery practice. The authors prefer cryolipolysis over liposuction for patients who are not amenable to surgery or those who desire to avoid downtime, also taking into consideration body mass index, skin laxity, comorbidities, and risk of contour irregularities. Patient counseling is critical for setting realistic expectations regarding outcomes and should focus on the efficacy of cryolipolysis, individual variability in results, potential side effects, time course of treatment response, and the need for multiple treatment cycles. Strategies for reaching new patients and expanding services among current cryolipolysis patients are discussed.

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Quality of life (QoL) is an important outcome in plastic surgery. However, authors use different scales to address this subject, making it difficult to compare the outcomes. To address this discrepancy, the aim of this study was to perform a systematic review and a random effect meta-analysis. METHODS: The search was made in two electronic databases (LILACS and PUBMED) using Mesh and non-Mesh terms related to aesthetic plastic surgery and QoL. We performed qualitative and quantitative analyses of the gathered data. We calculated a random effect meta-analysis with Der Simonian and Laird as variance estimator to compare pre- and postoperative QoL standardized mean difference. To check if there is difference between aesthetic surgeries, we compared reduction mammoplasty to other aesthetic surgeries. RESULTS: Of 1,715 identified, 20 studies were included in the qualitative analysis and 16 went through quantitative analysis. The random effect of all aesthetic surgeries shows that QoL improved after surgery. Reduction mammoplasty has improved QoL more than other procedures in social functioning and physical functioning domains. CONCLUSIONS: Aesthetic plastic surgery increases QoL. Reduction mammoplasty seems to have better improvement compared with other aesthetic surgeries.

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Modern abdominoplasty is a powerful and safe body sculpturing tool. In combination with other body contouring procedures, it can lead to a comprehensive body transformation: anatomic, physiologic, and psychological. With vigilant patient screening, preoperative planning, and aggressive postoperative management, modern abdominoplasty can be safely and effectively performed in combination with other procedures.

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BACKGROUND: Numerous techniques have been used to rejuvenate the aging midface. The Endotine midface technique involves an endoscopic temporal approach, including midface dissection and malar suspension with fixation. The Endotine device (Microaire, Charlottesville, Virginia) eliminates the intraoral incision and use of sutures, enabling multipoint fixation and fast, simple adjustability for optimal control of midface elevation and volume. OBJECTIVES: The authors describe their preferred technique for the endoscopic midface lift and summarize their 13 years of experience. METHODS: A retrospective chart review was conducted of 183 patients who underwent endoscopic midface surgery. Patients treated from 1998 to 2003 received direct needle fixation (n = 95). Those treated later underwent fixation with the Endotine device (n = 88). RESULTS: Most (90%) of the patient population was female, and the average age at the time of surgery was 46 years (range, 39-54 years). Needle fixation was used in 95 patients and Endotine fixation in 88. The average follow-up period was 7 years. The authors have observed many improvements in outcomes since the introduction of the Endotine device into their practice. These include reduced swelling and bruising, more symmetric elevation of the malar fat pad, mild improvement of tear trough deformity, softening of the nasolabial folds, and, in some cases, decreased "jowling." The asymmetry often associated with direct needle fixation has decreased, and no skin dimpling has occurred. Through their experience, the authors' preferred technique has become the temporal-only approach with Endotine fixation. CONCLUSIONS: The Endotine midface suspension device enhances soft-tissue fixation, provides simple adjustability for optimal elevation and projection, and maintains mechanical fixation until biologic fixation becomes adequate. The 5 tines provide multiple points of contact for secure soft-tissue fixation. Elevation forces are evenly distributed over a wide area, which eliminates skin irregularities. Insertion and deployment are accomplished easily through temporal incision.

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BACKGROUND: Many chest wall deformities have a characteristic radiologic appearance that can be the basis for a definitive diagnosis. Consequently, imaging techniques have fundamental roles in the detection, location, and characterization of these disorders. OBJECTIVE: The authors propose a clinical and radiographic Poland syndrome (CRPS) classification system and possible treatment algorithm for the thoracic manifestations of Poland syndrome (PS) in women, based on both clinical examinations and imaging studies. METHODS: A retrospective study was conducted of 28 female patients evaluated over 17 years in the 28th Infirmary, Plastic and Reconstructive Surgery Division of the Hospital Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil. After clinical examination, all patients underwent radiographic examination with chest radiographs, conventional computed tomography scans, magnetic resonance imaging and, in some cases, additional imaging studies. All clinical and radiologic variables were compiled in a database and used in the classification system, which included three levels of disease severity. RESULTS: Based on the CRPS classification of the 28 female patients, 10 patients had first-degree PS, 14 patients had second-degree PS, and four patients had third-degree PS. Eighteen patients underwent surgical correction; a total of 39 surgical procedures were performed using the CRPS algorithm. CONCLUSIONS: Identification of the severity of PS using the proposed classification system provided an accurate study of each patient and enabled better planning for the surgical correction of functional and aesthetic deformities.

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BACKGROUND: The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery launched a joint Cosmetic Medicine Task Force to address the growing trend of non-plastic surgeons entering the cosmetic medicine field. The task force commissioned two surveys in 2007 to determine consumer attitudes about choosing cosmetic medicine providers and to learn about the cosmetic services that plastic surgeons offer. METHODS: The first survey obtained responses from 1015 women who had undergone a cosmetic procedure or were considering having one within 2 years. The second survey obtained responses from 260 members of the two societies. RESULTS: Compared with other practitioners, plastic surgeons enjoy higher rates of satisfaction among their patients who undergo noninvasive procedures. Injectables present a particularly promising market for plastic surgeons. Half of consumers surveyed said they were very concerned about complications associated with injectables, and generally, the higher the perceived risk of the procedure, the higher the likelihood that a patient would choose a plastic surgeon to perform it. In addition, injectables were among the noninvasive treatments most frequently being considered by consumers. However, almost half of consumers said that if they had a positive experience with a non-plastic surgeon core provider for a noninvasive procedure, that physician would likely be their first choice for a surgical procedure. CONCLUSIONS: These findings suggest that plastic surgeons, and especially those who are building young practices, must expand their offerings of nonsurgical cosmetic services to remain at the core of the cosmetic medicine field.

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Lipomas are benign tumors composed of mature fat, usually encapsulated. A literature review showed that the vast majority of lipomas are small, weighing only a few grams, and grow slowly. According to Hawary et al. (Ann Saudi Med 19(2):174-176, 1999) a giant breast lipoma is characterized by a lesion of at least 5 cm in one dimension and weighs more than 500 g. We present a rare case of a giant breast lipoma with slow growth over 22 years that compromised the entire hemithorax through the right iliac fossa. A 49-year-old woman was referred to our plastic surgery unit because of complaints of severe breast asymmetry due to an enormous mass in the right breast. Twenty-two years earlier she had noticed a soft, mobile, nonpulsatile mass in the inferior quadrant of her right breast. She did not look for medical treatment for all those years for fear of it being cancer. Ultrasound suggested a lipomatous lesion. Open mass biopsy revealed lipoma. The patient underwent a whole mass resection, reconstruction with a parenchymal cross flap, and left breast symmetrization with an inverted T technique. An excellent result with a high degree of patient satisfaction was achieved with the procedure. Parenchymal cross flaps seem to be an option in these situations.

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The Endotine midface technique, through an endoscopic temporal-incision only approach, is the author's preferred method of malar fat pad suspension and fixation. The bioabsorbable Endotine device avoids an intraoral incision, eliminates sutures, offers multipoint fixation, and the leash fixation mechanism provides fast and simple adjustability for optimal control of midface elevation and volume.

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Os autores apresentam uma análise dos prontuários de 20 pacientes submetidos a tratamento cirúrgico para infecçäo de esterno após revascularizaçäo coronária

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A prevalência do vício de fumar e aspectos relacionados foram registrados através de um levantamento estatístico realizado com 500 médicos de Porto Alegre. Vinte e nove por cento eram fumantes. O maior número de fumantes localizava-se na faixa etária dos 20-29 anos. Dos médicos näo fumantes, vinte e nove por cento eram ex-fumantes. O maior número de mulheres começou a fumar na última década. É salientada a importância de atuar-se sobre a faixa de médicos jovens e tê-los como aliados no combate ao tabagismo. Nossa classe médica apresenta um comportamento semelhante ao apresentado há 15 anos por médicos americanos em relaçäo ao tabagismo. A mudança de um posicionamento teórico para um mais prático com uma açäo efetiva contra o vício de fumar certamente determinaria uma elevaçäo no número de médicos näo-fumantes

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