The American Journal of Cosmetic Surgery

Bovine collagen and glycolic acid have been used in recent years to rejuvenate skin. Both stimulate new endogen collagen synthesis in the host. The authors have worked out a protocol based on a contemporary use of the two substances in progressive steps in order to prove a synergistic action of bovine collagen and glycolic acid used in combination, giving better and longer lasting aesthetic results.

Studies were performed on 48 Sprague-Dawley female rats and clinically on 60 carefully informed female human volunteers. Bovine purified American collagen conjugated with glutaraldehyde and unbuffered glycolic acid in gel form, combined with fluorescein, at pH 0.95 and at 70% was utilized. Evaluations of histological aspects were carried out on macroscopic and microscopic levels in animals.

At the second month, the collagen implant treated with glycolic acid was observed to be more voluminous and better preserved than the untreated implant. On a clinical level, the group undergoing the “Protocollo Sito” obtained far more satisfactory results than the two control groups.

One of the most difficult problems in aesthetic rhinoplasty is in obtaining and maintaining adequate tip projection. Over 40 years ago, Dr. Irving Goldman described his technique of vertically incising the tip cartilages lateral to the domes and then bringing the medial crura together to increase tip projection. Tip grafting has been used more and more as the means of obtaining greater tip projection. However, difficulties with proper placement of these grafts, rotation, and displacement, as well as procuring graft material, have made these procedures somewhat more difficult for the surgeon and patient alike. In a retrospective review, 145 patients who underwent primary rhinoplasty with vertical division of the lower lateral cartilages in order to increase tip projection were compared with 41 patients who underwent tip grafting to achieve the same goal. Similar results were obtained in both groups; however, the vertical dome division patients were found to have fewer complications.

We describe endoscopic forehead and brow-lift surgery for male patients. The endoscopic approach to the male forehead and brow-lift differs distinctly from the female lift. One difference is the consideration for placement of the incisions with respect to male pattern baldness. Another is the elevation of the brow on the orbital rim. Men often possess deeper forehead rhytids which are resistant to flattening out. The approach described allows for an easy solution by scoring of the tissue parallel to the rhytid in the subgaleal plane endoscopically. Our endoscopic technique uses both subgaleal and subperiosteal planes in a composite dissection. With this approach, the surgeon has the ability to regulate the elevation of the brow and deal with rhytids. Our experience with this method involves five male patients aged 44–56 years. Their chief complaints were excessive wrinkles of the forehead and a scowl appearance. To date, there have been no complications including infections, hair loss, or nerve injuries. All of the scars are well camouflaged within the hairline, with good wound healing. All patients have been pleased with the results of their surgery.

Although CO₂ lasers have been available to the cosmetic surgeon for more than 20 years, it is only recently that the ultrapulse mode has made the laser user-friendly. Now, tissue can be vaporized without significant charring. To shorten our learning curve with this treatment modality, various skin lesions were ablated with variable spot sizes and energy settings. Our results are presented as personal guidelines. Large and small areas may be resurfaced. If occlusive dressings are used, rapid reepithelization occurs across previous skin lesions or scars. This results in the appearance of rejuvenation. The only troublesome sequela has been persistent erythema similar to that seen after a phenol peel.

Resurfacing of the skin for eliminating defects like acne scars, wrinkles, keloids, etc. has traditionally been done by ultrapulse CO₂ lasers in which there are very short pulses with high peak power in a repetitive fashion. The pulse duration may range from 0.1 to 200 per second with 1000 pulses per second. A short laser exposure with a high power density ablates the same volume of tissue as a longer exposure at a lower power. The high-power lasers are more expensive. A lower-power laser with longer pulse intervals provides a less expensive alternative. This paper describes the resurfacing results achieved with a lower-power and longer-pulse laser available at a fraction of the cost. The Luxar CO₂ laser was used in pulse mode, with an exposure time of 20 milliseconds and a repetition rate of 20 times per second. The power level of 2–5 W pulse rate was evaluated on 69 patients using the following four metrics: (1) postoperative pain reported by the patient, (2) length of recovery period, (3) quality of achieved final result as measured by patient's satisfaction, and (4) complications. In each of these four regards the selected protocol was found to be very satisfactory and the results were comparable to those reported by the ultrapulse lasers.

The sole purpose of cosmetic surgery is the improvement of patients' body images (their attitudes about their physical appearance). This article offers an overview of contemporary theory and research on body image. The nature and prevalence of negative body image experiences are delineated. A cognitive social learning model elucidates dysfunctional body image development, including its predisposing, precipitating, and maintaining causes. The author describes his psychotherapeutic program for body image improvement and its potential adjunctive utility in the treatment of patients who receive cosmetic surgery.

Allergy to the latex protein in surgical gloves has become a major occupational hazard among physicians and cosmetic surgeons over the last few years. Reactions to latex range from urticaria to contact dermatitis to anaphylaxis. The latex proteins bound to cornstarch powder added as a donning agent can become aerosolized and inhalation of the powder can trigger bronchospasm and/or anaphylaxis. Continued exposure to latex by health care personnel increases the possibility of developing an allergy to the substance. Nonlatex alternatives have been developed to eliminate the problem of latex allergy.

Digital imaging and recent advances in computer software and hardware provide the medical industry with a new technology for archiving photos without film and assessing patients' expectations before surgery to make sure patients receive the results they expect. Hardware advances such as the instant-access digital video capture board, advanced digital video/still cameras, and dual Pentium processors allow complex photos to be manipulated quickly so that doctors can point out subtle changes in a patient's image and realistically create end results on a screen before beginning a surgical procedure, allowing the doctor to bring the client's expectations in line with real surgical potential. Other advantages of digital imaging over traditional photography and sketching include the elimination of photo degradation over time, a lessened need for printing with the use of an on-screen image, and a limitless file room for photo storage.

Hair loss is a psychological problem. Untreated hair loss is, of course, not detrimental to health and a person experiencing hair loss can continue to live a perfectly healthy life, unhindered. Why then is a cure so important to millions of patients and thousands of scientists? Unquestionably, it is because a psychological problem is indeed a health problem and needs to be addressed. Analysis of the reasons why hair loss disturbs the human mind is for the philosopher, the sociologist, and the anthropologist.

This study focuses on identifying the patient's approach to the problem. One thousand patients completed a questionnaire that had been devised with the help of a psychologist. The research focused on patients' awareness of the problem and of the treatments available, their reasons for seeking treatment, their biggest fears before treatment, and which age group is most concerned with hair loss.

“New Patient” is an interactive compact disc (CD) program that features a host and hostess presenting motivational material and information about popular cosmetic surgery procedures. It is illustrated by fast-paced live-action video and relevant pre- and postoperative examples. The viewer presses on the interactive monitor screen to view particular topics of interest, such as face-lift, laser resurfacing, and many others. After viewing as many topics as they like, they may enter their own name and phone number for a follow-up call for more information or a consultation.

This program runs unattended on a CD player. A timer returns the program to its starting point, making it ready for the next viewer. It is housed in a locked cabinet holding the physician's brochures and is further personalized with a backlit header bearing name, address, phone number, and color picture. Systems may be placed in businesses with which the physician may have a reciprocal referral relationship. Examples are a salon where postoperative patients are sent for a makeover, or a spa where the physician has a schedule of conjoint presentations on health and beauty. A business such as “Glamour Shots,” normally in a mall setting, is another possibility. The lobby of a multispecialty clinic and the waiting room of a physician friend of a different specialty are also good locations.

Because the system runs unattended, it enhances the physician's current marketing program by speaking for the physician all day every day in strategic locations where prospective patients live, work, and play. Rather than depending on prospective patients to think of plastic surgery on their own and then search the phone book for someone to call, the interactive CD uses fun and exciting new technology to inspire them about available possibilities and provides them with the physician's name as the source for further information.

Today's patients who undergo cosmetic surgery for facial rejuvenation demand no scars, no sequelae, and excellent long-lasting results without changes in their physiognomy. Some conventional techniques may produce an unnatural appearance. Simple ambulatory procedures can achieve complete facial rejuvenation. Closed face-lifting, autologous collagen/fat grafting, blepharoplasty, neck liposuction, platysmaplasty, and skin peeling used individually or in combination can produce facial improvement without any conspicuous scars and with minimal edema or ecchymosis, and allow the patient to return to everyday activities within a few days. These ambulatory techniques provide both patients and surgeons with excellent long-lasting results. This is a retrospective study of 50 patients who underwent one or more procedures for facial rejuvenation. Pre- and postoperative photographs are shown.

Various methods have been used to try to prevent or to reduce the rate of capsule contracture following breast augmentation. Methods commonly used to prevent contracture that have shown some success include the use of low-dose steroids in the implant pocket, antibiotics, implant manipulation with smooth-shelled saline implants, textured implants, and placing the implant in the submuscular position. An excellent means of treating capsule contracture is with partial or total capsulectomy followed by placement of a textured saline implant on the opposite side of the pectoralis major muscle, creating a new implant pocket.

Mammographic breast mass, cyst, calcified mass, papable mass, or hematoma are the possible consequences of leaving some fibrous capsule in place when a breast implant is removed or changed. Indications for total capsulectomy include: calcified fibrous capsule, polyurethane implant, symptoms of autoimmune disease, plans for replacement with a textured implant in the same pocket, ruptured implant, and patient fear of developing autoimmune disease. The decision to perform capsulotomy, partial capsulectomy, or total capsulectomy is up to the operating surgeon according to the facts of the case and the surgeon's experience after consultation with the patient.

The issue presented in breast implant litigation, whether breast implants cause harm, graphically displays the fron-tiers of the interface of law and medicine, and the complex method of evaluating causal relationships in medicine. Should the law wait for an answer?

This paper provides a system for evaluating the results of studies in the area of breast implant litigation, in terms of the extent to which those results support or refute a causal relationship.

The concept and characteristics of causation and the re-liability of cases, reports, descriptive studies, and anecdotal cases as evidence of causation are discussed. Because of the current media and medical legal environment, recommen-dations for the care and treatment of patients with breast implants are being made without careful thought. The con-sequences of widespread litigation may be the determining factor in attempting to resolve the question of the potential harm of the silicone-gel breast implant.

The author provides a legislative history of the False Claims Act and discusses the potential impacts of the April 1993 amendments to the False Claims Act on the health care industry. The False Claims Act allows any private citizen with knowledge that a false claim had been submitted to the government for payment to bring a civil action in the name of the government to recover any damages suffered by the government. As an incentive, the person is entitled to a “bounty” plus costs. False claims in the health industry take three principal forms: nondelivery of services, delivery of unnecessary services, misrepresentation of services, charges, or costs. The author emphasizes that no specific intent to defraud is required. Items billed by a hospital in deliberate ignorance or reckless disregard for the truth or falsity of a bill are the only proof necessary.