Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study

Kiang, Lee,Deptula, Peter,Mazhar, Momal,Murariu, Daniel,Parsa, Fereydoun Don Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.5

Background Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected. Conclusions Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study

Lee Kiang,Peter Deptula,Momal Mazhar,Daniel Murariu,Fereydoun Don Parsa 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5

Background: Standard upper blepharoplasty involves removal of both the skin and a portionof the underlying orbicularis oculi muscle. The senior author had observed sluggishness ofeyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patientsduring the early postoperative period. He postulated that these findings could be due toorbicularis muscle excision. He therefore undertook a prospective study 27 years agocomparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods: A randomized, prospective, single-blinded study was designed using the fellow eyeas an internal control. 22 patients undergoing upper blepharoplasty procedure requiringgreater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, orprevious eyelid surgery were selected. Upper blepharoplasty was performed with skin-onlyremoval on one side, and combined skin-muscle removal on the other side. Patients wereevaluated until six months after surgery except for two patients who were lost to follow-upafter three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result wereoutcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results: There were comparable aesthetic outcomes in both eyelids. The incidence of sluggisheyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelidswhere wide segments of muscle had been resected. Conclusions: Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes asconventional blepharoplasty, while significantly reducing the complications of sluggish eyelidclosure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

Polyurethane-Coated Breast Implants Revisited: A 30-Year Follow-Up

Castel, Nikki,Soon-Sutton, Taylor,Deptula, Peter,Flaherty, Anna,Parsa, Fereydoun Don Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.2

Background Polyurethane coating of breast implants has been shown to reduce capsular contracture in short-term follow-up studies. This 30-year study is the longest examination of the use of polyurethane-coated implants and their correlation with capsular contracture. Methods This study evaluates the senior surgeon's (F.D.P.) experience with the use of polyurethane-coated implants in aesthetic breast augmentation in 382 patients over 30 years. Follow-up evaluations were conducted for six months after surgery. After the six-month follow-up period, 76 patients returned for reoperation. The gross findings, histology, and associated capsular contracture were noted at the time of explantation. Results No patient during the six-month follow-up period demonstrated capsular contracture. For those who underwent reoperation for capsular contracture, Baker II/III contractures were noted nine to 10 years after surgery and Baker IV contractures were noted 12 to 21 years after surgery. None of the explanted implants had macroscopic evidence of polyurethane, which was only found during the first five years after surgery. The microscopic presence of polyurethane was noted in all capsules up to 30 years after the original operation. Conclusions An inverse correlation was found between the amount of polyurethane coating on the implant and the occurrence of capsular contracture. Increasingly severe capsular contracture was associated with a decreased amount of polyurethane coating on the surface of the implants. No contracture occurred in patients whose implants showed incomplete biodegradation of polyurethane, as indicated by the visible presence of polyurethane coating. We recommend research to find a non-toxic, non-biodegradable synthetic material as an alternative to polyurethane.

Polyurethane-Coated Breast Implants Revisited: A 30-Year Follow-Up

Nikki Castel,Taylor Soon-Sutton,Peter Deptula,Anna Flaherty,Fereydoun Don Parsa 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.2

Background Polyurethane coating of breast implants has been shown to reduce capsular contracture in short-term follow-up studies. This 30-year study is the longest examination of the use of polyurethane-coated implants and their correlation with capsular contracture. Methods This study evaluates the senior surgeon’s (F.D.P.) experience with the use of polyurethanecoated implants in aesthetic breast augmentation in 382 patients over 30 years. Follow-up evaluations were conducted for six months after surgery. After the six-month follow-up period, 76 patients returned for reoperation. The gross findings, histology, and associated capsular contracture were noted at the time of explantation. Results No patient during the six-month follow-up period demonstrated capsular contracture. For those who underwent reoperation for capsular contracture, Baker II/III contractures were noted nine to 10 years after surgery and Baker IV contractures were noted 12 to 21 years after surgery. None of the explanted implants had macroscopic evidence of polyurethane, which was only found during the first five years after surgery. The microscopic presence of polyurethane was noted in all capsules up to 30 years after the original operation. Conclusions An inverse correlation was found between the amount of polyurethane coating on the implant and the occurrence of capsular contracture. Increasingly severe capsular contracture was associated with a decreased amount of polyurethane coating on the surface of the implants. No contracture occurred in patients whose implants showed incomplete biodegradation of polyurethane, as indicated by the visible presence of polyurethane coating. We recommend research to find a non-toxic, non-biodegradable synthetic material as an alternative to polyurethane.

The utility of three-dimensional models in complex microsurgical reconstruction

Adeyemi A. Ogunleye,Peter L. Deptula,Suzie M. Inchauste,Justin T. Zelones,Shannon Walters,Kyle Gifford,Chris LeCastillo,Sandy Napel,Dominik Fleischmann,Dung H. Nguyen 대한성형외과학회 2020 Archives of Plastic Surgery Vol.47 No.5

Background Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes. Methods A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Preoperative decision- making to undergo a deep inferior epigastric perforator (DIEP) versus muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap, as well as whether the decision changed during flap harvest and postoperative complications were tracked based on the preoperative imaging used. In addition, we describe three example cases showing direct application of 3D mold as an accurate model to guide intraoperative dissection in complex microsurgical reconstruction. Results Fifty-eight abdominal-based breast free-flaps performed using conventional CTA were compared with a matched cohort of 58 breast free-flaps performed with 3D model print. There was no flap loss in either group. There was a significant reduction in flap harvest time with use of 3D model (CTA vs. 3D, 117.7±14.2 minutes vs. 109.8±11.6 minutes; P=0.001). In addition, there was no change in preoperative decision on type of flap harvested in all cases in 3D print group (0%), compared with 24.1% change in conventional CTA group. Conclusions Use of 3D print model improves accuracy of preoperative planning and reduces flap harvest time with similar postoperative complications in complex microsurgical reconstruction.