Revision rhinoplasty

Acta Otorhinolaryngol Ital. 2013 June; 33(3): 183–189.

Grafting in revision rhinoplasty

M. BUSSI, F. PALONTA, and S. TOMA

SUMMARY

Rhinoplasty is one of the most difficult aesthetic surgery procedures with a high rate of revision. In revision rhinoplasty the surgeon should explore the patient's concerns and then verify the possibility to satisfy expectations after complete internal and external examination of the nose. For the vast majority of complex secondaries, an open approach is the only reasonable method. In fact, in secondary nasal surgery, because of the scarring process following the primary operation, dissection is tedious, and landmarks are lost. One of the main objectives for the surgeon who approaches secondary rhinoplasty is to restore the structural support of the nose and to replace the lost volume of soft tissues. To achieve this purpose, the surgeon must often rely on grafts. An ideal grafting material must be easy to sculpt, resistant to trauma, infection and extrusion, mechanically stable, inert and readily available. For all these reasons, autogenous cartilage grafts harvested from septum, auricular concha and rib represent the first choice in rhinoplasty. In order to obtain a camouflage graft that provides natural contouring to the nose, temporalis fascia can be used. All these carefully trimmed grafts are useful in tip revision surgery, in secondary surgery of the dorsum and to resolve or reduce functional problems.

Full article at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709529/

Autologous fat transplantation to the breast

Aesthetic Plast Surg. 2009 Sep;33(5):706-15. doi: 10.1007/s00266-009-9377-1. Epub 2009 Jun 4.

Autologous fat transplantation to the breast: a personal technique with 25 years of experience.

Illouz YG, Sterodimas A.

Department of Plastic Surgery, Saint Louis Hospital, Avenue Claude-Vellefaux, 75010, Paris, France.

Abstract

BACKGROUND:

Over the last 30 years there has been interest in the use of autologous fat transplantation for breast reconstructive and cosmetic purposes. Up until now injection of adipose tissue into the breast has been subject to two limiting factors. First, fat injection into the breast could result in fat necrosis, cyst formation, and indurations that could be mistaken as cancerous calcifications. Second, the degree of reabsorption of the injected adipose tissue is unpredictable.

METHODS:

Patients included in the study were candidates for either breast reconstruction after tumor resection or breast augmentation and were divided into three groups. Group I included patients with asymmetry after mastectomy and breast reconstruction; Group II consisted of patients with congenital breast asymmetry; and Group III included patients requesting bilateral breast augmentation. All patients signed a consent form acknowledging potential complications of infiltrating fat into the breast.

RESULTS:

A total of 820 consecutive female patients were operated on between 1983 and 2007. The age distribution of the patients ranged from 19 to 78 years, with a mean of 45.6 years. There were 381 patients in Group I, 54 in Group II, and 385 in Group III. Complications included ecchymosis in 76 patients, striae in 36 patients, 12 hematomas, and 5 infections. Long-term breast asymmetry was observed in 34 cases. Six hundred seventy patients have undergone mammography and ultrasonography 6 months and 1 year after their first intervention under our care. The majority of complications resulting from lipofilling of the breast have been seen in this series during the first 6 months after each session. Breast lesions, including calcifications, cysts, and cancer, that are not apparent in the first year after the final procedure of lipofilling we believe may not be directly associated with the autologous fat grafting to the breast. This has been confirmed by the long-term follow-up of 230 patients (range = 2-25 years, mean = 11.3 years) who have been followed up yearly with mammographic examination.

CONCLUSION:

In the last 25 years the results of autologous fat transplantation have been predictable and satisfying on the condition that the treatment is performed in stages with small quantities of adipose tissue fat injected in each treatment session. To prevent major complications the final expected result should not be the aim of a single procedure. Mammary lipografting is a procedure that can be offered to patients for breast reconstructive and cosmetic purposes.

Female genital cosmetic and plastic surgery

J Sex Med. 2011 Jun;8(6):1813-25. doi: 10.1111/j.1743-6109.2011.02254.x. Epub 2011 Apr 14.

Female genital cosmetic and plastic surgery: a review.

Goodman MP.

Source

Caring For Women Wellness Center, Davis, CA 95616, USA. michaelgoodman250@gmail.com

Abstract

INTRODUCTION:

This review studies rationale and outcome of vulvovaginal aesthetic surgery.

AIM:

Discuss procedures designed to alter genital appearance and function; investigate sexual, philosophical, and ethical issues; examine outcomes.

METHODS:

(i) Medline search of the existing literature utilizing terms labiaplasty, clitoral hood reduction, hymenoplasty (HP), vaginoplasty (VP), perineoplasty (PP), female genital surgery, sexual satisfaction/body image, and anterior/posterior colporrhaphy; (ii) references from bibliographies of papers found through the literature search and in the author's reading of available literature.

MAIN OUTCOME MEASURES:

(i) Demographics and psychosexual dynamics of women requesting female genital plastic/cosmetic surgery; (ii) overall and sexual satisfaction of subjects undergoing these procedures.

RESULTS:

The majority of studies regarding patient satisfaction and sexual function after vaginal aesthetic and functional plastic procedures report beneficial results, with overall patient satisfaction in the 90-95% range, sexual satisfaction over 80-85%. These data are supported by outcome data from nonelective vaginal support procedures. Complications appear minor and acceptable to patients. There are little data available regarding outcomes and satisfaction of HP, or function during the rigors of subsequent vaginal childbirth, although the literature contains no case reports of labiaplasty disruption during parturition.

CONCLUSION:

Women requesting labiaplasty and reduction of their clitoral hoods do so for both cosmetic and functional (chafing, interference with coitus, interference with athletic activities, etc.) reasons, while patients requesting VP and/or PP do so in order to increase friction and sexual satisfaction, occasionally for aesthetic reasons. Patients appear generally happy with outcomes. The majority of patients undergoing genital plastic surgery report overall satisfaction and subjective enhancement of sexual function and body image, but the literature is retrospective. Female genital plastic surgery procedures appear to fulfill the majority of patient's desires for cosmetic and functional improvement, as well as enhancement of the sexual experience. Little information is available regarding HP outcomes.

Semin Plast Surg. 2011 May; 25(2): 130–141.

Aesthetic and Functional Genital and Perineal Surgery: Female

Guest EditorsChristopher J. Salgado, M.D.Stan J. Monstrey, M.D., Ph.D.

Aesthetic Surgery of the Female Genitalia

Julie M.L.C.L. Dobbeleir, M.D.,1 Koenraad Van Landuyt, M.D., Ph.D.,2 and Stan J. Monstrey, M.D., Ph.D.2

Aesthetic female genital surgery involves surgery on normal female external genitalia; therefore, it falls into the same category as liposuction, breast augmentation, facial rejuvenation, cosmetic dental surgery, or any other aesthetic surgery procedure to the body.

It is designed to improve the appearance subjectively, and potentially provide psychological and functional improvement in sexual stimulation and satisfaction.1

Aesthetic procedures in the genital area can resemble female cutting in terms of technique and final result, but the fundamental difference lies in the intention and the purpose never to harm the functionality of the female genitals with this surgery.9,15

Obviously, patients should be aware that this surgery carries inherent risks and complications that eventually can result in a diminished function.3

 There are no absolute medical contraindications for aesthetic genital surgery, although current gynecological disease, smoking, unrealistic expectations, and sexual dysfunction are relative contraindications.1,6

Indications:

1. Perceived genital hypertrophy or significant discrepancy
2. Discomfort with sports activities or clothing, or vaginal entrapment with coitus
3. Genital changes due to childbearing or obstetrical injury affecting beauty or gripability and pleasurable coital sensation. 

LABIOPLASTY

Labioplasty refers to reduction of the labia minora (mostly) or majora, as well as to augmentation through injection of bulking agents or autologous fat transfer.1

Women will seek labioplasty for different reasons.4,16,17,19 Functional indications include: discomfort in clothing or during sports, dyspareunia due to invagination of the labia on penetration can be another functional reason but a growing number of women seek this kind of surgery purely for aesthetic reasons.

VAGINAL TIGHTENING PROCEDURE

During life, up to 76% of women experience decreased vaginal sensation, most commonly with a feeling of a widened vagina.

The goal of these procedures is to reconstruct (or to narrow) the lower third of the vagina, which includes “the orgasmic platform, internal and external vaginal diameter (introitus) and the perineal body.”24 The procedure enhances vaginal muscle tone strength and control, and decreases internal and external vaginal diameters.

HYMENOPLASTY

The hymen is the mucous membrane that partially closes the entrance to the vagina, named after the god of marriage in classical Greek mythology, Hymenaios.

The hymenoplasty procedure consists of surgically tailoring the hymenal remnants so that they can be sutured together with absorbable interrupted sutures to narrow the vaginal orifice.27 The procedure can be repeated as many times as desired. 

Clitoral Hood Reduction

Clitoral hood reduction is designed to produce more exposure of the clitoral body (with theoretically improved sexual stimulation) and to improve the appearance of the genital area.

Clitoropexy

Clitorises viewed to be longer than usual and deemed to look more like a penis than a clitoris must be reduced to ensure social acceptance as a female

Clitoral Reduction

Clitoral hypertrophy may be primary or secondary to hormonal or genetic abnormalities such as in disorders of sex development (DSD).

Pubic Lifting

Reduction of the mons pubis for ptosis and excess tissue in this area usually requires direct wedge excision in a transverse direction. This procedure is usually combined with or part of an abdominoplasty procedure

Pubic Liposuction

Liposuction of the mons pubis is effective in patients without skin excess.

G SPOT AMPLIFICATION

The G spot or Gräfenberg spot was first described in the 1950s as a highly erogenous zone inside the vagina that enlarges when directly stimulated. The erotic zone can be found on the anterior wall of the vagina along the course of the urethra, which seems to be surrounded by erectile tissue much like the corpora cavernosa of the penis.

The amplification is performed by collagen or hyaluronan injections under local anesthetic. 

CONCLUSION

Female genital surgery mostly consists of a labioplasty or a vaginal tightening procedure. These surgical procedures seem to have acceptable complications and a reasonable cosmetic outcome.

Ann Plast Surg. 2013 May;70(5):513-6. 

Autologous fat transfer in aesthetic facial recontouring.

Gamboa GM, Ross WA.

Source

Section of Plastic and Reconstructive Surgery, Department of Surgery, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912-4080, USA. MGAMBOA@gru.edu

Abstract

Autologous fat graft transplantation has become increasingly popular in recent years. The recognition that soft tissue volume loss contributes to the aging of the face has driven the use of this procedure. Tumescent lipoaspirate provides ready accessibility of tissue for this transplantation, despite some perceived deficiencies in the predictability of volume maintenance with this method. We report our experience with immediately processed sedimented fat transfer for facial grooves and volume correction. A retrospective review of a consecutive series of 75 autologous fat transfers from October 2008 to July 2011 in 8 female patients between ages 46 and 73 years was conducted at Georgia Health Sciences University. The grafting was performed to improve facial aesthetic contours. Twenty-two were performed for correction of grooves and creases: 12 for nasolabial fold, 4 glabella, and 6 nasojugal. Fifty-three transfers were performed for volume augmentation: 17 malar, 14 submalar, 11 lip, 8 temple, 2 chin, and 1 jowl. A tumescent technique with manual syringe harvest was used. The abdomen was the most frequently used donor site. The tumescent was decanted from the lipoaspirate. Oil and nonviable fat were excluded. Care was taken to reduce the time from harvest to transplantation, with no syringe transfers, minimizing potential oxidation and injury of the tissue. The mean volume of fat transferred was 24 mL (range, 4-54 mL). Mean follow-up was 25 months (range, 6-36 months). A second session of fat transfer was required in a small percentage. Complications included minor asymmetry in 1 patient (resolved with graft manipulation) and prolonged swelling in another. No postoperative cellulitis orfat necrosis was reported. Clinical evaluations and patients reported a satisfactory result 88% of the time. Patients universally reported (100%) a desire to have the procedure performed again. Autologous fat transfer for facial soft tissue contouring is simple, safe, inexpensive, and effective. Its ready availability, natural integration into host tissues, and potentially permanent correction make it particularly useful for this application. All patients were satisfied with the soft, natural appearance.