Michelle A Spring

University of California, Los Angeles, Los Ángeles, California, United States

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Publications (15)22.98 Total impact

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    ABSTRACT: Numerous surgical options for breast reduction have been described, but in the current healthcare environment, efficiency is of the utmost importance. In this Featured Operative Technique, the authors describe an efficient, reproducible, and simple method for minimal to moderate reduction mammaplasty that utilizes a superior pedicle. The surgical maneuvers were developed and conveyed to the senior author (W.G.S.) by Dr John Bostwick. This approach preserves superior and medial breast fullness while providing appropriate resection of the breast parenchyma to ameliorate symptoms and produce a smaller, lifted breast with a more youthful appearance. The surgical technique maintains a reliable blood supply to the nipple-areola complex (NAC) from the internal mammary artery and its perforators, and involves minimal transposition of the NAC. The authors reviewed the charts of 62 consecutive patients who underwent this procedure and found the complication rate to be 11.3%. Complications included 1 hematoma, 1 standing cone deformity, 3 soft-tissue infections, 8 incisional breakdowns, and 1 unilateral necrosis of the NAC. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 01/2015; 35(1):94-104. DOI:10.1093/asj/sju011 · 2.03 Impact Factor
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    ABSTRACT: Increasing the volume of the breast while simultaneously decreasing the skin envelope equates to surgery involving opposing forces. Increasing patient demand and the evolving perceptions of surgeons have led to the growing popularity of the combined augmentation-mastopexy operation. In turn, secondary augmentation-mastopexies and revisional surgeries of primary augmentation-mastopexies also have increased in popularity. In this article, the authors describe indications for secondary augmentation-mastopexy, techniques for performing this combined procedure safely and effectively, adjunctive procedures, potential pitfalls, and the treatment of complications.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 09/2014; 34(7):1018-40. DOI:10.1177/1090820X14543943 · 2.03 Impact Factor
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    ABSTRACT: Background:Despite the increasing popularity of the combined augmentation mastopexy procedure among patients, the safety and efficacy of this surgery have been questioned by many surgeons.Objective:The authors investigated the safety and efficacy of the combined augmentation mastopexy procedure.Methods:The authors retrospectively reviewed the medical records of 615 consecutive patients who underwent combined augmentation mastopexy procedures at a single outpatient surgery center from 1992 through 2011. Patient demographics, operative and implant details, and long-term outcomes were analyzed. Rates of complications and revisions were calculated.Results:The most common complications were poor scarring (5.7%), wound-healing problems (2.9%), and deflation of saline implants (2.4%). Of the 615 patients evaluated, 104 (16.9%) elected to undergo revision surgery: 54 revision procedures were secondary to implant-related complications, and 50 were secondary to tissue-related complications. Our data compare favorably with previously reported revision rates for breast augmentation alone and mastopexy alone.Conclusions:With a skilled surgeon and proper patient selection, the combined augmentation mastopexy procedure can be safe and effective.Level of Evidence: 4.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 05/2014; 34(5). DOI:10.1177/1090820X14531434 · 2.03 Impact Factor
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    ABSTRACT: Goals/Purpose: Form-stable silicone gel breast implants represent the fifth generation of silicone gel augmentation devices. The combination of the additional silicone crosslinking combined with surface texturing may provide other advantages. The purpose of the study is to compare the surgical outcomes of a consecutive series of breast augmentation cases using Siltexª round, textured, fourth-generation cohesive, MemoryGel silicone implant (Mentor, Santa Barbara, CA) to those in a consecutive series of patients by the same surgeon using Silimed fifth generation, round, textured, highly-cohesive, form stable, silicone gel implant (Sientra, Inc, Santa Barbara, CA). Methods/Technique: This is a single surgeon (WGS), single outpatient surgical center, retrospective review of a 13 year period of patients that underwent silicone breast augmentation with the Mentor Siltexªtextured silicone MemoryGel breast implants, as well as a 5 year period where Silimed textured, fifth generation, highly-cohesive, form-stable silicone gel breast implants. For each patient, demographic information, comorbidities, surgical information, complications, and need for revision were recorded. Results/Complications: A total of 1720 implants in 866 patients were included. 1012 implants (in 511 patients) fourth generation, cohesive silicone breast implants and 708 (in 355 patients) textured, fifth generation, highly cohesive, form-stable silicone gel breast implants were identified. The mean age was 32.2 years (19-72) for the MemoryGel group and 38 years (18-65) for the Silimed group. Average follow up was 32 months (8-47) for the MemoryGel group and 28 months (0.5-48) for the Silimed group. There is a statistical difference in primary augmentations versus secondary augmentations noted in the two groups: half of the Silimed group underwent primary augmentations and a quarter of the Mentor group had primary augmentations. Capsular contracture (Baker Grade II-IV) was noted in 26/1012 (2.6%) for the Memory Gel group and 5/708 (0.7%) implants in the Silimed group (statistically significant at p<0.05). For the MemoryGel and Silimed groups respectively, rupture was noted 4/1012 (0.4%) and 0/708, rippling 4/1012 (0.4%) and 2/708 (0.3%), ptosis 1/1012 (0.1%) and 2/708 (0.3%), infection 4/1012 (0.4%) and 5/708 (0.7%), seroma 0/1012 and 7/708 (1.0%, statistically significant at p<0.05), asymmetry 6/1012 (0.6%) and 5/708 (0.7%), galactorrhea 0/1012 and 2/708 (0.3%), scarring 11/1012 (1.1%) and 15/708 (2.1%), revisions 69/1012 (6.8%) and 28/708 (4.0%). Conclusion: There is statistically significant decrease in capsular contracture noted in the textured, fifth generation, highly-cohesive, form stable, silicone gel breast implants as compared to the fourth generation, textured, cohesive, silicone breast implants used in this study. Although the frequency of secondary augmentations and reduction/reconstruction procedures is higher in the Mentor group, the raw percentages consistently show less capsular contracture in the Sientra group. In fact, the number of secondary mastopexies is higher in the Sientra group (44 vs. 20), but the consistently lower rate is still evident (0 vs. 10%). The statistically different seroma rate (0 vs. 1%) may be secondary to difference in texturing. Prospective randomized controlled studies are needed to determine differences with the new textured, highly cohesive, form-stable, silicone breast implants.
    The Aesthetic Meeting 2014 The American Society for Aesthetic Plastic Surgery; 04/2014
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    ABSTRACT: Goals/Purpose: The authors performed a retrospective study to determine perioperative and long term outcomes for superior pedicle breast reduction in the outpatient setting. Methods/Technique: A review of 62 total patients who underwent superior pedicle breast reduction from 1990 to 2013 in a single outpatient center was performed. In these cases, a superior pedicle wise pattern reduction mammoplasty was performed. The patient demographic and surgical data was reviewed along with complication frequency and type and revision rate. Recorded complications included seroma, hematoma, breast cellulitis, standing cone deformity, incisional breakdowns, and nipple areola complex necrosis. The charts were also examined for all other potential complications including need for blood transfusion, deep venous thrombosis, myocardial infarction, and death. Results/Complications: The mean patient age was 40 (standard deviation 12.5 years) mean body mass index was 25 (+/- 2.9 kg/m2). Reported bra cup size ranged from 32 D to 40 G, with DD being the most common size. The mean preoperative sternal notch to nipple distance was 27.6 cm (2.8 standard deviation). Twenty nine patients (47%) had some form of preoperative morbidity, including hypothyroidism, obesity and hypertension. Ten patients (16%) were smokers. Mean clinical follow up was 12 months for these patients. Average total resection weight was 406 grams with a standard deviation of 163 grams. The mean operative time for those patients who underwent superior pedicle reduction as the sole procedure was 112 minutes with a standard deviation of 21 minutes. Thirteen patients underwent multiple procedures on the same day, including abdominoplasty, liposuction and facelift with a mean operative time of 170 minutes (standard deviation of 42 minutes). The overall complication rate was 31 % with 19 minor complications occurring, including one hematoma, one standing cone deformity, one case of nipple areolar necrosis, 3 infections, 8 incisional breakdowns and 12 cases of poor scar formation. Incisional breakdowns included areas of the t zone junction (8) and the nipple areolar complex (4). No major complications were recorded. Statistical analysis of the complication data showed there was no significant difference in those undergoing multiple procedures from those undergoing one procedure. Comparison of BMI showed a significant difference between those with and without complications. Those without complications had an average BMI of 24.5 and those with complications had an average BMI of 26.5, P=0.03 (using a paired, 2 tailed student’s t test). Conclusion: This large retrospective study examines the safety of outpatient superior pedicle reduction and identifies BMI as an important factor which may predispose patients to complications. Complication data from this outpatient facility is similar to reported outcomes in the literature and this supports the safety and efficacy of outpatient superior pedicle breast reduction in an accredited facility.
    The Aesthetic Meeting 2014 The American Society for Aesthetic Plastic Surgery; 04/2014
  • W Grant Stevens, Michelle A Spring, Luis H Macias
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 04/2014; 34(5). DOI:10.1177/1090820X14529960 · 2.03 Impact Factor
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    W Grant Stevens, Laura K Pietrzak, Michelle A Spring
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    ABSTRACT: Background:Cryolipolysis has been shown to be a safe and effective noninvasive procedure for the reduction of localized subcutaneous fat.Objectives:The authors examine the safety, efficacy, and procedural growth of cryolipolysis (via the CoolSculpting device; Zeltiq, Pleasanton, California) in a single plastic surgery practice.Methods:A retrospective chart review was conducted for 528 consecutive patients who underwent cryolipolysis treatment from January 2010 to December 2012. The number of patients, the number of treatment cycles, the average number of cycles per patient, all treatment areas, and all procedural complications were recorded and analyzed. Overall practice growth with the device was also analyzed.Results:Over the study period, 1785 anatomic sites were treated with 2729 cycles, primarily in the lower abdomen (28%, n = 490 cycles), upper abdomen (11%, n = 189), left flank (19%, n = 333), right flank (19%, n = 333), inner thigh (6%, n = 111), outer thigh (5%, n = 87), and back (6%, n = 99). The age distribution for men and women was similar (46.6 ± 12.8 years for women and 46.5 ± 12.3 years for men; overall range, 18-79 years). Only 3 cases of mild or moderate pain/neuralgia were reported and resolved in 4 or fewer days. No adverse events were reported. Procedure volume showed consistent growth, with treatment cycles increasing by 823% by 2012.Conclusions:Based on the results in this single plastic surgery practice, cryolipolysis is a safe and effective nonsurgical body contouring method associated with high patient satisfaction that can generate steady, significant business growth.Level of Evidence:4.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 07/2013; 33(6). DOI:10.1177/1090820X13494757 · 2.03 Impact Factor
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    ABSTRACT: Breast reconstruction rates remain low, at 5%-15% of mastectomy patients, despite the safety and high patient satisfaction of these procedures. Reasons for this are multifactorial, including the attitudes and biases of the referring breast surgeon, as well as patient factors. The purpose of this study was to explore attitudes of general surgeons towards breast reconstruction. We surveyed 369 general surgeons in Wisconsin with questions about breast surgery. Responses from 135 (36%) surgeons were analyzed. Seventy-three percent of the respondents performed at least some breast surgery and were eligible for the study. For a little over 50% of the general surgeons surveyed, breast surgery made up less than 10% of their practice. Fifty-one percent never performed a skin-sparing mastectomy. A large number of breast surgeons (40%) did not refer all mastectomy patients for reconstruction. Reasons cited for not referring patients included the concerns over cancer recurrence and advanced patient age. Reasons for patients not undergoing reconstruction included patient's refusal, need for radiation therapy, delaying adjuvant oncologic treatment, patient factors, and having no plastic surgeon available locally. The decision by a patient to undergo breast reconstruction involves many complex factors. As a specialty, we should focus on improving the availability of breast reconstructive surgeons and educating referring surgeons and patients about reconstructive indications and options in order to positively affect the utilization of breast reconstruction.
    WMJ: official publication of the State Medical Society of Wisconsin 10/2008; 107(6):292-7.
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    ABSTRACT: In the last 15 years, reduction mammaplasty has been increasingly performed on an outpatient basis. Despite this evolution, few outcome studies have been published regarding outpatient breast reduction surgery. The authors documented clinical outcomes of reduction mammaplasty performed in an outpatient setting over an 11-year period and compared these results with published normative values in the plastic surgery literature. A retrospective review was undertaken of 884 reduction mammaplasties in 444 patients at a single outpatient surgical center performed by the senior author (W.G.S.) from 1995 through 2006. In all cases, a laser-assisted, inferior pedicle, Wise pattern, reduction mammaplasty was performed. In addition to demographic and surgical data, complication frequency and type were recorded. Complication data were further stratified into minor and major categories. Potential minor complications included seroma, hematoma, soft tissue infection, dog-ears requiring revision, and small incisional breakdowns or delayed healing of less than 2 cm. Potential major complications included large incisional breakdowns or delayed healing of greater than 2 cm, nipple/areolar necrosis, need for blood transfusion, deep vein thrombosis, pulmonary embolus, myocardial infarction, and death. The mean patient age was 38 years (range, 16 to 73 years). Mean body-mass index was 27 (range 17 to 47). The reported preoperative brassiere cup sizes ranged from a 34 C to a 38 K, with a DD being the most common size. The mean preoperative sternal notch-to-nipple distance was 29 cm (range 22 to 54 cm). Forty patients smoked (9%). Mean clinical follow-up was 13 months. Mean total resection weight of breast tissue was 1228 g (range 100 to 5295 g). Mean operative time for reduction mammaplasty was 115 minutes (range 50 to 195 minutes). Nineteen percent of patients underwent multiple procedures, including abdominoplasty, lipoplasty, and facial procedures, with a mean operative time of 132 minutes (range 75 to 345 minutes). The overall complication rate was 14%, with 70 minor complications occurring in 62 patients. Specific minor complications included one seroma, four hematomas, eight soft tissue infections, two of which required a short course of intravenous antibiotics, one patient with dog-ears requiring surgical revision, and 56 small incisional wound breakdowns (< 2 cm). The small incisional breakdowns, which represented the largest group of complications, were further subdivided into 44 minor T-zone wounds, 3 nipple-areolar complex wounds, and 9 wounds of the vertical and horizontal incisions. Three major complications (0.67%) were recorded. Two patients had development of partial nipple/areolar necrosis. A third patient required anticoagulation for a pulmonary embolus diagnosed 10 days after surgery. Statistical analysis of the complication data revealed one significant relationship. Patients with a body mass index above the mean had a 21% complication rate as compared with a 12% rate for those below the mean. Of note, there was no increase in complication rate in the context of multiple procedures. This retrospective series is the largest to date involving outpatient reduction mammaplasty. Complication data derived from this series are comparable to previously published studies and thus support the safety and efficacy of outpatient reduction mammaplasty performed in an accredited facility.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 03/2008; 28(2):171-9. DOI:10.1016/j.asj.2008.01.001 · 2.03 Impact Factor
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    ABSTRACT: Simultaneous breast augmentation and mastopexy has historically been a controversial topic, and it has been considered by some to be a difficult and unpredictable procedure. Secondary breast augmentation and mastopexy after previous breast surgery is rarely discussed in the literature, and little is known about the outcomes of these secondary procedures. The authors present the indications, surgical techniques, and outcomes in a series of 100 consecutive secondary simultaneous breast augmentation and mastopexy cases. One hundred consecutive patients who underwent secondary combined augmentation mammaplasty and mastopexy from 1992 to 2005 were retrospectively reviewed. The complications and revision rates in this group of patients were analyzed and compared with primary mastopexy alone, as well as with primary combined augmentation and mastopexy. Independent variables such as patient age, history of smoking, body mass index, type and size of implant, and type of mastopexy incision were analyzed for correlation with complication and revision rates. No major complications were noted in an average of 3.5 years follow-up (range 13 months to 13 years). Minor complications occurred in 13 patients, of whom 8 required revision surgery. The most common tissue-related complications were poor scarring (3%) and recurrent ptosis (3%). The most common implant-related complications were infection (3%) and capsular contracture (2%). In addition, 6 patients underwent reoperation for implant size exchange, and 1 patient underwent revision surgery to receive silicone implants. Patient age, history of smoking, body mass index, type and size of implant, type of mastopexy incision, type and number of previous breast surgeries, surgical time, concurrent non-breast operations, and preoperative ptosis grade were not statistically significant risks when correlated to the complication and revision rate. Simultaneous breast augmentation and mastopexy after previous breast surgery is a commonly performed procedure that is not adequately reported in the literature. Our study indicates that the procedure is safe and has complication and revision rates comparable to primary augmentation/mastopexy.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 09/2007; 27(5):485-92. DOI:10.1016/j.asj.2007.07.003 · 2.03 Impact Factor
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    ABSTRACT: Office-based plastic surgery with general anesthesia has several benefits compared with hospital-based surgery. Office-based procedures can be done in a safe, cost- and time-efficient manner, with improved convenience for both the surgeon and the patient. A review and discussion of outpatient plastic surgery procedures at the Marina Outpatient Surgery Center in Marina del Rey, California, was performed.
    Seminars in Plastic Surgery 05/2007; 21(2):99-101. DOI:10.1055/s-2007-979209
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    ABSTRACT: Abdominoplasty has traditionally been described in the literature as an operation that is performed in a hospital setting, although more recently it is likely that most procedures are performed on an outpatient basis. To date, there have been very few large series illustrating the safety and efficacy of abdominoplasty performed in outpatient surgery centers. This study reports the complications and revisions of outpatient abdominoplasties in a large patient population. The charts of 519 consecutive abdominoplasty procedures performed at a single outpatient surgical center over the past 10 years (1996-2006) were reviewed. Follow-up was 6 months to 10 years, with an average of 4.3 years. Mean age at the time of operation was 43 years; range 19 to 74 years. Gender, smoking history, American Society of Anesthesiologists risk score, body mass index, type of abdominoplasty, and concurrent procedures were recorded. Each patient's chart was reviewed to assess complication and revision rates, including deaths, venous thromboembolism events, wound dehiscence, infection, seroma, hematoma, and scarring unacceptable to the patient or surgeon. The most common complication was seroma (10.6%), followed by unacceptable scarring of the abdominal or umbilical incisions (7.9%). The most common reason for revision was abdominal scar revision (6.4%). Most patients had concurrent additional procedures at the time of abdominoplasty, most commonly lipoplasty (91%). There was no statistically significant difference in complications or revisions when comparing groups based on age, body mass index, operating room time, smoking status, full abdominoplasty versus a less complex procedure such as a "mini" or floating umbilical abdominoplasty or simultaneous procedures. Men were significantly less likely to have a complication when compared with women. This large retrospective study of 519 consecutive abdominoplasty procedures performed on an outpatient basis demonstrates that abdominoplasties may be performed safely and effectively at an accredited outpatient surgery facility.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 05/2007; 27(3):269-75. DOI:10.1016/j.asj.2007.04.003 · 2.03 Impact Factor
  • Michelle A Spring, Karol A Gutowski
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    ABSTRACT: Recommendations for venous thromboembolism (VTE) prophylaxis have been published in the plastic surgery literature. However, no comprehensive survey of the overall incidence of VTE among plastic surgery patients has been undertaken. This study was performed to determine the incidence of VTE in plastic surgery patients, to delineate which procedures have the most risk for VTE, and to establish whether published guidelines are utilized by plastic surgeons. An e-mail survey was sent to 3797 plastic surgeons based in the United States. Of those queried, 1106 (29%) completed the questionnaire. Respondents were asked to report VTE events in their patients over the last 24 months. There were 8 patient-based questions about VTE prophylaxis to determine the preferred method used. Overall, 329 VTE events were identified. The most commonly associated procedures were abdominoplasty with another procedure (87 events) and abdominoplasty alone (71 events). Whether abdominoplasty is performed alone or combined with another procedure, the survey revealed similar rates of VTE per 10,000 patients (36 events per 10,000 patients). Plastic surgeons' prophylaxis methods vary, and 38% of the respondents were not aware of the published recommendations. Based on our study, abdominoplasty with or without a second procedure has the highest incidence of VTE events among plastic surgery procedures. Combining abdominoplasty with another procedure does not increase the risk for VTE. A significant number of plastic surgeons are not aware of the published recommendations, and there is no consistent VTE prophylaxis used by the plastic surgeons who responded to the survey.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 09/2006; 26(5):522-9. DOI:10.1016/j.asj.2006.07.003 · 2.03 Impact Factor
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    Michelle A Spring, Delora L Mount
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    ABSTRACT: Mandibular distraction osteogenesis has proven to be an effective treatment for upper airway obstruction related to micrognathia. Changes in the aerodigestive space can help facilitate tracheostomy removal in children and prevent tracheostomy in newborns. However, this may also precipitate changes in the ability to orally feed. There are few data on early postoperative feeding and growth rate following mandibular lengthening. The authors found evidence of growth rate decline and feeding difficulty in pediatric patients following mandibular distraction osteogenesis. Ten pediatric patients underwent mandibular distraction osteogenesis for treatment of upper airway obstruction. Outcomes in resolution of upper airway obstruction, oral feeding success, and growth rate were analyzed. Follow-up ranged from 12 to 28 months. All 10 patients had complete resolution of upper airway obstruction. The length of distraction ranged from 10 to 17 mm. Three patients demonstrated a feeding disorder after mandibular distraction osteogenesis, defined as requiring a long-term (>1 month) alternate feeding method (gastric tube in two patients and gastric gavage in one). Seven of 10 patients exhibited an early decline in growth rate following distraction. Data used to determine growth rate changes were weight measurements at the time of distraction, at the time of distractor removal (6 to 8 weeks after distraction), and at 6 and 12 months after the date of distraction initiation. These results suggest that infants and children undergoing mandibular lengthening by distraction osteogenesis should be carefully monitored for postdistraction feeding disorder and growth rate disturbance.
    Plastic and Reconstructive Surgery 08/2006; 118(2):476-82. DOI:10.1097/01.prs.0000227740.48021.c3 · 3.33 Impact Factor
  • Michelle A Spring, Michael L Bentz
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    ABSTRACT: Vascular anomalies are lesions seen in all surgical disciplines, particularly in pediatric patients. Specialization in vascular anomalies involves a team effort, with the team consisting of plastic surgeons, general surgeons, neurosurgeons, pediatricians, interventional radiologists, dermatologists, ophthalmologists, otolaryngologists, hematologists, and pathologists. Inconsistent nomenclature in the literature has historically resulted in confusion about classification, diagnosis, and treatment. A biologic classification system has emerged, based on clinical observations, natural history, and cellular features, which separates vascular anomalies into two broad categories: vascular tumors and vascular malformations. For many vascular anomalies, photodocumentation, psychosocial support, and communication are important throughout the treatment course.
    Clinics in Plastic Surgery 05/2005; 32(2):171-86. DOI:10.1016/j.cps.2004.11.004 · 1.35 Impact Factor

Publication Stats

111 Citations
22.98 Total Impact Points

Institutions

  • 2014
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 2008
    • University of Southern California
      • Keck School of Medicine
      Los Ángeles, California, United States
  • 2007
    • American Society of Ophthalmic Plastic and Reconstructive Surgery
      Maryland, United States
  • 2005–2006
    • University of Wisconsin–Madison
      • Division of Plastic and Reconstructive Surgery
      Madison, Wisconsin, United States