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Aesthetic Surgery - Science topic

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Since these are not procedures for recovering lost health, people should have easy access to safety information from the different hospitals that offer it.
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Dear Dr. Berend Van der Lei
It is true. But we must admit that cosmetic surgeries are usually not necessary while they may have serious side effects. Therefore, patients need to be aware of these issues before surgery and the adequate safety gueidlines must be considered .
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Allergan, Galderma and Merz all provide a list of what appears to be a standard list of aftercare advice to be used following their treatments. However, I have not been able to find any evidence to support this. Can anyone help?
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I was at a meeting where Alastair Carrathers was asked about post Botox recommendations. He said when they were starting he was using the most powerful neurotoxin in the world to treat wrinkles - he thought he should give them some take home instructions (no exercise, don't lie down, don't drink alcohol). He said he just made them up and does not use them any more.
But don't rub the face too much
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I have done microneedling for 19 years and I always apply vitamin A, C and E to the skin immediately after the treatment. I have never seen a reaction ever and my experience covers about 2000 personal cases and in excess 10,000 when including my associates using the same regime.   The product we use is Environ vitamin ACE Oil which has no added preservatives, colourants or perfumes.  This is the same oil as used by Zeitter et al in their research at Hannover Medical School to test needling skin at weekly intervals.   In their research the vitamin A,C E oil vastly increased the magnitude of the result.
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  • I think cleaning the skin properly with a suitable anti septic and anti microbial agent will help in preventing granulomas.
  • post exposure to unsuitable environment especially malls, road dust house dust soaps or even dirty hands also may contribute.
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presently skin excision is the answer for simon 's grade 3 gynecomastia for good cosmetic results 
can anyone suggest if any other treatment guidelines available
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When skin excision is necessary I usually prefer to do inferior pedicle. As a result the final scar is located in the IMF and there is no horizontal scar on the left and right of the areola.
The technique is well described in a plastic surgery book by Peter Neligan.
However, especially in young patients two stages should be considered. After liposuction many patients are happy with the result and they don’t want to proceed to further operation.
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See above
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I have had experience with Thermage early versions.  Even though the published data suggested it might be effective, the clinical outcomes were disappointing in that a significant number of our patients did not demonstrate photographable improvement in facial laxity.  The procedure was extremely painful and in our hands did not deliver enough improvement to cover the cost or pain of the procedure.  The company kept providing upgrades claiming that they would improve outcomes, we bought a few but eventually gave up.   The single use tips were expensive and a significant component of the charges making it difficult to refund unhappy patients.  Even now they say the newer versions are more effective but "once bitten twice shy".  I do however speak with international colleagues that I respect who are happier with the procedure than I was.  
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Hydrolipoclasy is an alternative technique less invasive than liposuction. It uses normal saline or hypotonic solution and ultrasound waves to directly act on local adiposity. In theory the saline solution applied makes the fat cells easily eliminated.
It is being used for aesthetic reasons and/or after a bariatric surgery or after loosing a lot of weight.
Is the ultrasound effective to eliminate/break fat cells?
Is the hydrolipoclasy effective?
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Hydrolipoclasy have been introduced in aesthetic market basically for the treatment of cellulite (just orange skin, or mild cellulite), supporting in the idea of removing the superficial fat, up to 1 cm below the skin surfece.
For this treatment, a high power ultrasound device (more than 20 watts per sq. inch), is needed. Besides, the ultrasound must be 3 MHZ type. Other physioterapist ultrasound are 1 MHZ, and those are not useful.
Although it is somewhat effective, these high power devices are dangerous, and may cause skin burns, so it is mandatory to use them with a temperature sensor during all the procedure.
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Any suggestions are welcome.
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Moh's surgery may not be absolutely necessary (too time consuming), the resection may include cartilage per primum and the reconstruction can be relatively simple (without flap surgery - see Head & Neck 36, 735-738,2014)
Ultimately, each case has to be evaluated seperately.
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Has somebody tried to assess the total fat volume after using tumescent liposuction with lipoaspirate far greater than 500ml?
Although the success of liposuction is not determined by absolute weight loss, patients are often told the volume of the lipoaspirate which is the supernatant fluid after several minutes without movement.
Yet, the fatty tissue should be socken with the tumescent solution and so overrating the actual amount of fat harvested.
While evaluating liters of lipoaspirate is not comfortable, perhaps taking a 10ml syringe sample to centrifugation may give a good estimate in relation?
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A good question and a sensible suggestion (re. centrifuging a sample to give an estimate - although that has to be after many hours to allow the different layers to settle in the initial collection-pot).
You are absolutely correct that the amount of fat aspirated is most likely overstated, given that there shall be tumescent fluid mixed in with it.
Furthermore, the tumescent fluid gets absorbed by the system during the procedure, particularly during prolonged procedures, and therefore it is not a case of subtraction, either.
Lastly, depending on the type of liposuction involved, some of the cavitated/ broken-down fat shall be removed by the lymphatics, et.c..
I do not think that a suitably accurate answer exists, and therefore it is better to give the patient an approximate value for the maximum amount of fat aspirated.
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There are hundreds of journals today and all of us have his/her preferred ones. Please share your favorites.
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I personally think that Annals of Surgery is a must for all the surgeons over and above the specialty they are expert in. The Journal deserves the given high impact factor (IF). I am quite sure that any surgeon could find an interesting article in any monthly issue, whereas many issues of NEJM - which is very informative in so many fields of medicine and surgery - quite often do not captivate the surgeon's attention. But, having been in many Editorial Boards of International Journals, I would like to take this opportunity to know your opinions about the current grading system of medical journals based on the Impact Factor. Looking at the ranking of surgical journals of one of the web sites (i.e. ISI Web of Knowledge or Scopus) I feel bewildered when I see that several highly regarded journals, where you can read the results of excellent studies are "punished" by a low IF. I know that something is wrong. It's a very delicate matter also because IF and the Citation Index (CI) as well are the main tools for the evaluation of the scientific production of an individual and also for allocation of grant fundings. It's probably time to move on and induce the experts in assessment and evaluation to study more unbiased and objective tools. I know it's difficult!
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Hyaluronic acid infiltration versus Medpore epitheses
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Thank you Johan,
Maybe we would have to look upon a higher complication rate with the use of synthetic epitheses and also the need for repetition of the procedure with the use of hialuronic acid. This is a question of balancing pros and contras.
Best wishes,
Raúl