Publications by authors named "Cagri Cakmakoglu"

23 Publications

  • Page 1 of 1

Brow Anatomy and Aesthetics of the Upper Face.

Clin Plast Surg 2022 Jul;49(3):339-348

Cleveland Clinic Department of Plastic Surgery, 9500 Eucllid Avenue, Cleveland Ohio 44195, USA.

The surgical approach to the brow has changed perhaps more than any other facial esthetic procedure in the past 20 years. Understanding the functional anatomy of the upper face is the best means of maximizing results and minimizing untoward events in this region. The surgical and clinical correlation is addressed in detail in this article. Cadaver and intraoperative photographs are used to illustrate critical points. Armed with the details of this anatomy, the reader will best be able to best individualize surgical treatment.
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http://dx.doi.org/10.1016/j.cps.2022.03.001DOI Listing
July 2022

Long-term efficacy of lymphovenous anastomosis for the treatment of retroperitoneal lymphangiectasia: A case report and a review of literature.

Microsurgery 2022 Jan 11. Epub 2022 Jan 11.

Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.

Lymphovenous anastomosis (LVA) represents an alternative treatment for retroperitoneal lymphangiectasia. In contrast to sclerotherapy or excision, which may risk lymphatic obstruction and subsequent lymphedema, LVA preserves existing lymphatic architecture and transit. This report shows long-term efficacy of LVA for functional decompression of a symptomatic pathologically dilatated retroperitoneal lymphatics. A 47-year-old female with retroperitoneal lymphangiectasia refractory to multiple percutaneous drainages and treatments with sclerosing agents underwent LVA with anastomosis of a dominant segment of retroperitoneal lymphangiectasia to the deep inferior epigastric vein. Postoperative serial magnetic resonance imaging with 3-dimensional volume calculation over the 27 months follow-up showed evidence of decompression of the lesion with patent bypass. There were no known immediate complications nor requirement of further interventions. The patient's subjective pain also decreased substantially. This report confirms long-term efficacy of LVA for retroperitoneal lymphangiectasia as an alternative to sclerotherapy and surgical excision in the setting of previously failed treatments.
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http://dx.doi.org/10.1002/micr.30859DOI Listing
January 2022

Determining the precise anatomic location of the sensory nerves to the abdominal wall: Optimizing autologous innervation of abdominally based free flaps.

J Plast Reconstr Aesthet Surg 2021 03 21;74(3):641-643. Epub 2020 Nov 21.

Department of Plastic Surgery, Dermatology & Plastic Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A60, Cleveland, OH 44195, United States. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2020.11.019DOI Listing
March 2021

Neurotization of the Nipple-Areola Complex during Implant-Based Reconstruction: Evaluation of Early Sensation Recovery.

Plast Reconstr Surg 2020 08;146(2):250-254

From the Departments of Plastic Surgery and Breast Services, Cleveland Clinic.

The concept of sensate autologous breast reconstruction is not novel, and prior literature has focused mainly on sensate abdominally based breast reconstruction. The goal of this article is to present the authors' results with a novel technique performing sensate implant-based reconstruction. A database was prospectively maintained for patients who underwent implant-based sensate breast reconstruction. The anterior branch of the lateral fourth intercostal is identified and preserved during the mastectomy by the breast surgeon. A processed nerve allograft is used as an interpositional graft connecting the donor nerve to the targeted nipple-areola complex. The sensory recovery process was objectively monitored using a pressure-specified sensory device. Thirteen patients underwent the proposed technique. Eight patients with 15 breasts were monitored for sensory recovery. For sensory measurement, the nipple had a mean threshold of 67.33 ± 34.48 g/nm. The upper inner (29 ± 26.75 g/nm) and upper outer (46.82 ± 32.72 g/nm) nipple-areola complex quadrants demonstrated better scores during the moving test compared with the static test. Mean time between the test and surgery was 4.18 ± 2.3 months, and mean time between the second test and surgery was 10.59 ± 3.57 months. Threshold improvements were documented after the second test for all nipple-areola complex areas evaluated. This is the first study to report on early results obtained after performing sensate implant-based breast reconstruction. More studies are required to determine the long-term outcomes and impact on quality of life and to assess whether patient or breast characteristics impact the success of this procedure.
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http://dx.doi.org/10.1097/PRS.0000000000006976DOI Listing
August 2020

Lymphedema Prevention Surgery: Improved Operating Efficiency Over Time.

Ann Surg Oncol 2020 Nov 27;27(12):4695-4701. Epub 2020 Jul 27.

Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave/A80, Cleveland, OH, 44195, USA.

Background: Lymphedema prevention surgery (LPS), which identifies, preserves, and restores lymphatic flow via lymphaticovenous bypasses (LVB), has demonstrated potential to decrease lymphedema in breast cancer patients requiring axillary lymph node dissection. Implementing this new operating technique requires additional operating room (OR) time and coordination. This study sought to evaluate the improvement of LPS technique and OR duration over time.

Methods: A prospective database of patients who underwent LPS at our institution from 2016 to 2019 was queried. Type of breast and reconstruction surgery, number of LVB performed, and OR times were collected. LPS details were compared by surgical group and year performed.

Results: Ninety-four patients underwent LPS, and 88 had complete OR time data available for analysis. Average age was 51 years, body mass index of 28, with an average of 15 lymph nodes removed. Reconstructive treatment groups included prosthetic reconstruction 56% (49), oncoplastic reduction 10% (9), and no reconstruction 34% (30). The number of patients undergoing LPS increased significantly from 2016 to 2019, and average number of LVB per patient doubled. In patients without reconstruction, the average time for LPS improved significantly from 212 to 87 min from 2016 to 2019 (p = 0.015) and similarly in patients undergoing LPS with prosthetic reconstruction from 238 to 160 min (p = 0.022).

Conclusions: LVB is an emerging surgical lymphedema prevention technique. While requiring additional surgical time, our results show that with refinement of technique, over 4 years, we were able to perform double the number of LVB per patient in half the OR time.
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http://dx.doi.org/10.1245/s10434-020-08890-zDOI Listing
November 2020

Advances and current concepts in reconstructive surgery for breast cancer.

Semin Oncol 2020 Aug 24;47(4):217-221. Epub 2020 May 24.

Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, United States of America. Electronic address:

In this article, we report on recent advancements in reconstructive care of the breast cancer patient. New developments in sensate breast reconstruction to help address the problem of numbness after mastectomy have emerged and show promise. Methods to restore lymphatic physiologic flow after axillary lymphadenectomy using supermicrosurgical techniques have begun to show benefit by reducing the short-term incidence of breast cancer related lymphedema (BRCL). Breast implant safety has received significant recent attention and we explore the emergence of BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) and its implications for the breast cancer patient and their multidisciplinary care team.
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http://dx.doi.org/10.1053/j.seminoncol.2020.05.007DOI Listing
August 2020

Color Duplex Ultrasound for Localization of Vascular Compromise in Microsurgical Breast Reconstruction.

Plast Reconstr Surg 2020 03;145(3):666e-667e

Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio.

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http://dx.doi.org/10.1097/PRS.0000000000006600DOI Listing
March 2020

Lymphaticovenous Bypass for Immediate Lymphatic Reconstruction in Locoregional Advanced Melanoma Patients.

J Reconstr Microsurg 2020 May 31;36(4):247-252. Epub 2019 Dec 31.

Department of Plastic Surgery, Cleveland Clinic, Dermatology and Plastic Surgery Institute, Cleveland, Ohio.

Background:  Extremity lymphedema is a dreaded complication of ilioinguinal or axillary lymphadenectomy. In conventional lymph node dissection, no effort is performed to maintain or reestablish extremity lymphatic circulation. We hypothesized that immediate lymphatic reconstruction (ILR) could be a reproducible procedure to maintain functional lymphatic flow after ilioinguinal and axillary lymphadenectomy in patients with malignant melanoma. This is the first report describing prophylactic ILR in patients with melanoma who underwent complete lymph node dissection for gross nodal disease.

Patients And Methods:  We report a case series of 22 malignant melanoma patients who had axillary or ilioinguinal lymph node dissection for bulky locoregional invasion with immediate lymphatic reconstruction. A novel method to identify and select lymphatics with high flow using fluorescent lymphangiogram with indocyanine green dye gradient software is described. Surgical details, common difficulties, as well as indications are discussed. Instructional videos are also provided.

Results:  Our technique is reproducible, since we have successfully completed immediate lymphatic reconstruction in 22 cases consecutively. Intradermal indocyanine green injections allowed for visualization of 1 to 3 transected lymphatics after lymphadenectomy. An average of 1.8 lymphaticovenous bypass (range 1-3) was performed per patient.

Conclusion:  Reestablishment of lymphatic circulation after ilioinguinal or axillary lymphadenectomy in patients with melanoma characterizes a novel method that may reduce the problem of upper and lower extremity iatrogenic lymphedema. This is particularly important given the emergence of new adjuvant treatment modalities that considerably improve patients' survival after lymphadenectomy.
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http://dx.doi.org/10.1055/s-0039-3401829DOI Listing
May 2020

Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate.

Ann Surg Oncol 2019 Oct 16;26(11):3550-3560. Epub 2019 Jul 16.

Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.

Introduction: The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature.

Methods: Consecutive cutaneous melanoma patients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate.

Results: Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage.

Conclusions: With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.
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http://dx.doi.org/10.1245/s10434-019-07617-zDOI Listing
October 2019

Axillary reverse mapping and lymphaticovenous bypass: Lymphedema prevention through enhanced lymphatic visualization and restoration of flow.

J Surg Oncol 2019 Aug 29;120(2):160-167. Epub 2019 May 29.

Department of General Surgery, Division of Breast Surgery, Cleveland Clinic, Cleveland, Ohio.

Background: A lymphedema (LE) prevention surgery (LPS) paradigm for patients undergoing axillary lymphadenectomy (ALND) was developed to protect against LE through enhanced lymphatic visualization during axillary reverse mapping (ARM) and refinement in decision making during lymphaticovenous bypass (LVB).

Methods: A retrospective analysis of a prospective database was performed evaluating patients with breast cancer who underwent ALND, ARM, and LVB from September 2016 to December 2018. Patient and tumor characteristics, oncologic and reconstructive operative details, complications and LE development were analyzed.

Results: LPS was completed in 58 patients with a mean age of 51.7 years. An average of 14 lymph nodes (LN) were removed during ALND. An average of 2.1 blue lymphatic channels were visualized with an average of 1.4 LVBs performed per patient. End to end anastomosis was performed in 37 patients and a multiple lymphatic intussusception technique in 21. Patency was confirmed 96.5% of patients. Adjuvant radiation was administered to 89% of patients. Two patients developed LE with a median follow-up of 11.8 months.

Conclusion: We report on our experience using a unique LPS technique. Refinements in ARM and a systematic approach to LVB allows for maximal preservation of lymphatic continuity, identification of transected lymphatics, and reestablishment of upper extremity lymphatic drainage pathways.
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http://dx.doi.org/10.1002/jso.25513DOI Listing
August 2019

Facelift Part I: History, Anatomy, and Clinical Assessment.

Aesthet Surg J 2020 01;40(1):1-18

Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH.

In this article, the authors aim to thoroughly describe the critical surgical anatomy of the facial layers, the retaining ligamentous attachments of the face, and the complex three-dimensional course of the pertinent nerves. This is supplemented with clarifying anatomic dissections and artwork figures whenever possible to enable easy, sound, and safe navigation during surgery. The historic milestones that led the evolution of cervicofacial rejuvenation to the art we know today are summarized at the beginning, and the pearls of the relevant facial analysis that permit accurate clinical judgment and hence individualized treatment strategies are highlighted at the end. The facelift operation remains the cornerstone of face and neck rejuvenation. Despite the emergence of numerous less invasive modalities, surgery continues to be the most powerful and more durable technique to modify facial appearance. All other procedures designed to ameliorate facial aging are either built around or serve as adjuncts to this formidable craft.
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http://dx.doi.org/10.1093/asj/sjy326DOI Listing
January 2020

Predictable Location of Breast Sensory Nerves for Breast Reinnervation.

Plast Reconstr Surg 2019 02;143(2):393-396

From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic; the Division of Plastic and Reconstructive Surgery, MetroHealth; and the University of Toledo College of Medicine.

The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves, which are at risk for injury or loss during mastectomy. Providing reinnervation after mastectomy was introduced almost 20 years ago, but it is not widely performed, perhaps because of the difficulty of locating a recipient nerve. The authors have performed cadaveric dissections to allow for precise anatomical localization of the lateral intercostal branch providing breast sensation. Bilateral chest dissections were performed on 10 female cadavers. The lateral intercostal nerve providing sensation to breast tissue was identified. The distances from the sternum, the midclavicular line, and the lateral pectoralis minor-in addition to nerve diameter-were measured. The nerve was successfully identified bilaterally in all cadavers. The majority of nerves (16 of 20) exited from under the fourth rib. The average distance from the sternum was 13.1 ± 1.3 cm (range, 10 to 15 cm) and the average distance from the midclavicular line was 11.8 ± 2.2 cm (range, 8 to 16 cm). The nerve exited at the lateral border of the pectoralis minor or within 2 cm from the lateral border for all cadavers. The diameter of the nerve was consistently 2 mm. The nerve traveled under the thoracodorsal vessels, aiding in identification. The authors identified the predictable location of the lateral intercostal nerve providing sensation to the breast. The authors hope that by enabling surgeons to locate this nerve, more well-conducted studies will be performed investigating techniques and outcomes for breast reinnervation.
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http://dx.doi.org/10.1097/PRS.0000000000005199DOI Listing
February 2019

Triple Mapping to Optimize Axillary Management in Breast Cancer Patients After Neoadjuvant Therapy.

Ann Surg Oncol 2018 Oct 13;25(10):3106. Epub 2018 Jul 13.

Department of Surgical Oncology, Cleveland Clinic, Cleveland, OH, USA.

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http://dx.doi.org/10.1245/s10434-018-6645-9DOI Listing
October 2018

Developing a protocol for normothermic ex-situ limb perfusion.

Microsurgery 2018 Feb 9;38(2):185-194. Epub 2017 Oct 9.

Plastic Surgery Department, Cleveland Clinic, Cleveland, Ohio.

Background: Ischemia time represents a significant limitation for successful extremity transplantation because of the rapid deterioration of ischemic muscle. Normothermic ex-situ preservation is an emergent method to prolong the organ viability following procurement, by replicating the physiologic conditions. The aim of this study was to develop an ex-situ normothermic limb perfusion system to preserve the viability and function of porcine limbs for 12 hours following procurement.

Methods: A total of 18 swine limbs were perfused. Thirteen limbs were used to develop the perfusion protocol. Five limbs were perfused according to the optimized protocol. These limbs were perfused at 39°C for twelve hours using an oxygenated colloid solution containing red blood cells. Glucose and electrolytes were kept within physiologic range by partial perfusate exchange. Limb specific perfusion quality was assessed by muscle contractility upon electrical nerve stimulation, compartment pressure, creatine kinase (CK) and myoglobin concentrations, tissue oxygen saturation (near infrared spectroscopy), indocyanine green angiography, and infrared radiation by thermographic imaging.

Results: The last five limbs reached the 12 hours' perfusion target maintaining normal compartment pressure (16.4  ± 8.20 mmHg), minimal weight increase (0.54 ± 7.35%), and mean muscle temperature of 33.6 ± 1.67°C. Myoglobin and CK concentrations were 875 ± 291.4 ng/mL, and 53344 ± 14850.34 U/L, respectively, at the end of perfusion. Muscle contraction was present in all limbs until cessation of perfusion. Differences in uniformity and quality of distal perfusion were identified with thermography and angiography imaging at 12 hours of perfusion.

Conclusions: Ex-situ normothermic limb perfusion preserves swine limb physiology and function for at least 12 hours.
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http://dx.doi.org/10.1002/micr.30252DOI Listing
February 2018

Resident and Program Director Perceptions of Aesthetic Training in Plastic Surgery Residency: An Update.

Aesthet Surg J 2017 07;37(7):837-846

Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH.

Background: This is the third survey exploring the quality of cosmetic training in plastic surgery residency. We focused on determining: (1) the applied modalities and extent of resident exposure; and (2) resident confidence in performing variable cosmetic procedures.

Objectives: To analyze trends in resident exposure and confidence in aesthetic plastic surgery procedures from the standpoint of program directors (PDs) and residents.

Methods: The survey was developed and e-mailed to 424 residents enrolled in the ASAPS Residents Program and 95 PDs. Both independent and integrated programs were included. The questions were posed in a five-point ranking format. Univariate statistical analysis was used to examine all aspects. The results were analyzed in relation to our previous surveys in 2008 and 2011.

Results: Thirty-three PDs (34.7%) and 224 (52.8%) residents responded. Residents felt most confident with abdominoplasty, breast reduction, and augmentation-mammaplasty. Facial aesthetic procedures, especially rhinoplasty and facelift, were perceived as "challenging." The three most preferred modalities of aesthetic education were, in descending order, residents' clinic, staff cosmetic patients, and cadaver dissections. Both residents and PDs felt a need for more training especially in facial procedures. Only 31.5% of residents who planned to focus on cosmetic surgery felt ideally prepared integrating cosmetic surgery into their practice (compared to 50% in previous surveys).

Conclusions: Despite improvements observed from 2008 to 2011 published surveys, there are still challenges to be met especially in facial cosmetic procedures. It is suggested that resident clinics and cadaver courses be universally adopted by all training programs.
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http://dx.doi.org/10.1093/asj/sjw275DOI Listing
July 2017

Current Evidence for Clinical Efficacy of Platelet Rich Plasma in Aesthetic Surgery: A Systematic Review.

Aesthet Surg J 2017 03;37(3):353-362

Facial Surgery Section Editor for Aesthetic Surgery Journal.

Background: Platelet rich plasma (PRP) has attracted attention in a number of surgical fields due to a wide variety of potential clinical benefits. Yet PRP has not gained wide popularity in aesthetic surgery as a result of uncertainty surrounding objective clinical evidence.

Objectives: We aim to describe the current applications, define preparation and activation, explore effectiveness, and propose a classification system to facilitate comparisons across studies.

Methods: A comprehensive review of the literature regarding the use of platelet rich plasma in aesthetic surgery was performed. Data gathered included: PRP application, study type, subject number, centrifugation, anticoagulation, activation, PRP composition, and outcomes.

Results: Thirty-eight reports were identified. Applications included injection into aging skin (29%), scalp alopecia (26%), lipofilling (21%), fractional laser (13%), and facial surgery (11%). The majority of studies (53%) were case series without controls. Leucocytes were sparsely defined (32%). The concentration of injected and/or baseline platelets was rarely clarified (18%). The mechanism of activation was described in 27 studies (71%), while anticoagulation was uncommonly elucidated (47%). While most studies (95%) claim effectiveness, objective measures were only utilized in 17 studies (47%).

Conclusions: Current studies produce context-dependent results with a lack of consistent reporting of PRP preparation, composition, and activation in aesthetic applications, making meaningful meta-analysis unrealistic. Thus the method of PRP preparation warrants increased attention. We recommend a set of descriptors, FIT PAAW (described below), to produce scientifically grounded conclusions, facilitating a clearer understanding of the situations in which PRP is effective.

Level Of Evidence: 4
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http://dx.doi.org/10.1093/asj/sjw178DOI Listing
March 2017

The Effect of Smoking on Facial Fat Grafting Surgery.

J Craniofac Surg 2017 Mar;28(2):449-453

*Division of Plastic and Aesthetic Surgery, Dicle University, Diyarbakir, Turkey †Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH.

Facial fat grafting has been increasingly performed to create a more youthful face. Cigarette smoking might have potential harmful effects on fat graft survival. The aim of this study was to evaluate the effects of cigarette smoking on facial lipofilling.Eighteen smoker patients (13 females and 5 males) with a mean age of 37.4 years (range: 21-53 years) who underwent facial lipofilling were enrolled in this retrospective study. The patients were followed up for an average of 19.3 months (range: 14-32 months). The fat-graft survival rate, degree of skin improvement, and presence and severity of surgical complications (fat necrosis, oil cysts, and infection) were evaluated. A 10-point Likert scale was used to assess patient satisfaction with facial fat grafting surgery.The mean injected fat volume was 42 mL (range: 30-80 mL). Clinical and photographic evaluation by the surgical team led to an estimation of 40% for the mean fat survival rate. Four instances of fat necrosis, 2 oil cysts, and 1 infection were diagnosed and treated conservatively. Five patients underwent a second fat grafting surgical procedure; 3 of these had a third fat grafting surgery to obtain the desired facial fullness. Improvement of skin quality was better during the first months after surgery, but not long standing. Overall patient satisfaction in terms of aesthetic appearance, facial fullness, and rejuvenation was 74%.Although cigarette smoking causes low fat survival rates and impairs the improvement of skin quality, successful results can be obtained with facial lipofilling in the smokers.
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http://dx.doi.org/10.1097/SCS.0000000000003356DOI Listing
March 2017

Dislocation of Mandibular Condyle Into Middle Cranial Fossa: Two Alternative Methods for Two Patients.

J Oral Maxillofac Surg 2015 Aug 14;73(8):1563.e1-16. Epub 2015 Apr 14.

Associate Professor and Department Head, Department of Plastic, Reconstructive, and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Kartal, İstanbul, Turkey.

Dislocation of the mandibular condyle into the middle cranial fossa is rare, and the number of cases discussed in published studies is limited. Various treatment routes have been suggested, and the entire published data are based on the presentations of single cases. The present report presents 2 cases of dislocation of the mandibular condyle into the middle cranial fossa. The first case was treated with closed reduction in the early stage; however, the second case, which was treated in the late stage, required open reduction. Both the methods of reduction and the key aspects of diagnosis are discussed.
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http://dx.doi.org/10.1016/j.joms.2015.04.010DOI Listing
August 2015

Idiopathic sixth nerve palsy after bimaxillary surgery: a complication or a sequential pathology independent from surgery?

J Craniofac Surg 2015 Jan;26(1):191-2

From the Department of Plastic Reconstructive and Aesthetic Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey.

This was a case of a 21-year-old female patient with a very rare and unexpected symptom "diplopia occurring due to the idiopathic sixth nerve palsy" encountered after 2 weeks following bimaxillary surgery performed for the correction of class III malocclusion deformity.
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http://dx.doi.org/10.1097/SCS.0000000000001205DOI Listing
January 2015

Simplifying knot adaptation in deeper tissue suturation: the knot sliding method.

J Craniofac Surg 2014 Nov;25(6):2262-3

Department of Plastic Reconstructive and Aesthetic Surgery, Dr Lütfi Kırdar Kartal Training and Research Hospital, Kartal, Istanbul, Turkey Department of Plastic Reconstructive and Aesthetic Surgery, Dr Lütfi Kırdar Kartal Training and Research Hospital, Kartal, Istanbul, Turkey.

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http://dx.doi.org/10.1097/SCS.0000000000000748DOI Listing
November 2014

An underestimated "ghost" foreign body as an unusual cause of mandibular osseocutaneous fistula formation: impacted spike of a soccer cleat.

J Craniofac Surg 2014 Mar;25(2):666-7

From the *Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training and Research Hospital; and †Division of Plastic Reconstructive and Aesthetic Surgery, Medipol University Medical Faculty, Istanbul, Turkey.

In this article, the case of a patient with osteocutaneous fistula at the left malar region secondary to impacted spike of a soccer cleat to the mandible is presented. Both the clinical and radiologic diagnoses failed because of an obscure anamnesis of the patient and the unavailability of viewing the spike in orthopantomogram and computed tomography. Surgical extirpation was performed to the 41-year-old man who was injured in a football match 3 months before the presentation and had a swooning history after an accidental booting. There were no early or late complications after the surgery at the end of 9 months. This study shows the importance of both obtaining a definite history of patients and sequential radiologic imaging to make a differential diagnosis between the foreign bodies and cystic or noncystic tumors and inflammatory lesions of the mandible.
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http://dx.doi.org/10.1097/SCS.0000000000000389DOI Listing
March 2014
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