Publications by authors named "Jeffrey M Kenkel"

140 Publications

The Efficacy of Intense Pulsed Light as a Treatment for Benign Pigmented Lesions on the Dorsal Hand.

Dermatol Surg 2022 Aug 26;48(8):827-832. Epub 2022 May 26.

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas.

Background: Intense pulsed light (IPL) is a noninvasive therapeutic option to treat benign pigmented lesions by targeting melanin.

Objective: The purpose of this study was to assess IPL as a treatment for benign pigmented dorsal hand lesions.

Materials And Methods: A total of fifteen subjects, 40 to 73 years old, received 3 monthly IPL treatments over the dorsal hands. Subjects followed up 1 and 3 months after treatment. At every visit, photographs were taken using the VISIA Complexion Analysis System (Canfield Scientific, Fairfield, NJ) and analyzed using the RBX Brown Spots Analysis algorithm. The Clinician Global Aesthetic Improvement Scale and Subject Global Aesthetic Improvement Scale were completed at both follow-up visits.

Results: A total of fifteen subjects completed all six visits. The number of brown spots decreased 9.26% ( p = .0004) and 7.52% ( p = .0132) at each follow-up visit. The mean brown intensity decreased 6.15% ( p = .0183) and 7.67% ( p = .0178), whereas the mean contrast intensity decreased 8.88% ( p < .0001) and 6.60% ( p = .0007) 1 and 3 months after treatment, respectively. The mean Clinician Global Aesthetic Improvement Scale was 2.03 and 2.23, whereas the mean Subject Global Aesthetic Improvement Scale 1 and 3 months after treatment was 1.6 and 1.8, respectively.

Conclusion: Objective analysis, along with clinician and subject assessments, showed an improvement in the appearance of benign pigmented lesions in the treated area after 3 IPL treatments.
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http://dx.doi.org/10.1097/DSS.0000000000003494DOI Listing
August 2022

A Randomized, Placebo-Controlled Trial Evaluating the Single and Combined Efficacy of Radiofrequency and Hybrid Fractional Laser for Nonsurgical Aesthetic Genital Procedures in Post-Menopausal Women.

Aesthet Surg J 2022 Jul 27. Epub 2022 Jul 27.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Background: The efficacy of interventions that provide long-term relief of genitourinary symptoms of menopause (GSM) has yet to be determined.

Objectives: To evaluate the efficacy of radiofrequency (RF) and hybrid fractional laser (HFL) treatments for management of menopausal vulvovaginal symptoms.

Methods: 31 post-menopausal women completed all treatments and at least one follow-up. Outcomes included the Vulvovaginal Symptom Questionnaire (VSQ), Vaginal Laxity Questionnaire (VLQ), laxity measurements via a vaginal biometric analyzer probe, the Urogenital Distress Short Form (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Female Sexual Function Index (FSFI), and gene expression studies.

Results: Mean VSQ score decreased 2.93 (p=0.0162), 4.07 (p=0.0035) and 4.78 (p=0.0089) among placebo, dual, and HFL groups three months post-treatment and remained decreased by 3.3 (p=0.0215) at six months for dual subjects. FSFI scores increased in the desire domain for placebo and dual groups and in arousal, lubrication, orgasm, satisfaction and pain domains for the HFL group three- and six-months post treatment. An average increase in VLQ score of 1.14 (p=0.0294) was noted at three months and 2.2 (p=0.002) at six months following dual treatment. There was also a mean decrease of 15.3 (p=0.0069) in IIQ-7 score for HFL subjects at three months. Dual, HFL and RF treatments resulted in statistically significant decreases in collagen I, elastin, and lysyl oxidase gene expression.

Conclusions: Several self-reported improvements were noted, particularly among HFL, dual and placebo groups at three and six-months post-treatment. Interestingly, objective biopsy analysis illustrated decreased gene expression, suggesting that treatments did not stimulate new extracellular matrix production.
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http://dx.doi.org/10.1093/asj/sjac202DOI Listing
July 2022

A Video Interview With William B. Adams, Jr., MD.

Aesthet Surg J Open Forum 2022 13;4:ojab053. Epub 2021 Dec 13.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1093/asjof/ojab053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9059525PMC
December 2021

A Correlation of the Glogau Scale With VISIA-CR Complexion Analysis Measurements in Assessing Facial Photoaging for Clinical Research.

Aesthet Surg J 2022 Apr 25. Epub 2022 Apr 25.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Background: Historically, common evaluations for photoaging have been subjective analysis; however, recently, investigators have turned to non-invasive devices for more objective evaluation of facial aging.

Objectives: This study aimed to establish a clinical correlation between the Glogau Photoaging Scale and VISIA-CR Complexion Analysis System. In doing so, decreasing intra- and inter-observer variability when assessing photodamage.

Methods: One-hundred seventeen subjects between ages 18 and 89 were included. 2D facial photographs were analyzed by three independent reviewers and were assigned Glogau scores. Images were also captured and analyzed using VISIA software. Data was grouped by median Glogau score and compared between groups.

Results: All groups were statistically different (p < 0.05) for Spots, Wrinkles and Remasked Wrinkles, except for Glogau 1 and 2 for Spots and Remasked Wrinkles. Wrinkles scores were plotted against age, and an exponential regression model was noted to be a better fit (R 2 = 0.5) compared to a linear model (R 2 = 0.47). The same was true for Spots with an exponential (R 2 = 0.36) compared to linear model (R 2 = 0.33). Scores were also evaluated based on sun exposure history, of which there were no significant differences.

Conclusions: The results illustrate that an imaging system can be used to reliably determine objective scores correlating to Glogau photoaging evaluations. Results also supported that aging more closely resembles an exponential process. Collectively, these findings will prove useful to those hoping to further investigate facial aging and therapeutic options available for facial skin rejuvenation and objectively assessing their outcomes.
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http://dx.doi.org/10.1093/asj/sjac108DOI Listing
April 2022

Efficacy and tolerability of a microneedling device for treating wrinkles on the face.

J Cosmet Dermatol 2022 Apr 11. Epub 2022 Apr 11.

Clinical Center for Cosmetic Laser Treatment and Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.

Objectives: A microneedling pen has been cleared by the US Food and Drug Administration, indicated for improving the appearance of adult facial acne scars. The objective of this study was to assess the device's effectiveness for treating wrinkles of the face area.

Materials And Methods: Healthy adults seeking to improve the appearance of face wrinkles were enrolled (N = 35), receiving four monthly microneedling procedures by a trained aesthetician who treated the face skin per manufacturer instructions. Wrinkle assessments were performed by two trained blinded raters by comparing baseline images of each subject with images obtained at 90 days post-procedure. Subsequently, the two raters were unblinded for the Clinician's Global Aesthetic Improvement Scale (CGAIS) assessment. Subjects completed the Subject's Global Aesthetic Improvement Scale (SGAIS) and a Satisfaction Questionnaire at 30 and 90 days post-treatment.

Results: The study was completed by 32 subjects with a mean (SD) age of 56.3 (5.0) years. Wrinkle assessments demonstrated significant improvement in the face areas (p < 0.001). The SGAIS scores showed significant improvements after 30 and 90 days post-treatment (for each, p < 0.001). The CGAIS scores also showed significant improvements at 90 days post-treatment (p < 0.001). Most subjects reported some level of improvement in their appearance at 30 days (73.3%) and 90 days (68.8%) post-treatment. The satisfaction questionnaire showed high levels of improvement in wrinkles (93.8%), satisfaction with the treatment procedure (87.5%) and would recommend microneedling to friends and family members (80.6%) on the face and neck.

Conclusion: Microneedling is a viable, minimally invasive option for treating wrinkles of the face.

Clinicaltrials: gov Identifier: NCT03803059.
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http://dx.doi.org/10.1111/jocd.14985DOI Listing
April 2022

Lower Lid Blepharoplasty With Lateral Retinacular and Orbicularis Suspension.

Aesthet Surg J Open Forum 2022 3;4:ojab057. Epub 2022 Jan 3.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1093/asjof/ojab057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8874863PMC
January 2022

A Video Interview With Louis Strock, MD.

Aesthet Surg J Open Forum 2022 13;4:ojab054. Epub 2021 Dec 13.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1093/asjof/ojab054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8874899PMC
December 2021

A Single-Center Pilot Study to Classify Signs of Dorsal Hand Aging Using 3 Grading Scales.

Aesthet Surg J Open Forum 2022 17;4:ojab059. Epub 2022 Feb 17.

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

Background: While validated scales must be created in order to systemically evaluate patients and quantify outcomes of aesthetic hand treatments, scales currently available are limited to the analysis of volume loss alone.

Objectives: The purpose of this study was to develop 3 validated scales for the assessment of dorsal hand aging that also take into consideration wrinkling and pigmentation.

Methods: Fifty (50) healthy volunteers (40 females and 10 males) with Fitzpatrick skin types I-IV were recruited, and standard photographs of their left and right dorsal hands were taken with a Nikon D7100 (Nikon; Minato, Tokyo, Japan) camera. Using 25 randomized photographs, 11 plastic surgery physicians (3 chief residents, 6 senior residents, and 2 aesthetic surgery fellows) were trained on the 3 scales under investigation as well as the already-validated Merz Hand Grading Scale (MHGS). The evaluators then viewed the remaining 75 photographs independently and assigned a grade for each of the 4 scales to each photograph. Inter-rater variability was calculated for each scale.

Results: The Kappa score for the MHGS was 0.25, indicating fair agreement; 0.40 for wrinkle scale, indicating fair agreement; and 0.48 and 0.46 for the pigmentation density and intensity scales, respectively, indicating moderate agreement ( < 0.001).

Conclusions: The results show that after receiving training, the inter-rater agreement for the 3 scales under investigation was similar or slightly higher than that for the MHGS. These 3 photographic classification systems can be used consistently and reliably to characterize multiple signs of dorsal hand aging.

Level Of Evidence 2:
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http://dx.doi.org/10.1093/asjof/ojab059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8862723PMC
February 2022

Asystolic Cardiac Arrest Associated With Unstable Bradycardia During Augmentation Mammaplasty: A Case Report.

Aesthet Surg J Open Forum 2022 20;4:ojab047. Epub 2021 Nov 20.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Cardiac arrest is a rare but reported complication during breast augmentation surgery. It is even more rare in a reportedly healthy patient without preexisting cardiac disease. The authors present the case of a healthy 34-year-old female who underwent elective bilateral augmentation mammaplasty and experienced unanticipated asystolic cardiac arrest intraoperatively following general anesthesia supplemented by a regional pectoral (pec I) nerve block. The performing plastic surgeon provided cardiopulmonary resuscitation while the anesthesiologist initiated a rescue protocol per Advanced Cardiac Life Support (ACLS) guidelines. Fortunately, the patient was resuscitated in a timely manner and had a successful return of spontaneous circulation within 1 minute. This case report serves to briefly review the literature and recommendations on proper resuscitation of cardiac arrest per ACLS protocols as well as discuss unstable bradycardia in otherwise healthy patients undergoing breast augmentation surgery. Plastic surgeons and anesthesiologists who perform this procedure should be aware of the possible, rare but serious progression to asystole as well as the proper resuscitative measures to take should they be required.

Level Of Evidence 5:
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http://dx.doi.org/10.1093/asjof/ojab047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8781763PMC
November 2021

The Institutional Review Board: A Discussion of the Importance of Ethical, Evidence-Based Research in Plastic Surgery.

Aesthet Surg J 2022 01;42(2):224-229

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1093/asj/sjab363DOI Listing
January 2022

Breast Implant Illness: An Expert-Panel Discussion on Current Research.

Aesthet Surg J Open Forum 2021 Sep 23;3(3):ojab027. Epub 2021 Jun 23.

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1093/asjof/ojab027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422335PMC
September 2021

Commentary on: Abdominal Laser Lipolysis Using a Microprocessor-Controlled Robotic Arm With Noncontact Heating and Cooling.

Aesthet Surg J 2021 11;41(12):NP1962-NP1964

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1093/asj/sjab282DOI Listing
November 2021

Bipolar Fractional Radiofrequency Treatment of Suprapatellar Skin Assessment Using Noninvasive Devices and Microbiopsy.

Aesthet Surg J 2021 11;41(12):NP1997-NP2008

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

Background: Noninvasive treatments for skin tightening are gaining popularity. However, no studies have assessed bipolar fractional radiofrequency treatment on suprapatellar skin.

Objectives: The purpose of this study was to evaluate the efficacy of bipolar fractional radiofrequency treatment on suprapatellar skin.

Methods: Twenty patients received 1 bilateral suprapatellar bipolar fractional radiofrequency treatment. They returned 7 days, 3 weeks, 3 months, and 6 months posttreatment. Noninvasive measurements were obtained at each visit, including high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and skin elasticity. Microbiopsies were collected in the treatment area for histologic and gene expression analyses. Three clinicians completed photographic evaluations comparing texture and laxity at baseline vs 6 months posttreatment.

Results: Fifteen subjects completed all 6 visits. Both transepidermal water loss and dermal-epidermal junction roughness were increased at 3 weeks and 3 months posttreatment. Both attenuation coefficient and stiffness were increased significantly at 3 and 6 months posttreatment. Blood flow 0.5 mm below the surface and expression of epidermal hyaluronic acid and inflammatory genes IL-1b and IL-6 were significantly higher at 7 days posttreatment compared with pretreatment and 3 months posttreatment. There were no statistically significant changes in collagen- or elastin-related genes and proteins at 7 days or 3 months posttreatment. An improvement in texture and laxity was observed at 6 months posttreatment in 17.7% and 24.4% of photographs, respectively.

Conclusions: Radiofrequency treatment by microneedling of suprapatellar skin shows limited effects in decreasing skin laxity and improving skin appearance. At a molecular level, the treatment resulted in lower elastin and hyaluronic acid levels and increased dermal-epidermal junction roughness based on histology and optical coherence tomography imaging.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjab210DOI Listing
November 2021

Remembering a Plastic Surgery Legend: Stanley Klatsky, MD.

Authors:
Jeffrey M Kenkel

Aesthet Surg J Open Forum 2021 Jan 17;3(1):ojaa047. Epub 2020 Nov 17.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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http://dx.doi.org/10.1093/asjof/ojaa047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954389PMC
January 2021

The Evolution of the My Way Section: From the 1990s to 2020 and Beyond.

Authors:
Jeffrey M Kenkel

Aesthet Surg J Open Forum 2020 Sep 16;2(3):ojaa032. Epub 2020 Jun 16.

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

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http://dx.doi.org/10.1093/asjof/ojaa032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671263PMC
September 2020

An Alternative Treatment of Pseudogynecomastia in Male Patients After Massive Weight Loss.

Aesthet Surg J Open Forum 2020 Jun 16;2(2):ojaa013. Epub 2020 May 16.

Background: There has been an increase in body contouring procedures following massive weight loss (MWL), including male breast reduction procedures. Treating male chest deformity after MWL using standard mastopexy techniques often leads to suboptimal results.

Objectives: The authors describe a technique to treat pseudogynecomastia using a modified elliptical excision and nipple-areola complex (NAC) transposition on a thinned inferior dermal pedicle as an alternative to conventional techniques.

Methods: A retrospective chart review from January 2011 to January 2019 identified a total of 14 male patients who underwent excision of pseudogynecomastia using the described technique.

Results: Patients were characterized by age, method of weight loss, pre-weight loss body mass index (BMI), post-weight loss BMI, total weight loss, grade of pseudogynecomastia, and concurrent procedures performed. Patients were followed for a period ranging from 3 months to 1.5 years (average, 8.1 months). Pre-weight loss BMI and post-weight loss BMI averaged 52.0 kg/m and 29.6 kg/m, respectively. The average weight lost was 79.72 kg and the average total amount of tissue removed was 2615 g. All patients had concurrent procedures with an average operative time of 274 minutes. Four out of 14 patients (28.6%) experienced minor complications, which included asymmetry, delayed wound healing, seroma, and hyperpigmentation. There were no wound infections, hematomas, flap necrosis, or dysesthesia.

Conclusions: Due to several cosmetic advantages and low complication profile, our technique using a modified elliptical excision and NAC transfer on an inferior dermal pedicle is an attractive option for treating male chest deformity after MWL.

Level Of Evidence 4:
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http://dx.doi.org/10.1093/asjof/ojaa013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780471PMC
June 2020

Accelerating Education During COVID-19 Through Virtual Learning.

Aesthet Surg J Open Forum 2020 Jun 21;2(2):ojaa023. Epub 2020 May 21.

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

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http://dx.doi.org/10.1093/asjof/ojaa023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314143PMC
June 2020

Why Cosmetic Surgery Is Not Better Represented in Top-Cited Plastic Surgery Articles of the Last 50 Years.

Plast Reconstr Surg 2021 04;147(4):699e-700e

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

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http://dx.doi.org/10.1097/PRS.0000000000007720DOI Listing
April 2021

Clinical Evaluation of the Safety and Efficacy of a 1060-nm Diode Laser for Non-Invasive Fat Reduction of the Abdomen.

Aesthet Surg J 2021 09;41(10):1155-1165

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

Background: Despite the proven efficacy of liposuction, there is a population of patients who prefer non-surgical alternatives. Laser hyperthermia-induced lipolysis has emerged as one non-invasive alternative to liposuction.

Objectives: The authors sought to evaluate the safety and efficacy of a 1060-nm (±10 nm) diode laser for non-invasive fat reduction of the abdomen.

Methods: This single-arm, 2-center study enrolled 30 patients. Patients received a 25-minute 1060-nm diode laser treatment on their abdomen. Ultrasound adipose measurements, body weight, and circumference were taken at baseline and at 6- and 12-week follow-up visits. Blinded evaluators identified "before" and "after" photos of each patient. A patient satisfaction questionnaire was completed by each patient at study exit.

Results: A total 29 patients completed all treatment and follow-up visits. Ultrasound images showed an adipose reduction of 8.55% at 12 weeks post-treatment (P < 0.0001). Blinded evaluators correctly identified 67% of the pre- and post-treatment images at site 01 (Sacramento, CA) and 56% at site 02 (Dallas, TX). Satisfaction was high, with 72% of patients reporting being either "satisfied" or "very satisfied" with their results on a 5-point Likert scale. Pain was rated as mild by 62% of patients, moderate by 38%, and severe by none on the Wong-Baker Scale.

Conclusions: These results indicate that a single treatment with a 1060-nm (±10 nm) diode laser, per the treatment protocol, is safe and effective in reducing unwanted fat in the abdomen as objectively measured employing ultrasound. The treatment was well-tolerated among all patients, with minimal discomfort reported and high patient satisfaction.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjaa418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438592PMC
September 2021

The Role of the Laser Safety Officer and Laser Safety Programs in Clinical Practice.

Aesthet Surg J 2021 10;41(11):NP1550-NP1554

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

Recent advancements in laser technology have led to its expanded utilization in smaller clinical settings and medical spas, particularly for facial rejuvenation and the treatment of other aesthetic concerns. Despite the increasing popularity of this technology, discussion of laser safety programs has remained limited, mostly to operating rooms at larger clinical institutions. Although smaller facilities do not operate at the same capacity as a large hospital or medical center, the requirements for utilizing a laser are no less stringent. Employers must comply with local and federal regulations, the Occupational Safety and Health Administration (OSHA) General Duty Clause, American National Standards Institute (ANSI) standards, and professional recommended practices applicable to their business. Although the laser safety officer (LSO) is often a full-time position within larger facilities, smaller clinical settings and medical spas may be limited in staff number. It is important, therefore, that clinical practices establish laser policies and procedures with consideration of their individual needs and capabilities. In this paper, we will define a laser safety program, highlight basic requirements needed to establish this program, and outline the specific responsibilities of the LSO. To ensure that safe laser practices are being conducted at the healthcare facility, it is imperative that small business owners are aware of these regulations and standards in place for the operation of laser systems.
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http://dx.doi.org/10.1093/asj/sjaa239DOI Listing
October 2021

Laser and Light-Based Device Education in a Plastic Surgery Residency Program: A Continuing Medical Education Overview.

Aesthet Surg J 2021 06;41(7):NP973-NP985

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

The increasing prevalence of laser use, particularly in plastic surgery, demands education of both practitioners and trainees to ensure efficacy and patient safety. The purpose of this continuing medical education module is to provide the learner with a detailed outline for laser training education for plastic surgery trainees. In this overview, a discussion of the characteristics of light, an introduction to fundamental laser principles, a comparison of lasers and pulsed light systems, and examples of several therapeutic applications for light-based devices in the clinical setting will be presented. Additionally, the 5 parameters necessary for operation of light-based devices, as well as the importance of laser safety education, will be reviewed. We hope this continuing medical education will provide both practicing plastic surgeons and trainees with the proper education on the lasers and pulsed light devices they will use in their clinical practices.
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http://dx.doi.org/10.1093/asj/sjab042DOI Listing
June 2021

The Effects of Aesthetic Lasers on Three Study Materials Used for Ocular Protection.

Aesthet Surg J 2021 11;41(12):NP1965-NP1971

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

Background: It is dangerous, although not uncommon, in some clinical settings for laser operators to place gauze underneath external patient protective eyewear when performing laser procedures.

Objectives: The purpose of this study was to evaluate 4 lasers, commonly used for aesthetic facial procedures, on 3 materials commonly found in the clinical setting.

Methods: We performed tests with 4 lasers: the 2940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser, the 532-nm potassium titanyl phosphate (KTP) laser, the 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, and a Lumenis UltraPulse 10,600-nm carbon dioxide (CO2) laser. Their effects were evaluated on dry gauze pads, wet gauze pads, and adhesive external eye shields.

Results: When exposed to the 2940-nm Er:YAG and 10,600-nm CO2 lasers, dry gauze smoked on the first pulse and ignited on the second pulse, whereas no damage occurred to the wet gauze or adhesive eye shields after 8 and 4 pulses, respectively. No damage to any material or the underlying surface was seen after 30 pulses of the 532-nm KTP laser. After 2 pulses of the 1064-nm Nd:YAG laser, the adhesive eye shields sparked; dry gauze smoked after 1 pulse, but no damage to the underlying surface occurred after 30 pulses.

Conclusions: The results of our study highlight the inherent flammability of gauze when exposed to lasers commonly used to address aesthetic facial concerns. Although moistened gauze conveyed more protection than dry gauze, these results do not guarantee patient ocular safety. Therefore, we do not recommend the use of any gauze under protective eyewear.
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http://dx.doi.org/10.1093/asj/sjaa319DOI Listing
November 2021

Three-dimensional (3D) synthetic printing for the manufacture of non-biodegradable models, tools and implants used in surgery: a review of current methods.

J Med Eng Technol 2021 Jan 20;45(1):14-21. Epub 2020 Nov 20.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

The advent of three-dimensional (3D) printing in the 1980s ushered in a new era of manufacturing. Original 3D printers were large, expensive and difficult to operate, but recent advances in 3D printer technologies have drastically increased the accessibility of these machines such that individual surgical departments can now afford their own 3D printers. As adoption of 3D printing technology has increased within the medical industry so too has the number of 3D printable materials. Selection of the appropriate printer and material for a given application can be a daunting task for any clinician. This review seeks to describe the benefits and drawbacks of different 3D printing technologies and the materials used therein. Commercially available printers using fused deposition modelling or fused filament fabrication technology and relatively inexpensive thermoplastic materials have enabled rapid manufacture of anatomic models and intraoperative tools as well as implant prototyping. Titanium alloys remain the gold-standard material for various implants used in the fixation of craniofacial or extremity fractures, but polymers and ceramics are showing increasing promise for these types of applications. An understanding of these materials and their compatibility with various 3D printers is essential for application of this technology in a healthcare setting.
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http://dx.doi.org/10.1080/03091902.2020.1838643DOI Listing
January 2021

Turning 25: A Retrospective and a Look to the Future.

Aesthet Surg J 2021 01;41(1):133-136

Professor and Chair, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

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http://dx.doi.org/10.1093/asj/sjaa270DOI Listing
January 2021

The Value of Integrating Fluorescent Imaging and Immunohistochemistry for Future Anatomical Studies in Aesthetic Surgery: Lessons From the Cerebrospinal Fluid Circulatory System of Human Nerves and Brain.

Aesthet Surg J 2021 09;41(10):1197-1206

Department of Microbiology and Medical Genetics, University of Florida College of Medicine, Gainesville, FL.

Background: During their work on the cerebrospinal fluid (CSF) circulatory system of human nerves and brain, the authors applied imaging and tissue techniques that complemented basic anatomical dissection.

Objectives: The authors sought to show how integrating fluorescent imaging and basic immunohistochemistry (IHC) with facial anatomy can address current problems in aesthetic surgery.

Methods: The authors developed an algorithm and a set of principles from their work on the CSF circulatory system and applied these to 3 problems in aesthetic surgery: the functional anatomy of the vermilion-cutaneous junction; chemosis; and the functional anatomy of periosteal fixation.

Results: Integrating fluorescent imaging and IHC with anatomical dissection characterizes structural and functional anatomy. Fluorescent imaging helps to identify and locate easily missed structures. IHC defines cell type and function. The vermilion-cutaneous junction is defined by a major lymphatic vessel. Lymphatic flow from the medial limbus to the lateral canthus suggests the etiology of chemosis. Periosteal sites of fixation prevent shear where dural CSF vessels drain directly to subcutaneous lymphatics.

Conclusions: Integrating anatomical dissection with fluorescent imaging and basic IHC characterizes structural and functional anatomy and helps to better understand many problems encountered in aesthetic surgery.
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http://dx.doi.org/10.1093/asj/sjaa247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438645PMC
September 2021

Safety Guidelines Concerning the Use of Protective Eyewear and Gauze During Laser Procedures.

Aesthet Surg J 2021 09;41(10):1179-1185

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

The advancement of laser technology has seen its use gain popularity across a wide range of specialties to treat diseases, as well as address aesthetic concerns. In order to protect both the patient and the healthcare personnel providing treatment, instruction and knowledge of laser safety remain of utmost importance. In this paper, we discuss the classification of laser systems, review ocular injuries that may be caused by inappropriate laser exposure, and provide background on laser protective eyewear. In addition, we highlight the current recommendations for proper eyewear during laser use outlined in the American National Standards Institute standard Z136.3, Safe Use of Lasers in Health Care. Finally, although it is common in some healthcare facilities to place gauze under external eye shields or use gauze alone over eyes during laser procedures, this practice poses an extreme risk to both patients and healthcare personnel. Therefore, we discuss why the use of gauze under eyewear for any laser procedures is not recommended, and instead, offer suggestions to consider when acquiring safe and comfortable patient eyewear.
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http://dx.doi.org/10.1093/asj/sjaa233DOI Listing
September 2021

Trends and Challenges of Telehealth in an Academic Institution: The Unforeseen Benefits of the COVID-19 Global Pandemic.

Aesthet Surg J 2021 01;41(1):109-118

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

The COVID-19 pandemic has necessitated a reorganization of healthcare delivery, shedding light on the many unrealized advantages telehealth has to offer. In addition to facilitating social distancing, minimizing the risk of pathogen exposure, and preserving healthcare resources, there are many benefits of utilizing this platform that can extend beyond the current pandemic, which will change the way healthcare is delivered for generations to come. With the rapid expansion of telehealth, we present data from our high-volume academic institution's telehealth efforts, with a more focused analysis of plastic surgery. Although state legislation regarding telehealth varies greatly, we discuss challenges such as legal issues, logistical constraints, privacy concerns, and billing. We also discuss various advantages and the future direction of telehealth not only for plastic surgery but also its general utilization for the future of medicine in the United States.
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http://dx.doi.org/10.1093/asj/sjaa212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543904PMC
January 2021

Commentary on: Ultrasound to Improve the Safety and Efficacy of Lipofilling of the Temples.

Aesthet Surg J 2021 04;41(5):613-615

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1093/asj/sjaa095DOI Listing
April 2021

Accelerating Education During COVID-19 Through Virtual Learning.

Aesthet Surg J 2020 08;40(9):1040-1041

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

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http://dx.doi.org/10.1093/asj/sjaa123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314220PMC
August 2020

Commentary on: Cell-Free Fat Extract Increases Dermal Thickness by Enhancing Angiogenesis and Extracellular Matrix Production in Nude Mice.

Aesthet Surg J 2020 07;40(8):914-916

Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX.

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http://dx.doi.org/10.1093/asj/sjaa001DOI Listing
July 2020
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