Publications by authors named "Julius W Few"

25 Publications

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Commentary on: Enhancing the Lateral Orbital "C-Angle" With Calcium Hydroxylapatite: An Anatomic and Clinical Study.

Authors:
Julius W Few

Aesthet Surg J 2020 Oct 31. Epub 2020 Oct 31.

University of Chicago Pritzker School of Medicine, Chicago, IL.

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http://dx.doi.org/10.1093/asj/sjaa263DOI Listing
October 2020

Alar Cinching with Subcutaneous Flaps: A Procedure to Achieve Narrowing of the Nasal Base While Controlling the Alar Axis and Sidewall Curvature.

Plast Reconstr Surg 2019 12;144(6):1107e-1108e

Division of Plastic Surgery, University of Chicago Pritzker School of Medicine, The Few Institute of Aesthetic Plastic Surgery, Chicago, Ill.

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http://dx.doi.org/10.1097/PRS.0000000000006246DOI Listing
December 2019

Practical Guidance for Optimizing Patient Comfort During Microfocused Ultrasound with Visualization and Improving Patient Satisfaction.

Aesthet Surg J 2020 01;40(2):208-216

aesthetic nurse specialist in private practice in Chicago, IL.

Background: Microfocused ultrasound with visualization (MFU-V; Ultherapy®) is an effective method for correction of skin laxity through lifting and tightening skin on the face, neck, and décolleté as well as on other parts of the body such as the knees, arms, and abdomen. In addition to being a noninvasive modality for tissue tightening, MFU-V has a biological effect on tissue, rejuvenating the skin through stimulation of elastogenesis and neocollagenesis. MFU-V is also commonly combined with other interventions such as fillers, neuromodulators, and absorbable suspension sutures.

Objectives: The aim of this study was to share the extensive experience of the authors in optimizing comfort for their MFU-V patients in order to provide guidance to the broader community surrounding optimal patient comfort with this procedure.

Methods: The authors discuss their approaches to patient comfort and satisfaction. Elements of each approach include patient selection, pharmacologic and nonpharmacologic comfort measures, and how prioritization of patient comfort affects both their individual patients and practices.

Results: The authors share their approaches for optimizing patient comfort during the procedure and provide an overview of both pharmacologic and nonpharmacologic measures that can be adopted to support patient comfort and satisfaction. The similarities and differences of each approach are discussed.

Conclusions: In addition to diligent patient selection, the authors find that attention to patient comfort is directly related to satisfaction and appears to be a primary factor in patients' decisions to return for additional treatments.
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http://dx.doi.org/10.1093/asj/sjz079DOI Listing
January 2020

Impact of Botulinum Toxin Type A Treatment of the Glabella and Crow's Feet on Static Forehead Rhytides.

Dermatol Surg 2019 01;45(1):167-169

The Few Institute for Aesthetic Plastic Surgery, Chicago, Illinois.

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http://dx.doi.org/10.1097/DSS.0000000000001512DOI Listing
January 2019

Commentary on: Gummy Smile Treatment: Proposal for a Novel Corrective Technique and a Review of the Literature.

Authors:
Julius W Few

Aesthet Surg J 2018 11;38(12):1339-1340

Division of Plastic and Reconstructive Surgery, The University of Chicago, Chicago, IL.

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http://dx.doi.org/10.1093/asj/sjy220DOI Listing
November 2018

Extended Transconjunctival Lower Eyelid Blepharoplasty with Release of the Tear Trough Ligament and Fat Redistribution.

Plast Reconstr Surg 2018 03;141(3):445e-446e

The Few Institute for Aesthetic Plastic Surgery, Chicago, Ill.

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http://dx.doi.org/10.1097/PRS.0000000000004139DOI Listing
March 2018

Does the Eyebrow Sag with Aging? An Anthropometric Study of 95 Caucasians from 20 to 79 Years of Age.

Plast Reconstr Surg 2016 11;138(5):941e

Section of Plastic and Reconstructive Surgery University of Chicago Medicine Chicago, Ill.

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http://dx.doi.org/10.1097/PRS.0000000000002708DOI Listing
November 2016

Commentary on: Micro-Needling Depth Penetration, Presence of Pigment Particles, and Fluorescein-Stained Platelets: Clinical Usage for Aesthetic Concerns.

Aesthet Surg J 2017 01 16;37(1):84-85. Epub 2016 Aug 16.

Dr Few is a Clinical Professor of Surgery, School of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Mr Semersky is a pre-medical student, University of North Carolina, Chapel Hill, NC.

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http://dx.doi.org/10.1093/asj/sjw133DOI Listing
January 2017

Advancing the Care of Post-Acne Scarring: Expert Insights Into New Treatment Options.

J Drugs Dermatol 2016 May;15(5):518-25

Most patients with acne have some degree of facial scarring even after their acne resolves, extending the period of psychosocial distress. Unfortunately, management of acne scars remains challenging. Many treatments for post-acne scarring including chemical peels, skin needling, laser resurfacing, surgical repair, subcision lifting, and punch elevation lifting, are limited by moderate and unpredictable results, significant morbidity, and substantial patient investments in time and money. The most recent addition to the armamentarium is tissue augmentation with soft tissue fillers, including a recently approved polymethylmethacrylate-collagen filler. Matching individual patient needs to the appropriate treatment is crucial. While many patients with acne scars have unrealistic expectations about treatment outcomes, open, honest, and realistic dialogue regarding their treatment options and concerns can facilitate realistic expectations. This article is based on a consensus discussion by the authors, who all have experience managing post-acne scarring, as well as the content of a series of live CME-accredited symposia in connection with major dermatology meetings.

J Drugs Dermatol. 2016;15(5):518-525.
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May 2016

Facial Aesthetic Surgery: The Safe Use of Oral Sedation in an Office-Based Facility.

Aesthet Surg J 2016 Feb 7;36(2):127-31. Epub 2015 Oct 7.

Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois.

Background: The desire for efficient and safe office-based facial plastic surgery procedures has continued to rise. Oral sedation is a safe and effective method to provide anesthesia for facial aesthetic surgery.

Objectives: This study reviewed private practice anesthesia-related outcomes using oral sedation combined with local anesthesia for office-based facial aesthetic surgery procedures.

Methods: A retrospective chart review was performed on all patients who underwent office-based facial plastic surgery procedures from July 2008 to July 2014. Patient demographic data including age, gender, body mass index (BMI), past medical history, social history, surgical history, allergies, and medications were collected. Anesthesia-related data were also collected including: American Society of Anesthesia (ASA) class, type of procedure, medications administered, and major complications related to sedation were assessed.

Results: There were 199 patients (23 males and 176 females) who underwent 283 facial aesthetic surgical procedures. Mean age was 49.8 years (range, 29 to 80 years). There were 195 patients in ASA class I and 4 patients were in ASA class II. Patients underwent 44 upper blepharoplasty procedures, 35 lower blepharoplasty procedures, 5 browlifts, 43 upper blepharoplasty-browpexy, 46 facelifts, 38 neck lifts/lower facelifts, 54 fat grafting, 3 tip rhinoplasties, and 15 minor revision cases. During the study period, there were no major complications and no sedation issues.

Conclusions: Facial aesthetic surgical procedures can be performed safely and comfortably in the office-based setting under oral sedation in appropriately selected patients. LEVEL OF EVIDENCE 4: Therapeutic.
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http://dx.doi.org/10.1093/asj/sjv200DOI Listing
February 2016

A novel, multistep, combination facial rejuvenation procedure for treatment of the whole face with incobotulinumtoxinA, and two dermal fillers- calcium hydroxylapatite and a monophasic, polydensified hyaluronic acid filler.

J Drugs Dermatol 2013 Sep;12(9):978-84

Facial aging is a three-dimensional process, and facial rejuvenation procedures intended to reverse the effects of aging need to address this by combining products that relax hyperkinetic musculature, volumize/fill, and recontour/lift the whole face. In line with the desire of patients to achieve an overall youthful facial appearance, we report for the first time three cases where patients have been successfully treated across the whole face with a novel, three-step approach, layering incobotulinumtoxinA and two dermal fillers (calcium hydroxylapatite and a monophasic hyaluronic acid filler with CPM Technology) injected at three separate treatment visits. The results suggest that this layering approach based on an understanding of the underlying causes of facial aging, where different products are used in combination to treat the entire face, can enable patients to achieve the desired outcome of a return to the characteristics of a more youthful face.
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September 2013

Current aesthetic use of abobotulinumtoxinA in clinical practice: an evidence-based consensus review.

Aesthet Surg J 2012 Sep;32(1 Suppl):8S-29S

University of California-San Francisco, CA 94115, USA.

The amount and complexity of scientific and clinical evidence for aesthetic use of botulinum neurotoxin type A (BoNT-A) has expanded rapidly in recent years, especially for abobotulinumtoxinA, necessitating reassessment of current knowledge about aesthetic use of abobotulinumtoxinA and other BoNT-A preparations. A committee of 13 plastic surgeons, facial plastic surgeons, and dermatologists engaged in a live discussion of information from a systematic literature review and an Internet-based survey of their beliefs and practices. The committee achieved consensus on most issues. It was concluded that doses of different BoNT-A preparations cannot be interconverted with a fixed ratio. The size of the "field of effect" is difficult to measure, and comparisons between preparations have yielded equivocal results. Nonresponse due to neutralizing antibodies appears exceedingly rare with currently available BoNT-A preparations and of little concern clinically. BoNT-A dose, injection depth, and injection technique should be adjusted according to the anatomic area being treated and each patient's individual characteristics and goals. Aesthetic use of BoNT-A has a good safety profile. Most adverse events are minor and related to the trauma of injection, although special care is needed in certain anatomic areas. Detailed recommendations for treatment of different anatomic areas are presented. BoNT-A products are often used in conjunction with other treatment modalities (eg, fillers and resurfacing), but little agreement was reached on best practices. The findings reported in this consensus document may serve as a practical guide for aesthetic practitioners as they apply the latest knowledge about BoNT-A in providing their patients with optimal care.
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http://dx.doi.org/10.1177/1090820X12455192DOI Listing
September 2012

The transconjunctival deep-plane midface lift: a 9-year experience working under the muscle.

Aesthet Surg J 2012 Aug;32(6):692-9

Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA.

Background: Rejuvenation of the midface with a natural-looking, safe, and long-lasting result is a challenge in aesthetic surgery. The ideal approach should be easy to perform, with minimal risk and significant benefit. The combination of transconjunctival exposure and preservation of the periosteum may result in lower morbidity than traditional midface rejuvenation.

Objectives: The authors present their 9-year experience with the transconjunctival deep-plane midface lift (TDML) and discuss the benefits and limitations of this procedure relative to traditional approaches.

Methods: A retrospective review (2000-2009) was conducted of 124 consecutive patients treated by the same surgeon (JWF) with the TDML approach. The technique combines transconjunctival and preperiosteal dissection under direct vision. Collected data included patient demographics, operative technique, concomitant procedures, and postoperative results. Complications and revisions were reviewed to assess safety and long-term efficacy.

Results: Patients included 97 women and 27 men, with a minimum of 13 months of postoperative follow-up (median, 56 months). The mean operating time for upper blepharoplasty with TDML was less than 150 minutes. No significant complications occurred. One patient required reexcision of redundant lower eyelid skin, and another patient underwent secondary excision via traditional midface lift.

Conclusions: The TDML procedure is safe and effective. The technique is readily applicable and more "forgiving" than the traditional midface lift. With proper patient selection, the limited soft-tissue dissection reduces surgical morbidity. Patients with excessive skin redundancy or festoons should be treated with more traditional techniques.
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http://dx.doi.org/10.1177/1090820X12452292DOI Listing
August 2012

Rejuvenation of the african american periorbital area: dynamic considerations.

Authors:
Julius W Few

Semin Plast Surg 2009 Aug;23(3):198-206

The Few Institute for Aesthetic Plastic Surgery, Chicago, Illinois.

The rejuvenation of the African American periorbit is rooted in select modifications of traditional techniques. The African American patient presents with dynamic considerations and needs. Whereas this subset is at risk for pigmentation and scar concerns, the natural resistance to actinic damage makes rejuvenation efforts rewarding. We will review the composite that makes up the periorbit, the brow, upper eyelid, lower eyelid/lateral canthus, and the midface unique. Specific indications and presurgical and postsurgical considerations will be presented in addition to technical considerations to manage periorbital aging that spares the skin. Common pitfalls and succinct ways to avoid them without compromising on the ultimate end result will be presented. Ultimately, periorbital rejuvenation can be done completely without jeopardizing one's ethnic identity.
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http://dx.doi.org/10.1055/s-0029-1224799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884926PMC
August 2009

Eyebrow and eyelid dimensions: an anthropometric analysis of African Americans and Caucasians.

Plast Reconstr Surg 2010 Apr;125(4):1293-1294

Section of Plastic Surgery University of Chicago Medical Center, Chicago, Ill.

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http://dx.doi.org/10.1097/PRS.0b013e3181d45adbDOI Listing
April 2010

Periorbital aging and ethnic considerations: a focus on the lateral canthal complex.

Plast Reconstr Surg 2008 Mar;121(3):1002-1008

Chicago Ill. From the Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University.

Background: There is a general perception that skin from various ethnic groups possesses different properties that may affect barrier function, responsiveness to topical agents, sebum production, chemical sensitivities, and aging changes. The first noticeable signs of facial aging are frequently localized to the upper face, brow, and eyes. The authors postulate that a greater relative descent of the lateral canthal complex in African Americans contributes to periorbital aging more so than in Caucasians.

Methods: The photographic archives of the senior plastic surgeon (J.W.F.) were reviewed. Two hundred ninety-six cases met inclusion criteria. Lateral canthal angles were measured, and the angle assigned to each patient was an average of the right and left lateral canthal angles.

Results: Statistically significant intrarace differences were found for the lateral canthal angle. The median lateral canthal angle for African American patients decreased from 3.00 degrees for those aged 45 years or younger to 1.15 degrees for African American patients older than 45 years (p = 0.03). The median lateral canthal angle for Caucasian patients decreased from 2.30 degrees for those aged 45 years or younger to 1.30 degrees for Caucasian patients older than 45 years (p = 0.00). When the data were age-matched, with 25 subjects in each group, the differences increased.

Conclusions: In comparing young and aged cohorts, African American women demonstrate a more dramatic attenuation of the lateral canthal complex than their Caucasian counterparts. It appears that the lateral canthal complex has been underappreciated, and it is a vital component to periorbital rejuvenation.
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http://dx.doi.org/10.1097/01.prs.0000299381.40232.79DOI Listing
March 2008

Modern endovascular and aesthetic surgery techniques to treat arteriovenous malformations of the scalp: case illustration.

Surg Neurol 2008 Aug 4;70(2):198-203; discussion 203. Epub 2008 Mar 4.

Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.

Background: Arteriovenous malformations of the scalp consist of abnormally connecting arterial feeding vessels and draining veins, devoid of a normal capillary bed within the subcutaneous fatty layer of the scalp. We present a case of a left temporal scalp AVM treated for aesthetic and pain-related concerns. A multidisciplinary approach combining endovascular AVM embolization and AVM excision with local flap reconstruction was chosen.

Case Description: The patient presented with a progressive painful pulsatile mass in the left temporal region. On examination, there was no evidence of any facial nerve compromise or any other neurologic deficits. Computed tomographic angiography revealed a 6-mm lesion located totally within the scalp and not associated with bone or periosteum. A recommendation was made to proceed with preoperative embolization to facilitate surgical resection. The AVM was occluded endovascularly using multiple detachable platinum coils, and the patient was neurologically intact. The following day, the patient was taken to the operating room. By that time, the mass was minimally pulsatile. The AVM was resected en bloc, and a 3-layered intermediate closure of the 5.5-cm defect was then performed. The procedure was well tolerated, and the patient had an uneventful postoperative course.

Conclusions: Scalp AVMs are interesting lesions with heterogeneous anatomical features. Treatment can be optimized in a multidisciplinary environment, using a prescribed treatment algorithm to minimize the size of soft/hard tissue defect and enhance cosmesis. Careful selection of therapeutic modalities based on AVM anatomy and aesthetic concerns can lead to safe and durable results with high patient satisfaction rates.
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http://dx.doi.org/10.1016/j.surneu.2007.04.016DOI Listing
August 2008

Restylane and people of color.

Plast Reconstr Surg 2007 Dec;120(7):2011-2016

Chicago, Ill. From the Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, and the Section of Plastic and Reconstructive Surgery, Pritzker School of Medicine, University of Chicago.

Background: Ethnic skin presents a unique paradox. Its melanin content provides protection from the sun, but the same skin can react to the slightest of injuries. The safety of Restylane in patients with increased susceptibility to keloid formation, hypertrophic scarring, hypersensitivity, and hyperpigmentation has not been studied. A retrospective review was used to determine whether Fitzpatrick skin types IV to VI are associated with an increased incidence of adverse outcomes related to Restylane use.

Methods: Sixty consecutive patients were injected with Restylane by a single surgeon (J.W.F.). Forty patients were categorized as Fitzpatrick skin types I to III and 20 as types IV to VI. Patient charts were reviewed for transient and permanent adverse outcomes related to Restylane injections, such as hypersensitivity, scar formation, altered pigmentation, and contour irregularities. All patients were evaluated at 2 to 4 weeks and 6 to 9 months.

Results: The authors observed that 97.50 percent of the Fitzpatrick type I to III patients had no transient adverse outcomes related to Restylane injections. One patient experienced a 36-hour episode of exaggerated angioedema of the lips after injection, which resolved spontaneously. Another patient had an inclusion cyst that required incision and drainage and a 7-day course of antibiotics. None of the type I to III patients had permanent adverse outcomes related to Restylane. There were no transient or permanent adverse outcomes among the type IV to VI subjects.

Conclusions: This study demonstrates that with proper and meticulous injection techniques, patients with Fitzpatrick skin types IV to VI can experience the same benefits of Restylane therapy as their lighter-complected counterparts.
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http://dx.doi.org/10.1097/01.prs.0000287330.94038.63DOI Listing
December 2007

Periorbital rejuvenation and the African American patient: a survey approach.

Plast Reconstr Surg 2006 Sep;118(4):1011-1018

Chicago, Ill. From the Division of Plastic Surgery, Northwestern University Feinberg School of Medicine.

Background: The number of African Americans pursuing cosmetic plastic surgery is increasing. Nonetheless, the authors postulate that the African American patients pursuing certain cosmetic procedures still have preconceived notions and concerns distinct from their Caucasian counterparts, thereby demanding a different surgical strategy. A questionnaire approach was used to determine the concerns, expectations, and desires of African American patients regarding periorbital rejuvenation and to compare these outcomes with those of Caucasian patients.

Methods: One hundred five African American female subjects and 30 Caucasian female subjects affiliated with the senior surgeon's cosmetic practice were contacted. Of these, 85 African American and 26 Caucasian subjects were administered a survey of 18 standardized questions. Patients were stratified in terms of age and race to dissect generational and ethnologic concepts toward oculoplastic surgery and features of the African American eyelid. The Caucasian subjects served as the control group.

Results: Of the African American subjects, 85.9 percent had a favorable or neutral opinion of plastic surgery, and 72.9 percent did not feel plastic surgery was exclusively for Caucasians. Nearly half of all African American subjects interviewed likened African American periorbital characteristics to those of Asians, whereas only 19.2 percent of Caucasian subjects acknowledged such similarities in African Americans.

Conclusions: This study demonstrates the idea that a directed approach to blepharoplasty is necessary to help African American patients achieve their desire to maintain their ethnic identity while rejuvenating their appearance.
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http://dx.doi.org/10.1097/01.prs.0000232223.62913.7fDOI Listing
September 2006

Anterior thoracic spine reconstruction using a titanium mesh cage and pedicled rib flap.

Spine (Phila Pa 1976) 2006 Jul;31(16):1820-7

Department of Neurological Surgery and Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, McGaw Medical Center, Northwestern University, Chicago, IL 60611, USA.

Study Design: A retrospective clinical study.

Objectives: To evaluate the safety and efficacy of using an integrated titanium mesh cage and pedicled rib flap for thoracic spine reconstruction in patients at high risk of pseudarthrosis.

Summary Of Background Data: A variety of materials are available for interbody thoracic reconstruction; however, the optimal treatment of patients at high risk of pseudarthrosis remains a challenging problem. Free or pedicled bone flaps have been shown to be highly effective in terms of promoting fusion and titanium mesh cages provide excellent structural support.

Methods: Eleven patients who underwent anterior thoracic corpectomy and spinal reconstruction using an integrated titanium mesh cage and pedicled rib flap were analyzed with a mean follow-up of 37 months (range, 25-55 months). The etiology of spinal disease was infection in 7 (64%) patients and tumor in the remaining 4 (36%) patients. Seven (64%) patients were treated with only an anterior approach while the remaining 4 (36%) patients underwent circumferential spinal reconstruction.

Results: All patients demonstrated clinical and radiographic evidence of spinal fusion at the time of follow-up. All patients had stable or improved Frankel grades after surgery. There was a mean kyphosis correction of 7 degrees for both the focal and regional thoracic kyphosis. There were three significant postoperative complications: bilateral pleural effusion, gram-negative bacteremia, and transient right lower extremity weakness requiring reoperation and pedicle screw revision. Two patients died after surgery: one from aneurysmal subarachnoid hemorrhage and the other from complications of breast cancer.

Conclusions: The use of an integrated rib flap and titanium mesh cage construct appears to be a safe and effective means of providing immediate and substantial anterior column support as well as achieving arthrodesis in challenging fusion candidates.
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http://dx.doi.org/10.1097/01.brs.0000226017.28265.a6DOI Listing
July 2006

Revisiting upper eyelid anatomy: introduction of the septal extension.

Plast Reconstr Surg 2006 Jan;117(1):65-6; discussion 71-2

Division of Plastic Surgery, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Background: The current trend in plastic surgery of the eyelid has taken on increased dependence on anatomical considerations in the marriage of aesthetic and functional ideals. Often, the plastic surgeon performs ptosis and/or septal surgery in conjunction with blepharoplasty. The relationship between eyelid adnexal structures and upper eyelid function is a delicate but critical one. Current anatomical description states that the septum does not reach the superior tarsal border and inserts at a variable level on the levator aponeurosis. Conflicting observations in clinical practice stimulated this study to delineate the septal relationship to surrounding structures. In addition, this study may help to explain the increased rate of recurrence in ptosis repairs that incorporate plication techniques.

Methods: Dissection of four fresh cadaveric upper lid specimens in situ along with hematoxylin and eosin and trichrome stains of harvested eyelid tissue were used to redefine septal anatomy. Clinical case correlations are made to illustrate the significance of the histologic findings.

Results: A distinct septal extension was demonstrated arising from the orbital septum and covering preaponeurotic fat and tarsus completely. Histology of the anterior lamellae confirmed the presence of this thin fibrous sheet. In vivo assessment of this structure verifies its dynamic role in upper lid function. The clinical ramifications of this anatomical nuance are realized.

Conclusions: A septal extension to the ciliary margin of the upper eyelid is established. Suture plication of the septal extension can induce lid elevation, with potential postoperative lid retraction. Intraoperative failure to recognize and distinguish this extension from the aponeurosis proper may lead to the high reported rates of unsuccessful ptosis correction. This refinement of septal anatomy should increase precision and help surgeons avoid complications in advanced blepharoplasty and ptosis surgery.
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http://dx.doi.org/10.1097/01.prs.0000194923.99879.90DOI Listing
January 2006

The use of biosynthetic skin substitute (Biobrane) for axillary reconstruction after surgical excision for hidradenitis suppurativa.

Plast Reconstr Surg 2005 Apr;115(5):1385-8

Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611-2923, USA.

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http://dx.doi.org/10.1097/01.prs.0000157013.40191.91DOI Listing
April 2005

Simultaneous reconstruction of the breast and empyema defect using a delayed TRAM flap and tissue expansion.

Plast Reconstr Surg 2004 Oct;114(5):1198-203

Department of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.

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http://dx.doi.org/10.1097/01.prs.0000135875.08299.afDOI Listing
October 2004

Plastic surgery: a component in the comprehensive care of cancer patients.

Oncology (Williston Park) 2002 Dec;16(12):1685-98; discussion 1698, 1702-5, 1708

Division of Plastic and Reconstructive Surgery, Northwestern University Medical School, Chicago, Illinois, USA.

Plastic surgery represents a small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more radically treat cancer, offering patients the best opportunity for cure. Although the most convincing data for improved psychosocial well-being through plastic surgery is in the setting of breast cancer reconstruction after mastectomy, it is reasonable to assume that all patients who undergo major reconstruction to minimize deformity due to cancer therapy feel some improvement in quality of life. This article will provide an overview of the role of plastic surgery in cancer treatment.
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December 2002

The prevention of emesis in plastic surgery: a randomized, prospective study.

Plast Reconstr Surg 2002 Jun;109(7):2487-94

Division of Plastic and Reconstructive Surgery, Northwestern University Medical School, 707 North Fairbanks Court, Chicago, IL 60611-2923, USA.

Perhaps the most unpleasant experience following outpatient plastic surgery procedures is postoperative nausea and vomiting. Postoperative nausea and vomiting often results in delayed recovery time and unintended admission, and it can be a contributing factor to the formation of hematoma following rhytidectomy. Ondansetron (Zofran) has proven benefit in preventing postoperative nausea and vomiting if given before general anesthesia in a variety of surgical procedures. Its utility in cases performed under conscious sedation has not been determined. The purpose of this study was (1) to test the ability of prophylactic ondansetron to prevent postoperative nausea and vomiting in plastic surgery cases performed under conscious sedation, and (2) to determine relative risk factors for postoperative nausea and vomiting and a selection policy for the administration of antiemetic prophylaxis. This was a prospective, randomized, double-blind study. One hundred twenty patients were enrolled after giving informed consent. Patients received a single dose of either placebo or ondansetron (4 mg intravenously) before administration of sedation. Sedation administration followed a standardized institutional protocol, using midazolam and fentanyl. Data were recorded from a series of three questionnaires: preoperatively, immediately postoperatively, and at the time of the first office return. Data were confirmed by means of telephone interview, chart analysis, and nursing documentation. Multivariate analysis was conducted. Nausea and emesis occurred with an overall frequency of 33 percent and 22 percent, respectively. Postoperative nausea and vomiting was associated with statistically longer recovery periods. The incidence of emesis was statistically higher among women, among those undergoing facial rejuvenation, and among those with a history of opioid-induced emesis or postoperative nausea and vomiting following a previous operation (p < 0.05). The incidence of postoperative nausea and vomiting paralleled increases in case duration; the incidence of emesis was zero in cases less than 90 minutes in duration. Ondansetron significantly reduced the incidence of emesis overall (placebo, 30 percent; ondansetron, 13 percent; p < 0.05). Postoperative perception of nausea was significantly lower among those who had received ondansetron (p < 0.05). These results confirm the efficacy of ondansetron for the prevention of postoperative nausea and vomiting in plastic surgery cases under conscious sedation. In those who are at increased risk, prophylaxis should be considered. Such risks include female gender, facial rejuvenation procedures, and a patient history of opioid-induced emesis or postoperative nausea and vomiting following a prior operation. The zero incidence of emesis in cases less than 90 minutes does not support the routine use of prophylaxis in such cases. Patient satisfaction in plastic surgery is derived from the overall subjective experience of the event as much as by the final result. By remaining attentive to patient concerns and optimizing perioperative care, we can improve the subjective experience for our patients.
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http://dx.doi.org/10.1097/00006534-200206000-00049DOI Listing
June 2002