Publications by authors named "Samuel J Beran"

7 Publications

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Combination procedures: balancing risk and reward.

Authors:
Samuel J Beran

Aesthet Surg J 2006 Jul-Aug;26(4):443

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http://dx.doi.org/10.1016/j.asj.2006.07.004DOI Listing
June 2009

Enhancing upper lid aesthetics with the lateral subcutaneous brow lift.

Aesthet Surg J 2006 Jan-Feb;26(1):19-23

Background: Surgical techniques for improving the upper eyelid aesthetic unit have recently focused on the management of eyebrow position. In our practice, we noticed that in some patients the lateral brow was low preoperatively, whereas in others it was well positioned but overly mobile.

Objective: We describe our experience using the lateral subcutaneous brow lift (LSBL) to elevate and stabilize the lateral brow.

Methods: An incision was marked at the junction of the hair-bearing scalp and forehead, beginning on a line extending superiorly from the mid-pupillary line, and carried down to the subcutaneous plane, just superficial to the frontalis muscle. The subcutaneous tissues were dissected from the frontalis muscle, and the skin and subcutaneous flap were retracted superiorly. The flap was divided vertically, a skin staple was placed, and after assessment of brow position and stability, the medial and lateral excess skin was excised. Tisseel (Baxter Hyland Immuno, Glendale, CA) was found to facilitate hemostasis and, to a lesser extent, flap adherence. At the end of the procedure, the brow was slightly overcorrected to compensate for some postoperative descent. If planned, an upper blepharoplasty was performed in the standard fashion.

Results: The LSBL was performed in 117 patients during a 2-year period; in 82 of these cases the brow lift was performed in conjunction with upper lid blepharoplasty, and in 31 cases it was performed as part of a facial rejuvenation procedure that did not include upper eyelids. All patients reported their scars as imperceptible. Complications included 2 hematomas and 6 cases of hypesthesia confined to the region just posterior to the incision; all resolved within 8 weeks. In 1 case, the flap was inadvertently torn during its elevation; it was repaired and did not affect the outcome.

Conclusions: The LSBL is a safe and technically simple technique that allowed us to achieve optimal aesthetic results in the upper periorbita with few complications and a high patient acceptance rate.
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http://dx.doi.org/10.1016/j.asj.2005.12.006DOI Listing
June 2009

Nasal reconstruction--beyond aesthetic subunits: a 15-year review of 1334 cases.

Plast Reconstr Surg 2004 Nov;114(6):1405-16; discussion 1417-9

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8820, USA.

A retrospective analysis was performed on 1334 patients who underwent nasal reconstruction between 1986 and 2001. The senior author performed all reconstructions in this series after Mohs' histographic excisions. Only secondary reconstructions were performed without a preceding Mohs' excision. Methods of reconstruction, number of operations per patient, locations of defects, and complications were recorded. Using preoperative and postoperative photographs, aesthetic results were reviewed. Basal cell carcinoma was the most common lesion, followed by squamous cancer and melanoma. The average age of the patients was 51 years. Cancers most commonly arose on the dorsum, ala, and tip. Of 1334 cases, a 1.9 percent recurrence rate was documented. The average time between surgery and clinical recognition of recurrence was 39 months. All recurrent lesions were reexcised by the Mohs' technique. Eighty-one percent of reconstructions were completed in three or fewer stages. Seventy-five percent of reconstructions were completed in two stages. Primary dermabrasion or primary laserbrasion using carbon dioxide or erbium lasers was used in nearly every case. Early secondary dermabrasion or laserbrasion was used in a few cases where indicated. A 1.2 percent revision rate was noted (16 patients). Thirteen partial flap necroses required revision. Three patients experienced dehiscence at the donor site of paramedian forehead flaps. A preferred philosophy toward nasal reconstruction is described. The goal is to achieve optimal cosmetic and functional results while minimizing stages and resection of healthy tissue. Six core principles are advocated that guide efficient and successful nasal reconstruction: (1) maximal conservation of native tissue is advised; (2) reconstruction of the defect, not the subunit, is advised; (3) complementary ablative procedures, such as primary dermabrasion, enhance the final result and decrease the number of revisionary procedures; (4) primary defatting also decreases the number of revisionary procedures; (5) when possible, the use of axial pattern flaps is preferred; and (6) good contour is the aesthetic endpoint.
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http://dx.doi.org/10.1097/01.prs.0000138596.57393.05DOI Listing
November 2004

Ultrasound-assisted lipoplasty.

Authors:
Samuel J Beran

Aesthet Surg J 2004 Mar-Apr;24(2):159-60

The author considers the circumstances in which it is more beneficial to use ultrasound-assisted lipoplasty (UAL) rather than traditional suction-assisted lipoplasty (SAL). He contends that the absolute benefit of UAL compared with SAL is the ability of the ultrasound to lyse fibrous tissue and fat.
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http://dx.doi.org/10.1016/j.asj.2004.01.003DOI Listing
June 2009

Autologous fat graft in nipple reconstruction.

Plast Reconstr Surg 2003 Sep;112(4):964-8

Reconstruction of the nipple is the penultimate step in breast reconstruction after mastectomy. A number of reconstructive techniques have been described for nipple reconstruction including skin grafts, composite grafts, and various local flaps. The authors' preferred reconstructive technique is the local C-V or modified star flap. This flap produces an excellent reconstruction, but it is dependent on underlying subcutaneous fat to provide bulk to the reconstructed nipple. In most instances, the subcutaneous tissue is adequate. However, under certain circumstances, the subcutaneous fat may be insufficient to produce a nipple of adequate projection. Two cases of bilateral nipple reconstruction after soft-tissue expansion and implant placement and subsequent nipple reconstruction with local flaps provided inadequate nipple projection. These instances, as well as a retrospective review of reconstructed nipples after mound restoration using a variety of techniques, led the authors to conclude that a more predictable alternative to sustain nipple projection was necessary. The authors identified two broad categories of breast reconstruction patients in whom this new technique would be beneficial. In the first category of patients, breast mounds are reconstructed with tissue expansion and implant insertion, and in the second category, breast mounds are reconstructed by any technique in which the nipple reconstruction subsequently flattens. This article describes the indications, techniques, and experience in 13 patients treated over a 10-month period with fat grafting for nipple reconstruction.
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http://dx.doi.org/10.1097/01.PRS.0000076245.12249.BEDOI Listing
September 2003

Management of the latex-reactive patient.

Authors:
Samuel J Beran

Aesthet Surg J 2003 Sep-Oct;23(5):389-90

The author provides a protocol for managing latex-sensitive surgical patients in the preoperative, intraoperative, and postoperative stages. Not only patients with a history of latex reaction but also patients with recurrent daily latex exposure and specific food allergies require careful monitoring.
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http://dx.doi.org/10.1016/S1090-820X(03)00204-8DOI Listing
June 2009

An update on the role of subcutaneous infiltration in suction-assisted lipoplasty.

Plast Reconstr Surg 2003 Feb;111(2):926-7; discussion 928

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas 75390, USA.

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http://dx.doi.org/10.1097/01.PRS.0000039396.69495.C5DOI Listing
February 2003
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