Editor's Choice: January 2014
I trust that you, our readers, have had an enjoyable holiday season. I wish you well for the New Year! Our first issue for 2014 is among our largest issues ever, packed full of articles with immediate clinical value to our practices. As always, I suggest you read the journal cover to cover, as I always do when it arrives on my desk - even though I know all the content months ahead of time! The following are articles I believe will be of particular interest to you.
In the Rhinoplasty section, I was fascinated by Kosins, Lambros, and Daniel’s paper, “The Plunging Tip: Illusion and Reality.” The authors quantified tip position before and after smiling in 25 women presenting for rhinoplasty who expressed concerns over a plunging tip. Their findings revealed that the nasal tip plunges, on average, by less than 1mm on smiling, concluding that the “plunging tip” is actually an illusion resulting from the concomitant elevation of the subnasale and nasal crease with a straightening of the alar rim.
There are 5 papers in the Breast Surgery section, and I am highlighting 2 of them. The first, by Fischer et al, is entitled “Complications Following Reduction Mammaplasty: A Review of 3538 Cases from 2005-2010 NSQIP Datasets.” The authors report a complication rate of 5.1%, with obesity and current history of smoking as the most significant predictors of morbidity. Though these findings provide only confirmatory information, the large numbers add further credence to information gained through smaller studies. The second paper, authored by Paik et al, is called “A Look Inside the Courtroom: Analysis of 292 Cosmetic Surgery Malpractice Cases” and examines various factors that triggered legal action by patients and influenced the judicial outcome.
I have also selected 2 papers from the Body Contouring section. First is a paper by Jeong et al, “Application of the Caprini Risk Assessment Model in Evaluation of Non-Venous Thromboembolism Complications in Plastic and Reconstructive Surgery Patients,” which concludes that Caprini scores are valuable predictors of non-VTE complications such as wound healing problems, seroma, and hematoma. Paik et al have a second article in this issue,“Beyond the Operating Room: A Look at Legal Liability in Body Contouring Procedure,” which appears in this section with commentaries by Ballard and Feagle and Ranum. The authors again examine factors leading to litigation. Ballard and Feagle, who wrote the first Commentary response, are noted malpractice attorneys in the Atlanta area; they underscore the importance of informed consent on the outcomes of litigation. Mr. Ranum, a regional vice president of patient safety for the Doctors Company, provides the perspective of a major liability carriers. In an age of medicolegal concerns, we should all familiarize ourselves with the article in the breast section, this article, and the comments of our learned legal colleagues.
Lastly, I have selected 2 papers from the Research section. First - and again, a second paper in this issue by the same authors – is Fischer et al’s “Patterns of Preoperative Testing in Patients Undergoing Outpatient Plastic Surgery Procedures.” The authors conclude that routine preoperative testing in healthy ambulatory patients yields limited benefit and may be costly. We should all reevaluate our preoperative testing protocols, especially in light of the current debate on the cost of healthcare. The second paper is by Derby et al, entitled “Adipose-Derived Stem Cell to Epithelial Stem Cell Transdiffentiation: A Mechanism to potentially Improve Understanding of Fat Grafting’s Impact on Skin Rejuvenation.” They suggest that ADSC may have transdifferentiated into epithelial stem cells in their mouse model, which may explain why fat grafting can rejuvenate the skin.
Dr. Foad Nahai
Editor-in-Chief, Aesthetic Surgery Journal