Editor's Choice: March/April 2013
The March/April issue of “The Gold Journal” - the ASAPS Annual Meeting edition - is packed full of information. While I actually recommend that you read every article, I have picked 10 (grouped into 5 topics) to highlight. These selections include many international contributions on a wide range of subjects, including stem cell facelifts, periorbital fat injections, complications of nonreconstructive breast surgery, investigations into the effectiveness of PC-DC, and patient safety. Be sure to look for some of these authors on the podium at The Aesthetic Meeting, and please visit us in the ASAPS booth (#531) for a demo of the exciting new RADAR (iPad app) features.
My first pick is an international contribution from Lebanon: “Stem Cell Facelift: Between Reality and Fiction” (Atiyeh, Ibrahim, and Dibo). Stem cells have an incredible potential in aesthetic and reconstructive surgery. However, the current hype and hucksterism has outpaced the science. Claims are made with no evidence to support them. In this article, the authors review the literature and conclude there is no evidence to support the claims that the so-called “stem cell facelift” adds or offers any more benefit than autologous fat grafting, which has now become routine for most of us during facial rejuvenation. An accompanying Commentary by Dr. Rubin clarifies the issue even further.
My second selection is another international paper, dealing also with fat! In “Augmentation Blepharoplasty: A Review of 500 Consecutive Cases,” Drs. Tonnard, Verpaele, and Zeltzer from Belgium report on their extensive experience with 500 consecutive blepharoplasty patients who underwent microfat grafting in combination with other periorbital procedures to enhance the result. The authors clearly establish the safety, efficacy, and longevity of fat grafting the periorbital area.
Third, in “A Multi-Institutional Perspective of Complication Rates for Elective Non-Reconstructive Breast Surgery: An Analysis of NSQIP Data from 2006-2010,” Hanwright, Hirsch, Seth, and coauthors review the data on 3612 patients who underwent nonreconstructive breast surgery between 2006 and 2010. Across the board, complication rates were low; they were lowest for breast augmentation, at 1.2% compared to mastopexy at 2.37% and reduction at 4.47%. Interestingly, reoperation rates were also lowest for augmentation mammaplasty at 0.97%, mastopexy at 1.58%, and reduction at 2.07%. There was only 1 death in the 3612 procedures, an incidence of 0.3%.
For the fourth pick, I have grouped 5 articles on phosphatidylcholine and deoxycholate (PC-DC). The first - by Reeds, Mohammed, and Klein et al - is entitled “Metabolic and Structural Effects of Phosphatidylcholine and Deoxycholate Injections on Subcutaneous Fat: A Randomized Controlled Trial.” The authors report on their ASERF-funded research into the effects of PC-DC for fat loss. The article is accompanied by 2 Commentaries, one Diane Duncan, MD and the other by Spencer Brown, Ph.D. Both help to put the study into perspective. The fourth article in this group is another international contribution, an experimental study by Noreldin, Elhamid, Hashem, and co-authors entitled “A Pilot Study on the Use of Injection Lipolysis in Visceral Adipose Tissue.” The authors investigate the effectiveness of PC-DC injections into the omentum of dogs. The final article selected for this group is a Letter to the Editor from England by Drs. Tanner, Barabas, Cook, and Link, with the intriguing title of “A Future for Injection Lipolysis.” In this Letter to the Editor, the authors prognosticate on the future role of PC-DC and similar preparations in cosmetic medicine, and aesthetic and reconstructive surgery.
My final Editor’s Choice article (or actually, pair of articles) for this month is centered on patient safety, and also includes an international contribution. The first article is by Captain Steven W. Harden, entitled “Six Things Every Plastic Surgeon Needs to Know About Teamwork, Training, and Checklists,” and it is followed by a Commentary from Dr. Claude Oppikofer, chair of the ASAPS patient safety committee. Captain Harden, a pilot, comments on the ways in which the checklists mandated by years ago the Federal Aviation Administration can also apply to plastic surgery protocols. He cites the success of the checklist and its effect in enhancing air safety. No doubt, those same principles will prove useful to us in and out of our operating rooms as we strive to reach the levels of safety seen in commercial air travel.
As I reviewed the articles described above, I found myself pleased that so many international authors have chosen to publish in ASJ and pleased that we can offer you such clinically-oriented, up-to-date information on such “hot topics” as fat grafting and fat dissolution.
Dr. Foad Nahai
Editor-in-Chief, Aesthetic Surgery Journal