Introduction The Cohesive polydensified matrix (CPM) gels are popular Hyaluronic acid (HA) gels along with the dermal filler calcium hydroxylapatite (CaHA-CMC). In recent years, CaHA-CMC has also been increasingly utilized as a biostimulatory agent due to its capacity to promote tissue regeneration. While each product is safe and effective when injected separately, combining CaHA-CMC and CPM in a customized CaHA-CMC:CPM admixture within the same syringe offers additional advantages including reduced treatment time and fewer injections, as well as complementary mechanisms of action: CPM compensates for the early volume loss associated with resorption of the CaHA-CMC carboxymethyl cellulose carrier, while CaHA-CMC stimulates neocollagenesis. As a noninvasive imaging modality, high-frequency dermatologic ultrasound enables evaluation of both short- and long-term post-procedure filler location and its interaction with surrounding soft tissues. Objective To describe high-frequency ultrasound findings at baseline and immediately after treatment, as well as at 30, 90, and 180 days following injection of a customized CaHA-CMC:CPM admixture. Method This descriptive longitudinal case series employed high-frequency ultrasound (20 MHz) performed at baseline, immediately post-injection, and at 30, 90, and 180 days following treatment with a customized CaHA-CMC:CPM admixture. Various admixture formulations were used, combining CaHA-CMC with CPM fillers of differing densities (20.0, 22.5, 25.5, or 26.0 mg/mL) and rheology from the CPM gel range. Dilution ratios ranged from 1:1 to 1:4, and injections were performed in different facial regions. Results Five patients underwent treatment and safety assessment; two female participants, aged 34 and 70 years, completed all predefined longitudinal ultrasound assessments and were included in the imaging analysis. On ultrasound, CaHA-CMC appeared as hyperechoic deposits with variable posterior acoustic shadowing. Variations in sonographic appearance were observed across the evaluated admixtures, anatomical regions, and follow-up timepoints. In general, a progressive reduction in sonographic distinction between the injected material and surrounding tissues was observed over time across the treated areas. Conclusion High-frequency ultrasound enabled longitudinal visualization of the injection technique, precise anatomical layer of hybrid filler placement, changes in sonographic distinction from the surrounding tissues over time, and variability in echogenicity related to product concentration and density. Exploratory three-dimensional imaging provided complementary information regarding regional volumetric changes and directional surface displacement; however, these findings should be interpreted descriptively and require confirmation in larger studies.
Background Scalp necrosis after neurosurgery is usually attributed to repeated surgery. We report two cases in which necrosis was precipitated by a single reoperation incision that disregarded scalp arterial anatomy and the previous scars, and describe how this dictated the reconstruction. Cases Case 1: a 56-year-old woman underwent emergency decompressive hemicraniectomy two days after meningioma resection, through a circumferential incision along the bone-flap margin that islanded the cutaneous flap from every axial pedicle; the whole hemiscalp necrosed with brain exposure. Case 2: a 15-year-old boy, operated on repeatedly for subdural empyema, underwent cranioplasty through an incision that transected the superficial temporal pedicle, the last axis supplying a scalp segment already isolated by previous incisions. In both cases the extent of necrosis and the absence of any remaining axial pedicle precluded local, regional or expanded flaps; a free latissimus dorsi muscle flap anastomosed to the superficial temporal vessels was the only option. Hair restoration in Case 2 was completed by follicular unit extraction onto the flap. Conclusions A scalp flap survives only if at least one axial pedicle enters its base. Neurosurgical incisions, particularly at reoperation, should be drawn on the arterial map and previous scars; plastic and neurosurgical teams should share this rule.
Background Breast deformities such as ptosis, bottoming out, atrophy, sagging, and implant malposition are common challenges following breast augmentation or augmentation-mastopexy procedures. Multiple factors—including implant volume, placement plane, surgical technique, and gravitational or muscular forces—affect long-term implant stability. Objective To describe the Double-Anchor Capsule Flap Technique (DAT) for breast remodeling in revision mastopexy and evaluate its safety and effectiveness in a retrospective series. Methods This retrospective case series included 30 bilateral cases performed between October 2023 and September 2024. Inclusion criteria were prior breast augmentation, ptosis of any degree, BMI 20–35, adequate flap thickness (≥3 cm), and suitability for Wise pattern skin resection. Exclusion criteria included prior liposuction in axillary/intercostal regions, ASIA or BII, restrictive illnesses, smoking, and reconstructive surgery within 12 months. Data collected included patient demographics, implant characteristics, surgical technique, intraoperative flap viability, complications, and outcomes at one-year follow-up. Results Flap survival was achieved in all patients. At one-year follow-up, all patients demonstrated stable breast shape, optimal nipple-areola complex positioning, and implant projection. No recurrent ptosis, implant malposition, or BIA-ALCL was observed. No postoperative complications were reported during the 12-month follow-up period. Average implant volume was reduced by 22.3 cc (SD 25.9 cc) to minimize eccentric forces, and dual anchor lines provided reliable long-term implant support. Conclusion The Double-Anchor Capsule Flap Technique is a safe and effective approach for stabilizing breast implants and correcting post-augmentation deformities. By preserving vascularized capsular tissue and providing dual support, DAT enhances long-term stability and aesthetic outcomes while minimizing the use of foreign materials. Careful patient selection and precise surgical planning are key to optimal results.
Background Reduction mammaplasty relieves macromastia symptoms and improves aesthetics. Traditional pedicles offer reliable vascularity for most patients, but their reliability is often limited by resection weight and notch-to-nipple or nipple-to-inframammary fold (N-IMF) distances. The double-unit superomedial central (DUS) pedicle, paired with a vertical resection pattern, was developed to improve vascular reliability and projection across a broader range of patients, irrespective of above mentioned limitations. Methods A retrospective review included all consecutive patients undergoing bilateral vertical reduction mammaplasty with the DUS pedicle by a single surgeon at the University of Florida (January 2021-December 2023). Demographic, anatomic, and outcome data were compared between patients with <500 g and ≥500 g resections (based on smaller-breast resection weight) using Welch’s t-test and Fisher’s exact test. Results Sixty-three patients (mean age 35.1 ± 16.0 years) were included; most had grade III ptosis (65%) and sternal notch-to-nipple distance ≤37 cm (89%). Thirty-nine patients underwent <500 g resections and 24 underwent ≥500 g resections. Compared with the <500 g cohort, patients undergoing ≥500 g resections had higher body surface area (BSA), longer operative times, more advanced ptosis, and longer sternal notch-to-nipple distances. Eleven complications (11/63, 17%) occurred, including eight minor and three major (3/63, 4.8%), with no significant difference in overall complication rates between resection groups (25% vs. 13%; p=0.307). Conclusion The DUS pedicle combined with a vertical resection pattern, demonstrated a favorable safety profile while preserving the aesthetic advantages of a vertical reduction, even in patients with advanced ptosis and larger resection volumes, without evident compromise in outcomes. These findings support the safety and feasibility of this approach and warrant prospective validation.
