Summary:. A conventional paramedian forehead flap—a reliable option for nasal reconstruction—typically requires multiple stages and often results in a vertically oriented donor-site scar that crosses the natural forehead rhytids. Although single-stage island forehead flaps have been introduced to reduce the treatment burden, concerns remain regarding aesthetic outcomes and flap perfusion stability. Herein, we report a successful case of nasal reconstruction using a modified 1-stage island forehead flap with a double horizontal semicircular design. An 89-year-old woman presented with a squamous cell carcinoma of the nasal dorsum. The patient lived with her husband, who required nursing care, and requested a treatment plan that minimized time away from home. Following tumor excision, 1-stage reconstruction was performed using a horizontally oriented double horizontal semicircular island forehead flap. A musculocutaneous island flap with a buried frontal muscle pedicle in the supratrochlear artery was elevated. The flap was transferred through a subcutaneous tunnel and folded to cover the nasal dorsal defect. The donor site was closed primarily along the horizontal rhytids. Postoperatively, mild transient venous congestion was observed, which resolved spontaneously. Minor secondary revisions, including flap defatting and medial brow lifts, were performed on an outpatient basis. At the 1-year follow-up, the patient demonstrated excellent aesthetic outcomes with a well-camouflaged donor-site scar. This modified 1-stage island forehead flap presented a balanced reconstruction approach that can achieve favorable cosmetic results, flap reliability, and early social reintegration. This technique is particularly suitable for older patients with horizontal forehead rhytids who prefer single-stage reconstructions.
Background:. Facial aging is a complex and multilayered process. Facial retaining ligaments play a critical role in maintaining soft-tissue position and resisting gravitational descent. Although radiofrequency (RF) therapy is widely used for noninvasive facial rejuvenation, ligament-targeted RF strategies remain insufficiently investigated. Methods:. This prospective, evaluator-blind, split-face controlled study enrolled patients with mild-to-moderate facial laxity. A 1.7-MHz bipolar RF device was used for 3 treatment sessions at 4-week intervals. The left side received conventional full-face RF treatment, whereas the right side underwent ligament-targeted RF treatment. The primary outcome was the change in 3-dimensional facial volume measured using the Vectra M3 imaging system. Secondary outcomes included physician- and subject-rated Global Aesthetic Improvement Scale scores at 1 month and 6 months post final treatment. Safety outcomes were also recorded. Results:. A total of 12 patients completed the study (N = 12 per side). One month after the final treatment, no statistically detectable difference was observed between the treatment and control sides in the mean change in 3-dimensional facial volume. Improvements in facial laxity were observed on both sides after treatment. Both physician- and subject-rated Global Aesthetic Improvement Scale scores improved at 1 month and 6 months posttreatment, with no statistically detectable differences between sides. All treatment-related adverse events were mild and transient. Conclusions:. No statistically detectable differences in contour outcomes were observed between the 2 treatment approaches in this preliminary study. These findings suggest that an anatomically guided approach may offer a feasible option for noninvasive structural facial rejuvenation and warrant further investigation in larger studies.
Background:. Multiple studies have demonstrated higher complication rates for patients undergoing reduction mammoplasty who have high body mass index (BMI). As a result, some insurance companies and providers have used a BMI limit to deny coverage of this procedure to patients seeking surgery. Still, few studies have examined whether higher complication rates affect patient satisfaction. This study further explores the relationship between BMI, complications, and patient satisfaction in reduction mammoplasty. Methods:. A total of 899 consecutive patients at a single institution underwent reduction mammoplasty by 8 surgeons for symptomatic macromastia from 2016 to 2021. This cohort was queried using the BREAST-Q survey postoperatively. Kruskal-Wallis H-test was used to evaluate patient satisfaction and complication rates for 4 BMI groups, that is, normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), obese (30–39.9 kg/m2), and morbidly obese (>40 kg/m2). Results:. Two hundred fifty patients completed surveys. The mean BMI was 32.4 kg/m2 (range 20.3-50.5 kg/m2). Mean survey responses were highly favorable in all BMI categories, including 90% stating they “definitely agree” they “would do it again.” There was no statistical difference between the 4 BMI categories for patient satisfaction or complications. Conclusions:. Patients with high BMI may have similar postoperative BREAST-Q satisfaction scores when compared to those with lower BMI.
Background:. First metacarpal osteotomy is a joint-preserving option for thumb carpometacarpal osteoarthritis, but its effect on the adjacent metacarpophalangeal (MCP) joint remains unclear. We evaluated postoperative changes in MCP kinematics and subchondral stress distribution. Methods:. We retrospectively analyzed 21 thumbs in 19 patients who underwent first metacarpal extension-abduction osteotomy. Assessments before surgery and at follow-up included pain and function, dynamic radiography of MCP motion, and computed tomography–based Hounsfield unit (HU) measurements as an index of subchondral bone density at 9 regions on the metacarpal head and proximal phalanx. Preoperative and postoperative data were compared with Wilcoxon signed-rank tests; regional HU distributions were assessed with Friedman tests and Dunn post hoc tests. Results:. Median clinical follow-up was 1.5 years. Median MCP hyperextension improved from 16 (interquartile range [IQR], 5–28 degrees) to 0 degrees (IQR, 0–10 degrees; P < 0.01), whereas flexion did not change. Ulnar deviation at maximal palmar adduction increased from 8 (IQR, 5–10.5 degrees) to 12 degrees (IQR, 7–15 degrees; P = 0.011). One-year computed tomography showed significant postoperative HU decreases in dorsal regions of the metacarpal head, whereas the proximal phalanx showed no significant regional change. No radiographic progression of MCP osteoarthritis was observed. Conclusions:. First metacarpal extension-abduction osteotomy improved MCP alignment and altered subchondral loading at the metacarpal head. These findings suggest that the procedure favorably affects thumb-ray biomechanics beyond the carpometacarpal joint.
