Search

Background: Scarring at the incision site represents one of the most impactful outcomes in breast augmentation surgery for both the patient and the surgeon. Few studies exist with the aim of assessing patient perception of scarring outcomes in primary breast augmentation. The aim of this study was to evaluate the impact on quality of life of scars by submitting the SCAR-Q in patients who underwent primary augmentation mammoplasty. Methods: The SCAR-Q was administered at one and at 6 months after surgery to 54 consecutive patients underwent primary breast augmentation with inferior hemi-periareolar or inframammary incision. A total of 50 patients were divided into two groups of 21 patients with inferior hemi-periareolar incision and 29 patients with inframammary fold incision, respectively. Statistical analysis was performed with Prism 9. Results: All mean values of the three SCAR-Q scales tend to decrease at the second administration meaning that the perception of the scar is better at time 6 from the patient perspective. In the "Psychosocial scale," lower values at both 1 month and 6 months for group 2 compared to group 1 were shown. Unpaired T tests with Welch's correction showed significance for delta values variations between the two groups with P values <0.0001. Conclusion: Data show that patients undergoing primary breast augmentation have a scar that has no significant impact. Patients with inframammary fold scar have less psychosocial impact than those with inferior hemi-periareolar scar. There were no statistically significant differences in scar-related symptoms and scar appearance between scar along the inframammary groove and inferior hemi-periareolar scar. Level of Evidence IV: Case series study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Blepharoptosis may result in an unattractive appearance and vision problems. According to the severity of ptosis, patients may undergo correction surgery using upper eyelid retractors. The conventional incision for surgical procedures was the double-eyelid incision, potentially resulting in an obvious and unnatural scar or long-lasting edema and prolonged recovery time. Objectives: The aim of this study was to introduce a supraciliary incision as an alternative to the double-eyelid incision for blepharoptosis correction that creates a scarless, natural appearance with a quick recovery time. Methods: From June 2019 to June 2021, 32 patients (36 eyelids) underwent blepharoptosis correction through a supraciliary incision. MRD1, the height of the eyelid fissure, and the patient's satisfaction with the shape and scar as well as postoperative complications (eyelid insufficiency, conjunctival prolapse, inadequate correction of ptosis, and excessive correction of ptosis). Results: All 32 patients (36 eyelids) were followed up for 6 to 18 months, with an average follow-up of 11.6 months. The postoperative satisfaction rate was 96.43%. There was no overcorrection, but one patient (1 eyelid, 2.8%) was under correction that required secondary correction. One patient (1 eyelid, 2.8%) experienced conjunctival prolapse. Sixteen patients showed lagophthalmos early after surgery, in which one patient experienced early-stage keratitis and completely recovered within two months. Conclusion: Blepharoptosis correction via supraciliary incision allows for broader indications and fewer surgical scars without disrupting eyelid integrity, resulting in quick recovery after surgery. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation. Methods: A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool. Results: A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers' ratings, with a SMD of − 1.09 [95% CI: − 1.32; − 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was − 0.99 [96% CI: − 1.31; − 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations. Conclusions: Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Downward-turning oral commissures and sagging mouth corners can present an unfavorable impression. We introduced a new oral commissure lift procedure and investigated its effectiveness and complication rates. Methods: Patients who underwent oral commissure lift in the plastic surgery clinic between January 2010 and December 2017 were enrolled retrospectively. Pre-and postoperative photographs were evaluated to measure oral commissure angles and analyze surgical complications, including visible scarring, unnatural appearance, and asymmetry. Many patients underwent a oral commissure lift with a simultaneous facelift. To exclude potential bias, we compared angular changes between patients receiving both oral commissure lift and facelift, with those receiving only oral commissure lift. Moreover, oral commissure angles of patients only receiving facelift were also measured. Statistical significance was set at p < 0.05. Results: Oral commissure lift was performed in 51 patients. The mean ages and follow-up periods were 46.7 ± 11.9 years, and 25.2 ± 22.9 months, respectively. The preoperative mean angles of the right and left oral commissures measured − 3.1 ± 4.0° and − 3.4 ± 3.7°, respectively, and postoperative mean angles measured 3.6 ± 3.2° and 3.3 ± 3.5°, respectively. Postoperative changes in oral commissure angles were statistically significant (p < 0.05). The low complication rate included undercorrection in one patient, asymmetry in one patient, and visible scarring in three patients. We found no statistically significant differences in the studies excluding bias. Conclusions: The new oral commissure lift procedure for correcting sagging oral commissures was simple, safe, and effective with a low complication rate. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Abdominal tissue transfer has become the most commonly used tool for breast reconstruction. However, a secondary operator is often responsible for donor closure, which leaves dissatisfaction to patients due to inconsistent donor scars. Now, an absorbable dermal stapler is popularized worldwide and currently used for wound closure in many surgical fields. In this study, we aim to evaluate the abdominal donor site scar in using an absorbable dermal staple compared to a conventional suture. Methods: This is a prospective, randomized controlled and double-blinded study. Between January 2018 and April 2019, a total of 30 patients who underwent breast reconstruction using abdominal flap were included. Donor sites were divided into equal halves, and the each dermal layer was sutured with either dermal staples or traditional suturing, respectively. At 1, 3 and 6 months after operation, the scar was evaluated by two blinded plastic surgeons by using the modified Manchester scar scale (MSS). Results: An averaged sum of modified MSS was lower for the side sutured with a dermal stapler at the first month (11.76 ± 2.12 vs. 12.28 ± 2.03, p = 0.097), third month (12.17 ± 1.86 vs. 12.62 ± 2.31, p = 0.301) and sixth month (11.28 ± 2.63 vs. 12.14 ± 2.76, p = 0.051). Also, the dermal stapler side scored significantly higher for patient satisfaction than did the suture side (4.03 ± 0.98 vs 3.66 ± 0.97, p < 0.05). Conclusion: The objective outcome of the scar closed by an absorbable dermal stapler was not statistically superior to conventional suturing. (p > 0.05) In the subjective outcome, however, it showed a significantly higher patients' satisfaction (p < 0.05). Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Despite civilization and progress, burns occur frequently in the world. Remarkable discoveries of wound healing mechanisms have been reported. On the other hand, long-term outcomes from burn injuries represent a barrier to improvement of patients' social, functional, and psychological condition. Lipofilling, described since the 1980s, currently is used for several clinical applications. This study aimed to verify whether lipofilling could ameliorate scar remodeling in three clinical cases. Methods: Three adult patients with hemifacial hypertrophic scars and keloids resulting from severe burns 2 to 13 years previously were selected. The patients were treated by injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman's technique. Two injections (with a 13-month interval between) were administered at the dermohypodermal junction. Histologic examination of scar tissue punch biopsies (hematoxylin-eosin staining) before and after the treatment was performed as well as magnetic resonance scan with contrast. Results: The clinical appearance and subjective patient feelings after a 6-month follow-up period suggest considerable improvement in the mimic features, skin texture, and thickness. Histologic examination shows patterns of new collagen deposition, local hypervascularity, and dermal hyperplasia in the context of new tissue, with high correspondence to the original. Conclusions: The preliminary results show that lipofilling improves scar quality and suggest a tissue regeneration enhancing process. [ABSTRACT FROM AUTHOR]

Background: Transmen are individuals who live a marked incongruence between the assigned gender and the experienced gender. Crucial and life-changing steps in their transition are testosterone treatment and mastectomy to remove the stigma of feminine identity. After surgery, patients' attention turns to the scars, often not aesthetically pleasant. We thus created an innovative galenic preparation for scar treatment after surgery composed by spironolactone, alfa bisabolol and silicone gel. Functional outcomes, side effects and satisfaction were assessed. Methods: For the present prospective randomized controlled study, 30 patients with similar demographic characteristics who underwent double incision mastectomy with NA grafts between February 2014 and June 2019 were selected. The treatment Group A (n = 15) was treated for 12 months with "Top Surgery Scar go," the control Group B (n = 15) with silicon gel. Statistical analysis including Wilcoxon test and Kruskal–Wallis test per variable was performed. To assess satisfaction, a second Wilcoxon test was applied. Results: The differences between Group A and Group B were statistically significant, especially at T12 with very low p values. Satisfaction was greater in Group A (p value = 3e−4). No major side effects were noticed in Group A. Conclusions: TSSgo scar innovative treatment showed long-term efficacy in comparison with silicon gel in terms of improved scar tissue texture, pigmentation, pliability and height. It is easy to set up, cost-effective and safe. Further studies are necessary to better assess efficacy and validity of TSSgo, but it appears to be promising as the new treatment of reference for scar management after top surgery in transmen. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Purpose: A linear surgical scar, when located in the head and neck region, can be a significant cosmetic concern. Laser skin resurfacing with a fractional laser and a pulsed dye laser has been proven to be useful for treating such scars. As alternatives, we used a classic ablative CO2 laser in continuous mode with a 1-mm spot size and a 595-nm Nd:YAG laser. We investigated the effect of the combination of the continuous CO2 laser and 595-nm Nd:YAG laser and compared it to the effect of fractional CO2 laser monotherapy on linear scars.Methods: This was a retrospective, case-controlled study designed to compare the efficacy between fractional CO2 laser therapy and combination therapy with a conventional CO2 laser in continuous mode and a 595-nm Nd:YAG laser. Treatment efficacy was evaluated by two different scar scales: the Stony Brook Scar Evaluation Scale (SBSES) and the modified Vancouver Scar Scale (mVSS). Laser treatments were performed every month until the 6th month after surgery.Results: The SBSES and mVSS scores improved over time in both the monotherapy and the combination therapy (P < 0.001). No significant differences were found between the therapies for all the subcategories of the SBSES. However, among all the subcategories of the mVSS, pigmentation showed a better prognosis with combination therapy (P = 0.04).Conclusion: Monotherapy and combination therapy can provide similar positive effects on linear scar improvement after repeated treatment, whereas combination therapy exerts more favorable anti-pigmentation effects than monotherapy. The combination of a continuous ablative CO2 laser with a 595-nm Nd:YAG laser can be used as a favorable alternative to a fractional CO2 laser. The 1-mm spot size of the CO2 laser beam may mimic the fractional laser form and offer more effective results for linear incision scars.Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background An occlusive overnight intensive patch medical device (OIP) containing onion extract and allantoin has been developed for preventing and treating dermatologic scars and keloids. Here, we examined the efficacy and safety of the OIP for post-dermatologic surgery scars.Methods This was an intra-individual randomized, observer-blind, controlled study in adults with post-dermatologic surgery scars. Two scars per subject were randomized to no treatment or overnight treatment with the OIP for 12–24 weeks. Scar quality was assessed using the Patient and Observer Scar Assessment Scale (POSAS) and a Global Aesthetic Improvement Scale.Results A total of 125 subjects were included. The decrease in observer-assessed POSAS from baseline was significantly greater for treated than untreated scars at week 6 (p < 0.001) and 24 (p = 0.001). The decrease in patient-assessed POSAS was significantly greater for the treated scar than the untreated scar at week 12 (p = 0.017) and 24 (p = 0.014). Subject- and investigator-evaluated Global Aesthetic Improvement Scale scores were higher for the treated than the untreated scar at all visits. All subjects considered the global comfort of the OIP to be good or very good, and no safety concerns were identified.Conclusions This study confirmed that the OIP safely promotes scar healing after minor dermatologic surgery.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. [ABSTRACT FROM AUTHOR]

Background: Scar management using laser phototherapy continues to evolve as it gains wide acceptance among patients and providers. Despite widespread use of laser therapy, there are no guidelines or consensus published regarding optimal pre- and post-procedure patient management. Our objective is to gain insight into the best laser practices; we decided to poll colleagues nationwide. Methods: An online survey was distributed to members of the American Society of Plastic Surgeons. The survey consisted of 34 questions regarding pre- and post-procedure protocols related to laser scar therapy. Results: Forty plastic surgeons responded to the survey. The survey demonstrated that ten types of lasers are currently used to treat scars. The most commonly used lasers are fractional Er:YAG (44.7%), pulsed dye (42.1%), and fractional CO (36.8%). On a Likert 3-point scale, providers favored the use of pre-procedural sunblock (2.12), topical analgesics (1.91), and oral antivirals (1.83). They also preferred the use of topical moisturizer (2.45), oral analgesics (2.29), and oral antivirals (1.97) as a part of the post-laser treatment regimen. Conclusion: The study verified there is no consensus regarding peri-procedure laser scar therapy regimens. As laser scar management continues to grow in popularity, this lack of consensus suggests the need for experts in the field to come together and propose agreeable protocols to be used as guidelines. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Introduction: Open and closed approaches for rhinoplasty have individual advantages and disadvantages; however, the resultant columellar scar of the open approach is directly considered as a disadvantage. This study focuses on the columellar scar awareness and its implications on overall satisfaction of the patients after open rhinoplasty. Patients and Methods: A total of 91 patients who have undergone open rhinoplasty were included in this study. A written questionnaire algorithm consisting of 4 sequential questions was applied. Except for the first question [Do you have any scar(s) caused by any trauma, operation or any other reason on your face?], every question was answered on a scale from 1 to 5. The respondents were given the 25-question 'Modified Body Cathexis Scale (MBCS)'and their scars graded using the 'Columellar Scar Assessment Scale' (CSAS). The data were statistically interpreted. Results: Of the 91 open rhinoplasty patients, 12 of them responded with a 'yes' to the first question reporting their columellar scars. There was no significant difference with regards to patient satisfaction regarding these patients ( p > 0.05). However, those who reported the scar yielded a significantly lower MBCS scores. 9 patients declared that they exerted effort to conceal their scars. Those who concealed their scars and those who did not yielded a significant difference in patient satisfaction. The CSAS scores of those who reported the columellar scar were significantly higher than those who did not. Conclusion: Our study suggests that MBSC can be a valuable tool for determining the impact of outcomes from the patient's standpoint, and awareness of the columellar scar is not related to patient satisfaction but with bodily perception. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcomes (PROs) are of growing importance in research and clinical care and may be used as primary outcomes or as compliments to traditional surgical outcomes. In assessing the impact of surgical and traumatic scars, PROs are often the most meaningful. To assess outcomes from the patient perspective, rigorously developed and validated PRO instruments are essential. Methods: The authors conducted a systematic literature review to identify PRO instruments developed and/or validated for patients with surgical and/or non-burn traumatic scars. Identified instruments were assessed for content, development process, and validation under recommended guidelines for PRO instrument development. Results: The systematic review identified 6534 articles. After review, we identified four PRO instruments meeting inclusion criteria: patient and observer scar assessment scale (POSAS), bock quality of life questionnaire for patients with keloid and hypertrophic scarring (Bock), patient scar assessment questionnaire (PSAQ), and patient-reported impact of scars measure (PRISM). Common concepts measured were symptoms and psychosocial well-being. Only PSAQ had a dedicated appearance domain. Qualitative data were used to inform content for the PSAQ and PRISM, and a modern psychometric approach (Rasch Measurement Theory) was used to develop PRISM and to test POSAS. Overall, PRISM demonstrated the most rigorous design and validation process, however, was limited by the lack of a dedicated appearance domain. Conclusions: PRO instruments to evaluate outcomes in scars exist but vary in terms of concepts measured and psychometric soundness. This review discusses the strengths and weaknesses of existing instruments, highlighting the need for future scar-focused PRO instrument development. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: Both patients and physicians desire minimal scarring after surgical procedures. The removal of foreign bodies from around the wound, prevention of infection, and wound closure without tension is recommended for reducing scarring. The reasons underlying the differing appearance of scars between different anatomical regions of the same individual are not fully understood. Moreover, to our knowledge, the relationship between incision width and dermal thickness in different anatomical regions has yet to be investigated. Hence, in the present study, we aimed to determine the effect of dermal thickness on scar formation. Methods: Fifty patients who were treated and followed up for breast hypertrophy between 2010 and 2013 were retrospectively investigated. In all patients, a 2 × 2-cm skin biopsy specimen was obtained from the medial right breast at the horizontal line of the T scar. A routine superomedial pedicle breast reduction was subsequently performed. The extracted excision materials and skin biopsy specimens were examined pathologically. Dermal thickness was measured from the starting point of the subcutaneous tissue to the end point of the epidermis, at four different sites. The average dermal thickness was then calculated for each patient. The skin color of all patients was determined according to the Fitzpatrick classification. Scar width was measured in three different regions, including a combination of the vertical and horizontal portions of the T scar and the flap confluence. After the measurements, the scars were evaluated for vascularity, pigmentation, elasticity, thickness, and height by two plastic surgeons and a clinical nurse, who were blinded to patient data. Results: The mean age of the 50 female patients was 40.8 years (range 18-65 years). The average follow-up period was 16 months (range 12-18 months). An average of 987.5 g (range 505-1621 g) of breast and fatty tissue was removed. The average dermal thickness was 4.99 mm (range 3.5-6.8 mm). The most common skin type was Fitzpatrick type IV (33 patients). The average total scar score was 14 (range 8-25). The total scar score was not significantly associated with dermal thickness. The scar width in patients with a dermal thickness of <0.5 cm was narrower than that in patients with a dermal thickness of ≥0.5 cm. Scar vascularity and noticeability were observed less often in patients with Fitzpatrick skin type III, regardless of scar width. Conclusion: The study findings show that increased dermal thickness is a risk factor for wide scar formation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer in women worldwide, affecting one in eight women. Breast-conserving surgery (BCS) has become a well-established alternative to mastectomy in the treatment of breast cancer, providing a less invasive treatment. Just as life expectancy after breast cancer has improved, so has morbidity increased. One of the most relevant and debilitating consequences of oncological breast surgery is postmastectomy pain syndrome (PMPS). Our results published in 2011 on the treatment of PMPS in patients who had undergone mastectomy and radiotherapy and our experience in scar treatment with fat grafts were the theoretical bases for this prospective study. Methods: From April 2011 to April 2012 a total of 96 patients, who had undergone lumpectomy and radiation therapy, with the diagnosis of PMPS were considered for fat grafts. We performed autologous fat grafting in 59 patients (study group), whereas 37 patients did not receive any further surgical procedure (control group). Pain assessment was performed using the visual analog scale (VAS) before and after treatment in the treated group and in the control group at the first visit and the control visit, with a mean follow-up of 10 months. Results were analyzed using the Wilcoxon rank sum test. Results: Four patients were lost to follow-up (two patients in the control group and two patients in the treated group). A significant VAS pain decrease was detected in patients treated with autologous fat grafting (3.1 point reduction, p ≤ 0.005). Conclusion: Because of the safety, efficacy, and optimal tolerability of the procedure, we believe that fat grafting can be considered useful in treating PMPS in patients who have undergone BCS and radiotherapy. Level of Evidence III: For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: Numerous surgical approaches for muscular torticollis are not effective enough to completely release the contracture and prevent further development of craniofacial asymmetry. Cosmetically unacceptable scars on the neck and compulsory functional exercises after surgery were also common problems. We applied the therapeutic principle of scar contracture to the surgical treatment of muscular torticollis. Surgical incision determination and the postoperative protocol were considerably improved. Satisfactory results were obtained. Method: According to the therapeutic principle of scar contracture, complete release of the contracted muscles and peripheral streak fascia and release or partial resection of peripheral normal tissues such as the scalenus anterior, anterior trapezius border, platysma, and partial carotid sheath are required to release all the affected contracted and tightened tissues. We chose to incise underneath the affected side of the clavicular border. We obtained a tension-free closure of the incision through an advanced skin flap of the inferior incision sutured on the clavicular fascia. Maximum head and neck stretch to the unaffected side of the shoulder when the patient lied down gave the affected side lateral decubitus position after surgery. Results: Satisfactory results were obtained and no complications were identified for all of the 104 patients. The development of craniofacial asymmetry and progressive deformities was prevented. The incision scar appeared linear in the pit above or below the clavicle border and was relatively inconspicuous. Conclusion: The application of the therapeutic principle of scar contracture to the surgical treatment of muscular torticollis was successful. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the efficacy of combined herbal extracts in a gel preparation (Cybele Scagel) in reducing scar development at a split-thickness skin graft donor site. Methods: A prospective, randomized, double-blind control study was performed to evaluate the efficacy of Scagel in 15 patients who underwent a split-thickness skin graft operation. Both Scagel and placebo were applied equally to the donor site within 1 month after complete epithelialization. Scar assessments using the Vancouver Scar Scale (VSS) and patient self-evaluation were taken at 2, 4, 8, and 12 weeks. Results: Of the 15 patients, 10 were enrolled and evaluated in this study. There was no significant difference in each parameter of the VSS. The total VSS was significantly lower in the Scagel group compared to the placebo group after 4 weeks ( p = 0.003, 0.003, and <0.001 at 4, 8, and 12 weeks, respectively). The patient satisfaction score in the Cybele Scagel group was significantly higher ( p = 0.002) at the 12-week evaluation. Conclusion: Application of combined herbal extracts in gel preparation might reduce scar development at split-thickness skin graft donor sites. There was a positive trend in the reduction of postinflammatory hyperpigmentation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

An epicanthal fold is common in the eyelids of Orientals, weakening the aesthetic appearance of blepharoplasty. Many techniques have been designed to eliminate the epicanthal fold and create a beautiful palpebral fissure with less scarring produced in the medial canthus. However, many of these procedures were designed to correct the epicanthus completely and create an out-type of palpebral fold, which leaves a minor scar in the epicanthus and an unnatural eye appearance. Thus, based on dynamic mechanisms, a beautiful design of the epicanthus, and a double fold in most Asian people, a new modified Z-plasty procedure combined with blepharoplasty to create an in-type of palpebral fissure was performed for 873 patients in our hospital from September 2006 to November 2010. The procedure showed good and natural results in most Asian patients. No recurrence of the epicanthal fold and no scarring of the medial canthus were found during a 6-month follow-up period. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: Gynecomastia is a benign, excessive development of the male breast that occurs at an overall incidence of 32-36 %. The authors effectively removed peripheral fat tissues with power-assisted liposuction (PAL) and periareolar glandular tissues with a cartilage shaver in a series of patients. The small periareolar incisions were not easily recognized. Methods: Between February 2010 and April 2012, the charts of 15 patients (28 breasts) treated with PAL and a cartilage shaver were retrospectively reviewed. Results: The mean volume of fat tissue removed with liposuction was 319 mL, and the mean volume of glandular tissue removed with the cartilage shaver was 70 mL. The mean follow-up period was 11.2 months. No infection, nipple-areola complex necrosis, nipple retraction, or saucer deformity was encountered in this series. Intraoperative bleeding occurred in one patient. Mild asymmetries developed in three patients. Conclusions: Use of PAL and a cartilage shaver for the treatment of gynecomastia allows for effective removal of both the fat and the glandular tissue of the breast through a minimal periareolar incision. This technique can achieve excellent aesthetic results with inconspicuous scarring. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

The basic principles influencing scar expression and outcome have long been defined. Although these were relatively clear at the time, the exact events at a molecular level were poorly defined. The past decade has delineated the myriad of events that occur in the run-up to scar evolution far more clearly, although the intricate details have yet to be elucidated. What is clear is that a series of conversations and crosstalk takes place in the cell cytosol, in the cellular nucleus, and outside the cell within in the extracellular matrix. This interaction or 'dynamic reciprocity' takes place via a series of signals, protein activation, ionic translocations, and receptor transactions. Marrying the previously defined principles with current described cellular/extracellular matrix (ECM) interactions enables us to describe more accurately the crosstalk occurring in scar evolution and possibly to influence the 'wording' of that crosstalk to improve scar outcome. Thus, the principles of mechanostimulation and scar support, hydration occlusion, controlled inflammation, and collagen/extracellular remodeling are discussed with possible interventions in each category. [ABSTRACT FROM AUTHOR]

The use of lasers has been proposed for scar revision. A recent pilot clinical study demonstrated that lasers could also be used immediately after surgery to reduce the appearance of scars. The LASH (Laser-Assisted Skin Healing) technique induces a temperature elevation in the skin which modifies the wound-healing process. We report a prospective comparative clinical trial aimed at evaluating an 810-nm diode-laser system to accelerate and improve the healing process in surgical scars immediately after skin closure. Twenty-nine women and 1 man (mean age = 41.4 years; Fitzpatrick skin types I-IV) were included to evaluate the safety and performance of the laser system. The laser dose (or fluence in J/cm²) was selected as a function of phototype and skin thickness. Each surgical incision (e.g ., abdominoplasty) was divided into two parts. An 8-cm segment was treated with the laser immediately after skin closure. A separate 8-cm segment was left untreated as a control. Clinical evaluations (overall appearance ratings, comparative scar scale) of all scars were conducted at 10 days, 3 months, and 12 months by both surgeon and patients. Profilometry analysis from silicone replicas of the skin was done at 12 months. Wilcoxon signed-rank test analyses were performed. Twenty-two patients were treated using a high dose (80–130 J/cm²) and 8 patients with a low dose (<80 J/cm²). At 12 months in the high-dose group, both surgeon and patients reported an improvement rate of the laser-treated segment over the control area of 72.73 and 59.10%, respectively. For these patients, profilometry results showed a decrease in scar height of 38.1% ( p = 0.027) at 12 months for the laser-treated segment versus control. Three patients treated with higher doses (>115 J/cm²) experienced superficial burns on the laser-treated segment, which resolved in about 5–7 days. For the eight patients treated at low dosage (<80 J/cm²), there was no significant difference in the treated segment versus the control segment. No side effects were observed. This prospective comparative trial demonstrates that an 810-nm diode laser treatment, performed immediately after surgery, can improve the appearance of a surgical scar. The dose plays a great role in scar improvement and must be well controlled. There is interest in LASH for hypertrophic scar revision. LASH can be used to prevent and reduce scars in plastic surgery. [ABSTRACT FROM AUTHOR]

This trial was undertaken to assess the efficacy of a multimodality management regime used for the prevention of hypertrophic scars. It follows previous research and experience (A.D. Widgerow et al, Aesthetic Plast Surg, 24(3):227–234, ) with a similar program but with the addition of active agents with specific effects against prolonged inflammation and enhanced hydrative capacity. The modalities specifically targeted are tension on the scar, hydration of the scar, collagen maturation, and controlled inflammation. Tape was impregnated with a combination of agents providing an occlusive dressing aimed at combatting exaggerated scarring. Patients who had undergone surgery were stratified into four groups: Group 1, 60 patients/60 scars following simple skin excisions, 30 treated scars, 30 untreated scars; Group 2, 20 patients/40 scars, each patient with two excisions, one treated, one untreated; Group 3, 10 patients/20 scars following bilateral breast surgery, one side treated with tape alone, one side treated with tape and gel; Group 4, 30 patients with varying cosmetic procedures/50 scars, all treated and compared with historical outcomes for hypertrophic scarring. Thus, 170 scars were assessed in 120 patients. Results were assessed at 1, 2, and 6 months using a combination of accepted scar assessment techniques. By amalgamating the Vancouver, Manchester, and morphologic table systems together with Patient and Observer Scar Assessment analyses, a comprehensive assessment of scar outcomes was undertaken and comparisons were made with control groups. Treated groups showed improvement outcomes in all variations of assessment. Patient and observer assessments correlated well, and morphologic appearances of the scars following the final assessment at 6 months showed statistically significant positive scar outcomes in the treatment groups. The multimodality approach to scar control showed significant benefits in the patient groups tested in this series. [ABSTRACT FROM AUTHOR]

Publications about breast implant surgery using the periareolar incision and those about mastoplasty do not mention the areolar smooth muscle. The purpose of this article is to present the importance that suturing the areolar smooth muscle may have in the prognosis of intra-areolar incisions in breast surgery and in the areola shape changes when it contracts after surgery. [ABSTRACT FROM AUTHOR]

Despite civilization and progress, burns occur frequently in the world. Remarkable discoveries of wound healing mechanisms have been reported. On the other hand, long-term outcomes from burn injuries represent a barrier to improvement of patients’ social, functional, and psychological condition. Lipofilling, described since the 1980s, currently is used for several clinical applications. This study aimed to verify whether lipofilling could ameliorate scar remodeling in three clinical cases. Three adult patients with hemifacial hypertrophic scars and keloids resulting from severe burns 2 to 13 years previously were selected. The patients were treated by injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman’s technique. Two injections (with a 13-month interval between) were administered at the dermohypodermal junction. Histologic examination of scar tissue punch biopsies (hematoxylin-eosin staining) before and after the treatment was performed as well as magnetic resonance scan with contrast. The clinical appearance and subjective patient feelings after a 6-month follow-up period suggest considerable improvement in the mimic features, skin texture, and thickness. Histologic examination shows patterns of new collagen deposition, local hypervascularity, and dermal hyperplasia in the context of new tissue, with high correspondence to the original. The preliminary results show that lipofilling improves scar quality and suggest a tissue regeneration enhancing process. [ABSTRACT FROM AUTHOR]

Correction of a crooked or deviated nose is a complex cosmetic and functional problem as well as a big challenge for the rhinoplasty surgeon. Although corrections using a wide range of surgical techniques to straighten the nose and maximize nasal function have been proposed, recurrence is very common because of cartilage memory and scar contracture. Therefore, to prevent recurrence and maintain the correction of the septum, a permanent support that is stable and strong with the ability to maintain its given shape after placement on one or both sides of the septum is needed. The author used a nasal bone graft. In this study, the concept and technique for correction of the crooked nose and the author’s experience using it are presented. This graft material was used for 12 patients with crooked noses (8 with C-type and 4 with S-type noses). During a mean follow-up period of 20 months (range, 12–36 months), there were no complications, recurrences, or extrusions. Functional evaluations were performed using a visual analog scale before surgery and 6 months after surgery. Patients were asked to score their nasal breathing on a scale ranging from 0 to 100. The mean preoperative value was 17.67% ± 1.22% (range, 15–25%), and the postoperative value was 89.88% ± 1.24% (range, 85–95%). Use of nasal bone grafts as the spreader graft is a safe, effective, reliable, and permanent method for correction of the crooked nose. The author advises using this technique with nasal bone grafts for functional recovery and increased strength against further trauma or forces of scar contracture. This technique may prevent recurrence attributable to cartilage memory. [ABSTRACT FROM AUTHOR]

Abnormal wound healing processes can result in hypertrophic scars and keloids. Transforming growth factor-β1 (TGF-β1) and hepatocyte growth factor/scatter factor (HGF/SF) are biphasic growth factor cytokines in physiologic and pathophysiologic conditions. Findings have shown TGF-β1 to be pivotal in the formation of keloid tissue. Therefore, neutralizing antibodies may allow wound healing without keloid formation. As reported, TGF-β1 is antagonized by HGF/SF. Some authors have reported that exogenous administration of HGF/SF prevented scar formation. Hence, this study targeted TGF-β1 and determined the levels of HGF/SF in fibroblast cell culture. Keloid tissue was taken from seven patients. Another seven patients with mature nonhypertrophic scar served as controls. All tissues were cultured, and fibroblast cultures were used for further experiments. The TGF-β1 antisense was administered at 3 and 6 μmol/ml, and HGF/SF levels were determined after 16, 24, and 48 h of incubation. The levels of HGF/SF showed significant differences after incubation with antisense oligonucleotides. The increasing antisense levels resulted in increased HGF/SF levels (up to 87.66 pg/ml after 48 h of incubation). In conclusion, targeting TGF-β1 resulted in significantly increased levels of HGF/SF. The clinical relevance could include the use of locally administered HGF/SF in protein or gene form to minimize formation of keloids. Nevertheless, wound healing is the result of many interacting cytokines, so neutralizing or targeting one protein could result in no significant effect. [ABSTRACT FROM AUTHOR]

The wish to prevent or improve scars, whether they are of surgical or traumatic origin, has led to the development of scar creams and gels that are said to influence the aesthetic appearance of a scar. In this article the literature on results of the topical application of various scar creams and gels is reviewed. It is concluded that no single modality has been proven to manage hypertrophic scarring except maybe silicone and BAPN. Further research into the physiology and pharmacophysiology of scar tissue is needed. With respect to scars, it still applies that even 'plastic surgeons can't erase without a trace.' [ABSTRACT FROM AUTHOR]

The scar in Orientals is more conspicuous than one in Caucasians and thus, repair procedures are different for each group. As the human body is solid, the scar should be repaired using W-plasties and Z-plasties with dermostitches to prevent scar contracture. The size of the flaps shouid be 3-5 mm and the angle of the flaps about 60°. When keloids are a concern, the wound margin should be elevated by dermostitches and elongated by multiple Z-plasties. [ABSTRACT FROM AUTHOR]

Over the past few years, treatment of burn scars with lipofilling has shown encouraging clinical results in terms of texture, color, softness, and quality of skin patterns. This clinical application has been widened to include treatment for scars resulting from surgical correction of cicatricial ectropion. In fact, although standard surgery with flaps and skin grafts can grant significant functional and cosmetic improvements, these often are not complete because of secondary surgical scars. The case of a 43-year-old man with cicatricial outcomes from chemical burns and subsequent surgical repair of medial ectropion in the lower eyelid is reported. The scar area was treated with injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman’s technique. At the 1-year follow-up assessment after lipostructure, the patient no longer reported xeroftalmia and epiphora. He had experienced complete functional recovery with excellent cosmetic results. Lipostructure of cicatricial ectropion seems to complete and improve the results of the standard surgical approach, and its long-lasting benefits are in keeping with the theoretical basis of this procedure. [ABSTRACT FROM AUTHOR]