A Modified, Direct Neck Lift Technique: The Cervical Wave-Plasty

Fereydoun Don Parsa,Nikki Castel,Natalie Niloufar Parsa 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.2

Background Major problems with cervicoplasty by direct skin excision include the subjective nature of skin markings preoperatively and the confusing array of procedures offered. This technique incorporates curved incisions, resulting in a wave-like scar, which is why the procedure is called a “wave-plasty”. Methods This prospective study includes 37 patients who underwent wave-plasty procedures from 2004 to 2015. Skin pinching technique was used to mark the anterior neck preoperatively in a reproducible fashion. Intra-operatively, redundant skin was excised, along with excess fat when necessary, and closed to form a wave-shaped scar. Patients were asked to follow up at 1 week, 6 weeks, and 6 months after surgery. Results The mean operation time was 70.8 minutes. The majority (81.3%) was satisfied with their progress. On a scale of 1 to 10 (1 being the worst, and 10 being the best), the scars were objectively graded on average 5.5 when viewed from the front and 7.3 when seen from the side 6 months after surgery. Complications consisted of one partial wound dehiscence (2.3%), one incidence of hypertrophic scarring (2.3%), and two cases of under-resection requiring revision (5.4%). Conclusions In select patients, surgical rejuvenation of the neck may be obtained through wave-like incisions to remove redundant cervical skin when other options are not available. The technique is reproducible, easily teachable and carries low morbidity and high patient satisfaction in carefully chosen patients.

A Modified, Direct Neck Lift Technique: The Cervical Wave-Plasty

Parsa, Fereydoun Don,Castel, Nikki,Parsa, Natalie Niloufar Korean Society of Plastic and Reconstructive Surge 2016 Archives of Plastic Surgery Vol.43 No.2

Background Major problems with cervicoplasty by direct skin excision include the subjective nature of skin markings preoperatively and the confusing array of procedures offered. This technique incorporates curved incisions, resulting in a wave-like scar, which is why the procedure is called a "wave-plasty". Methods This prospective study includes 37 patients who underwent wave-plasty procedures from 2004 to 2015. Skin pinching technique was used to mark the anterior neck preoperatively in a reproducible fashion. Intra-operatively, redundant skin was excised, along with excess fat when necessary, and closed to form a wave-shaped scar. Patients were asked to follow up at 1 week, 6 weeks, and 6 months after surgery. Results The mean operation time was 70.8 minutes. The majority (81.3%) was satisfied with their progress. On a scale of 1 to 10 (1 being the worst, and 10 being the best), the scars were objectively graded on average 5.5 when viewed from the front and 7.3 when seen from the side 6 months after surgery. Complications consisted of one partial wound dehiscence (2.3%), one incidence of hypertrophic scarring (2.3%), and two cases of under-resection requiring revision (5.4%). Conclusions In select patients, surgical rejuvenation of the neck may be obtained through wave-like incisions to remove redundant cervical skin when other options are not available. The technique is reproducible, easily teachable and carries low morbidity and high patient satisfaction in carefully chosen patients.

Case of late hematoma after breast augmentation

Kim, Leslie,Castel, Nikki,Parsa, Fereydoun Don Korean Society of Plastic and Reconstructive Surge 2018 Archives of Plastic Surgery Vol.45 No.2

We present a case report of a patient who experienced a late, spontaneous breast hematoma 26 years after primary breast augmentation. Late hematomas are a rare complication of breast augmentation with uncertain etiology. In this case, there was no trauma, calcifications, or implant rupture. We believe the patient's hematoma was secondary to erosion of a capsular vessel due to capsular contracture.

Case of late hematoma after breast augmentation

Leslie Kim,Nikki Castel,Fereydoun Don Parsa 대한성형외과학회 2018 Archives of Plastic Surgery Vol.45 No.2

We present a case report of a patient who experienced a late, spontaneous breast hematoma 26 years after primary breast augmentation. Late hematomas are a rare complication of breast augmentation with uncertain etiology. In this case, there was no trauma, calcifications, or implant rupture. We believe the patient’s hematoma was secondary to erosion of a capsular vessel due to capsular contracture.

Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study

Lee Kiang,Peter Deptula,Momal Mazhar,Daniel Murariu,Fereydoun Don Parsa 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5

Background: Standard upper blepharoplasty involves removal of both the skin and a portionof the underlying orbicularis oculi muscle. The senior author had observed sluggishness ofeyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patientsduring the early postoperative period. He postulated that these findings could be due toorbicularis muscle excision. He therefore undertook a prospective study 27 years agocomparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods: A randomized, prospective, single-blinded study was designed using the fellow eyeas an internal control. 22 patients undergoing upper blepharoplasty procedure requiringgreater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, orprevious eyelid surgery were selected. Upper blepharoplasty was performed with skin-onlyremoval on one side, and combined skin-muscle removal on the other side. Patients wereevaluated until six months after surgery except for two patients who were lost to follow-upafter three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result wereoutcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results: There were comparable aesthetic outcomes in both eyelids. The incidence of sluggisheyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelidswhere wide segments of muscle had been resected. Conclusions: Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes asconventional blepharoplasty, while significantly reducing the complications of sluggish eyelidclosure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study

Kiang, Lee,Deptula, Peter,Mazhar, Momal,Murariu, Daniel,Parsa, Fereydoun Don Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.5

Background Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected. Conclusions Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

Polyurethane-Coated Breast Implants Revisited: A 30-Year Follow-Up

Nikki Castel,Taylor Soon-Sutton,Peter Deptula,Anna Flaherty,Fereydoun Don Parsa 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.2

Background Polyurethane coating of breast implants has been shown to reduce capsular contracture in short-term follow-up studies. This 30-year study is the longest examination of the use of polyurethane-coated implants and their correlation with capsular contracture. Methods This study evaluates the senior surgeon’s (F.D.P.) experience with the use of polyurethanecoated implants in aesthetic breast augmentation in 382 patients over 30 years. Follow-up evaluations were conducted for six months after surgery. After the six-month follow-up period, 76 patients returned for reoperation. The gross findings, histology, and associated capsular contracture were noted at the time of explantation. Results No patient during the six-month follow-up period demonstrated capsular contracture. For those who underwent reoperation for capsular contracture, Baker II/III contractures were noted nine to 10 years after surgery and Baker IV contractures were noted 12 to 21 years after surgery. None of the explanted implants had macroscopic evidence of polyurethane, which was only found during the first five years after surgery. The microscopic presence of polyurethane was noted in all capsules up to 30 years after the original operation. Conclusions An inverse correlation was found between the amount of polyurethane coating on the implant and the occurrence of capsular contracture. Increasingly severe capsular contracture was associated with a decreased amount of polyurethane coating on the surface of the implants. No contracture occurred in patients whose implants showed incomplete biodegradation of polyurethane, as indicated by the visible presence of polyurethane coating. We recommend research to find a non-toxic, non-biodegradable synthetic material as an alternative to polyurethane.

Polyurethane-Coated Breast Implants Revisited: A 30-Year Follow-Up

Castel, Nikki,Soon-Sutton, Taylor,Deptula, Peter,Flaherty, Anna,Parsa, Fereydoun Don Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.2

Background Polyurethane coating of breast implants has been shown to reduce capsular contracture in short-term follow-up studies. This 30-year study is the longest examination of the use of polyurethane-coated implants and their correlation with capsular contracture. Methods This study evaluates the senior surgeon's (F.D.P.) experience with the use of polyurethane-coated implants in aesthetic breast augmentation in 382 patients over 30 years. Follow-up evaluations were conducted for six months after surgery. After the six-month follow-up period, 76 patients returned for reoperation. The gross findings, histology, and associated capsular contracture were noted at the time of explantation. Results No patient during the six-month follow-up period demonstrated capsular contracture. For those who underwent reoperation for capsular contracture, Baker II/III contractures were noted nine to 10 years after surgery and Baker IV contractures were noted 12 to 21 years after surgery. None of the explanted implants had macroscopic evidence of polyurethane, which was only found during the first five years after surgery. The microscopic presence of polyurethane was noted in all capsules up to 30 years after the original operation. Conclusions An inverse correlation was found between the amount of polyurethane coating on the implant and the occurrence of capsular contracture. Increasingly severe capsular contracture was associated with a decreased amount of polyurethane coating on the surface of the implants. No contracture occurred in patients whose implants showed incomplete biodegradation of polyurethane, as indicated by the visible presence of polyurethane coating. We recommend research to find a non-toxic, non-biodegradable synthetic material as an alternative to polyurethane.