Volume Loss, Not Just ‘Sagging,’ Causes Upper Lip Aging

Are aging-related changes in the face related more to “deflation” or “sagging”? A new study helps settle the debate, showing significant loss of volume in the upper lip in older adults, reports the February issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

“Our results suggest that the aging perioral area is affected with a combination of soft tissue lengthening, thinning, and volume loss,” concludes the new research, led by Patrick L. Tonnard, MD, PhD, of Coupre Centre for Plastic Surgery, Ghent, Belgium. For plastic surgeons, the findings may help to inform and improve evidence-based approaches to facial rejuvenation.

The researchers analyzed magnetic resonance imaging (MRI) scans of the head obtained for other reasons in 200 adults: 100 women and 100 men. Participants were divided into a younger group aged 20 to 30 and an older group aged 65 to 80. Detailed measurements of the “upper lip unit” were analyzed to evaluate differences between the two groups, with an average age difference of nearly 50 years.

The measurements revealed several age-related differences in the anatomy of the upper lip. These included significant lengthening of the upper lip in older adults: about 19 percent longer in women and 18 percent longer in men, compared to the younger group.

The older group also had decreased soft tissue thickness of the upper lip: by about 41% in women and 33% in men. Most of the reduction in tissue thickness occurred at the “alar nasolabial fold” – the top of the lines running from the base of the nose to the corners of the lips.

The findings suggest that age-related lengthening and thinning of the upper lip represents more than just “sagging.”

“[V]olume loss is an obvious feature of the aging upper lip,” Tonnard and colleagues write. Loss of soft tissue volume also seems to contribute to deepening of the nasolabial folds, a prominent feature of the aging face.

“The mouth and perioral area play a primary role in emotional expression and attractiveness of the face,” according to the authors. “Unfortunately, the mechanisms of centrofacial aging are poorly understood” – as illustrated by the debate over “sagging versus deflation.”

The new study provides insights into these mechanisms, based on detailed MRI measurements in a large sample of older versus younger adults.

Lengthening, thinning, and volume loss all contribute to aging of the area around the mouth, the study suggests. The findings add to the evidence base underlying plastic surgery and other cosmetic procedures for facial rejuvenation.

Tonnard and colleagues plan a follow-up article to discuss the clinical implications of their findings, including the role of dermal fillers for minimally invasive volume augmentation.

[Source(s): Wolters Kluwer Health, EurekAlert]

Autologous Breast Reconstruction is a Safe Alternative After Implant Failure

Implants are usually the first choice for breast reconstruction after mastectomy. But when implant-based reconstruction fails, autologous reconstruction – using the patient’s own tissues – is a safe procedure that improves patient outcomes, reports a study in the February issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

“Autologous breast reconstruction after failed implant-based reconstruction is associated with significantly improved patient satisfaction and quality of life,” concludes the study by ASPS Member Surgeon Joseph J. Disa, MD, and colleagues of Memorial Sloan Kettering Cancer Center, New York.

Implants are the most frequent option for breast reconstruction after mastectomy, used in about 80% of patients. But in some cases, the initial reconstruction fails, due to complications or other reasons. In this situation, some patients opt for the autologous technique, with the breast reconstructed using the patient’s own tissue – typically using a flap obtained from a “donor site” in the abdomen.

Disa and colleagues analyzed 137 women who underwent autologous breast reconstruction after failed implant reconstruction. In about three-fourths of patients, the initial reconstruction failed due to scarring around the implant (capsular contracture) causing pain or deformity. Other patients had infections or other implant-related complications, or were dissatisfied with the appearance of the reconstructed breast.

The second reconstruction was performed an average of about 3.5 years after the initial procedure. Both breasts were reconstructed in 55 patients, for a total of 192 flaps. Outcomes were assessed using the validated BREAST-Q questionnaire, which evaluates various aspects of quality of life after breast reconstruction.

The results suggested that autologous reconstruction after failure of initial implant reconstruction is a safe procedure. Complication rates were similar to previous studies, despite the additional challenges posed by capsular contracture or previous radiation therapy.

Analysis of BREAST-Q responses showed “a high degree of satisfaction and quality of life” after autologous reconstruction. About one-fourth of patients filled out the BREAST-Q after both implant procedures. This group had significant improvements in satisfaction with the appearance of the breasts, psychosocial well-being, and physical well-being of the chest.

The women also reported improved satisfaction with overall well-being on the BREAST-Q. That was despite a decrease in physical well-being of the abdomen, related to the tissue donor site in the abdomen.

Implant and autologous reconstruction each have advantages for breast reconstruction after mastectomy. While reconstruction using the patient’s own tissues may provide a more natural-appearing breast, implant-based reconstruction is more widely available and less costly. Both procedures are safe and provide good reconstructive outcomes.

The new study is one of only a few to assess the outcomes of autologous reconstruction after failed implant-based reconstruction, and the first to use the validated BREAST-Q questionnaire. The results show improvements in physical and psychological well-being for this group of breast cancer survivors, as well as increased satisfaction with the appearance of the reconstructed breast or breasts.

“Regardless of reason for implant failure, this study shows changing to autologous tissue after implant removal is safe,” Disa and coauthors conclude. While there may be some additional challenges related to previous breast cancer treatment and reconstruction, they add, “The procedure has an acceptable complication rate.”

[Source(s): Wolters Kluwer Health, EurekAlert]

U.S. Providers Fix Complications From Medical Tourism Procedures

Cosmetic surgery procedures done in developing countries can carry substantial risks of complications that U.S. providers and payers must handle, according to a study published in the April issue of Plastic and Reconstructive Surgery.

Kimberly M. Ross, M.P.H., from Brigham and Women’s Hospital in Boston, and colleagues retrospectively reviewed the cases of patients who presented to the plastic surgery service of an urban tertiary academic hospital with complications or complaints associated with plastic surgery done in a developing country.

Sientra Reports the Long-Term Safety and Effectiveness of Silicone Gel Breast Implants with Results from the Largest Core Breast Implant Trial To-Date

Plastic and Reconstructive Surgery‘s recently published annual supplement included data validating Sientra’s growing portfolio of implants and expanders as safe and innovative options for surgeons and patients undergoing aesthetic or reconstructive breast surgery.

The four-part supplement, which includes the Company’s finalized 10-year FDA Core Study, provides a comprehensive look at the long-term outcomes, surgical best practices and product differentiation of Sientra’s breast implants and tissue expanders.

Read the full press release at www.prnewswire.com