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High mobile glandular ptotic breasts present the greatest challenge for implant breast augmentation with suboptimal outcomes occurring frequently. Here, we describe and evaluate an innovative approach for breast augmentation in this breast type. By widely disrupting and redefining the parenchyma-muscle interface, this technique offers opportunities to restore the takeoff point of the breast and improve the fullness of the upper pole, thus producing a "perkier" breast appearance. A retrospective review was performed, and 68 patients who underwent breast augmentation with either type III dual-plane or the new approach between January 2015 and January 2021 were included. The patients were divided into two groups. The aesthetic outcome and patient satisfaction were evaluated using different 10-point rating forms. Data on demographic information, surgical details, and relative complication rates were recorded and compared. Upon comparing the aesthetic outcomes and satisfaction, the test group demonstrated better breast shape, nipple-areola position, upper pole contour outcome, and upper pole satisfaction. No post-operative hematoma, seroma, or infection occurred in either groups. No double-bubble deformity occurred in the test group, whereas it occurred in two patients in the control group. The rates of capsular contracture were 1.4% and 1.6%, in the test and control groups, respectively. The new approach is a safe surgical method with good aesthetic outcome, high patient satisfaction, and long-lasting result. This approach is a supplement to the dual-plane techniques, to realize the benefits of mastopexy and type III dual-plane breast augmentation. [ABSTRACT FROM AUTHOR]

Surgical management of grade III gynecomastia with excess redundant skin is challenging. The choice of the surgical technique is mainly decided upon the size of the gynecomastia, the skin redundancy and correction of nipple position. We report our experience in the use of the circular incision bi-pedicled vertical flap based mastectomy for grade III gynecomastia according to Simon classification. This is a retrospective study conducted between January 2022 and April 2023 at two selected units in Sri Lanka. A total of 7 patients with bilateral grade III gynecomastia were included in this study with a median age of 24 years (range: 18–42 years). The mean BMI was 23.2 kg/m 2 . All patients exhibited near symmetrical breasts and large areolar diameters. All patients complained of physical and psychological dissatisfaction with their condition and sought an aesthetic correction. Two patients were diagnosed with Klinefelter syndrome and others were apparently healthy. The main complication was seroma formation (7/7). No patients developed haematoma. Nipple hypothesia was noted in two patients which improved on follow up. The mean follow- up duration was 4–9 months. The survey of patient satisfaction showed 9 for contour, 8.6 for wound scars, 9.2 for overall satisfaction and 9.6 for improvement in self-confidence. The above surgical technique achieved satisfactory aesthetic results while avoiding unsightly scars or serious complications and can be considered in the surgical decision making for grade III gynecomastia. • Surgical management of grade 3 gynecomastia is challenging. • This article describes the experience in the use of the circular incision bi-pedicled vertical flap based mastectomy for grade 111 gynecomastia. • This surgical technique achieves satisfactory aesthetic results while avoiding unsightly scars. [ABSTRACT FROM AUTHOR]

Although the primary aim of pollicization is to augment function, aesthetic improvement is an important secondary aim. Satisfaction with hand appearance in children with index pollicization for thumb hypoplasia was evaluated in 18 patients at an average of 7.5 years after surgery. Patients and their parents rated the appearance of their operated hand using a 10-point visual analogue scale (VAS). Four independent surgeons and 16 non-surgeon observers also rated the hands after reviewing standardized photographs of each child. The median patient-reported and parent-reported scores were 9 for both groups (IQR: 7–10) with a trend for children 12 years and older, to report lower satisfaction with appearance. The non-surgeon group assessments varied more for a given hand than the surgeons' assessments, though when scores were averaged within these groups for each hand, there was a high degree of correlation between the two groups. Surprisingly, the patient's own assessment showed a trend towards negative correlation when compared with the average rating of the non-surgeon assessors, suggesting that patients' own assessment of their hand's appearance is more affected by subjective factors than the objective physical outcome. [ABSTRACT FROM AUTHOR]

The study aimed at comparing outcomes between split-thickness skin graft (STSG) and local ipsilateral full-thickness skin graft (FTSG) after radial forearm free flap defect closure. A comprehensive study protocol for objective and subjective assessment was established for this retrospective, single-center study. Clinical examinations were carried out, encompassing measuring wrist and finger range of movement and grip strength, testing skin sensitivity, and evaluating aesthetics using the Patient and Observer Scar Assessment Scale (POSAS). In addition, medical history, and questionnaire, including Cold Intolerance Severity Score (CISS) and 18 items, were used to assess satisfaction, functional limitations, and complaints. 44 patients were examined, and 40 patients included, who had received STSG (group 1; n = 19) respectively local FTSG from the ipsilateral forearm (group 2; n = 21) at least three months previously. Significantly lower values for parameters pigmentation, relief (p = 0.015), overall impression (p = 0.044), as well as mean POSAS observer scale total score (p = 0.046) and no complaints wearing a wristwatch (p = 0.012) were shown in group 2 (FTSG). Within the limitations of the study, it seems that FTSG harvested from the forearm should be preferred over STSG to cover RFFF donor site whenever appropriate, because of beneficial outcomes, while providing single intervention closure and avoiding secondary donor site. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the clinical, aesthetic, and functional outcomes between amniotic membrane (test group) and split-thickness skin grafts (control group) used for radial forearm free flap defect closure. The primary outcome measurement for both groups was assessment of the defect closure healing process. In addition, aesthetic (Vancouver Scar Scale) and functional outcomes (skin sensitivity, hand/wrist functionality, grip strength) were evaluated. Fifty eligible patients with radial forearm free flap donor site defects were randomly assigned to two groups receiving either amniotic membrane (test group; n = 25) or split-thickness skin graft (control group; n = 25) for defect covering. Forty-seven of the 50 patients (n = 47) were able to be followed up for 6 months and showed a significantly longer healing process (p < 0.001) with amniotic membrane (64.5 ± 38.4 days; n = 24) than with split-thickness skin grafts (29.2 ± 8.9 days; n = 23); however, there were no differences in the prevalence of healing defects/dehiscence and/or wound infections. Forty-two of the 47 patients (21 in each group) were able to be continually followed up for 12 months, and showed no differences in terms of clinical outcome as well as the subjective and objective aesthetic and functional results evaluated. With regard to the clinical, aesthetic, and functional outcomes evaluated for radial forearm free flap defects, coverage with amniotic membrane offers an excellent alternative treatment approach, avoiding secondary induced donor site morbidity. [ABSTRACT FROM AUTHOR]

To assess and compare the changes in satisfaction with facial appearance and psycho-social well-being in dento-skeletal class II and III patients after orthognathic surgery with the FACE-Q among Hong Kong Chinese. The questionnaires for thirteen orthognathic-relevant FACE-Q scales, translated into Cantonese and validated, were administered to Hong Kong Chinese patients before and after orthognathic surgery in the short- and long-term, respectively. The assessed scales were categorized into four main domains: satisfaction with facial appearance, quality of life, patient's experience of care, and adverse effects. Generally, highly significant (p < 0.001) improved FACE-Q scores were found in the long-term in the scales investigating the satisfaction with overall facial appearance, lower face and jawline, and chin. Although dento-skeletal class III patients demonstrated significantly improved satisfaction with their post-surgical nostril appearance (p = 0.003), this was not evident in dento-skeletal class II patients (p = 0.231). Nonetheless, both class II and class III subjects have also revealed significantly improved psychological well-being (0.003; <0.001) and social function (0.001; <0.001) in the long-term. Age was not found to be correlated with all scales for satisfaction of facial appearance. Previously validated Face-Q scales are valuable instruments to measure clinical outcomes, psychological well-being and social function in Cantonese speaking patients. Both Class II and Class III patients showed significantly improved satisfaction with facial appearance, psychological well-being and social function after orthognathic surgery regardless of skeletal pattern and gender, confirming findings in other ethnicities. [ABSTRACT FROM AUTHOR]

The aim of this study was to retrospectively evaluate the perceptions of aesthetic outcome following the autologous and prosthetic reconstruction of nasal and auricular defects among patients, professionals (oral and maxillofacial surgeons and ear, nose and throat surgeons) and people unfamiliar with reconstructive surgery. The influence of anatomical subunits on the overall perception of nasal and auricular reconstructions was also determined. A total of 119 patients treated for nasal and auricular defects between 1997 and 2016, with a minimum follow-up period of 6 months, were selected, and photographs of 77 of these patients (65%) were presented in a digital survey and reviewed using a standardized questionnaire. No clinically relevant correlations were found between the age or gender of patients (as well as those of the respondents) and their scores. Prosthetic reconstructions of nasal and auricular defects were considered advantageous over autologous reconstructions in terms of the subjective aesthetic outcome in the view of the professionals, in particular oral and maxillofacial surgeons; however, the patients judged both techniques to be equally effective in terms of aesthetics. No anatomical subunits were found to have a significant impact on the overall match of a nasal or auricular reconstruction with the patient's face. [ABSTRACT FROM AUTHOR]

Background: The suturing technique and its associated complications could affect cosmetic outcome after facial surgery. Literature on this topic is limited.Objective: To compare the cosmetic results 12 months after treatment and complications associated with simple interrupted sutures (SIS) versus running subcuticular sutures (RSS) in facial surgery.Methods: A randomized, controlled multicenter trial was performed. Adults receiving dermatologic surgery on the face were randomized to receive SIS or RSS for wound closure. The primary outcome was the overall opinion score on the Patient and Observer Scar Assessment Scale (POSAS) 12 months after surgery. Secondary outcomes were the complication rates and scores according to alternative methods for assessment of cosmetic outcome. The observer of cosmetic outcome was blinded to treatment assignment.Results: 142 patients were randomized to receive SIS (n = 73) or RSS (n = 69). Twelve months after surgery, the median score of the overall opinion on the POSAS was 2.0 (range 1-8) according to the patients and 3.0 (range 1-8) according to the observer in both groups. In the RSS group, hyper- or hypoesthesia was reported more often.Limitations: The cosmetic result was assessed by 1 observer.Conclusion: SIS and RSS in facial surgery resulted in comparable cosmetic outcomes. RSS was more often associated with hyper- or hypoesthesia. [ABSTRACT FROM AUTHOR]

One hundred and one patients with complete or incomplete cleft lip underwent the anatomical subunit approximation technique for repair. The patients were followed up prospectively for 1 year. The objective of this study was to determine the outcomes for the nasolabial area through anthropometric measurements and assessment of the Asher-McDade Aesthetic Index and Steffensen’s criteria at 1 year after surgery. Six assessors (three cleft surgeons and three non-surgeon medical professionals) examined cropped images; reliability was assessed using Cronbach’s alpha. The difference in lip length between the healthy and operated sides was 0.61 mm and the difference in nostril diameter was 0.37 mm (differences not significant). The average scar width was 2.78 ± 1.35 mm. Hypertrophic scars were observed in 9.9% of cases. The average Asher-McDade Aesthetic Index rating varied between 1.35 and 1.98 for all parameters. Cronbach’s alpha coefficient was 0.83, 0.89, 0.98, and 0.89 for nasal form, nasal symmetry, vermilion border, and nasolabial profile, respectively. Steffensen’s criteria rated appearance as ‘good’ in 69.3% to 91.1% of cases. The anatomical subunit approximation technique can be performed in Sub-Saharan Africans for all types of unilateral cleft lip. It significantly improves the length of the medial and lateral lips, leaving an acceptable scar. A study with a larger sample size and longer follow-up is warranted. [ABSTRACT FROM AUTHOR]

Surgery for craniosynostosis implies a relevant strain on the child and the parents. The development of the child's self-perception and self-confidence is mainly influenced by parental attitudes. The outcomes of 46 patients were analysed, taking into consideration parental perceptions. Parents were asked to indicate their satisfaction with the medical care and treatment provided using a questionnaire. Aesthetics were evaluated by the parents and doctors using a score (1 = perfect, 5 = deficient). Major surgical complications (2.2%) were reported only in the case of complex synostosis. Reoperation was necessary in 2.9% of isolated cases and 45.5% of complex cases. In general, parents were satisfied with the medical (1.3) and nursing (1.6) inpatient care. Aesthetic assessments differed between parents and surgeons, although not significantly ( P = 0.27). The surgeons perceived the results to be better than the parents, especially for complex synostosis (1.3 vs. 2.7). Alopecia and persistent asymmetry led to a worse perception of aesthetics. Persistent bone defects did not influence parental satisfaction. All participating parents would opt for surgery again. Surgery led to satisfactory results with a low risk of severe complications. Nevertheless, the outcomes and limits of the surgical procedure must be communicated effectively to parents, especially in complex cases, to avoid a mismatch in expectations. It would be desirable to implement structured interviews with parents during regular treatment management. [ABSTRACT FROM AUTHOR]

Summary Background and aim The reproducible measurement of aesthetic outcomes after cleft lip and palate (CLP) surgery remains elusive, and there is no internationally recognised system. The aim of this pilot study was to better understand how humans rate post-operative aesthetic outcome after unilateral cleft lip and palate (UCLP) repair using a novel web-based rating platform with an extended panel of surgeon raters. Methods Cropped images of 5-year-old UCLP patients were arranged in a randomly generated sequence within a web-based aesthetic scoring tool as part of an agreement/reliability study. Assessors rated the appearances of patients using a five-point Likert-type scale on two occasions. A mixed-effect statistical model was adopted to analyse the effects of rater, image and timing. Results Images of 76 patients were scored by 29 UK-based cleft surgeons. Intra-rater variability was found, and the linear weighted kappa was 0.56. This allowed identification of the most and least consistent raters. The random image effect ( p < 0.001) suggested that a broad range of aesthetic outcomes were included in the current study. Surgeon raters in this study were likely to score the images more preferably at the second assessment. Conclusions A web-based scoring system provides extended data capture, and mixed-effect statistical modelling reveals the effect that time, image and rater have on the scorings. The selection and training of raters, in combination with an exemplary yardstick, might improve inter- and intra-rater agreement. The development of objective measures based upon digital facial recognition can replace the highly variable subjective human influence on rating the aesthetic outcome. [ABSTRACT FROM AUTHOR]

Summary Background Barbed sutures have unidirectional circumferential shallow barbs, which distribute tension throughout the wound and close wound securely without the need to tie knots. Objectives We compare two different methods of wound closure in elective plastic surgical cases: barbed 3/0 V-Loc™180 suture and smooth 3/0 Maxon™ sutures, both polyglyconate monofilament synthetic absorbable sutures. We assessed the aesthetic long-term results with a minimum two year follow up. Methods This is a prospective, randomized controlled study with internal control. A single surgeon performed all cases. Patients who underwent elective operations that involved long wound closure were enrolled in the study. Each patient acted as their own internal control with half their wound being sutured with 3/0 V-Loc™180 barbed suture and the other half with smooth 3/0 Maxon™ deep dermal sutures and then a subcuticular skin closure. In both groups, the superficial fascial system was closed with 1 Vicryl interrupted sutures on both sides. Long-term cosmesis was evaluated using the modified Hollander cosmesis score by review of standardized postoperative photographs by 9 blinded plastic surgeons and specialist registrars. Results The study reports on 33 female patients. The time taken for wound closure was significantly reduced using the barbed suture (p < 0.001). There was no difference in the complication ratio in either group. Two-year aesthetic outcome was significantly superior when using the barbed suture (p = 0.0075). Conclusion Barbed sutures closure of long wounds is faster and produces a better long-term aesthetic outcome than smooth sutures. [ABSTRACT FROM AUTHOR]

Summary: In 1996 we published a study evaluating the difference between patient and surgeon opinion on the aesthetic outcome of reduction mammaplasty (see Ref. 1). The patients rated the aesthetic outcome of their surgery as significantly higher than the consultant panel. The surgical panel suggested scope for improvement. Areas of dissatisfaction were poor scarring, high placement of the nipple areola complex and high rates of revision surgery. Fifteen years on, the same team has regrouped to repeat this assessment. In 1996 the consultants scored their own patient results. In 2011 they graded the results of their former trainee who has modified her operative technique to address aesthetic problems highlighted in the first study. Forty-four patients attended a review clinic at least one year post reduction mammaplasty. Patient scored their satisfaction using the original questionnaire employed in 1996. The cohort were photographed and their images graded blindly by the original surgical panel. Statistical analysis was performed by the original statistician. The patients graded aesthetic aspects of body harmony, breast mound appearance, nipple areolar complex appearance and post-operative scarring significantly more positively (p < 0.01) than both the 1996 patient cohort and surgical panel. The consultant panel showed a trend for more positive grades for all aesthetic features assessed versus their previous views but this was only significant for breast mound symmetry. They expressed that there was a decrease in post-operative breast ptosis (p < 0.04) and improvement in the nipple areolar complex position (p = 0.02). The rate of revision surgery has decreased from 53% to 16% between the studies. In keeping with clinical audit, outcomes have been assessed and modifications implemented to address aesthetic concerns. Assessment of outcomes following the modifications demonstrates a trend for increased patient and surgeon satisfaction. Patient satisfaction however still exceeds that of the surgeons. [Copyright &y& Elsevier]

Summary: Background: There remains controversy as to whether immediate autologous breast reconstruction with postoperative radiotherapy is associated with acceptable complications and aesthetic outcomes. This systematic review analyses the literature regarding outcomes of immediate autologous breast reconstruction with postoperative radiotherapy compared with no radiotherapy, as well as with delayed autologous breast reconstruction following post-mastectomy irradiation. Methods: Pubmed (1966 to October 2012), Ovid MEDLINE (1966 to October 2012), EMBASE (1980 to October 2012), and the Cochrane Database of Systematic Reviews (Issue 10, 2012) were searched. Overall complications (including fat necrosis), fat necrosis, revisional surgery, loss of volume, and aesthetic outcome, were analysed individually. Comparable data from observational studies were combined for meta-analysis where possible and quality assessment of the studies was performed. Results: The majority of studies of immediate autologous breast reconstruction and postoperative radiotherapy reported satisfactory outcomes (19 of 25 studies; n = 1247 patients). Meta-analysis of observational studies demonstrated no significant differences in total prevalence of complications (p = 0.59) or revisional surgery (p = 0.38) and a summary measure for fat necrosis favouring the group without radiotherapy (OR 2.82, 95% CI 1.35–5.92, p = 0.006). The majority of studies comparing immediate reconstruction and postoperative radiotherapy with delayed reconstruction following post-mastectomy radiotherapy (10 of 12 observational studies; n = 1633 patients) reported satisfactory outcomes following immediate reconstruction. Meta-analysis of observational studies demonstrated no significant difference in overall incidence of complications (p = 0.53) and fat necrosis (OR 0.63, 95% CI 0.29–1.38, p = 0.25), and a summary measure for revisional surgery (OR 0.15, 95% CI 0.05–0.48, p = 0.001) favouring the delayed surgery group. No randomised-controlled trials met the inclusion criteria, and all of the observational studies included were missing more than one important component for reporting of observational studies. Discussion: The majority of studies reported satisfactory outcomes and a similar incidence of complications for immediate autologous breast reconstruction and adjuvant radiotherapy when compared with no radiotherapy or delayed reconstruction following radiotherapy; the proportion that required revisional surgery was higher though for immediate than delayed breast reconstruction. The findings are limited by the paucity of high quality data in the published literature, and until better data is available the findings of this review suggest that immediate autologous breast reconstruction should at least be considered when adjuvant chest wall radiotherapy is anticipated. [Copyright &y& Elsevier]

Abstract: Aesthetic outcome is as an important endpoint of breast cancer treatment and is associated with better psychological recovery and improved quality of life. Researchers in Portugal have developed a computerised program, BCCT.core, to objectively assess aesthetic outcome of conservation breast treatment photographs. This study aimed to investigate the correlation between the Harris Scale and the BCCT.core program in patients who have undergone mastectomy and reconstruction for breast cancer. 67 cases were assessed by five independent assessors using the Harris Scale and compared with BCCT.core software. Correlation between BCCT.core and the Harris Scale was significant for all cases (r = 0.66, p < 0.01, n = 67), unilateral cases (r = 0.70, p < 0.01, n = 50), implant reconstruction cases (r = 0.72 p < 0.01, n = 28) and latissimus dorsi flap reconstruction cases (r = 0.74, p < 0.01, n = 23). BCCT.core demonstrated correlation with the Harris Scale for measuring aesthetic outcome for unilateral surgery and suggests potential use for BCCT.core to measure aesthetics for breast reconstruction after mastectomy. [Copyright &y& Elsevier]

Objectives: Acquired skull deformities are common and most likely treated surgically by cranioplasty. Since data on patient aesthetic outcome after cranioplasty are rare in literature, we aimed to assess patient satisfaction after polymethyl-methacrylate (PMMA) cranioplasty in this study using a questionnaire. Methods: A patient questionnaire was developed to evaluate the grade of satisfaction after surgery. After approval by the institutional ethical review board, we were allowed to send to all 115 patients, who received a cranioplasty from 2001 to 2008 at the University Hospital of Zurich, our questionnaire once to retrospectively analyze the patient response together with the patient hospital records. Results: Out of 115 patients, 36 patients were lost to follow-up and our questionnaire was sent out once to 79 patients. Sixty-three of 79 patients replied to the questionnaire (79.7%) and 16 did not reply. Seventeen declined to participate in this study and out of the remaining 46 patients (58.2%, 18 women, mean age 54 years, range 20-83 years), who agreed to participate in this study, 22 (47.8%) judged their cranioplasty to be aesthetically 'excellent', 16 (34.8%) 'favorable' and 4 (8.7%) 'poor'. Another four patients (8.7%) were not satisfied, asking for a surgical revision. Patient age and gender was not related to the assessment of the aesthetic result. A higher satisfaction grade was found in patients with primary PMMA cranioplasty compared to PMMA cranioplasty implanted during a second surgery (Fisher's exact test, P=0.031). A dent was strongly associated with absence of satisfaction (P<0.01, Fisher's exact test). Conclusion: Our questionnaire was suitable to assess patient satisfaction after cranioplasty. Localization of cranioplasty showed to be an important factor of aesthetic outcome, especially in the fronto-temporal region where a carefully planned reconstruction should be performed to guarantee an excellent grade of satisfaction after surgery. [ABSTRACT FROM AUTHOR]

Abstract: We analysed intra- and inter-rater agreement of subjective third party assessment and agreement with a semi-automated objective software evaluation tool (BCCT.core). We presented standardized photographs of 50 patients, taken shortly and one year after surgery to a panel of five breast surgeons, six breast nurses, seven members of a breast cancer support group, five medical and seven non-medical students. In two turns they rated aesthetic outcome on a four point scale. Moreover the same photographs were evaluated by the BCCT.core software. Intra-rater agreement in the panel members was moderate to substantial (k = 0.4–0.5; wk = 0.6–0.7; according to different subgroups and times of assessment). In contrast inter-rater agreement was only slight to fair (mk = 0.1–0.3). Agreement between the panel participants and the software was fair (wk = 0.24–0.45). Subjective third party assessment only fairly agree with objective BCCT.core evaluation just as third party participants do not agree well among each other. [Copyright &y& Elsevier]

Summary: In determining patient satisfaction with functional and aesthetic outcome after reconstructive surgery, including nasal reconstruction, standardised assessment instruments are very important. These standardised tools are needed to adequately evaluate and compare outcome results. Since no such instrument existed for nasal reconstruction, a standardised evaluation questionnaire was developed to assess aesthetic and functional outcome after nasal reconstruction. Items of the Nasal Appearance and Function Evaluation Questionnaire (NAFEQ) were derived from both the literature and experiences with patients. The NAFEQ was validated on 30 nasal reconstruction patients and a reference group of 175 people. A factor analysis confirmed the arrangement of the questionnaire in two subscales: functional and aesthetic outcome. High Cronbach''s alpha values (>0.70) for both subscales showed that the NAFEQ was an internally consistent instrument. This study demonstrated that the NAFEQ can be used as a standardised questionnaire for detailed evaluation of aesthetic and functional outcome after nasal reconstruction. Its widespread use would enable comparison of results achieved by different techniques, surgeons and centres in a standardised fashion. [Copyright &y& Elsevier]

Summary: Background: Nasal reconstruction after extensive ablative therapy poses a reconstructive challenge. The aim of this study was to assess subjective aesthetic outcome after nasal reconstruction scored by patients and a panel. In addition, inter-rater variability as well as important parameters of good aesthetic outcome were analysed. Methods: A total of 39 consecutive patients treated between November 2001 and May 2005 for (sub) total nasal defects were included. All patients were photographed in a standardised setting. Subjective aesthetic outcome (eight different nasal characteristics on a five-point Likert scale) was assessed by reconstructed patients individually as well as an independent professional panel consisting of five plastic surgeons. Results: Thirty-three patients (87%) participated in the follow-up study. Questionnaire results demonstrated statistically significant lower panel satisfaction scores (3.5±0.9) with total nasal appearance than patients (4.2±1.3; P =0.03). There was a high agreement among panel members as judged by a low inter-rater variability. No relationship between severity of nasal defects and aesthetic outcome was found by patients or professionals. Conclusion: Patient subjective aesthetic outcome was significantly higher than that of a professional panel. Severity of nasal deformity was not an indicator for patient satisfaction. [Copyright &y& Elsevier]

Summary: Prophylactic mastectomy is an effective risk-reducing option in women with hereditary increased risk of breast cancer. It may be combined with immediate reconstruction, with the intention of improving aesthetic outcome and health-related quality of life. Sixty-one women underwent prophylactic mastectomy and immediate breast reconstruction in Malmö, Sweden, between 1995 and 2003. Forty women underwent bilateral prophylactic mastectomy and immediate reconstruction. Ten of these had a previous breast cancer diagnosis. Twenty-one women underwent contralateral prophylactic mastectomy and immediate reconstruction after a previous breast cancer. Fifty-four of the women (89%) were evaluated clinically for aesthetic results and complications. Patient satisfaction and quality of life were evaluated with one study-specific and two standardised health-related questionnaires administered at time of clinical follow-up. Median follow-up time was 42 months (range 7–99 months). The position of the reconstructed breasts was judged as satisfactory in 77% of breasts. Symmetry in relation to the midline was adequate in 89% of breasts. A capsular contracture grade III according to Baker and indentation tonometry was observed in 1% of breasts (1/104). The complication rate was 18% (7% early and 11% late). Secondary corrections were carried out in 11% of breasts. The study-specific questionnaire revealed a high degree of satisfaction. No woman regretted the procedure, and all women would have chosen the same type of surgery again. An age-stratified comparison of Swedish women using the Short Form 36 Health Survey Questionnaire (SF-36) questionnaire was carried out for this study. The study population scores were high, suggesting that prophylactic mastectomy and immediate reconstruction on both physical and psychological issues in this retrospective study had no negative effect. Also, the Hospital Anxiety and Depression Scale (HAD) questionnaire did not suggest any increased anxiety or depression among the patients. Prophylactic mastectomy and immediate breast reconstruction in women at risk of hereditary breast cancer may be carried out with a satisfactory aesthetic outcome and an acceptable rate of complications comparable to those in other studies, and does not in itself seem to be associated with a decreased quality of life. [Copyright &y& Elsevier]

Summary: Background: The goal of nasal reconstruction after a partial or total amputation is to achieve a nasal appearance as natural and normal as possible. It is assumed that laypersons'' opinion on facial appearance could affect patient satisfaction or self-concept. The aim of this study was to assess laypersons'' opinions on aesthetic outcome of nasal reconstruction. This was compared with the opinion of a professional panel. Second, the effect of informing laypersons about the previous nasal reconstruction of patients on their assessment of facial attractiveness and abnormality was studied. Third, the effects of individual facial features on the assessment of facial attractiveness and abnormality were determined. Methods: A total of 39 consecutive patients treated between November 2001 and May 2005 for (sub) total nasal defects were included, together with a control group of 39 persons without a facial deformity. A group of 20 randomly selected laypersons (10 men and 10 women) assessed facial appearance and abnormality of all 78 persons using standardised colour slides, not knowing who was a patient and who control. Two weeks later they were informed about the true study design and the same questions were asked. In addition, they assessed final treatment results of 39 patients. Results: No differences existed between assessment of aesthetic outcome after nasal reconstruction by laypersons and professionals (54% good to excellent). Patients were perceived significantly less attractive and more abnormal than controls. Prior knowledge had a significant positive effect on mean facial attractiveness and abnormality scores. High positive correlations were found between facial attractiveness and abnormality scores and the frequency of the item ‘nothing in particular’, meaning if no particular facial feature was judged to be striking, a face was perceived more attractive and less abnormal. Conclusion: Nasal reconstruction patients were perceived significantly less attractive and more abnormal by laypersons than controls. Since faces without striking features were judged to be more attractive, the goal of nasal reconstruction would not only be to create a nose as normal as possible, but also as inconspicuous as possible. [Copyright &y& Elsevier]

Abstract: Regarding the cosmetic results of wound closure using tissue adhesives as opposed to sutured wounds, most published studies are performed on children and with non-standardized lacerations, which makes it difficult to transfer the results to facial incisional wounds in adults. There are also conflicting conclusions about the cosmetic results. The purpose of this randomized prospective study was to compare the cosmetic outcomes of wound closure with sutures and octyl-2-cyanoacrylate in standardized facial wounds in adults. To compare very similar facial wounds, the infraorbital cut (lower eyelid incision) was used in 45 patients. The assessment was performed by patients and surgeons blind to the data. Phase-shifting profilometry was used to measure the profile of the scars. No early complications were observed in any group. The wound depth in the tissue adhesive group was significantly greater than in the suture group. There were no differences in the overall cosmetic results among all patients in the two groups. Interestingly, in the younger patients the result of the sutured wounds was superior to that of the adhesive-treated patients. The Dermabond® skin adhesive provides a means of closure of facial surgical wounds without early complications, but adjustment of the edges of the wound and the cosmetic result in younger patients are less successful than with thin sutures. [Copyright &y& Elsevier]