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Background: Dual plane breast augmentation is a technical variation of the submuscular plane described as a technique that reduces contour deformities due to contraction of the pectoralis major muscle and lower risk of double-bubble deformity associated with breast ptosis. Despite improvement in the aesthetic aspect, there is still no consensus whether this technique affects the function of the pectoralis major muscle., Objectives: The aim of this study was to correlate functional with volumetric changes associated with dissection of the muscle origin in submuscular breast augmentation., Methods: Thirty women who desired to undergo breast augmentation were selected prospectively and randomly allocated to 2 groups: 10 patients in the control group and 20 patients in the interventional group, who underwent submuscular breast augmentation. Magnetic resonance imaging and volumetric software were used to assess muscle volume and isokinetic dynamometry was used to assess function of the pectoralis major muscle. Preoperative measurements were compared with those at 3, 6, and 12 months after surgery., Results: Magnetic resonance imaging revealed significant decrease in muscle volume at 6 and 12 months follow-up. The isokinetic test conducted during adduction showed a significant difference in muscle strength between groups from baseline to the 12-month follow-up, and between the 3- and 12-month follow-up. No significant differences in muscle strength during abduction were observed from baseline to the 3-, 6-, and 12-month follow-up., Conclusions: Submuscular breast augmentation reduced muscle strength during adduction 12 months after surgery, but without a significant correlation with volumetric muscle loss., (© 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com)

Background: Despite being the cosmetic procedure most performed worldwide, there are still few objective measurements of postoperative volumetric analysis of breast augmentation available in the literature., Objective: The aim of this study was to evaluate volumetric changes in the breast parenchyma after the placement of silicone implants in the subglandular plane., Methods: Thirty-four women were randomly allocated to the intervention group (n = 24), who underwent breast augmentation in the subglandular plane, or to the control group (n = 10), who received no intervention. Volumetric magnetic resonance imaging was performed at inclusion, and after 6 and 12 months in all participants. The non-parametric Friedman's test was used for statistical analysis., Results: There was a significant reduction in glandular volume (mean, 22%) at 12 months postoperatively in patients who underwent breast augmentation., Conclusions: Breast augmentation caused reduction in the volume of the breast parenchyma., Level of Evidence: 3 Therapeutic., (© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Background: Breast augmentation through incisions in the axillae is an option for patients who wish to avoid scars on the breasts. The axillary approach also preserves the mammary parenchyma and lactiferous ducts. The utility of video-assisted endoscopy during this procedure as a means to improve safety and aesthetic outcomes remains debatable., Objectives: The authors compared outcomes of transaxillary breast augmentation with and without video-assisted endoscopy., Methods: Thirty-four women who underwent transaxillary breast augmentation with or without video-assisted endoscopy were evaluated in a prospective, randomized study. Patients received high-profile silicone implants in the subglandular plane and were monitored for an average of 25 months. Operating time, complication rates, postoperative pain, patient satisfaction, and aesthetic parameters were evaluated., Results: Operative time were significantly longer for patients who underwent transaxillary breast augmentation with video-assisted endoscopy compared with patients who underwent nonendoscopic surgery., Conclusions: Video-assisted endoscopy increased operating time but did not improve the safety of transaxillary breast augmentation or yield better aesthetic outcomes., Level of Evidence: 3 Therapeutic., (© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

In this article, the authors present a case of postrhinoplasty periorbital subcutaneous emphysema in a 35-year-old woman. This is an uncommon and benign rhinoplasty complication that can sometimes result from other pathologies such as barotrauma, hematoma, and allergic reaction. This patient's symptoms appeared to be a result of postanesthesia agitation. The patient's symptoms resolved after 1 week.

Background: The transaxillary approach for breast augmentation has gained popularity because of the absence of scarring on the breast. However, the effects of this procedure on breast cancer detection and treatment (which rely heavily on the results of axillary status studies) remain under debate. Specifically, sentinel lymph node biopsy is not indicated for patients who have undergone axillary surgery, due to controversy about the interference of the axillary approach with evaluation of the axillary drainage., Objectives: The authors evaluate changes in axillary lymphatic drainage in patients who underwent transaxillary breast augmentation., Methods: Twenty-seven patients who presented to Rio de Janeiro State University for breast augmentation were selected for this study. All patients underwent preoperative mammary lymphoscintigraphy, a subsequent transaxillary breast augmentation, and postoperative lymphoscintigraphy at 21 days and six months after the procedure. The postoperative imaging results examining the axillary lymphatic chain and the first axillary lymph node were analyzed and compared to the preoperative images., Results: One of the 27 patients (4.5%) demonstrated a lower rate of lymphatic drainage at 21 days postoperatively compared to preoperative values, but the flow rate had recovered by her six-month follow-up visit. All other patients showed no changes between the preoperative and postoperative images at either time point. The sentinel lymph node remained visible in all patients at all time points, and all breasts showed drainage primarily to the axillary lymphatic chain. Two patients experienced hematoma and one patient experienced late infection at four months postoperatively. The sentinel lymph node was still evident in both axillae., Conclusions: The data showed preservation of lymphatic drainage and visible sentinel lymph nodes even after transaxillary breast augmentation. Therefore, the authors believe that this procedure does not alter the integrity of mammary drainage for properly selected patients. These data provide surgeons with a less invasive treatment option for patients with early breast cancer, even when they have undergone prior breast augmentation through a transaxillary approach.

Background: Although the placement of implants for gluteal augmentation is becoming more common, the procedure still faces strong resistance from patients and some surgeons as a result of unsatisfactory outcomes in the past., Objective: The authors describe easily-identifiable anatomic reference points that can assist the surgeon in the performance of gluteoplasty, making the procedure simpler and safer., Methods: Based on a literature review, an anatomic study was performed of dissections of the gluteal region in seven formalinized and fresh cadavers. This study allowed the authors to observe anatomic details and propose bony reference points to guide gluteoplastic surgery. Between July 2006 and February 2009, 105 patients underwent gluteoplasty according to the guidelines resulting from the cadaveric study., Results: All patients were female, ages 22 to 50 years. The surgical procedure, once refined, resulted in a low complication rate. In the final 50 patients in the series, there was only one seroma, one wound infection, and no cases of dehiscence. Bruising on the side of the thigh was encountered in four of the total 105 cases (3.8%). The clinical photos demonstrate the positive aesthetic results of this technique., Conclusions: When gluteoplasty is performed utilizing a systematic strategy based on bone anatomy references, it can be a predictable procedure with reproducible results and minimal complications.

Background: Both surgical and nonsurgical techniques, including soft tissue augmentation, are available to restore a youthful appearance to the face. Soft tissue augmentation with nonabsorbable fillers is increasingly important, as a growing number of patients are seeking aesthetic improvement without the downtime and cost of major surgical procedures. Polymethylmethacrylate (PMMA), an injectable implant composed of a suspension of microspheres in different media, is one such soft tissue filler., Objectives: Because the application of PMMA into the pericartilage of the ear is becoming a more common practice among plastic surgeons, the authors offer a systematic analysis of its effects. They believe this information to be of paramount importance to prevent injuries and deformities., Methods: Twenty-one patients who presented to the lead author's clinic with prominent ears during a period of 16 months between 2007 and 2008 were retrospectively reviewed. The authors analyzed PMMA's effects on each patient's ear shell cartilage, which was extracted during correction without causing any kind of injury or deformity to the participants in this study., Results: The histopathologic study from the excised skin and cartilage samples showed a granulomatous inflammation in all patients. There was no association between the incidence of tissue alterations and the mean length of PMMA on the conchal cartilage., Conclusions: The potential consequences of PMMA injection in close proximity to cartilage cannot be predicted and the possibility of myxomatous cartilage degeneration is a serious potential adverse event because it can cause permanent deformities of the cartilaginous skeleton.

The author provides advice on face lift incision placement to preserve ear contour and maintain normal sideburn position.

Background: The treatment of the aging neck is still a challenge to the plastic surgeon., Objective: The results of anatomic studies of the platysma muscle and its role in the treatment of the aging neck are presented., Methods: Dissection of 50 cadavers revealed differences in the distribution of the medial fibers of the platysma muscle in the suprahyoid region that could significantly affect surgical results. A 4-cm incision at the submental area, 0.3 to 0.4 mm behind the submental crease, and submental skin undermining permitted visualization of the medial fibers of the platysma. The medial fibers were dissected laterally and excess muscle removed. The fibers were sutured without tension to the median line, followed by a medial section at the level of the cricoid cartilage., Results: With the use of the approach described here, very good results were obtained in the treatment of patients who presented with deformities in the median line of the neck., Conclusions: Appropriate treatment of the platysma, based on anatomic analysis and facilitated by the submental approach, is the key to optimal results in the treatment of the aging neck. (Aesthetic Surg J 2003;23:165-169.).

The author describes his preferred technique for mastopexy and reduction mammaplasty. He contends that patients are accepting of a longer scar if it results in improved breast appearance and that scar quality, more than length, is an important factor in achieving patient satisfaction. (Aesthetic Surg J 2002;22:569-572.).