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A proper knowledge of noninvasive facial rejuvenation is integral to the practice of a cosmetic surgeon. Noninvasive facial rejuvenation can be divided into patient- versus physician-directed modalities. Patient-directed facial rejuvenation combines the use of facial products such as sunscreen, moisturizers, retinoids, α-hydroxy acids, and various antioxidants to both maintain youthful skin and rejuvenate damaged skin. Physicians may recommend and often prescribe certain products, but the patients are in control of this type of facial rejuvenation. On the other hand, physician-directed facial rejuvenation entails modalities that require direct physician involvement, such as neuromodulators, filler injections, laser resurfacing, microdermabrasion, and chemical peels. With the successful integration of each of these modalities, a complete facial regimen can be established and patient satisfaction can be maximized. This article is the first in a three-part series describing noninvasive facial rejuvenation. The authors focus on patient-directed facial rejuvenation. It is important, however, to emphasize that even in a patient-directed modality, a physician's involvement through education and guidance is integral to its success.

The demand for aesthetic augmentation with soft tissue fillers has greatly increased in recent years and has led to an expansion in the number of products available. Unfortunately, an increase in adverse events has followed. These can be categorized into early, late, and delayed. Early infectious complications generally present as a localized skin infection, cellulitis, or abscess. Fillers can also serve as a focus for chronic infection, which is associated with the development of foreign body granulomas, a late complication. Bacterial colonization and indolent infections of the filler site can lead to biofilms that are extremely difficult to treat. Therefore, it is important to focus on prevention through eliciting a thorough patient history including an injection history, practicing sterile technique, and minimizing tissue trauma. Looking forward, much can be done to curtail complication rates. Early teaching and training, a central recording registry for complications, and a standardized filler passport for patients are suggested.

The wrist and hand are essential in the placement of the upper extremity in a functional position for grasp, pinch, and release activities. This depends on the delicate balance between the extrinsic and intrinsic muscles of the wrist and hand. Spasticity alters this equilibrium, limiting the interaction of the upper limb with the environment. Classically, pediatric patients with upper limb spasticity present with a flexed wrist, thumb-in-palm, and flexed finger posture. These contractures are typically secondary to spasticity of the extrinsic flexor muscles of the wrist and hand and intrinsic muscles of the thumb and digits. Tendon release, lengthening, or transfer procedures may help correct the resultant abnormal postures. A total wrist arthrodesis with or without proximal row carpectomy may help address the severely flexed wrist deformity. With proper diagnosis, a well-executed surgical plan, and a consistent hand rehabilitation regimen, successful surgical outcomes can be achieved.

Since Mikamo developed the double blepharoplasty technique at the end of the 19th century, there has been significant developments in the idealized periorbital appearance of the Asian patient. Currently there are four potential vectors of change possible (upper, lower, medial, and lateral). South Korea is the only country that most often utilizes the change in all four vectors. There is additionally a stark contrast between Asia-based and Western-based approach to the Asian eyes. In Asia, outside of South Korea, many surgeries employ a combined vertical upward vector and a medial directional change, particularly for the young eyes. In Western-based approaches, Asian blepharoplasty remains at this time primarily an open incision, upward vector change.

With their rising benefits, cardiac implantable electronic devices (CIEDs) such as pacemakers and left ventricular assist devices (LVADs) have witnessed a sharp rise in use over the past 50 years. As indications for use broaden, so too does their widespread employment with its attendant rise of CIED infections. Such large numbers of infections have inspired various algorithms mandating treatment. Early diagnosis of inciting organisms is crucial to tailoring appropriate antibiotic and or antifungal treatment. In addition, surgical debridement and explant of the device have been a longstanding modality of care. More novel therapies focus on salvage of the device by way of serial washouts and instilling drug-eluting antibiotic impregnated beads into the wound. The wound is then serially debrided until clean and closed. This technique is better suited to patients whose device cannot be removed, patients who are poor candidates for cardiac surgery, or patients who have failed conventional prior treatments.

OBJECTIVE: The Surgical Care Improvement Project (SCIP) established surgical antibiotic prophylaxis guidelines as part of a national patient safety initiative aimed at reducing surgical complications such as surgical site infection (SSI). Although these antibiotic prophylaxis guidelines have become well established in surgical patients, they remain largely unstudied in patients with injury from trauma undergoing operative procedures. We sought to determine the role of these antibiotic prophylaxis guidelines in preventing SSI in patients undergoing trauma laparotomy. METHODS: A retrospective review of all patients who underwent emergency trauma laparotomy at two Level I trauma centers (2007Y2008) revealed 306 patients who survived more than 4 days after injury. Demographics and clinical risk SSI factors were analyzed, and patients were compared on the basis of adherence to the following SCIP guidelines: (1) prophylactic antibiotic given, (2) antibiotic received within 1 hour before incision, (3) correct antibiotic selection, and (4) discontinuation of antibiotic within 24 hours after surgery. The primary study end point was the development of SSI. RESULTS: The study sample varied by age (mean [SD], 32 [16] years) and injury mechanism (gunshot wound 44%, stab wound 27%, blunt trauma 30%). When patients with perioperative antibiotic management complying with the four SCIP antibiotic guidelines (n = 151) were compared with those who did not comply (n = 155), no difference between age, shock, small bowel or colon resection, damage control procedures, and skin closure was detected (p 9 0.05). After controlling for injury severity score, hypotension, blood transfusion, enteric injury, operative duration, and other potential confounding variables in a multivariate analysis, complete adherence to these four SCIP antibiotic guidelines independently decreased the risk of SSI (odds ratio, 0.43; 95% confidence interval, 0.20Y0.94; p = 0.035). Patients adhering to these guidelines less often developed SSI (17% vs. 33%, p = 0.001) and had shorter overall hospital duration of antibiotics (4 [6] vs. 9 [11] days, p G 0.001) and hospital length of stay (14 [13] vs. 19 [23] days, p = 0.016), although no difference in mortality was detected (p 9 0.05). CONCLUSIONS: Our results suggest that SCIP antibiotic prophylaxis guidelines effectively reduce the risk of SSI in patients undergoing trauma laparotomy. Despite the emergent nature of operative procedures for trauma, efforts to adhere to these antibiotic guidelines should be maintained. (J Trauma Acute Care Surg. 2012;73: 452Y456. Copyright * 2012 by Lippincott Williams & Wilkins)

The field of plastic surgery originally developed out of the necessity to reconstruct the human body after the destruction of war. However, injured soldiers were not the only people who desired a change in appearance. After World War II, many people in Asian countries sought to attain a more Western look through surgery. Along with eyes, the nose was the main focus for these cosmetic procedures. In this article, the authors examine the evolution of Asian rhinoplasty from its original description in 1964 to the present. The characteristic anatomical differences between the Western and Asian nose are identified in relation to the technical challenges for rhinoplasty surgeons. Then the benefits and risks of the two major surgical approaches, autograft versus alloplast, are detailed. Finally, the coevolution of techniques and implant usage is traced from a dorsum-only implant, to an L-shaped implant, a cartilaginous cap graft with a one-piece rhinoplasty, an I-shaped implant, and a two-piece augmentation rhinoplasty. Outlining these changes demonstrates the advancement of the field of plastic surgery and the growing expectations of the patient. These advancements have provided the tools necessary to better align a patient's aesthetic goals and their unique anatomical presentation with a specific surgical approach.

Surgery to create eyelid folds accounts for the highest percentage of surgeries in Asians and Koreans who receive the surgery on the upper eyelid 2 to 3 times during their lifetimes for functional or cosmetic reasons. Patients are generally satisfied with the results—the eyes becoming brighter and bigger via the improvement of pseudoptosis by fold creation. The recent trend is to seek the “perfect” eye: a vertically and horizontally big palpebral fissure with more than 90% cornea showing. Surgery of the levator aponeurosis–Muller muscle complex is required to expose the cornea, except in those patients who inherently have good levator-Muller function. However, many complications occur during surgeries of the levator aponeurosis–Muller muscle complex, which increase the reoperation rate. Here, the authors briefly summarize recent experiences correcting subclinical ptosis using the nonincision, incision, and partial incision methods.

Surgery is an increasingly important management option for patients with obesity. Laparoscopic adjustable gastric banding is a procedure employed to treat morbid obesity refractory to medical therapy. It works by reducing the capacity of the stomach and promoting early satiety. We report the unusual case of a 33-year-old female who presented acutely 2 years following laparoscopic adjustable gastric banding with cecal volvulus and closed loop obstruction caused by displacement of the connecting tube.