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Silicone breast augmentation remains one of the most common aesthetic surgery procedures, and 2022 marks the 60th anniversary of the first case. Recent studies suggest a link between double capsule (DC) formation and macro-textured devices.Between 2010 and 2015, 268 aesthetic patients underwent bilateral mammary prosthesis exchange for indications including PIP exchange, adverse capsular contracture and ultrasonographic evidence of rupture. All surgery, in the form of implant exchange and capsulectomy, was undertaken by the senior author using standard techniques. A retrospective review was undertaken, and data analysed with descriptive statistics and Fisher's exact and Mann-Whitney U tests.Of 268 patients identified, 40 (14.9%) showed some degree of capsular duplication and bilateral involvement was marginally more common (52.5%). Two macroscopic patterns of duplication were observed: complete and subtotal. Complete DCs correlated with a clinical triad of extreme firmness, mobility and minimal-to-no pain. Whilst a wide range of manufacturers was represented, macro-textured devices were associated with the highest DC prevalence (58.3% vs. 5.6%) (Fisher's exact test p0.00001). Patients with DC had been implanted for less than half the time, median 52 versus. 120 months (p = 0.0003) of those without.An elevated prevalence of duplicate capsules in macro-textured prostheses is reconfirmed in addition to a novel symptom constellation that may assist with clinical diagnosis. Our study reinforces the aetiopathogenic influence of the elastomer in DC formation and reports DC for the first time in non-macrotextured implants. Single-surgeon cohort of 268 consecutive patients with 532 implants Statistically significant association of macro-textured devices with DC Statistically significant reduced duration of implantation of macro-textured devices First report of DC in non-macro-textured devices LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The human body is rarely at complete rest instead sitting amidst variable and opposing forces coexisting in dynamic counterpoint. For example, biceps on the anterior surface of the arm is balanced by triceps on the posterior. Contraction of one requires relaxation of the other in order to flex or extend the elbow respectively. In the face, the elevators (frontalis) are balanced by the depressors so weakening of one shifts the force equilibrium and skin may be more easily pulled in the opposite direction by unparalysed muscles. Good neurotoxin treatment therefore starts with an appreciation of this dynamic interplay. Product selection, administration and examples of the most common sites for BoNT are provided along with side-effects. The latter are vital as only when one is aware of a pitfall can one take the necessary steps to avoid or minimise it.

The desire to optimise one’s appearance is probably as old as mankind itself. In order to apply the artistic flourish of such a precise chemical tool as BoNT on the infinite variation of human anatomy some basic influences, both biological and fashion, are presented. Important contributors to aging are introduced.

Whilst perhaps initially not the most appealing topic awareness of the wider regulatory context is worthwhile nonetheless. Unlike most clinical specialties, aesthetic medicine has evolved almost entirely without any formal training pathway in the UK. Other than BoNT being a prescription-only medicine in the UK and other countries, there have been few regulations otherwise. This lack stimulated the British government to establish some form of system of training and education. The extant recommendations are just that, recommendations, and this chapter summarises the situation at the time of publication.

Comprehensive understanding of a subject results from a thorough background knowledge that then underpins future clinical practice. It is instructive for a practitioner, and recommended if possible, to comprehend the first-hand experience of a patient receiving BoNT.

Whilst far from exhaustive, this chapter will briefly introduce some of the more common applications of BoNT in a non-aesthetic environment. It never ceases to amaze how few, in and out of the profession, are aware of these beneficial medical uses. Botulinum neurotoxin provides effective symptom relief in a number of disabling, but not life-threatening, conditions. Whilst the common theme is usually paralysis of the causative muscle, there are other mechanistic pathways of action that are clinically useful and embraced by many specialties.

Despite significant advances in the medical treatment and chemo-manipulation of breast cancer, surgery with curative intent retains a fundamental mainstay of treatment, with surgeons continuing to play a central and key role within the multidisciplinary team setting. There has been a continued evolution from the radical extirpation of 19th and 20th centuries, involving total loss of the breast, skin and underlying muscle, to the individually tailored procedures of today where the aim is for complete tumour excision whilst preserving as much of the native breast as possible. Developments in sentinel node biopsy for staging have reduced formerly extensive axillary interventions to minimally invasive levels; with the possibility of doing even less in the axilla, lying just over the horizon. Breast reconstruction is increasingly the norm and today's surgeons have an expanding range of both alloplastic and autologous techniques from which to choose. Oncoplastic surgery is the combination of simultaneous tumour extirpation using cosmetic surgery techniques. This produces improved aesthetic outcomes whilst constantly ensuring that oncologically safe surgery is performed. The recent addition of fat transfer and stem cell technology extends the possibilities even further and this article summarizes the current state-of-the art surgical techniques for breast cancer.

Liposuction is one of the most commonly performed aesthetic procedures worldwide and has caught the imagination of surgeons, patients and manufacturers alike during its brief history. The latter are now increasingly marketing direct to patients; however, liposuction is not a panacea for obesity and patients may not always fully appreciate this. On the other hand, eminently satisfactory outcomes are achievable with careful patient selection when undertaken by appropriately trained surgeons using optimally selected technologies. With such a range of techniques, technologies and recent advances, this chapter briefly reviews some of the pertinent scientific evidence.

Despite important advances in medical treatment, surgery remains a fundamental part of the primary management of breast cancer. Surgeons have a significant input into the therapeutic planning of treatment under the aegis of the multidisciplinary team. Breast cancer management has seen an evolution from the radical extirpation of the previous century, involving loss of the breast, skin and underlying muscle, to current practice, which aims for local excision of the tumour whilst preserving much of the breast. Advancements in the techniques of sentinel node biopsy have reduced formal extensive axillary staging surgery to a minimally invasive procedure. Breast reconstruction has become more common and today's surgeons and patients have a wide range of both alloplastic and autologous techniques from which to choose. Plastic surgery techniques have recently been used at the time of onco-logical tumour excision to allow wider resection margins and improved aesthetic outcomes, thus allowing more women to safely avoid a mastectomy. This article provides a resume of the current state-of-the art surgical techniques in breast cancer.

Amniotic band syndrome refers to the uncommon occurrence of a variety of congenital deformities, most probably due to foetal entanglement in strands ruptured from the amniotic sac. We present a rare case of an abdominal constriction band together with a short literature review.