BSAPS Journal

Objective: To review the efficacy of Intense Pulse Light (IPL) in the treatment of unwanted facial hair removal in hirsutism patients. Study Design: Case series. Observational study. Place and Duration of Study: Department of Burn and Plastic Surgery, Dhaka National Medical College, Dhaka, from January 2022 to June 2024. Methodology: A total of 100 patients with hirsutism were included in this study, who were diagnosed by a dermatologist. Intense pulse light therapy was applied for five sessions, one month apart. The reduction in hair count was reviewed on three occasions, before the start of the treatment, before the start of the third session, and after one month of ending of the last session. Any adverse effects experienced by the patients were also recorded. Results: In the study, the age range is about 15-55 years, with 27.31 mean age; 15% of patients have >75% hair reduction, also 32% have <25%. Among all participants, 68% experienced mild to moderate side effects, while 62% reported a good level of satisfaction. Conclusion: Our study revealed that intense pulse light has been effective, well tolerated, with good patient satisfaction feedback in removing unwanted facial hair in the treatment of hirsutism.

The periareolar approach has emerged as a fundamental technique in aesthetic and reconstructive breast surgery, owing to its ability to minimize visible scarring while preserving natural breast contour. This literature review traces the evolution of the periareolar approach from its early development to its current applications in oncoplastic and nipple-sparing surgeries. Early iterations of the technique focused on addressing breast ptosis and hypertrophy, with significant advancements such as the introduction of the "round block" technique and the integration of suction-assisted lipectomy. The use of advanced materials, including acellular dermal matrices (ADMs), has further enhanced the effectiveness of the periareolar approach, particularly in complex reconstructive procedures. Comparative studies indicate that while the periareolar approach is associated with some risks, including potential scar widening and flattening of the breast cone, these challenges can often be mitigated through careful patient selection and adjunctive techniques. The approach has shown high levels of patient satisfaction, particularly in oncoplastic and nipple-sparing mastectomies, making it a valuable tool in the surgeon's repertoire. As the periareolar approach continues to evolve, future research should aim to optimize its outcomes through further refinement and technological integration, ensuring its continued relevance in modern breast surgery.

Aims: To describe the surgical outcome of a new technique, "Advancement of the Frontalis Muscle Flap", for correcting congenital Ptosis with poor levator action. Methods: A longitudinal study was performed in a tertiary Eye Hospital in Bangladesh from January 2020 to May 2021. Patients with severe congenital Ptosis with levator function 4 mm or less who underwent the advancement of the Frontalis Muscle Flap were included in this study. Drafted medicolegal consent was obtained from the patient or the patient's guardian. Results: Seven patients were evaluated for this study. The eyelid height was significantly improved (p-value <0.0001) after the advancement of the Frontalis Muscle Flap. The eyelid contour and lid crease were improved aesthetically following surgery. Conclusion: The advancement of the Frontalis Muscle Flap for managing congenital Ptosis with poor levator function is technically safe, simple, and more physiological with less or no complications.

Correction of nasal deformity in cleft lip and palate patient is one of the most challenging jobs of a plastic surgeon. It not only involves the complex 3D repair of skin, cartilage, mucosa, and skeletal platform but also the psychological aspect of unfortunate cleft patients. So, proper technique in proper time is a must for successful outcome. Though Shusruta and his disciples showed the path, Cruzo and Findlay started the modern rhinoplasty technique. But still the appropriate approach is extensively debated in the literature with respect of timing, technique, and extent of surgical intervention. In this article the authors review the literature and summarize the various modalities for achieving a successful rhinoplasty in the patient with a cleft nasal deformity.

Large incisional hernias are now commonly encountered in surgical practice. Obesity and laxity of the abdominal wall is also present in many of these patients. Abdominoplasty can be combined with hernia repair surgery to provide some additional benefit for the patient. A total of 72 patients (67 females and 5 males) were included in the study. The period was from 1^st January 2018 to 30^th December 2021. The place of study was Combined Military Hospital, Dhaka. Out of the 72 patients, 61 had comorbidities like DM and hypertension. 11 had no comorbidities. 47 patients had full abdominoplasty, and 20 had mini-abdominoplasty along with hernia repair surgery. Complications were minimal, with 2 partial flap necrosis, 2 umbilical necrosis, and 1 wound dehiscence. There was no recurrence of hernia during the follow-up period. Abdominoplasty can be conveniently combined with large incisional hernia repairs as it allows the incision line to be transverse rather than vertical, and away from the hernia repair line. In addition, it can significantly relieve the patient from the excessive load of his/her lower abdominal fat and redundant skin. It also provides a much better aesthetic result.

Rejuvenation of the face is an important component of aesthetic plastic surgery practice.  Periorbital aging contributes significantly to the overall facial aging. Therefore, periorbital rejuvenation is a big concern for aesthetic plastic surgeons. Various surgical and nonsurgical treatment procedures are available for correction of these signs of aging. The study was conducted in Cosmetic Surgery Centre and Bangladesh Specialized Hospital Ltd. The period of study was from December 2017 to December 2020. A total of 495 procedures were carried out in 121 patients who had signs of periorbital aging. 92 were females and 29 were males. Both surgical and nonsurgical procedures were done. Each of the procedure was evaluated in terms of their effectiveness and probability of complications. The overall results are very nice and pleasing. Complications were minimal. Well-chosen procedures, especially when done in combination, can provide gratifying results in patients undergoing periorbital rejuvenation.

Background: Bilateral athelia, the congenital absence of both nipples and areolae, is an extremely rare condition. This case report documents the presentation, diagnosis, and surgical management of bilateral athelia in a 22-year-old female from Bangladesh, highlighting the clinical implications, challenges, and outcomes of reconstructive procedures. Case Presentation: The patient, born to non-consanguineous parents following an uneventful pregnancy and normal vaginal delivery, presented with bilateral athelia noted in the postnatal period. Despite initial consultations with local physicians, no diagnosis or treatment was provided. The patient’s developmental milestones were normal, and she experienced regular menarche at 13 years. At 21, she sought care at Bangladesh Specialised Hospital, Dhaka, for severely hypoplastic breasts and the absence of the NAC. Physical examination revealed well-developed pectoral muscles, small breast mounds, hypopigmentation, sparse hair, symbrachydactyly of the toes, and myopia. Laboratory tests, including hormonal assays and chromosomal analysis, were normal. Ultrasound confirmed the absence of the NAC and the presence of glandular tissue substituted by adipose tissue. Intervention: Under general anesthesia, bilateral breast augmentation was performed using autologous fat transfer. Nipple-areola reconstruction was achieved using the skate flap technique and full-thickness skin grafting. Follow-up included a second session of fat grafting to enhance results and tattooing of the NAC for aesthetic improvement. Results: The patient reported high satisfaction with the aesthetic and functional outcomes. The postoperative course was uneventful, with no significant complications observed. The follow-up procedures significantly enhanced the aesthetic results, demonstrating the effectiveness of the chosen surgical techniques. Conclusion: This case highlights the successful management of bilateral athelia through comprehensive diagnostic evaluation and advanced reconstructive surgery. Early diagnosis, meticulous surgical planning, and follow-up procedures are critical for achieving satisfactory outcomes in patients with rare congenital anomalies like athelia. Further research and case documentation are necessary to develop standardized management protocols and improve patient care.

With the advent of newer technological advancements in various non-surgical treatment options, the scenario of aesthetic plastic surgical practice has changed significantly. In addition to surgical procedures like breast implant, tummy tack, face lift, rhinoplasty etc. aesthetic plastic surgeons are now including non-surgical procedures in their aesthetic practice. The concept is to provide the full spectrum of aesthetic procedures to their patients under one roof – without having to refer these patients to another doctor. Common non-surgical aesthetic procedures are–

Botox: A neurotoxin used for injection to reduce fine lines and wrinkles of the aging face. They need to be injected every 6 months or so for continued results.

Fillers: Hyaluronic acid (HA) is the most common filler that is used to replace volume in deflation of certain areas of aging face. They need to be topped up by further injections every few months.

Microneedling: This is a procedure where the skin of aging face (or post acne scars) is treated by a rolling device (Dermaroller) which causes numerous micropunctures using a row of fine needles. This can also be done by using and electrically operated Dermapen. This treatment induced collagen growth in the dermis, but needs to be repeated several times at 10 to 14 days interval.

Laser: The most commonly used are NdYAG and Diodelasers for removal of unwanted facial hairs in young ladies. CO2 laser is used for wart removal and skin rejuvenation (CO2 Fractional), while Q Switch laser is used for removal of pigmented lesions and tattoos. Pulsed Dye laser is useful for treatment of certain vascular lesions like Port Wine Stain (PWS).

Chemical peeling: Is a very common procedure used for facial rejuvenation. Glycolic, Ascorbic and Trichloroacetic Acid (TCA) can be used in varying concentrations, depending on the indication.

Patients undergoing face lift younger than 50 years begin non-invasive facial rejuvenation treatments at an even earlier age. The majority of these patients did not regret the costs associated with noninvasive treatments, even though they saw that face lift provided a greater rejuvenation effect. Plastic surgeons should therefore incorporate nonsurgical techniques into their practice to cater to the needs of the aging patient (ref. 1)

A patient seeking facial rejuvenation, often requires surgical operations like facelift or blepharoplasty; but more often than not, they also need nonsurgical procedures like Botox and fillers. And this has led aesthetic plastic surgeons to offer a variety of non surgical aesthetic procedures in their clinic, or else refer the patient to an aesthetic physician. that a majority of the patients who goes to a dermatologist/nonsurgical aesthetician for nonsurgical procedure would choose to go back to him/her for a surgical operation, instead of going to a plastic surgeon. This is because nonsurgical procedures have certain benefits like shorter downtime and faster recovery, less expensive, being non invasive and not requiring anesthesia and hospital stay. Most of patients know that these procedures do not provide lasting results, as compared to the surgical options – and that nonsurgical procedures need to be repeated at certain intervals. In spite of this, recent Global Surveys have revealed an enormous rise in the number of nonsurgical procedures done worldwide, 54.4% increase over the last four years. The report shows a continuing rise in aesthetic surgery with a 41.3% increase over the last four years. The 2021 survey showed a surge of 16.7% and 7.2% in both surgical and non-surgical procedures respectively compared to the 2018 survey (ref 3).

Botox is now the commonest aesthetic procedure with 7.3 million cases done across the globe in 2021 (ref 3). This is 17.7% increase from the last year. Chemical peels were done in 534,831 patients in 2021, which is 49.5% more than 2017 (ref 3). Surgical procedures have also increased worldwide. Liposuction was done in1.9 million patients during 2021, which is 24.8% higher than the previous year. Breast augmentation was done in 1.68 million patients, with increase of 3.8% as compared with the previous year (ref 3). And Tummy Tuck surgery was done in almost 1million patients, with an increase of29.5 %.There is well-grounded evidence showing that self-esteem increases after surgery. Majority of the participants stated that they were satisfied with the results of procedures such as Laser Hair Removal, dermal fillers, and Botox (ref. 4).

Even though nonsurgical procedures are considered safe, there are complications that can happen after some of these procedures. Ptosis following botox injections, or blindness following inadvertent intravascular injection of filler injections in the face (ref 5) can be devastating. Training and supervision are therefore very important before anyone embarking on the practice of nonsurgical aesthetic procedures. Following strict guidelines is also imperative to avoid these undesirable complications.

REFERENCES:

1. Andrew A. Jacono, Melanie H. Malone, Thomas John Lavin, Nonsurgical Facial Rejuvenation Procedures in Patients Under 50 Prior to Undergoing Facelift: Habits, Costs, and Results, Aesthetic Surgery Journal, Volume 37, Issue 4, 1 April 2017, Pages 448–453.
2. Global Survey Results. 2021. Available online: https://www.isaps.org/discover/about-isaps/global-statistics/reports-and-press-releases/global-survey-2021-full-report-and-press-releases/
3. Imadojemu S, Sarwer DB, Percec I, et al. Influence of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes: a systematic review. JAMA Dermatol. 2013;149(11):1325–1333. [PubMed] [Google Scholar]
4. Vikram Sinha, Mohsan Malik, Mimi R. Borrelli, Ambika Sinha, Naveen Cavale, The quality of online information regarding non-surgical aesthetic procedures, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 74, Issue 8, 2021, Pages 1881-1887.