Local Anesthesia For Plastic Surgery An Issue Of Clinics In Plastic Surgery

The scope of use of local anesthetics in procedures in plastic surgery is covered in this issue of Clinics in Plastic Surgery. Discussion centers on plastic surgeons in private practice in ambulatory facilities and those scheduling time for OR in hospital facilities using local anesthetics while accommodating patient comfort and absence of side-effects post general anesthesia. Presented in this publication are the most common plastic surgeries that can be done under local anesthesia, each with a discussion of the optimal anesthetic, method of administration, and dosage. Video of the procedure or portion of the procedure, as applicable, accompanies the techniques along with a surgical case. The goal of this issue is to provide a concise reference for surgeons’ planning surgeries to review and perhaps adapt currently used methods with this latest information on local anesthetics. Surgical Technique is provided in detail with full analysis of Patient Selection and Planning, Complications and Post-procedure Care. Contents include Complications; Basic Science of Locals; Skin Grafts and Flaps; Peripheral Nerve; Foot Surgery; Breast Surgery; Liposuction; Hand Trauma; Oculoplastic Surgery; Ear Surgery; Hair Transplantation; among others.

With approximately 13.8 million minimally-invasive cosmetic surgeries performed in the United States, and approximately 12.2 million minimally invasive cosmetic treatments performed in 2011, most of these are undertaken in surgeons’ group practice or surgery center locations. The most common as well as the most dreaded complications are presented along with articles presenting “best practice for cosmetic surgery centers. Each topic presents Anesthesia, Infection control, Complication avoidance and management, along with technique video. Some of the topics include: Patient Selection in Outpatient Surgery; Airway Management in the Outpatient Setting; Deep Venous Thrombosis - Prevention and Management; Intravenous Sedation from the Surgeon’s Perspective; Postoperative Nausea and Vomiting; among other relevant issues to the surgeon. Guest Editors are Geoffrey Keyes and Robert Singer, both involved with the Association for Accreditation of Ambulatory Surgery and fervent about certified surgeons running ambulatory facilities for best outcomes and avoidance of mortalities and severe morbidities.

Complications in cosmetic surgery – no surgeon wants to admit to them, all surgeons dread them, and all have experienced them. This issue is devoted solely to complications in facial plastic surgery – the most common and the most feared - and discussion on best approaches to avoid them. Each article focuses on a specific procedure. Each article discusses: Surgical Complications, Pharmacologic or Interaction Complications, Nonpharmacologic Complications, Complication Avoidance, Procedural Approach (with video), Complication Management Perioperative, Complications Management Postoperative. Written by facial plastic surgeon experts, this information is essential for facial plastic surgeons, plastic surgeons, and to cosmetic adjunct professionals who perform injections and resurfacing. This publication is directed by two expert practitioners and academicians who are at the apex of their field, Dr Richard Goode and Dr Sam Most. Their substantive teaching and training experiences position them to provide comprehensive understanding and skills in performing cosmetic surgery.

One major by-product of the aging baby-boom generation has been a surging interest in cosmetic surgery. Out-patient cosmetic surgery clinics have sprouted up in droves all over the U.S., and the number of cosmetic procedures performed in 2005 increased by over 95% from the previous year. Although procedures like facelifts and abdominoplasties (the 'tummy-tuck') are considered minimally invasive, the anesthetic protocols and regimens here are often overly complex and unnecessarily toxic. Major complications involving anesthesia in this (and any other) surgical milieu can range from severe post-operative nausea and vomiting (PONV) to neuromuscular spasticity to mortality. The mortality spectrum of things may be rare, but there have been many cases in which perfectly healthy cosmetic surgery patients require emergency intervention due to a severe complication involving anesthesia. In recent years, many new anesthetic protocols have been developed to reduce the incidence of PONV and other complications, while ensuring that effective pain management and level of 'un-awareness' during surgery is always maintained.

This issue of Clinics in Plastic Surgery, guest edited by Bradley P. Bengtson, is devoted to Breast Augmentation. This issue will include topics such as Explanation and what to do with the capsule; Pexy/Auto augmentation/fat transfer; Update on BIA-ALCL; Mastopexy markings and outcomes; High Resolution Ultrasound Basics for Plastic Surgeons; Lymphoproliferative source of BIA-ALCL and genetics; New Shells, surface, fillers in Breast Implants; Capsular contracture and implant surfaces; Capsular Contracture and Biofilm; Consensus on Complication Terminology in Breast Surgery; Local Anesthetic Blocks in Breast Surgery; Hot topics in Breast surgery; Anatomical implants; and Clinical applications, Case Studies and Outcomes with High Resolution Ultrasound.

A collection of minimally invasive facial rejuvenation techniques are examined to answer the question: Are they replacing more traditional/aggressive surgical procedures? This clinical and surgical information in Facial Plastic Surgery Clinics examines the increasing use of less invasive procedures and addresses how these are changing the surgeon’s traditional approaches. . .15-minute rhinoplasty, 1-hour facelift, lunchtime laser treatment, 5-minute Botox . .all are very much in the public consciousness and facial plastic surgeons address minimally invasive procedures with the question: Do they work? What is the evidence in terms of outcomes for each of the procedures addressed? What are the challenges? Authors compare a minimally invasive technique with its more invasive procedure counterpart in facial rejuvenation and provide their own experience and sense of ultimate long-term results, technique, complications, contraindications, recovery, patient selection. Endoscopic brow lift is compared with coronal brow lift; Necklifts are compared with cervical skin tightening devices; Facial fillers are compared with facial implants; Fractional and ablative CO2 resurfacing are compared; Rhinoplasty versus fillers; and more. . .Guest Editor Theda Kontis leads this presentation intended for facial plastic surgeons, plastic surgeons, and other specialists who are certified to practice cosmetic surgery.

Evidence base in 2015 remains a subject of controversy for surgeons related to its application in surgery that cannot be approached as it is in medical evidence. Academic surgeons acknowledge that evidence base is necessary and private practitioners know it is woven into the fabric of their practice. Dr. Lisa Ishii and Dr. Travis Tollefson, editors of this publication, are at the forefront of clinical use of and research into evidence based surgery. The Oxford Centre system of evidence is used for this issue. Currently, evidence is dominant in the reconstructive aspect, moreso than the cosmetic aspect; as such, this resource focuses on the nerve and microvascular procedures. Topics include Facial vascular anomalies, Cleft lip and palate; Trauma; Facial reanimation; System reviews and metanalyses; and Skin care, Laser treatments; and Rhinoplasty. Audience for this resource is facial plastic surgeons, otolaryngologists, plastic surgeons, laser therapists, dermatologists, and skin researchers.