Philosophical pitfalls in cosmetic surgery: a case of rhinoplasty during adolescence.
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In the process of deciding to undergo cosmetic surgery for aesthetic reasons, people may err in various ways. Adolescents in particular run the risk of making errors, and both parents and surgeons have special moral responsibilities to avoid disappointments. Parents should face a number of moral issues; if they fail to do so, surgeons have a moral if not legal responsibility, to raise these issues and take a moral stand. In this paper, a number of pitfalls are specified from a philosophical perspective. A request for surgery should not be granted if patients do not meet the standards required for stable decision making and a balanced judgment, and particularly in those case where patients fail to understand the assumptions--in terms of human values--underlying the surgical intervention. Assessments of competence should go beyond formal conceptions of autonomy, and should, as will be shown, be made on an individual basis. Substantive questions of personal identity and identity formation, within the context of often rapid psychosocial development and emotional turmoil peculiar to adolescents, should be addressed. The key to the moral evaluation of this surgery therefore lies primarily in a patient's life story. (+info)
Severe facial dermatitis as a late complication of aesthetic rhinoplasty; a case report.
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BACKGROUND: Contact dermatitis, as a cutaneous complication after rhinoplasty, is of early onset, limited and transient. The cause of this dermatitis is irritant or allergic. Late onset skin complications are rare and non-inflammatory. CASE PRESENTATION: We are reporting an unexpected, severe allergic contact dermatitis of the face, in a young female, appearing one month following aesthetic rhinoplasty. She failed to respond to ordinary treatments for dermatitis. We did standard battery--including nitrofurazone, tincture of benzoin and hydrocortisone--patch test for the patient that showed sensitivity to benzoin and corticosteroid. CONCLUSIONS: In summary we report a case of a severe allergic contact dermatitis of the face, in a 21-year-old girl who underwent corrective aesthetic rhinoplasty, appearing one month following surgical operation. We were unable to find a similar report in the medical literature. (+info)
A review of psychosocial outcomes for patients seeking cosmetic surgery.
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The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological well-being and psychosocial functioning and whether there are identifiable predictors of an unsatisfactory psychological outcome. They conducted a search of appropriate computerized databases for studies that evaluated psychological and psychosocial status both before and after elective cosmetic surgery. They identified 37 relevant studies of varying cosmetic procedures that utilized disparate methodologies. Overall, patients appeared generally satisfied with the outcome of their procedures, although some exhibited transient and some exhibited longer-lasting psychological disturbance. Factors associated with poor psychosocial outcome included being young, being male, having unrealistic expectations of the procedure, previous unsatisfactory cosmetic surgery, minimal deformity, motivation based on relationship issues, and a history of depression, anxiety, or personality disorder. Body dysmorphic disorder was also recognized by some studies as a predictor of poor outcome, a finding reinforced by reference to the psychiatric literature. The authors conclude that although most people appear satisfied with the outcome of cosmetic surgical procedures, some are not, and attempts should be made to screen for such individuals in cosmetic surgery settings. (+info)
Nonpsychiatric medical treatment of body dysmorphic disorder.
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Many individuals with body dysmorphic disorder seek nonpsychiatric medical and surgical treatment to improve perceived defects in their physical appearance. However, the types of treatments sought and received, as well as the treatment outcome, have received little investigation. This study describes the frequency, types, and outcomes of treatments sought and received by 200 individuals with body dysmorphic disorder. Treatment was sought by 71.0% and received by 64.0%. Dermatological treatment was most frequently sought and received (most often, topical acne agents), followed by surgery (most often, rhinoplasty). Twelve percent of the subjects received isotretinoin. Such treatment rarely improved body dysmorphic disorder. Thus, nonpsychiatric medical treatments do not appear effective in its treatment. (+info)
The forehead flap for nasal reconstruction: how we do it.
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The forehead flap is a useful technique to reconstruct deep and large nasal defects. It can safely be performed under local anesthesia in an outpatient setting. Advantages of this flap include the fact that it provides an excellent color and texture match to the missing nasal skin. Disadvantages include the fact that it is at least a two-stage procedure and that often patients require "touch up" surgeries to provide the best possible cosmetic outcome. (+info)
Unilateral blindness as a complication of nasal septoplasty: case report.
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Blindness as a complication of nasal septoplasty is a devastating occurrence with only a few cases reported in the literature. In most of these cases, visual loss was attributed to retinal embolism following intra-arterial injection of substances into the nasal turbinate. This paper documents one case of complete unilateral blindness from direct optic nerve trauma following an apparently uneventful septorhinoplasty. Ophthalmologists and otolaryngologists should therefore be aware of the possible occurrence of such complication. (+info)
Antibiotics in septoplasty: is it necessary?
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The use of antibiotics is a common practice among otorhinolaryngogists for surgical procedures. The majority of the American Rhinology Society members uses post-operative antibiotics routinely in septoplasties, which is considered unnecessary by many authors. AIM: To study the real necessity of the antibiotic usage in septoplasties, as well as the main post-operative complications described in the literature. STUDY DESIGN: clinical prospective with transversal cohort. MATERIAL AND METHOD: We studied prospectively 35 patients who were undergone to septoplasty with or without turbinectomy, in the Clinical Hospital of the University of Sao Paulo. The patients were split in three groups: Group A: without antibiotics; Group B: antibiotics (cefazolin) only during the anesthesic induction; Group C: antibiotics both in the anesthesic induction and post-operatively for seven days. A questionnaire was applied in the immediate post-operatory, in the 7th post-operative day and in the 30th post-operative day asking for bleeding, fever, pain, nausea, vomits and followed by physical and endoscopic evaluation looking for hematoma, septal abscess and purulent secretion which as quantified. RESULT: We do not observed significative difference among the groups concerning to pain, fever, nausea, vomits, bleeding and purulent secretion. None of the patients had hematoma or septal abscess. The groups also do not differ in respect to the quantity of purulent secretion. CONCLUSION: The nasal surgeries are clean contamined and do not need antibioticprophilaxy because of the low infection risk. (+info)
Precultivation of engineered human nasal cartilage enhances the mechanical properties relevant for use in facial reconstructive surgery.
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OBJECTIVE: To investigate if precultivation of human engineered nasal cartilage grafts of clinically relevant size would increase the suture retention strength at implantation and the tensile and bending stiffness 2 weeks after implantation. SUMMARY BACKGROUND INFORMATION: To be used for reconstruction of nasal cartilage defects, engineered grafts need to be reliably sutured at implantation and resist to bending/tension forces about 2 weeks after surgery, when fixation is typically removed. METHODS: Nasal septum chondrocytes from 4 donors were expanded for 2 passages and statically loaded on 15 x 5 x 2-mm size nonwoven meshes of esterified hyaluronan (Hyaff-11). Constructs were implanted for 2 weeks in nude mice between muscle fascia and subcutaneous tissue either directly after cell seeding or after 2 or 4 weeks of preculture in chondrogenic medium. Engineered tissues and native nasal cartilage were assessed histologically, biochemically, and biomechanically. RESULTS: Engineered constructs reproducibly developed with culture time into cartilaginous tissues with increasing content of glycosaminoglycans and collagen type II. Suture retention strength was significantly higher (3.6 +/- 2.2-fold) in 2-week precultured constructs than in freshly seeded meshes. Following in vivo implantation, tissues further developed and maintained the original scaffold size and shape. The bending stiffness was significantly higher (1.8 +/- 0.8-fold) if constructs were precultured for 2 weeks than if they were directly implanted, whereas tensile stiffness was close to native cartilage in all groups. CONCLUSION: In our experimental setup, preculture for 2 weeks was necessary to engineer nasal cartilage grafts with enhanced mechanical properties relevant for clinical use in facial reconstructive surgery. (+info)