Suture Suspension Brow-Lifting: The Minitac System

As their face ages, a significant number of individuals require elevation of the eyebrows to improve brow-ptosis and pseudo-ptosis of the upper eyelids. This may be for functional disability, i.e. when there is a reduction in visual fields, or for purely cosmetic reasons. Eyebrow elevation can be achieved by non-surgical or by direct surgical methods. There are advantages and disadvantages to the non-surgical use of Botulinum Toxin or fillers, and minimally invasive techniques such as endoscopic methods or Endotine® fixation. Bicoronal brow lift procedures appear to be reducing in popularity compared to the other methods. Suture suspension of the brow is not new but recently Minitac®, a kit system that allows intra-osseous fixation using two non-absorbable paired needle sutures, has been introduced. Whilst this system was primarily developed for ligament to bone approximation, we demonstrated in this mini-series that it can be adapted to provide a simple and effective means for brow lifting, whilst controlling the vectors of elevation. Due care and the understanding of anatomy are essential

Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia

Background Gynaecomastia is a benign enlargement of the male breast, of which the psychological burden on the patient can be considerable, with the increased risk of disorders such as depression, anxiety, and social phobia. Minimal scarring can be achieved by liposuction alone, though it is known to have a limited effect on the dense glandular and fibroconnective tissues. We know of few studies published on “liposuction alone”, so we designed this study to evaluate the outcome of combining liposuction with glandular liposculpturing through two axillary incisions as a single treatment for the management of grades I and II gynaecomastia. Methods We made a retrospective analysis of 18 patients with grade I or II gynaecomastia who were operated on by combined liposuction and glandular liposculpturing using a fat disruptor cannula, without glandular excision, during the period 2014–2016. Patient satisfaction was assessed using the Breast Evaluation Questionnaire (BEQ), which is a 5-point Likert scale (1 = very dissatisfied; 2 = dissatisfied; 3 = neither; 4 = satisfied; 5 = very satisfied). The post-operative aesthetic appearance of the chest was evaluated by five independent observers on a scale from 1 to 5 (5 = considerable improvement). Results The patient mean (SD) overall satisfaction score was 4.7 (0.7), in which 92% of the responders were “satisfied” to “very satisfied”. The mean (SD) BEQ for all questions answered increased from 2.1 (0.2) “dissatisfied” preoperatively to 4.1 (0.2) “satisfied” post-operatively. The observers’ mean (SD) rate for the improvement in the shape of the front chest wall was 4.1 (0.7). No haematomas were recorded, one patient developed a wound infection, and two patients complained of remnants of tissue. The median (IQR) body mass index was 27.4 (26.7–29.4), 11 patients had gynaecomastia grade I, and 7 patients grade II. The median (IQR) volume of aspirated fat was 700 ml (650–800), operating time was 67 (65–75) minutes, 14 patients had general anaesthesia, and hospital charges were US$ 538 (481–594). Conclusions Combined liposuction and liposculpturing using the fat disruptor cannula resulted in satisfied patients and acceptable outcomes according to the observers’ ratings. It could be a useful alternative with an outcome that corresponds to that of more expensive methods