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Showing 1 - 200 of 372 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 9, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 61, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 86, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 18, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 162, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 38, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 179, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 20)
American J. of Legal History     Full-text available via subscription   (Followers: 9, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 28, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 14, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 23)
Annals of Botany     Hybrid Journal   (Followers: 35, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 28, SJR: 0.837, h-index: 57)
Annals of Oncology     Hybrid Journal   (Followers: 48, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 8, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal  
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 18, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 54, SJR: 1.749, h-index: 63)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 0.779, h-index: 11)
Arbitration Intl.     Full-text available via subscription   (Followers: 21)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 32, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 47, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 51, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 289, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.646, h-index: 149)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 30, SJR: 2.374, h-index: 154)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 16, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 170, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 65, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 66, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 46, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 35, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 27, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 592, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 88, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 30)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 61, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 10, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 11, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal   (Followers: 2)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 12, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 45, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 17, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 4)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 22, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 9, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 25, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 62, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 3, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 25, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 9, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 2)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 27)
Current Zoology     Full-text available via subscription   (Followers: 1, SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 10, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 13)
Diplomatic History     Hybrid Journal   (Followers: 19, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 5, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 38, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 56, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 14, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 3)
Environmental History     Hybrid Journal   (Followers: 28, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 16, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 54, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 8, SJR: 2.044, h-index: 58)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. Supplements     Hybrid Journal   (Followers: 7, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 8, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 185, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 23, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 11, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 28, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 41, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 14, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 10, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 22, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 27, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 14, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 23, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 15, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 32, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 14, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 34, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 27, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 55, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 14, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 23, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 22, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 30, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 27, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 80, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 20, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 64, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 53, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 12)
ILAR J.     Hybrid Journal   (Followers: 2, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 9, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 33, SJR: 0.184, h-index: 15)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 11, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 5, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 55, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 31)
Intl. Health     Hybrid Journal   (Followers: 5, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 35, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 63, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 182, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 31, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 10, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 10, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 36, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 13, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Political Sociology     Hybrid Journal   (Followers: 35, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 21, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 8, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 41, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 19, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 48, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 15, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 14, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 5, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 43, SJR: 1.341, h-index: 96)
J. of Burn Care & Research     Full-text available via subscription   (Followers: 8, SJR: 0.713, h-index: 57)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 36, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 13, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 44, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 10, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 10, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 18, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 24, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 24, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 21)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 23, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 4)
J. of Heredity     Hybrid Journal   (Followers: 4, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 8, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 20, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 41, SJR: 4, h-index: 209)

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Journal Cover Aesthetic Surgery Journal
  [SJR: 1.538]   [H-I: 35]   [6 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1090-820X - ISSN (Online) 1527-330X
   Published by Oxford University Press Homepage  [372 journals]
  • Dorsal Preservation: The Push Down Technique Reassessed
    • Authors: Saban Y; Daniel R, Polselli R, et al.
      First page: 117
      Abstract: Management of the nasal dorsum remains a challenge in rhinoplasty surgery. Currently, the majority of reduction rhinoplasties results in destruction of the keystone area (K-area), which requires reconstruction with either spreader grafts or spreader flaps, both for aesthetic and functional reasons. This article will present the senior author’s current operative technique for dorsal preservation in reduction rhinoplasty based on 320 clinical cases performed over a 5-year period. The author’s operative technique is as follows: (1) endonasal approach; (2) removal of a septal strip in the subdorsal area whose shape and height were determined preoperatively; (3) complete lateral, transverse, and radix osteotomies; and (4) dorsal reduction utilizing either a push down operation (PDO) or a let down operation (LDO). The PDO consists of downward impaction of the fully mobilized nasal pyramid and is utilized in patients with smaller humps (<4 mm). The LDO consists of a maxillary wedge resection and is performed in patients who need more than 4 mm of lowering. A total of 320 patients had a dorsal preservation operation (DPO). Postoperatively, there were no dorsal irregularities nor inverted-V deformities. Among our 44 personal revision cases, 27 patients (8.74%) had had a previous DPO, 16 of whom required tip revisions with no further dorsal surgery. Of the remaining 11 patients, the main problems were either hump recurrence and/or lateral deviation of the dorsum or widening of the middle third, which required simple surgical revision. Based on the authors’ experience, adoption of a PDO/LDO is justified in selected primary patients. The key question before any primary rhinoplasty procedure should be “Can I keep the nasal dorsum intact'” Precise analysis and surgical execution are required to preserve the dorsal osseocartilaginous vault and K-area. Dorsal preservation results in more natural postoperative dorsum lines and a “not operated” aspect without the need for midvault reconstruction. Moreover, this technique is quick and easy to perform by any rhinoplasty surgeon. Rhinoplasty surgeons should consider incorporating dorsal preservation techniques in their surgical armamentarium rather than relying solely on the Joseph reduction method or an open structure rhinoplasty.Level of Evidence: 4
      PubDate: Mon, 08 Jan 2018 00:00:00 GMT
      DOI: 10.1093/asj/sjx180
  • Commentary on: Dorsal Preservation: The Push Down Technique Reassessed
    • Authors: Kern E.
      First page: 132
      Abstract: Some time ago, in 2010, I was visiting my esteemed colleague and friend, the great Mexican functional rhinologist and cosmetic rhinoplasty surgeon, Dr Fausto Lopez Infante (1935-2013). I asked him how often he performed dorsal preservation procedures in rhinoplasty such as the push down or let down operations. He paused for not more than a blink and earnestly stated, “For the first 10 years of practice I did the Push Down; the next 10 years I chiseled off the dorsum. What do you think I did for this last 10 years'” As I remember that instant in time, I said, “You returned to the push down or let down.” “Exactly,” he replied, “because I loved the smooth dorsum and avoiding the postoperative disrupted K-area with the attendant dorsal irregularities. And of course, I did not like the infracture needed to close the open roof that at times narrowed the nasal valve angle and area producing postoperative breathing disturbances.”
      PubDate: Mon, 08 Jan 2018 00:00:00 GMT
      DOI: 10.1093/asj/sjx240
  • The Preservation Rhinoplasty: A New Rhinoplasty Revolution
    • Authors: Daniel R.
      First page: 228
      Abstract: Rhinoplasty surgery tends to evolve in generational epochs often associated with landmark publications and the simultaneous popularization of revolutionary surgical techniques. In 1978, Sheen published his monumental text Aesthetic Rhinoplasty which confirmed his status as the greatest rhinoplasty surgeon since Joseph.1 Three critical concepts were summarized. First, rhinoplasty became a truly aesthetic operation which included preoperative analysis, operative planning, and surgical execution. Second, the reduction-only concept of Joseph was replaced with a balanced approach combining reduction and grafting in primary rhinoplasty. Third, the previously dismal results for secondary rhinoplasty were dramatically improved. Suddenly, the mark of a great rhinoplasty surgeon was no longer how quickly one could do a “nose job,” but rather the achievement of an attractive natural nose with normal function.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT
      DOI: 10.1093/asj/sjx258
  • Comments on “Double-Blind Comparison of Ultrasonic and Conventional
           Osteotomy in Terms of Early Postoperative Edema and Ecchymosis”
    • Authors: Çağıcı C.
      Abstract: I read the manuscript by Ilhan et al1 with great interest. The authors performed a randomized study comparing two types of osteotomy in rhinoplasty: ultrasonic and conventional osteotomy. They found that ultrasonic osteotomy results in less edema and ecchymosis. Their patients were blind to the study and not informed about which osteotomy technique was applied to them. The same surgeon performed both types of surgery and was not blinded. The postoperative evaluation of the surgical results was performed by blinded examiners. Although the authors called their study a “double-blinded” comparison, I do not agree with them.
      PubDate: Thu, 21 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjw232
  • Response to “Comments on ‘Double-Blind Comparison of Ultrasonic and
           Conventional Osteotomy in Terms of Early Postoperative Edema and
    • Authors: Ilhan A; Cengiz B, Eser B.
      Abstract: We thank Dr Cağici for his kind thoughts and for commenting1 on our article.2 Dr Cağici is correct that one cannot consider a study as “double-blinded” if both patients and surgeons are not blinded. Unfortunately, Dr Cağici misunderstood in thinking that our surgeon was not blinded. Patients who underwent surgery during odd-numbered months received conventional osteotomy, and patients who underwent surgery during even-numbered months received ultrasonic osteotomy. However, the surgeon was blinded as to which patients were included in the study, which was our randomization method for the surgeon. The patients were also blinded, as they were not informed preoperatively which osteotomy procedure they would undergo.
      PubDate: Thu, 21 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx233
  • ASJ’s Position on Publishing Papers That Discuss Off-Label Product
    • Authors: Nahai F.
      Abstract: As the Editor-in-Chief of Aesthetic Surgery Journal (ASJ), I would like to thank Dr Solomon for his Letter to the Editor entitled “Comments on ‘Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations.’”1 One of Dr Solomon’s remarks calls for a response.
      PubDate: Sat, 16 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx205
  • The Micromort Concept and its Applicability to Breast Implant-Associated
           Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Assessment
    • Authors: Baxter R.
      Abstract: I read with interest the article by Sieber and Adams about the micromort concept and its applicability to anaplastic large cell lymphoma (ALCL) risk assessment.1 While I concur with the conclusions of the article, I wish to point out some issues with the source data in Table 1 for risks associated with common activities. I recently attempted to locate the original reference for the micromort concept and this proved challenging. The only reference from Ronald Howard listed in PubMed is from 1989.2 A 1979 article by Richard Wilson in Technology Review3 is the first appearance of the table of lifestyle risks that I could locate. The author’s methodology in drafting the table appears to have simply taken averages such as the number of deaths from alcoholic cirrhosis and national average drinking, and deriving risk of a single drink from that. More sophisticated analysis shows a J-shaped curve for alcohol, especially wine, with lower risk at moderate consumption.4 The risk we run is missing more nuanced aspects of risk for ALCL by not factoring in the positive aspects of breast implant use. For example, there is some evidence that breast cancer survival is improved with reconstruction5; breast implants may have their own J-shaped curve. So while micromort analysis offers a reassuring perspective on the ALCL situation, we need to be cautious about citing outdated and poorly documented data on comparative risk.
      PubDate: Sat, 16 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx173
  • Response to “The Micromort Concept and its Applicability to Breast
           Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk
    • Authors: Sieber D; Adams W, Jr.
      Abstract: Thank you for your insightful comments1 on our article entitled “What’s Your Micromort' A Patient-Oriented Analysis of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Assessment.”2 Activities such as drinking wine present risk in a J-shaped curve, in part because wine consumption may occur along a spectrum from none to excess. Whereas moderate wine consumption, even alongside heavy alcohol consumption, demonstrates multiple health benefits.3 Although the activities demonstrated by Wilson occur along a spectrum as well, many may present as all or none events, such as riding a bicycle 10 miles, riding 300 miles in a car, or traveling 1000 miles in a jet.4 Despite his data being older, these events would not present in a J-shaped curve as riding less in a car will not impose health benefits, but will instead only decrease risk. Likewise, having breast implants is an all or nothing event. Therefore, one cannot have “less” of a breast augmentation in hopes of pursuing health benefits. For this reason, we believe using the micromort terminology is well founded and is a valuable tool for patient education on BIA-ALCL.
      PubDate: Sat, 16 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx212
  • Comments on “Nonsurgical Medical Penile Girth Augmentation:
           Experience-Based Recommendations”
    • Authors: Solomon M.
      Abstract: I am writing to express my concern regarding this article.1 The authors support the use of hyaluronic acid as an injectable material for penis enlargement. As a plastic surgeon who has been performing procedures for penis enlargement for more than 20 years, I have concerns about this endorsement. Hyaluronic acid dissipates in all cases over time. Its absorption is irregular creating nodules in every case (Figure 1). About half of the patients that I treat have unsatisfactory results from injection of a variety of materials, including hyaluronic acid, polymethylmethacrylate, fat (Figure 2), liquid silicone (Figure 3), and silicone devices (Figure 4). Each of these has unique challenges for surgical removal and each of these patients is very unhappy when they present to me. While there are options for increasing the length and girth of the penis, they are surgically demanding (Figure 5). Unlike hyaluronic acid, or any of the other fillers mentioned, the results are permanent. This is not to say that complications of surgery cannot occur. Complications do occur and as surgeons, we should be prepared to manage them to restore our patients to full function. I think it is incumbent for our members to be aware that the US Food and Drug Administration has not approved any filler for penile injection therapy. These are dermal fillers and there is no significant dermal layer in the penis. Due to the anatomy of the penis, these materials are placed in the superficial fascial layer of the penis. Placement of these materials disrupts the blood supply to the skin of the penis. When removing these materials, the blood supply to the overlying skin is compromised, which can cause skin loss as a subsequent challenge for reconstruction. I would discourage our members from adopting this method of penis enlargement.
      PubDate: Sat, 16 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx204
  • Response to “Comments on ‘Nonsurgical Medical Penile Girth
           Augmentation: Experience-Based Recommendations’”
    • Authors: Oates J; Sharp G.
      Abstract: We thank Dr Solomon1 for his interest in our article.2 We agree that penile augmentation using injectable materials, including hyaluronic acid (HA), does have some disadvantages. HA fillers do slowly reabsorb over time and so are not a permanent solution. However, our in-progress research suggests that the nonpermanency of the procedure is potentially part of the appeal for at least some patients. These men consider a nonpermanent procedure on such an important part of their body, which they closely associate with their sense of masculinity, to be less daunting.
      PubDate: Sat, 16 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx226
  • Does Stromal Vascular Fraction Supplementation Improve Facial
    • Authors: Swanson E.
      Abstract: Gontijo-de-Amorim et al1 claim that fat enriched with the stromal vascular fraction (SVF) improves volume retention after facial lipotransfer. The authors describe a comparison of 5 patients injected with enriched fat vs 5 patients injected without SVF supplementation using computed tomography (CT). The authors report that the enriched fat group lost only 9.6% of its volume vs 24% in the untreated group.1 The authors simply centrifuge the lipoaspirate rather than separating it enzymatically using collagenase to isolate adipose-derived stem cells.1 Whether the cell pellet left at the bottom of the tube after centrifugation truly represents the SVF is open to question.2
      PubDate: Fri, 08 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx201
  • Response to “Does Stromal Vascular Fraction Supplementation Improve
           Facial Lipotransfer'”
    • Authors: Gontijo-de-Amorim N; Charles-de-Sá L, Rigotti G.
      Abstract: In response to the previous letter written by Dr. Swanson,1 we are very grateful for his interest in our paper and for spending the time to analyze and comment on it. We appreciate the opportunity to clarify our arguments and ideas that, we hope, can contribute to science and to plastic surgery practices.
      PubDate: Fri, 08 Dec 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx222
  • Aesthetic Refinements in C-V Flap: Raising a Perfect Cylinder
    • Authors: Losco L; Cigna E.
      Abstract: Nipple reconstruction is the keystone procedure to complete an aesthetically satisfying postmastectomy breast reconstruction. Positioning the nipple at the edge of the breast cone and achieving symmetry with the contralateral side (native or reconstructed nipple) are critical in completing a pleasing result. Furthermore, patient expectations are always higher; aesthetics becomes of paramount concern after having gone through the feelings connected with the disease.
      PubDate: Tue, 28 Nov 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx195
  • Facial Plastic Surgery Clinics of North America: Functional Rhinoplasty
    • Authors: Langsdon P.
      Abstract: MarcusBenjamin C., ed. Facial Plastic Surgery Clinics of North America: Functional Rhinoplasty. New York, NY: Elsevier, 2017. ISBN-13: 978-0323528382. $98.99.
      PubDate: Wed, 08 Nov 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx156
  • Current Trends in Breast Augmentation: An International Analysis
    • Authors: Heidekrueger P; Sinno S, Hidalgo D, et al.
      First page: 133
      Abstract: BackgroundBreast augmentation surgery remains the most frequently performed aesthetic surgical procedure worldwide. However, many variations exist regarding preoperative planning, surgical management, and postoperative care.ObjectivesThe goal was to evaluate current trends and practices in breast augmentation, with a focus on international variability.MethodsA questionnaire was sent to over 5000 active breast surgeons in 44 countries worldwide. The survey inquired about current controversies, new technologies, common practices, secondary procedures, and surgeon demographics. The findings and variations were evaluated and correlated to evidence-based literature.ResultsThere were a total 628 respondents equaling a response rate of approximately 18%. While certain approaches and common practices prevail also on an international basis, there exist several geographic controversies. For example, while almost fifty percent of surgeons in the United States and Latin America never use anatomically shaped implants, in Europe and Oceania most surgeons use them. Similarly, in Latin America, Europe, Asia, and Oceania, over 80% of surgeons use silicone implants only, whereas in the United States only 20% use them − meanwhile US surgeons use the largest implants (78% > 300 cc). Internationally dominant practice preferences include preoperative sizing with silicone implants, as well as the use of inframammary incisions and partial submuscular pockets.ConclusionsSignificant differences exist when comparing most common surgical breast augmentation approaches on an international basis. While certain techniques seem to be universal standards, there still remain several controversies. Further standardizing this most common aesthetic surgical procedure according to evidence-based guidelines will help to improve outcomes.
      PubDate: Wed, 07 Jun 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx104
  • Commentary on: Current Trends in Breast Augmentation: An International
    • Authors: Brown M.
      First page: 149
      Abstract: This study aimed to evaluate trends and current practices in breast augmentation surgery with a focus on international practice patterns.1 Specifically, the authors investigated a variety of areas including implant selection, implant size, pocket selection, specifics with regards to surgical technique, and management of complications. It was a survey based study that included questionnaires delivered to over 5000 breast surgeons in 44 countries. Surgeons were identified via access to member rosters of regional and national specialty societies.
      PubDate: Tue, 04 Jul 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx125
  • Eight-Year Safety Data for Round and Anatomical Silicone Gel Breast
    • Authors: Duteille F; Perrot P, Bacheley M, et al.
      First page: 151
      Abstract: BackgroundThe safety and efficacy of all medical devices, including breast implants, is important and consistent performance is best shown by undertaking long-term clinical and vigilance studies. Local complications such as capsular contracture and rupture are risks often associated with breast implant surgery.ObjectivesThe authors investigate and evaluate the safety and performance of Eurosilicone’s (Eurosilicone S.A.S, Apt Cedex, France) Cristalline Paragel breast implants at 8 years postimplantation.MethodsIn this prospective clinical study, 995 Eurosilicone textured cohesive Cristalline Paragel mammary implants were implanted in 526 women undergoing augmentation and reconstructive surgery at 17 centers across France. Complications were recorded at 3 months and annually thereafter for 8 years. Descriptive statistics were used and key complications were analysed using the Kaplan-Meier method.ResultsCapsular contracture was reported in 8.5% of implants across all cohorts through 8 years. The Kaplan-Meier risk of capsular contracture (Baker Grade III/IV) per implant was 8.4% in the primary augmentation cohort and 18.0% in the primary reconstruction cohort. Eight implant ruptures were identified by surgeon examination during this follow-up period. The Kaplan-Meier risk of rupture occurring within 8 years postimplantation, across all cohorts, was 1.4% per patient and 0.9% per implant. Actual implant removal rate (explantation/exchange) was 6.0% and 13.8% for primary augmentation and primary reconstruction, respectively. Actual rates of local complications including infection and seroma were low with risk rates of 0.6% and 0.2% by subject.ConclusionsThis multicenter clinical study involving Eurosilicone’s silicone gel breast implants in both round and shaped profiles demonstrates an excellent safety and efficacy profile through 8 years.Level of Evidence: 3
      PubDate: Sat, 24 Jun 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx117
  • Incidence and Predictors of Venous Thromboembolism in Abdominoplasty
    • Authors: Keyes G; Singer R, Iverson R, et al.
      First page: 162
      Abstract: BackgroundThe prevention of venous thromboembolism (VTE) is a high priority in aesthetic surgery. Abdominoplasty is the aesthetic procedure most commonly associated with VTE, yet the mechanisms for the development of VTE associated with this procedure are unclear.ObjectivesThe purpose of this study was to analyze the incidence and predictors of VTE in patients undergoing abdominoplasty procedures in outpatient surgery centers using data from the Internet Based Quality Assurance Program (IBQAP).MethodsIBQAP data from 2001 to 2011 were queried retrospectively to identify abdominoplasty cases and VTE cases. Patient- and procedure-specific variables were analyzed to identify potential predictors of VTE in abdominoplasty.ResultsAmong all outpatient aesthetic surgery cases entered from 2001 to 2011, 414 resulted in VTE, representing a VTE incidence of 0.02%. Of these, 240 (58%) occurred in abdominoplasty cases. Predictors of VTE were age greater than 40 years and BMI greater than 25 kg/m2. Patient sex, duration of anesthesia and surgery, type of anesthesia, type of additional procedure, and number of procedures did not appear to influence the risk of VTE. Importantly, 95.5% of the VTEs identified for this study occurred in patients whose Caprini risk assessment model score was between 2 and 8, which would not be an indication for chemoprophylaxis according to current recommendations.ConclusionsMany factors must be considered when determining the true incidence of VTE in abdominoplasty. Research is needed to discover the reason abdominoplasty carries a greater risk compared with other aesthetic surgery procedures so that appropriate steps can be taken to prevent its occurrence and improve the safety of the procedure.Level of Evidence: 2
      PubDate: Sun, 08 Oct 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx154
  • Commentary on: Incidence and Predictors of Venous Thromboembolism in
    • Authors: Grotting J; Higdon K, Gupta V, et al.
      First page: 174
      Abstract: Among healthcare providers, we all agree that collecting data is essential to document our current approach to patient care and learn how to optimize and improve this. However, if data are merely collected and never analyzed, it serves no real purpose. We congratulate the authors of this excellent paper1 for “looking into the box” and uncovering some interesting observations through analysis of the Internet Based Quality Assurance Program (IBQAP) database that lends insight into the enigma of venous thromboembolism (VTE) occurring in patients undergoing abdominoplasty.
      PubDate: Tue, 14 Nov 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx196
  • Body Contouring Surgery and the Maintenance of Weight-Loss Following
           Roux-En-Y Gastric Bypass: A Retrospective Study
    • Authors: Smith O; Hachach-Haram N, Greenfield M, et al.
      First page: 176
      Abstract: BackgroundBariatric surgery leads to significant weight loss with reduced morbidity and mortality. However, excess skin as a consequence of weight loss represents a major problem, impacting upon patient’s functionality with potential negative effects on weight loss.ObjectivesWe evaluated the effect of body-contouring surgery on weight-loss maintenance following bariatric surgery.MethodsWe undertook a retrospective analysis of patients undergoing Roux-en-Y gastric bypass (RYGB) +/- body-contouring surgery (BC). The control group (n = 61) received RYGB, the test group (n = 30) received RYGB+BC 12 to 18 months after bariatric surgery. Each RYGB+BC patient was matched to two control patients for age, sex, glycaemic status, and weight on day of surgery. Per cent weight loss (%WL) was calculated at 3, 6, 12, 24, 36, 48, and 60 months post-RYGB for both groups.ResultsThe %WL was similar at 3, 6, and 12 months post-RYGB. At 24 months, %WL was 35.6% in the RYGB+BC group and 30.0% in the RYGB group (P < 0.05). At 36 months, the RYGB+BC group maintained their weight loss (%WL 33.0%), in contrast, the RYGB gained weight (%WL = 27.3%, P < 0.05). This trend continued (RYGB+BC vs RYGB) at 48 months (%WL 30.8% vs 27.0%) and at 60 months (%WL 32.2% vs 22.7%, P < 0.05).ConclusionsOur results suggest patients who undergo body contouring after bariatric surgery are able to lose significantly more weight and maintain weight loss at five years of follow up compared to those undergoing bariatric surgery alone.Level of Evidence: 3
      PubDate: Wed, 04 Oct 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx170
  • Liquid Formulation of AbobotulinumtoxinA Exhibits a Favorable Efficacy and
           Safety Profile in Moderate to Severe Glabellar Lines: A Randomized,
           Double-Blind, Placebo- and Active Comparator-Controlled Trial
    • Authors: Ascher B; Kestemont P, Boineau D, et al.
      First page: 183
      Abstract: BackgroundIn most countries, approved botulinum toxin type A formulations require reconstitution before injection.ObjectivesTo evaluate the efficacy and safety of a ready-to-use liquid formulation of abobotulinumtoxinA (abobotulinumtoxinA solution for injection, ASI) in subjects with moderate to severe glabellar lines (GL).MethodsIn this Phase II, double-blind, placebo-controlled, randomized study, 176 female subjects (aged 30 to 60 years) were randomized into five treatment groups: ASI 20, 50, or 75 U, reconstituted abobotulinumtoxinA (aboBoNT-A) 50 U, and placebo. GL severity was assessed at maximum frown using a 4-point grading scale. Responders were subjects with severity grade of moderate [2] or severe [3] at baseline improving to none [0] or mild [1], evaluated at each time-point by Investigator’s Live Assessment (ILA) or Subject’s Self-Assessment (SSA). Safety profiles were also determined.ResultsBaseline characteristics were similar across groups. Responder rates on Day 29 by ILA were significantly greater for ASI 20, 50, and 75 U versus placebo (88.9%, 91.4%, and 87.9% vs. 0%, respectively; P < 0.0001). Similar results were observed by SSA. A greater proportion of responders was observed in ASI groups vs placebo from Day 8 to 113 for ILA and SSA (P < 0.001). AboBoNT-A responder rate on Day 29 for ILA was 77.1% (P < 0.1006 vs ASI 50 U); with comparable results by SSA. The ASI safety profile was comparable to that of aboBoNT-A.ConclusionsReady-to-use liquid formulation of abobotulinumtoxinA was shown to be efficacious, with comparable results to reconstituted abobotulinumtoxinA, and to have a favorable safety profile in subjects with severe to moderate GL.Level of Evidence: 1
      PubDate: Tue, 14 Feb 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjw272
  • Does Botulinum Toxin Injection into Masseter Muscles Affect Subcutaneous
    • Authors: Park G; Choi Y, Bae J, et al.
      First page: 192
      Abstract: BackgroundBotulinum toxin (BoNT) is widely used to treat masseter muscle hypertrophy. Changes in the muscle thickness have been found in many studies, but there has been no report on changes in the thickness from the skin surface to the masseter muscle.ObjectivesWe aimed to use ultrasonography to measure not only changes in the muscle thickness but also changes in subcutaneous thickness.MethodsThis study enrolled 20 volunteer patients: 10 were assigned to an experimental group (injected with each side 25 U of botulinum toxin into both masseter muscles) and 10 to a control group (injected with normal saline). The thicknesses were measured before the injection and at 4, 8, and 12 weeks after the injection both at rest and during maximum muscle contraction.ResultsThe subcutaneous thickness did not differ significantly over time either at rest (P = 0.063) or during maximal contraction (P = 0.392), or between the experimental and control groups at rest (P = 0.392) or during maximum contraction (P = 0.259). The muscle thickness in the experimental group differed significantly over time.ConclusionsBotulinum toxin injection only changes the muscle thickness and does not affect the subcutaneous thickness from the skin surface to the masseter muscle.Level of Evidence: 2
      PubDate: Wed, 21 Jun 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx102
  • Adipose-Derived Stem Cells in Aesthetic Surgery: A Mixed Methods
           Evaluation of the Current Clinical Trial, Intellectual Property, and
           Regulatory Landscape
    • Authors: Arshad Z; Halioua-Haubold C, Roberts M, et al.
      First page: 199
      Abstract: BackgroundAdipose tissue, which can be readily harvested via a number of liposuction techniques, offers an easily accessible and abundant source of adipose-derived stem cells (ASCs). Consequently, ASCs have become an increasingly popular reconstructive option and a novel means of aesthetic soft tissue augmentation.ObjectivesThis paper examines recent advances in the aesthetic surgery field, extending beyond traditional review formats to incorporate a comprehensive analysis of current clinical trials, adoption status, and the commercialization pathway.MethodsKeyword searches were carried out on clinical trial databases to search for trials using ASCs for aesthetic indications. An intellectual property landscape was created using commercial software (Thomson Reuters Thomson Innovation, New York, NY). Analysis of who is claiming what in respect of ASC use in aesthetic surgery for commercial purposes was analyzed by reviewing the patent landscape in relation to these techniques. Key international regulatory guidelines were also summarized.ResultsCompleted clinical trials lacked robust controls, employed small sample sizes, and lacked long-term follow-up data. Ongoing clinical trials still do not address such issues. In recent years, claims to intellectual property ownership have increased in the “aesthetic stem cell” domain, reflecting commercial interest in the area. However, significant translational barriers remain including regulatory challenges and ethical considerations.ConclusionsFurther rigorous randomized controlled trials are required to delineate long-term clinical efficacy and safety. Providers should consider the introduction of patient reported outcome metrics to facilitate clinical adoption. Robust regulatory and ethical policies concerning stem cells and aesthetic surgery should be devised to discourage further growth of “stem cell tourism.”
      PubDate: Wed, 07 Jun 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx093
  • Commentary on: Adipose-Derived Stem Cells in Aesthetic Surgery: A Mixed
           Methods Evaluation of the Current Clinical Trial, Intellectual Property,
           and Regulatory Landscape
    • Authors: Mosahebi A.
      First page: 211
      Abstract: Adipose-derived stem cells (ADSC) continue to incite controversy in the medical profession, are highly sought after by the public, incite excitement in commercial companies, and are seen as a lucrative income generator in clinics. This interesting analysis of ADSC registered trials as well as registered intellectual properties further illustrates these points.1
      PubDate: Tue, 31 Oct 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx177
  • Demystifying the “July Effect” in Plastic Surgery: A
           Multi-Institutional Study
    • Authors: Blough J, Jordan S, De Oliveira G, Jr; et al.
      First page: 212
      Abstract: BackgroundThe “July Effect” refers to a theoretical increase in complications that may occur with the influx of inexperienced interns and residents at the beginning of each academic year in July.ObjectivesWe endeavored to determine if a July Effect occurs in plastic surgery.MethodsPlastic surgery procedures were isolated from the National Surgical Quality Improvement Program registry. Cases involving residents were grouped as either having occurred within the first academic quarter (AQ1) or remaining year (AQ2-4). Groups were propensity matched using patient/operative factors and procedure type to account for baseline differences. Univariate and multivariate regression analyses assessed differences in overall complications, surgical and medical complications, individual complications, length of hospital stay, and operative time. A comparison group comprised of procedures without resident involvement was also analyzed.ResultsThere were 5967 cases with resident involvement, 5156 of which successfully matched. Both univariate and multivariate regression analyses revealed no significant differences between AQ1 and AQ2-4 in terms of overall, surgical, medical and individual complications, or length of hospital stay. There was a statistically significant, albeit not clinically significant, increase in operative time by 10 minutes per procedure during AQ1 in comparison to AQ2-4 (P = 0.001). For procedures lacking resident participation, there were no differences between AQ1 and AQ2-4 in terms of these outcomes.ConclusionsA July Effect was not observed for plastic surgery procedures in our study, conceivably due to enhanced resident oversight and infrastructural safeguards. Patients electing to undergo plastic surgery early in the academic year can be reassured of their safety during this period.Level of Evidence: 2
      PubDate: Fri, 15 Sep 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx099
  • Commentary on: Demystifying the “July Effect” in Plastic Surgery: A
           Multi-Institutional Study
    • Authors: Kasten S; Cederna P.
      First page: 225
      Abstract: We would like to compliment the authors on a very nicely designed, conducted, and interpreted study investigating the “July Effect” in plastic surgery.1 This study is particularly significant because The “July Effect” has not been previously evaluated in plastic surgery. Hypothetically, complications will be higher at the beginning of the academic year, when trainees and new attending surgeons are relatively inexperienced in their new roles and may be in an unfamiliar facility. It is logical to postulate that this inexperience and unfamiliarity will lead to poorer outcomes as compared to the remainder of the year. However, there is no conclusive data to support the existence of this phenomenon.
      PubDate: Sat, 16 Sep 2017 00:00:00 GMT
      DOI: 10.1093/asj/sjx158
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