Regional trends in plastic surgery patients and procedures differ and they do not always match that of national trends, according to a recent survey conducted by the American Society of Plastic Surgeons (ASPS). ASPS Member Surgeons located in Chicago, Dallas, Los Angeles and Washington, D.C. (including Baltimore, Md.) were surveyed on how their practices compared to the 2006 ASPS national procedural data.

Upon closer examination in these major metropolitan areas, ASPS found a higher percentage of male patients as well as younger patients compared to national figures. This survey also reported increases in ethnic groups; however, nationally the ASPS reported slight decreases in certain ethnic groups from 2005 to 2006.

Additionally, all four markets reported an increase in the following trends over the past three years: couples/families having surgery together, patients seeking minimally invasive procedures in lieu of surgery, and massive weight loss patients seeking body contouring procedures.

Since 1992, the ASPS has been the source of the most comprehensive and reliable cosmetic and reconstructive plastic surgery national statistical trends in the U.S. This is the first time the ASPS has conducted a regionally focused survey.

“We took the pulse in these large regional markets to see who the typical plastic surgery patient is compared to what we’ve found nationally,” said Michael McGuire, MD, ASPS Vice President of Communications. “We discovered interesting nuances between the cities. For instance, while breast augmentation ranked 1st in all four markets, surprisingly a higher percentage of ASPS Member Surgeons in the Midwest-Chicago-ranked this procedure the highest as opposed to Los Angeles with its appearance-driven stereotype.”

Key Differences in Procedures:*

- Eyelid surgery among women ranked significantly higher among respondents in Los Angeles (33%) than in Dallas (12%).

- Male breast reduction ranked significantly higher among respondents in Dallas (88%) than in Los Angeles (42%).

- Laser hair removal ranked significantly higher among respondents in Washington, D.C./Baltimore (34%) than in Chicago (6%).

Conversely, with certain procedures these markets revealed similarities but differed in comparison with national statistics. For instance, tummy tuck ranked in the top three in these markets among women but ranked 5th nationally. Breast reduction in women ranked in the top two in these markets, but ranked 5th nationally. Among men, nose reshaping ranked either 3rd or 4th in these markets but ranked 1st nationally. Also among men, liposuction ranked 1st in these markets but ranked 3rd nationally.

Key Findings in Reconstructive Plastic Surgery:

- Scar revision ranked significantly higher among respondents in Los Angeles (70%) than in Chicago (22%).*

- A higher percentage of respondents in Chicago (16%) and Washington, D.C./Baltimore (21%) reported a decrease in plastic surgery patients in the last three years with lawnmower injuries than in Dallas (4%) and Los Angeles (6%).

- All four markets reported a decrease in plastic surgery patients with fireworks injuries in the last three years.

- The highest percentage of respondents reporting a decrease in plastic surgery patients with dog bite injuries in the last three years was Chicago (34%).

“We’re so pleased to see a decrease in these terrible, preventable injuries that often involve children,” said Dr. McGuire. “The data is promising, but more research needs to be done so we can better understand trends in both reconstructive plastic surgery as well as cosmetic procedures.”

Key Findings in Patient Demographics:

- A significant percentage of respondents in Chicago (56%), Dallas (67%) and Los Angeles (67%) reported an increase in Hispanic patients in the last three years. Nationally, ASPS reported a 1% decrease from 2005 to 2006.

- A significant percentage of respondents in Washington, D.C./Baltimore (60%) reported an increase in African American patients in the last three years. Nationally, ASPS reported a 1% decrease from 2005 to 2006.

- Ethnic patients represented a significantly higher mean percentage in Los Angeles (40%) than in both Chicago (26%) and Dallas (28%).

- The average percentage breakdown of male patients among the four markets was 21%. Nationally, ASPS reported male patients comprised 10% of total cosmetic plastic surgery patients in 2006.

- More than 50% of ASPS Member Surgeons in all four markets reported an increase in males seeking cosmetic plastic surgery in the last three years.

- On average the highest percentage of patients were 31 to 45 years old (31%). Nationally, the highest percentage of patients fell in the 40 to 54 age group (45%).

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

*ASPS Member Surgeons in Chicago, Dallas, Los Angeles, Washington, D.C./Baltimore were asked to choose the most common procedures in their practices from the list of the 2006 top five procedures reported nationally by ASPS in various categories.

American Society of Plastic Surgeons

Plastic surgeons are re-evaluating past scientific findings and developing new knowledge about the effects of silicone breast implants. A recent supplement to Plastic and Reconstructive Surgery(R) (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS), sheds new light on the psychological impact and health concerns of silicone breast implants.

Body Image

One review of important recent studies refuted a common perception – women who want breast augmentation do not suffer from lower overall body image than other women.

“Breast augmentation patients do not have a poorer overall self-image, nor are they more self-critical and preoccupied with their appearance than other women,” said Mary McGrath, MD, ASPS Member Surgeon and study author. “It appears it is their significant dissatisfaction with their breasts that serves as the motivation for surgery, not a poor overall body image.”

The positive effect of breast augmentation on women’s thoughts and feelings is also limited to their breasts. After surgery, they report being less embarrassed about their breasts and spending less time feeling upset about and camouflaging their breasts.

Cancer Risk

While some studies have raised concerns about the potential link between silicone breast implants and breast cancer, others have suggested the implants could cause other types of cancer (cervical, vulvar, lung, etc). A National Cancer Institute (NCI) review of past epidemiologic studies showed little support for an increased risk of cancer among breast implant patients.

“At present, there is no convincing evidence that breast implants alter the risk of cancer,” said Louise Brinton, Ph.D., NCI, and study author. “The few increases in risk that have been noted in studies appear to be largely attributable to lifestyle characteristics of the women, such as smoking, rather than the implants.”

Effect on Breast feeding

Despite the overwhelming advantages of breast-feeding, some women with silicone breast implants may fear silicone could be passed on to their child, possibly affecting growth and development. However, according to a study, that measured silicon as an indicator of silicone, the levels of silicon found in lactating mothers with implants, as compared to lactating mothers without implants, was not significantly different.

“Our findings suggest there is no difference in silicone levels in the breast milk of women with silicone breast implants than in the breast milk of women without implants,” said John Semple, MD, ASPS Member Surgeon and study author.

More than 329,000 breast augmentations were performed in 2006, according to the ASPS. For the first time since ASPS began collecting statistics in 1992, breast augmentation was the top cosmetic surgical procedure performed.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons

http://www.plasticsurgery.org

A review published in Dermatologic Therapy reveals that men can be treated with Botox for cosmetic procedures in the same way as women but require higher doses of Botox in all treatment areas.

There has recently become a growing interest in cosmetic procedures by men. Although most practices see a majority of women, the number of male patients who seek treatment is slowly increasing.

Men often require more units of Botox than women which may be because men have a greater muscle mass than women. Similarly, it has been a common clinical observation that larger, stronger men need more units per treatment area than slender, small-boned men. The most common cause of inadequate results in male patients is under-dosing, which may lead to men requiring additional Botox injections.

“Various areas of the male face can be treated with Botox and injections need to keep in mind the greater muscle mass in men,” the author notes.

“Botox in men”
Timothy Corcoran Flynn
Dermatologic Therapy 20 (6), 407-413.
doi:10.1111/j.1529-8019.2007.00156.x
Click here to view abstract online

Dermatologic Therapy was created to fill an important void in the dermatologic literature: the lack of a readily available source of up-to-date information on the treatment of specific cutaneous diseases and the practical application of specific treatment modalities. The information contained in each issue is so practical and detailed that the reader should be able to directly apply various treatment approaches to daily clinical situations.

Disappointed with results from the last few years’ much ballyhooed “lunch hour” and “weekend” cosmetic surgery procedures, people interested in facial rejuvenation are expected to pursue more reliably effective approaches in 2008.

According to Jeffrey Spiegel, MD, chief of facial plastic and reconstructive surgery at Boston University School of Medicine and Boston Medical Center, people are frustrated and disappointed with the expensive, minimally effective procedures touted as rapid solutions. Several significant changes in plastic surgery are expected in the coming year.

“People are going to expect better and more predictable results. With the economy slowing somewhat, the desire to look your best will remain, but people will expect to get what they paid for and be less tolerant of only minor improvement with a big cost,” stated Spiegel.

Spiegel predicts the following specific trends in 2008:

* A return to more traditional procedures with a decline in shortcuts. The time invested pays off in the long run and the safety of established procedures is so high that people don’t have the same concerns they may have had in the past. “We’ve really gotten people to heal nearly as quickly from the traditional procedures as they do from the much less effective interventions that are so widely publicized.”

* New fillers last longer without the need for skin testing. Many new types of filler have been recently released to treat the fine facial lines and wrinkles for which Botox™ is not appropriate. Some of these may last a year or longer. “This is one area where you truly can expect good results with just a very short (few hours) recovery,” states Spiegel.

* Laser technologies continue to progress but the greatest innovation is a new way to deliver energy beneath the skin. Smartlipo™ is an example of a technology where laser can be used to rapidly and safely melt fat beneath the skin with only a very tiny incision. Expect further refinements in how lasers are delivered (without the need to send energy through the outer layers of the skin).

A 47 year-old woman recently came to Spiegel to have threadlift™ barbed sutures removed from her face. “I’m so glad to have those things out of my face!” she said. The implants, which had been placed by a physician outside of Boston, were just one of several technologies that were supposed to provide all the benefits of a face lift with only a day or two of recovery.

“Unfortunately, the results weren’t there, the speed of recovery wasn’t there, and the plastic threads were often visible poking at the skin,” notes Spiegel. “Less recovery doesn’t do any good if there isn’t any benefit from the procedure.”

Spiegel also notes that many laser procedures can be particularly disappointing. “Patient reports of satisfaction with skin conditioning procedures such as Fraxel™, IPL, Thermage™ and others are not encouraging. While these approaches are as expensive as proven surgical techniques, only approximately 50 percent of people who have these done feel that it was worthwhile. The other percent can’t tell that anything was done,” he said.

Finally, Spiegel notes that his research efforts are beginning to change the way faces are evaluated. “We’re starting to make progress in understanding how our brains define and recognize attractiveness. This work should have important implications in determining what procedures are recommended for people to look their best. Parts of the face that previously have not been considered important for facial appearance will change greatly in significance and likely become more important than some more traditional procedures.”

Spiegel’s practice attracts patients from around the world who fly to Boston for facial plastic surgery for correction/modification of procedures done elsewhere. Nearly 80 percent of his cosmetic practice consists of patients from outside of Massachusetts.

Internationally renowned reconstructive surgeons John Reinisch, M.D., and his colleague Sheryl Lewin, M.D., have joined the Cedars Sinai Medical Group. The two plastic surgeons will provide corrective and cosmetic surgery to children and adults.

In joining the medical group, Reinisch also becomes the director of Craniofacial and Pediatric Plastic Surgery at Cedars-Sinai Medical Center. Reinisch, in practice for more than 25 years, is an internationally recognized pediatric plastic surgeon who pioneered a corrective surgery for children with microtia, a congenital ear deformity that can affect hearing. Reinisch, who has performed the surgery on children from around the world, uses a porous plastic framework covered with tissue and skin to shape a new ear. This surgery can provide a child as young as age three with a natural appearing ear compared to a previous technique which must be performed on older children and involves harvesting rib cartilage to shape the ear. Reinisch is also highly regarded for his skill in reconstructive techniques for young patients with large or complex vascular and pigmented birthmarks.

Reinisch and Lewin, who will be associate director of Craniofacial and Pediatric Plastic Surgery at Cedars-Sinai Medical Center, specialize in cleft lip and palate correction, hemangioma (vascular tumors) removal, and nevi (pigmented birthmarks) reconstruction, of which they have performed thousands.

For adults, the surgeons perform breast surgery, facial rejuvenation, nasal reshaping, tummy tucks and other cosmetic procedures.

“For surgeries on children with tiny features and delicate skin, our technique is very refined; we use tiny sutures so that scarring and discomfort is minimized,” says Reinisch. “We use this same approach when treating our adult patients, which we believe is a real benefit to them.”

Reinisch was formerly at Childrens Hospital Los Angeles (CHLA), where he established the division of plastic surgery in 1983. He also served as the chief of the division of plastic surgery at CHLA and head of the division of plastic surgery at USC Medical Center. Board certified since 1980, Reinisch received his medical degree from Harvard Medical School. He completed his general surgery residency at the University of Michigan and Tulane University, and his plastic surgery fellowship at the University of Virginia.

Lewin is board certified in plastic surgery and received her medical degree from Stanford University. She did her plastic surgery residency at USC and obtained specialized fellowship training at Childrens Hospital Los Angeles.

Established in 1985, the Cedars-Sinai Medical Group includes more than 90 primary care and specialty physicians and offer a myriad of medical services, including internal medicine, gastroenterology, orthopaedics, dermatology, oncology, sports medicine and obstetrics and gynecology. The group recently received two honors for excellence in patient care, including the “Top Performance Award” from the Integrated Healthcare Association (IHA), a statewide non-profit healthcare group, and a top rating of “Excellent” from the Office of the Patient Advocate’s (OPA) 2007 Health Care Quality Report Card.

“Drs. Reinisch and Lewin share the medical group’s commitment to high quality medical care,” said Thomas D. Gordon, CEO of Cedars-Sinai Medical Delivery Network. “They also care deeply about their patients and their families especially the children whose lives they literally change through surgery. We’re delighted to have them on our team.”

The first in Southern California and one of only 11 hospitals in the state whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 years, it has been named Los Angeles’ most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and its human research protection program is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP).

Cedars-Sinai Medical Center
8700 Beverly Blvd., Rm 2429A
Los Angeles, CA 90048
United States

http://www.cedars-sinai.edu

A new study recently published in the Journal of Cosmetic Dermatology reports on the discovery of caffeine’s novel benefit in slenderizing thighs.

The Brazilian researchers studied 99 women treated with a cream consisting mostly of a 7 percent caffeine solution. The women used the cream twice daily for 30 days.

When the researchers took their subjects’ measurements at the end of the study, the slimming effect was clear. More than 80 percent of the women had a reduction in the circumference of their upper and lower thighs. Nearly 68 percent also reduced their hip measurements.

Whether caffeine banishes cellulite is less clear. The researchers assessed cellulite changes with a handheld imaging instrument that reveals microcirculation in fat tissue. Imaging showed little change in cellulite even in the hips and thighs that slimmed down. The researchers speculate that the 30-day trial might not have been long enough for the cream to act on cellulite.

“This is no cure for cellulite”, said lead researcher Omar Lupi of the Federal University of then State of Rio de Janeiro. “But it can help women who want to look thinner. Exercise is still the best way to go.”

At the annual fall meeting of the National Conference of State Legislatures in Phoenix, the Cosmetic, Toiletry, and Fragrance Association, announced it is changing its name to the Personal Care Products Council and launched an ambitious new consumer information Web site that contains in-depth information about cosmetic safety. Founded in 1894, the Washington, D.C.-based Council represents the global cosmetic, fragrance and personal care product industry.

The new Web site, http://www.cosmeticsinfo.org, is an in-depth online resource that gives consumers easy access to safety information about cosmetic ingredients and the science behind the personal care products found in nearly every medicine cabinet and cosmetic case. The site currently contains information on 13 personal care product categories and more than 1,500 ingredients that represent a majority of all ingredients used in cosmetic and personal care products today. Additionally, http://www.cosmeticsinfo.org provides links to other authoritative bodies and to scientific research so consumers can confidently select the products that are right for them. The site will continue to be expanded and updated with new information.

“The wide range of beauty and personal care products we represent are essential to today’s lifestyles, and consumers turn to us for accurate information about them,” said Marc Pritchard, President – Global Strategy at Procter & Gamble and chairman of the board of the Personal Care Products Council. “This new Web site is a fulfillment of that trust and offers consumers the important information they seek about the products and ingredients they purchase for themselves and their families,” he said.

The new, broader and more contemporary name for the association reflects its increasingly diverse membership, and the new motto for the association and the consumer information Web site emphasize the Council’s continuing and enhanced focus on consumer safety.

ADD ONE/The Personal Care Products Council

“We are a science-based, safety-first organization and industry with a long track record of safety initiatives that go beyond the requirements of the law,” said Pamela Bailey, president and CEO of the Personal Care Products Council. “Our new name, motto and consumer Web site are the latest expression of our shared core values of safety, quality, and innovation.”

Past Council safety initiatives include the establishment in 1976 of the Cosmetic Ingredient Review (CIR) Expert Panel, an independent, nonprofit body of scientific and medical experts that assess the safety of cosmetic ingredients used in the U.S. With the participation of representatives from the U.S. Food and Drug Administration (FDA) and the Consumer Federation of America, CIR thoroughly reviews the safety of cosmetic and personal care product ingredients in an open forum and publishes the results in peerreviewed scientific literature.

Earlier this year, the Council also instituted a Consumer Commitment Code to further strengthen industry safeguards for consumers. The Code formalizes and strengthens some practices already in place for most companies, such as the current reporting of manufacturing establishments to the FDA, and includes new practices such as a Safety Information Summary Program that makes cosmetic product and ingredient safety information immediately available to the FDA upon request. All members of the Council’s Board of Directors have signed the Code on behalf of their companies. Together, their companies’ sales volume represents more than 80 percent of the U.S. market and 93 percent of Council member sales. The Council will continue to educate its members on the practices embodied in the Code to gain additional industry participation.

Based in Washington, D.C., the Personal Care Products Council is the leading national trade association representing the $250 billion global cosmetic and personal care products industry. Founded in 1894, The Council’s more than 600 member companies manufacture, distribute, and supply the vast majority of finished personal care products marketed in the U.S. As the makers of a diverse range of products millions of consumers rely on everyday, from sunscreens, toothpaste and shampoo to moisturizer, lipstick and fragrance, personal care products companies are global leaders committed to product safety, quality and innovation.

For men with mild gynecomastia or excess breast tissue, the shame of their pecs can be paralyzing. Pectoral etching is proving to be a viable option for men who do not want pectoral implants but want to feel more comfortable with their chest, according to a study in December’s Plastic and Reconstructive Surgery(R) (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS).

“Although not common, requests for pectoral etching are increasing slowly,” said Henry Mentz, MD, ASPS Member Surgeon and study co-author. “Many men simply don’t know the procedure is even out there let alone that it’s a safe, effective option for them.”

During pectoral etching, targeted liposuction is used along the lower and outer edges of the chest muscles. A modest fat pad is left over the pecs, creating a noticeable contrast outlining the muscle.

Many patients who want the procedure suffer from minor gynecomastia or have lost weight but still have a more feminine-looking chest. Other patients are serious athletes that, despite working out and eating right, cannot develop the masculine, muscular chest they desire. To get a balanced look, these patients often have both abdominal and pectoral etching.

Unlike pectoral implants, etching leaves virtually undetectable scars, has no potential rejection issues and offers permanent results. Of the more than 200 men who had pectoral etching, only four experienced minor complications, according to the study.

“Pectoral etching can be a life-altering experience for patients,” said Dr. Mentz. “For 74 years, one patient wouldn’t remove his shirt in public. Last year he proudly spent his vacation on the beach in Hawaii.”

In a recent study presented at Plastic Surgery 2007, the annual scientific meeting of the ASPS, all study participants who had abdominal etching, a similar procedure, reported an improvement in appearance. In addition, 86 percent reported they were satisfied with their surgery.

More than 1.1 million men had plastic surgery in 2006, up 8 percent since 2000, according to ASPS statistics. More than 400 pectoral implant procedures were performed on men last year, up 99 percent since 2005.

Visit http://www.plasticsurgery.org for referrals to ASPS Member Surgeons and to learn more about cosmetic and reconstructive plastic surgery.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

Founded 25 years ago by plastic surgeons, Operation Smile has treated more than 100,000 children with cleft lip and cleft palates throughout the world demonstrating that no other specialty can approach what plastic surgery does in reconstructing patients, restoring dignity and changing lives. This November, nearly 300 plastic surgeons lent their expertise to the World Journey of Smiles (WJOS) — a unique Operation Smile 25th anniversary effort where from November 7th – November 16th in 25 countries plastic surgeons and other medical professionals conducted 40 missions, treating 4,149 children with facial deformities.

Leading by example in Ecuador were long-time Operation Smile volunteer and American Society of Plastic Surgeons (ASPS) President-Elect John Canady, MD and ASPS Executive Vice President, Paul Pomerantz. Both were humbled by their experience.

“I have volunteered for Operation Smile for over 15 years, and throughout this time I have had the pleasure of meeting some of the most incredible people in the world,” said Dr. Canady. “It is an honor to be able to restore smiles to the faces of both my young patients and their concerned parents. Participating in the World Journey of Smiles here in Ecuador has reconfirmed for me what a positive impact plastic surgeons have on the lives of those who may not otherwise be given this opportunity.”

In total, the World Journey of Smiles in Ecuador evaluated 197 patients, conducted 107 surgeries and 174 procedures. The medical director of Hospital de los Valles, where the mission took place, commented that Operation Smile had served as a great example of the impact that great teamwork and solidarity can have on the patients, setting an example for the staff at this new hospital.

The important role ASPS Member Surgeons played in the World Journey of Smiles is a great example of their passion and commitment to those in need–here in the United States and internationally. Over a thousand ASPS Member Surgeons, 20% of its full membership, travel internationally to provide no-cost plastic surgery for children–affirming that volunteerism is at the core of the American Society of Plastic Surgeons.

Through the World Journey of Smiles “We have been able to show through medicine the value of truly committed joint efforts, and we will continue changing lives one smile at a time,” said Operation Smile’s Co-founder and former ASPS Member Surgeon William Magee, MD.

Visit http://www.plasticsurgery.org for referrals to ASPS Member Surgeons and to learn more about reconstructive and cosmetic plastic surgery.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

Some soldiers can undergo surgery for facial fracture without being taken out of war zones, as long as they meet certain criteria, says an article in Archives of Facial Plastic Surgery (JAMA/Archives), November/December issue.

Approximately 61% of all US patients wounded during Operation Iraqi Freedom experienced a head and neck injury, the authors explained. “Prior to May 2005, most American military personnel with facial fractures were air evacuated from the Iraqi theater for definitive treatment of their facial fractures. Concerns about sterility, infection with Acinetobacter baumannii (a bacteria that has infected wounds and prostheses and caused catheter-related sepsis in many troops returning home) and delaying evacuation out of theater were all reasons cited for not definitively repairing facial fractures in theater.”

As from May 2005, a procedure called open reduction and internal fixation was introduced. This involves using mesh implants/plates to fix broken bones. For a patient to have this operation in Iraq he/she had to meet the following criteria?

– The fracture was exposed either by a wound, or by another procedure already being performed
– Treating the patients in Iraq would not delay their evacuation from the theater of war
– Treatment would allow them to stay in Iraq

Manuel A. Lopez, M.D., and Jonathan L. Arnholt, M.D., both from the Wilford Hall Medical Center, San Antonio, analyzed the records of 207 soldiers taken from the operating room by the otolaryngologist – facial plastic surgeon at the 332nd Expeditionary Medical Group at the Air Force Theater Hospital, Balad Air Base Iraq, during the period May-September 2005. The hospital is about 40 miles north of Baghdad, within the Sunni Triangle.

85% of them – 175 patients – were operated on for traumatic injuries, while 52 required open reduction and internal fixation of a facial fracture. 17 of the 52 patients were US military personnel who had undergone an open reduction and internal fixation. 8.3 months (average) after their procedures, 16 were followed up on the global military medical database.

The authors explain “None of these patients developed an Acinetobacter baumannii infection or had a complication caused by the definitive in-theater open reduction and internal fixation.” In fact, just one patient needed revision surgical repair – this was due to high pressure in the skull.

The researchers wrote “The practice of definitively treating facial fractures in a war zone using the criteria discussed in this article can lead to improved patient outcomes. It has been shown that a delay in fracture fixation can lead to both increased technical difficulties and infectious complications.”

As the muscles that surround an untreated facial fracture are fibrous and often contract, an untreated fracture can become more difficult to repair. Patients with jaw fractures which are not treated promptly are more likely to have complications, such as nerve weakness and misaligned teeth.

The authors concluded “Primary closure of soft tissue defects by open reduction and internal fixation of facial fractures on initial presentation to a well-equipped, in-theater hospital decreases the need for further facial surgery for patients when they return to the United States.”