Tackling common tummy tuck myths

tackling common tummy tuck myths

For men and women alike, a toned and flat stomach is considered to be the epitome of a fit, healthy and attractive figure. But whether due to genetics, childbearing, weight fluctuations or lifestyle habits, achieving that slim and smooth belly can feel impossible with so many factors actively working against you.

Tummy tuck surgery, otherwise known medically as an abdominoplasty, is a frequently requested surgical cosmetic procedure that helps patients attain the otherwise unattainable by tightening the abdominal muscles and eliminating excess fat and skin from the midsection for a more toned and sculpted stomach that lasts for years to come.

If you are bothered by the appearance of stretched skin, stubborn fatty deposits or weakened muscles in the abdominal region, tummy tuck surgery may be the perfect solution for getting the body you want. We’ve debunked some of the more common myths about tummy tucks to help you determine whether tummy tuck surgery is right for you.

Myth: Tummy tucks are a weight loss procedure

One of the more common misconceptions patients have regarding tummy tucks is that it is a surgery intended for those who would like to lose a substantial amount of weight from their midsection. However, a tummy tuck is not considered to be a weight loss or bariatric procedure.

In fact, the ideal candidate for tummy tuck surgery is someone who is at or close to a normal weight for their physique and who is otherwise active and healthy but is troubled by the appearance of a protruding abdomen or sagging, loose skin on their stomach.

That’s not to say that a tummy tuck won’t address excess fat within your abdominal region. Often times, liposuction techniques will be utilized during your tummy tuck surgery to gently minimize stubborn zones of fat that have proven resistant to diet and exercise to improve the contours and tone of your midsection.

While your stomach will be flatter and slimmer after your abdominoplasty, it will not drastically lower the number you see on your scale. For this reason, if you are considering a tummy tuck you should be within a reasonable range of your goal weight before undergoing the procedure but will also need to have maintained a stable weight for at least six months. Any future significant weight fluctuations can start to reverse the results of your surgery.

Myth: You can get tummy tuck results with diet and exercise

When it comes to getting the slimmer and sleeker stomach you desire, diet and exercise are well-known as the most effective tools in your toolbox for losing weight, building muscle and improving your overall health and wellness.

However, while each of us should incorporate eating right and exercising into their daily lives, traditional weight loss methods still have their limitations in terms of the results they can provide. No matter how much time or energy you put into these efforts, you cannot control where you will lose weight from and may still struggle with a stubborn belly even if you’ve hit your target weight.

Additionally, there are some aesthetic concerns that working out and eating right simply cannot address alone. Excess or stretched abdominal skin, for example, can usually not be reversed or tightened without surgical intervention, especially when it is a result of pregnancy or massive weight loss.

Childbearing or significant weight fluctuations can also weaken the abdominal muscles and stretch the inner girdle of connective tissues known as the abdominal fascia, which only further exacerbates the appearance of a protruding belly. If your skin, abdominal wall or fascia have become stretched, tummy tuck surgery is the only way to restore a taut and youthful midsection.

Myth: Tummy tucks are only for women

Tummy tuck surgery was the fourth most popular cosmetic surgery among women in 2018 with 152,446 women undergoing the procedure. Abdominoplasty has been an incredibly popular cosmetic option for women for years, in part due to the many irreversible changes to the midsection that accompany pregnancy and childbirth, such as stretched skin and abdominal muscles.

A tummy tuck is frequently included in “mommy makeover” procedures, which refer to a full suite of cosmetic surgeries performed concurrently to help women restore their pre-baby body and men to regain a leaner physique.

While women did make up for 96.8 percent of the total tummy tucks performed in 2018, men can also benefit from this procedure. Tummy tuck surgery was the fifth most popular cosmetic surgery for men in 2018. While men may not have to worry about the physical changes that women’s bodies endure from pregnancy, they are not necessarily immune from developing a “dad bod.”

Heredity or significant weight loss can leave men with stubborn belly fat or loose skin that leaves them feeling self-conscious of their midsection. Whether you are male or female, tummy tuck surgery will tighten and tone the contours of your abdomen to allow clothes to fit better and restore a fit and youthful stomach you are thrilled to flaunt.

Myth: You’re too old to get a tummy tuck

When it comes to cosmetic surgery, age truly is just a number. While a majority of patients who underwent tummy tuck surgery in 2018 were between the ages of 35 and 50 (56.3 percent), 21 percent were between the ages of 51 and 64 and four percent were over the age of 65.

There is no wrong age to opt for a tummy tuck procedure, however, there are more critical factors that will be considered by your board-certified plastic surgeon when determining your candidacy for the procedure.

To be a good candidate for abdominoplasty, patients must be:

  • Physically healthy: You must be in good overall health before undergoing invasive surgery to prevent complications.
  • A nonsmoker: Smoking can inhibit the healing process or cause serious complications both during and after your tummy tuck surgery. If you do smoke, you will be asked to quit for two months before and after your procedure.
  • Within a stable, healthy weight: Tummy tuck surgery is not intended for significant weight loss or for treating obesity.
  • Realistic with their expectations: While a tummy tuck will dramatically enhance the contours of your midsection with long-lasting results, no cosmetic surgery will stop the aging process or deliver perfection, or fully camouflage a larger core abdominal shape.

Next steps on your tummy tuck journey

When you are ready to schedule your tummy tuck consultation, be sure to choose a board-certified plastic surgeon on the ASPS Plastic Surgeon Match service.

Board-certified plastic surgeons undergo a rigorous training process and are vetted by their peers through both a written and oral board examination process. Each and every ASPS member surgeon is board certified in plastic surgery, making them the most qualified plastic surgeons to perform your procedure.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Frontal Sinus Transillumination in Cranioplasty for Facial Feminization Surgery

Cranioplasty in facial feminization surgery (FFS) contours the frontal bone to achieve an improved feminine appearance of the forehead. The surgery was first described in 1986 by Whitaker et al1 and then in 1987 by Ousterhout.2 Since then, multiple articles have focused on the technique and the clinical outcomes of the surgery specific to FFS.3,4 In general, the frontal bone is approached via a coronal incision to contour frontal bossing and the orbital rims. Variable techniques to address frontal bossing are reported, including using a burr alone, onlay implants, and osteoplastic flap setback. One critical component of frontal cranioplasty is the ability to safely and effectively reduce bony prominence overlying the frontal sinus/absent frontal sinus. Previously, the amount of bone reduction was based on the external appearance with or without imaging. Interestingly, frontal sinus transillumination for estimation of frontal sinus configuration in osteoplastic flap surgery is described in the context of rhinologic disease but not FFS.5,6 Here, we describe the use of frontal sinus transillumination in cranioplasty during FFS (Video 1).

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How better body contouring options give you more choices

better body contouring options give you more choices

There are many people out there who feel they could benefit from some sort of body contouring but are confused about which body contouring option would be best for them. The phrase “body contouring” encompasses a wide variety of cosmetic procedures and treatments.

By using both new and traditional procedures in addition to being able to choose between surgical, minimally invasive and noninvasive body contouring treatments, men and women are able to customize their body contouring to fit their needs.

Narrowing your search

With all the options you have available to enhance your look, it can feel as though the choices are overwhelming. Fortunately, there are five questions you can ask yourself to begin the determination of how to pick body contouring procedures.

  • Are you within 10 pounds of your optimal weight? People who are within a healthy weight range can benefit the most from liposuction or one of the many nonsurgical body contouring procedures. These individuals are considered to be generally fit but have particular areas of stubborn body fat that they wish to remove.
  • Is your body mass index (BMI) 30 or less? A person should have a BMI of about 30 or less in order to be fit enough for most body contouring procedures. If someone’s BMI is over 30, a good idea for them is to concentrate their efforts on diet and exercise before exploring procedure options.
  • Do you have sagging muscles or loose skin? Sagginess is a common cosmetic concern, particularly as people get older, have experienced weight fluctuation throughout their lives or lost a dramatic amount of weight recently. Separation of the abdominal muscles is common during pregnancy and can be addressed with an abdominoplasty. Excess skin and stretched and weakened muscles can be tightened or surgically eliminated.
  • Are you wanting quick results? Liposuction and other surgical body contouring choices can provide results that can be seen in a matter of days or a few weeks. Nonsurgical body contouring procedures often need multiple treatment sessions stretched out over time for the best results.
  • Do you have the time to recover? Surgical choices such as liposuction and tummy tucks need dedicated recovery time in which physical activities are restricted. Nonsurgical treatments can offer less downtime or even no downtime since they do not involve surgical incisions, anesthesia or needles. So, you can get back to your daily activities fairly quickly.

Surgical options for body contouring

There are many surgical and nonsurgical body contouring options to consider. Body contouring can be an excellent option for anyone who is looking to redefine their figure. It’s especially effective for people who have experienced major weight loss. A combination of procedures can help reduce the stubborn fat deposits and tighten up the loose skin and muscles often left behind.

Here are some common surgical procedures that people opt for:

  • Liposuction involves the removal of unwanted stubborn fat pockets to create a slimmer, more streamlined body. This can be performed on practically any area of the body that has excess fat.
  • Abdominoplasty, commonly known as a tummy tuck, involves the toning and tightening of the stomach area. With this procedure, loose skin is removed and stretched and weakened muscles are repaired.
  • A thigh lift and body lift can help the condition of baggy skin surrounding the buttocks and thighs which can be caused by genetics, aging or major weight loss. This is accomplished by getting rid of excess skin and stubborn fat and tightening the underlying musculature.
  • An arm lift can help improve the appearance of loose sagging skin on the upper arms by removing the excess, hanging skin.
  • A Brazilian butt lift can enhance the buttocks, providing a better balance of natural curves. This is achieved by using a person’s own fat cells to augment the buttocks.

Minimally and noninvasive body contouring options

Nonsurgical options can be great for individuals who want to address mild body contouring concerns that may not need extensive treatment from a surgical procedure. They are also a popular choice for people who have busy schedules and can’t take the necessary time to recover after surgery. For instance, a busy mom who wants to achieve some toning and tightening now has nonsurgical options to consider, where 10-15 years ago, a surgical mommy makeover was her only reliable contouring option.

There are many nonsurgical treatments to consider. Some use cold temperatures to kill unwanted fat cells, some use heat. There are also treatments that use ultrasound waves aimed at fat cells under the skin to break down the fat. All of these options then rely on your body’s natural cleansing process to remove the destroyed cells and create a slimmer look in the treated area. Most of these require a 30-90 minute treatment sessions, with several sessions needed for noticeable body slimming. In some cases, nonsurgical treatments can also tone and tighten the skin in the area being treated.

When considering nonsurgical options, it’s important to visit with several board-certified plastic surgeons to see which treatments they offer and find out why they’ve chosen one method over another. See how each one might be able to help your specific cosmetic concern, get pricing and take the time you need to make a good decision for your own goals.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Alopecia Following Deoxycholic Acid Treatment for Submental Adiposity

Alopecia is an increasingly recognized adverse effect of deoxycholic acid treatment. A retrospective review of 66 male patients demonstrated an incidence of alopecia of 15% (8 patients).1 The alopecia was first noticed approximately 4 weeks after injection and in this series, 5 of the 8 patients reported improvement or complete resolution of the alopecia. Review of the literature identified 4 other cases with varying degrees of regrowth observed.24 Herein, we report a case of alopecia following deoxycholic acid treatment.

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Where will your breast implants be placed?

breast implant location

If you are considering breast augmentation there are many questions you will want to have answered by the plastic surgeon before making your final decision.

Among a host of other important questions that you should ask during your breast augmentation consultation is “where the breast implants will be placed?”

Many patients are not aware that there is an option when it comes to the placement of the breast implants. Implants may be placed either over the muscle or under the muscle, and there are several factors which help determine the optimal implant placement for each individual patient, including:

  • Your body type
  • Your current health
  • The actual size (cc’s) of the implants
  • Saline vs silicone implants
  • Your individual goals and desires

Board-certified and experienced plastic surgeons who have performed a high volume of breast augmentation surgeries will be able to direct the best position to determine optimal implant placement, and it is extremely important for breast augmentation patients to understand the pros and cons for the two different placement options.

Subglandular placement

Also known or referred to as “over-the-muscle” placement, the subglandular placement technique is where the implant is positioned between the chest muscle and the existing breast tissue areas. The over the muscle positioning is done so the implant lies below the glands of the breast, thus providing the ability for the patient to breast-feed in the future.

PROS: Patients tend to have less movement of the implants during physical activity, as well as less discomfort immediately following the surgery.

CONS: The appearance can me more artificial. In addition, during mammograms the readings may be less accurate. Also, patients may experience a higher rate of capsular contracture, which occurs when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant.

Submuscular placement

The other option is known as submuscular, or under-the-muscle placement of the breast implant. This technique includes placement of the implant partially under the pectoralis major chest muscle.

PROS: Patients experience more accurate mammograms. In addition, the submuscular placement tends to produce a more natural appearance, and a reduced rate of capsular contracture.

CONS: Some patients experience slightly more discomfort after surgery, with a longer postsurgical recovery.

The role of the chest muscle

The muscles in the chest play an important role in breast augmentation procedures with regards to optimal placement of the implants. Each individual patient will vary in the amount of muscle they have and this could be a factor in determining whether subglandular or submuscular placement is best.

The anatomy of each patient must be factored in. For example, women who have very large or strong chest muscles will be best suited for over-the-muscle positioning of the implants. One reason for this is with larger chest muscles there will be a tendency for distortion of the breasts as the chest muscles move and are flexed. In these cases, subglandular placement is advised.

How much breast tissue is present

In addition to the muscle density and mass, the amount of tissue in the breast area before surgery will also have an impact on where the placement should be for optimal postsurgical results. When there is a significant amount of breast tissue, there will be adequate soft tissue coverage making the pectoralis muscle superfluous in this regard.

As you move through the process of selecting your breast surgeon, and during your consultation about the procedure, you will want to discuss the placement of the breast implants, going over which option – over the muscle or under – will be best for you.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Masseteric Nerve Transfer and Selective Neurectomy for Rehabilitation of the Synkinetic Smile

Key Points

Question  Is masseteric-to-facial nerve transfer combined with selective neurectomy associated with improved synkinetic smile?

Findings  In this case series, 7 patients underwent masseter-to-facial nerve transfer with selective neurectomy for synkinesis. Patients experienced a statistically significant improvement in multiple eFACE domains including smile, dynamic function, synkinesis, midface and smile function, and lower face and neck function at 1-year mean follow-up.

Meaning  Masseteric-to-facial nerve transfer with selective neurectomy may provide significant smile improvement with a long-term decrease in synkinesis for patients.

Importance  Synkinesis is the involuntary movement of 1 area of the face accompanying volitional movement of another; it is commonly encountered in patients affected by facial palsy. Current treatments for synkinesis include biofeedback for muscular retraining and chemodenervation via the injection of botulinum toxin. Chemodenervation is effective in reducing unwanted muscle movement, but it requires a commitment to long-term maintenance injections and may lose effectiveness over time. A permanent solution for synkinesis remains elusive.

Objective  To evaluate masseteric-to-facial nerve transfer with selective neurectomy in rehabilitation of the synkinetic smile.

Design, Setting, and Participants  In this case series, 7 patients at a tertiary care teaching hospital underwent masseteric-to-facial nerve transfer with selective neurectomy for synkinesis between September 14, 2015, and April 19, 2018. The medical records of these patients were retrospectively reviewed and demographic characteristics, facial palsy causes, other interventions used, and changes in eFACE scores were identified.

Intervention  Masseteric-to-facial nerve transfer.

Main Outcomes and Measures  Changes in eFACE scores (calculated via numeric scoring of many sections of the face, including flaccidity, normal tone, and hypertonicity; higher scores indicate better function and lower scores indicate poorer function) and House-Brackmann Facial Nerve Grading System scores (range, 1-6; a score of 1 indicates normal facial function on the affected side, and a score of 6 indicates absence of any facial function [complete flaccid palsy] on the affected side).

Results  Among the 7 patients in the study (6 women and 1 man; median age, 49 years [range, 41-63 years]), there were no postoperative complications; patients were followed up for a mean of 12.8 months after surgery (range, 11.0-24.5 months). Patients experienced a significant improvement in mean (SD) eFACE scores in multiple domains, including smile (preoperative, 65.00 [8.64]; postoperative, 76.43 [7.79]; P = .01), dynamic function (preoperative, 62.57 [15.37]; and postoperative, 75.71 [8.48]; P = .03), synkinesis (preoperative, 52.70 [4.96]; and postoperative, 82.00 [6.93]; P < .001), midface and smile function (preoperative, 60.71 [13.52]; and postoperative, 78.86 [14.70]; P = .02), and lower face and neck function (preoperative, 51.14 [16.39]; and postoperative, 66.43 [20.82]; P = .046). Preoperative House-Brackmann Facial Nerve Grading System scores ranged from 3 to 4, and postoperative scores ranged from 2 to 3; this change was not significant.

Conclusion and Relevance  This study describes the application of masseteric-to-facial nerve transfer with selective neurectomy for smile rehabilitation in patients with synkinesis, with statistically significant improvement in smile symmetry and lower facial synkinesis as measured with the eFACE tool. This technique may allow for long-term improvement of synkinesis and smile. This study is only preliminary, and a larger cohort will permit more accurate assessment of this therapeutic modality.

Level of Evidence  4.

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What type of tummy tuck is right for you?

tummy tuck types

Are you feeling discouraged because exercising isn’t giving you the results you desire? Do you still have a tummy pooch despite eating well? Do you wish your tummy was trim, toned and tight?

It can be difficult to regain your body’s shape after significant changes in your figure (such as pregnancy or major weight loss), and even a healthy lifestyle may not be able to restore your slender midsection. Even if you have lost belly fat, you may still be experiencing a decrease in skin elasticity, which can cause your skin to sag.

A tummy tuck can be an effective solution when your best efforts have not yielded any results in regards to the appearance of your midsection. With multiple procedure options, a tummy tuck can tighten your sagging skin and help you regain subtle tummy contours.

How does a tummy tuck help?

During your tummy tuck surgery consultation, your plastic surgeon will examine the condition of your skin and tissue to determine which of the following types of tummy tuck is best suited for your needs.

Mini tummy tuck

A mini tummy tuck focuses on the area of the tummy that lies below the navel. Your plastic surgeon will make a single incision at the bikini line that is easily concealed under a swimsuit. He will stretch the skin downward as he smooths and adjusts the skin. If you are also in need of muscle tightening to correct a slight pooch, this type of tummy tuck would be appropriate. Women who are wanting to correct the physical changes after pregnancy are ideal candidates for a mini tummy tuck.

Full tummy tuck

This is the most common type of tummy tuck procedure since it focuses on the entire midsection. Your surgeon will make two incisions – one will be located in the lower abdomen and the second is made around the navel. Though scarring is more obvious with this procedure, these incision sites allow your surgeon to remove sagging skin from both the upper and lower abdomen. He will also tighten the abdominal muscles necessary to give you a more toned midsection. Many patients benefit from this type of tummy tuck, including women who are post-pregnancy, have experienced major weight loss and are unhappy with how their bodies have changed due to genetics or aging.

Extended tummy tuck

An extended tummy tuck is most commonly performed for patients who need removal of significant amounts of skin. This typically occurs after a massive weight loss. Your surgeon will make a single incision; it will wrap around the abdomen to reach the hips. Such a large incision allows him to tighten the skin evenly down across the tummy. It can leave a larger scar than the other procedures that may be hard to hide under intimate clothing.

BodyTite™

BodyTite™ is a radiofrequency-assisted liposuction (RFAL) procedure that uses cutting-edge technology to help eliminate stubborn fat for a smoother, slimmer physique. During this procedure, a thin tube, also known as a cannula, is inserted under the skin while an electrode is placed on the outer surface. The radiofrequency waves from the electrode melt the fat, making it easier to remove. These waves heat the skin, which stimulates the production of collagen to tighten the skin. This procedure is used in conjunction with liposuction.

Starting your tummy tuck journey

If you think that tummy tuck surgery might be right for you and your aesthetic goals, be sure to meet with a board-certified plastic surgeon for a consultation. You can use the ASPS Plastic Surgeon Match referral service to find ASPS member surgeons in your area.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Assessing Nasal Soft-Tissue Envelope Thickness for Rhinoplasty

Key Points

Question  How does nasal soft-tissue envelope (STE) thickness vary in our patient population, and can facial plastic surgery clinicians predict nasal STE thickness based on visual examination of the nose?

Findings  This study of 190 patients found that the STE is thickest at the sellion, thinnest at the rhinion, thickened over the supratip and nasal tip, and thinned over the columella; thickness followed a near-normal distribution for each measured subsite, with the majority of patients in a medium thickness range. The 4 study experts accurately predicted nasal STE thickness from clinical photographs, with the highest accuracy at the nasal tip.

Meaning  Experts can accurately predict nasal STE thickness based on visual examination of the nose, which has implications for surgical planning in rhinoplasty.

Importance  Preoperative assessment of nasal soft-tissue envelope (STE) thickness is an important component of rhinoplasty that presently lacks validated tools.

Objective  To measure and assess the distribution of nasal STE thickness in a large patient population and to determine if facial plastic surgery clinicians can predict nasal STE thickness based on visual examination of the nose.

Design, Setting, and Participants  This retrospective review and prospective assessment of 190 adult patients by 4 expert raters was conducted at an academic tertiary referral center. The patients had high-resolution maxillofacial computed tomography (CT) scans and standardized facial photographs on file and did not have a history of nasal fracture, septal perforation, rhinoplasty, or other surgery or medical conditions altering nasal form. Data were analyzed in March 2019.

Main Outcomes and Measures  Measure nasal STE thickness at defined anatomic subsites using high-resolution CT scans. Measure expert-predicted nasal STE thickness based on visual examination of the nose using a scale from 0 (thinnest) to 100 (thickest).

Results  Of the 190 patients, 78 were women and the mean (SD) age was 45 (17) years. The nasal STE was thickest at the sellion (mean [SD]) (6.7 [1.7] mm), thinnest at the rhinion (2.1 [0.7] mm), thickened over the supratip (4.8 [1.0] mm) and nasal tip (3.1 [0.6] mm), and thinned over the columella (2.6 [0.4] mm). In the study population, nasal STE thickness followed a nearly normal distribution for each measured subsite, with the majority of patients in a medium thickness range. Comparison of predicted and actual nasal STE thickness showed that experts could accurately predict nasal STE thickness, with the highest accuracy at the nasal tip (r, 0.73; prediction accuracy, 91%). A strong positive correlation was noted among the experts’ STE estimates (r, 0.83-0.89), suggesting a high level of agreement between individual raters.

Conclusions and Relevance  There is variable thickness of the nasal STE, which influences the external nasal contour and rhinoplasty outcomes. With visual analysis of the nose, experts can agree on and predict nasal STE thickness, with the highest accuracy at the nasal tip. These data can aid in preoperative planning for rhinoplasty, allowing implementation of preoperative, intraoperative, and postoperative strategies to optimize the nasal STE, which may ultimately improve patient outcomes and satisfaction.

Level of Evidence  NA.

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Effect of Vibratory Anesthetic Device on Pain Anticipation and Perception During Dermatologic Surgery

Key Points

Question  Do patients who catastrophize pain, defined as patients who anticipate higher pain levels on the 11-point Numeric Rating Scale (score >4), receive equal benefit from a vibratory stimulus during local anesthetic injection as patient who do not catastrophize pain (Numeric Rating Scale score ≤4)?

Findings  In this randomized clinical trial of 87 patients who experienced 101 unique events, patients who catastrophized pain reported significantly higher Numeric Rating Scale scores during local anesthetic injection than patients who did not. The addition of vibration resulted in a 25.5% reduction of Numeric Rating Scale scores during local anesthetic injection in patients who catastrophized pain and a 79.4% reduction in patients who did not catastrophize pain.

Meaning  Patients who catastrophize pain can be identified in the clinical setting with assessment of anticipation of pain levels (Numeric Rating Scale score >4), and these patients benefit from the addition of vibration during local anesthetic injection.

Importance  Vibration has been shown to decrease injection site pain in patients; however, to date, this effect has not been assessed for patients who catastrophize pain (ie, patients who anticipate a higher pain level). The anticipation of a pain score greater than 4 on the 11-point Numeric Rating Scale (NRS) has been associated with an increase in a patient’s perception of procedural pain.

Objective  To assess the efficacy of vibration during cutaneous anesthetic injection for dermatologic surgery for patients who catastrophize pain (NRS score >4) and patients who do not (NRS score ≤4).

Design, Setting, and Participants  Randomized, parallel-group clinical trial from June 19 to September 4, 2018, at a tertiary dermatologic surgery clinic among 87 adults undergoing cutaneous cancer removal surgery. Patients completed a preprocedural questionnaire detailing their baseline pain, anticipated pain, and drug use. Analysis was performed on an intent-to-treat basis.

Interventions  Use of a vibratory anesthetic device (VAD) on the treatment site prior to anesthetic injection in the on (VAD ON) or off (VAD OFF) mode.

Main Outcomes and Measures  Pain was reported using the 11-point NRS (where 0 indicates no pain and 11 indicates the worst pain imaginable). A minimum clinically important difference of 22% or more and a substantial clinically important difference of 57% or more were used to assess the efficacy of vibration in patient-reported NRS score during anesthetic injection (iNRS score).

Results  A total of 87 patients were included, with 101 unique events reported (among the unique events, 37 were reported in women and 64 were reported in men; mean [SD] age, 66.0 [11.3] years). The mean (confidence level [CL]) iNRS score for patients who catastrophized pain was 2.27 (0.66) compared with 1.44 (0.39) for patients who did not (P = .03). A 38.9% decrease in mean (CL) iNRS score was reported with VAD ON compared with VAD OFF in all participants (1.24 [0.38] vs 2.04 [0.54]). Patients who catastrophized pain reported a 25.5% decrease in mean (CL) iNRS score with VAD ON vs VAD OFF (1.91 [0.99] vs 2.57 [0.98]), and patients who did not reported a 79.4% decrease (1.02 [0.40] vs 1.84 [0.66]). VAD ON was the only statistically significant variable to affect iNRS score (F statistic, 2.741; P = .03).

Conclusions and Relevance  This trial demonstrates that those who catastrophize pain prior to a procedure report a higher perceived level of pain. The application of vibration during local anesthetic injection resulted in a minimum clinically important difference in pain level for patients who catastrophize pain and a substantial clinically important difference in pain level for patients who do not.

Level of Evidence  2.

Trial Registration  ClinicalTrials.gov identifier: NCT03467685

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Association Between Pain and Patient Satisfaction After Rhinoplasty

Key Points

Question  In rhinoplasty surgery is there an association between postoperative pain and perception of surgical success?

Findings  In this prospective case series survey study of 104 patients who underwent cosmetic and/or functional rhinoplasty, a statistically significant negative association was found between perception of pain and perception of outcome (breathing improvement) in purely functional rhinoplasty. In contrast, among patients who underwent rhinoplasty with simultaneous cosmetic changes, no association between pain and perception of surgical success was found.

Meaning  This prospective study highlights important results that may help guide preoperative rhinoplasty counseling because patients who are interested in purely functional improvement (without cosmetic change) may warrant additional pain-specific counseling to optimize patient satisfaction.

Importance  In light of the current opioid crisis, there exists a demonstrated need to balance adequate postrhinoplasty pain control with measured use of narcotics. If pain is inadequately controlled, patients may be unsatisfied with their elective surgical experience.

Objectives  To characterize the association between patient-reported pain outcomes, objective opioid use, and perception of surgical success.

Design, Setting, and Participants  A case series survey study was conducted from July 2018 to January 2019. Consecutive patients who underwent cosmetic and/or functional rhinoplasty by 2 facial plastic surgeons (D.A.S. and L.N.L.) at an academic medical center were surveyed 1 month after surgery.

Main Outcomes and Measures  The number of oxycodone tablets taken, patient-reported pain outcomes, number of narcotic prescription refills, and patient-reported functional and cosmetic outcomes were recorded. Perception of pain, surgical outcome, and oxycodone intake were also evaluated by sex. Demographic information and perception of surgical results were recorded. Statistical analysis was performed using STATA statistical software (version 12.0, STATA Corp). Spearman rank order correlation was used for ordinal, monotonic variables with P < .05 being considered statistically significant.

Results  Overall, 104 patients were surveyed; 6 were lost to follow-up. Of the participants included, 50 were women with a mean (SD) age of 38 (16.0) years and 48 were men with a mean (SD) age of 38 (16.7) years. Although patients were prescribed a range of 10 to 40 tablets of oxycodone, patients took a mean (SD) of 5.2 tablets (range, 0-23). There were no significant sex differences in perception of pain, perception of outcome, or narcotic use. Among patients undergoing purely functional rhinoplasty, a statistically significant negative association between perception of pain and perception of functional outcome (breathing improvement) was evident. Patients who experienced less pain than they expected had a greater perception of functional improvement (rs = −0.62, P = .001). In contrast, among patients who underwent rhinoplasty with cosmetic improvement, no association was found between pain and perception of surgical outcome (rs = 0.05, P = .64).

Conclusions and Relevance  To our knowledge, this is the first study to prospectively evaluate the association between opioid use, patient-reported pain, and perceived surgical success. These data may help guide preoperative counseling because patients who are interested purely in breathing improvement (without cosmetic change) may warrant additional pain-specific counseling to optimize patient satisfaction.

Level of Evidence  3.

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