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hen reporting penile dimensions, outcomes, and patient satisfaction. Despite the reportedly high satisfaction rates, patients should be counseled regarding high complication rates. Best-practice guidelines will be critical to achieve safe and reliable outcomes.<br />Microbotulinum refers to the systematic injection of tiny blebs of diluted botulinum toxin at repeated intervals into the skin. This targets the superficial fibers of the facial muscles, and weakens their insertion into the undersurface of the skin, which is responsible for the fine lines and wrinkles on the face. The authors present a pilot study based on quantitative evaluation, by means of a skin-scanning technology, of the aesthetic improvement of skin texture, microroughness, and enlarged pore size in a patient group treated with microbotulinum injections for cosmetic purposes.<br />The treatment was performed using a 32-gauge needle to deliver injections on a regular 1-cm grid from the forehead to the cheek and down to the jawline.<br />Sixty of the 62 patients completed the study. All analyzed parameters improved significantly (p &lt; 0.0001) at 90 days with respect to the pretreatment time point (skin texture, -1.93 ± 0.51; microroughness, -2.48 ± 0.79; and pore diameter, 2.1 ± 0.43). Best results have been obtained in patients aged between 42.7 and 46.8 years, and standard deviation calculation allows us to recommend it in patients aged between 36.5 and 53 years.<br />The results of this pilot study suggest that intradermal botulinum toxin injection, or so-called microbotulinum, is a safe and effective method to treat skin flaws. Because of the high satisfaction rate among both physicians and patients, further studies are indeed mandatory to determine the optimal number of units needed for a longer and lasting effect with this particular novel dilution.<br />Therapeutic, IV.<br />Therapeutic, IV.The umbilicus offers no functional importance to the adult human but remains a key aesthetic landmark of the anterior abdominal wall, and its absence can be a cause for concern in aesthetic and reconstructive patients. Umbilical reconstruction or transposition for abdominoplasty and abdominally based flap operations is frequently complicated by umbilical death, infections, development of wounds needing prolonged wound care, and generally poor aesthetic outcomes. A multitude of techniques have been described to create the "ideal" neoumbilicus, but none has proven to be superior to the technique that comes before it. [https://www.selleckchem.com/products/Gefitinib.html Selleck Gefitinib] Our data demonstrate that, in a select set of patients, it may be beneficial to electively remove the umbilicus. Thus, umbilical reconstruction can be performed as an adjunct procedure to the primary operation with a superior aesthetic result and minimal risk for complications. This article describes the authors' approach to delayed neoumbilical reconstruction in patients undergoing elective umbilical resection.<br />Breast implant removal is becoming a common procedure in light of the current events and controversies with silicone breast implants. The authors believe strongly in informing patients about the indications and options regarding both explantation and the management of the secondary breast deformity.<br />Relevant literature regarding the management of the explant patient was reviewed and organized to provide an update on prior publications addressing the explant patient population.<br />Surgical management options after implant removal include breast contouring and volume restoration. Fat augmentation has been used in both aesthetic and reconstructive breast surgery.<br />The authors review the surgical management for explantation, breast contouring, and autologous fat grafting for volume restoration. In the explant patient, autologous fat grafting serves as a reliable option for volume restoration.<br />The authors review the surgical management for explantation, breast contouring, and autologous fat grafting for volume restoration. In the explant patient, autologous fat grafting serves as a reliable option for volume restoration.<br />There is ongoing debate regarding the optimal timing of contralateral prophylactic mastectomy fueled by concern that performing it at the time of the mastectomy for the index breast cancer may delay adjuvant therapy. The study objective was to examine the effect of simultaneous contralateral prophylactic mastectomy with immediate breast reconstruction on the complication rate and adjuvant therapy timing.<br />A retrospective study was conducted of consecutive patients who underwent contralateral prophylactic mastectomy with immediate breast reconstruction and received adjuvant therapy over a 6-year period. Demographic, treatment, and outcomes data were collected, and relationships between multiple variables and outcomes were evaluated.<br />Of 241 patients (482 breasts) included, 186 (372 breasts) underwent simultaneous index breast mastectomy and contralateral prophylactic mastectomy with immediate breast reconstruction followed by adjuvant therapy (immediate group), and 55 (110 breasts) underwent index mastectopect to the risks and benefits.<br />Therapeutic, III.<br />Therapeutic, III.The aim was to evaluate the performance of 2-dimensional (2D) shear-wave elastography from general electric (2D SWE-GE), implemented on the new LOGIQ S8 system, for the noninvasive assessment of liver fibrosis, and to identify liver stiffness (LS) cutoff values for predicting different stages of fibrosis using transient elastography (TE) as the control method. We included 179 consecutive subjects, with or without chronic hepatopathies, in whom LS was evaluated in the same session using 2 elastographic techniques TE (FibroScan, EchoSens) and 2D SWE-GE (LOGIQ S8; GE Healthcare, Chalfont St Giles, United Kingdom). Reliable LS measurements were defined for TE the median value of 10 measurements with a success rate of 60% or greater and an interquartile range/median ratio (IQR/M) less then 0.30; for 2D SWE-GE the median value of 10 measurements acquired in a homogenous area and IQR/M less then 0.30. To discriminate between fibrosis stages by TE, we used the following cutoffs F2-7; F3-9.5 and F4-12 kPa. Reliable LS measurements were obtained in 97.