Researcher: Yavuzer, Cahit Reha
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Publication Metadata only The quantitative effect of botulinum toxin a over brow height(Lippincott Williams & Wilkins, 2013) Uygur, Şafak; Eryılmaz, Tolga; Bulam, Hakan; Latifoğlu, Osman; Yavuzer, Cahit Reha; Other; School of Medicine; N/AN/APublication Metadata only A practical method for accurate coordination between the plastic surgeon and the pathologist: the clockwork technique(Korean Soc Plastic & Reconstructive Surgery, 2018) N/A; N/A; N/A; N/A; N/A; N/A; N/A; Sezgin, Billur; Kapucu, İrem; Yenidünya, Bahar Güliz; Bulutay, Pınar; Armutlu, Ayşe; Özmen, Selahattin; Yavuzer, Cahit Reha; Faculty Member; Researcher; Undergraduate Student; Teaching Faculty; Teaching Faculty; Faculty Member; Other; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 133762; 327602; N/A; N/A; 133565; 133567; 125951; N/ACooperation between the surgeon and the pathologist is essential for the correct diagnosis and treatment of skin tumors [1]. Precise communication between these two specialties allows for the precise evaluation of the tumor borders by the pathologist, which in turn reduces the amount of unnecessary tissue removed, thereby improving functional preservation and the aesthetic outcomes of surgery. Although not every skin tumor excision requires a high level of interdisciplinary interaction, the location and the type of tumor are key elements that can make such a collaboration necessary. This is especially true for tumors located near critical facial aesthetic subunits such as the eyelids, nostrils, and mouth, and for locally aggressive tumors that spread in unpredictable patterns. Mohs micrographic surgery (MMS) is an alternative to conventional surgery in such cases, and allows tissue preservation to be maximized without compromising adequate surgical excision of the tumor [2]. MMS remains an effective, yet not commonly accessible option, as it can only be performed by pathologically trained surgeons. Nevertheless, regardless of the surgical method, establishing the orientation of the specimen is always critical, and accuracy in this regard can be achieved by various techniques, such as using sutures in different lengths or color codes for each side. Surgeons may use hand-drawn pictures, printed maps of the areas in question, and photographs to guide the patholoCOMMUNICATION A practical method for accurate coordination between the plastic surgeon and the pathologist: The clockwork technique Billur Sezgin1 , Irem Kapucu1 , Guliz Yenidunya1 , Pinar Bulutay2 , Ayse Armutlu2 , Selahattin Ozmen1 , Reha Yavuzer1 Departments of 1 Plastic, Reconstructive, and Aesthetic Surgery and 2 Pathology, Koc University School of Medicine, Istanbul, Turkey Correspondence: Billur Sezgin Department of Plastic, Reconstructive, and Aesthetic Surgery, Koç University Hospital, Maltepe Mh., Davutpasa cad. No 4, Topkapı, 34010 Zeytinburnu, Istanbul, Turkey Tel: +90-850-250-8250–20201, Fax: +90-0442-232-5300, E-mail: bsezgin@ku.edu.tr This article was presented as a poster at the 38th Congress of the Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons on 27–30 October, 2016 in Antalya,Turkey. gist. Tissue nicks or poly-angulated drawings can also be used to improve the orientation [3]. These markings are especially useful when determining the need for re-excision; thus, precision is key for minimizing further tissue loss while obtaining tumor-free margins. We present an easily applicable technique that has been developed to increase the precision of surgical margin evaluation in various skin tumors. The ‘clockwork technique’ uses a clock face template for the orientation of the specimen. This method ensures accurate coordination between the surgeon excising the tumor and the pathologist who guides the surgeon in re-excision until tumor-free margins are achieved. The first step is to determine the type of the lesion via biopsies if necessary, as the safety margin will be adjusted according to the characteristics of the primary tumor. Lesions involving facial subunits may be an exception, as the required margin may not be planned accordingly in certain critical locations. The second step is to outline the approximate borders of the visually apparent tumor and to draw a safety margin that will serve as the clock face for the orientation of the specimen. Then, the periphery of the circle is numbered through 12 as in a clock (Fig. 1). The hourly markings go through both the excised specimen and the healthy tissue, so that the surgeon knows which part of the excised tissue corresponds to which ‘hour.’ The lesion is excised as a complete circle and a single suture is placed at a pre-determined hourly interval as a guide if the marking is disrupted. After microscopic examination, the pathologist can state which hour slice corresponds to a tumor-positive margin, and further excision can be carried out only in the area of that hour slice. Plastic surgeons need to work very meticulously alongside pathologists, as every millimeter of skin preserved can be used to achieve better aesthetic and functional outcomes. The clockwork technique can be applied to any type and size of lesion. It is also beneficial for tumors that have unpredictable growth patterns, where it is not possible to agree on a standard optimal safety margin, such as dermatofibrosarcoma protuberans. Moreover, in areas where aesthetic and functional preservation are concerns, it helps to preserve more healthy tissue, as further re-excision can be carried out in only onetwelfth of the excisional border. In conclusion, this technique is advantageous because it is an easily applicable and fast method that facilitates optimal communication between the surgeon and pathologist regarding specimen borders, allowing precise re-excisions that can be limited to intervals corresponding to one-twelfth of the surgical margin.Publication Metadata only The efficacy of vibration anesthesia on reducing pain levels during lip augmentation: worth the buzz?(Oxford Univ Press Inc, 2017) Güney, Kırdar; N/A; N/A; Sezgin, Billur; Yavuzer, Cahit Reha; Faculty Member; Other; School of Medicine; School of Medicine; 133762; N/ABackground: Lip augmentation procedures have increased drastically in the last years as patients seek to enhance the shape and size of their lips with dermal fillers. One of the main concerns faced with these procedures is the pain inflicted through injections. On the other hand, many different techniques have been introduced for the reduction of pain while performing office-based minimal invasive procedures. Objectives: This study aims to determine the analgesic effect of vibration anesthesia during lip augmentation procedures and to evaluate its overall effect on the comfort of patients. Methods: A split-lip study was designed in a randomized fashion for 25 lip augmentation patients who received hyaluronic acid fillers with or without with a concurrent vibration stimulus on either half of their lips. Patients were asked to score the pain that they felt during lip injections on a scale from 0 to 10 (0 being no pain and 10 being the worst pain ever felt) for either lip half. The pain scores were then analyzed for significance. Results: The overall pain score on the vibration-assisted side was 3.82 +/- 1.73 while the pain score for the side with no vibration was 5.6 +/- 1.76 (P < 0.001). Twenty-three patients (92%) felt less pain with the addition of vibration while, interestingly, 2 patients (8%) stated that they felt an increase in pain levels on the vibration-treated side. Conclusions: Vibration devices can be a safe and effective tool for lowering pain levels in patients undergoing lip augmentation with hyaluronic acid fillers.Publication Metadata only Defining a new variable that may impact long-term postoperative nasal tip support the biomechanical properties of the columellar strut graft(Lippincott Williams and Wilkins (LWW), 2019) Layegh, Ehsan; N/A; N/A; Department of Mechanical Engineering; N/A; N/A; N/A; N/A; Sezgin, Billur; Güney, Kırdar; Lazoğlu, İsmail; Tatar, Sedat; Özel, Melis; Özmen, Selahattin; Yavuzer, Cahit Reha; Faculty Member; Doctor; Faculty Member; N/A; Undergraduate Student; Faculty Member; Other; Department of Mechanical Engineering; School of Medicine; N/A; College of Engineering; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 133762; N/A; 179391; N/A; N/A; 125951; N/ABackground: Although columellar strut grafts (CSGs) are considered among the fundamental steps for providing nasal tip support, a downward rotation of the nasal tip in patients with strut grafts can still be encountered. Patient-related factors such as nasal skin thickness can allow the plastic surgeon to anticipate certain drawbacks that can be encountered in the healing phase, but patient-based differences of nasal cartilage and the resulting impact have yet to be investigated. The purpose of this study was to evaluate the effect of the biomechanical properties of CSGs on late postoperative nasal tip position and support. Methods: The study was undertaken with the participation of 20 patients undergoing closed-technique primary rhinoplasty with CSGs. Each cartilage specimen was biomechanically analyzed to calculate the modulus of elasticity. Preoperative and postoperative images were obtained to determine nasal tip position and rotation with quantitative measurements. Postoperative 3- and 12-month measurements were evaluated according to their relationship with the elasticity modulus of the utilized cartilages. Results The evaluation demonstrated that the elasticity modulus can impact the long-term support of the nasolabial angle in which an increase in the coefficient of elasticity can result in a decrease in long-term nasal tip support. Conclusion: The results of the study reveal a new objective variable that can impact nasal tip dynamics and patient-related differences following rhinoplasty. This study not only brings forth a different perspective in the evaluation of nasal tip dynamics but can also provide data for determining ideal values for cartilage prefabrication.Publication Metadata only Aesthetically thriving through coronavirus disease 2019 (COVID-19): an evaluation of patient motivation and perception on aesthetic surgery and minimally invasive procedures(Thieme Medical Publ Inc, 2021) N/A; N/A; N/A; N/A; N/A; Sezgin, Billur; Tatar, Sedat; Kara, Başak Selin; Özmen, Selahattin; Yavuzer, Cahit Reha; Faculty Member; Faculty Member; N/A; Faculty Member; Other; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 133762; N/A; N/A; 125951; N/AAlthough the cancellation of elective procedures due to the COVID-19 outbreak has been a vital precaution, it has resulted in the suspension of aesthetic procedures and surgeries worldwide. Consequently, this postponement and other factors might have a negative impact on patients planning to undergo aesthetic procedures. Understanding the changes in patient motivation and perception in comparison to the prepandemic period is imperative for proper adjustment of plastic surgery clinics. A prospective questionnaire study was conducted on patients with cancelled aesthetic surgeries or procedures to determine the effects that coronavirus disease 2019 (COVID-19) had on patient motivation regarding cosmetic surgery and procedures and to establish a relationship between patient characteristics and the overall effect of pandemia on the perception of cosmetic surgery. Although most patients felt angry or frustrated due to the cancellation of their surgeries or procedures, the majority accepted that it was a necessary precaution. Patients with a history of previous minimally invasive procedures had a significantly higher ratio of acceptance for cancellations, whereas single patients were more likely to want to have their treatments done if the decision were left up to them. A subset of patients considered undergoing additional cosmetic procedures in the setting of self-isolation, and all patients stated that they would reschedule once the pandemia was under control. Patients with established motivation for plastic surgery and minimally invasive procedures ultimately plan to resume their normal treatments alongside others after the pandemia subsides. Plastic surgeons must actively communicate with their patient population during this time to properly educate, embrace, and direct them under scientific guidelines.Publication Metadata only The quantitative effect of botulinum toxin a over brow height(Lippincott Williams and Wilkins, 2013) Uygur, Halil Şafak; Bulam, Hakan; Yavuzer, Cahit Reha; Doctor; N/A; Doctor; Other; N/A; N/A; N/A; N/A; School of Medicine; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/AIntroduction: Botulinum toxin type A (BTX-A) is currently used in temporal brow lifting. Reducing the activity of the superolateral portion of orbicularis oculi muscle causes lateral brow elevation. The objective of this study was to determine the quantitative brow elevation after paralysis of the superolateral portion of orbicularis oculi muscle. Material and Methods: This study includes 10 female patients. Six units of BTX-A were injected into the superolateral portion of the orbicularis oculi in a serial manner into 3 points, below the lateral half of the brow at each side. Bilateral measurements were obtained by using calipers, immediately before and 2 weeks after the treatment. The medial canthus to the medial brow margin (AB), the lateral brow margin to the lateral canthus (CD), the medial brow margin to the lateral brow margin (BC), the brow apex to upper lid margin at the level of the lateral limbus (EF), the brow apex to the medial brow margin (EB), the brow apex to the lateral brow margin (EC), and upper eyelid margin to lower eyelid margin at the level of the pupil (GH), were measured. Results: There were no statistically significant differences found between pretreatment and posttreatment left and right measurements. There were statistically significant increases in CD, EF, and GH measurements, which are point out brow elevation. There were no statistically significant differences found in other measurements. Conclusions: Same doses of BTX-A application did not disrupt symmetry. Applications of 6U BTX-A to the superolateral portion of orbicularis oculi provide brow elevation and increased interpalbebral distance and upper eyelid distance. Our study has confirmed that BTX-A treatment of superolateral portion of the orbicularis oculi muscle produces quantitative temporal brow elevation.Publication Metadata only Management of cranial bone defects: a reconstructive algorithm according to defect size(Lippincott Williams & Wilkins, 2013) Uygur, Şafak; Eryılmaz, Tolga; Çukurluoğlu, Onur; Özmen, Selahattin; Yavuzer, Cahit Reha; Other; School of Medicine; N/AIntroduction: Reconstruction of cranial bone defects is one of the most challenging problems in reconstructive surgery. The timing of reconstruction, the location of the defect, the materials to be used, and the medical history of the patient are parameters that have been mostly discussed in the literature. To the best of our knowledge, there has not been any published classification for the cranial bone defect reconstruction according to defect size. Materials and Methods: Twelve patients underwent reconstruction of cranial vault defects. Cranial bone defects were classified into 3 groups according to the size of the defect. The small-sized group included the defects smaller than 25 cm(2), the medium-sized group included the defects between 25 to 200 cm(2), and the large-sized group included the defects larger than 200 cm(2). The small-sized defects were reconstructed with split calvarial graft, demineralized bone matrix, or hydroxyapatite cement; the medium-sized defects were reconstructed with split calvarial graft or allogenic bone graft; and the large-sized defects were reconstructed with methyl methacrylate, autoclaved bone, or porous polyethylene. Results: Two patients needed revision for irregularities with demineralized bone matrix. Other patients had no skull defects or irregularities for which revision was suggested. Conclusions: We believe that the size of the defect is important for the reconstruction of cranial vault defects and that using a standard algorithm can increase the success rate.Publication Open Access Response to "Clarification needed for case presented in 'the excision of the buccal fat pad for cheek refinement: volumetric considerations'"(Oxford University Press (OUP), 2019) N/A; N/A; Sezgin, Billur; Tatar, Sedat; Böge, Medine; Özmen, Selahattin; Yavuzer, Cahit Reha; Faculty Member; Faculty Member; School of MedicinePublication Open Access Safety guidelines for nonsurgical facial procedures during COVID-19 outbreak(Wiley, 2020) Bertossi, Dario; Mohsahebi, Ash; Philipp-Dormston, Wolfgang G.; Heidenrich, Izolda; Pirayesh, Ali; D'Souza, Alwyn; Saleh, Hesham; Fakih, Nabil; Vent, Julia; Rahman, Eqram; Kapoor, Krishan Mohan; Yavuzer, Cahit Reha; Other; School of MedicineBackground: the novel coronavirus (COVID-19) pandemic is expected to last for an extended time, making strict safety precautions for office procedures unavoidable. The lockdown is going to be lifted in many areas, and strict guidelines detailing the infection control measures for aesthetic clinics are going to be of particular importance. Methods: a virtual meeting was conducted with the members (n = 12) of the European Academy of Facial Plastic Surgery Focus Group to outline the safety protocol for the nonsurgical facial aesthetic procedures for aesthetic practices in order to protect the clinic staff and the patients from SARS-CoV-2 infection. The data analysis was undertaken by thematic and iterative approach. Results: consensus guidelines for nonsurgical facial aesthetic procedures based on current knowledge are provided for three levels: precautions before visiting the clinic, precautions during the clinic visit, and precautions after the clinic visit. Conclusions: sound infection control measures are mandatory for nonsurgical aesthetic practices all around the world. These may vary from country to country, but this logical approach can be customized according to the respective country laws and guidelines.Publication Open Access The excision of the buccal fat pad for cheek refinement: volumetric considerations(Oxford University Press (OUP), 2019) N/A; Sezgin, Billur; Tatar, Sedat; Böge, Medine; Özmen, Selahattin; Yavuzer, Cahit Reha; Faculty Member; Faculty Member; School of MedicineBackground: although the excision of the buccal fat pad has become very popular for achieving a slimmer midface, not all patients are good candidates for this procedure. Unfortunately, studies that provide guidelines by emphasizing volumetric and technical details are limited. Objectives: the study compared preoperative and postoperative volumetric data to identify the amount of tissue that can safely be removed and important technical concepts involved in lower cheek contouring with buccal fat pad excision. Methods: patients complaining of cheek fullness were evaluated to determine if they were good candidates for the procedure. Eligible patients were screened with transbuccal ultrasound to determine tissue volumes and anatomical details. Intraoperative and postoperative, 6th-month volume measurements were undertaken and residual tissues and vascular pedicles reevaluated. Results: ultrasound imaging showed that the mean preoperative volume of the fat pads was 11.67 ± 1.44 mL, and the mean postoperative volume was 8.58 ± 1.07 mL. The mean volume of the excised tissues was 2.74 ± 0.69 mL. Postoperative buccal fat pad volume values correlated with the reported average in the literature for the same age group. Conclusions: Buccal fat pad removal is an effective technique for refining the facial silhouette that should be reserved for patients with increased buccal fat pad volume. Removal of only the excessive portion of the fat pad is important because this structure provides significant volume in the midface that can be difficult to restore once aging affects the surrounding soft and bony tissue.