Volume 138, Number 6 Letters

Delegacin Benito Jurez, Mexico 03229

drgaxiola@gmail.com

DISCLOSURE
The authors declare that there is no conflict of interest
related to any aspect treated in the text. There were no royalties
nor economic benefits.
REFERENCES
1. Narasimhan K, Ramanadham S, OReilly E, Rohrich RJ. Secondary neck lift and the importance of midline platysmaplasty:
Review of 101 cases. Plast Reconstr Surg. 2016;137:667e675e.
2. Parsa FD, Castel N, Parsa NN. A modified, direct neck lift technique: The cervical wave-plasty. Arch Plast Surg. 2016;43:181188.
3. Narasimhan K, Stuzin JM, Rohrich RJ. Five-step neck lift:
Integrating anatomy with clinical practice to optimize
results. Plast Reconstr Surg. 2013;132:339350.

Fig. 1. Wide exposure and primary platysmal plication performed in a 73-year-old male patient.

our few modifications in the past few years have

sought the modification in the scar pattern as suggested by others.2 Regarding scar aesthetics, despite
these modifications (Z-plasties, multiple Z-plasties,
wave-plasties), in our mestizo population, we have
not found differences in scar cosmesis, evaluated
from the side view. Specific steps for addressing the
lateral neck are performed according to the indication in each case.3
Thus, our emphasis has turned from scar awareness to contour detail, understanding that most
patients accept the resulting scars as a tradeoff for
an improved neck contour, which we conclude is
more easily achieved by platysmal plication with
nonresorbable sutures placed by a direct submental approach ending just above the sternal notch
(Fig. 1). As the authors express, in the most honest of ways, residual deformities are related to lack
of primary platysmal plication in at least 76 percent
of cases; therefore, as demonstrated by the authors,
we must emphasize the importance of data gathering and systematic analysis. We congratulate the
authors.
DOI: 10.1097/PRS.0000000000002801

Alejandro Duarte-y-Snchez, M.D.

Miguel Angel Gaxiola-Garca, M.D.
Plastic and Reconstructive Surgery Department
Centro Mdico Nacional 20 de Noviembre
Instituto de Seguridad y Servicios Sociales de los
Trabajadores del Estado
Mxico City, Mxico
Correspondence to Dr. Gaxiola-Garca
Centro Mdico Nacional 20 de Noviembre Edificio E
Flix Cuevas 540
Colonia Del Valle

Reply: Secondary Neck Lift and the Importance

of Midline Platysmaplasty: Review of 101 Cases
Sir:

We thank the authors for their interest and insight

into our article, Secondary Neck Lift and the Importance of Midline Platysmaplasty: Review of 101 Cases.1
As they point out, we sought to emphasize in our evolution that opening the neck has truly provided consistent and reliable results. In our practice, we have
not found scarring to be an issue in our patients, and
a standard submental linear scar has been acceptable
to patients. As the patient experience referred to in the
Mexican population has also proven, the benefits of
platysmal tightening and vastly improved neck contour
far outweigh the scar burden. Opening the midline
neck is clearly a reproducible technique.2
DOI: 10.1097/PRS.0000000000002802

Kailash Narasimhan, M.D.

Private practice
Sherman Surgery Center
Sherman, Texas

Rod J. Rohrich, M.D.

Department of Plastic Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
Correspondence to Dr. Narasimhan
Sherman Surgery Center
1111 Sara Swamy Drive
Sherman, Texas 75090

DISCLOSURE
Dr. Narasimhan has no conflict of interest related to any
aspect treated in the text. There were no royalties nor economic
benefits. Dr. Rohrich is a volunteer member of the Allergan Alliance for the Future of Aesthetics and receives instrument royalties

1075e
Copyright 2016 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.

Plastic and Reconstructive Surgery December 2016

from Eriem Surgical, Inc., and book royalties from Taylor and
Francis Publishing. No funding was received for this article.
REFERENCES
1. Narasimhan K, Ramanadham S, OReilly E, Rohrich
RJ. Secondary neck lift and the importance of midline
platysmaplasty: Review of 101 cases. Plast Reconstr Surg.
2016;137:667e675e.
2. Narasimhan K, Stuzin JM, Rohrich RJ. Five-step neck lift:
Integrating anatomy with clinical practice to optimize
results. Plast Reconstr Surg. 2013;132:339350.

The Use of Autologous Fat Grafting for

Treatment of Scar Tissue and Scar-Related
Conditions: A Systematic Review
Sir:

egenborn and colleagues have recently published

in Plastic and Reconstructive Surgery a very interesting
systematic review based on the available published literature entitled The Use of Autologous Fat Grafting for
Treatment of Scar Tissue and Scar-Related Conditions:
A Systematic Review.1 We would like to congratulate
Negenborn et al. for their article, which systematically
describes the currently available evidence on the effectiveness of autologous fat grafting for the treatment of
scar tissue and scar-related conditions, and kindly thank
them for citing our study. Their review reports the positive effects of autologous fat grafting on a variety of
scar-related symptoms, such as appearance, skin quality,
volume and/or contour restoration, and pain and itch
control. The authors highlight the need for future randomized controlled trials with a methodologically strong
design to confirm these results. Considering the authors
interest in our study, we would like to add our more recent
studies on the use of autologous fat grafting in the irradiated breast.2 We recently confirmed the pain-reducing
effect of this technique, reviewing a total of 120 treated
patients affected by postmastectomy pain syndrome. In
this larger group, we detected a statistically significant
reduction in the visual analogue scale scores when comparing the assessment performed before and after treatment, whereas no significant reduction was observed in
the control group of 70 patients. Moreover, more than
80 percent of the treated patients discontinued their
analgesic drug therapy following the procedure. The
pain reduction is strictly related to the improvement in
movement impairment.3 Indeed, we recently published
a series of 36 children affected by pathologic dwarfism
treated for postsurgical scars resulting from surgical correction of short stature.4 Clinical assessment of the study
population was conducted using a modified Patient and
Observer Scar Assessment Scale, to which a new item was
added in the patient section to investigate scar-related
movement impairment. This new parameter has been
shown to be reliable after test and retest and has been
shown to be the feature most closely related to patient
overall satisfaction and therefore to patient quality of
life, being especially relevant in the extremities. It could

be hypothesized that autologous fat grafting decreases

pain by induction of molecular changes in the microenvironment of posttraumatic scar and by down-regulation of the radiation therapyinduced inflammatory
response, as mesenchymal stem cells inhibit production
and release of proinflammatory cytokines, which are
the main mediators of radiation therapyinduced tissue
damage. Our study in the treatment of scars of different
origins shows a reduction or complete resolution of pain
and an increase in scar elasticity.5 The technique is minimally invasive and no complications were recorded.
In conclusion, our more recent results confirm
pain reduction and the improvement in quality of life
in treated patients. Moreover, we support the use of our
modified Patient and Observer Scar Assessment Scale,
which was implemented with a specific item regarding
impairment to movements, to provide a more complete
evaluation of the patients perception of their own scar.
DOI: 10.1097/PRS.0000000000002804

Andrea Lisa, M.D.

Luca Maione, M.D.
Valeriano Vinci, M.D.
Andrea Rimondo, M.S.
University of Milan
Reconstructive and Aesthetic Plastic Surgery School
Department of Medical Biotechnology and Translational
Medicine BIOMETRA
Plastic Surgery Unit
Humanitas Research Hospital
Rozzano

Francesco Klinger, M.D.

University of Milan
Reconstructive and Aesthetic Plastic Surgery School
MultiMedica Holding S.p.A.
Plastic Surgery Unit
Sesto San Giovanni

Marco Klinger, M.D.

University of Milan
Reconstructive and Aesthetic Plastic Surgery School
Department of Medical Biotechnology and Translational
Medicine BIOMETRA
Plastic Surgery Unit
Humanitas Research Hospital
Rozzano
Milan, Italy
Correspondence to Dr. Marco Klinger
University of Milan
Reconstructive and Aesthetic Plastic Surgery School
Department of Medical Biotechnology and Translational
Medicine BIOMETRA
Plastic Surgery Unit
Humanitas Research Center
Via Manzoni 56
20089 Rozzano, Milan, Italy
marco.klinger@humanitas.it

1076e
Copyright 2016 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.