Plastic surgeons commonly administer subcutaneous epinephrine to reduce intraoperative blood loss. The authors hypothesized that there are safe and effective concentration of epinephrine for vasoconstriction and their durations. The aim of this study is to summarize the existing literatures for the usage of epinephrine mixed with lidocaine in plastic surgical field. In 1903, Braun reported that adrenaline prolonged the local anesthetic effects of cocaine. The Parke-Davis Company began selling cocaine with adrenaline, as well as combining adrenaline with new synthetic local anesthetics. Based on a review of the literature, concentrations between 1:50,000 and 1:400,000 are equally effective and provide superior vasoconstriction compared with more dilute solutions. If epinephrine is further diluted, its onset and time to peak serum concentration are delayed, and its duration of action is shortened. When lidocaine is used without epinephrine, duration of anesthesia is shortened reverse proportionally to the lidocaine concentration. When lidocaine is used with epinephrine, duration of anesthesia is prolonged proportionally to the lidocaine concentration. With slow injection rate in the soft tissue, the maximum safe dose of lidocaine is approximately 3 mg/kg plain and 7 mg/kg when mixed with epinephrine. Lidocaine may protect the myocardium because of its antiarrhythmic activity, which is the rationale for infiltrating lidocaine mixed with epinephrine in general anesthesia. In plastic surgery, subcutaneous infiltration of epinephrine-lidocaine solution is performed to reduce intraoperative blood loss. Even in general anesthesia, infiltrating lidocaine mixed with epinephrine may protect the myocardium because of its antiarrhythmic activity.

The aim of this study was to analyze lip shapes as represented in the British edition of Vogue over the last century (1916–2015). Photographs containing distinguishable lips were selected from a book entitled Vogue 100: A Century of Style. A total of 98 frontal pictures (20 males, 78 females) in which the lips and mouth were identifiable were included and analyzed in terms of 4 lip-related ratios (lip thickness-to-width ratio [LTW]; upper-to-lower vermillion ratio [ULR]; upper vermillion thickness-to-upper lip height ratio [VUL]; and lip-to-nose width ratio [LNW]). The LTW was 0.39 ± 0.07, and did not vary significantly over time (P = 0.261 [linear regression analysis]). The LTW of women (0.41 ± 0.07) was significantly greater than that of men (0.34 ± 0.05) (P < 0.001 [independent 2-samples t-test]). The ULR was 0.74 ± 0.16, and did not vary significantly over time (P = 0.647). There was no significant difference in the ULR between men (0.75 ± 0.10) and women (0.74 ± 0.17) (P = 0.769). The VUL was 0.43 ± 0.09, and did not vary significantly over time (P = 0.550). The VUL of women (0.44 ± 0.09) was significantly greater than that of men (0.37 ± 0.06) (P = 0.001). The LNW was 1.49 ± 0.19, and did not vary significantly over time (P = 0.619). There was no significant difference in the LNW between men (1.43 ± 0.16) and women (1.51 ± 0.19) (P = 0.082). The results of this study may be useful for planning facial rejuvenation operations, as well as for clinical practitioners dealing with brow esthetics or lip tattooing.

The aim of this paper is to review the origin, physical properties, advantages, and usage of catgut in plastic surgery and oral surgery. In PubMed search, the search terms (“catgut” AND [“plastic surgery” OR “facelift”]) and (“catgut” AND “oral surgery”) were used, resulting in 28 and 30 papers, respectively. Of those 58 papers, 31 papers were excluded. Eight other papers were added; therefore, 35 papers were analyzed. Catgut has been used in cleft palate surgery since 1938. In 1976, it was used in a superficial wound with anti-tension taping. In the 1970s, 1980s, and 1990s, catgut was used in otoplasty, scrotoplasty, hemostasis of neurofibroma, blepharoplasty, ptosis surgery, and rhytidectomy. From the 2000s until the present day, it has been preferred in many fields of plastic surgery, including pediatric lacerations and conjunctiva sutures. In oral wound repairs and tonsillectomy, catgut has been used from the 1970s to the present. Many studies have compared catgut with other suture materials in terms of wound healing, inflammatory reaction, and longevity, and their respective advantages and disadvantages continue to be discussed. The advantages of catgut as a suture material are as follows: 1, The fundamental advantage of catgut is its absorbability. 2, Catgut has excellent tensile strength. 3, Sterility, when catgut is taken from a sealed tube, is assured. 4, Hardened, or ‘chromed,’ catgut is preferable to the ‘plain’ variety. 5, The finest possible size should be used in preference to thicker sizes. Catgut sutures are still widely used in plastic surgery and oral surgery.