Dr. Baxter's Publications

Original Publications – Peer-Reviewed Journals (Partial List)

Update on the split muscle technique for breast augmentation: Prevention and correction of animation distortion and double-bubble deformity.
Aesth Plast Surg [epub 2010 Oct 7]
Background: Most breast implants are placed below the pectoral muscle (dual plane technique) but more than 70% of these cases will have animation deformities, and the “double bubble” contour deformity may be related. In 2004 I reported the split muscle technique as an option that balances competing issues of coverage and the desire to avoid problems with submuscular placement.
Objective: This report updates my experience and outlines the surgical approach to correction of animation and double bubble deformities by conversion to the split muscle plane.
Results: In more than 400 cases, the use of the split muscle plane has been successful in minimizing animation distortion and double bubble when muscle coverage is needed. The anatomic basis of the double bubble is described along with a strategy for correction based on release of the muscle on the capsule.

Subfascial Breast Augmentation: Theme and Variations.
Aesthetic Surgery Journal 25(5);447-53, 2005.
Subfascial placement of breast implants for augmentation has been advocated as an option that has some of the advantages of both the subpectoral and subglandular approaches while minimizing the disadvantages of each.
Objective: The author reports on the use of the subfascial approach in athletic and thin individuals, including extension of the range of applications for this approach through the use of partial muscle flaps for upper pole coverage.
Methods: A periareolar approach was preferred, particularly when segmental muscle flaps were incorporated into the augmentation. Medially-based flaps supplied by the intercostal perforators were used to achieve greater upper-pole coverage, which can be particularly beneficial when using high-profile implants. Conversion from dual-plane submuscular to subfascial placement was used for correction of a “dynamic” breast (a breast that is distorted with muscle activity) or related contour deformity.
Results: Examples of the range of applications of the subfascial approach are presented, including the use of small and larger segmented muscle flaps and correction of the dynamic breast or contour deformity.
Conclusions: Use of the subfascial approach, with selective application of segmented muscle flaps, can help reduce reoperation rates after breast augmentation.

Indications and Practical Applications for High-Profile Saline Implants.
Aesthetic Surgery Journal, 24(1); 24-27, 2004
High-profile round saline breast implants have become available, allowing for better match of implant diameter to the base diameter of the breast.
Objective: Initial experience with high profile implants has helped to define their advantages and disadvantages.
Methods: Preoperative measurements with emphasis on base diameter determine maximum optimal implant diameter. Patients select desired implant size using trial implants in a bra of the desired cup size. The implant profile with the best match to base diameter at the selected size range is used. High profile implants are also advantageous with periareolar mastopexy in order to counteract the tendency for central flattening attendant to that procedure.
Results: A series of 67 patients with high profile implants out of 164 total saline implant patients over a 14-month period are reviewed and representative cases are presented.
Conclusions: High profile saline implants provide a useful option for the patient who desires an implant size that exceeds the natural base diameter in standard profiles. Problems of rippling may thereby be diminished in these cases. A more conical shape may be achieved with periareolar mastopexy cases with augmentation.

Intracapsular Allogenic Dermal Grafts for Breast Implant-Related Problems.
Plastic and Reconstructive Surgery, 112(6); 1692-6, 2003.
Abstract: Despite advances in surgical techniques and breast implant design, certain problems unique to breast implant surgery remain. The historically most onerous problem, capsular contracture, is relatively uncommon now. However, problems related to thin capsules and periprosthetic atrophy are becoming more common; these problems include rippling, symmastia, implant malposition, and bottoming out. Options for treatment of these conditions remain extremely limited, particularly with saline implants. Allogenic dermal grafting provides one satisfactory option. Techniques for use of allogenic dermal grafts and early results from 10 patients are summarized in this article, along with histologic analysis confirming viability of the grafts at 6-month follow-up in one patient. No graft-related problems were identified.

Nipple or Areolar Reduction with Simultaneous Breast Augmentation.
Plastic and Reconstructive Surgery, 112(7); 1918-21, 2003.
Abstract: Patients requesting nipple or areolar reduction often desire simultaneous breast augmentation. A technique is described for implant placement by means of a nipple base incision with either nipple reduction or intraareolar reduction. Nipple reduction is accomplished by removing a ring of skin from the base of the nipple, while areolar reduction is performed by removing a donut-shaped area of skin whose inner diameter is at the nipple base. The elasticity of the areolar skin allows for access for saline implant placement. The resulting scar is well concealed. Results from 15 patients demonstrate that the technique is safe, practical, and appears to pose no increased risk of sensory changes to the nipple.

Controlled Results with Abdominoplasty.
Aesthetic Plastic Surgery, 25(5); 357-64, 2001.
Abstract: An approach to abdominoplasty has been developed incorporating a series of key surgical maneuvers designed to minimize complications while controlling scar position and eliminating the need for long-term drains. These include sharp defatting of the layer deep to the superficial fascia, progressive tension anchor sutures from the flap to the rectus sheath, and anchor sutures from the superficial fascia to the deep fascia along the line of closure.

Histologic Effects of Ultrasonic-Assisted Lipoplasty.
Aesthetic Surgery Journal, 19:109-114, 1999.
Background: In spite of the increasing popularity of ultrasound-assisted lipoplasty (UAL), questions remain about the effects of ultrasound energy on soft tissues, indications for the technique, and parameters for safe application and optimal results.
Objective: This study was undertaken to evaluate the tissue effects of UAL and to correlate those effects with parameters based on clinical experience.
Methods: Histologic evaluation with standard histologic staining was done on abdominoplasty specimens treated with UAL on one side and standard liposuction on the opposite side in patients undergoing both abdominoplasty and UAL. Additionally, 100 consecutive patients treated with UAL were reviewed.
Results: it was found that optimal results correlated with submaximal amplitude settings, loss of tissue resistance to cannula movement, and change in color of the aspirate from pale yellow to pink or tan as end points for the application of ultrasound. Histologic evaluation revealed that these parameters were associated with minimal effect on connective tissues and blood vessels. Longer application times were associated with disruption of collagen and elastin structures.
Conclusions: This study confirms that UAL is an effective and safe technique in experienced hands when attention is given to easily observed end points for application of ultrasound energy.

Publications – General (Partial List)

“Plane” talk about breast augmentation.
SkinDeep magazine, Issue 1, 2005

The 10 biggest plastic surgery myths.
SkinDeep magazine, Issue 2, 2006.

“Restylane and Relaxation: What You Need to Know About Plastic Surgery Tourism”
SkinDeep magazine, Issue 3, 2007.

Optimizing Results with Saline Breast Implants.
Plastic Surgery Products May/June 1999.

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