Technique for Correction of the Retracted Columella, Acute Columellar-Labial Angle, and Long Upper LipFlowers, Robert S. ; Smith, Jr., Eugene M.
doi: 10.1007/s002669900276pmid: 10441712
The excess tissue from upper lip vertical length reduction provides bulk for opening the columella–labial angle and increasing the visibility of the columella and upper lip vermillion. Decorticated centrally based transverse flaps from the lip and nostril floor, when transposed into a columellar pocket, correct commonly combined degenerative or developmental deformities. The technique delivers premaxilla, columella, and columella–labial angle mass, which simultaneously corrects the retracted columella, opens the columella-labial angle, shortens the upper lip length, and enhances vermillion visibility.
Aesthetics and Function in Lip ReconstructionPeled, Isaac J.
doi: 10.1007/s002669900282pmid: 10441718
Reconstruction of the lip following excision of malignant tumors is a frequent task of the plastic surgeon. Adequate oncological treatment must be followed by a satisfactory aesthetic and functional result. A simple and successful technique of lip reconstruction is revisited. It consists in using the remaining lip, which is released by way of a horizontal mucomyocutaneous flap(s) and stretched to fill the gap. Twenty-six consecutive cases of T2–T3 squamous cell carcinoma of the lip were treated using this technique, with excellent aesthetic and functional results.
New Indications in the Approach to the Pendulous AbdomenPlanas, Jorge ; Morais, Beatriz B.
doi: 10.1007/s002669900280pmid: 10441716
The appearance of the superficial liposuction technique has permitted the surgeon to advance in his indications for treating localized lipodystrophy, without skin resection. With the cutaneous retraction phenomenon that follows superficial liposuction, pendulous abdomen, which was once treated by classical dermolipectomies, can now be treated with liposuction alone, obtaining satisfactory results. The authors recommend this form of treatment for patients with pendulous abdomen and with good skin quality, with few or no stretch marks, and with little or no diastasis of the rectoabdominal musculature.
Increasing Projection in Patients Undergoing Free Nipple Graft Reduction MammoplastyAbramson, David L.
doi: 10.1007/s002669900284pmid: 10441720
Reduction mammoplasty in patients with gigantomastia has traditionally been performed by a technique involving free nipple grafting. These patients usually have only a small amount of breast tissue above the inframammary fold and therefore this type of procedure has often left patients with an insufficient amount of superior pole projection. I have performed free nipple grafting in three patients with gigantomastia using a technique that utilizes two deepithelialized pedicles to increase projection. This technique is simple to perform, does not significantly lengthen the operative time, and results in a breast that provides significant projection.
General Anesthesia via Tracheosubmental Intubation from Our Own ExperienceBartkowski, Stanisław B. ; Zapała, Jan ; Szuta, Mariusz ; Podziorny, Henryk ; Kuchta, Krzysztof
doi: 10.1007/s002669900286pmid: 10441722
In our department from 1995 to 1998, 30 patients were operated on under general anesthesia via tracheosubmental intubation (TSI). No local or general complications were observed. Operating in the field free from the intubation tube is very comfortable for a surgeon, while for an anesthesiologist the safety of the tube and efficiency of ventilation are very important. TSI, as a technically simple, safe, and efficient procedure, is extremely helpful in the surgical treatment of patients with simultaneous multifragmentaric and comminuted fractures of the maxilla and mandible, and in orthognathic and aesthetic plastic surgery of the face, where assessment of facial symmetry and occlusion is especially important.
Buckled Upper Pole Breast Style 410 Implant Presenting as a Manifestation of Capsular ContractionHodgkinson, Darryl James
doi: 10.1007/s002669900283pmid: 10441719
Recent experience with the cohesive gel implant has shown an interesting variation of capsular contracture. Instead of spherical contraction, the capsule formation around the 410 implant seems to cause a buckling of the superior pole of the implant. This buckling has been observed in four implants and presented clinically in 2 of 50 patients with a superior pole mass. The capsular contraction around the implant and the buckling are probably camouflaged by a subpectoral implantation and this presentation should be recognized by the surgeon, especially when considering placement of the cohesive gel implant in a subglandular position. Histological sections of a capsule around the implant show fragmented silicone, with a cellular reaction around the fragmented silicone.
Anesthesia for Facial SurgeryUllmann, Yehuda ; Levy, Yoram ; Isserles, Schlomo ; Vohradnik, Gabriele
doi: 10.1007/s002669900287pmid: 10441723
We describe a reliable, simple, and safe method of monitored anesthesia care, with local anesthesia, which was used for 4500 patients undergoing facial rejuvenation procedure, without major complications and with minor side effects. All procedures were performed in a setup of a private clinic not affiliated with any hospital. The disadvantages of general anesthesia were avoided. Using careful monitoring and drug titration, even aged patients with medical problems, can benefit from this method. We are using classical, inexpensive, and safe compounds, which cope with all goals of anesthesia for aesthetic facial surgery.
The Effect of Skeletal Remodeling on the Nasal Profile: Considerations for Rhinoplasty in the Older PatientPessa, Joel E. ; Desvigne, Lisa D. ; Zadoo, Vikram P.
doi: 10.1007/s002669900275pmid: 10441711
The effect of continued differential growth of the adult male craniofacial skeleton on the nasal profile is examined in the present study. Two groups of individuals (N= 20) were compared, young (ages 16–23) and old (49–64). A three-dimensional CT scan was created for each individual in a standardized view. The change in position of four skeletal reference points with soft tissue correlates was analyzed. Changes were evaluated in both the vertical and the horizontal dimensions relative to the sella-nasion and to a perpendicular from the sella-nasion. Results show that the area of the maxilla at the pyriform remodels posteriorly with age (p= 0.017), while the position of the other three points does not change in a significant fashion. This suggests that differential growth continues to occur in the aging craniofacial skeleton. Differential growth is further documented by calculating the percentage change in the position of any of the four points: the pyriform changed 80.2% from young to old, while the other points changed only from −9.3 to +22.1%. The craniofacial skeleton is the scaffold for the overlying soft tissues. Because the pyriform aperture represents the skeletal platform for the nasal pyramid, pyriform remodeling in a posterior direction retrudes the nasal profile with age. In addition, loss of pyriform height may distort the normal relationship of the alar base to the columella. These changes require assessment for the optimal result from aesthetic rhinoplasty.