Daniel Murariu

Surgical correction of the frowning mouth.

Background: The available perioral rejuvenation procedures only partially correct the frowning mouth deformity, which is composed of sagging of the oral commissures and frequently associated with marionette folds. The authors describe their method of surgical correction for this condition and offer a classification for frowning mouth deformity. Methods: Twenty-seven patients underwent correction for frowning mouth deformity from 2000 to 2009. The deformities and the corresponding methods of correction were divided into two types. In type I frowning mouth deformity, correction was performed by lentiform excisions at the vermilion border, and in type II deformity, lentiform excisions also included the marionette folds. Results: Correction of frowning mouth deformities, either as an isolated procedure or concurrent with face lift, was satisfactorily achieved in all 27 patients. All patients were followed for a minimum of 3 months, and 88.9 percent were followed for 1 year; 18.8 percent of the patients showed erythema and scar hypertrophy at the sites of marionette fold excision during the early postoperative period. However, all scars improved over time, with high patient satisfaction. Conclusions: Frowning mouth deformities are correctable by excising lentiform segments of skin through incisions placed at the vermilion border that may be extended to include the marionette folds. Proper patient selection and counseling, particularly regarding temporary or possibly permanent noticeable scar formation, is of utmost importance. When such measures are taken, the outcome is good and patient satisfaction is high.

Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study

Background Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected. Conclusions Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

Comparison of mean labial width in patients requesting labioplasty to a healthy control: an anatomical study.

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Abstract: Soft Tissue Reconstruction after Concomitant Vertebrectomy and Chest Wall Resection for Spinal Tumors

CONCLUSION: This small, retrospective series of complex open CST in patients after liver or kidney transplantation shows an acceptable long-term hernia recurrence rate and overall healing rate. By using a multidisciplinary approach and plastic surgery techniques for abdominal wall reconstruction, we believe that open CST with biologic mesh is a safe and effective technique in the transplant population with abdominal hernias.

Calvarial Regeneration With Use of Acellular Dermal Matrix in Aplasia Cutis Congenita.

Abstract Aplasia cutis congenital (ACC) is a rare congenital anomaly, most commonly affecting the scalp, with a variable penetrance ranging from a small (<2 cm2) area of missing skin to large defects characterized by absent skin, subcutaneous tissue, calvarium, and dura. Calvarial reconstruction in ACC can be challenging. Due to exposed neurologic structures, in large defects, ACC has a high mortality rate. A stable reconstruction is optimally achieved shortly after birth to minimize complications. Herein the authors present a case of a neonate with an extensive (4.5 × 7 cm) cutis aplasia defect associated with absent skin, subcutaneous tissue, calvarium, dura, and with exposed cortical surface and sagittal sinus. This defect was successfully reconstructed in a single stage with the use of an acellular dermal matrix/skin graft construct. The acelluar dermal matrix served as a scaffold for tissue ingrowth, promoting regeneration of the bony calvarium as well as soft tissue. At 18-month follow-up, the patient exhibits a 50% smaller calvarial defect as well as stable skin coverage.