Edwin F. Williams

tissue Response to Suture Materials Implanted Subcutaneously in a Rabbit Model

&NA; We compared the tissue response to a nonabsorbable monofilamented suture made of expanded polytetrafluoroethylene (ePTFE), which has recently been introduced for use in plastic surgery, with the response to 10 other commercially available absorbable sutures and nonabsorbable monofilamented and multifilamented sutures. The sutures were used to secure a patch of ePTFE implanted in the dorsum of adult New Zealand White rabbits. At 30, 60, and 120 days after implantation, the tissue response to the sutures was assessed with respect to the number of foreign‐body giant cells present, the thickness of the fibrous capsule that developed, and the general inflammatory response (n = 4 for each suture for each time period). Analysis of variance revealed that specific suture type was significantly associated with foreign‐body giant cell count and fibrous capsule thickness. Tevdek had a significantly higher value for mean number of foreignbody giant cells. Silk and Tevdek had significantly thicker fibrous capsules, and ePTFE suture had a significantly thinner capsule. Absorbable sutures and nonabsorbable multifilamented sutures evoked a more extensive tissue response than monofilamented sutures; the differences between nonabsorbable monofilamented and nonabsorbable multifilamented sutures were significant for capsule thickness. In general, suture made of ePTFE produced a minimal tissue response. It should be a good choice for use in facial plastic surgery, in which excellent functional and aesthetic results are critical. (Plast. Reconstr. Surg. 100: 1788, 1997.)

Complications Associated With Injectable Soft-Tissue Fillers: A 5-Year Retrospective Review

IMPORTANCE Even when administered by experienced hands, injectable soft-tissue fillers can cause various unintended reactions, ranging from minor and self-limited responses to severe complications requiring prompt treatment and close follow-up. OBJECTIVES To review the complications associated with injectable soft-tissue filler treatments administered in the Williams Rejuva Center during a 5-year period and to discuss their management. DESIGN AND SETTING Retrospective medical record review in a private practice setting. PARTICIPANTS Patients receiving injectable soft-tissue fillers and having a treatment-related complication. INTERVENTIONS Injectable soft-tissue filler treatments. MAIN OUTCOME MEASURES A retrospective medical record review was conducted of patients undergoing treatment with injectable soft-tissue fillers between January 1, 2007, and December 31, 2011, and identified as having a treatment-related complication. RESULTS A total of 2089 injectable soft-tissue filler treatments were performed during the study period, including 1047 with hyaluronic acid, 811 with poly-L-lactic acid, and 231 with calcium hydroxylapatite. Fourteen complications were identified. The most common complication was nodule or granuloma formation. Treatment with calcium hydroxylapatite had the highest complication rate. CONCLUSIONS AND RELEVANCE Complications are rare following treatment with injectable soft-tissue fillers. Nevertheless, it is important to be aware of the spectrum of potential adverse sequelae and to be comfortable with their proper management. LEVEL OF EVIDENCE 4.

Thread-lift for Facial Rejuvenation Assessment of Long-term Results

OBJECTIVE To evaluate the long-term success of the thread-lift procedure for facial rejuvenation. METHODS Thirty-three patients underwent a thread-lift procedure alone or in combination with other facial rejuvenation procedures to the brow, midface, jowl, and neck. Ten patients underwent thread-lifts only, and 23 had thread-lifts with other procedures. Ten additional patients having had non-thread-lift rejuvenation procedures, including lipotransfer, chemical peels, and rhytidectomies, were randomly designated as controls. The mean follow-up period was 21 months (range, 12-31 months). Photodocumentation was obtained at each visit. Long-term aesthetic results were evaluated by 4 independent, blinded, and board-certified facial plastic surgeons. Each result was graded on a scale of 0 to 3, with 0 indicating no change; 1, minimal improvement; 2, moderate improvement; and 3, considerable improvement. The population was divided into 3 groups for comparison. Two-tailed t test (P = .05) was used for statistical analysis of aesthetic outcomes. RESULTS Although aesthetic improvement was noted in all groups at 1 month, measurable results persisted to the end of the study for all but the group that underwent the thread-lift procedure only. Aesthetic improvement scores of the non-thread-lift control group were better than the group that underwent thread-lift only. Similarly, when the thread-lift was combined with other procedures, scores were better than when thread-lift was used alone. Statistical significance was demonstrated in both of these comparisons (P < .01). CONCLUSIONS The thread-lift provides only limited short-term improvement that may be largely attributed to postprocedural edema and inflammation. Our results objectively demonstrate the poor long-term sustainability of the thread-lift procedure. Given these findings, as well as the measurable risk of adverse events and patient discomfort, we cannot justify further use of this procedure for facial rejuvenation.

The treatment of facial verrucae with the pulsed dye laser

Objectives/Hypothesis To evaluate the treatment of facial verrucae with the pulsed dye laser.

Pulsed-Dye Laser for Treating Ecchymoses After Facial Cosmetic Procedures

OBJECTIVE To assess the safety and efficacy of a 595-nm pulsed-dye laser in the treatment of ecchymoses after facial cosmetic procedures. METHODS Twenty consecutive patients with ecchymoses after facial cosmetic procedures underwent treatment with the pulsed-dye laser. A 10-mm spot size was used, with pulse duration of 6 milliseconds, fluence of 6 J/cm(2), and cryogen spray for 30 milliseconds with a 20-millisecond delay. The ecchymotic area was outlined; the lateral half was treated on postoperative day 5 or 6 and the medial half on postoperative day 7 to 10. Clinical photographs were obtained before and after each treatment. Three blinded independent observers evaluated the photographs and graded the ecchymoses on a scale of 0 to 3, with 3 indicating severe ecchymosis. RESULTS The most common procedures associated with ecchymoses are cervicofacial rhytidectomy, facial lipocontouring, thread lift, and minimally invasive subperiosteal midface-lift. Pulsed-dye laser treatment resulted in a 63% mean improvement in ecchymosis scores within 48 to 72 hours. The only adverse effects were mild edema and discomfort. Maximal efficacy of the laser treatment was observed when it was performed between 5 and 10 days postoperatively. Patient satisfaction was universally high. CONCLUSIONS Treatment with the pulsed-dye laser is safe and effective for expeditious resolution of postoperative ecchymoses after facial cosmetic procedures. It has the potential for wider application in treating postoperative ecchymoses on other areas of the body and after trauma.

Evolution of Midface Rejuvenation

Age is the most significant factor contributing to the overall change in the appearance of an individuals facial features over time. This gradual process of structural weakening of the face begins during the third decade and continues to worsen during the remainder of an individuals lifetime. In this article we discuss how the approach to midface rejuvenation has evolved over time owing to our increased understanding of the aging process. In addition, we discuss specific techniques that we employ that have helped us achieve more natural and lasting results.

Fat Transfer in Conjunction with Facial Rejuvenation Procedures

Age is the most significant factor contributing to the overall change in the appearance of an individuals facial features over time. The purpose of any cosmetic procedure is to reverse the aging process that has occurred in an individual. During the last 5 years, volume restoration through lipotransfer combined with lifting procedures has been instrumental in elevating these procedures to a new level of excellence in comprehensive facial rejuvenation. The authors believe that restoration of facial volume can be achieved safely, precisely and reliably by lipotransfer. In this article they describe their techniques of lipotransfer.

Lipotransfer in the upper third of the face.

Autologous lipotransfer provides an effective means of volume restoration for facial rejuvenation. The upper one-third of the face falls victim to age-related volume depletion and can be a target for fat transfer. This article describes the senior authors technique of fat transfer in some of the specific anatomic subunits of the upper face.

The decision process in choosing costal cartilage for use in revision rhinoplasty.

The aims of rhinoplasty reconstruction include maintaining or augmenting long-term tip projection, restoring rigid dorsal stability, and restoring optimum respiratory function. The methods set forth to obtain these objectives are inherently based on the intrinsic nasal principles at the time of the rhinoplasty. Because of the excellent and consistent results autologous costal cartilage grafts provide when faced with problems such as the traumatic saddle deformity, defects after neoplastic resection, congenital nasal deformities, severe tip weakness or underprojection, rhinoplasty in the ethnic patient, and revision rhinoplasty, they are an invaluable resource to the rhinoplasty surgeon. Once the surgeon becomes comfortable and proficient at harvesting this graft, it inevitably will become the graft of choice when substantial amounts of cartilage are required.

Giant cell angiofibroma of the nasolacrimal duct.

Purpose To describe clinical and histologic features of the first case, to our knowledge, of giant cell angiofibroma located in the nasolacrimal duct region in a 28-year-old woman. Methods Interventional case report. A left nasolacrimal duct tumor was excised en bloc by lateral rhinotomy. Histopathologic examination was performed with the use of light microscopy. Immunohistochemical staining included S-100 protein, muscle-specific actin, desmin, myoglobin, vimentin, and CD34. Results The lesion was characterized by haphazardly arranged oval to spindled cells, a myxoid and collagenous stroma, multinucleated giant cells, prominent blood vessels, and pseudovascular spaces. Tumor cells were strongly positive for vimentin and CD34 and were negative for other antigens. After excision, there has been no recurrence over 4 years of follow-up. Conclusions Originally described as an orbital tumor, giant cell angiofibroma also may occur in the nasolacrimal duct and lacrimal sac region. This mesenchymal neoplasm should be included in the differential diagnosis of lacrimal drainage system tumors.