Frank M. Kamer

SMAS rhytidectomy versus deep plane rhytidectomy : An objective comparison

Although there are a multitude of techniques currently used for performing face lifts, there is no general agreement as to which, if any, of these techniques is most effective. There may never be a definitive answer to this issue because of the highly subjective nature of aesthetics, variability among surgeons, differences in patient anatomy, and specific patient desires. In an attempt to evaluate face lift techniques objectively, this study compares the rate of patients undergoing a tuck procedure after traditional SMAS (superficial musculoaponeurotic system) rhytidectomy to that of patients after deep plane rhytidectomy. A retrospective chart review was performed on all patients who underwent a tuck procedure following a face lift by the senior author (Kamer) between July of 1990 and January of 1997. There were 634 patients who electively underwent either a SMAS or deep plane type of rhytidectomy during the 6.5-year period; 48 patients subsequently underwent tuck operations, and adequate information was available on 44 patients. Of these, 43 were women and the average age was 57 years. The overall tuck rate from July of 1990 to January of 1997 was 7.5 percent. The tuck rate following SMAS rhytidectomy was 11.4 percent, and that following deep plane rhytidectomy was 3.3 percent. Therefore, a tuck was required 71 percent less frequently after a deep plane lift than after a SMAS lift. This was found to be a statistically significant difference with a p value of .0001 (Fishers exact test, 2-tail). If the assumption is made that the need for a tuck procedure implies a less than optimal face lift, then the data of this study suggest that the deep plane technique is more effective than the SMAS technique.

Mentoplasty — A clinical analysis of alloplastic implants

Different types of alloplastic implants are currently being utilized in performing mentoplasty. A review of the literature points out the number of prostheses that have been used. Each type of material has inherent physical properties which determine its characteristics for use as a chin implant. The type of implant and method selected in chin augmentation depends upon accurate preoperative evaluation and full understanding of the properties of alloplastic substances.

Experience with fibrin glue in rhytidectomy.

Background: The authors conducted a large, prospective, controlled trial of fibrin glue in rhytidectomy using a wide set of variables. Methods: Two hundred consecutive patients undergoing elective rhytidectomy were studied. One hundred patients received fibrin glue over a 1-year period and were followed prospectively. Another 100 patients from the previous year who had not received fibrin glue had their charts reviewed retrospectively. All patients underwent bilateral face lifts using the deep plane technique. Results: The following data were observed for the glue versus nonglue patients: expanding hematoma rate, 1 percent versus 3 percent (p > 0.05); seroma rate, 1 percent versus 7 percent (p > 0.05); and prolonged induration, edema, and ecchymosis, 0 percent versus 22 percent (p < 0.05). The pain score for glue versus nonglue patients was 100 percent minimal versus 95 percent minimal and 5 percent moderate (p > 0.05). The average score for patient satisfaction (scale, 1 to 10, with 10 being best) for glue versus nonglue patients was 9.5 versus 9.0 (p > 0.05). Conclusions: The use of fibrin glue was associated with some benefits for rhytidectomy. Fibrin glue eliminated the use of drains. The difference in expanding hematoma was clinically, but not statistically, significant. The seroma rate was decreased and neared statistical significance. There was an impressive immediate decrease in postoperative swelling. The fibrin glue was most advantageous in eliminating prolonged induration, edema, and ecchymosis. There were no statistical differences between groups for patient satisfaction or pain. The use of fibrin glue has been shown to reduce some of the morbidity and severe complications of face lifting.

Lengthening the Short Nose

In the more difficult cases of short nose deformity in which there is loss of septal membrane, lining as well as cartilage must be provided to adequately correct the functional and aesthetic deformity. A discussion of these techniques is outlined and a procedure discussed that makes use of staggered septal incisions to aid in implanting the composite conchal graft. After release of the entire inferior septal columella unit, a gap remains, which is filled by a composite conchal graft. The mechanics of the steplike incisions enable the bare-grafted cartilage, which has been denuded of conchal perichondrium, to be covered by normal septal perichondrium. The risk of perforation or graft failure is greatly reduced due to the rich blood supply of the septal mucosa, which provides nutrition to the cartilaginous surfaces. The benefits, complications, and limitations of the procedure are described.

High septal hemitransfixion for the correction of caudal septal deformities.

High septal hemitransfixion has demonstrated superior versatility and reliability in a series of 68 patients for correction of caudal septal deformity. The literature has contained many references to high septal transfixion for use in rhinoplasty to preserve tip support. An alternative application of this approach for repair of caudal septal deformity is herein discussed.

Nasal tip surgery: a 30-year experience

An algorithm for an endonasal approach to most aesthetic problems of the nasal tip is presented. Endonasal surgery in this manner has been successful in the management of many thousands of cases through the years and effective for most variations of tip anatomy and appearance. Every attempt is made to maintain the pleasing, natural, and individual aesthetic elements of the tip while eliminating the offending features through minimally invasive techniques.

Treatment of alopecia in temporal region following rhytidectomy procedures.

Satisfactory treatment of alopecia following rhytidectomy is discussed using the punch graft technique. In spite of the presence of scar tissue following rhytidectomy, this procedure has been quite successful because of the rich blood supply in that area.

Deep plane rhytidectomy: A personal evolution

As the rhytidectomy procedure has evolved over the years, the understanding of facial anatomy and critical examination of results have led to the adoption and modification of the deep plane technique by the senior author. Experience with the deep plane rhytidectomy technique has shown that reliable, safe, and effective results can be achieved consistently. The aesthetic benefit has increased particularly with respect to the nasolabial fold and the jowl, while complications have been few. The historical background, evolution, and details of the technique are presented.

Median horizontal split tip.

One of the most difficult problems encountered in rhinoplasty is lack of nasal tip projection. An innovative technique is described that utilizes the removal of a median horizontal strip of lower lateral cartilage to enhance projection, while maintaining a natural highlight and tip support without the use of grafts. The indications are limited to noses that have a widened dome requiring removal of a central strip, and tip rotation. Alternate techniques are discussed; cases and results are discussed.

High frequency needle dissection rhytidectomy.

Fifty consecutive rhytidectomies were performed utilizing high frequency needle dissection on one side and standard sharp dissection on the other for all incisions and flap elevation. The efficacy of this technique in hemostasis, prevention of hematoma, and wound healing is compared to the conventional technique of rhytidectomy. The advantages and disadvantages of the modality are discussed.