Jack A. Friedland

Retrospective cephalometric analysis of mandibular bone absorption under silicone rubber chin implants.

A longitudinal study was conducted on 85 patients who received silicone rubber implants to the chin. Over half of these patients were found to have some absorption of the bone beneath the implants, and much other information was obtained. There were no concomitant changes in the soft tissue profile in the patients who demonstrated bone absorption under their implants. It appeared that the bone absorption was less when the implant was placed over the hard bone of the lower part of the mandible, rather than higher or over alveolar bone.

Otoplasty: the experience of 100 consecutive patients.

Although prominent ears are the most common congenital deformity in the head and neck region, only approximately 8 percent of patients who present for treatment of this deformity will have some family history of the abnormality. More than 200 techniques have been described for correction of this deformity, indicating that there is no single widely accepted procedure that has been adopted by most surgeons. The authors of this study present their choice of a procedure that combines the most beneficial features of three previously described techniques and that provides consistently satisfactory results. The surgical technique consists of scoring of the antihelical cartilage on its anterior surface in a subcutaneous position (as described by Stenstrom), suturing to recreate the fold of the antihelix (in the fashion of Mustarde), and concha-mastoid suturing applied to the back of the ear to decrease the concha-scaphoid angle (in the manner of Furnas). The last 100 consecutive patients operated on by the senior author (J.A.F.) over a 10-year period were evaluated. Follow-up data were analyzed using the Kaplan-Meier survival method. The postoperative analysis focused on the incidence of postoperative complications and the overall results of the technique.Most operations were performed bilaterally, on women, and with the patient under local anesthesia. There were few complications, and the incidence of complications was much lower than had been noted in previously reported series. All patients were very satisfied with the improvement in the appearance of their ears. The combined technique presented is safe, easy to perform, and has few complications, and its final outcome is reproducible and long-lasting. It can be considered a standard technique to be used for treating patients of any age and with any magnitude of defect.

The superficial-plane rhytidectomy revisited.

Complex procedures for aesthetic facial rejuvenation, such as the deep-plane, extended SMAS, subperiosteal, and composite rhytidectomies, have received significant attention in the literature and at recent symposia. Young plastic surgeons striving to achieve excellent results may be intimidated by these procedures and find them difficult to perform. We suggest a renewed interest in the superficial plane approach for facial rejuvenation. On the basis of our experience with a synthesis of result-oriented technical modifications in 750 patients, we present a procedure to offer not only the beginning but also the more experienced surgeon a safe and satisfactory surgical alternative that will provide both predictable and lasting results while limiting risks and avoiding complications. (Plast. Reconstr. Surg. 93: 1392, 1994.)

Repair of ischial pressure ulcers with gracilis myocutaneous island flaps.

Ischial pressure sores can be repaired with gracilis myocutaneous island flaps, and this technique offers numerous advantages over the use of posterior thigh flaps. Several illustrative cases are described.

Use of the temporary soft-tissue expander in posttraumatic alopecia.

Use of temporary soft-tissue expansion in five patients with posttraumatic alopecia and one patient with congenital alopecia is presented. Indications, operative technique, results, and complications are discussed. It is recommended that transpositional and free scalp flaps be expanded prior to transfer, and it is shown that to achieve greater expansion secondarily, the expanders can be reinserted and the scalp reexpanded as needed. The expansion technique provides a quantity of tissue of similar color, texture, and hair-bearing qualities for reconstruction of adjacent defects and makes secondary reconstruction of donor sites unnecessary. After a minimum follow-up of at least 1 year in each case presented, we have determined that the method is safe, simple, and reliable and provides excellent aesthetic results and high patient acceptance and satisfaction.

MOC-PS(SM) CME article: abdominoplasty.

LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the reasoning behind obtaining a thorough medical history from abdominoplasty patients and determine how that information (e.g., history of massive weight loss, prior operations with abdominal scars) may affect the surgical plan. 2. Understand the thromboembolic risks associated with abdominoplasty patients, especially when abdominoplasty is performed in conjunction with other surgical procedures, and appropriate and currently accepted prophylaxis. 3. Describe the indications and potential risks of performing liposuction as an adjunct to abdominoplasty. 4. Evaluate a patients abdomen, taking into consideration all the aesthetic subunits of the trunk and lower body, and determine the appropriate type of abdominoplasty indicated. 5. Identify and understand the treatment of early and late complications associated with abdominoplasty. SUMMARY In this article, the authors review the preoperative assessment, surgical treatment plan, and outcomes of abdominoplasty. Preoperative assessment emphasizes obtaining an accurate and detailed medical history, conducting a thorough physical examination, and determining suitable and safe anesthetic options in appropriate surgical facilities. Preoperative planning stresses measures taken to minimize perioperative complications, and intraoperative planning reviews the various surgical techniques. Postoperative complications and their treatments are discussed, as well as the safety of combining abdominoplasty with other procedures. Current procedural terminology is also reported, since there have been recent changes to those codes commonly used in abdominoplasty.

An evidence-based approach to blepharoplasty.

Scottsdale, Ariz.; Saint John, New Brunswick, Canada; and Dallas, Texas The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented. (Plast. Reconstr. Surg. 126: 2222, 2010.)

Submental Suction-Assisted Lipectomy without Platysmaplasty: Pushing the (Skin) Envelope to Avoid a Face Lift for Unsuitable Candidates; Joe M. Gryskiewicz, M.D.

The aging-associated morphological changes that are observed among patients seeking aesthetic facial rejuvenation include decreases in the thickness and elasticity of the skin and attenuation of the subcutaneous adipose tissue, especially in the temporal and buccal regions. In addition, there is decreased adherence of the skin to the underlying layers, gravitational descent of the soft tissues, and the formation of skin folds along the lines of skin adherence where the muscles of facial expression insert. Laxity in the lower face and submental areas develops because of loss of support from the superficial musculoaponeurotic system, as well as loss of elasticity of the skin and its attachments to the deeper tissues (except attachments to the facial skeleton through the osteocutaneous ligaments). The seemingly endless variety of approaches for correction of these deformities suggests that many techniques, when properly applied, can yield satisfactory results. After liposuction was added to the techniques available for facial rejuvenation, almost every patient underwent aspiration of subcutaneous fat in the face and neck. Improvement of facial and neck profiles had previously been achieved with open-scissors dissection and contoured removal of fat. I think that our techniques have now come full circle; first we performed contouring with scissors, then we used aspiration, and now in most cases we again rely on scissors for contouring or at least opening of the plane for vacuum cleaner-like suctioncontouring of fat in the neck. Because fat becomes attenuated with age, liposuction of the cheeks is reserved for rare cases involving overweight patients. The author’s technique for treating submental fullness with liposuction is not new, but he justifies its use by limiting the indications for the procedure, hoping to keep his patients’ expectations realistic. Postoperative use of a chin strap for external compression facilitates immediate adherence of the cervical skin to the underlying muscular fascia, as well as subsequent contraction of the skin. In my practice, I have not examined patients with submental fullness who were not suitable candidates for surgical procedures more extensive than liposuction alone. I perform rejuvenation of the neck through an open submental approach, which allows removal of supraplatysmal and subplatysmal fat, plication of the platysma muscles, resection of platysmal bands, and insertion of an implant for chin augmentation (if deemed necessary and desirable). These procedures are performed through a small incision that heals quite well; with fiber-optic exposure, hemostasis is achieved and significant tissue trauma is avoided. I prefer delicate scissors dissection for exposure and contouring, rather than closed-cannula dissection and aspiration. The author educates his patients to expect improvement but not a tight neck, as the photographs provided document. The author thinks that the shorter submental suctionassisted lipectomy procedure provided a reasonable alternative when his patients were unable or unwilling to undergo a face lift. I agree, but I either would not have surgically treated those patients or would have convinced them to undergo more-extensive surgical procedures, to obtain better results.