Javier de Benito

Galea and subgalea graft for lip augmentation revision

In this paper we will review the results obtained during the last 2 years with the aponeurotic galea and subgalea for vermillion lip augmentation. The survey was carried out on 42 patients who displayed either an absence of or reduction in the vermillion of one or both lips or a senile lip. In all cases the surgical procedure introduced aponeurotic galea and subgalea in the space found between the orbicular lip muscle and the vestibular mucus, just behind the vermillion. All the operations were performed under local anaesthetic.The size of the aponeurotic galea fragment removed varied in length between 10 and 12 cms. and in width between 1 and 2 cms., using the following parameters for its dimensions: the previous volume of the lips, and the distance between the two buccal commissures when in the “smile position.”

Periareolar Techniques for Mammary Reduction and Elevation

Between June 1990 and June 1992 we carried out 56 breast operations: 18 reductions, 32 mastopexies, and 6 implant changes. The surgical techniques used in all cases basically consisted of three phases: the periareolar incision, the creation of the superior pedicle with two medial and lateral flaps, and the “anchoring,” crossed by both flaps in order to hold up the mammary gland. The diameter of the “doughnut” of skin that we had to deepidermize varied between 5 and 15 cm, thus raising the nipple-areola complex by as much as 10 cm. The volume of tissue removed from the hypertrophic breast ranged from 70 to 520 g. In 24 of the 32 mastopexies, the use of a silicone implant was necessary in order to provide greater volume, texture, and better mammary contour. In these cases the size of the prostheses varied between 120 and 300 cc. All patients completed the postop followup in the normal way. Only three patients suffered a slight dehiscence of the periareolar suture, which was solved within a few days of the operation by means of a Friedreich. The periareolar cutaneous pleats and the hardness of the breast gradually disappeared, as predicted, within a period of 3–4 months; afterward the breast looked perfectly natural.

Treatment of depressed scars with a dissecting cannula and an autologous fat graft.

Contemporary options for the improvement of depressed scars include scar revision with an elliptical excision, z-plasty, w-plasty, and geometric broken-line closure. Dermabrasion and laser treatment has been used to obtain a uniform skin surface. When scars are hypertrophic, intralesional steroids and silicone pressure therapy may be useful. Occasionally, scars may be adherent to the underlying fascia. The resulting depression along the length of the scar worsens the aesthetic deformity. Fat injection is an established method for treating depressions and contour deformities. We report encouraging results with the use of this fat injection technique into a pocket made with a sharp cannula in treating 30 patients with postsurgical scars that were depressed and adherent to the underlying fascia. This technique is a useful addition to the surgeon’s resources when treating scars.

Aesthetic incision in the subcutaneous forehead lift

The forehead plays a relevant role, perhaps the most important role, in what we shall call the topographical area of the orbital rims, since it flaccidity causes the eyebrows to droop, thus dragging down the upper eyelid and producing skin redundancy. Most published works on the subject of the forehead lift describe the classic coronal incision, with subgalea dissection involving an individualized design for each patient, according to the density of the hair. However, when the forehead has hair growing high on the head, the coronal incision becomes an anterior incision, following the first hairline. However, this has the same problems as the coronal incision, namely, anesthetizing the posterior part of the scar and, in some cases, depression of the scar on the edge of the flap caused by the retraction of the galea and the inadequate elimination of forehead furrows. Over the past two years, the author has used a nonlinear anterior incision with subcutaneous dissection in many select cases.

Rhinoplasty and the aesthetic of the smile

The resection of the columella and nasal depressor muscles is a simple operation to perform and one which allows an improvement in the facial physiognomy of many patients. This operation can be done alone or in conjunction with the classic rhinoplasty, thus achieving an improvement in the aesthetics of the smile. It has also been proved, contrary to common belief, that the action of these muscles has no connection with physiological breathing mechanisms.

Key Points in Mastopexy

Breasts represent femininity and any change of shape may affect their appearance. Breast ptosis may be caused by several factors, including significant weight loss, pregnancy, long breastfeeding periods, and involution of the postmenopausal breast tissue. Breast ptosis may be associated with breast hypoplasia; thus, in case of a mastopexy with or without the use of implants being indicated, several considerations have to be taken into account: the wishes of the patient, age of the patient, degree of ptosis, parenchymal volume, covering tissue, quality of the tissue, pocket implant, shape and content of the implant, and resulting scars.

Absorbable Screws in Endoscope-Assisted Forehead Lifting

Many methods have been used to make the soft tissue fixation in endoscope-assisted forehead lifting (EAFL). Since we started doing EAFL, we have employed the fixation with stainless screws and absorbable screws. After noticing that the temporary fixation with metallic screws had some negative effects, we changed to temporary fixation by bioabsorbable (polylactic acid copolymer) screws. The purpose of this study is to transmit our experience and to comment on some points that we believe will improve this method. Our study includes the endoscopic surgeries we have performed over the last four years. Ninety-nine patients were operated on. In 61 of them, absorbable screws were used. We have had very good results using these screws without important complications. We think that they offer a great improvement to endoscopic facial surgery.

Secondary Breast Augmentation: Managing Each Case

Breast augmentation is one of the most regularly performed interventions requiring reoperation in aesthetic surgery. For this reason, it involves a greater chance for complications. In this report, the authors aim to provide young plastic surgeons with guidelines based on their experience for responding to each of these complications, to explain the causes and ways of avoiding them, and to show how they can be treated when they occur.

Suspension of the gluteal region with silhouette sutures.

The authors present their minimally invasive gluteopexy technique, using polypropylene 2-0 sutures with 10 absorbable polylactic cones in their distal section (Silhouette Lift, Irvine, California) to improve the anteroposterior projection of the gluteal region. Histological study of the reaction of adipose tissue surrounding the cones previously has shown that, 3 months after insertion of the sutures, fibrous scar tissue is sufficiently developed to resist the weight of the tissues. On the basis of this finding, the authors decided to perform the gluteopexy with sutures, in 2 surgical steps. During the first step, the sutures are inserted in the adipose tissue without any proximal fixation. In the second step, performed 3 months after the first procedure when the fibrous reaction is more solid, the sutures are tightened to obtain the gluteopexy. Among the advantages of this technique are its simplicity, the fact that it produces no traumatic effects, and the fact that it can be performed with local anesthetic, reducing surgical time. It is also possible to combine this procedure with lipofilling or liposuction techniques.

Suspension Sutures for Neck Rejuvenation

Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of