John Q. Owsley

Update: lifting the malar fat pad for correction of prominent nasolabial folds.

The malar fat pad suspension technique is a safe and effective method for rejuvenation of the aging midface. When combined with the SMAS-platysma rotation flap face-lift as a multi-vector technique, most of the changes that occur with aging are addressed and corrected in an anatomic fashion, resulting in an aesthetically pleasing result. Careful attention to the tension and position of the suspension suture enhances the improvement of the infraorbital flattening as well as correcting the excessive prominence of the nasolabial fold.

Histological investigation of the etiology of capsule contracture following augmentation mammaplasty.

Sections obtained from contracted breast capsules were examined by light and electron microscopy. We observed the presence of multiple areas of a particulate foreign material, consistent with the appearance of droplets of dimethylpolysiloxane. An active foreign-body reaction was observed at the interface of the capsule and implant, as well as throughout the tissue subjacent to the deposits of foreign material. Based on these histological observations, we present a theoretical explanation of the etiology of capsular contracture of the breast after augmentation mammaplasty.

SMAS-platysma face lift.

Correction of laxity in the submental area and of hypertrophic neck cords has been enhanced with the SMAS-platysma face life over that which was achieved with a standard skin face lift. Evaluation of a 6-year experience with the SMAS-platysma face lift reveals that the operation can be safely performed with an acceptably low incidence of complications. The incidence of hematoma and associated complications is less than that which occurs when cervical and submental defatting is performed in conjunction with a skin face lift.

Platysma-fascial rhytidectomy: a preliminary report.

The technique of platysma-fascial rhytidectomy is based upon the anatomy of the platysma muscle and the superficial facial fascia. The operative procedure is described in detail, and the advantages and disadvantages of this method are listed.

Resection of the prominent lateral fat pad during upper lid blepharoplasty.

: The presence of a lateral fat pad beneath the orbicularis muscle, which overlies the lateral orbital rim, is described in patients who have marked bagginess of the upper lid and a bulky hood of tissue extending well beyond the lateral canthal region. This fat is separate from the fusiform central fat pad and lies superficial to the orbital septum. Resection of a strip of orbicularis muscle and the underlying lateral fat pad, in addition to the routine removal of central and medial fat pads, provides an enhanced appearance and complete correction of the lateral hood in such individuals.

THE RE-DO PHARYNGEAL FLAP

Twelve patients with persistent hypernasal speech after a previous pharyngeal flap operation had a second pharyngeal flap operation performed by the high-attached technique. Six of them achieved complete or near complete correction of hypernasality in connected speech. Four showed speech improvement of a lesser degree. Two patients had no significant improvement.

Discussion: Medial Approximation of the Platysma Muscle in the Treatment of Neck Deformities

The platysma muscle has become recognized as a key to the correction of deformities of the neck. We believe that the decussation of the medial fibers of the platysma muscle is critical to the support of the submental region and is a factor in the pleasing angle between the neck and the chin. The approximation of the medial borders of the platysma has been described in combination with other direct approaches to the anterior neck or with aggressive repositioning or flaps of the platysma. We have achieved pleasing results in the treatment of neck deformities in a variety of clinical situations by medial approximation of the platysma through a short submental incision without other manipulations of the platysma and without complications in 45 patients. All have been followed more than 1 year.