Peter McKinney

Liposuction and the treatment of nasolabial folds.

We investigate whether the application of liposuction to the nasolabial region is a useful adjunct to the rhytidectomy procedure. We have devised a system to grade the severity of the depth and the length of the nasolabial folds pre-and postoperatively. This grading system was used to evaluate the nasolabial region in 60 consecutive patients who underwent rhytidectomy. We compared two subgroups: those who underwent rhytidectomy alone (Group I) and those who underwent rhytidectomy augmented by liposuction in the region of the nasolabial folds (Group II). A change in the length of the fold occurred in 2% of Group I and in 30% of Group II. A change in depth of the fold occurred in 12% of Group I and in 70% of Group II. These results suggest that suction-assisted lipectomy consistently improves the results of rhytidectomy in the region of the nasolabial fold.We investigate whether the application of liposuction to the nasolabial region is a useful adjunct to the rhytidectomy procedure. We have devised a system to grade the severity of the depth and the length of the nasolabial folds pre-and postoperatively. This grading system was used to evaluate the nasolabial region in 60 consecutive patients who underwent rhytidectomy. We compared two subgroups: those who underwent rhytidectomy alone (Group I) and those who underwent rhytidectomy augmented by liposuction in the region of the nasolabial folds (Group II). A change in the length of the fold occurred in 2% of Group I and in 30% of Group II. A change in depth of the fold occurred in 12% of Group I and in 70% of Group II. These results suggest that suction-assisted lipectomy consistently improves the results of rhytidectomy in the region of the nasolabial fold.

Calibrated alar base excision: a 20-year experience.

Conflicting guidelines for excisions about the alar base led us to develop calibrated alar base excision, a modification of Weirs approach. In approximately 20% of 1500 rhinoplasties this technique was utilized as a final step. Of these patients, 95% had lateral wallexcess (“tall nostrils”), 2% had nostril floor excess (“wide nostrils”), 2% had a combination of these (“tall-wide nostrils”), and 1% had thick nostril rims. Lateral wall excess length is corrected by a truncated crescent excision of the lateral wall above the alar crease. Nasal floor excess is improved by an excision of the nasal sill. Combination noses (e.g., tall-wide) are approached with a combination alar base excision. Finally, noses with thick rims are improved with diamond excision. Closure of the excision is accomplished with fine simple external sutures. Electrocautery is unnecessary and deep sutures are utilized only in wide noses. Few complications were noted. Benefits of this approach include straightforward surgical guidelines, a natural-appearing correction, avoidance of notching or obvious scarring, and it is quick and simple.

Complications of Face Lift Surgery

Dr. Kaye: The first case is a patient shown with hair loss—or, perhaps more accurately, repositioning of the hair—after undergoing a face lift (Figure 1). Dr. Connell, how does one avoid this type of problem? Figure 1. Patient shown with repositioning of the hair after undergoing face lift. Dr. Connell: In the preoperative evaluation, I carefully examine the patient, pinching the skin to determine how the hair will shift as a result of surgery. If the amount of skin that will be moved toward the temple area would shift the hair to an objectionable degree, I discuss this with the patient. The choices are either having a scar that follows along the hairline, which is not ideal but rarely causes a problem, or having the hairline shift. Most of my patients opt for the incision along the hairline, but there may be some who would not object to the hair shifting. Dr. McKinney: I would have avoided this patients problem by not trying to lift the midface so much by means of the temporal incisions. I find that an endoscopie brow lift offers a better option for achieving similar improvement to the mid or upper face, and it avoids shifting the hairline. Dr. Stuzin: The key is in the design and control of the incisions. A good scar that is imperceptible is a much better alternative than hairline alteration. Dr. Kaye: What treatment would you recommend for this patients current problem? Dr. Connell: We used to try various flaps, and some of my colleagues had success with derotating and then correcting the defect on top. However, today the results of micrografts and single-hair grafts are very good. I have sent this type of patient to a colleague for micrografts, and the outcome has been excellent. Bernard L Kaye, MD Bruce F. Connell, …

Herpes zoster as a complication of a face lift

A case of herpes zoster neuritis (shingles) is reported, closely following a face lift with adjunctive dermabrasion and chemical peel. The etiologic relationships are unclear. However, the mental nerve distribution suggests mechanical irritation of the nerve as a possible factor. Management of this complication is conservative. It is suggested that herpes zoster be included in the differential diagnosis of unusual alterations of sensation or persistent pain following procedures for facial aging.A case of herpes zoster neuritis (shingles) is reported, closely following a face lift with adjunctive dermabrasion and chemical peel. The etiologic relationships are unclear. However, the mental nerve distribution suggests mechanical irritation of the nerve as a possible factor. Management of this complication is conservative. It is suggested that herpes zoster be included in the differential diagnosis of unusual alterations of sensation or persistent pain following procedures for facial aging.

Avoiding secondary rhinoplasty

Secondary rhinoplasty can be avoided by careful analysis of the preoperative anatomy, the patients goals, and meticulous execution of the rhinoplasty. In addition, knowledge of the problems that more commonly cause revision will allow the surgeon to avoid these pitfalls. In this article, we concentrate on the most likely causes of a secondary rhinoplasty in the dorsum, lobule, and airway and how to avoid them.

Secondary upper eyelid blepharoplasty

Peter McKinney, MD Andre Camirand, MD James H. Carraway, MD Steven Fagien, MD Dr. McKinney: The first patient is a 41-year-old woman who had a bilateral upper-eyelid blepharoplasty 3 months ago. She is unhappy with pigment changes in her upper lid and complains that her scar is too high (Figure 1). Dr. Fagien, how do you control scar height in the upper lid, and what scar level is best for a patient such as this one? Figure 1 This 41-year-old woman is unhappy with color changes in her upper lid and complains that the scar is too high 3 months after upper eyelid blepharoplasty. Dr. Fagien: With good incision planning, you can often avoid these obvious color changes and an overly high visible scar. This scar appears to be positioned at about 14 mm, suggesting that the planned incision was at least at 10 mm or higher and was possibly placed at or near the patients natural crease at the time of surgery — a common mistake. I design the crease incision much lower, typically at 7 to 9 mm, which begins the process of regaining the youthful upper-eyelid configuration and includes both a lower-positioned upper-eyelid crease and fold, along with more supratarsal volume and fullness.1 I consider many factors with this design, including the height of the incision, the location of the eventual crease, the contour of the crease, the contour of the ellipse that I design, and the ultimate distance of the eyebrow from the eventual crease. You can notice, even in the medial aspect of her upper eyelid, that the incision is very close to her brow, even more so on the left side. It starts off low, but it has a curvilinear arch that approaches the brow. My incision planning would be far lower. And you can …

Management of the Lower Eyelid

Peter McKinney, MD Sam T. Hamra, MD Andre Camirand, MD Allen M. Putterman, MD Dr. McKinney: Blepharoplasty, much like rhinoplasty, has evolved from a procedure of simply removing skin and fat to one of shaping and repositioning these structures, especially the fat. Our current thinking about blepharoplasty has been shaped by the work done by Drs. Leob and De LaPlaza in the 1970s and 1980s. The first patient (Figure 1) is a 55-year-old woman who is in good health and would like improvement in the appearance of her eyes. Dr. Camirand, what potential problems do you see for this patient, and how would you correct them? Figure 1 A 55-year-old woman seeks improvement of the tired look in her eyes. Dr. Camirand: Assuming that this patient is in good health, I would not discuss thyroid ophthalmopathy. First, her brow is too low, which reduces the distance between the brow and the lashes. She also has dynamic and static crows feet, enophthalmia, and a sunken upper eyelid—more on the right side than on the left. The lateral canthus is low, causing scleral show. She also has actinic skin damage and a prominent infraorbital sulcus because the premalar fat pad has descended. For this patient I would consider doing a brow lift and a canthopexy to raise the lateral canthus. I think she would need a release of the lid retractors and a spacer in the posterior lamella as well to support the lower eyelid. I would relocate the orbital fat rather than excise it. In addition, I would consider lifting the premalar fat pad and eventually resurfacing her skin. Dr. Hamra: Because this patient is 55 years old, I would consider doing surgery on the eyes, brows, and complete face. The lower eyelids are the secret to achieving a good result. I would …

Augmentation mammaplasty using a non-inflatable prosthesis through a circum-areolar incision

Abstract A technique for augmentation mammaplasty with non-inflatable prostheses through a circumareolar incision is described. It has been successful thus far for 4 patients, and offers predictably less scarring. The question as to whether this approach has a greater hazard of nipple paraesthesia is raised.

A note on fixation techniques

To the Editor: I enjoyed the article by Dr. W. Grant Stevens and colleagues on “The Endotine: A New Biodegradable Fixation Device for Endoscopic Forehead Lifts” (2003;23:103-107), but I must correct their citation of …

The purse-string reduction mammaplasty: a variation of the marconi technique to minimize inframammary scars

Fourteen patients underwent an inferior pedicle breast reduction modified to significantly reduce the transverse inframammary scar. The technique is described and its results and limitations are discussed. We believe this technique provides the benefits inherent in an inferior pedicle procedure while avoiding the sometimes objectionable inframammary scar, especially for breasts in which the resection is less than 600 g.