Richard C. Webster

Comparison of SMAS plication with SMAS imbrication in face lifting.

Undermining and imbricating the superficial musculoaponeurotic system (SMAS) have been advocated by many recent authors to enhance the results of face lifting procedures. Because all undermining has dangers, we compared in 5 fresh cadavers and 15 patients the immediate operative effects on the labial commissures, buccolabial grooves, submental areas, and cervicomental regions of undermining and imbrication with those of plication without any undermining. Closures were made on both sides and with each technique with the layers pulled to their limit of stretch. We found no significant difference between the two methods in the effects on the areas mentioned.

Wound closure with absorbable sutures

For many years, we have used 6-0 catgut for closure of epithelial and superficial dermal wound edges. Only when absolutely necessary do we use deeper dermal or subcutaneous sutures. The superficial suturing is supplemented with antitension skin taping. Details of the technique are presented and reasons why satisfactory results occur are postulated. The recommended techniques have been used in closure of wounds on the face and body. It is emphasized that only certain catgut and antitension taping products work well.For many years, we have used 6‐0 catgut for closure of epithelial and superficial dermal wound edges. Only when absolutely necessary do we use deeper dermal or subcutaneous sutures. The superficial suturing is supplemented with antitension skin taping. Details of the techniques are presented and reasons why satisfactory results occur are postulated. The recommended techniques have been used in closure of wounds on the face and body. It is emphasized that only certain catgut and antitension taping products work well.

External marking in rhinoplasty planning

Photographs, drawings, and examination at consultation have value in rhinoplastic planning. However, the surgeon is not operating on photographs, drawings, or an alert sitting or standing patient; he is operating on a nose with what was forward now facing upward. We find it most helpful to plan and mark almost the entire procedure on the external nose and surrounding structures just before the patient is put supine and sedated or anesthetized.