Sherrell J. Aston

Propranolol-epinephrine Interaction: A Potential Disaster

Presented here are six examples of potentially life-threatening propranolol-epinephrine interactions. The only report found that warns of a deleterious clinical interaction between propranolol and epinephrine appeared in 1980. With widespread use of propranolol for approved and unapproved conditions, the population at risk is significant. All physicians and dentists using local anesthetic with epinephrine should be aware of this interaction.

Ocular Manifestations and Treatment of Hemifacial Atrophy

Enophthalmos, flattening of the maxilla that may progress to inferior orbital rim and floor defects, eyelid atrophy, and slight relative hypotony occurred in patients with hemifacial atrophy. Less common manifestations included pupillary and iris abnormalities, vertical muscle imbalances, and retinal changes. The prognosis for vision was good. Fluid silicone injection was the major modality in treatment and the results were generally excellent.

A clinical evaluation of the results of submusculo-aponeurotic dissection and fixation in face lifts.

In 25 random patients undergoing rhytidectomy, we did unilateral subplatysmal-fascial dissections of the superficial musculoaponeurotic system (SMAS) of the face and neck--with redistribution of the tension of this system and fixation by suturing. Late evaluation of these patients by 3 observers showed no detectable difference in the results, as compared to the other side on which the standard technique of skin flap elevation alone was done. Our investigation did not study the usefulness of more extensive dissections of the muscle with complete transection excision of segments of it, or the formation of long muscle flaps.

The male rhytidectomy.

More men are undergoing rhytidectomy now. This operation is specifically different in the preoperative planning, the surgical procedure, the postoperative complications, and the final results (compared to rhytidectomy in females). Large hematomas occurred in our male patients more than twice as often as in females.

Orbicularis Oculi Muscle Flaps: A Technique to Reduce Crows Feet and Lateral Canthal Skin Folds

Flaps of the lateral orbital portion of the orbicularis oculi muscle splayed out and sutured under tension help smooth skin folds and reduce wrinkles in the lateral canthal area.

A comparison of capsule formation following breast augmentation by saline-filled or gel-filled implants

A retrospective analysis of data on 307 patients was made. The incidence of firmness in breasts augmented by saline-filled prostheses was compared to the incidence in breasts augmented by gel-filled prostheses. A statistically significant lower rate of constricting capsule formation was found in the saline-inflated group.

Neurosensory Preservation in Endoscopic Forehead Plasty

The recent introduction of endoscopic techniques and instrumentation in aesthetic surgery was caused in part by the desire to minimize surgical scars as well as to decrease the possibility of sensory changes secondary to extended incisions, such as the execution of a coronal incision in performing a forehead plasty. Although endoscopic surgical techniques provide field magnification together with excellent illumination, localization and preservation of the forehead neurovascular bundles via the endoscope can be time consuming and tedious. A new method is introduced where percutaneous localization of the supraorbital and supratrochlear nerves enables the surgeon to perform an endoscopic forehead plasty in an expeditious manner with preservation of sensation of the forehead and scalp.

Malar augmentation with silicone implants.

This study is a retrospective review of all consecutive surgeries involving insertion of silicone malar implants performed at the Manhattan Eye, Ear and Throat Hospital from January 1, 1985 to April 30, 1993. Sixty-four patients underwent placement of 126 silicone malar implants. Three different sizes were utilized: 23 size 1, 85 size 2, and 18 size 3. Eleven patients underwent unilateral implant placement, all for reconstructive purposes. The average and median ages of the patients were 43 and 44 years, respectively, with a range of 18 to 83 years. Malar implants were inserted for the following reasons: hypoplasia, post-traumatic deformity, post-tumor resection deformity, and correction of hemifacial microsomia. In 79 percent of the patients, malar augmentation was performed in conjunction with other surgical procedures. All implants were placed in a subperiosteal pocket by either the intraoral, subciliary, or preauricular approach. Forty-one percent were fixed in place by percutaneous sutures. Malar augmentation with silicone implants for both aesthetic and reconstructive purposes is an increasingly common surgical procedure. Good results are obtained with few complications. Infection is rare even with transoral placement. Silicone malar implants should be placed in a subperiosteal pocket and can be inserted safely through various routes. Malpositioning of implants is infrequent, and fixation sutures are not required. The most common problem is improper size selection. Patient satisfaction is high, in that no patient underwent permanent removal of a malar silicone implant once inserted.

Influence of steroids on postoperative swelling after facialplasty : a prospective, randomized study

Steroids are widely used in facial aesthetic surgery to reduce postoperative edema. We performed a randomized, double-blind study to try to document the effectiveness of this practice. Fifty consecutive facialplasty patients of one surgeon were randomized to steroid and no steroid groups. Steroid group patients received betamethasone 6 mg IM preoperatively. Postoperative scoring of swelling was performed at approximately days 5 and 9 by a single observer. There were no significant differences between the two groups at either postoperative interval or in the rate of improvement. Subgroups of patients who underwent additional procedures also showed no significant differences. We were not able to demonstrate any statistically significant difference in swelling after facialplasty with this steroid regimen.

An anatomical comparison of transpalpebral, endoscopic, and coronal approaches to demonstrate exposure and extent of brow depressor muscle resection.

BACKGROUND Approaches for exposure of the muscles of brow depression include transpalpebral, endoscopically assisted, and open coronal techniques. The purpose of this anatomical study was to compare the capacity for visualization and amount of brow depressor muscle resection with each technique. METHODS The corrugator supercilii, depressor supercilii, medial orbicularis oculi, and procerus muscles were studied by gross anatomical dissection carried out on 24 sides of 12 cadaver heads. First, all visible corrugator and depressor supercilii muscles were resected by means of an upper blepharoplasty incision. Subsequently, a subgaleal endoscopic approach was used to evaluate the extent of resection performed and remove the remaining muscle after transpalpebral corrugator resection. This was followed by coronal exposure to assess the anatomical location and extent of muscle resection accomplished by the two previously mentioned techniques. RESULTS In all dissections, endoscopy demonstrated that up to one-third of the lateral aspect of the transverse heads of the corrugator supercilii remained following transpalpebral resection. Oblique corrugator head resections were complete, without significant residual muscle following transpalpebral corrugator resection. The procerus muscle was able to be blindly transected by means of the transpalpebral incision but exposed and ablated in all 12 specimens using endoscopy. Coronal exposure demonstrated that no significant amount of corrugator, depressor supercilii, or procerus muscle remained in any of the 12 heads following endoscopically assisted exposure and resection. The medial head of the orbital portion of the orbicularis oculi was visualized and accessible regardless of the technique used. CONCLUSIONS In 24 anatomical dissections, transpalpebral corrugator resection failed to remove up to one-third of the transverse head of the corrugator muscle. Removal of the brow depressor muscles was accomplished with the endoscopic approach, as confirmed by coronal exposure.