Chemical peel: a change in the routine

The use of occlusive taping following phenol chemical peel has become a standard technique. Many studies have demonstrated the effectiveness of tape occlusion in producing a deeper, more profound chemical peel. For the last 18 months, we have abandoned tape occlusion following phenol peel and have substituted an occlusive dressing using a thick layer of petroleum jelly (Vaseline). The occlusiveness provided by the petroleum jelly has proved to be almost as effective as the standard tape mask, and the results using this technique parallel those with a tape mask. The advantages of Vaseline occlusive dressing include greater patient comfort, the ability to evaluate the wound beneath the petroleum jelly, and the prevention of streaking, which can occur from uneven tape application. Eschar formation and crust separation are avoided after the peel by the constant use of facial lubricants, our preference being A & D ointment.

New horizons in surgical rejuvenation of the aging face

The development of aesthetic surgery as a major segment of plastic and reconstructive surgery is accepted among physicians. From a procedure at one time limited to the few, aesthetic surgery of the aging face has become commonplace. The patient seeking aesthetic surgery is attempting to improve self-image. The three major factors necessary for successful results are proper patient selection, a careful preoperative psychological evaluation, and expertise in carrying out the surgical procedure including management of complications. A total preoperative evaluation is essential to individualize the appropriate procedure which is correct for the particular patient.

Midazolam (Versed) in ambulatory surgery

Midazolam is a very useful drug in outpatient aesthetic surgery. Its principal advantages are (1) short duration of action (a half-life of 2.3 hours), (2) painless injection, (3) no incidence of postoperative phlebitis (as compared with diazepam), and (4) a high degree of safety and effectiveness. Since one of the main objectives in outpatient surgery is to have the patient recover as quickly as possible and be discharged without any significant drug hangover, we recommend the incorporation of midazolam into the armamentarium of the aesthetic surgeon. Subsequent to the presentation of this paper (Twentieth Annual Meeting of the American Society for Aesthetic Plastic Surgery, in Los Angeles, California, March 23, 1987), we have administered midazolam to an additional 400 patients undergoing outpatient surgery and no apnea has occurred requiring an airway or supportive respiratory measures.

Facial mimics and the coronal brow lift

The classic rhytidectomy leaves the upper third of the face without improvement. Yet the eye-eyebrow region is the most influential in determining facial expressions. There is only a narrow range of positions of the eyebrows in which they are perceived as attractive. The influence of the coronal browlift on facial mimics is discussed as it seems to be a way to predictably reposition the eyebrows and improve crow's feet and forehead, and glabellar wrinkles at the same time. The results of 56 patients surveyed 1-3 years postoperatively are presented.

Interleukin 1 of the central nervous system is produced by ameboid microglia

By screening specific populations of rat brain cells, we found that ameboid microglia secrete an 18 kD peptide with IL-1 biological activity. The IL-1 activity released by microglia was found to be identical to rat macrophage IL-1 on fractionation by gel filtration and high pressure liquid anion-exchange chromatography, and it was neutralized by an antiserum specific for murine IL-1. When added to astroglia grown in culture, microglial IL-1 increased the cell number of five- to sevenfold, and increased astroglial incorporation of [3H]thymidine by three- to fivefold. We propose that the proliferation of astroglia in specific brain regions may be regulated by the signaled release of IL-1 from activated microglial cells.

Characterization of ameboid microglia isolated from developing mammalian brain

Ameboid microglia are isolated from the cerebral tissue of neonatal rat by selective cell adhesion to plastic. Histochemical markers show that the microglial preparations are homogeneous (95 +/- 3%) and represent a 10% yield from starting cultures. Isolated ameboid microglia contain nonspecific esterase activity, the macrophage surface antigens MAC-1 and MAC-3, and acetylated low-density lipoprotein receptors. Ameboid cells have functional properties similar to those of macrophages, including the ability to engulf 5 micron latex beads, to secrete Interleukin-1 (IL-1) and to release superoxide anion. Unlike monocytes and adherent spleen cells, ameboid microglia do not show peroxidase activity by histochemical stain. Unlike resident peritoneal macrophages, ameboid microglia proliferate in vitro. Scanning electron microscopy shows that ameboid cells have short, spinous processes that can be distinguished from the ruffled surfaces of body macrophages. Our observations suggest that ameboid microglia are a distinct class of mononuclear phagocytic cells. Retinoic acid and dimethyl sulfoxide, agents known to accelerate differentiation in vitro, stimulate ameboid cells to develop thin processes several hundred microns in length. These "process-bearing" microglia eventually lose the capacity to engulf latex beads and to proliferate. They also show reductions in nonspecific esterase activity and in the binding of acetylated low-density lipoprotein. We suggest that in vitro ameboid microglia differentiate into nonphagocytic cells similar to ramified microglia found in normal adult brain. The isolation techniques described here provide the opportunity to study the composition and function of different microglial subpopulations during the development of the CNS.

Brain peptides and glial growth. I. Glia-promoting factors as regulators of gliogenesis in the developing and injured central nervous system

Glia-promoting factors (GPFs) are peptides of the central nervous system which accelerate the growth of specific glial populations in vitro. Although these factors were first discovered in the goldfish visual system (Giulian, D., Y. Tomozawa, H. Hindman, and R. Allen, 1985, Proc. Natl. Acad. Sci. USA., 83:4287-4290), we now report similar peptides are found in mammalian brain. The cerebral cortex of rat contains oligodendroglia-stimulating peptides, GPF1 (15 kD) and GPF3 (6 kD), as well as astroglia-stimulating peptides, GPF2 (9 kD) and GPF4 (3 kD). The concentrations of specific GPFs increase in brain during periods of gliogenesis. For example, GPF1 and GPF3 are found in postnatal rat brain during a peak of oligondendroglial growth while GPF2 and GPF4 are first detected at a time of astroglial proliferation in the embryo. Stab wound injury to the cerebral cortices of rats stimulates astroglial proliferation and induces marked elevations in levels of GPF2 and GPF4. Our findings suggest that two distinct classes of GPFs, those acting upon oligodendroglia and those acting upon astroglia, help to regulate cell growth in the developing and injured central nervous system.

Peptides released by ameboid microglia regulate astroglial proliferation

Peptides that stimulate astroglial proliferation are produced in traumatized adult rat brain by 10 d after injury. These same peptides are released by ameboid microglia activated in vitro. Our findings suggest that astroglial scarring is regulated in part by the release of factors from ameboid microglia near the site of brain injury.

Long-term histologic follow-up of phenol face peels

Deep phenol peels were done on 11 middle-aged white women with severe actinic damage. Subsequently, face lifts were carried out after periods of 1.5 to 20 years. This made it possible to obtain a full-thickness specimen extending several centimeters on either side of the border between peeled and unpeeled skin. In contrast to the markedly abnormal elastotic appearance of unpeeled skin, a new band of connective tissue 2 to 3 mm in width was laid down in the subepidermal region. Fine elastic fibers formed a dense network in the band of regenerated collagen. The disarray and cytologic abnormalities of sun-damaged epidermis were also largely corrected. Melanocytes were not eliminated, but melanin synthesis was evidently impaired, accounting for the bleaching effects. The effects of a phenol peel are very long lasting and adequately account for the effacement of wrinkles and obliteration of actinic keratoses, mottling, and freckling.

Chemical peeling as a practical method for removing rhytides of the upper lip

Chemical peeling is a safe, effective method for removing upper lip lines, or rhytides, over a long period of time. While the predictable, undesirable sequela of loss of pigmentation occurs in a significant number of patients, the effectiveness and safety of the procedure seem to outweigh this problem. Chemical peeling has become an accepted and effective tool for eliminating upper lip lines due to aging, and should be considered by physicians undertaking treatment of the wrinkled upper lip.

Chemical peel

Chemical face peeling as described in this article produces gross and microscopic changes in the skin which are permanent. The most important aspect in assuring the success of this procedure is the proper selection of patients. The primary use of this procedure is for the purpose of eliminating wrinkles, whether as the primary or ancillary procedure, such as regional peeling. Chemical peeling of the face is a valuable adjunct in the treatment of the aging face and can produce some rather dramatic results with the careful selection of patients and meticulous attention to detail in carrying out the peel, as well as the exact adherence to the post peel instructions by the patient.

Upper lid blepharoplasty

We reviewed, retrospectively, our upper lid blepharoplasties to critically compare our own postoperative results after (1) conventional blepharoplasty, or (2) fixation of the levator aponeurosis to the lower margin of the orbicularis, or (3) fixation of the levator to the lower margins of the orbicularis and the skin. We found no demonstrable difference in our results with these 3 techniques. It is our opinion that the standard conventional blepharoplasty (including excision of a strip of orbicularis muscle) is preferable for use in most caucasian eyelids. The results are as good, it is simple, and it is less likely to cause problems.

Rhytidectomy: a statistical analysis

A statistical analysis of 1,500 consecutive rhytidectomies is presented. In rhytidectomy, complications occur in a significant percentage of the operations. The plastic surgeon must be aware of the incidence and significance of these complications, and also he must know how to avoid or manage them.