Deep Neck Lift: Defining Anatomical Problems and Choosing Appropriate Treatment Strategies

A well-contoured neck is an artistic imperative to an attractive and appealing appearance. A good neckline conveys a sense of youth, health, fitness, confidence, and vitality and lends an appearance of decisiveness, sensuality, and beauty. Neck improvement is of high priority to almost every patient seeking facial improvement, and the results of "face lift" procedures are judged largely by the outcome obtained in the neck. If the neck is not sufficiently improved, our patients will often feel we have failed them. Despite the fact that it is a common practice, it is not enough to perform submental liposuction and tighten the skin and platysma in most patients as such an approach ignores a number of anatomical problems present in many patients seeking neck improvement including excess subplatysmal fat, large submandibular glands, and digastric muscle hypertrophy and malposition. Removing subcutaneous fat and tightening skin and platysma over these problems does not correct them, and the presence or absence of each must be looked for in order to create and apply an appropriate surgical plan. Success or failure in treating the neck lies in the diagnosis of underlying problems and the application of a logical surgical plan to correct them. Any surgeon capable of identifying the anatomic basis of patient problems and forming a sound plan for their correction will achieve excellent outcomes.

High SMAS Facelift: Combined Single Flap Lifting of the Midface, Cheek, and Jawline

The traditional deep plane and "low" cheek superficial musculoaponeurotic system (SMAS) flaps elevated below the zygomatic arch suffer the drawback that they cannot, by design, exert an effect on tissues of the midface and infra-orbital region. Traditional deep plane and low designs target the lower cheek and jowl only and produce no improvement in the upper anterior cheek and "midface" area. Planning the flap "higher," along the zygomatic arch, and extending the dissection medially in an "extended SMAS" fashion to release and mobilize midface tissue, overcomes this problem and allows a combined, simultaneous, single flap lifting of the jawline, cheek, and midface. An improved outcome is obtained in many patients and no separate midface lift procedure is needed.

Periorbital Fat Grafting: A New Paradigm for Rejuvenation of the Eyelids

Fat grafting represents the most important new addition to surgical procedures to rejuvenate the orbit since the inception of the "blepharoplasty" technique. Traditional blepharoplasty procedures do not always address the changes that occur with age in the orbital area and can actually degrade the appearance of the eye. Fat grafting allows treatment of age-associated loss of periorbital volume not addressed by traditional blepharoplasty procedures. Fat grafting is an artistically powerful method to rejuvenate the periorbital orbital area that often provides a more healthy, fit, youthful, and sensual appearance than traditional blepharoplasty procedures.

Bacillus thuringiensis (Bt) toxin susceptibility and isolation of resistance mutants in the nematode Caenorhabditis elegans

The protein toxins produced by Bacillus thuringiensis (Bt) are the most widely used natural insecticides in agriculture. Despite successful and extensive use of these toxins in transgenic crops, little is known about toxicity and resistance pathways in target insects since these organisms are not ideal for molecular genetic studies. To address this limitation and to investigate the potential use of these toxins to control parasitic nematodes, we are studying Bt toxin action and resistance in Caenorhabditis elegans. We demonstrate for the first time that a single Bt toxin can target a nematode. When fed Bt toxin, C. elegans hermaphrodites undergo extensive damage to the gut, a decrease in fertility, and death, consistent with toxin effects in insects. We have screened for and isolated 10 recessive mutants that resist the toxin's effects on the intestine, on fertility, and on viability. These mutants define five genes, indicating that more components are required for Bt toxicity than previously known. We find that a second, unrelated nematicidal Bt toxin may utilize a different toxicity pathway. Our data indicate that C. elegans can be used to undertake detailed molecular genetic analysis of Bt toxin pathways and that Bt toxins hold promise as nematicides.