[Endoscopy and face-lift]

For many years, the face-lift has not been the only intervention for facial rejuvenation. It is necessary today to specify the type of face-lift, cervico-facial lifting, frontal lifting or facelift. We will consider in this article the frontal lift and centro-facial lift and its possible execution assisted by endoscopy with therefore minimal scars, hidden in the scalp. We will consider successively its technique, its indications and its results highlighting a very long hold over time.

Endoscopic deep periorbital lifting: study and results based on 50 consecutive cases

The endoscopic deep periorbital lifting is a surgical technique for rejuvenation of the upper two-thirds of the face. The operative principle is the suspension of the premalar tissues to the superficial temporal aponeurosis. This operation decreases the height of the inferior eyelid, corrects the nasolabial fold, and enhances the relief of the cheekbone. We have studied 50 consecutive cases operated on between 1995 and 1999; 70% had good to excellent results. The cutaneous palpebral resection must be inferior or equal to 5 mm to avoid the risk of a postoperative round eye. The subperiosteal undermining of premalar tissue gives the best results and lowers the risk of transitory facial paresis.

[Surgical classification of androgenetic baldness and its therapeutic implications]

In order to understand the various operative indications in baldness surgery, we describe a dynamic classification of baldness with practical implications. The most predictive factors of this classification are scalp laxity and the height of the crown.

Treatment of male pattern baldness and postoperative temporal baldness in men

The use of plastic surgery techniques such as flaps and reductions has resulted in dramatic progress in the treatment of baldness. The operative indications are difficult because of the variety of baldness and the multiple techniques available. Surgeons place themselves at a disadvantage by refusing a specific technique, and this may harm the patient. Surgeons should establish a careful plan before undertaking the treatment of a patient, to make maximum use of the techniques that are available. We prefer flaps and reductions to grafts because of the decrease in the number of operations and time required to obtain a good result. We have described our personal classification, which takes into account the distribution of the hair, the density in each region, and the position of the frontal and temporal hairlines. This enables us to be more precise as to the indications and limitations of surgery. Different modern techniques have been described, concentrating on major reductions or scalp lifts as described by the author, which results in advancement of the crown 6 cm posteriorly and between 2 and 3 cm laterally. Dramatic results can be obtained if one or two vertical flaps are raised during the same operation. Vertical flaps provide a better result than horizontal flaps because they provide a deep android recession and natural forward hair growth. These techniques have the advantage of providing a rapid and aesthetic result after each operation as compared with punch grafts, which require long periods of time before obtaining a reasonable result. Finally, we propose a rapid, easy, two-stage procedure for extensive baldness that combines a one-stage preauricular flap with a scalp lift. The aesthetic result is good and may be completed by another reduction or by punch grafts.

The one-stage preauricular flap for male pattern baldness: long-term results and risk factors

Following a review of the operative technique for a single-stage vertical flap for reconstruction of the frontal hairline, we present a series of 156 such flaps with a minimum follow-up of 6 months. Risk factors for necrosis or alopecia of the distal end of the flap include retroauricular design and cigarette smoking. There was not a single case of necrosis in nonsmokers with flaps shorter than 16 cm. Finally, we demonstrate that the final appearance of the donor site is directly related to the tension under which it is closed.

Treatment of male baldness

Indications for surgical treatment of male baldness are usually related to the capability and experience of the surgeon. Based on the technique of the one-stage vertical flap described at the VIIIth International Congress of Plastic Surgery (Montreal 1983), we propose a system for management of the different types of baldness. Flaps, bald scalp resections, and punch grafts are used, depending on the extent and the topography of the baldness.

Aesthetic surgery of the medial thigh

Aesthetic surgery of the medial thigh is indicated in three instances: excess of skin, localized steatomery, and diffuse obesity after loss of weight. In the first two cases it is possible to limit scarring to the gluteal fold. In obese patients the functional benefits of a combination excision-suction lipectomy outweigh the disadvantages of the scarring over the medial thigh.

Treatment of male pattern baldness with one-stage flap

A 1-stage correction of baldness is described, using a vertical preauricular or retroauricular flap, and employing local anesthesia rather than general anesthesia.

[Evaluation of 10 years of surgical treatment for decubitus ulcer]

The authors report a series of 67 patients presenting with 103 decubitus ulcers, treated between 1969 and 1977, and with a follow-up of one year or more. The majority of the patients were paraplegics, other etiologies being present in smaller numbers and raising different problems. They first studied the importance of the pre-and post-operative treatment. This was followed by study of the importance of different surgical techniques for each of the three localizations (sacral, ischial and trochanteric). They demonstrated the absolute need for surgical management, especially with paraplegic patients. Surgery alone allows rapid healing with a high success rate. While it does not, however, preclude any possibility of recurrence (whatever the technique used), it does at least allow the patient to live a normal life. The authors further emphasize the importance of the preoperative treatment, using the nutripump, and the postoperative treatment, using the pulsating air bed (in preference to the water bed). They consider the nutripump to be the most important breakthrough in this field, in recent years. As regards the different localizations, they consider muscle or musculocutaneous flaps to be the treatment of choice for ischial ulcers, but stress the need for wide ischiectomy and the excision of the bursa. In their experience, insufficient excision is a source of failure, even if the flap is good. Similarly, musculocutaneous flaps offer the best solution for trochanteric ulcers, but again, only accompanied by excision of the bursa. Recognition of coxofemoral arthritis is also essential, and no flap will take until this has been remedied. In the case of sacral ulcers, however, they prefer large rotation skin flaps, which allow further advancement in the event of recurrence. The association of two or three ulcers makes surgical management imperative because of the frequently severe undermining of the patient's general state of health. The treatment of two locations in a single stage is always preferable whenever it is feasible.

Use of dermal-fat flaps in treating abdominal scars, in abdominoplasty, and in subtrochanteric lipectomy

Triangular dermal-fat flaps can be used in the excision of adherent vertical scars in the lower abdomen to prevent a recurrence of the depressed adhesion. Also, several such flaps can be used on the upper margin of an abdominoplasty, and one on the lower edge (above the pubis), to equalize the thickness and the lengths of the two edges. This results in a better final appearance. Finally, the use of a single triangular dermal-fat flap on the lower margin when doing a lipectomy for "subtrochanterric lipodystrophy" (or a "plastic on buttock") gives the buttock a more normal shape--round in the medial two-thirds and almost flat in the lateral one-third.