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Corona-Rodarte E, Cano-Aguilar LE, Baldassarri-Ortego LF, Tosti A, Asz-Sigall D. Dermatological perspectives on pressure alopecias: A call for awareness. J Am Acad Dermatol 2024; 90:e133-e134. [PMID: 37778661 DOI: 10.1016/j.jaad.2023.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Eduardo Corona-Rodarte
- Department of Dermatology, Instituto Dermatológico de Jalisco Dr. José Barba Rubio, Jalisco, Mexico.
| | | | | | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Asz-Sigall
- Trichology Clinic, Department of Dermatology, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.
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2
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Soltany A, Alhallak N, Al Aissami M. Tranexamic acid in rhytidectomy: a scoping review. Ann Med Surg (Lond) 2023; 85:4964-4968. [PMID: 37811108 PMCID: PMC10553119 DOI: 10.1097/ms9.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/12/2023] [Indexed: 10/10/2023] Open
Abstract
Background Intraoperative and postoperative bleeding is considered one of the most common risks in rhytidectomy. Recently, the use of antifibrinolytic agents in facial plastic and reconstructive surgeries has been evaluated, but their use in rhytidectomy remains a topic of ongoing discussion. Tranexamic acid (TXA) is an antifibrinolytic agent that prevents enzymatic degradation of the fibrin clot by blocking the conversion of plasminogen to plasmin, improves platelet function, and has a direct anti-inflammatory effect. This review covers pertinent literature to elucidate whether the use of TXA in rhytidectomy confers intraoperative and postoperative benefits. Methods A systematic literature search was conducted in online databases: PubMed, Google Scholar, Cochrane, Scopus, and Web of Science for all articles on the topic of TXA in facelift published up to and including June, 2023 using the following terms: "TXA," "tranexamic acid," "plastic surgery," "aesthetic surgery," "facelift," "rhytidectomy". They were either searched individually or in combination. All relevant original research articles, of any study design were included and narratively discussed in this review. Studies not carried out in humans and studies centred on the use of TXA in other specialties were excluded. English Language was included. Results Eight articles were reviewed in this paper. Through these articles, the authors provided in detail the possible beneficial effects of TXA in facelift patients in evaluating several clinical outcomes: intraoperative blood loss, postoperative drain output, postoperative oedema, ecchymosis, operative time, and surgical field quality. Conclusion Although there is still a lack of information on TXA in facelift patients, we are not able to deny the beneficial effects of TXA on this topic. Therefore, further investigations including prospective, case-controlled multi-institutional studies comparing routes of delivery should be performed until reaching, at the end, an evidence-based guideline providing a clear protocol in terms of the administration and dosage of TXA in facelift.
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Affiliation(s)
- Amjad Soltany
- Department of Plastic and Reconstructive Surgery, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
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3
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Knollinger A, Morgan P, Loek R, Laporte C. Treatment of canine periocular dermatitis with rhytidectomy (surgical face-lift) and fluorescence photobiomodulation: A case report. Vet Dermatol 2023; 34:478-482. [PMID: 37221446 DOI: 10.1111/vde.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/31/2023] [Accepted: 03/29/2023] [Indexed: 05/25/2023]
Abstract
Canine periocular dermatitis may be associated with excessive facial folds and heavy brows (EFF-HB). There is no gold standard therapy for EFF-HB-associated periocular dermatitis, and conventional medical management may fail. Herein, we describe periocular fluorescence photobiomodulation and rhytidectomy as novel approaches to treat EFF-HB-associated periocular dermatitis refractory to medical management.
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Affiliation(s)
| | - Paul Morgan
- Advanced Veterinary Care, Surgical Service, Salt Lake City, Utah, USA
| | - Rachael Loek
- Dermatology for Animals, Salt Lake City, Utah, USA
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Abraham MT, Klimczak JA, Abraham-Aggarwal M. Comparing Lateral Rhytidectomy With and Without Neck Suture Suspension. Plast Surg (Oakv) 2023; 31:275-286. [PMID: 37654534 PMCID: PMC10467435 DOI: 10.1177/22925503211042868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 09/02/2023] Open
Abstract
Background: Characteristic aesthetic changes of the aging neck include skin laxity and rhytid formation, submental fat deposition, plastysmal banding, and ptosis of underlying structures that lead to the development of an obtuse cervicomental angle (CMA). Cervical rejuvenation techniques that aim to restore the CMA are widely discussed in the literature, and share variable outcomes. The aim of this study is to compare the restoration of the CMA in patients undergoing the addition of midline platysmal plication using a modified Giampapa stitch with absorbable PDS suture, to those patients undergoing standard deep plane lateral rhytidectomy alone. Methods: A retrospective cohort study was performed by a single surgeon in a private facial plastics practice. 264 patients undergoing rhytidectomy were included in the study. Pre and postoperative measurement differences in CMA degree and depth were compared in patients undergoing only traditional deep plane lateral rhytidectomy (TDPLR) in isolation, with those who also had modified suture suspension and platysma plication (MSSPP). The primary outcome in the study was the change in the degree of the CMA taken from standardized preoperative and postoperative surgical photos in the Frankfort profile view. Secondary outcomes include the change in the depth of the CMA as determined by the hyomental distance between study and control groups. Results: A total of 264 patients were identified who met the study criteria. A total of 134 (123 female; 11 male; average age, 62.66 ± 8.19) underwent TDPLR with MSSPP, and 130 (127 female; 3 male; average age, 63.09 ± 7.75) underwent TDPLR alone. All patients in the study underwent preoperative photographic evaluation in Frankfurt profile view and the same postoperative photographic evaluation at an average of 436.56 days (14.4 months) after surgery. Patients in the cohort study group were found to have a statistically significant increase in the depth of the CMA by an average of 13.9 degrees ± 6.26 and increase in the hyomental distance of 1.38 cm ± 0.87, compared to the control group who underwent traditional lateral rhytidectomy with an average CMA change of 6.87 degrees ± 6.7 (P = .00146) and hyomental distance increase of 0.75 ± 0.68 (P = .00031), respectively. Statistical significance was taken at P < .05. Conclusions: The results from this study indicate that the addition of a relatively minimally invasive approach to neck rejuvenation using a modified Giampapa stitch with absorbable PDS suture is helpful in restoring the CMA in an aging neck.
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5
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Ruthberg JS, Meleca JB, Ko JS, Billings SD, Ku JA. Rhabdomyosarcoma Arising in an Old Rhytidectomy Scar. Ann Otol Rhinol Laryngol 2023; 132:221-225. [PMID: 35311358 DOI: 10.1177/00034894221084482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The clinical evaluation and management of an adult with head and neck rhabdomyosarcoma is explored to delineate the diagnostic challenge posed by soft-tissue sarcomas bordering scar tissue. CASE REPORT A 59 year old female presents with persistent, evolving paresthesia and burning in the right posterior neck, which was found to be in close proximity to a well-healed rhytidectomy scar. Serial biopsies were non-diagnostic. Six months after initial presentation, rhabdomyosarcoma was diagnosed subsequent to histopathological and immunohistochemistry analysis. A wide local excision with posterolateral neck dissection was performed. CONCLUSION A high index of suspicion for soft-tissue sarcoma should be maintained for patients with persistent soft-tissue lesions, especially in areas of scarred tissue, who present with new-onset neurological symptoms in the context of nondiagnostic biopsies.
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Affiliation(s)
- Jeremy S Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joseph B Meleca
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jamie A Ku
- Section of Head and Neck Surgical Oncology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Otolaryngology - Head & Neck Surgery, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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6
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Chkadua TZ, Visaitova ZY, Libin PV, Ibragimova KM, Khamkhoev MB. [Applications of the lipofilling method in the rehabilitation of patients with defects and scar deformities of the terminal part of the nose]. Stomatologiia (Mosk) 2023; 102:27-30. [PMID: 37622297 DOI: 10.17116/stomat202310204127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
A clinical case of the treatment of a 30-year-old patient with a diagnosis of a defect and cicatricial deformity of the terminal part of the nose, deviated septum with a defect in the cartilaginous part, valvular insufficiency and hypertrophy of the inferior turbinates is presented. Reconstructive surgery of the terminal part of the nose using cartilage autografts required special preparation of scar soft tissues of the nose. For this purpose, the method of lipofilling was used as an additional stage in the complex rehabilitation of patients with postoperative defects and deformities of the terminal section.
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Affiliation(s)
- T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Z Yu Visaitova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - P V Libin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Kh M Ibragimova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - M B Khamkhoev
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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7
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Minelli L, Bown RGC, Mu EWH, Whitehead DL, Henderson TH, Lawrence F, Mellor I, Wissemann MI, Brown CP, van der Lei B, Mendelson BC. Enhanced study of facial soft tissues using a novel large scale histology technique. Clin Anat 2023; 36:110-117. [PMID: 35951617 PMCID: PMC10086818 DOI: 10.1002/ca.23943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Abstract
The safety and effectiveness of facial cosmetic surgery procedures are dependent on detailed 3D understanding of the complex surgical anatomy of the face. Traditional, small sample size anatomical dissection studies have limitations in providing definitive clarification of the fascial layers of the face, and especially in their relationship with the facial nerve, and their reaction to surgical manipulation. The objective study of large tissue areas is required to effectively demonstrate the broader architecture. Conventional histology techniques were modified to handle extraordinarily large tissue samples to fulfill this requirement. Full-thickness soft tissue samples (skin to bone) of maximum length 18 cm, width 4 cm, and tissue thickness 1 cm, were harvested from 20 hemifaces of 15 fresh human cadavers (mean age at death = 81 years). After fixation, the samples were processed with an automated processor using paraffin wax for 156 h, sectioned at 30 μm, collected on gelatin-chromium-coated glass slides, stained with a Masson's Trichrome technique and photographed. Using this technique, excellent visualization was obtained of the fascial connective tissue and its relationship with the facial mimetic muscles, muscles of mastication and salivary glands in 73 large histological slides. The resulting slides improved the study of the platysma and superficial musculo-aponeurotic system (SMAS), the spaces and ligaments, the malar fat pad, and the facial nerve in relations to the deep fascia. Additionally, surgically induced changes in the soft-tissue organization were successfully visualized. This technique enables improved insight into the broad structural architecture and histomorphology of large-scale facial tissues.
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Affiliation(s)
- Lennert Minelli
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia.,Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia.,Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rory George Charles Bown
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia
| | - Erica Wung Hwa Mu
- School of Biomedical Sciences, The University of Queensland, Saint Lucia, Australia
| | | | - Tania Helen Henderson
- Central Analytical Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Felicity Lawrence
- Central Analytical Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Ian Mellor
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Matthew Ian Wissemann
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Cameron Peter Brown
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Berend van der Lei
- Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Bryan Christopher Mendelson
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia
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8
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Abstract
Facial rejuvenation procedures have become more commonly performed due to an increasing elderly population and greater general public acceptance. As a result, patients are now increasingly undergoing secondary and tertiary rhytidectomies to treat natural aging and/or to correct complications from prior procedures. Revision face and neck lifts are more complex by nature of the procedure and require a comprehensive preoperative assessment for enhanced outcomes. In this review, we discuss the preoperative evaluation, surgical challenges encountered, primary face and neck lift deformities, and their surgical management for patients undergoing secondary face and neck lifts.
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Affiliation(s)
- Rami P Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward Chamata
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew M Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
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9
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Jovanovski T, Umek N, Kansky A, Cvetko E. Platysma muscle additionally innervated by a variant anterior branch of the great auricular nerve. Folia Morphol (Warsz) 2020; 79:863-866. [PMID: 32073137 DOI: 10.5603/fm.a2020.0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/25/2022]
Abstract
Damage to the great auricular nerve, with consequent clinical deficits, is a common surgical complication in facial aesthetic and in head and neck procedures such as parotidectomy, neck dissection, rhytidectomy and platysma flap operations. Hence, a thorough knowledge of nerve anatomy, particularly its potential variations, is critical in reducing the associated operative morbidity. Accordingly, we report an unusual variation of the anterior branch of the great auricular nerve noted in an 81-year-old female cadaver. The nerve was observed to course into the submandibular region anterior and superficial to the internal jugular vein, communicating with the cervical branch of the facial nerve, while independently innervating the platysma muscle. Although several anatomical variations of the branches of the cervical plexus have been documented, our report describes unique innervation of the platysma muscle by the great auricular nerve, which provides a new insight on the motor component of the nerve.
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Affiliation(s)
- T Jovanovski
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Slovenia
| | - N Umek
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Slovenia.
| | - A Kansky
- University Clinical Centre Ljubljana
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10
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Haen P, Laversanne S, Graillon N, Foletti JM. Facial necrotising fasciitis following rhytidectomy. Br J Oral Maxillofac Surg 2019; 57:685-687. [PMID: 31204188 DOI: 10.1016/j.bjoms.2019.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/28/2019] [Indexed: 11/24/2022]
Abstract
Rhytidectomy is the most common surgical procedure used to rejuvenate the appearance of the aging face and neck. Necrotising fasciitis is a rapidly progressing, life-threatening, bacterial infection of the skin, the subcutaneous tissue, and the fascia. We report a case of necrotising fasciitis of the face caused by a group A streptococcal infection after rhytidectomy on a healthy female patient. An abscess on her hand that had been caused by an infection related to a venous catheter had provided a potential entry for the pathogen, and treatment combined both surgical debridement and antibiotics. The operation had resulted in large tissue losses around the ears, which we treated by healing by second intention.
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Affiliation(s)
- P Haen
- Department of Oral and Maxillofacial Surgery, Hôpital d'Instruction des Armées Laveran, Boulevard Laveran, 13013 Marseille, France.
| | - S Laversanne
- Department of Oral and Maxillofacial Surgery, Hôpital d'Instruction des Armées Laveran, Boulevard Laveran, 13013 Marseille, France
| | - N Graillon
- Department of Oral and Maxillofacial Surgery, Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Boulevard Baille, 13005 Marseille, France
| | - J M Foletti
- Department of Oral and Maxillofacial Surgery, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13326 Marseille, France
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Swiergosz A, Gunn J, Schulz S, Henderson J, Choo J, Mowlavi A, Wilhelmi B. The Danger Zone in the Anterior Neck: Anatomical Landmarks to Avoid Injury to Anterior Jugular Vein During Face-Lift and Neck-Lift. Eplasty 2018; 18:e3. [PMID: 29445428 PMCID: PMC5793692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: An estimated 125,711 face-lifts and 54,281 neck-lifts were performed in 2015. Regardless of the technique employed, facial and neck flap elevation carries with it anatomical risk of which any surgeon performing these procedures should be aware of. Statistics related to anterior jugular vein injury during these procedures have not been published. Objective: To define a "danger zone" that will contain both of the anterior jugular veins on the basis of anatomical landmarks to aid surgeons with planning their surgical approach during rhytidectomy in the anterior neck region. Methods: Ten fresh tissue heminecks were dissected. All specimens were dissected under loupe magnification in a 45° (face-lift) position in which a midline incision was used for exposure. Measurements from the anterior jugular vein to the hyoid, thyroid cartilage, and cricoid cartilage bilaterally were taken. The transverse distance between the anterior jugular veins at the level of the hyoid, thyroid cartilage, and cricoid cartilage was also measured. Results: The anterior jugular veins remain in an anatomical danger zone while they travel in the anterior neck. Regardless of anatomical variation of the vessels between bodies, they generally reside in this danger zone from their inferior emergence behind the sternocleidomastoid muscle until they branch in the suprahyoid region. Conclusions: Knowledge of the anatomy, course, and location of the anterior jugular veins through the anterior neck based on anatomical landmarks and distance ratios can facilitate a safer dissection during rhytidectomy procedures.
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Affiliation(s)
| | | | | | | | - Joshua H. Choo
- University of Louisville School of Medicine, Louisville, Ky
| | - Arian Mowlavi
- University of Louisville School of Medicine, Louisville, Ky
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12
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Pfaff MJ, Clune J, Steinbacher D. Component approach to the temporomandibular joint and coronoid process. Craniomaxillofac Trauma Reconstr 2014; 7:323-6. [PMID: 25383157 DOI: 10.1055/s-0033-1364196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/14/2013] [Indexed: 10/25/2022] Open
Abstract
Reconstruction of the temporomandibular joint (TMJ) region is challenging. The conventional direct preauricular incision permits only limited access to the TMJ and surrounding structures, therefore risking injury to the facial nerve during retraction. The ideal approach allows sufficient exposure, preservation of underlying neurovascular structures, and achieves an optimal aesthetic outcome. We describe a preauricular posttragal incision with a superficial musculoaponeurotic system flap to allow wide exposure of the zygomatic arch, TMJ, condyle, and coronoid process. We postulate that this approach improves access, lessens the amount of retraction required, and creates a more inconspicuous scar.
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Affiliation(s)
- Miles J Pfaff
- Department of Plastic and Reconstructive Surgery, Yale University, New Haven, Connecticut
| | - James Clune
- Department of Plastic and Reconstructive Surgery, Yale University, New Haven, Connecticut
| | - Derek Steinbacher
- Department of Plastic and Reconstructive Surgery, Yale University, New Haven, Connecticut
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13
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Hu X, Wang Z, Wang Q, Zhang C, Hu G, Qin H. Are There Differences Between the Upper and Lower Parts of the Superficial Musculoaponeurotic System? A Preliminary Biomechanical Study. Aesthet Surg J 2014; 34:661-7. [PMID: 24744395 DOI: 10.1177/1090820x14528947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The superficial musculoaponeurotic system (SMAS) becomes thinner and gradually disappears from the midface. In rhytidectomy, manipulation of the SMAS occurs in the lateral area, and previous research has focused primarily on the SMAS region as a whole. OBJECTIVES In this preliminary study, the authors compared the viscoelasticity of the upper and lower regions of the SMAS using biomechanical techniques. METHODS Two adjacent projection regions of the SMAS were designated: region 1 and region 2, representing the upper and lower parts, respectively. The SMAS tissues from 8 fresh-frozen cadaver heads were cut into 64 samples before biomechanical testing, and the following variables were recorded for subsequent analysis: stress-strain curve, elastic modulus, ultimate strength, and elongation at break. RESULTS The stiffness of region 1 was markedly greater than that of region 2. Energy dissipation was greater in region 2. Elastic modulus and ultimate strength were significantly higher for region 1, and elongation at break was longer in region 2. The fit curve of the 2 regions deviated markedly. CONCLUSIONS The biomechanical properties of the upper and lower regions of the lateral SMAS are functionally different. Such knowledge will help refine the planning and design of facial surgery and improve outcomes for patients who undergo rhytidectomy.
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Affiliation(s)
- Xiaoqing Hu
- Dr X. Hu is a Clinical Attending Surgeon and Drs Z. Wang and Zhang are Professors of Plastic Surgery in the Department of Plastic Surgery, Affiliated Xinhua Hospital of Dalian Medical University, LiaoNing, China
| | - Zhijun Wang
- Dr X. Hu is a Clinical Attending Surgeon and Drs Z. Wang and Zhang are Professors of Plastic Surgery in the Department of Plastic Surgery, Affiliated Xinhua Hospital of Dalian Medical University, LiaoNing, China
| | - Qi Wang
- Dr Q. Wang is a Clinical Attending Physician in the Department of Pediatric Intensive Care, Children's Hospital of Zhengzhou, HeNan, China
| | - Chen Zhang
- Dr X. Hu is a Clinical Attending Surgeon and Drs Z. Wang and Zhang are Professors of Plastic Surgery in the Department of Plastic Surgery, Affiliated Xinhua Hospital of Dalian Medical University, LiaoNing, China
| | - Gang Hu
- Drs G. Hu and Qin are Professors of Plastic Surgery in the Department of Plastic Surgery, First Affiliated Hospital of Dalian Medical University, LiaoNing, China
| | - Hongzhi Qin
- Drs G. Hu and Qin are Professors of Plastic Surgery in the Department of Plastic Surgery, First Affiliated Hospital of Dalian Medical University, LiaoNing, China
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14
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Abstract
BACKGROUND The great auricular nerve (GAN) is the most commonly injured nerve during facelift surgery. Although rare, injury can result in long-term sequelae. OBJECTIVES Previous reports have described the nerve's location at the midbelly of the sternocleidomastoid muscle (SCM) or at its emergence from underneath the SCM. The purpose of our study was to identify the superior course of the great auricular nerve as it applies to facelift. METHODS Thirteen fresh cadavers were dissected. A vertical line through the midlobule was drawn perpendicular to the Frankfort's horizontal, acting as a reference to the course of the GAN. Transparent paper overlay tracings were then done to record each nerve's location. The distance from the bony external auditory canal (EAC) to the nerve was measured at the anterior muscle border, at the midbelly of the SCM, and as the nerve emerged from under the SCM. Branching patterns of the nerve and its relation to the external jugular vein were identified. RESULTS In 100% of the dissections, the superior course of the GAN fell within a 30-degree angle constructed using the vertical limb perpendicular to the Frankfurt horizontal and a second limb drawn posteriorly from the midlobule. The distance from the EAC to the nerve was 4.9 ± 1.1 cm at the anterior muscle border, 7.3 ± 1.0 cm at the midbelly of the SCM, and 9.8 ± 1.2 cm at the GAN's emergence from under the SCM. Four types of branching patterns were identified. CONCLUSIONS The 30-degree angle described above rapidly and accurately identifies the nerve's location.
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Affiliation(s)
- Cemile Nurdan Ozturk
- Dr C. N. Ozturk is an Aesthetic Surgery Fellow, Dr C. Ozturk is a Microsurgery Fellow, Dr Huettner is an Aesthetic Surgery Fellow, and Dr Zins is Chairman in the Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
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15
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Hönig JF, Knutti D, Hasse FM. Centro-lateral subperiosteal vertical midface lift. GMS Interdiscip Plast Reconstr Surg DGPW 2014; 3:Doc04. [PMID: 26504715 PMCID: PMC4582511 DOI: 10.3205/iprs000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of fiberendoscopic video-assisted technique in facial rejuvenation is one of the most advances in aesthetic plastic surgery of the face. It substitutes the coronal incision without the necessity of skin resection and allows a vertical reposition of the mobile soft tissue of the midface in indicated cases. It can easily be done through a small incision of the scalp just behind the coronal incision and in the temporal area.
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Affiliation(s)
- Johannes Franz Hönig
- Georg-August-Universität, Goettingen, Germany ; Paracelsus Klinik, Hannover, Germany
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Botti G, Pascali M, Botti C, Bodog F, Gentile P, Cervelli V. Comparison of commercial fibrin sealants in facelift surgery: a prospective study. Clin Cosmet Investig Dermatol 2013; 6:273-80. [PMID: 24222983 PMCID: PMC3823615 DOI: 10.2147/ccid.s45233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The aim of this study was to compare the effects of two types of fibrin glue in patients undergoing facelift surgery. Methods A prospective, controlled “right-left side” study was carried out in 20 patients. The two fibrin sealants used were Quixil® and Tissucol®. The two sealants were used at the same time, ie, one on one side of the face and the other on the contralateral side. Comparisons were made with regard to rates of hematoma and seroma, degree of induration, edema, ecchymosis, pain levels, and patient satisfaction. Results The results were almost equivalent. The only exception was a significant (40 mL) hematoma in a patient treated with Quixil. Bleeding was most likely due to a sudden rise in blood pressure during the immediate postoperative period. However, it must be emphasized that, while Tissucol actually seals the undermined area, thus virtually eliminating the dead space, Quixil acts differently, in that its effectiveness in preventing hematoma is linked mainly to its hemostatic effect. Conclusion The two fibrin sealants used were nearly identical with regard to patient safety and quality of the result. Nevertheless, it is noted that, while Tissucol has both hemostatic and “gluing” effects, Quixil is mainly effective in securing hemostasis.
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Affiliation(s)
- Giovanni Botti
- Villa Bella Clinic, Salò, University of Rome Tor Vergata, Italy
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Abstract
BACKGROUND Many techniques have been presented over recent decades to address the neck contour in facial rejuvenation surgery. Despite advances, limitations remain when dealing with the obtuse cervical angle. OBJECTIVE The authors describe a technique for improving the obtuse cervicomental angle. METHODS The authors reviewed the charts of 295 patients who underwent the authors' submental muscular medialization and suspension (SMMS) technique to improve their neck contour, either alone or in combination with a facelift, between January 1, 2001, and December 30, 2003. The technique medializes and suspends the medial free edges of the platysma muscle and, when anatomy dictates, the anterior bellies of the digastric muscle to the deeper mylohyoid muscle. RESULTS Eighty-seven (30.5%) of the 285 facelift patients examined underwent SMMS, and 10 additional patients underwent isolated SMMS. No patient required reoperation for hemostasis or evacuation. Three (1.05%) of the facelift with SMMS patients required reoperation for dehiscence of the submental suspension. None of the isolated SMMS patients had muscular suspension dehiscence or required reoperation. Seven (2.4%) patients (5 with SMMS and 2 without SMMS) with excessive facial and cervical tissue preoperatively developed a small amount of postoperative submental skin redundancy and subsequently underwent submental skin excision at 1 year postoperatively. CONCLUSIONS Submental muscular medialization and suspension is a simple yet highly effective surgical technique that can result in dramatic and enduring improvement in the cervicomental angle.
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Affiliation(s)
- Phillip R Langsdon
- Dr Langsdon is a Professor at the University of Tennessee Health Science Center and Chief of the Division of Facial Plastic Surgery in the Department of Otolaryngology-Head & Neck Surgery, University of Tennessee Health Science Center, Germantown, Tennessee, where Dr Velargo and Dr Rodwell are residents
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Hester TR, Shire JR, Nguyen DB, Gerut ZE, Chen AH, Diamond J, Desmond JC, Silvati-Fidell L, Abrams SZ, Rohrich RJ. Randomized, controlled, phase 3 study to evaluate the safety and efficacy of fibrin sealant VH S/D 4 s-apr (Artiss) to improve tissue adherence in subjects undergoing rhytidectomy. Aesthet Surg J 2013; 33:487-96. [PMID: 23563904 DOI: 10.1177/1090820x13479969] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Suction drains are commonly placed after rhytidectomy to avoid seroma formation that may result from dead spaces between skin layers. Fibrin sealants promote tissue adherence by crosslinking with extracellular matrix proteins, which may reduce the dead space under skin flaps. OBJECTIVES The authors evaluate the safety and efficacy of the fibrin sealant (FS) VH S/D 4 s-apr (Artiss; Baxter Healthcare Corp, Deerfield, Illinois), added to standard-of-care (SoC) treatment, in improving flap adherence and reducing dead space in patients undergoing rhytidectomy. METHODS Patients with planned facial rhytidectomy were enrolled in this phase 3, prospective, controlled, randomized, patient-blinded, multicenter trial. They received SoC treatment on 1 side of the face and adjunctive FS VH S/D 4 s-apr on the other. RESULTS Seventy-five patients completed the trial. The mean (SD) drainage volume was 7.7 (7.4) mL from the sides treated with sealant and 20.0 (11.3) mL from the SoC-only sides (P < .0001). Rates of hematoma and seroma were similar for the 2 treatments, as were changes in postoperative skin sensitivity. Adverse events generally were mild; 2 serious adverse events were reported (wound abscess, dehydration). CONCLUSIONS Adjunct use of FS VH S/D 4 s-apr in rhytidectomy was proven safe in this study. It significantly reduced drainage volumes without increasing the incidence of hematoma or seroma, which suggests that it eliminates dead space through improved flap adherence. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- T Roderick Hester
- Baxter Healthcare Corporation, One Baxter Way, Westlake Village, CA 91362-3811 USA
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Abstract
PURPOSE To evaluate the use of the CoolSkin(®) (Elbio, Seoul, Korea) skin-cooling device to reduce injection pain during rhytidectomy. METHOD Nineteen patients underwent rhytidectomy using the CoolSkin at -4°C on the first side lateral injection. The second side was then started without the cooling. Patients were offered cooling if they desired it on the second side. Surveys were administered 24 hours after the procedure, comparing pain (scale 0-5) and investigating treatment preferences. Patient healing was tracked for 6 weeks. RESULTS Mean pain score for the untreated side was 4.63 versus 2.37 for the CoolSkin-treated side (P < 0.001). All patients asked for the second side to be cooled, and 89% were in favor of the chilling procedure when surveyed 24 hours afterwards. Sixty eight percent of patients stated that this device reduced fear of future injections. No flap loss or healing sequelae were noted from device use. CONCLUSION The CoolSkin device is an effective tool to reduce injection pain laterally during rhytidectomy.
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Abstract
In the first of this two-part article on the 'optimum mobility' facelift, facial tissue mobility was analyzed, and three theories or mechanisms emerged: 'intrinsic mobility', 'surgically induced mobility' and 'optimum mobility points'.In this second part, these three theories are applied to a rhytidectomy procedure termed 'optimum mobility' facelift. Before surgery, 'optimum mobility points' are marked on the skin. During surgery, the subcutaneous dissection is kept to a minimum by carrying it out precisely to these 'optimum mobility points'. The facial tissues, with their skin and superficial musculoaponeurotic system attachments intact, are then mobilized laterally using the 'intrinsic mobility' phenomenon, and this mobilization fixed in place using mattress sutures.The 'optimum mobility' facelift is an efficient rhytidectomy technique that has a thoughtful, precise plan, a low complication rate, a fast recovery and very satisfactory results.
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Affiliation(s)
- Nabil Fanous
- Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Quebec
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Abstract
The face-lift procedure (rhytidectomy) is increasingly popular in Asia. There is extensive literature on different techniques in Western patients. Cultural and anthropomorphologic differences between Asian and Caucasians require the adaptation of current techniques to obtain a satisfactory outcome for both the patient and the surgeon. This article therefore attempts to define important differences between Asians and Caucasians in terms of signs of facial aging, perception of beauty, and surgical goals. Our face-lift technique, a modified deep-plane face lift for Asians, is detailed and cases are presented.
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Affiliation(s)
- Léonard Bergeron
- Department of Plastic and Reconstructive Surgery, Chang Gung Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
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Abstract
BACKGROUND Patients considering a facelift (facial rhytidectomy)need some means of predicting their surgical outcomes. This will help them decide whether to proceed with the operation. METHODS A total of 50 consecutive patients were asked to examine themselves with a hand-held mirror while lying supine on an examining table to give them a reasonable approximation of their postoperative result. RESULTS The tissues of the face redrape in a very when lying completely supine. The appearance that the patient sees of himself or herself during the "supinetest" correlated very well with the actual postop result after rhytidectomy consisting of subcutaneous undermining,SMAS plication, and platysmaplasty. CONCLUSION This supine test may be useful in helping patients preoperatively predict their facelift outcomes and may serve as a good adjunct to imaging.
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Affiliation(s)
- Charles Hsu
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA 94304, USA.
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Fanous N. 'Optimum mobility' facelift. Part 1 - the theory. Can J Plast Surg 2006; 14:67-73. [PMID: 19554118 PMCID: PMC2585029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Traditional rhytidectomy techniques, such as the cutaneous lift, the superficial musculoaponeurotic system lift, the deep plane lift and the subperiosteal lift, are mostly differentiated by their different planes of dissection. As well, many of these techniques consider the complete mobilization of tissues a prerequisite for obtaining a satisfactory result.However, is it true that the result of a rhytidectomy is linked to the choice of the dissection plane? Also, is it true that the adequacy of the surgical mobilization of tissues is vital to the outcome? The present paper discusses the above questions and introduces a factor that is believed to be crucial to the planning and success of a rhytidectomy: facial tissue mobility. The analysis of this mobility is presented and leads to the development of three theories: 'intrinsic mobility', 'surgically induced mobility' and 'optimum mobility points'. These theories form the foundation of a rhytidectomy technique termed 'optimum mobility' facelift.
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Affiliation(s)
- Nabil Fanous
- Correspondence: Dr Nabil Fanous, 1 Westmount Square, Suite 1380, Westmount, Montreal, Quebec H3Z 2P9. Telephone 514-935-9906, fax 514-935-6482, e-mail
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