For decades, open brow-lift procedures have been the criterion standard for forehead and brow rejuvenation. However, since its introduction in the early 1990s, the endoscopic brow-lift has emerged as the preferred technique for many surgeons, with proponents citing reduced complication rates and superior results compared with standard open techniques. Benjamin W. Cilento, MD, and Calvin M. Johnson Jr, MD, reviewed over 1000 consecutive open forehead rejuvenation cases, finding that their complication rates are equal to, if not lower than, those published for endoscopic brow-lift series. They also demonstrate a very high patient satisfaction rate and explore the possible biases introduced by surgeons when recommending a surgical approach to forehead rejuvenation.
Facial fat grafting has become an increasingly popular technique for facial rejuvenation. Its effectiveness in volume retention after transplantation is debated in part owing to a paucity of objective clinical data following facial fat grafting. Jason D. Meier, MD, and colleagues used 3-dimensional photography software in 33 patients, demonstrating a mean 32% retention of volume at 16 months and providing the first clinical quantification of autologous fat transfer reported in the literature.
Reconstruction of nasal alar defects ranges from secondary intention, skin grafts, composite grafts, local nasal flaps, and 2-stage interpolated flaps from either the cheek or forehead. Nonanatomic cartilage grafts are often placed to prevent alar notching. These grafts are typically covered by vascularized tissue, but Paul A. van der Eerden, MD, and colleagues present a technique of a free cartilage graft placed in subcutaneous pockets of the ala in combination with secondary intention as an alternative, simple, 1-stage method of reconstructing relatively small but deep defects of the alar subunit and nasal side wall of the nose with little morbidity for the patient.
In facial plastic surgery, repairing cartilage defects is often limited by a lack of available cartilage and morbidity related to harvest, requiring the use of implants that have varying success. Tissue engineered cartilage offers the possibility of producing durable implants that are biologically inert and identical to the tissue being replaced, in addition to causing minimal morbidity. Eric J. Dobratz, MD, and colleagues successfully produced engineered cartilage within mice using human chondrocytes and alginate in an injectable model that allowed for in situ molding of the injection. The cartilage remained stable throughout the study period and was relatively similar to native cartilage on explanation. This model may provide the foundation to develop ideal injectable cartilage implant.
Girl Before a Mirror by Pablo Picasso (1881-1973).
This issue's Highlights were written by Amit Bhrany, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2009;11(1):5. doi:10.1001/archfacial.2008.520