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Highlights of Archives of Facial Plastic Surgery
Mar/Apr 2009

Highlights of Archives of Facial Plastic Surgery

Arch Facial Plast Surg. 2009;11(2):76. doi:10.1001/archfacial.2009.4
Correction of the High Female Hairline

The female hairline typically lies 5 to 6 cm above the eyebrows at the trichion. Women with a higher hairline often complain of a large forehead that makes them look more masculine and older than their respective ages and that prevents them from wearing their hair pulled back. Alexander L. Ramirez, MD, and colleagues review a 20-year experience for correcting the high female hairline. They measured a mean reduction in midfrontal hairline height of 1.6 cm, correlating to a 2.1-cm curvilinear advancement when evaluating the profile view, and conclude that advancement of the female hairline using an irregular trichophytic incision is a safe and effective technique.

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Preserving Structural Integrity of the Alar Cartilage in Aesthetic Rhinoplasty Using a Cephalic Turn-in Flap

The lower lateral cartilage (LLC) determines the shape, size, and position of the nasal tip. It also determines the tip's relation to the ala, and supports the lateral nasal wall. Cephalic resection of the LLCs is one of the most common techniques used to reduce volume of the nasal tip, but overresection can lead to alar retraction, collapse, and loss of nasal tip support. Craig S. Murakami, MD, and colleagues describe the cephalic turn-in flap as a nondestructive, reversible alternative to the cephalic trim. The turn-in flap enables aesthetic refinement of the nasal tip but also reinforces the lateral crus, strengthening the tip and base while reducing the risk of the complications of cephalic resection of the LLC.

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Long-term Safety and Efficacy of a New Botulinum Toxin Type A in Treating Glabellar Lines

The reduction of hyperdynamic lines via injection of botulinum toxin type A (BTX-A) is the most common procedure performed today for facial rejuvenation. Botox (Allergan, Irvine, California) is the only currently US Food and Drug Administration–approved BTX-A for cosmetic use. Reloxin (Medicis Pharmaceutical Corp, Scottsdale, Arizona) is another form of BTX-A approved and marketed as botulinum neurotoxin (Dysport; Ipsen Biopharm Ltd, Wrexham, Wales) outside the United States. Ronald Moy, MD,and colleagues report the data from a phase 3 open-label study of subjects who received as many as 5 repeated treatments with 50 U of Reloxin for the correction of glabellar lines, showing that multiple treatment cycles with Reloxin is well tolerated, safe, and maintains clinical benefit over a period of 13 months.

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Refining Vertical Lobule Division in Open Septorhinoplasty

The Goldman technique of vertical dome division to narrow the nasal tip and increase projection and rotation was described in 1957. Since that time, many modifications have been reported. Etai Funk, MD,and colleagues illustrate the senior author's modification, termed vertical lobule division, which involves division of the domal arches either at the junction of the medial and intermediate crura or nearer to the apex of the dome with overlapping suture stabilization of the divided segments. The location of the division dictates the amount of nasal tip deprojection, nasal tip narrowing, change in rotation, or improvement of lobule irregularities, and the authors find the technique to be most useful in the overprojected, underrotated nose.

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Consuelo Vanderbilt (1876-1964), Duchess of Marlborough, and Her Son, Lord Ivor Spencer-Churchill (1898-1956), by Giovanni Boldini (1845-1931).

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This issue's Highlights were written by Amit Bhrany, MD.