A deepened nasolabial fold and a malar ptosis are 2 signs of midfacial aging. Many surgeons argue that standard face-lifting techniques fail to adequately address these features of midfacial aging, and a number of midface-lift techniques have been developed and coined. E. Gaylon McCollough, MD, and colleagues reviewed the cases of 53 patients who underwent a standard temporal cheek-lift with superficial musculoaponeurotic system suspension and imbrication from 2005 through 2007. They contend that this classic technique is effective at rejuvenating the cheek, nasolabial fold, and corner of the mouth, and that a separate, unique midface-lift procedure is not required.
Portrait of Adelaide Christina Meyer, 1913, by Childe Hassam (1859-1935).
Microvascular free tissue transfer for the reconstruction of head and neck defects has been found to be extremely reliable, with success rates upward of 98%. However, patients who undergo microvascular reconstruction of head and neck defects are at risk for clinically significant perioperative complications. To help determine predictors of these complications, Michael J. Nuara, MD, and colleagues performed a prospective analysis on 300 consecutive microvascular free tissue transfer head and neck reconstructions, stratifying patients into groups based on preoperative comorbidity. They reported a 98.6% overall complete flap survival rate and found that patients with diabetes mellitus or a history of surgery or radiation had a clinically significantly increased risk of postoperative cervical wound complications.
The accumulation of submental fullness and blunting of the cervicomental angle are defining features of the aging neck. This aging process is contributed by the changes in subcutaneous fat, subplatysmal fat, and platysma muscle as well as the digastric muscles. Choosing the most appropriate treatment option for aesthetic refinement of the neck can be challenging because of the limited ability to predict the relative contribution of each submental component on physical examination alone. Grigoriy Mashkevich, MD, and colleagues used high-frequency ultrasound to delineate the submental anatomy in 10 patients, demonstrating that it can be a useful adjunct for assisting the surgeon in deciding whether to perform an open or closed submentoplasty for the correction of age-related submental ptosis.
Excessive width of the nasal lobule is a frequent complaint of many seeking rhinoplasty consultation, and refinement of the nasal tip offers one of the greater challenges to the rhinoplasty surgeon. Lucas G.Patrocínio, MD, and colleagues reviewed over 600 rhinoplasties performed at their institution from 2003 through 2006 and present a graduated approach to refinement of the nasal tip lobule with the following 7 techniques: (1) no surgery needed, (2) interdomal breakup, (3) cephalic trim, (4) domal sutures, (5) shield tip graft, (6) vertical dome division, and (7) replacement of the lower later cartilages. With this approach they achieve high patient satisfaction with a revision rate of 5.6%.
This issue's Highlights were written by Amit Bhrany, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2009;11(4):220. doi:10.1001/archfacial.2009.48