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Laxity of the lateral canthal tendon is a common problem in both reconstructive and aesthetic surgery. It is difficult to evaluate the many procedures available to correct this laxity and the corresponding functional problems because there is no accepted grading system or objective outcome analysis. Kris S. Moe, MD, and Thomas Linder, MD Article , report a new variation of a canthoplasty, the lateral transorbital canthopexy (LTC), and an ectropion grading scale (EGS). The authors analyzed 16 procedures performed on 15 consecutive patients who underwent lower eyelid correction with the LTC and were subsequently evaluated with the EGS. There were no surgical failures or complications, and there was a mean 83% reduction in patient-reported discomfort. James C. Orcutt, MD, PhD Article , discusses the LTC and places it in a spectrum of other procedures designed to address the functional problems resulting from lateral canthal tendon laxity.
The tear trough deformity has become a more widely recognized contour deformity seen with aging. There are multiple approaches to the correction of this depression. M. Sean Freeman, MD Article , demonstrates with cadaver dissections that these nasojugular or tear trough deformities are caused by inferior migration of the subconjunctival suborbicularis ocular fat pad. He then describes a transconjunctival approach to reposition the suborbicularis ocular fat pad and improve the contour in this anatomical area. He reports on 64 patients who obtained good to excellent results from the subconjunctival suborbicularis ocular fat pad lift with no significant complications. Robert Alan Goldberg, MD Article , discusses the procedure.
Various techniques are available to modify the shape of the lower lateral cartilages. These include scoring, morselization, resection, various grafts, and suture techniques. Shan R. Baker, MD Article , prefers suture techniques as the primary method to recontour alar cartilages with mild to moderate tip deformities. He recommends limited or no cartilage resection, no scoring or morselization of cartilage, the use of support grafts to supplement structure, and the limited use of contour grafts only in situations that cannot be addressed with the other techniques. An analysis of the various techniques and specific case reports supplement these recommendations.
Throughout the country, some widely publicized patient safety problems in outpatient surgical facilities have increased interest in the regulation of these facilities by both the medical boards and state legislatures. Florida and California have been the 2 most visible states in establishing such regulations. This interest in regulation of outpatient facilities will almost certainly spread to the remainder of the country. In this article, Robert L. Simons, MD Article , presents his personal view of the issues as seen by a private practitioner and facial plastic surgeon in the state of Florida. He discusses the difficulties encountered in devising regulations that will maximize patient safety and still allow cost-effective care in the outpatient surgical setting. This is an area in which surgeons from around the country should be proactive to ensure patient safety. Understanding the problems addressed in Florida will provide insight into the nature of the regulations that may be required.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2000;2(1):6. doi: