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Highlights of Archives of Facial Plastic Surgery
January 2002

Highlights of Archives of Facial Plastic Surgery

Arch Facial Plast Surg. 2002;4(1):4. doi:
Beauty: Thérèse Louise de Sureda

Francisco de Goya (1746-1828), Spanish, Thérèse Louise de Sureda, c 1803-1804. Oil on canvas 120 × 80 cm. The National Gallery of Art, Washington, DC.Article


Correction of the Soft Tissue Pollybeak Using Triamcinolone Injection

The pollybeak deformity is one of the more common complications of rhinoplasty. The deformity has multiple causes but commonly follows inadequate skin contraction in the thicker-skinned patient in whom excessive dead space fills with scar tissue. Revision surgery can sometimes be avoided by injection of triamcinolone acetonide into the supratip scar tissue. Matthew M. Hanasono, MD, and his colleagues observed 127 patients who underwent 1 or more injections postoperatively into the supratip area (all patients of Norman Pastorek, MD). Eighty-five percent of the patients had acceptable results with good supratip definition, and there were no significant complications. Rod J. Rohrich, MD, comments on the technique.

Article | Article

Biplanar Plating of Mandibular Fractures: A New Concept With In Vitro Testing and Comparison With the Traditional Plate-and-Screw Technique

Sara Pieri, MD, and colleagues introduce the concept of biplanar plating of mandibilar fractures and experimentally compare this method with the traditional single mandibular plate. Simulated masticatory force was delivered vertically to the anterior end of polymer hemimandibles, and mobility of fracture sites was subsequently tested. Four of 5 specimens plated with mandibular fixation plates developed significant vertical mobility at the fracture site. Only 1 of 5 specimens fixed with biplanar plating developed this degree of mobility. The authors used this technique clinically on 15 patients with unfavorable fractures and found it to be simple, secure, and reliable.


The Versatility of Distraction Osteogenesis in Craniofacial Surgery

Distraction osteogenesis represents an exciting and new development in craniofacial surgery. Mario J. Imola, MD, and colleagues review the cases of 24 consecutive patients treated with distraction osteogenesis over a 34-month period. The procedures included 6 midface and 29 mandibular osteotomies with 40 distraction devices inserted. Twenty-two deformities were congenital, and 2 were acquired. Outcomes measured included planned vs actual distraction, improvement in facial form measured with a semiquantitative scale, and functional improvements. Good to excellent success in correcting skeletal deformities was seen in 80% of patients. Functional improvement in upper airway obstruction and corneal exposure was excellent, but correction of malocclusion was less reliable.


Reconstruction of the Nasal Columella

Columellar defects are relatively uncommon and difficult to reconstruct. David A. Sherris, MD, and colleagues describe 16 patients who underwent reconstruction of the columella with various techniques—primarily forehead flaps, nasolabial flaps, and nasofacial sulcus flaps. The latter, a new flap developed by coauthor Peter A. Hilger, MD, is an elliptical skin island created in the nasofacial sulcus with an inferior vascular pedicle, which is tunneled subcutaneously with an autogenous cartilage graft. All patients were analyzed on a visual analog scale. This study represents the largest collection of columella reconstruction in the literature and demonstrates satisfactory reconstruction with recommended techniques.


Elevation of the Malar Fat Pad With a Percutaneous Technique

Reversal of midface aging has become a focus of facial rejuvenation. Ptosis of the malar fat pad is a major anatomic component of this aging. Standard face-lifting techniques result in only modest improvements in the midface (without aggressive techniques) and increased morbidity. Gregory S. Keller, MD, and colleagues describe a simplified percutaneous suture technique to elevate the malar fat pad. They present results in 118 patients over a 20-month period with excellent outcomes and little morbidity.