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
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
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
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.
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.
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.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2002;4(1):4. doi: