Crimson Roses, by Charles Webster Hawthorne (1872-1930).Article
Nonablative laser treatment holds the promise of achieving dermal remodeling without the healing problems associated with ablative laser resurfacing. In this animal study Ravinder Dahiya, MD, Samuel M. Lam, MD, and Edwin F. Williams III, MD, performed a systematic evaluation of outcomes after nonablative pulsed-dye laser treatments. Variations in fluence, spot size, pulse duration, and use of cooling spray were studied with both nontreated skin controls and controls treated with the ablative carbon dioxide ablative laser. Both the nonablative pulsed-dye laser treatments and the ablative carbon dioxide ablative laser treatments resulted in significant increases in collagen band width over controls. Higher fluence, larger spot size, and longer pulse duration all increased the collagen band width. This quantitative analysis of the effects of nonablative therapy on dermal collagen bodes well for the continued development of nonablative laser therapy in clinical situations.
An Evolving Technique
Routine open reduction of subcondylar fractures of the mandible is controversial. Reports of minimally invasive approaches for the reduction and repair of subcondylar fractures have been well received because smaller incisions lower the risks of facial nerve paresis and other associated morbidity. This report summarizes the experience of Robert M. Kellman, MD, with 17 endoscopic procedures. Rigid plate fixation was completed endoscopically for 10 fractures, and 2 were plated after conversion to a full open approach. Four were reduced but could not be plated. In 1 exploration, a bent plate was removed but a new plate was not applied. Nine of the 10 fractures plated endoscopically resulted in normal occlusion and function. In the 10th case a revision was required, resulting in a successful outcome. The author concludes that this approach is challenging but feasible and useful.
Patrick J. Byrne, MD, William E. Walsh, CMI, and Peter A. Hilger, MD, describe a useful technique to lateralize inwardly displaced lateral nasal bony sidewalls secondary to previous procedures, trauma, or congenital deformities. A straight 2-mm osteotome is used to perform a transnasal perforating "inside-out" lateral osteotomy at the usual lateral osteotomy site. Working with a series of 4 fresh cadavers, the authors demonstrated that, compared with a continuous osteotomy performed on the contralateral side, this technique results in a lateralized nasal bone with good stability and periosteal support. This osteotomy technique is another tool in the armamentarium of the rhinoplasty surgeon to address the not uncommon situation of a medially displaced lateral nasal wall.
Stanley W. Jacobs, MD, Article discusses his preventive canthopexy procedure, which he has used in 247 patients over the last 5 years. He performed a lateral canthopexy in patients with a lid distraction distance of less than 10 mm, and a tarsal strip canthoplasty in patients with greater lid distraction. The author advocates routine canthal tightening in lower-lid blepharoplasty. This approach, which is adhered to by many surgeons, may resolve many of the lower-lid malposition problems experienced by patients who had blepharoplasty. In his Commentary Robert A. Goldberg, MD, Article recommends the underlying mechanics of the procedure and discusses an individualized approach to optimize results and minimize complications. Both authors emphasize the potential problems and attention to detail required when performing lower-lid blepharoplasty.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2003;5(3):217. doi:10.1001/archfaci.5.3.217