Derya Özçelik, MD, and associates performed an interesting and novel study to investigate the bone induction capacity of neonatal dura in a rat zygomatic arch fracture model. A standard 2-mm defect was created in the midportion of the zygomatic arch, and then covered with neonatal dura or periosteum, or left open (control). The animals were followed up and studied with 3-dimensional computed tomographic scans and histologic evaluations. Whereas the fracture sites treated with neonatal dura and periosteum demonstrated good osteogenesis, osteogenesis was limited in the control group. Statistical analysis revealed no difference in bone regeneration between the neonatal dura group and the periosteum group. The most important result of this study is to show the osteogenic potential of neonatal dura outside of its usual microenvironment. This study also reinforces the clinical wisdom of maintaining periosteum at fracture sites whenever possible.
Tea Leaves, by William McGregor Paxton (1869-1941).Article
Elizabeth G. Whitaker, MD, and Calvin M. Johnson, Jr, MD, performed a retrospective review of representative patients to determine the evolution of open structure rhinoplasty. Calvin Johnson, Jr, MD, and Dean M. Tourimi, MD, published their seminal book, Open Structure Rhinoplasty, in 1990. Its basic concepts have remained valid but the technique has evolved in subtle ways to create a more natural-appearing nasal contour. Domal suturing techniques are now used more frequently, especially in thin-skinned patients requiring subtle definition. Shield tip grafts continue to be used, especially when significant projection is needed. For thin-skinned patients the cap graft provides good camouflage and a softer profile when significant tip projection is not required. Domal apex grafts provide additional strength to the domes. The power strut can increase domal support and projection. The authors review the overall concepts underlying open structure rhinoplasty and update it with new refinements.
Multiple techniques are available to achieve nonablative rejuvenation of the skin. Their goal is to preserve the epidermis and create improvement in skin quality at the dermal level. Steven H. Dayan, MD, and his colleagues present a clinical series utilizing the 1064-nm Nd:YAG laser with a tip-cooling device. In this series the authors analyzed the 51 patients' own subjective scores of their improvement and the judgment of physicians who performed a blinded evaluation of photographs. The patients noted statistically significant improvement in categories of coarse wrinkles, skin laxity, and overall improvement. The 3 physicians noted statistically significant improvement in the same categories. This study adds to the continuing evidence that nonablative rejuvenation procedures can provide real, albeit subtle, improvement without injuring the epidermis.
Most of the literature on face-lift surgery describes techniques to improve the overall quality of the result, but the avoidance of complications and the prevention of visible incisions are paramount. Russell W. H. Kridel, MD, and Edmund S. Liu, MD, analyze the placement of the face-lift incisions and recommend techniques to create inconspicuous scars and avoid changes in the hairline. They detail surgical planning to avoid elevation of the temporal hairline or notching in the posterior hairline and discuss salvage of poor face-lift incisions, which includes microfollicular-unit hair transplantation.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2003;5(4):290. doi:10.1001/archfaci.5.4.290