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Many methods have been described that address lower-eyelid skin and fat. Newer procedures have focused on orbital fat preservation and repositioning, but their long-term results have not yet been reported. Carlo P. Honrado, MD, and Norman J. Pastorek, MD, provide a detailed description of their technique for the skin-muscle flap with lower-lid suspension and report on results accumulated over 30 years. They contend that the lid suspension suture, along with other reinforcement techniques, helps prevent some of the complications often associated with transcutaneous approaches such as ectropion or scleral show. Results seen in 3988 patients over 3 decades attest to the reliability of this procedure in tightening the loose skin and muscle of the lower eyelid to create a more attractive and youthful appearance.
A retrospective review of 53 patients was performed by Maurice M. Khosh, MD, and associates to determine the etiology of nasal valve obstruction in patients requiring surgical correction and evaluate efficacy of repair and cosmetic result. Most of the patients who required surgical correction of internal and/or external nasal valve had a history of rhinoplasty (79%) or trauma (15%). This study discusses the cosmetic changes associated with the placement of spreader and alar batten grafts to improve nasal airflow, and demonstrates that proper diagnosis and surgical technique can create an aesthetically pleasing nose and improve subjective nasal obstruction.
Bigger and fuller lips have become increasingly popular in recent years, especially with the availability of many different soft tissue fillers. Although lip fullness can easily be addressed, changes to the shape of the lips are often less predictable. Using digital imaging software, Andrew A. Jacono, MD, and Vito C. Quatela, MD, analyze 3-dimensional changes in 8 patients who underwent a V-Y lip advancement procedure. Statistically significant increases in the vertical height and area of the upper red lip were calculated. The recovery ranged from 2 to 3 months, but patients were very pleased with their results. Follow-up, which averaged 11 months, suggests that this procedure may be a permanent solution to lip augmentation.
Behrooz A. Torkian, MD, and associates present a novel wound-healing model to study keloid-derived fibroblast activity and collagen production. Multiphoton microscopy is a technique used to produce a nondestructive, optical section of living tissues with diffraction-limited image resolution. A tissue-engineered wound model was created by using a scalpel to "wound" a "raft," an artifical tissue construct consisting of fibroblasts embedded in a collagen gel. Fibroblasts were found to aggregate along incision line margins and display enhanced collagen production. This model will be useful in performing long-term, noninvasive studies of wounds that are characterized by excessive and undesirable collagen deposition and possible treatments.
Self-portrait by Cai Guo-Qiang.Article
This issue's Highlights was written by Carlo P. Honrado, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2004;6(3):149. doi:10.1001/archfaci.6.3.149