The use of hydroxyapatite (HA), a natural substrate of bone, has been extensively studied in craniofacial repair but not in facial augmentation. A prospective study using adult New Zealand rabbits was performed by Mimi S. Kokoska, MD, and associates to study the results of implantation with HA cement and preformed HA disks for facial augmentation. Disks and cement were implanted along the rabbits' nasal dorsum and along both supraorbital ridges. Histologic examination performed at intervals from 3 to 24 months revealed that HA cement underwent both osteoconversion and osteointegration, along with a 15% decrease in height and width. In contrast, a vascularized fibrous capsule formed around the HA disk implants, which did not incur any changes in size. This study shows promise in the use of HA implants for non–stress-bearing areas of the craniofacial skeleton.
A novel approach to provide an objective measurement of nasal tip projection and the nasolabial angle is proposed by Susanne Spörri and associates. Noting that the position of the cornea in lateral views and the diameter of the iris in frontal views remain constant, they indicate calibrations that can standardize preoperative and postoperative photographs and discuss photographic conditions required for accurate measurement. They used their calculations to determine changes in patients undergoing surgery for saddle nose deformities. Using this iris-dependent calibration can provide a more accurate and objective comparison of photographs for future studies.
Recent statistics show that humans are projected to live longer, and many elderly individuals have shown a great interest in undergoing cosmetic procedures. Given the advances in anesthesia care and monitoring, Ferdinand F. Becker, MD, and Richard D. Castellano, MD, retrospectively compared the senior author's experience in performing face-lift surgery in patients older than 75 years and in patients between 45 and 61 years. They noted that all the patients in the older group were classified as having American Society of Anesthesiologists (ASA) physical health status 2, except 1 patient who had ASA 3 status, whereas the younger patients all had ASA 1 or ASA 2 status. Although the authors found no statistical difference, there was a trend for patients with ASA 1 status to experience fewer complications than those with ASA 2 status; and when matched for ASA status, elderly and middle-aged patients had similar postoperative complication risks from face-lift procedures. This study supports using health status rather than chronological age when considering risks of postoperative complications.
Several materials are available to use in static facial suspension procedures for patients who develop facial paralysis. Materials such as human acellular dermis and expanded polytetrafluoroethylene (PTFE) are popular because they do not require a donor. However, the former material has been observed to have variable longevity and unpredictable results, and the latter to have a tendency for extrusion or infection necessitating removal, especially in patients who have received radiation therapy. Using a materials testing machine, Adam S. Morgan, MD, and associates tested the maximum load to stiffness and/or failure of 3 different materials: superficial dermis, deep dermis, and PTFE. Samples of dermis displayed a statistically greater mean stiffness than PTFE samples, and there was a statistical difference in maximum load to failure between the deep dermis and PTFE. This study shows that the biomechanical properties of cadaveric dermis may be superior for use in static facial suspension.
A Tough Story by John George Brown (1831-1913).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(5):289. doi:10.1001/archfaci.6.5.289