Reattachment of the periosteum to the underlying calvarium is essential to maintaining the elevated brow position after an endoscopic forehead-lift. Until the periosteum reattaches, it is critical to provide fixation of the brow in the lifted position. Different fixation options have been described in the literature, each with specific advantages and disadvantages. Douglas M.Sidle, MD, and associates report a retrospective review of 80 patients who underwent endoscopic browplasty with BioGlue Surgical Adhesive as the primary means of periosteal fixation. Objective improvements of brow elevation were maintained throughout 1-year follow-up. Complications and revision rates were low. This study shows promise in the use of BioGlue for periosteal fixation after endoscopic browlift.
Stenosis of the nasal vestibule can result in both aesthetic and functional concerns. Surgical techniques to correct this difficult problem commonly employ a cartilage and/or composite graft to expand the contracted vestibule. Restenosis after surgical correction is a well-known complication, and many authors have shown it necessary to stent open the vestibule during the contractile stage of healing. Dirk-Jan Menger, MD, and colleagues present a custom-made vestibular device based on a mold of the patient’s anatomy used as a postoperative stent. Most patients had functional (98%) and aesthetic (94%) improvements. Only 1 patient required revision surgery during a mean follow-up period of 50.5 weeks.
Distraction osteogenesis (DO) is a surgical technique for reconstruction of skeletal deformities. It involves gradual, controlled displacement of surgically created fractures that results in expansion of soft tissue and bone volume. This technique has been applied to the craniofacial skeleton, including the cranium, orbits, maxilla, and mandible. Robert J. Tibesar, MD, and associates describe their innovative study in which DO was used to close surgically created cleft palates in 5 of 8 dogs. New bone formation was demonstrated histologically, and fluorochrome labels were used to analyze growth patterns. They postulate that the use of DO to close bony palate defects would reduce the forces that often result in decreased midfacial growth. This study shows that DO-induced closure of hard palate clefts is feasible in the canine model and that further study is needed before attempting such techniques in neonates born with cleft palates.
The overly projected nasal tip can disrupt normal nasal and facial harmony. Surgical correction of this aesthetic problem represents a unique challenge to the rhinoplasty surgeon. Peyman Soliemanzadeh, MD, and Russell W. H. Kridel, MD, retrospectively review the senior author’s long-term experience with deprojection techniques. They present a thoughtful algorithm of preferred methods used to correct nasal tip overprojection while maintaining or altering tip rotation. Deprojection procedures included complete transfixion incision, lateral crural overlay, medial crural overlay, dome truncation, and combinations of these. An overview of each technique is presented, with emphasis given to the medial crural overlay technique.
Kala by Gloria DeArcangelis (1957– ).Article
This issue’s Highlights were written by Bryan Ambro, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2005;7(6):369. doi:10.1001/archfaci.7.6.369