The transvestibular approach is a unique endonasal rhinoplasty method originally described by Nabil S. Fuleihan, MD, in 1998. Having performed more than 800 cases using this approach, he has refined the technique with an expanded number of suture possibilities that can be performed through this exposure. He documents in this large series the simplicity of the dissection and the predictability of the results. The approach is not well suited for revision cases because scarring limits the dissection of vestibular skin flaps. This article reaffirms with the author's extensive experience the usefulness of the transvestibular approach as a viable alternative to more traditional endonasal rhinoplasty procedures.
Glycyl-l-histidyl-l-lysine-Cu2+ (GHK-Cu) is a copper tripeptide complex that has been shown to improve wound healing and the appearance of photoaged skin. This naturally occurring complex has recently been introduced into skin care product lines. Timothy R. Miller, MD, and colleagues present a randomized, prospective study to objectively and subjectively evaluate the effects of skin care products containing GHK-Cu on wound healing by following a cohort of patients who underwent carbon dioxide laser resurfacing. Computer analysis and blinded evaluators found no significant difference in resolution of erythema. All patients in both groups showed improvement in wrinkles and overall skin quality; however, no significant differences were found between the groups. Validated patient questionnaires did show a significant difference in overall skin quality for patients who used the copper tripeptide complex.
Efforts to provide more balanced facial rejuvenation have advanced the development of techniques to correct midfacial ptosis. Endoscopically assisted midface-lift with suture suspension has gained significant popularity. James Newman, MD, presents a prospective cohort of 10 patients who underwent isolated midfacial lifting using the absorbable Endotine soft tissue device as a suspension alternative to sutures. To determine the safety and efficacy of this technique, objective and subjective criteria were recorded and photodocumented for at least 6 months after surgery. Of the 10 patients, 9 had significant improvement in aesthetic outcomes. One patient experienced a temporary zygomatic branch weakness, and malar sensitivity was the most common objective symptom reported. There were no complications of infection, extrusion, or need for device removal. Newman believes this device to be another option for safe and secure suspension of the mobilized midface and one that has the advantage of placement adjustability and a theoretical decreased risk of nerve entrapment.
The overly projected nasal tip can be secondary to a number of different anatomic causes. Various deprojection techniques have been described to correct specific causes of tip overprojection. Jeffrey B. Wise, MD, and colleagues present an intermediate crural overlay technique to deproject the nasal tip without increasing nasal length. Eleven patients with overdeveloped intermediate crura as the cause of overprojection were prospectively treated with this deprojection technique. Review of postoperative photographs showed decreased projection in all 11 patients. Seven of 11 patients had an increase in the nasolabial angle. One patient had no change in the nasolabial angle, and 3 patients had mild degrees of counterrotation. The authors believe this technique to be especially well suited for thin-skinned patients in whom vertical dome division would be relatively contraindicated.
Madre y Niño by Oswaldo Guayasamín (1919-1999).Article
This issue's Highlights were written by Bryan Ambro, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2006;8(4):232. doi:10.1001/archfaci.8.4.232