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Highlights of Archives of Facial Plastic Surgery
January 2007

Highlights of Archives of Facial Plastic Surgery

Arch Facial Plast Surg. 2007;9(1):5. doi:10.1001/archfaci.9.1.5
Selective Creation of Thermal Injury Zones in the Superficial Musculoaponeurotic System Using Intense Ultrasound Therapy

W. Matthew White, MD, and colleagues investigate intense ultrasound technology as a potential novel method of nonablative skin resurfacing; it induces thermal lesions in deep soft tissues and also permits imaging of the target tissues. Various thermal injury zones were created in the superficial musculoaponeurotic system over different anatomical sites in 6 human cadaver heads. Findings from histologic examination demonstrated that zones of thermal injury were confined to the target areas with excellent reproducibility among different specimens. The degree of thermal injury correlated with preset source power and exposure time settings, and the overlying skin was reliably spared. This method warrants further study to elucidate its potential role in facial rejuvenation.


The Effect of Low- Molecular-Weight Heparin on Microvenous Thrombosis in a Rat Model

Kevin S. Emerick, MD, and Daniel G. Deschler, MD, investigate the effect of low-molecular-weight heparin sodium on vessel patency in a rat model. The animals were assigned to receive subcutaneously administered dalteparin sodium or isotonic sodium chloride solution. Fifty-eight tuck procedures were performed on the femoral venous pedicle using microsurgical techniques creating a small intraluminal flap, predisposing the vessel to thrombosis. Thromboses were observed in 50% of the placebo group and 60% of the experimental group. However, these data do not suggest that administration of low-molecular-weight heparin reduces the perioperative risk of intraluminal thrombosis.


Midface Effects of the Deep-Plane vs the Superficial Musculoaponeurotic System Plication Face-lift

Peter A. Adamson, MD, and colleagues present a retrospective blinded study of deep-plane and superficial musculoaponeurotic system (SMAS) plication face-lift techniques. The 2 study groups consisted of 25 patients, each followed up for at least 6 months. Three expert observers were blinded to the type of procedure performed and were asked to evaluate photographs taken before and after surgery. Five aspects of the face were rated using a linear 7-point visual analogue scale that included the appearance of the malar eminence, melolabial fold, and cervicomental angle. Statistically significant and clinically relevant differences were observed, especially in the malar eminence and the melolabial fold, showing that the deep-plane face-lift can provide superior results. The SMAS plication technique show less marked improvement, but its results approached those of the deep-plane face-lift for improvement of platysmal banding and appearance of the cervicomental angle. The authors conclude that the deep-plane face-lift technique achieves a superior improvement of the appearance of the midface compared with that of the SMAS placation technique.


A Simplified Approach to Midface Aging

Ryan N. Heffelfinger, MD, and colleagues discuss a retrospective series of 110 patients who underwent a midface-lift using the 82/18 L-lactide/glycolide device (Coapt Endotine Midface ST 4.5) for fixation. Simultaneously performed ancillary procedures included rhytidectomy, blepharoplasty, and endoscopic brow-lift. The authors dissected the midface through a 4-cm temporal incision. With increasing experience, they found that an additional gingivobuccal sulcus incision was less frequently required. Duration of follow-up ranged from 1 to 26 months. Complications included postoperative asymmetry and infection, which occurred early in the series and were attributed to a learning curve with this elegant method. The surgical technique is described in detail, and the impressive surgical results are well illustrated.


Woman Holding a Balance by Johannes Vermeer (1632-1675). Article


This issue's Highlights were written by Holger G. Gassner, MD.