Reanimation of the lower face after facial paralysis has been addressed using the temporalis muscle transfer and the static sling procedure. Both techniques have been shown to improve speech, deglutition, and cosmesis. David A. Sherris, MD, describes a slight modification to avoid the asymmetry of the paralyzed lip that may develop owing to stretching of the paralyzed muscle. By making incisions at or just across the midline at the vermilion border of the lips, and by suturing extensions of the fascial or static sling attachments that are passed through subcutaneous tunnels from the oral commissure at these openings, the lip is better able to maintain its symmetry. Readjustment of this technique can also be performed if necessary to improve the aesthetic outcome of the procedure.
Altering the nasal dorsum via reduction or augmentation to achieve an aesthetically pleasing profile is very common in rhinoplasty surgery. On the other hand, a wide nasal dorsum with an ideal dorsal height can be quite challenging to address. Monte O. Harris, MD, and Shan R. Baker, MD, developed an algorithm to help the rhinoplasty surgeon manage the broad nasal dorsum. They first provide a detailed anatomical description of the nasal dorsum, which helps identify areas that may need to be addressed during surgery. An open rhinoplasty is necessary to provide access, and alteration of the bony or cartilaginous septum, nasal bone, or upper lateral cartilage is performed via the techniques described by the authors to create, in essence, an open-roof deformity without affecting dorsal height. Subsequent medialization of the nasal sidewalls is done to narrow the dorsum. Case studies are included to illustrate the techniques used to narrow the nasal dorsum while preserving height.
Face-lift techniques have evolved from skin-only elevation to more extensive dissection of the deeper tissues of the face in various planes to achieve a more youthful appearance. In a study, Ferdinand F. Becker, MD, and Benjamin P. Bassichis, MD, compared the short-term results of correcting the melolabial fold, jowl, and cheek areas using the superficial musculoaponeurotic system (SMAS) plication face-lift vs the deep-plane face-lift. Four facial plastic surgeons were asked to evaluate aesthetic results in 40 patients who had undergone rhytidectomy, 20 with the SMAS plication and 20 with the deep-plane procedure. There was a trend toward better results with the SMAS plication in patients in their 50th and 60th decade of life, and the deep-plane rhytidectomy scored higher for patients older than 70 years. Although no statistical difference between the 2 procedures was seen, this study objectively compares the aesthetic results of 2 different face-lift procedures.
Defects caused by trauma or neoplastic resection of the scalp and forehead can vary greatly in size. Small defects can usually be closed primarily but larger defects can pose a difficult problem. Nigel J. P. Beasley, MB, and associates examine the indications and success of free flap reconstruction for both forehead and scalp defects. They developed a staging system and algorithm that takes into account the size and location of the defect, along with factors that may impair the viability of the surrounding tissues. Of the 34 free flap reconstructions performed, the latissimus dorsi muscle–only flap with split-thickness skin graft was used primarily for the scalp and the cutaneous scapular free flap was used primarily for the forehead. The authors found that using free vascularized tissue entailed very few complications and could be a reliable way to close large forehead and scalp defects.
The Fountain of Youth, by Lucas Cranach the Elder (1472-1553).Article
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2004;6(1):6. doi:10.1001/archfaci.6.1.6