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Holger G. Gassner, MD, and colleagues present a detailed study of the midface anatomy. The authors address several important questions, including the exact anatomic structure of the medial aspect of the superficial musculoaponeurotic system and its relation to the melolabial fold. They show that the melolabial fold consists of 3 anatomically distinct horizontal thirds. The anatomy of the melolabial bulge is demonstrated, and novel observations are depicted in photographs and surgical drawings. A new “sublevator space” is described and the contributions of the buccal fat noted. These results shed light on previously elusive anatomic details that may have important implications for current face-lift techniques.
The lateral crural division has been traditionally used to control projection and rotation of the nasal tip. Cephalocaudal positioning of the lateral crura is yet another parameter with important aesthetic and functional implications; if malpositioned, it can cause the “parenthesis deformity” of the nasal tip. Armando Boccieri, MD, and Giuseppe Raimondi, MD, describe a modification of the lateral crural overlay in which the incision is stairstep shaped rather than vertical and the cartilage is completely dissected from the vestibular skin. The subsequent downward displacement and overlap successfully resolves the parenthesis deformity. A detailed description of the technique, with illustrations and photographs, is provided.
Various autologous and alloplastic materials are used for columellar strut grafting to increase projection and rotation of the nasal tip. Although septum cartilage is the most commonly used material, it may not be available for various reasons. Michael E. Jones, MD, and colleagues describe a technique in which an autologous demucosalized inferior turbinate is used as a graft for augmentation of nasal tip projection. The nasal tip projection was increased in all of the patients undergoing this technique, and results were maintained at the immediate and long-term follow-up visits.
Key factors in recognizing and treating eyebrow deformities are discussed in a retrospective series by Catherine L. Noel, DO, and John L. Frodel, MD. Forty consecutive patients were identified as having asymmetric eyebrow ptosis or deformity. Patients underwent various surgical approaches for correction of eyebrow malposition with a mean duration of follow-up of 15 months. Preoperative and postoperative photographs were analyzed. Improvement in symmetry was graded as complete in 8 patients (20%), significant in 23 (57%), modest in 7 (18%), and not improved in 2 (5%). The authors emphasize that identification of the eyebrow deformity must be included in a systematic evaluation of every cosmetic or reconstructive patient. The surgeon must be able to apply various eyebrow-lifting techniques and be critical of results to maximize outcomes.
Still Life with Sweets and Pottery by Juan Van der Hamen y Leoén (1596-1631).
This issue's Highlights were written by Joseph Shvidler, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2008;10(1):7. doi:10.1001/archfacial.2007.5
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