Design  A 17-year retrospective medical chart review at a teaching hospital, community hospital, and private facial cosmetic surgery center. A total of 521 patients (122 male and 399 female; age range, 13-70 years) were followed for 12 months to 17 years. All patients had undergone GORE-TEX implantation rhinoplasty (685 implants in 158 primary procedures and 508 secondary procedures) performed by 1 surgeon. Patient satisfaction, expressed with respect to desired cosmetic benefit and functional outcome, and physician assessment, based on aesthetic improvement, technical considerations, and complications, were evaluated. Results were assessed according to the follow-up notes in the medical chart reflecting patients' and surgeon's comments and full preoperative and postoperative photographic documentation.

Results  GORE-TEX alloplasts, 1 to 10 mm thick, implanted in the nasal dorsum (n = 264), lateral nasal wall (n = 252), supratip dorsum (n = 85), and premaxilla (n = 84) showed excellent stability and tissue tolerance. Biological complications that required implant removal occurred in 1.9% of patients and included infection, soft tissue swelling, migration, and extrusion.

Conclusions  With the exception of the nasal tip, columella, or problems in which corrections would require rigidity of the grafted or implanted material, the GORE-TEX alloplast is a safe, inexpensive, and predictable alternative to autografts. In the present series, more than 95% of implants used were 1 to 4 mm thick. In the remaining 5%, 6 implants ranged from 8 to 10 mm thick, and we found them acceptable. It is our opinion that for both primary and secondary rhinoplasty with adequate endonasal and external soft tissue coverage, GORE-TEX should be strongly considered for major and minor corrections of the nasal wall and bridge in properly selected patients.

Patients  African American male (n = 21) and female (n = 54) patients aged 14 through 58 years (mean, 33.8 years) who underwent rhinoplasty.

Methods  Open structure rhinoplasty, using the 3-tiered approach, was performed on all 75 patients. An anonymous questionnaire addressed postoperative patient satisfaction, maintenance of ethnic characteristics, self-esteem, and nasofacial harmony. The rate of complications was determined by medical record review.

Results  On a scale of 1 to 5 (1, no change; 5, complete change), patients reported a significant degree of preservation of ethnic characteristics (mean, 2.3), high self-esteem (mean, 4.3), and very high satisfaction (mean, 4.6) and facial harmony (mean, 4.3) postoperatively (P < .001 for all). The overall complication rate was 2.7%.

Conclusion  In African American patients, 3-tiered open structure rhinoplasty yields high patient satisfaction with a minimal rate of major complications.

Methods  This retrospective report describes our experience with 47 patients who underwent entire facial carbon dioxide laser resurfacing.

Results  The mean improvement in facial rhytid score at long-term follow-up was 45%. This improvement was consistent in all facial subsites. With the exception of 1 case of hyperpigmentation, which resolved within 2 years of treatment, hypopigmentation was the only long-term adverse effect. This complication was present in 6 patients (13%). The patients who developed hypopigmentation were more likely to have a greater response to treatment.

Conclusion  Our findings show that carbon dioxide laser resurfacing is a safe and effective treatment for facial rhytids.

Methods  Rabbit nasal dorsum cartilage grafts were placed in 3 groups. The first group used fresh autologous cartilage; the second group, alcohol-preserved homologous cartilage; and the third group, alcohol-preserved autologous cartilage. Each rabbit received 2 grafts, one crushed and another noncrushed. After 16 weeks, the grafts were removed for analysis.

Results  No graft calcification occurred in any group. Chondrogenesis was observed in all groups. The fresh autograft group had the best results in the evaluation of the area of graft recovered and chondrocyte viability. The preserved autologous and homologous grafts did not differ in relation to any of the variables analyzed. Crushed grafts had inferior results in the area of graft recovered and chondrocyte viability compared with the noncrushed forms. No significant difference among the 3 groups was noted in the thickness of the fibrous capsule that developed around the graft.

Conclusions  The fresh cartilage autograft was superior to the crushed and uncrushed preserved homografts and autografts; both types of preserved grafts had equivalent histological results. The uncrushed forms were superior to the crushed forms.

Methods  In this case series, 25 gastro-omental free flaps were performed. The technical aspects of harvest are reviewed, and the advantages and disadvantages of this flap are described, as well as illustrative cases displaying this flap's utility when other donor sites cannot be harvested.

Results  Flap survival was 96%, with 1 flap being successfully salvaged after the development of a venous thrombosis and 1 flap failing as a result of a kink in the arterial pedicle. Exteriorization of the omentum as an external marker heralded vascular compromise in both cases. Complications included 2 delayed gastric outlet obstructions, 1 salivary leak, 1 delayed abscess and fistula formation 7 months following reconstruction, and 1 case of mild superficial bleeding from the transplanted gastric mucosa.

Conclusion  The gastro-omental flap has proven to be a reliable and valuable tool in head and neck reconstruction, particularly in complex oropharyngeal wounds with large soft tissue components.

Methods  Single-blinded cohort study in a private facial plastic surgery practice. Treatment and control patients were selected from those presenting for aesthetic surgery. All patients underwent rhytidectomy with SMAS imbrication by a single surgeon. In addition, treatment patients underwent subcutaneous implantation of excised SMAS strips to the nasolabial fold. Treatment and control patients were matched for any other simultaneous procedures known to affect appearance of the nasolabial folds. Preoperative and postoperative photographs were graded by 3 blinded observers using the Wrinkle Severity Rating Scale to evaluate the nasolabial fold. Postoperative photographs were evaluated approximately 3 months and again 1 year after the procedure.

Results  Compared with controls, there was a significant difference in the nasolabial folds of patients undergoing SMAS implantation at the 3-month postoperative evaluation (P = .03; ² = 4.696). This benefit was lost when the results were evaluated 1 year after the procedure (P = .88; ² = 0.0212).

Conclusion  Superficial musculoaponeurotic system implantation to the nasolabial folds offers modest temporary improvement to this area in patients undergoing rhytidectomy with SMAS imbrication.

Methods  Twenty-five patients who underwent an endoscopic forehead midface-lift with a lower eyelid blepharoplasty or lower eyelid blepharoplasty without a midface-lift between January 1, 2005, and May 15, 2005, were included in the study. Preoperative and immediate postoperative measurements of the vertical height of the lower eyelid were taken in all patients. The change in the vertical height of the lower eyelid after endoscopic forehead midface-lift with blepharoplasty was compared with the change in lower eyelid height after either transconjunctival or lower eyelid skin pinch blepharoplasty or skin muscle flap blepharoplasty alone. The amount of lower eyelid skin excised after endoscopic forehead midface-lift with blepharoplasty was compared with both transconjunctival or lower eyelid skin pinch blepharoplasty and skin muscle flap blepharoplasty when a midface-lift was not performed.

Results  The average change in the vertical height of the lower eyelid after the endoscopic forehead midface-lift was 5 mm. Lower eyelid blepharoplasty alone, whether transconjunctival with skin pinch or skin muscle flap, did not affect the vertical height of the lower eyelid. The change in the vertical height of the lower eyelid with midface surgery over blepharoplasty alone was statistically significant (P < .001). The average amount of lower eyelid skin excised after endoscopic forehead midface-lift and lower eyelid skin pinch was 7.0 mm compared with 5.5 mm for both the transconjunctival lower eyelid skin pinch and the skin muscle flap techniques. The difference in skin excision when a midface-lift was performed compared with blepharoplasty alone was statistically significant (P = .008).

Conclusions  The endoscopic forehead midface-lift can reduce the vertical height of the lower eyelid by an average of 5 mm and allows more skin excision over blepharoplasty alone. The endoscopic forehead midface-lift is a powerful tool for decreasing the vertical height of the lower eyelid, lessening infraorbital hollowing, and improving dermatochalasis.

Methods  We conducted a prospective, double-blind, randomized controlled trial at an academic facial plastic surgery practice with 40 volunteers for treatment of horizontal forehead rhytids, each acting as his or her own control. In a blinded fashion each subject received freshly reconstituted Botox (control) on one side of the forehead (frontalis muscle) and 2-week-old reconstituted Botox (experimental) stored at 4°C (refrigerated) or stored at –20°C (frozen) on the other side. The right and left forehead movement was measured and photographed at rest and during maximum contraction of the frontalis muscle prior to Botox administration and on follow-up days 14, 30, 60, 90, and 120 after injection. Each participant also completed a questionnaire regarding right and left forehead movement prior to injection and at each follow-up visit.

Results  No significant difference was noted for any subject in the timing of onset or duration of action or the measurable reduction of forehead movement between the fresh and 2-week-old refrigerated Botox or between the fresh and 2-week-old frozen Botox. The subjects had a gradual return of muscle function over the 4-month follow-up period.

Conclusions  No measurable difference was found in the potency or duration of efficacy of Botox in the treatment of forehead rhytids after 2 weeks of refrigeration or freezing compared with fresh reconstituted Botox. When Botox, fresh or stored, is given at an adequate dose to cause full paralysis of the desired muscle, the duration of the muscle paralysis is dependent on the physiologic rate for the motor nerve to reestablish neural transmission.

Methods  The study included 120 patients with aesthetic and functional nasal problems resulting from the loss of caudal septal and premaxillary support. An external rhinoplasty approach was performed to reconstruct the lost support using a cartilaginous caudal septum replacement graft and premaxillary augmentation with Mersilene mesh.

Results  The majority of cases (75%) involved revisions in patients who had previously undergone 1 or more nasal surgical procedures. A caudal septum replacement graft was combined with premaxillary augmentation in 93 patients (77.5%). The mean follow-up period was 3 years (range, 1-12 years). The technique succeeded in correcting the external nasal deformities in all patients and resulted in a significant improvement in breathing in 74 patients (86%) with preoperative nasal obstruction. There were no cases of infection, displacement, or extrusion.

Conclusions  The caudal septum replacement graft proved to be very effective in restoring the lost tip support in patients with caudal septal deficiency. Combining the graft with premaxillary augmentation using Mersilene mesh helped increase support and stability over long-term follow-up.

Methods  Tibial defects of 1.0 cm were created in 5 New Zealand white rabbits. After a 6-day latency phase, a 1.0-cm distraction segment was created in 0.3-mm increments every 12 hours. Within 24 hours of the distraction completion, the tibia received the biologic equivalent of 6000 rad (60 Gy). After 6 weeks of consolidation, the animals were humanely killed. Bone was analyzed radiographically, grossly (at autopsy), and histomorphometrically.

Results  Four rabbits completed the 6-week consolidation period. All specimens had evidence of calcified bone in the segmental defect on radiographic analysis. At autopsy, the volume of new bone equaled that of the removed segment. On histologic examination, the volume of new trabecular bone was similar to adjacent cortical bone.

Conclusions  Consolidation of segmental distraction osteogenesis defects can occur in rabbit tibia during external beam radiotherapy. To our knowledge, this study is the first to demonstrate successful consolidation of segmental distraction osteogenesis during external beam radiotherapy.

Design  A retrospective medical record review was performed for 12 patients undergoing intranasal Z-plasty for nasal valve collapse. Medical records were evaluated for age, sex, indication for surgery, prior surgical procedures, complications, results, and length of follow-up. A visual analog scale was used to rate nasal obstruction preoperatively and postoperatively.

Results  A total of 8 men and 4 women underwent surgery, and the procedure was bilateral in 10 of the 12 patients, for a total of 22 nasal valves. Eleven patients noted subjective improvement in airflow on both sides, with the remaining patient noting improvement on one side and no change in the opposite side. Mean follow-up was 16.8 months (range, 5-32 months). The mean preoperative nasal obstruction score was 7.2, and the mean postoperative nasal obstruction score was 3.3 (on a scale of 0 to 10, with 10 being total obstruction). No complications were reported, and no patients complained about postoperative nasal appearance.

Conclusion  Intranasal Z-plasty appears to be a safe, effective, and relatively noninvasive technique to repair internal nasal valve collapse.

Methods  Analysis of current surgical methods, scientific studies, and predominant theories to produce a new model of nasal tip support based on the biomechanical properties of the nasal cartilages.

Results  The nasal tip acts as a cantilevered spring that associates with other rigid and semirigid regions of the nose. Application of these concepts resulted in preservation of projection and tip rotation in appropriately selected patients.

Conclusion  The cantilevered spring tripod provides a more universal model for explaining nasal tip dynamics in a contemporary multiethnic population of patients seeking functional or cosmetic rhinoplasty correction.

Methods  In fresh cadaver heads, identical, unilateral 1-cm circular defects were created at the superior alar margin. Three different laterally based bilobed flap templates for reconstruction were used. One template, used on 3 cadavers, had an angle of 60° between the alar rim and the long axis of the secondary defect. Another template, used on 3 cadavers, had an angle of 90°. The last template had an angle of 135° and was used on 2 cadavers. Photographs were taken before the repair and after with the camera and cadaver heads in the same spatial relationship to each other.

Results  In the 3 cadavers that had repair using an angle of 60°, all cadavers experienced alar retraction, with a mean displacement of 1.3 mm. This was not a statistically significant change (P = .07). In the defects that had repair using an angle of 90°, there was also no significant alar displacement (P = .72). In the 2 cadavers that underwent repair using an angle of 135°, both ala underwent depression by 1.0 mm. When the differences achieved between the different angles were compared, there was a significant difference in measured distortion between the cadavers that had 90° and 60° vector placement (P = .02). There were no measurable changes to the contralateral maximal nostril distance.

Conclusions  Vector alignment can have an impact on nostril displacement. In bilobed flaps, the axis of the secondary defect may play an important role. This study suggests that secondary defects aligned perpendicular to the nostril have the least amount of alar distortion.

Methods  Twenty-five New Zealand white rabbits were used. Equally sized autogenous (fat, fascia, cartilage, and dermal) grafts and AlloDerm were implanted into subcutaneous dorsal pockets on the rabbits. Animals were killed 1, 2, 3, and 4 months after surgery. The grafts were examined microscopically for thickness, resorption, fibrosis, neovascularization, inflammation, eosinophilia, and the presence of multinucleated giant cells or microcysts.

Results  The cartilage grafts revealed excellent viability with no resorption. The fascial grafts showed negligible volume loss. The dermal grafts developed epidermoid cysts. The AlloDerm grafts demonstrated graft thickening at 1 month and total resorption at 3 and 4 months. The fat grafts demonstrated 30% to 60% partial resorption.

Conclusions  The major disadvantage of using an autogenous fat graft was partial resorption, whereas cyst formation was observed with dermal grafts. AlloDerm caused tissue reaction and resorption. The best graft material was cartilage, with a low absorption rate, good biocompatibility, and minimal tissue reaction or fibrosis, followed by fascia, with a minimal shrinkage capacity and tissue reaction.

Methods  A review of the English-language literature was performed to identify outcomes instruments specific for targeted facial plastic surgery interventions and conditions. A search was performed using MEDLINE (1950 to September 2007), CINAHL (Cumulative Index to Nursing & Allied Health) (1982 to September 2007), and PsychINFO (1806 to September 2007). Outcomes instruments were categorized as patient-reported or clinical efficacy measures (observer-reported or objective measures). Instruments were then categorized to include relevant details on the intervention, degree of validation, and subsequent use.

Results  Sixty-eight distinct instruments were identified (23 patient-reported, 35 observer-reported, and 10 objective measures), with some overlap among categories. Most patient-reported measures (76%) and half observer-reported instruments (51%) were developed in the past 10 years. The rigor of validation varied widely among measures, with formal validation being most common among the patient-reported outcome measures.

Conclusions  Validated outcomes measures are present for many common facial plastic surgery conditions and have become more prevalent during the past decade, especially for patient-reported outcomes. Challenges remain in harmonizing patient-reported, observer-based, and other objective measures to produce standardized clinically meaningful outcome measures.

Methods  A 3-year prospective cohort study. The patient population, which comprised a consecutive series of patients 16 years or older, undergoing cosmetic nasal or facial surgery, was obtained from the senior author's (P.A.A.) private surgical practice. All patients presenting for surgery were offered participation. The main outcome measure was the 59-item Derriford Appearance Scale (DAS59), a valid and reliable instrument assessing psychological distress associated with self-consciousness of facial appearance. Three patient score subgroupings were established: group 1, the DAS59 scores for all patients; group 2, the DAS59 score according to sex; and group 3, the DAS59 score according to the main surgical procedure. Surveys were administered to eligible patients at the final preoperative clinic visit and at 3 months after surgery. Data from the case-control groups were analyzed by a blinded statistician with appropriate t tests.

Results  A total of 93 patients were enrolled with a 100% response rate (82 females [88%] and 11 males [12%]). The most common procedures were rhinoplasty (49%) and surgery for the aging face (51%). Marked differences in perioperative QOL were noted across all DAS59 domains for group 1 and for all females in group 2. Male patients in group 2 analysis experienced QOL improvement only from DAS59 domain 2 (General Self-consciousness of Facial Appearance). Rhinoplasty and surgery for the aging face improved patients' QOL but differed with respect to which DAS59 domains were affected.

Conclusions  Quality of life was enhanced by facial plastic surgery in this patient population. Male and female patients seem to have different needs to be met from facial cosmetic surgery and correspondingly different areas of improvement in QOL. Rhinoplasty and surgery for the aging face act on different domains of QOL.

Design  Prospective clinical study at an outpatient facial nerve center.

Results  The overall Facial Clinimetric Evaluation score improved from a mean (SD) of 51.7 (20.9) in the pretreatment group to 63.7 (17.8) in the posttreatment group (P < .05). Statistically significant improvements were noted in all subdomain scores, including Facial Movement, Facial Comfort, Oral Function, Eye Comfort, Lacrimal Control, and Social Function (P < .05 for all comparisons).

Conclusions  Botulinum toxin has a well-established objective benefit in the control of facial hyperkinesis in patients with facial nerve disorders. This study establishes the associated QOL benefit and reaffirms its important role in the multimodality management of patients with facial nerve disorders.

Design  A retrospective review (1975-2005) was conducted. Patients were selected from a computerized rhinoplasty database of operative cases. The database was used to extract a subset population that had received the hockey-stick tip procedure and had follow-up data for 1 year or more after surgery. Medical records and photographs were also analyzed in this review of results and complications.

Results  The hockey-stick modification of vertical dome division was used in 137 patients (9.9% of the rhinoplasties in the computerized database). Of these, 64 patients had 1 year or more of follow-up. Complications referable to the nasal tip (eg, bossae, persistent tip projection, and alar asymmetry) were seen in 8 patients (13%). Revisions for tip-related problems were performed in 4 patients (6%).

Conclusions  The hockey-stick technique is an effective method for nasal tip deprojection and narrowing via an endonasal approach. The length of follow-up in this patient population allows good long-term evaluation of this technique.

Methods  A retrospective analysis was conducted of the clinical records of 703 patients (2440 anatomic burn sites) treated at the Turin Burn Outpatient Clinic between January 1994 and May 15, 2006. Prevalence and evolution time of postburn pathologic scarring were analyzed with univariate and multivariate risk factor analysis by sex, age, burn surface and full-thickness area, cause of the burn, wound healing time, type of burn treatment, number of surgical procedures, type of surgery, type of skin graft, and excision and graft timing.

Results  Pathologic scarring was diagnosed in 540 patients (77%): 310 had hypertrophic scars (44%); 34, contractures (5%); and 196, hypertrophic-contracted scars (28%). The hypertrophic induction was assessed at a median of 23 days after reepithelialization and lasted 15 months (median). A nomogram, based on the multivariate regression model, showed that female sex, young age, burn sites on the neck and/or upper limbs, multiple surgical procedures, and meshed skin grafts were independent risk factors for postburn pathologic scarring (Dxy 0.30).

Conclusion  The identification of the principal risk factors for postburn pathologic scarring not only would be a valuable aid in early risk stratification but also might help in assessing outcomes adjusted for patient risk.

Methods  This is a retrospective review of 605 patients (78 male and 527 female) who, over a 6-year period, underwent deep-plane face-lift surgery (n = 544) or lateral superficial musculoaponeurotic system (SMAS)ectomy (n = 61) by the senior author (S.S.R.) without the use of surgical drains. One hundred forty-six consecutive patients underwent rhytidectomy without fibrin tissue glue, and the following 459 consecutive patients were sprayed with fibrin glue under the flap prior to flap closure. Pressure dressings were used on all patients for 24 hours.

Results  None of the patients in either group had major or expanding hematomas requiring operative intervention. In the group of patients treated without fibrin glue (n = 146), there were 5 minor, nonexpanding hematomas, all managed by needle aspiration. This is a minor hematoma rate of 3.4%. In the fibrin glue group (n = 459), there were 2 hematomas, for a rate of 0.4%. Using a Fisher exact test, we found a statistically significant decrease in the hematoma rate from 3.4% to 0.4% (P = .01). Male patients had a higher hematoma rate than female patients, and only men had significantly fewer hematomas when fibrin glue was applied (P = .01). All 7 hematomas were recognized in the first 24 hours after surgery. Of the 7 patients with hematomas, 2 (29%) had emesis in the recovery room despite medication.

Conclusions  The use of fibrin glue demonstrates a significant decrease in the rate of hematoma formation. Fibrin glue may benefit male more than female patients. If meticulous hemostasis and pressure dressings are used, drains are not necessary. The prevention and prompt treatment of postoperative nausea may also help prevent hematoma formation.

Methods  In 30 fresh cadavers of white individuals, nasal dissections were performed, divided into 3 different approaches: from radix to nasal tip, from nasal tip to radix, and from midline to lateral. The anatomical and surgical planes of dissection were followed to isolate the nasal superficial musculoaponeurotic system (SMAS). Correlations between the nasal SMAS and the nasal framework were noticed. In 9 specimens, the left nasal wall was resected for histologic examination.

Results  The nasal SMAS consists of a unique layer, and it divides at the level of the nasal valve into deep and superficial layers. Each layer has medial and lateral components. The dermocartilaginous ligament corresponds to the deep medial expansion. Both the deep and the superficial medial expansions correspond to the lowering ligaments of the nasal tip; the cephalic rotation of the nasal tip is allowed by their cut. The histological examination showed that the deep lateral expansion is composed of fat.

Conclusions  This description of the nasal SMAS explains the relationship between the nasal muscles and ligaments, including the dermocartilaginous ligament described by Pitanguy. Furthermore, it is helpful to surgeons during rhinoplasty.

Methods  The patient charts of 780 patients who underwent a deep-plane rhytidectomy between 2001 and 2007 were reviewed for postoperative wound infections. Culture results and sensitivities were recorded. To our knowledge, this is the first study that documents MRSA-positive surgical site infections after face-lift surgery.

Results  Five of 780 patients (0.6%) who underwent face-lift surgery by the senior surgeon had postoperative surgical site infections. Four of the 5 patients had cultures that were positive for MRSA. Two of these patients (0.3%) required hospitalization and had collections that had to be opened or drained and developed wound breakdown. Both patients eventually responded to wound care along with intravenous and then oral antibiotic therapy. The other 2 MRSA-infected patients responded to oral antibiotic therapy and local wound care alone. The 2 complicated infections occurred on postoperative days 5 and 8. These 2 patients were the only ones among the 5 patients with positive cultures who had known recent contact with another physician or a hospital. All infections occurred in the year 2006, with 3 patients experiencing infection in the last 4 months of the year. Herein, we describe the incidence and sequelae of MRSA infections and colonization. The 2 major different subsets of MRSA are community-acquired MRSA and health care–associated MRSA. Surgical site infections that are positive for MRSA blur this division, which affects many aspects of the course of disease and treatment. We also discuss strategies for screening, preventing, and treating MRSA surgical site infections.

Conclusions  Methicillin-resistant S aureus–positive surgical site infection is an increasingly problematic issue in all surgical fields. In the future, MRSA-positive infections will be more prevalent and will require well-developed screening, prevention, and treatment strategies.

Methods  Twenty-two rabbits were used. Posterior skin flaps were elevated, and 4 cartilage struts were prepared on each auricula. Each strut was bent at its midpoint, and the skin under the bent area was elevated only in 1 side. The strut was sutured either with catgut, polyglactin 910, polydioxanone, or polypropylene sutures. Anteriorly, the suture was passed subcutaneously on 1 side, while transcutaneously on the other. Animals were killed at the first and fourth months. The shape of the struts was macroscopically evaluated. Inflammation and foreign body reaction around the suture were examined under light microscopy.

Results  Maintenance of shape with all suture materials was significantly lower in the transcutaneously sutured group than in the subcutaneously sutured group. Because of high rates of suture loss in the transcutaneously sutured group, further evaluations on cartilage tissue were made only in subcutaneously sutured group. Success rate in maintenance of shape was similarly high in the polydioxanone, polyglactin 910, and polypropylene suture groups; however, it was significantly lower in the catgut suture group.

Conclusion  Long-lasting absorbable suture materials are as effective as nonabsorbable ones, and the subcutaneous technique is more effective than the transcutaneous technique.

Design  Case series of 16 patients needing reconstruction for lesions of the alar subunit with 1 or more adjacent facial subunits after Mohs surgery for cutaneous malignant neoplasms.

Results  All flaps healed well by secondary intention, and the results were gauged at least satisfactory by the patients and surgeons. In 4 patients there were minor aesthetic concerns: in 1 patient the underlying cartilage graft was prominent and a minor revision was undertaken, 1 patient had effacement of the nasofacial sulcus, 1 patient developed a hypertrophic scar, and 1 patient developed both effacement of the nasofacial sulcus and a scar.

Conclusions  The use of subcutaneous hinge flaps allowed to heal by secondary intention is a simple 1-stage technique that may be useful in reconstruction of small but deep nasal sidewall defects.

Methods  A total of 100 facial halves (from 50 cadaveric heads) were studied, including gross and microscopic dissection and histologic findings. Laboratory findings were correlated with intraoperative findings in more than 150 deep-plane face-lift dissections (300 facial halves) performed during the study period.

Results  In contrast to previous reports, the superficial musculoaponeurotic system (SMAS) was not found to form an investing layer in the midface. The SMAS, zygomatici muscles, and levator labii superioris alaeque nasi were found to be located in corresponding anatomic layers and to form a functional unit. Additional findings of the present study include the description of 3 structurally different portions of the melolabial fold, of an anatomic space below the levator labii superioris alaeque nasi (sublevator space), and of extensions of the buccal fat pad into the sublevator space and the middle third of the melolabial fold.

Conclusions  The findings of the present study may contribute to augment our understanding of the complex anatomy of the midface and melolabial fold. Potential implications for modern face-lift techniques are discussed.

Methods  Medical records of 102 patients with pure inferior blowout fractures who were treated between June 1996 and December 2005 were reviewed regarding fracture type and location and surgical approach.

Results  Ocular symptoms persisted in 14 of the 102 cases after surgery, and revision procedures were performed in 11 of those cases. Cases with persistent symptoms were analyzed in terms of fracture location and type of surgery. For anterior orbital floor fractures, symptoms persisted in 2 of the 4 cases treated using a transantral approach, while no symptoms persisted in any of the 15 cases treated using a transorbital approach or in either of the 2 cases treated using a combined approach. For posterior orbital floor fractures, symptoms persisted in 2 of the 31 cases treated using a transantral approach, in 4 of the 6 cases treated using a transorbital approach, and in 1 of the 19 cases treated using a combined approach. For anteroposterior orbital floor fractures, symptoms persisted in 2 of the 5 cases treated using a transorbital approach and in 3 of the 20 cases treated using transantral and combined approaches.

Conclusion  Patients with large orbital floor fractures or posterior half fractures of the orbit should undergo surgery via a transantral or a combined approach, while patients with trapdoor fractures or anterior half fractures of the orbit should undergo surgery via a transorbital or a combined approach.

Methods  Study participants were consecutive patients presenting to a facial plastic and reconstructive surgery practice for injectable lip augmentation with a nonanimal-sourced stabilized hyaluronic acid (Restylane; Medicis Aesthetic Inc, Scottsdale, Arizona). A nonrandomized, prospective case series.

Results  A total of 137 treatments were performed on lips of 66 patients. The mean (SD) satisfaction score was 4.5 (0.6) on an integral scale of 1 (dissatisfied) to 5 (most satisfied). The mean (SD) persistence until lips returned to preoperative appearance based on patient subjective evaluation was 4.9 (1.5) months. Patients were free of adverse effects.

Conclusions  Using a new classification of lip anatomical zones to direct the injection of a nonanimal-sourced stabilized hyaluronic acid has increased my ability to better control lip shape and size in lip augmentation. This technique was met with high patient satisfaction and no adverse effects. Persistence of injected nonanimal-sourced stabilized hyaluronic acid was similar to that seen in other studies.

Design  A prospective, uncontrolled case series examining the results of lip augmentation using Surgisis in patients presenting to an academic otolaryngology/facial plastic surgery office.

Results  Nineteen Surgisis implants were placed in 8 patients. All patients tolerated the procedure and denied unnatural sensations or complications at any interval. Adverse events included transient erythema and 1 case of local cellulitis treated effectively with oral antibiotics. Four patients were satisfied with the procedure and 4 patients requested greater augmentation. Six-month follow-up was reported, and preoperative and postoperative photography was used in all cases.

Conclusions  Short-term lip augmentation was achieved in all 8 patients (4 patients had multiple strands placed). This study demonstrates technical ease and early safety. Surgisis should serve as scaffolding for ingrowth of striated muscle of the lip, potentially providing long-term augmentation. This study introduces Surgisis as a novel implant for lip augmentation.