Faculty Bibliography

The deep nasolabial fold and other facial furrows and wrinkles have challenged the facial plastic surgeon. A variety of techniques have been used in the past to correct these troublesome defects. Advances in the last five years in new materials and design have created a subcutaneous implant that has excellent properties. This article reviews the development and use of Softform facial implant

A resurgence of malar augmentation using alloplastic implants can be attributed to the safety, simplicity of technique, and reliable good results of these implants. As the more sculpted face becomes a common aesthetic goal, malar augmentation plays an increased role in facial plastic surgery practices. It provides a natural, 'unoperated' look that is preferred by most patients today. The history of our current aesthetic and how new alloplasts have contributed is reviewed. The development of simpler techniques of malar analysis will also be reviewed. An indepth look at aesthetic analysis, implant choice, surgical approach, postoperative results, and possible complications will provide a thorough review of current malar implantation

Endoscopic equipment and specially designed elevators and dissecting instruments provide access to the forehead and scalp region through minimal incisions. This technique is now widely accepted for aesthetic forehead and browlifts. To our knowledge, however, it has not previously been used in reconstructive forehead and scalp surgery. We carried out a retrospective review of 5 cases involving patients who underwent reconstructive scalp and frontal bone defect surgery: 2 patients had frontal defects that were contoured with expanded polytetrafluoroethylene (Gore-Tex; WL Gore & Assoc, Phoenix, Ariz) inserted endoscopically; 2 patients had scalp soft tissue defects that were treated with wide subgaleal undermining and endoscopically guided galeotomies that resulted in primary closure; and 1 patient was treated for facial paralysis to improve the aesthetic result. We conclude that aesthetic endoscopic surgical techniques and equipment can be used in reconstructive therapy for patients with bony and soft tissue defects of the scalp and forehead

BACKGROUND: Midline facial clefts are rare deformities with a wide range of clinical findings from a simple midline vermillion notch to major skeletal malformations, including orbital hypertelorism. The bifid nose is a relatively uncommon malformation that is frequently associated with hypertelorbitism and midline clefts of the lip. The presentation of a bifid nose ranges from a minimally noticeable midline nasal tip central groove to a complete clefting of the osteocartilaginous framework, resulting in 2 complete half noses. We describe our experience with 2 patients with midface clefts who presented with bifid noses and a variety of other congenital abnormalities. The anatomy, extensive treatment, and complications of the bifid nose are discussed. DESIGN: Retrospective case review and literature review. RESULTS: Successful creation of an aesthetic nasal contour and normal nasal function was achieved without complication via extensive skin, bony, and cartilaginous resection. CONCLUSIONS: The bifid nose challenges the rhinoplasty surgeon. A successful outcome is dependent on a thorough understanding of the bifid nasal anatomy, proper patient evaluation, careful preoperative planning, and meticulous surgical technique

Digital photography is becoming an increasingly popular alternative to traditional 35-mm photography. Clearly, the efficiency and versatility of digital cameras will have a major impact on the future of clinical photodocumentation in facial plastic surgery. However, most physicians who are interested in incorporating digital photography into their clinical practice have limited experience with this new technology. This article reviews the difference between traditional and digital cameras, compares various commercially available products, and discusses several features unique to digital cameras

OBJECTIVE: To assess the effectiveness of replantation in the treatment of nasal amputations. DESIGN: Retrospective chart review. SETTING: A university medical center. RESULTS: In no case did the replant survive completely, and in all cases revision surgery was required. However, in all cases, the resulting deformity was less than the original defect. In our pediatric patients, reconstruction with cartilage grafting and a midline forehead flap was successful and demonstrated proportionate and appropriate growth. CONCLUSIONS: It is our belief that replantation serves many therapeutic functions. At the very least, there is the psychological/emotional factor that is involved in attempting to replace a native body part that has been severed. Also, it is difficult to persuade parents and patients that the amputated tissue that has been handled with kid gloves by paramedics, maintaining its pink 'alive' color, is ultimately doomed to failure. Forehead flaps and conchal cartilage grafts are more willingly accepted after a 'failed' replantation than as primary reconstructions. In every instance, we believe, the ultimate defect will be smaller than the original deformity. Certainly, the need for vestibular lining reconstruction is far less. Thus, the ultimate healed defect from the replantation greatly facilitates final nasal reconstruction

The nasal valve is the most important region responsible for air flow and nasal resistance. In the past five years, numerous advances have been made in nasal valve analysis and surgery. The discovery that the valve consists of two distinct regions, the external and internal valves, has led to tailored surgical techniques to improve each site independently. Improved objective tests using rhinomanometry, acoustic rhinometry, and magnetic resonance imaging have proven that certain surgical techniques will improve nasal valve function. The roles of septoplasty, inferior turbinate surgery, and cartilage grafting have been objectively analyzed and methodically delineated. The nasal valve is now a prominent factor in planning cosmetic and functional rhinoplasty. This review examines the recent developments in nasal valve surgery and fits them into historical perspective with the evolution of our understanding of the nasal valve