Faculty Bibliography

Presented is a prospective study comparing limited SMAS (lateral SMASectomy), conventional SMAS, extended SMAS, and composite rhytidectomies. Randomized patients received either a limited SMAS or conventional SMAS face lift on one side and an extended SMAS or composite rhytidectomy on the other. All procedures were performed at Manhattan Eye, Ear and Throat Hospital in accordance with their well-defined surgical descriptions. Postoperative courses were followed clinically for at least 1 year. Photographs were taken preoperatively and at 6 and 12 months postoperatively. Photographs were reviewed by three independent experienced face lift surgeons. The study comprises 21 patients, 20 women and 1 man, with a mean age of 59 years (range 47 to 70 years). Nineteen patients underwent primary rhytidectomies; two underwent secondary face lifts. For the first 12 patients, each had an extended SMAS procedure performed on one side; on the other, 7 had a conventional SMAS and 5 had a limited SMAS (lateral SMASectomy) face lift. In the last 9 patients, a conventional SMAS was carried out on one side in 8, a limited SMAS in 1, and on the opposite side, a composite rhytidectomy was performed. Complications were few. Temporary weakness of the buccal branch of the facial nerve occurred in 2 patients on the side of the more extensive surgery. On the operating table at completion of the surgery, there was more improvement in reversal of midfacial ptosis and flattening of the nasolabial folds with both extended SMAS and composite rhytidectomies. The composite flap had the most dramatic effect on the nasolabial folds and oral commissure. After 24 hours, once swelling developed and facial motion became reactivated, the noticeable differences in the midface and nasolabial folds were lost. No discernible differences in facial halves were noted again. Differences between facial sides on the 6- and 12-month postoperative photographs were not detectable. We conclude that for routine facial plasty, comparable clinical outcomes are obtained at 6 months and 1 year with limited (lateral SMASectomy) and conventional SMAS face lifts compared with extended SMAS and composite rhytidectomies. All procedures are lacking in their improvement of midface ptosis and the nasolabial folds. The increased surgical risks, morbidity, and convalescence associated with those more extensive procedures do not seem to be warranted in the average patient

Steroids are widely used in facial aesthetic surgery to reduce postoperative edema. We performed a randomized, double-blind study to try to document the effectiveness of this practice. Fifty consecutive facialplasty patients of one surgeon were randomized to steroid and no steroid groups. Steroid group patients received betamethasone 6 mg IM preoperatively. Postoperative scoring of swelling was performed at approximately days 5 and 9 by a single observer. There were no significant differences between the two groups at either postoperative interval or in the rate of improvement. Subgroups of patients who underwent additional procedures also showed no significant differences. We were not able to demonstrate any statistically significant difference in swelling after facialplasty with this steroid regimen

The recent introduction of endoscopic techniques and instrumentation in aesthetic surgery was caused in part by the desire to minimize surgical scars as well as to decrease the possibility of sensory changes secondary to extended incisions, such as the execution of a coronal incision in performing a forehead plasty. Although endoscopic surgical techniques provide field magnification together with excellent illumination, localization and preservation of the forehead neurovascular bundles via the endoscope can be time consuming and tedious. A new method is introduced where percutaneous localization of the supraorbital and supratrochlear nerves enables the surgeon to perform an endoscopic forehead plasty in an expeditious manner with preservation of sensation of the forehead and scalp

This study is a retrospective review of all consecutive surgeries involving insertion of silicone malar implants performed at the Manhattan Eye, Ear and Throat Hospital from January 1, 1985 to April 30, 1993. Sixty-four patients underwent placement of 126 silicone malar implants. Three different sizes were utilized: 23 size 1, 85 size 2, and 18 size 3. Eleven patients underwent unilateral implant placement, all for reconstructive purposes. The average and median ages of the patients were 43 and 44 years, respectively, with a range of 18 to 83 years. Malar implants were inserted for the following reasons: hypoplasia, post-traumatic deformity, post-tumor resection deformity, and correction of hemifacial microsomia. In 79 percent of the patients, malar augmentation was performed in conjunction with other surgical procedures. All implants were placed in a subperiosteal pocket by either the intraoral, subciliary, or preauricular approach. Forty-one percent were fixed in place by percutaneous sutures. Malar augmentation with silicone implants for both aesthetic and reconstructive purposes is an increasingly common surgical procedure. Good results are obtained with few complications. Infection is rare even with transoral placement. Silicone malar implants should be placed in a subperiosteal pocket and can be inserted safely through various routes. Malpositioning of implants is infrequent, and fixation sutures are not required. The most common problem is improper size selection. Patient satisfaction is high, in that no patient underwent permanent removal of a malar silicone implant once inserted