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Facial Implants in Male Rejuvenation
Brawley, Craig Cameron; Lee, Daniel D; Miller, Philip
Many different methods achieve male facial augmentation. Arranged from shorter- to longer-term results, these methods include filler, fat/tissue grafting, fat/tissue transposition, and alloplastic implants. This study solely reviews allografts, which provide the most predictable hard-tissue augmentation. An array of alloplasts will be discussed in this study including chin, cheek, mandibular angle, frontal, and temporal implants. The most common and severe complications will also be explored with preventative and treatment algorithms.
PMID: 38936993
ISSN: 1558-1926
CID: 5733362
Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty
Frants, Anna; Varelas, Antonios N; Franco, Alexa M; White, W Matthew; Constantinides, Minas S; Miller, Philip J; Lee, Judy W
PURPOSE/OBJECTIVE:Rhinoplasty is amongst the most challenging surgeries to perfect and can take decades. This process begins during residency; however, residents often have limited exposure to rhinoplasty during their training and lack a standardized method for systematically analyzing and formulating a surgical plan. The DESS (Deformity, Etiology, Solution, Sequence) is a novel educational format for residents that serves to increase their pre-operative comfort with the surgical evaluation and intraoperative planning for a rhinoplasty. MATERIALS AND METHODS/METHODS:A qualitative study performed at a tertiary academic institution with an otolaryngology residency program evaluating three consecutive residency classes comprised of four residents per class. A 9-item questionnaire was distributed to measure change in resident comfort after utilizing the DESS during their facial plastics rotation. Questionnaire responses highlighted resident comfort with facial nasal analysis, identifying deformities, suggesting surgical maneuvers, and synthesizing a comprehensive surgical plan. RESULTS:Ten of the twelve residents surveyed responded. Of those that responded, comfort in facial nasal analysis, identification of common nasal deformities, surgical planning, and development of an overall surgical plan were significantly improved after completion of the facial plastic rotation. These residents largely attributed their success to the systematic educational format, with an average score of 4.8/5.0 (SD 0.42). CONCLUSION/CONCLUSIONS:While rhinoplasty is a challenging artform to master, systematic approaches to analysis and operative planning are vital for teaching and guiding residents. Through this novel methodology, residents display significant improvement in their comfort with facial nasal analysis and overall surgical preparation.
PMID: 37952257
ISSN: 1532-818x
CID: 5610802
Correction of the Nasal Ala
Locketz, Garrett D; Franco, Alexa; Miller, Phillip
None.
PMID: 34921357
ISSN: 1098-8793
CID: 5109972
Management of Lip Complications
Gupta, Amar; Miller, Philip J
This article discusses complications that may occur after procedures on the lips, specifically focusing on injectable fillers. Evidence-based guidelines and suggested methods to manage these complications are presented in a systematic format.
PMID: 31587774
ISSN: 1558-1926
CID: 4130462
Outcomes of Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release
Jacobson, Joel; Rihani, Jordan; Lin, Karen; Miller, Phillip J; Roland, J Thomas Jr
Lesions of the temporal bone and cerebellopontine angle and their management can result in facial nerve paralysis. When the nerve deficit is not amenable to primary end-to-end repair or interpositional grafting, nerve transposition can be used to accomplish the goals of restoring facial tone, symmetry, and voluntary movement. The most widely used nerve transposition is the hypoglossal-facial nerve anastamosis, of which there are several technical variations. Previously we described a technique of single end-to-side anastamosis using intratemporal facial nerve mobilization and parotid release. This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) with a mean follow-up of 55 months. There were no cases of hemiglossal atrophy, paralysis, or subjective dysfunction. Direct facial-hypoglossal neurorrhaphy with parotid release achieved a functional reinnervation and good clinical outcome in the majority of patients, with minimal lingual morbidity. This technique is a viable option for facial reanimation and should be strongly considered as a surgical option for the paralyzed face.
PMCID:3312414
PMID: 22451794
ISSN: 1531-5010
CID: 210292
The bow-tie mattress suture for the correction of nasal cartilage convexities and concavities [Letter]
Miller, Philip J; Dayan, Steven H
PMID: 20855781
ISSN: 1538-3660
CID: 141870
Biomechanical analysis of anchoring points in rhytidectomy
Carron, Michael A; Zoumalan, Richard A; Miller, Philip J; Shah, Anil R
OBJECTIVE: To quantify tissue tearing force at various anchoring points on the face. METHODS: This is a prospective anatomic study using 4 fresh cadavers of persons aged 60 to 70 years at the time of death, for a total of 8 sides. Standardized 1-cm distances were measured at the various anchor points, and a single 0 Prolene suture loop was tied at each standardized anchoring point. Steady force was applied perpendicular to the plane of the face with a digital hanging scale. The scale was pulled until the suture ruptured the tissue at the anchoring point. The values at which the tissue ruptured were recorded, averaged, and compared. RESULTS: The average tissue force was 7.01 kg for the root of the zygoma vs 3.44 kg for the temporalis fascia (P < .05). The average tissue force was 5.50 kg for infralobular tissue vs 4.09 kg for tissue of the superficial musculoaponeurotic system located 1 cm anterior to the infralobular tissue (P < .05). The force for the fascia of the sternocleidomastoid was 3.89 kg vs 5.57 kg for the mastoid fascia (P < .05). There was a statistically significant difference between vertical bites of the temporalis fascia at 1.90 kg vs horizontal bites of the temporalis at 5.01 kg (P < .05). CONCLUSION: The tissue tearing force varies by location on the face as well as suture orientation
PMID: 20083739
ISSN: 1538-3660
CID: 129087
Treatment of dorsal deviation
Zoumalan, Richard A; Carron, Michael A; Tajudeen, Bobby A; Miller, Philip J
The deviated nasal dorsum is a complex problem with a variety of proposed solutions. Straightening the deviated nose should be focused on maximizing cosmetic outcome while preserving or improving nasal function. Deviations can occur in one or a combination of the nasal thirds. A simple approach to treatment is to develop a strategy for each third of the nose. Tailoring maneuvers to alleviate problems in each specific third helps the surgeon deal with deviations in an effective and straightforward manner
PMID: 19486752
ISSN: 0030-6665
CID: 99245
The subzygomatic fossa: a practical landmark in identifying the zygomaticus major muscle
Miller, Philip J; Smith, Sarah; Shah, Anil
OBJECTIVE: To test the validity of the subzygomatic fossa as a possible landmark in identifying the origin of the zygomaticus major muscle (ZMM). METHODS: Twenty-three fresh cadaver facial halves were dissected. Four references points were identified in each cadaver head: the zygomatic arch, the malar eminence, the modiolus, and the ZMM insertion notch. The ZMM insertion notch is a palpable landmark that is typically identified midway between the zygomatic arch and the malar eminience. A straight line was drawn from the ZMM insertion notch to the modiolus. An additional line was drawn from the malar eminence to the modiolus. An incision was made along the each line to the depth of the facial muscles. The presence or absence of the ZMM was recorded, and the location of the ZMM insertion notch was characterized in each cadaver. RESULTS: The ZMM insertion notch was palpated and identified in 23 of 23 facial halves. It was accurate in identifying the course of the ZMM in all 23 facial halves. The line created by the malar eminence to the modiolus was inaccurate in all 23 facial halves. CONCLUSION: The ZMM insertion notch is a reliable landmark for identification of the ZMM
PMID: 17638762
ISSN: 1521-2491
CID: 73809
Recruiting participants for injury studies in emergency departments [Comment]
Kendrick, Denise; Lyons, Ronan; Christie, Nicola; Towner, Elizabeth; Benger, Jonathan; Groom, Lindsay; Coffey, Frank; Miller, Phillip; Murphy, Rachel; ,
Emergency departments have the potential to maximize recruitment efficiency and minimize recruiting costs
PMID: 17446244
ISSN: 1353-8047
CID: 5724482