Faculty Bibliography

The marriage of endonasal rhinoplasty with structural grafting has resulted in more consistent rhinoplasty results. The nasal base can be stabilized by tongue-in-groove techniques, a columellar strut, or extended columellar strut. The middle vault can be addressed with spreader grafts or butterfly grafts. Lower lateral cartilage weakness can be supported with alar batten grafts or repositioning of the lower lateral cartilages

PURPOSE OF REVIEW: Technology in general and computer capabilities in particular are growing at an exponential rate. Keeping current with the latest technological capacities and means of incorporating this technology into the facial plastic surgeon's office poses a significant challenge. This review will document the most appropriate method of incorporation and the latest available technological tools. RECENT FINDINGS: Recent developments in wireless networking, systems integration, digital photography and video, powerful inexpensive computer systems, and the growth of personal digital assistant integration have all contributed to a surge in technological advances. Implementing any or all can significantly benefit the busy facial plastic surgery office. SUMMARY: Keeping abreast of technological advances is a daunting task. Adaptation of these advances into the office can at times be overwhelming. This review will assist the practicing physician in incorporating selective technological tools to streamline his or her systems and increase efficiency

Gore-Tex, a form of expanded polytetrafluoroethylene (ePTFE), over the past 30 years has attracted much attention as an alloplast for use in rhinoplasty, both from advocates and opponents of its use. It has many desirable traits as an alloplast implant, but many surgeons harbor hesitation and reluctance for alloplast use in rhinoplasty based on historical data of previous nasal implants. Only when objective data from large series of patients with long-term follow-up become available will such skepticism be resolved. Large series of patients with Gore-Tex implant placement during rhinoplasty are beginning to emerge in the literature. The purpose of this article is twofold. The first is to provide the reader with an up-to-date review of the literature on the host response to polymer implants and, second, of the current indications and operative techniques for use and outcomes of Gore-Tex implants in rhinoplasty

We have developed a simple method of evaluating nasal obstruction both before and after corrective surgery. With our system, patients self-rate their nasal patency on a 10-point visual analog scale under different conditions. After a baseline self-assessment, patients rate their breathing while the examiner lifts the lower lateral nasal cartilage with an ear curette and again during lifting of the upper lateral cartilage. Separate assessments during cartilage support are made before and after the patient has received nasal decongestion therapy. The results of these manipulations help identify the specific structural abnormality and its anatomic site, thereby serving as a reliable aid to planning surgery (i.e., open septorhinoplasty, turbinoplasty, external valve surgery with alar batten grafts, and/or internal valve surgery with spreader grafts with or without composite skin/cartilage grafts). We tested our method in preoperative evaluation and surgical planning on 19 patients with nasal obstructions. Our method was just as useful in making postoperative assessments, and it allowed us to judge the effectiveness of specific procedures in restoring nasal patency. Of the 19 patients, 18 (94.7%) reported that their nasal breathing had improved following surgery

BACKGROUND: Expanded polytetrafluoroethylene (ePTFE) is a synthetic porous material that has been used for static suspension in facial paralysis. It is manufactured in thin (1-mm or 2-mm) sheets that can be cut into strips and implanted through keyhole facial incisions. Regional deformities are addressed by multiple suspensions that provide cosmetic and functional therapy. The use of ePTFE eliminates donor site morbidity associated with the traditional harvest of fascia from either the temporal area or fascia lata. However, properties unique to this alloplast contribute to the complications that have occurred after its use in facial reanimation. OBJECTIVE: To describe complications with the use of ePTFE for facial suspension. SETTING: Academic medical center. METHOD: Retrospective chart review and review of literature. RESULTS: Six patients with facial paralysis who were treated with the ePTFE sling procedure had complications. Five slings failed because of stretch despite prestretching at implantation. One patient developed a late wound infection requiring removal of the sling. CONCLUSION: An ePTFE facial sling is an option for static facial suspension that can be therapeutic for patients with seventh nerve damage. There is a high rate of complications leading to revision surgery. Future studies are needed to evaluate alloplastic alternatives to ePTFE

OBJECTIVE: To review the indications for, surgical techniques of, and results of vertical lobule division (VLD) of the alar cartilages. DESIGN: Prospective study of patients assigned to undergo variations of VLD of the lower lateral cartilages. SETTING: Private facial plastic surgery practice in a major university teaching hospital. PATIENTS: Twenty-four patients who underwent variations of VLD of the lower lateral cartilages with re-creation of an intact strip, including 4 patients undergoing revision. MAIN OUTCOME MEASURES: Postoperative photographs were reviewed for tip projection and rotation, tip symmetry, bossae, knuckles, columellar position and length, and alar retraction. Patients were polled about their overall satisfaction with nasal aesthetics and degree of subjective nasal obstruction preoperatively and postoperatively. RESULTS: Vertical lobule division decreased projection in 22 of 22 patients, increased rotation in 12 of 12 patients, decreased rotation in 1 of 2 patients, corrected tip asymmetry in 3 of 4 patients, and shortened a long infratip lobule in 1 patient. Postoperatively, bossae and knuckling developed in 1 patient, and 2 patients demonstrated alar retraction that did not exist preoperatively. One patient undergoing revision noted worsened nasal obstruction not related to VLD. CONCLUSIONS: Vertical lobule division is a reliable, safe technique with predictable outcomes in tip repositioning. It allows for preservation of a strong tip complex while adding versatility to tip refinement

Rejuvenation of the midface is a challenge in facial plastic surgery. To this end, several techniques have been developed to address the changes seen in the midface with aging. Specifically, ptosis of the malar fat pad and deepening of the nasolabial fold contribute to the aesthetic changes that characterize midfacial aging. The history of modern facelifts and deep-plane facelift techniques to correct the nasolabial fold are presented

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

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