Laser-assisted facial contouring using a thermally confined 1444-nm Nd-YAG laser: a new paradigm for facial sculpting and rejuvenation
The micropulsed 1444-nm neodymium-doped lipolysis laser exhibits favorable characteristics for novel application in facial contouring. The study described herein is the first clinical report of laser-assisted facial contouring (LAFC). We retrospectively reviewed records of 478 LAFC patients (mean age 52) who underwent contouring of 1278 individual mid- and lower facial treatment sites over 18 months. Along with clinical assessment, study parameters evaluated among "original" and "modified" (where protocol updates included deep dermal soft tissue coagulation as an optional step) protocol groups included laser power, pulse energy, and total energy delivery as well as lipoaspirate volume at each treatment site. Mean power and pulse energy were similar (within 5%) and total energy use was greater (70% higher for mid- and lower face) in the original protocol group. Lipoaspirate volume was similar for both groups for the midface (within 10%) but elevated in the modified protocol group for the lower face (40% higher). Treatment complications were observed in 47 of 363 treatment sites (13%) in the original and in 12 of 915 treatment sites (1%) in the modified protocol group with the majority (63%) of the complications comprising over- versus undercorrections of desired tissue contour. Clinical efficacy varied with improvements of mid- and/or lower facial contour ranging from marginal to subtle to very apparent. LAFC as detailed herein is a novel treatment modality that enables selective soft tissue removal for greater precision in three-dimensional contouring of the face. Protocol modifications based on laboratory and observed tissue photothermodynamics have improved LAFC safety.
Midfacial degloving approach for repair of naso-orbital-ethmoid and midfacial fractures
OBJECTIVE: To demonstrate that the midfacial degloving (MFD) approach can provide the proper exposure to successfully reduce naso-orbital-ethmoid (NOE) and midfacial fractures while eliminating the need for external skin incisions. DESIGN: A retrospective review of patients with NOE and concomitant midfacial fractures that were repaired via the MFD approach for exposure. SETTING: Tertiary care academic medical center. METHODS: The MFD approach was used to access NOE and concomitant midfacial fractures for repair in 9 patients with facial trauma. Physical examination and imaging studies were used for preoperative evaluation. Functional and cosmetic results were assessed during follow-up with serial physical examinations and postreduction films. RESULTS: No significant technical problems were encountered in the treatment of NOE and concomitant fractures, which included 5 Le Fort I, 1 Le Fort II, 1 Le Fort III, 6 orbital rim (1 superior, 4 inferior, and 1 lateral), and 4 zygomatic complex fractures. Physical examination and imaging studies showed adequate reduction in all patients, and all patients were satisfied with their short- and long-term functional and cosmetic results. CONCLUSION: The MFD approach can provide the necessary exposure to properly reduce NOE and midfacial fractures without the need for external skin incisions
Temporoparietal osteofascial flap for head and neck reconstruction
PURPOSE: This article describes the use of the temporoparietal osteofascial flap (TOF) for reconstruction of bony defects in the midface and mandible. PATIENTS AND METHODS: We reviewed the demographics, etiology, indications, surgical technique, radiographic evaluation, and final outcome of 11 patients with upper or lower jaw defects who underwent reconstruction using the TOF between 1994 and 1999. RESULTS: The TOF was used to reconstruct a defect of the mandible in 7 patients, the hard palate in 2 patients, the maxilla in 1 patient, and the zygoma in 1 patient. The defect was a result of tumor resection in 9 patients and of trauma in 2 patients. The defect size ranged from 3 to 6 cm. Ten flaps (91%) were successful and 1 flap failed. There was 1 donor site complication (small dural tear) that was repaired immediately without sequelae. One patient had osseointegrated dental implants placed in the bone with good results. Exploration of the construction area was performed in 1 patient 13 months after surgery because of recurrent tumor. It showed a fully integrated bone flap. CONCLUSION: This vascularized calvarial bone flap can be used for the reconstruction of small to medium-sized defects of the maxilla and lateral mandible with good functional and cosmetic results. It can be performed without special microvascular expertise and with minimal donor site morbidity. A full-thickness bone flap can support osseointegrated dental implants