Skin care in my practice: the "spectrum concept".

The spectrum system of skin rejuvenation has proven to be a universal method adaptable to virtually every skin type without exception. It is a simple, logical approach that is easily understood by the patient, the staff, and the physician. It is remarkably inexpensive, user friendly, and achieves consistently successful results. It is an invaluable key to the comprehensive treatment of not only the rejuvenative patient, but it is beneficial to patients of all age groups and results in a beneficial long-term doctor-patient relationship and continued patient satisfaction.

Prevention and correction of temporal hair loss in rhytidectomy.

Routine incisions in the temporal area for rhytidectomy often remove hair-bearing skin anterior to the ear. This results in a cosmetic deformity, making the surgical intervention clearly visible. This is especially problematic for revision rhytidectomy or for patients with naturally high hairlines. This article describes a systematic approach to the temporal hairline and introduces a novel, hair-bearing, transposition flap that corrects iatrogenic loss of the preauricular tuft of hair.

Distortion of the auriculocephalic angle following rhytidectomy. Recognition and prevention.

Distortion of ear protrusion after rhytidectomy results in an aesthetically unfavorable appearance. We have seen cases in which the auriculocephalic angle has widened postoperatively, producing a noticeable deformity. Herein, we report 3 cases that resulted in abnormal postsurgical ear protrusion. We also discuss prevention through the use of conchal setback sutures.

The ptotic chin syndrome corrected by mentopexy.

The ptotic chin syndrome, which occurs most commonly, but not exclusively, in patients missing lower teeth, is discussed with regard to pathogenesis, analysis, and treatment. Surgical correction is aimed at reversing ptosis by performing mentopexy, and increasing projection. This technique offers noteworthy improvement for affected patients.

Dome-splitting technique in rhinoplasty with overlay of lateral crura.

While the majority of nasal tips respond to the more conventional and conservative surgical approaches, there are those patients who require a more radical approach. The prerequisites for the ideal nasal tip are outlined. The indications for the proposed technique are enumerated and the dome-splitting overlapping technique is described. The advantages and disadvantages are discussed and photographic results are presented.

Current concepts of browpexy.

The excess skin of the upper lid is not uncommonly secondary to the ptosis of the eyebrows. Blepharoplasty not only fails to correct this deformity but, in fact, may aggravate the sagging of the eyebrow, imparting a sad and elderly appearance to the face. A gracefully arching eyebrow at or slightly above the supraorbital rim renders the face more alert and beautiful. Of many procedures described, three browpexy techniques have withstood the test of time, each with its own set of advantages and limitations: (1) direct, (2) midforehead, and (3) frontal lift. Particular emphasis is given to the coronal-type forehead lift which, in addition to browpexy, can deal with the ptosis of the forehead, transverse forehead wrinkles, and glabellar rhytids.

Midforehead incisions in treatment of the aging face.

The concept of total facial rejuvenation requires attention to all areas of the face, including the upper third. Recently there has been a resurgence of interest in this area of the aging face. Various clinical conditions may be seen as a single entity or in combination with others, and it is important for the facial aesthetic surgeon to diagnose and treat these conditions. The conditions first observed, diagnosis, and conventional surgical remedies are reviewed in an attempt to clarify the rationale for forehead lift v temple lift v browpexy v upper blepharoplasty. Midforehead glabellaplasty (vertical and longitudinal), browpexy, and rhytidectomy are analyzed in depth, as well as the indications, contraindications, technique, and results.

Augmentation malarplasty.

The well-defined prominent high cheekbone is classically a sign of beauty in Western culture. Based on discussions with (1) representatives of Heyer-Schulte, Goleta, Calif, a leading manufacturer of malar implants regarding the demand for these implants, (2) other facial plastic surgeons, and (3) patients who are aware and request this procedure compared with other procedures in my practice, malar implants, available for the past few years, while effective, have not received universal acceptance and usage. The design limitations of the available implants and the bony resorption under the implant similar to what has been described in mentoplasty are discussed, as well as the long-term results using the standard implants, including photographic and radiographic findings. A modification in the shape of the malar implant and its advantages also will be discussed.

The forehead lift.

The technique proposed is one that deals with the problems of the aging appearance of the upper third of the face as a separate surgical entity. Malar or cervical rhytidectomies are performed through a separate incision, the upper limit of which is in the region of the supra-auricular groove. The primary advantages of the procedure are that it yields a universal lift for ptosis and redundancy throughout the upper third of the face; that it allows for ready accessibility to offending muscles, namely, procerus, corrugator, frontalis, and fibrotic galea; that the incision is behind the hairline and therefore relatively inconspicuous; and that when it is combined with meloplasty, separate compartments are retained so as to alleviate at least some of the problems developing from postoperative facial hematomas. The results obtained with this procedure are shown in Figures 8 through 12.

Correction of the ptotic brow.

Aesthetic considerations of the eyebrow are reviewed. It is imperative that the aesthetic surgeon be aware of the importance of brow shape and position as they relate to the appearance of the upper face and eyes. The surgeon must diagnose brow ptosis and correct it appropriately. The variations in approach in men and women are outlined.

Delineating the cleft in upper blepharoplasty.

The subject of the esthetic qualities of the upper eyelid-eyebrow complex is discussed and how the cosmetic surgeon should diagnostically evaluate the problems occurring in this area. Emphasis is put on the other contributing factors that may contribute to blepharochalasis of the upper lid other than redundant skin limited to the upper lid space. A blepharoplasty technique with an incision at the supratarsal fold and evaluation of a skin muscle flap is discussed briefly.

The frontal lift.

Indications and advantages of the frontal lift are seen in comparison to the limitations of the conventional browplasty. The anatomy is reviewed, including the planes of dissection, nerves, vessels, muscles, and bony landmarks. Temporal and frontal ptosis, as well as glabellar and frontal creases are treated through this approach. The surgical procedure includes site of incision, extent and plane of dissection, and treatment of frontalis, procerus, and corrugator muscles. Some variations of technique have been performed. These include the V-Y shaped closure technique in the temple area and retaining separate anatomic compartments when combined with meloplasty.

Correcting the aging platysma.

The aging neck in which the stringy appearance is due to hyperactive platysma can be surgically treated. The technique involves partial transection of the anterior border of the platysma and has been used in more than 160 cases during the past 2 1/2 years with results that seem to be more predictable and longer lasting than previously described methods. Further studies under way that involve sectioning of the cervical branch of the facial nerve may yield an even better solution to this problem.