A simple and inexpensive method of preoperative computer imaging for rhinoplasty.

UNLABELLED: GOALS/PURPOSE: Despite concerns of legal liability, preoperative computer imaging has become a popular tool for the plastic surgeon. The ability to project possible surgical outcomes can facilitate communication between the patient and surgeon. It can be an effective tool in the education and training of residents. Unfortunately, these imaging programs are expensive and have a steep learning curve. The purpose of this paper is to present a relatively inexpensive method of preoperative computer imaging with a reasonable learning curve. MATERIALS AND METHODS: The price of currently available imaging programs was acquired through an online search, and inquiries were made to the software distributors. Their prices were compared to Adobe PhotoShop, which has special filters called "liquify" and "photocopy." It was used in the preoperative computer planning of 2 patients who presented for rhinoplasty at our institution. Projected images were created based on harmonious discussions between the patient and physician. Importantly, these images were presented to the patient as potential results, with no guarantees as to actual outcomes. RESULTS: Adobe PhotoShop can be purchased for 900-5800 dollars less than the leading computer imaging software for cosmetic rhinoplasty. Effective projected images were created using the "liquify" and "photocopy" filters in PhotoShop. Both patients had surgical planning and operations based on these images. They were satisfied with the results. CONCLUSIONS: Preoperative computer imaging can be a very effective tool for the plastic surgeon by providing improved physician-patient communication, increased patient confidence, and enhanced surgical planning. Adobe PhotoShop is a relatively inexpensive program that can provide these benefits using only 1 or 2 features.

Levator anguli oris: a cadaver study implicating its role in perioral rejuvenation.

The purpose of this study was to investigate the role of the levator anguli oris in perioral rejuvenation by delineating the detailed anatomy of this muscle and illustrating a new technique to elevate the oral commissure using this muscle. Fresh cadaver dissection was carried out in 9 facial halves specifically examining the anatomy of and surrounding the levator anguli oris. This muscle was identified in each cadaver to coalesce with the zygomaticus major muscle at the modiolus, thus elevating the oral commissure. In 3 facial halves, an intraoral incision from the canine to the modiolus was performed. This allowed easy access to the levator anguli oris muscle for plication and successful elevation of the oral commissure. This procedure could be applied in combination with traditional face lifts to enhance facial rejuvenation or potentially used to reanimate the partially paralyzed face.

Successful closure of abdominal wall hernias using the components separation technique.

The "components separation" technique involves separating the layers of the abdominal wall to allow midline advancement. The purpose of the study was to compare the success rate of the components repair versus other methods. Repair methods included components separation (n = 11), mesh (n = 15), primary (n = 21), TFL grafts (n = 5), TFL or latissimus flaps (n = 4), and rectus turnover (n = 4). The results were: 16 of 60 hernias recurred, with significant risk factors being body mass index (BMI) greater than 30 kg/m2 (p = 0.04), wound infection or breakdown (p < 0.03), and possibly concurrent colostomy or enterocutaneous fistula repair (p = 0.11). Only one of 11 hernias recurred using the components methods, four of 15 recurred using mesh repairs, three of 21 recurred using primary repairs, four of five recurred using TFL grafts, two of four recurred using TFL/latissimus flaps, and two of four recurred using rectus turnovers. There were 19 complications (infection or wound breakdown), with risk factors being smoking (p = 0.002) and possibly BMI greater than 30 kg/m2 (p = 0.08). The results suggest that the components separation method is a viable option for repair of complex abdominal wall hernias without the use of distant flaps or grafts.