Anterior Ear Reconstruction with the Posterior Pull-through Flap.

Background: Defects of the central ear after skin cancer removal remain a common problem for the reconstructive surgeon. The experience with a one-stage, postauricular, skin-island flap passed through the cartilage to reconstruct ear defects is reported. Methods: Patients with an intact ear helix and an anterior full-thickness defect (cartilage defects included) were reconstructed with a skin-island flap based on posterior subcutaneous tissue deep to the flap base. The flap was passed through a generous aperture created in the ear cartilage. The skin at the base was incised superficially after the flap was passed through the cartilage to create a skin-island and avoid burial of epithelium. The flap periphery and postauricular harvest site were sutured with absorbable chromic sutures. Results: Twenty-two patients (six women, 16 men) with ear defects underwent single-stage reconstruction over a 9-year period. The defects reconstructed measured in diameter from 2 cm to 4.5 cm. Six patients required a second skin flap from the preauricular area to close ear canal defects. The pull-through flap added structural support, and prevented ear distortion. No flap necrosis occurred. Venous congestion was common and self-limiting. No epithelial cysts developed. Conclusions: A one-stage postauricular skin-island flap can reliably reconstruct anterior ear defects without distorting shape or position of the ear. Care is needed to provide a generous aperture through the ear cartilage to accommodate the flap. Healing proceeds predictably, and minimal complications are associated with this posteriorly-based, pass-through, skin-island flap in ear reconstruction.

Lip-Shortening Surgery.

BACKGROUND: Many changes are associated with the aging face. Upper lip lengthening with atrophy, lip thinning, and diminution of the lip margin are commonly seen. METHODS: Lip-shortening surgery over a 32-year period by a single surgeon is reviewed. A direct surgical excision of the upper lip skin at the base of the nose with an irregular or curvilinear incision was used. RESULTS: Facial aesthetics were improved with this direct surgical approach. A more youthful vermilion border and an increased lip projection were achieved. Lip asymmetry and an improvement in lip dynamics were also observed. A high rate of revision surgery (approximately 25%) was found in this series. The highly visible, delicate, central facial landmarks involved in lip shortening magnify small scar irregularities, and revision, although relatively minor, is often necessary. Patient satisfaction is high, as a subjective improvement in lip aesthetics is readily appreciated. Patients frequently request further shortening. CONCLUSIONS: Surgeons need to review the exigent nature of this surgery with their patients and be willing to perform the associated revisions inherent in the procedure. Lip-shortening surgery reliably improves facial aesthetics and should be used by plastic surgeons when treating the aging face.

Eyelid phenol peel: an important adjunct to blepharoplasty.

Deep peeling with phenol solutions has been criticized because of the hypopigmentation that usually results. The lower eyelid skin after routine blepharoplasty will retain its hyper-pigmentation and fine wrinkles. Phenol peeling of the lower eyelid will produce a complementary lightening of the skin and improvement in the wrinkling. This report explains the technique used by the author to improve blepharoplasty results.