Reconstruction of the submammary crease for correction of postoperative deformities in aesthetic and reconstructive breast surgery.

This article discusses a method of reconstruction of breast crease for correction of postoperative deformities. These deformities are usually the result of implant insertion for the purpose of breast enlargement or reconstruction. The operation is performed by creating a new crease in the appropriate site by suturing capsular and soft tissue structures from the anterior to the posterior wall of the pocket to eliminate excess space at the lower, medial, or lateral breast. This article will detail crease reconstruction through an internal approach. Patient selection, technique, and results are discussed.

Augmentation in ptotic and densely glandular breasts: prevention, treatment, and classification of double-bubble deformity.

After breast augmentation, separation of breast tissue from the implant is common, especially in patients with well-formed preoperative breasts. This problem is enhanced to a marked deformity in cases of scar contracture with firm, fixed implants. This paper addresses this problem preoperatively and therapeutically in secondary correction of double-bubble and waterfall deformity. The author classifies and explains double-bubble deformity in patients in whom the implant is below the normal crease, with glandular breast tissue superior and anterior to the implant. In "waterfall" deformity (a term suggested by the author), the glandular breast tissue droops over the implant and is inferior and anterior to the implant. Treatment used consists of opening the breast tissue from its posterior surface using radial incisions to accommodate the implant. This allows the two structures--the breast tissue and the implant-to blend as one unit with satisfactory results. The technique is easy to perform and teach. Complications are similar to those of regular breast augmentation. Strangely, radial incisions have not increased complications, and there have been no cases of seroma or hematoma to date.

Elliptical horizontal excision and repair of alar cartilage in open-approach rhinoplasty to correct cartilaginous tip deformities.

Correction of nasal tip deformities, especially bulbous tip deformities, has improved greatly with the advancement of open-approach rhinoplasty. Bulbous and double-dome deformities of the nasal tip are more often cartilaginous, rather than fibrous, in nature. Therefore, direct alterations of the cartilage are necessary to achieve the desired effect. In the past, these alterations were accomplished by resection of the cephalic part of the lateral crura of the lower lateral cartilage and, less commonly, by resection of the caudal ends of the lateral crura. For the past several years, we have used elliptical excision of the central segment of the lower lateral cartilage in a horizontal direction. The upper and lower edges of the remaining cartilage are repaired with 5-0 nylon sutures. This procedure removes the most protruding and bulbous portion of the lateral crura, and the cephalic and caudal portions that remain are sutured together to form a flatter and more narrow lateral crura. It changes the bulge of the dome where a change is necessary, at the top. It also preserves the anatomically intricate relationship of the junctions of the upper and lower lateral cartilage. There are no free or loose edges of cartilage to warp or deform during the healing process. Satisfactory, long-lasting clinical results can be achieved consistently.

A method of reconstructing a natural-looking umbilicus in abdominoplasty.

The umbilicus, in the opinion of the authors, is a significant aesthetic unit of the abdominal area. Restoration of this structure to its most natural form in abdominoplasty, breast reconstruction, or primary reconstruction of the umbilicus due to surgery or trauma has been the goal of plastic surgeons from the early times of modern plastic surgery. The authors present a technique of umbilicoplasty that transfers the incisions and suture line deep to the level of the rectus muscle. This procedure can result in the appearance of a normal umbilicus in many patients. Umbilicoplasty, done as part of an abdominoplasty, or to restore the umbilicus due to surgical loss, has progressed during time. However, the most significant disadvantage has been the incisions and scars around the new umbilicus, which detract from the aesthetic value of the newly constructed umbilicus. Any attempt to give a more natural look to it thus far has been less than satisfactory in our hands. In the last several years, we have concealed the scar deep in the bottom of the umbilicus, with good initial results.

Combined skin and skin-muscle flap technique in lower blepharoplasty: a 10-year experience.

Because of the important function of the pretarsal orbicularis muscle in blinking and tear drainage, the skin and skin-muscle flap technique for lower blepharoplasty was conceived to preserve the anatomical integrity of this muscle as well as its intimate relationship with the tarsal plate. The procedure involves elevating a skin flap over the pretarsal part of the orbicularis muscle followed by a skin-muscle flap at the preseptal part of the orbicularis muscle. This technique permits easy access to orbital fat pads while leaving the pretarsal orbicularis muscle intact and, in turn, facilitates the lateral suspension of the preseptal orbicularis muscle only. Trimming of the excess muscle is performed at the level of the preseptal orbicularis muscle, which is much less important functionally than the pretarsal orbicularis muscle, the part removed in the McIndoe-Beare muscle flap technique. This procedure, which has been performed on 700 eyelids (350 patients) from 1979 to the present, has successfully corrected lower eyelid deformity as a result of aging, particularly lower eyelid atonicity and infrapalpebral crease. The method also offers a safe and fast approach to the infraorbital bony structures in patients undergoing trauma operations or other surgical procedures.