Midface lift using a minimally invasive technique and a novel absorbable suture.

BACKGROUND: Midface rejuvenation is a minimally invasive procedure designed to correct early ptosis of the cheeks and deepening nasolabial folds. Implementation of this technique requires a detailed understanding of the anatomy of this region in addition to recognizing the vectors of change that occur over time as one matures. Finally, aesthetic competence and requisite surgical skills are required to restore the midface in a minimally invasive fashion. OBJECTIVE: To describe a new minimally invasive approach to facial rejuvenation using a novel absorbable suture with segmented stabilizers that allows for a superolateral reversal of the senescent changes of the midface. METHODS: In a case series study, 30 patients with aging changes of the midface signed informed consent to have this procedure done. An incision was made in the preauricular area, followed by hydrodissection with tumescent anesthesia and blunt dissection with the aid of a 4-mm spatula cannula. Two angiocatheters (14GA 3.25 IN, 2.1 x 83 mm, 14 gauge) were tunneled through the malar fat pad and pierced the skin just lateral to the nasolabial fold. The angiocatheter was then removed and the suture tethered to facilitate the proper amount of lifting entirely in the subcutaneous supra-SMAS plane and anchored superolaterally to the temporalis fascia. The segmented stabilizers anchored themselves in multiple directions but ultimately lifted the tissues of the midface. RESULTS AND CONCLUSION: This technique uses the multidirectional segmented stabilizers of the Monograms to counteract the downward displacement of the malar fat pad while simultaneously softening the nasolabial fold. This is a minimally invasive technique that addresses the multiple factors involved in the senescent changes of the midface. Proper patient selection, good aesthetic judgment, and surgical competence are required to restore the midface in a minimally invasive fashion. The objective of this study was to report a novel approach to midfacial rejuvenation using the Monograms. This cross-hatched suture achieves simultaneous malar fat pad elevation and nasolabial fold effacement. The midface lift adds another vital dimension to panfacial augmentation.

A novel specialized suture and inserting device for the resuspension of ptotic facial tissues: early results.

BACKGROUND: In the past decade, the popularity of minimally invasive procedures for facial rejuvenation has increased. OBJECTIVE: To describe a new specialized suture, and its associated technique, used to elevate sagging tissues of the face and neck. METHODS: A detailed description of the technique and the results obtained in 20 patients in whom we have used this novel approach. Attention was given to appropriate patient selection. The primary focus was on the correction of the jowl, jawline, and neck subunits. It involves the percutaneous introduction of a novel 3-0 polypropylene suture that has 10 absorbable hollow cones along its axis that are equally interspersed with knots. Once the absorbable cones are resorbed into the surrounding tissues, the non-absorbable suture component can be removed without compromising the aesthetic outcome. RESULTS: All patients demonstrated improvement in these areas, with minimal complications. One patient required resuspension using the open technique. (Excessive ptotic tissue was later excised for an optimal cosmetic result.) CONCLUSION: The suture and technique described in this article provide a major contribution to the correction of ptosis of facial tissues. When done in conjunction with other procedures, such as neck and jowl microliposuction, this technique has proven to be a useful addition to facial rejuvenation.

Persistent inflammatory reaction to hyaluronic acid gel: a case report.

Soft tissue augmentation is widely used to enhance or improve a patient's appearance. Hyaluronic acid is considered to be one of the best fillers for cosmetic procedures, mainly because of its lack of immunogenicity. We report a case of a persistent inflammatory reaction to injectable hyaluronic acid gel used for the correction of melolabial folds.

Anterior face-lift for correction of middle face aging utilizing a minimally invasive technique.

OBJECTIVE: A minimally invasive face-lifting approach aimed at rejuvenation of the midface was examined, for patients with concerns limited to midfacial aging. METHODS: An incision in the preauricular area and then minor undermining to lift superfical musculo apponeurotic system (SMAS), followed by SMAS plication and removal of skin laxity in the midface, results in excellent superolateral reversal of inferomedial displacement of the aging vector. RESULTS AND CONCLUSION: A minimally invasive procedure was performed easily under local anesthesia in an office/ambulatory surgery center setting.

Merkel cell carcinoma: a case report with treatment summary and updates.

Merkel cell carcinoma (MCC) is a rare primary cutaneous neoplasm known for its propensity to develop early regional and distant metastasis. Fewer than 400 cases occur annually in the United States. MCC ranks as the most deadly of cutaneous malignancies, with a fatality rate of approximately 25%. Because of its aggressive nature, MCC is often resistant to surgery, radiation, and chemotherapy regimens. Standardized treatment patterns have not been established, and difficulty arises finding appropriate treatment for the elderly, who comprise the majority of patients with MCC.

Herpes simplex virus prophylaxis with famciclovir in patients undergoing aesthetic facial CO2 laser resurfacing.

Herpes simplex virus 1 (HSV-1) reactivation may occur in patients undergoing facial carbon dioxide (CO2) laser resurfacing and can delay healing and result in severe scarring. Prophylactic oral antiviral agents are administered routinely to patients undergoing laser resurfacing to prevent postoperative HSV-1 eruptions; however, dosage and duration of treatment vary in the literature. Famciclovir is a highly effective nucleoside analog used in the treatment of HSV infections. In this study, 60 patients, with and without a prior history of facial HSV-1 outbreaks, were given famciclovir 250 mg twice a day (BID), starting the day before facial laser resurfacing and continuing for 14 days. No reactivation was observed in any of the patients. In this small study, famciclovir 250 mg given BID for 14 days was an effective prophylactic treatment in facial laser resurfacing patients for the prevention of facial HSV reactivation.

Resuspension of mild to moderate jawline laxity using a minimally invasive technique.

BACKGROUND: A practical approach for superficial musculoapponeurotic system plication and neck lift is indicated for early aging changes of jawline. METHODS: A single or series of small punches or single incisions at the earlobe and then minor undermining to lift the superficial musculoapponeurotic system followed by removal of skin laxity in neck and jowl result in a seamless scar via a simple V to Y closure. RESULTS AND CONCLUSION: A minimally invasive procedure was performed easily under local anesthesia in an office/ambulatory surgery center setting.

Experience with more than 5,000 cases in which monitored anesthesia care was used for liposuction surgery.

BACKGROUND: Conscious sedation using monitored anesthesia care can provide a clinical spectrum from relaxation to moderate anesthesia. This middle ground between general anesthesia and "pure" tumescent liposuction can help facilitate patient comfort and surgical proficiency during the procedure. OBJECTIVE: To describe a method of liposuction surgery with monitored anesthesia care in which a designated licensed and qualified individual is responsible for administration of supplemental intravenous conscious sedation as well as continuous monitoring of the patient. METHODS: Conscious sedation is induced with midazolam, and the patient is titrated to level II-V on the Ramsey sedation scale with propofol. The basic surgical technique is that of tumescent liposuction. However, the supplemental conscious sedation allows the tumescent fluid to be infiltrated at higher rates and fat extraction to be completed in a shorter period with minimal or no discomfort. RESULTS: In the authors' experience with more than 5,000 cases of liposuction surgery using this method, safety and efficacy have been proved. No patients have experienced significant adverse effects. CONCLUSION: Tumescent liposuction surgery with monitored anesthesia care provides a middle ground between general anesthesia and purely tumescent liposuction.

Reduction of conchal enlargement and/or anterolateral rotation: otoplasty by the cosmetic dermatologic surgeon.

BACKGROUND: Otoplasty is the correction of protuberant ears. One of the most common malformations responsible for prominauris is conchal enlargement and/or anterolateral rotation. The surgical technique we utilize for the correction of this type of auricular malformation is not unlike the removal of auricular skin and cartilage frequently performed by dermatologic surgeons in the treatment of cutaneous malignancies of the ear. OBJECTIVE: To introduce the reduction of conchal enlargement and/or anterolateral rotation for the correction of protuberant ears into the armamentarium of the cosmetic dermatologic surgeon. METHODS: We describe in detail the development and anatomy of the ear along with indications, preoperative considerations, surgical technique, postoperative care, and potential complications for this type of cosmetic surgery. RESULTS: The technique described herein is an effective approach in the surgical management of protuberant ears that are caused by conchal enlargement and/or anterolateral rotation. CONCLUSION: With proper patient selection, thorough knowledge of this step-by-step surgical approach to otoplasty, and some prior surgical experience involving the skin and cartilage of the external ear, the successful correction of protuberant ears is well within the scope of the cosmetic dermatologic surgeon's practice.

Management of large surgical defects of the forehead and scalp by imbrication of deep tissues.

BACKGROUND: When facing surgical defects, the dermatologic surgeon follows certain basic principles that help reduce the inherent tension to allow for a better cosmetic outcome. These commonly include the use of undermining, releasing technique such as galeotomy if applicable, selection of suture material of appropriate tensile strength, and closure along relaxed skin tension lines. OBJECTIVE: To review the imbrication of deep tissues, another surgical principle aimed at wound tension reduction and widely utilized by cosmetic surgeons in forehead lifts and scalp reductions, as it applies to dermatologic surgeons in the repair of large surgical defects of the upper face and scalp. The latter may be utilized both with primary closure and with local flaps. METHODS: We describe in detail the technique of imbrication of deep tissues and provide illustrations for a better understanding of how to correctly use this surgical principle. RESULTS: The dermatologic surgeon has an additional tool, termed imbrication of deep tissues, available to aid in the closure of sizable wounds of the forehead and scalp as seen following Mohs surgery for cutaneous malignancies by providing deep tissue support. CONCLUSION: Imbrication of deep tissue is an effective tool that may be used by dermatologic surgeons in conjunction with the more commonly utilized basic surgical principles to enhance the cosmetic outcome in the closure of large, high-tension defects of the forehead and scalp.

Auricular reconstruction of helical rim defects: wedge resection revisited.

Auricular reconstruction of an acquired helical rim defect is a clinical situation commonly encountered by dermatologic surgeons. Wedge resection is a simple but effective method for repairing such helical rim defects. This is a review of the wedge resection, outlining its indications, limitations, surgical technique, postoperative care, and pitfalls.