Limited-incision face lift technique.

BACKGROUND: For the past 4 decades, the full subcutaneous face lift has been the procedure of choice for treatment of the facial effects of aging. OBJECTIVE: We report the use of a less invasive procedure, the limited-incision face lift technique (LIFT), in a series of 1000 patients from January 1991 through January 2001. METHODS: Each of the lift procedures was performed while the patient was under intravenous sedation and local field block infiltration; no narcotics were administered. Suction-assisted lipoplasty was used to defat the submental area and jowls, except in cases of prominent platysmal bands in the erect position, when open lipoplasty was performed. Undermining was carried medially 5 to 6 cm from the preauricular incision throughout the cheek and over the mandible to the submental area. The superficial musculoaponeurotic system (SMAS) was then developed distally; redundant SMAS tissue was resected at the apex of the closure and along its posterior border, followed by plication and closure. RESULTS: Patients were pleased with the operative experience and surgical results. Complications included 6 cases of hematoma that required surgical drainage. There were also numerous small collections. In addition, development of skin ripples behind the ear lobule occurred in some patients early in the series but virtually disappeared as we gained experience in the procedure. The necessity for immediate neck lifts as an additional procedure occurred in 6 early patients but was eliminated by careful patient evaluation for neck skin laxity later in the series. CONCLUSIONS: The LIFT is an alternative to the traditional face lift. Advantages include limited incision and scar as well as excellent correction of nasolabial folds, cheek laxity, jowls, and redundant submental skin and fat. It is not indicated for patients with significant lower neck skin laxity. (Aesthetic Surg J 2001;21:216-226.).

Spermatic granuloma. An uncommon complication of the tension-free hernia repair.

A patient with a sperm granuloma following a tension-free hernia repair utilizing Marlex mesh 4 years prior to presentation is described. The mechanism of granuloma formation is believed to be secondary to vas deferens injury due to erosion by the cut edges of the mesh at the medial end of the slit used to recreate the internal inguinal ring. Spermatic granuloma has been rarely described in hernia surgery and requires a previous vas deferens injury. While the more common and clinically significant events of hernia recurrence and wound infection should be considered first, the occurrence of spermatic granuloma as a cause of postoperative pain or a mass should be included in the differential diagnosis.