Liquid Rhinoplasty.

Soft tissue filler injections have become the second most common noninvasive cosmetic procedure performed in the United States, accounting for roughly 26% of all noninvasive procedures. As experience with filler injections has increased, so too have the applications and uses throughout the face. The popularity of "liquid," or nonsurgical, rhinoplasty has grown considerably with both patients and surgeons over the last decade. First documented in 2006, numerous descriptions of technique and application have grown in tandem with the increasing popularity of nonsurgical rhinoplasty procedures. Although nasal injections remain an "off-label" use in the United States, hyaluronic acid fillers have gained multiple applications for the nose. These include, but are not limited to, leveling a dorsal hump through the addition of volume above and below the dorsal convexity, filling of visible nasal concavities, correcting upper and middle third asymmetries, as well as improving the under-rotated or under the projected tip. Though attractive to both patient and surgeon for various reasons, nasal filler injections are not without risk, and knowledge of nasal surgical anatomy and management of complications are critical for safe, viable outcomes.

Liquid Rhinoplasty.

Soft tissue filler injections have become the second most common noninvasive cosmetic procedure performed in the United States, accounting for roughly 26% of all noninvasive procedures. As experience with filler injections has increased, so too have the applications and uses throughout the face. The popularity of "liquid," or nonsurgical, rhinoplasty has grown considerably with both patients and surgeons over the last decade. First documented in 2006, numerous descriptions of technique and application have grown in tandem with the increasing popularity of nonsurgical rhinoplasty procedures. Although nasal injections remain an "off-label" use in the United States, hyaluronic acid fillers have gained multiple applications for the nose. These include, but are not limited to, leveling a dorsal hump through the addition of volume above and below the dorsal convexity, filling of visible nasal concavities, correcting upper and middle third asymmetries, as well as improving the under-rotated or under the projected tip. Though attractive to both patient and surgeon for various reasons, nasal filler injections are not without risk, and knowledge of nasal surgical anatomy and management of complications are critical for safe, viable outcomes.

Fundamentals of Wound Healing.

At the moment of soft tissue injury, an immediate wound healing ballet commences. This coordinated cascade of events works over minutes, hours, weeks, and months to restore tissue integrity and viability in an attempt to rebuild the site to its preinjured state. A thorough understanding of these processes, and options to navigate forks in the road, can help guide patient selection, surgical planning and execution, management of complications, and ultimately the restoration of tissue form and function for optimal outcomes. An exhaustive account of tissue healing mechanics is beyond the scope of this writing. However, a summation of much that is known of these processes and the directions research and therapeutic developments are currently aimed will help the facial plastic surgeon prevent or minimize debilitating functional and cosmetic consequences in the head and neck.

Forehead lifting: state of the art.

Forehead lifting serves to restore a more youthful appearance as well as a more functional and aesthetically pleasing brow position. The purpose of this review is to describe the pertinent anatomy and forehead aesthetics, then to discuss the patient evaluation, surgical approaches, complications, and nonsurgical adjuncts. Anatomic features reviewed include the layers of the forehead and scalp, blood supply, innervation, musculature, and the temporal branch of the facial nerve anatomy. Forehead aesthetics described include the aging process, with its contributing factors and consequences, and the ideal brow position in women and men. Key aspects of the patient evaluation include assessment of skin type; ptosis; hairline, brow, and lid position; symmetry; and bony contours. Pertinent past medical/surgical history as well as family history are reviewed, and the need for ophthalmology evaluation is discussed. Surgical indications and approaches, including direct, coronal, mid-forehead, endoscopic, and trans-blepharoplasty, are reviewed. The advantages and disadvantages of each approach are discussed and techniques briefly described. Complications are mentioned, and the article concludes with a review of nonsurgical adjuncts.

Fat grafting of the midface.

Autogenous fat injection of the midface is a viable and lasting remedy for midface soft tissue loss and has become a mainstay in facial rejuvenation. This serves as either a stand-alone technique or as an adjunct to other restorative lifting and repositioning techniques depending on patient needs. Although the use of fat grafting carries the inherent concern for resorption and a need for additional augmentation in the future, several tenets of fat transfer have emerged over the past century. Founded in these principles, the regimen set forth here has proved reliable and reproducible with little to no evidence of resorption over time.

Antiphospholipid antibodies and stroke in young women.

BACKGROUND AND PURPOSE: Antiphospholipid antibodies have been associated with ischemic stroke in some but not all studies. METHODS: We performed a population-based case-control study examining antiphospholipid antibodies (anticardiolipin antibodies and lupus anticoagulants) using stored frozen sera and plasma in 160 cases and 340 controls enrolled in the Stroke Prevention in Young Women study. We evaluated for the presence of anticardiolipin antibody (IgG, IgM, and IgA isotypes) by an enzyme-linked immunosorbent assay and for the lupus anticoagulant using several phospholipid-dependent coagulation tests (activated partial thromboplastin time, dilute Russell's viper venom time) with mixing studies. If mixing studies were prolonged, confirmatory tests were performed. RESULTS: A positive anticardiolipin antibody level of any isotype was seen in 43 cases (26.9%) and 62 controls (18.2%) (P=0.03), lupus anticoagulant in 29 cases (20.9%) and 38 controls (12.8%) (P=0.03), and either anticardiolipin antibody or lupus anticoagulant in 61 cases (42.1%) and 86 controls (27.9%) (P=0.003). After adjustment for age, current cigarette smoking, hypertension, diabetes, angina, ethnicity, body mass index, and high-density lipoprotein levels, the relative odds of stroke for women with anticardiolipin antibody immunoreactivity of any isotype or a lupus anticoagulant was 1.87 (95% confidence interval, 1.24 to 2.83; P=0.0027). CONCLUSIONS: The results from this study support the importance of antiphospholipid antibodies as an independent risk factor for stroke in young women.