[Indications and results of breast implant replacement with implants pre-filled with silicone gel]. / Indications et résultats de l'opération déprothèse-prothèse avec implants préremplis de gel de silicone.

Based on a series of 74 patients, the authors report their experience of reoperation on unsatisfactory breast implants by the implant replacement technique using silicone prefilled implants. In 92 (57.8%) of the 160 cases, the implant was modified because of a peri-implant capsule, with a satisfactory aesthetic result after only a single operation. However, this leaves the problem of repeated surgical operations, especially in the context of Baker stage IV capsules, which are only partially improved after two to three surgical operations. A particular surgical revision technique is required in the cases, while the role of in situ cortivazol is under investigation. This series comprises two patients with auto-immune disease and dysimmune profiles, not exarcerbate by secondary surgery. Analysis of this series clearly argues in favour of reoperation for unsatisfactory breasts implants. Squeezing manoeuvres appear to be dangerous and useless. Textured implants filled with very cohesive silicone gel should be maintened in view of the absence of any reported serious complications.

[Results of biplane face lifts with maximal skin underlining and vertical SMAS flap]. / Résultats des liftings biplans avec décollement cutané étendu et lambeau de smas vertical.

It is difficult to evaluate the medium and long-term results of facelift due to loss to follow-up of a large number of patients. The authors developed a questionnaire which they sent to their patients. 148 patients (143 women and 5 men) answers this questionnaire and 54 patients returned for review. This subjective evaluation of the results nevertheless had the advantage of identifying three target organs specifically treated by the surgical techniques used: the nasolabial folds, the jowls and the neck. Improvement or deterioration of the results was therefore evaluated and reported on a series of tables. The results are analysed in this paper. 70.3% of patients studied reported a satisfactory objective result with a mean follow-up of 26.8 months. The least favourable results were observed in the neck, due to the small number of technical procedures performed on the platysma, which would appear to justify greater surgical attention. Among the complications reported, 9.2% of cases indicated inadequate results, especially concerning the "lion's wrinkle", which emphasizes the value of a complementary endoscopic procedure at this site. Perioral wrinkles were a source of dissatisfaction in 14.8% of cases, and can be treated by dermabrasion. Lastly, a number of minor complications such as malposition of the ear lobe, facial redness or scar abnormalities were also mentioned and are easily accessible to an ambulatory secondary improvement procedure. This study therefore validated the operative technique of biplane facelift with a satisfactory stability of the results over time. Objective review of dissatisfied patients, who generally returned for review after receiving the questionnaire, led to a number of reoperations, which appear to be useful in the case of early deteriorations occurring during the first postoperative year and which concern about 5% of patients. The ultimate objective of this paper was to try to establish a methodology for the analysis of the long-term results of facelift, without directly involving the examiner or operator, who may ignore what the patient really feels.