Blepharoplasty.

Blepharoplasty is one of the more common cosmetic procedures, with most candidates being over the age of 40. The upper lid blepharoplasty is an exceedingly simple and gratifying procedure to perform, with few side effects or complications. By contrast, the lower lid blepharoplasty is a more complex procedure, requiring skill and expertise and accompanied by the possibility of more complications, some of which can be severe. Both upper and lower lid blepharoplasty are well within the range of dermatologic surgeons, many of whom perform this surgery on a regular basis.

Dermatologic cosmetic surgery.

Many cosmetic surgery procedures performed today were either developed or refined by dermatologic surgeons. The role played by dermatologic surgeons in the development of dermabrasion, hair transplantation, liposuction, blepharoplasty, face-lift, cutaneous implants, fat transplantation, chemical peel, and sclerotherapy is described.

Occluded Baker-Gordon chemical peel: review and update.

The Baker-Gordon phenol chemical peel is a safe and effective method to improve fine and moderate depth wrinkles as well as actinically damaged skin. Indications, applications of the chemical, taping, and pre- and postoperative care are reviewed.

Aids to scalp reduction surgery.

Utilizing certain surgical techniques during scalp reduction surgery will assist the surgeon in achieving a carefully planned and more efficient result. Measurement of scalp depth will assist in predicting the amount of skin to be excised. A simple method of safe identification of the periosteum is described along with the description of an elevator which assists in rapid, safe, and extensive undermining in the galeal-periosteal plane. An accessory supra-auricular scalp incision can be employed to allow for extensive scalp undermining. A transverse incision into the skin flap to be advanced, allows the surgeon to safely approximate the amount of skin to be excised. When skin closure becomes impossible due to overzealous excision of bald skin, galeotomies can provide closure. A special order suture is described which allows for easier galeal closure. Surgical skin staples are recommended to provide a faster skin closure.

Advantages of the paramedian scalp reduction.

The paramedian scalp reduction as compared to the midline (sagittal) scalp reduction provides distinct advantages, particularly in the patient who has undergone reconstruction of the frontal hairline. The paramedian approach causes less distortion of the frontal hairline, allows greater direct visualization of the advancement flaps, permits more extensive undermining, creates less stretchback, provides for coronal advancement of the hair-bearing occipital donor site, and allows for a greater amount of camouflage of the scalp reduction scar during the immediate postoperative period. Surgeons should be knowledgeable and capable of providing varied forms of scalp reduction procedures to meet the specific needs of the various patients that present for hair replacement surgery.

Facial dermabrasion: advantages of the diamond fraise technique.

The first effective method of performing facial dermabrasion employed the use of a wire brush. The introduction of diamond fraises has, in the author's opinion, provided greater safety and more versatility than the wire brush. The diamond fraise is a more exacting instrument and with the recent introduction of the extra-coarse grit diamond fraise, the instrument is as abrasive as the standard wire brush. The diamond fraise is more easily controlled by the less experienced surgeon and because of its availability in many different shapes, widths, and grits, it provides greater versatility to the surgeon than the wire brush.

Technical aids for dermabrasion.

Since the introduction in the 1940s of an effective method for facial dermabrasion using the wire brush, there have been many ancillary procedures developed. Preoperative aids include scar elevation and punch grafting of deep scars prior to dermabrasion. Retinoic acid can prime the skin for more rapid healing. Gas sterilization of electrical equipment eliminates cross-contamination between patients. Intraoperative improvements include regional block anesthesia of the face, staged narcotic administration and newer methods of facial prechilling, and criteria for the ambient air in the operatory. Gentian Violet staining of the face and use of microfoam tape to delineate the mandibular boundary of a dermabrasion are helpful. The use of a custom handle for the spray refrigerant, the safety of Turkish towels used for retraction, and the application of a sharp Buck's curette make the procedure simpler and more effective. Postoperative aids include the use of systemic steroids and the new biological dressings which simplify the postoperative recovery period.

Evaluation of donor harvesting techniques in hair transplantation.

Ultra close-up photography shows that an ideal donor graft in hair transplantation is harvested using a sharp carbon steel punch driven at approximately 5000 rpm by an electrically powered hand engine. Skin distortion at the donor site is minimized by firm infiltration using physiologic saline. Dull punches, hand driven punches, or flaccid donor skin all increase distortion which is detrimental to the harvesting of superior quality donor grafts. Carbon steel punches attain and maintain a sharper cutting edge than stainless steel punches.

Scalp reduction as an adjunct to hair transplantation. Review of relevant literature and presentation of an improved technique.

The literature on scalp reduction is reviewed and an improved technique of scalp reduction is presented. The amount of bald skin that can be excised by the author's technique exceeds that previously reported by two to three times. The technique rests on tried principles of wide undermining in the galeal-periosteal plane, use of serial relaxing incisions in the galea, closure of specifically designed flap edges under increased tension, and the administration of adrenocorticosteroids postoperatively.