The art of the trichloroacetic acid chemical peel.

Despite escalating interest in laser resurfacing techniques, chemical peel procedures remain an integral part of the armamentarium for resurfacing aging, sun-damaged, and diseased skin. Like other chemicals, the advantage of the technique of tricholoracetic (TCA) acid application is that the degree and depth of penetration within the skin can be controlled accurately according to specific requirements. This article reviews the preoperative evaluation of skin and the techniques for preconditioning, intraoperative peel, and postoperative management of TCA-treated skin.

The use of expanded polytetrafluoroethylene as a permanent filler and enhancer: an early report of experience.

Plastic and reconstructive surgeons have long sought the ideal material to fill and enhance defects of the head and body. Many of the most widely used materials present problems for the surgeon or the patient, so the search continues. For the past 15 months, we have been using expanded polytetrafluoroethylene (ePTFE) Gore-Tex Soft Tissue Patch to fill in nasolabial and glabellar creases and to augment malar bones and the chin. Early evaluation indicates that ePTFE performs well with very few problems, with a high level of patient and surgeon satisfaction. Histological examination of 3-month explants from the postauricular subcutaneous plane and the antecubital fossa indicate minimal inflammatory response and some collagen penetration into the interstices of the prosthesis.

Application and modification of the circular skin excision and pursestring procedures.

The concept of the circular excision is not new. However, it was complicated by excessive postoperative areolar stretching and scar hypertrophy. The Benelli principle of a permanent subdermal pursestring suture overcame these drawbacks. We present our experiences with the circular skin excision for mastopexy procedures and for circular skin incision for total mastectomy and immediate reconstruction.

The "no flap" technique for lower-lid blepharoplasty.

The transconjunctival approach to fat pad excision has gained popularity for use on those patients who require fat excision but not redundant skin excision. For skin excision cases, the pinch technique for raising the cuff of redundant skin of the lower lid has been found helpful, particularly in the older patient with latent senile ectropion. We find that elevating the skin or the skin/muscle flap produces edema of the already weak musculature predisposing it to postoperative senile lid hang. Avoiding lower-lid flaps in a lower-lid blepharoplasty has helped prevent this troublesome problem.

Breast reconstruction utilizing subcutaneous tissue expansion followed by polyurethane-covered silicone implants: a 6-year experience.

Reconstruction of the breast after modified radical mastectomy can be safely and adequately performed in the subcutaneous plane. Placement of a subcutaneous tissue expander (as either an immediate or a delayed procedure), rapid expansion over a 3- to 4-month period, capsulotomy, and placement of a polyurethane-coated implant have led to satisfactory results over a 6-year period. Breast reconstruction methods are well documented; however, the utilization of expanded subcutaneous chest wall skin has not been reported heretofore.

Planning the aesthetic foreheadplasty.

Different approaches to aesthetic foreheadplasty have been thoroughly described and well documented. However, there has been a paucity of information in the literature describing indications for the various approaches. We detail our approach to planning the foreheadplasty; most commonly, we opt for the anterior forehead-hairline approach. We believe that proper patient selection with regard to anatomical, aesthetic, and physiological factors is of the greatest importance in planning an aesthetic foreheadplasty.

Carcinoma of the breast occurring in routine reduction mammaplasty.

We report the case of an 18-year-old female undergoing routine reduction mammaplasty in whom bilateral diffuse intraductal cribriform breast carcinoma was reported upon review of the surgical specimen. This highlights the importance not only of sending specimens for pathologic examination, but also of marking the specimens accurately by location, such as medial, central, and lateral. Treatment with bilateral modified radical mastectomy with lower axillary dissection and immediate reconstruction with autogenous tissue is reported.

Breast reconstruction with a subcutaneous tissue expander followed with a polyurethane-covered silicone breast implant.

We have reexamined the subcutaneous route of reconstruction of the breast following mastectomy. For either delayed or immediate reconstruction of the breast, we have used a subcutaneously placed Radovan tissue expander, followed by expansion of the skin flap, then capsulotomy and insertion of the polyurethane-coated implant. The results of these procedures are presented after follow-up periods ranging from one and one-half to three years, with more than satisfactory results.