Jawline Refinement in Face Lifting: The Five Zones and the Five-Step Technique✰.

Facial aging changes due to increased skin laxity as well as soft tissue atrophy and decent lead to blunting and distortion of previously well-defined zones of the face and neck. A critical component of re-establishing a youthful appearance during facelift and neck lift surgery is restoring a well-defined mandibular contour. Key principles of jawline refinement include the addition of volume to deficient areas and removal of volume in areas of unwanted fullness to re-establish facial harmony in the lower face and neck. In this article, we describe a novel classification of jawline zones and discuss our stepwise surgical approach to aid in the systematic evaluation and surgical treatment of the jawline.

Minimally Invasive Approach to Skin Tightening of the Face and Body: Systematic Review of Monopolar and Bipolar Radiofrequency Devices.

BACKGROUND: Radiofrequency treatment is a relatively new and increasingly popular option for patients desiring skin tightening and an improvement in facial or body contour without undergoing an excisional surgical procedure. A systematic review of the literature was performed to investigate the safety and efficacy of monopolar and bipolar radiofrequency devices for facial and body rejuvenation. METHODS: A computerized search of the MEDLINE database was performed for clinical studies investigating the use of monopolar and bipolar radiofrequency devices in facial and body rejuvenation. Data on the type of device, treated areas, number of patients, number of treatments, follow-up, complications, and outcomes were collected. RESULTS: The systematic review was performed in September of 2020. A total of 207 articles examined the use of radiofrequency technology for cosmetic purposes, and 23 articles remained after all inclusion and exclusion criteria were considered. Nine articles evaluated monopolar devices and five articles evaluated bipolar devices for treatment of the face. Three articles evaluated monopolar devices and six articles evaluated bipolar devices for treatment of various body areas. CONCLUSION: There is clinical evidence that monopolar and bipolar radiofrequency devices produce measurable improvement in skin laxity of the face and body with an acceptable complication profile. The majority of reported complications are minor and transient in nature; major complication rates are higher with the use of monopolar devices than with the use of bipolar devices.

Personal Evolution in Rhinoplasty Tip Shaping: Beyond the Tripod Concept.

SUMMARY: Introduced over 50 years ago, the "tripod concept" has long been the foundation of our understanding of tip dynamics in rhinoplasty. Modern approaches to rhinoplasty have built on these principles and seen the evolution of several operative techniques to address tip aesthetics. This article and accompanying case video detail our algorithmic approach to tip shaping, based on the use of complete lower lateral cartilage reshaping and tensioning, clarified use of medial crural transection and overlap, with stabilization on a fixed-floating septal extension graft, and deliberate management of the soft-tissue envelope. The intraoperative sequencing, key technical considerations, relevant classification schemes, and global decision-making processes are reviewed. .

Technique for Minimally Invasive Face and Neck Contouring with Bipolar Radiofrequency Devices.

SUMMARY: Radiofrequency devices have grown in popularity as minimally invasive options for the treatment of skin laxity in the face and neck. These treatments are often combined with liposuction procedures to provide enhanced tissue contraction alongside the reduction in adiposity. Proper patient selection and intraoperative technique are crucial to achieving the desired outcomes in a safe manner. In this article, the authors discuss their indications and technique for the treatment of the face and neck with bipolar radiofrequency devices.

Versatility of the Fixed-Mobile Septal Extension Graft for Nasal Tip Reshaping.

SUMMARY: Key goals of nasal tip reshaping include precise control of tip shape and position, along with restoration of proper structural support. Unfortunately, traditional techniques attempting to address these goals have yielded unpredictable results. In this article, the authors detail their surgical technique and discuss the numerous aesthetic and functional benefits of this graft, along with its applicability to a wide variety of patient populations and nasal deformities. The authors' technique utilizing the fixed-mobile septal extension graft has demonstrated reliability in establishing proper tip positioning through precise adjustments to tip rotation and projection, while simultaneously providing a stable structure for maintaining tip support. While fixed at the anterior septal angle, this graft also proves beneficial in maintaining natural tip mobility because of its anterior extension past the septum. The fixed-mobile septal extension graft is versatile and reliable when used for tip reshaping and support.

Revision Rhinoplasty: With Introduction of a Novel Preoperative Assessment Classification System.

Revision rhinoplasty presents several complex surgical challenges. Proper patient selection for revision rhinoplasty, along with thorough preoperative examination and surgical planning, is key to achieving ideal outcomes. Along with achieving a high level of understanding of primary rhinoplasty techniques, surgeons performing revision rhinoplasty must understand and diagnose deformities created by the primary surgery. A systematic approach to diagnosing rhinoplasty deformities assists in forming a suitable surgical plan. A classification system based on nasal analysis, described here, may be used to differentiate the degree of difficulty of the surgery as well as assist in surgical planning. Surgeons have a multitude of options available in their armamentarium for addressing common nasal deformities encountered during revisional surgery, and a stepwise surgical approach may facilitate the creation of an optimal aesthetic and functional result.

Platelet-Rich Plasma: Evolving Role in Plastic Surgery.

BACKGROUND: The use of platelet-rich plasma has emerged as one of the most desired nonsurgical treatments for facial rejuvenation and hair restoration. It has grown to encompass a wide variety of applications within the field of plastic surgery, including its use in combination with microneedling, laser, and fat-grafting procedures. METHODS: In this article, the authors aim to (1) describe the preparation process of platelet-rich plasma; (2) discuss the proposed science behind platelet-rich plasma with regard to its evolving role in hair restoration and facial rejuvenation; and (3) highlight the recent literature examining its widespread use. RESULTS: Based on the available literature, there is a therapeutic advantage to the use of platelet-rich plasma as a single treatment modality for alopecia and skin rejuvenation and in combination with laser skin treatment and fat grafting. There is, however, a considerable amount of variability in the processing, preparation, and treatment modalities. CONCLUSIONS: Despite a lack of standardized protocols for platelet-rich plasma preparation and a scarcity of large-scale studies with long-term follow-up, there is convincing evidence with objective measurement modalities that display positive outcomes after treatment for skin rejuvenation, hair regrowth, wound healing, and fat graft take.

Midline Craniofacial Masses in Children.

Nasal dermoids, encephaloceles, and gliomas are rare congenital lesions that result from improper embryologic development. The differentiation between them and a firm understanding of their pathology is necessary to avoid unnecessary complications. In view of their potential intracranial connection, prompt diagnosis and treatment are paramount. The authors review the embryology, diagnoses, radiologic work-up, surgical management, and complications of these midline craniofacial masses in children.