The Persian woman's face: a photogrammetric analysis.

BACKGROUND: The aim of this study was to establish normative quantitative anthropometric measurements of the Persian woman's face and assess differences from established North American White women's measurements. METHODS: Standard photographs (frontal, left lateral, and base views) of 107 Persian women volunteers (both parents of Persian ancestry) between the ages of 18 and 40 were digitally acquired. Twenty-six standard anthropometric measurements were obtained using Adobe Photoshop. The results were compared with those previously published for North American White women using an unpaired t test with differences being considered significant if p<0.05. RESULTS: A statistically significant difference was found between Persian women and North American White women in 18 of 26 anthropometric measurements. CONCLUSION: The anthropometric differences between Persian women and North American White women reflect fundamental differences in the osseochondrous scaffold and soft tissue covering of the face. These differences partially account for the disharmony and loss of ethnic identity that occurs when surgery is planned using classical canons. For patients wishing to maintain their ethnic features following aesthetic surgery, access to ethnicity-specific normative anthropometric data will help guide the surgeon to achieve this goal. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Novel endoscopic management of penetrating intracranial trauma.

We report a unique case of minimally invasive endoscopic removal of a penetrating orbitocranial foreign body (POCFB), and present a review of the literature. A 12-year-old boy was impaled in the orbit with a gate latch. Neurosurgical consultation ascertained that removal via bifrontal craniotomy would necessitate extensive brain retraction and result in permanent anosmia. Attempting nasal endoscopic removal was deemed prudent, given this morbidity and a lack of brain parenchymal violation. The patient recovered without a cerebrospinal fluid leak or other neurologic sequelae. To date, craniotomy is the only reported management of POCFBs in the literature. We herein report the first nasal endoscopic removal of a POCFB.

Management of the Asian upper eyelid.

Relating the rejuvenation of the eye in terms of the Asian face, this article covers the unique set of strategies for this population that include understanding cultural and aesthetic aspects of the Asian patient, anatomy of the Asian patient, and techniques that would be appropriate based on these cultural and anatomic considerations. Along with strategic planning, a detailed surgical technique is presented with graphic examples, in addition to a brief guide to postoperative care.

Management of the aging upper eyelid in the asian patient.

Successful management of the aging upper eyelid region in the Asian patient requires a unique skill set and clinical experience. The surgeon must exhibit a thorough understanding of the unique anatomy of the Asian eyelid and its variations and of the cultural expectations of the patient and must possess a unique set of surgical skills such as de novo creation of the supratarsal crease as well as complementary procedures such as fat transfer used for volume augmentation of the periorbital region. The modern approach outlined here summarizes the key elements necessary to restore the youthful appearance of the upper eyelid region in a natural and ethnically consistent fashion.

Supratarsal crease creation in the Asian upper eyelid.

Supratarsal crease fixation in the Asian patient can provide a more open-eyed, awake look without compromising their ethnic appearance. A conservative supratarsal crease height and conservative to no removal of postseptal fat help to ensure this natural-appearing result. With the full-incision method, consistently excellent results have been achieved with durable crease fixation despite a prolonged recovery time. The supratarsal crease fixation provides an excellent method for the younger patient seeking cosmetic eyelid enhancement. However, for the aging Asian patient, the complexity of the strategy is greater.

Chemical peels for darker skin types.

This article focuses on chemical peels for darker skin types. All races comprise a range of Fitzpatrick skin color types: light skin types in African Americans, Asians, Middle Easterners, and Latinos and dark skin types in whites. With the focus on Fitzgerald skin types IV to VI, this article discusses chemical peels, providing current information on types of peels, detailed techniques, preoperative and postoperative care, complications, hazards, and nuances of management.

Short-scar purse-string facelift.

Despite the variety of novel facial rejuvenation technologies available today, the reference standard for correction of the senescent jaw line and neck remains rhytidectomy. This article describes the purse-string facelift, a vertical facelift that moves away from traditional techniques that use a horizontal vector of subcutaneous muscle-aponeurotic system repositioning. The vertical facelift can counterbalance the effects of gravity and natural facial aging and can reposition the facial soft tissues into a more youthful position more directly and correctly. Rather than multiple, separate sutures to support the suspended tissues, the purse-string technique offers two distinct advantages: operative expediency and a tenacious suture anchor based on the periosteum of the posterolateral zygomatic arch.

Facial fracture repair in the traumatic brain injury patient.

PURPOSE: To review the surgical complications of patients who had facial fractures repairs in the setting of a traumatic brain injury (TBI). PATIENTS AND METHODS: A review of all individuals admitted with the diagnosis of TBI based on an evaluation by the neurotrauma service who also underwent facial fracture repair was performed. More than 600 charts were reviewed and 99 patients met study criteria. Univariate and mulitvariate logistic regression model analysis were performed comparing the complication rate in the immediate postoperative period to the patients' age, gender, mechanism of injury, zone of facial injury, preoperative Glasgow Coma score, presence of multisystem injury, mechanism of TBI and treatment, length of time from injury to surgical repair and length of surgical procedure. RESULTS: Of the 99 individuals studied, there was an 11% complication rate (8 minor, 3 major) in the immediate postoperative period. After univariate analysis, the length of time from injury to surgical repair, zone 1 facial injury and low Glasgow Coma score were all factors associated with increased complications. Multivariate logistic regression model analysis revealed that the odds of a patient sustaining a postoperative complication was 1.298 as the hour of procedure increased by 1 hour (95% CI, 1.065-1.582) and was 1.152 as the days of repair increased by 1 day (95% CI, 1.030-1.288). CONCLUSIONS: The overall complication rate of facial fracture repair in the TBI patient was 11%. A prolonged surgical procedure and delay in surgical repair were associated with higher complication rates as identified by multivariate logistical regression analysis.

Cartilage regeneration in the rabbit nasal septum.

OBJECTIVE: Rhinoplasty frequently includes harvesting of nasal septal cartilage. The objective of this prospective basic investigation is to determine whether cartilage can regenerate after submucosal resection (SMR) of the nasal septum in the rabbit. Neocartilage formation has not heretofore been described in this model. METHODS: By lateral rhinotomy, SMR was performed on 17 rabbits followed by reapproximation of the perichondrium. After 7 months, septi were fixed, sectioned, and examined histologically. Findings were photographed and data tabulated according to location and extent. RESULTS: Sites of matrix-secreting isogenous chondrocyte islands were identified between the perichondrial flaps of every animal, principally in the anterior inferior septum. The width of the islands averaged 190 microm, and the mean neocartilage height was found to be 840 microm. The newly formed cartilage consisted of chondrocytes within chondrons and was comparable in shape and structure to native septal cartilage. CONCLUSIONS: After SMR, rabbit cartilage tissue can regenerate and form matrix within the potential space created by surgery. The surrounding stem cell-rich perichondrium may be the site of origin for these chondrocytes. These findings suggest that after SMR of the human nasal septum, it may be possible for new cartilage tissue to develop provided the mucosa is well approximated. This biologic effect may be enhanced by insertion of cytokine-rich tissue scaffolds that exploit the native ability of septal perichondrium to regenerate and repair cartilage tissue.

Long-term viability and mechanical behavior following laser cartilage reshaping.

OBJECTIVE: To investigate the long-term in vivo effect of laser dosimetry on rabbit septal cartilage integrity, viability, and mechanical behavior. METHODS: Nasal septal cartilage specimens (control and irradiated pairs) were harvested from 18 rabbits. Specimens were mechanically deformed and irradiated with an Nd:YAG laser across a broad dosimetry range (4-8 W and 6-16 seconds). Treated specimens and controls were autologously implanted into a subperichondrial auricular pocket. Specimens were harvested an average +/- SD of 208 +/- 35 days later. Tissue integrity, histology, chondrocyte viability, and mechanical property evaluations were performed. Tissue damage results were compared with Monte Carlo simulation models. RESULTS: All laser-irradiated specimens demonstrated variable tissue resorption and calcification, which increased with increased dosimetry. Elastic moduli of the specimens were significantly either lower or higher than controls (all P<.05). Viability assays illustrated a total loss of viable chondrocytes within the laser-irradiated zones in all treated specimens. Histologic examination confirmed these findings. Experimental results were consistent with damage profiles determined using numerical simulations. CONCLUSION: The loss of structural integrity and chondrocyte viability observed across a broad dosimetry range underscores the importance of spatially selective heating methods prior to initiating application in human subjects.