Complications of rhytidectomy.

In a recent study of rhytidectomy patients, the most common complications were hematoma, inflammation, crusting, hypertrophic scars, hair loss, and changes in ear lobe appearance. The nurse's role in early detection and prevention cannot be overlooked. This article will review these complications and less common ones, emphasizing the known etiologies, signs and symptoms, and the nurse's role in assessment and intervention.

Performance appraisal and career development: a shotgun marriage.

Both performance and career development have potential for developing human resources--potential that can be increased by linking them together, says author Beverly L. Kaye, organization consultant. This marriage of convenience--and common sense--not only produces synergy, but also strengthens each process individually. Stressing a win/win approach designed to meet the needs of both individual employees and the organization, Kaye first examines the preparation required--preparation in terms of communication, especially listening and giving feedback; awareness of employees as individuals; the recognition that developmental moves are not always upward ones; and time assigned to soul-searching and self-assessment. However well the processes are integrated, the manager is still primarily responsible for performance appraisal and the employee for career development. Kaye offers a checklist of questions designed to help each.

Two helpful technical aids in blepharoplasty.

We describe two helpful technical aids in blepharoplasty. The first is a method of securely holding orbital fat without risk of excessive traction if the patient's head moves. The second involves use of a battery-powered cautery as a safe, convenient cutting instrument.

The extended face-lift with ancillary procedures.

Our present face-lift technique is a double-layered operation, consisting of standard skin flap dissection in the cheeks and undermining in the neck, often across the midline. The underlying foundation for the lift is created by superficial musculoaponeurotic system advancement in the cheeks, partial medial and lateral transection of the platysma muscle in the neck, and suturing together of the medial borders of the platysma in the submental region. We do not divide the platysma completely. When ancillary procedures are indicated, the operations are done in two stages because of the increased operating time required. We believe the improvement in quality and duration of results makes the increased time, effort, and expense worthwhile, though scientific proof of our impression is not yet available. A method for objective evaluation of results is suggested.

The extended neck lift: the "bottom line".

Although adequate submental lipectomy and procedures to reposition and modify the supportive role of the platysma muscles have added to the quality and duration of neck lifts, the "bottom line" is still excision of as much excess skin as possible. A method of extended neck lift is described. It involves ancillary methods of cervical lipectomy and platysma repositioning but it also permits excision of large amounts of excess skin, by extending the posterior incisions medially and inferiorly and pulling the dog ears toward the midline. The results appear to make the additional effort worthwhile.

Rhinoplasty in the older patient.

Rhinoplasty is often indicated in the older patient, either as an isolated procedure or in continuous or staged combination with other facial rejuvenative operations. The operations must be tempered with conservatism and artistic judgment. The nose of an older person should look natural and inconspicuous and fit the patient's face. Because of possible coronary or hypertensive problems, epinephrine in the local anesthetic solution should be used in lesser concentrations, requiring a longer wait for its full vasoconstrictive effect. Nasal cartilage is tougher, and the nasal bone more brittle in the older patient. In addition to the usual complete rhinoplasty, the partial rhinoplasty is a useful operation for the older individual.

General anesthesia for rhytidectomy: a review of 100 consecutive cases.

Although local anesthesia will, and should, continue to be the principal method of anesthesia for most face lift operations, we believe that general endotracheal anesthesia, supplemented by local anesthesia with epinephrine, offers significant advantages in a selected group of patients. We review 100 consecutive rhytidectomies done under this combination of anesthetics. These patients had no significant intraoperative or postoperative problems, and the results compare favorably with the usual technique of local anesthesia plus basal sedation. Good cooperation between surgeon and anesthesiologist, and a thorough understanding of the principles involved in such anesthesia administrations (particularly when relatively large volumes of local anesthesia with epinephrine are going to be used) are necessary for the patient's safe course during the procedure.

The forehead lift: a useful adjunct to face lift and blepharoplasty.

The forehead lift, with interruption of the continuity of the frontalis muscle, has been an effective method in our hands for improving the appearance of the upper third of the face. It can be done independently, or combined with a facial rhytidectomy, a blepharoplasty, and/or other ancillary procedures. In some cases of apparent upper lid redundancy, it can eliminate the need for an upper lid blepharoplasty. The results are pleasing and seem to be lasting, while the complications have been few and mild. We describe the operation and discuss its indications, contraindications, advantages, and disadvantages.