Face lift with U threads.

The main and more frequent problem in face lift is recurrence of platysma bands, and of skin excess at the bitterness and naso-jugal folds. To improve face lift stability, a new aging analysis is proposed. The visible sign of face aging is skin excess. SMAS retraction is a much less visible sign. Nevertheless, botulinum toxin injections elongate muscles of the SMAS and rejuvenate the face. In the Face Recurve Concept, MRI studies prove the mimic muscles retraction that comes with aging. Face lift techniques that are used today include SMAS plication, traction or excision, which increases discrepancy between the envelop, the skin and the core, the SMAS. As skin excision is poorly efficient because performed posteriorly, far from the anterior skin excess located at the medial neck or at the bitterness fold, the association to SMAS retraction exacerbates the gradient difference between envelop and core. This analysis shows first of all that it is paramount to preserve the SMAS. Secondly, that the sub-skin dissection has to be executed moving beyond the paramedian folds. Then permanent tensor threads anchored in the malar, parotid and mastoid aponeurosis with a U pass flatten the folds and reposition sub cutaneous tissue excess backward to the SMAS. No action is performed on the SMAS, only an horizontal section of the platysma at the hyoid level will avoid platysma band recurrence. Botulinum toxin injections performed just after block muscle regeneration. 35 patients have been operated on a one year period. Results are a lot more stable and swelling is lowered down to the minimum.

Concentric Malar Lift in the Management of Lower Eyelid Rejuvenation or Retraction: A Clinical Retrospective Study on 342 Cases, 13 Years After the First Publication.

BACKGROUND: Lower eyelid rejuvenation can, unfortunately, induce scleral show even if the lower eyelid procedure is limited. This study was designed to assess the effectiveness and reliability of the concentric malar lift technique in two scenarios: the first, in rejuvenation of the mid-face and, the second, in reconstructive surgery for correction of congenital or acquired eyelids malposition. METHODS: The concentric malar lift technique was first published by Le Louarn (Aesthet Plast Surg 28(6):359-372, 2004). This retrospective study was carried out by analyzing data on patients operated on between January 2010 and January 2016. Patients operated on before 2010 were excluded because barbed thread sutures were not used in the first version of the technique. Patients after January 2016 were excluded to ensure adequate follow-up, and so 342 patients are included in the study. A total of 256 cases (75%) were for aesthetic mid-face lifting, and 86 cases (25%) were reconstructive surgeries for lower eyelid retraction. A spacer graft was used in 30 of these reconstructive cases (35%). The mean follow-up time was 13.6 months. All the concentric malar lifting procedures included strengthening the lateral canthus, which is a key element of the procedure. RESULTS: None of the patients developed secondary eyelid malposition, and all the cases of lower eyelid retraction displayed marked improvement both functionally and aesthetically. Two patients experienced loss of sensitivity of part in the infra-orbital nerve distribution for 4 months after the procedure. CONCLUSION: The concentric malar lift procedure enables the recruitment of a significant amount of skin into the lower eyelid: between 10 and 30 mm. It ensures better rejuvenation of the mid-face with minimal risk of lower eyelid malposition. In reconstruction of the lower eyelid lid, the concentric malar lift is able to reduce the need for skin grafting and a skin flap reducing the risks of visible scarring. LEVEL OF EVIDENCE IV: 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 www.springer.com/00266 .

International importance of robust breast device registries.

BACKGROUND: Breast implants are high-risk devices that have been at the epicenter of much debate and controversy. In light of the Poly Implant Prothèse crisis, data registries among 11 national societies around the world are cooperatively calling for the urgent need to establish robust national clinical quality registries based on international best practice within a framework of international collaboration. METHODS: A survey was conducted on the historic and current status of national breast device registries. Eleven countries participated in the study, illustrating different data collection systems and registries around the world. Data collection was designed to illustrate the capabilities of current national registries, with particular focus on capture rate and outcome reporting mechanisms. RESULTS: A study of national breast implant registries revealed that less than half of the participating countries had operational registries and that none of these had adequately high data capture to enable reliable outcome analysis. The study revealed that the two most common problems that discouraged participation are the complexity of data sets and the opt-in consent model. CONCLUSIONS: Recent implant crises have highlighted the need for robust registries. This article argues the importance of securing at least 90 percent data capture, which is achievable through the opt-out consent model. Since adopting this model, the Australian Breast Device Registry has increased data capture from 4 percent to over 97 percent. Simultaneously, it is important to foster international collaboration from the outset to avoid duplication of efforts and enable the development of effective international early warning systems.

How to achieve synergy between volume replacement and filling products for global facial rejuvenation.

The objective of this paper is to provide an expert consensus regarding facial rejuvenation using a combination of volume replacement (Juvéderm(®) VOLUMA(®)), filling products (Juvéderm(®) Ultra product line) and botulinum toxin. The Juvéderm product line exploits innovative 3-D technology, producing a range of cohesive, homogenous gels that produce predictable, long-lasting and natural results. The products are easy to use by practitioners and are well-tolerated by patients, and used in combination can provide additional benefits not achieved with one product alone. An assessment of facial anatomy and consideration of the aging process, as well as available treatment options, are also addressed in determining the best combination of products to use. Outcomes from a questionnaire and workshop sessions focusing on specific aspects of use of the Juvéderm product line and botulinum toxin in daily clinical practice are discussed, and recommendations for product use following debate amongst the experts are provided.

The high-superior-tension technique: evolution of lipoabdominoplasty.

Because abdominoplasty is associated with complications such as seroma and necrosis as well as epigastric bulging and a suprapubic scar located too high, the demand for this procedure is not as high as it otherwise might be. However, although these negative effects were common many years ago, their incidence has decreased dramatically with modern abdominoplastic techniques. One approach using a combination of abdominoplasty and liposuction or lipoabdominoplasty has resolved many of the problems faced with earlier techniques, offering aesthetically pleasing results and excellent reliability. The keys to successful lipoabdominoplasty, first developed as the high-superior-tension technique, are extensive liposuction, preservation of lymphatic trunks, preaponeurotic epigastric dissection, major muscle fascia plication, two high-tension paraumbilical sutures, hypogastric tension sutures, and closure of the dead spaces. The most recent updates to this technique are described in this article.

Flector tissugel used to treat capsular contracture after breast augmentation surgery.

Capsular contracture constitutes the main postoperative complication after breast augmentation by implant placement. To date, no systemic treatment known allows for improvement that does not simultaneously put the patient at risk for secondary complications of a more general nature. Flector Tissugel is the sole locally active antiinflammatory patch. Its durable local antiinflammatory effect is associated only with a risk for rare and highly limited side effects. After approximately 3 weeks of treatment, a high frequency of change from capsular contracture Baker 2 or 3 to Baker 1 occurs, provided the application was started no later than 3 months after the onset of capsular contracture.

The face recurve concept: medical and surgical applications.

The application of the Face Recurve theory gives rise to new technical opportunities in the fields of both aesthetic medicine and aesthetic surgery to block the action of the age marker fascicules largely responsible for aging of the paramedian folds. With respect to aesthetic medicine, the combination of botulinum toxin and soft tissue fillers has proven effective. On the basis of the authors' theory, however, two new technical refinements become pertinent. First, the filler must be injected predominantly deep to the muscle to treat the skin depressions in a more natural manner, bringing restoration to the curve of the overlying muscle. Second, a very low number of botulinum toxin units (one-fourth to one unit) should be injected into specific muscles to diminish their resting tone without diminishing their maximal contraction strength. With respect to aesthetic surgery, the authors present new techniques for the treatment of early aging, specifically a combination of segmental muscular section, microliposuction, and retromuscular fat grafting, all of which can be performed readily with the patient under local anesthesia. For more advanced aging, surgery offers new treatment opportunities that include the concentric malar lift for correction of the midface region, with repositioning of suborbicularis oculi fat back onto the orbital rim from its descended eccentric displacement at the hands of repeated orbicularis oculi contractions. At the same time, specific muscles can be weakened and fat volume restored. Each area can be studied in a specific way and treated definitively. Currently, the skin does not need to be tensioned to a maximum during a face-lift for treatment of the irregular jaw line, the palpebromalar groove, and so forth. Skin tension can be moderated to remove only the true excess of skin. Facial contour is improved, whereas the specific glide is restored between muscles and their underlying fat.

Structural aging: the facial recurve concept.

Cutaneous facial aging is responsible for the increasingly wrinkled and blotchy appearance of the skin, whereas aging of the facial structures is attributed primarily to gravity. This article purports to show, however, that the primary etiology of structural facial aging relates instead to repeated contractions of certain facial mimetic muscles, the age marker fascicules, whereas gravity only secondarily abets an aging process begun by these muscle contractions. Magnetic resonance imaging (MRI) has allowed us to study the contrasts in the contour of the facial mimetic muscles and their associated deep and superficial fat pads in patients of different ages. The MRI model shows that the facial mimetic muscles in youth have a curvilinear contour presenting an anterior surface convexity. This curve reflects an underlying fat pad lying deep to these muscles, which acts as an effective mechanical sliding plane. The muscle's anterior surface convexity constitutes the key evidence supporting the authors' new aging theory. It is this youthful convexity that dictates a specific characteristic to the muscle contractions conveyed outwardly as youthful facial expression, a specificity of both direction and amplitude of facial mimetic movement. With age, the facial mimetic muscles (specifically, the age marker fascicules), as seen on MRI, gradually straighten and shorten. The authors relate this radiologic end point to multiple repeated muscle contractions over years that both expel underlying deep fat from beneath the muscle plane and increase the muscle resting tone. Hence, over time, structural aging becomes more evident as the facial appearance becomes more rigid.

Treatment of depressor anguli oris weakening with the face recurve concept.

The authors have created a strategy for rejuvenation of the peribuccal region based on the concept that the repeated contraction of certain fascicles of the mimetic muscles, and not gravity, is the primary cause of structural aging. Treatment is based on a 4-stage strategy, with interventions including botulinum toxin, hyaluronic acid, autologous fat transfer, and surgery of the depressor anguli oris.

Brachioplasty.

The upper arm is a difficult area to manage after massive weight loss. The goal of the authors' new technique is to avoid complications in massive weight loss cases and simple cases because of aging. After analysis of the excess skin, the authors explain their markings. The main innovation is to preserve all the lymphatic vessels, both the deep and superficial ones, thanks to liposuction and very superficial resection. This eliminates effusions and maintains good vascularization of the wound edges. The suturing technique used to close the wound is very important for minimizing the risks of widening the scar.

The concentric malar lift: malar and lower eyelid rejuvenation.

Midface rejuvenation surgery is most challenging. The margin of error for the lower lid is on the order of 0.5 mm, and the cosmetic result can sometimes look unnatural. A minimally invasive technique for malar and lower lid lift is proposed. Two incisions are used: the standard subciliary lower eyelid incision and one on the lateral part of the upper eyelid. Through these incisions a skin flap lower eyelid dissection and a subperiosteal malar dissection are performed. The arcus marginalis itself is not transected as is the case when the malar area is entered from the lower eyelid. Rather, a subperiosteral release of the arcus marginalis is performed through a muscle-splitting incision at the lateral canthus. Eyelid malposition is avoided because the muscles, vessels, and nerves converging toward the medial canthus are not interrupted. The subperiosteal dissection of the arcus marginalis extends to the medial canthus and also releases the insertion of the orbicularis oculi superior malar part. Consequently, all the attachments of the tear trough are released. Two subperiosteal suspensions connect the central part of the nasolabial volume and, more laterally, the central part of the malar area to the inferolateral orbital rim. The elevation of the malar volume resulting from these suspensions is concentric with the orbit. A final third suspension vertically connects the orbicularis oculi muscle with the underlying periosteum to the bone of the lateral orbital rim. Significant skin excess is removed from the lower eyelid. Complete disinsertion of the tear trough attachments combined with the malar elevation treats the entire palpebromalar groove. The lifted fat volume fills the space resulting from the subperiosteal disinsertion. A safer, more natural and more reliable result is achieved because the vectors of traction with this technique are exactly opposite those of the midface aging process, and because a very stable fixation is created between the lifted malar periosteum and the malar and latero-orbital rim bones.