Lipotransfer in the upper third of the face.

Autologous lipotransfer provides an effective means of volume restoration for facial rejuvenation. The upper one-third of the face falls victim to age-related volume depletion and can be a target for fat transfer. This article describes the senior author's technique of fat transfer in some of the specific anatomic subunits of the upper face.

Multiple revenue streams from your existing and new practice opportunities: focusing on core values versus distractions.

The addition of profit centers to an existing or new plastic surgery practice has the potential to produce countless tangible and intangible rewards. It is important however, not to become engrossed in ventures that could distract from one's core business (i.e. aesthetic facial plastic surgery). This article relates some of the strategies taken from the popular business development literature to the setting of plastic surgery practice development.

An update on hair restoration therapy.

PURPOSE OF REVIEW: This study is aimed towards clinicians involved in the rapidly developing field of hair restoration. We provide a review of recent literature on this topic. RECENT FINDINGS: Recent studies discussed in this article focus on various aspects of follicular unit transplant surgery, including hairline design and associated complications. In addition, a relatively new surgical technique termed follicular unit extraction (FUE) is discussed. In recent years, larger series in FUE have been published, adding to the growing body of literature on this technique. SUMMARY: Follicular unit strip surgery continues to be the gold standard of hair replacement technique. FUE has been used by several authors with success and further refinements may increase its utility in hair restoration surgery.

Contemporary Mohs surgery applications.

PURPOSE OF REVIEW: The incidence of cutaneous malignancies continues to rise and it is likely that the majority of skin cancers referred to otolaryngologists will have characteristics that necessitate a more complex and aggressive approach. Mohs micrographic surgery is a tissue-sparing technique that allows for excision of cancers under complete microscopic control and thus boasts high cure rates. This paper reviews the Mohs technique and discusses the current indications for Mohs surgery in the head and neck. RECENT FINDINGS: For high-risk basal cell and squamous cell carcinomas, studies continue to report superior cure rates with Mohs surgery compared with non-Mohs modalities such as standard surgical excision. Despite several supporting studies, Mohs surgery for melanoma continues to be controversial in the literature, as histological identification of melanoma with frozen sections remains challenging despite advances. Other means of margin control remain popular among non-Mohs surgeons, including frozen section analysis and, more recently, photodynamic delineation. SUMMARY: For cutaneous malignancies of the head and neck, Mohs surgery offers the distinct advantages of complete microscopic margin control coupled with tissue conservation and thus boasts of high cure rates. It is important for otolaryngologists to understand the technique and current indications for Mohs surgery.

The use of fibrin glue for fixation of acellular human dermal allograft in septal perforation repair.

OBJECTIVES: Acellular human dermal allograft used as an interpositional graft between mucoperichondrial flaps has been shown to be effective in the repair of septal perforations. The material is typically sutured to the septum, but this can be technically difficult. We describe a technique in which fibrin glue is used to secure the acellular human dermal allograft for septal perforation repair. STUDY DESIGN: A retrospective case series of 5 patients who underwent this procedure are reviewed. METHODS: Five patients with preexisting septal perforations underwent septal repair using fibrin glue to secure the interpositional acellular human dermal allograft. The graft was first placed between the mucoperichondrial flaps, and 1/3 cm(3) of fibrin glue was applied to both sides. One side was then covered with a bipedicled mucosal flap and compressed for 5 minutes to allow for fixation. RESULTS: The use of fibrin glue compared with conventional suturing decreased the length of the procedure by approximately 30 minutes. At the 3-month postoperative examination, all 5 patients were found to have successful outcomes. CONCLUSION: The use of fibrin glue for fixation of the acellular human dermal allograft in septal perforation repair is technically less difficult and reduces the length of the procedure, and we believe it reduces graft migration when compared with conventional suturing techniques.