Lip augmentation using an alloderm graft.

A wide variety of surgical procedures and implant materials have been used to satisfy the growing demand of patients for lip augmentation. The authors describe our experience with Alloderm (LifeCell Corp, The Woodlands, TX). It has proven to be a safe and effective means of offering mild to moderate augmentation of the lips.

Hemifacial atrophy: a case report of fat transplantation.

A case of hemifacial atrophy affecting a young female is presented and the manifestations of this uncommon disorder are reviewed. The various methods employed in correcting the facial deformity including the relatively new technique of fat injection are described.

Office surgery: the surgical suite.

A brief history of office based surgery as well as a guide to economic and practical considerations for new facility planning.

Operative setting and anesthesia.

Just as surgical techniques have changed in rhinoplasty, there have been dramatic changes in the techniques of delivery of care. This article has emphasized concepts of outpatient operative technique and anesthesia, especially as they relate to an ambulatory facility incorporated in a surgical practice.

The less-than-satisfactory rhinoplasty: comparison of patient and surgeon satisfaction.

An analysis of patient response to less-than-ideal results in rhinoplasty reveals a marked discrepancy between the way patients react and the way in which surgeons think they would react. We feel that, by showing less-than-ideal results to prospective patients, we may be able to develop a method to predict the degree of dissatisfaction that a patient might show to a result that was less than ideal.

Electrosurgical blepharoplasty: a technique that questions conventional concepts of fat compartmentalization.

Traditional teaching on blepharoplasty surgery emphasizes the existence of several discrete fat compartments in the upper and lower lids. Surgical techniques are based upon removal of fat from each of the two or three so-called compartments within the upper or lower lid. Anatomically, there is little basis for assuming the existence of such compartments. They usually represent areas of weakness or dehiscence within the overlying muscle or septum. A technique of blepharoplasty using electrosurgical dissection is described which emphasizes wide incision of the orbital septum with abundant presentation of the entire fat pad. Removal of fat is carried out without clamping and with great assurance that there will be no subsequent bleeding. Since it is not necessary to pull on the fat pads, retraction of open vessels is avoided.

Low-dose ketamine and diazepam. Use as an adjunct to local anesthesia in an office operating room.

I evaluated the response of 200 patients undergoing office surgery to low-dose ketamine hydrochloride and diazepam as an adjunct to local anesthesia. In most patients, there was a slight increase in pulse rate and BP, but this was relatively mild. In almost all patients, there were no unpleasant recollections of the operative procedure, and I concluded that combination low-dose diazepam and ketamine is an effective and safe adjunct to local anesthesia in an office operating room facility.

Office fiberoptic laryngeal photography.

Fiberoptic direct laryngoscopy has been widely accepted as part of the office laryngeal examination, because it can provide photographs that can be used to document the examination. This is especially useful in serial examinations and in surgical cases for which a visual record of the preoperative and postoperative appearances add greatly to the medical record.

Radiation-induced pharyngeal stenosis. A report of two cases after planned postoperative radiation therapy.

Two cases of almost complete stenosis of the hypopharynx occurred after laryngectomy, radical neck dissection, and postoperative radiation therapy. Successful reconstruction that utilized a tubed, deltopectoral flap was accomplished in each case. In the absence of evidence indicating increased long-term survival with combined surgery and postoperative radiation therapy, one must question the utilization of these methods. Decreased local recurrence or cervical metastasis may not be an adequate justification if the rate of complications is notably increased, especially when complications can be as severe as these.

Office surgery in otolaryngology.

Rising hospital costs have prompted many surgeons to develop office surgical facilities. This can be particularly useful in the type of practice seen by the otolaryngologist. This paper deals with the requirements for an office surgical setup, the scope of surgery that can be carried out in the office, as well as the advantages and disadvantages of operating in the office. Of particular importance is the fact that one must be prepared for the emergency situation when operating in his office.