Micro-face-lift: A novel biplanar, composite, less-invasive procedure.

Background: Facial rejuvenation procedures have been in existence for over a century. Since its first introduction, it improved anatomical understanding and clinical implications and gave rise to numerous techniques and re-ideations of the original face-lift. The increase in popularity of face-lift procedures attracts patients of various ages and with different medical comorbidities. In this paper, we describe the less-invasive facelift procedure, termed the "Micro-Face-lift," with minimal complications, a short recovery period, and few contraindications. Materials and Methods: The authors retrospectively analyzed the medical files of 51 patients who underwent the "Micro-Face-lift" procedure between 2014 and 2019 by three independent surgeons. Results: Fifty-one patients met the inclusion criteria for the procedure. Forty-nine patients were women (96.1%) and the remainder were men (3.9%). The mean age at the time of the procedure was 60.8 years (range 45-87). Complications were encountered in five patients (9.8%): two hypertrophic scars (3.8%), one hematoma (2%), one surgical wound infection (2%), and one edema (2%), persistent for more than 2 weeks postoperatively. All complications resolved within 6 weeks of postoperatively. Thirty-five patients (68.6%) underwent additional procedures to maximize the aesthetic outcome. Thirty patients (58.8%) underwent submental liposuction and five patients (9.8%) underwent mid-face lipo-filling. The average satisfaction score on the self-reported "Likert" scale was 4.27 (range 1-5). All patients were followed for a minimum period of 18 months. Conclusions: The "Micro-Face-lift" is a less-invasive procedure that can be performed under local anesthesia and sedation in the outpatient setting. Complication rates and mortality are low, contraindications are rare, and the recovery period is short. In our experience, patient satisfaction is high with the Micro-Face-lift procedure, and the learning curve for the experienced practitioner is short.

Effectiveness of Elastic Therapeutic Tape in Reducing Edema, Pain and Trismus following Surgery for Facial Fractures: A Systematic Review and Meta-Analysis.

Facial fractures cause postoperative morbidity, including edema, pain, and trismus. Elastic therapeutic tapes are used for optimizing recovery. Background: The aim of the present systematic review and meta-analysis was to evaluate the effectiveness of elastic tape Kinesio taping (KT) in reducing postoperative morbidity in facial fractures surgeries. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. Searches were conducted in the Cochrane, Medline, Scopus, Embase and Web of Science databases using a pre-established search strategy. Results: A total of 811 studies were retrieved after the duplicates were removed, and only randomized clinical trials were included. Eight trials, involving 319 participants, were deemed eligible. One study solely investigated the effect on edema, while the others analyzed at least two of the variables of interest. Results from two RCTs, where qualitative analysis was applicable, suggest a potential reduction in edema in the KT group compared to the control group on the second (RR -0.55, 95% CI -0.89 to -0.22; p = 0.01; I2 = 0%) and third postoperative days (RR -0.71, 95% CI -1.01 to -0.40; p < 0.00001; I2 = 0%). Conclusions: KT is effective in controlling postoperative edema following surgery for facial fractures. However, the effects on pain and trismus should be explored further in studies with standardized methods.

Anatomical Conditions in Simultaneous Orthognathic Surgery and Structural Rhinoplasty. A Clinical Series / Condiciones Anatómicas en Cirugía Ortognática y Rinoplastia Estructural Simultanea. Una Seria Clínica

SUMMARY: Orthognathic surgery and rhinoplasty show synergy in terms of function and aesthetic results. The aim of this research is to analyze variables related to simultaneous orthognathic surgery and rhinoplasty and to discuss the surgical sequence. Male and female subjects between 18 and 45 years old were included in this research. Diagnosis related to nasal morphology (nasal tip bifid, rotate, square and others as well as the alae morphology and columella), facial deformity (sagittal and vertical deformity), type of surgery (rhinoplasty techniques and orthognathic techniques) and complications were included. The minimum follow-up was 12 months; Chi- Square and t test were used to define correlations, considering a value of p<0.05 for statistical significance. Class III facial deformity was observed in 40 % of subjects and class II facial deformity was present in 43 %. For the nasal deformities, the tip and nasal bridge were most prevalent; primary nasal deformity was observed in the 83 % of subjects and was significant more than secondary nasal deformity (p=0.042). Bimaxillary surgery was performed in 31 cases (88 %). In 10 cases a change of the original plan for rhinoplasty due to previous maxillary surgery was realized, mainly in class III facial deformity, with no statistical differences. Revision rhinoplasty was realized in 5 cases (14 %) and was not related to surgical variables; revision for orthognathic surgery was not necessary in this series. Rhinoplasty and orthognathic surgery simultaneously show low complications and predictable results. We can conclude that maxillary mandibular osteotomies and rhinoplasty could be performed safely. However, larger studies are necessary to understand the best choice and variables involved in simultaneous procedures and soft tissue response.

La cirugía ortognática y la rinoplastia muestran sinergia en términos de resultados funcionales y estéticos. EL objetivo de esta investigación es analizar variables relacionadas con la cirugía ortognática y rinoplastia ejecutada de forma simultanea. Fueron incluidos hombres y mujeres entre 18 y 45 años de edad. EL diagnóstico fue en base a la morfología nasal (punta bífida, rotada, cuadrada u otras así como alteraciones del ala nasal y columela), deformidad facial (deformidad sagital y vertical), tipo de cirugía (técnica de rinoplastia y cirugía ortognática) y complicaciones asociadas. El seguimiento mínimo fue de 12 meses; se utilizo las prueba t test y chi cuadrado para definir relaciones estadísticas considerando un valor de p< 0,05 para obtener diferencias significativas. La deformidad clase III fue observada en el 40 % de los sujetos y la deformidad facial de clase II se presento en el 43 %. Para la deformidad nasal, las alteraciones de a punta nasal y nasal fueron mas prevalentes; la deformidad nasal primaria se presentó en el 83 % de los sujetos y fue significativamente mayor que la deformidad nasal secundaria (p=0,042). La cirugía bimaxilar se realizó en 31 casos (88 %); en 10 casos se realizó el cambio del plan quirúrgico inicial de la rinoplastia debido a cambios generados en la cirugía maxilar previa, mayormente en deformidad facial de clase III, sin presentar diferencias significativas. La rinoplastia de revisión fue realizada en 5 casos (14 %) y no fue relacionada con ninguna variable de tipo quirúrgica; la revisión de cirugía ortognática no fue realizada en ningún caso de esta serie. La rinoplastia y la cirugía ortognática simultanea mostraron bajas complicaciones y resultados predecibles. Se puede concluir que la osteotomía maxilo mandibular y la rinoplastia son seguras; sin embargo, estudios de mayor volumen son necesarios para entender la mejor opción y variables relacionadas con procedimientos simultáneos y la respuesta de tejidos blandos faciales.

Three-dimensional Quantitative Standards for Assessing Outcomes of Facial Lipotransfer: A Review.

BACKGROUND: Reliable quantitative data are required to address the unpredictability of facial autologous fat grafting (AFG). Facial evaluation by 3D scanning technology is getting popular. However, this process lacks unified standards and the reliability assessments. This study aimed to summarize a set of standards to improve the 3D quantified reliability of AFG outcomes. METHODS: A systematic review was used to collect the differences in and limitations of 3D assessments and analyze the effect of the quantification process on the AFG outcomes. Healthy subjects undergoing only one facial structural AFG and 3D assessments were included. The revealed specific issues guided the subsequent narrative review that involves 3D measurement and fat volume retention rate (FVRR) analysis. Criteria were formulated based on the narrative review. RESULTS: The systematic review revealed the quantitative process to be operator-dependent. The intra-group FVRR in the postoperative 11+ month group varied significantly (P=.03). The review identified a set of 3D measurement standards, including two optimal software products, two necessary steps for preprocessing, and four testing criteria. We proposed a new calculation formula and parameter and recommended a segmental area analysis for assessing the outcomes of full-face fat grafting. CONCLUSIONS: As far as the 3D evaluation of AFG outcomes is concerned, this is the first study to comprehensively analyze the process and set quantitative criteria. These standards would not only guide future research more reliably, but also provide fresh insight into the review of the past research. 3D measurement standards also apply to all face-related studies requiring 3D registration. 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 www.springer.com/00266 .

Versatility of Tunneled Island Flaps for the Reconstruction of Facial Defects. / Versatilidad del «colgajo en isla tunelizado¼ para la reconstrucción de defectos faciales.

BACKGROUND AND OBJECTIVE: Tunneled island flaps that transfer skin from a site adjacent to the wound are an effective way to reconstruct defects. These flaps provide good aesthetic and functional results and can be completed during a single surgical session, thus reducing complications. The procedure consists of taking an island of skin about the size of the surgical defect and moving it through a subcutaneous tunnel to cover the wound. We aimed to exemplify the use of these flaps in different regions of the face. MATERIAL AND METHODS: Retrospective descriptive study of 12 cases in which tunneled island flaps were used after removal of malignant tumors in different facial regions. RESULTS: The tumors, all of which were basal cell carcinomas, were removed by means of conventional surgery from 9 patients and Mohs micrographic surgery from 3 patients. Histology demonstrated tumor-free margins after excision in all cases. None of the tumors recurred during a mean follow-up period of 25 months. All complications were minor and transient. There were 3 cases of trapdoor effect and 2 each of postsurgical bleeding, transient superficial flap necrosis, and slight protrusion of the pedicle. The final cosmetic and functional outcome was satisfactory in all cases. CONCLUSIONS: Tunneled island flaps are particularly useful for repairing defects in the center of the face, where several anatomical structures converge. These flaps, which use donor skin that is similar to skin in the receptor site, can be used to close large defects in one-step procedures with only slight alteration of the facial architecture.

Versatilidad del «colgajo en isla tunelizado» para la reconstrucción de defectos faciales / Versatility of Tunneled Island Flaps for the Reconstruction of Facial Defects

Introducción y objetivos: El colgajo en isla tunelizado (CIT) supone una opción eficaz para la reparación de grandes defectos faciales trasponiendo piel desde una unidad anatómica adyacente. La realización del colgajo aporta buenos resultados estéticos y funcionales en un único tiempo quirúrgico, evitando así complicaciones. El procedimiento consiste en labrar una isla de piel de dimensiones similares a las del defecto original, para luego desplazarla a través de un túnel subcutáneo a la región receptora. Nuestro objetivo es ejemplificar su uso en diferentes regiones de la cara. Material y métodos: Estudio descriptivo retrospectivo de 12 casos con reconstrucción mediante CIT tras la extirpación de tumores malignos en distintas áreas faciales. Resultados: Presentamos una serie de 12 casos intervenidos de carcinoma basocelular, 9 mediante cirugía convencional y 3 mediante cirugía de Mohs. El estudio histológico mostró bordes quirúrgicos libres en todas las piezas de resección. El tiempo medio de seguimiento fue de 25 meses sin detectarse recidivas tumorales. Las complicaciones fueron menores y temporales: efecto trampilla en 3 pacientes, hemorragia posquirúrgica en 2, necrosis superficial transitoria del colgajo en 2 y protrusión leve del pedículo en 2 casos. El resultado final cosmético y funcional fue satisfactorio en todos los casos. Conclusiones: Los CIT son especialmente útiles en defectos centrofaciales donde convergen distintas unidades anatómicas. Permiten la reconstrucción en un único tiempo quirúrgico de grandes defectos faciales, aportando piel de características similares a las de la zona receptora y alterando mínimamente la arquitectura facial (AU)

Background and objective: Tunneled island flaps that transfer skin from a site adjacent to the wound are an effective way to reconstruct defects. These flaps provide good aesthetic and functional results and can be completed during a single surgical session, thus reducing complications. The procedure consists of taking an island of skin about the size of the surgical defect and moving it through a subcutaneous tunnel to cover the wound. We aimed to exemplify the use of these flaps in different regions of the face. Material and methods: Retrospective descriptive study of 12 cases in which tunneled island flaps were used after removal of malignant tumors in different facial regions. Results: The tumors, all of which were basal cell carcinomas, were removed by means of conventional surgery from 9 patients and Mohs micrographic surgery from 3 patients. Histology demonstrated tumor-free margins after excision in all cases. None of the tumors recurred during a mean follow-up period of 25 months. All complications were minor and transient. There were 3 cases of trapdoor effect and 2 each of postsurgical bleeding, transient superficial flap necrosis, and slight protrusion of the pedicle. The final cosmetic and functional outcome was satisfactory in all cases. Conclusions: Tunneled island flaps are particularly useful for repairing defects in the center of the face, where several anatomical structures converge. These flaps, which use donor skin that is similar to skin in the receptor site, can be used to close large defects in one-step procedures with only slight alteration of the facial architecture (AU)

[Translated article] Versatility of Tunneled Island Flaps for the Reconstruction of Facial Defects / Versatilidad del «colgajo en isla tunelizado» para la reconstrucción de defectos faciales

Background and objective: Tunneled island flaps that transfer skin from a site adjacent to the wound are an effective way to reconstruct defects. These flaps provide good aesthetic and functional results and can be completed during a single surgical session, thus reducing complications. The procedure consists of taking an island of skin about the size of the surgical defect and moving it through a subcutaneous tunnel to cover the wound. We aimed to exemplify the use of these flaps in different regions of the face. Material and methods: Retrospective descriptive study of 12 cases in which tunneled island flaps were used after removal of malignant tumors in different facial regions. Results: The tumors, all of which were basal cell carcinomas, were removed by means of conventional surgery from 9 patients and Mohs micrographic surgery from 3 patients. Histology demonstrated tumor-free margins after excision in all cases. None of the tumors recurred during a mean follow-up period of 25 months. All complications were minor and transient. There were 3 cases of trapdoor effect and 2 each of postsurgical bleeding, transient superficial flap necrosis, and slight protrusion of the pedicle. The final cosmetic and functional outcome was satisfactory in all cases. Conclusions: Tunneled island flaps are particularly useful for repairing defects in the center of the face, where several anatomical structures converge. These flaps, which use donor skin that is similar to skin in the receptor site, can be used to close large defects in one-step procedures with only slight alteration of the facial architecture (AU)

Introducción y objetivos: El colgajo en isla tunelizado (CIT) supone una opción eficaz para la reparación de grandes defectos faciales trasponiendo piel desde una unidad anatómica adyacente. La realización del colgajo aporta buenos resultados estéticos y funcionales en un único tiempo quirúrgico, evitando así complicaciones. El procedimiento consiste en labrar una isla de piel de dimensiones similares a las del defecto original, para luego desplazarla a través de un túnel subcutáneo a la región receptora. Nuestro objetivo es ejemplificar su uso en diferentes regiones de la cara. Material y métodos: Estudio descriptivo retrospectivo de 12 casos con reconstrucción mediante CIT tras la extirpación de tumores malignos en distintas áreas faciales. Resultados: Presentamos una serie de 12 casos intervenidos de carcinoma basocelular, 9 mediante cirugía convencional y 3 mediante cirugía de Mohs. El estudio histológico mostró bordes quirúrgicos libres en todas las piezas de resección. El tiempo medio de seguimiento fue de 25 meses sin detectarse recidivas tumorales. Las complicaciones fueron menores y temporales: efecto trampilla en 3 pacientes, hemorragia posquirúrgica en 2, necrosis superficial transitoria del colgajo en 2 y protrusión leve del pedículo en 2 casos. El resultado final cosmético y funcional fue satisfactorio en todos los casos. Conclusiones: Los CIT son especialmente útiles en defectos centrofaciales donde convergen distintas unidades anatómicas. Permiten la reconstrucción en un único tiempo quirúrgico de grandes defectos faciales, aportando piel de características similares a las de la zona receptora y alterando mínimamente la arquitectura facial (AU)

Ritidoplastia clásica: una técnica vigente / Classic rhythodoplasty: a current technique

La cirugía de correctiva del envejecimiento facial tiene más de un siglo de historia documentada. Los cambios culturales han aumentado el número de operaciones. En Latinoamérica también ha aumentado, y la región ha sido activa en realizar aportes en los conceptos, técnicas y procedimientos complementarios. Además del crecimiento cuantitativo, la comprensión de los planos anatómicos faciales, cambios con la edad y los modos de corregirlos han sido de gran utilidad. Nuestra técnica del lifting cérvico-facial presentan ventajas como seguridad en el plano de disección, ausencia de tracción cicatricial y respeto capilar, proporcionando un resultado final natural de acuerdo a la solicitud de los pacientes

Corrective surgery for facial aging has more than a century of documented history. Cultural changes have increased the number of operations. In Latin America it has also increased, and the region has been active in making contributions in complementary concepts, techniques, and procedures. In addition to quantitative growth, the understanding of facial anatomical planes, changes with age and the ways to correct them have been very useful. Our cervical-facial lifting technique presents advantages such as safety in the dissection plane, absence of scar traction and capillary respect, providing a natural final result according to the request of the patients

A Rare Case of Facial Artery Branching-A Review of the Literature and a Case Report with Clinical Implications.

Background and Objectives: Vascular variations appear as morphologically distinct patterns of blood diverging from the most commonly observed vessel patterns. The facial artery is considered to be the main vessel for supplying blood to the anterior part of the face. An anatomical understanding of the facial artery, its course, its topography, and its branches is important in medical and dental practice (especially in neck and face surgery), and is also essential for radiologists to be able to interpret vascular imaging in the face following angiography of the region. A profound knowledge of the arteries in the region will aid in minimizing the risks to the patient. Materials and Methods: In our publication a narrative literature review and a case report are presented. Results: A rare case of a facial artery pattern has been described anatomically for the first time with respect to its course and branching. This variation was found on the left side of a 60-year-old male corpse during anatomical dissection. The anterior branch of the facial artery arched in the direction of the labial angle, and there divided into the inferior and superior labial arteries. At the same time, the posterior branch coursed vertically and superficially to the masseter muscle. It here gave off the premasseteric branch, and continued towards the nose, where it ran below the levator labii superioris and the levator labii superioris alaeque nasi muscles and terminated at the dorsum nasi. Conclusions: Our review of the literature and the case report add to knowledge on the facial artery with respect to its topographical anatomy and its branching and termination patterns, as well as the areas of supply. An exact knowledge of individual facial artery anatomy may play an important role in the planning of flaps or tumor excisions due to the differing vascularization and can also help to prevent artery injuries during aesthetic procedures such as filler and botulinum toxin injections.

[Contribution of 3D technology for maxillofacial surgery]. / Apport de la technologie 3D en chirurgie maxillo-faciale.

In recent years, 3D design and printing technology has been successfully used in maxillofacial bone reconstruction procedures. We had the opportunity to observe its benefits in the manufacture of custom facial implants. The production is so precise that perfect anatomical congruence and biocompatibility are possible. Within the plastic and maxillofacial surgery department of the University Hospital of Liège, we had the opportunity to perform two operations requiring facial skeleton redefinition implants. The purpose of this article is to highlight the current possibilities of facial prostheses via new 3D techno¬logies, but also the advantages and possible complications of this type of surgery.

Depuis quelques années, la technologie dite «conception et impression 3D¼ s'utilise avec succès dans les interventions de reconstruction osseuse maxillo-faciale. Nous en avons apprécié les bénéfices dans la confection d'implants faciaux sur mesure. La finesse de leur réalisation permet d'obtenir une parfaite congruence anatomique avec la meilleure biocompatibilité. Au sein du service de Chirurgie plastique et maxillo-faciale du CHU de Liège, nous avons effectué deux interventions avec implants 3D redéfinissant le squelette facial. Le but de cet article est de mettre en évidence les possibilités actuelles des implants faciaux via les nouvelles technologies 3D, mais également les avantages et les complications éventuelles de ce type de chirurgie.

Ritidoplastia videoassistida do terço inferior da face: corset videoendoscópico / Endoscopically assisted rhytidoplasty of the lower third of the face: the videoendoscopic corset

INTRODUÇÃO: Após um período em que a controvérsia em cirurgias faciais teve como foco a abordagem ao SMAS, atualmente se persegue a melhora do contorno cervical. Descolamentos maiores, como os praticados pelo acesso submentoniano, podem aprimorar os resultados, entretanto acarretam aumento das complicações, sobretudo de hematomas, desencorajando seu emprego. No intuito de minimizar estes riscos, propõe-se o uso adjuvante do videoendoscópio durante a realização de cervicoplastias, segundo a Técnica de Feldman. As adaptações necessárias para a realização do procedimento são detalhadas. MÉTODO: Estudo retrospectivo de 16 pacientes submetidos a procedimento cirúrgico nos últimos 12 meses, sequencialmente, de acordo com a técnica apresentada. Os resultados foram graduados pelo autor principal (RR) e por três cirurgiões plásticos independentes (EC, RN, AM), sem que estes conhecessem detalhes da técnica empregada. Os fotogramas pré e pós-operatórios de seis meses foram avaliados e pontuados conforme os parâmetros definidos por Ellenbogen & Karlin, gerando notas 'de 0 a 10', que foram aplicadas à Grade de Labbé. RESULTADOS: A média geral do grupo foi 8,29, escore ótimo, segundo a Escala de Labbé. Em dez casos (62,5%), atingiu-se resultado ótimo (8-10 pontos); cinco casos (31,25%), bom (6-7 pontos), e apenas um caso (6,25%), escore abaixo de 6 pontos, classificado como mediano. Não houve ocorrência de hematomas, aderências cutâneas ou recidiva das bandas platismais. CONCLUSÃO: A técnica apresentada parece propiciar resultados adequados, sem aumento das complicações. Adicionalmente, possibilita uma cicatriz submentoniana de menor extensão, além da visualização magnificada e direta de todas as estruturas abordadas, por todos os membros da equipe.

INTRODUCTION: In contemporary facial surgery, the focus of controversy has shifted from superficial muscular aponeurotic system approaches, to methods by which to improve the neck contour. Larger detachments, such as those resulting from the use of submental access, can provide better outcomes. However, the associated potential for increased complication rates, particularly hematomas, discourages the practice of such detachments. In order to minimize these risks, we propose the use of videoendoscopic assistance during cervicoplasty procedures, such as Feldman's method. The adjustments required to carry out this procedure are described in this study. METHOD: This retrospective study included 16 patients, who were sequentially submitted to a surgical procedure in the preceding 12 months, using the technique described above. The results were scored by the main author (RR) and 3 independent plastics surgeons (EC, RN, AM), who were unaware of the details of the technique used. Preoperative and 6-month postoperative photographs were evaluated and scored according to the parameters defined by Ellenbogen and Karlin, with values ranging from 0-10 subsequently applied to the grading system of Labbé. RESULTS: The group average postoperative score was 8.29, the optimal grade according to the scale of Labbé. An optimal outcome (8-10 points) was reached in 10 cases (62.5%); a good outcome (6-7 points) was reached in 5 cases (31.25%); a score below 6, rated as average, occurred in only one case (6.25%). There was no occurrence of hematomas, skin adhesions or recurrent platysmal bands. CONCLUSION: The proposed technique appears to provide satisfactory results without increasing the rate of complications. Moreover, use of the technique was associated with less extended submental scar, in addition to improving the direct view of the structures manipulated for all members of the surgical team.

Lipofacelift: plástica facial com descolamento mínimo da pele / Lipofacelift: facelift with minimal skin undermining

Introdução: Procedimentos cirúrgicos menos extensos, com tempo de recuperação maiscurto, têm atualmente sido mais solicitados pelos pacientes candidatos à ritidoplastiafacial. Objetivo: Apresentar procedimentos cirúrgicos menos invasivos, que atinjamos objetivos dos pacientes e dos cirurgiões com o menor tempo de recuperação, narealização de ritidoplastias. Método: Dissecação mínima do tegumento cutâneo daface, restrita ao redor da orelha num raio de 4 cm. As restantes áreas do segmento médioda face e cérvico-mandibular são “tunelizadas” mediante cânula de lipoaspiração,somente aspirando o tecido adiposo nos depósitos submentoniano e submandibularquando necessário, mantendo as conexões vásculo-nervosas da pele com o planosubjacente. Foram comparados 309 pacientes operados de ritidoplastias, dos quais 89foram submetidos à técnica proposta e os restantes 220 à técnica convencional de ampladissecação e tratamento do SMAS. Resultados: Os pacientes operados pela técnicaproposta apresentaram melhores resultados estéticos, com preservação da textura e dotrofismo da pele. Conclusões: A técnica proposta permite diminuir o tempo cirúrgicoem 50%, por ser um procedimento menos invasivo e apresentar menor morbidade, alémde melhorar a qualidade do resultado.

Introduction: Less extended surgical procedures with short recovery post-operativeperiod of time have been requested by patients submitted to rhitidectomies. Objective:Study of minimal invasive surgical procedures in facelift that offer the desiredresults in less post-operative recovery period. Method: Four centimeters ratio skinundermining around the ear combined with cannula skin tunneling along the mid-faceand neck regions with or without liposuction according to the necessity, preservingthe nervous-vascular connections with the deep skin plane. 309 patients submitted tofacelift, 89 were operated by this technique and the other 220 patients operated throughconventional procedures by extensive skin undermining and SMAS treatment. Results:Patients operated by the proposed technique presented better aesthetic results due to skinconnection preservation, less secondary skin fibrosis and better skin trophic conditions.Conclusion: These less invasive technical procedures reduce 50% of the surgical time,maintaining the quality of the results with minor morbility.

Ritidoplastia com cicatriz periauricular / Periauricular rhytidoplasty

Os autores analisam a aplicabilidade da ritidoplastia com cicatriz periauricular em 107 pacientes operados. Técnica esta, que tem como diferencial, a incisão que circunda o pavilhão auricular e se acomoda no sulco retroauricular, terminando em cicatriz única na região temporal. É indicada primariamente em pacientes que iniciam mais cedo o tratamento da ritidose facial.

The author’s analyze the use of face-lifting with periauricular scar in 107 cases. The main differential of this technique is the incision that circles the auricle, and accommodate in post auricular region, finishing in a unique scar in temporal region. It’s indicated at first for the patients who initiate early the treatment of facial rhytidosis.

Abordagem segmentar do terço médio da face: triângulo na região geniana: ponto de sutura dermogorduroso / Segmented approach to the midface: triangle on cheek area: dermal fat suture point

Introdução: O tratamento cirúrgico apresentado pelos autores tem inovações táticas e peculiaresque tornam o tratamento seguro. Objetivo: Demonstrar uma maneira diferente de abordar aregião geniana e de fixar a pele com pontos dermogordurosos. Método: Abordagem da regiãogeniana com os descoladores progressivos, deixando bridas. A fixação da pele com pontos dermogordurososusando fio de nylon 4.0 favorece a diminuição da tensão na cicatriz pré-auricular.Resultados: Foram operados trinta e nove pacientes usando essa tática. O período de internaçãofoi de 24 horas, sendo observado apenas um caso de hematoma. Conclusão: O método propostoé eficiente e simples, onde a abordagem da região geniana com o uso dos descoladores é depouco sangramento. As bridas deixadas por esse método favorecem melhor irrigação da pele. Ospontos dermogordurosos mantêm a pele no local e diminuem a tensão na cicatriz pré-auricular.

Introduction: The surgical treatment presented by the authors has tactical innovations andunique features that make the treatment safer. Objective: To show a different approach tocheek area and fix the skin with dermal fat points. Methods: Approach the cheek area withprogressive retractors, leaving bands. Skin fixation with dermal fat points using nylon 4.0favors tension reduction in the scar. Results: Thirty-nine pacients were operated using thistactic. The period of hospitalization was 24 hours and there was only one case of hematoma.Conclusion: It is an efficient and simple method where the approach to the cheek areausing retractors show low bleeding. The adhesion left by this method encourage betterskin irrigation. Dermal fat points keep the skin in place and reduce the tension in the scar.

Reposicionamento do terço médio na cirurgia da face: uma técnica simples de suspensão e de fixação / Repositioning the malar fat pad in facelifting: a simple technique of suspention and fixation

Introdução: Hilton Becker descreveu nos anos 80 o uso do expansor permanente na reconstrução mamária, que poderia ser deixado como implante uma vez atingido o volume desejado, constituindo um novo caminho para as reconstruções. Objetivo: Este trabalho tem como objetivo levantar a experiência com o uso desta técnica, estabelecendo as indicações consideradas para sua escolha, suas vantagens, resultados e complicações. Método: Foram estudadas 131 pacientes em um total de 151 reconstruções. Dessas pacientes, 42 foram submetidas a reconstrução com expansor de mama, totalizando 49 mamas reconstruídas. Resultados: Em relação às complicações pós- operatórias, verifica-se um total de 20,8(per cent), sendo grande parte destas relacionadas à radioterapia, mostrando ser este um fator que deve ser levado em consideração, pois aumenta as taxas de complicações e resultados adversos.A perda do expansor foi considerada a maior complicação nesta série, pela sua importância, ocorrendo em 6,3(per cent). O estudo apresentou uma porcentagem importante do uso de expansorpermanente nas reconstruções de mama. Conclusão: Mostrou ser um método seguro, eficiente, rápido, através de intervenções menores e com índices de complicações semelhantesa outros métodos já conhecidos. Os resultados estéticos são favoráveis, justificando a indicação da técnica em diferentes idades e condições clínicas dos pacientes.

Introduction: The use of a permanent expander in breast reconstruction was first described by Hilton Becker in the eighties. It is great advantage is to be left in place as an implant, once thedesired breast volume is achieved. Objective: The present series is a review of 151 breast reconstructions. Methods: One hundred thirty one cases were enrolled in the study. Indicationsand type of reconstruction used, results, advantages and complications were considered. A total of 49 breast reconstructions with permanent expander were performed in 42 patients.Results: General rate of post operative complications was 20.8(per cent). Radiotherapy related complications were the most commonly seen. Loss of implant was the most severe complication and occurred in 6.3(per cent). The permanent expander was used in a significant percentage of patients in the present series. Conclusion: The authors considered the method safe, simple and fast, since the intervention is smaller. The complication rate observed in this series was similar to what is described for other reconstructions methods. Aesthetic results were considered good, and the technique is amenable to patients of different ages and/or clinical conditions.