PAHs in franciscana dolphins from the Southwestern Atlantic Ocean: Concentration and maternal transfer assessments.

Polycyclic aromatic hydrocarbons (PAHs) are organic compounds ubiquitous in the environment and known for their toxic, mutagenic, and carcinogenic effects. These compounds can bioaccumulate in the biota and be transferred through trophic webs. The franciscana dolphin (Pontoporia blainvillei), as top predators, can be an environmental sentinels. Thus, this study aimed to provide data about PAHs concentration in their hepatic tissue collected on the coast of Espírito Santo (Franciscana Management Area, FMA Ia), Rio de Janeiro (FMA IIa), and São Paulo states (FMA IIb), in Southeastern Brazil. PAHs were detected in 86 % of franciscana dolphins (n = 50). The highest ∑PAHsTotal median concentration was reported in FMA Ia followed by FMA IIb and FMA IIa (1055.6; 523.9, and 72.1 ng.g-1 lipid weight, respectively). Phenanthrene was detected in one fetus and two neonates, showing maternal transfer of PAHs in these dolphins. Evaluating PAHs with potential toxic effects is of utmost importance for the conservation of a threatened species.

Spatial trends of trace elements bioaccumulation in the most endangered dolphin from the Southwestern Atlantic Ocean: The franciscana (Pontoporia blainvillei).

Trace elements bioaccumulation patterns can be an important tool to assess differences among cetaceans' populations. In this work, their use as potential chemical markers to differentiate franciscanas (Pontoporia blainvillei) populations was evaluated. Franciscanas were collected from three states in southeastern Brazil, which comprise three different Franciscana Management Areas (FMAs): Espírito Santo (FMA Ia), southern Rio de Janeiro (FMA IIa), and central São Paulo (FMA IIb). The concentrations of As, Cd, Cu, Fe, Hg, Mn and Zn were determined in the muscle, liver and kidney of the animals. Cadmium was the most valuable chemical marker to differentiate stocks, separating at least FMA IIa from the others. The higher Cd levels in FMA IIa, along with dietary information, indicate that the predominant consumption of cephalopods by this population is the main reason for the differences found. Additionally, environmental characteristics of the areas should also be considered as divergent sources of trace elements. Our findings suggest that non-essential trace elements, such as Cd, can be successful markers to differentiate populations. The Mn concentrations in FMA Ia raised concern and must be carefully monitored, as well as other elements that compose the iron ore tailings that have impacted the Espírito Santo coastal area. Additionally, this is the first study to report trace element concentration in the franciscanas from FMA IIa (southern Rio de Janeiro). Trace element concentrations found in franciscanas may represent different contamination levels in their preys and environments, which might pose specific threats to distinct populations. Therefore, our findings are important to characterize and differentiate franciscana populations and to guide precise management and conservation actions for the distinct stocks of this endangered species.

Temporal trends of trace elements bioaccumulation by a vulnerable cetacean (Pontoporia blainvillei) before and after one of the largest mining disasters worldwide.

One of the largest environmental disasters worldwide occurred on November 5th, 2015, when the Fundão dam collapsed in Mariana (Minas Gerais State, Southeast Brazil). The tailing mud flooded the Doce River basin and reached the sea in the coast of Espírito Santo State (ES), Southeast Brazil. This coastal region is the habitat of the most isolated population of franciscana dolphins (Pontoporia blainvillei), with the lowest populational census and lowest genetic diversity in Franciscana Management Area Ia (FMA Ia) - 18° 25'S and 21° 17'S. This study aimed to assess the bioaccumulation of trace-elements (As, Cd, Cu, Fe, Hg, Mn, and Zn) in muscle, liver and kidney of franciscana dolphins collected near the Doce River's mouth before (n = 32) and after (n = 19) the tailing mud reached the sea. The Generalized Additive Model (GAM) showed increasing temporal trends of Hg and Zn in muscle and liver after the dam failure, probably related to higher concentrations and bioavailability in the water column and sediments from the Doce River. Declining trends were found for As and Cu muscular and hepatic concentrations and Fe concentrations in kidney due to their lower bioavailability after the disaster, caused by association with tailings mud trapped in the riverbanks and suspended particulate material. Additionally, higher As and Hg concentrations found in the first period of sampling may be due to historical contamination by mining activities. The full extent of the impacts caused by the Fundão dam failure is still unknown. However, due to their rapid increase and remobilization process, toxic effects can be induced in the biota by these elements. Elements' bioaccumulation in this study contributes to the knowledge of franciscana dolphins from FMA Ia. Considering the conservation concern regarding this franciscana population and its scarce knowledge, the impact of this disaster can be alarming for species conservation.

Management of malignant pleural mesothelioma: a French multicenter retrospective study (GFPC 0802 study).

BACKGROUND: Malignant pleural mesothelioma (MPM) is a rare disease with poor prognosis in spite of significant improvement in survival, due to new chemotherapy regimens. We describe here patients' profiles and management in daily practice in France. METHODS: Observational retrospective study. Data were collected from medical files. All patients with histologically proven MPM diagnosed from January 2005 to December 2008 were included in the participating sites. RESULTS: Four hundred and six patients were included in 37 sites: mean age 68.9 ± 9.8 years, male predominance (sex ratio 3.27), latency of the disease 45.7 years, epithelioïd type 83 %. Diagnosis was made using thoracoscopy in 80.8 % of patients. Radical surgery was performed in 6.2 % of cases. Chemotherapy was administered to 74.6 % of patients. First line regimens consisted mainly of platinum + pemetrexed (91 %) or pemetrexed alone (7 %). Objective response rate was 17.2 % and another 41.6 % of patients experienced disease stabilization. Half of these patients underwent second line chemotherapy (platinium + pemetrexed 31.6 %, pemetrexed alone 24.6 %), resulting in a 6 % response rate. Third-line chemotherapy (56 patients) yielded disease control in 5.4 % of cases. CONCLUSIONS: The management of MPM in France is usually in accordance with guidelines. Response rates are somewhat lower than those described in clinical trials.

Study of the radio-opacity of base and liner dental materials using a digital radiography system.

OBJECTIVES: This study investigated the radio-opacity of commercially available glass ionomer cements (GICs), flowable resin composites (FRCs) and calcium hydroxide cements (CHCs) and compared this with the radio-opacity of enamel, dentine and aluminium stepwedge. 16 GICs, 8 FRCs and 4 CHCs were analysed. METHODS: Three sets of three samples were prepared: 1 mm, 2 mm and 3 mm thickness for GIC and FRC and 1 mm thickness for CHC. Specimens of enamel and dentine with the same thicknesses were obtained. As a control, an aluminium stepwedge was used. Radiographs were taken with a digital Kodak RVG 5000 (0.32 s, 30 cm). The images were analysed using the Image Tool(®) program (v. 2.00; The University of Texas Health Science Center, San Antonio, TV) to obtain the mean grey values. RESULTS: Analysis of variance was used to investigate the significance of differences among the groups. For pairwise comparisons, the Tukey test was applied (p < 0.05). The GICs Ionomaster (Wilcos, Petrópolis, Brazil), Maxxion (FGM, Joinville, Brazil), Bioglass R (Biodinâmica, Ibiporã, Brazil), Bioglass F (Biodinâmica), Vidrion R (SS White, Rio de Janerio, Brazil) and Vidrion F (SS White), presented radio-opacity lower than that of dentine. All FRCs and CHCs studied showed radio-opacity higher than that of dentine. Vitro Fil (DFL, Rio de Janeiro, Brazil), Magic Glass (Vigodent, Rio de Janeiro, Brazil), Vitrebond (3M, Sumaré SP, Brazil), Riva Self Cure (SDI, Victoria, Australia), Riva Light Cure (SDI), Fill Magic (Vigodent), Opallis (FGM, Joinville, Brazil), Surefil SDR (Dentsply, Milford, DE), Tetric N (Ivoclar Vivadent, Schaan, Lichtenstein), Tetric (Ivoclar Vivadent), Hydro C (Dentsply, Petrópolis, Brazil), Hydcal (Technew, Madalena, Portugal) and Liner (Vigodent) showed radio-opacity similar to or greater than that of enamel for all thicknesses. CONCLUSIONS: The increased thickness of the materials studied increases their radio-opacity. Some commercially available GICs used as a base and liner for restorations have a very low radio-opacity (Ionomaster, Maxxion, Bioglass R, Bioglass F, Vidrion R and Vidrion F).

Grazing incidence wide angle x-ray scattering at the wiggler beamline BW4 of HASYLAB.

We present an upgrade of the available measurement techniques at the wiggler beamline BW4 of the Hamburger Synchrotronstrahlungslabor (HASYLAB) to grazing incidence wide angle x-ray scattering (GIWAXS). GIWAXS refers to an x-ray diffraction method, which, based on the measurement geometry, is perfectly suited for the investigation of the material crystallinity of surfaces and thin films. It is shown that the overall experimental GIWAXS setup employing a movable CCD-detector provides the capability of reliable and reproducible diffraction measurements in grazing incidence geometry. Furthermore, the potential usage of an additional detector enables the simultaneous or successive measurement of GIWAXS and grazing incidence small angle x-ray scattering (GISAXS). The new capability is illustrated by the microbeam GIWAXS measurement of a thin film of the conjugated polymer poly(3-octylthiophene) (P3OT). The investigation reveals the semicrystalline nature of the P3OT film by a clear identification of the wide angle scattering reflexes up to the third order in the [100]-direction as well as the first order in the [010]-direction. The corresponding microbeam GISAXS measurement on the present morphology complements the characterization yielding the complete sample information from subnanometer up to micrometer length scales.

Asociación de polimorfismos de simple nucleótido (SNP) de CD28 (IVS3+17T/C) Y CTLA-4 (+49A/G) con autoinmunidad tiroidea (AIT) / Association of single nucleotide polymorphism (SND) of CD28 (IVS3+17+K) and CTLA-4 (+49 A/G) with thyroid autoimmunity AIT)

La enfermedad tiroidea autoinmune es la patología autoinmune más prevalente y afecta hasta el 5% de la población general. Su desarrollo está dado por la interacción entre susceptibilidad genética y otros factores. Una característica es la temprana producción de anticuerpos antiperoxidasa tiroidea (aTPO) que a menudo predicen el desarrollo clínico de la enfermedad. La susceptibilidad genética para AIT es generada por genes del HLA y por otros candidatos del cromosoma 2q33. Esta región contiene los genes CTLA-4 y CD 28, y sus polimorfismos estarían asociados. Objetivo: Analizar y comparar la distribución de los polimorfismos de simple nucleótido (SNP) de CD28 (IVS3+17 T/C) y CTLA-4 (+49 A/G) en pacientes con aTPO >10 IU/ml (AIT) comparados con un grupo control aTPO ≤ 10 IU/ml sin AIT. Sujetos y métodos: Estudiamos 69 pacientes y 36 sujetos considerados controles. Para determinar aTPO se utilizó IMMULITE 1000 y muestra sérica. Para el estudio de los SNP se extrajo ADN de sangre periférica. La amplificación de los genes se realizó por PCR. Las diferencias entre grupos fueron comparadas usando el test de Chi Cuadrado. Resultados: Observamos diferencia significativa en el genotipo CD28 C/T entre AIT y controles (p=0.026). Analizando los genotipos de los polimorfismos CTLA-4 no observamos diferencia significativa entre AIT y controles. Del análisis de asociación de genotipos CD28 C/T y CTLA-4 A/A o A/G, observamos diferencia significativa comparando AIT vs. controles (p=0,013). Conclusión: Encontramos una posible asociación significativa del genotipo CD28 C/T en individuos con AIT, y estos portadores tendrían un riesgo tres veces mayor de adquirir AIT. La combinación de los genotipos CD28 C/T y CTLA-4 A/A o A/G incrementaría cuatro veces el riesgo de adquirir AIT. Estos resultados permitirían llevar a cabo un diagnóstico precoz, con la adecuada caracterización de una posible enfermedad tiroidea autoinmune en pacientes con AIT.

The autoimmune thyroid disease is the most prevalent autoimmune affection and affects until 5% of the general population; its development is given by the interaction between genetic susceptibility and other factors. One particularity is the early production of thyroid autoantibodies against thyroid peroxidase (aTPO) which often predicts the clinical development of the disease. The genetic susceptibility for the thyroid autoimmunity (AIT) is generated by genes of the HLA and by other genes candidates of the chromosome 2q33. This region contains the genes: CTLA-4 and CD 28. Several polymorphisms of both would be associated according to previous studies. Objective: To analyze and to compare the simple nucleotide polymorphism distribution (SNP) of CD28 (IVS3+17 T/C) and CTLA-4 (+ 49 A/G) in patients with aTPO> 10 IU/ml (AIT) compared to a control group aTPO ≤ 10 IU/ml with no AIT. Subjects and Methods: We have studied 69 patients with AIT and 36 control subjects. Serum aTPO were measured by using chemiluminescence immunoassay (IMMULITE1000, Siemens). Genomic DNA was prepared from peripheral white blood cells. The amplification of the genes was carry out by polymerase chain reaction (PCR). Statistical analyses : the differences between groups were made using the chisquare test. P less than 0.05 was considered statistically significant. Results: There was a significant difference of genotype CD 28 C/T in patients with AIT compared with controls (p=0.026). The genotypes of CTLA-4 was analyzed and there was no significant difference between AIT and controls. Analysis of genotypes association CD 28 C/T and CTLA-4 A/A or A/G, revealed significant difference comparing AIT versus controls (p= 0.013). Conclusions: We found a possible association of genotype CD 28 C/T in individuals with AIT, since carriers of genotype C/T would have a risk three times higher to acquire AIT. The combination of genotypes CD 28 C/T and CTLA-4 A/A or A/G would increase the risk of acquiring AIT four times. These results could be useful in order to make a premature diagnosis, with adequate characterization of a possible autoimmune thyroid disease in patients with AIT.

Low levels of hepatitis C virus RNA in blood of infected patients under maintenance haemodialysis with high-biocompatibility, high-permeability filters.

BACKGROUND: Patients undergoing maintenance haemodialysis are often infected with hepatitis C virus, yet the clinical course of liver disease is usually mild. We investigated whether the hepatitis C virus viral load is influenced by the haemodialytic procedure and the type of dialyser. METHODS: Hepatitis C virus-RNA levels were measured using a quantitative polymerase chain reaction assay in predialysis blood from 51 hepatitis C virus-infected patients dialysed with different membranes. Paired pre- and post-dialysis measurements were also obtained in 18 patients. RESULTS: Patients dialysed using cuprammonium-regenerated cellulose membranes with low (cuprofan) or intermediate (cellulose acetate or diacetate) biocompatibility had higher pre-dialysis hepatitis C virus-RNA levels (p<0.05] compared to those dialysed with synthetic high-biocompatibility, high-permeability polymeric membranes (polyacrylonitrile, polysulfone, polymethylmethacrylate or polycarbonate). Hepatitis C virus-RNA levels were unrelated to the duration of haemodialysis and the presence of abnormal transaminases. A significant reduction (p=0. 04) of serum hepatitis C virus-RNA levels was observed after a single haemodialysis, particularly in patients with high pre-dialysis viral load. Patients with low pre-dialysis hepatitis C virus-RNA levels (<2. 5 x 10(3) copies/ml) exhibited only minimal changes following the procedure. Four patients with medium-high basal viral load switched from a low-biocompatibility/low-permeability to a high-biocompatibility/high permeability filter had a marked reduction of viraemia after three weeks, in one case followed by a new increase after return to the original filter. CONCLUSIONS: Haemodialysis with high-biocompatibility/high-permeability filters in hepatitis C virus-infected patients is associated with low blood levels of hepatitis C virus-RNA. This finding may be of clinical relevance, especially in patients listed for kidney transplantation.

Self-hypnosis as anesthesia for liposuction surgery.

This article demonstrates how the surgeon performs a major surgical procedure on himself using self-hypnosis as the means of anesthesia and pain control. The hypnotic techniques used by the author for self hypnosis are reviewed. These include glove anesthesia and transference; the switch technique; dissociation; positive imagery; as well as the specific post-hypnotic suggestions used by the surgeon during the operative procedure.

Low virological response to interferon in children with chronic hepatitis C.

BACKGROUND/AIMS: Children with chronic hepatitis C were recently found to have higher rates of sustained response to interferon compared to adults. The aim of this study was to verify the response to interferon using frequent viremia measurements. METHODS: Sera from 25 children (13 males; mean age 7.9 years) with chronic hepatitis C, treated with recombinant alpha-2b interferon for 12 months, were tested for liver function tests and viremia levels for a median of 27.5 months. Autoantibodies were evaluated during and after interferon. RESULTS: Fifteen patients completed 12 months of interferon; treatment was stopped in 10 other patients. In 11 (44%) patients viremia was undetectable already at the second administration of interferon; one of them remained viremia-free up to the end of follow-up and had persistently normal alanine-aminotransferase levels (complete sustained responder). A complete sustained response was observed only in one other patient, who normalized alanine aminotransferase and cleared viremia from the 3rd month of therapy. Three patients with persistent viremia normalized alanine-aminotransferase from the 3rd week of therapy up to the end of follow-up (biochemical sustained responders). Viremia was undetectable during treatment in four patients, who stopped interferon because of worsening in hypertransaminasemia. Three of these four patients were anti-liver-kidney microsomal type 1-positive. CONCLUSIONS: In this study the response rate to interferon was very low and viremia and transaminase findings were often discordant.

Chronic cryptogenic hepatitis in childhood is unrelated to hepatitis G virus.

OBJECTIVES: The aim of this study was to define the features of chronic cryptogenic hepatitis (CCH) in childhood and to investigate whether it is related to hepatitis G virus infection. METHODS: Forty-six children (24 males; age range, 1.5 to 17 years) with CCH were studied. CCH was diagnosed when serum alanine aminotransferase concentrations were more than 1.5 times normal for longer than 6 months without any apparent cause of liver disease. RESULTS: No patient had acute symptomatic onset or had received a blood transfusion. Three had undergone minor surgical procedures. All appeared to be healthy during follow-up (median, 4.2 years; range, 1 to 10 years). Hypertransaminasemia was the only aberrant liver function test. Elevated serum alanine aminotransferase values alternated with normal values in 40 children (86.9%). Five children (10.8%) had a spontaneous sustained (>12 months) remission of hypertransaminasemia. Twelve (26%) had laboratory signs of autoimmunity, but none fulfilled the criteria for autoimmune hepatitis. Of 20 children who underwent liver biopsy, 13 (65%) had minimal chronic hepatitis, 4 (20%) had mild chronic hepatitis and 3 (15%) had moderate chronic hepatitis. Serum hepatitis G virus RNA was detected in 2 girls (4%) whose risk factor was a hepatitis G virus-infected mother and a minor surgical procedure, respectively. In 12 families at least 1 other member had chronic liver disease. CONCLUSIONS: Childhood CCH seems to be a symptomless disease characterized by isolated hypertransaminasemia with onset during the first 4 years of life and mild to moderate histologic liver lesions. Although the frequency of spontaneous remissions is low, childhood CCH seems, in the short run, to be a nonprogressive disease. Hepatitis G virus does not play a major role in CCH.

In vivo addition of poly(A) tail and AU-rich sequences to the 3' terminus of the Sindbis virus RNA genome: a novel 3'-end repair pathway.

Alphaviruses are mosquito-transmitted RNA viruses that cause important diseases in both humans and livestock. Sindbis virus (SIN), the type species of the alphavirus genus, carries a 11.7-kb positive-sense RNA genome which is capped at its 5' end and polyadenylated at its 3' end. The 3' nontranslated region (3'NTR) of the SIN genome carries many AU-rich motifs, including a 19-nucleotide (nt) conserved element (3'CSE) and a poly(A) tail. This 3'CSE and the adjoining poly(A) tail are believed to regulate the synthesis of negative-sense RNA and genome replication in vivo. We have recently demonstrated that the SIN genome lacking the poly(A) tail was infectious and that de novo polyadenylation could occur in vivo (K. R. Hill, M. Hajjou, J. Hu, and R. Raju, J. Virol. 71:2693-2704, 1997). Here, we demonstrate that the 3'-terminal 29-nt region of the SIN genome carries a signal for possible cytoplasmic polyadenylation. To further investigate the polyadenylation signals within the 3'NTR, we generated a battery of mutant genomes with mutations in the 3'NTR and tested their ability to generate infectious virus and undergo 3' polyadenylation in vivo. Engineered SIN genomes with terminal deletions within the 19-nt 3'CSE were infectious and regained their poly(A) tail. Also, a SIN genome carrying the poly(A) tail but lacking a part or the entire 19-nt 3'CSE was also infectious. Sequence analysis of viruses generated from these engineered SIN genomes demonstrated the addition of a variety of AU-rich sequence motifs just adjacent to the poly(A) tail. The addition of AU-rich motifs to the mutant SIN genomes appears to require the presence of a significant portion of the 3'NTR. These results indicate the ability of alphavirus RNAs to undergo 3' repair and the existence of a pathway for the addition of AU-rich sequences and a poly(A) tail to their 3' end in the infected host cell. Most importantly, these results indicate the ability of alphavirus replication machinery to use a multitude of AU-rich RNA sequences abutted by a poly(A) motif as promoters for negative-sense RNA synthesis and genome replication in vivo. The possible roles of cytoplasmic polyadenylation machinery, terminal transferase-like enzymes, and the viral polymerase in the terminal repair processes are discussed.

Alternatives for the surgical correction of severe gynecomastia.

Two surgical techniques available for the correction of severe gynecomastia in the male patient are described in detail. Severe gynecomastia complicates the plan for correction by presenting the same obstacles which are found in mastopexy or breast reduction for the female patient. These include: tissue resection, skin excision, and nipple-areolar complex elevation. The amount of each of these will determine which specific procedure should be used.

Side effects of alpha-interferon therapy and impact on health-related quality of life in children with chronic viral hepatitis.

BACKGROUND: Interferon (IFN) is standard therapy for chronic viral hepatitis in children. The aim of this study was to evaluate the side effects of alpha-interferon (IFN) in 94 consecutive children (58 males; age range, 3 to 14 years) affected by chronic viral hepatitis treated with different schedules ranging from 3 to 10 MU and from 3 to 12 months, and the impact of this therapy on health-related quality of life. METHODS: Side effects were evaluated with clinical and laboratory examinations and were recorded on a diary card. The health-related quality of life was evaluated with a modified version of the Sickness Impact Profile. RESULTS: All patients experienced at least one adverse reaction to IFN treatment; 80% had more than five side effects. There were no life-threatening reactions. Three children experienced severe reactions (febrile seizure, severe hypertransaminasemia and relapsing episodes of epistaxis, respectively) that required permanent IFN withdrawal. Another child had a febrile seizure requiring temporary IFN withdrawal. In seven children the neutrophil count fell below 1000/mm3 and promptly increased when IFN was temporarily discontinued. The remaining children had mild or moderate clinical and/or laboratory adverse reactions. Age, sex, viral etiology of chronic hepatitis and response to therapy were not significantly associated with the appearance of side effects. The pre-IFN health-related quality of life was good in all children; it deteriorated significantly during IFN therapy and returned to basal standards within 3 months after IFN withdrawal. No patient required suspension of IFN therapy because of worsening of health-related quality of life. CONCLUSION: Children have a low risk of developing severe IFN-induced side effects. Adverse reactions and worsening of health-related quality of life were tolerable and did not seem to be a limiting factor for IFN therapy in young candidates.

A technique for otoplasty.

Numerous otoplasty procedures for correcting the protruding ear are described in the literature. What makes one technique superior to another lies in its reproducibility of natural-appearing results. One must avoid the "operated-on" postoperative look of sharp cartilaginous margins and the straight-line antihelical appearance.

Personal refinements in the single pedicle Skoog technique for reduction mammaplasty.

A review of the Skoog technique for reduction mammaplasty is presented. A laterally based single pedicle is used for transposition of the nipple-areola flap, deriving its blood supply from a cutaneous vasculature. From our experience using this procedure in a majority of patients, we have developed specific refinements starting with the preoperative planning and including various modifications in the operative technique. The advantages of these refinements are discussed as well as their contribution to the final aesthetic result.

Cardiac arrhythmias in phenol face peeling: a suggested protocol for prevention.

Cardiac arrhythmias are a potential complication in phenol face peeling. A comprehensive review of the literature is presented here demonstrating its reported incidence, as well as the actions of phenol both locally and systemically. In addition to the conventional measures that are presently followed in chemical face peeling, we present further recommendations for the prevention of cardiac arrhythmias. These include maintaining the patient with a sufficient fluid load, forcing diuresis with furosemide, and using lidocaine hydrochloride as a prophylactic antiarrhythmic agent. These guidelines will help avoid serious and even lethal complications.

Male face lift in continuity with lower blepharoplasty.

Rhytidectomy in the male is always more complicated than in the female. We present important modifications of the usual female-type face lift procedure that solve problems peculiar to the male patient. We describe a combined procedure of male rhytidectomy in continuity with the lower blepharoplasty incision. This technique increases the aesthetic results significantly. It provides an increased mechanical advantage in rotation and elevation of the cheek flap which is necessary to correct adequately the frequent redundancy and marked sagging in the lower face and neck often witnessed in the aging male patient. The preauricular non-hair-bearing portion of skin is left undisturbed with no change in the appearance of the sideburn. There is no elevation of the temporal hairline. The operative technique is fully described with emphasis on the complications we observed and how to avoid them. The results presented justify the slightly visible scarring that may occur in the temporal area which heals extremely well and is very acceptable aesthetically.