Fat management in lower lid blepharoplasty.

Aging of the lower eyelid involves a complex series of anatomic and physiologic changes that occur over time. Rejuvenation of the lower eyelid complex must systemically address the various contributions of soft tissue laxity, pseudoherniation of orbital fat, and loss of periorbital volume. This article outlines the evolution of our approach to lower eyelid blepharoplasty with a specific focus on the importance of management of fat in the periocular region. A discussion of various surgical approaches with their advantages and disadvantages is presented, and the importance of maintaining a safe lower eyelid is emphasized. A comprehensive and systematic approach to restoration of the lower eyelid is highlighted with specific postoperative results.

Effect of FK506 on functional recovery after facial nerve injury in the rat.

OBJECTIVE: To examine the effect of the immunosuppressive agent FK506 on the rate of functional recovery of the rat facial nerve after crush injury. METHODS: Forty rats underwent facial nerve crush injury and were randomly assigned to 4 experimental groups: isotonic sodium chloride solution control, FK binding protein 52 (FKBP-52) antibody control, FK506, and FK506 and FKBP-52 antibody. Rats underwent daily recovery testing from postoperative day 9 until postoperative day 21 by videotaping 3 validated variables in this model: blink reflex return, vibrissial fibrillation loss, and return of vibrissial sweeping symmetry. RESULTS: FK506-treated animals demonstrated improved recovery in all 3 variables compared with control animals. The FK506 and FKBP-52 antibody group demonstrated improved recovery of only the return of the blink reflex. CONCLUSIONS: FK506 accelerated functional recovery of facial nerve function after crush injury. Neuroregeneration was inhibited by FKBP-52 antibody in the rat midface but not the upper face. FK506 may be a viable adjuvant treatment for facial nerve neurapraxic injury.

Flow loading induces macrophage antioxidative gene expression in experimental aneurysms.

OBJECTIVE: Reactive oxygen species may act as proinflammatory mediators in abdominal aortic aneurysm (AAA) disease. Flow loading increases antioxidative enzyme expression and limits reactive oxygen species production in vascular smooth muscle cells in vitro, limits experimental AAA enlargement in rodent models, and is indirectly associated with reduced clinical AAA risk. We attempted to determine the mechanism or mechanisms by which flow loading limits AAA enlargement. METHODS AND RESULTS: Rodent AAAs were flow loaded via femoral arteriovenous fistula creation. Aortic wall shear stress and relative wall strain were significantly higher in flow-loaded rodents. Flow loading reduced AAA diameter by 26% despite evidence of flow-mediated aortic enlargement proximal to the aneurysmal segment. Messenger RNA from AAA tissue was harvested for cDNA labeling and hybridization to a 384-clone DNA microarray. Twenty-nine genes were differentially expressed (relative intensity/relative intensity of control ratio >1.5 and <0.67) in flow-loaded compared with normal flow AAA tissue, including heme oxygenase 1 (HO-1). Increased HO-1 expression was confirmed via reverse transcriptase-polymerase chain reaction. Immunohistochemistry localized HO-1 expression to infiltrative macrophages. alpha-Tocopherol was found to be as effective as flow loading in limiting AAA enlargement. Flow loading and alpha-tocopherol therapy reduced AAA reactive oxygen species production. CONCLUSIONS: Flow loading may attenuate AAA enlargement via wall shear or strain-related reductions in oxidative stress.

Long-term results of autologous periorbital lipotransfer.

OBJECTIVE: To evaluate the long-term aesthetic results in patients treated with autologous periorbital lipotransfer. METHODS: A retrospective review of 114 consecutive patients during 4 years who underwent autologous periorbital lipotransfer. Of these patients, 99 were identified who had complete photographic and medical records and were therefore included in the study. Patients were placed into 5 groups based on their total length of postoperative follow-up. Periorbital volume augmentation was assessed by 3 independent masked evaluators using a standard aesthetic scale from 0 to 2 (with 0 indicating no improvement; 1, mild improvement; and 2, marked improvement). Interobserver correlation was determined by κ correlation, and Mann-Whitney tests were used to assess for statistical significance comparing the same patients in each group. RESULTS: Scores from the 3 independent evaluators correlated well (κ = 0.316); aesthetic improvement was seen in almost all patients (86.4%), who had demonstrated improvement for the first 3 years of follow-up. The degree of improvement decreased each year, and only mild improvement was retained in most patients (68.2%) by the 3-year follow-up point (P = .049). CONCLUSIONS: Results from most patients who underwent autologous periorbital lipotransfer demonstrated improvement that lasted as long as 3 years. Autologous periorbital lipotransfer remains a valid and effective technique for periorbital rejuvenation and demonstrates long-term potential effectiveness.

Midface restoration in the management of the lower eyelid.

Aging of the midface and lower eyelid represents one of the earliest clinically detectable areas of aging on the face. These senile changes include laxity of eyelid skin, pseudoherniation of orbital fat, ptosis of the suborbicularis oculi and malar fat pads, and loss of facial volume. Several approaches, including surgical and nonsurgical procedures, have been developed to counter the effects of aging on the midface and lower eyelid. This article reviews the techniques used by the authors to rejuvenate the midface and lower eyelid, and illustrates a comprehensive approach to management of this complex facial region.

Cosmetic and functional effects of cephalic malposition of the lower lateral cartilages: a facial plastic surgical case study.

Certain anatomic variations of the lower lateral cartilages can predispose patients to nasal obstruction. One particular orientation is the cephalic malposition of the lower lateral cartilages which often results in both cosmetic and functional nasal effects. This article will discuss the pertinent surgical anatomy, diagnosis, the process to identify patients at risk with cephalic malposition of the lower lateral cartilages, pitfalls, and poor surgical changes that result in external nasal valve collapse. Appropriate diagnosis, prevention, and surgical maneuvers to address this will be discussed.