Direct cervicoplasty.

Rejuvenation of the aging neck is one of the common reasons for the patients presented to facial plastic surgeons. In the author's opinion, most of these patients will be best served by a full rhytidectomy approach with periauricular incisions, skin flap undermining, and platysmaplasty. There is a subset of patients, however, who presented with complaints limited to the so-called Turkey Gobbler deformity, and who do not wish to undergo a full rhytidectomy approach. These patients may be well served by a lesser procedure such as a direct cervicoplasty or submentoplasty. The advantages of this approach include shorter operative time, faster recovery, and lower complication rates. The primary disadvantage of these more limited approaches is that there is an anterior cervical scar that may be visible under some conditions. This article will review the multiple options for skin incisions as well as details of the technique that the authors have found may lead to a successful rejuvenation of the submental region.

Injectable fillers for volume replacement in the aging face.

In recent years, there has been a better understanding of the aging process. In addition to changes occurring in the skin envelope, significant changes occur in the subcutaneous fat and craniofacial skeleton. This has led to a paradigm shift in the therapeutic approach to facial rejuvenation. Along with soft tissue repositioning, volumizing the aging face has been found to optimize the result and achieve a more natural appearance. Early in the aging process, when there has not been a significant change to the face requiring surgical intervention, fillers alone can provide minimally invasive facial rejuvenation through volumizing. Multiple injectable soft tissue fillers and biostimulators are currently available to provide facial volume such as hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, polymethyl methacrylate, and silicone. A discussion of the morphological changes seen in the aging face, the properties of these products, and key technical concepts will be highlighted to permit optimum results when performing facial volumizing of the upper, middle, and lower thirds of the face. These fillers can act as a dress rehearsal for these patients considering structural fat grafting.

Melolabial flaps for nasal reconstruction.

Nasal reconstruction remains a significant surgical challenge. The melolabial flap and its multiple variations relies on the robust vascularity and abundant subcutaneous fat of the melolabial fold, to transfer skin and soft tissue to the lower one-third of the nose, the nasal sidewall or as a replacement for nasal lining while hiding the donor scar in the melolabial crease. This content discusses pertinent cutaneous anatomy, patient selection, preparation and education, flap design, surgical techniques and post-operative considerations to enable the surgeon to achieve a reconstruction result that closely approximates the pre-injury state while producing limited donor site deformity.

Selective removal of stratum corneum by microdermabrasion to increase skin permeability.

This study sought to determine if microdermabrasion can selectively remove stratum corneum to increase skin permeability. Although, microdermabrasion has been used for cosmetic treatment of skin for decades, no study has assessed the detailed effects of microdermabrasion conditions on the degree of skin tissue removal. Therefore, we histologically characterized the skin of rhesus macaques and human volunteers after microdermabrasion at different conditions. Using mobile tip microdermabrasion, an increase in the number of treatment passes led to greater tissue removal ranging from minimal effects to extensive damage to deeper layers of the skin. Of note, these data showed for the first time that at moderate microdermabrasion conditions selective yet full-thickness removal of stratum corneum could be achieved with little damage to deeper skin tissues. In the stationary mode of microdermabrasion, selective stratum corneum removal was not observed, but micro-blisters could be seen. Similar tissue removal trends were observed in human volunteers. As proof of concept for drug delivery applications, a model fluorescent drug (fluorescein) was delivered through microdermabraded skin and antibodies were generated against vaccinia virus after its topical application in monkeys. In conclusion, microdermabrasion can selectively remove full-thickness stratum corneum with little damage to deeper tissues and thereby increase skin permeability.

Gunshot wounds to the face--acute management.

The complex facial trauma victim poses a genuine therapeutic challenge as a whole, and may be particularly challenging to the medical team. The literature on acute management of gunshot wounds to the face is scarce. We performed an extensive review of the English-language literature in an effort to better delineate the diagnosis and acute management of these injuries. Most of these injuries do not present with initial threat to life and can safely be managed non-operatively. Definitive treatment is often deferred in patients with multiple, or more severe, injuries. Airway compromise is the most frequent and most life-threatening early problem reported in most series. CT scan remains the most useful method in the evaluation of these types of injuries and associated cervical spine lesions. Facial bleeding is best controlled by angiography and subsequent embolization. Anatomic repair of soft tissue and bony injuries is recommended to obtain an optimal functional and aesthetic outcome. Despite the creation of some algorithms, no clear correlation has been found between the site of entrance wound and the injuries and outcome of gunshot wounds to the face.