Lifting lips: 28 years of experience using the direct excision approach to rejuvenating the aging mouth.

The mouth ages along with the face, but it is frequently ignored when performing facial rejuvenation. The authors have addressed the mouth area with direct surgical options and excisions since 1980. In using the direct approach, the tradeoff for an improved appearance at a conversational distance is a scar that is barely visible from inches away. In more than 3000 procedures, the results have been consistently good, with very few minor scar irregularities that required revision. The authors advocate performing a lip lift to elevate the central lip and a corner mouth lift to elevate the lateral lip. Although the lip and corner lift are important in shortening the long lip of aging, one of the most useful perioral procedures is the direct excision of loose skin at the lower nasolabial/marionette foldover area. The authors conclude that results of facial rejuvenation are greatly enhanced by appropriate procedures of the mouth.

Cine-MRI swallowing evaluation after tongue reconstruction.

OBJECTIVE: To determine the feasibility of cine-MRI for non-invasive swallowing evaluation after surgery for lingual carcinoma with reconstruction using microvascular free flaps. METHODS: Ten patients with stage IV carcinoma of the mobile tongue and/or tongue base treated by surgical resection and reconstruction with a free flap were evaluated after an average of 4.3 years (range: 1.5-11 years), using cine-MRI in "single-shot fast spin echo" (SSFSE) mode. Fiberoptic laryngoscopy of swallowing was performed before MRI to detect aspiration. The tolerance and ability to complete the exam were noted. The mobilities of the oral and pharyngeal structures visualized were evaluated as normal, reduced or increased. RESULTS: Cine-MRI was well tolerated in all cases; "dry" swallow was performed for the 2 patients with clinical aspiration. Tongue base-pharyngeal wall contact was observed in 5 cases. An increased anterior tongue recoil, increased mandibular recoil, increased posterior oropharyngeal wall advancement and an increased laryngeal elevation were observed in 4 cases. One case of a passive "slide" mechanism was observed. CONCLUSIONS: Cine-MRI is a safe, non-invasive technique for the evaluation of the mobility of oral and oropharyngeal structures after free-flap reconstruction of the tongue. For selected cases, it may be complementary to clinical examination for evaluation of dysphagia after surgery and free-flap reconstruction. Further technical advances will be necessary before cine-MRI can replace videofluoroscopy, however.