Cleft palate in a patient with Williams' syndrome.

Cleft lip or palate has not been reported in the medical literature as a part of Williams' syndrome. We present a patient who had cleft palate among other congenital manifestations. This patient's immediate postnatal period clinically seemed to have a Pierre Robin sequence. With the development of the craniofacial complex, microgenia and micrognathia with glossoptosis gradually became apparent. On further assessment, the patient showed other clinical findings that suggested a syndromic association. This required a complete evaluation to discard other conditions that present with low psychomotor development and distinctive facies, such as Kabuki syndrome or fetal alcohol syndrome. The diagnosis for Williams' syndrome was established based on the clinical features and supported by the fluorescent in situ hybridization test. Williams' syndrome has been described as a rare, congenital disorder characterized by physical and developmental problems. Common features include characteristic "elfin-like" facies, supravalvular aortic stenosis, hypercalcemia, low birth weight, slow weight gain, feeding problems, impulsive and outgoing personality, limited spatial skills and motor control, and intellectual disability. Although individuals with Williams' syndrome may show competence in areas such as language, music, and interpersonal relations, their IQs are usually low and they are considered moderately to mildly retarded.

Beauty and the body: the origins of cosmetics.

Ancient cultures were as preoccupied with the aesthetics of appearance as individuals are today. Dermabrasion for skin resurfacing has been performed with salt, pumice, ground grains, bone, and horn. Chemical peels have been performed with acids, metals, botanical extracts, or animal fats. Tattoos, ear piercing, makeup, skin treatments, and massages have existed for the past 5000 years. According to history, when the rise of more complex societies brought an ever-increasing demand for cosmesis, perfumers, cosmetologists, barbers, and gentlewomen became pioneers, undertaking and developing the cosmetic practices that had evolved through the ages. With the consolidation of medical specialties concerned with the management of skin care, the scientific method has been applied to adapt and perfect many of the procedures that had been carried out with only empirical knowledge. To have a better perspective from which to envision future technical and technological developments, plastic surgeons should be familiar with the origins of cosmetics and some cosmetology practices that society demands.

Current considerations for myelomeningocele repair.

Important advances have been made in the reconstruction of myelomeningocele during the last few years. Techniques of closure that use diverse tissues available in the back range from very simple to very complex. Most of them have become essential to the plastic surgeon. To facilitate a more efficient interdisciplinary approach, recent advances in knowledge of the vascular anatomy of the skin and specific clinical surgical considerations concerning skin grafts, cutaneous flaps, and musculocutaneous flaps are reviewed. A topographical division of the lesion that will permit a methodologically adequate treatment plan for congenital defects in the back, specifically in the thoracic, thoracolumbar, and lumbosacral regions is suggested.

Anatomical study of the blood supply to the skin in rhytidectomy.

This study was undertaken to evaluate the blood supply to the facelift flap by identifying the perforating arteries in the anterior facial region, which is preserved during the undermining of the flap. We have called this medial zone the pedicle area of the flap. Eleven pairs of musculocutaneous perforator arteries supplying the facelift flap were identified, all of them emerging from three main arterial trunks: the facial, the superficial temporal, and the ophthalmic arteries. A rich anastomotic network connected all the vessels; however, we were able to group this network into five basic forms including the ipsilateral and contralateral external and internal carotid arteries. We found these anastomotic links to be constant. We propose that this anatomical feature of the face provides for adequate blood supply even when certain regions have been altered by previous dissection, injury, or congenital deformity. This study confirms previous anatomical findings but also adds specific information regarding the blood supply to the facelift flap that will allow this procedure to be carried out with maximum safety and effectiveness.

The cleft earlobe: a review of methods of treatment.

The plastic surgeon must frequently deal with the aesthetic repair of cleft earlobe deformities. Many techniques have been described, each claiming to achieve the best results. In this review of the literature, we discuss the various operations for the treatment of this condition. A classification of the traumatic earlobe clefts is proposed, and some basic principles for surgical treatment are suggested.

Homage to an unknown photographer.

The Daguerreotype is an integral part of modern history as artifact and witness to great events and forms the basis on which the first surgical photograph of an amputation was taken in North America, during the Mexican-American War between 1846 and 1847; however, its photographer remains unknown.