Long-Term Improvement of Crow's Feet Wrinkles in Combination With Cervicofacial and Temporal Lifting: Review of the Literature.

BACKGROUND: The lateral orbital crow's feet area is one for which rejuvenation is most frequently requested by patients. Moreover, lateral canthal wrinkles are a common source of dissatisfaction after rhytidoplasty. Botulinum toxin injection has emerged as a most popular, easy, and effective solution; nevertheless, repeated injections are required periodically for long-term effect. Other nonsurgical options have also been described to have some demonstrable advantages. Orbicularis oculi surgical manipulations have been described as well. MATERIAL AND METHODS: A systematic PubMed literature search was conducted to identify clinical cohort studies including more than 10 patients describing surgical approaches for improvement of crows' feet wrinkles in combination with face and/or temporal lifts. The search was complemented by Embase, Medline, and Cochrane searches in addition to screening of reference lists of selected studies and simple term searches about surgical treatment of crow's feet. RESULTS: Fourteen studies satisfied the inclusion criteria and were included in this review describing various muscle excision techniques including vertical strip excision, lateral partial resection, wedge resection, muscle resection in "C" pattern, and enlarged myectomy of about one-third of the whole orbital extension in addition to muscle manipulation modalities, including muscle splaying, muscle division, muscle division and splaying, muscle undermining with partial denervation, and muscle suspension. Interposition of fascia between orbicularis muscle and overlying skin was also reported. CONCLUSION: View the few studies retrieved and the wide spectrum of reported techniques, it is not possible to determine from this review the most effective modality. Nevertheless, it seems that subcutaneous undermining of the lateral canthal area combined with splaying and traction of the orbicularis oculi muscle and fixation to the temporalis fascia with or without muscle division would yield the best long-term results. This review indicates also that surgical correction of crow's feet during rhytidectomy or temporal lift could be a positive complement to improve aesthetic outcome. Unfortunately, if not underreported, it is definitely neglected. We believe that this review may be an eye-opener for surgeons.

Percutaneous Thread Lift Facial Rejuvenation: Literature Review and Evidence-Based Analysis.

PURPOSE: Interest in noninvasive facial rejuvenation procedures continues to grow. With the advent of the so-called lunch-time face-lift, suture suspension facial rejuvenation has gained prominence and much popularity largely patient driven rather than data driven. We have published a decade ago a review about this rejuvenation technique. Despite its popularity at that time, serious long-term studies and peer-reviewed data about longevity and patient satisfaction were lacking to our surprise. As 10 years have passed, we have conducted a new systematic PubMed database search limited to the last 10 years interval. METHODS: The search identified 192 publications. After screening the titles and abstracts, 20 clinical and 2 experimental studies met the inclusion criteria and were selected for this review. RESULTS: Though thread lift facial rejuvenation is considered to be a promising modality, no new evidence has been added to the literature to support its use. CONCLUSION: Until evidence-based efficacy and robust data are objectively documented, patients requesting percutaneous facial rejuvenation must be well informed about adverse events, longevity of effect, and limited available data on efficacy. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Pericranial Flap as a Salvage Procedure in Pediatric Neurosurgical Complications.

ABSTRACT: The pericranium is a vascularized structure that can be used for the treatment of complex scalp and skull defects. It is also utilized as a prophylactic measure to prevent wound complications in high-risk patients. In this study, we looked at the use of the pericranial flap in pediatric patients. A retrospective chart review was done in the American University of Beirut Medical Center from February 2010 to 2020. Ten pediatric patients were identified who required either prophylactic pericranial flap (n  =  3) or for treatment of a chronic draining sinus (n =  7). Patients were followed up for an average of 23 days. There were no cases of infection, hematoma, seroma, or meningitis. Only 1 case developed dehiscence of the skin. It was managed conservatively and healed within 2 weeks. The pericranial flap is a workhorse flap for scalp and skull reconstruction, with no donor site morbidity and thus should always be considered.

Secondary Cleft Nasolabial Deformities: A New Classification System for Evaluation and Surgical Revision.

INTRODUCTION: Secondary or residual cleft lip and nasal deformities following primary unilateral or bilateral cleft lip repair are common. Many classification systems have been proposed to describe congenital cleft lip and palate deformities before repair. This article proposes a one-of-a-kind classification system for residual cleft deformities and describes its application to 136 cleft lip revision cases from cleft outreach missions worldwide. METHODS: Patients' demographics and deformities were classified preoperatively, and a database of the classification was created. Postoperatively, the type of surgery performed was added to the database and comparison was done using an independent t test. RESULTS: Kappa coefficient was 0.92 and showed excellent agreement between the type assigned preoperatively to the patient and the type of procedure done. CONCLUSIONS: This system proves to provide good descriptions of the deformities, is user friendly, facilitates the planning of the corrective surgical procedure, and enhances the communicative lingo between surgeons and members of cleft multidisciplinary care teams. It is broadly applicable in outreach missions with limited resources and cleft referral centers with considerable load.