Surgical correction of crow's feet deformity with radiofrequency current.

BACKGROUND: There are many published surgical techniques for the correction of crow's feet deformity, but subsequent contour irregularities and early recurrence are often reported. OBJECTIVE: The authors present a radiofrequency (RF) technique to treat crow's feet that can prevent complications while simultaneously maintaining long-term results. METHODS: From April 2010 to February 2012, a total of 52 consecutive patients (3 men and 49 women) underwent surgical correction of crow's feet with an RF current. Following elevation of the skin flap in the temporal area, the lateral portion of the orbicularis oculi muscle was partially elevated and splayed. Then the RF current was applied to the elevated muscle flap until the target temperature of 60°C to 80°C was reached. Clinical outcomes were observed through photographs with patients in a natural smiling position. RESULTS: Mean (SD) patient age was 52.7 (2.2) years (range, 31-73 years). Patients were followed postoperatively during a mean period of 23 months (range, 15-36 months). There were no recurrences of crow's feet during the follow-up period. No major complications were noted. CONCLUSIONS: The main advantage of this surgical technique is preserving continuity of the orbicularis oculi muscle while selectively decreasing muscle tone. Hence, this technique may prevent any contour irregularities. The RF current causes irreversible muscle fibrosis, which in turn provides long-lasting results. While the early results of this series show promising long-term efficacy and a good safety profile, the small number of patients and short-term follow-up period warrant further study.

Preserving Orbicularis Branches of the Zygomatic Nerve with the Orbicularis Oculi Muscle-Superficial Musculoaponeurotic System Flap Complex in Facelift Surgery.

The orbicularis oculi muscle (OOM) is sometimes incorporated with the superficial musculoaponeurotic system (SMAS) flap to provide a stronger flap. While elevating the OOM flap, it is important to avoid injury to the orbicularis branches of the zygomatic nerve. When the orbicularis branches of the zygomatic nerve are identified during the OOM-SMAS flap elevation, a transverse OOM flap was created to preserve the nerve. Postoperative follow-up was 12 months. There was no functional impairment of the OOM in the follow-up period. There are anatomical variations of the orbicularis branches of the zygomatic nerve. When it is identified, a transverse OOM flap incorporating it can be raised to avoid inadvertent injury. Using this method, good results were achieved with virtually no complications.

Ad libitum feeding: safely improving the cost-effectiveness of pyloromyotomy.

BACKGROUND/PURPOSE: Patients undergoing pyloromyotomy traditionally have been placed on complex postoperative feeding regimens. The authors evaluated the substitution of an ad libitum feeding regimen to determine if it could decrease length of hospital stay and cost without increasing the morbidity rate. METHODS: Fifty-six consecutive patients undergoing open pyloromyotomy were evaluated. The initial 31 patients were treated with a traditional protocol, whereas the next 25 patients received ad libitum feeding. Time to first full-strength feeding, amount and time of any emesis, and time to discharge were recorded. Hospital costs and number of readmissions were assessed. RESULTS: Patients in the ad libitum group had a statistically significant shorter time to discharge (25.1 hours versus 38.8 hours), which translated into a savings of $1,290 per patient. Whereas more patients in the ad libitum group experienced postoperative emesis (32% v 26%), this was not statistically significant. There was no other morbidity and there were no readmissions in either group. CONCLUSIONS: Postoperative ad libitum feedings resulted in significant decreases in hospital stay and associated costs without increasing morbidity. Ad libitum feeding is safe, simple, and cost effective, and may offer an avenue for short-stay pyloromyotomy in selected patients.