A simplified approach to alar base reduction: a review of 124 patients over 20 years.

OBJECTIVES: To simplify the approach and diagnosis of alar base reduction, suggest a treatment algorithm, and evaluate the long-term outcomes of 3 different techniques used separately or in conjunction with one another. DESIGN: Retrospective review of 124 patients seen in a private practice by a single surgeon. Patients ranged in age from 15 to 59 years (mean age, 30.4 years). Patients were undergoing primary (83.9%) or revision (16.1%) procedures. RESULTS: Of the 124 patients undergoing alar base reduction, 31 (25%) were male and 93 (75%) were female. Average follow-up was 2 years. All patients underwent wedge excision, and for 64 patients (51.6%), this was the only technique used on the alar base. Alar wedge and nasal sill excisions were performed in 21 patients (16.9%); 19 (15.3%) underwent alar wedge excision with V-Y advancement, and 20 (16.1%) underwent alar wedge excision, nasal sill excision, and V-Y advancement. Thirty-one patients (25.0%) received dermabrasion for notable postoperative incision scars. CONCLUSIONS: The data represent the senior author's outcomes of alar base reductions over the past 20 years. The 3 techniques we describe have been effective when used alone or in combination in reducing alar flare and in narrowing the nasal base. Patients should be counseled that dermabrasion of the wedge excision areas in the alar-facial groove may be necessary to diminish visible scars.

Experience with percutaneous suspension of the malar fat pad for midface rejuvenation.

Repositioning of the ptotic malar fat pad represents a key element of midface rejuvenation. Traditional face-lifting techniques have been minimally effective in correcting the midface changes commonly seen in aging. Many candidates, especially younger patients, desire procedures that have rapid recovery times with reduced risk and the absence of visible incisions. Percutaneous suspension of the malar fat pad to reposition it in a more youthful position is a minimally invasive technique producing a long lasting elevation that would be a welcomed addition to midface rejuvenation.

Safety of face-lifts in the older patient.

OBJECTIVE: To compare the surgical and anesthesia complications after rhytidectomy in patients 75 years and older vs those aged 45 to 61 years. DESIGN: Retrospective review of 107 patients of a single surgeon in private practice. All patients 75 and older who underwent rhytidectomy (using deep-plane and superficial musculoaponeurotic system plication techniques) from 1998 to 2002 were selected. This cohort was compared with a randomly selected group of rhytidectomy patients aged 45 to 61 from the same period. Complications related to the procedure or anesthesia were recorded, as well as American Society of Anesthesiologists (ASA) physical class, method of procedure, and patient age. RESULTS: The mean ages of the 2 groups were 79.0 years (33 patients) and 54.2 years (74 patients). Five patients in the older cohort had minor complications after surgery, compared with 7 in the younger group (P = .52). No major complications were reported. CONCLUSIONS: Patients 75 and older carry risks of postoperative complications from face-lift procedures that are similar to those of middle-aged patients, when matched for ASA class. Preoperative counseling should emphasize patient health status rather than age when considering the risk of postoperative complications. Face-lift surgery can be safely performed in patients 75 years and older with ASA class less than 3.

Experimental facial augmentation with hydroxyapatite cement.

OBJECTIVE: To study the results of implantation of preformed hydroxyapatite (HA) disks and HA cement in onlay augmentation. METHODS: In this prospective study involving 16 adult New Zealand rabbits, HA disk and HA cement samples were implanted separately and together along the bony and cartilaginous nasal dorsum as well as over the supraorbital bone. Gross and histologic examinations of the implants were performed at intervals ranging from 3 to 24 months. RESULTS: There was no evidence of infection, adverse reaction, or implant extrusion in the 15 rabbits surviving the planned period. Grossly, all rabbits had prominent noses and supraorbital regions that were immobile on digital palpation. No measurable change in HA disk height and width was noted but there was a 15% decrease in height and width in the HA cement implant. Microscopically, preformed HA disks were found to be enclosed in a vascularized fibrous capsule. When disks were combined with HA cement, a vascular fibrous capsule was still noted around the implant but there was osteoconversion in the underlying cement layer. Used alone, HA cement underwent both osteoconversion and osteointegration. Neither the preformed HA disk with and without HA cement nor the HA cement alone elicited giant cell reaction or inflammatory changes. The HA cement alone was found to have microscopic fissures at the edges. CONCLUSION: This animal study suggests that preformed HA implants and HA cement, alone or in combination, can be used to augment the non-stress-bearing craniofacial skeleton.