Five long-term case reports (average 15 years) of saddlenose correction using cast Silastic implants.

A 15-year review of patients who underwent silicone implants to the nasal bridge was conducted. None of my implants had to be removed because of either hematomas or infection. To my knowledge, only one implant has been removed for any reason over the last 10 years. Another nasal implant was removed by a surgeon in New Orleans and was replaced by a rib cartilaginous graft, which, within 2 years, severely curled, causing a nonacceptable result. This cartilage graft was removed and replaced with a second silicone implant and, to my knowledge, was still satisfactory and in place 10 years postoperatively. Insertion of implants with lateral nasal bone infracturing and submucous resection, along with tip reduction, is now performed in almost all patients. Tip elevation, when necessary, is accomplished by rotation of the nasal floor and columella up the maxillary spine (and septal cartilage) to obtain a maximum of 6 mm of elevation, some of which is lost following subsidence of swelling and/or dissolution of the suture material.

Partial resection of the tongue for the amelioration of obstructive sleep apnoea: a report on 34 cases with long-term follow-up.

This is a report on 34 consecutive patients who had partial resection of the tongue (PROT) for severe snoring and obstructive sleep apnoea (OSA). Short-term (7-24 months) follow-up of 30 patients and long-term (7-11 years) follow-up of 20 patients revealed 88% short-term and 65% long-term improvement in symptoms. Weight loss (4.5 to 24.5 kg) occurred in 10 patients, 5 of whom were improved by the procedure. The oropharyngeal and nasopharyngeal spaces are widened by removal of a wedge of tissue from the body of the tongue. PROT appears to be a simple but effective means of relieving OSA symptoms. There were no long-term complications. This procedure seems likely to reduce the morbidity and mortality of OSA, especially when associated with serious cardio-vascular or pulmonary pathology.

Influence of some operative and postoperative factors on capsular contracture around breast prostheses.

In a follow-up of 490 patients with breast implants, neither the size of the prosthesis nor the nature of the surgical procedure (simple augmentation mammaplasty or after subcutaneous mastectomy) increased the incidence of capsular contracture. Hematoma or infection were followed by a higher incidence of capsular contracture. Drainage with suction and the instillation of steroid around the prostheses seemed to be effective in reducing the incidence of capsular contracture. In the steroid-treated group, the need for open surgical treatment was reduced. The recurrence rate after closed capsulotomy, or open capsulotomy, was not significantly different from that following the more extensive procedure of capsulectomy.

The study of hematomas in 500 consecutive face lifts.

Our incidence of hematoma in 500 consecutive face lifts was 2.6 percent, of which 1.6 percent were severe enough to need evacuation. This incidence of hematoma correlated well with the blood pressures of patients on admission; when the pressure was above 150/100 mm Hg on admission, hematoma occurred 2.6 times more frequently than in normotensive patients. Our premedication regime and hypotensive therapy was effective in reducing preoperative hypertension to normotensive levels in most, but not all, patients. However, this reduction of the postoperative blood pressure to normal levels did not prevent hematoma formation entirely.

Circumsuture treatment for varicosities.

A surgical procedure that can be used either as an alternative to saphenous vein stripping or as a supplement to it has been developed and used successfully at the Straith Clinic for the past 12 years. The method avoids surgical scars and pigmentation, is simple enough to do with use of local anesthesia, and does not require hospitalization. That the patient can remain ambulatory is another desirable feature. Follow-up of 16 patients who have undergone this procedure has been very encouraging.

Dropped lateral wall syndrome--the No. 2 complication in rhinoplasty.

A new technique of infracturing the lateral wall, using a "chisel forceps," allows precise infracturing without tearing of the periosteal attachments in the nasion region. This technique has so far also prevented double fracturing of the lateral walls so difficult to treat in the past.

Male face lift in continuity with lower blepharoplasty.

Rhytidectomy in the male is always more complicated than in the female. We present important modifications of the usual female-type face lift procedure that solve problems peculiar to the male patient. We describe a combined procedure of male rhytidectomy in continuity with the lower blepharoplasty incision. This technique increases the aesthetic results significantly. It provides an increased mechanical advantage in rotation and elevation of the cheek flap which is necessary to correct adequately the frequent redundancy and marked sagging in the lower face and neck often witnessed in the aging male patient. The preauricular non-hair-bearing portion of skin is left undisturbed with no change in the appearance of the sideburn. There is no elevation of the temporal hairline. The operative technique is fully described with emphasis on the complications we observed and how to avoid them. The results presented justify the slightly visible scarring that may occur in the temporal area which heals extremely well and is very acceptable aesthetically.

Cardiac arrhythmias in phenol face peeling: a suggested protocol for prevention.

Cardiac arrhythmias are a potential complication in phenol face peeling. A comprehensive review of the literature is presented here demonstrating its reported incidence, as well as the actions of phenol both locally and systemically. In addition to the conventional measures that are presently followed in chemical face peeling, we present further recommendations for the prevention of cardiac arrhythmias. These include maintaining the patient with a sufficient fluid load, forcing diuresis with furosemide, and using lidocaine hydrochloride as a prophylactic antiarrhythmic agent. These guidelines will help avoid serious and even lethal complications.