The choice of incisions and myoplasties in face lifts

The choice of the site of incision in facial and forehead face lifts is very important, as, apart from minimising the scars, it determines the absence of alteration in the hairline. This is particularly important in occipital and frontal regions but also in the "sideburns". After defining the incision, the surgeon must decide which platysma muscles must be used to correct frontal, horizontal or vertical wrinkles, crows feet or cervical folds. The author presents his experience and technical developments in these two fields.     

The use of sprayed fibrin glue for face lifts

Summary The use of a fibrin and thrombin tissue glue administered in aerosol form has been evaluated in 65 patients undergoing a face lift. In 55 cases the glue was applied to the undermined areas bilaterally, and appeared to decrease postoperative oedema and bruising. In a further 10 cases the adhesive was used on one side only. In 5 of these patients there was no difference between the two sides, while in 5 cases the glued side was judged superior. With this technique drains and dressings are not necessary in the postoperative period and patients find this especially convenient.     

Eyebrow, face, and neck lifts for males

Alternate locations to skin excisions adjacent to the eyebrows for correction of eyebrow ptosis have been presented. Excisions in the upper forehead or in the scalp permit flexibility in width and length of skin or scalp to be excised and may be extended laterally to produce a temporal lift which not only improves the lateral canthal area of sagging skin but also may improve the lower eyelid surgical correction results (Figs. 1 and 3). By use of adequate lipectomy and full-width platysma muscle flaps to support the new neck contour, better and longer lasting results have been accomplished. The currently used techniques for eyebrow, face, and neck lifts for males produce better and longer lasting results than could have been accomplished with previously used techniques. The continued search for improvement in techniques by many surgeons in different areas of the world has enabled these longer lasting and better results to be accomplished.     

Improving of scars from temporal and frontal face lifts]

In order to prevent a widening of the frontal and temporal area and to avoid reducing the presence of hair in these areas we practice "W" like incisions at the junction of the scalp and skin. We preserve the deep part of the hair follicules and eliminate tension as we suture the wound. We will demonstrate a technique which is simple and quick allowing us to obtain excellent scars and we discuss its physiology.     

除皱术中多切口应用的探讨

目的通过分析面部老年化的解剖学特征,在除皱术中应用多切口充分矫正面部老年化所带来的解剖学的改变,以达到年轻化效果.方法行除皱术同时应用下睑缘切口、颏下切口或鼻翼缘切口以矫正面部老年化解剖学的改变.结果自1999年以来完成手术18例,随访半年至1年,效果满意.结论在除皱术中应用多切口可更有效地矫正面部老年化解剖学的改变,以获自然、持久的术后效果.     

除皱术中多切口应用的探讨

目的　通过分析面部老年化的解剖学特征 ,在除皱术中应用多切口充分矫正面部老年化所带来的解剖学的改变 ,以达到年轻化效果。方法　行除皱术同时应用下睑缘切口、颏下切口或鼻翼缘切口以矫正面部老年化解剖学的改变。结果　自 1999年以来完成手术 18例 ,随访半年至 1年 ,效果满意。结论　在除皱术中应用多切口可更有效地矫正面部老年化解剖学的改变 ,以获自然、持久的术后效果。     

Avoiding visual tipoffs to face lift surgery. A troubleshooting guide.

As aesthetic surgeons we should look more closely at our finished products. A visible scar, distorted ear lobe or tragus, or unnatural hairline says "face lift" to a patient's friends and creates a self-conscious, unhappy patient. The modifications I have adopted of accepted techniques give a more natural look and less conspicuous scarring. They avoid the most dreaded question a patient's associates may ask: "Have you had a face lift?" The text outlines the areas where tipoffs are most prevalent and makes suggestions to minimize them. It is impossible to do inconspicuous surgery all the time, but it is possible by careful observation to minimize visual tipoffs. An unnatural tragus or bad scar should be considered as severe a complication as nerve damage. We should use as proficient avoidance techniques for one as for the other.     

Results of multiple ligament injured knees operated by three different strategies

Background:

Multiple ligament injured knee is generally described for a scenario when at least 2 of the 4 major ligaments are ruptured. The most effective treatment for these injuries remains controversial. This study presents the clinical outcome of 3 surgical strategies based on personalized treatment.

Materials and Methods:

Thirty two patients with multiple ligament injured knee were treated by 3 surgical strategies in the acute phase. (1) One-stage: Twelve patients treated by repair and reconstruction of all ruptured ligaments in a single operation. (2) Staged: Eleven patients treated by repair or reconstruction of the extraarticular (EA) ligaments and then intraarticular ligaments in 2^nd stage. (3) EA ligament repair: Nine patients underwent only EA ligaments repair.

Results:

The patients were followed up for an average of 34.7 ± 12.1 months. Significant improvements in knee stabilities (P < 0.01), Lysholm score (P < 0.01) and International Knee Documentation Committee grade (P < 0.01) were noticed in all groups. Of the 32 patients, none had gross mal alignment or gait abnormalities at the latest followup. Comparing the 3 groups, a significant difference in Lysholm score was shown between the one stage group and the EA repair group (P = 0.040); additionally, significant differences were found in 2 subscales of knee injury and osteoarthritis outcome score (P < 0.05).

Conclusion:

Satisfactory clinical and functional outcomes could be achieved adopting the 3 surgical strategies based on personalized treatment. However, a combination of EA repair and intraarticular repair or reconstruction might be more reasonable options for the young and active patients.     

Fascio-fascial suspension technique in medial thigh lifts

Redundant thigh tissue can be corrected by the thigh lift. However, this is a seldomly used procedure because of postoperative problems such as inferiorly displaced and wide scars, vulvar distortion, and early recurrence of ptosis. In order to limit these complications, we developed a deep anchoring technique based on the overlap of the adductor longus and gracilis fasciae. A group of 18 patients underwent a medial thigh lift using this technique and were followed for at least 12 months after surgery. The fascio-fascial suspension gives strong vertical support with minimal tension on the skin, thereby reducing the complications traditionally associated with this procedure.     

An operated case of multiple endocrine neoplasia type IIb and review of the Japanese literature

Multiple endocrine neoplasia, type IIb (MEN IIb) is a rare syndrome characterized by the occurrence of medullary thyroid carcinoma (MTC), pheochromocytoma and mucosal neuroma. A 35-year-old male patient with MEM IIb having megacolon, marfanoid habitus and no family history of the disease underwent surgery. Because MTC was present in both lobes, total thyroidectomy and modified neck dissection were performed. Pheochromocytoma was found bilaterally and bilateral adrenalectomy with adrenal autotransplantation in the rectus abdominis muscle was carried out. Postoperative course was satisfactory except for transient hypocalcemia and mild ileus. After the slow corticosteroid weaning process, his adrenocortical function was at the lower level within a normal range. In August 1986 (24 postoperative months), he was maintained by the administration of 10mg of hydrocortisone every three days, and calcitonin and CEA levels in sera were normal. We collected 15 cases reported in Japanese literatures. MTC and mucosal neuroma were found in all cases, whereas pheochromocytoma was present in 9 cases. Bilateral and multicentric occurrences were usual, and total thyroidectomy and bilateral adrenalectomy were, warranted. We believe that autotransplantation following bilateral adrenalectomy is a worthy alternative.     

Avoiding the labrum in hip arthroscopy

Summary: Iatrogenic joint damage is a potential complication of any arthroscopic procedure. The anatomic constraints of the hip cause particular concern. The greatest risks are perforation of the acetabular labrum and scuffing of the articular surface. Careful attention to the details of the technique described can reduce the likelihood of this problem. With current technology, some occasional damage is unavoidable. However, all steps should be taken to minimize the likelihood and magnitude of such occurrences.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 770–773     

颧骨复合体肥大患者正貌面型满意度的测查及分析

目的:了解颧骨复合体肥大患者对颜面正貌的审美要求,为临床面部轮廓改型提供参考依据。方法:应用心理—物理学方法测定了22名颧骨复合体肥大患者对7种美貌女性正貌面型的满意度,由高至低进行排序。并与55名正常对照组的满意度排序结果进行分组比较。结果:患者对美貌女性正貌型的选择顺序为:A、E、B、F、G、C、D。正常人为:A、C、B、G、E、F、D。患者的满意度排序与正常对照满意度排序只有A、B、D相同,其余均有差异。测试组与正常对照组之间相同面型的得分均无显著性差异(P>0.05)。结论:患者和正常人的最高满意度都为椭圆型,最不被认可的为颧骨肥大型。患者对颜面正貌的审美观基本与大众相同。     

Avoiding hypothermia in the trauma patient

Hypothermia may be encountered during the management of severely injured patients, and with exception of deliberate hypothermia for neuroprotection, has been associated with increased morbidity and mortality. This review examines the recent literature with regard to risk factors for developing hypothermia, significance of hypothermia, therapeutic use of hypothermia, and invasive and noninvasive methods to prevent and treat hypothermia.     

Maximizing aesthetics in lateral-tension abdominoplasty and body lifts

The high-lateral-tension abdominoplasty addresses the practical and theoretic faults of standard abdominoplasty design. Key features include limited direct undermining, increased lateral skin resection with highest-tension wound closure along lateral limbs, two-layer superficial fascial system repair, and significant truncal liposuction when needed. The high-lateral-tension design limits the unfavorable features of standard abdominoplasty and produces balanced natural aesthetic contours. The high-lateral-tension abdominoplasty is the foundation for treatment of more generalized relaxation problems in the circumferential trunk and thighs. For more significant thigh laxity and buttock ptosis, the lateral-tension abdominoplasty is combined with the transverse thigh/buttock lift to produce the lower body lift #2.     

Bone grafting in femoral neck fractures: Results in 28 cases operated on with multiple pinning and cancellous bone grafting

Summary Twenty-eight patients with displaced femoral neck fractures were operated on with multiple pinning combined with cancellous bone grafting from the ipsilateral greater trochanter. The bone graft was introduced through a drilled channel in the femoral neck without exposing the fracture. At follow-up after 2 years, seven patients had died. Two patients had been reoperated with prosthetic replacement of the hip. Nineteen fractures were united and one had developed segmental collapse. In femoral neck fractures, complications from non-union and segmental collapse are still a major problem. Even if the imparied vascular supply to the femoral head is responsible for most of the complications [11, 15], anatomic reduction and a stable fixation are conductive to fracture union [2]. Comminution of the posterior wall of the femoral neck has a negative influence on the security of fixation due to a persisting posterior gap after reduction [16]. In previous reports, bone grafting of the posterior defect in the femoral neck through an open approach has achieved good results [1, 13]. Only a few studies, however, describe a technique of introducing bone chips through a drilled channel in the femoral neck [10, 17]. The use of the ipsilateral greater trochanter as the sole donor site for bone grafting in femoral neck fractures has not been reported previously.