Design of local skin flaps

Design of the optimal local skin flap to repair a specific facial defect requires an understanding of the geometry of the various flaps, local facial anatomy, and the biomechanics of skin and soft tissue. The creative integration of these variables is one of the most challenging areas of facial plastic surgery. This article discusses some general principles of flap design with emphasis on the importance of skin tension and its distribution in preventing complications and maximizing the use of local tissue in difficult reconstructive situations.     

Lidocaine v bupivacaine in facial plastic surgery. A clinical trial

The ideal local anesthetic agent for facial plastic surgery should have rapid onset, good surgical anesthesia, and reasonably long duration. The purpose of this prospective, randomized, double-blind study was to compare 1% lidocaine hydrochloride with 1:200,000 epinephrine with 0.5% bupivacaine hydrochloride with 1:200,000 epinephrine, a newer, longer-acting local anesthetic, in different facial operations. The results suggest that bupivacaine is an effective and safe agent for these procedures.     

Local anesthetics for facial plastic procedures.

The use of local anesthetic in facial plastic surgical procedures is well established as an effective and safe mode of anesthesia delivery. Local infiltration of anesthesia may be used alone for minor surgical procedures, or it may be used with general anesthesia or intravenous sedation and analgesia for more complex, lengthy procedures. When considered independently, the use of local anesthetic agents has undeniable limitations. Local anesthetics can cause toxicity and side effects. Injection of local anesthetics for subcutaneous infiltration frequently is painful until sensory anesthesia occurs. Local anesthetics have limited efficacy with respect to the intensity and duration of sensory blockade that can be achieved. In some situations, use of local anesthesia with the maintenance of an awake patient also may be undesirable for the surgeon and impractical for the patient. Despite these shortcomings, local anesthetics are fundamentally ideal for use in facial plastic surgery.     

Genioplasty, indications and therapeutic methods in dento-maxillary malformations

Genioplasty constitutes an adjunctive surgical procedure used in adult plastic surgery of the facial profile. It is used after dental malocclusion has been corrected and facial morphological features have been reassessed (soft tissue changes consecutive to maxillary osteotomy should be previously analyzed by cephalometry). Genioplasty permits achieving a modification of the chin point in the three planes. The authors describe several types of genioplastic operations, depending on the aim.     

Versatile use of skin expanders in facial plastic surgery.

Large soft-tissue resection defects of the face and scalp present an arduous technical problem for the facial plastic surgeon. Successfully matching tissue coverage with similar skin color and texture is usually limited by the amount of available local skin. Also, the need to limit distortion of fixed anatomic sites when harvesting local skin must be addressed. With the advent and utilization of soft-tissue expanders, the availability of local skin is increased and anatomic distortions are limited. This article describes the versatile use of skin expansion in facial plastic and reconstructive surgery. Expansion techniques include long-term expansion for scalp and cervicofacial defects. Acute intraoperative expansion techniques address repair of perioral, labial, and nasal mucosal lining defects. The success, limitations, and complications of these techniques are reviewed.     

Facial plastic surgery-otolaryngology responds to Sullivan inquest findings

The CIFPS members are individuals who have demonstrated competency to perform facial plastic surgical procedures. It is in the public interest that the public be aware of the various specialties performing facial plastic surgery, and that several specialties confine their training and interest to a particular region. The term "facial plastic surgery--otolaryngology" accurately and truthfully defines the practice and expertise of the otolaryngologist performing cosmetic and reconstructive facial surgery. It is in the interest of the medical community and the public that this term be recognized.     

Facial plastic surgery in the otolaryngology training program: an update

In 1985, we demonstrated that, following the institution of a specific curriculum in facial plastic surgery, the number of cosmetic procedures generated and performed by residents rose dramatically. We have now demonstrated that this increase has been sustained in the 5 years since establishing the curriculum. We continue to maintain that the key to a successful curriculum in facial plastic surgery is the presence of at least one full-time staff member whose primary function is the practice and teaching of facial plastic surgery.     

Localized loss of facial tissue. Criteria of use of extra-oral implants and clinical cases

Osseointegrated maxillofacial epitheses are an interesting therapeutic response for rehabilitation after loss of facial tissue when reconstructive plastic surgery cannot be proposed. We analyzed the criteria used for deciding on this type of treatment for the loss of local areas of auricular tissue, the nasal pyramid and the orbitopalpebral region, presenting individual clinical examples.     

A specific curriculum in facial plastic surgery. Effect on residency training

There has been a dramatic change in the degree of exposure to facial plastic surgery by the otolaryngology resident in the past decade. The amount of this exposure and the method of presentation of aesthetic concepts and procedures varies. We favor a specific curriculum in facial plastic surgery for the residency training program. The effect of this curriculum is measured by statistical analysis of resident-generated aesthetic surgery cases in one year following the introduction of this curriculum into the teaching program. These data are compared with the same period one year prior to the initiation of the program. Tympanoplasty, mastoidectomy, and tonsillectomy case numbers served as controls for statistical comparison over the same time period. These data serve as a guide to residency programs in determining the most effective means of providing optimum facial plastic surgery exposure to their trainees.     

Cyanoacrylate tissue adhesives for skin closure in the outpatient setting.

Cyanoacrylate and fibrin tissue adhesives can aid the facial plastic surgeon performing surgery in the outpatient setting. Octyl-2-cyanoacrylate is ideal for superficial skin closure and eliminates the need for suture removal. Subcutaneous sutures are needed in most cases to provide the best cosmetic outcomes. Fibrin tissue adhesives can be used to aid in attaining hemostasis or to seal or fixate tissues. Cyanoacrylate and fibrin-based adhesives can simplify office-based facial plastic surgery.     

Profile analysis in facial plastic surgery

We devised a simple and reliable method of profile analysis for facial plastic surgery. Profile photographs are taken with the natural head position technique. Key cephalometric landmarks are then identified and digitalized from either photographs or slides, using a digitalizer with a resolution of 0.001 in. The digitalizing pad is connected to a microcomputer. The menu-driven software allows selection of multiple functions from different cephalometric systems. Data can be stored on disk for future analysis. The method is useful in preoperative planning and postoperative evaluation of facial plastic surgery procedures.     

The effects of computer simulated facial plastic surgery on social perception by others

Previous studies have demonstrated the remarkable impact of facial plastic surgery on the perception of facial features. However, pre- and postoperative differences other than the surgically changed features such as facial expression, hairstyle, make-up etc., have influenced the results of previous studies. To exclude these visual cues a computer composite photograph of the changed feature mounted upon the preoperative photograph, instead of the standard postoperative photograph, was presented to observers in this study. Computer graphic technology was used to superimpose the postoperative, surgically changed facial features such as the nose, ear and chin of 16 patients on standardized preoperative photographs. The randomized preoperative photographs and the ‘postoperative’ composed images were presented to 67 subjects, using a person-perception questionnaire. Multivariate analysis demonstrated a more favourable postoperative judgement in only two patients (12.5%). The exclusive effect of facial plastic surgery on the social perception of patients by others when excluding visual cues, such as facial expression, hairstyle, make-up etc, is limited. It is tentatively assumed that the role played by facial plastic surgery is one of initiating a positive cycle by changing the patient’s self-perception rather than one of direct social impact from the changed features.     

Preventing complications in facial plastic surgery

PURPOSE OF REVIEW: The demand for cosmetic procedures has increased dramatically over the past few years, in part fueled by the prevalence of cosmetic 'makeover shows', increased media coverage on television and easy accessibility to the Internet. This growing social acceptance of aesthetic surgery has caused an increasing number of women and men to undergo elective noninvasive and invasive procedures to enhance their appearance. As the number of patients interested in cosmetic surgery increases and the number of physicians performing these procedures increases, the risk of complications invariably also rises. An article focusing on the prevention of complications in facial plastic surgery, therefore, is clearly appropriate in the current era. RECENT FINDINGS: One of the recurring themes in the literature is preventing complications before they occur. Proper patient selection, a thorough understanding of the anatomy and adhering to proper techniques are some of the methods mentioned to avoid unfavorable outcomes. SUMMARY: The literature is replete with articles that focus on the newest techniques for facial rejuvenation. Only through careful analysis of the pitfalls of cosmetic procedures, however, can the facial plastic surgeon adopt principles to help prevent complications.     

A computer-based method of filing photographs and procedures

Careful preoperative and postoperative photographs are an essential part of facial plastic surgery for medical and legal documentation, publication, patient education, and lectures. Computers play an increasing role in many aspects of the medical practice. A method of filing photographs and procedures and a related data base system allows rapid access by multiple factors, including name, procedure, age, surgeon, assistants, anesthetic, complications, dates of all photographs, multiple procedure subheadings, and so on. Additional variables can be added as a date base for analysis of operation results and postoperative recall of patients. This system is based on a personal computer (IBM-PC Computer) and readily available software. The system allow simple entry and retrieval of photographs on any of the multiple variables. We found it to be a superb adjunct to photography in facial plastic and reconstructive surgery.     

Blepharoplastik und Brauenlift

Upper eyelid blepharoplasty is one of the most common procedures in facial plastic surgery (in 2011 second place in the annual statistics of the American Association of Facial Plastic and Reconstructive Surgeons, AAFPRS). Nowadays, a simple resection of the excess skin is ineffectual if the aim is to achieve an optimal functional and aesthetic result. According to the treatment of the upper eyelid the surgeon has to examine and possibly treat the position of the eyebrow in order to correctly estimate the amount of excess skin of the eyelid. This article presents the state of the art techniques of surgical correction of dermatochalasis of the upper eyelids and eyebrow ptosis and clinical examples are demonstrated.     

The ideal tissue adhesive in facial plastic and reconstructive surgery

In this paper we have reviewed cutaneous wound closure in facial plastic and reconstructive surgery using two different tissue adhesives: (1) Fibrin glue (Tisseel), and (2) N-butyl-2-Cyanoacrylate (Histoacryl Blue). Fibrin glue was used on 23 patients: eight lower blepharoplasties, eight hemi-facelifts, five mid browlifts and seven facial reconstructive procedures. Histoacryl glue was used in 108 blepharoplasty incisions, 30 facelift incisions, 21 submental incisions for liposuction, and 19 local flaps for facial reconstructive procedures. Comparison was made of the adequacy of bonding, cosmetic result of the incision, ease of use and cost. The results of our experience with tissue adhesives indicate the use of fibrin glue mainly on the undersurface of flaps. We think histoacryl glue is the ideal tissue adhesive for surface cutaneous wound closure in regards to safety, reliability, tensile strength and cost effectiveness.     

Maxillofacial prosthesis, fixation by endo-osseous implants and transcutaneous pillars]

Osseointegrated facial prostheses are an interesting solution in maxillo-facial rehabilitation when reconstructive plastic surgery is not envisageable. Authors report two cases and give their opinion on the use of this kind of prostheses.     

Update on botulinum toxin use in facial plastic and head and neck surgery

PURPOSE OF REVIEW: The purpose of this review is to discuss current trends in the medicinal use of botulinum toxin in head and neck and facial plastic surgery. The basic science of botulinum toxin is presented along with a comparison of the subtypes currently available on the market. Site-specific applications of botulinum toxin in the head and neck region are presented. RECENT FINDINGS: The use of botulinum toxin continues to expand, both in volume and in number of applications. The main application of botulinum toxin in facial plastic surgery is in the effacement of dynamic or hyperkinetic facial lines. The granting of US Food and Drug Administration approval for the use of Botulinum Toxin type A in the treatment of glabella lines marks a major milestone for the more widespread usage of this product in cosmetic settings. Additional cosmetic applications include crow's feet, marionette lines, and platysma banding. Noncosmetic applications in the head and neck include dystonias (including torticollis), facial and generalized muscle spasms, migraine headaches, hyperhidrosis, spasmodic dysphonia, sialorrhea, gustatory sweating, and involuntary movement disorders. SUMMARY: The use of botulinum toxin in the treatment of hyperkinetic conditions and disorders of excessive salivation is well established and enjoys an excellent safety profile. The cosmetic use of botulinum toxin continues to expand. The chronic use of botulinum toxin specifically for cosmetic purposes is worthy of additional study.     

Local anaesthesia for middle ear surgery

Thirty-two consecutive patients undergoing middle ear surgery using local anaesthesia were assessed on the adequacy of anaesthesia for their surgery, both by the patients themselves, and by the surgeon. A method of local anaesthesia is described which includes the possibility of inducing an iatrogenic transient homolateral facial weakness in order to simplify the technique of administration of anaesthesia. Both the surgeon and the patients were happy with the quality of the anaesthesia, and no adverse effects occurred either as a consequence of the local anaesthesia itself, or of the transient facial weakness.     

Update on lasers in facial plastic surgery

PURPOSE OF REVIEW: Since the theory of selective photothermolysis was described, the field of facial plastic surgery has advanced the science behind laser: tissue interactions. Particular advances in skin cooling, hair removal, intense pulsed light, and uses for aesthetic and nonaesthetic skin problems are described in this review. RECENT FINDINGS: Continued basic science research in lasers has led to improvements in current technology available to the facial plastic surgeon. Advances in skin cooling have allowed for wider use in all Fitzpatrick skin types without concomitant adverse reaction. SUMMARY: Our understanding of laser science continues to expand our knowledge in basic laser: tissue interaction. An improvement in various laser mediums and adjunctive devices provides the facial plastic surgeon with instruments to treat a wider patient population. The benefit is a successful clinical and aesthetic result with improved safety.