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Introduction: Crows' feet wrinkles are caused by the action of the orbicularis oculi muscle on overlying skin. Treatment options range from botulinum toxin to a multitude of surgical methods. We first described our technique in 2003 and refined it in 2006. We highlight the evolution of our technique and look at our results to assess the effectiveness of our technique., Objective: The aim of this article is to show our experience of 13 years in 134 patients with our technique of orbicularis oculi myectomy., Methods: From September 2000 to July 2013, we operated on 134 patients with an age range of 28-77 years. Of these patients, 104 had myectomies via lifting and 22 via a blepharoplasty approach. Five patients had myectomies for treatment of blepharospasm and a further three patients to restore symmetry in facial palsy. An evaluation of the results was performed by two medical students., Results: Our results showed reduction of the wrinkles in all cases. For the statistical analysis the Wilcoxon test was performed. The p value was less than 0.001 showing a significant reduction of crows' feet wrinkles in both sides when the orbicularis myectomy was performed, via blepharoplasty or lifting. For myectomy performed for blepharospasm or facial palsy, the statistical analysis was not done due to the low numbers., Conclusion: In the appropriate patient, orbicularis oculi myectomy is an effective and long-term treatment for crows' feet wrinkles with a low risk of complications and high patient satisfaction., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation., Methods: Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry., Results: There was significant improvement in smile symmetry in 89.5 % of patients., Conclusion: Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .

Background: The goal of mentoplasty is to improve chin projection. Traditionally, this is accomplished by either mandibular osteotomy or alloplastic implants. However, these procedures are not free of complications. This report describes gliding mentoplasty, a novel, simple technique for chin projection., Methods: The 12 patients in this study underwent gliding mentoplasty. By means of a 2-cm intraoral incision, a subcutaneous dissection was made in the caudal direction. The dissection then proceeded in the subperiosteal plane, leaving a 1-cm cuff of muscle attached to the bone, and advanced toward the lower border of the chin. Subsequently, the dissection was extended laterally, and the whole mental area was dissected from the surrounding tissue. Three 2-0 monofilament nylon sutures were placed in the submandibular periosteum and connected through the remaining muscle cuff to the periosteum. These key sutures allowed the submandibular region to slide forward, project the subcutaneous tissue and mentalis muscle, define the labiomental fold, and improve the pogonion projection., Results: Gliding mentoplasty resulted in a symmetric projection of the chin in all cases. In two patients, a submandibular dimple developed, which spontaneously resolved in 1 month. No revision surgery was performed, and no tissue relapse was noted. The mean follow-up period was 24.7 ± 5.17 months (range 19-33 months). All the patients were satisfied with the result., Conclusion: Gliding mentoplasty is a simple, easy-to-perform, rapid surgical technique of chin projection that produces low pain, rapid recovery, and excellent cosmetic results., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .