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Most changes that occur in the aging face are related to gravity working on skin that is becoming progressively thinner, drier, and less elastic. Exposure to sunlight hastens these changes, and protection from the sun is the only proved way to delay them. Dermabrasion, chemabrasion, and collagen implant (Zyderm) injection are safe and effective nonsurgical procedures that can improve the appearance of the aging face. Plastic surgical procedures to remove excess skin at the upper eyelids, raise the eyebrows, tighten the lower lids, and elevate the nasal tip can provide functional as well as cosmetic improvement.

Introduction The management of aging facial skin by the mere removal of the redundant tissue (face-lift operation), as described in (face-lift books and journals, resolves only half of the problem. Our experience has proved to us that no operation limited to the excision or movement of skin en masse can efface the wrinkles over the forehead, glabella, nasolabial region, and around the mouth, chin, and neck despite the most radical undermining (even down to the clavicle). The other half of the problem—the removal of the wrinkles (rhytidectomy)—is equally important but has received little or no attention in the literature. If the result is to be acceptable, both procedures must be carried out simultaneously. This one may prove for himself 29 by making a drawing of an aged person and blocking out the redundant tissue. The age is still betrayed by the remaining wrinkles. Conversely, if the wrinkles only are removed

Zyderm, the trade name for injectable liquid collagen that was developed at Stamford University, is now marketed by the Collagen Corporation, which obtained approval by the Food and Drug Administration in July 1981. This material has only become available since March 1982, in countries outside the United States, although the author was fortunate in having the material made available to him. The technique, application, and relatively short-term results of Zyderm use in the aging face are reported here.

• Collagen implants (Zyderm) have found extensive applications in the adjunctive management of the aging face and in the primary treatment of cutaneous defects resulting from acne, trauma, or prior surgery. Our initial clinical experience from 1979 to 1982 involving more than 300 patients is analyzed for treatment efficacy, duration, and untoward responses. A majority of our patients are clearly pleased. Likewise, our confidence has increased as our experience evolved. Positive skin tests number 3.5% and delayed hypersensitivity reactions 1.3%. We have found injectable collagen relatively easy to use as well as safe and effective. Further research may enable prolonged results. (Arch Otolaryngol1984;110:93-98)

An approach to the aging face based upon an analysis of surgical principles and dynamics is presented. This approach emphasizes that the face-lift operation should be directed toward areas in which its potential for improvement is greatest, that is, the jowl and neck. Correction of associated manifestations of aging is best accomplished using ancillary procedures specifically designed for rejuvenating these areas rather than by extension of the face-lift operation per se.

Most patients seeking esthetic surgery are female. Most surgeons performing it are male. These facts reflect the present status and attitudes of women and, conversely, of men in our society.2,19 Our culture places a higher value on the attractive appearance of the female than on the male; and the female, deprived of the many sources of gratification available to the male, has learned to use and value her body, consciously and unconsciously, to please herself and/or others. This behavior is rewarded and is perpetuated and reinforced throughout her life by such acts as using makeup, adopting hair and clothing styles, and keeping “young and trim.”

• The concept of total facial rejuvenation requires attention to all areas of the face, including the upper third. Recently there has been a resurgence of interest in this area of the aging face. Various clinical conditions may be seen as a single entity or in combination with others, and it is important for the facial aesthetic surgeon to diagnose and treat these conditions. The conditions first observed, diagnosis, and conventional surgical remedies are reviewed in an attempt to clarify the rationale for forehead liftvtemple liftvbrowpexyvupper blepharoplasty. Mid-forehead glabellaplasty (vertical and longitudinal), browpexy, and rhytidectomy are analyzed in depth, as well as the indications, contraindications, technique, and results. (Arch Otolaryngol1982;108:732-734)

Rhytidectomy or face-lift is an operation designed to remove facial wrinkles. Most often, it is performed in conjunction with other facial procedures, such as brow-lifts, blepharoplasty, and submental liposuction, for complete rejuvenation of the aging face. The recent surge of interest in cosmetic surgery has prompted more patients to inquire about and undergo a face-lift operation. Careful preoperative selection of patients is extremely important in achieving a successful outcome. At the Mayo Clinic, most facial cosmetic surgical procedures performed by the Department of Otorhinolaryngology are done on an outpatient basis. A combination of local anesthesia and intravenous sedation provides excellent patient tolerance and comfort both intraoperatively and postoperatively. Treatment involving the superficial musculoaponeurotic system is used for those patients who require additional underlying support and definition of the facial contour. Postoperative recovery is routinely uneventful. Complications of face-lift surgery are rarely encountered. Case reports are presented to illustrate the representative postoperative results.

• The "nose-lift" procedure offers a simple technique for correction of the sagging tip of the aging nose. With careful patient selection, the procedure offers a valuable adjunct to an aging-face surgical program. (Arch Otolaryngol104:1-3, 1978)

Observations of worldwide attitudes toward the increasing problems of aging are presented. In a brief preliminary summary report on the postoperative clinical, physical, and psychological results in a group of 86 individuals who came for consultation for a regional or total rhytidectomy, it is emphasized that the patients not only obtained improvements in their external appearance as well as their expressions and functional activity, but soon came to request a full “health and appearance program.” From the psychologic standpoint, plastic surgeons are now challenging their patients to help themselves in such an overall program to forestall the effects of aging.

It appears that we are being continually inundated with treatises on cosmetic surgery. This book is simply one more among the recent onslaught of texts on aesthetic surgery of the face. Using sequential black-and-white photographs of actual subjects, the authors attempt to demonstrate the techniques they employ in the use of common aesthetic procedures. In general, these photographs succeed quite well, some better than others. The photographs were generally of good quality, but the great majority of them were superfluous. More than half of these photographs could have been eliminated without detracting from the book's value, especially those showing the authors and their pretty nurses in various poses. Frequently, the same photograph is shown four or five times. The chapter on blepharoplasty is well presented. The description of the skin muscle flap is excellent. The author mentioned the skin flap briefly. I find this method very useful for heavily wrinkled

The Aging Face and Neck is a book that utilizes an unusual format to describe the clinical practices of experienced cosmetic surgeons. The editors selected a group of cosmetic surgeons and sent them a set of detailed illustrations demonstrating the clinical stages of the aging face and neck. These illustrations were accompanied by a list of specific questions regarding clinical and personal methods used in a cosmetic surgery practice. The questions dealt with such subjects as initial patient evaluation, patient personalities, and coping with complications. Other areas specifically addressed included patient-physician fee discussions, the appropriate place for professional courtesy, and practical business matters relating to a cosmetic practice. The editors also supplied their own answers to the question list to prompt discussion and to bring out differences among the authors. The answers provided by the authors, who span the specialties of otolaryngology-head and neck surgery, plastic surgery, dermatology, and general

This book represents the published proceedings of the November 1976 symposium of the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons and the American Society for Plastic Surgery. The two editors have carefully organized the material from this symposium into a useful reference textbook that discusses, with the benefit of 296 illustrations, rhytidectomy, regional lifts, blepharoplasty, and the use of cosmetics and dermabrasion. An abstraction of the panel discussion that followed each of the major topics includes commentary by such notable authors as Thomas D. Rees, MD, D. Ralph Millard, Jr, MD, and Thomas J. Baker, MD. These commentaries are perhaps the most valuable aspect of this book. Jack H. Sheen's presentation of modifications of his earlier technique for supratarsal fixation in upper blepharoplasty is perhaps the most complete discussion of a contemporary topic presented in this volume. In summary, this book represents knowledgeable commentary by

Renowned for his operative surgical technique and surgical thinking, Professor Tord Skoog's book fulfills the highest expectations and sets new standards in medical publishing. This is not an ordinary textbook of plastic surgery, but rather chapters on the following problems toward whose solutions the author has made singular advances: cleft lip and palate; regeneration of periosteum, bone, and cartilage; rhinoplasty; correction of prominent ears; surgery for the aging face; breast hypertrophy; inverted nipples; axillary hyperhydrosis; syndactyly; Dupuytren contracture. In essence, his book is his surgical summary. The format is esthetically magnificent, and the text is insightful and authoritative. The 701 colored plates and the black and white drawings are the best that I have ever seen in any 20th century medical or surgical publication. What we have here is an extraordinary union of surgical science and art, which goes far beyond even the category of "excellent." The reader need not

As the American Academy of Facial Plastic and Reconstructive Surgery celebrates its 25th year, it is only fitting that the theme of the 1989 Aging Face course will be the long-term result. Procedures done five to 25 years ago will be presented and compared with present-day techniques in order to learn how and why specific treatments have stood the test of time. Similarly, new procedures of the 1980s will be presented and evaluated. The faculty consists of facial plastic surgeons who have established themselves as leaders in our specialty. Panel discussions, didactic lectures, break-out sessions, and edited videotapes of surgery will provide an opportunity for close interaction between the registrants and the faculty. The course will be held at the five-star Breakers Hotel, Palm Beach, Fla, during the height of the season. The ambience of the Breakers, as well as the Island of Palm Beach, will provide a perfect setting

This two-volume set is a compilation of the reports presented at the Second International Symposium on Plastic and Reconstructive Surgery of the Face and Neck, held in Chicago in 1975. As the presentations were divided into "aesthetic" and "rehabilitative," so also are the two volumes titled. Volume 1, Aesthetic Surgery , is composed of 229 pages, over half of which deal with rhinoplasty. This section begins with two excellent panel discussions of rhinoplasty in which experts give their analyses and corrective techniques for problem noses. Fourteen individual reports then deal with specific techniques and problem areas, such as maintaining nasal tip projection, surgery of the aging nose, and the cleft-lip nose. This section, like the rest of the book, is profusely and clearly illustrated. The second section in volume 1 includes eight papers dealing with face lift and associated procedures, and a panel on the aging face. Another section deals with

The first in a series of symposia devoted to an in-depth study of aesthetic surgery is concerned with three anatomic areas, the breast, face, and eyelids. There has been no attempt to detail all the methods of surgical management; as the senior editor says, the book tries to present accepted standards and time-proved procedures that the plastic surgeon can use like building blocks in constructing his own approach to this particular area. The more than three dozen authors have done just that. Much of the technical material will, of course, find a limited audience. On the other hand, several chapters should interest the general medical reader. For example, chapter 1 discusses "Psychological Aspects of Aesthetic Surgery" in a brief, concise manner, adding a complete bibliography of enticing publications on the subject. Historical chapters on surgery of the aging face, neck, and eyelid, and on mammoplasty will prove equally interesting. In