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The horizontal neck lift is a procedure involving direct excision of a horizontally oriented ellipse of skin from the neck. This procedure was developed for neck rejuvenation in patients with significant horizontal creases and excess skin of the middle and lower neck, areas that often cannot be adequately addressed with traditional techniques. This article describes the procedure, indications, patient counseling, and postoperative care in detail from the senior author's (H. M.) experience.

The aging face results in increase in laxity of the skin and the underlying supporting tissue. There is a fundamental volume loss in the face and it is most apparent in the midface. A traditional superficial musculoaponeurotic system (SMAS) rhytidectomy addresses the laxity of the face but not volume loss. Multivector high SMAS plication allows for natural excess tissue to be placed into the area of volume loss, thereby addressing midface volume loss. This technique is easy to perform, reproducible, and effective with the added benefit of helping to volumize the lower face.

The prejowl sulcus is a complex anatomic structure that results from several age-related changes in the lower face. These changes include the localized atrophy of a segment of the mandible inferior to the mental foreman, fat atrophy, and dehiscence and laxity of the ligamentous and muscular components of the region. The correction of the prejowl sulcus is rarely accomplished through rhytidectomy alone. Instead, the volume deficit of the sulcus usually requires the replacement of volume. Solid implants, fillers, and fat transfer may be used to improve the contour of the lower face. These can be used in isolation and in conjunction with rhytidectomy. The decision of what method to be used depends on the severity of the deformity, the patient's adjacent anatomy, the patient's wishes, and the skill set of the surgeon.

This article addresses the use of fractionated CO(2) laser and erbium:YAG laser for facial rejuvenation. Outcomes and limitations of these techniques are discussed, along with a stepwise summary of techniques as they are used in clinical practice. An evaluation of patient satisfaction is presented for a group of patients who underwent combined fractional CO(2) and erbium:YAG facial resurfacing.

No nonsurgical technique can come close to rejuvenating the face like a cervicofacial rhytidectomy. However, one of the most difficult areas to improve during a facelift is the midface. The multi-vector high superficial musculoaponeurotic system (SMAS) facelift and extended lower-lid midface lift are important techniques that can adequately address the midface during rhytidectomy. The multi-vector high SMAS facelift is a natural extension of a traditional SMAS plication or imbrication facelift. The extended lower-lid midface lift can be an important adjunct during a facelift or as an independent procedure to address the midface.

The carbon dioxide (CO 2 ), potassium titanyl phosphate (KTP), and sapphire sculptured-tip neodymium:yttrium-aluminum-garnet (Nd: YAG) lasers have been shown to be very useful for performing blepharoplasty. The controversy that remains regarding the use of lasers for a common, longstanding procedure such as upper and lower lid blepharoplasty revolves around their advantages and disadvantages when compared with conventional techniques, which are augmented in their effectiveness and hemostatic qualities by using fine insulated needle tips on a number of cautery or radiosurgery units. Many surgeons who have used lasers for blepharoplasty as well as the hemostatic capabilities of insulated needle tip radiosurgery devices see little difference in the hemostatic capabilities of these two modalities. Other surgeons cite the advantages of the laser in creating hemostasis and minimizing postoperative morbidity. In the end, each surgeon must determine what works best in his or her hands and provides the patient with the best result with the least amount of risk. Individuals interested in cosmetic surgery frequently are impressed by the use of high-technology devices such as lasers, assuming that the results will be better with the use of lasers. Certainly, the marketing advantage of using the laser for blepharoplasty is a consideration in choosing the instrumentation for this procedure.

The aging forehead and brow are an important aspect of facial rejuvenation. While there are many techniques in brow rejuvenation, both nonsurgical and surgical, there is no consensus on an optimal technique. With advances in technology, endoscopic brow lifts initially became very popular at the expense of open techniques. With longer term patient follow-up, dissatisfaction with predictability and longevity of results has caused resurgence in the open approaches. The Mid-Forehead Buttonhole Technique was developed for more accurate eyebrow elevation with better reliability than endoscopic techniques with less morbidity and recovery than more traditional open techniques. The incision is made over the lateral aspect of the brow and placed within a horizontal skin crease. Subcutaneous undermining allows access to the orbicularis oculi muscle. This is elevated with a modified purse-string suture which is secured to the frontal bone periosteum. An ellipse of skin is usually excised concurrently. The incision is meticulously closed to minimize any visible scarring.

Many patients seeking facial rejuvenation report concerns regarding neck skin laxity manifesting as the classic “turkey waddle,” platysmal banding, and deep horizontal neck lines as a top priority. Standard face/neck lift procedures coupled with submentoplasty can effect great improvements in the upper neck and cervicomental angle in the large majority of patients. Nonetheless, in some patients, especially those with pronounced lower neck vertical banding and/or horizontal pleating and deep lines, additional procedures may be beneficial. The pathophysiology of the aging neck, evaluation of the aging neck, and surgical technique selection are discussed. The choice of treatment options, especially surgical options, needs to be tailored to the individual and depend on the patient’s physical findings. The various techniques are described.

Using just a small number of alloplastic extended mandibular implants can fulfill more than 95% of the needs of the facial plastic surgeon in chin and prejowl augmentation to restore balance to a patient's jawline. Current chin implants are artistically designed to impart good form and fit and give significant improvement for a somewhat uncomplicated procedure.

Ten patients underwent upper eyelid blepharoplasty using the carbon dioxide laser on one eyelid and a conventional technique on the other. Administrative factors, safety considerations, ease of procedure, and short- and long-term results were evaluated. The carbon dioxide laser added considerable ad

The purpose of this study is to evaluate the safety and effectiveness of the New Star Model 130 neodymium:yttrium aluminum garnet (Nd:YAG) laser system for nonablative laser treatment of facial rhytides (e.g., periorbital wrinkles). Facial rhytides are treated with 1.32 micrometer wavelength laser light delivered through a fiberoptic handpiece into a 5 mm diameter spot using three 300 microsecond duration pulses at 100 Hz pulse repetition frequency and pulse radiant exposures extending up to 12 J/cm2. Dynamic cooling is used to cool the epidermis selectively prior to laser treatment; animal histology experiments confirm that dynamic cooling combined with nonablative laser heating protects the epidermis and selectively injures the dermis. In the human clinical study, immediately post-treatment, treated sites exhibit mild erythema and, in a few cases, edema or small blisters. There are no long-term complications such as marked dyspigmentation and persistent erythema that are commonly observed following ablative laser skin resurfacing. Preliminary results indicate that the severity of facial rhytides has been reduced, but long-term follow-up examinations are needed to quantify the reduction. The mechanism of action of this nonablative laser treatment modality may involve dermal wound healing that leads to long- term synthesis of new collagen and extracellular matrix material. ©2005 Copyright SPIE - The International Society for Optical Engineering.

The purpose of this study is to evaluate the safety and effectiveness of nonablative laser treatment of facial rhytides (e.g., periorbital wrinkles) using the New Star Model 130 Nd:YAG laser system. Previous ablative laser skin resurfacing (LSR) using, for example, a pulsed or scanned CO2 laser has been accompanied by complications such as persistent erythema, dyspigmentation, scarring, and infection. A nonablative laser modality may be effective in reducing both the severity of wrinkles and the incidence of morbidity presently associated with LSR.

Mouse heteroploid fibroblasts were grown nine future generations in vitro tissue culture. The cells were exposed to argon laser, CO2 laser, and x-ray. Results of scoring for mangnant transformation foci were tabulated and compared. Lasers did not produce a significant malignant transformation. Clinical laser use is reviewed and histology as well as long-term clinical experience confirms the safety of lasers.

This chapter is intended to provide general guidelines, suggestions, and resource information for consideration in evaluating, planning, implementing, and maintaining an effective Laser Program. It is hoped by the authors that the information, in whole or in part, will be relevant for facilities considering the feasibility of a Laser Program, those in the process of initiating a Program, as well as for facilities seeking to revise or expand their present approach.

• One of the possible disadvantages of tip rhinoplasty with the use of a cartilagesplitting incision technique is the inability to attain nasal tip symmetry in a few patients. Surgeons occasionally make an error in judgment on the amount of lateral crura to be removed and the amount of lateral crura to remain. A technique of marking the desired positions of the lateral crura on the external nose and viewing those positions in the nasal vestibule has been developed. This technique provides greater consistency in attaining better results of tip rhinoplasty with good symmetry when the surgeon chooses to use this cartilage-splitting technique. ( Arch Otolaryngol 1981;107:425-427)

SINCE its introduction in 1948, medical opinion concerning the use of chloramphenicol has fluctuated considerably. However, from 1953 to 1963, this wide spectrum bacteriostatic antibiotic had enjoyed better than a fivefold increase in usage. This was attributed largely to a greater understanding of its hematopoietic reactions and to an increased awareness of the precautions necessary to minimize such complications. Since that time, safer antibiotics with an effective spectrum, somewhat more limited than that of chloramphenicol, have been introduced and have gained popularity, although chloramphenicol is still widely used. Because of its wide spectrum, chloramphenicol has been used systemically by otologists for some resistant cases of otitis media and mastoiditis and postoperatively following tympanomastoid and fenestration operations. Although the drug is often effective systemically in acute infections, many otologists empirically found it to be more effective when applied topically in the middle ear in cases of chronic refractory otitis media and

The use of dermal implants for improving acne scarring and facial rhytids has increased dramatically in the last ten years. The introduction of, and experience with, collagen dermal implants during that period has played a great role in this increased popularity. Dermal implants are now an adjunct to facial rejuvenation surgical procedures, and to the improvement of depressed cutaneous scars. In March 1988, a new dermal implant (Fibrel) was approved by the US Food and Drug Administration for use in the elevation of depressed cutaneous scars. Fibrel is a gelatin matrix implant consisting of absorbable gelatin powder and aminocaproic acid, which is reconstituted with the patient's plasma before being injected intradermally beneath the scar. A total of 321 patients were evaluated after a skin sensitivity test; 2% had positive skin reactions. Eight hundred forty scars were treated with Fibrel implant material and followed up for approximately one year. About 6%