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For decades, chemical peels have remained a trusted option for treatment of aging facial skin. However, emerging technologies are being adopted by many practitioners who may not have had sufficient opportunity to learn the art of chemical peeling. Properly performed peels can improve the condition of the skin, are less expensive than light-based machines, and exfoliate the skin without the thermal damage associated with light-based machines. This article presents a new variation of a trusted method, using a series of low-strength trichloroacetic acid peels and proper skin preparation that is cost-effective and produces excellent results in selected patients.

Juvenile rheumatoid arthritis (JRA), now termed juvenile idiopathic arthritis (JIA), is a well-described group of arthritides in the pediatric population with known associations with airway compromise. Subclasses are based on associated symptoms and number of joints involved, namely pauciarticular, polyarticular, and systemic onset JRA. Cricoarytenoid arthritis (CA), as a cause of airway compromise, is rarely associated with JRA as compared to adult onset rheumatoid arthritis, however, there are reports of CA with JRA. Additionally, JRA is associated with other rheumatologic diseases, which include a reported case of Wegener's granulomatosis. Wegener's granulomatosis has a well-established association with subglottic stenosis. Described below is the case study of an 18 year-old African American female with a 5-year history of pauciarticular juvenile rheumatoid arthritis developed worsening shortness of breath, orthopnea, and stridor over a 1-month period. The patient had a firm circumferential subglottic mass obstructing approximately 80% of the lumen and requiring tracheostomy tube placement. Biopsies of the mass revealed only acute and chronic inflammation. There was no evidence of rheumatoid nodules, granulomas, acid fast, or fungal organisms. To our knowledge, this is the first case history reported of a patient with JRA and idiopathic subglottic stenosis; this potentially establishes an association between the two disease processes.

Background: Many techniques have been presented over recent decades to address the neck contour in facial rejuvenation surgery. Despite advances, limitations remain when dealing with the obtuse cervical angle. Objective: The authors describe a technique for improving the obtuse cervicomental angle. Methods: The authors reviewed the charts of 295 patients who underwent the authors' submental muscular medialization and suspension (SMMS) technique to improve their neck contour, either alone or in combination with a facelift, between January 1, 2001, and December 30, 2003. The technique medializes and suspends the medial free edges of the platysma muscle and, when anatomy dictates, the anterior bellies of the digastric muscle to the deeper mylohyoid muscle. Results: Eighty-seven (30.5%) of the 285 facelift patients examined underwent SMMS, and 10 additional patients underwent isolated SMMS. No patient required reoperation for hemostasis or evacuation. Three (1.05%) of the facelift with SMMS patients required reoperation for dehiscence of the submental suspension. None of the isolated SMMS patients had muscular suspension dehiscence or required reoperation. Seven (2.4%) patients (5 with SMMS and 2 without SMMS) with excessive facial and cervical tissue preoperatively developed a small amount of postoperative submental skin redundancy and subsequently underwent submental skin excision at 1 year postoperatively. Conclusions: Submental muscular medialization and suspension is a simple yet highly effective surgical technique that can result in dramatic and enduring improvement in the cervicomental angle. Level of Evidence: 4 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

This article presents a review of the contribution of the periorbital musculature and brow depressors to the overall brow aesthetics. Special focus is given to the role of transblepharoplasty brow lift as well as myotomy of the corrugator and procerus muscles. The authors' preferred surgical technique and patient results are reviewed in detail.

Objective: Postirradiation gustatory dysfunction (PIGD), which may cause malnutrition, is common in patients with head/neck cancer undergoing radiation therapy (XRT). Synsepalum dulcificum (miracle fruit) changes taste transduction mechanisms of certain substances. This investigation addresses whether S dulcificum can improve PIGD and result in weight augmentation in head/neck cancer patients.Method: Sixteen patients meeting criteria were separated into 2 groups based on timing after XRT. In a double-blind randomized fashion, patients were assigned miracle fruit or placebo. A series of taste batteries/questionnaires were performed. Patients were given a 1-month supply of test substance. We measured pre- and posttrial weight.Results: Fifty-four percent of patients subjectively reported that sweet tastes were most adversely affected by XRT; however, objectively all patients correctly identified sweet tastes while 30% of patients answered sour tastes incorrectly. The majority of patients in both groups had a...

Objective: Resection of basal cell carcinoma (BCCA) from a background of advanced rhinophyma can present a reconstructive challenge, thus a novel surgical treatment option is presented. Report a case of concurrent rhinophyma and BCCA, review the literature, and discuss surgical options available.Method: A review of the literature reveals only 12 reported cases of concurrent BCCA and rhinophyma since 1955, all describing occult discovery of BCCA. This is the first reported case of known BCCA complicated by rhinophyma.Results: The traditional repair options after excision of BCCA from the nasal tip include healing by secondary intention, skin grafting, and local flap rotation. In patients with rhinophyma, these options are less than ideal. As a novel alternative, wide local excision of the lesion with intra-operative frozen section margin control was carried out, followed by single-stage tangential excision and dermabrasion of the nasal skin involved with rhinophyma. Negative margins were obtained, symmetry...

Since the early 2000s, studies have shown that the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections in the pediatric population has been increasing. Moreover, studies also have indicated a trend toward increased resistance to commonly used antibiotics over time. However, few studies have specifically focused on such trends in pediatric neck abscesses. We undertook a retrospective study of 109 patients to compare the incidence of pediatric neck abscesses caused by MRSA during two separate 5-year periods at Children's Hospital of New Orleans in an attempt to determine if the incidence was indeed increasing. We also analyzed differences in MRSA susceptibility to various antibiotics over the same two time periods-January 1997 through December 2001 (n = 22) and January 2002 through December 2006 (n = 87). We found a statistically significant increase in the incidence of MRSA between the first 5-year period and the second-from 25 to 70.3% (p = 0.0388). We did not find any significant difference in antibiotic susceptibility patterns between the two 5-year periods.