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Biomedical subjects

F M Kamer

Publications and source records attributed to F M Kamer.

At least 19 recordsLinked to original sources
PubMed2001

Surgical treatment of the aging neck.

To obtain consistently successful results, surgical treatment of the aging neck must be based upon a comprehensive anatomic diagnosis, using an appropriate sense of cervicofacial aesthetics and taking into account the relative contributions of each structural component of the deformity. The degree to which the projection and contour of the anterior mandible, redundancy of cervical skin, presence of excess submental fat, hyoid bone position, and configuration of the platysma muscles affect the appearance of the neck should be determined preoperatively to develop an effective surgical plan. Experience has shown that extensive incisions in the region of the anterior neck and transection of the platysma should be avoided. Depending upon the specific findings, any combination of a group of procedures may be required, including cervical rhytidectomy, submental suction-assisted lipectomy, chin augmentation, and midline imbrication of the platysma muscles. The indications, limitations, and possible complications of each procedure are described, and some technical considerations are discussed.

Aging↗
PubMed1998

Chemical browlift.

OBJECTIVE: To determine if the medial brow can be elevated following administration of botulinum toxin type A (Botox, Allergan, Irvine, Calif). DESIGN: A before-after interventional study comparing pretreatment and posttreatment brow height. Objective measurements and subjective comparisons of pretreatment and posttreatment slides were made by 7 independent observers unaware of treatment status. All measurements and observations were based on standardized photographs taken with identical lens settings. SETTING: Private facial plastic surgery practice. All injections were performed in office examination rooms without anesthesia or sedation. PATIENTS: Thirty adult patients electively seeking improvement of glabellar frown lines or low-positioned medial brows (angry appearance). INTERVENTION: Twenty units of botulinum toxin type A was injected into the corrugator supercilli and procerus muscles. An electromyographic needle was used for the initial 10 injections, and a 30-gauge needle was used for the remainder. OUTCOME MEASURES: In the objective arm, change in brow height was measured from the medial canthus and midpupil directly vertical to the brow hairs; the change in interbrow distance was also measured. In the subjective arm, the number of patients who were found to have an elevated medial brow by the independent observers was noted. Objective and subjective findings were correlated. RESULTS: Objective measurements yielded a raise in the medial brow in 8 (32%) of 25 patients from the medial canthus and in 12 (48%) of 25 from the midpupil and an increase in interbrow distance in 17 (59%) of 29 patients. Subjective comparison found 18 (62%) of the 29 patients to have higher medial brows after treatment. CONCLUSIONS: Botulinum toxin type A treatment can create a chemical browlift. Further studies with more specific selection criteria are needed to better evaluate this effect.

Adult↗
PubMed1998

SMAS rhytidectomy versus deep plane rhytidectomy: an objective comparison.

Although there are a multitude of techniques currently used for performing face lifts, there is no general agreement as to which, if any, of these techniques is most effective. There may never be a definitive answer to this issue because of the highly subjective nature of aesthetics, variability among surgeons, differences in patient anatomy, and specific patient desires. In an attempt to evaluate face lift techniques objectively, this study compares the rate of patients undergoing a tuck procedure after traditional SMAS (superficial musculoaponeurotic system) rhytidectomy to that of patients after deep plane rhytidectomy. A retrospective chart review was performed on all patients who underwent a tuck procedure following a face lift by the senior author (Kamer) between July of 1990 and January of 1997. There were 634 patients who electively underwent either a SMAS or deep plane type of rhytidectomy during the 6.5-year period; 48 patients subsequently underwent tuck operations, and adequate information was available on 44 patients. Of these, 43 were women and the average age was 57 years. The overall tuck rate from July of 1990 to January of 1997 was 7.5 percent. The tuck rate following SMAS rhytidectomy was 11.4 percent, and that following deep plane rhytidectomy was 3.3 percent. Therefore, a tuck was required 71 percent less frequently after a deep plane lift than after a SMAS lift. This was found to be a statistically significant difference with a p value of .0001 (Fisher's exact test, 2-tail). If the assumption is made that the need for a tuck procedure implies a less than optimal face lift, then the data of this study suggest that the deep plane technique is more effective than the SMAS technique.

Esthetics↗
PubMed1997

Isolated submentoplasty. A limited approach to the aging neck.

OBJECTIVE: To evaluate the application of a limited submentoplasty for improving the aesthetics of the cervical region. DESIGN: Retrospective analysis. SETTING: Private facial plastic surgery practice. All procedures were performed at an ambulatory surgical facility on an outpatient basis. PATIENTS: Forty patients (36 women and 4 men) ranging from 37 to 68 years of age with a mean age of 52 years. Surgical procedures were performed over a 4-year period and follow-up ranged from 3 months to 3.5 years with a mean follow-up of 1.2 years. INTERVENTION: Isolated submentoplasty operations performed by the senior surgeon (F.M.K.) over a 4-year period. OUTCOME MEASURES: Aesthetic appearance of the neck as determined by comparison of preoperative and postoperative physical examinations and photographs, subjective patient responses, and chart reviews to determine complications. RESULTS: Eighty percent success rate and 10% complication rate, with these complications being minor and easily correctable. CONCLUSION: Isolated submentoplasty is a viable option for correction of cervical deformities in selected patients.

Adult↗
PubMed1997

The effect of blepharoplasty on eyebrow position.

OBJECTIVE: To determine if upper eyelid blepharoplasty causes eyebrow position to drop in a cosmetic surgery population. DESIGN: Retrospective, observational study. A treatment group that underwent upper eyelid blepharoplasty was compared with a matched control group that did not undergo the surgery. SETTING: Private facial plastic surgery practice. All surgery was performed at an ambulatory surgical facility on an outpatient basis. PATIENTS: A total of 82 patients (164 eyes) were included in this study: 54 (8 men and 46 women; average age, 46.8 years) in the treatment group and 28 (6 men and 22 women; average age, 43.8 years) in the control group. The treatment group was chosen in a retrospective fashion to include only those patients (1) for whom preoperative and postoperative photographs were available and (2) who had undergone upper eyelid blepharoplasty by the senior author (F.M.K). These patients underwent no other procedures, either before or during the time span between the photographs, that could affect eyebrow position. The control group consisted of patients who had an available set of matching photographs taken over time. These patients did not undergo blepharoplasty or any other procedure that could alter eyebrow position between their initial and final photographs. INTERVENTION: Upper eyelid blepharoplasty performed by the senior surgeon (F.M.K.). The surgical technique was identical in all cases. OUTCOME MEASURE: The change in eyebrow height reflected as a percentage of the pretreatment height. Results are based on measurements taken from standardized photographs. RESULTS: Original treatment and control groups of 108 and 56 eyes, respectively, were restricted to a smaller number to create similar populations for comparison. Therefore, 40 eyes in the treatment group were matched with 28 eyes in the control group to control for the duration between measurements. A t test found no significant difference (P = .94) in eyebrow height between patients who had a blepharoplasty and those who had not. CONCLUSION: In a cosmetic surgery population, upper eyelid blepharoplasty does not cause a lowering of the eyebrow.

Eyebrows↗
PubMed1996

One hundred consecutive deep plane face-lifts.

A subplaytysmal face-lift technique in a deeper anatomical plane of the face was described in the 1970s. The deep plane rhytidectomy is based on sound anatomical principles of tissue mobilization, advancement, and repair. Wide undermining is accomplished in a subplaytysmal plane and continued, extending over the zygomatic muscle to the melolabial fold. This large compound cheek flap of skin, muscle, and fat is then advanced and tightened to dramatically influence the jowl and melolabial fold. A prospective study was undertaken to evaluate the results of 100 deep plane face-lifts using this technique. Postoperative observations and evaluations were made at 1 week, 1 month, and 6 months. A questionnaire response and photographic analysis were obtained after 6 months. The rate of hematomas was low, with none occurring beneath the thick cheek flap. There were no persistent problems, facial irregularities, paralysis, or paresis. Ninety-seven percent of the patients were pleased with the aesthetic results. In conjunction with wide cervical undermining and an anterior platysmal plication, the deep plane face-lift affords a predictable improvement for the aging face and neck.

Adult↗
PubMed1995

The effect of propofol on hematoma formation in rhytidectomy.

Significant surgical advances in face-lift surgery have evolved over the years, including wider flap undermining, the development of the superficial musculoaponeurotic system as a separate layer, and appropriate platysmal and coronal procedures. These more radical concepts offer improved results, but they may be associated with more complications, the most frequent being hematoma formation. A retrospective study of 386 patients was undertaken over a period of 5 years. Patients were separated into two groups: those that were sedated with a drug combination of diazepam, meperidine hydrochloride, and methohexital sodium; and those sedated with propofol. Patients sedated with propofol were more than twice as likely to develop a hematoma than those sedated with the other drug regimen. Although the hematoma rate with propofol is similar to that reported with other drugs, this increased risk must be carefully considered when one is choosing an anesthetic for rhytidectomy.

Adult↗
PubMed1993

Postoperative platysmal band deformity. A pitfall of submental liposuction.

Submental liposuction is an established advance in treatment of the aging neck. However, its misapplication may result in an aesthetic deformity involving postoperative anterior platysmal banding. To identify preoperative conditions relating to this sequela, we retrospectively analyzed 301 patients treated with submental liposuction. Submental obesity and an anatomic pattern of platysmal nondecussation were found to be significant correlates in the development of postoperative anterior platysmal banding.

Chin↗
PubMed1991

Submental surgery. A graduated approach to the aging neck.

Adequate aesthetic contouring of the aging neck often presents a difficult surgical challenge to the facial plastic surgeon. The apparent failure of the classic rhytidectomy to achieve acceptable results in the submental region has encouraged previous surgeons to develop surgical techniques specifically addressing this area. Definitive procedures were developed to treat the excess skin, fat, or muscle. Aesthetic results have progressively improved with the introduction of liposuction, judicious muscle rearrangement, and more conservative submental skin violation. This article describes our experience with these concepts and presents a useful classification devised to serve as an operative guide in the management of the aging neck.

Adipose Tissue↗
PubMed1991

Preexcision blepharoplasty.

Numerous techniques have been described for lower lid blepharoplasty. Over the past 15 years, a preexcision (pinch) technique with preservation of the pretarsal orbicularis oculi muscle has been used in more than 1000 cases presenting with dermatochalasis and pseudoherniated fat without lateral skin redundancy. The amount of lower lid skin to be excised is estimated by pinching the skin. Preservation of the pretarsal orbicularis oculi muscle adds support to the tarsoligamentous complex. This technique aids in preventing the development of both postoperative ectropion and rounding of the lower lid. Technical considerations of the preexcision (pinch) technique and a description of alternative techniques are outlined. Indications, complications, and patient satisfaction are discussed.

Eyelids↗
PubMed1989

Histoacryl. Its use in aesthetic facial plastic surgery.

Since their discovery in 1949, cyanoacrylates have evoked interest as being a possible ideal "tissue glue." Several different forms of these compounds have been developed in order to try to reduce or eliminate tissue toxicity. Butyl-2-cyanoacrylate (Histoacryl) appears to be the closest ideal material as it induces low tissue reactivity and toxicity. It has been used extensively for middle ear surgery with little or no adverse effects. A historical review of tissue adhesives and a discussion of technical considerations is outlined. A clinical trial of 100 patients treated with Histoacryl on various surgical wounds revealed no significant adverse effects with wound healing, graft rejection, or infection over a six-month period. Histoacryl appears to offer many advantages and few disadvantages over conventional suture techniques.

Conjunctivitis↗
PubMed1988

Revision rhinoplasty. Analysis and treatment.

As rhinoplasty becomes an increasingly popular procedure, the aesthetic expectations of both the facial plastic surgeon and the patient become more discriminating. Thus, the number of revision rhinoplasties increases. Of 697 rhinoplasties performed by the senior author (F.M.K.) during a three-year period, 18% of those procedures were revision surgeries. The senior author was the primary surgeon in 53% of those revision cases. This article presents an analysis of 126 consecutive revision rhinoplasty cases from that period, outlining the major deformities in a clinically meaningful system. Treatment of each problem category is discussed and representative cases are shown. The senior author's own revision rate and observations are discussed and compared with those in the medical literature.

Adolescent↗
PubMed1988

Postrhinoplasty epistaxis. Role of vitamin E?

Postrhinoplasty epistaxis occurred in two patients, both of whom were found to be ingesting megadoses of vitamin E. The rate of vitamin E consumption in a population of 100 uncomplicated nasal operations during this same period was 16%. A review of the medical literature on vitamin E found recent evidence demonstrating a marked decrease in platelet adhesiveness with megadose ingestion of vitamin E. It is concluded that this should be avoided in the perioperative period.

Adult↗
PubMed1987

Minicomposite graft for nasal alar revision.

Auricular composite grafts are being used increasingly for repair of nasal deformities. Most commonly these grafts have been employed to repair alar rim and columellar defects secondary to trauma or tumor resection. A technique for reconstruction of the lateral crural area with auricular minicomposite grafts was used in a series of cases. Results have been satisfactory to alleviate the functional and cosmetic difficulties in patients requiring alar revision.

Adult↗
PubMed1986

The nasal bossa: a complication of rhinoplasty.

A study of 1,033 consecutive rhinoplasties was undertaken to focus on etiology and treatment of nasal bossa. Of the 2% that developed bossa, the only consistent, statistically significant etiology factor was that of preoperative nasal asymmetry. There was no correlation with skin or cartilage characteristics. Those tips requiring alteration by the delivery technique were five times more likely to develop bossa than those treated by cartilage split or retrograde techniques. The surgical dilemma of treatment by either augmentation of the lesser side or resection of the bossa was discussed.

Adult↗
PubMed1985

Median horizontal split tip.

One of the most difficult problems encountered in rhinoplasty is lack of nasal tip projection. An innovative technique is described that utilizes the removal of a median horizontal strip of lower lateral cartilage to enhance projection, while maintaining a natural highlight and tip support without the use of grafts. The indications are limited to noses that have a widened dome requiring removal of a central strip, and tip rotation. Alternate techniques are discussed; cases and results are discussed.

Humans↗
PubMed1985

High frequency needle dissection rhytidectomy.

Fifty consecutive rhytidectomies were performed utilizing high frequency needle dissection on one side and standard sharp dissection on the other for all incisions and flap elevation. The efficacy of this technique in hemostasis, prevention of hematoma, and wound healing is compared to the conventional technique of rhytidectomy. The advantages and disadvantages of the modality are discussed.

Ambulatory Surgical Procedures↗