Sir Harold Gillies Memorial Lecture. Aesthetic plastic surgery and the future plastic surgeon.
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Education, Medical, Graduate↗
Biomedical subjects
F V Nicolle
Publications and source records attributed to F V Nicolle.
The isolation and maintenance of the human pilosebaceous unit.
We have previously developed methods for the isolation and maintenance of human sebaceous glands and hair follicles. However, in long-term culture the maintenance of both is suboptimal. This may be due to a lack of stem cells, which are thought to be located in the bulge area of the hair follicle, and this region is not present in either model. Isolation of the entire pilosebaceous unit would retain this region, and may lead to improved maintenance of both structures. We describe a method for the isolation of viable, individual, pilosebaceous units by microdissection from human scalp face-lift skin. The viability of isolated pilosebaceous units has been determined by light microscopy, patterns of DNA synthesis by [methyl-3H] thymidine autoradiography, and lipogenesis by [U-14C] acetate uptake into lipids. When maintained for 7 days in supplemented Williams E medium, isolated pilosebaceous units showed a significant increase in length. This was due to the production of a keratinized hair fibre which grew at the in vivo rate of 0.3 mm/day. Light microscopy and [methyl-3H] thymidine autoradiography confirmed that after 7 days maintenance the hair follicle retained apparently normal morphology and patterns of DNA synthesis, However, the morphology of the sebaceous gland on maintenance was more variable, generally showing luminal keratinization. Moreover [methyl-3H] thymidine autoradiography of sebaceous glands showed a marked reduction on maintenance. The rates and patterns of lipogenesis by the whole pilosebaceous unit were, respectively, lower and different from those seen with isolated human sebaceous glands; this indicates that the bulk of pilosebaceous lipogenesis is derived from the hair follicle. Rates of recovery of [14C] from 2 mM-[U-14C] sodium acetate into thin-layer chromatography plates after 7 days maintenance decreased, although this was not statistically significant, indicating that rates of lipogenesis may fall on maintenance. Pilosebaceous units were maintained for 7 days on Gelfoam (an absorbable gelatin sponge) at the media-air interface. Initial results show a marked improvement in sebaceous gland morphology. It is possible, therefore, to obtain viable human pilosebaceous units by microdissection, and to maintain them in vitro for up to 7 days, with apparently full retention of hair follicle function, but only partial retention of sebaceous gland function.
Autoradiography↗
Dermal and facial autografts in facial aesthetic surgery.
Results are presented of dermis grafts used in conjunction with surgery for aging changes in the face. During a two-year period grafts were used to correct crease lines in the glabella and nasolabial creases, as well as angles of the mouth and vermilion. Volume of the grafts was well maintained and very few complications occurred. This technique offers better long-term results than can be obtained by collagen or fat injections. The results and techniques are presented in detail.
Adult↗
Clinical use of Zyplast in correction of age- and disease-related contour deficiencies of the face.
The authors present their experience with the use of Zyplast (glutaraldehyde crosslinked collagen) for the treatment of skin creases in the aging face, lip augmentation, scars, and facial atrophy. One hundred female patients were studied over a nine-month period. The results were found to be superior in some aspects compared with Zyderm II collagen, but there is loss of correction after six months and repeated "top-up" injections are needed every four to six months to maintain a satisfactory cosmetic correction. Zyplast collagen has not reduced the number of patient visits nor the cost of treatment.
Adolescent↗
A simple technique for removing a silastic gel-filled breast implant through the axillary approach.
We present a simple, atraumatic technique for removing a breast implant through a small incision following transaxillary breast augmentation, using straight artery forceps with jaws covered with a length of soft rubber catheter. This provides a gentle but firm grasp on the silicone gel-filled prosthesis for easy removal, without rupture.
Breast↗
The comma-shaped tip cartilage graft.
Conventional onlay grafts of cartilage to the tip, columella, and alar margin provide valuable techniques for the refinement of minor deformities in both primary and secondary rhinoplasty. However, they cannot produce a full restoration of the dynamic anatomy of the lower lateral cartilages, which give forward thrust and arch support to the tip and nostril margins. For these grosser problems another graft design has been devised by the author. A report is given of the successful use of a comma-shaped septal graft used for over five years in selected cases of secondary rhinoplasty. The graft replaces the deficient lateral crus and alar dome and is sculpted and then sprung into position so that it restores function and gives the desired aesthetic effect.
Cartilage↗
Correction of the overshortened nose.
Excessive shortening of the nose is often successfully corrected by the undermining or release of the soft tissue lining. It may also need free cartilage grafts to the tip columella or septum to supplement this release of the soft tissue lining and to prevent recurrent retraction. In extreme cases there is a shortage of lining as well as cartilage. Such cases may be successfully treated with the use of a composite graft taken from the concha of the ear with skin lining preserved on both sides.
Ear, External↗
Open capsulotomy by the transaxillary approach.
The release of capsular contracture through the axillary approach is presented. The technique is used in cases that have previously undergone breast augmentation, through the same approach and using the same blunt instrumentation for dissection.
Axilla↗
Use of Orthoplast as nasal splint.
Nasal splintage is routinely employed in standard rhinoplasty. For 3 years one of the authors has used Orthoplast as an alternative to plaster of Paris, which has proved to have many advantages.
Humans↗
Secondary rhinoplasty of the nasal tip and columella. The choice of cartilage grafts.
Aesthetic improvement of the nasal tip requires both surgical skill and artistic judgement, and is the area where post-surgical stigma may most frequently be apparent. Important aesthetic guidelines are described, and techniques which the author considers unsatisfactory are listed. A simple basic technique is recommended for routine procedures, which may then be varied according to special needs. Preferred methods of raising the tip, augmentation of the tip and correction of secondary deformities are outlined. The aim throughout is to employ those techniques which create a natural appearance, both visual and tactile.
Cartilage↗
Correction of age- and disease-related contour deficiencies of the face.
The main indications for Zyderm Collagen Implant in the face are for the correction of acne scars and facial wrinkles, such as the lines of the forehead, crow's feet, naso-labial crease lines, and creases of the lips. Few complications have been found, but it is vitally important that patients are carefully assessed and well informed before treatment is commenced.
Acne Vulgaris↗
Reduction mammoplasty and mastopexy: a personal technique.
Surgical correction of the ptotic or hypertrophic breast is performed with increasing frequency. Many different techniques are widely practiced and give predictably reliable results. Greater consideration needs to be given to the long-term aesthetic results, breast shape, quality of scars, and preservation of nipple sensation. This paper presents a personal technique practiced for the past 10 years in which consideration is given to achieving better nipple projection and less conspicuous scars. In addition, a method of wide tissue overlapping is advocated to maintain better long-term breast contour.
Adult↗
Problems of aesthetic plastic surgery training within the National Health Service.
In 1949 a National Plastic Surgery Training Program was set up in Great Britain. At that time there was a relative shortage of trained specialists in such a new field, and a vast accumulation of wartime injuries and a backlog of untreated civilian cases. This situation has changed during the past 30 years so that emphasis in training has also had to adapt to include the subspecialties of hand surgery, microsurgery, craniofacial surgery, and aesthetic plastic surgery. The problems of training in aesthetic surgery and the formation of a new British Association of Aesthetic Plastic Surgeons are described.
Esthetics↗
Use of radio-frequency pulsed energy in the control of postoperative reaction in blepharoplasty.
This is a preliminary report of the use of a device to apply small pulses of radio-frequency energy to surgical wounds in order to improve wound healing. The device was applied to one eye in 21 patients who underwent bilateral blepharoplasty. There were no device-related complications. In 11 patients, edema and ecchymosis were noticeably less on the treated side within 24 hours of surgery. In 6 patients, ecchymosis and swelling were so slight that no difference between treated and untreated sides was visible. Two patients were noticeably worse on the treated side. Further studies will be conducted.
Eyelids↗
Use of Zyderm in the aging face.
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.
Adult↗
Assessment of past results and current practice in the treatment of rheumatoid metacarpophalangeal joints. Five year review.
A new design of prosthetic finger joint for the rheumatoid patient, and the technique for its insertion is described, which has now been in use for five years. The technique includes the soft tissue correction of the ulnar deviation. Results are reported for all the cases performed in one year giving a two year follow up, assessing flexion strength, pinch strength and the degree of recurrence of ulnar drift associated with loss of pinch strength.
Arthritis, Rheumatoid↗
Surgical correction of ulnar drift in the rheumatoid hand.
A new technique for the correction of ulnar drift is described which has been used by the author in selected cases during the past 5 years. Results of this technique during a 2 year period are compared with those treated by prosthetic joint replacement alone, or a combination of the two methods.
Adult↗