Biomedical subjects
Publications and source records attributed to G F Maillard.
A case report of a young patient with marked asymmetry treated successfully with ultrasonically assisted lipectomy with a good functional cosmetic result, undetectable scars, and mammographic control and showing no ill-effect on the breast parenchyma is presented. Further studies and follow-up are needed to confirm the value and advisability of using ultrasonic energy in the female breast.
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As endoscopic subperiosteal lifting of the upper face is explored, it may significantly limit the indications for the open approach. However, this report is based on our combined large experience and long follow-up in open bicoronal subperiosteal lifting. The combined experience of four surgeons in four countries with an open subperiosteal approach to lifting of the upper face in 545 patients is described. The complications of the procedure, both common and rare, and techniques to avoid untoward effects are discussed. Reasons for patient dissatisfaction are addressed. Based on their evaluation of results and complications of the surgery over a 6-year period (1986-1992), we conclude that subperiosteal lifting is an effective, reliable, reproducible, and safe operation.
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Breast reconstruction was carried out with rectus abdominis musculocutaneous flap on 7 women (8 breasts) with defect of breast, and perfect result was obtained on all the patients. The flap which was normally excised in an abdominal lipectomy was used to cover the defect of breast. The rectus abdominis of the flap was used to fill the reconstractive breast and to carry the vascularization from the internal mammary artery. The advantages of the method are as follow: (1) the waist-line is reduced by closing the musculoaponeurtic defect; (2) The scar of the donor area is well hidden by the abdominoplasty; (3) The breast reconstruction need not use an implant. The disadvantage is a risk of postoperative herniation if the suture tears.
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A 26-year-old woman underwent breast augmentation with fat injections from trochanteric liposuction. After one year firm lumps developed in both breasts. Surgical treatment included excising the cysts through an inframammary approach. Volume replacement consisted of a silicone gel prosthesis inserted through an axillary retropectoral approach. In a second stage, a supra-areolar dermopexy was done to centralize the nipple-areola complex.
The subperiosteal lift developed by Tessier is a technique for rejuvenating the face and emphasizing beauty. It is performed using two approaches: intraoral and bicoronal or precapillary. It entails a total subperiosteal undermining of the face beginning 2 cm over the orbits and continuing on the orbital rims, the zygomatic arches, and the malar bones. This allows total lifting of the soft tissues of the face (DMAS, deep musculo aponeurotic system). The lateral and vertical traction allows elevation of the superior two thirds of the face, eyebrows, and cheeks. Lifting pulls up from the forehead to the mandibular line. The fixation of the superficial layer of the temporal aponeurosis in traction to the upper part also has an effect on tissue elevation. The best candidates for this procedure are women in their late 30s or early 40s but can be used on those from 30 to 50 and more. It is highly specialized operation which requires substantial surgical experience both in selecting the patient and in execution.
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Craniofacial surgery, developed by Paul Tessier, has shown that subperiosteal undermining and lifting of the soft tissues of the upper two-thirds of the face results in an excellent and long-lasting rejuvenated look to the entire face. The result is significantly more durable and longer lasting than the classic subcutaneous facelift reinforced with SMAS plication, transposition, and shortening. The authors--three surgeons working independently--are convinced that we have entered a new era in facelift procedures. We decided to combine our experiences which total 250 patients with followups of 6 months to 6 years.
In patients with difficult facial reconstructions, one of the most important requirements is to plan well, before beginning treatment. It is known that it is important to consider the aesthetic unit of the face. Each cutaneous area is to be reconstructed by a single, separate graft or flap. We present 4 patients illustrating difficult situations. Special attention has been drawn to the choices for each separate graft or flap. This study was made possible with the aid of a medical illustrator who prepared a real dissection of our final reconstruction. In fact, after these difficult operations, we often forget exactly what was previously done and we believe that a good catamnesis of our surgical adventure can be useful to share with other surgeons who deal with the same difficult procedures.
The subperiosteal face lift described by Psillakis has been criticized for not showing a more dramatic improvement over conventional brow/face lift procedures. His approach also has a significantly high incidence of nerve injury. This study reports our anatomic findings and surgical modifications, which have permitted a significant improvement in the safety of execution and clinical results using the subperiosteal face lift concept. Pertinent points of applied local anatomy and dissection techniques are as follows: First, we use extensive interconnected subperiosteal dissection that includes the entire zygomatic arch. This allows better repositioning of the deep soft tissues of the entire upper face, most of the midface, and indirectly, key structures of the lower face. Second, the upward pull of the muscles of the cheek and mouth will produce an elevation of the corner of the mouth, affecting positively the smiling mechanism, the oral frowning, and the jowls. Third, the dissection deep to both layers of the temporal fascia decreases the risk of injury to the frontalis nerve. Fourth, the temporal fascia is used as a lifter and anchoring element of the entire cheek-perioral soft tissues as opposed to the periorbital fibrofatty tissues. This will decrease the risk of injuring the frontal and zygomatic branches of the facial nerve. These modifications have been used in 28 patients. Our rate of patient satisfaction has been high, and no complications with regard to nerve injury have been observed. This compares favorably with our initial 60 patients, in whom the Psillakis or Tessier approach was used. In these patients, there was an 11 and 20 percent rate of nerve injury, respectively.