Subgaleal endoscopic browlift with absorbable fixation.
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Bandages↗
Biomedical subjects
J Regan Thomas
Publications and source records attributed to J Regan Thomas.
The use of Botox to treat glabellar rhytids.
The goal of the article is to allow a physician to become more familiar with Botox as a treatment of glabellar wrinkles. An overview of the anatomy of that region is reviewed. Evaluation of the facial muscles before treatment and injection technique is also covered.
Botulinum Toxins, Type A↗
Scar revision.
Classic techniques of scar revision in general are ablative and remain the gold standard, although newer nonablative laser therapies, such as the frequency-doubled neodymium:yttrium-aluminum-garnet laser, can help. Ablative therapies and techniques are examined.
Cicatrix↗
Lower lid blepharoplasty and canthal surgery.
Lower lid blepharoplasty is an effective procedure to address aging changes of the eyes and periorbital regions. Success requires a thorough understanding of the relevant anatomy, proper patient selection, and meticulous surgical technique. When performed skillfully, the transcutaneous and transconjunctival approaches can offer the patient excellent results with a low risk of complications.
Blepharoplasty↗
Effects of age and diet on rat skin histology.
OBJECTIVE/HYPOTHESIS: To document age-related histologic morphometric changes of rat skin and the effects of calorie restriction on such changes. STUDY DESIGN: Fischer 344 rats of three age groups (young, 4 mo; adult, 1 year; old, 24+ months) were procured from ad libitum (AL) diet and calorie-restricted (CR) colonies of the National Institute of Aging and were used for histologic study. Each study group consisted of six animals. METHODS: Skin samples from the dorsum (DS) and footpad (FP) of these animals were excised and processed for histology with staining techniques for general morphology (hematoxylin-eosin-phloxine) and for differentiation of collagen bundles and elastic fibers (Verhoeff-van Gieson technique). Light microscopic morphometric and stereologic point counting procedures were applied manually to tissue sections to obtain quantitative data on the depth of the epidermis, dermis, and stratum corneum, epidermal nuclear number, and percentage fraction of collagen, elastic fibers, capillaries, and pilosebaceous units. Data were analyzed with two-way of analysis of variance (ANOVA) to determine significant effects of age, diet, and age-diet interaction on these parameters in AL rats and their age-matched cohorts. RESULTS: Significant effects of age, diet, or age-diet interaction were observed in respect of the thickness of epidermis, dermis, stratum corneum of FP, epidermal nuclear number, collagen percentage fraction, and area fraction of capillaries. DS epidermis showed increasing thickness in AL group, but this was reduced in CR rats. A similar trend in DS dermal depth was observed. Fewer capillaries were present in aging CR rats. The DS epidermal nuclear profiles and collagen area fraction also showed effects of diet and age-diet interaction. Aging changes, especially the effect of CR, was more evident in the measured parameters of dorsal skin. No alterations were observed in the distribution of pilosebaceous units and elastic fiber profiles of the skin. CONCLUSIONS: The Fischer 344 rat shows many age-related changes in the skin, some of which are different from data reported in literature. The pattern of aging changes in skin parameters was different in the two groups, suggesting an in influence of CR. CR appears to modify the aging rate of some skin components, and this may be caused by metabolic changes imposed by diet.
Aging↗
Recreating the alar crease following melolabial flap reconstruction of a full-thickness alar defect.
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Aged↗
Use of a nonablative radiofrequency device to rejuvenate the upper one-third of the face.
OBJECTIVE: To evaluate the use of the ThermaCool TC nonablative radiofrequency device for rejuvenation of the upper one-third of the face, as determined by brow elevation. Study design and setting Twenty-four patients in a facial plastic surgery office were treated with the nonablative radiofrequency device. The patients had pretreatment photos, in-office procedure, and follow-up photos. Brow elevation measurements were used to gauge efficacy of the procedure. These results were compared to an untreated, control group of 12 patients. RESULTS: Compared to the control group, the post-treatment measurements were improved (P < 0.05). The post-treatment measurements were also improved from pretreatment baseline (P < 0.05). Subjective results obtained from patient satisfaction questionnaires did not correlate to the objective data. The data also showed that improvement in brow elevation was not uniform in each patient. CONCLUSION: The ThermaCool TC nonablative radiofrequency device for in-office rejuvenation of the upper one-third of the face procedure does provide brow elevation in a majority of patients; however, the majority of the study patients did not perceive benefit from the procedure. Patient satisfaction in facial plastic surgery must be an important part of the decision of whether or not to introduce a new device into a practice setting.
Adult↗
Overly wide cartilaginous middle vault.
Any maneuver in rhinoplasty that alters the ULCs should be based on a preoperative analysis of the patient's functional complaints and aesthetic characteristics. All techniques should be harmonious with the desired postsurgical result. The majority of established procedures to alter the middle vault focus on dorsal hump reduction, correction of internal nasal valve collapse, or correction of a twisted nose with the use of spreader grafts [9 12]. Although the latter two techniques achieve satisfying functional results, they can have the effect of broadening the middle third of the nose. Reduction of the dorsal height of the middlenasal vault by way of horizontal shaving of the ULC scan sometimes result in functional compromise by narrowing the nasal valve [13]. Each technique has advantages when performed with appropriate indications. For example, a narrow middle vault with internal nasal valve collapse is functionally and aesthetically addressed by the insertion of spreader grafts; however, the inverse of this situation is sometimes encountered. A patient who has a broad middle vault without internal nasal valve collapse will benefit from reduction of the horizontal width of the cartilaginous dorsum, which is, in effect,the reverse of spreader grafts [2]. A select patient population requires aesthetic refinement of the middle vault in a way that avoids functional compromise. This reverse spreader technique has probably been applied clinically by others, but it is has not been reflected in the literature before this year [2]. Johnson and Toriumi have described a similar maneuver in addressing a wide bony dorsum, encouraging the surgeon to "think vertically" [8]. Likewise, Toriumiand Ries have described a selective tangential shaving of the convex side dorsal septum to assist in correction of the C-shaped deformity [11]. In the setting of a wide middle vault, the reverse spreader technique is a useful alternative to dorsal augmentation, which creates the illusion of a narrower dorsum [ 14]; however, it should be noted that patients who have a wide, low dorsum might benefit more from dorsal augmentation than from this technique. Caution should be employed in individuals who have internal nasal valve compromise, which can be exacerbated by this maneuver.
Esthetics↗
The use of Botox to treat glabellar rhytids.
Many areas of the face benefit from Botox. The deep vertical and horizontal creases between the eyebrows or glabellar area are the best known to cosmetically improve with Botox injections. As with almost any cosmetic procedure, adequate evaluation and pre-operative assessment can lead to a good outcome and a satisfied patient.
Botulinum Toxins, Type A↗
Update in scar revision.
Scar revision is indicated in certain situations for cosmetic and functional reasons. Improvement is not feasible with all scars; expectations must be tempered and realistic goals set. There is no generic approach to timing or technique in scar revision. Certain scars will benefit from revision at 6 to 12 months after the inciting traumatic event; others from much earlier intervention. Most scars will show degrees of improvement for up to 1 year. Many scars, however, may benefit from earlier treatment, including dermabrasion. The decision to revise a scar must be reached by patient and surgeon, with realistic expectations and the end-point clearly established. The simplest and most direct approach. should then be taken to reach this goal.
Cicatrix↗
Middle-vault narrowing in the wide nasal dorsum: the "Reverse Spreader" technique.
The middle vault is a transition zone between the nasal tip and nasal bones and plays an important role in profile, tip projection, tip rotation, and tip support. This report presents an alternative to conventional techniques specific to the middle nasal vault for a patient population with particular nasal features. A narrow middle vault with internal nasal valve collapse is functionally and aesthetically addressed by the insertion of spreader grafts. However, the inverse of this situation is sometimes encountered. A patient with a broad middle vault and without internal nasal valve collapse will benefit from reduction of the horizontal width of the cartilaginous dorsum, which is in effect the reverse of spreader grafts. This effect is achieved by excising a vertical wedge-shaped strip of cartilage that follows the length of the upper lateral cartilage at the junction of the upper lateral cartilage and the dorsal nasal septum.
Cartilage↗
A comparative study of surgical techniques on the cervicomental angle in human cadavers.
BACKGROUND: The cervicomental (CM) angle is formed by the horizontal plane of the submental region and the vertical plane of the neck. OBJECTIVE: To compare the 2-dimensional effect of 4 surgical techniques on the CM angle in a human cadaver model. DESIGN: Anatomic presurgical and postsurgical comparative study performed on human cadavers preserved with ethylene glycol. SETTING: Academic medical research center in St Louis, Mo. SUBJECTS: Twelve cadaver specimens with obtuse CM angles with heads attached to the sternum and upper thorax. INTERVENTIONS: Standard superficial musculoaponeurotic system rhytidectomy techniques were performed on all cadaver heads. Four techniques were compared: (1) platysmal plication; (2) platysmal plication and plication of the anterior bellies of the digastrics; (3) platysmal plication, plication of the anterior bellies of the digastrics, and interlocking mastoid-to-mastoid sutures; and (4) platysmal plication and interlocking mastoid-to-mastoid sutures. MAIN OUTCOME MEASURES: The comparative changes in CM angle, the distance between the mentum and CM angle (mentum-CM distance), and the distance between the sternum and CM angle (sternum-CM distance) obtained with each of the 4 surgical techniques. Anatomic characteristics of the cadavers were also noted. RESULTS: On average, the CM angle was significantly reduced after all procedures (P<.001). The mean sternum-CM distance increased significantly (P =.01). A trend toward significance was observed in the change in mentum-CM distance (P =.10). The presence of a low hyoid was significantly associated with a smaller CM angle after surgery (P =.009) and demonstrated a trend toward significance with an increase in mentum-CM distance (P =.07), but it was not significantly associated with an increase in sternum-CM distance (P =.58). After controlling for the presence of a low hyoid, the mastoid-to-mastoid suture significantly reduced the CM angle by approximately 11.3 degrees (P =.002) and the sternum-CM distance by 1.15 cm (P<.001). CONCLUSIONS: The CM angle and the sternum-CM distance were significantly affected by all procedures. The addition of the mastoid-to-mastoid suture had the greatest effect on the CM angle, and the reduction in CM angle was strongly associated with an increase in the sternum-CM distance. Presence of a low hyoid was the only preoperative factor associated with a significant postoperative reduction in CM angle.
Aged↗
Foreign-body inclusion cyst presenting on the lateral nasal sidewall 1 year after rhinoplasty.
Hemostasis and decreased risk of synechiae formation are benefits of nasal packing after sinus surgery; however, these must be weighed against the possible complications, which can include devastating toxic shock syndrome. Nasal packing is often impregnated with an ointment that allows for a less traumatic placement into and removal from the nasal cavity, as well as providing some antibiotic coverage for nasal bacterial flora. Orbital complications secondary to the petroleum-based packing have been reported. When sinus surgery is performed in conjunction with a rhinoplasty, there is a possibility of petroleum ointment migrating into intranasal incisions or osteotomy sites. A 15-year-old girl was examined 1 year after endoscopic sinus surgery combined with an open rhinoplasty had been performed at another institution. Physical examination showed a widened nasal dorsum with an open-roof deformity and a 1-cm firm mass lateral to her lateral nasal sidewall. The pathological examination after removal of the cyst showed a foreign-body inclusion cyst or lipogranuloma. The cyst contained a petroleum-based substance.
Adolescent↗
Histomorphologic changes in aging skin: observations in the CBA mouse model.
BACKGROUND: Aging of human skin is a phenomenon resulting from a combination of chronological aging and environmental stressors such as sunlight. OBJECTIVES: To study the effects of intrinsic aging on the skin in laboratory-raised CBA mice in 3 age groups, and to assess histological alterations as a function of age in this model. METHODS: Skin samples from CBA mice in 3 age groups (young, young adult, and old) were obtained from the dorsal and ventral areas, pinna, and hind foot to study the following variables using light microscopic manual morphometric methods: the depth of the epidermis and number of epidermal cells, depth of the dermis, and percentage area of dermal collagen, elastic fibers, pilosebaceous units, blood vessels, and tissue space. The obtained values were analyzed using 1-way analysis of variance to detect any significant effects of age. RESULTS: There was a notable attrition of the epidermal thickness and number of cells that could be correlated with age. A reduced number of pilosebaceous units was noted in skin samples from the dorsal region and the footpad. No conspicuous change was noted in the depth of the dermis or percentage area of collagen in aging animals. A proliferation of stainable elastic fibers was demonstrated in the dorsal skin and footpad of older mice. CONCLUSIONS: CBA mice show unique age-related histological modifications of the skin that are different from other rodent species. These baseline data will be helpful in further studies of regenerative effects of pharmaceutical agents on the histological structure of skin and in photoaging studies.
Aging↗
The virtual nose: a 3-dimensional virtual reality model of the human nose.
BACKGROUND: The 3-dimensionally complex interplay of soft tissue, cartilaginous, and bony elements makes the mastery of nasal anatomy difficult. Conventional methods of learning nasal anatomy exist, but they often involve a steep learning curve. Computerized models and virtual reality applications have been used to facilitate teaching in a number of other complex anatomical regions, such as the human temporal bone and pelvic floor. We present a 3-dimensional (3-D) virtual reality model of the human nose. METHODS: Human cadaveric axial cross-sectional (0.33-mm cuts) photographic data of the head and neck were used. With 460 digitized images, individual structures were traced and programmed to create a computerized polygonal model of the nose. Further refinements to this model were made using a number of specialized computer programs. This 3-D computer model of the nose was then programmed to operate as a virtual reality model. RESULTS: Anatomically correct 3-D model of the nose was produced. High-resolution images of the "virtual nose" demonstrate the nasal septum, lower lateral cartilages, middle vault, bony dorsum, and other structural details of the nose. Also, the model can be combined with a separate virtual reality model of the face and its skin cover as well as the skull. The user can manipulate the model in space, examine 3-D anatomical relationships, and fade superficial structures to reveal deeper ones. CONCLUSIONS: The virtual nose is a 3-D virtual reality model of the nose that is accurate and easy to use. It can be run on a personal computer or in a specialized virtual reality environment. It can serve as an effective teaching tool. As the first virtual reality model of the nose, it establishes a virtual reality platform from which future applications can be launched.
Humans↗
The "pinch and slide" blepharoplasty: safe and predictable aesthetic results.
Blepharoplasty is one of the most common facial cosmetic surgical procedures. When done properly, this relatively simple operation can result in a dramatic improvement for the patient with relatively little downtime. However, when it is performed improperly, the results can be crippling for the patient and often difficult for the surgeon to correct. Standard treatments for upper eyelid dermatochalasis include surgical excision of skin, muscle, and fat. Several techniques have been described for removing some or all of these components, depending on the patients' anatomic requirements. In particular, the "pinch" technique can be used to remove either the upper eyelid skin alone or a combination of skin, muscle, and fat. While this technique is not new, its appearance in the literature is sparse. We demonstrate herein how a modified version of the pinch technique can be used to remove the central orbital fat pad by "sliding" the pad through the medial fat pad incision. This procedure maintains the integrity of the central orbital septum and the delicate structures that lie beneath.
Blepharoplasty↗
Modulation of cutaneous aging with calorie restriction in Fischer 344 rats: a histological study.
OBJECTIVE: To examine whether histological changes in skin owing to intrinsic aging in a laboratory rodent model are modulated by caloric restriction (CR). METHODS: The abdominal skin from colony-raised ad libitum-fed Fischer 344 rats and age-matched rats subjected to CR was studied in the light microscope using histological morphometric methods. Animals 4, 12, and 24 months or older were used in this study. We studied the skin to obtain (1) quantitative data on the depth of the epidermis, dermis, and fat layer, the epidermal cellular density, the percentage fraction of dermal collagen, elastic fibers, pilosebaceous units, and capillaries, and the fibroblast density; and (2) qualitative assessment of histological staining for dermal glycosaminoglycans. We analyzed data by means of general linear model 2-way analysis of variance to obtain significance for the effects of age, diet, and age-diet interaction. RESULTS: The ad libitum-fed rats showed age-related increase in the depth of the epidermis, dermis, and fat layer. Calorie restriction prevented these changes, but epidermal nuclear density appeared to be stimulated. A trend toward increased values for collagen and elastic fibers, fibroblasts, and capillaries in skin samples from CR rats was observed. Pilosebaceous units were not modified. Moderately reduced staining for the dermal glycosaminoglycans in the skin of CR rats was noticed. CONCLUSIONS: Histomorphological changes resulting from intrinsic aging affected some of the studied variables in the rat skin, and these changes were delayed or prevented by CR. Some stimulatory effects, such as increased densities of fibroblasts and capillary profiles and higher values of connective tissue fibers resulting from CR, were also observed. Cutaneous morphological changes due to natural aging in this rat model seem to be modified by physiological or metabolic alterations imposed by CR.
Analysis of Variance↗
Perceptions regarding facial plastic surgery among Dutch otolaryngologists.
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Attitude↗