PubMed Health⌕ Search

Biomedical subjects

Thomas Romo

Publications and source records attributed to Thomas Romo.

At least 19 recordsLinked to original sources
PubMed2006

Medpor alternative for microtia repair.

Autologous costal cartilage has been the material of choice for framework in auricular reconstruction. However, the advent of porous high-density polyethylene (Medpor) has provided an effective alternative in microtia repair. A ready-to-use allopastic material, Medpor has distinguished itself from other implants via its durability, tensile strength, biocompatibility, and malleability. Results from clinical experience and bench research support this claim. When using this material, the authors noted impressive results with low associated morbidity.

Biocompatible Materials↗
PubMed2006

Nasal grafts and implants in revision rhinoplasty.

Problems associated with primary rhinoplasty are often due to overresection of the nasal skeleton. One of the primary goals in revision rhinoplasty is to restore nasal architecture. To do so, the facial plastic surgeon can choose from numerous grafting materials. A key understanding of the benefits and limitations of each implant or graft and implants commonly used in revision rhinoplasty surgery.

Biocompatible Materials↗
PubMed2006

Difficult revision case: Overaggressive resection.

This article reviews the case of a 45-year-old female who had undergone previous rhinoplasty in which there had been overaggressive resection of the nasal skeletal architecture. A revision rhinoplasty was preformed using available autogenous septal cartilage and various porous high-density polyethylene implants. One year after the procedure, the patient demonstrated restoration of nasal architecture and persistent aesthetic outcomes.

Cartilage↗
PubMed2005

Reduction structured rhinoplasty.

The reduction structured rhinoplasty has evolved based on an increased understanding of nasal function and structural anatomy. The discussion begins with the philosophic origins of this technique. Next, the preoperative visit is outlined including the history, physical examination, basic facial analysis, and surgical planning. The procedure is detailed and the postoperative care is described.

Humans↗
PubMed2005

Endoscopic forehead lifting.

The aging process of the face is often most drastic in the upper third of the face, with the development of forehead rhytides and brow prolapse. Traditionally, an open approach to addressing aging of the forehead has been used. The introduction of endoscopic technology to surgical correction of forehead aging has resulted in comparable results without the significant disadvantages inherent in the open approach. The success of the endoscopic technique for forehead lifting has been reflected by its immense popularity and demand by the public. The aging process, relevant surgical anatomy, patient selection and planning, surgical technique, and current controversies in fixation are reviewed.

Endoscopy↗
PubMed2005

Chin and prejowl augmentation in the management of the aging jawline.

The effects of aging in the lower face and neck are reflected in the contour of the jawline. Soft tissue atrophy, the formation of jowls, and retrusion of the chin are all age-associated changes that contrast starkly with the smooth harmony of a young lower face. These soft tissue changes in the jawline are exacerbated by the effects of aging on the bony portion of the mandible. Bone resorption of the mandible seen with aging can lead to the development of a hypoplastic mentum and the formation of an anterior mandibular groove. Rhytidectomy serves to address the soft tissue changes from aging but cannot counter the effects of aging on the bony mandible itself. Understanding the effects of bone resorption on the aging mandible allows the facial plastic surgeon to augment the mandible appropriately to achieve a more effective rejuvenation of the lower face. The aging process in the mandible and the development of the prejowl sulcus are reviewed. The use of chin and prejowl augmentation as a valuable adjuvant to facelift surgery is discussed.

Aging↗
PubMed2003

The ethnic nose.

There are distinctive anatomical differences between the non-Caucasian (platyrrhine, mesorrhine) nose and the Caucasian (leptorrhine) nose. In general, non-Caucasian patients requesting aesthetic rhinoplasty desire improvement and refinement of their noses with preservation of defining ethnic characteristics. Surgeons who perform rhinoplasty in this patient population must be familiar with the variations in nasal anatomy and implement augmentation rather than reduction techniques to achieve the desired aesthetic and functional outcomes. We provide a brief review of recent historical trends in ethnic rhinoplasty, highlight relevant anatomical differences, and describe our strategy for addressing the challenges of ethnic rhinoplasty.

Esthetics↗
PubMed2003

Revision rhinoplasty.

Revision rhinoplasty can be one of the most complicated procedures performed by the facial plastic surgeon. As septal cartilage is often not available in revision procedures, grafting material is often needed. This material can come in the form of autogenous bone and cartilage. Allografts also can be used, including mersilene, expanded polytetrafluoroethylene, and porous high-density polyethylene (PHDPE). In this article, emphasis is placed on the senior author's method in evaluating candidates for revision rhinoplasty as well as techniques using PHDPE. In addition, the properties of the more commonly used allografts are described, including the advantages and disadvantages of using each material in revision rhinoplasty procedures. In comparing the various alloplastic materials available, it is shown that PHDPE has properties that make it an excellent implant for revision rhinoplasty.

Biocompatible Materials↗
PubMed2003

Rhinoplasty in the aging nose.

The aging nose presents a difficult challenge for the rhinoplastic surgeon. To best address the patient's wishes, the surgeon must possess a sound understanding of the atrophic changes associated with the aging nose, including tip ptosis, increased nasal bulbosity, a lengthened nasal appearance, and altered nasal airflow patterns. Surgical emphasis is placed on conservative structured reduction to address functional concerns. Overresection risks destabilizing the nasal tip and altering the patient's concrete self-image. This article outlines our approach to rhinoplasty in the aging nose with a special emphasis on the use of porous polyethylene alloimplants to provide added structural support.

Aging↗
PubMed2003

Reduction structured rhinoplasty.

Rhinoplastic surgeons continue to seek technical refinements that will result in a consistently reliable postoperative outcome. Over the past 25 years there has been a steady progression away from the simple Joseph reductive rhinoplasty technique toward the use of various grafts to improve both the functional outcomes and aesthetic end result of this procedure. The original reductive template continues to be a major component of a new conceptual paradigm, which has evolved to incorporate the understanding that structural components must be placed to allow a more precise outcome. Specifically, once the nose is reduced to proportions that correspond to the preoperative analysis, separate grafts and implants are placed to prevent a change in the shape of the nose by the constricting effects of the skin shrink-wrapping around the skeletal framework. This article focuses on the use of implants for structural architecture in the senior author's primary reduction-structured rhinoplasty cases.

Biocompatible Materials↗
PubMed2003

Management of the severe bulbous nasal tip using porous polyethylene alloimplants.

Reliable outcomes in correction of the severely bulbous nasal tip remain elusive. Reduction and binding of the tip cartilages result in a partial external nasal valve collapse. If a concurrent dorsal hump reduction is accomplished and osteotomies are completed to close the open roof deformity, then a severe constriction of the external valve may result. This is best avoided by resection of the residual lower lateral cartilages and substitution with external valve batten implants. The tripod of nasal tip supports is then rigidly reconstituted. When autogenous graft materials are considered inadequate or undesirable, the surgeon may safely use porous polyethylene alloimplants to support the external nasal valve. A dependable surgical technique based on extensive experience with these materials is outlined.

Biocompatible Materials↗
PubMed2003

Adjustment of subtle postoperative nasal defects: managing the "near-miss" rhinoplasty.

Rhinoplasty entails several steps that affect the appearance and function of the nose in an interrelated way. Occasionally, an excellent result can be marred by a minor imperfection and lead to dissatisfaction of both patient and surgeon. For significant pathology, revision rhinoplasty can be performed safely if the architecture and physiology of the nose are respected. To correct the "near-miss" result, minor corrections can successfully restore the aesthetic result. This can require a different frame of reference and approach and can often be thought of in terms of soft tissue correction. Subcutaneous fibrosis, skin depressions, asymmetries, and deficits can be corrected with minor procedures and techniques not routinely associated with rhinoplasty. We detail several methods that can be used to restore simply and effectively an otherwise excellent rhinoplasty result.

Adult↗
PubMed2003

Secondary cleft-lip rhinoplasty utilizing porous high-density polyethylene.

Secondary nasal deformity associated with cleft lip is a difficult surgical task. For more than 100 years, numerous surgical methods have been created to address the structural changes that occur over time after the primary surgery. Although early surgical methods have relied on various rotational flaps and local tissue manipulation, the recent advent of synthetic materials has provided facial plastic surgeons with more tools to correct the structural and supportive deficiencies. In this article, we describe our 10-year experience with porous high-density polyethylene (PHDPE) implants in secondary cleft-lip rhinoplasty. PHDPE implants have been well tolerated and achieved excellent long-term aesthetic results through fibrovascular ingrowth to the surrounding tissue.

Adult↗
PubMed2002

Homologous collagen dispersion (dermalogen) as a dermal filler: persistence and histology compared with bovine collagen.

To assess the biological behavior and clinical efficacy of homologous collagen dispersion (Dermalogen) in augmenting human dermis, Dermalogen and bovine cross-linked collagen (Zyplast) were compared in a human postauricular injection model. Dermalogen (two sites implanted behind one ear) and Zyplast (two sites behind the contralateral ear) were injected into an upper to middermal level in 20 healthy adults. Digital photographs of all implant sites were taken over a 12-week period after injection. Biopsies of each implant type were taken at 4 and 12 weeks after injection. At 12 weeks after injection there was a small but significant difference in persistence rates between Dermalogen and Zyplast (4% vs. 2%; = 0.005). Histologically, Dermalogen was identifiable at 4 weeks after implantation, with evidence of neovascularization. Zyplast was identified more uniformly than Dermalogen in specimens 12 weeks after implantation, and more chronic inflammatory cells and foreign body giant cells were seen in the Dermalogen specimen. Clinical persistence and the histological behavior of Dermalogen appears to be at least as favorable as Zyplast bovine collagen. Dermalogen does not require pretesting and can also be used in the patient already sensitized to bovine protein. For these reasons, the authors think Dermalogen is a reasonable alternative to bovine collagen for facial soft-tissue augmentation.

Adult↗
PubMedDate not supplied

Rejuvenation of the aging lip with an injectable acellular dermal graft (Cymetra).

OBJECTIVE: To evaluate the effects of Cymetra (micronized AlloDerm tissue) in rejuvenating the aging and atrophic lip. PATIENTS: Forty-four patients aged 32 to 80 years who reported age-related changes in the size and contour of the upper lip. METHODS: Patients were randomized to treatment with either Cymetra or glutaraldehyde cross-linked bovine collagen (Zyplast). Standardized photographs of each subject were taken before and after treatment initially and 3, 6, 9, and 12 months after initial treatment. Patients were monitored for signs of hypersensitivity, infection, and inflammation. MAIN OUTCOME MEASURES: Digital photographs were analyzed for changes in the nasolabial angle, percentage of the total lip accounted for by the exposed red lip in the midline and on the lateral view, the visible red upper and lower lip surface areas, and the anterior projection of the upper and lower lips. RESULTS: All patients tolerated treatment well without any significant local or systemic complications. Nineteen patients were treated with Cymetra and 25 with Zyplast. Cymetra-treated patients were more likely than Zyplast-treated patients at 12 months (3 months after the previous treatment) to have increased the percentage of red lip in the midline (84.6% vs 38.9%; P =.01), the vermilion height in the upper lip midline (84.6% vs 38.9%; P =.01), and the exposed red lower lip on the lateral view (69.2% vs 33.3%; P =.048) by at least 20%; increased the lower lip projection by 0.5 mm or more (69.2% vs 27.8%; P =.02); and decreased the nasolabial angle by at least 10 degrees (46.2% vs 16.7%; P =.07). CONCLUSIONS: Cymetra is a suspension of particulate dermal matrix that seems to increase the upper lip bulk, vermilion, and lower lip projection after a threshold of Cymetra has been administered. There are few differences in any measured long-term (3 months after treatment) variables until the 12-month visit, when there were statistically significantly more Cymetra-treated patients with improved lip aesthetics than those treated with Zyplast. With repeated treatments, Cymetra seems to accumulate, producing a long-term effect superior to Zyplast in many patients.

Adult↗
PubMedDate not supplied

Strength and histological characteristics of periosteal fixation to bone after elevation.

BACKGROUND: Loss of brow elevation in the early postoperative period has been well documented; however, there has been no study quantifying the minimum time necessary to achieve lasting brow elevation. Previous work in our laboratory has demonstrated that complete readherence of periosteum to bone can take 12 weeks to occur after periosteal elevation. The correlation between adherence and the development of strength has never been examined. OBJECTIVE: To correlate histological characteristics of raised forehead periosteum with the strength of the periosteum-bone union postoperatively. SUBJECTS: Eighteen New Zealand white rabbits. METHODS: Rabbit foreheads were elevated in a subperiosteal plane and the flap reapproximated with chromic sutures. Animals were killed at 14, 28, 45, 63, or 84 days postoperatively, and all tissue superficial to the periosteum removed. The tension required to avulse sections of periosteum was then measured. Skulls were then sectioned and prepared for histological analysis of remaining periosteum. Avulsion forces and histological findings were compared with those unoperated-on controls. RESULTS: The forces necessary to avulse periosteum in the 14- and 28-day groups were significantly lower than for control animals; values at 45, 63, and 84 days were not significantly different from control animals. Healing periosteum displayed varying degrees of thickness, cellularity, edema, and vascular congestion. These features peaked at 28 days postoperatively then gradually resolved to near-control values by 84 days. Significant periosteal-to-bone contact did not appear until 45 days postoperatively. CONCLUSION: Our results promote the use of methods of brow fixation that support mobilized soft tissues for a minimum of 6 weeks, until the elevated periosteum has significantly readhered to the underlying bone.

Animals↗