Biomedical subjects
Publications and source records attributed to Vito C Quatela.
Success in microtia surgery requires meticulous patient education, planning, technique, and follow-through. When these principles are followed, excellent results as well as tremendous satisfaction are achievable for both the patient and surgeon.
The endoscopic forehead midface lift is perhaps the most powerful tool has been made available to the facial aesthetic surgeon in the last 10 years. Although this technique can reap the greatest rewards, it is also fraught with the greatest peril. A difficult dissection, prolonged period of edema, and numerous other pitfalls have tempered enthusiasm among facial aesthetic surgeons for this powerful technique. Nonetheless, the midface lift can be performed both safely and effectively. Through careful analysis of the pitfalls of midface surgery, one can adopt principles that help prevent or minimize potential complications. Such an approach can maximize the surgical benefit to the patient and lessen the anxiety surrounding the procedure for the patient and surgeon alike.
Normal topographic anatomy of the distal nose is a reflection of the delicate integration between the lower lateral cartilage, the upper lateral cartilage, the sep-tum, and skin. Understanding these relationships will help the rhinoplasty surgeon diagnose and treat con-cavities of the distal nose. Most patients present with a hybrid of these defects. For example, the patient in Fig. 19 presented for a primary rhinoplasty. A variety of concavities can be noted and include dorsal septal deflection, upper lateral cartilage avulsion on the left,bilateral lower lateral complete concavities, and the beginning of a dorsal depression (Fig. 19A-I). The nasal skeleton and the skin and soft tissue are normally in equilibrium, but trauma and reduction rhino-plasty disrupts this equilibrium. Skeletal distortion can lead to septal deflection, middle vault collapse, or alar buckling [20]. It is important to realize that correction of deflection or depression by excision needs to be balanced with augmentation, which provides balance for the previously disequilibrated skeletal and soft tissue forces. Augmentation can be done with spreader grafts, tip grafts, columellar strut, and dorsal grafts. A patient's soft tissue envelope will also play a major role in the success of a septorhinoplasty. The surgical principles of septorhinoplasty such as judicious resculpting of the cartilaginous framework, respect of major tip support, tip grafting technique, and postoperative tissue contraction still apply and must be placed in conjunction with repairing a pathological topographic concavity.
The introduction of endoscopes is responsible for the surge in many of the aesthetic facial plastic surgeries in the past decade. This relatively new technology is widely used in upper-third facial rejuvenation and created a natural evolution into the rejuvenation of the central midthird of the face. After careful patient selection and evaluation, several key maneuvers are accomplished to achieve forehead and midface rejuvenation: (1) a subperiosteal dissection of the scalp to the level of the superior and lateral orbital rims and zygomatic arch, (2) incision and release of orbital periosteum, (3) selective myectomies of the glabella muscles, (4) subperiosteal dissection of the midface (from infraorbital rim to the inferior aspect of the maxilla and laterally over the entire zygomatic arch to the gonial angle beneath the masseteric aponeurosis), and (5) suspension and reposition of the malar fat pad, suborbicularis oculi fat, and soft tissue overlying the angle of the mandible. Endobrow-midface lift is a safe and reliable method to rejuvenate the upper two thirds of the face with excellent results while minimizing the morbidities and complications associated with the traditional open procedures.
PURPOSE: This report describes the clinical, radiographic, and histopathologic findings in patients with proptosis secondary to lipomatosis after retrobulbar corticosteroid injection. DESIGN: Retrospective, noncomparative, interventional case series and review of the literature. METHODS: Five patients who developed symptomatic unilateral proptosis after steroid injection were studied and the literature was reviewed. RESULTS: No previous description was found in the literature. All five cases were studied with computed tomography, and two cases were confirmed with histopathology. No fibrosis or granulomatous inflammation was identified. CONCLUSIONS: Orbital lipomatosis is a potential complication of retrobulbar steroid injections. Symptomatic relief can be provided by a transconjunctival approach to the lower lid fat compartment.
Most of the advances in face lift techniques in the past decade have been directed at altering the aging changes of the midface. Our technique for endoscopic midface lifting releases the entire central and lateral midface, which allows for a complete resuspension and rejuvenation. This technique utilizes a subperiosteal release of the midface from the infraorbital rim to the inferior aspect of the maxilla and laterally over the entire zygomatic arch to the gonial angle beneath the masseteric aponeurosis. Suspension is achieved superolaterally to the deep temporal fascia and repositions the malar fat pad, SOOF, and soft tissues overlying the angle of the mandible. Over 400 procedures have been performed. We found the degree of improvement in the following order, from greatest to least: (1) correction of midface ptosis and infraorbital hollowing, (2) improvement of the depth of the nasolabial fold, and (3) improvement of the degree of jowling. This technique is one of low morbidity and few complications.
Many surgeons consider cosmetic rhinoplasty to be one of the most challenging facial plastic surgical procedures. Open-structure rhinoplasty allows for visualization of bony-cartilaginous deformities, preservation of nasal structural integrity, and precise nasal reshaping. The ultimate, external appearance of the nose is the sum of the interaction of the bony-cartilaginous skeleton and the skin soft-tissue envelope. This article describes the use of autologous, structural cartilage grafts in primary and secondary rhinoplasty. Emphasis is placed on the use of septal, auricular, and costal cartilage grafts to provide for a structurally sound skeletal framework and thereby a predictable postoperative result. Deformities of the middle and lower third of the nose are specifically addressed.
OBJECTIVE: To define the relationship between the frontal branch of the facial nerve and a series of blood vessels that are encountered during endoscopic forehead procedures. DESIGN: Anatomical study using 6 fresh cadavers (12 sides). RESULTS: In 11 of 12 dissected specimens, the blood vessels in the temporal region were found to lie within 2 mm of the frontal branch of the facial nerve. CONCLUSIONS: We believe that a series of veins encountered during endoscopic forehead procedures provide the surgeon with the ability to identify the precise location of the frontal branch of the facial nerve. During endoscopic surgery, these vessels are found in a plane between the deep temporal fascia (below) and the superficial temporal fascia (above). We believe that these vessels can be thought of as arrows pointing superiorly to a frontal branch of the facial nerve as it courses through the superficial temporal fascia.
OBJECTIVE: To quantitatively analyze the changes in the 3-dimensional appearance of the lips after V-Y lip advancement for lip augmentation. DESIGN: A retrospective single-blinded study of patients who had a V-Y lip augmentation from January 1999 to December 2001. Standardized anterior and lateral preoperative and postoperative digital photographs of patients were analyzed using digital imaging software to quantify postoperative changes. RESULTS: There were statistically significant increases in the vertical height of the upper red lip (75%) and in the area of the upper red lip (66%). The upper and lower lip projection increased by approximately 40%. The vertical distance from the apex to the trough of Cupid's bow increased by 56.7%. CONCLUSIONS: The V-Y lip advancement for lip augmentation increases the parameters that characterize the fullness of the upper lip and enhances the vermilion "pout" and projection of the upper and lower lip. It also increases the curvature of Cupid's bow.
OBJECTIVE: To evaluate and quantify the increase in lower eyelid tension (stress) after endoscopic forehead/midface-lift in a cohort of patients with normal lower eyelid function preoperatively. METHODS: A prospective nonrandomized study was conducted at a private facial plastic surgery practice and ambulatory surgical center on 22 patients who underwent subperiosteal endoscopic forehead/midface-lift from October 2000 to June 2002. Patients were evaluated preoperatively, 4 to 6 months postoperatively, and approximately 12 months postoperatively. RESULTS: Compared with preoperative lower eyelid tension, there was a 4- to 5-fold increase in lower eyelid tension at 3 and 5 mm of distraction immediately after the operation. Four to 6 months after the operation, lower eyelid tension decreased but was still 2 to 3 times that of preoperative values. Twelve-month measurements for the 15 patients who remained in the study (the other 7 patients were lost to follow-up or refused to have measurements taken) showed that lower eyelid tension was 1.7 to 1.9 times preoperative values. CONCLUSIONS: Our results show that lower eyelid tension increases following endoscopic forehead/midface-lift and that this increased tension is long lasting and quantifiable 12 months after surgery.
OBJECTIVES: To assess the differences in nasal anthropometric measurements between Korean American women and North American white women and to perform an in-depth nasal index calculation. METHODS: This anthropometric survey included a volunteer sample of Korean American women (n = 72) aged 18 to 35 years with Korean parents and no previous nasal surgery or trauma to the nose. Standardized and referenced frontal, lateral, and basal photographs of the nose were taken of the subjects and 22 standard anthropometric measurements of the nose were determined. Results were compared with published standards for North American white women. In addition, 18 nasal indices were calculated and compared with the published standards for North American white women. RESULTS: The Korean American woman's nose did not fit the neoclassic facial canons. Compared with North American white women, 20 of 22 nasal measurements in Korean American women were found to be significantly different. Nasal indices also revealed significant differences in 16 of the 18 that were calculated. The Korean American woman's nose exhibits less rotation, has a flatter dorsum, and is more flared at the alae, with less definition of the nasal tip. CONCLUSIONS: The average Korean American and North American white female nasal anthropometric measurements are very different. As cosmetic surgery becomes more popular among Asian Americans, our findings bolster the need for a broader view of facial analysis and transcultural aesthetics.