Biomedical subjects

Wallace K Dyer

Publications and source records attributed to Wallace K Dyer.

4 recordsLinked to original sources

PubMed2005

Minimal incision facelift.

Many procedures have been developed in an attempt to improve facial ptosis. These have ranged from subcutaneous dissections with skin excision to deeper dissections focused on supporting the superficial musculoaponeurotic system and even the periosteal layer. These deeper dissections, although theoretically giving better and longer lasting results, also carry an increased risk of complications. This article describes a new facelift technique that minimizes complications while maximizing cosmetic results (especially in the neck and jowl areas) and patients' comfort and satisfaction. Aesthetic results (as determined by pre- and postoperative photographs) and complications of 35 consecutive patients undergoing both traditional rhytidectomy and minimal incision facelift are compared. The minimal incision facelift technique has shown improved cosmetic results and a decreased complication rate compared with traditional rhytidectomy and is a safe and very effective technique for the treatment of facial ptosis.

Adult↗

PubMed2004

Nasal tip support and its surgical modification.

As noted by Drs. Johnson and Toriumi, "The keyto successful rhinoplasty lies in the restructuring of the lower third of the nose. The modified skeletal elements must have both proper form and sufficient skeletal strength to give shape to the overlying skin-soft tissue envelope. A skeleton that lacks this load-bearing integrity becomes distorted or collapses under the weight of overlying tissues and the forces of scar contracture" [6]. All facial plastic surgeons have seen (or caused)a weakened nasal tip and have been frustrated at attempts to correct the resultant aesthetic and functional deformities. In a well-reasoned plea for surgical conservatism Dr. Tardy states that "Tip cartilage reorientation and repositioning often produce more favorable and predictable appearances. Notching, pinching, cephalicalar retraction, over-rotation, asymmetries, and tip support loss are all almost entirely eliminated in long-term healing when this conservative philosophy is embraced" [3]. Though conservation of surgical injury will certainly improve rhinoplasty results, a midline tensegrity rebuild using the time-honored surgical technique of layered wound closure will provide the maximum level of surgical control presently available overnasal tip modification. The basic knowledge of architecture and engineering presented here, along with the application of these concepts to nasal tip support,will benefit all of our patients through improvement of surgical results. As surgical architect/engineers we should all em-brace the concept that "The resistant virtue of the(nasal tip) structure that we seek depends on its (architectural) form; it is through its form that it is stable,not because of an awkward accumulation of material. There is nothing more noble and elegant from an intellectual viewpoint than this: to resist through form" [12].

Esthetics↗

PubMedDate not supplied

The quantification of surgical changes in nasal tip support.

OBJECTIVES: To quantify the changes in the strength of nasal tip support associated with various surgical modifications and to identify the procedures that best maintain or augment tip support. DESIGN: Case study in 2 phases. Phase 1 included 10 patients undergoing primary rhinoplasty, 5 undergoing secondary rhinoplasty, and 5 control patients. Fresh cadavers were used in phase 2. A purpose-built instrument (Beaty Tensegrometer; G. M. Tooling, Chamblee, Ga) was used to measure nasal tip support before and after surgical modifications. RESULTS: In the patients who underwent primary rhinoplasty, there was a 25% decrease in tip support when the ligamentous attachments between the lateral crura were divided. Reconstruction of these attachments increased tip support over baseline by 35%. With a columellar strut and ligament reconstruction, tip support was increased by 44%. In the secondary rhinoplasty group, reconstruction with the dynamic adjustable rotation tip-tensioning technique increased nasal tip support over baseline by 70%. In cadavers, intercartilaginous incisions and delivery of the lower lateral cartilages caused a loss of tip support, while raising the skin-soft tissue envelope with the open technique did not. Extensive resection of the lower lateral cartilages caused a loss of tip support. CONCLUSIONS: This study demonstrates that nasal tip support can be reliably quantified in a reproducible manner. Use of the open approach, reconstruction of the attachments between the lateral crura, conservative resection of the lower lateral cartilages, and the dynamic adjustable rotation tip-tensioning technique for secondary rhinoplasty best preserve nasal tip support.

Biomechanical Phenomena↗

PubMedDate not supplied

Improving surgery on the aging neck with an adjustable expanded polytetrafluoroethylene cervical sling.

OBJECTIVES: To evaluate the ability of the expanded polytetrafluoroethylene (ePTFE) cervical sling to improve results of surgery on the aging neck in the short term as well as its ability to achieve long-term cosmesis through its secondary adjustability. DESIGN: A retrospective analysis. SETTING: A private facial plastic surgery practice. Patients The first 100 consecutive patients who underwent placement of the ePTFE cervical sling with a minimum follow-up of 36 months. Intervention Placement of a preplatysmal, mastoid-to-mastoid, ePTFE cervical sling sutured to the fascia overlying the insertion of the sternocleidomastoid bilaterally in conjunction with a graded surgical approach appropriate for each patient. This included lipoplasty, midline platysmal plication, and rhytidectomy. OUTCOME MEASURES: Aesthetic appearance of the neck was evaluated by comparison of preoperative and postoperative photographs at 1 year. Appraisal of secondary adjustability was similarly assessed 1 month after sling tightening. Patient satisfaction was recorded via self-assessment of both procedures for cosmesis and comfort. Complications specific to sling placement and tightening were reviewed. RESULTS: One year after initial surgery, 85 patients had significant or marked improvement. More than 90% of patients felt that the procedure met or exceeded their cosmetic expectations, while 99 patients felt no residual discomfort. Secondary to rebound tissue relaxation, 9 of 100 patients required sling tightening a mean interval of 14 months after primary surgery. All 9 of these had either a significant or marked improvement, with similarly high patient satisfaction in cosmesis (n = 9; 100%) and comfort (n = 8; 89%). Two patients had postauricular infections necessitating sling removal. There were no complications with sling tightening. CONCLUSIONS: Placement of the ePTFE cervical sling is a safe and effective procedure to aesthetically improve short-term surgical results on the aging neck. By virtue of its secondary adjustability, it offers a safe, long-term solution to rebound tissue relaxation and associated submental laxity.

Female↗