Arch Facial Plast Surg Research Articles

Recurrence rates in the treatment of keloids and hypertrophic scars with intralesional triamcinolone combined with other intralesional agents.

Hypertrophic scars (HTS) and keloids are pathologic scars that are products of a wound healing pathway error attributed to genetic and inflammatory causes (Leventhal et al., Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362 , 2006). Methods of pathologic scar treatment include intralesional agents, cryotherapy, surgical excision, pressure dressings, topical agents, laser resurfacing, radiotherapy, and other investigational therapies (Leventhal et al. 2006). The recurrence of pathologic scar is high across all treatment modalities, including the use of intralesional agents (Trisliana Perdanasari et al., Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620 , 2014). In the treatment of pathologic scar, combination approaches using intralesional agents, such as triamcinolone (TAC), 5-fluorouracil (5FU), verapamil (VER), bleomycin (BLM), and botulinum toxin (BTX), are superior therapies when compared to monotherapy (Yosipovitch et al., J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363 , 2001; Yang et al., Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628 , 2021; Sun et al., Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8 , 2021). This review assesses recurrence and the reporting of recurrence in pathologic scar after treatment with intralesional triamcinolone (TAC) in combination with another intralesional agent.A literature review was conducted using research journals from PubMed using the following search terms: [(keloid) AND (triamcinolone) AND (combination) AND (intralesional)], as well as [(keloid) AND (triamcinolone) AND (combination)]. Articles were reviewed and included if the article analyzed or compared intralesional agents for pathologic scar treatment within the last 10years.The average follow-up period of included articles (n = 14) that utilized combination intralesional therapy (TAC-X) was approximately 11months (range 1-24months). Consistent recurrence rate reporting across studies was lacking. The combination agent with the highest recurrence rate was TAC-5FU (23.3%). The range of reported recurrence rates was 7.5-23.3%. Six studies using various intralesional combination regimens reported 0% recurrence over the follow-up period (TAC-5FU, TAC-BTX, TAC-BLM, TAC-CRY). Three studies did not report recurrence rates.While the efficacy of combination therapy is typically assessed via scar scales, the assessment of recurrence across studies of combination therapy is inconsistent and inadequate, with truncated follow-up periods. While scar recurrence can take place during 1-year post-treatment, long-term follow-up (18-24months) is needed to characterize recurrence in the treatment of pathologic scar using various intralesional agents. Long-term follow-up periods allow patients to receive accurate prognostic information regarding recurrence after combination intralesional therapy. There are limitations to this review in that comparisons were made across studies with varying outcome variables, including scar size, injection concentration and interval, and follow-up period. Standardized follow-up periods and recurrence rate reporting are integral to furthering the understanding of these therapies and enhancing patient care.

Transconjunctival lower eyelid blepharoplasty with fat transposition above the orbicularis muscle for improvement of the tear trough deformity.

The tear trough is the hollow concavity of the medial lower eyelid. Surgery can address tear trough deformities and reverse visible signs of periorbital aging. The previous methods of transconjunctival blepharoplasty with fat transposition were first described with subperiosteal placement of fat (Plast Reconstr Surg, 125, 2010,699, Aesthetic Surg J, 32, 2012, 426). This was followed by techniques with submuscular transposition of fat, which overcame certain difficulties associated with the subperiosteal methods (Clin Plast Surg, 20, 1993, 393, Arch Facial Plast Surg, 2, 2000, 16). We present a detailed description, evaluate the efficacy, safety, and advantages of transconjunctival blepharoplasty with fat pedicle transposition above the orbicularis muscle for lower eyelid rejuvenation and improvement of the tear trough deformity. Forty-one patients underwent lower eyelid blepharoplasty with fat transposition above the orbicularis muscle. Clinical and photographic documentation along with patient satisfaction ratings were evaluated for a minimum of 44months postoperatively. Significant improvements of lower eyelid aesthetics and correction of tear trough abnormalities were observed in most patients. At 44months postoperatively, surgical correction was maintained in all patients with a high satisfaction and long-term survival. No contour irregularities or significant long-term complications were detected in any of the patients. Transconjunctival blepharoplasty with the fat pedicle transposition placed above the orbicularis muscle is a safe and effective technique for lower eyelid rejuvenation. Compared to previously described techniques of repositioning fat into the subperiosteal or submuscular plane, this technique of transposing fat above the orbicularis muscle is an alternative technique resulting in long-term improvement of tear trough abnormalities with no major complications.

The Biaxial Double Barrel Flap—a Simplified Technique for Fibular Maxillary Reconstruction

Objective: Previously described techniques for microvascular fibular reconstruction of post–extirpative maxillectomy defects are limited by their complexity, multiple osteotomies, limited pedicle length, and inadequate reconstruction of the dental alveolus for endosseous implants. 1 Shipchandler T.Z. Waters H.H. Knott P.D. Fritz M.A. Orbitomaxillary reconstruction using the layered fibula osteocutaneous flap. Arch Facial Plast Surg. 2012; 14: 110-115 Crossref PubMed Scopus (25) Google Scholar , 2 Trosman S.J. Haffey T.M. Couto R.A. Fritz M.A. Large orbital defect reconstruction in the setting of globe-sparing maxillectomy: the titanium hammock and layered fibula technique. Microsurgery. 2018; 38: 354-361 Crossref PubMed Scopus (9) Google Scholar

Nasal bone length in Saudi rhinoplasty: a clinical-radiological study

BACKGROUND AND OBJECTIVESHump reduction in the presence of short nasal bones can result in significant esthetic and/or functional problems in patients seeking rhinoplasty in the Middle East. The aims of this study were to determine the mean length of nasal bones, amount of nasal dorsum it forms in relation to the whole nose, and incidence of short nasal bones in the Middle Eastern population.DESIGN AND SETTINGSA prospective study that has been carried out in a tertiary care hospital.PATIENTS AND METHODSA total of 154 patients (80 females and 74 males) who were scheduled for computed tomography scan for the paranasal sinuses were included in the study. The inclusion criteria were adults with no history of facial/nasal trauma, sinus space occupying lesions, or surgery.RESULTSIn males, the mean clinical nasal bone length was 19.59 mm and the mean radiological nasal bone length was 24.96 mm. In females, the mean clinical nasal bone length was 18.17 mm and the mean radiological bone length was 22.82 mm.CONCLUSIONThe bony vault represents 44.2% of the female nose and 44.3% of the male nose. In the present study, no patients displayed a short nasal bone that was less than one-third of the whole nasal length.

Botulinum toxin type A: implications in wound healing, facial cutaneous scarring, and cleft lip repair

Botulinum toxin is a neurotoxin that has been utilized to induce chemo-denervation of muscles. Cutaneous wounds represent a special situation in which the tensile forces applied by these muscles on wound edges might have deleterious effects on the healing process. The aim of this review was to investigate such an effect and to review other mechanisms this toxin might have on the healing process. We also reviewed the role of botulinum toxin in the management of hypertrophic scars and cleft lip repair.

The Nasal Keystone Region

The Nasal Keystone Region

Facing Levels of Evidence

Facing Levels of Evidence

Leonardo da Vinci's Aesthetic Analysis of Nasal Tip Prominence

Leonardo da Vinci's Aesthetic Analysis of Nasal Tip Prominence

Use of Carbon Dioxide Laser to Treat Lentigo Maligna and Malignant Melanoma In Situ, Lentigo Maligna Type

Archives of Facial Plastic SurgeryVol. 14, No. 6 Free AccessUse of Carbon Dioxide Laser to Treat Lentigo Maligna and Malignant Melanoma In Situ, Lentigo Maligna TypeMichael McLeod, Katlein Franca, Katherine Ferris, and Keyvan NouriMichael McLeodSearch for more papers by this author, Katlein FrancaSearch for more papers by this author, Katherine FerrisSearch for more papers by this author, and Keyvan NouriCorrespondence: Dr Nouri, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 12th Ave NW, Ste 2175, Miami, FL 33136 (E-mail Address: knouri@med.miami.edu).Search for more papers by this authorPublished Online:1 Nov 2012AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail We read with great interest the recent article published by Lee et al titled “Carbon Dioxide Laser Treatment for Lentigo Maligna: A Restrospective Review Comparing 3 Different Treatment Modalities.”1While the carbon dioxide ablative laser may offer some usefulness as a third-line treatment, the nature of its emitted light has stark limitations. Most notably, the 10 600-nm wavelength is not actively absorbed by melanocytes; instead, the laser targets water as a chromophore. In addition, the 10 600-nm wavelength may not penetrate deep enough to destroy the atypical melanocytes extending down the periadnexal structures, using reasonable fluences.2,3 Future studies may wish to explore a laser wavelength that is more actively absorbed by melanocytes, such as using indocyanine green as a photosensitizer followed by treatment with the titanium sapphire laser.4,5An important distinction needs to be made between lentigo maligna and malignant melanoma in situ, lentigo maligna type. These 2 lesions exhibit histologic nuances that likely result in differences in their biological behavior.6,7 Lentigo maligna is histologically characterized by atypical melanocytic hyperplasia along the dermoepidermal junction, whereas malignant melanoma in situ, lentigo maligna type, exhibits atypical melanocytic hyperplasia along the dermoepidermal junction along with confluence and nesting of the melanocytes at higher layers in the epidermis (ie, above the dermoepidermal junction). This histologic distinction is important because malignant melanoma in situ, lentigo maligna type, likely progresses to lentigo maligna melanoma much more quickly than the often quoted rates of 4.7% if diagnosed by age 45 years and 2.2% when diagnosed by age 65 years.4,8,9Thus, if the carbon dioxide laser is used to treat lentigo maligna, it should be used only if other modalities are not applicable and if the histologic characteristics are consistent with lentigo maligna and not malignant melanoma in situ, lentigo maligna type.Financial Disclosure: None reported.REFERENCESLee H, Sowerby LJ, Temple CL, Yu E, Moore CC. Carbon dioxide laser treatment for lentigo maligna: a retrospective review comparing 3 different treatment modalities.. Arch Facial Plast Surg. 2011;13(6):398–403 Abstract, Google ScholarMadan V, August PJ. Lentigo maligna: outcomes of treatment with Q-switched Nd:YAG and alexandrite lasers.. Dermatol Surg. 2009;35(4):607–612 19309345 Google ScholarLee PK, Rosenberg CN, Tsao H, Sober AJ. Failure of Q-switched ruby laser to eradicate atypical-appearing solar lentigo: report of two cases.. J Am Acad Dermatol. 1998;38(2, pt 2):314–317 9486705 Google ScholarMcLeod M, Choudhary S, Giannakakis G, Nouri K. Surgical treatments for lentigo maligna: a review.. Dermatol Surg. 2011; 21631635 Google ScholarMamoon AM, Gamal-Eldeen AM, Ruppel ME, Smith RJ, Tsang T, Miller LM. In vitro efficiency and mechanistic role of indocyanine green as photodynamic therapy agent for human melanoma.. Photodiagnosis Photodyn Ther. 2009;6(2):105–116 19683211 Google ScholarTannous ZS, Lerner LH, Duncan LM, Mihm MCJr, Flotte TJ. Progression to invasive melanoma from malignant melanoma in situ, lentigo maligna type.. Hum Pathol. 2000;31(6):705–708 10872664 Google ScholarTannous ZS, Mihm MC, Flotte TJ, González S. In vivo examination of lentigo maligna and malignant melanoma in situ, lentigo maligna type by near-infrared reflectance confocal microscopy: comparison of in vivo confocal images with histologic sections.. J Am Acad Dermatol. 2002;46(2):260–263 11807439 Google ScholarWeinstock MA, Sober AJ. The risk of progression of lentigo maligna to lentigo maligna melanoma.. Br J Dermatol. 1987;116(3):303–310 3567069 Google ScholarDavis J, Pack GT, Higgins GK. Melanotic freckle of Hutchinson.. Am J Surg. 1967;113(4):457–463 6023013 Google ScholarFiguresReferencesRelatedDetails Volume 14Issue 6Nov 2012 InformationCopyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Michael McLeod, Katlein Franca, Katherine Ferris, and Keyvan Nouri.Use of Carbon Dioxide Laser to Treat Lentigo Maligna and Malignant Melanoma In Situ, Lentigo Maligna Type.Archives of Facial Plastic Surgery.Nov 2012.462-462.http://doi.org/10.1001/archfaci.2012.874Published in Volume: 14 Issue 6: November 1, 2012PDF download

The Hyoplatysmal Ligament

The Hyoplatysmal Ligament

Jacques Louis David's Madame de Pastoret and Her Son

Jacques Louis David's <i>Madame de Pastoret and Her Son</i>

Ethical Conduct of Humanitarian Medical Missions

Ethical Conduct of Humanitarian Medical Missions

A Retrospective Review of the Use of Autologous Platelet Gels for Rhytidectomy

A Retrospective Review of the Use of Autologous Platelet Gels for Rhytidectomy

A Global Surgical Journal

A Global Surgical Journal

Use of two-piece polyetheretherketone (PEEK) implants in orbitozygomatic reconstruction

Polyetheretherketone (PEEK) is a semicrystalline polyaromatic linear polymer that exhibits an excellent combination of strength, stiffness, durability, and environmental resistance. 1 Kim M.M. Boahene K.D. Byrne P.J. Use of customized polyetheretherketone (PEEK) implants in the reconstruction of complex maxillofacial defects. Arch Facial Plast Surg. 2009; 11: 53-57 PubMed Google Scholar It is derived from the polyaryletherketone family of linear aromatic polymers. 2 Schlegel J. Green S. Polyetheretherketones (PEEK). A biocompatible high performance plastic. Med Plastics. 2000; 14 (12.1–12.10) Google Scholar

Reply to “Essentials of Cheek and Midface Implants”

I read with great interest the article by Niamtu 1 Niamtu III, J. Essentials of cheek and midface implants. J Oral Maxillofac Surg. 2010; 68: 1420 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar entitled “Essentials of cheek and midface implants,” which reported on his personal experience in treating aging midface deficiency with facial implants. As for the vast majority of surgeons, the author also prefers preformed and non–custom-made implants, among which the porous polyethylene and silicone rubber undeniably get the lion's share. Although the author gives an exhaustive list of the common material for facial implant, for the sake of accuracy, I would like to discuss another material, polyetheretherketone (PEEK). PEEK is a semicrystalline thermoplastic polymer characterized by excellent mechanical and chemical properties, as well as biological safety, which makes this material a reliable alternative to the other alloplastic bone substitutes. At the beginning, PEEK polymers were especially used in spine surgery (interbody fusion cage implants) and in orthopedic surgery (hip implants). A great advantage with this material is that it can be coupled with the computer-aided design/computer-aided manufacturing techniques, thus allowing the manufacturing of custom-made implants, which can be exactly tailored according to the individual anatomy. Moreover, this procedure dramatically minimizes the need for major intraoperative manipulations, which are often necessary to adequately fit the non–custom-made implants, thus reducing the operative time. In 2007 we first reported on the use of a custom-made PEEK implant for the reconstruction of a large complex orbito-fronto-temporal defect. 2 Scolozzi P. Martinez A. Jaques B. Complex orbito-fronto-temporal reconstruction using computer-designed PEEK implant. J Craniofac Surg. 2007; 18: 224 Crossref PubMed Scopus (92) Google Scholar Since then, computer-designed PEEK implants have progressively gained in popularity, rapidly becoming a standard in calvarial reconstructive surgery. Conversely, the utilization of such implants for correcting facial problems has been and still is more problematic, essentially because of the technical difficulty in precisely reproducing the tortuous 3-dimensional anatomy of the facial skeleton. However, this procedure is particularly attractive for unilateral secondary post-traumatic or congenital maxillofacial deformities. In fact, in these cases the healthy side can be used as a template and computationally superimposed on the affected side using specific “mirroring” software. This allows for the creation of a patient-specific implant (PSI), which has the potential of precisely restoring the facial symmetry. So far, Kim et al 3 Kim M.M. Boahene K.D. Byrne P.J. Use of customized polyetheretherketone (PEEK) implants in the reconstruction of complex maxillofacial defects. Arch Facial Plast Surg. 2009; 11: 53 PubMed Google Scholar have been the only authors to report on unilateral midface rehabilitation (2 patients) using a computer-designed PEEK-PSI. Since the introduction of this technique in our department 3 years ago, 3 patients with residual maxillofacial defects (1 with secondary right post–orbito-zygomatic fracture deformity, 1 with mandibular asymmetry after bilateral sagittal split osteotomy, and 1 with chin deformity after advancement genioplasty) were treated by use of computer-designed PEEK-PSI at the Hôpitaux Universitaires de Genève in Switzerland. All the patients had a satisfactory and anatomically correct reconstruction of the maxillofacial defect as assessed on the immediate postoperative computed tomography scan. None of the patients had intraoperative or postoperative complications. In 1 patient 2 implants could not be placed given their limited size, which prevented their adequate stabilization. Essentials of Cheek and Midface ImplantsJournal of Oral and Maxillofacial SurgeryVol. 68Issue 6PreviewThis author has placed cheek implants sporadically for the past 25 years. Previous to 2004, expanded polytetrafluoroethylene cheek implants were used, but since that time, only Silastic implants (ImplanTech, Ventura, CA) have been placed. Full-Text PDF Letter to the EditorJournal of Oral and Maxillofacial SurgeryVol. 69Issue 4PreviewOne of the rewards of contributing to the scientific literature is the input of the readers. I thank Dr Scolozzi for his discussion of the use of polyetheretherketone (PEEK) in facial implant surgery. Although I am not aware of this material's availability in the United States for facial implants, I am aware of its use in orthopedics and other surgical specialties. It is important that our journal brings to the forefront new materials regardless of geographic acceptance. Dr Scolozzi reports on the use of PEEK for reconstructive cases, but my article was solely aimed at the use of silicone implants for cosmetic enhancement. Full-Text PDF

Gore-Tex Nasal Augmentation

Gore-Tex Nasal Augmentation

Facial Acne Scarring

Facial Acne Scarring

Effect of Perioperative Hyperbaric Oxygen on Bruising in Face-lifts

Effect of Perioperative Hyperbaric Oxygen on Bruising in Face-lifts

Daily Facial Stimulation to Improve Recovery After Facial Nerve Repair in Rats

To establish whether daily mechanical stimulation improves functional recovery of whisking after facial nerve transection injury and repair in rats. Forty rats underwent facial nerve transection injury and repair and subsequent quantitative facial movement testing. Animals were randomized into 2 experimental groups (n = 20 each). Both groups received daily 5-minute manual stimulation of their whiskers, with one group undergoing whisker protraction and the other, whisker retraction. Rats were tested on postoperative weeks 1, 4 through 8, and 15 via a validated, quantitative whisking kinematics apparatus. Whisks were counted and analyzed for whisking amplitude, velocity, and acceleration. Animals receiving manual stimulation by passive protraction of their whiskers demonstrated significantly improved functional recovery at multiple time points during the 15 weeks compared with historical controls (P < .005; 1-tailed t test). Recovery was similar in the protraction and retraction groups, trending toward better whisking recovery in the protraction group. Daily mechanical whisker stimulation via either protraction or retraction significantly improves recovery of whisking after facial nerve transection and repair. This finding supports the role of early soft-tissue manipulation after facial nerve repair and may have clinical implications for the postoperative management of patients after facial nerve manipulations.