Facial Plastic Surgery Practice Research Articles

Long-term Analysis of Lip Augmentation With Superficial Musculoaponeurotic System (SMAS) Tissue Transfer Following Biplanar Extended SMAS Rhytidectomy.

To our knowledge, long-term, objective results of lip augmentation using superficial musculoaponeurotic system (SMAS) tissue transfer beyond 1 year have not been previously described. To evaluate the efficacy, longevity, and safety of lip augmentation using SMAS tissue transfer. A retrospective single-blind cohort study was designed to evaluate all patients who underwent surgical lip augmentation using SMAS following rhytidectomy between January 1, 2000, and November, 16, 2015, at a private facial plastic surgery practice in Birmingham, Alabama. Preoperative photographs of each patient served as controls and were compared with postoperative photographs at 3 months, 1 year, and 5 years after lip augmentation. A total of 104 images (from 26 individual patients) were reviewed by 12 blinded observers using a validated lip augmentation grading scale. Lip augmentation using SMAS. Median lip volumes of all patients at each postoperative interval (3 months, 1 year, and 5 years) compared with preoperative lip volumes. Secondary outcome measures included postoperative complications. A total of 423 patients were identified who underwent surgical lip augmentation using SMAS. Sixty patients with approximately 5 years or more of postoperative photographs were reviewed for complications. Twenty-six patients had 3-month, 1-year, and 5-year postoperative follow-up photographs and were included in the photographic evaluation. The mean age of these patients at the time of surgery was 54.6 years (range, 41.2-80.6 years. Fifty-nine of the 60 patients (98.3%) were female. Two of 60 patients (3.3%) with 5 years or more of postoperative follow-up developed complications requiring intervention. Both the superior lip and the inferior lip showed statistically significant increases in volume at 3 months, 1 year, and 5 years (P ≤ .004 for the superior lip after 5 years; P ≤ .001 for all other comparisons) after SMAS lip augmentation. The greatest median increase was observed in the superior lip at 3 months, while the smallest median increase was observed for the inferior lip at 5 years. The degree of increase in median volume seemed to weaken slightly over time, but remained statistically significant even at 5 years. SMAS lip augmentation is an effective and safe method for lip augmentation that can yield natural, long-lasting results with minimal risk. The degree of augmentation tends to fade slightly over time, but remains significant for at least 5 years postoperatively. 3.

Measurement of Change in Lower Eyelid Position in Patients Undergoing Transcutaneous Skin-Muscle Flap Lower Eyelid Blepharoplasty

Transcutaneous lower eyelid blepharoplasty is a commonly performed procedure with a postoperative risk of eyelid malposition. To quantify the change in lower eyelid position after transcutaneous lower eyelid blepharoplasty. This retrospective medical record review describes patients who underwent transcutaneous blepharoplasty at a private facial plastic surgery practice. Patients with less than 3 months of follow-up, a history of periocular trauma, and concurrent midface lift were excluded. Bilateral skin-muscle flap lower eyelid blepharoplasties with possible tarsorrhaphy, canthopexy, or canthoplasty as indicated. Lower eyelid position determined by measurement of preoperative and postoperative pupil to eyelid and lateral limbus to eyelid distances. Data from 100 consecutive patients (mean age, 56.7 years; 92 female [92.0%]) undergoing bilateral skin-muscle flap lower eyelid blepharoplasty were analyzed. The mean increase in distance was 0.33 mm (95% CI, 0.24-0.42 mm) from the pupil to the lower eyelid margin and 0.32 mm (95% CI, 0.23-0.41 mm) from the lateral limbus to the lower eyelid margin at final follow-up. For both measurements, patients undergoing concurrent canthopexy had a significantly greater change in eyelid position (P < .001). Men had a greater change in the distance of pupil to lower eyelid compared with women (0.76 mm; 95% CI, 0.44-1.08 mm, vs 0.30 mm; 95% CI, 0.20-0.39 mm, respectively; P = .008) at final follow-up. Two patients required revision procedures secondary to eyelid malposition, and 25 patients had new onset of dry eye symptoms. Transcutaneous skin-muscle lower eyelid blepharoplasty with selective performance of canthoplasty or canthopexy causes a small, predictable eyelid position change in this population with a low rate of revision procedures. 3.

Safety and Efficacy of Expanded Polytetrafluoroethylene Implants in the Surgical Management of Traumatic Nasal Deformity.

The ideal alloplastic implant for correction of traumatic nasal deformity has not been adequately examined. To evaluate the safety profile and postoperative results of expanded polytetrafluoroethylene (ePTFE) implants used in functional nasal surgery (FNS) in the setting of traumatic nasal deformity. We conducted a 13-year retrospective medical chart review for patients treated at a tertiary academic facial plastic and reconstructive surgery practice between July 1999 and July 2012. A total of 404 FNS procedures were performed by a single surgeon during this period, 255 to repair traumatic deformities, 35 of these involving ePTFE implants. Patient demographics, medical comorbidities, operative and technical considerations, functional and aesthetic results, complications, and postoperative course findings were collected from patient records. In addition, preoperative and postoperative photographic documents were examined. Functional nasal surgery. Postoperative complications or presentations necessitating revision. A total of 404 patients (197 male, 207 female) underwent FNS. Of those, 255 procedures were to treat traumatic deformities. Forty patients altogether required the use of an ePTFE implant, 35 of those 40 deformities being associated with a traumatic injury. One of the 35 patients in the ePTFE-repaired traumatic deformities group experienced postoperative infection. This patient ultimately developed exposure after the infection failed to resolve with oral antibiotics, and the implant was removed. An additional patient in the ePTFE group required revision of the implant owing to contour irregularity and aesthetic concerns. No infections or other complications occurred among the 220 patients with traumatic deformity treated with autologous grafts. Analysis of other variables including sex, tobacco use, diabetes, immunosuppression, implant thickness, suture material, and prior septorhinoplasty were not associated with increased rate of infection (P > .05 for all). In the setting of traumatic nasal deformities requiring FNS, ePTFE implants can be used at the level of the nasal dorsum, where soft tissue coverage is often adequate, with a low risk of complications.

Subcutaneous vs Intramuscular Botulinum Toxin

IMPORTANCE Much has been published regarding rejuvenation of the upper face with botulinum toxin A injection; however, the optimal target tissue layer has not been specifically examined. OBJECTIVE To seek a difference between subcutaneous (SC) and intramuscular (IM) administration. DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized study at a tertiary care university facial plastic surgery practice. Nineteen patients who underwent botulinum toxin A treatment to the forehead were randomized so that each patient received IM injection on one side of the face and SC injection on the contralateral side. INTERVENTION Patients were assessed on the basis of eyebrow elevation before treatment, and at 2 weeks, 2 months, and 4 months following injection. Patients also completed a subjective questionnaire examining discomfort during injection, bruising, and tenderness, as well as their perception of their appearance after treatment. MAIN OUTCOME AND MEASURE Eyebrow height measurements between SC and IM techniques. RESULTS There was no difference in eyebrow height measurements between SC and IM techniques (0.00 [95% CI, -0.02 to 0.02]). Patients did report greater discomfort when receiving IM injections compared with SC injections (-0.76 [95% CI, -1.53 to 0.0005]). Patient satisfaction scores did not demonstrate a statistically significant difference between IM and SC techniques when measured on the first and second posttreatment visits; however, there was a trend toward significance on the final follow-up visit. CONCLUSIONS AND RELEVANCE Subcutaneous injection of botulinum toxin A is equally effective in achieving paralysis of the underlying frontalis muscle as IM botulinum toxin A administration. In addition, the SC route may result in less pain to patients receiving botulinum toxin A injection for rejuvenation of the upper face.

Development of a Severity Classification System for Subjective Nasal Obstruction

Nasal airway obstruction is a common presenting symptom in otolaryngology and facial plastic surgery practices, and the potential for multiple contributing causes requires extensive evaluation. To develop a classification system for nasal obstruction using a subjective, validated quality-of-life instrument. Retrospective study of patients' responses on the Nasal Obstruction Symptom Evaluation (NOSE) instrument performed from July 2011 through May 2012. All patients were seen at a university-based tertiary medical center. Scores from patients with or without nasal obstruction were used to develop a classification system after receiver operating characteristic curve analysis. The classification subdivides nasal obstruction scores into a range of defined classes. Data analysis was performed using results from 345 patients. A score of 30 on the NOSE survey best differentiated patients with and without nasal obstruction. This threshold also provided intervals used to define the other class ranges. Patients were categorized as having mild (range, 5-25), moderate (range, 30-50), severe (range, 55-75), or extreme (range, 80-100) nasal obstruction, depending on responses on the NOSE survey. The NOSE scale is an important tool for gauging symptoms in patients with nasal obstruction. The proposed classification system will improve patient care by providing a framework for the severity of their symptoms and helping them understand potential treatment effects. If the classification is used in future outcomes research, it will allow physicians to better understand the study patient population and the effect of treatment on each severity class. NA.

Trends in Facial Plastic Surgery in Latin America

In an effort to try to define the tendencies in the practice of facial plastic surgery in the different countries of Latin America, a survey was conducted from June 2012 to August 2012. Questionnaires were sent to specialists in otolaryngology and facial plastic surgery in the countries of Colombia, Brazil, Venezuela, Ecuador, Chile, Peru, and Mexico. Results are shown and discussed. Comparisons are made with existing surveys performed by the American Academy of Facial Plastic and Reconstructive Surgery.

Open and Closed, or Endoscopic, Brow-lifts Revisited

Objectives: To measure and compare surgical brow elevation with open and endoscopic techniques; to compare patients who did and did not undergo an eyelid procedure in the same setting as the brow-lift; and to determine whether a learning curve exists for a successful endoscopic brow-lift procedure. Design: A retrospective review of patients who underwent coronal, trichophytic, and endoscopic brow-lift surgery from January 1, 1993, to December 31, 1997 (performed by K.A.L.). We analyzed preoperative and postoperative photographs obtained from 10 to 56 months after surgery while masked to the surgical technique used. Measurements included a horizontal baseline drawn through the midpoint of the right and left medial canthi, and extended laterally across the face; the distance from the baseline to the superior border of the medial eyebrow on the right and left sides; and the distance from the baseline to the highest point of the brow on the right and left sides. A second, nonbiased observer analyzed a random sampling of patient photographs to determine the degree of interobserver variation. Setting: Private facial plastic and reconstructive surgery practice. All procedures were performed in an ambulatory surgery setting. Participants: We identified 125 patients (average age, 54 years) with greater than 10 months of postoperative photographic documentation. We excluded 41 patients owing to several inconsistencies between their preoperative and postoperative photographs and included 84. These patients were divided into 3 groups: those undergoing coronal, trichophytic, and endoscopic procedures. Of the patients undergoing concomitant eyelid procedures, 12 underwent upper lid blepharoplasties; 15, lower lid blepharoplasties; 16, bilateral upper and lower lid blepharoplasties; 6, periorbital laser resurfacing or chemical peel; 1, canthoplasty; and 1, ptosis repair. The endoscopic brow-lift procedure was not performed in this facial plastic surgery practice until 1995. To determine whether better results were obtained in the later half of the study, when the surgeon had more experience, this group was divided between the 14 patients who underwent the procedure from January 1, 1995, to June 30, 1996, and the 20 who did from July 1, 1996, to December 31, 1997. Main Outcome Measures: Comparison of preoperative photographs with postoperative 10to 32-month follow-up photographs and with final 35to 56-month follow-up photographs. Results: We found no statistically significant difference in: the distance of the medial brow (P=.89) or highest elevated point of the brow (P=.93) between the coronal, trichophytic, and endoscopic groups; the distance that the medial brow (P=.15) or the highest point of the brow (P=.11) was raised for those patients undergoing concomitant eyelid procedures; and the distance that the medial brow (P=.80) or highest point of the brow (P=.79) was raised between the 2 endoscopic brow-lift groups. Interobserver variation in brow measurements was 0.1 cm or less in more than 90% of cases. Conclusions: Both open and endoscopic brow-lift techniques described herein elevate the entire brow successfully. We found no statistical difference in patients undergoing concomitant eyelid procedures, and there was no identification of a “learning curve” for a successful endoscopic brow-lift with the surgical technique described.

Reconstruction of Nasal Alar Defects in Asian Patients

To present the aesthetic and functional outcomes of nasal alar reconstruction in Asian patients and to propose a working surgical algorithm. Seventeen patients underwent nasal alar reconstruction at a university-based facial plastic surgery practice from March 1, 1998, through February 28, 2010. The male-female ratio was 10:7, with a median age of 59 years (range, 34-78 years), and the mean follow-up duration was 64 months. The defect was mostly caused by basal cell carcinoma resection (14 of 17 [82%]), followed by the resection of squamous cell carcinoma, trauma, and excision of a previous scar. The mean defect size was 1.71 cm (range, 1-4 cm). The full-thickness defects were noted for 8 patients, whereas 9 had partial-thickness defects. The choice of reconstruction method was primarily based on the size and depth of the surgical defect. Most of the defects 1 to 2 cm in diameter needed nasolabial flaps (10 of 17 [59%]), whereas full-thickness defects larger than 2 cm needed forehead flaps (3 of 17 [18%]) to reconstruct the external defect. Smaller defects less than 1 cm were reconstructed with composite grafts (2 of 17 [12%]), a bilobed flap (1 of 17 [6%]), or primary closure (1 of 17 [6%]). Seven of 8 full-thickness defects had the internal nasal lining reconstructed using a septal mucoperichondrial flap, and 1 case was reconstructed using a cutaneous turn-in flap. Reinforcement cartilage graft was used in 8 patients. No flap failure occurred except in 1 case, in which necrosis of the internal lining flap caused contraction of the external flap with resultant alar rim elevation. An elevation of the alar margin and alar groove blunting occurred in 3 cases. No functional problems emerged. Subjective surgical outcome on a 4-point satisfaction scale revealed that 5 patients (29%) were much satisfied, 10 patients (59%) were satisfied, 1 patient (6%) was fairly satisfied, and 1 patient (6%) was dissatisfied. The choice of reconstruction method of nasal alar defect in Asian patients depends primarily on the size and depth of the defect. Staged local flaps, use of cartilage reinforcement grafts, and internal lining reconstruction using septal mucoperichondrial flaps are key elements for achieving optimal aesthetic and functional results.

A Novel Technique to Repair Moderate-Sized Nasoseptal Perforations

To describe a novel technique for closure of moderate-sized nasoseptal perforations and to review the current literature on various techniques for closure of nasoseptal perforations. Retrospective review. Academic research. We performed a retrospective review of a successful novel technique that has been used at a facial plastic and reconstructive surgery practice for closure of nasoseptal perforations during 3 years (January 1, 2008, to January 1, 2011). Medical records were reviewed to identify patient characteristics, symptoms, causes of nasoseptal perforations, and outcomes, including patient satisfaction and rate of recurrent nasoseptal perforation. During 3 years at our institution, 7 patients were identified with nasoseptal perforations that had been closed using bilateral mucosal advancement flaps (one inferiorly based flap advanced from the floor of the nose and another superiorly based flap advanced from the lateral nasal wall). The nasoseptal perforations ranged from 0.6 to 1.6 cm. Most patients had excellent outcomes, with resolution of symptoms and no recurrence. Nasoseptal perforations have traditionally been closed using 2 superiorly based flaps or 2 inferiorly based flaps. We present a novel technique combining both flaps for closure of moderate-sized nasoseptal perforations. This procedure decreases the risk for recurrence of the perforation, necrosis of the flaps, and development of a new perforation.

Successes, Revisions, and Postoperative Complications in 446 Mohs Defect Repairs

To determine factors predictive of complications and the need for adjunctive treatments repair of facial Mohs defects. Charts of patients undergoing repair of facial defects from 2000 to 2010 in an academic facial plastic surgery practice were reviewed for patient medical history, tumor type, defect site and size, method of repair, postoperative sequelae, and adjunctive treatments. A total of 446 Mohs defect repairs were analyzed. Average patient age was 61.54 ± 14.81 years. The average defect size was 17.55 ± 10.48 mm. Overall complications were fairly uncommon and required intervention in only 18.74%; other than postoperative corticosteroid injections, additional procedures were necessary in only 6.95% of patients. Female sex; Fitzpatrick skin type 3; upper lip and nasal defects; glabellar, superiorly based nasolabial, bilobed, and rhombic flaps; and dermal suture extrusion were associated with increased complications. The most common complications seen were scar erythema and flap pincushioning. The most common revision techniques performed/recommended were selective laser photothermolysis (3.59%) and scar excision (3.59%). Repair of Mohs defects uncommonly requires adjunctive/revision techniques to reach satisfactory appearance. By understanding certain factors related to the patient, the defect, and the method of repair, surgeons can better choose reparative techniques and anticipate patient postoperative needs.

Sonic Rhinoplasty

To demonstrate histologic correlates and describe refinements in cosmetic rhinoplasty using the ultrasonic bone aspirator. This retrospective review of 103 consecutive patients undergoing cosmetic rhinoplasty at a tertiary care academic facial plastic surgery practice extends the applications for the ultrasonic bone aspirator to include reducing the nasal spine, glabellar deepening, sculpting of mobile bone fragments after osteotomy, smoothing of bony edges after medial osteotomy, and reducing the convexity of nasal bones. We performed histologic analysis of cartilage samples, and the patient and surgeon subjectively evaluated the aesthetic outcome of the procedure. All patients obtained satisfactory outcomes. Seven patients experienced minor complications. One patient had a visible dorsal irregularity, 2 had palpable but not visible dorsal irregularities, 2 had asymmetry of the dorsum, and 2 had underresection of the dorsum. No patients experienced skin or soft-tissue injury. The ultrasonic bone aspirator can be a useful adjunct for the cosmetic rhinoplasty surgeon. The ultrasonic bone aspirator permits precise, graded removal of bone without damage to surrounding soft tissue or mucosa. With multiple applications in nasal surgery, the ultrasonic bone aspirator permits refinement of subtle irregularities and asymmetry of the nasal bones. Complications associated with the device are rare.

A Novel Technique in Repair of Moderate‐sized Nasal Septal Perforations

Objective: 1) Describe a novel technique which has been successful in closure of moderate-sized nasal septal perforations. 2) Review the current literature on various techniques that have been previously described for closure of nasal septal perforations. Method: Retrospective review of a successful technique used at our institution for closure of septal perforations over a 5-year span (2006-2010) at a facial plastic surgery practice. Charts were reviewed to find patient characteristics, symptoms, etiologies of perforation, and outcomes, including patient satisfaction and rate of recurrent perforation. Results: Over the past 5 years at our institution, 12 patients were identified with nasal septal perforations, which were closed using bilateral mucosal advancement flaps: one inferiorly-based flap advanced from the floor of the nose and another superiorly-based flap advanced from the lateral nasal wall and upper lateral cartilage. The size of the perforations ranged from 0.6 cm to 1.6 cm. The majority of patients had excellent outcomes with resolution of symptoms and a low rate of recurrence. Conclusion: Nasal septal perforations have been approached traditionally with 2 superiorly based or 2 inferiorly based flaps. We present a technique with a combination of both flaps for closure of a moderate-size perforation. This decreases the risk of recurrence of the perforation, flap necrosis, and development of a new perforation.

The Angry Face Syndrome

The Angry Face Syndrome

The Nasal Obstruction Symptom Evaluation Survey as a Screening Tool for Obstructive Sleep Apnea

To determine if clinical data and Nasal Obstruction Symptom Evaluation (NOSE) scores can be used to identify patients at risk for obstructive sleep apnea (OSA). Intake surveys using the NOSE, Epworth Sleepiness Scale (ESS), and Snore Outcomes Scale (SOS) were administered to new patients visiting a facial plastic surgery practice and a rhinology practice. An academic facial plastic surgery practice and an academic rhinology practice. New patients to both practices. NOSE score and presence of septal deviation. The odds ratio (OR) for an ESS score higher than 10 was 2.98 (95% confidence interval [CI], 1.17-7.57) when snoring was present; 5.5 (95% CI, 1.35-22.58) when the NOSE score was 10 or higher; and 3.3 (95% CI, 0.98-11.0) when a deviated septum was found on clinical examination. The probability of an elevated ESS score was 88% when all 3 factors were present and 56% when the NOSE score was not elevated. Receiver operating characteristic analysis with predictors "snore" and NOSE score of 10 or higher had an area under the curve of 0.72. With a probability cutoff of 0.5, the sensitivity was 30%, and the specificity 90%. Sinonasal surgery is among the most common outpatient procedures performed in the United States each year. Many patients undergoing sinonasal surgery have undiagnosed OSA or nasal obstruction, a known risk factor for OSA. Patients with OSA have unique perioperative needs. In patients with nasal obstruction, a deviated septum, and/or snoring, there is an association between the NOSE score and the ESS score. The NOSE survey may serve as a simple screening instrument instead of the ESS for patients at risk for undiagnosed OSA and special perioperative needs.

Facial Suspension With Acellular Human Dermal Allograft

Objective To study the efficacy of acellular human dermal (AHD) allograft as a material for static slings used to treat ptosis of the oral commissure after facial paralysis. Design In the university facial plastic surgery practices (Baltimore, Md, and Albuquerque, NM) of the senior author (J.L.F.), 11 consecutive patients with facial paralysis were treated with AHD allograft slings. Follow-up was 4 to 14 months with 1 patient excluded for inadequate follow-up. Six of the remaining 10 patients received radiation therapy. Results were considered excellent and designated grade 1 when the affected oral commissure was at the same level as the normal commissure. Complete ptosis was designated grade 4. Grades 2 and 3 were designated between these extremes. Results All 10 patients showed improvement in the position of the oral commissure, in oral competence, and in cheek ptosis. Four patients were grade 1; 5, grade 2; and 1, grade 3. There were no implant extrusions or infections. Conclusions The increased biointegration of AHD allografts in comparison with alloplastic materials may account for the absence of infection reported in this study and the relatively high success rate, especially in patients receiving radiation therapy.

Molecular Effects of Fractional Carbon Dioxide Laser Resurfacing on Photodamaged Human Skin

To elucidate the sequential changes in protein expression that play a role in the clinically beneficial results seen with fractional carbon dioxide (CO2) laser resurfacing of the face and neck. Nine healthy volunteers were recruited for participation from the senior author's facial plastic surgery practice. After informed consent was obtained, each volunteer underwent a 2-mm punch biopsy from a discrete area of infra-auricular neck skin prior to laser treatment. Patients then immediately underwent laser resurfacing of photodamaged face and neck skin at a minimal dose (30 W for 0.1 second) with the Pixel Perfect fractional CO2 laser. On completion of the treatment, another biopsy specimen was taken adjacent to the first site. Additional biopsy specimens were subsequently taken from adjacent skin at 2 of 3 time points (day 7, day 14, or day 21). RNA was extracted from the specimens, and reverse transcriptase–polymerase chain reaction and protein microarray analysis were performed. Comparisons were then made between time points using pairwise comparison testing. We found statistically significant changes in the gene expression of several matrix metalloproteinases (MMPs). The data demonstrate a consistent up-regulation of MMPs 1, 3, 9, and 13, all of which have been previously reported for fully ablative CO2 laser resurfacing. There was also a statistically significant increase in MMP-10 and MMP-11 levels in this data set. This study suggests that the molecular mechanisms of action are similar for both fractional and fully ablative CO2 laser resurfacing.

Molecular Effects of Fractional Carbon Dioxide Laser Resurfacing on Photodamaged Human Skin

Objective To elucidate the sequential changes in protein expression that play a role in the clinically beneficial results seen with fractional carbon dioxide (CO(2)) laser resurfacing of the face and neck. Methods Nine healthy volunteers were recruited for participation from the senior author's facial plastic surgery practice. After informed consent was obtained, each volunteer underwent a 2-mm punch biopsy from a discrete area of infra-auricular neck skin prior to laser treatment. Patients then immediately underwent laser resurfacing of photodamaged face and neck skin at a minimal dose (30 W for 0.1 second) with the Pixel Perfect fractional CO(2) laser. On completion of the treatment, another biopsy specimen was taken adjacent to the first site. Additional biopsy specimens were subsequently taken from adjacent skin at 2 of 3 time points (day 7, day 14, or day 21). RNA was extracted from the specimens, and reverse transcriptase-polymerase chain reaction and protein microarray analysis were performed. Comparisons were then made between time points using pairwise comparison testing. Results We found statistically significant changes in the gene expression of several matrix metalloproteinases (MMPs). The data demonstrate a consistent up-regulation of MMPs 1, 3, 9, and 13, all of which have been previously reported for fully ablative CO(2) laser resurfacing. There was also a statistically significant increase in MMP-10 and MMP-11 levels in this data set. Conclusion This study suggests that the molecular mechanisms of action are similar for both fractional and fully ablative CO(2) laser resurfacing.

Comparison of Lip Enhancement Using Autologous Superficial Musculoaponeurotic System Tissue and Postauricular Fascia in Conjunction With Lip Advancement

To evaluate and compare the short- and long-term aesthetic results of surgical lip enhancement using the superficial musculoaponeurotic system (SMAS) and postauricular fascia graft implantation with and without vermilion border advancement. A single-blinded cohort study was performed using 39 patients who underwent surgical lip enhancement at a private facial plastic surgery practice between 2005 and 2007. The cohort was grouped as follows: 14 patients underwent lip augmentation using SMAS grafting; 10 patients underwent lip augmentation using postauricular fascia grafting; and 15 patients underwent combined lip augmentation and lip advancement (SMAS grafting was used in 8 of the procedures, and postauricular fascial tissue was used in 7). All procedures were performed in a controlled setting by a single surgeon (E.G.M.). Patients who had undergone previous lip augmentation of any kind were excluded from the study. Preoperative and postoperative photographs were analyzed by 3 blinded physician observers using the Lip Fullness Grading Scale. Postoperative photographs were evaluated at approximately 6 months and 1 year after the procedure. Reviewers noted a significant improvement in aesthetic scoring for each of the methods of lip augmentation examined at 6 months after surgery. This result was sustained at 12 months after surgery. Postauricular fascia graft lip augmentation and combined lip advancement and postauricular fascia augmentation recorded the highest scores after surgery. The largest mean scoring increases of 1.459 (t = -9.5049; P < .001) at 6 months and 1.584 (t = -9.0308; P < .001) at 1 year were found in the lip advancement and SMAS lip augmentation study group. Youthful, natural-appearing lips tend to enhance an individual's appearance. Surgical lip augmentation using SMAS or postauricular fascia, with or without vermilion border advancement, is a straightforward, safe, potentially long-lasting treatment for hypoplastic lips, with little to no morbidity.

A review of dermal fillers in facial plastic surgery

Over the last decade, injectable soft tissue fillers have become an integral part of facial plastic surgery practice. The vast choice of new products being brought to the market, improved safety profile, lower costs in the current economic climate and high street availability mean that demand for nonsurgical rejuvenation treatments are increasing at an exponential rate and are no longer the preserve of the affluent. Recent published work has focused on the addition of local anaesthetic into fillers, widening their indications, reporting longer term results, avoidance of complications, regulation and future directions. The refinement of techniques to restore facial volume with dermal fillers, and widely available botulinum (BTX) injections to treat dynamic facial rhytids, fuelled by widespread mainstream advertising, has led to a surge in demand for nonsurgical rejuvenation procedures. An increasingly well informed and discerning patient population now seek better value procedures that require minimal downtime and have instant results. A thorough knowledge of the dermal fillers available for soft tissue facial augmentation is therefore essential to any clinician involved in facial plastic surgery.

FILLERS-Q: An Instrument for Assessing Patient Experiences after Treatment with Facial Injectable Soft Tissue Fillers

Patient-reported outcomes data are limited after injectable soft tissue filler treatment. Patient-reported outcome measures (PROMs) are becoming integral to medical practices in other specialties and will become so as well in facial plastic surgery. The obvious differences in types of disorders treated and the outcomes of primary importance seen between general medical/surgical and facial plastic surgery practices make institution of standard outcomes studies difficult in facial plastic surgery. However, understanding the patient's experience and satisfaction with treatment is essential to continue to provide excellent care to facial aesthetic patients. This article describes use of a new survey instrument, Facial Injectables: Longevity, Late and Early Reactions and Satisfaction Questionnaire (FILLERS-Q), in assessing patient response to facial injections of soft tissue fillers. FILLERS-Q is a 43-item questionnaire that captures patient demographics (4 items), patient satisfaction with treatment (10 items), procedure-related events (3 to 7 items), impact on relationships (9 to 15 items), and economic considerations related to dermal filler treatment (3 to 7 items). The results provide a "snapshot" of patients treated in an individual surgeon's practice.