The high-superficial musculoaponeurotic system technique in facial rejuvenation: an update

The medical charts of 267 patients who had primary high-superficial musculoaponeurotic system (SMAS) rhytidectomies were reviewed. The depth of the nasolabial fold was used as an indicator of the degree of descent of the subcutaneous cheek mass, as a guide in procedure selection, and as a method of judging the operative results. Fold depth was assigned a score of 0 to 3, with 3 being most severe. According to their preoperative fold depth, patients were operated on using one of three variants of the high-SMAS technique: sub-SMAS dissection up to the nasolabial fold, sub-SMAS dissection up to the nasolabial fold plus transnasal SMAS graft, or sub-SMAS dissection across the nasolabial fold. An independent trained observer rated the postoperative fold depth in each case from photographs taken at the 6-month follow-up visit. Of patients with fold scores of 2 or 3, 97 percent (183 of 189 patients) showed visible improvement in nasolabial crease depth after the operation.     

射频联合电针除皱在面部年轻化美容术中的应用

目的:探讨将射频技术联合电针除皱应用于面部年轻化美容的临床效果.方法:对皮肤松弛或皱纹明显的面部老化者,分别或联合应用射频除皱术和微针电子除皱术进行治疗.射频除皱采用深圳GSD公司GP699A型射频皮肤治疗仪.能量密度50～100J/cm2,频率2M-8M,6次为一个疗程,每次治疗间隔10天;电针除皱采用英国ERP Face Magic电子美容除皱仪,电流强度1.0mA～20.0mA,每次30分钟,疗程及间隔时间同射频治疗组;联合治疗组先行射频除皱治疗,五天后再进行电针除皱,疗程及间隔时间同上.结果:178例面部皮肤老化者,行单纯射频除皱58例,单纯电针除皱49例,二者联合治疗71例.其中射频治疗组总有效率为84%,半年有效维持率49%;电针治疗组总有效率78%,半年有效维持率42%;联合治疗组总有效率为96%,半年有效维持率72%,显著高于任何单一治疗组.结论:射频技术联合电针除皱即能改善面部浅表皱纹又能收缩面部肌肉促进其紧缩,具有起效快、效果显著、疗效持久的特点,是面部年轻化美容的理想方法.     

Relevance of the lesser occipital nerve in facial rejuvenation surgery

Nerve injuries are possible during facial rejuvenation surgery. The great auricular nerve has been studied; however, little is known about the lesser occipital nerve and its relevance in facial rejuvenation surgery. To understand the importance of the lesser occipital nerve in a face lift procedure, the specific anatomy of the nerve was studied in the laboratory in 19 hemifaces, with additional nerve observations in the operating room. The course of the lesser occipital nerve, its branches, and the relationship with the surrounding structures were evaluated and recorded. The great auricular nerve was also dissected to compare the two nerve territories. In the majority of the dissections, the lesser occipital nerve supplied the superior ear and the mastoid area, whereas the great auricular nerve innervated the inferior ear and a portion of the preauricular area. The nerves, however, were variable in size and distribution. Five lesser occipital nerves provided the dominant supply to the ear, compensating for a small great auricular nerve contribution. Therefore, injury to the lesser occipital nerve can result in a major sensory deficit of the ear. We also found the lesser occipital nerve to have a subcutaneous course at a proximal and variable level. These nerve branches can be superficial, and therefore postauricular flap dissection can injure the nerve if the flap is dissected at the fascial level. We therefore suggest that the dissection be at a more superficial level to avoid nerve injury. And finally, if SMAS/platysma suspension sutures are placed, we suggest these be done in a vertical-oblique direction along the course of the lesser occipital nerve, because this should minimize the possibility of trapping terminal branches.     

Stereotactic radiofrequency ablation: A minimally invasive technique for nonpalpable breast cancer in postmenopausal patients

Background: The purpose of this study was to determine the feasibility of radiofrequency ablation (RFA) of nonpalpable breast cancer in postmenopausal women, and report on long-term follow-up with clinical examination and mammography. Methods: Since November 2000, we have performed RFA on stereotactically localized nonpalpable breast cancers (only mammographic densities) in women older than 65 years with other serious health problems. Results: The first patient had the procedure done in the office with sedation and local anesthesia. The radiofrequency probe was inserted by stereotactic localization, and the RFA proceeded for 20 min at 75 °C. Two weeks later, the lesion was not seen mammographically, but by palpation there was induration at the ablation site. Six weeks later, open excision of the area confirmed a prominent ablation site with no remaining viable tumor cells. The second patient had the same procedure, and has been followed without open biopsy. The third patient had DCIS and the probe arrays were not able to penetrate the lesion. The fourth and fifth patients had light sedation with an intercostal nerve block to eliminate discomfort and this approach was found to be a very effective office procedure. The last two patients’ ablation sites were injected with depo-medrol and they were placed on anti-inflammatory therapy to decrease the palpable induration caused by fat necrosis. Conclusion: We found RFA feasible for definitive therapy for nonpalpable breast cancer. If our results are confirmed by larger clinical trials, RFA would eliminate open surgery and decrease the morbidity associated with lumpectomy and radiation.     

The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation

Resetting of the septum orbitale over the orbital rim, or "septal reset," is the latest step in achieving periorbital rejuvenation in composite rhytidectomy. The first significant step was the addition of orbicularis repositioning to conventional lateral vector deep plane rhytidectomy, followed by orbital fat preservation using the arcus marginalis release and fat transposition over the orbital rim. Those early procedures have been further refined to include the zygomaticus muscles with the orbicularis oculi in the composite flap, or zygorbicular cheek flap, and a septal reset. The septum orbitale reset has distinct advantages over transposition of orbital fat alone, as it creates a firmer undersurface for the lower eyelid. This maneuver will create a truly youthful lower eyelid-cheek complex, as the normal concave aging skeletonization of the periorbit is transformed to a convex contour of youth. The effectiveness of this operation can be demonstrated in most variations of human anatomy, whether congenital or iatrogenic, allowing the plastic surgeon to utilize the septal reset in virtually every patient undergoing and desiring a harmonious facial rejuvenation.     

Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children

Surgical correction of pectus excavatum in children has gained new momentum since the introduction of the new minimally invasive repair by Nuss. To date, no studies directly evaluate the outcome of the new technique versus that of the conventional technique. From 2000 to 2002, 28 patients underwent pectus excavatum correction in the authors' hospital. Twenty-one were treated by minimally invasive repair of pectus excavatum and seven patients had open correction. Intraoperative and postoperative complications, clinical outcome, and patient satisfaction were evaluated. In the minimally invasive repair of pectus excavatum group, the children were younger (14.4 +/- 2.9 versus 17.8 +/- 3.2 years), had shorter operation times (53 +/- 18 versus 125 +/- 6 minutes), and had less blood loss (minimal versus 380 +/- 175 ml). No intraoperative complications were recorded. In the conventional group, two pleural lacerations occurred. Early postoperative complications in the minimally invasive repair group included two pneumothoraces and one case of pleural effusion. In the conventional group, one pneumothorax and one case of pleural effusion occurred. Late postoperative complications in the Nuss group included one costal erosion, two bar dislocations, one severe wound infection requiring bar removal, one hematothorax, and one case of postpericardiotomy syndrome; in the conventional group, there was one severe wound infection. In both groups, the patients rated their cosmetic results as good to very good. Minimally invasive repair of pectus excavatum is a novel method with clear advantages, such as limited surgical trauma and small scars. The high rate of postoperative complications may decrease with growing experience in the future. In well-selected patients (age, symmetric deformity), the Nuss procedure may become the method of choice. However, there is still a lack of long-term follow-up.     

A novel, minimally invasive, segmental myocardial infarction with a clear healed infarct borderzone in rabbits

Ventricular arrhythmias in the setting of a healed myocardial infarction have been studied to a much lesser degree than acute and subacute infarction, due to the pericardial scarring, which results from the traditional open-chest techniques used for myocardial infarction (MI) induction. We sought to develop a segmental MI with low perioperative mortality in the rabbit that allows optimal visualization and therefore improved study of the infarction borderzone. Rabbits underwent MI using endovascular coil occlusion of the first obtuse marginal artery. Three weeks postprocedure, we evaluated our model by echocardiography and electrophysiology studies, optical mapping of isolated hearts, and histological studies. Seventeen rabbits underwent the protocol (12 MI and 5 sham) with a 92% survival to completion of the study (11 MI and 5 sham). MI rabbits demonstrated wall motion abnormalities on echocardiography while shams did not. At electrophysiological study, two MI rabbits had inducible ventricular tachycardia and one had inducible ventricular fibrillation. Isolated hearts demonstrated no pericardial scarring with a smooth, easily identifiable infarct borderzone. Optical mapping of the borderzone region showed successful mapping of peri-infarct reentry formation, with ventricular fibrillation inducible in 11 of 11 MI hearts and 1 of 5 sham hearts. We demonstrate successful high resolution mapping in the borderzone, showing delayed conduction in this region corresponding to late deflections in the QRS on ECG. We report the successful development of a minimally invasive MI via targeted coil delivery to the obtuse marginal artery with an exceptionally high rate of procedural survival and an arrhythmogenic phenotype. This model mimics human post-MI on echocardiography, gross pathology, histology, and electrophysiology.     

Design of a multifunctional compliant instrument for minimally invasive surgery

A new multifunctional compliant instrument has been designed for use in minimally invasive surgery. The instrument combines scissors and forceps into a single multifunctional device. The main advantage of using multifunctional instruments for minimally invasive surgery is that instrument exchanges can be reduced, thus reducing procedure time and risk of inadvertent tissue injury during instrument exchanges. In this paper, the length, width, and thickness of the multifunctional compliant mechanism tool tip is optimized to maximize the jaw opening and the grasping force. The optimized design is then modeled to simulate the stresses encountered in the scissors mode. A 5.0 mm diameter stainless steel prototype is fabricated using electro-discharge machining and is shown to grasp and cut successfully.