The Anterior SMAS Approach for Facelifting and for Buccal Fat Pad Removal.

Unlabelled: Having performed numerous varieties of SMAS advancement including: plication, resection, flap elevation with variable anterior deep dissection, the author has developed a direct approach to the mobile anterior SMAS which allows correction of midface descent, modest elevation of the modiolus, jawline correction, and, where indicated, direct access for buccal fat pad resection.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.

Face expressive lifting (FEL): an original surgical concept combined with bipolar radiofrequency.

Background: Aging can lead to changes in facial expressions, transforming the positive youth expression of happiness to negative expressions as sadness, tiredness, and disgust. Local skin distension is another consequence of aging, which can be difficult to treat with rejuvenation procedures. The "face expressive lifting" (FEL) is an original concept in facial rejuvenation surgery.

Barbed sutures in aesthetic plastic surgery: evolution of thought and process.

The evolution of barbed suture technologies and their application in the field of plastic surgery is now in its third decade. Much has been learned along the way. Initial excitement was often followed by disappointment as we learned more about the limited longevity of minimally invasive procedures and complications arising from various suture designs of the past.

Venous thromboembolism after facelift surgery under local anesthesia: results of a multicenter survey.

Background: Venous thromboembolism (VTE) is a serious complication of cosmetic surgery, and studies have suggested that the incidence is not insignificant in facelift surgery. Use of local anesthesia over general anesthesia and shorter operative times are probable contributing factors to lower VTE incidence. Because there have been no large-scale assessments of VTE in facelifts as such, we investigated VTE incidence and relevant factors in facelift surgeries performed under local anesthesia only.

Lifting and wound closure with barbed sutures.

The advent of barbed sutures has been a novel and useful adjunct for the aesthetic plastic surgeon in properly selected patients. The deployment of a barbed suture minimizes the risks of cheese wiring and stress relaxation, facilitating the minimally invasive repositioning of soft tissue in the head and neck, as well as optimizing and enhancing traditionally long and potentially tedious procedures in body contouring. This article highlights the advances, advantages, and efficacy associated with the use of barbed sutures in lifting and wound closure.

Noninvasive body contouring with radiofrequency, ultrasound, cryolipolysis, and low-level laser therapy.

Noninvasive body contouring is perhaps one of the most alluring areas of esthetic surgery today. This article discusses current noninvasive body-contouring modalities, including suction massage devices, radiofrequency energy, high-frequency focused ultrasound, cryolipolysis, and low-level light laser therapy devices. It also discusses imminent technologies awaiting approval by the Food and Drug Administration, reviews the basic science and clinical effects behind each of these existing and emerging technologies, addresses patient selection and clinical applications of each modality, and discusses the applicability and economics of providing noninvasive lipolysis services in office.

Dermabrasion.

This review presents skin anatomy, dermabraders, indications for dermabrasion and microdermabrasion, and dermabrasion techniques for the face, along with potential complications. Dermabrasion is a minimally invasive technique used for skin resurfacing. Its applications include treatment of rhytids, abnormal scarring, and premalignant lesions.

An overview of cosmetic medicine and surgery: past, present, and future.

The evolution of thought and process in cosmetic medicine and surgery has united specialists from various backgrounds with the goal of providing safe, reproducible techniques to improve the various elements of the aging face from within and without. The realization that the aging face is both vector and volume based has dramatically altered the approach to reversing the signs of aging. Ultimately, it was the joining of forces from multiple specialties that provided a blueprint for impressive improvement in the return of a youthful, natural look.

A safety and feasibility study of a novel radiofrequency-assisted liposuction technique.

Background: The feasibility, safety, and efficacy of a novel radiofrequency device for radiofrequency-assisted liposuction were evaluated in various body areas.

Methods: From July to December of 2008, 23 subjects underwent radiofrequency-assisted liposuction using the BodyTite system. Information regarding aesthetic results and local and systemic complications was collected immediately after the procedure and at 6- and 12-week follow-up.

Bidirectional barbed sutures for wound closure: evolution and applications.

Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound.

Infection risk from the use of continuous local-anesthetic infusion pain pumps in aesthetic and reconstructive abdominal procedures.

Postoperative pain control after abdominal procedures can be an area of significant concern. Continuous local-anesthetic infusion pain pumps have been clearly documented in recent literature to provide effective early postoperative pain control, in addition to other benefits. Our goal was to evaluate any increase in the risk of infection with the use of pain pumps with aesthetic and reconstructive abdominal procedures.

Continuous-infusion local anesthetic pain pump use and seroma formation with abdominal procedures: is there a correlation?

Background: Seroma formation is the most commonly occurring complication in plastic surgery abdominal procedures. Continuous local anesthetic pain pump delivery systems are often used to decrease postoperative pain. An unreported concern with use of these devices in abdominal procedures is the effect of continuous fluid infiltration of the surgical site and a possible increase in the incidence of seroma formation.

Barbed sutures for aesthetic facial plastic surgery: indications and techniques.

This article describes the indications and techniques related to the use of barbed sutures in facial aesthetic plastic surgery. The principle applications for barbed sutures in facial aesthetic plastic surgery are those involving lifts of the brow, midface, and the lower face and neck. Usually all three areas require surgical maneuvers to create a harmonious rejuvenation.

Reconstructive rhytidectomy?

Muscular dystrophies are commonly considered hereditary progressive degenerative diseases that affect skeletal and cardiac muscles. Oculopharyngeal muscular dystrophy is a rare hereditary disorder of later onset consisting of progressive dysphagia and bilateral blepharoptosis unlike the peripheral muscular weakness common to other muscular dystrophies. The symptoms of progressive dysphagia, with bilateral ptosis, usually occur after the age of 40 years.

Using barbed sutures in open/subperiosteal midface lifting.

The author has found that the use of barbed sutures simplifies midface suspension not only by stacking elevated soft tissue, but also by providing the ability to adjust sutures postoperatively. Complications, such as breaking of sutures, malposition, and failure to maintain support have been rare in his practice.

The evolution of the midface lift in aesthetic plastic surgery.

The midface lift has recently gained significant popularity with many surgeons. It allows the surgeon an opportunity to achieve greater facial harmony with facial rejuvenation procedures by correcting midfacial atrophy, addressing the tear trough deformity, and correcting the perceived malposition of the malar fat pad. This article examines the history of midfacial procedures.

Blending the lid/cheek junction.

Background: Rejuvenation of the periorbital area requires an understanding of the morphologic changes that occur with aging. Blending the lid/cheek junction is a goal of periorbital rejuvenation.

Objective: Transblepharoplasty techniques are proposed to achieve aesthetic periorbital rejuvenation with predictable improvement and minimal morbidity.

Breast augmentation and abdominoplasty: postoperative management with pain pumps.

Using pain pumps, the author has been successful in reducing postoperative pain after breast augmentation and abdominoplasty. Further, patients ambulate sooner, which reduces the risk of deep vein thrombosis, and more fully expand their lungs, which averts a compromise in pulmonary function.

Assessing the options for lip augmentation.

The author prefers autologous tissue from a combined SMAS/fat graft for lip augmentation. However, he considers Alloderm the best alternative. Here he describes his technique and compares Alloderm with other available materials.

Brow lift fixation.

One of the more difficult and controversial aspects of forehead and brow lift is fixation with control and stabilization of the result. Aesthetic Surgery Journal has invited Robert W. Bernard, MD; Robert S.