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Biomedical subjects

Anthony P Sclafani

Publications and source records attributed to Anthony P Sclafani.

At least 19 recordsLinked to original sources
PubMed2006

Aesthetic reconstruction of the auricle.

Repair of auricular defects can be a challenging endeavor due to a broad variety of clinical presentations and available reconstructive options. Acquired auricular deformities most commonly result from a wide range of traumatic injuries and following Mohs' extirpation of cutaneous malignancies. A choice of repair ultimately depends on patient factors, amount of soft tissue loss, and location of the auricular defect. Meticulous re-establishment of proper physical dimensions, smooth external contour, and complex surface landmarks ensures satisfactory aesthetic outcomes for surgeons and their patients.

Cosmetic Techniques↗
PubMed2005

Restoration of the jawline and the neck after bariatric surgery.

Bariatric surgery can result in massive, rapid weight loss. Patients who undergo this surgery can be left with significant facial and neck skin redundancy and may request restorative facial plastic surgery. Optimal results require a thorough understanding of the unique physiologic, metabolic, and anatomic findings in these patients. Modifications of standard rhytidectomy techniques are necessary to suit the specific features of the patient after bariatric surgery.

Cervicoplasty↗
PubMed2005

Chin and prejowl augmentation in the management of the aging jawline.

The effects of aging in the lower face and neck are reflected in the contour of the jawline. Soft tissue atrophy, the formation of jowls, and retrusion of the chin are all age-associated changes that contrast starkly with the smooth harmony of a young lower face. These soft tissue changes in the jawline are exacerbated by the effects of aging on the bony portion of the mandible. Bone resorption of the mandible seen with aging can lead to the development of a hypoplastic mentum and the formation of an anterior mandibular groove. Rhytidectomy serves to address the soft tissue changes from aging but cannot counter the effects of aging on the bony mandible itself. Understanding the effects of bone resorption on the aging mandible allows the facial plastic surgeon to augment the mandible appropriately to achieve a more effective rejuvenation of the lower face. The aging process in the mandible and the development of the prejowl sulcus are reviewed. The use of chin and prejowl augmentation as a valuable adjuvant to facelift surgery is discussed.

Aging↗
PubMed2005

Alternative management of the aging jawline and neck.

The lower third of the face and neck have distinct changes that occur with aging. These changes can be globally and dramatically addressed with a traditional rhytidectomy. However, as the demographics of facial plastic surgery patients evolve, patients seek increasingly less invasive procedures that will result in faster recovery time and less postoperative morbidity. To accommodate this change, today's facial plastic surgeon must include less invasive procedures in the treatment strategies for the lower face and neck. Correct, patient-specific procedure selection and patient education can yield results similar to those of a traditional facelift. This article discusses options available for treatment of the lower face and neck.

Age Factors↗
PubMed2005

Soft tissue fillers for management of the aging perioral complex.

Rejuvenative therapy of the lower face has traditionally been surgical in nature, with office-based treatments such as soft tissue fillers relegated to "second tier" status. However, traditional rhytidectomy does not significantly affect the perioral complex and leaves the central lower face unaltered and unimproved. If it is left untreated, there is a clear disparity between the rejuvenated neck and aged perioral area. Soft tissue augmentation of the perioral area can provide rapid aesthetic improvement. Careful analysis of this area and appropriate treatment can harmonize these areas and produce a globally aesthetic result.

Biocompatible Materials↗
PubMed2003

Revision rhinoplasty.

Revision rhinoplasty can be one of the most complicated procedures performed by the facial plastic surgeon. As septal cartilage is often not available in revision procedures, grafting material is often needed. This material can come in the form of autogenous bone and cartilage. Allografts also can be used, including mersilene, expanded polytetrafluoroethylene, and porous high-density polyethylene (PHDPE). In this article, emphasis is placed on the senior author's method in evaluating candidates for revision rhinoplasty as well as techniques using PHDPE. In addition, the properties of the more commonly used allografts are described, including the advantages and disadvantages of using each material in revision rhinoplasty procedures. In comparing the various alloplastic materials available, it is shown that PHDPE has properties that make it an excellent implant for revision rhinoplasty.

Biocompatible Materials↗
PubMed2003

Rhinoplasty in the aging nose.

The aging nose presents a difficult challenge for the rhinoplastic surgeon. To best address the patient's wishes, the surgeon must possess a sound understanding of the atrophic changes associated with the aging nose, including tip ptosis, increased nasal bulbosity, a lengthened nasal appearance, and altered nasal airflow patterns. Surgical emphasis is placed on conservative structured reduction to address functional concerns. Overresection risks destabilizing the nasal tip and altering the patient's concrete self-image. This article outlines our approach to rhinoplasty in the aging nose with a special emphasis on the use of porous polyethylene alloimplants to provide added structural support.

Aging↗
PubMed2003

Reduction structured rhinoplasty.

Rhinoplastic surgeons continue to seek technical refinements that will result in a consistently reliable postoperative outcome. Over the past 25 years there has been a steady progression away from the simple Joseph reductive rhinoplasty technique toward the use of various grafts to improve both the functional outcomes and aesthetic end result of this procedure. The original reductive template continues to be a major component of a new conceptual paradigm, which has evolved to incorporate the understanding that structural components must be placed to allow a more precise outcome. Specifically, once the nose is reduced to proportions that correspond to the preoperative analysis, separate grafts and implants are placed to prevent a change in the shape of the nose by the constricting effects of the skin shrink-wrapping around the skeletal framework. This article focuses on the use of implants for structural architecture in the senior author's primary reduction-structured rhinoplasty cases.

Biocompatible Materials↗
PubMed2003

Management of the severe bulbous nasal tip using porous polyethylene alloimplants.

Reliable outcomes in correction of the severely bulbous nasal tip remain elusive. Reduction and binding of the tip cartilages result in a partial external nasal valve collapse. If a concurrent dorsal hump reduction is accomplished and osteotomies are completed to close the open roof deformity, then a severe constriction of the external valve may result. This is best avoided by resection of the residual lower lateral cartilages and substitution with external valve batten implants. The tripod of nasal tip supports is then rigidly reconstituted. When autogenous graft materials are considered inadequate or undesirable, the surgeon may safely use porous polyethylene alloimplants to support the external nasal valve. A dependable surgical technique based on extensive experience with these materials is outlined.

Biocompatible Materials↗
PubMed2003

Adjustment of subtle postoperative nasal defects: managing the "near-miss" rhinoplasty.

Rhinoplasty entails several steps that affect the appearance and function of the nose in an interrelated way. Occasionally, an excellent result can be marred by a minor imperfection and lead to dissatisfaction of both patient and surgeon. For significant pathology, revision rhinoplasty can be performed safely if the architecture and physiology of the nose are respected. To correct the "near-miss" result, minor corrections can successfully restore the aesthetic result. This can require a different frame of reference and approach and can often be thought of in terms of soft tissue correction. Subcutaneous fibrosis, skin depressions, asymmetries, and deficits can be corrected with minor procedures and techniques not routinely associated with rhinoplasty. We detail several methods that can be used to restore simply and effectively an otherwise excellent rhinoplasty result.

Adult↗
PubMed2003

Secondary cleft-lip rhinoplasty utilizing porous high-density polyethylene.

Secondary nasal deformity associated with cleft lip is a difficult surgical task. For more than 100 years, numerous surgical methods have been created to address the structural changes that occur over time after the primary surgery. Although early surgical methods have relied on various rotational flaps and local tissue manipulation, the recent advent of synthetic materials has provided facial plastic surgeons with more tools to correct the structural and supportive deficiencies. In this article, we describe our 10-year experience with porous high-density polyethylene (PHDPE) implants in secondary cleft-lip rhinoplasty. PHDPE implants have been well tolerated and achieved excellent long-term aesthetic results through fibrovascular ingrowth to the surrounding tissue.

Adult↗
PubMed2002

Homologous collagen dispersion (dermalogen) as a dermal filler: persistence and histology compared with bovine collagen.

To assess the biological behavior and clinical efficacy of homologous collagen dispersion (Dermalogen) in augmenting human dermis, Dermalogen and bovine cross-linked collagen (Zyplast) were compared in a human postauricular injection model. Dermalogen (two sites implanted behind one ear) and Zyplast (two sites behind the contralateral ear) were injected into an upper to middermal level in 20 healthy adults. Digital photographs of all implant sites were taken over a 12-week period after injection. Biopsies of each implant type were taken at 4 and 12 weeks after injection. At 12 weeks after injection there was a small but significant difference in persistence rates between Dermalogen and Zyplast (4% vs. 2%; = 0.005). Histologically, Dermalogen was identifiable at 4 weeks after implantation, with evidence of neovascularization. Zyplast was identified more uniformly than Dermalogen in specimens 12 weeks after implantation, and more chronic inflammatory cells and foreign body giant cells were seen in the Dermalogen specimen. Clinical persistence and the histological behavior of Dermalogen appears to be at least as favorable as Zyplast bovine collagen. Dermalogen does not require pretesting and can also be used in the patient already sensitized to bovine protein. For these reasons, the authors think Dermalogen is a reasonable alternative to bovine collagen for facial soft-tissue augmentation.

Adult↗
PubMedDate not supplied

Biophysical and microscopic analysis of homologous dermal and fascial materials for facial aesthetic and reconstructive uses.

OBJECTIVES: To evaluate the microscopic structure and physical properties of homologous tissue grafts commonly used in aesthetic and reconstructive facial plastic surgery in order to determine specific properties of these materials that may affect their performance in vivo. METHODS: Two decellularized dermal materials (AlloDerm and DuraDerm) and 2 fascia lata tissue grafts (Tutoplast and cadaveric fascia lata) were examined by light microscopy (hematoxylin-eosin and Movat staining) and scanning electron microscopy. The physical properties of these materials were also examined for thickness, maximum sustainable load, strain, conformability, and elasticity. RESULTS: Significant differences in microscopic appearance existed between the 2 dermal materials and the 2 fascial materials. AlloDerm and Tutoplast fascia lata retained architecture closer to that of untreated tissue than did DuraDerm and cadaveric fascia lata, respectively. Tutoplast fascia lata and AlloDerm were also stronger than cadaveric fascia lata and DuraDerm, respectively. AlloDerm retained significantly more elasticity than DuraDerm. CONCLUSIONS: AlloDerm and Tutoplast fascia lata retain more natural architecture and physical properties than do DuraDerm and cadaveric fascia lata, respectively. These differences clearly show the effect of the specific processing of these materials. The alteration in architecture and the degradation of the physical properties of DuraDerm and cadaveric fascia lata may hinder the performance of these grafts in vivo. Further studies on these materials in humans are currently under way.

Biocompatible Materials↗
PubMedDate not supplied

Rejuvenation of the aging lip with an injectable acellular dermal graft (Cymetra).

OBJECTIVE: To evaluate the effects of Cymetra (micronized AlloDerm tissue) in rejuvenating the aging and atrophic lip. PATIENTS: Forty-four patients aged 32 to 80 years who reported age-related changes in the size and contour of the upper lip. METHODS: Patients were randomized to treatment with either Cymetra or glutaraldehyde cross-linked bovine collagen (Zyplast). Standardized photographs of each subject were taken before and after treatment initially and 3, 6, 9, and 12 months after initial treatment. Patients were monitored for signs of hypersensitivity, infection, and inflammation. MAIN OUTCOME MEASURES: Digital photographs were analyzed for changes in the nasolabial angle, percentage of the total lip accounted for by the exposed red lip in the midline and on the lateral view, the visible red upper and lower lip surface areas, and the anterior projection of the upper and lower lips. RESULTS: All patients tolerated treatment well without any significant local or systemic complications. Nineteen patients were treated with Cymetra and 25 with Zyplast. Cymetra-treated patients were more likely than Zyplast-treated patients at 12 months (3 months after the previous treatment) to have increased the percentage of red lip in the midline (84.6% vs 38.9%; P =.01), the vermilion height in the upper lip midline (84.6% vs 38.9%; P =.01), and the exposed red lower lip on the lateral view (69.2% vs 33.3%; P =.048) by at least 20%; increased the lower lip projection by 0.5 mm or more (69.2% vs 27.8%; P =.02); and decreased the nasolabial angle by at least 10 degrees (46.2% vs 16.7%; P =.07). CONCLUSIONS: Cymetra is a suspension of particulate dermal matrix that seems to increase the upper lip bulk, vermilion, and lower lip projection after a threshold of Cymetra has been administered. There are few differences in any measured long-term (3 months after treatment) variables until the 12-month visit, when there were statistically significantly more Cymetra-treated patients with improved lip aesthetics than those treated with Zyplast. With repeated treatments, Cymetra seems to accumulate, producing a long-term effect superior to Zyplast in many patients.

Adult↗
PubMedDate not supplied

Strength and histological characteristics of periosteal fixation to bone after elevation.

BACKGROUND: Loss of brow elevation in the early postoperative period has been well documented; however, there has been no study quantifying the minimum time necessary to achieve lasting brow elevation. Previous work in our laboratory has demonstrated that complete readherence of periosteum to bone can take 12 weeks to occur after periosteal elevation. The correlation between adherence and the development of strength has never been examined. OBJECTIVE: To correlate histological characteristics of raised forehead periosteum with the strength of the periosteum-bone union postoperatively. SUBJECTS: Eighteen New Zealand white rabbits. METHODS: Rabbit foreheads were elevated in a subperiosteal plane and the flap reapproximated with chromic sutures. Animals were killed at 14, 28, 45, 63, or 84 days postoperatively, and all tissue superficial to the periosteum removed. The tension required to avulse sections of periosteum was then measured. Skulls were then sectioned and prepared for histological analysis of remaining periosteum. Avulsion forces and histological findings were compared with those unoperated-on controls. RESULTS: The forces necessary to avulse periosteum in the 14- and 28-day groups were significantly lower than for control animals; values at 45, 63, and 84 days were not significantly different from control animals. Healing periosteum displayed varying degrees of thickness, cellularity, edema, and vascular congestion. These features peaked at 28 days postoperatively then gradually resolved to near-control values by 84 days. Significant periosteal-to-bone contact did not appear until 45 days postoperatively. CONCLUSION: Our results promote the use of methods of brow fixation that support mobilized soft tissues for a minimum of 6 weeks, until the elevated periosteum has significantly readhered to the underlying bone.

Animals↗