Injectable collagen, chemical peeling and dermabrasion as an adjunct to rhytidectomy.
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Chemexfoliation↗
Biomedical subjects
F M Kamer
Publications and source records attributed to F M Kamer.
Submental surgery. A graduated approach to the aging neck.
Adequate aesthetic contouring of the aging neck often presents a difficult surgical challenge to the facial plastic surgeon. The apparent failure of the classic rhytidectomy to achieve acceptable results in the submental region has encouraged previous surgeons to develop surgical techniques specifically addressing this area. Definitive procedures were developed to treat the excess skin, fat, or muscle. Aesthetic results have progressively improved with the introduction of liposuction, judicious muscle rearrangement, and more conservative submental skin violation. This article describes our experience with these concepts and presents a useful classification devised to serve as an operative guide in the management of the aging neck.
Adipose Tissue↗
Preexcision blepharoplasty.
Numerous techniques have been described for lower lid blepharoplasty. Over the past 15 years, a preexcision (pinch) technique with preservation of the pretarsal orbicularis oculi muscle has been used in more than 1000 cases presenting with dermatochalasis and pseudoherniated fat without lateral skin redundancy. The amount of lower lid skin to be excised is estimated by pinching the skin. Preservation of the pretarsal orbicularis oculi muscle adds support to the tarsoligamentous complex. This technique aids in preventing the development of both postoperative ectropion and rounding of the lower lid. Technical considerations of the preexcision (pinch) technique and a description of alternative techniques are outlined. Indications, complications, and patient satisfaction are discussed.
Eyelids↗
Histoacryl. Its use in aesthetic facial plastic surgery.
Since their discovery in 1949, cyanoacrylates have evoked interest as being a possible ideal "tissue glue." Several different forms of these compounds have been developed in order to try to reduce or eliminate tissue toxicity. Butyl-2-cyanoacrylate (Histoacryl) appears to be the closest ideal material as it induces low tissue reactivity and toxicity. It has been used extensively for middle ear surgery with little or no adverse effects. A historical review of tissue adhesives and a discussion of technical considerations is outlined. A clinical trial of 100 patients treated with Histoacryl on various surgical wounds revealed no significant adverse effects with wound healing, graft rejection, or infection over a six-month period. Histoacryl appears to offer many advantages and few disadvantages over conventional suture techniques.
Conjunctivitis↗
Revision rhinoplasty. Analysis and treatment.
As rhinoplasty becomes an increasingly popular procedure, the aesthetic expectations of both the facial plastic surgeon and the patient become more discriminating. Thus, the number of revision rhinoplasties increases. Of 697 rhinoplasties performed by the senior author (F.M.K.) during a three-year period, 18% of those procedures were revision surgeries. The senior author was the primary surgeon in 53% of those revision cases. This article presents an analysis of 126 consecutive revision rhinoplasty cases from that period, outlining the major deformities in a clinically meaningful system. Treatment of each problem category is discussed and representative cases are shown. The senior author's own revision rate and observations are discussed and compared with those in the medical literature.
Adolescent↗
Postrhinoplasty epistaxis. Role of vitamin E?
Postrhinoplasty epistaxis occurred in two patients, both of whom were found to be ingesting megadoses of vitamin E. The rate of vitamin E consumption in a population of 100 uncomplicated nasal operations during this same period was 16%. A review of the medical literature on vitamin E found recent evidence demonstrating a marked decrease in platelet adhesiveness with megadose ingestion of vitamin E. It is concluded that this should be avoided in the perioperative period.
Adult↗
Minicomposite graft for nasal alar revision.
Auricular composite grafts are being used increasingly for repair of nasal deformities. Most commonly these grafts have been employed to repair alar rim and columellar defects secondary to trauma or tumor resection. A technique for reconstruction of the lateral crural area with auricular minicomposite grafts was used in a series of cases. Results have been satisfactory to alleviate the functional and cosmetic difficulties in patients requiring alar revision.
Adult↗
The nasal bossa: a complication of rhinoplasty.
A study of 1,033 consecutive rhinoplasties was undertaken to focus on etiology and treatment of nasal bossa. Of the 2% that developed bossa, the only consistent, statistically significant etiology factor was that of preoperative nasal asymmetry. There was no correlation with skin or cartilage characteristics. Those tips requiring alteration by the delivery technique were five times more likely to develop bossa than those treated by cartilage split or retrograde techniques. The surgical dilemma of treatment by either augmentation of the lesser side or resection of the bossa was discussed.
Adult↗
Median horizontal split tip.
One of the most difficult problems encountered in rhinoplasty is lack of nasal tip projection. An innovative technique is described that utilizes the removal of a median horizontal strip of lower lateral cartilage to enhance projection, while maintaining a natural highlight and tip support without the use of grafts. The indications are limited to noses that have a widened dome requiring removal of a central strip, and tip rotation. Alternate techniques are discussed; cases and results are discussed.
Humans↗
High frequency needle dissection rhytidectomy.
Fifty consecutive rhytidectomies were performed utilizing high frequency needle dissection on one side and standard sharp dissection on the other for all incisions and flap elevation. The efficacy of this technique in hemostasis, prevention of hematoma, and wound healing is compared to the conventional technique of rhytidectomy. The advantages and disadvantages of the modality are discussed.
Ambulatory Surgical Procedures↗
Clinical use of injectable collagen. A three-year retrospective review.
Collagen implants (Zyderm) have found extensive applications in the adjunctive management of the aging face and in the primary treatment of cutaneous defects resulting from acne, trauma, or prior surgery. Our initial clinical experience from 1979 to 1982 involving more than 300 patients is analyzed for treatment efficacy, duration, and untoward responses. A majority of our patients are clearly pleased. Likewise, our confidence has increased as our experience evolved. Positive skin tests number 3.5% and delayed hypersensitivity reactions 1.3%. We have found injectable collagen relatively easy to use as well as safe and effective. Further research may enable prolonged results.
Aging↗
512 rhytidectomies. A retrospective study.
A retrospective study of 512 rhytidectomy surgeries performed by one of us (F.M.K.) showed that the sequential technique and two-stage concept was used in most cases, with improvement in results noted when platysmal-superficial musculoaponeurotic system flaps were incorporated into the surgical routine. The majority of the patients were treated as outpatients; drains were rarely used. Statistical analysis of results and complications are discussed, as well as the aesthetic philosophy involved in this area of surgery. A comparison with other retrospective studies of this procedure is also given.
Adult↗
Shield graft for the nasal tip.
Onlay cartilage grafts have been used in the region of the nasal tip since first reported in 1895, and renewed interest in the procedure has increased steadily during the past ten years. Throughout the past five years, 43 cases of noses that lack tip projection have been treated by us with the use of the shield graft technique. There was an improvement in appearance that satisfied the aesthetic criteria in all cases. The complications were few, and the results seemed more natural and pleasing when compared with the results of other techniques that enhance projection.
Adult↗
High septal hemitransfixion for the correction of caudal septal deformities.
High septal hemitransfixion has demonstrated superior versatility and reliability in a series of 68 patients for correction of caudal septal deformity. The literature has contained many references to high septal transfixion for use in rhinoplasty to preserve tip support. An alternative application of this approach for repair of caudal septal deformity is herein discussed.
Female↗
Pseudomonas after nasal and facial surgery.
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Blepharoptosis↗
Rhinoplasty record and retrieval system.
The rhinoplastic surgeon must vary technique to fit the anatomic variations of nose and face. Our system to record and correlate preoperative findings with surgical methods could help accomplish this. It includes three forms to record pertinent findings of the history and physical examination, operative findings and techniques, and postoperative evaluations. These forms are numerically coded, and data can be transferred to a punch card system or computer cards for quick and easy retrieval and statistical analysis. The system tries to simplify the many anatomic and surgical variations, yet remain complete. We hope that this system, which has been used in other disciplines, can be applied to rhinoplasty. In this way, more scientific statistical data can be used to support surgical approaches.
Adult↗
"How I do it"--plastic surgery. Practical suggestions on facial plastic surgery. Smile surgery.
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Alveolar Process↗
A maneuver to improve the nasal airway.
The functional sequelae of rhinoplastic surgery are emphasized and the functional and anatomical causes of postoperative nasal obstruction are discussed. A maneuver to improve the airway and decrease the incidence of postoperative nasal obstruction is presented.
Humans↗