Biomedical subjects
Publications and source records attributed to H D Graham.
Creating a more youthful appearance of the aging upper face requires a treatment plan which is tailored to address the patient's individual needs. The process begins with a comprehensive knowledge of anatomy and the physical effects of aging, involves discussion and understanding of aesthetic ideals, and culminates in the selection and performance of the appropriate procedure.
Blindness is the most dreaded complication of an untreated paralyzed eyelid following injury to the facial nerve. Injuries to the facial nerve are mainly postsurgical. Assessment of neural injury using serial testing is important to be able to differentiate between temporary and permanent paralysis. In the former case, medical management could be sufficient and, in the latter case, a surgical procedure is required. The physician has the choice among several procedures to repair upper eyelid paralysis with the gold standard being the gold weight implant. Lower eyelid ectropion can be repaired using a lateral or medial canthal tightening procedure. If the lower eyelid ectropion is severe, a cartilage implant may be required.
A chemical peel is a procedure in which a topically applied wounding agent creates smooth, rejuvenated skin by way of an organized repair process. This article describes the indications, classifications, operative procedure, and complications of chemical resurfacing. In addition, alternatives to chemoexfoliation are discussed.
Revitalization of the aging face is a complex process that must include several components all working together in harmony to create a natural, youthful appearance. As more details of the facial anatomy have been described, the facelift operation has expanded tremendously to include deeper layers of the face with a goal of achieving both a longer lasting effect from surgery and a more complete recontouring effect of the melolabial fold. A comprehensive understanding of the anatomy of the face and the different procedures available is necessary in order to perform facelift surgery effectively and safely.
Although the benefits of endoscopic techniques including direct visualization as well as minimization of scars and morbidity have been employed in general, gynecological, and thoracic cases, only recently have plastic surgeons begun to champion endoscopic procedures in their practices. The authors describe an endoscopic procedure that reduces an anterior wall frontal sinus fracture through two 1.0 cm paramedian stab incisions located less than 1.0 cm behind the hairline of a 13-year-old female patient. The repair, performed in the bloodless subperiosteal plane, was executed with a 30 degrees endoscope and endoscopic instrumentation. The patient had restoration of her cosmetic deformity and no postoperative morbidity. To the authors' knowledge, this represents the first description of endoscopic repair of a traumatic frontal bone defect.
We have presented the development and current status of endoscopic browlifting from its inception at UAB to the present techniques as they are now practiced by the authors. Endoscopic browlifting was based on sound preclinical research and included thorough training of all investigators in the use and application of endoscopic equipment. We believe that endoscopic browlifting represents clear advantages over the open technique in selected patients. These advantages included avoidance of the long transverse incision and its secondary sequelae. Improved magnification and visualization of small structures are also a secondary advantage. Complications are no greater than the open technique and tend to diminish with experience. We feel that endoscopic browlifting will continue to be refined and will find a permanent place among the armamentarium of all aesthetic plastic surgeons.
Basal cell carcinoma is the most commonly occurring skin cancer in the United States with 85% of the lesions occurring in the head and neck region. Several risk factors have been identified but the most critical is cumulative light exposure in the ultraviolet B spectrum. Treatment of these lesions is variable and must be individualized as to the type and location of the tumor, the status of the individual patient, and the skill and experience of the operator.
Epistaxis in children is a common disorder that is usually due to local irritation in Kiesselbach's area. The most common disorders underlying epistaxis are local inflammatory diseases, infections, and trauma. Other diagnoses, including sinus and nasopharyngeal abnormalities, must be considered systematically. Epistaxis also may be the initial sign of serious systemic illness. Most children can be treated effectively with simple pressure to the alae and septum. Refractory bleeds may require progressively more aggressive measures. Recurrences usually are prevented with medical management control of the local or systemic problem, but excessively frequent recurrences may require surgical correction.
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