Biomedical subjects
Publications and source records attributed to R C Webster.
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Certain tip-projecting techniques require insertion of grafts and/or implants into the premaxillary region. These grafts may extend anteriorly into the columella or may have to reach all the way to the tip to exert the projecting forces exactly where the surgeon wishes to have them applied. The most direct technique for insertion of these long grafts is one of the columella-splitting maneuvers, but some patients will not accept the external scarline necessitated. An intraoral approach can be used in these patients or in any others in whom the surgeon wishes to have no external scar. It allows good exposure, easy insertion of the grafts and/or implants, and secure closure for stabilization and fixation of the grafts.
Brow elevations via the indirect temporal lift approach was carried out on a series of 26 cadaver half heads. The purpose of the dissection was to identify the course and depth of plane of the frontalis branch of the facial nerve. Of particular interest was the area superolateral to the brow. Histologic sections were taken along the course of the nerve to determine its exact depth. It was determined that the nerve lay in the superficial musculoaponeurotic system layer of superficial fascia lying above the level of the temporalis fascia. Utilizing this information, a method of dissection in the temporal lift operation is described that safely avoids the frontalis branch of the facial nerve.
The factors and differences in incisions for face-lifting in women and men are presented and discussed in detail. The recommended approaches hide scars effectively, allow the hair growing in front of the ear to be left in its original location, and prevent future hair growth from being too close to the ear, which would make shaving or washing difficult in men.
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The iconoclast is an instrument that facilitates blunt dissection in areas where this basic technique is difficult because of anatomical or postsurgical adherence. Medical and inferior undermining in augmentation mammaplasty in primary and revisional cases is described. The instrument capitalizes on the gripping rather than the spreading strength of the surgeon's hand, allows easy penetration of tissues to be spread apart, and diminished severance of blood vessels. We have used the iconoclast for almost two years in selected cases and have had no problems or complications attributable to it.
A clinical classification of baggy lids is presented to allow for categorization of existing deformities and their subsequent surgical correction. Standard photographic documentation is suggested for impartial evaluation of the selected surgical procedure. A technique in the placement of skin incisions and their modifications, based on position and degree of skin excess, is outlined and recommendations directed toward avoidance of complications are proposed.
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Lateral canthopexy using permanent suspending sutures to shorten the lateral canthal tendon helps prevent scleral show, increased sloping of the upper lid, and inferomedial displacement of the lateral canthus following lower lid blepharoplasty. While these complications usually are prevented by flap suspension techniques, in which more skin is excised above and lateral to the commissure than below it, sutures running from the inferomedial part of the lateral canthal tendon to its superolateral aspect and to periosteum just inside the orbit still further reduce the tendency toward the complications mentioned. We report technical aspects and results. After several years of clinical experience, we have the impression that the technique is a useful adjunct, even though it may produce more swelling and inflammation and a longer recuperative period.
Otolaryngology shares responsibility for provision of plastic surgical services involving facial and cervical structures, but many training programs have been weak in this part of the specialty. Some still are. Beginning in 1963 when a national organization was formed, leading facial plastic surgeons and the senior author analyzed the weaknesses and embarked on a program to correct these educational deficits. There was widespread lack of surgical background, woefully inadequate knowledge of soft tissue techniques, and poor understanding of dynamics involved in cosmetic procedures. Annual meetings, international symposia, numerous courses, and extensive videotape and microfiche production, as well as political and academic recognition, have all helped plastic surgical teaching endeavors at both residency and postgraduate levels. However, much remains to be done. Program directors are the "key" people here. Suggestions for future action are presented.
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Some patients coming for esthetic blepharoplasty should have one of three supplemental procedures performed to elevate or change the position of the eyebrows. The most precise eyebrow alterations are effected with brow lifting procedures, but these may produce adverse scarring. The temple lift may be employed to draw the lateral part of the eyebrow upward and laterally. Drooping of the central part of the eyebrow requires a frontal or coronal lift or an eyebrow lift. Additional guides to the selection and combination of the procedures are provided.
Nasal profiles are altered in almost every rhinoplasty operation. Often neglected in diagnosis and surgery are alterations in profiles of the cheeks and upper lip that should be made at the same time. We show aesthetic effects produced by alterations in these structures and describe how we measure and record the adjustment. A few examples of results are presented to indicate the techniques used and the importance of including changes in profiles of the cheeks and upper lip in cosmetic rhinoplastic diagnosis and treatment.
The rhomboid and other 60 degrees transposition flaps have theoretical and practical disadvantages for many applications. A better flap for these is one having an angulation of 30 degrees at its distal end. When this 30 degrees flap is combined with the M-plasty, a versatile and cosmetically favorable repair is provided for many surface defects. In fact, over the years, it has become our most useful method of closure with flaps. Fundamentally, it allows sharing of tensions of closure better than does the rhomboid flap, produces less level disparities or protrusions than does any 60 degrees flap, and its resulting scar length is only fractionally longer than that of the rhomboid flap. Rhomboid and other 60 degrees angle flaps have been exceedingly valuable tools to many surgeons; the 30 degrees flap combined with M-plasty should be significantly more useful.