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PubMed1998

Subperiosteal face lift: a 200-case, 4-year review.

The subperiosteal face lift is a procedure designed to rejuvenate the upper and middle thirds of the face. Herein is reviewed a 4-year series of 200 consecutive patients who have undergone a subperiosteal face lift with a special emphasis on handling of the zygomatic arch. The main operative indication was significant ptosis of the midface soft tissue. Dissection of the maxilla, zygoma, periorbital areas, and the anterior arch was carried out through either a gingivo-buccal sulcus incision (39 cases) or a subciliary incision (161 cases). Dissection of the posterior arch was carried out in a plane superficial to the innominate fascia. A back-cut was made in the superficial musculoaponeurotic system and subcutaneous tissue down to midtragus, and a subperiosteal tunnel was entered by piercing through the posterior arch periosteum. By using a Cottle elevator (sweeping superiorly and inferiorly), the arch dissection was completed in a posterior to anterior direction. All patients underwent a concurrent brow lift (190 endoscopically and 10 by means of coronal incision). The forehead incision was used to dissect the lateral orbital rims. Twelve patients (6 percent) had undergone a previous rhytidectomy. All but four patients were women and ranged in age from 34 to 76 years (mean, 54+/-11). Mean follow-up period was 27 months (1 to 41 months). The postoperative complication rate was 5 percent and included transient frontal branch weakness (n = 2), resolved at 41 and 71 days postoperatively; hematoma (n = 2); transient infraorbital nerve paresthesia (n = 1); asymmetrical smile (n = 3); and facial tics (n = 2). Two patients (1 percent) required a secondary surgery on their brows or midface. An upper blepharoplasty was needed in 26 patients (13 percent). The overall aesthetic results were excellent, with good elevation of the eyebrows, lateral canthus, and the midface soft tissues. In conclusion, the subperiosteal face lift is a procedure designed to rejuvenate the upper and middle thirds of the face. Approaching the arch posteriorly and in a systematic fashion simplifies the procedure and reduces the risk of facial nerve injury.

Adult↗
PubMed2001

Combined erbium:YAG laser resurfacing and face lifting.

Facial aging occurs secondary to gravity-induced tissue ptosis and photoaging. Combined face lifting and carbon dioxide laser resurfacing provides a comprehensive one-stage approach to facial rejuvenation but is condemned by many plastic surgeons due to the nonspecific thermal effects of the laser and risk of skin necrosis. Newer high-energy erbium:YAG lasers allow precise tissue ablation with minimal thermal effect. In this study, various facial rejuvenation techniques were combined with simultaneous erbium:YAG laser resurfacing to assess results and complications. A total of 257 patients from Florida, Melbourne, Australia, and Tel Aviv, Israel, underwent combined erbium:YAG laser resurfacing and surgical facial rejuvenation. Various face-lift methods were used, including endoscopic, deep plane, and subcutaneous. Simultaneous, full-facial laser resurfacing was performed using a variety of erbium:YAG lasers. It was found that combined laser resurfacing and face lifting was successful in greater than 95 percent of patients with minimal morbidity. Two patients (1 percent) (both heavy smokers) developed small areas of skin necrosis that healed with minor pigment changes. Five patients (2 percent) developed synechia that was treated with no residual effect. Two additional patients (1 percent) developed temporary ectropion. There were no other cases of scarring, infection, or cosmetically obvious hypopigmentation. Although larger studies are necessary, it seems that the lack of thermal injury from the erbium:YAG laser makes it possible to safely perform laser resurfacing with surgical facial rejuvenation in nonsmokers. However, the authors caution that familiarity with the nuances of erbium:YAG laser resurfacing be obtained before performing combined laser resurfacing and face lifting.

Adult↗
PubMed1989

Isometric lifting strength as a predictor of industrial back pain reports.

The objective of our investigation was to study isometric lifting strength in a population of industrial workers who perform a great variety of manual tasks, and to determine whether isometric strength is predictive of future back problems in such a population. Of 3,020 study subjects, 2,178 (72%) underwent strength testing in three standard lifting positions. During a 4-year follow-up period, 172 subjects tested reported back problems. When examining each isometric lift separately as a predictor of industrial back pain reports, those with greater isometric strength were at significantly greater risk than were weaker workers. However, after controlling for the effects of age, only a slight trend remained. For the blue collar workers in this study, isometric lifting strength testing was ineffective in identifying individuals at risk for industrial back problems.

Adult↗
PubMed2003

The impact of femoral component rotational alignment on condylar lift-off.

The surgical technique and implant design influence femoral condylar lift-off in total knee arthroplasty. With the use of the classic method of bone resection and appropriate soft tissue releases, alignment of the femoral component along the transepicondylar axis will create a symmetric and balanced flexion space. This surgical technique will reduce the incidence of condylar lift-off. If condylar lift-off does occur, it may be beneficial to have a prosthesis that is designed with a conforming frontal articulation. Reducing lift-off with a relatively conforming articulation reduces edge loading and in turn should reduce polyethylene damage.

Arthroplasty, Replacement, Knee↗
PubMed2003

Reinforced orbitotemporal lift: contribution to midface rejuvenation.

The changes in the aging face occur from progressive ptosis of the skin, fat, and muscle, in conjunction with bone absorption and cartilage atrophy. In the orbital region, hollowness and compartmentalization occur. Conventional face lift procedures correct only the skin flaccidity, and superficial musculoaponeurotic system techniques reposition the skin and platysma without repositioning the middle third of the face, creating an artificial jawline. Subperiosteal rhytidectomy disrupts the anatomy of the periorbita, which gives the patient a certain scarecrow aspect. Composite rhytidectomy associated with brow lift and blepharoplasty may offer better results, with improvement in the malar and orbital regions. The reinforced orbitotemporal lift (ROTEL) is a new procedure in a face lift that allows the orbicularis oculi muscle and all the structures connected to it to be elevated and stretched and the orbitotemporal skin to be raised, repositioning these structures and ending orbital compartmentalization. The result is an impressive improvement in the malar-orbitotemporal region, resulting in a natural and youthful appearance.

Adult↗
PubMed2004

Reducing complications in cervicofacial rhytidectomy by tumescent infiltration: a comparative trial evaluating 678 consecutive face lifts.

Tumescent infiltration has been widely used in body-contouring surgery to facilitate dissection and reduce blood loss. Although its use in facial surgery has been suggested, there are presently no comparative studies of its efficacy. The aim of this study was to investigate the long-term outcome in a large series of consecutive face lifts performed with and without tumescence. During a 6-year period, 678 consecutive face lifts were performed: 449 without tumescence and 229 with tumescent infiltration using 200 ml on each side of the face. The spectrum of techniques included the extended superficial musculoaponeurotic system (SMAS) procedure, the lateral SMASectomy, the extended supraplatysmal plane lift, and the cutaneous face lift. Complications, such as hematoma, skin necrosis, alopecia, and scar quality, were compared between groups using Fisher's exact test. The use of tumescent infiltration facilitated dissection, particularly in the neck. Postoperative swelling and bruising were reduced in the tumescent group. In comparisons of major complications between groups, no difference was seen in hematoma rate (p > 0.5), although the incidence of other complications was significantly reduced by tumescent infiltration. Significant reduction was observed in the rate of skin necrosis (p = 0.03), alopecia (p = 0.006), hypertrophic scarring (p = 0.001), stretched scarring (p = 0.003), and scar revision (p < 0.001). This is the first comparative study of tumescent infiltration in facial rejuvenation surgery. Tumescence made dissection easier and significantly reduced the incidence of troublesome complications. The surgical technique and aesthetic implications for rejuvenation surgery are discussed.

Anesthetics, Local↗
PubMed2004

Endoscopic brow lift: a personal review of 538 patients and comparison of fixation techniques.

Since the introduction of endoscopic brow lifting in the mid-1990s, it has become widely accepted as a method for rejuvenation of the upper third of the face. Despite the multitude of brow fixation techniques, there are few long-term studies providing accurate analysis of outcome. The aims of this investigation were to evaluate the long-term objective results of endoscopic brow lifting and to establish whether the technique of fixation altered the longevity of aesthetic outcome. The outcome of endoscopic brow lifts carried out on 538 consecutive patients over a 6-year period was assessed. For each patient, midpupil-to-brow distance was measured preoperatively and at intervals postoperatively. Two different fixation methods were compared: fibrin glue (n = 189, group 1; 104 records available) and polydioxanone sutures tied through bone tunnels (n = 349, group 2; 220 records available). In 214 patients, an upper lid blepharoplasty was performed simultaneously (85 in group 1 and 129 in group 2). At 1 month postoperatively, each fixation technique had produced a significant change in mean pupil to brow height (5.93 mm in group 1 and 6.21 mm in group 2, with no significant difference between the two methods; p = 0.17). However, when measurements were compared more than 3 months postoperatively (mean, 9.4 months), there was a significant difference, with some relapse in the patients treated with fibrin glue (p < 0.01). However, in group 2 (tunnel fixation), measurements remained stable, with 6.21 mm at 1 month compared with 6.16 mm long term (no significant difference, p = 0.34). In contrast, in group 1 (fibrin glue), measurements showed significant reduction, with a 1-month result of 5.93 mm and a long-term outcome of 3.79 mm (p < 0.01). Upper lid blepharoplasty had no effect on the long-term outcome of either group (p > 0.3 in group 1, p > 0.4 in group 2). Complications were few in both groups. In group 1, there was one infection, two instances of significant alopecia (both temporary), and one reoperation for relapse. In group 2, four patients required minor surgical revision of a lateral port scar and three minor areas of temporal alopecia, which recovered in less than 3 months. One patient had a paresis of the frontal branch that had recovered after 4 months. The endoscopic brow lift is therefore a safe and effective technique for increasing mean pupil to brow height. Fixation with polydioxanone sutures tied through bone tunnels produces a significantly more stable result than fibrin glue, without greater risk. This lends weight to experimental evidence that periosteal fixation must be maintained for at least 6 weeks to be secure.

Blepharoplasty↗
PubMed2005

Circumauricular incision (water-drop shape) for mid- to lower face lift.

The conventional method of mid- to lower face rhytidectomy that involves removing a strip of occipital scalp always creates a conspicuous transverse scar crossing the postauricular skin, which may leave a stair-step deformity at the occipital hairline. The author has designed a new face lift method using a circumauricular incision, shaped like a water droplet, that curves around the auricle. In this new method, the upper part of the "O" shape is modified to the tip of a water droplet. The dissection of the cheek and neck is performed as in the conventional method with light-retractor assistance. The temporal region above the deep temporal fascia is managed under endoscopic control. This dissection can extend to the forehead region lateral to the supraoptic nerve and around the lateral orbital rim to release the arcus marginalis. A mesentery of superficial temporal fascia is created cephalic to the zygomatic arch. The postauricular dissection is performed beneath the galea in the upper part and beneath the occipital scalp and neck skin in the lower area. The lifting vector is upward and backward for the anterior skin flap and upward for the posterior skin flap. The excess skin is trimmed around the ear. The wound at the upper pole of the incision is closed in a V-to-Y advancement fashion. The dog-ear is left above the normal hairline, and there is little or no hairy scalp to be removed. The skin pleating in the postauricular region will settle down spontaneously after several months. The dog-ear in the scalp will become smaller and flat as well. The scar around the ear is quite inconspicuous and well covered under the upper pole of the auricle. From the author's experience, the new "water drop" circumauricular incision is a good alternative for the mid- to lower face lift. It can also be used in conjunction with endoforehead lift for full-face rejuvenation.

Adult↗
PubMed2006

Simplifying circumferential body contouring: the central body lift evolution.

BACKGROUND: Optimal central body contouring may be achieved with a combination of circumferential liposuction and excisional techniques for patients with diffuse lipodystrophy or generalized skin laxity or after massive weight loss. The central body lift has evolved to improve the contour of the trunk and proximal lower extremity in patients with skin redundancy and lipodystrophy. Liposuction is used as an adjunct to improve the results of excisional body contouring. The authors' goal is to review the literature and describe the evolution of their technique for the central body lift, which optimizes safety and contouring of the abdomen, thighs, and buttocks using a circumferential abdominoplasty and discontinuous circumferential liposuction. METHODS: The authors present a retrospective chart review of their series of 151 patients over a 12-year period that underwent the central body lift procedure. Patient selection, safety factors, key operative elements, and postoperative care are reviewed and discussed. RESULTS: There were three major complications (2.0 percent) (two deep vein thromboses and one pulmonary embolus) and 32 minor complications (21.1 percent). Surgical revision was required in eight patients (5.3 percent). Overall patient and physician satisfaction was high. CONCLUSIONS: The central body lift is an effective and safe body contouring technique for patients with diffuse lipodystrophy or generalized skin laxity or after massive weight loss. Adherence to safety guidelines is critical.

Abdomen↗
PubMed2005

Anti-inertial lift in foams: a signature of the elasticity of complex fluids.

To understand the mechanics of a complex fluid such as a foam we propose a model experiment (a bidimensional flow around an obstacle) for which an external sollicitation is applied, and a local response is measured, simultaneously. We observe that an asymmetric obstacle (cambered airfoil profile) experiences a downwards lift, opposite to the lift usually known (in a different context) in aerodynamics. Correlations of velocity, deformations, and pressure fields yield a clear explanation of this inverse lift, involving the elasticity of the foam. We argue that such an inverse lift is likely common to complex fluids with elasticity.

Journal Article↗
PubMed2004

The concept of safer face-lifting.

Face-lifting is now a common aesthetic procedure, performed mainly by plastic surgeons but increasingly also by ENT surgeons, oral surgeons, general surgeons and dermatologists. The level of expertise is dependent on training and exposure to patients, in addition to basic surgical skills. With cosmetic surgery clients, a holistic approach to patients is becoming increasingly important and, with increasing demands from the Care Standards Committee, there should be less demand for part-time aesthetic surgeons. This paper describes the working practice and thought processes of a single surgeon, based on 14 years of a busy aesthetic surgery practice. There are numerous types of face-lift described in the literature but, in practical terms, the simplest technique often gives the best result, with little risk of morbidity. Undoubtedly, some clients need an aggressive approach but, in most cases, the vertical pull mini-face-lift gives consistently good results in cases that are carefully assessed preoperatively and managed by skilled aesthetic/plastic nurses in the postoperative period. This paper is unique in its holistic approach to assessment, technique and aftercare. It is designed for the sensible surgeon, looking for a low-risk technique that reaps professional satisfaction and a happy client base. The more complex face-lift should be referred to recognized specialists in the field.

Journal Article↗
PubMed1998

Carbon dioxide laser resurfacing combined with endoscopic forehead lift, laser blepharoplasty, and transblepharoplasty corrugator muscle resection.

BACKGROUND: Endoscopic forehead lifting has become an increasingly popular method for rejuvenating the upper face, due to its less invasive nature and minimal scars. However, adequate ablation of frown muscles (i.e., corrugator and depressor supercili) is difficult with this approach. The frown muscles are in close proximity to the upper eyelid, and it is possible to oblate them via the blepharoplasty approach using the carbon dioxide laser. OBJECTIVE: The purpose of this paper is to describe the combined approach of endoscopic forehead lifting and carbon dioxide laser resurfacing to rejuvenate the upper face. The former technique addresses the issue of brow elevation and improvement of dynamic glabellar frown lines. The latter technique deals with static wrinkles caused by sun damage. METHODS AND RESULTS: Thirty-seven patients underwent endoscopic forehead lift, transblepharoplasty corrugator ablation, with simultaneous carbon dioxide laser resurfacing of forehead skin. Twenty-eight of 37 patients (76%) achieved excellent results, while nine of 37 (14%) experienced good results. Complications were minimal, being mostly due to inadequate corrugator muscle resection with recurrent frowning. There were no instances of scarring, skin necrosis, or permanent hair loss. CONCLUSION: The combination of endoscopic forehead lifting, transblepharoplasty corrugator muscle resection, and carbon dioxide laser resurfacing is an effective and safe technique for rejuvenating the upper face, producing a natural result with minimal complications.

Adult↗
PubMed2005

Transcutaneous face-lift.

BACKGROUND: Face-lifting can result in a number of complications. A mini-invasive technique is now presented. OBJECTIVE: To perform face-lifting as a simple, quick, and mini-invasive ambulatory approach in patients requiring mild to moderate lift. MATERIALS AND METHODS: Using a Khawaja-Hernandez or Keith needle and polypropylene 2-0, the superficial SMAS is pulled up and fixed to the periosteum of the temporal bone. Nineteen patients were so operated on, 14 women and 5 men, whose ages varied from 51 to 67 years. Pre- and postoperative photographs were taken. The degree of satisfaction was measured from 1 to 3 (1 being the least satisfactory). Informed consent was signed by all of the patients. RESULTS: Satisfactory results were obtained in all cases. Patients enjoyed the ease of the procedure. CONCLUSION: This is a simple, quick, and noncomplicated way to perform a face-lift. It can be combined with other modalities of facial rejuvenation.

Aged↗
PubMed1991

Intracranial self-stimulation motivates weight-lifting exercise in rats.

The purpose of this study was to determine the feasibility of using a positive reinforcement protocol to motivate weight-lifting exercise in rats. Intracranial self-stimulation was used to induce weight-lifting exercise. Bipolar electrodes were implanted in the ventral tegmental area of rats, and the animals were trained to bar press on a continuous reinforcement schedule for electrical brain stimulation. Animals with response rates of 1,200-1,500 presses/h were then trained with a discriminative light stimulus to alternate between a normally positioned bar and an elevated bar that could be reached only by standing on the hindlimbs. The animals were fitted with a weighted jacket at a starting resistance of 5-10% of their body weight. Weight-training sessions were conducted 5 days/wk for 10 wk. Training consisted of 600 presses/session, alternating every 15 presses between the low and high bars. At the beginning of each subsequent week, the resistance was progressively increased, with some animals eventually training at resistances greater than 50% of their body weight. At the end of the training period, the rats were lifting over 550% of the starting weight. Gastrocnemius size and mean fiber diameter were increased in the weight-lifting animals. This model combines exercise with positive incentive and has the advantages of being relatively easy to implement and not producing any apparent physical or mental trauma in the animal.

Animals↗
PubMed2003

Control and quantitation of voluntary weight-lifting performance of rats.

The present paper describes an exercise model that produces a voluntary hindlimb weight-lifting response. Each rat was operantly conditioned to enter a vertical tube, insert its head into a weighted ring (either 70 g or 700 g), lift the ring until its nose interrupted an infrared detector, and then lower the ring. Load cells measured the external force generated, and displacement transducers measured the vertical displacement of the ring during each lifting and lowering movement. The apparatus and training procedures were computer automated. Peak force, velocity, work, and power were calculated for each movement. Rats in both groups easily acquired the task after 12-15 training sessions, on average, conducted 5 days/wk. Once rats were trained, the lifting patterns were quite stable during several more weeks of posttraining exercise; however, the lighter 70-g load gave rise to more variable performances across rats. Results demonstrate the utility of quantitating the biomechanics of volitional movements and suggest that the present model can establish and maintain controlled repetitive movements necessary for studies of adaptation and/or injury in muscles, tendon, and bone.

Animals↗
PubMed1990

Purkinje cell simple spike activity during grasping and lifting objects of different textures and weights.

1. Three monkeys (2.5-3.5 kg) were trained to pinch an object between the thumb and forefinger and to lift it a vertical distance of 1.0-2.0 cm. Either the object weight (15, 65, or 115 g) or the surface texture (sand paper or polished metal) contacting the fingers could be varied. The object was equipped with a vertical position transducer, an accelerometer, and strain gauges that measured the grip force and the vertical load force. 2. In accordance with similar previously published studies on human subjects, it was found that monkeys appropriately scaled the grip forces according to the weight and coefficient of friction of the object. The grip force preceded the load force by 25 ms, and they both covaried with the changes in surface friction. 3. An analysis of electromyograms (EMGs) recorded intramuscularly from the muscles of the wrist and fingers including both flexors and extensors indicated that 26 muscles were active during pinching and lifting. Of these, 17 produced the maximum activity for the slippery surface and the greatest weight and the least activity with the roughest surface and lightest weight. 4. A total of 59 Purkinje cells and 123 unidentified units recorded from the paravermal and lateral cerebellar cortex were found to change their firing frequency during lifting the experimental object. 5. Increased discharge during the grasping and lifting was found for 56% (33/59) of the Purkinje cells and 80% (98/123) of the unidentified neurons, whereas 44% (26/59) of the Purkinje cells and 20% of the unidentified neurons decreased activity during the same period. 6. Significant modulations of the firing frequency with surface texture or object weight occurred for 59% (35/59) of the Purkinje cells and 67% (82/123) of the unidentified neurons. 7. One hundred and three Purkinje and unidentified neurons recorded in the paravermal and lateral region of the cerebellar cortex were examined for peripheral receptive fields, and of these, 43/103 (42%) responded exclusively to imposed displacements and tapping of muscles suggesting afferents originating from proprioceptors. A further 28/103 (27%) had exclusively cutaneous receptive fields on the hand that could be stimulated by brushing the skin lightly with a sable hair brush. Only six neurons demonstrated convergent cutaneous and proprioceptive receptive fields and no response to peripheral stimulation could be found for 26 neurons. No difference was found between the receptive fields of Purkinje cells and those of the unidentified neurons.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMed1995

Wing-beat coupling between flying locust pairs: preferred phase and lift enhancement

Pairs of locusts flying in tandem in a wind tunnel are known to couple their wing-beats intermittently. The rhythmically oscillating air flow from the front locust's wing-beat, detected by the rear individual, appears to convey the timing information for coupling. Three predictions of this arrangement were tested quantitatively in this study. (1) Given that the oscillating air flow has a wavelength of 7.5 cm, placing the rear locust 7.5 or 15 cm behind the front one should produce the same phase of coupling, whereas placing it at an intermediate distance of 11 cm should produce an opposite phase. (2) At any distance, the preferred phase at which wing-beat coupling occurs should depend, in part, on the difference in the wing-beat frequencies of the two locusts just before the coupling began. (3) At the moment that the wing-beats of the two locusts become coupled, a change should be observed consistently in the wing-beat frequency of the rear individual only. Each of these three predictions was fulfilled. We also recorded the instantaneous lift of the rear locust by tethering it to a laser torque meter. Lift varied with the phase of the wing-beats between the two locusts. For a given distance between the two locusts, lift was greater by a mean of 16 % of the locust's body mass at those phases where coupling most commonly occurred than at opposite phases. This lift effect was seen even if the wing-beats of the two locusts drifted through these preferred phases without actually coupling. These results are discussed in terms of a possible energetic advantage conferred to the rear locust by flying in tandem and by coupling its flight rhythm to the leader's wing-beat.

Journal Article↗
PubMed2001

Histological and clinical evaluation of 3 different grafting materials for sinus lifting procedure based on 8 cases.

BACKGROUND: The reconstruction of edentulous patients with adequate bone volume and density by using dental implants has become a viable treatment option with high predictability. However, initial stabilization is difficult to achieve in the posterior maxillary regions where cortical bone is thin or absent due to severely resorbed alveolar ridges. Maxillary sinus lift procedures applied with various grafting materials enable clinicians to place implant-supported prostheses even in cases with increased pneumatization of the maxillary sinus. METHODS: The purpose of this study was to evaluate histologically and clinically different grafting materials used in maxillary sinus floor augmentation. Deproteinized bovine bone granules (DBBG), demineralized freeze-dried bone powder (DFBP), and porous hydroxyapatite (PHA) were used as grafting materials. A total of 19 implants in 8 patients were placed into grafted sites. In 3 patients, a 2-stage approach was used wherein implants were inserted after a 6-month healing period following a sinus lift procedure. Specimens were taken with a trephine drill, and the site of the specimen was enlarged to accept an implant. For the remaining cases, a 1-stage approach, which included sinus lifting and implant placement, was used and bone biopsies were taken during the uncovering stage. After 6 months of healing, fixed prosthetic restorations were fabricated. RESULTS: The healing period progressed without any complications, and all implants were loaded. The mean functioning time was 12 months, varying from 9 to 24 months. CONCLUSION: The results indicate that DFBP resorbs earlier than PHA and DBBG in sinus lift procedures.

Adult↗