James E Zins

Cleveland Clinic, Cleveland, OH, United States

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Publications (114)172.1 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A systematic review was conducted to compare the speech outcomes and fistula rates following repair of the cleft palate with Furlow double-opposing Z-plasty and straight-line intravelar veloplasty techniques.
    Plastic and reconstructive surgery. 11/2014; 134(5):1014-22.
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    ABSTRACT: Postoperative pain is a major concern for patients undergoing facial aesthetic surgery. Aggressive efforts to reduce postoperative pain while avoiding adverse sequelae, such as nausea and vomiting, will result in an improved patient experience. Newer pharmaceuticals, medical devices, and longer-acting local anesthetics offer the potential to reduce pain and enhance patient satisfaction. The purpose of this report is to review the options and apply them to 3 specific facial aesthetic procedures: face-lift, brow lift, and blepharoplasty.
    Plastic and reconstructive surgery. 10/2014; 134(4S-2 Current Concepts in Pain Management in Plastic Surgery):108S-112S.
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    ABSTRACT: Refrigerant sprays have been widely used to reduce pain in the office setting. However, more recently, their use has been limited by both concern regarding flammability and questions of bacterial contamination.
    Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 09/2014;
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    ABSTRACT: Vascularized composite allotransplantation (VCA) has experienced a growing acceptance, which has led to a debate centered on extending the indications of the procedure to include pediatric patients. The aim of this article was to discuss such indications based on the evidence in pediatric solid organ transplantation, reconstructive surgery in children, and VCA in adult patients.
    Annals of plastic surgery. 07/2014;
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    ABSTRACT: Since 2009, a synthetic material known as kryptonite has become increasingly utilized during cranioplasty to repair bony defects. It provides bone-like strength and adhesive properties that make it a suitable replacement for bone. However, applications have been observed in the immediate postoperative period that demonstrates an increase in its original volume, giving rise to irregularities in the cranial surface. Ten kryptonite samples were reconstituted and allowed to polymerize according to the manufacturer's directions. The kryptonite samples were molded into a cylindrical shape, and they were immersed in 10 graduated cylinders filled with normal saline. Measurements of the rise in saline relative to baseline were taken at 0, 10, 20, 30, 40, 50, and 60 minutes, and then hourly through 5 hours, with the final measurement recorded at 24 hours. The mean expansion of kryptonite was approximately 49% with an SD of 22%. The bulk of the expansion occurred within the first 2 hours, after which the rate tended to plateau for the remaining 22 hours. Kryptonite has been touted as an excellent alternative for repairing contour abnormalities manifested in cranioplasty. Given the unpredictability of its expansile properties, the surgeon must take this variability into careful consideration when planning the desired surgical outcome.The results of the current study were communicated with the manufacture. Immediately thereafter, the manufacturer withdrew the product from the US market and is no longer Food and Drug Administration approved for cranioplasty.
    The Journal of craniofacial surgery 04/2014; · 0.81 Impact Factor
  • Plastic and reconstructive surgery 04/2014; 133(4 Suppl):986. · 2.74 Impact Factor
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    ABSTRACT: Background:Cervicoplasty is an important component of aesthetic facial and neck surgery, but the fat content in this area has not been described.Objectives:The authors identify anatomic compartments of fat in the neck (specifically the areas relevant to surgical management), quantify the fat in each compartment, and describe the relationships between each compartment and the submandibular glands.Methods:The skin was removed from 10 fresh cadaver heads. Each compartment of fat was weighed, along with the submandibular gland. Supraplatysmal fat was found between the skin and the platysma muscle, and it was compartmentalized into suprahyoid and infrahyoid fat. Subplatysmal fat was found deep to the platysma and between the medial edges of the anterior digastric in the midline; this fat also fell into suprahyoid and infrahyoid compartments. The "very deep" fat was deep to the anterior digastric muscles and submandibular gland, and adherent to the strap muscles.Results:On average, supraplatysmal fat represented 44.7% of the fat in the neck, the subplatysmal fat represented 30.7%, and the submandibular gland represented 24.5%. The very deep fat was scant, representing less than 1% of the fat in the neck.Conclusions:This anatomic study provides a comprehensive review of fat in the neck, and the results should serve as an additional guide as surgeons approach this challenging area in surgical rejuvenation.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 03/2014;
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    ABSTRACT: In the craniofacial surgery literature, there is a wide disparity of opinions regarding the appropriate treatment of nonsyndromic sagittal synostosis. With the lack of level 1 evidence to support a particular regimen, our study aims to elucidate the current state of practice among craniofacial surgeons with the hope of establishing a standard of care. An internet-based survey was sent to 102 craniofacial surgeons in 14 countries on 4 continents. Data were collected regarding the following parameters: primary indication for surgery, preference of timing, and choice of operative intervention for patients presenting with nonsyndromic isolated sagittal synostosis with normative intracranial pressure values. Surgeons were also queried regarding preoperative, intraoperative, and postoperative protocols. After 2 mailings, the response rate was 58% (59/102). For 63% of respondents, skull deformity was the primary indication for treatment of craniosynostosis.Open surgical management of sagittal craniosynostosis was most commonly performed at 6 months (35%) of age. Total cranial vault remodeling was the most commonly performed procedure (37%). Thirty-five percent of craniofacial surgeons chose an endoscopic surgical approach for patients presenting at younger than 4 months. Only 10% of craniofacial surgeons selected spring-assisted strip craniectomy. Seventy-one percent of polled surgeons performed computed tomographic scans of the skull in all cases, irrespective of presentation. Our survey demonstrates that there exists a wide disparity of opinion regarding diagnosis and treatment of nonsyndromic sagittal synostosis. When current practice is compared to findings in the literature, significant discrepancies exist.
    The Journal of craniofacial surgery 01/2014; · 0.81 Impact Factor
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    ABSTRACT: In health care, it is widely known that evidence-based medicine (EBM) has a significant impact on clinical practice, and opinion leaders can enhance the clinician's application of EBM in various disciplines. In this article, we examine the existence and impact of opinion leaders in craniofacial surgery as well as barriers to evidence-based practice. We compiled the answers of an Internet questionnaire, which was sent to 102 craniofacial surgeons. Our results demonstrate that opinion leaders most definitely can be identified in craniofacial surgery. They are tightly connected to their field's social network and promote EBM. In this survey, 44% of craniofacial surgeons reported that their greatest obstacle to clinical decision making in the management of nonsyndromic synostosis was lack of surgical consensus. In addition, craniofacial surgeons stated that EBM and opinion leaders are the most influential factors that caused them to change their management of craniosynostosis. We expect that the use of opinion leaders can further enhance the uptake of EBM in craniofacial surgery.
    The Journal of craniofacial surgery 01/2014; 25(1):106-10. · 0.81 Impact Factor
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    ABSTRACT: Background:The great auricular nerve (GAN) is the most commonly injured nerve during facelift surgery. Although rare, injury can result in long-term sequelae.Objectives:Previous reports have described the nerve's location at the midbelly of the sternocleidomastoid muscle (SCM) or at its emergence from underneath the SCM. The purpose of our study was to identify the superior course of the great auricular nerve as it applies to facelift.Methods:Thirteen fresh cadavers were dissected. A vertical line through the midlobule was drawn perpendicular to the Frankfort's horizontal, acting as a reference to the course of the GAN. Transparent paper overlay tracings were then done to record each nerve's location. The distance from the bony external auditory canal (EAC) to the nerve was measured at the anterior muscle border, at the midbelly of the SCM, and as the nerve emerged from under the SCM. Branching patterns of the nerve and its relation to the external jugular vein were identified.Results:In 100% of the dissections, the superior course of the GAN fell within a 30-degree angle constructed using the vertical limb perpendicular to the Frankfurt horizontal and a second limb drawn posteriorly from the midlobule. The distance from the EAC to the nerve was 4.9 ± 1.1 cm at the anterior muscle border, 7.3 ± 1.0 cm at the midbelly of the SCM, and 9.8 ± 1.2 cm at the GAN's emergence from under the SCM. Four types of branching patterns were identified.Conclusions:The 30-degree angle described above rapidly and accurately identifies the nerve's location.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 12/2013;
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    ABSTRACT: This study aimed to systematically evaluate all reported outcomes of facial allotransplantation (FT) using the previously described FACES scoring instrument. This was a retrospective study of all consecutive face transplants to date (January 2012). Candidates were identified via using medical and general internet database searches. Medical literature and media reports were reviewed for details regarding demographic, operative, anatomic, and psychosocial data, which were then used to formulate FACES scores. Pre-transplant and post-transplant scores for "functional status", "aesthetic deformity", "co-morbidities", "exposed tissue", and "surgical history" were calculated. Scores were statistically compared using paired-samples analyses. Twenty consecutive patients were identified, with 18 surviving recipients. The sample was composed of 3 females and 17 males, with a mean age of 35.0 ± 11.0 years (range: 19-57 years). Overall, data reporting for functional parameters was poor. Six subjects had complete pre-transplant and post-transplant data available for all 5 FACES domains. The mean pre-transplant FACES score was 33.5 ± 8.8 (range: 23-44); the mean post-transplant score was 21.5 ± 5.9 (range: 14-32) and was statistically significantly lower than the pre-transplant score (P = 0.02). Among the individual domains, FT conferred a statistically significant improvement in aesthetic defect scores and exposed tissue scores (P ≤ 0.01) while, at the same time, it displayed no significant increases in co-morbidity (P = 0.17). There is a significant deficiency in functional outcome reports thus far. Moreover, FT resulted in improved overall FACES score, with the most dramatic improvements noted in aesthetic defect and exposed tissue scores.
    The Journal of craniofacial surgery 11/2013; · 0.81 Impact Factor
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    ABSTRACT: Face-lift surgery when combined with perioral phenol-croton oil peel is an underappreciated tool for face rejuvenation. The procedure results in significant central face skin tightening and wrinkle reduction. A retrospective review of 47 consecutive patients who underwent simultaneous face lift and perioral peel was performed. The objective measures used to evaluate the change in appearance of the patients included (1) a validated patient satisfaction questionnaire, (2) an evaluation of apparent age, and (3) an evaluation of perioral wrinkles by independent reviewers using a validated model. The assessment of apparent age was performed as follows: preoperative and postoperative photographs were shown randomly to six reviewers, who were asked to estimate the patient's age. The apparent age was compared with the patient's actual age, and the reduction in apparent age was calculated. Improvement in perioral rhytides was evaluated by using the Glogau classification system (range, 1 to 4). Survey results documented overall patient satisfaction, which was rated as 6.5 on a scale of 1 to 7 (with higher scores indicating greater satisfaction). Patients' postoperative apparent age estimate was 8.2 years younger than their real age (p = 0.0002). The Glogau classification system score demonstrated a mean reduction of 1.15 (3.3 preoperatively as compared with 2.15 postoperatively, p < 0.0001). Outcomes measurements, including patient satisfaction, objective evaluation of wrinkle improvement, and significant reduction in apparent age, document the power of this technique. Therapeutic, IV.
    Plastic and reconstructive surgery 11/2013; 132(5):743e-53e. · 2.74 Impact Factor
  • Ozan Bitik, Hakan Uzun, James E Zins
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    ABSTRACT: Background:The pigment density and texture of breast skin are not uniform. Especially in patients with massive breasts, lower pole skin can be significantly darker and coarser than the upper pole skin. Nipple areola reconstructing (NAR) reduction mammaplasty is a technical modification of the "free nipple" procedure in which the original nipple areola complex (NAC) is discarded and the new NAC is reconstructed from coarse pigmented lower pole skin using a modified skate flap purse-string technique.Objectives:The authors review their initial clinical experience with NAR reduction mammaplasty.Methods:Between 2010 and 2012, 16 patients (31 breasts) underwent the NAR procedure, and these cases were retrospectively reviewed for patient demographics, preoperative topographic breast measurements, amount of reduction per breast, and complications. The operative goal was to obtain the smallest breast size that can be achieved with tension-free wound closure. Patient satisfaction was also assessed.Results:Breast reductions varied from 1150 to 2850 g/breast (average, 1590 g/breast), and patients were followed up for a minimum of 1 year (average, 15.9 months). No major local or systemic complications were encountered. Two patients required touch-ups for the correction of minor periareolar irregularities resulting mainly from the inversion of wound closure. At 1 year, average score for general satisfaction was 4.6, and the average score for NAC satisfaction was 3.9, on a scale from 1 (not satisfied) to 5 (extremely satisfied).Conclusions:NAR reduction mammaplasty enables the surgeon to perform massive reductions, design different non-NAC-bearing glandular pedicles for breast shaping, and obtain tension-free closure without the fear of ischemic complications.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 10/2013;
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    ABSTRACT: Background Facial aging is a dynamic process with impact on both the soft tissues and the bones. Despite a growing body of evidence, controversy still exists regarding absolute characteristics of the aging facial skeleton.Objective The purpose of this study was to investigate various mandibular measurements in different age groups and to delineate the relation of the dentition to these parameters.Methods Ninety Caucasian mandibles were assessed for the following distance landmarks: gonion-gonion, infradentale-gnathion, mental foramen-mandibular crest, mental foramen-inferior mandibular border, gnathion-gonion, condyle-gonion, and gonial angle. The measurements were compared according to age, sex, and dentition.ResultsThe number of teeth decreased significantly with increasing age in males (P = .002) and females (P < .001). There were no other statistically significant differences between age groups for the rest of the parameters. The infradentale-gnathion distance (P = .005) and the mental foramen-mandibular crest distance (P < .001) was found to increase with total number of teeth. Other parameters did not show a significant relation to dentition. All parameters were significantly larger in the male subgroups with the exception of gnathion-gonion distance and gonial angle. Bilateral mandibular measurements were symmetric except for the gonial angle, which was more obtuse on the right side in males (P = .007) and females (P = .018).Conclusions Our findings support previous evidence that dentition is the main determinant of the morphology of the mandible. The skeletal characteristics are variable among individuals, and a longitudinal study is required to better understand age-related changes of the mandible.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 09/2013;
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    ABSTRACT: Background:Soft-tissue filler injection is a very common procedure in the United States. Although the safety profile is favorable, adverse events (AE) can occur, ranging from mild to severe in intensity.Objectives:The authors performed a literature search to identify the facial sites most prone to severe complications. They review the course of these complications and discuss preventive measures.Methods:The National Library of Medicine, the Cochrane Library, and Ovid MEDLINE were searched, and relevant articles (published through August 2012) were retrieved based on prespecified inclusion criteria. The complications reviewed were limited to "severe" events, such as soft-tissue necrosis, filler embolization, visual impairment, and anaphylaxis. The filler materials included were those approved by the US Food and Drug Administration at the time of this study.Results:Forty-one articles, representing 61 patients with severe complications, were identified. Data collected from these case reports included filler type, injection site, complication site, symptom interval, symptom of complication, time to therapy, modality of treatment, and outcome. The most common injection site for necrosis was the nose (33.3%), followed by the nasolabial fold (31.2%). Blindness was most often associated with injection of the glabella (50%). An estimated incidence of 0.0001% for developing a severe complication was calculated by reviewing society-based filler data and case reports within same time period.Conclusions:Although soft-tissue fillers are a popular choice for minimally invasive rejuvenation of the face, physicians should be aware of the serious potential adverse effects, recognize their presentations, and have appropriate treatments readily available.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 07/2013;
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    ABSTRACT: Goals/Purpose: What happens to fat in the neck as we age? In recent years, fat in the neck has received increased attention from an aesthetic perspective, demonstrated by the increased number of procedures that target only the neck. While the literature is replete with accounts of surgical options for this region, a thorough description of the fat content of this area has not been described. Building on the work of previous studies, this study seeks to describe the compartments of fat in the neck with particular attention to those areas relevant to surgical management. Methods/Technique: Eleven fresh cadaver heads were obtained and the skin was removed. Each compartment of fat was weighed along with the submandibular gland, which was also measured and weighed. Fat in the superficial compartment was found between the skin and the platysma muscle. This was further sub-compartmentalized into suprahyoid and infrahyoid fat. The intermediate fat was found deep to the platysma and between the medial edges of the platysma in the midline. This fat was typically in an hour-glass shape and also fell into suprahyoid and infrahyoid compartments. The deep layer of fat in the neck was bordered superficially by the anterior belly of the digastric and the submandibular gland. Because of its adherence to deeper structures and small volume relative to the superficial and intermediate compartments, it was not removed or weighed. Dye injection studies were performed in four specimens. Methylene blue was injected subcutaneously through a submental injection site, and the dye was allowed to diffuse through the tissue planes over 24 hours. Results/Complications: Of the eleven specimens dissected, four were male and seven were female. All patients were elderly, with age range from 64-87 (mean, 73.0 years). The superficial infrahyoid compartment contained 15% (±8.3%) of the total fat and glandular complement of the neck. The superficial suprahyoid compartment contained 29.7% (±11.2%) of the glandular and fat complement of the neck. The intermediate compartment consisted of four sub-compartments, the infrahyoid central, the infrahyoid lateral, the suprahyoid central and the suprahyoid lateral. The infrahyoid central contained 6.0% (±4.2%) of the total subcutaneous soft tissue complement. The infrahyoid lateral subcompartment contained 7.6% (±1.4%) of the fat and glandular complement. The suprahyoid central contained 9.1% (±4.9)% of the total subcutaneous soft tissue complement, and the suprahyoid lateral contained 8.0% (±4.1%) of the total subcutaneous soft tissue complement. The submandibular glands weighed an average of 9.4 g (±3.2 g), representing 24.5% (±14.4%) of the total subcutaneous soft tissue complement. Gender differences were also investigated. In female cadavers, 51% of the fat and glandular content was found in the superficial compartment, while in males, only 35% of the fat was in the superficial compartment. Both genders demonstrated a similar amount of fat in the intermediate compartment, which was approximately 1/3 (males 33%, females 29%) of the fat/glandular content of the neck. In males, 32% of the fat/glandular content was occupied by the submandibular gland, while this amount was only 20% in females. Cadavers were also analyzed by age group. In the superficial compartment, those with ages 60-69 (n=4) had 40% of their fat, those aged 70-79 (n=4) had 50% of fat in the superficial compartment and those aged 80-87 (n=3) had 44% of their fat in this compartment. In the intermediate compartment, those with ages 60-69 had 28% of their fat, those aged 70-79 had 35% of fat in the intermediate compartment and those aged 80-87 had 33% of their fat in this compartment. Dye injection studies demonstrated several findings. First, the superficial and intermediate fat compartments were continuous in both the anterior/posterior and superficial to deep planes. Dye staining was present throughout the superficial fat, the platysma and the intermediate fat. In patients that had larger volumes of fat in the neck, fat in the deeper compartments was stained less densely. However, dye staining was not present in the deep fat compartment in any specimen, demonstrating that the intermediate and deep compartments are distinct from one another. Dye injections also demonstrated that within the intermediate compartment, the lateral infrahyoid fat did not stain, suggesting this fat pad may be in an anatomically distinct plane within the neck. Conclusion: In conclusion, our study represents an attempt at further classifying the clinically relevant fat compartments that are routinely encountered during surgical rejuvenation of the neck. Building on the work done by previous investigators, this study contributes another anatomical perspective, the goal being that an improved understanding of the anatomy will necessarily lead to improved surgical technique, more aesthetic results, and better satisfied patients.
    The Aesthetic Meeting 2013 The American Society for Aesthetic Plastic Surgery; 04/2013
  • Cemile Nurdan Ozturk, Franziska Huettner, C. N. Ozturk, Marisa Bartz-Kurycki, James E. Zins
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    ABSTRACT: Goals/Purpose: Facelift surgery combined with perioral phenol-croton oil peeling is a powerful and under-recognized tool for lower face rejuvenation. This approach results in significant central face skin tightening as well as wrinkle ablation. In this study we reviewed our experience with these simultaneous procedures using a variety of outcomes measures. Methods/Technique: A retrospective review of 47 consecutive patients who underwent simultaneous facelift and perioral peel was performed. The extended SMAS approach was the most common facelift procedure combined with perioral resurfacing. Phenol-croton oil peel solution used consisted of 33% phenol, 1.1% croton oil, septisol and purified water. The solution was applied to the perioral region until a dense white frosting was observed. In none of the cases was undermined flaps peeled. The objective measures used to evaluate appearance change included: (1) patient satisfaction questionnaire, (2) evaluation of apparent age by 6 observers, (3) evaluation of perioral wrinkles by 2 independent plastic surgeons. The validated patient satisfaction questionnaire consisted of 14 items designed to measure satisfaction after treatment.1 The items questioned overall satisfaction, improvement in appearance and improvement in facial lines. Assesment of apparent age was calculated as follows: Pre and post operative photographs were randomly mixed and were shown to 6 independent reviewers who were asked to estimate the patient`s age. The apparent age was then compared to patient`s actual age. Additionally, reduction in apparent age was calculated by the formula [Postoperative Apparent Age-Actual Age] [Preoperative Apparent Age-Actual Age]. 2 Improvement in perioral rhytids was evaluated by 2 independent plastic surgeons using pre and postoperative perioral photographs. Objective wrinkle assessment was made using the Glogau (1-4) scale. All reviewers were blinded to the patient`s operative status. Results/Complications: The average patient age was 635.6. Mean follow up was 23.2 months. The extended SMAS was the most common type of facelift performed (n=39, 83%). In 37 (78.7%) of 47 patients submental lipectomy and platsymaplasty was also done. During their follow up period, 6 (12.8%) patients had re-peeling of perioral region. Average time to re-peeling was 12 months. The response rate to the patient questionnaire was 57.4%. Overall satisfaction was rated as 6.5 on a 1 to 7 scale, with higher scores indicating greater satisfaction. The highest satisfaction score was 6.6 for the item which questioned no sign of a procedure. All the items in the questionnaire had a mean score above 5 indicating satisfied or very satisfied. Preoperative apparent age assessment was quite accurate. There was no statistical significant difference between the patient`s real age and the preoperative apparent age. (p>0.05). However, when postoperative photographs were assessed significant differences were found between real age and apparent age (p=0.0002). Patients` postoperative apparent age estimate was 8.2 years younger than their real age. The mean Glogau score as evaluated by two plastic surgeons was 3.5 and 3.2 prior to the combined procedure and was 2.3 and 2.1 postoperatively. The 95% confidence interval of the reduction was 0.87 - 1.53 (p<0.0001) for surgeon one and 0.79 - 1.42 (p<0.0001) for surgeon two. Figures 1-4 demonstrate patients` representetive frontal views before and 10 to 13 months postoperatively. Profile views will be included in the presentation. Conclusion: Outcomes measurements including patient satisfaction, objective evaluation of wrinkle improvement and significant reduction in apparent age document the power of this technique. References 1. Cox SE, Finn JC, Stetler L, et al. Development of the Facial Lines Treatment Satisfaction Questionnaire and initial results for botulinum toxin type A-treated patients. Dermatol Surg 2003; 29: 444-9; discussion 449 2. Swanson E. Objective assessment of change in apparent age after facial rejuvenation surgery. J Plast Reconstr Aesthet Surg 2011; 64: 1124-31 Figures Figure 1. Preoperative pictures of a 59 year old patient (A).She underwent extended SMAS facelift combined with perioral phenol-croton oil peel, platsymaplasty and lipofilling. The patient is seen 12 months postoperatively (B). Figure 2. A 64 year old patient presenting for facial rejuvenation (A). She is seen 11 months postop following extended SMAS facelift combined with perioral phenol-croton oil peel, platsymaplasty and lipofilling (B). Figure 3. A 68 year old patient is seen prior to surgery (A).She had extended SMAS facelift combined with perioral phenol-croton oil peel and platsymaplasty. She is seen 10 months postoperatively (B). Figure 4. A 63 year old patient presenting for facial rejuvenation (A). She is seen 13 months after extended SMAS facelift combined with perioral phenol-croton oil peel,platsymaplasty and lipofilling (B).
    The Aesthetic Meeting 2013 The American Society for Aesthetic Plastic Surgery; 04/2013
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    ABSTRACT: : The transition zone between cheek superficial musculoaponeurotic system (SMAS) and malar SMAS is difficult to raise because of proximity of zygomatic nerve branches. The authors attempted to clarify the three-dimensional anatomy of the retaining ligaments in relation to nerve branches in this area. : Facial dissection was performed on 22 cadaver hemifaces. The zygomatic and masseteric retaining ligaments and the zygomatic and buccal facial branches in the area of dissection were identified. Ninety-five percent confidence regions for the locations of the zygomaticus major origin and the main zygomatic retaining ligament and upper masseteric retaining ligament were created. : The distribution, density, and size of the retaining ligaments varied. The main zygomatic and upper masseteric retaining ligaments were located at a mean distance of 44.91 ± 9.72 mm and 46.35 ± 8.34 mm from the tragus. An upper zygomatic branch passed between the main zygomatic and the upper masseteric retaining ligaments and was always located deep (4.07 ± 1.29 mm) in the sub-SMAS plane of dissection and passed deep under the upper third of the zygomaticus major muscle. An inferior zygomatic branch passed inferior to the upper masseteric retaining ligament or penetrated its inferior margin (54 percent of cases) and was located more superficially (1.41 ± 0.95 mm), becoming visible just distal to the ligament. : Despite anatomical variation, the main zygomatic and upper masseteric retaining ligaments create a safe passage in between, through which a zygomatic facial branch passes deep. The area of danger is immediately inferomedial to the upper masseteric retaining ligament, where a zygomatic branch becomes superficial and vulnerable.
    Plastic and reconstructive surgery 02/2013; 131(2):245e-52e. · 2.74 Impact Factor
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    ABSTRACT: BACKGROUND: The soft tissue envelope of the nose consists of skin, the superficial musculoaponeurotic system (SMAS), and multiple layers of fat. Similar layers have been well described in the neck and face regions but there are few reports of its detailed anatomy in the nose. METHODS: Nine fresh Caucasian cadaver noses were dissected in the subcutaneous, sub-SMAS, and submuscular layers. Specimens were examined to determine the extent and continuity of the nasal SMAS into the face. Fat distribution in different layers was also analyzed. RESULTS: A distinct layer of SMAS in continuation with the facial SMAS was identified in all cadavers. The subcutaneous fat was found to be concentrated in the glabella, lateral wall of the nose, tip and supratip areas. Distribution of sub-SMAS fat was similar to that of superficial fat. An additional layer of fat underneath the transverse nasalis muscle was identified. The presence of an interdomal fat pad was confirmed. In the upper lateral wall of the nose, an area of deficient muscle, where the SMAS and a small amount of fat were the only soft tissue coverage, was observed. CONCLUSIONS: We have confirmed the existence of the SMAS in the nose as a unique layer. We have also provided a detailed description of fat distribution. The knowledge of soft tissue coverage and fat distribution in the nose allows for various surgical modifications and provides an essential basis for procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
    Aesthetic Plastic Surgery 01/2013; · 1.26 Impact Factor
  • James E Zins, Cemile Nurdan Ozturk
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 01/2013; 33(1):167-8.

Publication Stats

929 Citations
172.10 Total Impact Points


  • 1988–2013
    • Cleveland Clinic
      • • Department of Plastic Surgery
      • • Department of Dermatology
      Cleveland, OH, United States
  • 2012
    • University of Wisconsin–Madison
      Madison, Wisconsin, United States
    • Hacettepe University
      Engüri, Ankara, Turkey
  • 2009
    • Gazi University
      • Faculty of Medicine
      Ankara, Ankara, Turkey
  • 1999–2001
    • Universität zu Lübeck
      Lübeck Hansestadt, Schleswig-Holstein, Germany
    • Vitos Orthopädische Klinik Kassel
      Cassel, Hesse, Germany
    • Blood Systems Research Institute
      San Francisco, California, United States