James E Zins

Cleveland Clinic, Cleveland, OH, United States

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Publications (85)120.89 Total impact

  • [Show abstract] [Hide abstract]
    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
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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: : 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.
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    ABSTRACT: : Although harvesting of in situ split cranial bone is a well-established technique, few data have been generated regarding the biomechanical effect of bone harvest on the cranial bone donor site, and even fewer data have been generated regarding the biomechanical effect of calcium phosphate bone cement inlay on the donor site. The authors documented the weakening of the skull at the in situ cranial harvest site and determined the benefit, if any, when the site is inlayed with calcium phosphate cements. : Cadaver skulls were divided into three groups: group 1, an in situ cranial bone defect was created in the frontal bone area on one side and the mirror-image, full-thickness area was untreated; group 2, a similar defect was created in the parietal area and repaired with calcium phosphate bone cement inlay, and on the opposite side, a similar defect was created but not repaired; and group 3, donor sites were created in the parietal area bilaterally and reconstructed with different cements. Mirror-image areas were harvested and testing was performed. The Wilcoxon rank sum test was used to evaluate all mirror-image specimens. : There was a statistically significant difference in strength to fracture when the in situ defect was compared with the in situ calcium phosphate construct (p = 0.008). No difference was demonstrated when the defect was compared with full-thickness bone or when calcium phosphate cements were compared. : Repair of the defect with calcium phosphate cement significantly increased strength at the donor site and may provide added safety from injury.
    Plastic and reconstructive surgery 10/2012; 130(4):527e-35e. · 2.74 Impact Factor
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    ABSTRACT: Autologous fat transplantation is a common technique for soft tissue augmentation in aesthetic and reconstructive surgery; however, the degree of fat graft take can be unpredictable. Hyaluronan has been shown to be a promising cell carrier in adipose tissue engineering. The authors investigate the effect of a hyaluronan hydrogel on fat graft survival, angiogenesis, and volume maintenance in a rat model. Fat was harvested from the groins of 27 rats, processed, and injected beneath the animals' dorsums to form 2 grafts: 1 containing fat alone and 1 containing fat and hyaluronan hydrogel in a 1:1 mix (fat-HA). The grafts were scanned in vivo under high-resolution computed tomography at baseline and prior to euthanasia at 4, 12, and 20 weeks to measure total fat-HA graft volume as well as the volume of the fat component alone. Histological studies were performed after sacrifice to evaluate fat necrosis and blood vessel density. All grafts were clinically viable. Overall, fat necrosis was significantly reduced in the fat-HA grafts compared with the grafts containing fat alone (P < .001). This difference was most profound at 4 weeks (P = .008) but did not reach statistical significance at 12 and 20 weeks. At 12 weeks, blood vessel density in the fat-HA grafts was significantly greater than in the grafts containing fat alone (P = .016), but this did not reach statistical significance at 4 or 20 weeks. At 20 weeks, the fat component of the fat-HA graft had significantly less volume loss than the fat-alone graft (P = .008). When mixed with fat, hyaluronan hydrogel can improve early fat graft survival and may enhance vascularity and prolong volume maintenance.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 07/2012; 32(5):622-33.
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    ABSTRACT: The second part of the authors' study on operating room fires analyzes the construct of the nasal cannula used during facial surgery for patients under conscious sedation with supplemental oxygen. This prospective study compares two common styles of nasal cannulas with a nasopharyngeal system described in their first report. Twenty patients underwent upper and/or lower lid blepharoplasty under conscious sedation with one of three methods of supplemental oxygen delivery: a Mac-Safe nasal cannula (Unomedical, Inc., McAllen, Texas), a Salter nasal cannula (Salter Laboratories, Arvin, Calif.), and a nasopharyngeal system with cut ends of a cannula placed into a rubber nasopharyngeal tube. Oxygen concentrations were measured at 24 locations around the face for each method at a low (3 liters/minute) and high flow rates (6 liters/minute) using a random access mass spectrometer unit. At both low and high oxygen flow rates, the median oxygen concentration at and above the nose was statistically lower (p < 0.001) using the nasopharyngeal system than with either the Mac-Safe or Salter nasal cannula. In addition, the oxygen concentrations measured using the two nasal cannulas were more variable than with the nasopharyngeal method, particularly at locations around and above the nose. This study demonstrates that mass spectrometry oxygen readings around the face are similar to room air when the cut ends of the oxygen cannulas are passed down the nasaopharyngeal tube, whereas readings are significantly higher with the nasal cannulas. The nasopharyngeal system that the authors describe represents a significantly safer means of oxygen delivery during conscious sedation.
    Plastic and reconstructive surgery 05/2012; 130(3):681-9. · 2.74 Impact Factor
  • Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 05/2012; 32(4):524.
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    ABSTRACT: Corrugator resection is an integral part of periorbital rejuvenation and can be accomplished through the open coronal, endoscopic, or transpalpebral technique. While most authors concur about the importance of corrugator resection during brow lift surgery, considerable debate remains regarding the efficacy and technical ease of muscle resection with these approaches. The authors conducted a cadaver study to compare the completeness of resection of the corrugator muscle with the transpalpebral and endoscopic techniques. A split-face study was performed in 10 fresh cadavers. On one side, the corrugator muscle was resected through an endoscopic approach, and on the opposite side of the face, a transpalpebral resection was performed. After the completion of both procedures, a coronal incision was made; gross observations were noted; photographs were taken; and muscle weights were recorded. In 19 of 20 cadaver halves, subtotal or total resection of the corrugator muscle was accomplished. In only one endoscopic instance was any muscle left in continuity. This occurred along the superior aspect of the arcus marginalis release when the corrugator muscle was hidden by the upper edge of the cut periosteum. Unlike the previous reports, the authors found that transpalpebral and endoscopic techniques both allow subtotal or total resection of the corrugator muscle. Inadequate resection is technique dependent rather than procedure dependent.
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 02/2012; 32(2):151-6.

Publication Stats

808 Citations
120.89 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