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Facial Plastic Surgery - Science topic

Explore the latest questions and answers in Facial Plastic Surgery, and find Facial Plastic Surgery experts.
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A male patient came to our observation with the request of a improvement in his jaw-line projection. 6 years ago, he had the installation of 2 mandibular angle hydroxyapatite implants (quadrangular shape, no screw, just scheletrization of the region and implants dropping). During the visit he showed us a CBCT with the perfect ossification of both implants in the lower jaw.
Now the question: which could be the best approach in a possible prevision of a BSSO?
  1. Implants removal - waiting - then orthognathic surgery
  2. orthognathic surgery on implants
  3. nothing, the implants installation it's no compatible with OS
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CBCT images might be obscure due to streaking artifacts.
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I am doing research with adolescents in Mexico City who have cleft lip and/or cleft palate and want to measure quality of life related to the facial difference.  I need a measure that has been validated in Spanish, not just translated into Spanish.
Thank you.
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I want to use the CLEFT-Q but my understanding is that it is not yet validated in Mexican Spanish.  How do I find the process of the MAPI-institute?
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What is the best treatment option for facial moles?
Cosmetics, Plastic surgery, Dermatology, Aesthetics
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If they are superficial clearly benign (freckles etc) and in younger patients, I shave them in an intradermal plane.- and let the wound epithelialize from the hair follicles. There is a 20 % chnce of recurrence, however, but young people bear the same chance of a hypertrophic or hyperpigmented scar !
Ellman-radio-shaving will do the same.  but if you use magnifying glasses, you can see in surgery possible melanin-nests and go deeper.
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I have done microneedling for 19 years and I always apply vitamin A, C and E to the skin immediately after the treatment. I have never seen a reaction ever and my experience covers about 2000 personal cases and in excess 10,000 when including my associates using the same regime.   The product we use is Environ vitamin ACE Oil which has no added preservatives, colourants or perfumes.  This is the same oil as used by Zeitter et al in their research at Hannover Medical School to test needling skin at weekly intervals.   In their research the vitamin A,C E oil vastly increased the magnitude of the result.
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  • I think cleaning the skin properly with a suitable anti septic and anti microbial agent will help in preventing granulomas.
  • post exposure to unsuitable environment especially malls, road dust house dust soaps or even dirty hands also may contribute.
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An elderly woman who complained of progressive ulcero-nodular lesion eroding the lower palpebra and the palpebral conjunctiva.. Duration 5 years. No lymph nodes were palpable, hearing was good, no vertigo, no diabetes, mild hypertension was told.
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For a biopsy-proven basal cell carcinoma like this, Mohs excision would also be an option.  It can have the advantage that all of the margin can be evaluated, whereas a standard frozen section, or "wax" histology, will only bread slice the specimen and therefore its results will only be based upon a sample of the margin. 
The other advisable thing to do, of course would be a pre-operative CT scan to rule out intra-orbital involvement, which might require orbital exenteration.
  For reconstruction, personally, I would use a temporal skin flap for the outer lamella.  For the inner lamella and uspport, a mucoperiosteal graft from hard palate is also excellent.
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I was asked to confirm or deny the possibility of any connection between mandibular body fractures (mandibular body and angle) caused by a dog in a young boy and mandibular hypoplasia observed many years later. It is required for legal purposes. I cannot find any relevant literature so far.
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dear sir,
it was documented that trauma to the growth centers subsequently sometimes lead to different degrees of growth affection starting from slowing to complete secession. in case of mandible the trauma to condylar growth center is almost always indirect meaning that one end of the bone receive the trauma and the other end affected. the maximum force transmitted to the growth center of the condyle occurs after anterior part of the mandible[symphyseal trauma] even if no fracture resulted. the body and angle have less transmitted force to the condyle but when the direction of trauma was at the inferior border great force will be transmitted to the condyle and affection resulted[your case] beside growth cession the case may undergo ankylosis later on due to joint haematoma.
Atef Fouda,
Prof Oral&Maxillofacial Surgery,
Cairo University,
Egypt.    
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A 24 year lady has presented with an occult cleft? How does one treat it?
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in cleft palate in age below 6 yr it require treatment as it cause speach defect
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The specific area of fate regeneration I am referring to is the nasolabial folds. Imagine that you have a patient with a bodyfat percentage of 3% and not the typical nasolabial fold patient who has them due to being overweight. The area is very thin and has almost no fat in or around it. The "fold" to be treated is a fine line that is not in the skin but the fat, and the patient is young(as in 21-24). Could injecting prp in the creased area induct fat regeneration?  I am talking about permanant results, as in repair or regenerating the fat, not temporarily hiding the lines while your time dwendles until the next injection date. I do not want to plump up the area or use prp as a filler. Do not suggest using fillers as they are an absolute disgrace to science and medicine.
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I'm afraid that I disagree with AND do not understand (not referring to your various errors in spelling and grammar) a number of your points. My comments are as follows:
1) Nasolabial folds are not due to being overweight, rather, midface structural volume-loss (along with loss of skin-elasticity and some effects of gravity) causes the folds to increase in 'severity';
2) What do you mean by a 'fine line' in the fat?;
3) PRP does not 'regenerate' fat, but 'supercharges' lipografts to increase survival of the transferred fat (e.g. due to angiogenesis, and by enhancing the natural antibacterial properties);
4) PRP as a filler is a flawed concept (and clinicians should not be 'solely' using PRP for such a purpose). At the very least, in the face, with such high blood-perfusion, the 'goodies' in PRP are washed away;
5) Why have you referred to fillers as a disgrace?! Firstly, fat is a filler (autologous), so I cannot see what is disgraceful about that. Secondly, if your statement is supposed to refer to ‘non'-autologous fillers, such as hyaluronic acid fillers (e.g. Juvéderm and Restylane), then they have been shown to be incredibly safe with great outcome-satisfaction. Furthermore, histological analyses have demonstrated their integration into the skin over long-term-use, and should their placement be suboptimal, they can be dissolved with enzyme. 
I agree with Tausif Alam's thoughts as a good discussion point to have with the patient in question, to start off with. Also, tell us more about this patient, e.g. weight, body mass, occupation (body-builder?), systemic diseases, et.c.. 
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When should patients after hypoglossal-facial-jump nerve suture start with the exercises? How should the treatment be structured? And which exercises are most effective?
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Physiotherapy can start when the first muscular contraction is noticed. Time for this to occur ranges widely, from just over 1 month to 6 months. Once this occur, apart from strengthening the excursion, the most important aspect of physiotherapy is to prevent  or suppress synkinesis.
These goals can be achieved by exercises such as swallowing with abduction of oral commissures, mirror therapy, and smiling with tongue pressure.
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What were your complications?
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long-term nasal reconstruction with rib graft can be extremely successful.  The main area of problem can be when warping occurs after a large graft is used to build the bridge of the nose. There are several articles that have shown that if the rib is carved in a certain manner, this problem is minimized. Furthermore, I like using diced cartilage wrapped with temporalis fascia as a way of augmenting the dorsum to avoid warping.  
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For those of you who don't know, there is a procedure called "SNIF", or sharp-needle-intradermal-fat graft. Here is a video for it, and a link to a pdf that details it in excellent easy detail.
video
pdf
From what I can understand and correct me if I am wrong, the ""SNIF" procedure is basically a dermal filler, not a fat graft. Is this correct? If so, then I have a few other questions.
First, when I see surgeons performing fat grafts into the nasolabial fold area, I see then go in through the upper lip with a cannula. I have given many manual liposuctions with different types of cannulas on the abdomen, and I know that technically, you could access the fat to be lipoaspirated from any point of entry. Of course there are places that are best, but if you had to, you could go in from (almost) anywhere.
IN the pdf, they say that a 23 gauge needle is used for injection. They also directly mention the nasolabial folds. They say that first, they fill it with "traditional lipofilling". What I want to know is, why can't this SNIF replace the "traditional lipofilling" that surgeons usually perform on the nasolabial fold area? Maybe not "replace", but you could graft fat into the nasolabial folds with a 23 gauge needle correct? Not as a filler, but as an actual fat graft that will take as a part of the patients face.
In other words:
Instead of using this snif type needle and point of entry for dermal filling, couldn't you technically graft fat into the nasolabial area (not just a dermal filler) and have that graft take as part of your facial fat?
If you had a patient that was just beginning to get the folds (as in early 20's, just barely visible), couldn't you solve this without going in through the lips? I think the answer is yes. You can access the subcutaneous fat via a 23 gauge needle, there is no need for anything else. I think by using the snif technique, you could do real lipofiling rather than just dermal filling.
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In Brazil I personally saw 3 cases of alar necrosis following treatments like this. For me is mandatory the use of microcannula to avoid facial vessels injury.
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I think so. First peer reviewed papers published support this opinion - bringing (cosmetic) surgery to a cellular and even molecular level within the 1.2.3. Dimensional Concept of cause related treatment of the ageing face seems very promising. Looking forward to your opinion.
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My experience in this field is quite positive when you enrich fat grafts with Stromal Vascular Fraction cells from lipoaspirates. The more you enrich, the better is the result in fat retention and regenerative effects. Regarding PRP addition i'm not so enthusiastic; I'm not observing better results when comparing PRP enriched vs non-enriched low volume fat grafts in the same patients.
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In our department, we failed to reconstruct consecutive two cases of Cheek reconstruction with PM Flap, but failed.
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Sorry to hear that two pect major flaps failed in your institution. Common causes for complete or partial loss of this flap are
1. Improper design of the flap
2. Damage to the pedicle
3. Tension at the distal end
4. Skin detachment from the muscle
5. Compression of the pedicle at clavicle area
1. This is the commonest cause. I design the skin paddle below the nipple. This extends the flap length. However, extending too far down to rectus muscle must be avoided as this area will necrose. If you need a larger area extend the flap medial to nipple.
2. Pedicle (Thoraco Acromion artery and vena commitantes) can be damaged during the dissection. Incorporate a good 3cm of muscle either side of the pedicle when harvesting. This will prevent inadvertent damage to the artery. Most important area is when dissecting closer to the clavicle. You can see the pedicle well here and avoid getting closer to the pedicle. Start dissecting at the skin paddle, then dissect under the muscle touching the ribs.
3. If you need cover above the zygomatic arch this flap will cause a lot of tension at the distal end. This area will open up and the distal end might necrose. Try to carefully dissect up to the clavicle to get a long pedicle.
4. When you dissect the skin paddle, after cutting down to muscle, use vicryl sutures to attach skin to the muscle
5. This is rare if you get a good tunnel to pass the muscle pedicle on to the cheek area. I make sure that the flap passes easily through the tunnel without compression.
Pect’ Major flap is such a good flap for head and neck reconstructions. Take your time and dissect slowly until you get confident. After harvesting and transposing to the face, if there is bleeding seen at the skin edges the flap is unlikely to fail.
Bilobed Pect Major design is shown here. Both areas are suitable for a single skin paddle.