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The Deep Fascia of the Head and Neck Revisited: Relationship with the Facial Nerve and Implications for Rhytidectomy.
[BACKGROUND] The deep fascia is important in face-lift surgery, as it is relied on for protection of the facial nerve during surgical dissection. Lack of consistency with the term may be attributable to the term deep fascia having two diffe…
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Enhanced study of facial soft tissues using a novel large scale histology technique.
The safety and effectiveness of facial cosmetic surgery procedures are dependent on detailed 3D understanding of the complex surgical anatomy of the face. Traditional, small sample size anatomical dissection studies have limitations in prov…
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Lifting the Anterior Midcheek and Nasolabial Fold: Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence.
[BACKGROUND] A limitation of current facelift techniques is the early postoperative reappearance of anterior midcheek laxity associated with recurrence of the nasolabial fold (NLF). [OBJECTIVES] This study was undertaken to examine the reg…
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Aesthetic Enhancement of the Brow using Hydroxyapatite.
[BACKGROUND] An aesthetically pleasing appearance of the 'eyes' usually includes good projection of the outer brow. Weak bony projection of the superolateral periorbital region tends to be not only less attractive, but also predisposes to h…
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Upper Blepharoplasty - Nuances for Success.
Given the central importance of the "eyes," meaning the periorbital region, to facial appearance, the motivated blepharoplasty patient has the opportunity to improve appearance significantly beyond the minimum of age reversal, to reveal inn…
- Reply: Extended Transconjunctival Lower Eyelid Blepharoplasty with Release of the Tear Trough Ligament and Fat Redistribution.
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Secondary upper lid blepharoplasty: a clinical series using the tarsal fixation technique.
[BACKGROUND] One hundred consecutive secondary upper lid blepharoplasties were reviewed retrospectively to determine the lid characteristics of patients undergoing secondary blepharoplasty and the outcomes of all the procedures, which were …
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Surgical anatomy of the middle premasseter space and its application in sub-SMAS face lift surgery.
[BACKGROUND] The premasseter space is a recognized, sub-superficial musculoaponeurotic system (SMAS) soft-tissue space overlying the lower masseter immediately anterior to the parotid. The performance, safety, and effectiveness of composite…
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Face lift.
[LEARNING OBJECTIVES] After reading this article, the participant should be able to: 1. Identify and describe the anatomy of and changes to the aging face, including changes in bone mass and structure and changes to the skin, tissue, and mu…
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Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold.
The anatomic basis for the jowl has not been fully described. A formal analysis was performed of the sub-superficial musculoaponeurotic system (SMAS) areolar tissue layer, which overlies the lower part of the masseter. For this research, fa…
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Histologic and ultrastructural evaluation of sutures used for surgical fixation of the SMAS.
In extensive SMAS face-lift surgery, retaining ligaments are released, and the SMAS is resutured to the deep fascia to maintain the advanced position. The suture used to reattach the SMAS should replicate the quality of support provided by …
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Surgery of the superficial musculoaponeurotic system: principles of release, vectors, and fixation.
The SMAS was described more than 25 years ago, yet its full potential in face-lift surgery has become appreciated only more recently. A reappraisal of the various aspects of SMAS surgery is now appropriate. These include aspects of its rele…
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Extended sub-SMAS dissection and cheek elevation.
The extended SMAS facelift techniques gave plastic surgeons the ability to correct the nasolabial fold and medial cheek. Retensioning the SMAS transmits the benefit through the multilinked fibrous support system of the facial soft tissues. …
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Herniated fat and the orbital septum of the lower lid.
The bulging fat of aging eyelids has always been described as a hernia; yet, the treatment has not been that of a true hernia. Rather, the contents (orbital fat) have been excised and the hernia wall left unrepaired. It is possible to treat…
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Correction of the nasolabial fold: extended SMAS dissection with periosteal fixation.
The nasolabial fold has defied satisfactory correction with the face lift operation. This is despite variations of the SMAS technique over the last 20 years. In this study, the nasolabial fold is shown to be part of the overall aging deform…
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Breast reconstruction after mastectomy. What the family physician should know.
The most common female malignancy, cancer of the breast, affects one in 15 women in Australia. A significant number of those who have had a mastectomy seek the advice of their general practitioner about breast reconstruction. The counsel of…
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Results of nipple areola reconstruction.
Reconstruction of the nipple-areola complex is being performed for about a quarter of postmastectomy breast reconstruction patients. The methods used and results achieved in thirteen reconstructions were reviewed. Full thickness skin grafts…
- Breast conservation and breast reconstruction.
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Submuscular mammary prostheses in reconstructive breast surgery.
The anatomical basis and operative technique for insertion of mammary prostheses in the completely submuscular position are described. The results of 38 completely submuscular prostheses used for reconstructive breast surgery form the basis…
- The evolution of breast reconstruction.
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Breast reconstruction.
This paper reviews a series of 40 consecutive breast reconstructions. Women of all ages, even many years after mastectomy, are seeking this form of rehabilitation. Breast reconstruction is now a practical proposition because of the low rate…
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Local recurrence of breast cancer: its significance in relation to breast reconstruction.
Questions regarding local recurrences are a major concern in considering mastectomy patients for breast reconstruction. A critical analysis of the literature on local recurrences indirectly provides answers to several of these concerns. Loc…
- A survey of general surgeon's attitudes towards breast reconstruction following mastectomy.
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The latissimus dorsi flap for breast reconstruction.
The major factor limiting reconstruction of major postmastectomy deformities (especially after a radical mastectomy, such as that of Halsted) has been the lack of a satisfactory flap operation. The latissimus dorsal flap fills this need, as…
- The psychological basis for breast reconstruction following mastectomy.
- Breast reconstruction after mastectomy.
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Flaps used for nasal reconstruction: a perspective based on 180 cases.
Flap reconstruction of the nose is historically one of the earliest surgical operations. In spite of this long experience, little has been reported on the viability and durability of the various flaps and the time involved in the reconstruc…
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Breast reconstruction after mastectomy.
Breast reconstruction is being performed with increased frequency, encouraged largely by the positive reaction of satisfied patients, and enabled by more recent advances in plastic surgery. Many of the disadvantages of external prosthesis (…
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Experience with the deltopectoral flap.
The deltopectoral flap is a most versatile source of skin coverage or mucosal lining (or both). There is remarkable safety in the use of this flap in relation to its size, and there is only limited need for delay--because it pedicle is an a…
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Xanthelasma: follow-up on results after surgical excision.
Xanthelasma palpebrarum is the most common xanthoma and is associated with other xanthomas or hyperlipemia syndromes in only 5 percent of the patients--even though one third of the affected patients have an elevated serum cholesterol level.…