E-PTFE (Gore-Tex) suspension cervical facial rhytidectomy

Multiple Applications of GoreTex Soft Tissue Patch in Facial Plastic Surgery

This communication reveals multiple uses, versatility, predictability, and excellent tissue compatibility of GoreTex® membrane in facial plastic surgery. An outline of the technique relying on subcutaneous undermining as opposed to the threading method is provided. Five-year experience (in more than 127 patients) with the GoreTex soft tissue patch demonstrates good tolerance to implants up to 8 mm in thickness and 10 cm2 in area as a tissue filler in the face and neck region. No functional impairment has been documented with the use of large implants to correct nasal labial grooves or in lip augmentation.

Isolated Cervicoplasty

Isolated cervicoplasty is a surgical procedure that improves and/or rejuvenates the central submental/neck area maximally and the jowl and lateral submandibular area mildly to moderately. Maximum improvement and/or rejuvenation of the jowl and lateral submandibular area of the neck involves superior-posterior repositioning of redundant facial tissue and requires a facelift concomitant with cervicoplasty. Isolated cervicoplasty is performed through a submental incision without pre- or postauricular incisions. In select patients, isolated cervicoplasty will give a very satisfactory result. A precise knowledge of the normal neck anatomy and the anatomy of the deformity of the neck is mandatory to determine the correct surgical procedure and to achieve the most acceptable result. Clinical evaluation and treatment planning for isolated cervicoplasty is discussed. Based on a thorough knowledge of neck anatomy, the surgical technique for isolated cervicoplasty is described. This usually involves conservative liposuction, accurate excision of lax neck fascia-platysma muscle complex and tension-free suture approximation of the central neck fascia-platysma complex from symphysis menti to the level of the thyroid or cricoid cartilage. The use of fibrin sealant has been found to be very helpful. When indicated, this surgical technique is a safe, uncomplicated method to produce a long-lasting, attractive neck.

Lower face-lift with expanded polytetrafluoroethylene superficial musculoaponeurotic system extension graft (bandlift implant)

We introduce the expanded polytetrafluoroethylene (ePTFE) superficial musculoaponeurotic system extension graft (SEG) as an effective method of lower face-lift and an alternative to the minimally invasive lower face-lift and thread-lift. During a 4.5-year period, 450 lower face-lifts with ePTFE SEG were performed. The procedure consisted of a primary ePTFE grafting operation followed by a secondary ePTFE SEG traction operation 3 to 4 weeks later; the skin flap was then excised and redraped to adjust the postauricular sulcus. No major complications resulted from surgery, but minor complications included wound infection (2.7%), insufficient traction (1.8%), slipped ePTFE graft (1.3%), temporary earlobe numbness (1.1%), asymmetric traction (0.9%), occipital pain (0.7%), and hematoma below the earlobe (0.2%). Lower face-lift with ePTFE SEG produces satisfactory results for both patients and surgeons in view of the short recovery time, less minimal invasion, simple techniques, and long-lasting outcome when compared with other minimally invasive methods of lower face-lift.

Immediate Gore-Tex sling suspension for management of facial paralysis in head and neck extirpative surgery

OBJECTIVE

We sought to evaluate the functional and aesthetic outcomes of immediate facial reconstruction with a Gore-Tex (expanded polytetrofluoroethylene) sling in irradiated patients undergoing large head and neck tumor extirpation with facial nerve resection.

STUDY DESIGN AND SETTING

We conducted a retrospective study of 17 patients at two academic institutions who underwent extirpative surgery with immediate Gore-Tex sling reconstruction and completed radiotherapy. Functional and aesthetic results were evaluated at three intervals.

RESULTS

All patients had excellent immediate results and good or excellent intermediate-term results. At long-term follow-up, results were good to excellent in 47% and unacceptable in 35% of patients.

CONCLUSION

In irradiated patients undergoing total parotidectomy with immediate facial reconstruction using Gore-Tex slings, early results are excellent, but there is a high incidence of major wound complications and unacceptable results in long-term follow-up.

SIGNIFICANCE

There is a high rate of late complications associated with immediate facial reconstruction with Gore-Tex slings in irradiated patients.

Improving Surgery on the Aging Neck With an Adjustable Expanded Polytetrafluoroethylene Cervical Sling

OBJECTIVES

To evaluate the ability of the expanded polytetrafluoroethylene (ePTFE) cervical sling to improve results of surgery on the aging neck in the short term as well as its ability to achieve long-term cosmesis through its secondary adjustability.

DESIGN

A retrospective analysis.

SETTING

A private facial plastic surgery practice. Patients The first 100 consecutive patients who underwent placement of the ePTFE cervical sling with a minimum follow-up of 36 months. Intervention Placement of a preplatysmal, mastoid-to-mastoid, ePTFE cervical sling sutured to the fascia overlying the insertion of the sternocleidomastoid bilaterally in conjunction with a graded surgical approach appropriate for each patient. This included lipoplasty, midline platysmal plication, and rhytidectomy.

OUTCOME MEASURES

Aesthetic appearance of the neck was evaluated by comparison of preoperative and postoperative photographs at 1 year. Appraisal of secondary adjustability was similarly assessed 1 month after sling tightening. Patient satisfaction was recorded via self-assessment of both procedures for cosmesis and comfort. Complications specific to sling placement and tightening were reviewed.

RESULTS

One year after initial surgery, 85 patients had significant or marked improvement. More than 90% of patients felt that the procedure met or exceeded their cosmetic expectations, while 99 patients felt no residual discomfort. Secondary to rebound tissue relaxation, 9 of 100 patients required sling tightening a mean interval of 14 months after primary surgery. All 9 of these had either a significant or marked improvement, with similarly high patient satisfaction in cosmesis (n = 9; 100%) and comfort (n = 8; 89%). Two patients had postauricular infections necessitating sling removal. There were no complications with sling tightening.

CONCLUSIONS

Placement of the ePTFE cervical sling is a safe and effective procedure to aesthetically improve short-term surgical results on the aging neck. By virtue of its secondary adjustability, it offers a safe, long-term solution to rebound tissue relaxation and associated submental laxity.

Advances and controversies in face lift surgery

PURPOSE OF REVIEW

The only constant in face lift surgery is the goal-rejuvenation of the lower two thirds of the face and neck. Societal shifts have focused patients on less invasive procedures, with less downtime and more rapid return to daily activities.

RECENT FINDINGS

The lateral SMASectomy procedure has proven to be an effective technique, with a high degree of safety, minimal morbidity, and high patient satisfaction. Additionally, younger patients often require less extensive procedures to achieve an aesthetically desirable result. Recent advances such as the short scar face lift with SMASectomy, and the S-lift, have centered upon less invasive approaches to lower face and neck restoration. The optimal technique for correction of platysma bands also remains elusive, with multiple options available. All procedures dramatically benefit from the use of tumescent anesthesia to decrease operative time, postoperative morbidity, and recovery time.

SUMMARY

There is no single ideal technique for each patient. The procedure used must be individualized for each patient's unique anatomy and goal for surgical restoration.

Multicenter evaluation of subcutaneous augmentation material implants

OBJECTIVE

To evaluate the performance of subcutaneous augmentation material preformed shapes for facial implantation.

DESIGN

One-year prospective multicenter evaluation of implant performance.

SETTING

General community hospital; private and institutional practice; and ambulatory care setting.

PATIENTS

Eighty-two patients undergoing elective cosmetic and reconstructive procedures.

INTERVENTIONS

Patients received nasal dorsal implants (31 patients); chin implants (38 patients); and malar implants (13 patients).

MAIN OUTCOME MEASURES

Complications and aesthetic outcome, including implant position, projection, contour, symmetry, and overall aesthetic index.

RESULTS

Complication rates for infection that required implant removal included nasal dorsal implants, 3.2%; chin implants, 5.3%; and malar implants, 3.8%. The overall aesthetic outcome was judged by an independent panel of facial plastic surgeons on a scale from 1 (poor) to 5 (excellent): nasal dorsal implants scored 4.1; chin implants, 3.8; and malar implants, 3.6.

CONCLUSIONS

This study demonstrates that subcutaneous augmentation material preformed shapes offer a relatively safe and effective treatment alternative for permanent facial augmentation.

Complications of static facial suspensions with expanded polytetrafluoroethylene (ePTFE)

BACKGROUND

Expanded polytetrafluoroethylene (ePTFE) is a synthetic porous material that has been used for static suspension in facial paralysis. It is manufactured in thin (1-mm or 2-mm) sheets that can be cut into strips and implanted through keyhole facial incisions. Regional deformities are addressed by multiple suspensions that provide cosmetic and functional therapy. The use of ePTFE eliminates donor site morbidity associated with the traditional harvest of fascia from either the temporal area or fascia lata. However, properties unique to this alloplast contribute to the complications that have occurred after its use in facial reanimation.

OBJECTIVE

To describe complications with the use of ePTFE for facial suspension.

SETTING

Academic medical center.

METHOD

Retrospective chart review and review of literature.

RESULTS

Six patients with facial paralysis who were treated with the ePTFE sling procedure had complications. Five slings failed because of stretch despite prestretching at implantation. One patient developed a late wound infection requiring removal of the sling.

CONCLUSION

An ePTFE facial sling is an option for static facial suspension that can be therapeutic for patients with seventh nerve damage. There is a high rate of complications leading to revision surgery. Future studies are needed to evaluate alloplastic alternatives to ePTFE.

The use of unilateral deep plane neck lifting to improve the aesthetic appearance of the neck dissection deformity

The primary concerns of head and neck cancer surgeons are, and should remain, the complete extirpation of tumor and the prevention of tumor recurrence. In recent years, numerous advances have been made in the reconstruction of this patient population, significantly improving their functional and aesthetic outcomes. In this article, with an illustrative case example, we present our technique of unilateral deep plane neck lift that may be considered when one is attempting to achieve better symmetry in patients after radical neck dissection.

A 6-year experience with the use of expanded polytetrafluoroethylene in rhinoplasty

To date, there are few published large series within the literature on the use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. This retrospective study, based on chart and photographic reviews, serves to contribute a 6-year experience (mean patient follow-up period, 17.5 months) with the alloplast in nasal surgery amassed by one surgeon. The same technique was used in all the 189 patients reviewed, who received 211 procedures. The 189 patients, 44 male and 145 female and from 15 to 70 years of age, were reviewed 3 months to 6 years after Gore-Tex implantation rhinoplasties. The results were assessed according to the follow-up notes in the chart reflecting patients' and surgeon's comments and full preoperative and postoperative photographic documentation. Patient satisfaction was expressed with respect to aesthetic and functional outcome in all cases. Patient impressions were verified by critical assessment during follow-up examination. The implants showed excellent stability and tissue tolerance. Complications requiring removal occurred in 2.7 percent of implants placed. The authors are of the opinion that, in rhinoplasty, with the exception of the nasal tip, columella, or problems in which corrections would require rigidity of the grafted or implanted material, the Gore-Tex alloplast is an excellent alternative to autografts. Nasal tip or columellar sites do not render adequate soft-tissue cover, allowing the implant to rest close to the surgical incision. Because this creates additional risk of implant extrusion, such locations were avoided in the series of patients presented.