Facial Plastic and Reconstructive Surgery: New Patients, New Reasons, New Techniques

Importantly, even recent patients are followed up for 5 and 10 years after surgery to monitor the effects of newer rhinoplasty techniques.

Regarding other types of nasal surgery, correction of septal perforations is unfortunately becoming more common, Dr. Kridel told ENToday. Some common causes for septal perforations are the use of impure “street” cocaine—talc or borax (products used to “cut” street cocaine) are very irritating to the nasal mucosa; long-term, nonmonitored use of certain medication such as nasal decongestants or nasal steroids; or chemical cauterization of the nasal septal mucosae to treat epistaxis. Some common symptoms associated with septal perforations include bleeding, crusting, and whistling. As the perforation becomes larger, there is increased likelihood of developing nasal obstruction.

Fortunately, in the past 20 years, consistent, successful techniques have been developed to repair the great majority of septal perforations. One specific technique favored by Dr. Kridel involves using bilateral sliding mucosal intranasal flaps. In the past, septal perforations were repaired with skin grafts, which often resulted in persistent nasal symptoms. “We incorporate nasal respiratory mucosal flaps to repair septal perforations which usually result in a return in normal respiratory function,” Dr. Kridel explains. “The interposition of a connective tissue graft between the two flaps may give the best technique. The connective tissue may come from the patient’s own temporalis fascia or acellular dermis may be obtained from a tissue bank. Inferior turbinate flaps are also used and are especially good for some very large, difficult perforations. This latter technique requires a second procedure to separate the connection and open the nasal passageway.”

The Aging—and Not So Aging—Face: Recent Modifications of Standard Facial Procedures

Brow Lifts

Even in the past 10 years, this procedure has undergone alterations. Now, according to Dr. Papel, rather than making an incision from ear to ear, peeling the forehead forward, elevating it, and dissecting and then excising part of the scalp in order to lift the brows, an endoscopic procedure is carried out via a very small incision behind the hairline. As in endoscopic procedures done elsewhere in the body, a camera is attached to the endoscope and images conveyed to a TV screen. “In this way we can see what we’re doing while we elevate the plane, avoiding small nerves and other structures while we do the dissection, and then use various methods to undermine and support the brow,” Dr. Papel said.

Patient recovery is easier and much faster, and complications such as loss of hair or of sensation on the top of the head are avoided.

Blepharoplasty of the Lower Eyelid

For people with fatty bags under their eyes, the location of the incision has been moved from just below the lash line to behind the lower eyelid, the so-called transconjunctival incision, and fat then removed. For patients with drooping lower lids and seemingly excess skin, there are new ways to correct the look with minimal incisions and very little excision of skin.