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In facial plastic surgery, the potential for direct delivery of growth factors from platelet preparations has been of particular interest for use in facial rejuvenation, recovery after facial surgery, and wound healing. A literature search was conducted through PubMed for the terms PRP, PRFM, platelet-rich plasma, platelet-rich fibrin matrix, platelet preparations, platelet therapy, growth factors, platelet facial, platelet facial rejuvenation, platelet wound healing, platelet plastic surgery. Articles pertaining to the use of platelet preparations in facial surgery and wound healing in plastic surgery after 2001 were included. Thirteen in vitro studies showed use of platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) had a significant effect on cellular activity. Twenty-four out of 28 animal studies exhibited favorable results with use of a platelet preparation, including five of six studies that showed enhanced fat graft survival with addition of a platelet preparation. Twenty-three case series and clinical trials were identified, only two of which showed no differences. Twenty-one reported favorable results with use of various platelet preparations. A total of 47 studies used PRP, four studies evaluated Leukocyte-rich PRP, and fourteen studies used PRFM. The vast majority of studies examined show a significant and measurable effect on cellular changes, wound healing, and facial esthetic outcomes with use of platelet preparations, both topical and injectable. One must also consider possible publication bias against null results that may have had an influence on the data that were available for review. However, the preponderance of studies suggests that platelet preparations might represent an as-of-yet untapped adjunct in facial plastic surgery.

Background: This study aimed to evaluate a surgical technique used for patients requiring revision rhinoplasty to reestablish their ethnic identity., Methods: A retrospective review involved 29 patients who underwent revision rhinoplasty to reestablish their ethnic identity using residual septal cartilage and porous polyethylene implants. The follow-up period ranged from 6 month to 7 years., Results: For all patients undergoing revision rhinoplasty, multiple porous polyethylene implants were used to reestablish ethnic identity and to restore nasal function. Implant extrusion developed in one (3.4%) of the 29 patients. There were no cases of postimplant infection., Conclusions: In our experience, patients who feel they have lost their ethnic identity after primary rhinoplasty tend to have overresected dorsal cartilage and bone and overresected tip cartilages. The use of multiple porous polyethylene implants in revision rhinoplasty to restore ethnic identity can provide the necessary grafting material needed for reconstruction. Many grafting options are available. According to our experience, porous polyethylene provides safe, effective, and reliable results.

The purpose of this study was to evaluate the preoperative use of a two-part standardized assessment program (Prime-MD, Biometrics Research Department, New York State Psychiatric Institute) to objectively detect psychiatric disorders in facial plastic surgery patients, and to compare its use to findings identified by the facial plastic surgeon. Seventy-five new patients requesting aesthetic facial surgery at two academic centers and two private practice locations were evaluated.

The introduction of fiberoptic endoscopes has fostered the development of minimally invasive aesthetic facial plastic surgery. The application of this new technology is most widely used in rejuvenation of the mildly to moderately ptotic brow. The concept of endoscopic foreheadplasty is based upon the following maneuvers. First, a sub- or supraperiosteal dissection of the parietal, occipital, and frontal scalp to the level of the superior and lateral orbital rims and zygomatic arch must be accomplished. Second, incision and release of the superior and lateral orbital periosteum are performed. Third, selective myotomies of the brow depressor muscles are completed. These maneuvers allow the brow to be permanently elevated into a desired position following fixation and healing. A significant limitation of this procedure appears to be the ability to predict the long-term forehead and brow elevation. We believe that permanent fixation is one of the best methods to ensure that the desired elevation is maintained. We contrast two series of patients, one with temporary fixation technique and the other with permanent fixation. We review the results and discuss the rationale and advantages of permanent fixation.

Nasal reconstruction presents a significant challenge to the facial plastic surgeon. Reestablishment of the desired aesthetic nasal contour and restoration of respiratory function are the dual goals of this endeavor. While autologous cartilage or bone is considered optimal grafting material, the supply is often limited and harvesting entails additional morbidity. Many synthetic materials have been introduced for use in nasal reconstruction, but high infection and extrusion rates have left most surgeons dissatisfied with conventional implants. Porous polyethylene (Medpor) implants were used for nasal reconstruction in 187 patients; 66 (35.3%) patients underwent primary rhinoplasty, while revision surgery was performed in 121 (64.7%) patients. Most patients required multiple implants, including columella struts, plumper grafts, dorsal tip implants, and nasal valve battens. Postoperative follow-up ranged from 6 months to 3.5 years. Complications occurred in five (2.6%) patients. Three early and two delayed infections necessitated implant removal in five patients, all of whom had compromised skin-soft tissue envelopes secondary to heavy smoking, cocaine abuse, or prior surgery. One case of an overly augmented nasal dorsum and tip required implant removal, reduction, and reinsertion. All implants were easily removed. No other complications including implant extrusion or skin erosion have been noted. Porous polyethylene (Medpor) implants allow for fibrovascular ingrowth, which lends stability to the implant. Porous polyethylene implants are well tolerated and provide an ideal material for nasal reconstruction.