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Ablative fractional laser treatment is considered the gold standard for skin rejuvenation. In order to understand how fractional laser works to rejuvenate skin, we performed microarray profiling on skin biopsies to identify temporal and dose-response changes in gene expression following fractional laser treatment. The backs of 14 women were treated with ablative fractional laser (Fraxel®) and 4 mm punch biopsies were collected from an untreated site and at the treated sites 1, 3, 7, 14, 21 and 28 days after the single treatment. In addition, in order to understand the effect that multiple fractional laser treatments have on skin rejuvenation, several sites were treated sequentially with either 1, 2, 3, or 4 treatments (with 28 days between treatments) followed by the collection of 4 mm punch biopsies. RNA was extracted from the biopsies, analyzed using Affymetrix U219 chips and gene expression was compared between untreated and treated sites. We observed dramatic changes in gene expression as early as 1 day after fractional laser treatment with changes remaining elevated even after 1 month. Analysis of individual genes demonstrated significant and time related changes in inflammatory, epidermal, and dermal genes, with dermal genes linked to extracellular matrix formation changing at later time points following fractional laser treatment. When comparing the age-related changes in skin gene expression to those induced by fractional laser, it was observed that fractional laser treatment reverses many of the changes in the aging gene expression. Finally, multiple fractional laser treatments, which cover different regions of a treatment area, resulted in a sustained or increased dermal remodeling response, with many genes either differentially regulated or continuously upregulated, supporting previous observations that maximal skin rejuvenation requires multiple fractional laser treatments. In conclusion, fractional laser treatment of human skin activates a number of biological processes involved in wound healing and tissue regeneration., Competing Interests: The authors have declared that no competing interests exist.

Micronostril is a cicatricial stenosis that may occur in the caudal-most portion of the nasal cavity of cleft lip patients. This stenosis can be severe and functionally debilitating. Previously proposed solutions have offered disappointing results. Our solution has three key elements: adequate scar release; restoration of the lining and support by way of chondrocutaneous composite graft; and post-operative custom acrylic splinting.

In 1975, Sobkowicz et al. (1) described long-term organotypic cultures of the organ of Corti of the newborn mouse. This paper provides detailed methods for dissection and maintenance of the isolated organ of Corti with its corresponding segment of spiral ganglion in culture. Descriptions and illustrations of cellular characteristics of the developing organ are carefully documented. The work is based on 19 years of experience and over one thousand cultures. Review of the literature and the application of the technique to research on the inner ear are provided.

Injectable bovine collagen has been used for treatment of glottic insufficiency at the University of Wisconsin Clinical Science Center since 1983. This report reviews our experience in treating 119 patients with a variety of vocal fold disorders manifested by glottic insufficiency. Many of the patients were referred because of prior treatment failures or problems that were impossible to treat with other modalities. Results were assessed by comprehensive voice evaluations using subjective patient self-assessments, perceptual judgments made by a panel of experts who had no prior knowledge of the study, objective assessments, and videostroboscopy. Objective assessment included vocal function measures and acoustic analysis. Results indicate that collagen not only is comparable to other injection filler substances but also has unique advantages as a bioimplant. Collagen injection seems uniquely suited for treatment of several problems, including vocal fold atrophy, focal defects, minimal glottic insufficiency, and scarred vocal folds that are not managed optimally with Teflon injection. Overall there were no serious complications and treatment was effective for a broad spectrum of problems. In most instances the correction persisted, and in those instances in which injected collagen seemed improperly distributed, the vocal fold was recontoured or the implant removed without appreciable damage to the surrounding tissues. Injectable collagen has been extensively studied and deserves to be included in the armamentarium of the laryngeal surgeon.

Fractures of the medial infraorbital rim may occur independently or in conjunction with fractures of the nose and zygoma. Infraorbital fractures are frequently associated with anesthesia in the distribution area of infraorbital nerve and can produce palpable "step-off" deformities. Because roentgenographic and clinical indications of these fractures are often subtle, such injuries may go unrecognized in the presence of more obvious nasal fractures or may be misdiagnosed as "tripod" fractures. A proper recognition of these fractures is necessary for correct diagnosis and treatment. Three cases are presented and seven cases are summarized.