Background Postrhytidectomy hemifacial paralysis is a frightening clinical condition affecting the proximal facial nerve and most often associated with Bell's palsy. Associated symptoms are common and include auditory, salivary, vestibular, and gustatory complaints. Objectives The aim of the study was to provide increased awareness of postrhytidectomy hemifacial paralysis secondary to Bell's palsy in the plastic surgery community. Methods Following a roundtable discussion with the senior author's (J.C.G.) plastic surgery colleagues located all over the world, 8 surgeons reported having had firsthand experience with hemifacial paralysis in patients following facelift. Descriptions of their cases, including preoperative, intraoperative, and postoperative courses were collected and reported. Results A total of 10 cases of postrhytidectomy hemifacial paralysis were analyzed based on results of a clinical questionnaire. Eight of the 10 cases involved all facial nerve branches, with 2 cases sparing the marginal mandibular branch. The vast majority of cases were referred to a neurologist and steroids initiated. Two patients were returned to the operating room for exploration. Associated symptoms reported included pain in the ear, hearing loss, ocular symptoms such as tearing or dryness, vestibular symptoms such as vertigo, changes in taste, and in 1 patient an electric-shock type sensation to the face. Conclusions Hemifacial paralysis associated with Bell's palsy following rhytidectomy is a rare but known clinical entity that should be included in the preoperative informed consent process before facelift. Current management trends are neurology referral and steroid initiation. Level of Evidence: 4

Use of the temporal muscle to raise the lips is a very old technique. In 1934, Gillies folded the temporal muscle over the zygoma to the lip subcutaneously. In 1952, MacLaughlin proposed to attach the temporal muscle tendon to the lips. With this aponeurotic relay there is a risk of lengthening and necrosis, the main cause of long-term failure. Taking inspiration from Maclaughlin, lengthening myoplasty lowers the temporal muscle as a whole descending the tendon to the lip, thus obtaining lengthening from the posterior part.

Background: Lengthening temporalis myoplasty (LTM) is a unique and definite facial reanimation procedure that involves inserting the whole temporal tendon directly into the nasolabial fold. However, the nasolabial fold incision remains one of the difficulties of this procedure, particularly in young or female patient. To avoid the need for this incision, the authors developed an intraoral approach to manipulate the temporal muscle tendon toward the nasolabial fold. in this study, we describe the details of this procedure. Method: The authors performed their intraoral approach procedure in 5 patients with established complete facial paralysis. instead of making an incision at the nasolabial fold to approach the coronoid process, the authors made the incision at the buccal mucosa. The results were evaluated both subjectively and objectively. Results: The authors achieved facial reanimation without leaving any obvious scar on the face or neck and the effect of static reconstruction is obvious, even immediately after the surgery. All the patients obtained good facial movement within 4 months (2.5 months in average), and improved all evaluated parameters postoperatively. No infections or other major complications were reported following surgery; however, 1 patient developed a slight dimple that required revision. Discussion: The authors could advance temporal tendon toward nasolabial fold firmly obtaining sufficient surgical field similar to that of nasolabial fold incision, and achieved fairly good results without an obvious scar on the face. Establishing LTM without nasolabial fold incision, we could expand the indication of LTM more widely, and it could be more familiar procedure for smile reanimation in all generation.

Introduction: Microfat grafting is a well-known technique that is underutilized in dermatology. Instead of removing sclerotic tissue, microfat grafting preserves the tissue and uses stem cells for remodeling its structure into normal tissue. We performed a retrospective study of patients treated with microfat grafting for sclerotic and atrophic skin lesions and scars. Patients and methods: Seventy-two microfat grafts were performed using the Magalon technique under general anaesthesia for the treatment of sclerotic and atrophic skin lesions. We performed grafts for different indications, such as scars (n = 55) and sclerotic and atrophic skin lesions (n = 17: Parry-Romberg syndrome, morphea). The main outcome was assessed for satisfaction during follow-up. In addition, an independent committee judged the results based on photographs. Results: Satisfaction levels (e.g. results were judged to be "good") were almost 91% (n = 50/55) for scars and 100% (n = 17/17) for atrophic and sclerotic skin lesions. Satisfaction levels according to the independent committee were 94.1% for sclerotic and atrophic lesions and nearly 51% for scars. Conclusion: Satisfaction was high after microfat grafting for atrophic and sclerotic skin lesions. Micro fat grafting enabled restoration of the skin texture by exploiting stem cell properties. It is an efficient dermatological therapy for sclerotic and atrophic lesions, for which there are few alternative treatments. (c) 2020 Elsevier Masson SAS. All rights reserved.

Background. - In this study we have based our research on botulinium toxin injection via targeted neuromuscular end plate zones, specifically in muscles with diffuse distribution of the latter. The muscular surface anatomical variety was also taken into consideration with thorough pre-injection examination of every subject. Method. - With consideration of the facial muscles anatomical variation and neuromuscular bundle distribution, we have applied the method of retrograde botulinium toxin injection on a series of 10 patients on the right side of the face with the left side as a control side, it was injected in a regular perpendicular manner in order to conclude the efficacy of targeted motor end zone injection. Using an auto-injecting syringe, we have delivered 6 Allergan units per zone (frontalis, glabellar lines of corrugator supercilii and orbicularis oculi crow's feet). Results. - On control day 8 we have noticed a more prominent effect mainly on the level of the orbicularis oculi muscle and the corrugator supercilii muscle on 9 out of 10 patients. Nine patients out of 10 needed the delivery of an additional 6 Allergan units per zone on the control side's glabellar lines and crow's feet rhytids. Where 1 out of 10 patients needed the reinjection of the control side on the glabellar lines zone. Conclusion. - The musculature of the face varies when it comes to neuromuscular plate distribution. Muscles with scattered distribution patterns show an optimal response to botulinum toxin injections when delivered in a retrograde manner. This has allowed us to achieve of optimal results while minimizing injection sites and hence pain, the use of lower dosage and hence treatment cost, as well as lowering the unwanted product dissemination to the neighboring mimic muscles. (C) 2020 Elsevier Masson SAS. All rights reserved.

In clinical practice nowadays, one is faced with a group of patients still in their youth, demanding a more defined cervicomental angle. This specific group, aging less than 40 years of age, while the classical approach in this population addresses the osseous structures as per genioplasty or mental prosthesis, and for soft tissue definition, they frequently undergo submental liposuction. We noticed that in certain cases this is not enough and the patients can be still dissatisfied, these patients can highly benefit from our technique using the digastric corset in order to restore this congenital absence of cervicomental angle definition. This technique addresses and treats the anatomical malposition of the floor of the mouth, resulting in cervicomental angle widening in the youthful individual. In this technical note we will state the anatomical detail explaining its specific indication and benefit, specifically in this age group.

Facial paralysis sequelae have an intense psycho-social impact which imposes an optimal care in the long run. The surgical challenges are numerous, and the therapeutic weapons are multiple. We propose an analysis of these treatments by the prism of their pitfalls and their limits. The complications of the main surgical procedures are described as well as the details of the rework necessary to cope with them or to quickly correct the defects. Moreover, the result limits are detailed with suggestions to improve them. Finally, we develop the necessary iterative treatments or new therapeutic proposals that are essential for the long-term care of these patients whose sequelae of facial paralysis evolve with time and aging. The surgery of facial paralysis is not unequivocal. It requires humility, patience and tenacity to support the patient throughout his life. (C) 2019 Published by Elsevier Masson SAS.

Learning Objectives: After studying this article, the participant should be able to: 1. Identify the different types of facial paralysis sequelae and define the several medical and surgical techniques commonly available today. 2. Develop a surgical plan to restore symmetry of the face at rest and in dynamic expressions and manage the patient during smile rehabilitation after dynamic smile reanimation with regional or free muscle transfer. 3. Understand the different types of facial paralysis sequelae and know the several medical and surgical techniques commonly available today. 4. Establish a comprehensive treatment plan to restore symmetry of the face at rest and in dynamic expressions and support the patient during smile rehabilitation after dynamic smile reanimation with regional or free muscle transfer. Summary: Sequelae of facial palsy have a negative impact on the cosmetic aspect and functions of the face. They bear severe consequences for patients with regard to their body image and social relationships. There are numerous medical and surgical treatments that should be proposed to patients to achieve comprehensive facial symmetry. The key to an adapted therapeutic choice, to achieve the best outcomes for patients, is to perform a comprehensive evaluation of the paralyzed face and have broad knowledge of the several techniques described over time in the literature. The patient should be informed of the different therapeutic alternatives, their implications, and their limits. With this article, readers will be able to accurately diagnose the different types of facial paralysis sequelae to develop a surgical plan adapted to each case to restore symmetry at rest and in motion.

Is largely known that the facial nerve virtually can be injured in every facial lift. Even though its importance, it is difficult to find in the literature articles related to this theme. Complete or incomplete facial paralysis after a facial procedures, may become a very uncomfortable situation between the patient and the surgeon, that is why we propose in this article a guide which intends to help avoid, identify and manage a facial nerve injury in the event of a face lift. Identifying Facial palsy before the surgery: Intending to make the pre-op facial assessment as simple as possible, we suggest a systematic approach examination. Avoiding facial nerve injury during face lifting: Several technical details are discussed along the text aiming to minimize the risk of nerve damage during the surgical procedure. What to in the event of a post-operative facial palsy: The authors propose a logical approach to the facial palsy, suggesting a planning for diagnosis, classification of the lesion and a rational treatment for the injury. Conclusion: This article presents a guide showing some safe technical options to avoid nerve damage during rythidoplasty, how to identify the lesion and treat it if necessary.

Background: Treatment of facial paralysis in the older population is often relegated to static rather than dynamic reanimation for fear of poor outcomes. This pervasive approach lacks physiologic foundation and is not evidence based. Thus, the authors present an extensive literature review demonstrating weak evidence supporting this misguided concept, followed by detailed outcomes from three centers of the largest reported series to date of patients older than 60 years after reanimation performed using three techniques—lengthening temporalis myoplasty, free functional muscle, and nerve transfers. Methods: A PubMed search spanning over 40 years identified all reports on reanimation in patients older than 60 years. In addition, detailed demographics, surgical techniques, and outcomes of 30 patients older than 60 years were analyzed. Results: Of 629 articles, only 45 patients were identified, described in case reports or small series, lacking details or consistent long-term follow-up. In the clinical series, average age, preoperative House-Brackmann score, and comorbidities were similar among the groups. Highest excursion was observed in the free functional muscle group, followed by nerve transfer and temporalis myoplasty, averaging 10.4, 6.8, and 3.1 mm, respectively. The most notable philtral deviation correction was in the lengthening temporalis myoplasty group, followed by the free muscle and nerve transfer groups, averaging 5.6, 2.2, and 1.13 mm, respectively. Complication rates were highest in the free functional muscle group. Conclusions: Facial palsy patients should not be denied dynamic restoration based on age alone. Although surgical technique may vary based on duration of palsy, surgeon experience, and preference, with each presenting advantages and disadvantages, dynamic restoration is feasible regardless of age. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Tessier clefts are a very rare entity. Number 4 Tessier cleft is describe like an orbito-facial cleft with trajectory between the lower eyelid and the lip. We report management of a bilateral number 4 Tessier cleft with amniotic band syndrome with 22 years of follow-up. After reviewing literature, we talk about difficulty to manage these kinds of rare Tessier clefts.

Background: Adipose tissue is an abundant source of mesenchymal stem cells, called adipose-derived stem cells, which have anti-inflammatory and trophic effects to enhance overall tissue repair. Objective: To determine the healing effects of autologous adipose tissue graft on hypertensive leg ulcers. Methods: Prospective pilot study in 1 French dermatology department. Ten patients with a hypertensive leg ulcer were enrolled from April 2013 to June 2015. The primary end point was the wound closure rate at each follow-up visit. The secondary end points were wound characteristics, pain assessment and adverse events. Results: One patient, the only smoker, was lost to follow-up at month 5 (M5). For the 9 non-smokers, wound surfaces constantly and significantly decreased: the median wound closure rate was 73.2% at M3 and 93.1% at M6, p < 0.001. The median wound closure rate of the 10 patients was 63.2% at M3, p < 0.001. Percentages of fibrin and necrosis decreased, granulation tissue increased significantly. Pain rapidly and significantly decreased. No recurrence or adverse event was observed. Conclusion: Our data suggest that autologous adipose tissue grafting induces pain relief and promotes wound healing with a good skin quality. Large prospective controlled randomized studies are required to confirm these results.

The neck is an aesthetic unit for which a rejuvenation request is sometimes very targeted or ore often encompassed in a global surgical project of face-lift. To obtain a long lasting outcome, the plastic surgeon has to make a full, detailed, and exhaustive analysis of the neck in order to choose the best indication within the multiple surgical tools. A full clinical examination is the key point, every aspects are outlined. The numerous surgical choices are described, illustrated, and sometimes revisited in the light of targeted anatomical studies. A didactic and graduated way is used to explain the recent evolutions of the surgical tools of the cervical lifting. Complications and insufficiencies in outcomes must be identified and explained. Finally, we illustrate this development by clinical cases. The surgical improvement of the cervical region is, for us, centered on the reconstruction of a cervical retaining structure: the Cervico-Mandibular Angle Suspensor (CMAS) ligament. This element makes it possible to understand and integrate the large number of technical proposals for cervical lifting. (C) 2017 Elsevier Masson SAS. All rights reserved.

This is a commentary and discussion in response to a cadaveric study entitled, "Cervico-mental angle suspensory ligament: The keystone to understand the cervico-mental angle and the aging process of the neck." While highlighting the cervico-mental angle suspensory ligament has the potential to give rise to new surgical technique in neck rejuvenation surgery, the authors caution readers of the study's major limitation. Without well-documented results aligning with aesthetic ideals or reports of the safety and longevity of the procedure, it seems too early to consider this ligament the keystone to understand the aging neck. An actual surgical technique must be described and further clinical studies need to be performed before this ligament can be included in the armamentarium of neck rejuvenation surgery. As the goal of surgery should be a natural result that restores aesthetic ideals of the youthful neck, regardless of the significance that this ligament will carry, its application should be tailored to the patient to avoid overly aggressive treatment. Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .