Santhosh Chhaya

SMAS Imbrication With Deep Plane Component 

A standard Blair incision should be marked. In men, the incision runs between the posterior border of the sideburn and the anterior margin of the tragus to avoid pulling hair-bearing skin too close to the auricle. Using a #15 blade, the incision is made through the dermis. A subcutaneous flap is elevated until the line between the lateral canthus and the angle of the mandible is reached. At this point, the plane of elevation dives deep to run between the malar fat pad and the zygomaticus major muscle. The zygomatic retaining ligaments are then released.

Once the fat pad is elevated, attention is turned to the SMAS. A strip of SMAS is incised starting 1 cm anterior to the tragus at the superior border of the zygomatic arch and carried inferiorly to the level of the angle of the mandible. This strip of SMAS should be about 1 cm in width and remain pedicled inferiorly. The SMAS flap is then rotated toward the mastoid and secured to the periosteum with a braided non-absorbable suture, such as coated polyester via half mattress sutures.

The malar fat pad is now be placed in a more youthful anatomic position along with the malar eminence and secured with a fibrin sealant or loose 4-0 sutures, taking care to ensure symmetry between the left and right cheeks.A drain can be placed in the occipital/temporal scalp near the incision or at the most posterior aspect of the incision and placed under bulb suction.

The skin is then re-draped over the face and tailored to the incision by excising the redundant skin. Deep dermal sutures are placed throughout the incision using an absorbable suture (e.g., 4-0 or 5-0 poliglecaprone). In the temporal hairline, either absorbable suture (5-0 plain gut) or staples may be used. The incision anterior to the ear should be closed with a non-absorbable suture (e.g., 6-0 polypropylene). The postauricular skin incision should be closed using an absorbable suture (e.g., 5-0 plain gut).

Bacitracin is then be applied to the incision. An external facelift dressing is placed using a combination of fluff sponges, a gauze wrap, a compressive elastic wrap, and ice packs.

Minimal Access Cranial Suspension Lift

Using a similar incision to that described above, a subdermal elevation is completed over the midface, leaving the malar fat pad down in the wound bed. Then, an 0 polydioxanone suture is used to create a purse-string surrounding the malar fat pad and ultimately suspending it under tension to the deep temporal fascia just lateral to the lateral orbital rim via a window in the orbicularis oculi muscle. The muscle window must be closed before redraping and excision of excess skin to reduce the palpability of the knot. If necessary, similar purse-string sutures may be used to lift the remaining mid and lower face soft tissue, to reduce jowls and improve mandibular definition.

Subciliary Midface Lift 

A subciliary incision is made from the level of the lacrimal punctum laterally to a point 7-10 mm beyond the lateral canthus. A traction suture is applied through the eyelid margin for a superior retraction and corneal protection.

The orbicularis oculi muscle is incised inferior to the pretarsal portion to preserve eyelid function and lower the risk of postoperative ectropion. Dissection is carried inferiorly in a preseptal plane to the inferior orbital rim and the arcus marginalis. This can be done as a single skin-muscle flap or in separate layers according to surgeon preference. This approach also provides access to the lower eyelid fat pads if necessary for reduction or repositioning.

APR: The higher your credit score, the lower the APR lenders offer you Car buyers with excellent credit receive loans with APRs between 3 and 5

Sears Marketplace is the first step towards becoming a vendor for Sears and Kmart Contact us today and tell us you are interested here; We will review your

Product Details · Item #: NTS986130 · ISBN13: 9780439861304 · Format: Paperback Book · Pages: 384 · Genre: Adventure, Myths and Legends · Grades: 6 - 8 · Lexile®

1. Select a cell within the column(s) to be hidden.
2. On the Home command tab, in the Cells group, click Format.
3. From the Format menu, in the Visibility section, select Hide & Unhide » Hide Columns. The column is hidden.

1. Select the Sent Items folder.
2. Select or double-click the message so it opens in another window.
3. Select File > Info.
4. Select Message Resend and Recall > Recall This Message, and select one of the two options.
5. Select the Tell me if recall succeeds or fails for each recipient check box.
6. Select OK.

Weight Watchers is now offered to all Humana members insured through qualified employer-based health plans.