The mouth ages along with the face, but it is frequently ignored when performing facial rejuvenation. The authors have addressed the mouth area with direct surgical options and excisions since 1980. In using the direct approach, the tradeoff for an improved appearance at a conversational distance is a scar that is barely visible from inches away. In more than 3000 procedures, the results have been consistently good, with very few minor scar irregularities that required revision. The authors advocate performing a lip lift to elevate the central lip and a corner mouth lift to elevate the lateral lip. Although the lip and corner lift are important in shortening the long lip of aging, one of the most useful perioral procedures is the direct excision of loose skin at the lower nasolabial/marionette foldover area. The authors conclude that results of facial rejuvenation are greatly enhanced by appropriate procedures of the mouth.

With the introduction of endoscopy to surgery, it has become apparent that magnification similar to the magnification provided by the surgical microscope can be achieved with its use. Endoscopic techniques provide both magnification and the ability to operate at a distance, potentially increasing the applications of microsurgery. An endoscopic unit is significantly less expensive than the operating microscope. Furthermore, it enables invasive techniques utilizing smaller incisions. The purpose of this project was to investigate whether the visual assistance provided by the endoscope is sufficient to perform a microvascular anastomosis. An initial experiment with six rats is presented. The right femoral artery was isolated, divided, and reconstructed by standard microanastomosis with the visual assistance provided by a 4-mm endoscope. All anastomoses were patent at 7 days by microangiography and histology. The magnification provided by the endoscope is sufficient for the creation of a microvascular anastomosis.

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