No abstract

An 87-year old Caucasian male with past medical history of rheumatoid arthritis (RA) and chronic kidney disease presents with left hand erythema, pain, tenderness, induration and edema. Clinically, these hand findings began proximal to the metacarpo-phalangeal joints and extended to the distal wrist. He was noted to have ipsilateral axillary lymph node enlargement but denied any constitutional signs or symptoms. Laboratory markers of inflammation were poor prognostic indicators due to relatively active RA, the use of chronic daily glucocorticoids and weekly adalimumab use. Oral antibiotics were administered with limited success leading to a skin biopsy which reported a hematogenously disseminated fungal panniculitis; cultures grew Cryptococcus neoformans, however, serum cryptococcal antigen was negative. With initial fluconazole treatment, skin findings and lymphadenopathy improved gradually over the next six months. However, the patient’s improvement stagnated and his condition reverted back to the state of initial presentation.

Aim: With the normal aging process, the malar fat pad descends vertically, causing a number of characteristic changes to the face. Various techniques have been used to correct ptosis of the malar fat pad. Methods: The authors describe a technique that is minimally invasive and can be used to correct malar fat pad ptosis. This technique uses a suspension suture to elevate the malar fat pad to a more youthful position. The technique has been successfully used in 71 patients. Results: All of the cases were performed in the office setting under local anesthesia. There were no complications, and, by patient self-report and physician exam, results have been lasting and satisfactory. Conclusion: The minimally invasive midface suspension is a safe and successful approach to midface rejuvenation in properly selected patients.