In this article we describe a technique of needle dermabrasion (tattoo without pigment) used to improve achromic, hypertrophic, and unsightly scars. It is simple, safe (no complications), and it gives us consistently good results.

We describe in detail the anatomy and function of the "Lockwood suspensory ligament" and the interrelated function of the orbital contents responsible for the intraorbital position of the eyeball and fat. With age, or because of genetic disposition, the eyeball descends, reducing the space between it and the floor of the orbit. This will inevitably cause forward projection of the extraconical orbital fat, creating herniated fat pads and resulting in enophthalmia. Based on the volume of the bony orbit and its contents, it is likely that relocating, rather then removing, herniated fat pads will greatly improve and prevent the enophthalmia of aging and give the globe a position and a projection of youth. Based on the results of surgery using the capsulopalpebral flap, it is likely that a descended Lockwood suspensory ligament, rather than a weakened orbital septum, is the cause of herniated fat pads and enophthalmia. We feel neither a weakened orbital septum nor an overabundance of orbital fat nor a shallow orbit is responsible for either of these conditions. We give a detailed description of how to raise the globe, preserve and relocate herniated fat pads, and manage and prevent enophthalmia and obtain a beautiful, youthful looking eye.

Our profession has not decided if it is better to incise parallel or perpendicular (at an angle) to hair follicles when performing a brow lift or a face lift. Thirty patients had one side incised parallel and the other side incised perpendicular to hair follicles. Neither the patients nor the examiners knew how each side was incised. By comparing the invisibility, the nonlinearity, the absence of hypopigmentation, and the abundance of hair into and in front of the scar, we obtained statistical proof that if we incised perpendicular to hair follicles (to preserve the deep follicles in the proximal flap), scars were better in 95 percent of patients.

The evolution of blepharoplasties is reviewed. By better understanding the mechanism of herniated lower eye lid fat pads, one can understand the interrelated enophthalmia, tear trough deformities, and sunken upper lid. The authors use a technique of relocating the herniated fat pad that reverses this process. All of this is described in detail.

In a review of 812 cases of rhinoplasty, none of our patients had early bone or septal displacement; swelling, bruising, and pain were almost nonexistent. This confirms that an external splint would not have been of any benefit in these cases. Packing should help prevent epistaxis, synechiae, and early bone and septal displacement. Not using any packing, we have not encountered these complications. Besides, we have not seen a single submucosal hematoma or a septal necrosis. Therefore, we doubt the value of packing in our patients. The inconveniences and complications of external splints and internal packing are described. Early postoperative photographs show the reduced swelling and bruising, and late photographs show the final results. Difficult primary and secondary rhinoplasty cases are demonstrated.