The present study indicates that ptosis alone does not account for the changes observed in the aging midface. Selective hypertrophy of the upper portion of the cheek fat pad was also observed. The mimetic muscles, on the other hand, showed no significant differences with aging. To attain maximum precision in facial rejuvenation, these data suggest that after suspension of the ptotic cheek fat pad, each patient should be evaluated for excess bulk in the upper portion of the cheek fat pad. If excess bulk is present, patients may benefit further from selective reduction directed to the upper portion of the cheek fat pad, remaining superficial to the mimetic muscles of the face.

No abstract

Although prosthetic patches (i.e., expanded polytetrafluoroethylene) are commonly used to repair abdominal fascial defects, autologous tissue is preferred in the presence of wound contamination. This study was undertaken to discover (1) whether fascial grafts are revascularized and incorporated as living tissue, and (2) whether fascial grafts are more resistant to bacterial contamination than prosthetic patches. In the first experiment, 18 New Zealand White rabbits underwent full-thickness resection of the central abdominal wall preserving only panniculus carnosus and skin. Six control animals had only skin repaired, and all developed large ventral hernias. Twelve animals had the defect repaired with thoracodorsal fascia patches. At 3- and 6-week intervals, no hernias were present and all patches were incorporated with minimal contraction. Fluorescein angiography verified revascularization from the surrounding abdominal wall. Next, 36 rabbits underwent similar resection followed by repair with either autologous fascia (n=18) or expanded polytetrafluoroethylene (n=17). Six rabbits of each repair group were inoculated with 10(4) Staphylococcus aureus and twelve rabbits with each repair were inoculated with 10(9) S. aureus. All rabbits receiving 10(4) S. aureus were infection-free survivors. Seven of the twelve expanded polytetrafluoroethylene-repaired animals receiving 10(9) S. aureus developed necrotizing wound infections and died. Only 2 of 12 rabbits with autologous fascia repairs died from wound sepsis and 1 died of diarrhea with a healed wound. Differences in wound infection rates achieved statistical significance, whereas survival differences approached significance (Fisher's exact test), suggesting that revascularized fascial grafts may be more resistant to bacterial contamination than expanded polytetrafluoroethylene patches at this concentration (10(9) S. aureus).