Plastic surgeons have sought to improve nasolabial folds, jowls, jaw lines, and cervical contour with face-lifting procedures that are abundant in the literature. The retaining ligaments of the face support facial soft tissue in normal anatomic position, resisting gravitational change. As this ligamentous system attenuates, facial fat descends into the plane between the superficial and deep facial fascia, and the stigmata of facial age develop. In this study, surgical correction of the retaining ligaments and plication of the superficial musculoaponeurotic system (SMAS) to reposition the structures that have descended with gravitation are discussed. The anatomy of the facial retaining ligaments was studied in 22 half-faces of 11 fresh cadavers, and the localization, extension, and width of the ligaments were examined macroscopically and histologically. Surgical correction of the retaining ligaments and plication of the SMAS have been accomplished in 27 face-lift patients with this anatomicohistologic study taken into consideration. There was hematoma in one patient at the cheek region and a permanent dimple caused by postoperative edema in two patients, with a localization of one zygomatic and two parotidomasseteric ligaments. In one patient, hypesthesia in the mandibular nerve region was seen, which remitted at 14 weeks. There were no other complications, and with a follow-up of 24 months, excellent aesthetic results and a high level of patient satisfaction were encountered.

This study was performed to ascertain the acute effects of brain missile wounding on brain-stem and hypothalamic biogenic amines in a group of cats anesthetized with pentobarbital (40 mg/kg). Brain wounding is associated with a concomitant increase in intracranial pressure (ICP); to separate the effects of elevated ICP alone from the effects of wounding, a second group of cats had ICP artificially increased from a normal level of approximately 5 mm Hg to approximately 140 mm Hg by infusion of mock cerebrospinal fluid into the cisterna magna. In both groups, significant epinephrine depletions (47% to 74%) occurred in the nucleus tractus solitarius, area A1C1, locus ceruleus, raphe nuclei, and posterior hypothalamus. Epinephrine levels were also significantly decreased in the anterior hypothalamus in the wounded cats. In addition, both brain wounding and artificially induced ICP increases caused significant decreases of norepinephrine in the posterior hypothalamus, and of serotonin, 5-hydroxyindoleacetic acid, dopamine, and homovanillic acid in the raphe nuclei. Only brain wounding, however, caused significant reductions of norepinephrine, dopamine, and homovanillic acid in the nucleus tractus solitarius and area A1C1. The plasma catecholamine levels resulting from brain wounding or artificially induced ICP increases were dissimilar only in the amount of time required to attain maximum plasma levels, with the wounded animals responding faster. It is concluded that the hypothalamic and brain-stem biogenic amine changes resulting from either brain wounding or increased ICP alone are reflective of a stress response. Brain-stem distortion caused by brain wounding did not appear to be a factor and monoaminergic systems appeared to remain intact despite a severe and eventually lethal brain injury.(ABSTRACT TRUNCATED AT 250 WORDS)

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