News in Cosmetic Surgery
By Leslie Laurence

To keep you up-to-date on the latest advances in the field, herewith some the new - though not necessarily proven - approaches to established techniques and materials.

Avoiding the "over-lift". For the woman who shies away from the face-lift, for fear of looking too "done," there's promise in the composite life, pioneered by Dr. Sam Hamra, associate clinical professor of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. Hamra and others try to prevent and correct telltale signs of a traditional face-lift (hollows beneath the eyes and tightness from the corners of the mouth to the ears) by moving the muscle, fat and skin as one unit toward both the ears and the eyes, resulting in a more natural and, doctors hope, long-lasting appearance. Recovery takes up to six weeks.

Extra Padding. Doctors often remove the excess fat that tends to accumulate in the lower eyelid with age. But, says Hamra, "by age forty, all of us start developing sockets around the eyes, and the bones begin to show through." Removing too much fat can accentuate a skeletal appearance. So instead of taking fat away, Hamra puts it where it looks best: over the bone in the lower eye socket. "The result is a smoother transition between the eye and the cheekbone," he says.

Less is more. For women in the forties to early fifties, a midface-lift, a new alternative to the traditional total face-lift, may be in order. The midface-lift elevates the brow and soft tissues of the cheek and is best suited to the person whose neck and lower face need no tightening. "There are instances when a big operation is overkill," says Peter Bela Fodor, M.D., a professor of plastic surgery at the UCLA School of Medicine. Fodor uses a tiny instrument called an endoscope, to which a camera is attached, and works through small incisions at the top of the head. His technique, less invasive than the usual lift, minimizes tissue trauma and, therefore, swelling, bruising and recovery time. Fodor has performed more than one hundred endoscopic procedures. How results will stand up over the long term remains uncertain.

Sticky situation. Fodor is also experimenting with a new way of closing incisions. Instead of using sutures, which, he says, can pull unevenly, he holds elevated tissue in place with fibrin sealant, a glue made from donor and bovine blood proteins (processed and tested for infection), which is absorbed by the body within ten days. Mark Jewell, M.D., a plastic surgeon in Eugene, Oregon, and an officer of the American Society for Aesthetic Plastic Surgery, says the procedure "makes sense and appears to help eliminate the lumpiness we all see in healing skin after a face-lift."

The heat's on. More and more doctors are shifting from the carbon dioxide laser to the erbium laser for skin resurfacing. A. Jay Burns, M.D., assistant professor of plastic surgery at the University of Texas Southwestern Medical Center, prefers the new variable-pulse-width erbium because it allows him to control the depth to which the laser's heat penetrates with greater accuracy and to seal damaged blood vessels to reduce bleeding. Experts point to the shorter recovery time - one to three weeks versus four months or more with the equivalent depth using CO2. Although results have generally been less dramatic with the erbium, some doctors believe it may do a better job than the CO2 for certain problem areas - the forehead, cheeks and around the mouth. But an increasing number of doctors no longer use any laser for tightening skin because, they say, the effects are temporary (Burns says he's seen skin relax after only sixty days), and recovery time is lengthy. Some are returning to good old-fashioned chemical peels.

Fat chance. A new tool has been added to the armamentarium of the liposuction surgeon, says New York plastic surgeon John E. Sherman. Power-assisted liposuction uses a moving cannula (imagine the motion of an electric toothbrush). The advantage: the surgeon can work more easily in dense areas that tend to scar readily. Surgeons happy with the power-assisted technique say it allows them to achieve a better cosmetic result than earlier kinds of liposuction, such as ultrasonic.