Short Scar Face Lift Rhytidectomy

Short-Scar Face Lift – Rhytidectomy


Wolf Krammel

Short-Scar Face Lift With Extended SMAS Platysma Dissection and Lifting and Limited Skin Undermining

Facelift, or rhytidectomy, is a surgical procedure to improve visible signs of aging on the face and neck. As individuals age, the skin and muscles of the face region begin to lose tone. The facelift cannot stop the process of aging. It can improve the most visible signs of aging by tightening deeper structures, re-draping the skin of face and neck, and removing selected areas of fat. A facelift can be performed alone, or in conjunction with other procedures, such as a browlift, liposuction, eyelid surgery, or nasal surgery.

Facelift surgery is individualized for each patient. The best candidates for facelift surgery have a face and neck line beginning to sag, but whose skin has elasticity and whose bone structure is well defined.

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Short-scar rhytidectomy is a procedure with the capacity to meet the high standards of minimal scars and deformities without any noticeable signs of manipulation. In the short-scar cervicofacial rhytidoplasty (also known as the S-lift), extended dissections with maximal correction are combined with short scar and decreased signs of manipulation. Over the past 8 years this technique has been used with great success and a high level of patient satisfaction. Described are the S-lift and the devolution of this technique from its more complex form, which is reserved for patients with severe aging damage and redundant neck skin to a simpler technique that is adequate for most younger patients with moderate aging-related changes.


The initial incisions in this procedure are limited incisions in the sideburn and periauricular areas, extending just around the fold of the ear lobule. Extensive undermining of the superficial musculoaponeurotic system (SMAS)/platysma is performed, and lifting of the face and neck is performed primarily at this level. Minimal skin undermining is performed, which eliminates the need for extended incisions for reduction of dog ears. The preservation of fibrous bands between the skin and the SMAS/platysma unit is an important factor in making an operation such as this one practical, and the preservation of these fibrous bands facilitates the use of short skin incisions. Dissection of large areas of skin and the separation of the skin from the underlying SMAS will require larger incisions.


The S-lift has been shown to be safe, speedy, less traumatic, and well tolerated among patients at high risk for complications, such as smokers. This procedure also reduced the risk of complications.

This article is submitted by Wolf Krammel –

. Hamid Massiha, M.D. performs Cosmetic, Plastic and Reconstructive Surgery in Metairie and Mandeville, Louisiana. Call (504) 455-9441 or visit the website at

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Pharmaceutical Formulation Development Series: Alternative Routes For Formulation Development

Submitted by: Bruce Rehlaender, Ph.D.

A major disadvantage of postoral delivery is that blood flow from the intestine leads into the portal vein which flows directly to the liver. This leads to the phenomenon of first pass clearance, in which drug is metabolized and/or excreted by the liver before it can reach the general circulation. Other routes of administration circumvent this direct flow to the liver and may have other specific advantages.

Sublingual or Buccal Administration:

Buccal or sublingual delivery is typically used for relatively potent drugs that are readily absorbed but undergo extensive first pass clearance. Specific dosage forms designed for the buccal cavity include sublingual tablets, buccal sprays, and buccal patches. These are not as readily accepted as postoral tablets but are still non-invasive and patient friendly.

Technically a dosage form for buccal administration has a quite high probability of success, and marketability and cost of goods would also be reasonable. Unfortunately the high probability of technical success could be a bit of a double-edged sword in that it could be used as the basis for an argument of obviousness by a patent examiner or someone challenging a patent in the future.

Oral Disintegrating Tablet:

Oral disintegrating tablets (ODTs) have been developed for ease of use since they do not require access to water and are suitable for patients who have trouble swallowing pills and capsules. Although these tablets are not typically intended to improve bioavailability, if a drug is absorbed rapidly enough, an ODT may act essentially as a buccal delivery dosage form.

Although the probability of technical success is lower for this approach than for specifically designed buccal dosage form, there are two substantial advantages. First, since ODTs are considered to be simply a different presentation for postoral delivery, any finding of improved bioavailability would be unexpected and would therefore constitute novel intellectual property. The second advantage is that unlike sublingual tablets, buccal sprays, and buccal patches, an ODT is considered to have a marketing advantage over standard postoral tablets and capsules.

Nasal Spray:

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Another alternate delivery site is the nasal cavity. Currently, nasal sprays are used almost exclusively for local, rather than systemic, delivery, so there would be an inherent degree of novelty in a nasal spray formulation that would make an intellectual property platform easier to obtain. However, there are reasons why nasal sprays are not commonly used for systemic delivery, and these serve as impediments to this approach.

The primary obstacle to nasal delivery is patient friendliness and patient acceptance. Nasal sprays are inconvenient, are relatively difficult to use, and can cause local irritation. Furthermore, dosing can lack reproducibility due to the coordination required in activating the device while inhaling and the effects of nasal inflammation and mucus secretions. Another limitation of nasal sprays is that the amount of drug delivered is quite limited. A typical device delivers 50 L per spray, and the amount of drug in that volume is limited by the solubility of the drug and/or the extent to which it can be stably suspended.

Nose to Brain Delivery:

An interesting variation on the theme of nasal delivery is so-called nose to brain delivery. Unlike conventional nasal delivery, in which relatively coarse droplets are targeted to the lower lobes of the nasal cavity, this approach involves the use of specialized devices that generate much finer droplets that can be deposited on the olfactory region, located at the top of the upper lobe. The olfactory region is highly enervated and is directly proximal to the brain so that, at least in principle, drug deposited there can be absorbed directly into the brain, bypassing not only the gastrointestinal tract and liver, but the bloodstream as well. This would potentially allow a much lower level of JDTic to be dosed.

Since nose to brain delivery is not yet well established or proven, a strong intellectual property position could be obtained if it did, in fact, lead to substantially enhanced brain deposition. However, unless a drug readily crosses the blood-brain-barrier as it is, the benefits of this approach may not be adequate to justify the downsides. These include patient inconvenience, higher cost, licensing fees for the device, and the likelihood of poorer drug stability in the liquid form. Furthermore, there are outstanding questions about the long term impact of delivering drugs to the olfactory region on the patient s sense of smell.

Subcutaneous Depot or Implant:

A subcutaneous sustained release dosage form could take many forms, from an injectable suspension of slow-release beads to a pellet-like device that can be placed under the skin with a trocar or oversized needle to a large device installed in a surgical outpatient procedure. Naturally, the larger the device is and therefore the more difficult it is to administer, the less frequently it needs to be administered.

The great advantage of a long-term depot or implant is that there is no need for a patient to regularly take his medicine. For treatment of addiction and similar indications, this could be a tremendous selling point for the drug product as it eliminates not only the possibility of a patient forgetting a dose but also of his intentional skipping doses.

If a drug has an extraordinarily long duration of action, an injectable or implantable slow release dosage form would need to have quite a long duration of release to provide a substantial benefit over an oral dosage, which may need to be taken only once a week. The feasibility of such a long-term dosage depends heavily on the required dose of the drug being low enough that an adequate amount could be contained in a reasonably sized device.

Because of the technical complexities of these dosage forms and the wealth of patents around them, development would undoubtedly be carried out under a licensing agreement. Equally doubtless is that the resulting drug product would enjoy strong intellectual property protection.

The downside of an injectable or implantable depot is the inconvenience and invasiveness of administration as well as the increased cost of goods and the loss of revenue to royalty payments for the technology. This means that an adequately compelling case would need to be made for this approach over infrequent oral administration.

Transdermal Patch:

A transdermal patch is another dosage form that lends itself to infrequent administration but is relatively patient friendly. Patches are usually designed to release drug over the course of a day or two.

Because the epidermis is such a formidable barrier, few drugs are good candidates are transdermal delivery. Molecules that can permeate through the stratum corneum, the outermost and most impenetrable layer of the skin, are generally lipophilic and of low molecular weight.

Numerous challenges are involved in developing a transdermal patch dosage form, and these challenges provide ample opportunity for securing intellectual property. A patent could likely be written broadly enough to cover essentially all reasonable approaches to transdermal delivery.

Compliance Indicating Dosage:

Another potential dosage form for use in the treatment of addictive disorders is a dosage form that can indicate non-compliance. For example, if patient was to wear a patch and chose to remove it, such a dosage form would indicate the non compliance to a family member or practitioner.

Although this idea might have some utility, it would be applicable only to limited indications and limited dosage forms. Furthermore, it is not clear how such a dosage form could be designed, and it is likely that development would be very costly. As such, this concept is normally assigned a low probability of success.

Find more articles like this one by searching for “PharmaDirections Formulation Development Blog”.

About the Author: Bruce Rehlaender, Ph.D., Principal, Formulation Development,


, a pharmaceutical consulting and project management company specializing in

preclinical development


formulation development


regulatory affairs

. We direct development for virtual biotechs.


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How Can I Be A Good Candidate For Liposuction?

Submitted by: Rena Graham

For a successful liposuction result one key factor is to be the right candidate for it. Not only is it just about removing stubborn fats from your body but also preparing your body to properly adapt after all those excess has been removed. Being the right candidate also means that you are prepared for the responsibility that your new body would require from you. So before you think about having this procedure done, here are essential facts you need to consider.

The best candidates for a liposuction surgery are those who have excess localized fat deposits in areas such as the arms, abdomen, thighs, flanks and the neck. Usually these fats are resistant to any amount of diet and exercise which is why mechanical removal is the best measure to permanently eliminate these adipose tissues.

But before anything else, the surgeon would always make sure that you are generally healthy. This means that there should be no pre-existing conditions such as cardiovascular diseases or pulmonary problems. Those who are diabetics may also be at risk for complications especially with healing. That is why it is important that you disclose any health conditions that you may have with your surgeon.

To be generally healthy, you must also be free from any vices. If you are a smoker or heavy drinker, make sure that you lay off these at least 4 weeks prior to surgery.

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You must also remember that liposuction is not a weight loss procedure, which is why you have to be within the appropriate weight before you are cleared for liposuction. With that said, you must be at least 30% of your ideal body weight to ensure better success.

When it comes to age, the lower limit for someone to be cleared for liposuction is 18 years old. There is no upper age limit, however due to the natural effects of aging to the skin the results for older patients may not be as optimal compared to younger individuals. That is why evaluation is very important so that you will be prepared of the possible results or the limitations of your particular case.

You must also have realistic expectations about the procedure if you want to pass as a good candidate for liposuction. This means that as you understand its advantages you must also consider its drawbacks. Knowing what to expect about the procedure is very crucial because this has caused some patients to feel frustrated with their results.

Having realistic expectations also mean that you have to be more responsible with your lifestyle and health practices. Not being too careful can cause fat build up yet again. The problem is that it no longer rests right underneath your skin, but rather it lies over vital organs, or what is called visceral fats. This can be very dangerous because it can cause cardiovascular and metabolic problems.

If you are taking any maintenance medications, you must give your surgeon an entire list of what you are taking. This is because there are some medications that could affect your body s clotting abilities which can pose a serious danger during surgery.

Money is also a very important factor for you to be a good candidate for surgery. Of course you cannot have this procedure done if you don t have the money to pay for it and its other related expenses. That is why before you even consider this; you need to make sure that you can afford it. And also remember that you should never let the cost drive you to settle for cheaper and unreliable services.

So if you think that you can work around the things mentioned above. Then you just might be a good candidate for liposuction surgery. You can be sure about this after you are thoroughly evaluated by a reputable surgeon.

About the Author: For $27/wk

payment plan for liposuction in Brisbane

, Sydney and Canberra, Esteem Cosmetic Studio is the place that you can trust. They have a team of highly competent and duly qualified surgeons who will work with you using only the best techniques and most reliable materials. Feel free to add

+Rena Sharma

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