Management of frontal sinus fractures (FSF) has been the subject of great debate for more than six decades. Multiple treatment options and algorithms have been proposed by multiple specialties throughout the years; however, the optimal method of frontal sinus repair has yet to be elucidated. Because of the location of the frontal sinus and its proximity to numerous intracranial structures, inadequate treatment may lead to life-threatening intracranial infectious complications. Meningitis, encephalitis, and brain abscess are the most common intracranial complications. Other complications include persistent cerebrospinal leakage, mucopyoceles, frontal osteomyelitis, meningoencephalocele, and nonunion of the frontal bone. Orbital involvement may result in ophthalmoplegia, orbital abscess, diplopia, enophthalmos, proptosis, preseptal cellulitis, and partial or complete loss of vision. Morbidity and mortality are often dependent on the anatomic characteristics of the fracture, concomitant injuries, treatments rendered, age, gender, and mechanism of injury. Management of frontal sinus fractures is so controversial that the indications, timing, method of repair, and surveillance remain disputable among several surgical specialties. The most important tenet of frontal sinus fracture management remains the same: create a safe sinus. This is accomplished by following four basic principles: reestablish the frontal bony contour to its premorbid state, restore normal sinus mucosa with a patent drainage system if possible, eradicate the sinus cavity if the normal mucosa or drainage system cannot be reestablished, and create a permanent barrier between the intracranial and extracranial systems to prevent overwhelming infectious complications. By following these four basic principles, frontal sinus fracture management will be safe and effective as long as extended surveillance is part of the protocol.

To prove through our experience that the use of transcutaneous lower eyelid blepharoplasty results in negligible incidence of unacceptable scar and eyelid malposition and that the overall lower eyelid contour is acceptable. A detailed overview of the lower eyelid anatomy and a discussion of the "aging" eyelid are further discussed. Design: Retrospective,observationalstudy.Thestudypopulation comprised 50 patients (100 eyes) seen at the McColloughPlasticSurgeryClinic,GulfShores,Ala,between 2002 and 2003 (45 women and 5 men), who had undergone transcutaneous lower eyelid blepharoplasty with fat excision. Lower eyelid blepharoplasty was performed by the senior surgeon (E.G.M.), and the surgical technique was identical in all cases. The patients were followed up for a minimum of 6 months and a maximum of 2 years. Patients were selected on the basis of return visits to record the findings, documented by consecutive digital photos. By comparing standard blepharoplasty digital views, the patients were as-sessedby3independentunbiasedplasticsurgeons.Thisstudy was performed in a private practice setting. The main outcome measure was mean score for the presence of unacceptable scarring, the presence of lower eyelid malposition, and theoverallappearanceoftheeyelidaftertranscutaneouslower eyelidblepharoplasty,asassessedwiththeGarcia-McCollough Scale for Lower Eyelid Appearance. Results: The 50 patients were retrospectively reviewed and analyzed by a group of 3 unbiased plastic surgeons, and there was negligible evidence of lower eyelid contour abnormality, lower eyelid malposition, or easily visible scars. Conclusions: Transcutaneous lower eyelid blepharoplasty with fat excision is a time-tested method of correcting the undesirable sequelae of the aging eye. This technique not only is a safe and effective manner to rejuvenate the lower eyelid but also results in virtually nonexistent ill effects.

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