Cosmetic Plastic Surgery, Ophthalmologist, Plastic Surgeon,
30 years of experience
Video profile
Accepting new patients
W Cosmetic Surgery
610 W Germantown Pike
Ste 161
Plymouth Meeting, PA 19462
610-828-8880
Locations and availability (1)

Education ?

Medical School Score Rankings
University of Pennsylvania (1980) *
Surgery
  • Currently 4 of 4 apples
Top 25%
* This information was reported to Vitals by the doctor or doctor's office.

Awards & Distinctions ?

Awards  
Top Docs 2012
Top Docs 2011
Top Docs 2010; Top Docs 2011; Top Docs 2012; Top Docs 2013
Top Docs 2010
Castle Connolly's Top Doctors™ (2012 - 2013)
Patients' Choice Award (2012 - 2013)
Compassionate Doctor Recognition (2012 - 2013)
Appointments
University Of Pennsylvania School Of Medicine
CLINICAL ASSOC. PROFFESOR
University Of Pennsylvania School Of Med
CLINICAL ASSOC. PROFFESOR
Associations
American College of Surgeons
American Society of Ophthalmic Plastic and Reconstructive Surgery
American Academy of Ophthalmology
American Academy of Cosmetic Surgery
American Board of Ophthalmology
American Board of Cosmetic Surgery

Affiliations ?

Dr. Wulc is affiliated with 12 hospitals.

Hospital Affilations

Score

Rankings

  • Pennsylvania Hospital University PA Health System
    800 Spruce St, Philadelphia, PA 19107
    • Currently 4 of 4 crosses
    Top 25%
  • University of PA Medical Center/Presbyterian
    51 N 39th St, Philadelphia, PA 19104
    • Currently 3 of 4 crosses
    Top 50%
  • Abington Memorial Hospital *
    1200 Old York Rd, Abington, PA 19001
    • Currently 2 of 4 crosses
  • Warminster Hospital
    225 Newtown Rd, Warminster, PA 18974
    • Currently 2 of 4 crosses
  • M L Hospital Bryn Mawr Hospital
  • Wills Eye Hospital Philadelphia, Pa
  • Bryn Mawr HospitalBryn Mawr, Pa
  • Hospital Of The University Of Pennsylvania
  • University Of PaPhiladelphia,Pennsylvania
  • Scheie Eye InstitutePhiladelphia, Pa
  • Presbyterian Medical Center Of The University Of Pennsylvania Health System
  • University Of Pennsylvania Medical Center
  • Publications & Research

    Dr. Wulc has contributed to 42 publications.
    Title Breast Reduction Performed by Liposuction.
    Date October 2006
    Journal Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]
    Excerpt

    BACKGROUND: Large breasts and their functional sequelae can be remedied via breast reduction. This procedure has undergone frequent modification to decrease complications inherent in the large flap-based procedures. Liposuction has fewer complications than traditional incisional approaches and less scarring. OBJECTIVE: It is our hope that dermatologic and plastic surgeons reevaluate the role of liposuction breast reduction based on our results and consider it as an alternative to incisional techniques. METHODS AND MATERIALS: Medical charts, photoimaging, and mammography were used to assess outcomes. Statistical data were calculated using the Fisher exact test (two-sided). RESULTS: Patients reported a satisfaction rate of 93%. Nipple elevation was measured to be at a mean of 2.57 cm compared to preoperative values. Older patients (>60 years of age) were noted to have a significantly larger nipple elevation (3.16 cm vs. 1.79 cm). Changes in volume ranged between 695.57 and 712.71 mL per breast. Radiographic changes induced by liposuction were not statistically different from those found in traditional reduction techniques. Patients with a normal body mass index (BMI) were more likely to have a larger breast reduction compared via the dip test. CONCLUSIONS: This study illustrates the efficacy of liposuction-based breast reduction for the properly selected patient.

    Title Fibrin Sealant for Müller Muscle-conjunctiva Resection Ptosis Repair.
    Date June 2006
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    PURPOSE: To determine the safety and efficacy of fibrin sealant for use in Müller muscle-conjunctiva resection ptosis repair. METHODS: This was a retrospective review of a consecutive case series. All patients underwent Müller muscle-conjunctiva resection ptosis repair with fibrin sealant used for wound closure. Surgery was performed in a manner similar to a previously described technique, using fibrin tissue sealant rather that suture for wound closure. Postoperative symmetry was defined as MRD1 of each eyelid within 0.5 mm. RESULTS: Müller muscle-conjunctiva resection ptosis repair with fibrin sealant used for wound closure was performed on 53 eyelids of 33 patients. There were 27 female patients and 6 male patients. Twenty patients underwent bilateral ptosis repair and 13 patients underwent unilateral ptosis repair. Average follow-up was 17 weeks (range, 3 to 45 weeks). Mean preoperative MRD1 was 1.22 mm (range, -1.5 to 2.5 mm) in the right upper eyelid and 1.50 mm (range, 0 to 2 mm) in the left upper eyelid. Mean postoperative MRD1 was 3.11 mm (range, 2 to 4.5 mm) in the right upper eyelid and 3.12 mm (range, 1 to 4.5 mm) in the left upper eyelid. Postoperative symmetry was found in 32 of 33 patients (97%). We found no evidence of keratopathy or other complications attributable to the fibrin sealant. CONCLUSIONS: Müller muscle-conjunctiva resection ptosis repair with fibrin sealant used for wound closure may allow for predictable results with few complications and appears to be an acceptable alternative to traditional suture techniques.

    Title Hyaluronic Acid Gel (restylane) Filler for Facial Rhytids: Lessons Learned from American Society of Ophthalmic Plastic and Reconstructive Surgery Member Treatment of 286 Patients.
    Date June 2006
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    PURPOSE: To review injection techniques and patient satisfaction with injection of Restylane in various facial areas by American Society of Ophthalmic Plastic and Reconstructive Surgery members. METHODS: Data from 286 patients treated with Restylane in nine American Society of Ophthalmic Plastic and Reconstructive Surgery practices were abstracted to a spreadsheet for analysis. RESULTS: Nine practices performed Restylane injections for 8.8 months on average (range, 2 to 28 months). Average practice volume per patient was 1.2 ml (range, 0.7 to 2.1 ml). Nine of nine practices injected the nasolabial and melolabial folds, 9 of 9 practices injected the lips, and 6 of 9 injected the glabella. Only 2 of 9 practices injected other fillers concurrently. Botox was injected concurrently by 8 of 9 practices. On a scale of 1 to 10, physicians rated average patient discomfort during Restylane injection 4.6 with topical anesthesia and 2.1 with injectable lidocaine, with or without topical anesthesia. The end point for injection was determined by visual cues, volume of injection, extrusion of the product, and palpation. "Problematic" complications, including bruising, swelling, bumpiness, and redness each had an incidence of 5% or less. Patient satisfaction on a scale of 1 to 10 had an average rating of 8.1, compared with that of Botox injection (8.9), upper blepharoplasty (8.9), and collagen injection (6.6). The source of Restylane patients was estimated to be existing Botox patients (45%); existing non-Botox patients (18%); word of mouth (14%); and new patients for other services (13%). CONCLUSIONS: Injection techniques, volume, end points, and anesthesia vary for different facial areas and between practices. Patients experience mild to moderate injection discomfort that is lessened with injectable lidocaine. Self-limited problems occur in about 5% of patients. Physician-determined patient satisfaction is perceived to be higher than that of collagen injection but slightly lower than that of botulinum toxin injection. The major source of Restylane patients was from existing practice patients, especially botulinum toxin patients.

    Title Modifying Brow Position with Botulinum Toxin.
    Date September 2005
    Journal International Ophthalmology Clinics
    Title Botulinum Toxin Type a for Dysthyroid Upper Eyelid Retraction.
    Date July 2004
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    PURPOSE: To evaluate the safety and efficacy of botulinum toxin type A for treatment of eyelid retraction resulting from thyroid eye disease (TED) during the inflammatory phase of the condition. METHODS: In this prospective, nonrandomized case series, 18 patients with inflammatory eyelid retraction caused by active TED received botulinum toxin type A injection (10, 5, or 2.5 U) for treatment of upper eyelid retraction. Botulinum toxin type A (Allergan, Irvine, CA, U.S.A.) was injected transconjunctivally just above the superior tarsal border in the elevator complex of the upper eyelid. RESULTS: Seventeen of 18 patients (94%) demonstrated a reduced marginal reflex distance (MRD1) after botulinum toxin injection. The average change in MRD1 of the treated eyelid after injection was -2.35 mm (range, 0 to -8.0 mm). Of the 27 eyelids injected, 33% had a 0- to 1-mm drop in eyelid height, 30% had a 1.5- to 2-mm decrease, 22% had a 2.5- to 3-mm decrease, and 15% had a greater than 3-mm decrease in eyelid height. None of the treated eyelids were noted to increase in height. One patient showed no alteration inafter treatment. One patient had clinically MRD1 significant ptosis and one patient reported worsening of preexisting diplopia after injection. Three patients undergoing unilateral injection had relative contralateral eyelid elevation. All untoward effects resolved spontaneously without sequelae. CONCLUSIONS:: Botulinum toxin type A may be used in the inflammatory stage of thyroid eye disease to improve upper eyelid retraction. Individual response to treatment is variable, but this modality should be considered as a temporizing measure until stability for surgery is reached.

    Title Caught by a Masquerade: Sclerosing Orbital Inflammation.
    Date March 2002
    Journal Survey of Ophthalmology
    Excerpt

    Idiopathic sclerosing inflammation of the orbit is a distinct form of orbital inflammatory disease characterized by slow and relentless involvement of orbital structures. It is this insidious and relentless course that makes distinction from neoplastic lesions clinically difficult. We report the case of a patient with a several-week history of headache and decreased vision that was originally thought to represent an optic nerve sheath meningioma, based on clinical and radiographic evaluation. Subsequent histopathology from an optic nerve biopsy, however, was more consistent with optic nerve glioma. Eventually, pathologic examination of whole sections through the optic nerve was required to establish and confirm the actual diagnosis of sclerosing orbital inflammation.

    Title Electrosurgical Modification of Orbicularis Oculi Hypertrophy.
    Date March 2001
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    PURPOSE: To assess two electrosurgical approaches for the modification of orbicularis hypertrophy that may be used in conjunction with, or separate from, lower lid blepharoplasty. The hypothesis to be tested is that purely electrosurgical nonexcisional techniques may be used to modify orbicularis oculi muscle. METHODS: Electrosurgical techniques to treat orbicularis hypertrophy with an "open" and a "closed" technique are described. The open technique is performed in conjunction with transconjunctival blepharoplasty. The closed technique requires a 1-mm to 2-mm dermal incision, 2 minutes of surgical time per eyelid, and a specially insulated and formed electrosurgical needle. A review and case series are presented to illustrate and describe the techniques and results. RESULTS: Results for both techniques were rated by both patients and surgeons using the categories of poor, fair, good, or excellent. The open technique was performed in conjunction with transconjunctival blepharoplasty on 23 patients during 2 years with a minimum follow-up of 6 months. Results for the open technique were considered "excellent" by 14 patients and "good" by 9 patients. The operating surgeons evaluated the improvement as "excellent" in 4, "good" in 11, and "fair" in 8 patients. The closed technique was performed on eight patients. Results for patient satisfaction for the closed technique were considered "good" by 4, "excellent" by 2, "fair" by 1, and the final patient abstained from categorization. Operating surgeon evaluation of the closed technique revealed "excellent" outcomes in 3, "good" in 3, and "fair" for 2 patients. CONCLUSION: Electrosurgical techniques may be used to modify orbicularis hypertrophy. Drawbacks include a significant learning curve, potential cutaneous ulceration, and occasional temporary anatomic distortion as manifested by scleral show. Complications are minimal, and the technique was safe in all patients studied.

    Title Cosmetic Indications for Botulinum A Toxin.
    Date December 1998
    Journal Seminars in Ophthalmology
    Excerpt

    This article describes the use of botulinum toxin type A in the cosmetic treatment of facial wrinkles. Injection techniques, volumes, and concentration of the botulinum A toxin are described for various types of facial wrinkles.

    Title Intraoperative Tissue Expansion in Eyelid Reconstruction.
    Date January 1998
    Journal Ophthalmology
    Excerpt

    OBJECTIVE: Chronic tissue expansion is a well-accepted modality for increasing available tissue for reconstructive surgery. In rapid intraoperative tissue expansion (RITE), a tissue expander is used intraoperatively to increase the available tissue area for defect closure. The use of the ubiquitous and inexpensive Foley catheter has previously been reported as a tissue expander in RITE. In this paper, the authors examine the application of the Foley catheter for RITE in oculoplastic surgery. DESIGN: Case series. PARTICIPANTS: Twenty-six patients (ages 50 to 87) with eyelid defects from various causes underwent reconstruction using RITE. INTERVENTION: Using this technique, the tip of a #14 French Foley catheter is trimmed, keeping the balloon intact. The balloon is inserted under a skin-muscle flap. Counter traction is applied, and the balloon is filled with saline until the flap blanches. The balloon is inflated twice for 5 minutes with a 1- to 2-minute rest period between expansions. This provides increased tissue area for reconstruction of periocular defects. MAIN OUTCOME MEASURES: The linear extent of the eyelid defect was measured prior to and after expansion with RITE. A comparison was made between the two measurements. RESULTS: The linear extent of the eyelid margin defect decreased by 36% after RITE. CONCLUSIONS: Rapid intraoperative tissue expansion with a Foley catheter is a means of providing increased tissue area for reconstructive surgery of the eyelids and periorbital region. This technique provides excellent tissue match for color, texture, and thickness. The technique decreases the size of the incised and undermined skin-muscle flap and the tension needed for wound closure.

    Title Orbital Venous Anomalies.
    Date July 1997
    Journal Ophthalmology
    Excerpt

    PURPOSE: The purpose of the study is to establish the natural history, probable nature, and optimal treatment of lesions within the orbit described previously as lymphangiomas or orbital varices. METHODS: The clinical and radiologic records of 158 patients with these lesions were reviewed. Of these, 91 had surgery, and histologic specimens from 57 were re-examined. RESULTS: Most patients were infants or children with a dark blue swelling in the superomedial part of the orbit, orbital hemorrhage, or proptosis. Computed tomography showed smooth, contoured lesions denser than brain extending posteriorly. Half enlarged with the Valsalva maneuver, 31% contained phleboliths. Surgery was performed in 91 patients, mainly for cosmesis. Excised tissue included endothelium-lined channels containing blood in the orbit and clear fluid in many superficial specimens. CONCLUSIONS: The behavior of these lesions and their prevalence in infancy and childhood favor a hamartoma. The authors observed a seamless range of clinical features that they could not subdivide, particularly in relation to any connection with the orbital veins. Many bleed and enlarge permanently and need excision, but surgery is difficult and management should be as conservative as possible. The origin of these lesions cannot be determined by histopathologic analysis, although the authors have evidence of venous features in the orbit and lymphatic features more superficially. The authors' clinical findings support a venous origin. Two-thirds have either a free venous connection or phleboliths. Their distribution corresponds with that of the normal orbital veins, and at surgery they derive from or replace those veins. "Orbital venous anomaly" is the most accurate term for their description.

    Title Computed Tomography in Lacrimal Outflow Obstruction.
    Date May 1997
    Journal Ophthalmology
    Excerpt

    BACKGROUND: Acquired nasolacrimal duct obstruction is a common ophthalmologic problem. Despite widespread understanding of treatments available for nasolacrimal duct obstruction, few authors have commented on its etiology. Because the nasolacrimal system is anatomically related to important nasal and sinus structures, the authors postulated that acquired nasolacrimal duct obstruction and its complications might occur simultaneous to, and possibly as a consequence of, rhinologic or sinus disease. MATERIALS AND METHODS: Twenty-three patients with acquired nasolacrimal duct obstruction and 100 control patients were evaluated by coronal computed tomography for evidence of sinus disease or nasal abnormalities. Specifically, five findings were noted: ostiomeatal complex disease, ethmoidal opacification, agger nasi cell opacification, concha bullosa, and nasal septal deviation. RESULTS: Overall, 20 (87%) patients with acquired nasolacrimal duct obstruction demonstrated one or more radiologic finding of sinus disease or rhinologic abnormality whereas 63 (63%) control subjects exhibited these findings. This difference was determined to be statistically significant (P < 0.05). A statistically significant higher incidence of ethmoidal opacification, agger nasi cell opacification, and nasal septal deviation was observed in patients with nasolacrimal outflow obstruction than in controls. Differences in the incidence of ostiomeatal complex disease and concha bullosa were not found to be statistically significant. CONCLUSION: These data demonstrate a correlation between computed tomography findings of sinus disease or nasal abnormality and the presence of acquired nasolacrimal outflow obstruction. This association between radiologic evidence of sinorhinologic disorders and lacrimal outflow obstruction may imply that dacryocystitis, like sinus disease, may be produced by disease of the lateral nasal wall. When evaluating a patient with acquired nasolacrimal duct obstruction, the physician should consider evaluation for concomitant nasal and sinus disease.

    Title Chronic Localized Conjunctival Chemosis.
    Date November 1996
    Journal Cornea
    Excerpt

    Conjunctival chemosis is a commonly encountered clinical finding stemming from the presence of excess fluid in the conjunctiva. It is typically self-limiting or reversible if the underlying condition is treated. The authors present a series of seven cases of chronic localized conjunctival chemosis. Each patient had a localized area of dependent conjunctival edema for >or= 6 months. Evaluation of each patient included clinical examination, laboratory studies, and neuroimaging to attempt to elucidate the pathogenesis of the chemosis. Conjunctival biopsy was performed in six of the seven patients. In all of the patients studied, clinical examination uncovered no definitive signs of local inflammation. Laboratory evaluation was normal, and neuroimaging failed to confirm obstruction of venous or lymphatic drainage. Conjunctival biopsies showed chronic tissue inflammation or lymphangiectasia. The diagnosis of chronic localized conjunctival chemosis (CLCC) can be made if localized conjunctival edema persists for 6 months. Evaluation of biopsy specimens supports the theory that CLCC may result from scarring and structural alteration of conjunctival lymphatics, which appears to irreversibly affect the distribution of fluid in the conjunctiva.

    Title The Use of Botulinum A Toxin to Ameliorate Facial Kinetic Frown Lines.
    Date June 1996
    Journal Ophthalmology
    Excerpt

    External photography and subjective response were used to evaluate the use of botulinum A toxin to diminish glabellar kinetic folds.

    Title Delayed Suprachoroidal Hemorrhage Mimicking Acute Retrobulbar Hemorrhage.
    Date April 1996
    Journal Survey of Ophthalmology
    Excerpt

    The signs and symptoms of an acute retrobulbar hemorrhage include sudden ocular pain, explosive unilateral proptosis, limitation of extraocular movements and loss of vision. Retrobulbar hemorrhage is a well-described complication of retrobulbar anesthetic injection. We report an unusual case of a presumed acute retrobulbar hemorrhage following intraocular surgery which, on further testing, was found to be a delayed suprachoroidal hemorrhage.

    Title Blood Loss Following Chalazion Excision.
    Date March 1995
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Title Eosinophilic Granuloma of the Eyelid.
    Date December 1994
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    A 15-year-old girl presented with a left lower eyelid tumor consistent with a nonresolving chalazion. The specimen was biopsied. Histopathologic examination revealed eosinophilic granuloma, an entity that rarely presents on the eyelid. The histopathologic features of eosinophilic granuloma--a member of the histiocytosis X group of diseases--are reviewed. Our patient responded well to incisional biopsy and has required no additional treatment.

    Title Haemangiopericytoma of the Orbit.
    Date April 1993
    Journal Australian and New Zealand Journal of Ophthalmology
    Excerpt

    Orbital haemangiopericytomas are ideally managed by complete surgical excision in the first instance. This is frequently not achieved, because difficulty in making the diagnosis preoperatively results in incisional biopsy and the highly vascular nature of the tumour makes complete excision difficult. A series of 12 patients with orbital haemangiopericytoma seen over a 23-year period is presented. The following combination of clinical and radiological features is suggestive of haemangiopericytoma. 1. Painless non-axial proptosis with downward displacement of the globe. 2. Intermittent upper lid swelling. 3. A soft, superiorly located mass with poorly defined borders, especially with a blue hue. 4. A superiorly located, rounded or elongated extraconal mass on CT, isodense with brain, with smooth, well-defined borders and moderate to marked enhancement with the injection of intravenous contrast medium. 5. Significant blush in all three phases of carotid angiography, without prominent arteriovenous shunting. Once haemangiopericytoma is suspected, complete surgical excision is recommended.

    Title Visual Loss After Retrogasserian Glycerol Injection.
    Date March 1993
    Journal American Journal of Ophthalmology
    Title Monopolar Cautery for Graft Cartilage Sculpting in Reconstructive Eyelid Surgery.
    Date November 1992
    Journal Ophthalmic Surgery
    Excerpt

    We describe a technique for using the monopolar cautery to sculpt ear cartilage to prepare it for use as a graft to reconstruct or support the posterior lamella of the eyelid in oculoplastic procedures. We have used this simple, rapid, and predictable technique in 16 patients with excellent results.

    Title Simultaneous Lateral, Anterior, and Posterior (slap) Lower-lid Blepharoplasty.
    Date June 1992
    Journal Ophthalmic Surgery
    Excerpt

    We report a hybrid of procedures for correcting the aging lower eyelid--transconjunctival blepharoplasty, skin blepharoplasty, and skin-muscle blepharoplasty--that maximizes the strengths of these procedures while minimizing their shortcomings. Our procedure, a simultaneous lateral, anterior, and posterior blepharoplasty, simultaneously attacks the lateral canthal angle, the anterior lamella, and the posterior lamella of the eyelid.

    Title Refinements of the Tarsal Strip Procedure.
    Date April 1992
    Journal Ophthalmic Surgery
    Excerpt

    We present several refinements in technique that simplify the tarsal strip procedure and enhance its results. Among these refinements are: electrosurgical deepithelialization of conjunctiva and lid margin, use of a V-shaped needle, direct needle passage about the lateral orbital tubercle, and the parallel placement of a buried absorbable suture to unite the upper and lower lid margins and to maintain a long-lasting sharp canthal angle. We have used these maneuvers in 45 patients with few complications; patient acceptance has been high. Also, we have found that using these maneuvers is helpful in teaching the procedure to residents.

    Title Bell's Palsy in Moebius Syndrome.
    Date November 1991
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    We report a case of unilateral transient and reversible facial paresis, which was superimposed on a congenital bifacial palsy in a young adult with Moebius syndrome. Our case illustrates the potential for two conditions, both affecting the facial nerve and both of unknown etiology, to be juxtaposed in a single individual. Worsening of facial palsy in the Moebius syndrome may not signify progressive disease.

    Title Canalicular Obliteration from Toxic Epidermal Necrolysis.
    Date November 1991
    Journal American Journal of Ophthalmology
    Title Asymptomatic Orbital Cavernous Hemangiomas.
    Date November 1991
    Journal Ophthalmology
    Excerpt

    Computed tomographic (CT) scanning and magnetic resonance imaging (MRI) are commonly performed to evaluate neurologic symptoms. Rarely are asymptomatic orbital tumors discovered, creating uncertainty about their management. Eleven patients are presented who were referred for asymptomatic orbital tumors discovered on either CT scanning or MRI performed for unrelated symptoms of headache, vertigo, peripheral numbness, seizures, stroke, or hallucinations. The asymptomatic orbital tumors were diagnosed clinically and radiologically as cavernous hemangiomas. All the patients were followed clinically and neuroradiologically for an average of 37 months (range, 8 to 120 months). None of the tumors enlarged during this time. The authors conclude that patients who have asymptomatic cavernous hemangiomas, discovered by coincidence during neuroimaging, that bear no relation to the indication for obtaining the CT scan or MRI, can be safely followed by observation as an alternative to surgical excision.

    Title A New Technique of Indirect Ophthalmoscopy for the Eye Plastic Surgeon.
    Date April 1991
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    The coaxial fiberoptic headlight used by the lacrimal and orbital surgeon is an excellent light source for visualization of the retina. When employed in conjunction with a condensing lens, an inverted stereoscopic aerial image is produced. The eye plastic surgeon might therefore routinely examine the dilated patient in conjunction with lacrimal or orbital surgery.

    Title The Universal Liposuction Cannula Handle Modifier.
    Date February 1991
    Journal The Journal of Dermatologic Surgery and Oncology
    Title Conjugal Temporal Arteritis.
    Date January 1991
    Journal Neurology
    Excerpt

    We report the simultaneous occurrence of biopsy-proven temporal arteritis in husband and wife. Serologic and viral studies were negative, including viral culture of the wife's temporal artery. The concurrent incidence of giant cell arteritis in a married couple would suggest a common exogenous exposure.

    Title Lateral Wall Advancement in Orbital Decompression.
    Date January 1991
    Journal Ophthalmology
    Excerpt

    Treatment of dysthyroid orbitopathy can be enhanced with a modified craniofacial approach using a lateral wall osteotomy, and anterolateral advancement and osteosynthesis in conjunction with medial and inferior wall orbital decompression. The technique of lateral wall advancement is described, and the results are discussed. While the authors advocate orbital decompression for dysthyroid optic neuropathy, advancement of the lateral orbital wall can easily be performed as an adjunct to the two- or three-wall decompression procedure. Advancement appears to increase the overall decompressive effect by providing a potential space where lateral expansion can occur and by enlarging the bony orbital volume. It also appears to lessen lid retraction and facilitates (and in some cases, obviates) the need for further lid retraction surgery.

    Title Rhinocerebral Mucormycosis: Management and Survival After Carotid Occlusion.
    Date August 1990
    Journal Annals of Neurology
    Excerpt

    Rhinocerebral mucormycosis is a rare but often fatal fungal infection. We present 2 patients with mucormycosis complicated by internal carotid artery thrombosis. Magnetic resonance imaging was superior to computed tomography in localizing the pathological process. Subtotal resection of devitalized tissue and intravenous amphotericin B therapy resulted in a successful outcome for both patients. Prompt recognition of this disorder by using modern diagnostic and therapeutic modalities promises to improve survival rates.

    Title Suture Tensor.
    Date July 1990
    Journal The Journal of Dermatologic Surgery and Oncology
    Excerpt

    The suture tensor is a simple stainless steel device that pulls the ends of a running subcuticular suture in opposite directions, maintaining the desired closure. The benefits of the use of this device may include minimization of train-track and excisional scarification (via the enhanced maintenance of "tenting"), time savings, and flexibility and durability for the sporting or physically active patient.

    Title Evaluation of the Lacrimal Apparatus with Digital Subtraction Macrodacryocystography.
    Date June 1990
    Journal Radiographics : a Review Publication of the Radiological Society of North America, Inc
    Excerpt

    Patients who suffer from epiphora can benefit from reconstructive surgery in many cases of obstructive and nonobstructive lesions of the lacrimal apparatus. We describe our technique of digital subtraction macrodacryocystography (DSM) and discuss its efficacy in the evaluation of various abnormalities involving the lacrimal drainage pathway. A variety of pathologic conditions of the lacrimal apparatus are portrayed. DSM is an accurate, easy to perform, but relatively unrecognized method of anatomic localization of obstructive lesions within the lacrimal drainage system.

    Title Bulbous-lysing Underminers.
    Date January 1990
    Journal The Journal of Dermatologic Surgery and Oncology
    Excerpt

    The blunt dissection offered by liposuction cannulas has greatly aided surgical undermining such as in face-lift surgery. Herein, we propose a new line of instruments that combines bulbous or blunt dissection with intervening lysing segments. The subgaleal version enables the surgeon to quickly undermine the scalp from ear to ear for scalp reductions in the subgaleal plane. In addition, the subgaleal device aids in the maintenance of the proper dissection plane and is useful in browlifts as well. A closely related "general" undermining device greatly facilitates face-life surgery and has found other uses in the undermining or separation of fibrous tissue planes.

    Title Orbital Optic Nerve Glioma in Adult Life.
    Date August 1989
    Journal Archives of Ophthalmology
    Excerpt

    In seven cases, optic nerve glioma presented as an expanding orbital mass in previously asymptomatic adults. Clinically and histologically, these tumors were similar to the orbital optic nerve gliomas of childhood; in contrast to the rapidly progressive malignant gliomas of the chiasm well described in adults, the patients with these tumors had a more benign clinical course. Management of optic nerve glioma in adulthood should be conservative in the presence of useful vision.

    Title Cerebrospinal Fluid Leakage Complicating Orbital Exenteration.
    Date July 1989
    Journal Archives of Ophthalmology
    Excerpt

    In three cases of cerebrospinal fluid leakage complicating orbital exenteration, leakage occurred intraoperatively following relatively low-power (0 to 25 W), high-frequency monopolar cautery to the orbital roof. Six cadaver orbits and 25 dried skulls were examined to investigate possible causes of intraoperative cerebrospinal fluid leakage. In this experimental model, monopolar cautery to the orbital roof did not cause cerebrospinal fluid leakage; however, cautery to preexistent foramina or experimentally created defects in the orbital bones did. In exenteration, monopolar cautery may transmit thermal energy through extant body defects in the orbital roof directly to the dura, resulting in its disruption. These defects may be congenital, tumor related, or iatrogenic. Alternative methods of hemostasis should probably be employed to control bleeding that occurs along the orbital roof during exenteration.

    Title Warning: Traditional Liposuction Cannulas May Be Dangerous to Your Patient's Health.
    Date November 1988
    Journal The Journal of Dermatologic Surgery and Oncology
    Excerpt

    Liposuction is the most frequently performed invasive cosmetic procedure in the United States. The vast majority of liposuctions are performed using mechanical aspirators that are connected by sterile tubing to a cannula. Although liposuction cannula shaft designs have been modified and "perfected" to various extents, little attention has been paid to the handle and handle/shaft junction. Herein we present an inherent design-induced difficulty of traditional liposuction cannulas, the inability to be optimally cleaned. In addition, we present a solution.

    Title Where is the Gray Line?
    Date October 1987
    Journal Archives of Ophthalmology
    Excerpt

    The gray line is a well-known surface anatomic landmark used by surgeons in the repair of lacerations involving the lid margin. To the best of our knowledge, no description of any deep or superficial anatomic counterpart of the gray line has been previously reported. We examined block resections of 51 eyelids histologically following localization of the gray line. The visualized gray line was consistently seen to correspond histologically to the most superficial portion of the orbicularis muscle, known as the muscle of Riolan. We comment on changes in gray line morphology with lid movement, and we advance a hypothesis to explain its "gray" color.

    Title Pseudoepiphora from Cerebrospinal Fluid Leak: Case Report.
    Date October 1986
    Journal The British Journal of Ophthalmology
    Excerpt

    A 4-year-old tearing child with obstruction of the nasolacrimal duct was treated with dacryocystorhinostomy three years after naso-orbital injury. However, what appeared to be tearing persisted, and meningitis developed. Coronal CT scans demonstrated traumatic encephalocele of the posterior superior orbital roof. A chronic orbital cerebrospinal fluid (CSF) leak was diagnosed. To our knowledge no case of chronic CSF leak has been reported that simulated tearing in an otherwise asymptomatic child. In the tearing patient who has a naso-orbital fracture the possibility of chronic CSF leak should be considered.

    Title Management of Complicated Ptosis with Contralateral Levator Recession.
    Date June 1986
    Journal Archives of Ophthalmology
    Excerpt

    We describe a unique approach to complicated unilateral minimal ptosis. Three cases of unilateral ptosis were successfully managed with the technique of contralateral levator recession. Contralateral levator recession is a useful procedure heretofore undescribed, to our knowledge, for the management of ptosis.

    Title The Preauricular Skin Graft in Eyelid Reconstruction.
    Date October 1985
    Journal Archives of Ophthalmology
    Excerpt

    The skin obtained from the preauricular graft for reconstruction of eyelid and midfacial defects is an excellent tissue and color match for the lower eyelid and medial canthus. This area is an excellent alternative graft site, and its usage should be added to the ophthalmic plastic surgeon's therapeutic armamentarium.

    Title Eyelid Ecchymosis and Proptosis in Lymphangioma.
    Date October 1985
    Journal American Journal of Ophthalmology
    Title Total Internal Reflection for Positioning Jones Tube.
    Date July 1985
    Journal Archives of Ophthalmology
    Excerpt

    Visualization of the Jones tube in the internal nose often poses difficulty for the surgeon and threatens the success of the operation. Postoperatively, localizing the end of the tube in the nose in order to confirm its placement or to analyze the cause of failure may also be technically challenging. A method of visualizing the tube in the nose under both surgical and postsurgical conditions is herein described.

    Title New Instrumentation for Fluid-air Exchange.
    Date September 1983
    Journal Retina (philadelphia, Pa.)
    Excerpt

    To facilitate fluid-air exchange, we have recently adapted and modified an instrument that has been designed to maintain the anterior chamber of an eye with pressurized air at levels which are pre-set by the surgeon. We have now altered this instrument to provide us with a means of performing a fluid air exchange that obviates the need for changing or refilling the air syringe. The intraocular pressure can be maintained at a predetermined level throughout the procedure, with unlimited filtered air controlled by the surgeon via an uncomplicated automated foot pedal control system.


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