Research and Innovation Allan E. Wulc, MD, FACS

Dr. Allan E. Wulc has published research in facial plastic surgery for nearly four decades, spanning eyelid anatomy, early cosmetic use of botulinum toxin, midface aging, and surgical device patents. Below is a selection of that work, organized by area of focus.

Selected Publications

Wulc AE, Dryden RM, Khatchaturian T. Where is the gray line? A clinical and histological study. Arch Ophthalmol. 1987;105(8):1092-1098.
Foster JA, Barnhorst D, Papay F, Oh PM, Wulc AE. The use of botulinum A toxin to ameliorate facial kinetic frown lines. Ophthalmology. 1996;103(4):618-622.
Sharma P, Czyz CN, Wulc AE. Investigating the efficacy of vibration anesthesia to reduce pain from cosmetic botulinum toxin injections. Aesthet Surg J. 2011;31(8):966-971.
Mally P, Czyz CN, Wulc AE. The role of gravity in periorbital and midfacial aging. Aesthet Surg J. 2014;34(6):809-822.
Steinsapir KD, Rootman D, Wulc A, Hwang C. Cosmetic microdroplet botulinum toxin A forehead lift: a new treatment paradigm. Ophthal Plast Reconstr Surg. 2015;31(4):263-268.
Harounian J, Wulc AE, Brackup AB, Ramesh S. Subtle eyelid retraction after lower blepharoplasty. J Plast Reconstr Aesthet Surg. 2019;72(10):1682-1687.
Shtraks JP, Fundakowski C, Yu D, Hartstein ME, Sarcu D, Lu X, Wulc AE. Investigation of the longevity of the endoscopic midface lift. JAMA Facial Plast Surg. 2019;21(6):535-541.
Ramesh S, Goldberg RA, Wulc AE, Brackup AB. Observations on the tear trough. Aesthet Surg J. 2020;40(9):938-947.
Ramesh S, Johnson P, Sarcu D, Wulc AE. Gravity in midfacial aging: a 3-dimensional study. Aesthet Surg J. 2021;41(2):143-151.
Dontu P, Ni G, Yan F, Ni R, Elmer N, Arosarena O, Hartstein M, Wulc A. Treatment of malar festoons with radiofrequency microneedling. Aesthet Surg J. 2025.

Where Is the Gray Line? (1986 to 1987)

Early in his career, Dr. Wulc, alongside Robert M. Dryden and T. Khatchaturian, conducted a histological study of the gray line, a surface landmark surgeons rely on when repairing eyelid margin lacerations.

The study was presented at the American Society of Ophthalmic Plastic and Reconstructive Surgery meeting in November 1986 and published as "Where Is the Gray Line? A Clinical and Histological Study" in the Archives of Ophthalmology in 1987. It remains cited in eyelid anatomy literature today and won the prize for best Paper in its category.

Early BOTOX Research (1990s)

Dr. Wulc's research on cosmetic uses of botulinum toxin dates to the early 1990s, a period when the treatment was still new to aesthetic medicine. He presented on botulinum toxin treatment of glabellar rhytids at the American Academy of Aesthetic and Restorative Surgery in 1993, and on treatment protocols for glabellar folds in 1994.

That work led to the 1996 paper "The Use of Botulinum A Toxin to Ameliorate Facial Kinetic Frown Lines," published in Ophthalmology with co-authors Jill A. Foster, Donald Barnhorst, Frank Papay, and Phaik Mae Oh.

A companion paper, "The Use of Botulinum A Toxin to Ameliorate Facial Dynamic Lines," appeared the same year in the International Journal of Aesthetic and Restorative Surgery. Dr. Wulc went on to teach BOTOX injection techniques in courses around the country over the following two decades.

Midface Aging and Midface-Lift Research

Dr. Wulc developed the WNatural Micromidfacelift, an endoscopic preperiosteal approach to midface lifting performed through a transtemporal incision. His research group has published extensively on both the underlying cause of midface aging and the durability of the procedure.

In "The Role of Gravity in Periorbital and Midfacial Aging" (Aesthetic Surgery Journal, 2014), Mally, Czyz, and Wulc argued that positional change plays a larger role in midfacial aging than volume loss alone, a position later tested further in "Gravity in Midfacial Aging: A 3-Dimensional Study" (2021).

In "Investigation of the Longevity of the Endoscopic Midface Lift" (JAMA Facial Plastic Surgery, 2019), Dr. Wulc and colleagues reviewed data from 143 patients treated between 2000 and 2016, finding sustained improvement in midfacial height that persisted over long-term follow-up.

He is also co-editor of the textbook Aesthetic Rejuvenation of the Midface (Springer, 2012), contributing chapters on the pathogenesis of midface aging and the preperiosteal midface lift technique.

More recently, he published an update to his technique in Advances in Cosmetic Surgery, Volume VII, a Springer text.

Lower-Eyelid and Tear-Trough Research

Dr. Wulc's research on the lower eyelid spans both surgical techniques and outcome measures.

"Contemporary Thoughts on Lower Eyelid and Midfacial Aging," co-authored with D.R. Buchanan (Clinics in Plastic Surgery, 2015), reviews the anatomic basis of lower-eyelid change with age. In "Observations on the Tear Trough" (Aesthetic Surgery Journal, 2020), Ramesh, Goldberg, Wulc, and Brackup examined how different surgical approaches affect the appearance of the tear trough, building on earlier work quantifying nasojugal fold depth after fat excision versus fat transposition in lower blepharoplasty.

Festoons and Malar Mounds

Festoons, sometimes called malar mounds or mid-cheek mounds, have been a recurring subject of Dr. Wulc's research and lecturing, including invited talks on festoon management at Vegas Cosmetic Surgery (2015, 2016) and the Aesthetic Meeting in Miami (2018).

That clinical experience informed "Treatment of Malar Festoons With Radiofrequency Microneedling" (Dontu, Ni, Yan, et al., Aesthetic Surgery Journal, 2025), a retrospective review of 43 patients treated with radiofrequency microneedling for festoons between 2017 and 2023, evaluated by both surgeons and laypeople.

Revision Eyelid and Facial Surgery

Dr. Wulc's practice includes a substantial focus on revision surgery for patients unhappy with the results of prior procedures, and his published work reflects this focus.

"Subtle Eyelid Retraction After Lower Blepharoplasty" (Harounian, Wulc, Brackup, Ramesh, Journal of Plastic, Reconstructive and Aesthetic Surgery, 2019) proposed more sensitive measurements for identifying early eyelid retraction and eversion following lower blepharoplasty, a common complication in revision cases.

Also the chapter in Ramesh, Holds, Burkat and Hartstein on midfacelifting for eyelid retraction

Books, Teaching, and Editorial Work

Dr. Wulc served as Editor of the Journal of Dermatologic Surgery and Oncology in 1993 and has co-edited Advances in Cosmetic Surgery (Elsevier) across eight volumes published from 2017 to 2025.

He co-edited Aesthetic Rejuvenation of the Midface (Springer, 2012) and has served as Editor of the Oculoplastics section of Advances in Ophthalmology and Optometry (Elsevier, 2016 to 2018).

Since 2010, he has co-directed the Practical Anatomy Workshops in Eyelid and Facial Plastic Surgery at Saint Louis University, teaching both basic and advanced surgical courses to other facial plastic surgeons.

Patents and Medical-Device Innovation

Dr. Wulc holds four issued United States patents related to endoscopic and minimally invasive facial surgery:

Surgical instrument for endoscopic suturing of deep subcutaneous tissue. US Patent No. 7,060,079. Issued June 13, 2006.
Surgical instrument for endoscopic suturing of deep subcutaneous tissue. US Patent No. 7,780,684. Issued August 24, 2010.
Suturing device and clamp for use with same. US Patent No. 11,701,107. Issued July 18, 2023.
Suturing device and clamp for use with same. US Patent No. 12,383,257. Issued 2025.

A related application (US Patent Application Publication No. 2026/0033830) was published in February 2026 and remains pending. Corresponding international patent protection has been pursued in Canada, Europe, Australia, Germany, Austria, South Korea, and under the Patent Cooperation Treaty.