Choice of Filler and Suitable Procedure for Augmentation Rhinoplasty

Because of its simplicity, augmentation rhinoplasty with filler material has been used as alternative choice of the operative augmentation rhinoplasty. With development of various filler materials the duration of which is long, the augmentation rhinoplasty using filler material has wide usage. This article describes the choice of filler suitable for augmentation rhinoplasty. As skin and soft tissue are abundant at the nasal tip and root, they are easily elevated when filler material is injected. However, in case of nasal dorsum, especially supratip depression, there is a lack of skin and soft tissue, therefore, the filler material injected is redistributed into the nasal tip and dorsum. Ideal filler material for augmentation rhinoplasty should be located at the injection site without quantitative change. Fortunately, 3.3% PAAG(polyacrylamide gel) has hard consistency, but no component change, and has long duration. Therefore, it seems to be an ideal filler material among numerous filler materials currently sold.

Analysis of the Improvement of Post-Traumatic Enophthalmos after Surgery

From 1996 to 2003, we reviewed 16 enophthalmos cases including 7 males(age 25 to 72 years) and 9 females (age 24 to 32 years) who have been treated in the Department of Plastic and Reconstructive Surgery, Guri and Seoul Hospital Hanyang Medical Center. We categorized the pattern of the facial bone fracture corresponding intra-orbital lesions and the operative methods(approaches and implant positioning) according to each lesions in the orbit. In preoperative and postoperative axial CT view, we measured the amount of exophthalmos at the orbital apex level. The most severe enophthalmos was observed in inferior and lateral wall defect and the differences between both globes was 5mm in CT measurement. In CT measurement, the most improved lesion was medial wall(3mm protrusion) and secondary most improved lesion was 4-wall-combined orbital lesion(2.7mm protrusion). In the other cases showed less 2mm differences in CT measurement except inferior and lateral wall lesion which showed 2.5mm difference. When the implant was located posterior to the mid-coronal line of globe, the mean improvement (2.16mm) was higher than other cases(1.7 mm).

A Case Report: Surgical Treatment of Pachydermodactyly

Pachydermodactyly is a rare distinct form of fibromatosis characterized by acquired, asymptomatic dense fibrosis and fibroblastic proliferation around one or more proximal interphalangeal joints. Intralesional triamcinolone injection may be helpful in improving the clinical appearance. A 20-year-old unemployed female patient gave a four years history of progressive swelling of the fingers affecting predominantly the proximal interphalangeal joints of index fingers of left hand and index, middle fingers of right hand. There was no pain and tenderness. Physical examination, complete blood count, antinuclear antibody, rheumatoid factor were unremarkable and radiograph of both hands showed soft tissue swelling only without bony abnormality. We excised the redundant soft tissue from the both sides of proximal interphalangeal joint with longitudinal elliptical fashion. After operation, the fingers of the patient showed marked improvement cosmetically. There were no motor or sensory changes. Pachydermodactyly was first reported in 1996 in Korea. Histologic features include an increased dermal accumulation of collagen and occasionally an increased number of fibroblast. We report for one patient with pachydermodactyly treated with longitudinal elliptical excision and obtained an improvement of clinical appearance.

Digital Sympathectomy for Treatment of Raynaud's Syndrome

Raynaud's syndrome causes discolorization, ischemic claudication(pain) and necrosis of the digits through insufficiency in the circulation which is induced by intermittent spasms of the digital arteries. From January, 2002 to December, 2004, 10 patients were surgically treated for Raynaud's syndrome. 9 patients were female and 1 patient was male. 2 patients showed unilateral involvement, 8 patients were operated on both hands. 6 patients had necrotic changes on the finger tips due to the disease. Ages ranged from 21 to 60 with an average of 39.1. Ischemic pain, discolorization, and cold intolerance of the digits were the common symptoms. All patients were evaluated with color doppler before the surgery. Two different procedures were applied according to the severity of the disease: Patients with decreased circulation received, what we call a limited digital sympathectomy, i.e. stripping of the adventitia of the ulnar, radial and common digital arteries. An extended procedure, radical digital sympathectomy, was performed on patients with a complete block of circulation. Stripping of the adventitia in these patients also involved the proper digital arteries. Symptoms like discolorization, ischemic pain, and cold intolerance improved immediately after the surgery. The patients did not suffer from pain even with exposure to cold weather. We conclude that digital sympathectomy could improve the symptoms in Raynaud's patients who do not respond to conservative treatment such as calcium channel blocker and other vasodilators.