Double Eyelid Operation in Middle-aged Women by Buried Suture Method

Double eyelid operation is the most common cosmetic surgery in Asian. There are two procedures for the double eyelid operation: one is an incision method and the other is a suture(non- incision) method. The latter is classified into two categories: stitch method and buried suture method. The popular indications for the non-incision method are listed below (1) A dislike is shown for a procedure that may possibly leave conspicuous scars. (2) The relaxation of the skin and orbicular oculi muscle is not strong, and they retain some tension. (3) The deposition of subcutaneous fat is not very heavy. (4) A wide double eyelid line is not desired. (5) A weak double eyelid line is already present. So the plastic surgeon generally offer the incision method when the patient is older than the age of 35. But rarely aged woman wants the double eyelid operation by non-incision method because of short recovery time and less scar. From December 1999 to June 2003, we performed the double eyelid operation by non-incision method in 22 patients who are older than the age of 40 with selective indications. 16 patients (72.73%) were satisfied with their aesthetic results.

Clinical Analysis of Pilomatrixoma: A Review of 107 Cases

Pilomatrixoma, calcifying epithelioma, is a benign neoplasm that arises from hair follicle matrix cells and a common skin neoplasm that is often misdiagnosed as other skin condition. Our study is to examine the clinical & histopathological presentation, and management of pilomatrixoma. We conducted a 4 year retrospective study of 102 patients who had a confirmed histopathologic diagnosis of pilomatrixoma. The symptom was a slowly growing, rock-hard, solitary, superficial mass in the head(64.5%), neck(14.0%) and upper extremities(12.2%). Male-to-female ratio was 1:1.3 and the mean age of patients was 13.2 years. The mean tumor size in greatest dimension was 1.3cm and the overlying skin was slightly reddish or bluish and slightly elevated than surrounding normal skin. The excised mass was relatively well encapsulated and showed multiple nodularity and calcification. The preoperative diagnosis was accurate and consistent with the pathological diagnosis of pilomatrixoma only in 38 cases (35.5%), and the most often preoperative diagnosis were unidentified mass(43%) with inclusion of 8 other possible diagnoses. All masses were treated with surgical excision without recurrence. This entity should be considered with other neoplasm in the clinical differential diagnosis of solitary firm skin nodules, especially those on head, neck, or upper extremities in young children. The results of our study was in accordance with previously published literatures and we agree that surgical excision is the treatment of choice and the recurrence rate is low.

The Technique for Correction of Male Nipple Hypertrophy: The Sinusoidal Wave Form Excision and Purse-String Suture Method

Nipple hypertrophy is not a common condition in male but it can cause psychological and social disturbances to young male patients and hinder them from participating in various recreational activities. The main goal of nipple reduction is cosmesis in male, but functional goals are more important in females. Several methods1-5 of reduction have been described. However very few 6-8 adress the problem of male nipple hypertrophy. In our report, we have described the technique for nipple hypertrophy in male using sinusoidal wave form excision and purse-string suture method. We have used this technique for a male nipple hypertrophy patient and had good aesthetic result without any postoperative complications.

Clinical Experiences of Endoscopically Assisted Mandibular Angleplasty

The reduction mandibular angleplasty is one of the most common aesthetic facial bone contouring surgery in the Oriental and the intraoral approach has been used commonly. However this method has some disadvantages because of anatomical restriction of operation field. We performed therefore the reduction of mandibular angle with endoscopic assistance in 15 patients of mandibular angle protrusion. Thirty patients of mandibular angle protrusion were randomly divided into control group (n=15) who received classic ostectomy and study group (n=15) who received endoscopically assisted ostectomy. We compared two groups in operative times, size of incision, duration of postoperative accommodation and satisfactory rate of doctors and patients. Size of incision was assessed as smaller in study group who received endoscopically assisted ostectomy than that of control group who received classic ostectomy on student t-test (5.50 + /-0.65 versus 4.70+/- 0.56, p< or= 0.01). Duration of postoperative accommodation was also assessed as shorter in study group on student t-test (5.07+/- 0.80 versus 4.00+/-1.00, p< or =0.01). There was no specific difference between 2 groups for operative time on x(2)-test (97.33+/- 12.22 versus 97.33+/-12.80, p=1.00). Satisfactory rate of cosmetic appearances were similar according to patients and surgeons. The postoperative course was satisfactory with smaller size of incision, shorter duration of postoperative accommodation and similar operative time and satisfactory rate of cosmetic appearances according to both patients and surgeons.

The Utility of Thin Section CT in Pediatric Nasal Bone Fracture

The incidence of facial bone fracture in children is relatively uncommon compared with that in adults. Nasal bone fracture in children may cause cosmetic or functional disabilities, so the patients should be properly treated. The diagnosis of nasal bone fracture in children is difficult because the pediatric patient does not permit the most gentle examination and x-ray examination. Failure to confirm a suspected fracture on radiography should not always deter treatment. Clinical judgment should overrule other consideration. The advent of computerized tomographic (CT) scanning has improved the radiologic diagnosis of facial fractures. But the facial bone CT is unable to image the nasal structures in detail. So the authors have performed thin section computed tomography in such children, and compares the accuracy of child`s nasal bone fractures of thin section CT scan with traditional CT scan.

The Use of Porous Polyethylene Implants (Medpor(R)) in Cross Pattern in Case of Extensive Blow Out Fracture

Implants are used in operative reconstruction of bony defect in case of blow-out fracture. If there is a large bony defect, the thin and flexible implants can not sustain intraorbital pressure, so it may be displaced. To prevent postoperative displacement of the implant, we tried reinforcing the center of the implant, where the intraorbital pressure was focused, piling up two pieces of porous polyethylene Implants(Medpor(R)) cross- shaped. 190 patients of large blow out fracture were divided into control group(n=95) who received classic orbital wall reconstruction and study group(n=95) to whom we inserted two small pieces of Medpor(R) one by one and covered a large defect cross shaped. We compared two groups in operative time, duration of postoperative accommodation and re-operation number. Operative time was assessed as shorter in study group(16.73+/-4.24min vs 21.40+/-5.32min, p> or =0.01). Duaration of postoperative accommodation also assessed as shorter in study group (2.05+/-0.70 weeks vs 3.00+/-1.00 weeks, p> or =0.01). There was no specific difference between two groups for re- operation number (3 vs 3, p=1.00). The method to insert two small pieces of Medpor(R) one by one and covered a large defect cross shaped shows shorter operative time and duration of postoperative accommodation than the classic method inserting large one piece of Medpor(R).

Reconstruction of Wide Soft Tissue Defect of Frontal Area with Terudermis(R) and Hydrogel(R)

There have been many difficult cases in direct closure of soft tissue defect of frontal area because of its tension, so that for reconstruction of this area skin graft, local flap and free flap has been used traditionally. Although local flap represent best result in concern of its color, touchness and compatability of function, it is not always available in case that the defect size is wide. we must consider skin graft in such case but it also can not be used if there is exposure of bone with loss of periosteum. Recently there are many reports about the use of collagen dermal substitude (Terudermis(R)) and the use of Hydrogel(R) which provide moist wound environment to facilitate epithelization is increased. The authors report the experience of combination treatment with Terudermis(R) and Hydrogel(R) to take rapid soft tissue regeneration in case of wide soft tissue defect in frontal area with bone exposure.

A Case of Mini-pudendal Flap for Vaginal Reconstruction in Turner Syndrome

Turner's syndrom is a disorder of gonadal differentiation in patients phenotypically female, marked by short stature. undifferentiated gonads, and variable abnormalities that may include webbing of the neck, low posterior hair line, cubitus valgus, and cardiac defects. It is typically associated with absence of the second sex chromosome(45, XO). The mini-pudendal flap was designed as a result to reconstruct the vaginal deformity of a patient with Turner's syndrom. The flap are raised bilaterally in the perineum just lateral to the labia majora and then are transposed toward the midline and sutured together. This technique is currently available method because it is simple and reliable. No stents or dilators are needed because of minimal flap contracture. It is a safe technique without complications. The donor scars in the groin are well hidden.

Case Report of Cranioplasty by Composite Use of Alloplastic Materials

In patients who have defects on cranial bone, it is well known that reconstruction with autogenous bony material is the method of choice. However, it has limitations.; manipulation difficulty, donor site morbidity. Recently, many available synthetic materials has been developed, and their use became more common. The original cranial bone has three layers. ; outer table, medulla, inner table. Based on this finding, we performed cranioplasty in bony defect patients by composite use of Bone wax(R), Bone chip(R), Medpor(R). With this method, we could reproduce more reliable bony contour which mimic original cranial bony three layers.

The Analysis of Perioperative Photogrammetry in Reduction Malarplasty Patients

Facial contouring surgery is a one of the most common and popular procedure in the field of plastic surgery. The aim of this study is to evaluate the effectiveness of photogrammetric analysis by measuring preoperatively and postoperatively in the patients who were undertaken reduction malarplasty. From January 1995 to May 1999, from thirty patients of reduction malarplasty, Photography of life size - frontal view, lateral view, worm's eye view - were taken. The photograph was analyzed by the same surgeon to reduce an analytic error. The distance between both malar eminences and both zygions was the anatomical landmarks. The differences between pre- and postoperative photographic distance represented the results of the operation. The distance between both malar eminences (ME): preop/postop = 94 - 105 mm/89 - 99 mm. The distance between both zygions(ZY): preop/postop = 125 - 141 mm/ 120 - 135 mm. The reduction values of ME-ME/ZY-ZY are 3 -13 mm / 4 - 12 mm. The photogrammetric analysis of reduction malarplasty was very practical in measuring postoperative changes. We may assume that photogrammetric analysis may be very useful tool on preoperative diagnosis, plan and analysis of result of operation.