Comparison of Physical & Histological Change of Alloplastic Implants after Implantation in Rat

Augmentation rhinoplasty is one of the most popular aesthetic procedure in Asians. Numerous alloplastic implants have been used until now, but no accurate comparative analysis about the implant materials has been reported yet. This study in animal model was designed to determine the safety and effectiveness of various implant materials in augmentation rhinoplasty. The 15 x 15 x 2 mm sized square shaped plate of Gore-Tex(R), silicone rubber, and 15 x 15 x 1.5 mm sized Medpor(R) were implanted under panniculus carnosus of the abdomen wall of rat. And tissue specimens including the implant and surrounding soft tissue were obtained by en bloc excision in 6 months after implantation. The implants were estimated in weight and volume, and also the specimens were examined grossly and microscopically. The results revealed that increase of average weight 26.9%, decrease of average volume 55.4% in Gore-Tex(R) implant, increase of each average weight and volume 62.6%, 8.7% in Medpor(R) implant and very slight increase of both average weight and volume 4.7%, 1.1% in silicone rubber implant. Grossly, the Gore-Tex(R) was deformed, Medpor(R) was strongly adherent to surrounding soft tissue and the silicone rubber was well encapsulated and easily peeled off. Microscopically, silicone rubber showed foreign body reaction slightly and there were no inflammatory responses in all alloplastic implants. In our study, silicone rubber showed very proper alloplastic features for augmentation rhinoplasty due to causing no inflammatory response, no physical change, and no deformity.

Augmentation Rhinoplasty Combined with Tip Plasty Using AlloDerm(R)

Because the Korean nose has a flat dorsum and depressed tip, tip projection procedure has frequently been performed as an ancillary procedure of dorsal augmentation. Although various materials have been used for tip plasty, an ideal technique has not yet been described. The authors performed classic augmentation rhinoplasty using a silicone implant to correct flat dorsum. Alloderm(R)(Life Cell Corporation, the Woodlands, Texas), acellular human dermis, was used for soft and smooth projection of the nasal tip. From January of 2000 to August of 2003, 20 patients underwent this procedure in Department of Plastic and Reconstructive Surgery. The patients were followed up for 2 to 26 months. Postoperative course was uneventful. Although partial graft resorption was noted in 3 patients, long-term follow-up showed good results. Alloderm(R) usage for tip plasty allows natural contour of the nasal tip, decreases donor site morbidity, and obviates time consuming procedures for graft harvesting. In conclusion, Alloderm(R) graft could be an appropriate alternative in tip projection procedure.

Combination of Nasal Ostectomy and Augmentation Rhinoplasty in the Correction of Traumatic Nasal Deformity

The nose is shaped as a pyramid and is the most prominent portion of the face. Nasal bone fractures are thus more frequent than those of the maxilla and zygoma. Whether the nasal bone fractures are corrected or not due to unnecessity of surgical treatment, the incidence of posttraumatic deformity occurs frequently. In Asian patients, even the corrected noses look low- lying and flat. To resolve these problems, we corrected the posttraumatic deformity of the nose with a combined procedure of nasal ostectomy and augmentation rhinoplasty. From 2000 to 2004, this procedure was performed in fifteen patients with posttraumatic nasal deformity. There were four female and eleven male patients with an average age of 32 years(range 19 to 52 years). All patients had previous trauma history. Of these, closed reduction was performed on 13 patients and no treatment was 2 patients. The deformed noses were corrected through lower columellar incision, by ostectomy or osteomy, and augmentation with silicone implant. We gained satisfactory results of correcting the deformed noses, except one case with implant deviation. Our method for the correction of traumatic nasal deformity proves to be simple and safe. The camouflage effect with silicone implant overcomes an unsatisfactory correction and brings a excellent cosmetic results.

A Simple Corrective Method for Prominent Ear

Various methods have been used to correct the prominent ear, in which the deformity is due to lack of formation of the normal antihelix. In 1963, Mustard presented a method which creates the antihelical fold by placing permanent mattress sutures through the cartilage without using any actual cartilaginous incisions. However, the main disadvantage of this method is difficulty in accurate full- thickness transcartilaginous suture without an injury to the anterior auricular skin. To solve this problem, the authors separated the anterior auricular skin from the cartilage by a subcision method using a 21-gauge needle without making a skin incision. Between 2001 and 2002, a total of 16 prominent ears in 12 patients were corrected by this method. Eight patients underwent unilateral correction and four patients underwent bilateral correction. Seven were female and 5 were male. Patients' age at operation ranged from 5 to 24 years(mean 9.7 years). Patients were followed up from 5 to 14 months(mean 8.6 months). No major complications were observed while using this method and good aesthetic result was achieved in all cases, except one recurrence case that needed revision procedure. This method is a simple and safe technique with reliable aesthetic results and no scar on the anterior auricular skin.

Surgical Correction of Cleft Lip and Nose Deformity Associated with Augmentation Rhinoplasty Using Silicone Implant

The correction of secondary cleft lip and nose deformity often presents an extremely difficult plastic surgical problem. The deformity is a complex, three dimensional alteration in nasal anatomy with defects in all tissue layers : skin, cartilage, vestibular lining and bone. The patient who has these kinds of deformities undergoes the aggravation of deformities, as the patient grows older. And the decreased length of maxilla is accompanied by the deficiency of posterior development. As a result, the depression of nose and midface is usually developed and especially the depression of nose is severely noted in an oriental. To correct this secondary cleft lip nose deformity in Oriental patients, alar cartilge mobilization and suspension techniques have been developed. But, these techniques have critical limitations in the suspension vector and power. Oriental people usually have thin alar cartilages and thick skin. So, the suspended, deformed alar cartilage may relapse and pull the normal alar cartilage to the deformed side. To overcome these limitations, we have carried out the augmentation rhinoplasty using a silicone implant with Tajima's inverted U incision and interdomal suturing at the same time, which is inexpensive and easily handled, to twelve patients of secondary cleft lip and nose deformity for recent 2 years. The results were considerably satisfactory, so we report this paper and then can ascertain the further aesthetic benefits, such as the postoperative augmentation of a nose, finer nasal tip and the symmetry of both nostrils.

Localization of Cyclooxygenase Isozymes in Skin Wound Healing in Mouse / 대한해부학회지

Cyclooxygenase (COX)-1 and -2 expressions in the incisional wound healing of mouse skin were determined by immunohistochemistry and Western blot analysis. By Western blotting, compared to normal skin, COX-2 activity was increased at days 1, 4, 8, and 12 and was maximal at 4 day after incisional wound of mouse skin whereas COX-1 was barely detectable. In normal skin, COX-1 immunostaining was observed among the basal cells of epidermis whereas COX-2 immunostaining was detected in the more differentiated, suprabasal keratinocytes. At 1~4 days after wound, COX-2 staining was particularly prominent in the inflammatory cells, and at day 8, many macrophage-like cells were stained positively. COX-2 immunoreactive fibroblast, macrophage-like cells, and newly formed vascular endothelial cells were increased in number at 12 days after incision. These data suggest that COX-2 is constitutively expressed, just as is COX-1, in epidermis and is associated with keratinocyte differentiation. In addition, these findings support the well-established role for COX-2, the prostaglandins that they generate, as mediators of inflammatory response.

Reconstruction of Ischial Pressure Sore by Using Posterior Thigh Transposition Flap

The area overlying the ischium is a frequent site for the development and recurrence of pressure sores because they directly overlie the points of maximum pressure on the sitting surface. Furthermore, they are frequently complicated by abnormal lesional bursae, or by extension, fistula toward the perineum or peritoneal cavity. In all cases of the ischial pressure sores, total en bloc excision of the ulceration, underlying bony prominence with immediate closure, and healthy, well-vascularized soft tissue is required to obtain the satisfactory result. It is well known that the choice of the treatment of the ischial pressure sore is the gluteal or posterior thigh flap. There have been many reports on the reconstruction of the ischial pressure sores such as cases involving the fasciocutaneous flap, muscle and musculocutaneous flaps, V-Y advancement flaps, rotation flaps, and long random flaps. In spite of these varieties, the recurrence of the ischial pressure sore after treatment still remains about seventy-five percent according to Conway and Griffith.9 Consequently, any surgical plane for ischial pressure sores must provide a stable, durable soft tissue cover that can be reused in the event of recurrence. From February to December 2002, we have performed the reconstruction of the ischial pressure sores on the posterior thigh's transposition flap in order to get following advantages: simplicity of the operation, sufficiency of padding with skin flap, preservation of the adjacent normal tissues and the capability of recycling this same flap in case of recurrences. Its design is somewhat different from and more extended widely than that of the gluteal or posterior thigh flap. This flap was elevated above the deep fascia to be cutaneous with appropriate backcut incision; some perforators from the inferior gluteal artery were also preserved. We present some cases of ischial pressure sores treated with a laterally based posterior thigh transposition flap herein. Therefore, the need to perform repetitive surgery in the future must be considered so that the maximum number of reconstructive options can be preserved. Although the follow-up period has not always been satisfactory, we have not had any serious complications in these patients until recently.

Formation of Philtral Column using AlloDerm(R) in Secondary Cleft Lip Deformity

It is essential to reconstruct philtral column correctly during cheiloplasty because philtrum has an important role in facial contouring and cosmetics of the human face. Regarding to the appropriate time of the philtral reconstruction, it is generally accepted that Millard rotation- advancement flap at the primary cheiloplasty has the advantages of decreasing tension and obtaining a remnant skin. But, many surgeons still have a tendency to reconstruct the philtrum during secondary cheiloplasty. From June 2000 to June 2001, at department of plastic and reconstructive surgery of Chonnam National University Hospital, 20 patients of secondary cleft lip and nasal deformity who previously received primary cheiloplasty were reconstructed the philtral column with acelluar human dermis(AlloDerm(R)) In conclusion, this technique have the several advantages such as simplicity, shorter operation time, absent donor site scar and effectiveness, compared with other surgical methods.

Vermilion Augmentation of Secondary Cleft Lip and Nose Deformity by AlloDerm(R)

Secondary deformities can exist after repair of cleft lip by sophisticated method of primary cheiloplasty and can affect some or all of the previously cleft regions. There may be lip scar, nasal deformity, vermilion deficiency, and maxillary hypoplasia. The correction of secondary cleft deformities is difficult and requires efforts of a multidisciplinary team. There are many operative techniques for correction of the vermilion deficiency, for example double V-Y advancement mucosal flap or double pendulum flap etc. But, these methods are very complex and can remained the scar on vermilion. Twenty six patients of secondary cleft lip and nose deformity with vermilion deficiency were operated in our department from January 1999 to June 2002. The secondary cleft lip and nose deformity was corrected by various operative methods, and the vermilion deficiency corrected by using acellular human dermis(AlloDerm(R), Life Cell Corp., Woodlands, Texas). The three cases suspected for AlloDerm(R) to be absorbed showed that the augmentation of vermilion was poor but another cases showed satisfactory result with good augmentation of vermilion and minimal scar. In conclusion, vermilion augmentation using AlloDerm(R) has the several advantages such as simplicity, shorter operation time, and effectiveness compared with other surgical methods.

Localization of Cyclooxygenase Isozymes in Dermal Wound Healing in Mouse

Cyclooxygenase(COX)-1 and COX-2 expression in dermal wound healing of mouse was detected by immunohistochemistry and Western blot analysis. In order to gain more information on the functional importance of COX-1 and COX-2 in dermal wound healing, we analysed COX-1 and COX-2 protein levels using the Western blotting technique. In addition, we used immunohistochemistry to determine the cellular localization of the protein products. The collected skins were rapidly frozen and kept at -70degrees Cuntil assayed. Each frozen skin was lysed with 0.5 ml of ice-cold solution. Large tissue debris and nuclear fragments were removed by two low-speed centrifugations and the resulting supernatant fraction was used for blots. The skin extracts were stored below -20degrees Cfor further experiments. By Western blotting, compared to the activity of COX-2 in normal skin, its activity was increased at days 1, 4, 8, and 12 and was maximal at 1 day after incisional wound of mouse skin whereas COX-1 was barely detectable. In normal skin, COX-1 immunostaining was observed among the basal cells of epidermis whereas COX-2 immunostaining was detected in the more differentiated, suprabasal keratinocytes. At post-incision 1-4 days, COX-2 staining was particularly prominent in the inflammatory cells, and at day 8, many macrophage-like cells were stained positively. COX-2 immunoreactive fibroblast, macrophage-like cells, and newly formed vascular endothelial cells were increased in number at 12 days after incision. These data suggest that COX-2 is constitutively expressed, just as is COX-1, in epidermis and is associated with keratinocyte differentiation. In addition, these findings support the well-established role for COX-2, the prostaglandins that they generate, as mediators of inflammatory response.

Role of Perivenous Areolar Tissue in the Viability of Island Flaps with an Exclusively Venous Pedicle

For the venous flap to survive, it apparently needs to be a flow-through of venous blood.1 Nevertheless, controversy remains, regarding the fact that an island flap based on a terminating venous pedicle is capable of maintaining viability.2-15 This study was designed to investigate the role of perivenous areolar tissue in the viability of island flaps with an exclusively venous pedicle in the rabbit ear model as described by Inada et al.16 Ten groups of flaps were studied: Group A-flaps based on a proximal venous pedicle; group B-flaps based on a distal venous pedicle; group C- nonvascularized grafts; each subgroup A1-, B1-flaps with perivenous areolar tissue; each subgroup A2-, B2-flap which was skeletonized pedicle; each subgroup A3-, B3-flap was same as A1-, B1-flap, which was sutured over a silastic sheet; each subgroup A4-, B4-flap with a skeletonized venous pedicle sutured over a silastic sheet; subgroup C1-control, placed directly on bed; subgroup C2-control which was sutured over a silastic sheet. Groups A3, A4, B3 and B4 had 20 flaps and the remaining groups had 10 flaps each. Flaps in group A1, A3, B3 had total survival. In groups A4, B4, C2, no flaps were survived. The survived flaps in groups A3 and B3 had tissue oxygen content values between those of arterial and venous levels. Histological examination of the pedicle of survived flaps in groups A3 and B3 showed small vascular channels present in the areolar tissue surrounding the venous pedicle. Static and dynamic computerized radioactive tracer experiments showed that the survived flaps in groups A3 and B3 were promptly perfused and drained through their pedicles. This study confirms the importance of the perivenous areolar tissue for survival of the venous skin flap in the rabbit ear model.

Surgical Correction of Scalp Defect after Tumor Removal by Tissue Expansion Technique

Since the introduction of expansion technique by Neuman(1957), the use of it has been repeatedly adjusted to the breast reconstruction, head and neck reconstruction and treatment of male pattern baldness, and so on, by the improvement of expansion devices and advancement of expansion techniques. We also used this technique in 5 patients who have scalp tumor, either benign or malignant, for 3 years(from 2000 to 2003) and specific complications were not found except wide scars. This technique has shown more excellent result than any other techniques already used and has made it possible to cover the scalp defect without the loss of hair in donor site, so we report this paper and then can ascertain the further benefits, such as the effective coverage of scalp defect by hair bearing normal scalp.

Compatibility of Ankle Skin as a Full Thickness Donor Site for Palmar Reconstruction

Although full-thickness skin grafts from the groin donor site are widely used to reconstruct a palmar skin defect, there are many aesthetic and functional problems. To solve the problems, we evaluated the compatibility of ankle skin as a full-thickness donor site for palmar reconstruction. In this study, a grafting method using ankle skin harvested from the just distal area of the lateral malleolus was performed in 17 patients to correct the post-graft contracture of the palm grafted from the groin area. Postoperative course was uneventful except 1 case of donor site disruption. Patient satisfaction rate and color difference rate using color chart manual between the grafts from the groin and ankle were assessed during the follow-up period. The parameters involved color matching, texture matching, durability, mobility, hair growth, hypertrophic marginal scar, donor site scar, patient satisfaction rate, and luminosity, yellowness, and redness in color difference. Most parameters were excellent in the graft from the ankle than that of the groin and significant difference in color was found between the 2 grafts(p < 0.05). The normal skin specimens of the palm, ankle, and groin were examined to compare their histological characters. Ten specimens were taken respectively from both sexes in each site. The skin of the palm and that of the ankle was histologically similar, but it is significantly different from the groin skin, especially in thickness(p < 0.05). Therefore, despite size limitation, the ankle should be considered as a useful option in case of palmar resurfacing of the digits and hand.

A Reconstruction of Upper Lip using Abbe Flap

Reconstruction of upper lip defects presents a challenge to the facial plastic and reconstructive surgeons. Flatness, shortness, and retrusion of the upper lip of cleft patients are caused by a combination of the initial maxillary hypoplasia, the subnormal maxillary growth, and the lack of upper lip soft tissue. Although the routine use of Abbe flaps has been questioned, various modifications of the flap have been used for the repair of deficient upper lip soft tissue. Between 1991 and 2000, the author performed a variety of Abbe flaps in 10 patients. The patients consisted of 5 males and 5 females (3 unilateral clefts, 3 bilateral clefts, 2 cancers and 2 traumas). Mean age at the time of the procedures was 28.5 years (from 16 to 48 years). The pedicles of the flaps were divided 10 to 14 days postoperatively. The follow-up period ranged from 9 to 27 months (mean=17 months). To evaluate the outcome of Abbe flaps objectively, an anthropometic ratio was measured in preoperative and postoperative photographs. This values were compared with the values found in non-cleft patients. Each patient showed a more natural contour of the upper lip. We have found that Abbe flaps were clinically useful, and our results were functionally and cosmetically acceptable. This study indicates that the lips are in better harmony postoperatively than they were preoperatively.

Surgical Correction of Microform Cleft Lip by Small Triangular Flap

Cleft lip is one of the most common major facial malformation. The defect of the midline tissue on the upper lip is due to failure of the contact and fusion between mesenchymal tissues of the lip. Microform cleft lip is defined as the cleft of the lip with the minor degree of the deformity on the lip and the nose. The hallmarks of the microform cleft lip are a small notching of the vermilion, a vertical congenital fibrous band extending from the vermilion to the nostril floor, and a displaced alar cartilage on the cleft side. The surgical methods of microform cleft lip include Rose-Thomson straight line closure and Millard Rotation- advancement repair. Although those methods repaired the functional impairment effectively, they failed to achieve the cosmetic improvement because of the long incision scar on the upper lip. The authors applied Tennison's small triangular flap to the microform cleft lips of the 10 patients from July 1998 to January 2001. We excised the scar on the notch of the vermilion with minimal incision using Tennison's small triangular flap and repaired the discontinuity of orbicularis oris musculture. The asymmetric nostrils were also corrected appropriately. We followed up each case with constant intervals and could get good results esthetically without shortening of the upper lip and the contracture of the scar band.

Development and Clinical Application of Critical Pathway for Cleft Lip and Palate

Objectives of this study is to determine the effect of a critical pathway on hospital stays and outcomes after cleft lip and palate repair. During a period of eleven months from March 2000 to January 2001, twenty six cases to applied by critical pathway for cleft lip and palate were followed up. Comparisions were made between the precritical pathway and postcritical pathway groups. The results of this study showed that expenses of treatment for cleft lip and palate was reduced to 20%, 30% respectively, after critical pathway. After critical pathway, hospital stays for cleft lip and palate was reduced to from 7 days to 4 days, from 9 days to 6 days, respectively. Postoperative complications was not increased. Patient satisfactions was increased because of the detailed explanations and reduced hospital stays. Conclusively, significant decreases in length of hospital stay are seen, and cost reductions can be realized after critical pathway.

Thinned Thoracodorsal Perforator-Based Cutaneous Free Flap

The latissimus dorsi has been used as an excellent donor site for free flap because of many advantages such as reliable anatomy, long pedicle with large-caliber vessels, easiness of dissection, and minimal functional deficit of the donor site. It is also one of the most versatile free flaps due to its carrying skin, muscle, and bone components. Nevertheless, bulkiness limits its use for resurfacing the defect in thin regions such as hand, foot, and anterior tibial area. To reduce its excessive volume when bulk is considered a disadvantage, surgical modifications were introduced: muscle sectioning, reduced musculocutaneous flap, muscle splitting, and thoracodorsal perforator-based cutaneous flap. Although the thoracodorsal perforator-based cutaneous flap excluding muscle component is thinner than others, it also needs secondary debulking procedures to resurface the thin regions. Thinning of the cutaneous flap was successfully performed in paraumbilical perforator-based flap and anterolateral thigh flap. These thinned flaps depend for their circulation on the subdermal plexus originating from their pedicled vessel. Based on their survival concept, we made the thoracodorsal perforator-based cutaneous flap thin and clinically applied it to 7 patients as a free flap. They were all survived and there was no need for secondary debulking procedures. This flap adds the advantage of little bulkiness to the conventional latissimus dorsi flap. However, it has some disadvantages such as technical difficulties in dissection of the perforator, anatomical variation in the location of the perforator, and nonsensory flap.

Expression of Proliferatin Cell Nuclear Antigen ( PCNA ) and P53 Protein in Skin Carcinomas

Basal cell carcinoma(BCC) and squamous cell carcinoma(SCC) are the most frequent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well established mutagen of p53 gene and is the major epidemiological risk factor in the development of basal cell carcinoma and squamous cell carcinoma. There is no general agreement in the several studies about the percentage of p53 positive staining of BCCs and SCCs. To evaluate the relationship between p53 positivity, PCNA index and other clinicopathological parameters, immunohistochemistry for p53 protein and PCNA was performed in 20 cases of BCCs, 14 SCCs and 3 Bowen's disease. The results are as follows; 1) The immunostaining of p53 protein and PCNA is localized to the nuclei of the tumor cells and some of adjacent normal surface squamous epithelium, more intense in the periphery of the tumor nests. 2) The pattern of immunostaining of PCNA is similar to that of p53 protein. 3) There was no difference in the expression of p53 protein according to the location of tumors, age or sex of patients, except thickness. 4) There was no difference among the BCCs, SCCs and Bowen's disease in the percentage of positive staining of p53 protein and PCNA but the aggressive BCCs and the less differentiated SCCs showed more high PCNA index and more intense p53 immunostaining. Above results suggest that the expressions of p53 protein and PCNA are related to the differentiation and biological behavior such as infiltrating property of the tumor, and they may be used as adjuvant indicators of prognosis in the skin carcinomas.

Reconstruction of Tissue Defects with Anterolateral Thigh Sensate Free Flap

As the use of free tissue reconstruction becomes more routine, attention is being focused not only on flap survival, but also on functional refinements in these flaps. One of the more important aspects of improving the outcome of these reconstruction may relate to the return of sensation. The anterolateral thigh free flap is based on the descending branch of the lateral circumflex femoral artery. This fasciocutaneous flap is indicated whenever a relatively thin flap is required in reconstruction. A neurosensory flap can be employed based on the anterior branched of the lateral femoral cutaneous nerve of the thigh. Since 1996, 15 patients with soft tissue defect on various regious were treated by using the anterolateral thigh sensate free falp. All flaps survived without total loss. Anastomosis of the sensible nerve on the recipient site with the anterior branch of the lateral femoral cutaneous nerve of the thigh was performed. All patients showed recovery of sensation in the anterolateral thigh sensate free falp beginning between the 4th and 6th month postoperatively. Follow-up periods ranged from 8 to 34 months and the results of sensory recovery were satisfactory. Therefore, resensitization of an anterolateral thigh free flap should be attempted by a nerve anastomosis in this transplant. The longterm success in this study suggests the benefits of microsurgical neurotization in free tissue transplantation.

Clinical Observation of Esthetic Genioplasty

The chin is located on the center of the face and plays an important role in making an esthetic and harmonious appearance of the face. A deformity of this part can either be an isolated problem, or coexist with malformations of the jaw or other facial structures. Surgery of the chin is performed to correct the size, shape, and appearance of the tip of the chin. The operation, also known as a genioplasty(chin reshaping), is performed most commonly to enlarge the chin. For those with a receded chin, it would improve the projection of the chin and result in better balance with the remainder of the face. Occasionally, the operation may also be performed to reduce the volume of an over-sized chin. Since the first description of the genioplasty by Hofer, 1942, it was performed more frequently and effectively in that patient's satisfaction has been higher than any other esthetic surgery. We have carried out 20 cases of esthetic genioplasty in recent 10 years from 1990 to 2000. We have restored the chin contour by using several methods including silastic or Medpor implant onlay support, ostectomy, horizontal sliding osteotomy. In this paper, we have retrospectively reviewed the experiences with many kinds of genioplasty through the patient's records, photographs and radiologic films. The results were summarized as follows: 1) The mean age of the patients was 26.2 years old, and the sex ratio was nearly equal. 2) The methods of operations included 8 cases of augmentation genioplasty, 8 cases of reduction genioplasty, 4 cases of horizontal osteotomy. 3) The procedures were done mainly with intraoral approach. 4) No special postoperative complications were noted except one case of infection. We have noted that all the patients who received the esthetic genioplasty were satisfied with the results and had no special complications except in one case. In this study, we present the various clinical experiences of correcting each malformed chin. The preoperative planning, operation methods, and postoperative complications are presented in detail.