Lower Blepharoplasty by Repositioning of Orbital Fat

Palpebral bag of the lower eyelid & tear trough groove is regarded as a sign of aging. This is mainly caused by weakening of the orbital septum, atrophy of the orbicularis oculi muscle and slackness of the skin. This palpebral bag is usually combined with a depression along the inferior orbital rim which is called a tear trough groove. In the past, the surgical excision of the fat pad has been the mainstay of the management of lower palpebral bag in cosmetic blepharoplasty. But, excision of the protruded orbital fat as a treatment for palpebral bag may contribute in long term to the senile enophthalmos due to a volume reduction of the intraorbital adipose tissue. Recently, fat pad sliding method with septal incision has been performed for preservation of orbital fat. This technique, however, causes problems such as lid ecchymosis, chemosis, lid contour irregularity, ectropion, and retrobulbar hematoma formation. The authors propose to restore the functional integrity of orbital septum. Attenuated orbital septum with orbital fat was stretched and transposed to cover the bony framework. The orbital septum with orbital fat meticulously sutured to the periosteum of inferior orbital rim with 5-0 nylon. This technique of septal draping over the inferior orbital rim was performed in 54 consecutive individuals(108 lower eyelids) for 27 months period. The overall results obtained, with the exception of mild degree of puffiness encountered soon after the surgery, were satisfactory and morbidity was minimal.

Correction of Traumatic Upper Lid Deformity

The most common type of emergency treatment in the field of plastic and reconstructive surgery is for facial soft tissue injuries. Especially upper lid injury cases can easily be treated by primary closure. However, primary closure of lid results vary from just scar formation to loss of double fold and ptosis. Having successfully performed correction of the traumatic upper lid deformity by various methods with satisfactory results, we now report these results. We performed correction on 24 patients, who visited our hospital primarily because of traumatic upper lid deformity. They had diverse main symptoms, including the loss of double fold, asymmetric eyelid, ectropion and ptosis after trauma. The surgical method was removal of previous scar tissues to prevent deformity by adhesion, followed by complete release of adhesive tissues around aponeurosis. If there was ptosis or loss of double fold, we fixed the cut levator aponeurosis to the tarsal plate, or fixed the posterior surface of the orbital septum or levator aponeurosis to the dermal plane of the lower line of skin incision or superior tarsal border. In cases of ectropion or lagophthalmos, adhesive scars were sufficiently detached from levator aponeurosis to enable eye closure. All patients showed improvement of previous deformities and there was no relapse or any newly developed deformities by adhesive scars. As traumatic upper lid noticeable deformities usually have excessive adhesion of scars and distortion of normal anatomical structures, preoperative evaluation with careful and accurate techniques suitable for each cause, are thought to be essential for obtaining good results.

Correction of Upper Lid Entropion in Childhood

Entropion is usually classified into congenital entropion, secondary entropion due to epiblepharon, cicatricial, involutional and spasmodic entropion. In cases of infants and children, congenital upper lid entropion, which is caused disinsertion and dysgenesis of levator aponeurosis, and epiblepharon with excessive skin are most common. Congenital entropion requires a surgical treatment because that is hard to be cured spontaneously. And epiblepharon that cause corneal irritation persistently, also requires a surgical treatment. As we got satisfactory results of repairs of upper lid entropion in childhood, both functionally and cosmetically, we report those. We performed surgical repair of 11 children with upper lid entropion from Jan. 2003 to Aug. 2006. Five of those, who had lower lid entropion also, repaired it together with upper lid entropion. Children were 2 to 14 years old, average 8 years old, and mean follow-up assessment period was 12 months. Under the general anesthesia, we drew the line on the prearranged double eyelid placing 5~6mm from superior border of eyelash. After removing connective tissues on and near of orbicularis oculi, orbital fat was preserved as much as possible. Then we fixed posterior surface of orbital septum or levator aponeurosis to dermis or superior border of tarsal plate under prearranged double eyelid line. In this time, the location of fixation should be determined carefully not to make lagophthalmos and to make eyelash facing upward. We've got sufficient results from all of 11 children functionally as well as cosmetically, and there were no complication such as asymmetric eyelid, lagophthalmos or a relapse during the follow-up period. When it comes to entropion, which is unable to be cured naturally, surgical treatment is required before the functional problems occur. It is important to decide the timing of surgery, thus observe lashes to rub the corneal carefully. It is difficult to correct appropriately, because the operation is performed in general anesthesia. Thus, the meticulous surgical technique and surgeon's experience are important for the correction of entropion in children completely.

Clinical Considerations of the Surgical Treatments of the Pressure Sore

PURPOSE: The number of sore patients are increasing steadily, especially in old ages, chronic disease and paralytic patients. Most of patients need to surgical treatment. The aim of this paper is to assess clinical analysis of surgical treatment and to consider operative methods, complications, and recurrences. METHODS: We reviewed the data from 82 consecutive patients with 101 pressure sores from March 2003 to May 2006 to discuss the occurrence rate and recurrence rate according to the site on the basis of the presence or absence of paraplegic and its etiology-the patients were categorized into three diagnostic groups: traumatic paraplegics(TP), nontraumatic paraplegics (NTP), and nontraumatic nonparaplegics(NTNP). We examined the sites and sizes of each lesions, patient's state, primary causes of pressure sore, operative methods as each sites and groups, occurrence of complications and recurrences on each groups. RESULTS: In 82 patients, 52 patients were male, 30 patients were female. The male to female ratio was 1.7 :1. Mean age was 55.8 years. 27 patients were in TP group, 35 in NTP group, and 20 in NTNP group, respectively. The common site of sore were sacral area (50.5%), greater trochanteric area(15.8%) and ischial area(13.9%). In each group, incidence rate of recurrence and complication were 11.1%, 40.7% in TP, 5.7%, 5.7% in NTP and 15%, 45% in NTNP. CONCLUSION: Surgeons must consider the general condition of the patient and possibility of recurrence and returning of daily life. We propose that cutaneous flap, fasciocutaneous flap or skin graft as well as musculocutaneous flap be useful to repair of sore site as each patient's state.

Psychiatric Analysis about Transsexuals

PURPOSE: Transsexualism is considered to be the extreme end of the spectrum of gender identity disorders characterized by, among other things, a pursuit of sex reassignment surgery(SRS). We evaluated psychologic status, health-related quality of life in female-to-male (FTM), male-to-female(MTF) transgender individuals. METHODS: We used the Minnesota Multiphasic Personality Inventory, Beck Anxiety Inventory, Beck Depression Inventory, Moudsley obsessive-compulsive Inventory, SCL-90-R, Short-Form 36-Question Health Survey version 2(SF-36v2). We enrolled 40 transsexual participants. RESULTS: Analysis of quality of life health concepts demonstrated statistically significant(p<0.01) diminished quality of life among the transsexual participants as compared to the Korea male and female population. FTM transgender participants reported more higher hostile, phobic than MTF transgenders. Overall, in all psychologic status examination, Transgender individuals are within normal population boundary. On all category, result is improved post-operatively. CONCLUSION: Transgender participants reported mental status within normal boundary. SRS improved their quality of life and mental stability.

Prevalence of Otitis Media in Cleft Palate Patients

PURPOSE: Cleft palate is very common congenital malformation in Korea. It is often accompanied with middle ear disease above all otitis media. Its cause is known as the functional dysfunction of Eustachian tube by the anatomical defects of hard and soft palate. Exudative fluid collection & inflammation is occurred on middle ear whose clearance and protection is inhibited by Eustachian tube blockage. Previous reported otitis media prevalence is various from 40% to 90% depends on regions and human races. MATERIALS & METHODS: For the past 5 years, from Jan. 2001 to Dec. 2005, we had been treated 144 cleft palate patients in Dong-A university medical center. The retrospective study was carried on the base of patient hospital course and operation records. RESULTS: Otitis media prevalence mean value was 73.3 % (211/288 ear), ventilation tube insertion rate was 85.3% (180/211 ear). Prevalence by age was 89.3%, 87.5%, 73.5%, 28.8% along 0-12, 13-24, 25-36, more than 37 months each. Ventilation tube insertion rate by age was 84.7%, 87.7%, 84.0%, 84.2%. Prevalence by cleft palate type was 23.7%, 46.4%, 51.2% along submucosal, incomplete, complete type each. Ventilation tube insertion rate by type was 40.0%, 77.6%, 94.4%. CONCLUSION: The otitis media prevalence was declined as the patients grew old. But the ventilation tube insertion rate had no significant decrease. The prevalence by type was increased as the severity of deformity rise up. And the ventilation tube insertion rate was also increased.

Comparative Analysis in Social Development of Children with Cleft Lip Nasal Deformity According to Timing of Correction: School Age and Preschool Age

PURPOSE: Correction of cleft lip nasal deformity has been performed from March, 1995 to June, 2006 at Donga-A University. The goal of this study is to evaluate children's psychosocial development and to determine the optimal timing of repair. METHODS: This is the retrospective study of patients operated at pre-school and school age. The patients could be divided into two groups, corrected at pre-school age(n=30), and school age(n=30). To evaluate the social development, we used 4 parameters, Children individualism-collectivism scale, Pictorial scale perceived competence social acceptance for young children, Matson's children social adaptability scale, Academic performance rating scale. RESULTS: Operated group at pre-school age had better social adaptation, social acceptance, self-image, self- esteem and academic performance than operated group at school age. CONCLUSION: It is better that correction of secondary lip nasal deformity at pre-school age than at school age in social development.

Secondary Blepharoplasty Using Various Methods

Surgical alterations of upper eyelids can have significant effect on the appearance of the individual. Blepharoplsty is a relatively simple method but it has the highest rate of complications. It includes supratarsal depression, excessively high and low crease, short or fading crease and asymmetric eyelids. Between March of 2003 and March of 2006, 50 cases of secondary correction of asymmetric eyelids were performed with various methods by authods. All patients had previously undergone primary upper eyelid surgery. The result were graded as excellent, good, fair, or poor, based on the correction of deformities, surgeon's satisfaction, patient's satisfaction. With an average follow up period of 8 months, 32(64%) patients were found to have excellent results, 15(30%) had good results, 3(6%) had fair results. Complications were 2 cases of hematoma, 2 cases of persistent swelling and 3 cases of remaining asymmetry. Secondary correction of eyelids require some considerations that extensive tissue scarring and adhesions, excessive fat removal, injury to the levator aponeurosis, and inaccurate placement of the anchoring sutures and so on. After careful preoperative evaluation and planning, using appropriate methods according to the etiologies of deformity, successful outcomes can be achieved.

Estimation of Lower Abdominal Flap Survival in Rabbit Model Using Laser Doppler Flowmetry Value

Microsurgery has developed over the last three decades to become a routine surgical operation and it's indications for autogenous tissue transplant have been increased. Despite of initial success rate ranging from 80 to 95 percent, the compromise of vascular pedicle causing flap loss has been still one of the serious complications in the microsurgery. As the success of re-exploration is inversely proportional to the time elapsed till the clinical recognition of vascular complication after operation, early detection of perfusion compromise is an important determinant of flap salvage. In this sense, the laser doppler flowmetry has been widely used as an objective monitoring system for the flap survival. This study was designed to investigate the critical time point of flap survival and to estimate the variation of flow value measured by laser doppler flowmetry. Sixteen New Zealand white rabbits weighed from 1.5 kg to 2 kg were used. The lower abdominal island flap(10 5 cm) based on the superficial epigastric pedicle was elevated and repositioned again. The flow values were checked before the flap elevation, immediately after the flap elevation. And thereafter, they were also checked before and after the ligation of pedicle at the 6th, 8th, 10th, 12th, 14th and 16th day of experimental period. After a preliminary study, additional 5 rabbits on each 14th and 16th experimental day were included in the same experimental procedure. The LD value in each point was measured with the laser doppler flowmetry and it was taken as the value of LD at the experimental time. After that, LD ratio(D/C) was obtained by calculating the ratio of LD value(D) after pedicle ligation to that(C) before pedicle ligation in each experimental period. The flap necrosis was noted from the 6th postoperative day to the 12th postoperative day after the pedicle ligation. On the 14th day after the operation, flap survival was noticed after the pedicle ligation. In the group of flap necrosis, LD ratio(D/C) from the 6th day to the 12th postoperativ

Classification and Operation of Microform Cleft Lip

Microform cleft lip is a mild expression of cleft lip. Downward depression of the nostril rim, skin striae of the upper lip, notching of the Cupid`s bow, and deformity of the vermilion border are characteristic findings. The definition is very important to aid in selection of the operative methods. Based on our operative experiences of cleft lip, we classified microform cleft lip according to our new definition.. According to author`s classification, class I(1 case) has cleft lip nose deformity without lip deformity or with slight short lip of cleft side, class IIa(5 cases) has minimal lip deformity with blurring of cupid`s bow, vermilion notching, and skin striae with intact of orbicularis oris muscle, class IIb(12 cases) has discontinuity of the orbicularis oris muscle, class III(5 cases) has mild lip nose deformity with discontinuity of orbicularis oris muscle including Cupid`s bow deviation. In class IIb and class III, reconstruction of orbicularis oris muscle is important and we repaired it with radical operation by rotation-advancement method. A total of 23 microform cleft lip result was reviewed. We treated the clefts following the above principles according to the classification and obtained satisfactory results.