ABSTRACT
Lacrimal fistula (LF) is a rare abnormality of the lacrimal system. Patients with LF are usually asymptomatic, and thus, treatment is unnecessary. During surgery on a patient with LF, the fistula may fall into the range of dissection. In such cases, fistula management becomes important. A 19-year-old woman visited our department to receive incisional blepharoplasty and medial epicanthoplasty, and a preoperative physical examination revealed LF. During surgery, we found the fistula tract to be within the dissection field, and thus, the LF was cut and cauterized. One year after the surgery, inflammation and hypertrophy of the remnant lacrimal duct occurred. The wound was stabilized by creating an opening that reconnected the stump and the overlying skin. Through this case, we hope to establish the appropriate strategy for managing LF detected during medial epicanthoplasty. As seen in our case, cauterization should be avoided because of the high recurrence rate of LF. Instead, as definitive treatment, fistulectomy should be performed, or the fistula should be moved along with the skin flap when a small skin flap is transferred.
Subject(s)
Female , Humans , Young Adult , Blepharoplasty , Cautery , Fistula , Hope , Hypertrophy , Inflammation , Lacrimal Apparatus , Physical Examination , Recurrence , Skin , Wounds and InjuriesABSTRACT
Lacrimal fistula (LF) is a rare abnormality of the lacrimal system. Patients with LF are usually asymptomatic, and thus, treatment is unnecessary. During surgery on a patient with LF, the fistula may fall into the range of dissection. In such cases, fistula management becomes important. A 19-year-old woman visited our department to receive incisional blepharoplasty and medial epicanthoplasty, and a preoperative physical examination revealed LF. During surgery, we found the fistula tract to be within the dissection field, and thus, the LF was cut and cauterized. One year after the surgery, inflammation and hypertrophy of the remnant lacrimal duct occurred. The wound was stabilized by creating an opening that reconnected the stump and the overlying skin. Through this case, we hope to establish the appropriate strategy for managing LF detected during medial epicanthoplasty. As seen in our case, cauterization should be avoided because of the high recurrence rate of LF. Instead, as definitive treatment, fistulectomy should be performed, or the fistula should be moved along with the skin flap when a small skin flap is transferred.
Subject(s)
Female , Humans , Young Adult , Blepharoplasty , Cautery , Fistula , Hope , Hypertrophy , Inflammation , Lacrimal Apparatus , Physical Examination , Recurrence , Skin , Wounds and InjuriesABSTRACT
BACKGROUND: There has been increasing interest in facial contouring procedures throughout Asian countries. As such, botulinum toxin A injections for masseteric hypertrophy have become a common procedure provided to patients who desire non-surgical correction of a square-angled mandible. We published a retrospective review of our initial results and our technique and treatment protocol in 2005. We also completed a long-term follow-up of the results (average follow-up period of 4.28 years) and the efficacy of repeated injections in 2010. The purpose of the current study is to systematically evaluate the changes to the masseter muscle at weekly intervals to determine the physiologic effects of botulinum toxin A injection. METHODS: Eight patients were prospectively followed on a weekly basis after botulinum toxin A injection for masseteric hypertrophy. Eight patients were followed for 15 weeks and four patients were followed for 25 weeks. Changes in the thickness of the muscle were recorded and analyzed. RESULTS: A reduction in the muscle thickness was found during the clenching phase of the muscle in the first week followed by a reduction in thickness during the resting phase in the second week. The reduction in muscle thickness continued until the eleventh week after which there was a gradual, but incomplete, return of muscle thickness over the study period. CONCLUSIONS: There is a predictable, phasic reduction in muscle thickness after botulinum toxin A injection for masseteric hypertrophy. This reduction first occurs during the clenching phase followed by a concomitant reduction during the resting phase. Maximal size reduction occurs at 11 weeks followed by gradual muscle size recovery.
Subject(s)
Humans , Asian People , Botulinum Toxins , Botulinum Toxins, Type A , Clinical Protocols , Follow-Up Studies , Resting Phase, Cell Cycle , Hypertrophy , Mandible , Masseter Muscle , Nerve Block , Prospective Studies , Retrospective StudiesABSTRACT
BACKGROUND: Combining blepharoptosis correction with double eyelid blepharoplasty is common in East Asian countries where larger eyes are viewed as attractive. This trend has made understanding the relationship between brow position and height of the palpebral fissure all the more important in understanding post-operative results. In this study, authors attempt to quantify this relationship in order to assess whether the expected postoperative brow descent should be taken into consideration when determining the amount of ptosis to correct. METHODS: Photographs of ten healthy female study participants were taken with brow at rest, with light elevation and with forceful elevation. These photographs were then viewed at 2 x magnification on a computer monitor and caliper was used to measure the amount of pull on the eyebrow in relation to the actual increase in vertical fissure of the eye. RESULTS: There was a positive, linear correlation between amount of eyebrow elevation and height of the palpebral fissure, which was statistically significant. Brow elevation increased vertical fissure, and thereby aperture of the eye, by 18%. CONCLUSIONS: Although the eye-opening strength as well as height of the palpebral fissure is improved with ptosis repair, the true effectiveness of ptosis surgery is diminished by the associated descent of the brow from relief of the involuntary frontalis muscle action and this should be taken into account prior to surgical intervention. Regardless, the combination of frontalis muscle relaxation and the increased eye-opening strength from ptosis repair gives the eye and the periorbital region a more natural look.
Subject(s)
Female , Humans , Asian People , Blepharoplasty , Blepharoptosis , Eyebrows , Eyelids , Muscle Relaxation , MusclesABSTRACT
BACKGROUND: As society changes, patients have high expectations of plastic surgery and rapid recovery after surgery. A thread-based facelift meets these requirements and is growing in popularity. METHODS: Former thread lifts were either floating or fixed types. The authors used both types. Using a vertical line from the lateral orbital rim as the center, the anterior face was lifted with floating-type threads and the lateral face was lifted with fixed-type threads. The Blue RoseTM thread was used for the combined-type facelift, as it is stronger than other threads. Improvements were measured using the Global Aesthetic Improvement Scale (GAIS). RESULTS: Eighteen patients out of 28 were followed over 3 months. Five patients (28%) reported a GAIS score of 2, 10 patients (55%) had a GAIS score of 3, 2 patients (11%) had a GAIS score of 4, and one patient was unsatisfied with the surgical results. Results showed improvements in 83% of the patients. CONCLUSIONS: The combined, minimally invasive, thread-based facelift has some benefits. First, the functional anatomy of the face is considered. Second, the pulling force of the threads is stronger than formerly used threads. Third, especially in Asian patients, the postoperative broadening of the malar area can be minimized. Thus, a combined thread lift using Blue Rose threads can provide a natural-looking and strong facelift.
Subject(s)
Humans , Asian People , Orbit , Rejuvenation , Rhytidoplasty , Surgery, Plastic , Minimally Invasive Surgical ProceduresABSTRACT
Autologous fat injection had not gained an attention in aesthetic plastic surgery, because of high reabsorption. Recently, fatty tissue was obtained by the low-power technique and centrifuged, results of autologous fat injection was improved. The authors performed autologous microfat injections on 277 patients from March 1997 through December 2002 to correct soft tissue facial contour such as aging, depressed facial contour, thin and long faces as well as postoperative complications and scars. The fatty tissues remaining from the first injection were kept at -20 degrees C up to twelve months, and were used for repeated injections in the overly- absorbed or inadequate areas. Of those 277 patients, 59% received an injection once, 35% received an injection twice, 5% received an injection three times and 1% received an injection up to four times. Follow-ups and postoperative photo confirmations were possible only in 119 out of 277 cases. 81.5% showed satisfied results, and development of complications were insignificant occurring at 6.2%. Owing to advances in tissue engineering and frozen storage method, autologous microfat used for injection will be developed as a better filler, which may substitute soft tissues.
Subject(s)
Humans , Adipose Tissue , Aging , Cicatrix , Follow-Up Studies , Postoperative Complications , Surgery, Plastic , Tissue EngineeringABSTRACT
Until the recent development of the Q-switched lasers, it was not possible to remove tattoos without permanent scarring and pigmentary changes. Among the Q-switched lasers which was introduced under the concept of selective photothermolysis, Q-switched Nd-YAG laser has a longer wave(1064nm), deeper penetration, and lesser pigmentary change of skin than other type Q-switched laser. So, proved effectivity in removing pigmented lesion and tattoos without scarring and pigmentary changes. But repeated treatment is essential for a good result and than there is no agreement on the treatment interval in using Q-switched Nd-YAG laser. In this experiment, the author tattooed on the back skin of rabbits and treated them twice using Q-switched Nd-YAG laser in 5 groups of different treatment interval(1,2,4,6,8 weeks). The authors analysed the histology and final therapeutic results of the 5 groups to find a reasonable and shorter treatment interval by which we can obtain an effective therapeutic result without causing permanent tissue injury and change of the skin texture. The result shows that the 4 week treatment interval of Q-switched Nd-YAG laser for the tattoo removal in rabbits is the shortest term by which we can get effective therapeutic results without permanent scar and pigmentary changes.
Subject(s)
Rabbits , Cicatrix , Lasers, Solid-State , SkinABSTRACT
Until the recent development of the Q-switched lasers, it was not possible to remove tattoos without permanent scarring and pigmentary changes. Among the Q-switched lasers which was introduced under the concept of selective photothermolysis, Q-switched Nd-YAG laser has a longer wave(1064nm), deeper penetration, and lesser pigmentary change of skin than other type Q-switched laser. So, proved effectivity in removing pigmented lesion and tattoos without scarring and pigmentary changes. But repeated treatment is essential for a good result and than there is no agreement on the treatment interval in using Q-switched Nd-YAG laser. In this experiment, the author tattooed on the back skin of rabbits and treated them twice using Q-switched Nd-YAG laser in 5 groups of different treatment interval(1,2,4,6,8 weeks). The authors analysed the histology and final therapeutic results of the 5 groups to find a reasonable and shorter treatment interval by which we can obtain an effective therapeutic result without causing permanent tissue injury and change of the skin texture. The result shows that the 4 week treatment interval of Q-switched Nd-YAG laser for the tattoo removal in rabbits is the shortest term by which we can get effective therapeutic results without permanent scar and pigmentary changes.