ABSTRACT
PURPOSE: It has always been an aspiration for Asians to look more balanced and feminine, considering their facial features regarding relatively flat midface with marked prominences of the zygoma. Many studies have been dealt in this subject. However, the authors would like to emphasize the concept and introduce the technique of repositioning of the malar complex to a cosmetically beneficial point and stationing it on proper position by fixation on zygoma body and arch. METHODS: From January 1998 to December 2007, this method was performed in 50 patients of mild to moderate prominence and malposition of the malar complex. A simplified technique of lateral orbital osteotomy and oblique osteotomy on zygomatic arch through intraoral and preauricular incision was developed. Then, liberal malar complex can be moved to a supero-posterior direction and repositioned to a more cosmetically beneficial point. To maintain the stationed position and to protect from vector affected by the attached masticating muscle to zygomatc bone, fixation was done on both zygoma body and arch. RESULTS: We have obtained satisfactory results using this procedure without any observable complications. The advantages of this procedure are proper exposure, inconspicuous scar, safe, more natural contour, improved stability, and shorter healing time. CONCLUSION: The authors suggest that reduction malarplasty should be approached with underlying concept of repositioning and fixation. In mild moderate malar prominent cases, our technique will provide with maintenance of aesthetic concept, equal to the malar reduction performed under coronal approach and provide with more natural facial contour with stability even with less invasive surgical approach.
Subject(s)
Humans , Asian People , Cicatrix , Muscles , Orbit , Osteotomy , ZygomaABSTRACT
Reduction malarplasty is one of the common aesthetic procedures performed in the Asia. Several surgical techniques for malar reduction have been reported. In reduction malarplasty, 'reposition of mobile malar complex to more cosmetically beneficial point' is more important than making flat malar complex. 'Fixation of bone on body and arch' is important for considering the action of attached masticating muscle to zygomatic bone. We have performed reduction malarplasty which consists of lateral orbital osteotomy and oblique osteotomy on zygomatic arch, reposition of mobile malar complex to more cosmetically beneficial point, and fixation of bone on body and arch with wires through bicoronal incisions over 700 patients from January, 1984 and through preauricular and intraoral incisions in 30 patients from December, 1997 to December, 2001. Preauricular and intraoral approaches can be indicated in most cases of mild to moderate prominence and malposition of malar complex, and bicoronal approach can be indicated in cases of severe prominence and malposition of malar complex and need of combined procedures such as face lift, frontal and orbital contouring. We have obtained satisfactory results with using reposition and fixation in reduction malarplasty.
Subject(s)
Humans , Asia , Orbit , Osteotomy , Rhytidoplasty , ZygomaABSTRACT
The reconstruction of the cheek area is a complex problem because the cheek is the most broad area of the face and is close to the aesthetically important region such as eyelids, nose, and mouth. The ultimate purpose of the cheek reconstruction is the restoration of the original shape and function, and establishment of the harmony with the adjacent structure in terms of color, nature and thickness. Various procedures such as skin graft, local flap, free flap, and local flap using skin expansion have been performed for cheek reconstruction. However, no golden principal or indication has been clarified to be imperative. Analyzing our clinical experiences of the cheek reconstruction, we intend to present a general guide of the cheek reconstruction and to assess the advantages and/or disadvantages of the operative methods. Between march of 1989 and August of 1999, we have experienced 154 cases of the cheek reconstruction. There were 52 males and 73 females, and their ages ranged from 3 to 89 years (mean 28.1 years). Preoperative diagnosis were post-burn deformity(n=74), Romberg disease (n=9), post-traumatic deformity(n=7), hemangioma(n=7), nevus(n=7), neurofibroma(n=5), hemifacial microsomia (n=3), lymphangioma(n=3), cancer(n=6), post-hemimandibulectomy(n=1), radical maxillectomy(n=1). The procedures were one stage cervicofacial flap(49 cases), cervicofacial flap following skin expansion(42 cases), local cheek flap (14 cases), deltocervicopectoral flap(2 cases), skin graft(29 cases), free flap(18 cases). Follow up period ranged from 3 to 72 months(mean 11.8 months). Advantages and disadvantages of each procedures were explained. The satisfaction rate was higher in one stage cervicofacial flap and free flap when assessed by both patients and surgeon. There were 3 cases of the ectropion of lower eylids, 4 cases of partial flap necrosis, and 1 case of exposure of tissue expander. The local flap is always the preferred method for the cheek reconstruction and the free flap is the treatment of choice for the cheek contour reconstruction. Selection of the most suitable flap is mandatory depending on the location and size of the defects.
Subject(s)
Female , Humans , Male , Cheek , Diagnosis , Ectropion , Eyelids , Facial Hemiatrophy , Follow-Up Studies , Free Tissue Flaps , Goldenhar Syndrome , Mouth , Necrosis , Nose , Skin , Tissue Expansion Devices , TransplantsABSTRACT
Romberg's disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue and bone. Facial asymmetry with soft tissue deficiency in Romberg's disease causes a significant disability affecting the social life and can bring about many psychological problems. The aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, silicone injections, cartilage and bone grafts, pedicled flaps and free flaps. We report our experience with 6 patients involving 6 free flaps with a minimun of 1 year follow-up who were treated from October 1989 to March 1998. All patients were classified as having moderate to severe atrophy. The average age of disease onset was 4.5 years. The average duration of atrophy was 5.2 years. No patient was operated on with a quiescent interval of less than 1 year. The average age at operation was 14.1 years, ranging from 10 to 24 years. Follow-up ranged from 1 to 9 years. Reconstruction was performed using 2 groin dermofat free flaps and 4 latissimus dorsi muscular free flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le-Fore 1 1/2 leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angleplasty, rib and calvarial bone graft, correction of alopecia and additional dermofat graft. All patients were satisfied with the results. We believe that free flap is one of the best choices for contoured restoration of facial asymmetry in Romberg's disease.
Subject(s)
Humans , Alopecia , Atrophy , Cartilage , Facial Asymmetry , Facial Hemiatrophy , Follow-Up Studies , Free Tissue Flaps , Groin , Osteotomy , Osteotomy, Sagittal Split Ramus , Ribs , Silicones , Skin , Superficial Back Muscles , Surgical Flaps , TransplantsABSTRACT
Patients with a poor or total absence of levator function require correction of their ptosis by a sling procedure. The aim of the procedure is to utilize the action of the frontalis muscle to mechanically raise a droopy eyelid Frontalis suspension procedure using a temporalis fascia or Tutoplast Dura was performed on 36 ptotic eyelids of 23 patients(age range 2-37 years) with a poor or absent levator function. The author used a surgical technique based on a modified Fox`s method. Satisfactory results were achieved in 42 lids according to the criteria of Jordan after an average follow-up of 23 months. No serious complication was seen immediately postoperative and during the follow-up period. Temporalis fascia and Tutoplast Dura appear to be effective and safe alternative sling materials for frontalis suspension surgery.
Subject(s)
Humans , Blepharoptosis , Eyelids , Fascia , Follow-Up Studies , JordanABSTRACT
The basic technique for total reconstruction of the microtia was established by Tanzer, who utilized autologous rib cartilages for constructing the auricular framework. In order to decrease the number of surgical stages and to achieve maximal convolution, we employed a surgical procedure with simultaneous three layered costal cartilage grafting for the high profiled auricle, concha formation and lobule rotation. However, we performed ear elevation as an additional procedure for some patients who had decreased helical height due to absorption of cartilage framework or postoperative trauma and who had wanted to wear the spectacles or to have more natural appearance of auriculocephalic sulcus. From August 1988 to October 1997 we had performed surgeries for the ear elevation of 58 patients in 177 patients with total ear reconstruction, using various elevation methods; skin graft, local flap, and local with costal cartilage block. When the ear elevation was performed with skin graft, postoperative contraction of the grafted skin was inevitable. In cases with two skin flaps, it was difficult to stabilize and maintain the correct projection of the constructed ear. So we elevated the reconstructed ear by utilizing a costal cartilage block, two skin flaps to cover the posterior region and skin graft. We conclude that the local flap with costal cartilage block is one of the most favorable methods in ear elevation which can maintain the adequate projection and make natural looking auriculocephalic sulcus.
Subject(s)
Humans , Absorption , Cartilage , Ear , Eyeglasses , Ribs , Skin , TransplantsABSTRACT
The first successful bone transplantation carried out in 1688 by Van Meek'ren, a Dutch surgeon. The ideal bone substitute should be biocompatible, osteoinductive or at least osteoconductive, available in unlimited quantity, low cost and have satisfactory mechanical properties. To accomplish these goals, autografts are still preferred material. However, bone harvesting procedures have been focused to solve the following problems; necessity of a second surgical site, morbidity and potential deformity of the donor site, an increased operative time, donor availability limitations, and resorption of autogenic bone grafts.Ten adult white New Zealand rabbits, three, 10 mm in diameter, full layer skull defects were made in the frontoparietal bone. Two bone defects were filled with hydroxyapatite and powdered eggshell, the other defect was not filled(control). All animals were sacrified at 10 weeks, the specimens were examined macroscopically to test for graft mobility. The graft with surrounding bone was then harvested and studied by histology. The results were as follows: 1. Control: Bone regeneration occurred nearly complete. 2. Hydroxyapatite: Macroscopically - No encapsulation. Despite a gross delineation between implant and bone, imlant was firmly united to bone. Histology - Bony trabeculae surrounded by proliferated connective tissue are observed in the defect site and implant. Osteoblastic rimming is noted along the bone fragments 3. Powdered eggshell:Macroscopically - Grafted site was encapsulated by proliferated connective tissue and palpable softer than the surrounding bone. Histology - The presence of eggshell particles encapsulated by fibrous connective tissue. Partial bone regeneration from the defect margin was noticed, but the bone healing was never complete. In conclusion, the use of safe and inexpensive material is recommended for filling limited bone defects in non-weight bearing areas. The use of powdered eggshell for bone substitute may also be considered, after further studies, to access its long term stability, porosity and biocompatibility.
Subject(s)
Adult , Animals , Humans , Rabbits , Autografts , Bone Regeneration , Bone Substitutes , Bone Transplantation , Congenital Abnormalities , Connective Tissue , Durapatite , Operative Time , Osteoblasts , Porosity , Skull , Tissue Donors , TransplantsABSTRACT
The chin plays a decisive role in the contour of the lower face. And harmonious jaw will correspond to good facial profile and positive image. Osseous genioplasty is a widely used method to correct the 3-dimensional(sagittal, vertical, tranverse) deformity of the chin with minimal complications. During an 8 year period from 1988, the authors at the In-Je University Seoul Paik Hospital experienced 198 patients of osseous genioplasty. Results of clinical analysis are as follows : 1) Male to female ratio was 1 : 3 with female being predoniment. The average age was 24.9 years. 2) Horizontal advancement genioplasty in 169 cases was the most common procedure with 7.0mm of average advancement. There was 4 cases of horizontal retrusion with average retrusion of 4.3mm. 52 cases had vertical augmentation with average of 7.5mm increase. 9 cases had vertical reduction with average redution of 4.9mm. 3) Although malocclusion is not necessarilly contraindication to genioplasty alone, genioplasty following surgical with or without orthodontical correction of malocclusion is the way to get better result with patient satisfaction. 4) 77% of the patients had adjunctive procedures simultaneously to acheive a better contour and profile 5) Complications such as hematoma, infection, fracture, nerve damage were minimal.
Subject(s)
Female , Humans , Male , Chin , Congenital Abnormalities , Genioplasty , Hematoma , Jaw , Malocclusion , Patient Satisfaction , SeoulABSTRACT
The double eyelid operation is one of the most common cosmetic surgery performed in orientals, and there are numerous studies about surgical procedures of that. In the case of appropriate candidates, the non-incision technique makes excellent cosmetic results, with the advantages of shorter operating time, less morbidity, less pain, no scarring and easy revision of shape. But, usually the non-incision technique is recommended in the cases with thin upper eyelid, small amount of orbital fat, less redundant skin of upper eyelid and in whom a wide fold is not desired so on. Therefore, the disadvantages of this method are that it cannot be applied to all patients. The postoperative complications are disappearance or faded fold, formation of cyst or lumps, asymmetry etc. and the incidence of these complications is slightly higher than those of the incisional method. In this study, the double eyelid operation using the continuous buried suture method was performed in 210 patients for formation of double eyelid from Jan. 1993 to Dec. 1995. In conclusion very good results can be obtained by the continuous buried suture method even in the cases of puffy upper eyelid. This method can make a double eyelid shape in the fashion the patient wants and can be a new indication for correction of unilateral double eyelid. This method is safe, satisfactory and take shorter postoperative recovery time and it can reduce the incidence of postoperative complications.
Subject(s)
Humans , Cicatrix , Eyelids , Incidence , Orbit , Postoperative Complications , Skin , Surgery, Plastic , SuturesABSTRACT
No abstract available.
ABSTRACT
No abstract available.
ABSTRACT
We reviewed surgical specimens from 11 patients with diffuse neurofibroma to define the specific clinicopathologic characteristics. Ten cases were cutaneous neurofibromas and one case was an uncommon gastrointestinal neurofibroma involving the rectum. The most frequent sites of involvement were the head and neck, especially the eyelids and the periorbital areas. They usually presented as a plaque-like elevation of the skin. They primarily occured in children and young adults and positive family histories of von Recklinghausen's neurofibromatosis were obtained in 45.4%. Pathologically, the involved skin & rectum were diffusely thickened by an infiltrative growing mass, showing proliferation of short fusiform cells in the uniform matrix of fine fibrillary collagen. The characteristic prominence of Wagner-Meissner bodies (45.4%) suggests they could be associated with pathogenesis of diffuse neurofibroma. On the basis of these findings, we could confirm diffuse neurofibroma to be a distinct form of neurofibroma.
Subject(s)
Child , Adult , Male , Female , HumansABSTRACT
No abstract available.