A new flap combination for reconstruction of lower nasal dorsum and supra-tip skin defects

Repairing surgical defects of the nose is still challenging due to its tridimensional shape and its aesthetic concern. Difficulty in reconstructing nasal subunits lies in their contour, skin texture and limited availability of adjacent skin. For lower nasal dorsum and supra-tip regions, we design a new combined local flap as existing local flaps may give disappointing results. This combination flap was performed on two patients for reconstruction of the lower nasal dorsum area after basal cell carcinoma excision. Size of the excision ranged from 20 to 25 mm diameter and safe margins were obtained. The defects were reconstructed with a local flap that combined a rotation nasal flank flap and a V-Y advancement nasolabial flap. Excision and reconstruction were performed in a one-stage surgery under intravenous sedation and local anesthesia. There were no postoperative complications and no flap loss occurred. Aesthetic and functional results after 6 months postoperatively were satisfying without modification of nasal shape. This flap is reliable and offers interesting functional and aesthetic outcomes. It can be considered as a new reconstruction alternative for supra-tip and lower nasal dorsum skin defects performed in a one-stage procedure under local anesthesia.

Chinese nomination for the lip and perioral morphological aesthetic subunits and aesthetic landmarks / 中华整形外科杂志

Objective@#To summarize and update the terminology of the lip and perioral morphological aesthetic subunits and aesthetic landmarks in the domestic medical aesthetics field.@*Methods@#36 English literatures, 13 Chinese literatures, 3 foreign academic compositions, 2 domestic academic compositions, 1 domestic medical aesthetics textbook, and 14 websites of the medical aesthetic field have been included. We summarized the commonly seen terminology of the lip and perioral morphological aesthetic subunits and aesthetic landmarks. Moreover, for the aesthetic subunits and aesthetic landmarks which are commonly used in clinical practice but have not yet been named in Chinese term are named following the current Chinese terminology rule. We summarized not only the terminology of lips but also the anatomical acknowledge of the commonly used aesthetic subunits.@*Results@#There are 17 standard nomenclatures for aesthetic subunits, 8 standard nomenclatures with abbreviations for aesthetic surface landmarks, 20 standard terms for aesthetic measurement and distance. Moreover, we named 5 aesthetic subunits and 6 aesthetic surface landmarks for which there are no standard Chinese medical terms.@*Conclusions@#The standard terminology for the aesthetic subunits and landmarks is the foundation for the lip and perioral measurement and evaluation. Besides, it also provides a reference basis for the development of lip cosmetic and perioral rejuvenation treatment programs.

A Study on Preferred Morphologic Feature and Proportion of Facial Aesthetic Subunit by Korean General Public

PURPOSE: As the influence of mass media increases, the general standard of attractiveness or beauty of a face also changes. The primary purpose of the study is to find out the factors of the attractive and beautiful face recognized by public. METHODS: We picked out standard model photography and operated with Adobe(R) Photoshop(R) and Monariza(R) virtual plastic surgery program. The contour of face, eye, nose, forehead, zygoma, chin and proportion of upper, middle, lower face were changed. The interview survey was conducted through structured standard photo for 310 respondents. That was utilized in the final analysis. Multiple regression analysis was executed by SPSS 12.0. It was used to deal with statistical data and all the other necessary analysis. RESULTS: According to general characteristics of the respondents, many differences were found in preferred face and facial aesthetic subunits. The younger generation preferred the lozenge and inverted triangle shape contour. The respondents over 40 of age preferred the egg shape contour. In chin and zygoma contour, the respondents at the age of 20 preferred distinctly small chin and relatively small lower face. On the other hand, the respondents over 40 of age preferred the wide zygoma relatively. In the proportion of upper, middle, lower face, 51.0% of respondents answered 1:1:1. If they want to have an aesthetic operation, they preferred protruding forehead. Also they preferred the small chin and V-shaped chin in frontal view. CONCLUSION: Many respondents preferred to have a plastic surgery for the better facial subunit. The statistical evidence from this study suggests that the harmony and balance of facial aesthetic subunits make attractive and beautiful face.

Evaluation of Influence of Individual Facial Aesthetic Subunits on the Congnition of Facial Attractiveness in Public

PURPOSE: Authors tried to analyze the influence of individual facial aesthetic subunits on the cognition of facial attractiveness in public and suggest a mathematical model which explain the facial attractiveness. METHODS: Independent facial aesthetic subunits are extracted from facial photographs from three women(11 frontal and 7 lateral aesthetic subunits). Each facial subunits of three women are rated in terms of relative rank by 164 peoples(68 man and 96 woman, average age was 32.4, and ranged +/- 9.8 years). chi-square-test and categorical regression analysis were performed. RESULTS: There was no difference in the aesthetic preference in terms of ages or sexes in large. Beautification of individual aesthetic subunits can predict the overall facial attractiveness up to 42.1% in frontal face(Adjusted R2=0.421, F=6.39, p=0.000<0.05) and 22.7% in lateral face (Adjusted R2=0.227, F=4.42, p=0.000<0.05). Aesthetic appearance of eyes(p=0.001), upper face(p=0.034) in frontal face and midface(p=0.000) in lateral face are statistically important factors in the cognition of facial attractiveness. CONCLUSION: Authors experimently proved that harmony and balance among facial aesthetic subunits are the most important factors, in embarking on facial aesthetic plastic surgery, for better enhancement of facial attractiveness.

Nasal Reconstruction for Nasal Deformity or Defects: Based on Aesthetical Nasal Subunits

The nose, salient part in the face, is more vulnerable to injury and its minor defect or deformity is highly perceptible. It is thus essential to establish the certain rules for reconstruction. Gonzalles Ulloa mentioned 5 aesthetic nasal subunits, which are nasal dorsum, nasal tip, lateral portion, alar portion and soft triangle. However, the authors insist on the importance of the columella and nasal floor as well as other nasal subunits, considering the nasal reconstruction in structural and functional aspects. Authors' study was based on the aesthetical nasal subunits considering the in-depth knowledge of anatomical and functional aspects of each unit as an individual. Reconstruction of the proximal 2/3 portion of the nose having thin, soft and mobile skin over the osteochondral framework with sparse distribution of the sebaceous glands can be done with skin graft, nasolabial flap, and median forehead flap and lateral wall defect can be repaired by nasolabial flap or glabellar flap. Reconstruction of the distal 1/3 portion of the nose is rather difficult due to its thick, sebaceous skin that is characterized by firm and dense cartilaginous attachment, which makes it more harder to handle especially when it comes to the alar portion. Therefore, composite graft for the small defect and nasolabial flap or median forehead flap for on the larger defect can be used. However, when defect is located on the nasal tip, it results in tremendous spoiling of the whole facial harmony even with a tiny defect so that replantation, composite graft or median forehead flap has been used for the reconstruction. Reconstruction of the columellar defect is considered more complicated and V - Y advancement flap, bilateral nasolabial flap, and composite graft have been utilized.Nasal deformity or defect was reconstructed based on 7 aesthetical nasal subunits; by further dividing the nasal units, in terms of adding 2 more subunits, columella and nasal base, aesthetically and functionally acceptable and advantageous results were deduced with less contractures and scars. Current trends of nasal reconstruction are based on the concepts of aesthetic nasal subnunits or units in which modification was added in some extent. The most important factors that contribute to the later results are evaluation of the depth and color of the deformed or defected area according to the aesthetic nasal subunits whether it is congenital or acquired. Various reconstruction methods of the nose can be utilized based on the size, depth and location of the defects where it can be reconstructed as a unit. Columella and nasal base were newly added in concepts of subdivision from the previously established nasal subunits to produce more detailed, precise and favorable result. Also, nasal reconstruction should be carefully carried out considering the importance of the psychological, social and functional influences of the nasal deformity.