Correction of Cicatricial Upper Eyelid Ectropion Using a Dermofat Graft and an Anti-Adhesive Agent

Ectropion is characterized by eversion of the eyelid margin and exposure of the cornea and conjunctiva. This leaves the inner eyelid surface exposed and prone to irritation, and in severe cases, poor eye closure. Ectropion can occur for several reasons including congenital malformations, trauma, burns, anti-cancer medications, allergies, and inappropriate eyelid surgery. Surgical treatments usually include local flaps or skin grafts, depending on the severity of the defect. We present a case of successful cicatricial upper eyelid ectropion correction using a dermofat graft and an anti-adhesive agent (Guardix-Sol) after the wide release of tethering scar tissue.

Augmentation Rhinoplasty with Dermofat Graft & Fat Injection

PURPOSE: Even though Augmentation rhinoplasty is very popular surgical procedure, it is not easy to obtain ideal materials for augmentation. Many different synthetic materials are used but frequent complications are seen such as infection, extrusion, deform, and dislocation. Autologous tissues were used for augmentation rhinoplasty. We used dermofat graft and fat injection in augmentation rhinoplasty minimizing these problems. METHODS: From 2006 to 2009, we used autologous tissues in augmentation rhinoplasty in 40 patients, 20 patients with dermofat graft and other 20 patients were treated with fat injection only. Dermofats were harvested from sacral area. gluteal fold, groin and preexisting scar tissue. Dermofats were inserted with small stab wound and fat tissues were injected as Coleman's technique. The patients were followed up 6 months to 5 years. RESULTS: Most of the patients were satisfied in shape and height the nose. Early complications such as hematoma, infection and seroma were not found. Secondary fat injection was performed in 3 patients (15%) of dermofat graft group instead of 7 patients (35%) of fat injection only group. CONCLUSION: We obtained satisfactory results in augmentation rhinoplasty with dermofat graft and fat injection. Secondary fat injections were more often in fat injection group than dermofat graft group. Dermofat graft and fat injection could be another alternative technique for augmentation rhinoplasty and fat injection could be a secondary adjunctive treatment for undercorrection due to absorption.

Correction of Pincer Nail using Autogenous Dermofat Graft

PURPOSE: Pincer nail is a relatively rare deformity characterized by an increase in transverse curvature along the longitudinal axis of the nail. This curvature commonly increases from proximal to distal end of nail, leading to pinching, curling, and distortion of the underlying soft tissue and resulting frequently in severe pain. Numerous surgical procedures have been reported. Preserving the width of the nail in the correction of the pincer nail is very important for functional and aesthetic reasons. We report the results of the correction of the pincer nail using autogenous dermofat graft with a good result. METHODS: From May 2006 to September 2008, dermofat graft was performed in 6 patients with pincer nail. Patients were four women and two men, and the average age was 51. The affected digits were the unilateral great toes in four patients and the unilateral thumbs in two patients. Average follow-up period was 13 months. Surgical procedure was removal of nail using an elevator to avoid damage to the nail bed. An incision was created in distal portion of hyponychium. Paronychium was dissected from distal phalanx by periosteal elevator through incision of hyponychium and tunnel was made. Then dermofat grafts harvested from inguinal area were inserted into the tunnel. Finally, a silicone sheet was inserted eponychial fold for prevention of synechia. Objective assessment was evaluated by use of the width index and height index. RESULTS: All patients reported resolution of the pain and soft tissue pinching sensation that they had before the operation. There was good adherence between the nail plate and the underlying nail bed. The nails have regrown and were corrected in a normal and flattened appearance. The width index and height index were improved. CONCLUSION: The autogenous dermofat graft seems to provide an effective treatment of the pincer nail with preservation of the nail matrix.

Secondary Augmentation Rhinoplasty with Immediate Autogenous Dermofat Graft after Removal of Paraffinoma

PURPOSE: Paraffin has been used to augment depressed nasal contour for many years by illegally. Reported complications of nasal paraffinoma were skin thinning, displacement of nasal profile, redness, chronic inflammation and malignant change to skin cancer. The current authors report results of the secondary rhinoplasty after excision of nasal paraffinoma. METHODS: Through the open rhinoplasty incision, paraffinoma was removed under direct vision. Saline irrigation and meticulous hemostasis were performed. Simultaneously, the secondary depressed nasal deformity was corrected with autogenous dermofat graft harvested from inferior gluteal fold. The dermofat was fixed to the nasofrontal area with bolster suture, and the interdormal area of the tip. RESULTS: A total of 13 patients underwent secondary augmentation with autogenous dermofat graft after removal of paraffinoma from 2000 to 2004. The mean follow-up period was 15 months. There were no postoperative complications. All patients were satisfied with their surgical results. However, there were 10 to 20 percent resorption of the grafted dermofat. CONCLUSION: It is suggest that autogenous dermofat be one of good materials for the correction of the secondary deformity after removal of nasal paraffinoma. In addition, autogenous dermofat graft presented easy harvesting and manipulation for transfer, high survival rate by firm fixation to the recipient site and stable surgical results.

One-stage Reconstruction after Partial Removal of Paraffinoma in Face with Dermofat Graft and Face Lift

Paraffin injection for aesthetic purpose by unauthorized people has many problems. One of the most common complication is the paraffinoma. Because of problems after paraffinoma removal, such as flap necrosis and facial nerve injury, the treatment of the choice is only partial removal. But there can be some depression and sagging of the cheek left after paraffinoma removal. So we have treated 8 patients who have suffered from paraffinoma in forehead and cheek by partial removal of paraffinoma and correction of the depression and the sagging of the cheek with dermofat graft and face lift. Through the extended preauricular incision, after skin flap elevation we removed paraffinoma as much as possible. Dermofat graft from the gluteal area was performed at paraffinoma removed site. And we prevented the sagging of the cheek skin by the suspension pull through suture. The follow up period was from 2 to 26 months(mean, 12 months). All the patients were satisfied with the reduction of the paraffinoma and they did not complain any deformity. One patient had flap necrosis on nasal dorsum and postauricular area, but they healed with dressing only in two weeks. We concluded that one-stage reconstruction with dermofat graft and face lift after partial removal of paraffinoma is reliable method in treating of paraffinoma in forehead and cheek.

Correction of Post-traumatic Fingertip Pain with Dermofat Graft

Fingertip is the end of tactile organ and the part of hand most frequently injured. Fingertip injuries should be evaluated on an individual basis considering patient's overall physical condition, medical history, etiology, time of injury, and anticipated future hand use, and accordingly one of various methods of reconstruction should be selected. Complications after the reconstruction of fingertip injuries have been reported as pain, hypersensitivity, numbness, distal paresthesia, cold intolerance, and atrophy. From January to December 2002, dermofat grafts were performed on 15 patients to correct painful fingertips after injury. The thickness of the soft tissue of fingertip was measured both preoperatively and postoperatively with simple X-ray. To evaluate the improvement of pain, visual analogue scale(VAS) was used through the direct interview with patients. The average of postoperative follow-up period was 10.9 months. The average of increased soft tissue thickness ratio was 88.4%(2.3mm to 3.8mm). The average of preoperative VAS was 7.6, and postoperative VAS was 3. Dermofat graft on fingertip needs a further long-term follow-up study for the absorption ratio of dermofat, however, this procedure is simple and could be done under local anesthesia, and would be a useful alternative procedure to correct painful fingertips with the soft tissue atrophy after injury.

Simultaneous Correction of Depressed Scar Using Dermofat Graft Harvested during Scar Revision

While no scar can be completely erased, most linear facial scars can result in a relatively good scar after revision. However, in case of round shaped depressed scar, the scar is often lengthened following an incisional technique. This study focuses on the technique of dermofat graft harvested from the adjacent scars for correction of depressed scars. 18 patients having multiple facial scars with a depressed scar among 375 patients who had undergone scar revision were treated from June 2003 to May 2004. Dermofat was harvested from the adjacent linear scar, then it was deepithelialized, reshaped, and grafted to the depressed scar through a small incision. Cosmetic results were generally good. Complications were overcorrection in 4 patients; hyperpigmentation occured in 1 patient. However, 13 patients were satisfied with the results. The advantages of our technique are as follows: it does not require additional operation; dermofat graft has low absorbable rate; it can maintain the volume with an adequate texture.

Correction of Neck Scar Retraction by Dermofat Graft

Untill now, dermofat graft has usually been used for repair or supplement of soft tissue for cosmetic cause. Generally, scar in the center portion of neck, left after tracheostomy, may cause skin traction and discomfort during swallowing due to adhesion in trachea or cricoid cartilage in high rates. In these cases, usual scar revision techniques maybe cannot correct the skin retraction and swallowing discomfort. We, therefore, solved the problems of skin traction and discomfort during swallowing, by first removing the preexisting scar in the center portion of neck, then, dissecting the surroundings after performing autodermofat graft. From September 2002 to September 2003, we performed autodermofat graft in 6 cases having skin traction and discomfort during swallowing. In all cases, symptoms were resolved, and adverse effects of infection, hematoma and calcifications did not occur. In the results of 10 months follow-up, there were no recurrence and cosmetic and functional results were acceptable.

Secondary augmentation rhinoplasty with dermofat graft

The nose is an important aesthetic projection affecting the profile of the face. Correction of the flat nose is one of the most popular aesthetic procedures in the orient. The Asian nose is characterized by flat, bulbous appearance due to thick and dense skin. Flared nostrils and restriction of nasal tip projection due to underdevelopement of the medial crus of alar cartilage, and short columella are also characteristic of Asian noses. Nasal augmentation has taken an increasingly important role in rhinoplasty. There are many procedures and materials for augmentation. Various implants have been used for many years but several kinds of complications have still occurred after these augmentations. After the primary augmentation rhinoplasty using foreign body such as paraffin, silicone, and ivory, some patients experienced complications. Experienced complications such as : 1) thinning of the skin on nose dorsum 2) hypertrophy of capsule 3) displacement of nasal tip 4) thinning of the skin creating dead space 5) movable implants In above cases, we could not reapply with silastic implant. In general, the use of foreign materials was mentioned only to be condemned for the purposes of above cases. The failure and complication rates were high, and the complications frequently result in distortions that were permanent and irreparable. In view of the availability, variety, and quality of autogenous materials, it was impossible to recommend anything but autogenous materials for secondary rhinoplasty. Dermofat was an autogenous material that could be as effectively used in nose dorsum. Its clinical record of survival and contouring in the author's practice has been excellent. Originally 276 patients underwent primary augmentation rhinoplasty. Out of the 276, 29 patients with nose complications underwent secondary augmentation rhinoplasty with dermofat. Our study, which began in September 1993 and ended in September 1996, concerned these 29 Patients. The follow up interval ranged for 3 to 36 months. Tissues must have time to heal so that an accurate assessment of the secondary procedure is made possible. The minimal time of two or three months is recommanded of patients with previous operation but we removed foreign body and then simultaneously augmented with dermofat when there is no evidence of inflammation and further resolution. As part of the procedure in order to minimize the scar on donor site, we harvested dermofat, in an elliptical shape, 5cm above from infra-gluteal fold. We harvested about 10% more dermofat than was required because of its potential decreased in volume caused by primary contracture and resorption. Primary contracture is the main cause of the decrease in volume. To prevent contracture, resorption and displacement of the dermofat, we have to accurately fix the implant in the central porticn of the nose. Using this method, we could have prevented complications and yielded more satisfactory results by accurately fixing the dermofat in the central portion.