Nasal Tip Plasty on the Bulbous Nose Revisited

Correction of bulbous nasal tip in rhinoplasty is a difficult subject, particularly in Asian. Since first published an article on the correction of bulbous nasal tip in 1999, we have accumulated more experiences and improved our result in refining nasal tip. We had 17 patients for the correction of bulbous nasal tip. Age ranged from 20 to 39 years old (Mean age, 26.7 years old) and 6 males and 11 females. We were able to follow up from 1 month to 6 years. We classified our patients into three groups according to the shapes of nasal tip and surgical procedures implicated. Group 1: Simple bulbous nasal tip requiring excision of subdermal soft tissue and rearrangement. Group 2: Bulbous nasal tip with flat dorsum of nose, requiring augmentation of dorsum of nose with silicone implant and augmentation of nasal tip with onlay graft with conchal cartilage. Group 3: Bulbous nasal tip with short columella, requiring nasal tip plasty and lengthening of columella with composite graft using helix of ear. Open rhinoplasty technique was applied in all patients with excising subdermal fibrous tissue from nasal tip, and realignment and fixation of alar cartilage with interdomal sutures. Pressure splint was applied on 7th postoperative days and maintained for a couple of months. Proper preoperative diagnosis, subdermal soft tissue excision, realignment and fixation of alar cartilage, cartilage graft, augmentation of dorsum of nose, columella lengthening, postoperative splint and combinations of these are the key of successful results.

Comparison of Treatment Effect between Superficial Suction and Subdermal Excision in Osmidrosis

Osmidrosis develops in many young people due to the apocrine gland becoming active after the adolescent period and can cause difficulty in social activities and personal relationships. We compared 2 surgical treatment methods for osmidrosis, superficial suction and subdermal excision, to determine how many of apocrine glands could be removed and examine if a significant difference was present in treatment outcome. The subjects used for the present study included 62 patients of whom 46 patients underwent subdermal excision and 16, superficial suction. We counted the total number of apocrine glands in tissue samples obtained using those 2 methods, fixed in formalin and treated with usual histologic treatment. We calculated the number of apocrine glands per unit area by measuring the axillary area of the surgery site determined before surgery. The patients who underwent surgery using those 2 methods were divided into satisfactory group and unsatisfactory group by evaluating the results subjectively and objectively after surgery. The satisfactory rate was 95.7% in 46 patients who underwent subdermal excision and 81.25% in 16 patients who underwent superficial suction. An average of 127.82 apocrine glands/ cm2 were removed through subdermal excision and 72.71 apocrine glands/cm2, through superficial suction. We determined that more apocrine glands were removed with a statistical significance using subdermal excision. However, considering the result that 81.25% satisfactory rate was seen despite 57% of apocrine glands being removed with superficial suction compared with subdermal excision, superficial suction would be also effective in reducing the number of apocrine glands to below a threshold.

Treatment of Axillary Hyperhidrosis; Manual Subdermal Excision Combined with the Tumescent Liposuction and Subcutaneous Tissue Shaver

BACKGROUND: Axillary osmidrosis is a distressing problem characterized by unpleasant odor, profuse sweating, and occasional wetting of clothes that may handicap those affected both socially and psychologically. A variety of surgical methods have been developed for the treatment of axillary osmidrosis. OBJECTIVE: To introduce the manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver for axillary osmidrosis. METHODS: Twenty-five patients with axillary osmidrosis were treated by the manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver. RESULTS: Twenty-one(84%) patients had good results, four(16%) fair, and none had a poor result or recurrence. Complications included one case of hematoma, two cases of partial skin necrosis. The wound complication rate was 6.0%(3/50) for the axilla and 12%(3/25) for patients. CONCLUSION: The manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver is effective surgical procedure for the treatment of axillary osmidrosis with a low complication rate and recurrence.