Revision of High Fold with Pretarsal Fibromuscular Flap

In double eyelid operation, if the eyes have too little fat and soft tissue, or if the orbital fat were removed too much in the operation, the double eyelid crease is too high. And the supra-tarsal recess becomes hollow and the adhesion of eyelid crease occurs even in orbital septum and levator muscle. Secondary double eyelid operation in response to these problem needs to correct the height of eyelid crease or the supra-tarsal depression by releasing the inadequately high eyelid fold and preventing re-adhesion. Moreover, in case the muscle and scar tissue are bulged below the incision line, the height of double eyelid should be appropriately lowered, the adhesion should be released, and the bulky lower flap should be flattened. In case the adjacent tissue (e.g., preaponeurotic fat) was excessively removed during the primary double eyelid operation, free-fat graft or dermis-fat graft has been done to correct supra-tarsal depression and re-adhesion. These graft materials are extracted from a distant donor site. Even if the adjacent tissue was not sufficient, we made the superiorly based local flap or graft of pre-tarsal scar-muscle tissue obtained after thinning the bulky lower flap. In these cases, the fibrous muscle flap or graft compensated tissue depletion with a proper mass around the double eyelid crease and help prevent re-adhesion. Of the 1225 patients with high placement of supra-tarsal fold with bulky lower skin flap, we used pretarsal fibro-muscular flap in 914 patients and pretarsal fibro-muscular graft in treating 311 patients from November 1997 to October 2005. And we eventually found that the operation was successful in making a natural eye shape and preventing re-adhesion with no requirement of a distant donor site. We found that the pretarsal fibro-muscular flap or graft were effective in reducing the operative time and lowering the risk of post-operative infection, preventing the re-adhesion, correcting the supratarsal depression and making a natural eye shape with a slender eyelid line.

FORMATION OF PHILTRAL COLUMN WITH PALMARIS LONGUS TENDON IN THE CORRECTION OF UNILATERAL CLEFT LIP NOSE DEFORMITY

A multitude of methods for correction of the residual cleft lip nose deformity have been developed. Inspite of the development it appears that no one procedure has achieved satisfactory results. In addition, the appropriate timing for surgical correction still remains unsettled. The philtrum plays a keyhole in the appearance of the upper lip and nostril sill. But the formation of philtrum with muscle flap or conchal cartilage have been resulted in a unsatisfactory aesthetic outcome. We performed 26 cases of the correction of unilateral cleft lip nose deformity between May 1993 and September 1996, and we always used autogenous palmaris longus tendon for reconstruction of philtral column and nostril sill augmentation. Palmaris longus tendon creates a more definite philtral unit comparing to other materials which have been used and it is easy to harvest and transfer and it does not affect normal function of the hand. And we followed up all patients and confirmed that disappearance of newly formed philtrum is rare. In conclusion, this study shows that autogenous palmaris longus tendon is a useful material for reconstruction of philtral column.

CORRECTION OF THE UNILATERAL DOUBLE EYELID BY NON-INCISION TECHNIQUES

Double eyelid operation is one of the most common cosmetic surgery in orientals. Among this, the non-incision technique has been usually performed in the patient with thin upper eyelid, lesser amounts of orbital fat, less redundant skin of upper eyelid, and so on. A non-incision technique make a more smooth and natural double eyelid. The merit comes from short operating time, short recovery time, less morbidity and inconspicuous scarring, Therefore, when we decide double eyelid operation on a patient who has a congenital unilateral double eyelid, we correct the aesthetic deformity in appearance caused by an unnatural asymetric upper lid which is not double eyelid using a non-incision technique. This study includes 255 patients to whom underwent double eyelid operation of unilateral double eyelid by non-incision techniques from 1990 to 1995, ranged in age 19 to 55years and follow-up period ranged from 2 months to 2 years. Two methods of non-incision technique were used in this study. One is single stitch method and the other is continuous buried suture method. The former was used in 176 patients(70.2% ) who are young with thin upper lid and the latter was used in 79 patients( 29.8% ) with redundant or puffy upper lid. Most of the patients were satisfied with smooth and symmetric appearance. We concluded that non-incision technique can be a good surgery method of correcting unilateral double eyelid. And we had good results using the continuous buried suture method in the case of puffy upper eyelid.