Cosmetic Lateral Canthoplasty: Preserving the Lateral Canthal Angle

Cosmetic lateral canthoplasty, in which the size of the eye is increased by extending the palpebral fissure and decreasing the degree of the eye slant, has become a prevalent procedure for East Asians. However, it is not uncommon for there to be complications or unfavorable results after the surgery. With this in mind, the authors have designed a surgical method to reduce complications in cosmetic lateral canthoplasty by preserving the lateral canthal angle. We discuss here the anatomy required for surgery, the surgical methods, and methods for reducing complications during cosmetic lateral canthoplasty.

Medial Epicanthoplasty Using a Modified Skin Redraping Method

BACKGROUND: The presence of an epicanthal fold is a distinctive characteristic of the eyelids in Asian population. Various medial epicanthoplasty techniques have been introduced to achieve aesthetic appearance. The objective of this article is to describe our modification of the previously performed medial epicanthoplasty procedures, minimizing deterioration of the original ciliary position and maximizing natural appearance. METHODS: From December of 2011 to February of 2013, total 386 patients with epicanthal folds have undergone medial epicanthoplasties using modified skin redraping method. The design of a new medial epicanthus, subciliary line of the lower eyelid and supratarsal fold line is crucial to this method. Intramuscular dissection and myotomy of the preseptal orbicularis oculi muscle are necessary to obtain natural eyelid position. RESULTS: Most of the patients showed satisfactory results aesthetically during the follow up period; from 3 months to 12 months, a mean of 7.5 months postoperatively. There was no recurrence of the epicanthal fold. There was not any patient who complained about postoperative complications including ectropion and visible scars around the medial canthal area. CONCLUSIONS: The results indicate that medial epicanthoplasty using a modified skin redraping method is reliable and feasible procedure to correct epicanthal fold maintaining natural eyelid appearance.

Clinical Application of Extended Lateral Arm Free Flap

Despite of its many advantages, application of the classic lateral arm flap has been limited due to its small skin paddle size, thick subcutaneous tissue, a short vascular pedicle, and inconsistent sensory innervation and recovery. The flap has been used for small to medium sized defects. Keuk and Chuan (1991) reported arterial mapping of the lateral arm through the dye injection study, and the posterior lateral collateral atery passed below the lateral epicondyle an average of 7.9 cm and then anastomosed with rich vascular plexus of the proximal forearm. From March 1997 to April 1998, we have performed 8 extended lateral arm free flaps successfully at various sites such as the face, hand, forefoot, and the heel. All flaps completely survived. We found out the extended lateral arm free flap could be suitable for resurfacing the face, hand and foot because of its long pedicle, very thin and pliable skin paddle. We present diversity for its use and its safety.

Successful Treatment of Auricular Arterio-Venous Malformation

Auricular arterio-venous malformation(AVM) is relatively rare and few have been reported in the literature. Two cases, presented here showed pulsating lesions of anterior and posterior auricular or even retroauricular mastoid area. They caused irregular macro and prominent ear compared with the opposite normal ear. After embolization of feeding arteries to the arteriovenous malformations, skin and subcutaneous masses were completely removed and grafted with full thickness skin: one was removed one stage and the other underwent a two stage operations. There were no evidence of recurrence for more than 2 years follow up and esthetic results were promising.