Prevention of Complication and Management of Unfavorable Results in Reduction Malarplasty

PURPOSE: Reduction malarplasty is a popular aesthetic surgery for contouring wide and prominent zygoma. However a few patients complain postoperative results and want to revise the midfacial contour. We analyzed the etiology of unfavorable results and treated unsatisfied midfacial contours after reduction malarplasty. METHODS: Total 53 patients were performed secondary operation for correction of unfavorable results after primary reduction malarplasty from elsewhere. Midfacial contour was evaluated with plain films and three- dimensional computed tomography. Unfavorable midfacial contours were corrected by secondary malarplasty. Flaring of zygomatic arch was reduced with infracturing technique and prominent zygomatic body was reduced with shaving. Drooped or displaced zygoma complex has been suspended to higher position and fixed with interosseous wiring. As adjuvant procedure, autologous fat injection has been performed in the region of depressed zygomatic body region. RESULTS: The etiology of unfavorable midfacial contour after reduction malarplasty was classified into 7 categories: undercorrection of zygomatic arch(n=8), undercorrection of zygomatic arch and undercorrection of zygomatic body(n=6), undercorrection of zygomatic arch and overcorrection of zygomatic body(n=28), overcorrection of zygomatic body(n=3), simple asymmetry(n=4), malunion(n=2) or nonunion(n=2). Slim and balanced malar contour was achieved with treatment. And most of the patients were satisfied with the results of the surgery. CONCLUSION: To prevent the unfavorable results after reduction malarplasty, complete analysis of facial contour, choice of appropriate operation technique, precise osteotomy under direct vision, and security of zygoma position are important.

Combined Approach for Rejuvenation of the Lower Third of the Face and the Neck in the Male Patient

Most men develop deep crease in the nasolabial area and visible redundant tissue in the anterior neck with aging. The ideal operation for those patients seeking facial rejuvenation because of prominent nasolabial folds and neck soft-tissue laxity is the cervicofacial rhytidectomy. If the patient doesn't wish to have a conventional face/neck lift under general anesthesia, a combined approach based on summation of partially effective modalities is a good option. We present our experience with combined subcutaneous neck lift, platysmaplasty, mentoplasty, and platysma graft in the treatment of the lower third of the face and the neck, and obtained good results without complications using this comprehensive approach. In terms of morbidity, the procedure left inconspicuous scars. The platysma grafts remained in place and were not palpable and/or perceptible after insertion. Finally, postoperative recovery occurred uneventfully and no patients presented complications or the need for complementary treatment modalities. The incorporation of this innovative technique will provide us with more choices for addressing this controversial issue with a combined approach. The combination of proven methods may have better results than each one alone. It is a simple, safe, and inexpensive procedure that leaves no visible scars and has long-term adequate outcome. In conclusion, the presented procedure offers an additional technique of rejuvenating the lower third of the face and the neck with excellent results in the male patients.

Role of Silver-containing Carboxymethyl Cellulose Dressing in the Management of Exudative Infected Wounds

PURPOSE: Wound healing is a result of complex processes whose components, such as cells, extracellular matrix, proteolytic enzymes, and their inhibitors receive effects from immune compartments, cytokines, chemokines, and growth factors. Impairment of normal physiologic response to wounding makes nonhealing chronic wounds. Wound infection and exacerbated proteolytic process may induce uncontrolled tissue degradation or exudates formation, which may result in the development of a nonhealing chronic wound. Thus proper management of wound infection and exudates is critical to prevent and treat nonhealing wound. The aim of this study is to evaluate effects of Aquacel AG, silver-containing carboxymethylcellulose dressing on treatment for exudative infected wound. METHODS: The study included 31 patients with nonhealing wound. Wound was dressed with Aquacel AG. The effect of dressing was investigated by serial bacterial culture and wound exudates assessment. Each infection and exudates control time was determined and statistically analyzed. RESULTS: Wound infection and exudates were effectively managed using Aquacel AG dressing. Mean infection and exudates control time were 3.4+/-1.2 and 5.7+/-1.4 weeks, respectively. Statistical analysis of the data indicated that infection control time correlated positively to age and exudates control time (p<0.05). CONCLUSION: There is as yet no ideal dressing for the topical treatment of chronic nonhealing wound. But silver-containing carboxymethylcellulose dressing can be used effectively for exudative, infected nonhealing wound.

Role of Silver-containing Carboxymethyl Cellulose Dressing in the Management of Exudative Infected Wounds

PURPOSE: Wound healing is a result of complex processes whose components, such as cells, extracellular matrix, proteolytic enzymes, and their inhibitors receive effects from immune compartments, cytokines, chemokines, and growth factors. Impairment of normal physiologic response to wounding makes nonhealing chronic wounds. Wound infection and exacerbated proteolytic process may induce uncontrolled tissue degradation or exudates formation, which may result in the development of a nonhealing chronic wound. Thus proper management of wound infection and exudates is critical to prevent and treat nonhealing wound. The aim of this study is to evaluate effects of Aquacel AG, silver-containing carboxymethylcellulose dressing on treatment for exudative infected wound. METHODS: The study included 31 patients with nonhealing wound. Wound was dressed with Aquacel AG. The effect of dressing was investigated by serial bacterial culture and wound exudates assessment. Each infection and exudates control time was determined and statistically analyzed. RESULTS: Wound infection and exudates were effectively managed using Aquacel AG dressing. Mean infection and exudates control time were 3.4+/-1.2 and 5.7+/-1.4 weeks, respectively. Statistical analysis of the data indicated that infection control time correlated positively to age and exudates control time (p<0.05). CONCLUSION: There is as yet no ideal dressing for the topical treatment of chronic nonhealing wound. But silver-containing carboxymethylcellulose dressing can be used effectively for exudative, infected nonhealing wound.

Experimental Assessment of the Histologic Changes of Collagen Matrix(Terudermis(R)) in Subcutaneous Implantation: Comparison with Autologous Dermal Graft

PURPOSE: Numerous materials, both autologous and nonautologous, have been used for augmentation of sunken areas, but they have their own limitations. The purpose of this study is to determine the histologic response and volume change of the xenogenic collagen-based scaffold(Terudermis(R)) to the transfer into a subcutaneous soft tissue location in vivo rabbit model. METHODS: Eighteen New Zealand white rabbits were used. Three 1.2x1.2cm sized subcutaneous pockets were created on the dorsal surface of each ear. 1x1 cm sized collagen matrix(Terudermis(R)) and autologous dermal graft were implanted into each pocket. Full thickness of ear was harvested in 3 days, 1, 2, 4 weeks, 3, 6 months after implantation. RESULTS: Histological analysis of implants demonstrated progressive neovascularization, fibroblast infilteration, neocollagen bundle synthesis and organization, and few foreign body reaction. The thickness of the collagen matrix in 3 days after the operation was 87.69% of the thickness of the collagen matrix in wet state. Then it decreased to 30.17% in 6 months after the operation. The rate of decrease was similar at all points at the same time compared with autologous dermal graft. CONCLUSION: Our experimental study suggests that Terudermis(R) could be a safe material as an implant for permanent augmentation in subcutaneous tissue. However the choice of graft for augmentation should be remained to the clinical situations.

Clinical Comparative Study of Continuous Method and Internal Perforating Method for Nasal Lateral Osteotomy

Recently many studies have demonstrated that perforating method of lateral nasal osteotomy causes less edema and echymosis than those of continuous method of lateral nasal osteotomy. For lessening the damage of nasal mucosa, authors performed continuous nasal lateral osteotomy(NLO) with an aid of silastic strip insertion into the subperiosteal pocket on the medial side of nose along the line of osteotomy. NLO was performed in 5 patients for correction of bony abnormality. In each patient, internal perforating NLO was performed on one side of nasal bone using 2-mm straight osteotome and protected continuous NLO was performed on the other side using 4-mm curved guided osteotome. The condition of nasal mucosa was checked using endoscopy immediately after the procedure. On postoperative days 2, 7, 14, and 21 the degrees of ecchymosis and edema of each side evaluated using clinical photos(Canon EOS 300D). Mild edema and ecchymosis were observed in both sides on postoperative days 2, 7, 14, there were no significant differences between right side and left side. This study confirmed that concerning postoperative ecchymosis and edema there were no significant differences between in protected continuous NLO and in perforating NLO. We conclude that whatever the technique of NLO, the degrees of post operative edema and ecchymosis may depends on the degree of nasal soft tissue trauma.

An Analysis of Frontal Photographs Using "Balanced and Proportional Measurement"

In the morphologic study on the face, it is very important fact that one must analyze not only anomalous structures but also proportional problems of face. Authors analyzed photographs in frontal views of Korean and Western famous female entertainers, which was secondary and supplementary analysis after "BAPA (Balanced Angular Profile Analysis)" This was also a preliminary study for developing a new computerized program of facial analysis. Authors extracted 56 famous female entertainers' photographs (30 Koreans, 26 Westerns) from Internet websites. When performing sampling procedures, authors made strict criteria for selection of photographs in frontal view. We executed 20 proportional measures and 4 angular measures for the analysis. Statistical analysis using SAS program (Version 8.1. USA), was performed. Data from each group(Korean versus Western) were presented to show the means, ranges, P and F values, and standard deviations of each measurement. In addition, the Student t-test(with significance level set to P=0.05) was performed to compare the two groups. Significant between-group proportional differences(P<0.05) were found for middle face height, brow height, interpupil width, eye fissure width, nasal height, interala width, upper lip height, and mandible height but no significant racial differences were found in terms of several proportions and all of the angular measures. If automated computer program is developed based on our data, we can use our data for useful tools for the first consultation process, and suggest that appropriate and harmonious aesthetic operations should be considered reflecting these differences.

Surgical Treatment of Choanal Stenosis Associated with Craniodiaphyseal Dysplasia

Craniodiaphyseal dysplasia is a rare genetic disorder of bone due to modelling errors of long bones and skull bones. Facial and cranial thickening and distortion are particularly striking in this form. The genetic understanding of this disorder is unsatisfactory. We present one case of Craniodiaphyseal dysplasia involving facial bone, skull that causes nasal obstruction. This 3-year old female who was diagnosed of craniodiaphyseal dysplasia presented abnormal facial figuring, which is excessively thickened cortical bone resulting in very large craniofacial bony structure. The patient sufferred from respiratory difficulty due to complete obstruction of choana. We performed surgical recanalization of choanal atresia by transpalatal approach and gained good postoperative result.

Two Cases of Ear Reconstruction Using Prefabricated Radial Forearm Free Flap

Deformities of the auricular region that have been resulted from burns or other traumatic injuries emotionally devastate the patients and frustrate the surgeons. The surgical procedure for ear reconstruction varies depending upon the quality and quantity of available skin in the auricular region after burns and other facial trauma for the coverage of cartilage framework. Postauricular skin, postauricular fascia, temporoparietal fascia have been used for traumatized ear reconstruction according to the literature. But toral ear reconstruction in the cases of severe trauma like burn or traffic accident is one of the most difficult problems because of its paucity and poor quality of the available skin in the auricular region. The author reports two cases of traumatized ear reconstruction using a prefabricated radial forearm fasciocutaneous free flap made of an autogenous costal cartilage framework. This flap is valuable for the reconstruction of severely traumatized ear when local tissue or other free flaps are improper to select.

Early Relapse of Mandibular Asymmetry During Consolidation Period in Distraction Osteogenesis

Mandibular distraction osteogenesis has gained popularity as a surgical technique for hemifacial microsomia. Although there was the general acceptance of mandibular distraction osteogenesis by surgeons, the standardization of techniques among surgeons has been limited due to short period of its history. So, many surgeons having make an effort for suggesting standard protocol, based on various clinical experiences. We found that corrected mandibular asymmetry of hemifacial microsomia by rapid distraction osteogensis has a tendency to relapse, in spite of external fixator during consolidation period. On this, we studied that which factors have influences on relapse of mandibular asymmetry during consolidation period. As a result, there were significant differences of the relapse during consolidation period in proportion to mandibular hypoplasia and the vertical distraction distance. But there was no significant difference of the relapse among the duration of the consolidation period groups. And there was significant difference of the vertical distraction distance in proportion to mandibular hypoplasia. The amount of the relapse during consolidation period has correlation with the severity of the mandibular hypoplasia. In conclusion, the severity of the mandibular hypoplasia is the important forecast index of relapse during consolidation period.

Longitudinal Evaluation of Secondary Iliac Bone Grafting in the Alveolar Cleft

Secondary bone grafting in the alveolar cleft has proven effective in stabilizing the maxillary segments, providing continuity of the maxillary arch and facilitating the canine eruption into the proper position. The purpose of this study is to longitudinally evaluate the treatment results of secondary iliac bone grafting in 40 alveolar cleft patients with an observation period of more than 12 months. Interdental alveolar cleft height was measured in conventional dental radiographs taken no more than 1 month preoperatively, following the completion of all orthodontic expansion, using ratio of the adjacent tooth root and the narrowest point of cleft height. And then we measured the bone resorption rates in 1, 3, 6, and 12 postoperative months, respectively. There was significant positive correlation between presurgical alveolar cleft height and postoperative bone resorption rate. But there was not significant correlation between presurgical alveolar height and the age at operation. The overall success rate for achieving bony bridge across the cleft was 95%. The maximal bone resorption occured in 1 month after operation. In case that the secondary iliac bone graft was performed at the patient's pre-eruption stage of canine, 89% of the patient's canine erupted in 12 months after operation.

Comparative Effects of Retin-A and Vitamin C on Photoaging Skin

Photoaging skin occurs as a result of long-term exposure to ultraviolet radiation. In contrast to intrinsic aging, skin changes of photoaging can be reversed by the topical use of skin care products. Several skin care products have now undergone sufficient evaluation and have a well-defined role in our practice. Retin-A and alpha hydroxy acids have a significant number of data available for evaluation; data for Vitamin C and antioxidants are still emerging. We conducted clinical trial to compare the anti-photoaging effects of Rein-A and Vitamin C in 25 women volunteers. Each formulation wes applied daily to the randomly assigned hemifaces over the 8-month study period. Comparative evaluations of anti-photoaging effects were made using subject self-appraisal questionnares, plastic surgeon's assessment, ultraviolet revelations, and histologic examinations. Subject self-appraisal and plastic surgeon's assessment showed predominance of Retin-A over Vitamin C. But both Retin-A and Vitamin C provided objective and subjective improvement in photodamaged facial skin and no significant difference was found between Retin-A and Vitamin C in histologic examinations.

Correction of Facial Soft Tissue Defects Using Acellular Human Dermal Allograft

The augmentation of soft-tissue defects in the facial region is a challenging task for plastic and reconstructive surgeons. Numerous materials, both autologous and nonautologous materials including alloplastic implants, have been used for augmentation of soft-tissue defects of the face. Each has its limitations. There is no ideal material for soft-tissue augmentation. Acellular human dermal allograft (Alloderm, LifeCell Corporation, Woodlands, Texas, U.S.A.) combines the benefits of autografts and allografts. Alloderm does not appear to be resolved, it is a much more cost- effective treatment than fat injection, collagen injection, or other treatments that require multiple surgical operations or repeated application. Using Alloderm eliminates the need for creating a donor site. The authors report its use in 13 patients who have soft-tissue defects in the face. No serious complications such as rejection, absorption, dislocation, or extrusion were encountered. Alloderm appears to be an easily handled, safe material to use as an implant for permanent soft-tissue augmentation. Further long-term tudies are warranted to monitor the persistent volume maintenance of Alloderm.