Forehead Augmentation with a Methyl Methacrylate Onlay Implant Using an Injection-Molding Technique

BACKGROUND: The forehead, which occupies about one third of the face, is one of the major determinants of a feminine or masculine look. Various methods have been used for the augmentation of the forehead using autologous fat grafts or alloplastic materials. Methylmethacrylate (MMA) is the most appropriate material for augmentation of the forehead, and we have used an injection-molding technique with MMA to achieve satisfactory results. METHODS: Under local anesthesia with intravenous (IV) sedation, an incision was made on the scalp and a meticulous and delicate subperiosteal dissection was then performed. MMA monomers and polymers were mixed, the dough was injected into the space created, and manual molding was performed along with direct inspection. This surgery was indicated for patients who wanted to correct an unattractive appearance by forehead augmentation. Every patient in this study visited our clinics 3 months after surgery to evaluate the results. We judged the postoperative results in terms of re-operation rates caused by the dissatisfaction of the patients and complications. RESULTS: During a 13-year period, 516 patients underwent forehead augmentation with MMA. With the injection-molding technique, the inner surface of the MMA implant is positioned close to the underlying frontal bone, which minimizes the gap between the implant and bone. The borders of the implant should be tapered sufficiently until no longer palpable or visible. Only 28 patients (5.4%) underwent a re-operation due to an undesirable postoperative appearance. CONCLUSIONS: The injection-molding technique using MMA is a simple, safe, and ideal method for the augmentation of the forehead.

Functional Anatomy-Based Botulinum Toxin A injection to Correct Glabellar Frown Lines

Botulinum toxin A injection to reduce glabellar lines has become one of the most popular procedures in facial rejuvenation. 5-site injection is generally accepted: into the procerus muscle at the midline and each corrugator muscle at its inferomedial and superolateral aspects. The superolateral injection site is above the pupil and approximately 1cm above the bony orbital rim. According to our observation, corrugator muscles are not either symmetric or tightly related to the surface anatomical landmarks such as pupils and bony orbital rims. Therefore when glabellar lines were treated by surface anatomical landmarks, in the case of asymmetrical corrugator, it was not precisely targeted to obtain sufficient paralytic effects. Herein, we suggest functional anatomy-based Botulinum toxic A injection to correct glabellar frown lines and its theoretical backgrounds. Between 1999 and 2007, 329 patients were enrolled in the study. 86 patients between 1999 and February of 2001 were injected by the traditional injection method. Later 243 patients were treated by the functional anatomy-based injection. By the new method, injection points were determined by observing glabellar furrows and skin fine wrinkles after repetition of muscle contraction. By this method, we could enhance the cosmetic effects and heighten patients' satisfaction.

Erratum Announcement

No abstract available.

Prevention of Cheek Drooping in Intraoral Reduction Malarplasty without Internal Fixation

PURPOSE: In general, orientals including Korean, have a mesocephalic face whereas Caucasians, among the western, have a dolichocephalic face .Unlike the western, in orientals including Korean, prominent malar bones are recognized as stubborn and unattractive appearance. That is why reduction malarplasty is one of the most popular aesthetic surgical procedure in Korea. Many surgical methods to reposition prominent malar bones have been performed by means of a coronal incision or a combined incisions, using both the intraoral and the external incision. Bicoronal approach has advantage such as wide operative field, easy to maintain symmetry and possibility of combining facial lift but has shortcoming, such as external scars, long operative time, and the possibility of facial nerve or artery injury. Intraoral approach has advantages of short operative time, simplicity of procedure and no external scar. But this approach is associated with problems of cheek drooping, limited exposure and difficulty in making symmetry. METHODS: During 8 years, we performed a reduction malarplasty without internal fixation through an minimal intraoral incision and dissection in 39 patients. RESULTS: The patients were followed for 46 months, with satisfactory results and no cheek drooping. There was no patient who want to revise the inappropriate operative result such as asymmetry and incomplete correction. CONCLUSION: We conclude that minimal intraoral incision and dissection could acquire satisfactory result of reduction malarplasty along with prevention of cheek drooping.

Application of Hard Tissue Filler for Chin Contouring

With hightened interest in bone contouring surgeries, newer and lesser invasive treatment modalities for bone augmentation surgeries are being introduced. Bone augmentation effects with long lasting injectable tissue fillers were studied. Between June, 2006 and November, 2008, 33 cases of small chin patients underwent chin augmentation via Royamid(R) and Radiesse(R) injections, 9 and 24 cases respectively. No complications were observed through the follow up period. Twenty six patients showed satisfaction with aesthetic results at 6 months follow up. In 7 cases, temporary swelling and erythema were observed. The augmentation effect lasted more than 6 momths in both Royamid(R) hard and Radiesse(R) groups. In 7 cases of Royamid(R) hard group, the aesthetic effects lasted more than one year. Long lasting tissue filler seems to be a good alternative treatment modality for bone augmentation surgery if approached with strict protocol indications and careful patient selection.

Anaphylactoid reaction after injection of ketorolac in a loading dose for patient-controlled analgesia: A case report / 대한마취과학회지

Anaphylaxis is a severe and life-threatening systemic hypersensitivity reaction. Ketorolac is a popular drug used for patient-controlled analgesia. Although anaphylactic reaction to ketorolac has not been frequently reported, it can develop by way of several mechanisms. A 41-year-old male patient was scheduled for laparoscopic correction of a perforated gastric ulcer. Emergency surgery was performed under general anesthesia with no complications. Near the end of anesthesia administration, ketorolac in a loading dose was administered intravenously in order to launch patient-controlled analgesia. Following injection, urticaria-like skin lesions, including rashes and wheels appeared systemically; tachycardia and breathing difficulty with oxygen desaturation also developed. Through additional inquiry into the patient's drug history, past experience with ibuprofen allergy was identified. Antihistamine, steroid, and aminophylline were administered, and continuous positive airway pressure by full facial mask was applied to relieve bronchospastic symptoms. The patient recovered without further complications.

Epicanthoplasty Using Y-V Advancement Flap Method

PURPOSE: The epicanthal fold is a unique finding in the medial canthal area of many Asians. Various methods have been developed to eliminate this fold. However, excessive and prominent scarring in the medial canthal and nasal area and recurrence restricted application of epicanthoplasty. The authors performed a epicanthoplasty using Y-V advancement flap method in order to obliterate the epicanthal fold without making incisions in the nasal area and as a result, to avoid postoperative scarring. METHODS: Sixty one patients underwent epicanthal fold correction using Y-V advancement flap method from July 1999 to February 2005. There were 4 males and 57 females with ages ranging from 9 to 60 years. The epicanthoplasty was performed combined with double eyelid operation, ptosis correction, augmentation rhinoplasty, nasal alar reduction, and nasal tip-plasty. RESULTS: There were few complications in our studies, and most of the patients were satisfied with the results. CONCLUSION: Remarkable advantages of our Y-V advancement flap epicanthoplasty are as follows: 1) minimal postoperative scarring in the medial canthal area, 2) application of modified double eyelid operation, 3) wider opening of the medial palpebral fissure, 4) the correction of entropion or epiblepharon, 5) no recurrence.

Intraoral Reduction Malarplasty without Internal Fixation

The concept of the Asian facial beauty is different from that of the western. Caucasians, especially among the western, consider prominent malar bones as a sign of youth and beauty. But in Orientals including Koreans, prominent malar bones are recognized as unattractive. Until recently, operations to reposition prominent zygoma have been performed by means of a coronal incision or a combined approach, using both the intraoral and the external(preauricular, temporopreauricular or side burn) incision. Such incisions have shortcomings such as external scars, long operative time, and the possibility of facial nerve or artery injury. Intraoral incision alone is associated with problems such as cheek drooping, limited exposure in the area of zygomatic arch, and difficulty in making symmetry of the cheek. During the past 4 years, we performed a reduction malarplasty without internal fixation through an intraoral incision alone in thirty-six patients who have prominent zygoma, mainly lateral projection of the zygoma. Osteotomy of the zygomatic arch was done posteromedially using a 120 degrees-angled oscillating saw, 1cm anterior to the articular tubercle and then osteotomy of the zygomatic body was done using a reciprocating saw. After complete osteotomy and posteromedial reduction, fixation using miniplate or wire was not done. The patients were followed for 14 months, with satisfactory results and few complications. We conclude that this technique is a simple and effective method of conduction an intraoral osteotomy and reduction malarplasty without internal fixation.

Age-related Alterations of Apoptosis in Ischemic-reperfused Rat Tibialis Anterior and Soleus Muscles / 체질인류학회지

Prolonged ischemic-reperfusion induces cellular damages and apoptosis in rat skeletal muscle. Such injury takes place in the phase of reperfusion following ischemia induction in part via regulating of apoptosis-related gene inductions. The present study was performed to examine the age-related alertation of expression of apoptosis in rat tibialis anterior and soleus muscles following ischemia-reperfusion. 9 weeks, 30 weeks, and 65 weeks old male Sprague-Dawley rats were divided into 2 groups such as controls and ischemia. For ischemia, left commom iliac artery was occulded for 4 hours using rodent vascular clamps. The tibialis anterior and soleus muscles were removed 0, 3, and 24 hours after onset of reperfusion. Muscle samples were embedded in paraffin and 6 micrometer sections were made. The apoptotic reactions was detected using TUNEL methods. The results obtained were as follows; 1. In control groups, the number of apoptosis was increased with aging, but not significantly. 2. In ischemia groups, the number of apoptosis was increased at 3 hours after ischemia, and decreased at 24 hours after ischemia. 3. In ischemia groups, the number of apoptosis was increased with aging. 4. In ischemia groups, the number of apoptosis in the tibialis anterior muscle was higher than that in soleus muscle. These results suggested that the ischemic injury of the rat skeletal muscle is increased with aging and that tibialis anterior muscle is more susceptabile to ischemic injury than soleus muscle.

Age-related Alterations of Bcl-2 and Bax Immunoreactivities in the Ischemic-reperfused Tibialis Anterior and Soleus Muscles of the Rats / 체질인류학회지

Prolonged ischemic-reperfusion induces cellular damages and apoptosis in rat skeletal muscle. Reactive oxygen species generated during reperfusion time induce expression of various genes and apoptosis. Among apoptosis-related gene products, Bcl-2 and Bax regulate the apoptotic response by inhibiting and promoting cell death, respectively. The purpose of this study was to observe the age-related alertation of expression profile of Bcl-2 and Bax in rat tibialis anterior muscle and soleus muscle following ischemia-reperfusion. 9 weeks, 30 weeks, and 65 weeks old male Sprague-Dawley rats were divided into control and ischemia groups. Ischemia group was divided into 3 subgroups based on reperfusion time. For ischemia, left commom iliac artery was occulded for 4 hours using rodent vascular clamps. The animals were sacrificed at hours 0, 3 and 24 after onset of reperfusion and tibialis anterior and soleus muscles were removed. Muscle tissues were embedded in paraffin and 6 micrometer sections were made. The expression level of Bcl-2 and Bax were examined using immunohistochemical methods. The results obtained were as follows; 1. In control group, immunoreactivities (IMRs) of Bcl-2 and Bax were weak or moderate in 30 weeks old rats and were trace in 9 and 65 weeks old rat. 2. In control group, IMRs of Bcl-2 and Bax in tibialis anterior muscle were more higher than those in soleus muscle, but not significantly. 3. In ischemia group, IMRs of Bax were increased with aging. 4. In ischemia group, IMR of Bax in tibialis anterior muscle was higher than that in soleus muscle. These results suggested that the increased IMR of Bax may be related to increasing of ischemic injury, and both old skeletal muscle and tibialis anterior muscle are susceptabile to ischemic injury of rat skeletal muscle.

Forehead Augmentation with Methylmethacrylate

No abstract available.