Levator Extension Method for Correcting Double Eyelids in Elderly Asian Patients: A Reliable and Flexible Blepharoplasty Technique.

Background: Conventional tarsal fixation techniques for creating a static double-eyelid fold frequently result in a nonmobile overdepression of the fold, which is particularly pronounced in elderly patients. Objectives: We propose a novel surgical approach aimed at achieving better results with fewer complications. This approach involves imitating the natural double-fold physiology by employing a turn-over flap of the orbital outer septum and carefully managing the pretarsal soft tissue to create a double fold. Methods: A total of 503 patients underwent double-eyelid surgery, involving a turn-over flap of the outer orbital septum and pretarsal soft-tissue management. The orbital septum was exposed and transversely opened superior to the incision margin and the pretarsal soft issue was removed as necessary. Turn-over flaps were trimmed and attached to the dermis and orbicularis oculi muscle of the lower flap. Patient follow-up occurred for 2 to 7 years (mean, 3.8 years). Results: This surgical method achieves a double fold with shallow or moderate depth, creating a natural-appearing fold line. Of the 503 patients, 94% of respondents provided a satisfaction score of 4 and 5 points; 20 people provided a score of 3 points; 10 were dissatisfied. A review of the patient chart showed that there were no specific complications in >94% (473) of patients. Conclusions: We proposed a double-eyelid surgery technique using the outer septum to control the depth and pretarsal soft-tissue management to minimize resistance in the creation of the double eyelid. Our method showed a high patient satisfaction rate and fewer complications in elderly Asians.

Aesthetic Removal of Foreign Body Granulomas of Forehead Via Pretrichial Approach.

ABSTRACT: In the field of plastic surgery, various filler types have been developed, which are widely used for cosmetic or reconstruction purposes. However, unregulated substances often injected by unlicensed practitioners may cause difficult-to-treat side effects, such as foreign body granulomas. Since the forehead is an exposed area and the lesions are likely extensive, complete surgical removal with inconspicuous scar can be difficult. In addition, pharmacological treatments, such as steroids, have only a temporary effect. The authors report successful cases of foreign body removal combined with subcutaneous forehead lift via a pretrichial approach for cosmetic satisfaction.Ten patients who had received illegal filler injections that resulted in chronic granulomas on the forehead were studied. The granulomas were confirmed using sonography, and simultaneous foreign body removal and subcutaneous forehead lifts using pretrichial incisions were planned. For the surgical method, the forehead flap was carefully elevated to a uniform thickness in the subcutaneous plane via a pretrichial incision, and the foreign body was removed, paying attention to the forehead contour and nerve damage; excess skin was excised from the top of the flap to tighten the remaining skin on the forehead.None of the patients developed complications, such as skin necrosis, infection, hematoma, or wound dehiscence, during the follow-up period. The functional and aesthetic outcomes were satisfactory in all the patients.The subcutaneous forehead lift via a pretrichial incision seems to facilitate foreign body removal and improve the forehead deformity by tightening the remaining skin.

Feasibility of a polydioxanone plate as an adjuvant material in rhinoplasty in Asians.

BACKGROUND: Nasal framework-supporting procedures such as septal extension grafts, derotation grafts, and columellar strut grafts are usually required in rhinoplasty in Asian patients because the skin envelope is tight, but the nasal framework is small and weak. Autologous materials are preferred, but they have some limitations related to the amount that can be harvested and the frequency of use. Therefore, synthetic materials have been used to overcome these limitations. METHODS: A total of 114 patients who received a polydioxanone (PDS) plate as an adjuvant material in rhinoplasty from September 2016 to August 2017 were retrospectively investigated. The PDS plate was used as to support the weak framework and to correct the contour of the alar cartilages. The PDS plate was used for reinforcement of columellar struts and septal L-struts, alar cartilage push-down grafts, fixation of septal extension grafts, and correction of alar contour deformities. RESULTS: Primary and secondary rhinoplasty was performed in 103 and 11 patients, respectively. Clinically, no significant inflammation occurred, but decreased projection of the tip was observed in seven patients and relapse of a short nose was noted in five patients. CONCLUSIONS: PDS plates have been used in the United States and Europe for more than 10 years to provide a scaffold for the nasal framework. These plates can provide reinforcement to columellar struts, L-struts, and septal extension grafts. In addition, they can assist in deformity correction. Therefore, PDS plates can be considered a good adjuvant material for Asian patients with weak and small nasal cartilage.

Comparison of Postoperative Outcomes Between Monitored Anesthesia Care and General Anesthesia in Closed Reduction of Nasal Fracture.

Fracture of nasal bone is among the most common facial bone fractures. Reduction of nasal bone fracture is able to be performed under local or general anesthesia. The aim of this study is to compare monitored anesthetic care (MAC) and general anesthesia (GA) based on intraoperative vital signs, and the adverse effects after closed reduction of nasal bone fractures.The authors performed a retrospective study of 45 patients who underwent a closed reduction of nasal bone fracture between January 1, 2016 and December 31, 2016. Patients are divided into an MAC group (n = 17) or GA group (n = 28). A sore throat, postoperative pain scores, nausea, vomiting, hospital stay, operation time, and the result of surgery are compared between the groups. All the patients have interviewed their satisfaction of aesthetic and functional outcome.The operation time and hospital stay were lower in the MAC group. There is no difference in a sore throat, postoperative pain score, and the result of surgery significantly. In the MAC and GA groups, there was no statistically significant difference in the postoperative cosmetic and functional satisfaction scores.Closed reduction of nasal bone fracture using MAC is as safe and efficient as GA. However, MAC anesthesia may not be feasible if airway discomfort due to bleeding is expected, or fracture is severe and multiple manipulations are required. Therefore, MAC is considered to be a good alternative when patients undergoing short-term or small operations do not prefer general anesthesia.