Coronal-splitting Reduction Genioplasty Combined with Bilateral Osteotomies of the Mandibular Inferior Border for Macrogenia.

There are various types of chin deformities, and the least established surgical method for deformity correction may be reduction for anteroposterior macrogenia. Anteroposterior macrogenia is commonly corrected by either setback genioplasty or burring reduction, but these approaches are less likely to produce aesthetically pleasing results. Both procedures have poor reduction effects because of the low response rate of soft tissues to skeletal alterations. There is a high likelihood of chin ptosis and flattening. Setback genioplasty can also yield step deformities at the inferior mandibular border. To overcome these drawbacks of conventional methods, I developed a novel technique of coronal-splitting reduction genioplasty. I have performed more than 83 procedures with a high success rate over the past 10 years. Alloplastic chin implant-shaped bone fragments were resected from the prominent bony chin, in which the average thickness of resected bone was 8.2 mm. Sufficient sagittal reduction effects were then achieved in most cases, although the soft tissue response rate remains 25%-50%, as reported in the literature. The no-degloving technique with cephalic suspension of the mentalis muscle prevents chin ptosis. Combined bilateral oblique osteotomies of the inferior mandibular border contribute to minimizing obvious postoperative chin flattening. Moreover, macrogenia can be large in multiple planes, including anteroposterior, vertical, transverse, or their combinations. This new technique can handle all three planes by combining both bilateral oblique osteotomies of the inferior mandibular border and burr ostectomy. Overall, these findings suggest that the coronal-splitting genioplasty method may replace conventional methods for correcting macrogenia.

A New Concept of Narrowing Genioplasty: Home Plate-Shaped Sliding Osteotomy.

BACKGROUND: Narrowing genioplasty is commonly performed among East Asian populations, as a broad and/or square chin can be aesthetically unappealing. This study was aimed to introduce the home plate-shaped sliding osteotomy technique for narrowing genioplasty and to evaluate the results of this technique. METHODS: A retrospective chart review of 117 patients who underwent home plate-shaped sliding osteotomy alone between 2011 and 2019 was performed. The angles of oblique osteotomy lines and measurements of caudal repositioning, which significantly affect the postoperative chin shape, were evaluated. RESULTS: The home plate-shaped sliding osteotomy technique was successfully accomplished for narrowing genioplasty as an isolated procedure. The mean distance of caudal repositioning was 3.9 ± 0.8 mm, and the mean angles of oblique osteotomy lines were 23.3 ± 4.8 degrees on the right and 21.8 ± 3.5 degrees on the left. This produced an aesthetically pleasing rounded and proportionately narrow chin. The incidence of minor complications was 6.0 percent. There were no major complications. In particular, the risk of inferior alveolar nerve injury was obviated, as an additional mandibular border osteotomy was not typically used with this technique. CONCLUSIONS: This new surgical procedure for narrowing genioplasty provides improved aesthetic results by altering the chin shape, rather than reducing the transverse width of the chin. The versatility of this procedure allows the chin shape to be adjusted with respect to narrowing, vertical lengthening, anterior advancement, and asymmetric or cleft chin correction. The present study suggests that home plate-shaped sliding genioplasty may be an excellent alternative for correcting broad and/or square chins and more complex chin deformities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells.

BACKGROUND: Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. METHODS: To overcome the problems with lipoinjection, the authors developed a novel strategy known as cellassisted lipotransfer (CAL). In CAL, autologous adiposederived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. RESULTS: Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. CONCLUSIONS: The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.

Alar Cinching with Subcutaneous Flaps: A Procedure to Achieve Narrowing of the Nasal Base while Controlling the Alar Axis and Sidewall Curvature.

BACKGROUND: Insufficient narrowing of alar width, alar distortion, and noticeable scarring are commonly encountered after alar base reduction. The authors aimed to demonstrate an alar cinching with subcutaneous flaps procedure to reduce the alar width while controlling the alar axis and sidewall curvature. METHODS: A retrospective chart review of 560 patients who underwent alar base reduction between 2000 and 2015 was performed. The clinical outcomes of alar cinching with subcutaneous flaps were compared to those of vestibular floor excision with cinching suture. Mean change in alar width was compared to assess narrowing efficacy between the two groups. In addition, mean changes in interalar distance for the upper, middle, and lower parts of the alae were compared to evaluate the alteration of alar axes. RESULTS: Seventy-three patients who underwent alar base narrowing alone (alar cinching with subcutaneous flaps, n = 42; vestibular floor excision with cinching suture, n = 31) were identified. Alar cinching with subcutaneous flaps was significantly more effective than vestibular floor excision with cinching suture in reducing alar width. In patients with vertical alar axes, alar cinching with subcutaneous flaps achieved more uniform narrowing of the entire alae, resulting in prevention of alar distortion. The incidence of complications after alar cinching with subcutaneous flaps was 5.7 percent. CONCLUSIONS: Alar cinching with subcutaneous flaps achieved sufficient narrowing of the nasal base in the long-term follow-up in patients with any type of alar axis and enabled the reduction of sidewall curvature while eliminating the need for wedge resection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Integrated Forehead and Temporal Augmentation Using 3D Printing-Assisted Methyl Methacrylate Implants.

BACKGROUND: Achieving aesthetic results with forehead augmentation procedures remains challenging. We have developed a method of integrated forehead and temporal augmentation using a three-dimensional (3D) printing-assisted methyl methacrylate implant. OBJECTIVES: The study objective was to assess the importance of combined temporal augmentation when performing forehead augmentation. METHODS: We identified 34 patients (from 2000 to 2010) who underwent forehead augmentation with a methyl methacrylate implant contoured in situ during surgery and 41 patients (from 2010 to 2016) who underwent integrated forehead and temporal augmentation with a prefabricated methyl methacrylate implant. We conducted a retrospective chart review of patient data including operation time, complications, and instances of revision surgery. Two blinded plastic surgeons scored the aesthetic results of the operations on a 4-point scale (1, poor, to 4, excellent) based on preoperative and posttreatment photographs. RESULTS: The integrated augmentation method resulted in a lower frequency of posttreatment implant removal (one [2%] vs. six [18%]; P < .05), a lower frequency of filler injection for touch up (one [2%] vs. six [18%]; P < .05), and higher mean aesthetic scores (3.7 ± 0.5 vs. 2.2 ± 1.0; P < . 001) compared to the forehead augmentation method. There was no statistically significant difference in surgical complications between the two groups. CONCLUSIONS: Integrated forehead and temporal augmentation using a 3D printing-assisted methyl methacrylate implant may be the optimal available procedure, enabling the custom fabrication of contours requested by the patient and providing a rejuvenating and balancing effect on facial appearance.

Stromal vascular fraction isolated from lipo-aspirates using an automated processing system: bench and bed analysis.

The heterogeneous stromal vascular fraction (SVF), containing adipose-derived stem/progenitor cells (ASCs), can be easily isolated through enzymatic digestion of aspirated adipose tissue. In clinical settings, however, strict control of technical procedures according to standard operating procedures and validation of cell-processing conditions are required. Therefore, we evaluated the efficiency and reliability of an automated system for SVF isolation from adipose tissue. SVF cells, freshly isolated using the automated procedure, showed comparable number and viability to those from manual isolation. Flow cytometric analysis confirmed an SVF cell composition profile similar to that after manual isolation. In addition, the ASC yield after 1 week in culture was also not significantly different between the two groups. Our clinical study, in which SVF cells isolated with the automated system were transplanted with aspirated fat tissue for soft tissue augmentation/reconstruction in 42 patients, showed satisfactory outcomes with no serious side-effects. Taken together, our results suggested that the automated isolation system is as reliable a method as manual isolation and may also be useful in clinical settings. Automated isolation is expected to enable cell-based clinical trials in small facilities with an aseptic room, without the necessity of a good manufacturing practice-level cell processing area.

Vertical enlargement of the palpebral aperture by static shortening of the anterior and posterior lamellae of the lower eyelid: a cosmetic option for Asian eyelids.

BACKGROUND: Although double eyelid plasty, levator aponeurotic surgery, and epicanthoplasty are well-accepted cosmetic treatments for Asian eyes, some patients are incompletely satisfied with the outcomes and request further surgery. Although lower eyelid descent is generally recognized as a symptom of aging or a complication after blepharoplasty, the authors propose a perceptional change: a lowering the lower eyelid procedure to vertically enlarge the palpebral aperture in selected Asian patients. METHODS: A total of 125 Japanese patients underwent the lowering the lower eyelid procedure between 2005 and 2009. The main indications were patients with vertically narrow palpebral aperture or an up-slanting appearance. The lowering the lower eyelid procedure is performed by a combination of the removal of approximately 4 to 6 mm of the subciliary skin (usually the lateral one-third to two-thirds of the lower eyelids) and static shortening of the lower eyelid retractors (posterior lamella) through a transconjunctival approach. The middle lamella was not touched during the procedure. RESULTS: The up-slanting lower eyelid margin was lowered and the lateral part of the palpebral aperture was enlarged by the procedure in all cases. Cosmetic outcomes were encouraging and satisfying to most patients. Three complications occurred (2.4 percent): lagophthalmos in one patient (0.8 percent) and entropion in two patients (1.6 percent). These minor complications resolved within 1 month. Eight revision operations were required for undercorrection. CONCLUSIONS: The lowering the lower eyelid procedure offers Asian patients desiring large oval eyes a novel surgical option. The procedure proved to be a reliable and consistent technique that provided satisfactory results in carefully selected patients.

Lower face reduction with full-thickness marginal ostectomy of mandibular corpus-angle followed by corticectomy.

BACKGROUND: In Asian countries, many patients with a prominent mandibular angle desire its correction, because they consider it to be an unappealing feature. Reduction mandibuloplasty has been frequently performed through the intraoral approach, but an invisible mandibular angle forces the surgeon to perform blind ostectomy. In addition, the limited mobility of the oscillating saw leads to semi-vertical ostectomy, and leaves unnatural mandibular contours, such as loss of the mandibular angle. METHODS: To overcome the drawbacks of conventional procedures, we performed en bloc mandibular corpus-angle ostectomy using a contra-angle handpiece and subsequent corticectomy in 519 patients with prominent mandibular angles. A retractor with an endoscope was supportively used in 190 patients. A pre- and postoperative cephalogram was taken in 86 patients, and the gonial angle (GA) and the mandibular plane angle to the Frankfort horizontal plane (MPA) were measured. RESULTS: The majority of patients were satisfied with the aesthetic results. GA and MPA were increased by approximately 10 degrees. GA was successfully improved to within the pre-set desired range in 84.5% and 60.0% of the female and male patients, respectively. The overall complication rate was 4.0%; all of these were minor complications, and no major complication such as malfracture or facial nerve injury was seen. CONCLUSIONS: Our new technique allows surgeons to perform accurate, safe and reproducible ostectomies and to reshape prominent angles to more natural-looking ones with smooth ostectomised borders.

Cell-assisted lipotransfer for facial lipoatrophy: efficacy of clinical use of adipose-derived stem cells.

BACKGROUND: Lipoinjection is a promising treatment, but its efficacy in recontouring facial lipoatrophy remains to be established. OBJECTIVE: The objective was to evaluate the efficacy and adverse effects of lipoinjection and supplementation of adipose-derived stem/stromal cells (ASCs) to adipose grafts. METHODS: To overcome drawbacks of autologous lipoinjection, we have developed a novel strategy called cell-assisted lipotransfer (CAL). In CAL, stromal vascular fraction containing ASCs was freshly isolated from half of an aspirated fat sample and attached to the other half of aspirated fat sample with the fat acting as a scaffold. This process converts relatively ASC-poor aspirated fat into ASC-rich fat. We performed conventional lipoinjection (non-CAL; n=3) or CAL (n=3) on six patients with facial lipoatrophy due to lupus profundus or Parry-Romberg syndrome. RESULTS: All patients obtained improvement in facial contour, but the CAL group had a better clinical improvement score than did the non-CAL patients, although the difference did not reach statistical significance (p=.11). Adipose necrosis was found in one non-CAL case who took perioperative oral corticosteroids. CONCLUSION: Our results suggest that CAL is both effective and safe and potentially superior to conventional lipoinjection for facial recontouring. The authors have indicated no significant interest with commercial supporters.

Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells.

BACKGROUND: Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. METHODS: To overcome the problems with lipoinjection, the authors developed a novel strategy known as cell-assisted lipotransfer (CAL). In CAL, autologous adipose-derived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. RESULTS: Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. CONCLUSIONS: The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.

Surgical correction of retracted nostril rim with auricular composite grafts and anchoring suspention.

Among concerned nasal appearances, a deformity with supero-lateral displacement of the nostril rim, called retracted nostril rim or elevated nostril rim is commonly seen and is considered one of the most difficult types of cases to treat aesthetically. A new surgical method for treating retracted nostril rim was performed in 10 patients, using the combination of auricular composite graft, internal fixation with a retainer, and external continuing suspension with anchoring sutures. The procedure was successful in maintaining the grafted cartilage in the ideal position and in avoiding recurrence of retraction or elevation of the constructed alar rim. The presented method merits consideration as a standard operative approach for correction of retracted nostril rim.