A modified intraoral and extraoral approach osteotomy for the prominent mandibular angle.

BACKGROUND: A prominent mandibular angle (PMA) is a relatively common condition in Asians, and surgeons typically use the intraoral approach to treat it. However, the approach can have many drawbacks due to the limited operative field and view. The procedures of osteotomy are not easily manipulated, and an exact resection is difficult. In addition, some major complications can easily occur. This article presents a modified osteotomy method for the PMA that avoids these disadvantages and makes the procedure easier to execute. METHODS: Four modifications of the procedures have been made: 1. The addition of a small extraoral incision in the auriculocephalic sulcus behind the earlobe; 2. A modest reduction in both the intraoral incision length and excessive mouth traction; 3. The use of a reciprocating saw through the extraoral incision tunnel to simplify the operative procedure; and 4. Extraction of sustained-suction drains from the extraoral incision. Postoperatively, all patients were followed up and administered the validated satisfaction questionnaire and the Patient Scar Assessment Questionnaire. RESULTS: From June 2010 to June 2015, 46 patients with a PMA underwent surgery using this method. All patients were satisfied with the esthetic results. The majority of patients could not feel an objectionable jaw line or bony step (86.9%), visible deformity (97.8%) or bony regrowth (95.6%). All patients noted a positive psychosocial influence. All patients perceived the overall appearance of their extraoral scar to be "good" or "excellent." Forty-five (97.8%) were "not at all" self-conscious of their scar. The overall complication rate was 6.5%, and no major complication was seen. CONCLUSION: The described method for the surgical treatment of PMA is a simple and safe procedure with fewer complications. The procedure is easy to perform, consumes less time, and can help resect the PMA accurately and easily.

Treatment of Tear Trough Deformity: Fat Repositioning versus Autologous Fat Grafting.

BACKGROUND: Fat-preserving lower blepharoplasty techniques and filling techniques using autologous or non-autologous materials are increasingly used to treat tear trough deformity. However, there has been no definitive comparison of the results of fat repositioning versus autologous fat grafting for this condition. The authors used statistical analysis to compare the results of the two methods. METHODS: From October 2013 to September 2015, a total of 101 patients, aged 20-43 years, underwent fat repositioning or autologous fat grafting in our department. Group 1 (51 patients, 102 eyes) underwent intraorbital fat repositioning with septal reset by transconjunctival lower blepharoplasty. Group 2 (50 patients, 100 eyes) underwent autologous fat grafting by lipoinjection. RESULTS: No significant complications occurred in any patient postoperatively. Four of 102 eyes in Group 1 and seven of 100 eyes in Group 2 had no improvement; the rest had different degrees of improvement. In Grade II and III deformities, fat repositioning resulted in significantly greater improvement of grade compared with autologous fat grafting. The surgical method of Group 1 resulted in better curative effects than that of Group 2. CONCLUSION: In patients with tear trough deformity and without obvious skin or orbicularis oculi muscle laxity, both fat repositioning and autologous fat grafting are acceptable for mild deformity. In patients with higher-grade deformities, fat repositioning produced superior results than autologous fat grafting. LEVEL OF EVIDENCE IV: This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .