Perforating frontal branch of the superficial temporal artery as related to subcutaneous forehead lift.

The aim of this study was to elucidate the precise anatomy of the perforating branch of the superficial temporal artery in relation to subcutaneous forehead lift (SFL).Ten hemifaces of 6 fresh adult Korean cadavers were used in this study. In 4 hemifaces, following injection of red latex, dissection was performed. In 2 hemifaces, following injection of methylene blue solution into the perforator, the area of discoloration was observed. An artery perforating the frontalis muscle into skin of the forehead was identified in 18 foreheads of 9 patients who underwent SFL. Measurements were taken of the external diameter and the location of the perforator.Perforating branches originating from the frontal branch of the superficial temporal artery, perforating the frontalis muscle into skin of the forehead, were observed in all 10 of the dissected hemifaces. Thereafter, it was referred to as the perforating frontal artery (PFA). Skin of the ipsilateral mid-forehead was discolored by methylene blue solution. Most of the PFA (83%) was included in a circle having a radius of 8.9 mm. The center of the circle was located 40.5 mm from the midline on the x axis and 53.6 mm from the supraorbital rim (on the y axis). The center of the circle was located at 89.8% of the length of the midline to the lateral canthus (x axis) and 79.1% of the length of the supraorbital rim to the hairline (y axis).Plastic surgeons can use the PFA in order to achieve sufficient circulation of the skin flap. When surgeons are required to sacrifice the PFA in order to achieve flap mobilization, they can safely cauterize the PFA after isolation without causing accidental burn injury to the skin flap. In addition, the PFA might be useful in creation of local or distant flaps for reconstruction of the forehead or scalp.

Pedicled perforator flap of stellate design.

The perforator flap has proven to be effective as both a free flap and a pedicled flap in the reconstruction of a variety of regions. Usually, a V-Y advancement pattern or simple ellipse is the design selected for pedicled perforator island flaps. On the other hand, the transposition of multiple perforator flaps or skin grafting on the donor sites is required for larger defects. The authors used a stellate design to elevate a perforator flap with large dimensions, whilst allowing the easier closure of the donor defect. This method was used for reconstructing the sacral (six cases), trochanteric (one case), and lower leg (three cases) regions. Although minor wound dehiscence at the donor sites was encountered in three cases, all the defects were reconstructed successfully using a single perforator flap. This design would be a valuable option for planning a pedicled perforator flap, particularly when a difficult donor closure is expected.

Radiofrequency volume reduction of gastrocnemius muscle hypertrophy for cosmetic purposes.

Muscularly prominent calves, caused mainly by hypertrophy of the gastrocnemius muscle (GCM), are prevalent among Asian women, and this condition can be a significant factor leading to psychological stress. The authors have devised a method for contouring the calf using radiofrequency (RF) applications to the GCMs to correct thick, muscular legs. This study was performed to investigate the effects of RF energy in reducing enlarged GCMs for 250 patients (249 women and 1 man) who sought aesthetic consultation for problems such as thick, muscular, asymmetric, or bowed calves. The operations were performed from June 2004 to April 2006. The patients first received a local anesthetic and sedation. After application of RF current, the prominent muscular contours improved, and the GCMs were contoured to an appropriate proportional volume. The range of the reductions in the calf circumferences at their thickest levels was 1 to 6 cm (mean, 2.5 cm) during the follow-up visits 6 months after the procedures. Most of the patients could return to their activities of daily living, except for exercise, after 1 to 7 days, and they were satisfied with the improved aesthetic contour lines of their lower legs. Clinical photography and ultrasonic examination were performed, and the leg circumferences were measured. Radiofrequency-induced coagulation tissue necrosis of the muscles caused no functional disabilities, and the clinical improvement was well maintained after the treatments for up to 17 months of follow-up evaluation.