Incisional Blepharoplasty for the Asian Eye.

The goal of Asian blepharoplasty is to create a lid crease configuration that resembles the natural-appearing crease found in other Asians. Because the Asian upper eyelid contains more prominent preseptal fat resulting in greater lid fullness, soft tissue work in blepharoplasty of the Asian eye is even more diverse and essential than that of whites in order for there to be the sustainability of the eyelid crease. Hence, Asian blepharoplasty should be performed specifically following the orbital anatomy of Asians. This article details the incisional method of blepharoplasty to create natural-appearing creases for Asians with single eyelids.

Asian Rhinoplasty with Rib Cartilage.

An Asian rhinoplasty is one of the most popular procedures in plastic surgery. The anatomical characteristics of the Asian nose are quite different from those of other races, including low dorsum height, short columella, a thick soft tissue covering on the tip with flaccid lower lateral cartilage, and a sunken midface with relative protrusion of the mouth due to maxilla or premaxillary retrusion. For augmentation and lengthening of the nose, a silicone implant has been commonly used in Asian countries. However, many patients suffer from silicone-related complications, which induce soft tissue contraction and deform the already fragile nasal structure. Additionally, revision surgery is also increasing in frequency due to greater patient sophistication and higher expectation that the end rhinoplasty result to be more harmonious with the patient's overall facial structure. In these circumstances, a rhinoplasty using autologous rib cartilage, giving strong support and enough amount of the cartilage to correct deformed structure and midface skeletal retrusion. If properly performed with enough experience, a rib cartilage rhinoplasty will provide excellent and long-lasting results with low risk.

Intraoperative measurements of harvestable septal cartilage in rhinoplasty.

The aim of this study was to assess the dimensions of the septal cartilage available for grafting in patients undergoing open rhinoplasty and analyze whether the size of the external nose might be a useful indicator of the size and amount of harvestable septal cartilage. A prospective study was conducted on 55 Korean rhinoplasties. Intraoperative measurement of the harvested septal cartilage with preservation of 10 mm width l-strut was performed. The correlation between the quantity and size of the septal cartilage in situ with anthropometric measurements were evaluated. The mean caudal length of the harvested septal cartilage was 15.1 mm, the mean dorsal length was 18.2 mm, and the mean area was 520.9 mm2. Only 5 patients (9.1%) had cartilage sufficient for full-length dorsal onlay grafts, whereas 10 patients (18.2%) had septal cartilages of length >25 mm that could be used as spreader grafts. Dimensions of the septal cartilage in situ did not correlate with preoperative external nose measurements. The amount of harvested septal cartilage is usually insufficient for simultaneous use for multiple grafts in Korean. External nose size may not be a useful indicator of the availability of adequate septal cartilage for rhinoplasty. The need to harvest additional graft material should be kept in mind during preoperative planning for rhinoplasty procedures.

Compliance with positive airway pressure treatment for obstructive sleep apnea.

OBJECTIVES: Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients. METHODS: We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7(R) of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors. RESULTS: After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other. CONCLUSION: The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.

Combined use of crushed cartilage and processed fascia lata for dorsal augmentation in rhinoplasty for Asians.

OBJECTIVES/HYPOTHESIS: Autologous dorsal nasal grafts have limitations including limited tissue availability, additional surgery time, donor site morbidity, a visible graft contour, and postoperative distortions and deformities owing to displacement and warping. This report describes our experience using combined Tutoplast-processed fascia lata (TPFL) and crushed cartilage for dorsal augmentation and contouring in rhinoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: The study involved a total of 113 patients (68 male, 45 female), who underwent crushed cartilage-TPFL grafting to the nasal dorsum. Patient satisfaction was evaluated using a questionnaire. Photographs and postoperative histories were reviewed to assess complications including graft resorption, graft infection, warping, extrusion, irregularity, and postoperative deformity. RESULTS: Different autologous grafts were used in combination with TPFL: septal cartilage in 70 cases (61.9%), septal cartilage and ethmoid bone in 17 cases (15.0%), costal cartilage in 15 cases (13.3%), and septal and conchal cartilage in 11 cases (9.7%). Of the 101 patients who responded to the questionnaire, 85.1% were satisfied with the surgical outcome. Complications were encountered in four patients (3.5%), comprising overcorrected dorsal augmentation in two patients, graft resorption in one patient, and dorsal irregularity in one patient. Eight patients (7.1%) required revision rhinoplasty due to dissatisfaction with the nasal tip shape (n = 6), graft resorption (n = 1) and overcorrected dorsal augmentation (n = 1). CONCLUSIONS: The combined use of crushed cartilage and TPFL appears to be a useful technique for dorsal augmentation and contouring. This technique provides favorable and predictable outcomes in rhinoplasty. Laryngoscope, 2009.

Processed costal cartilage homograft in rhinoplasty: the Asan Medical Center experience.

OBJECTIVE: To report our experience using a commercially available homograft (Tutoplast-processed costal cartilage [TPCC]; Tutogen Medical GmbH, Neunkirchen am Brand, Germany) in augmentation rhinoplasty. DESIGN: Retrospective review. SETTING: Tertiary care academic center. PATIENTS: The study population comprised 35 patients who underwent rhinoplasty with TPCC between November 2003 and October 2004. INTERVENTIONS: The TPCCs were used for full-length dorsal grafts in all 35 patients, as well as for septal batten, spreader graft, septal extension, tip onlay, and shield grafts. MAIN OUTCOME MEASURES: Surgical outcomes were evaluated in 35 patients who underwent rhinoplasty in which TPCC was used. Anthropometric measurements of the nose were made on lateral photographs and compared with preoperative measurements. Postoperative complications were also assessed. RESULTS: Anthropometric measurements, expressed as mean (SD), documented postoperative increases in tip projection (5% [9%]), nasal length (10% [10%]), nasolabial angle (1.5 degrees [8.7 degrees ]), and nasofrontal angle (3.1 degrees [8.7 degrees ]). The overall complication rate was 31% (11 of 35 patients). Complications included resorption (17%), warping (9%), visible graft contour (3%), and graft fracture (3%). CONCLUSION: Although TPCC could serve as an alternative graft material for rhinoplasty, the high complication rates of this material may preclude its use for dorsal augmentation.

Deviated nose cartilaginous dorsum correction using a dorsal L-strut cutting and suture technique.

OBJECTIVE: A deviated nose with involvement of a severely deviated cartilaginous dorsum is a particular challenge for rhinoplasty surgeons. We applied a new approach for treating such cases, the "dorsal L-strut cutting and suture technique," and assessed its efficacy and the surgical outcomes. STUDY DESIGN: Retrospective chart review. METHODS: The study population consisted of 27 patients who received the "cutting and suture technique of dorsal L-strut" to control a severe cartilaginous dorsal deflection between February 2004 and September 2006. Two otolaryngologists who were not involved in surgeries assessed surgical outcomes. Preoperative and postoperative photographs were studied to evaluate outcomes, and anthropometric measurements were made. Postoperative complications were assessed. RESULTS: Postoperative assessments showed that 81.5% of patients had "excellent" or "good" deviation correction. Two (7.4%) patients experienced cephalic rotation of the tips and shortening of the nasal length. There were no reports of recurrence, saddling, or infection during follow-up. Pre- and postoperative anthropometric measurements showed there was no significant change in tip projection, nasal length, nasofrontal angle, or nasolabial angle. CONCLUSIONS: The dorsal L-strut cutting and suture technique appears to be a useful method for correcting severe cephalocaudal convexity of the dorsal L-strut in deviated noses.

Tutoplast-processed fascia lata for dorsal augmentation in rhinoplasty.

OBJECTIVE: Tutoplast-processed fascia lata (TPFL) is a commercially available homograft, which has been successfully used as human graft tissue for physical support procedures. The present report evaluates the use of TPFL in rhinoplasty. STUDY DESIGN AND SETTING: The study involved a retrospective analysis of rhinoplasty cases using TPFL. The study population consisted of 69 patients (52 male and 17 female) and a minimum follow-up of 12 months. RESULTS: TPFL was used as a smoothening graft after correction of deviated and hump noses, as a major dorsal contouring graft for saddle or flat noses, and in secondary rhinoplasty following silicone implant complications. TPFL alone was used in 41 cases and in combination with other material in 28 cases. The only complication was major resorption in three cases, with two being secondary rhinoplasty patients. CONCLUSION: TPFL alone or in combination with other materials can be used as a dorsal augmentation material in rhinoplasty. TPFL was particularly useful for correction of dorsal irregularities and in cases requiring a minimal amount of augmentation.

Organizing hematoma of the maxillary sinus.

OBJECTIVE: The study aims to elucidate the clinical features and surgical results of OHMS (organizing hematoma of the maxillary sinus). STUDY DESIGN AND SETTING: We performed a chart review of 20 patients undergoing surgery for maxillary sinus lesions and pathologically diagnosed with OHMS between January 1990 and December 2005. RESULTS: The most common complaint was frequent epistaxis (70%). Paranasal CT scans showed unilateral expansile maxillary opacification, heterogeneous enhancement, bony destruction (25%), and focal calcification (15%). Treatment consisted of a sublabial approach combined with endonasal endoscopic surgery (50%), endonasal endoscopic surgery alone (45%), and Denker's operation (5%). All patients had a successful outcome without recurrence. CONCLUSION: Conservative surgical approaches such as sublabial or endonasal endoscopic surgery alone or in combination lead to excellent outcomes without recurrence. We propose the term "OHMS" to better describe this rare pathology. SIGNIFICANCE: Our report is the largest series of OHMS to date.