Parry-Romberg syndrome treatment with fat transfer and a new bleaching formula.

Parry-Romberg syndrome is a hemifacial atrophy which can be complicated by melasma. We present two cases of Parry-Romberg syndrome, treated by fat transfer and bleaching of the skin using a modified "Kligman's formula." The atrophy, as well as the skin dyschromia, improved, and the results were stable.

Redraping of the fat and eye lift for the correction of the tear trough.

INTRODUCTION: Tear trough deformity is very difficult to correct. It can appear at relatively young age and it deepens over the years due to laxity and loss of structural support. We describe a technique for the correction of tear trough deformity and mid-face laxity by means of redraping blepharoplasty and lateral "eye lift". MATERIALS AND METHODS: Upper lid markings were made and removal of the excess skin was employed. The herniated fat was removed from the nasal fat pad. Using a subciliary incision the dissection was completed at the level of the orbital rim and the fat was repositioned with 5-0 Monocryl (poliglecaprone 25, Ethicon) sutures at the inner canthus to correct the tear trough. Subsequently, a canthopexy performed to secure the lower eyelid. We then dissected the cheek over the periosteum of the zygomatic bone-arch and the flap was suspended through a tunnel at the periosteum of the upper-lateral orbit by 5-0 Monocryl (poliglecaprone 25, Ethicon) suture. RESULTS: Thirty-five procedures were performed between 2009 and 2013. Patients were followed for at least one year. Successful correction of the tear trough deformity with middle face elevation was achieved in all patients. Sclera show was noted in 7 patients but resolved over 3-6 months period with no surgical intervention. Diplopia was noted in 1 patient probably due to oedema and was released 4 weeks after the operation. The oedema was prolonged (more than 1.5 month) in 10 patients probably due to the lymphatic stasis. Conjunctivitis was also noted in 2 patients and was released by conservative treatment. CONCLUSION: Our technique of redraping blepharoplasty and mid-face lift describes a relatively new approach for the correction of the tear trough deformity and middle face laxity. It shows stable results for up to 4 years although longer follow-up is needed to confirm the stability of the correction.

Secondary rhinoplasty fixations with hyaluronic acid.

The management of nasal deformities especially after rhinoplasty is a challenge. Postsurgical edema may last 6-8 months, causing aesthetic irregularities and nose deformities. The aim of this study is to present the correction of minor nose deformities secondary to rhinoplasty using hyaluronic acid subdermal injections. Eleven patients were treated between 2009 and 2011 with subdermal injections of hyaluronic acid (24 mg/mL) with 0.3% lidocaine (Juvederm, Allergan, Pringy-France) at the 1-month follow-up visit. The volume of hyaluronic acid injected varied from 0.4 to 1 mL according to the deformity. Injections were aimed to correct minor surface irregularities and to provide aesthetic symmetry. These patients were followed for at least 12 months postoperatively. Irregularities were aesthetically corrected immediately after hyaluronic acid injections. No complications were reported with the exception of minor swelling that resolved within 1 week. Esthetic correction was achieved in all patients as determined by the surgeon as well as by overall patient's satisfaction. Our 1-year follow-up data suggest that hyaluronic acid absorption is slow enough to provide the necessary time for postsurgical edema resorption. Rhinoplasty is among the most commonly used procedures for aesthetic improvement in men and women. However, achievement of the final outcome may take several months due to the induced postsurgical edema. Subdermal hyaluronic acid injections can provide temporary correction of these nose irregularities. Our data suggest that subdermal hyaluronic acid injections may provide immediate and long-lasting correction of these minor deformities. As a result, the aesthetic outcome is achieved and maintained throughout the postsurgical course of edema decompression.

Liposuction and suspension of the orbicularis oculi for the correction of persistent malar bags: description of technique and report of a case.

BACKGROUND: The purpose of this study was to present an alternative surgical procedure for the correction of persistent malar bags and to review the literature. METHODS: A 45-year-old female patient with persistent malar bags, secondary to previous blepharoplasty, was admitted. Liposuction of the edema and suspension of the orbicularis muscle to the temporal region was performed through a lateral canthal incision. RESULTS: A successful malar bag removal was demonstrated, exhibiting stable results at the 6-month follow-up. CONCLUSION: Persistent malar bags resulting from previous blepharoplasty may be difficult to correct with conventional treatment. The combination of liposuction and suspension of the orbicularis oculi is proposed as an efficient alternative for the correction of persistent malar bags.

Giant Basal cell carcinoma: clinicopathological analysis of 51 cases and review of the literature.

BACKGROUND: Giant basal cell carcinoma (GBCC) is an aggressive malignant neoplasm. Because of the rarity of the tumor and its recognized high risk of recurrence, there are no guidelines for its treatment. PATIENTS AND METHODS: Published articles in PubMed Central were carefully reviewed. Data from 48 patients obtained from 30 individual articles were added to our 3 cases, producing a total number of 51 cases of GBCC. A clinical database was established in order to define the behavior of this tumor, prognostic factors and optimal treatment. RESULTS: GBCC mostly occurs in elderly male patients, with a peak incidence in the seventh decade of life. It develops as long-standing dermal tumor with mean disease duration of 14.5 years and is most commonly located on the back, followed by the face and upper extremity. The most common histological subtype is nodular. The average size at presentation is 14.77 cm in its largest diameter. The presence of metastasis at the time of presentation represents the most significant adverse prognostic factor. Local recurrence or metastasis develops in 38.3% of patients despite optimal therapy. The overall reported cure rate is 61.7% by a mean follow-up of 2 years. Wide local excision of the tumor with or without postoperative radiochemotherapy represents the optimal treatment. CONCLUSION: Optimal management of GBCC consists of wide local excision with histologically confirmed tumor-free margins, frequently followed by adjuvant therapy. In cases of lymphatic spread, a regional lymphadenectomy is also necessary. In addition, consideration should be given to a close and long-term follow-up because of the high rate of locoregional recurrence.