A new assisted fixation technique to prevent zygoma displacement in malar reduction.

BACKGROUND: Reduction malarplasty via an intraoral approach for correction of a prominent malar complex is quite popular in the Orient. However, one point of fixation in the anterior zygoma body area, the most widely used method, sometimes is insufficient and likely to result in malunion and cheek drooping. We designed a new assisted fixation technique to strengthen the effect of fixation. METHODS: Two parallel oblique vertical ostectomies were performed on the zygomatic body with a groove left in the inner osteotomy line. The zygomatic arch root was cut obliquely through a small sideburn incision just in front of articular tubercle, medial to lateral and anterior to posterior. The freed malar complex was medially and superiorly repositioned with the zygomatic body wedged in the groove, followed by fixation with one miniplate or wire. Finally, the periosteum in the zygomatic area was pulled and sutured to the deep temporal fascia. RESULTS: Most patients were satisfied with their results. No inferiorly displaced malunion occurred in the zygomatic body. There were no serious complications such as nonunion or permanent facial nerve injury. Minor complications, including palpable step-off, mild asymmetry, hematoma, and mild cheek drooping, occurred in some cases. CONCLUSION: Our assisted fixation method, combined with subperiosteal lifting, can provide ideal effects and sufficient fixation in malar reduction to prevent many complications such as malunion and cheek drooping. LEVEL OF EVIDENCE IV: This journal requires that 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 www.springer.com/00266 .

Combined long-curved ostectomy in the inferior mandibular border and angle of the mandible with splitting corticectomy for reduction of the lower face.

BACKGROUND: In Asian countries, a square-shaped face is considered unattractive. Many operative techniques have been developed and reported for reduction of the lower face, including mandibular angle ostectomy and splitting corticectomy. Many surgeons have performed the operation in the angle region using one of the aforementioned techniques, which may not lead to effective results. This report mainly discusses the standard procedures of surgery. METHODS: To overcome the drawbacks of conventional procedures and to perform ostectomy accurately, proper preoperative analysis and design were implemented for 159 patients with square-shaped faces. Based on a new type of classification and concepts for mandible reduction, long-curved ostectomy combined with splitting corticectomy was used for reduction of the lower face. A series of standard procedures was developed during the operative process. RESULTS: The majority of patients were satisfied with both their frontal and lateral appearances. The gonial angle and the mandibular plane angle were increased effectively. No major complications such as fracture or facial nerve damage occurred. Lip numbness occurred for 15% of the patients. CONCLUSIONS: The authors' series of standard procedures allows surgeons to perform accurate, safe, and reproducible ostectomy and to obtain reliable and stable effects.

[Investigation of satisfactory rate in patients with body dysmorphic disorder after cosmetic surgery].

OBJECTIVE: To explore the satisfactory rate in patients with body dysmorphic disorder (BDD) after cosmetic surgery. METHODS: We designed a questionnaire to investigate the postoperative satisfactory rate in patients with BDD and without BDD. RESULTS: There was significant difference in postoperative satisfactory rate between patients with BDD and without BDD. CONCLUSION: The patients with BDD have a lower satisfactory rate, which is even worse after repeated surgery.