Epicanthal Restoration Surgery with Scar Excision in Severe Epicanthal Scar.

BACKGROUND: Medial epicanthoplasty is a common aesthetic surgery in Asia to remove the epicanthal fold. With increasing use of this surgery, unsatisfactory results have grown. Several methods have been developed to correct it. However, there are limitations in restoration if the patient has a severe scar or does not have enough skin for reconstruction. By aggressively removing scar tissue, the authors present a better reverse redraping epicanthoplasty. METHODS: The procedure was performed on 512 patients who had complications of medial epicanthoplasty from May 2011 to October 2015. The mean age was 31.3 years. Those who had already undergone reconstruction were 15.4% (n = 79). Of these, 68 patients received a V-Y flap and the rest had V-Y modification surgery. After the design, the skin-muscle flap was dissected and elevated. The upper and lower eyelid skin was pulled medially. The previous scar tissue was widely excised while removing skin excess, and the new epicanthal fold was created without a rectangular shape. RESULTS: The mean interepicanthal distance has been increased from 32.8 to 36.6 mm. The mean lengthening effect is 3.8 mm. Lacrimal lake exposure, fierce and narrow appearance, and incomplete medial eyelid closure were improved. CONCLUSIONS: Medial epicanthoplasty is a common cosmetic surgery in the Asian population. A demand for an effective reconstructive method has grown in association with higher complication rates. The authors have better results to make a natural epicanthal fold through aggressive scar removal in the reverse redraping epicanthoplasty. 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 .

Restoration of Complicated Epicanthus: Modified Reverse Skin Redraping With Mini-epicanthoplasty for Rescue in Unsatisfied Epicanthoplasty Patients.

PURPOSE: We had reported the surgical outcome of reverse skin redraping technique for restoration of previously performed epicanthoplasty. In this study, we introduce a modified reverse skin redraping technique that added mini-epicanthoplasty in patients with unsatisfactory results after epicanthoplasty. METHODS: Three hundred twenty-four patients (288 female and 36 male patients) who had unsatisfied results with previous epicanthoplasty and that were treated with our modified restoration surgery were included in this study. RESULTS: The mean preoperative interepicanthal distance was 33.6 mm, and the mean postoperative interepicanthal distance was 36.9 mm; the mean difference in the interepicanthal distance before and after restoration surgery was 3.3 mm. Satisfactory aesthetic results were obtained with improvements in areas of asymmetry, overexposure of the caruncle, and the appearance of the previous scar. Only minor complications developed in 15 patients (4.6%) that were resolved with minor revisions. No severe complications requiring reoperations were noted. CONCLUSIONS: Our modified method involving reverse skin redraping and mini-epicanthoplasty is simple and reproducible and is useful for resolution of unsatisfactory results to obtain a naturally shaped epicanthus.

Aesthetic Shoulder Augmentation with Silicone Implants.

BACKGROUND: Men with narrower shoulders may appear less muscular than other men. Deltoid muscle underdevelopment or atrophy, a condition commonly linked to narrow shoulder issues, may be associated with congenital deformity, trauma, or neoplasm. For some people, regular exercise does not effectively develop the deltoid muscle region. Some people naturally have a smaller build than others. Even with developed deltoid muscles, these people still appear to be small. The authors have performed lateral shoulder augmentation with silicone implants for 4 years. Based on their experience, this procedure stands as a reliable solution for men with narrow shoulders. METHODS: Lateral shoulder augmentation with silicone implants was developed and used for 81 patients between April 2009 and April 2013. None of the patients had shoulder deformities except for two patients (one patient with Poland's syndrome and one patient with Sprengel's deformity). The implants were placed through a horizontal axillary crease incision in a plane dissected between the deltoid fascia and muscle. RESULTS: All augmentation or correction procedures have been met with complete patient approval. Five patients had minor complications such as hematoma and implement displacement. However, all these complications were resolved to the satisfaction of the patients. CONCLUSION: When silicone implants are used to achieve purely aesthetic improvements, successful shoulder augmentation procedures are observed. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Restoration of the medial epicanthal fold: reverse skin redraping method in patients unsatisfied with epicanthoplasty.

BACKGROUND: Many Asians receive epicanthoplasty to improve their medial epicanthal fold.Excessive performance of such surgery may cause multiple unwanted results, but there is no report on any restoration method for an overcorrected result of epicanthoplasty. Accordingly, the authors have created a new method for reversely restoring the excessively corrected medial epicanthal fold using skin-redraping epicanthoplasty (Plast Reconstr Surg. 2007;119:703-710). METHODS: During the interval between January 2009 and April 2011, 35 patients received surgery for restoration of the epicanthal fold using the authors' method, which involves sufficiently elevating the skin flap and redraping it to reconstruct the epicanthal fold. This method is very simple to design and perform, and it effectively covers the excessively exposed lacrimal lake. In addition, it can be used independently of the type of prior epicanthoplasty. RESULTS: After the surgery, 2 patients experienced overcorrection, and we repeated the epicanthoplasty. In the other patients, there was no severe complication except for mild redness, a condition that improved after several months. The mean measured distance between the medial canthi after the surgery was 36.8 mm, corresponding to a total lengthening effect of 4.5 mm. This improved the aggressive facial expression caused by the exposed lacrimal lake, and the eyes no longer appeared to be too close together. Moreover, in the case of patients who had more visible scars due to prior epicanthoplasty on the medial epicanthal area, the overall scar length decreased. CONCLUSIONS: This method is simple in design and easy to perform. It can also control the degree of restoration with an additional advantage of reducing a prior scar. Using this method, we could effectively restore the overcorrected epicanthal fold.

Reoperation of epicanthal reconstruction using a modified reverse skin-redraping method.

With the increasing adoption of medial epicanthoplasty or reconstruction procedures, the number of patients undergoing reoperations is also increasing. However, the surgical techniques useful for reoperations and the potential difficulties during reoperations have not been adequately elucidated. We aimed to describe the use of our modified reverse skin-redraping technique to improve cosmetic outcomes in patients who had previously undergone epicanthal reconstruction. From January 2014 to January 2021, we performed reoperations using our modified reverse skin-redraping technique in patients who had previously undergone epicanthal reconstruction. The main reason for the reoperations was cosmesis. The patients' ages ranged from 21 to 46 years (average, 28.7 years), and the follow-up periods ranged from 6 to 12 months. A total of 389 patients (311 females and 78 males) underwent reoperations, of which 324 patients (83%) underwent 1 reconstructive surgery and 65 (17%) underwent reconstructive surgeries more than twice after primary epicanthoplasty. The postoperative intercanthal distances could be increased or decreased depending on the preoperative design. After reoperation, 22 patients (5.6%) required additional reoperation. Reoperation of epicanthoplasty is technically challenging. The scarred round shape of the medial epicanthus during the reoperation poses difficulties, and the optimal technique to be used remains unknown. We believe that selection of an individualized restoration method that suits the purpose of surgery is important for patients who require reoperations. In this respect, we suggest that our modified reverse skin-redraping method is a suitable option for improving esthetic outcomes.

Conjunctivorhinostomy with rubber-tipped Jones tube.

One of the problems of conjunctivorhinostomy that employs the conventional Jones tube is that the end of Jones tube has to be manipulated by the surgeon so that the tube resides within the nasal cavity while not touching the middle turbinate and the nasal septum. As a result, patients who have high nasal septal deviation, paradoxical curvature, or middle turbinate hypertrophy have inadequate space in the nasal cavity for the Jones tube to rest. Such patients required either septoplasty or turbinectomy prior to conjunctivorhinostomy. To overcome such a problem, the authors connected a 4 French rubber tube to the tip of the Jones tube and helped the end of the tube to reside within the nasal cavity regardless of the anatomic variation of nasal septum or the middle turbinate. When such modified procedure is used, the Jones tube makes good contact with the conjunctiva, lacrimal sac, and the nasal mucosa while the rubber tube remains afloat within the nasal conjunctiva. Such modification helps the tube to reside within the nasal cavity without foreign body reactions and granulation tissue complications, and there is no need to change tubes to make up for the loss of tube length because of postoperative tissue contracture. Between April 2000 and August 2001, the authors performed conjunctivorhinostomy with a rubber-tipped Jones tube on 8 patients with drainage problems of the nasolacrimal duct system and obtained satisfactory results without complications.

Reconstruction of a lower extremity soft-tissue defect using the gastrocnemius musculoadipofascial flap.

Use of the gastrocnemius as either a muscle or musculocutaneous flap has proved to be effective in the management of knee and lower leg soft-tissue defects because of its reliable constant vascular pedicle and ease of procedure with little or no functional deficit. As a muscle flap, the volume of the distal part of the muscle for coverage is small, and is even smaller when accompanied by posttraumatic disuse atrophy. Although there have been many modifications to increase the arc of rotation and dimensions of the muscle flap, the disadvantage is the skin graft on the flap donor site and the resulting deformity of the leg contour. Also, clinical limitations occur when the defect size is extensive or there is an inadequate arc of rotation or dimension. The authors present their clinical application of a gastrocnemius muscle flap with a distal adipofascial flap as a useful alternative for various sizes and types of defects. Between 1999 and 2000, gastrocnemius adipofascial flaps were used in 7 patients with various types of defects. This form of musculoadipofascial flap has not yet been described in the known literature. In the authors' opinion, this procedure is a valuable extension of local flap procedures in reconstructing relatively large defects in the region of the knee and lower extremity.