An Experimental Study of Auricular Reconstruction Using a Thin Porous Silastic Frame Assisted by Tissue Expansion: An Animal Study.

BACKGROUND: In the 1960s, the silastic ear frame was used for auricular reconstruction. Most surgeons abandoned the use of the silastic ear frame in the 1980s because of the high incidence of exposure. In this study, we introduce the computer-aided design and manufacture of a thin, porous silastic auricle frame and investigate the possibility of auricular reconstruction using this frame assisted by tissue expansion. METHODS: An adult male with average sized, normal ears was selected. A spiral CT scan was performed to obtain primitive data on his external ear. Mimics-8.1 and Geomagic studio-12 were used for 3D reconstruction and image processing. A thin, porous silastic auricle frame 1.4 mm in thickness was manufactured. A 50 ml kidney-shaped tissue expander was implanted between the panniculus carnosus and the deep fascia through an incision on the back of each of 10 New Zealand white rabbits. Each week the expander was inflated with 10 ml saline to a total of 160 m1. Maintenance of the expansion lasted for a month. The expander was then removed, and the silastic auricle frame was inserted into the pocket. The reconstructed ears were observed for 6 months postoperatively. RESULTS: The reconstructed ears remained soft and flexible, with no deformation, contracture, or extrusion observed 6 months postoperatively. The scaphoid fossa, triangular fossa, cavum, helix, and antihelix remained defined. CONCLUSIONS: The silastic frame, 1.4 mm in thickness manufactured by computer-aided design, stood up to the contraction of the overlying expanded flap. It is possible to be used for auricular reconstruction assisted by tissue expansion.

Treatment of postblepharoplasty lower eyelid malposition by Aptos thread.

BACKGROUND: Lower eyelid malposition is the most common complication after lower eyelid blepharoplasty. Although the traditional techniques were effective for correcting lower eyelid malposition, they had potential disadvantages, including additional trauma, additional scar, and long recovery period. OBJECTIVE: To evaluate the efficacy of a minimally invasive surgical technique using Aptos thread for postblepharoplasty lower eyelid malposition. METHODS: A retrospective review of all patients undergoing lower eyelid malposition surgery via a minimal invasive, Aptos thread technique from June 2005 to June 2010. Symptoms, including epiphora, ocular irritation, conjunctivitis, and measurement of lower eyelid scleral show (measured from the inferior limbus of cornea) were recorded. Presurgery and postreconstruction photographs were reviewed for functional and cosmetic outcome. RESULTS: A total of 15 patients (24 eyelids) underwent successful lower eyelid malposition surgery using this minimally invasive technique. On clinical examination, all cases of lower eyelid retraction stemmed from overzealous excision of skin and orbicularis. After a follow-up interval of 12 to 25 months (mean, 15 months), inferior corneal exposure and ocular symptoms were corrected thoroughly. The decrease in lower eyelid retraction was 2.7 ± 0.9 mm. The functional and cosmetic result was satisfactory in all cases. CONCLUSIONS: Aptos thread technique is a safe, effective, and the least invasive method of managing mild and moderate postblepharoplasty lower eyelid malposition secondary to shortening anterior lamella.

[A new procedure to correct the crow's feet by covering the orbicularis oculi muscles with the superficial temporal fascia flap in rhytidectomy].

OBJECTIVE: To explore an ideal procedure with more lasting aesthetic results by covering the orbicularis oculi muscles with the superficial temporal fascia flap in rhytidectomy, which can help to correct the crow's feet successfully. METHODS: During rhytidectomy, dissection was performed subcutaneously and also under pericranium and superficial temporal fascia at temporal area. Then the superficial temporal fascia flap was formed by cutting between pericranium and superficial temporal fascia. The fascia flap was reversed to cover the lateral orbicularis oculi muscle with fixation. RESULTS: From May 2004 to May 2010, 18 cases were treated with a follow-up period of 6-12 months. The crow's feet was corrected better with long lasting results, compared with conventional rhytidectomy. No complication happened. CONCLUSIONS: The crow's feet can be corrected markedly with long lasting results by covering the orbicularis oculi muscles with the superficial temporal fascia flap in rhytidectomy.

[En block frontal-temple silicone for humping the forehead and temple].

OBJECTIVE: To explore the reliability of humping the forehead and temple by en block frontal temporal silicone . METHODS: Make wax mold by piling up wax slices layer by layer according to the rang of depressing of the forehead and temple, the section being humped and the hight need to be projected. Order the silicone block according to the dimension of the wax mold. Make the implant from the silicon block. Under local anaesthesia dissection under the superficial temporal fascia and galea through forehead and two temporal incisions. Implant the silicon through the middle incision. RESULTS: Total 18 cases in this group were followed up for 3-12 months. Wound healed primarily without infection. I case with early blood effusion cured after aspiration. l case with later clear effusion cured after aspiration ad injection of prednisone in to the capsular. The frontal temporal contours were satisfactory . No outline of the implant was seen. CONCLUSION: It is safety and satisfied to hump the forehead and temple by en block frontal temporal silicone.

[Correct conglutination deformities of the upper eyelid after double eyelid operation by relieving infraorbicularis oculi fat flap and infilling].

OBJECTIVE: Adhesive or too highly located folds upper eyelid and even blepharoptosis are common complications of double eyelid operation. To correct such deformities. METHOD: We shifted down the double eyelid line, removed adhesion thoroughly, relieved orbital fat and restarted the volume with infraorbicularis oculi fat flap. RESULT: We had treated 32 case in past two years. The results were satisfying. CONCLUSION: The method are acted easy and gained fine result, so behaving to extend application.

[A preliminary approach of covering corrugator with rectangle periosteous flap in rhytidectomy].

OBJECTIVE: To evaluate the aesthetic outcome after application of rectangle periosteous flap to cover corrugator. METHODS: On the basis of regular rhytidectomy, a inter-eyebrow periosteous flap is applied to cover the fascia flap of corrugator by means of turnover. This manipulation helps to separate the skin from the muscle and prevent the re-adherence between the skin and muscle. RESULTS: The approach was applied on 15 cases. The follow-up ranged from 6 months to 1 year. The results were satisfactory. CONCLUSIONS: The method is effective in elimination of inter-eyebrow crease.

[Facial anatomic study and application in rhytidectomy].

OBJECTIVE: To find a procedure for facial rejuvenation which is simple, safe with lasting aesthetic results based on facial anatomic study. METHODS: Anatomy study was performed on 12 sides from 6 head specimens. Observe the range and thickness of fat lateral to the nasolabial grooves. Observed the location of the skin retaining ligaments and reappraised their functions combining with clinical observations. RESULTS: Skin and subcutis and SMAS (including mimic muscles) become slackening with aging, but the loosening degrees are different, especially in the region lateral to the nasolabial groove. So they should be handled respectively. The fat lateral to the nasolabial groove is thick and is mobile with aging . So the subcutaneous detachment need not beyond the anterior border of the masseter. In the past two years, we performed rhytidectomy on 100 patients by limited subcutaneous detachment and SMAS double-plication. Satisfactory results were obtained. There are no serious complications observed. CONCLUSIONS: Rhytidectomy by limited subcutaneous detachment and SMAS double-plication is a simple and safe procedure with lasting aesthetic results.

[Aesthetic correct depressed nose and prolong nasal columella using nasal columella base flaps, bilateral labial mucosa flaps, and the silicone imitation].

OBJECTIVE: Using simple method to reform depressed middle part of the face and to prolong nasal columella. METHODS: Fill silicone into the subcutaneous cavity of the nase and maxillary attended by using nasal columella base and bilateral labial mucosa flaps. RESULTS: Obtain a satisfactory result to reform depressed nose,nasal columella and maxilla. CONCLUSIONS: It is a propagable economic way to resolve a complex deformation using this simple method, and get a satisfactory result.