Correcting the Cleft Lip Nose Deformity: The Graft Number 1 for the Columella.

BACKGROUND: The nose deformity associated with cleft lip is difficult to solve in the primary and secondary surgery. In an adult patient, many techniques are used including mobilization, suspension, fixation and trimming the alar cartilages, septoplasty, nasal bones osteotomies, and dorsal bone and cartilage resection. Different types of cartilage grafts are commonly used. METHODS: A septal cartilage graft was used in 75 adult patients with mild to severe cleft lip deformities. Based on the golden ratio proportions of the columella that can be observed in the lateral view, a septal cartilage graft with a number 1 shape was created and inserted between the medial cruras in 75 patients, with unilateral or bilateral cleft lip, between 2007 and 2014. Complementary surgery was done in the nose of all the patients. A retrospective, observational, and descriptive study was made with presurgical and postsurgical photographs, throughout a 6-month follow-up period. RESULTS: Excellent cosmetic and functional results were seen, especially in the lateral view. There was 1 septal perforation reported. The patients were satisfied with the aesthetic results. CONCLUSION: The graft number 1 works in the reality; it has proven to be a stable support to the affected cartilage, projects a nice nasal tip, and is a lasting solution for adults.

Calf lipo-reshaping.

BACKGROUND: Augmentation and remodelling of the calf is becoming more and more frequent, representing a challenge for the surgeon who must consider this body zone as a functional and aesthetical whole. Historically, calf reshaping has been carried out with silicone implants, mainly in the subaponeurotic plane; nonetheless, as in other body sites it is possible to perform lipoinjection which is a reliable procedure with minimal scarring and a lasting outcome with rare, long-term complications. MATERIALS AND METHODS: Between the years 2009 and 2011, five patients (three women and two men) underwent bilateral calf liporemodelling. Follow-up was between 6 and 18 months. The larger perimeter of each calf was measured for follow-up. Magnetic resonance imaging was used to localise the injected fat at the end of the follow-up period in two of the patients. RESULTS: An average of 126.8±21.2 cc was lipoinjected into each calf. The average final augmentation in the larger perimeter of each leg was 2.8 cm. All patients obtained a good aesthetical outcome and were satisfied. No important complications were seen in this series. CONCLUSION: According to our experience and outcomes we can recommend the liporemodelling technique of the calf as a valid alternative for the reshaping of the distal third of the inferior extremity.