Forehead Augmentation with a Methyl Methacrylate Onlay Implant Using an Injection-Molding Technique

BACKGROUND: The forehead, which occupies about one third of the face, is one of the major determinants of a feminine or masculine look. Various methods have been used for the augmentation of the forehead using autologous fat grafts or alloplastic materials. Methylmethacrylate (MMA) is the most appropriate material for augmentation of the forehead, and we have used an injection-molding technique with MMA to achieve satisfactory results. METHODS: Under local anesthesia with intravenous (IV) sedation, an incision was made on the scalp and a meticulous and delicate subperiosteal dissection was then performed. MMA monomers and polymers were mixed, the dough was injected into the space created, and manual molding was performed along with direct inspection. This surgery was indicated for patients who wanted to correct an unattractive appearance by forehead augmentation. Every patient in this study visited our clinics 3 months after surgery to evaluate the results. We judged the postoperative results in terms of re-operation rates caused by the dissatisfaction of the patients and complications. RESULTS: During a 13-year period, 516 patients underwent forehead augmentation with MMA. With the injection-molding technique, the inner surface of the MMA implant is positioned close to the underlying frontal bone, which minimizes the gap between the implant and bone. The borders of the implant should be tapered sufficiently until no longer palpable or visible. Only 28 patients (5.4%) underwent a re-operation due to an undesirable postoperative appearance. CONCLUSIONS: The injection-molding technique using MMA is a simple, safe, and ideal method for the augmentation of the forehead.

Regraft from Amputated Forehead Tissue of a 4x7 cm Skin Defect Containing Bony Defects

No abstract available.

Regraft from Amputated Forehead Tissue of a 4x7 cm Skin Defect Containing Bony Defects

No abstract available.

Erratum Announcement

No abstract available.

Prevention of Cheek Drooping in Intraoral Reduction Malarplasty without Internal Fixation

PURPOSE: In general, orientals including Korean, have a mesocephalic face whereas Caucasians, among the western, have a dolichocephalic face .Unlike the western, in orientals including Korean, prominent malar bones are recognized as stubborn and unattractive appearance. That is why reduction malarplasty is one of the most popular aesthetic surgical procedure in Korea. Many surgical methods to reposition prominent malar bones have been performed by means of a coronal incision or a combined incisions, using both the intraoral and the external incision. Bicoronal approach has advantage such as wide operative field, easy to maintain symmetry and possibility of combining facial lift but has shortcoming, such as external scars, long operative time, and the possibility of facial nerve or artery injury. Intraoral approach has advantages of short operative time, simplicity of procedure and no external scar. But this approach is associated with problems of cheek drooping, limited exposure and difficulty in making symmetry. METHODS: During 8 years, we performed a reduction malarplasty without internal fixation through an minimal intraoral incision and dissection in 39 patients. RESULTS: The patients were followed for 46 months, with satisfactory results and no cheek drooping. There was no patient who want to revise the inappropriate operative result such as asymmetry and incomplete correction. CONCLUSION: We conclude that minimal intraoral incision and dissection could acquire satisfactory result of reduction malarplasty along with prevention of cheek drooping.

A Ten-year Survey of Giardia Cysts in Drinking Water Supplies of Seoul, the Republic of Korea

To understand the distribution of Giardia cysts in drinking water supplies in Seoul, Korea, we collected water samples quarterly at 6 intakes in the Han River, its largest stream and 6 conventional water treatment plants (WTPs) serving drinking water, from 2000 to 2009. Giardia cysts in each of 10 L water were confirmed in 35.0% of intake water samples and the arithmetic mean was 1.65 cysts/10 L (range 0-35 cysts/10 L). The lowest cyst density was observed at Paldang and Kangbuk intakes, and the pollution level was higher at 4 intakes downstream. It seemed that these 4 intakes were under influence of Wangsuk stream at the end of which cysts were found in all samples with the mean of 140 cysts/10 L. The annual mean number of cysts was 0.21-4.21 cysts/10 L, and the cyst level at the second half of the 10 years was about 1/5 of that at first half on average. The cysts were more frequently found in winter, and their mean density was 3.74 cysts/10 L in winter and 0.80-1.08 cysts/10 L in other seasons. All finished water samples collected at 6 WTPs were negative for Giardia in each of 100 L sample for 10 years and cyst removal by physical process was average 2.9-log. It was concluded that conventional water treatment at 6 WTPs of Seoul appears to remove the cysts effectively under the present level of their source water. Domestic wastewater from the urban region could be an important source of Giardia pollution in the river.

Clinical Usefulness of a Newly Standardized Bird's Eye View Clinical Photography in Nasal Bone Fracture

PURPOSE: Nasal bone fracture is the most common type of facial bone fracture. The standard 6-view photography was not adequate to support the evaluation of nasal deformity and the results of closed reduction. The authors have standardized a bird's eye view photography to more effectively evaluate this nasal deformity. METHODS: We reviewed the medical records and radiologic studies of 63 nasal bone fracture patients. We had taken clinical photography including bird's eye view that was standardized as nasal tip was aligned to Cupid's bow of upper lip and light was focused on the nasion of all 63 patients. RESULTS: Nasal deviations and reductions were more noticeable on the newly standardized bird's eye view. This clinical photography was very useful to explain the results of reduction. CONCLUSION: It was concluded that this photography can be more reliable for evaluation of severity of nasal deformity and the result of closed reduction.

Functional Anatomy-Based Botulinum Toxin A injection to Correct Glabellar Frown Lines

Botulinum toxin A injection to reduce glabellar lines has become one of the most popular procedures in facial rejuvenation. 5-site injection is generally accepted: into the procerus muscle at the midline and each corrugator muscle at its inferomedial and superolateral aspects. The superolateral injection site is above the pupil and approximately 1cm above the bony orbital rim. According to our observation, corrugator muscles are not either symmetric or tightly related to the surface anatomical landmarks such as pupils and bony orbital rims. Therefore when glabellar lines were treated by surface anatomical landmarks, in the case of asymmetrical corrugator, it was not precisely targeted to obtain sufficient paralytic effects. Herein, we suggest functional anatomy-based Botulinum toxic A injection to correct glabellar frown lines and its theoretical backgrounds. Between 1999 and 2007, 329 patients were enrolled in the study. 86 patients between 1999 and February of 2001 were injected by the traditional injection method. Later 243 patients were treated by the functional anatomy-based injection. By the new method, injection points were determined by observing glabellar furrows and skin fine wrinkles after repetition of muscle contraction. By this method, we could enhance the cosmetic effects and heighten patients' satisfaction.

A Survey of Cryptosporidium Oocysts in Water Supplies during a 10-Year Period (2000-2009) in Seoul

This study has been conducted to estimate the occurrence of Cryptosporidium oocysts in water supplies in the Metropolitan area of Seoul, South Korea, for 10 years from 2000 to 2009. Water samples were collected quarterly at 6 intakes in the Han River and its largest stream and 6 conventional Water Treatment Plants (WTPs) serving drinking water for 10 million people of Seoul. Cryptosporidium oocysts were found in 22.5% of intake water samples and arithmetic mean was 0.65 oocysts/10 L (range 0-22 oocysts/10 L). Although the annual mean of oocyst number was as low as 0.04-1.90 oocysts/10 L, 3 peaks in 2004 and 2007 were observed and the pollution level was a little higher in winter. The lowest density was observed at Paldang intake and the pollution level increased at Kuui and Jayang intakes. At the end of the largest stream, oocysts were found in 70% of collected samples (mean 5.71 oocysts/10 L) and it seemed that its joining the Han River resulted in the increase at Kuui intake and downstream. Oocyst removal by physical process exceeded 2.0-2.3 log and then all finished water samples collected at 6 WTPs were negative for Cryptosporidium in each 100 L sample for 10 years. These results suggested that domestic wastewater from the urban region could be a source of Cryptosporidium pollution and separating sewage systems adjacent to the intakes could be meaningful for some intakes having weakness related to parasitological water quality.

Application of Hard Tissue Filler for Chin Contouring

With hightened interest in bone contouring surgeries, newer and lesser invasive treatment modalities for bone augmentation surgeries are being introduced. Bone augmentation effects with long lasting injectable tissue fillers were studied. Between June, 2006 and November, 2008, 33 cases of small chin patients underwent chin augmentation via Royamid(R) and Radiesse(R) injections, 9 and 24 cases respectively. No complications were observed through the follow up period. Twenty six patients showed satisfaction with aesthetic results at 6 months follow up. In 7 cases, temporary swelling and erythema were observed. The augmentation effect lasted more than 6 momths in both Royamid(R) hard and Radiesse(R) groups. In 7 cases of Royamid(R) hard group, the aesthetic effects lasted more than one year. Long lasting tissue filler seems to be a good alternative treatment modality for bone augmentation surgery if approached with strict protocol indications and careful patient selection.

Epicanthoplasty Using Y-V Advancement Flap Method

PURPOSE: The epicanthal fold is a unique finding in the medial canthal area of many Asians. Various methods have been developed to eliminate this fold. However, excessive and prominent scarring in the medial canthal and nasal area and recurrence restricted application of epicanthoplasty. The authors performed a epicanthoplasty using Y-V advancement flap method in order to obliterate the epicanthal fold without making incisions in the nasal area and as a result, to avoid postoperative scarring. METHODS: Sixty one patients underwent epicanthal fold correction using Y-V advancement flap method from July 1999 to February 2005. There were 4 males and 57 females with ages ranging from 9 to 60 years. The epicanthoplasty was performed combined with double eyelid operation, ptosis correction, augmentation rhinoplasty, nasal alar reduction, and nasal tip-plasty. RESULTS: There were few complications in our studies, and most of the patients were satisfied with the results. CONCLUSION: Remarkable advantages of our Y-V advancement flap epicanthoplasty are as follows: 1) minimal postoperative scarring in the medial canthal area, 2) application of modified double eyelid operation, 3) wider opening of the medial palpebral fissure, 4) the correction of entropion or epiblepharon, 5) no recurrence.

Epicanthoplasty Using Modified Uchida Method to Shift an Epicanthal Fold in a Superomedial Direction

PURPOSE: The presence of epicanthal fold and the absence of supratarsal fold are characteristics of Korean eyelids. There has been many surgical procedures to eliminate medial epicanthal fold but those procedures focus on the lengthening of horizontal palpebral fissure and the shortening of intercanthal distance so that the shape of eye had tendency to be sharp. The authors suggest that the supermedial shifting of epicanthal fold enhance the aesthetic result. METHODS: From Sep 2006 to May 2007, total 17 women(mean age 22) with Type III epicanthal fold underwent epicanthoplasty using author's modified Uchida method. The design for epicanthoplasty was drawn superolaterally along epicanthal fold and split V-W plasty was done to shift the epicanthal fold superomedially. Also non-incisional double-eyelid operation was underwent. RESULTS: The epicanthal fold was shifted in superomedially, intercanthal distance was shortened and double-eyelid was achieved. The patients were satisfied with the result and no major complication was noted. CONCLUSION: This method can be effective in correcting the epicanthal fold of Korean eyelid by shifting the epicanthal fold superomedially to make the shape of eye aesthetically without noticeable scar.

2-loop En Block Double Fold Operation through 3 Small Incision

Korean small eyes are characterized in thickness and pseudoptosis of the skin of the upper eyelid. They also have a large amount of subcutaneous and preaponeurotic fat. The hypertrophic orbicularis oculi muscles and the lower positioned transverse ligaments are included in their structural characteristics. These special features act as various burden factors in Korean double eyelid operation. Just burden factors restrict the movement of the upper eyelid and so Korean eyes looks like Ptosis (pseudoptosis). For creation of double fold eyelid, we performed continuous 2-loop single stitch buried suture to make an en bloc fixation with dermis, levator aponeurosis and Muller muscle through three small incisions. And then we tried to eliminate the burden factors through small sized lateral incision. After removal of the external sutures at postoperative 3 days, we obtained our intended double fold lines such as in-fold, in-ward fold and out fold successfully and only experienced minor complications such as edema, ecchymosis and loss of fold. And also the range of excursion in the upper eyelid improved without levator shortening or any other operation such as a sling. The objective of this article is to share our experience and to introduce our method of treating Korean pseudoptotic eyes by using 2-loop en bloc fixation through three small incisions with various reviews of literature.

Tip Plasty of Plunging Nasal Tip through Endonasal Approach: Resection of Cephalic Lateral Crus & Caudal Septum and Suturing

Usually the open rhinoplasty is used to correct the plunging nasal tip, but it can increase patient's psychological trauma and lengthen the operation time. In this study, the authors present a simple and effective surgical procedure to correct the plunging nasal tip with minimal morbidity. Between April 2005 and February 2006, we performed our nasal tip plasty in 6 patients who were concerned about the long nose with plunging nasal tip. We used the suture method after cephalic resection of the alar cartilage and caudal resection of the septal cartilage through endonasal approach. After that, we evaluated the nasal profile and compared the result with preoperative photographs. We followed these patients for 1 to 4 months. We could achieved good nasal tip projection, improvement of the columellolabial angle and shortening of long nose. The result were relatively satisfactory and there were no complications such as visible scar, alar deformity or asymmetry. Our tip plasty through endonasal approach could reform the plunging nasal tip properly and easily without external scar. We believe that this procedure could be applicable for correcting the plunging nasal tip and an alternative technique which helps to form the harmonious nasal profile with augmentation rhinoplasty.

A Case of Pilomatrixoma after Split Thickness Skin Graft

PURPOSE: Pilomatrixoma is a benign, usually asymptomatic tumor. It presents clinically as a solitary superficial subcutaneous nodule measuring between 0.5 cm and 5 cm in diameter on the head or upper extremeties and has not been reported after skin graft. The objective of this article is to report our experience in treating pilomatrixoma which occurred after split thickness skin graft on the lower extremity. METHODS: A 56-year-old female was treated in August 2005 with a 0.5 X 0.5 cm firm subcutaneous nodule at recipient site of split thickness skin graft on the left medial thigh. The tumor was successfully removed by complete excision and histologic examination was followed. RESULTS: The diagnosis was pilomatrixoma which was characterized by a dual population of proliferating basophilic cells and diagnostic shadow cells. CONCLUSION: The tumor was successfully treated by complete resection. The authors report this very rare case of pilomatrixoma which occurred at recipient site of split thickness skin graft.

Intraoral Reduction Malarplasty without Internal Fixation

The concept of the Asian facial beauty is different from that of the western. Caucasians, especially among the western, consider prominent malar bones as a sign of youth and beauty. But in Orientals including Koreans, prominent malar bones are recognized as unattractive. Until recently, operations to reposition prominent zygoma have been performed by means of a coronal incision or a combined approach, using both the intraoral and the external(preauricular, temporopreauricular or side burn) incision. Such incisions have shortcomings such as external scars, long operative time, and the possibility of facial nerve or artery injury. Intraoral incision alone is associated with problems such as cheek drooping, limited exposure in the area of zygomatic arch, and difficulty in making symmetry of the cheek. During the past 4 years, we performed a reduction malarplasty without internal fixation through an intraoral incision alone in thirty-six patients who have prominent zygoma, mainly lateral projection of the zygoma. Osteotomy of the zygomatic arch was done posteromedially using a 120 degrees-angled oscillating saw, 1cm anterior to the articular tubercle and then osteotomy of the zygomatic body was done using a reciprocating saw. After complete osteotomy and posteromedial reduction, fixation using miniplate or wire was not done. The patients were followed for 14 months, with satisfactory results and few complications. We conclude that this technique is a simple and effective method of conduction an intraoral osteotomy and reduction malarplasty without internal fixation.