Experience with use of Expanded Polytetrafluoroethylene(Gore-tex(R)) in Cosmetic Facial Surgery

To date, for facial soft tissue augmentation, numerous implant materials have been used, including autogenous, homogenous, and alloplastic grafts. Among these, the porous material, Gore-tex(R) has a pore (0.5-30 microns, average 22 microns) which allows sufficient but limited soft tissue ingrowth to anchor implants, but not so much to make removal difficult or destructive to adjacent structures. In addition, this material has some advantage: non-carcinogenic, non-allergic, less capsule formation and reduced chance of infection due to high vascularity. In the past years Gore-tex(R) has found multiple applications in facial plastic and reconstructive surgery. However this alloplastic material can be associated with potentially severe complications and side effects such as soft tissue reaction, infection, extrusion, exposure, etc. There have been also adverse criticism of Gore-tex(R) : relative difficulties in postoperative removal, in carving implant, higher infection and extrusion rates in scarred tissue and thicker implant as well as postoperative volume reduction. In order to analyze results depending on the implantation site, the presence of scar on recipient site, thickness and type of implant, a retrospective chart review of 56 patients(69 cases) was undertaken of all patients who underwent facial soft tissue augmentation with Gore-tex(R) graft from November 1998 to November 2001 in a wide variety of situations. All cases were categorized as either primary(normal recipient site) or secondary(scarred recipient site) cases and the thickness of each graft used in millimeters was recorded. Postoperative follow up revealed a stable implant material with no major complications relating to the graft material and no differences in developing complications according to the implantation site, the presence of scar, thickness and type of implant. All patients were highly satisfied with their results.

Anatomical Nasal Tip Plasty with Autogenous Cartilage Graft

Augmentaion rhinoplasty is one of the most common aesthetic surgery in Korea. Plastic surgeons have been more interested in not only simple augmentation of nasal dorsum, but making more beautiful and natural nasal tip. In the people who has depressed nasal bridge with round and blunted tip, simple augmentation of the nasal dorsum with silicone or Gore-Tex implants could aggravate the tip's disfigurement, so the need for tip plasty has been more emphasized in those persons. There have been used two traditional techniques in endonasal autogenous cartilage tip graft for increasing tip projection, Sheen's shield graft and Peck's onlay graft. But these techniques have several disadvantages such as displacement, visibility of graft margin and flattening of infralobule. The most criticizable problem is that these grafts have limitation in producing the natural and anatomical tip contour.We have done 45 consecutive nasal tip plasties using anatomically-shaped cartilage grafts which was developed from the idea of combination of Sheen's shield and Peck's onlay graft. We followed up the patients from 2 to 14 months. Most patients have been very satisfied with the results and no serious complications were noted. Author's graft was designed to minimize displacement by stable placement on both alar domal and lobular segments, minimize graft visibility by increasing graft contact to nasal tip skin, manipulate the cephalo-caudal length by modification of onlay thickness, and most of all, reproduce the anatomical tip projection and contour.

Scar Revision of Wide Facial Scar by Serial Excision Using the Sure-Closure(R)

Conventional methods of scar revision of wide facial scar are skin graft, local flap coverage, local flap using the tissue expander, and free flap method, but these methods have disadvantages such as color dismatching, deformity of facial structure, inevitable additional scar, great expense, and waste of time. From April 1996 to April 2001, we performed the scar revision of wide facial scar by serial excision using the Sure- Closure(R) in 8 patients. Of these, 4 had scars on the cheeks, 2 on the preauricle, and the remaining 2 on the mentum and temporal area. The mean follow-up period was 18 months, ranging from 6 to 24 months. By pinching the skin on the scar site, we got a rough idea as to whether the available skin on either side of excision margin was sufficient for closure. The tension on the skin margin was 3.0 kilograms and the device was employed over a duration of 50 minutes. A skin stretching device is designed to exploit the viscoelastic properties, that is mechanical creep and stress relaxation. In this study, we use the serial excision with the Sure- Closure(R), because excessive scar excision could result in the deformity of facial structure and wound dehiscence, hypertrophic scar, and skin necrosis. The skin stretching device is easy to use and achieves good aesthetic results in the scar revision of wide facial scar.

A Study on the Morphologic Change of the Tongue Muscle in Down Syndrome Children

Anatomy of oral cavity in Down syndrome is characterized by hypotonic macroglossia, small oral cavity, narrow palate with high-arch shape and hypertrophy of tonsil and adenoid. Because of such a anatomic characteristics, they show difficulty in respiration, mastication, swallowing and articulation. So far we operated on 135 children with Down syndrome for partial glossectomy in average volume of 4.6cc. This study is histopathologic finding of partially resected tongue in 4 cases, analyzed by histochemical stain and electron microscopy. The results of histochemical study showed predominant of Type 2 myofiber and interstitial edema, fibrosis and chronic nonspecific inflammation. In the study of electron microscope, the size and number of mitochondria were increased, but structural abnormality was not showed.