A Wrapping Method for Inserting Titanium Micro-Mesh Implants in the Reconstruction of Blowout Fractures

Titanium micro-mesh implants are widely used in orbital wall reconstructions because they have several advantageous characteristics. However, the rough and irregular marginal spurs of the cut edges of the titanium mesh sheet impede the efficacious and minimally traumatic insertion of the implant, because these spurs may catch or hook the orbital soft tissue, skin, or conjunctiva during the insertion procedure. In order to prevent this problem, we developed an easy method of inserting a titanium micro-mesh, in which it is wrapped with the aseptic transparent plastic film that is used to pack surgical instruments or is attached to one side of the inner suture package. Fifty-four patients underwent orbital wall reconstruction using a transconjunctival or transcutaneous approach. The wrapped implant was easily inserted without catching or injuring the orbital soft tissue, skin, or conjunctiva. In most cases, the implant was inserted in one attempt. Postoperative computed tomographic scans showed excellent placement of the titanium micro-mesh and adequate anatomic reconstruction of the orbital walls. This wrapping insertion method may be useful for making the insertion of titanium micro-mesh implants in the reconstruction of orbital wall fractures easier and less traumatic.

Manual Kirschner-Wire Insertion through the Soft Tissue for Finger Immobilization after Scar Contracture Release

PURPOSE: Finger immobilization by Kirschner-wire (K-wire) insertion may be used for postoperative stability after release of scar contracture. K-wire insertion through the phalangeal bone requires drilling and can result in joint and/or tendon injury or pain during wire removal. To prevent these problems, we inserted the K-wire through the soft tissue. METHODS: Seventy-five fingers of 45 patients who underwent reconstruction of scar contracture of the fingers were immobilized by K-wire. After contracture release, just before skin grafting and/or local flap surgery, in full extension of the finger, a K-wire was inserted manually from the fingertip to the proximal phalanx or metacarpal bone through the soft tissue under the phalangeal bone, along the longitudinal axis on the volar side. If the graft site did not have enough soft tissue or the K-wire was felt on the recipient bed, the K-wire was inserted on the dorsal side of the finger. K-wires were manually removed two weeks after surgery. RESULTS: In most cases, the time to insert the K-wire was 2-3 minutes per finger, and immobilization and stability was maintained for two weeks. In two fingers, the K-wire came out prematurely during wound care; this did not affect the overall outcome. There were no complications due to K-wire insertion or pain during removal. CONCLUSION: Finger immobilization by K-wire insertion through soft tissue is simple to perform, leads to stable immobilization, has no adding procedure. This method is useful for temporary finger immobilization in full extension.

Full-Thickness Skin Grafting with De-Epithelization of the Wound Margin for Finger Defects with Bone or Tendon Exposure

BACKGROUND: Full-thickness skin grafts (FTSGs) are generally considered unreliable for coverage of full-thickness finger defects with bone or tendon exposure, and there are few clinical reports of its use in this context. However, animal studies have shown that an FTSG can survive over an avascular area ranging up to 12 mm in diameter. In our experience, the width of the exposed bones or tendons in full-thickness finger defects is <7 mm. Therefore, we covered the bone- or tendon-exposed defects of 16 fingers of 10 patients with FTSGs. METHODS: The surgical objectives were healthy granulation tissue formation in the wound bed, marginal de-epithelization of the normal skin surrounding the defect, preservation of the subdermal plexus of the central graft, and partial excision of the dermis along the graft margin. The donor site was the mastoid for small defects and the groin for large defects. RESULTS: Most of the grafts (15 of 16 fingers) survived without significant surgical complications and achieved satisfactory functional and aesthetic results. Minor complications included partial graft loss in one patient, a minimal extension deformity in two patients, a depression deformity in one patient, and mild hyperpigmentation in four patients. CONCLUSIONS: We observed excellent graft survival with this method with no additional surgical injury of the normal finger, satisfactory functional and aesthetic outcomes, and no need for secondary debulking procedures. Potential disadvantages include an insufficient volume of soft tissue and graft hyperpigmentation. Therefore, FTSGs may be an option for treatment of full-thickness finger defects with bone or tendon exposure.

Treatment of Verruca Vulgaris in Both External Auditory Canals Using Bleomycin Injections

Verruca vulgaris is caused by human papillomavirus (HPV) infections. Verruca in the external auditory canal (EAC) has rarely been reported. A previous case report introduced surgical excision as a treatment for verruca in the EAC. We present a case of verruca vulgaris in both EACs that was successfully treated with an intralesional bleomycin injection. A 32-year-old male patient presented with ear fullness and palpable lumps in both EACs. Both of his canals were filled with multiple pinkish, papillomatous masses. Verruca vulgaris was confirmed by skin biopsy. An otolaryngologist referred this patient and recommended surgical excision. However, we performed intralesional bleomycin injections for treatment. Twice intralesional bleomycin injections at one-month intervals had excellent results without recurrence, ulceration or scar formation. This result indicates that bleomycin injections may prove to be an effective first-line treatment of verruca in the EAC.

Minimally Invasive Excision of Epidermal Cysts through a Small Hole Made by a CO2 Laser

To improve the cosmetic results of removing epidermal cysts, minimally invasive methods have been proposed. We proposed a new minimally invasive method that completely removes a cyst through a small hole made by a CO2 laser. Twenty-five patients with epidermal cysts, which were 0.5 to 1.5 cm in diameter, non-inflamed, and freely movable, were treated. All of the patients were satisfied with the cosmetic results. This method is simple and results in minimal scarring and low recurrence rates without complications.

Microplate Fixation without Maxillomandibular Fixation in Double Mandibular Fractures

BACKGROUND: Maxillomandibular fixation (MMF) is usually used to treat double mandibular fractures. However, advancements in reduction and fixation techniques may allow recovery of the premorbid dental arch and occlusion without the use of MMF. We investigated whether anatomical reduction and microplate fixation without MMF could provide secure immobilization and correct occlusion in double mandibular fractures. METHODS: Thirty-four patients with double mandibular fractures were treated with open reduction and internal fixation without MMF. Both fracture sites were surgically treated. For bony fixations, we used microplates with or without wire. After reduction, each fracture site was fixed at two or three points to maintain anatomical alignment of the mandible. Interdental wiring was used to reduce the fracture at the superior border and to enhance stability for 6 weeks. Mouth opening was permitted immediately. RESULTS: No major complications were observed, including infection, plate exposure, non-union, or significant malocclusion. Five patients experienced minor complications, among whom the only one patient experienced a persistant but mild malocclusion with no need for additional management. CONCLUSION: This study showed that double mandibular fractures correction with two- or three-point fixation without MMF simplified the surgical procedure, increased patient comfort, and reduced complications, due to good stability and excellent adaptation.

Microplate Fixation without Maxillomandibular Fixation in Double Mandibular Fractures

BACKGROUND: Maxillomandibular fixation (MMF) is usually used to treat double mandibular fractures. However, advancements in reduction and fixation techniques may allow recovery of the premorbid dental arch and occlusion without the use of MMF. We investigated whether anatomical reduction and microplate fixation without MMF could provide secure immobilization and correct occlusion in double mandibular fractures. METHODS: Thirty-four patients with double mandibular fractures were treated with open reduction and internal fixation without MMF. Both fracture sites were surgically treated. For bony fixations, we used microplates with or without wire. After reduction, each fracture site was fixed at two or three points to maintain anatomical alignment of the mandible. Interdental wiring was used to reduce the fracture at the superior border and to enhance stability for 6 weeks. Mouth opening was permitted immediately. RESULTS: No major complications were observed, including infection, plate exposure, non-union, or significant malocclusion. Five patients experienced minor complications, among whom the only one patient experienced a persistant but mild malocclusion with no need for additional management. CONCLUSION: This study showed that double mandibular fractures correction with two- or three-point fixation without MMF simplified the surgical procedure, increased patient comfort, and reduced complications, due to good stability and excellent adaptation.

Vascularized Bipedicled Pericranial Flaps for Reconstruction of Chronic Scalp Ulcer Occurring after Cranioplasty

BACKGROUND: Intractable chronic scalp ulcers with cranial bone exposure can occur along the incision after cranioplasty, posing challenges for clinicians. They occur as a result of severe scarring, poor blood circulation of the scalp, and focal osteomyelitis. We successfully repaired these scalp ulcers using a vascularized bipedicled pericranial flap after complete debridement. METHODS: Six patients who underwent cranioplasty had chronic ulcers where the cranial bone, with or without the metal plate, was exposed along the incision line. After completely excising the ulcer and the adjacent scar tissue, subgaleal dissection was performed. We removed the osteomyelitic calvarial bone, the exposed metal plate, and granulation tissue. A bipedicled pericranial flap was elevated to cover the defect between the bone graft or prosthesis and the normal cranial bone. It was transposed to the defect site and fixed using an absorbable suture. Scalp flaps were bilaterally advanced after relaxation incisions on the galea, and were closed without tension. RESULTS: All the surgical wounds were completely healed with an improved aesthetic outcome, and there were no notable complications during a mean follow-up period of seven months. CONCLUSIONS: A bipedicled pericranial flap is vascularized, prompting wound healing without donor site morbidity. This may be an effective modality for treating chronic scalp ulcer accompanied by the exposure of the cranial bone after cranioplasty.

Prognosis of Full-Thickness Skin Defects in Premature Infants

BACKGROUND: In the extremities of premature infants, the skin and subcutaneous tissue are very pliable due to immaturity and have a greater degree of skin laxity and mobility. Thus, we can expect wounds to heal rapidly by wound contraction. This study investigates wound healing of full-thickness defects in premature infant extremities. METHODS: The study consisted of 13 premature infants who had a total of 14 cases of full-thickness skin defects of the extremities due to extravasation after total parenteral nutrition. The wound was managed with intensive moist dressings with antibiotic and anti-inflammatory agents. After wound closure, moisturization and mild compression were performed. RESULTS: Most of the full-thickness defects in the premature infants were closed by wound contraction without granulation tissue formation on the wound bed. The defects resulted in 3 pinpoint scars, 9 linear scars, and 2 round hypertrophic scars. The wounds with less granulation tissue were healed by contraction and resulted in linear scars parallel to the relaxed skin tension line. The wounds with more granulation tissue resulted in round scars. There was mild contracture without functional abnormality in 3 cases with a defect over two thirds of the longitudinal length of the dorsum of the hand or foot. The patients' parents were satisfied with the outcomes in 12 of 14 cases. CONCLUSIONS: Full-thickness skin defects in premature infants typically heal by wound contraction with minimal granulation tissue and scar formation probably due to excellent skin mobility.

Treatment of Complete Scalp Avulsion with the Conditions of Unstable Vital Signs: A Case Report

PURPOSE: Scalp avulsion is a life-threatening injury that may cause trauma to the forehead, eyebrows, and periauricular tissue. It is difficult to treat scalp avulsion as it may lead to severe bleeding. Therefore, emergency scalp replantation surgery is necessary, and we must consider the function, aesthetics, and psychology of the patients. A case of scalp avulsion leading to massive bleeding was encountered by these authors, which led to a failure to achieve the proper operation conditions in an adequate time period. METHODS: A 49-year-old female was hospitalized due to having had her head caught in a rotatory machine, causing complete scalp avulsion which included the dorsum of the nose, both eyebrows, and ears. Emergent microsurgical replantation was performed, where a superficial temporal artery and a vein were anastomosed, but the patient's vital signs were too unstable for further operation due to excessive blood loss. Three days after the microanastomosis, venous congestion developed at the replanted scalp, and a medicinal leech was used. Leech therapy resolved the venous congestion. A demarcation then developed between the vitalized scalp tissue and the necrotized area. Debridement was performed 2 times on the necrotized scalp area. Finally, split-thickness skin graft with a dermal acellular matrix(Matriderm(R)) was performed on the defective areas, which included the left temporal area, the occipital area, and both eyebrows. RESULTS: The forehead, vertex, right temporal area, and half of the occipital area were successfully replanted, and the hair at the replanted scalp was preserved. As stated above, two-thirds of the scalp survived; the patient could cover the skin graft area with her hair, and could wear a wig. CONCLUSION: Complete scalp avulsion needs emergent replantation with microsurgical revascularization, but it often leads to serious vital conditions. We report a case with acceptable results, although the microanastomosed vessel was minimal due to the patient's unstable vital signs.

A Case Report of Surgical Treatment for Relief of Intractable Pain Developed after Browlift Surgery

PURPOSE: Nerve injury is one of the complication which can develop after brow lift. Peripheral nerve ending which is stretched from supraorbital nerve and supratrochlear nerve can be injured and symptoms such as pain, dysesthesia may appear. Usually, developed pain disappeared spontaneously and does not go on chronic way. We experienced a case that a patient complained chronic pain after brow lift which was not controlled by conservative management such as medications, local nerve block and report a successful surgical treatment of chronic pain after brow lift. METHODS: A 24-year-old male who received brow lift with hairline incision at local hospital was admitted for chronic pain at the right forehead. The pain was continued for 3 months even though fixed thread was removed. Local nerve block at trigger point with mixed 1mL 2% lidocaine and 1mL Triamcinolone acetonide was done and oral medications, Gabapentine and carbamazepine, were also applied but there was no difference in the degree of pain. Therefore the operation was performed so that careful dissection was carried out at right supraorbital neurovascular bundle and adhered supraorbital nerve was released from surrounding tissues and covered with silastic sheet to prevent adhesion. RESULTS: The pain was gradually relieved for a week. The patient was discharged without complications. No evidence of recurrence has been observed for 2 years. CONCLUSION: The pain developed after brow lift was engaged with nerve injury and sometimes remains chronically. Many kinds of conservative management to treat this complication such as medications, local nerve block have been reported and usually been used. But there are some chronic cases that conservative treatment do not work. In sum, we report 1 case of successful surgical treatment for relief of intractable pain developed after brow lift surgery.

Anthropometric Analysis on Facial Profile Alterations Following Augmentation Rhinoplasty with Nasal Tip Plasty

There are various nasal measurement parameters for rhinoplasty, so it is difficult for surgeons to decide which measurements to place more emphasis on. Among many, we searched for measurements that are significantly altered after the augmentation rhinoplasty with nasal tip plasty to figure out which measurements are most required in preoperative preparation. From January, 2006 to July, 2008, a total of 85 patients underwent augmentation rhinoplasty with nasal tip plasty and 40 were selected for comparative analysis of preoperative and postoperative photographs. Among many measurement factors reflecting changes of a face and a nose, we measured and compared following parameters, 1) nasofrontal angle, 2) nasofacial angle, 3) nasolabial angle, 4) nasal tip angle, 5) columella-lobular angle, 6) nasal length to tip projection, 7) alar slope angle, 8) nostril axis angle, 9) lobule-to-nostril ratio before and after operations. The result was analyzed using paired t-test. The measurement parameters most significantly altered after augmentation rhinoplasty with nasal tip plasty were the increase in nasolabial angle, the decrease in nasofacial angle, and the decrease in nostril axis angle. Therefore, surgeons should place more emphasis on these parameters in preoperative planning and postoperative evaluation.

Mondor's Disease after Bilateral Mastectomy in Both Breast Paraffinoma Patient

PURPOSE: Mondor's disease is a rare benign condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall after breast surgery, breast tissue biopsy, inflammatory reaction, breast cancer, trauma. The affected veins include the lateral thoracic, axillary veins, thoracoepigastric veins and superior epigastric veins. METHODS: A 49-year-old woman presented to the outpatient department with complaints of the sudden appearance of a subcutaneous cord just under the skin at left lower lateral abdominal wall 1 month later of bilateral mastectomy due to both severe breast paraffinoma. The cord was initially red and tender and subsequently became a painless, tough, fibrous band that was accompanied by tension and skin retraction. RESULTS: On ultrasonographic findings, palpable threadlike structures at both lateral superficial abdominal wall after bilateral mastectomy were noted. Superficial short elongated hypoechoic tubular structures were noted just under the skin at palpable lower lateral abdominal wall. It was compatible to Mondor's disease of thoracoepigastric vein. CONCLUSION: The increase in breast surgery will give rise to the increase in the frequency of Mondor's disease clinically. Mondor's disease can be diagnosed with clinical symptoms and image findings and the disease has proved to be benign and self-limited.

Mondor's Disease after Bilateral Mastectomy in Both Breast Paraffinoma Patient

PURPOSE: Mondor's disease is a rare benign condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall after breast surgery, breast tissue biopsy, inflammatory reaction, breast cancer, trauma. The affected veins include the lateral thoracic, axillary veins, thoracoepigastric veins and superior epigastric veins. METHODS: A 49-year-old woman presented to the outpatient department with complaints of the sudden appearance of a subcutaneous cord just under the skin at left lower lateral abdominal wall 1 month later of bilateral mastectomy due to both severe breast paraffinoma. The cord was initially red and tender and subsequently became a painless, tough, fibrous band that was accompanied by tension and skin retraction. RESULTS: On ultrasonographic findings, palpable threadlike structures at both lateral superficial abdominal wall after bilateral mastectomy were noted. Superficial short elongated hypoechoic tubular structures were noted just under the skin at palpable lower lateral abdominal wall. It was compatible to Mondor's disease of thoracoepigastric vein. CONCLUSION: The increase in breast surgery will give rise to the increase in the frequency of Mondor's disease clinically. Mondor's disease can be diagnosed with clinical symptoms and image findings and the disease has proved to be benign and self-limited.

A Case of MALT Lymphoma in Parotid Gland Duct

PURPOSE: Primary malignant lymphomas of the salivary glands are uncommon. The parotid gland was most frequently involved, followed by the submandibular gland, minor salivary gland and sublingual gland. The most common subtype is mucosa-associated lymphoid tissue (MALT) lymphoma. We experienced a case of salivary MALT lymphoma involving parotid gland duct, so report a case with a review of the literature. METHODS: A 65 year old female presented with a palpable mass on the left side of her cheek. There was no clinical or laboratory evidence of pre-existing autoimmune disease. Preoperative facial and neck CT with contrast showed 2.1x1.7cm sized, ill defined, homogeneous low density mass near left masseter muscle, and no evidence of other enlarged lymph nodes. RESULTS: At operation, a yellowish oval shaped mass was found slightly adhered to middle portion of the parotid gland duct, measuring 2x1.5x0.7cm. Microscopic finding showed that centrocyte-like cells, monocyte B cells and plasma cells were diffusely infiltrated. Immunophenotyping was preformed on fixed section. The majority of the small cells were immunoreactive for the B cell marker CD20. Based on the typical histological findings supported by immunostaining, the mass was defined as MALT lymphoma. CONCLUSION: We report a very rare case of MALT lymphoma involving parotid gland duct in 65 year old female patient with clinical characteristics, histologic features and references.

A Case Report of the Chemical Burns Due to Sodium Hypochlorite(NaOCl)

PURPOSE: Chemical burn accounts for a small proportion of burns in burn patient population. However, chemical injuries own importance to their deep tissue destruction which continues long after the initial exposure. YUHANROX(R) is a domestic bleach which has been widely used in Korea. Chemical burn by the domestic bleach is an unusual case. METHODS: A 70 yrs old female soiled with stool, her husband wiped the mess with YUHANROX(R). Skin edema, erythematous lesion was developed the second day, and she was admitted to our hospital via emergency department. RESULTS: Complete epithelization was done after 3 times STSG but, severe scar was formed. CONCLUSION: We report this case to warn about the dangers of domestic bleaches chemical substances and to emphasize that they should be used with caution. Public relation of the primary care of the chemical burn injury is needed.

Correction of Sunken Eyelid with Unfavorable Fold Using Autologous Fat Injection

PURPOSE: Sunken eyelid is a deformity of upper eyelid due to atrophy of periocular fat tissue, loss of skin elasticity. It causes the skin retraction of eyelid and unfavorable fold. Sunken eyelid occurs from the results of natural aging process, facial trauma, complication of previous periocular surgery, etc. We acquired a satisfied correction of sunken eyelid and unfavorable fold using autologous fat injection only. The aim of this study is a assessment of autologous fat injection for correction of sunken eyelid accompanied with unfavorable fold. METHODS: From August 2002 to March 2006, we performed 37 cases of correction of sunken eyelid with unfavorable fold using autologous fat injection. They were all females with ages ranged from 23 to 63. Fat was harvested from lower abdomen and centrifuged with Coleman system. Multi-layered injection of purified fat was done from orbital fat layer to orbicularis oculi muscle. RESULTS: Overall, improvement of sunken eye and unfavorable fold was observed in the majority of the patients. Discomfort of eye opening was improved in 24 patients. The average injection volume was 1.33mL in right eyelid, 1.31mL in left eyelid at first injection. Second injection was done in patients who absorption of injected fat was noted with. No specific complications were observed. CONCLUSION: Natural and attractive upper eyelid was acquired from fat injection only in sunken eyelid with unfavorable fold. To the authors' knowledge, it is desirable for sunken eyelid accompanied with unfavorable fold to be treated with autologous fat injection at first. Although some shortcomings are substantial, autologous fat injection is easy and effective method for correction of unfavorable fold in sunken eyelid without specific complication.

Reconstruction of Philtral Column with Overlapping of Orbicularis Oris Muscle Flap in Secondary Cleft Lip Nose Deformity

PURPOSE: Philtral deformity is a stigma of secondary cleft lip nose. It occurs from the false arrangement of orbicularis oris muscle and the scar of previous operation. Various methods have been used to correct this deformity. We successfully corrected philtral deformity using overlapping of orbicularis oris muscle flap. METHODS: From November 2000 to August 2007, we performed 39 cases of correction of philtral deformity in secondary cleft lip nose with overlapping of orbicularis oris muscle flap. Their age ranged from 5 to 53 years old. Existing scar tissue of previous operation was deepithelialized and preserved as scar flap. Lateral orbicularis oris muscle flap was elevated, advanced and overlapped upon medial muscle flap after dissection of orbicularis oris muscle of both sides. Reconstruction of philtral column was made from overlapping area by fixation of end part of lateral muscle flap to the point between philtral dimple and column. The degree of muscle flap advancement was decided by correction state of lateral muscle bulging. Correction of nostril floor depression or whistle deformity was also performed with preserved scar flap, if necessary. RESULTS: Realignments of orbicularis oris muscle were possible in the majority of the patients and final results of philtral reconstruction were satisfactory mostly. Correction of nostril floor depression and whistle deformity was also achieved. Additional correction was performed later to 4 patients in whom insufficient reconstruction was noted. No significant complication was observed. CONCLUSION: More natural and symmetric philtrum was acquired with overlapping of orbicularis oris muscle flap. To the authors' knowledge, it is an easy and effective method for correction of philtral deformity through anatomical rearrangement of distorted orbicularis oris muscle with relatively simple procedure.

The Classification of Aging Lower Eyelid and Selection of the Operation Options in Asians

PURPOSE: It is generally accepted that anatomical structures of the soft tissue in Asian faces are quite different from those in Caucasian. It is presumed that these differences are due to collagen rich thick dermis and durable superficial musculo-apponeurotic system (SMAS) in Asian. We classified the aging lower eyelids and reviewed the operative procedures according to the types of aging lower eyelids in Asian. METHODS: We compared preoperative and postoperative photos of 117 patients over 30 years of age, who underwent lower blepharoplasty at the Kyunghee Medical Center from January 2001 to April 2006. We classified the patients based on the degree of skin laxity, presence of nasojugal groove and malar bag, the extent of aging process. We also reviewed the operative procedures according to each type of classification. RESULTS: We classified our patients into four types as following. Type I patients showed minimal skin-muscle excess confined to lower eyelids regardless of the facial line. For these patients, we performed only transcutaneous or transconjunctival blepharoplasty. In type II patients, nasojugal grooves were shown and skin- muscle laxity was limited to the medial side of imaginary vertical line at lateral margin of pupil. In these cases, we performed free fat graft or fat repositioning on nasojugal groove or fat removal and septal duplication confined to medial side. Type III patients displayed more advanced medial bulging and remarkable laxity over the lateral side, the same operation methods as those of type II were applied at the lateral side of the line. Type IV patients demonstrated extensive midfacial aging changes including malar bags and underwent superficial subciliary cheek lift. CONCLUSION: The lower eyelid aging of Asian is different from those of Caucasian. We think that our classification is useful in selection of appropriate operative procedure to address specific problems for Asian patients.

Reccurent Foreign body Granuloma after Gore-tex(R) Removal in Rhinoplasty

PURPOSE: Infection, foreign body reaction and decreased volume of implant are common complications after augmentation rhinoplasty with Gore-tex(R) implant. The author experienced two cases of recurrent foreign body granuloma in the patients who underwent Gore-tex(R) removal because of infection after augmentation rhinoplasty. and treated them with complete removal of Gore-tex(R). METHODS: Case 1: A 49 year-old female visited our clinic for recurrent foreign body reaction on nasal dorsum and tip area. The patient underwent augmentation rhinoplasty with Gore-tex(R) 3 years ago and implant was removed due to infection 9 months ago. Excision of the granuloma was performed and a piece of foreign body suspicious to be a Gore-tex(R) implant debris was detected under the subcutaneous pocket. The implant fragments were removed and nasalis muscle rotation flap was performed to cover the lesion. The specimen was proved to be Gore-tex(R) in histological study. Case 2: A 31 year-old-male with recurrent foreign body granuloma on the nasal tip area visited our clinic. 10 years ago, the patient had augmentation rhinoplasty with silicone implant and then, he underwent revisional rhinoplasty five times including nasal implant removal, which was performed 9 months ago. The authors excised the granuloma and found a small sized foreign body suspicious to be a Gore-tex(R) implant debris under the granuloma. The foreign body was excised and identified to be Gore-tex(R) in histological study. RESULTS: In both cases, the lesions were healed without any complications and there were no evidences of recurrence up to 6 months of follow-up. CONCLUSION: The Gore-tex(R) is known to be weak against mechanical force. These properties of Gore-tex(R) make it difficult to remove the implant completely. In the patient who have infection after augmentation rhinoplasty with Gore-tex(R), the operator should take care to perform the complete removal without remaining fragment of the implant.