Nipple reduction using the mushroom flap technique for male transgender.

Nipple reduction is a well-established procedure that is widely used and can improve the self-confidence of male transgender individuals. The nipple reduction procedure in male transgender individuals differs from that in cisgender females due to a greater disparity in postoperative nipple sizes compared to preoperative sizes. Flaps used in male transgender nipple reduction should be simple to avoid skin necrosis. We present the nipple reduction of a 25-year-old male transgender patient using the mushroom technique. A 6 mm circular line was drawn at the most prominent part of the apex of the nipple. Another circular line was created at the base of the nipple. The skin and subcutaneous tissue were removed. The original diameter of the nipple was reduced. The two circular lines were re-approximated and sutured. Both right and left nipple height was 7 mm, and the width of the right and left nipple was 12 and 13 mm, respectively. The new nipple height and width of both sides at six months postoperative were 3 mm and 6 mm, respectively. The nipples were healed uneventfully, and the patient reported high satisfaction and self-confidence. This method can be used as a promising alternative to previously described techniques.

The anatomical variations of the emergence routes of supraorbital nerve: A cadaveric study and systematic review.

BACKGROUND: Knowledge of the location of supraorbital nerve is essential to perform supraorbital endoscopic surgery, regional nerve block, and nerve decompression in the treatment of migraine. This study discusses the emergence routes of supraorbital nerve as well as a systematic literature review on previous anatomical studies. This comparative analysis will be beneficial for surgeons worldwide. METHODS: The study sample consisted of 19 cadavers with bilateral supraorbital nerve dissections. The emergence route of the nerve through either a notch or foramen was recorded. Additionally, the distance from midline, nerve branching patterns, and diameter of emergence routes were measured. RESULTS: Our findings showed an equal number of supraorbital emergence route between notch and foramen (42%) and demonstrated average distance from emergence route and facial midline 22.34 (3.05) mm in male and 23.58 ± 2.42 mm in female. Diameter of notch type is 3.97 (0.99) mm and 3.39 (1.09) mm in foramen type. Data from systematic review showed range of distance from emergence route to facial midline from 22.2 to 33.7 mm. East Asia population had significant shorter distance of supraorbital emergence route to facial midline than Middle Asia and Caucasian population. CONCLUSION: This study provides greater insight into the anatomic variations and supraorbital never course in an understudied minority population. Surgeons should be aware of this critical area and strive to minimize dissection to prevent iatrogenic nerve injury.

Anthropometry Analysis of Beautiful Upper Eyelids in Oriental: New Eyelid Crease Ratio and Clinical Application.

BACKGROUND: Beautiful upper eyelids can make one feel more attractive and confident. However, the definition of a beautiful upper eyelid in Orientals is still not defined. The aim of this study was to define the most beautiful upper eyelids in Orientals. METHODS: Participants, who met the inclusion criteria such as Asian ethnic, ages between 18 and 25 years, and double eyelid fold, were conducted. Double upper eyelids were classified into three groups, group A: most beautiful; group B: average; and group C: less beautiful upper eyelid, by plastic surgeons and beauty contestant winners. Eleven linear measurements and type of epicanthal fold were analyzed. RESULTS: A total of 153 participants were included, 66 were male and 87 were female. The mean ages were 21.45 years in males and 21.41 years in the female group. The vertical distances of the palpebral fissure, height of the double fold, height of the lid crease and height of the closed upper eyelid were found to be significantly different between the most, average and less beautiful upper eyelids in both males and females. The type 1 epicanthal fold was the most common in the most beautiful upper eyelid group. CONCLUSION: The most beautiful double upper eyelids in Orientals demonstrated a higher vertical palpebral fissure, double eyelid fold, and height of eyelid crease than the average and the less beautiful double upper eyelids. The ratio of height of lower margin of eyebrow to eyelid crease: Height of eyelid crease is 1.2:1 to create the beautiful double upper eyelids. However, preoperative consultation with realistic expectations is important. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Malignant proliferating trichilemmal tumors with CD34 expression.

Malignant proliferating trichilemmal tumors (MPTT) are rare neoplasm arising from outer root sheath of hair follicle, the diagnosis of which is base essentially on histological features resulting in occasionally misdiagnosis of squamous cell carcinoma. In difficult cases, however evaluation of additional parameters may be needed to differentiate benign proliferating trichilemmal tumor from MPTT or differentiate PTT and MPTT from squamous cell carcinoma. We report two cases of MPTT on which, in addition to histologic features, we have determined p53 immunohistochemical expression pattern, proliferative fraction, and CD34 expression. For comparison, concurrent proliferating trichilemmal tumors (PTT) and trichilemmal cysts (TC) as well as well-differentiated squamous cell carcinoma (SCC) were studied. The two MPTTs show expression of p53 with increased proliferative index as well as all three SCC. The PTTs and TCs stained negative and few basal cells for p53 and Ki-67, respectively. MPTTs exhibit CD34 immunoreactivity, indicating trichilemmal differentiation. The contrast p53 and Ki-67 expression pattern in MPTT and PTT may be helpful in the diagnosis of MPTT. Expression of CD34 may be an additional feature to distinguish MPTT from SCC.