Age-related ptosis of the buttock: an anthropometric gender-specific analysis.

UNLABELLED: Buttock reshaping has received a lot of attention, although to date there are no anthropometric gender-specific datasets to show the aging of the gluteal region from infancy to old age to guide surgical planning of gender-specific buttock reshaping. To make surgical planning easier, we analyzed the characteristics of the aging buttock in 280 volunteers ranging in age from 15 to 85 years and classified the age characteristics of the gluteal region into gender-specific categories to establish a classification system that could guide surgical techniques needed to reshape and rejuvenate the buttock. Based on our measurements it was evident that males showed fewer signs of atrophy and less ptosis of their buttock with less reduction of the gluteal volume as they aged than did females. Based on the results, it is concluded that gender-specific surgical rejuvenation of the buttock area should include shortening of the gluteal crease, lifting the gluteal mass, adding volume, and smoothening of curvature to the lateral sides of the gluteal region. LEVEL OF EVIDENCE IV: 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 .

Frontal bone remodeling for gender reassignment of the male forehead: a gender-reassignment surgery.

Gender-reassignment therapy, especially for reshaping of the forehead, can be an effective treatment to improve self-esteem. Contouring of the cranial vault, especially of the forehead, still is a rarely performed surgical procedure for gender reassignment. In addition to surgical bone remodeling, several materials have been used for remodeling and refinement of the frontal bone. But due to shortcomings of autogenous bone material and the disadvantages of polyethylene or methylmethacrylate, hydroxyapatite cement (HAC) composed of tetracalcium phosphate and dicalcium phosphate seems to be an alternative. This study aimed to analyze the clinical outcome after frontal bone remodeling with HAC for gender male-to-female reassignment. The 21 patients in the study were treated for gender reassignment of the male frontal bone using HAC. The average age of these patients was 33.4 years (range, 21-42 years). The average volume of HAC used per patient was 3.83 g. The authors' clinical series demonstrated a satisfactory result. The surgery was easy to perform, and HAC was easy to apply and shape to suit individual needs. Overall satisfaction was very high. Therefore, HAC is a welcome alternative to the traditional use of autogenous bone graft for correction of cranial vault irregularities.

Vertical subperiosteal mid-face-lift for treatment of malar festoons.

BACKGROUND: Malar mounds may be accentuated by chronic lid edema, with the development from malar edema to malar mounds and finally to malar festoons. Because standard techniques do not seem effective and not specifically proposed for the treatment of malar festoons, subperiosteal vertical upper-midface lift associated with lower blepharoplasty overcomes these shortcomings. METHODS: Twelve patients (3 males and 9 females, age = 47 ± 6 years) underwent video-assisted endoscopic subperiosteal vertical upper-midface lift (SUM-lift) in conjunction with a lower blepharoplasty between 2006 and 2007 for treatment of malar festoons. This includes simultaneous lower blepharoplasties and video-assisted transtemporal subperiosteal and sub-SMAS tissue release. RESULTS: All patients healed uneventfully without any major postoperative problems. The surgical outcome was evaluated according to the analysis of photographs obtained before and after surgery and the analysis of pre- and postoperative measurements. The technique we used (SUM-lift) achieved a significant rejuvenation of the midface and the malar festoons. CONCLUSION: Subperiosteal vertical midface lift resuspends and redrapes the facial network that originates at the level of the orbital rim. It seems to improve the permeability characteristics of the malar septum in the treatment of malar festoons and malar mounds by freeing the cheek tissue from underlying bone and redraping the malar septum. It is a reliable technique to improve malar mounds, palpebral bags, or festoons.

Sliding osteotomy genioplasty for facial aesthetic balance: 10 years of experience.

The chin, one of the most obvious facial structures, plays an important role in the perception of the face as an instrument of communication. To alter the chin contour in a reliable manner, horizontal sliding osteotomy of the mandibular symphysis with advancement of the mobilized segment is the technique of choice for correction of the anterior posterior deficiency. This study describes surgical techniques used in aesthetic and functional surgery of the chin as well as the outcomes. Over a 10-year period, 474 patients underwent orthognathic surgery for correction of their malocclusion. Of these 474 patients, 155 were treated in combination with a sliding genioplasty (SGP) and 37 (29 women and 8 men; average age, 32 years; range, 18-47 years) had an isolated SGP. Of these patients, 33 had chin advancement and 4 had chin reduction. The mean chin advancement was a modest 4.5 mm (range, 2-7 mm), and the mean chin vertical displacement was 3.9 mm (range, 2.5-4.1 mm). All the patients in the mandibular deficiency group had a residual sagittal disproportion of the progonion relative to the subnasale (mean, -7.6 mm) and a newly created vertical disproportion, with mean lower face heights of 67.8 mm compared with mean midface heights of 65.3 mm. The surgical outcome was evaluated by analysis of pre- and postoperative photographs, analysis of pre- and postoperative measurements, and patients' self judgment. All the patients healed uneventfully without any major postoperative problems. Paraesthesia of the mental nerves occurs to some degree in almost all patients measured by the Simmon Weinstein diagnostic device. In the single sliding chin osteotomy group, no major branches of the mental nerves were transacted. Paraesthesia was only transient, usually lasting for only a few weeks. At least 1 year after the operation, normal sensitivity of the lower lip and both sides of the chin was reported by almost all of the patients (93.1%). All who had only a single genioplasty recovered totally from a neurosensory deficit. The level of satisfaction was significantly high for all the patients. The results were judged to be excellent in 73.2% and good in 23.6% of the cases. Only in 3.2% of the cases was it considered to be poor (bimaxillary surgery combined with SGP). The current findings strongly suggest that SGP is a reliable procedure for achieving harmony of the lower face. In addition, it permits a simplification of facial reconstruction and rejuvenation. The combination of chin advancement and submental recontouring can have a positive effect on facial appearance, provided the increased chin projection is appropriate.

Dove tail osteotomy in distraction osteogenesis of costochondral bone grafts in the mandible: a new concept.

To correct the malocclusion and facial asymmetry in patients with Pruzansky type III hemifacial microsomia after autogenous costochondral grafting during early childhood (two male and three female patients with an average age of 17.8 years), the technique of distraction osteogenesis with a three-dimensional device was used. Because of the missing periosteum of the transplanted rib and its relatively small height compared with the horizontal mandible, a dovetail geometrical pattern osteotomy was introduced to increase the osteotomy surface area, which by itself could enhance the amount of fibrin filaments between 30% and 40% in the hematoma occurring during the initial distraction process. These fibrin filaments are biofunctional guiding structures for the development of the microcallus, followed by enhancement of the bone-healing capacity, which allows optimal bone regeneration. Between 20 and 27 days (mean = 21.5 days) after distraction, complete ossification was noted radiographically in all treated patients. Based on our histological animal studies and clinical investigations, dove tail osteotomy enhances the osteotomized surface area and offers protection to the tension-sensitive structures in the center of the distraction zone. It increases early bone formation and mineralization adjacent to the center zone in the distraction gap. Therefore, the dove tail geometrical pattern in combination with distraction osteogenesis of autologous costochondral grafts in the treatment of congenital Pruzansky type III mandibular hypoplasia is strongly recommended.