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BACKGROUND: Upper blepharoplasty is 1 of the most popular cosmetic procedures in Asia. As people become older, they develop soft tissue atrophy and multiple folds due to a sunken upper eyelid. Furthermore, people with thin upper eyelid skin are more likely to develop multiple folds, even at a young age. The authors investigated the effectiveness of a transverse mattress suture technique to prevent recurrence during upper blepharoplasty in patients with primary multiple folds. PATIENTS/METHODS: Data on 656 patients with primary multiple folds who underwent upper blepharoplasty from March 2017 to January 2020 were retrospectively reviewed. The authors compared the operative time, patients' satisfaction, panel assessment, and complications according to whether the suture technique was used. RESULTS: Among 656 patients, 228 were lost to follow-up or had incomplete data; therefore, the files of 428 patients were analyzed. In total, 199 patients did not undergo the suture technique, whereas 229 patients did. Statistically significant differences were found between the 2 groups in patients' satisfaction, aesthetic results, and recurrence. However, between-group difference was not significant in terms of symmetry or complications such as hematoma and swelling. CONCLUSIONS: People with thin upper eyelid skin or slightly protruding eyes are more likely to develop multiple folds at a young age, even in their teens or 20s. The authors performed a skin suture during upper blepharoplasty, and then performed a transverse mattress suture on the spots where multiple folds are expected. Patients who underwent the suture technique showed better aesthetic results and a significantly lower recurrence rate.
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Blefaroplastia , Estética Dentária , Adolescente , Humanos , Estudos Retrospectivos , Pálpebras/cirurgia , Técnicas de SuturaRESUMO
BACKGROUND: An electrosurgery unit (ESU) is the mainstay of bleeding control in blepharoplasty. There are two different types of ESUs: monopolar (m-ESU) and bipolar (b-ESU). AIMS: We used m- and b-ESUs in upper, lower, and combined blepharoplasty and compared their outcomes. PATIENTS/METHODS: In this retrospective file review of 292 blepharoplasty patients, we excluded 14 who were lost to follow-up or had missing data; among the 278 enrolled patients, we recorded operative time, a surgeon panel's score for edema and ecchymosis on the third postoperative day, patients' scores of their satisfaction and inconvenience, and postoperative complications. RESULTS: One hundred thirty-nine patients were included in the m-ESU and b-ESU group. Overall, 105 patients underwent upper blepharoplasty, 77 underwent lower blepharoplasty, and 96 underwent combined blepharoplasty. The total mean operative time in the m-ESU and b-ESU was 67.94 and 62.82 minutes, respectively. This difference was not significant (P > .05). The panel's edema and patient satisfaction and inconvenience scores were significantly better in the b-ESU group (P < .05). There were no significant differences in the panel's ecchymosis score and frequency as well as nature of complications between the m-ESU and b-ESU group (P > .05). CONCLUSIONS: In this cohort of blepharoplasty patients, minimally invasive b-ESUs were efficient in obtaining reliable surgical results with higher satisfaction and lower inconvenience rates of patients than m-ESUs. We would like to recommend the use of b-ESUs in blepharoplasty, especially for plastic surgeons inexperienced in periorbital esthetic surgery.
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Transtorno Bipolar , Blefaroplastia , Blefaroplastia/efeitos adversos , Eletrocirurgia/efeitos adversos , Humanos , Satisfação do Paciente , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Alveolar clefts give rise to many aesthetic and functional problems among affected patients. Therefore, surgical adjustments of the bony defective anomalies are important. The authors performed secondary bone grafts and analyzed the effects particularly on the nasal septum and maxillary area (midface). METHODS: The patients who had alveolar bone grafts were retrospectively reviewed with pre/postoperative 3-dimensional computed tomography; the measurements included distances between the anterior nasal spine (ANS) and the vertical midline, angles between the nasal septum and the transverse line, and angles between the floor of the pyriform aperture and the transverse line. RESULTS: A total number of 23 patients were finally included in the study. The mean age of the patients was 9.7â±â1.95 years (range, 7-14 years). The mean distance between the ANS and the vertical midline was 5.3â±â4.70âmm/4.9â±â4.15âmm pre/postoperatively, showing the mean paired difference of 0.4â±â0.89âmm (Pâ<â0.05). The mean angles between the nasal septum and the transverse line and between the floor of the pyriform aperture and the transverse line were 64.5â±â14.69°/65.9â±â13.73° and 21.7â±â8.94°/11.5â±â7.03° pre/postoperatively, showing the mean paired differences of -1.4â±â2.78° and 10.1â±â8.20°, respectively (both Pâ<â0.05). CONCLUSION: The results suggest that secondary alveolar bone grafting has expanded effects on the adjacent midfacial structures.
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Fissura Palatina/diagnóstico por imagem , Maxila/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Adolescente , Enxerto de Osso Alveolar , Transplante Ósseo , Criança , Fissura Palatina/cirurgia , Feminino , Humanos , Masculino , Maxila/cirurgia , Septo Nasal/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: This study was conducted to determine the effect of the distributional relationship between dental roots and the mandibular bone on single mandibular bone fractures, which are common craniofacial fractures. METHODS: This was a retrospective, single-center study in Seoul, Korea. Patients with single mandibular fractures in the symphysis, parasymphysis, body, and angle area, with tooth structure involvement were included. The control group included patients with simple, bone-level lacerations without fractures. In total, 94 patients (72 males and 22 females) were included in the treatment group, and 125 (71 males and 54 females) were included in the control group. The height of the mandibular bone and the dental root were measured with panoramic radiography. The central incisor represented the symphysis area, the canine represented the parasymphysis area, the first molar represented the body area, and the second molar represented the angle area. RESULTS: In the treatment group, symphysis fractures occurred in 16 patients (17%), parasymphysis fractures in 36 patients (38%), body fractures in 17 patients (18%), and angle fractures in 25 patients (27%). The ratios of the dental roots to the total height of the mandibular bone in the treatment group were 30.35%, 39.75%, 39.53%, and 36.27% for symphysis, parasymphysis, body, and angle areas, respectively, whereas in the control group, they were 27.73%, 39.70%, 36.76%, and 35.48%. The ratios of the treatment group were significantly higher than those of the control group. CONCLUSION: The results show that the higher ratio of the dental root to the height of the mandibular bone increases the fracture risk.
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Tear trough deformity has been an area that has received much attention in terms of esthetic improvements. Fat transposition has been commonly used for the treatment of tear trough deformity. As some patients have had minimal improvement by that method, we propose the use of fat grafting combined with open blepharoplasty to complement the sunken area, including some of anterior maxilla region, and evaluate and precisely remove the excessive tissue.Lower blepharoplasty was performed by separating the skin and muscle flap. The excessive or laxed tissue was evaluated during the procedure and resected in each flap. Fat grafting was performed after completing a lower blepharoplasty, to ensure accurate placement on the spot where the surgeon originally intended. Overcorrection is not recommended.No serious complications were reported during a period of 10 years. Only 4 patients required a secondary fat injection.Patients who require structural correction of the lower eyelid area (eg, aggressive herniated fat, excessive skin laxity, or bulky orbicularis oculi muscle) and who need complementary material to fill the lower lid area (eg, deep, wide sunken area or relative exophthalmos) are good candidates for blepharoplasty with a fat grafting procedure.
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Tecido Adiposo/transplante , Blefaroplastia/métodos , Doenças Palpebrais/cirurgia , Pálpebras/cirurgia , Retalhos Cirúrgicos/cirurgia , Humanos , Complicações Pós-OperatóriasRESUMO
BACKGROUND: Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients' confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue. METHODS: Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman's strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit. RESULTS: The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0-32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5-7.1 mL) and 4.6 mL on the left side (IQR, 3.7-5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year. CONCLUSIONS: Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.
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INTRODUCTION: Septorhinoplasty in cleft patients is relatively difficult to perform and the outcomes are often unsatisfactory owing to weakness of the cartilage. Therefore, providing support to the cartilage is necessary. The authors used bioabsorbable mesh as a spreader or batten graft to support the septum in cleft patients those with weak cartilages. The purpose of this study was to evaluate the efficacy of bioabsorbable mesh when performing septorhinoplasty in cleft patients. METHODS: Between 2009 and 2013, 34 patients with cleft lip and nose underwent open septorhinoplasty by using bioabsorbable mesh at the Konkuk University Medical Center. The authors determined the nasolabial angle, Goode ratio, alar base-nasal tip-columellar base angle, and columellar axis angle and performed a panel evaluation. RESULTS: In all, 29 of the 34 patients were included; 5 patients were excluded as lost to follow-up. The nasolabial angle increased from 85.69° to 91.62° (Pâ=â0.0032), and the mean Goode ratio increased from 0.51 to 0.55, which was approximately the ideal value (Pâ=â0.0017). The alar base-nasal tip-columellar base angle decreased from 36.28 to 31.74 (Pâ<â0.0001). The columellar axis angle increased from 82.36 to 86.90 (Pâ<â0.0001). DISCUSSION: As bioabsorbable mesh can provide strong support, results in good esthetic outcomes, and causes minimal complications, it can be used in septorhinoplasty for cleft patients.
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Implantes Absorvíveis , Fenda Labial/cirurgia , Septo Nasal/cirurgia , Nariz/anormalidades , Rinoplastia/métodos , Telas Cirúrgicas , Adolescente , Adulto , Estética , Feminino , Humanos , Masculino , Cartilagens Nasais/cirurgiaRESUMO
BACKGROUNDS: The aims of the present study were to determine the exact level of separation of the upper lateral cartilage from the septal cartilage, and to classify the patterns of connection between the upper lateral cartilage and the lower lateral cartilage. METHODS: We dissected and photographed 60 sides of noses; 18 specimens were sectioned and stained with Masson's trichrome. RESULTS: The mean length of the connection between the upper lateral cartilage and septal cartilage was 16.1 mm. The mean level for separation of the upper lateral cartilage was 7.5 mm from the nasal bone. The pattern of connection between the upper lateral cartilage and lower lateral cartilage could be classified into five types: disconnection, end-to-end, overlap, scroll, and reverse scroll. CONCLUSIONS: The results of the present study will be helpful for surgical procedures such as nasal hump reduction and nasal cartilage work and also provide information for the anthropometric study of the nose.
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Povo Asiático , Cartilagens Nasais/anatomia & histologia , Rinoplastia , Idoso , Idoso de 80 Anos ou mais , Antropometria/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da CoreiaRESUMO
OBJECTIVES: The purpose of this study was to investigate the general structure of the incisive canal (IC) using 3-dimensional reconstruction and to classify into various types according to several criteria. STUDY DESIGN: The materials used in the study were 56 anterior maxillae harvested from human cadavers. The specimens were scanned with microscopic computerized tomography (microCT), and the resulting microCT images were reconstructed in 3 dimensions. RESULTS: Many ICs had 1 foramen inferiorly and 2 foramina superiorly, and the separating level was just beneath the nasal floor. The middle part of the IC was not always a single hollow canal. Single-channel, 2-channel, 3-channel, and even 4-channel ICs were observed. The ICs were classified into 4 types according to the lateral shape of the canal: vertical-straight, vertical-curved, slanted-straight, and slanted-curved. CONCLUSIONS: This study disclosed the detailed morphologic features of the IC, which will be helpful in the placement of local anesthesia or implants.