Natural Adhesion Blepharoplasty Technique.

ABSTRACT: Nonincisional blepharoplasty is widely practiced to make natural double eyelids. However, this method has the disadvantage of the double fold loosening compared to incisional blepharoplasty. Many researchers have proposed a method of nonincisional blepharoplasty with lower risk of loosening. The authors innovated the method to induce spontaneous adhesion in a nonincisional blepharoplasty with induction of partial linear adhesions, and, therefore, lowering the risk of suture loosening. While performing this procedure, the orbicularis oculi muscle and the levator palpebrae muscle were partially incised through eight tiny incisions to induce adhesion, and the double eyelid was made with the nonincisional continuous suture technique. This study included 99 patients who underwent natural adhesion blepharoplasty technique between January and December 2018. After 1 year of follow-up, no double eyelid loosening was observed. Natural adhesion blepharoplasty is simple technique to create natural-looking results and a durable double fold with satisfactory aesthetic results.

Modified Infrabrow Excision Blepharoplasty for Severity of Medial Blepharochalasia.

Infrabrow excision blepharoplasty can be a satisfactory and useful alternative for patients with blepharochalasia. Sixty patients underwent modified infrabrow excision blepharoplasty from March 2017 to February 2018. The design of the skin excision was modified according to the severity of the medial blepharochalasia: (1) excision up to the medial limbus was performed if there was no medial blepharochalasia, (2) excision up to the medial epicanthus was performed if there was mild medial blepharochalasia, and (3) excision with triangular back cut was performed if there was moderate-to-severe medial blepharochalasia. The surgical method included (1) skin excision, (2) orbicularis oculi muscle excision, (3) orbicularis oculi muscle closure, and (4) skin closure. The mean postoperative follow-up period was 9 months, and the photographic results were collected retrospectively and evaluated. There were no complications related to surgery in terms of the resulting scar and dysesthesia. The mean operative time was 55 minutes. Patient satisfaction was very high in terms of both aesthetic outcome and comfort. Modified infrabrow excision blepharoplasty can be an easy and satisfactory alternative in a selected group of patients.

La blépharoplastie sous-ciliaire par excision peut être une solution satisfaisante et utile pour les patients qui présentent une blépharochalasie. Ainsi, 60 patients l'ont subie entre mars 2017 et février 2018. Les plasticiens ont modifié la conception de l'excision cutanée en fonction de la gravité de la blépharochalasie médiane : 1) excision jusqu'au limbe médian en l'absence de blépharochalasie médiane, 2) excision jusqu'à l'épicanthus médian en cas de blépharochalasie médiane bénigne et 3) excision avec incision arrière triangulaire en cas de blépharochalasie médiane modérée à grave. La méthode chirurgicale incluait 1) une excision cutanée, 2) l'excision du muscle orbiculaire, 3) la fermeture du muscle orbiculaire et 4) la fermeture de la peau. Le suivi postopératoire était d'une moyenne de neuf mois, et les chercheurs ont colligé et évalué rétrospectivement les résultats au moyen de photographies. L'opération, d'une moyenne de 55 minutes, n'a provoqué aucune complication de la cicatrice ni dysesthésie. La satisfaction des patients était très élevée, tant pour ce qui est du résultat esthétique que du confort. La blépharoplastie sous-ciliaire par excision peut être une solution simple et satisfaisante chez un groupe sélectionné de patients.

Filler rhinoplasty based on anatomy: The dual plane technique.

Filler rhinoplasty is susceptible to spreading because of the way the nose protrudes away from the face. Often, the well-defined appearance immediately after the procedure is poorly maintained, and the nasion area develops a bulbous appearance. Therefore, I developed a "dual plane technique" to prevent spreading and to maintain the desired shape of the filler rhinoplasty. Dual plane injections were administered in 96 patients. Based on the anatomy of the nose, a highly elastic filler was injected in the deep fat layer and a moderately elastic filler was injected in the superficial fat compartments. The retrograde linear threading technique was used to inject the fillers to prevent mixing with each other. Afterwards, the highly elastic hyaluronic acid filler was injected from the anterior nasal spine into the supracartilaginous layer by a retrograde linear threading technique. All patients were followed up for at least 3 months, during which time there were no major complications and aesthetic satisfaction was high. The dual plane technique is an injection technique based on the anatomical base. Different types of filler can be used according to the plane and filler rheology to obtain an aesthetically pleasing result.

A Safer Non-surgical Filler Augmentation Rhinoplasty Based on the Anatomy of the Nose.

BACKGROUND: Filler augmentation rhinoplasty is a quick, non-surgical procedure that can produce outcomes comparable to open rhinoplasty surgery. However, the increased frequency of vascular complications has emerged as an important issue. The present study aimed to investigate measures to overcome the vascular complications based on the anatomy of the nose. METHODS: A colored filler was injected into cadavers for augmentation of the nasal dorsum using the retrograde injection technique and direct percutaneous injection technique. The concavity of the sellion area was measured using lateral view cephalography X-ray images. Lastly, we used ultrasonography to determine filler location in 20 Korean patients who had filler injected into the sellion area by injection at the infratip lobule. RESULTS: Filler was injected into the superficial layer by the retrograde injection technique in three cadavers and into the deep layer by direct percutaneous injection technique in another three cadavers. The average angle between the nasal dorsum skin and sellion was found to be 10.2 ± 2.8 degrees, while the minimum angle was 5.1 degrees. The average distance between the needle tip and nasal bone was 1.9 ± 0.3 mm, while the minimum distance was 0.4 mm. CONCLUSIONS: When performing filler augmentation rhinoplasty on the sellion area, direct percutaneous injection from the glabella can allow more accurate injection into the supraperiosteal level, which can reduce complications such as visual loss and skin necrosis due to vascular compromise. 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 .

Modified Upper Blepharoplasty Using Combination of Incision and Nonincision Surgical Approaches.

Upper blepharoplasty can be divided into incision and nonincision technique. Each has its advantages and disadvantages. The author innovated a method of modified upper blepharoplasty by taking advantage of both procedures' strengths. This method involves redundant skin excision followed by double fold formation using the buried suture method. Orbicularis oculi muscle (OOM) excision or orbital fat excision may be performed if necessary, and ptosis can be corrected using Muller tucking. Lateral double fold reinforcement may be performed in older patients, where the OOM is sutured and fixed on to the levator aponeurosis in the lateral canthal area to prevent the lateral double fold from fading. This procedure was performed in 30 patients from March 2017 to February 2018, with satisfactory outcomes in most patients. Modified upper blepharoplasty is simple to perform, has fast recovery time as swelling rapidly disappears, and creates a dynamic fold.

The Double Thread Buried Nonincisional Blepharoplasty Technique.

The nonincisional blepharoplasty technique is widely practiced because it is relatively simple, causes less scarring than the incisional technique, provides a quick recovery, and allows easy correction. Although various modified nonincisional techniques have been used to create a more natural appearance, complications such as loosening of the double fold and regression of the double fold line may still occur. So the authors introduce the double thread buried nonincisional blepharoplasty technique to reduce such complications. This study included 300 patients who underwent upper eyelid blepharoplasty between January 2016 and June 2017. Most patients displayed satisfactory aesthetic results, and no significant complications occurred, such as loosening of the double fold. There was no obvious regression of the double fold; however, of the patients who underwent surgery early, 1 patient required reoperation to correct loosening of the fold on one side during the follow-up period. One patient presented with a subcutaneous suture knot, and the knot was removed in the clinic. The double thread buried nonincisional blepharoplasty technique is a simple and less time-consuming method for a durable double fold and provides satisfactory aesthetic results.

Eyebrow Position and Shape Favored by Korean Women.

PURPOSE: The shape and position of the eyebrows are among the most important facial features from an esthetic point of view. However, significant cultural differences exist with respect to the eyebrow shape and position that are considered ideal. The purpose of this study was to identify the position and shape of eyebrows preferred by Korean women and to apply these, including forehead lifts, to the clinics. METHODS: The authors took full facial photographs in the Frankfort plane of Korean women aging from young childhood to their 50s. On the basis of these, 2 parameters were calculated: first, the height-to-width ratio (HWR), the ratio between the vertical distance from the brow apex to the palpebral fissure and the horizontal distance from the medial canthus to the lateral canthus; and second, the takeoff angle (TOA), the angle between the straight line connecting the 2 lateral canthi and the line from the brow apex through the center of the medial brow segment. The authors then had drawings of "Anastasia arch" eyebrows made; as high eyebrows are considered beautiful in Korea, and the eyebrows of women in their 20s were the highest, the drawings depicted the mean HWR and TOA values for this age group and their various degrees of deviation. These drawings were shown to 300 women aged 21 to 40 years from May 1 to June 30, 2014; they were instructed to choose the drawing they preferred among the 5 drawings differing in HWR and again among the 5 differing in TOA. RESULTS: Among the 99 Korean women in their 20s, the mean HWR and TOA was 1:1.01 ±â€Š0.23 and 12°â€Š±â€Š5.2°, respectively. Regarding the survey, the most preferred HWR was 1:1.0, which was selected by 204 respondents (68%); the most preferred TOA was 10°, which was chosen by 122 respondents (40.7%). CONCLUSION: This study shows that HWR gradually decreases and TOA increases with age. Furthermore, Korean women's preferred eyebrows have an HWR of ∼1:1 and a TOA of ∼10°. These results could guide plastic surgeons performing periorbital rejuvenation surgeries, including brow lifts, not only for Koreans but also for North-East Asians.

A giant trichoblastic carcinoma.

Trichoblastic carcinoma usually occurs as a malignant transformation of the trichoblastoma, but is very rare. A 25-year-old man was admitted with trichoblastoma in the nuchal area with frequent recurrences since birth. The preoperative neck magnetic resonance image revealed lobulated soft tissue lesions involving superficial fascia and infiltrating into both proximal trapezius muscles. In our department, wide excision and reconstruction with a free anterolateral thigh flap were performed. Histological examination revealed skin adnexal carcinoma, originating from the hair follicles, consistent with trichoblastic carcinoma. There was no palpable mass 5 years postoperatively, and there was no recurrence on follow-up positron emission tomography-computed tomography. Trichoblastic carcinomas are rare and difficult to diagnose, but histopathological findings include atypical basaloid keratinocytes with crowded, hyperchromatic nuclei, and increased mitotic activity. The presence of hypercellular stroma is a criterion for distinguishing trichoblastic carcinoma from basal cell carcinoma. A rare giant trichoblastic carcinoma was reported, which was the biggest one in the literature.