Corrective epicanthoplasty in patients with unnatural results of prior epicanthoplasty: rearrangement of the orbicularis oculi muscle above the medial canthal tendon.

BACKGROUND: Medial epicanthal fold operations are among the most frequent cosmetic procedures performed on Asians. However, in complicated patients with this procedure, as yet no effective method has been reported. We have therefore developed a modified epicanthoplasty method for correcting unnatural results in patients who have gone through prior epicanthoplasty. METHODS: In this study, corrective epicanthoplasty was performed on 85 patients in the interval from January 2006 to December 2011. The age of these patients ranged from 18 to 67 years, with a mean age of 29.3 years. The follow-up period ranged from 13 months to 5 years, with a mean of 2.8 years. The 2 major complaints leading to the procedure were either presence of a prominent incisional scar with contracted tissue around the medial canthal area or relapse of the fold. RESULTS: After the procedure, in each case, a contracted scar was released, and most patients seemed to be satisfied with the plasty. There was no case of definite relapse, hypertrophic scar, or lacrimal apparatus injury. Two patients experienced more overcorrection than anticipated. We reduced these patients' overcorrected epicanthal fold by repeating this procedure. A few patients complained about mild redness around their wounds, but after several months, most of them experienced improvement. CONCLUSIONS: We have presented a method for correction of complicated epicanthoplasty, an area in which there have been no previously reported results. This modified method is simple in design, easy to perform, and effectively corrects medial epicanthoplasty.

Use of the pectoralis major, serratus anterior, and external oblique fascial flap for immediate one-stage breast reconstruction with implant.

BACKGROUND: Skin- or nipple-sparing mastectomy facilitates immediate one-stage reconstruction with an implant. Traditionally, an acellular dermal matrix or a muscle flap has been used because the inferolateral portion of the implant cannot be covered by the pectoralis major muscle. However, this method has drawbacks, including infection, cost, and donor-site morbidity. Therefore, we used an autologous conjoined fascial flap composed of the pectoralis major, serratus anterior, and external oblique fascia in patients with small-to-medium breasts. METHODS: A series of 11 immediate breast reconstructions in 11 patients was carried out from March 2010 to June 2011. The conjoined fascial flap and smooth round implants were used in all patients. Postoperative photographs were evaluated by a blinded panel and scored on a four-point scale. Patient satisfaction was evaluated by a postoperative questionnaire that had five items designed to evaluate quality of life with the reconstruction. RESULTS: The mean body mass index was 23.2 kg/m(2), follow-up period was 30.9 months, and implant volume was 286.3 cc. Regarding complications, we observed one case of partial skin flap necrosis and one case of seroma accumulation in the axilla, both of which healed with conservative care. The mean overall breast satisfaction score was 3.18 ± 0.5. CONCLUSIONS: The conjoined fascial flap is a viable alternative for immediate one-stage breast reconstruction with an implant. We recommend appropriate patient selection with a body mass index greater than 20 kg/m(2) and small-to-medium sized nonptotic breasts. 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 http://www.springer.com/00266 .

Restoration of the medial epicanthal fold: reverse skin redraping method in patients unsatisfied with epicanthoplasty.

BACKGROUND: Many Asians receive epicanthoplasty to improve their medial epicanthal fold.Excessive performance of such surgery may cause multiple unwanted results, but there is no report on any restoration method for an overcorrected result of epicanthoplasty. Accordingly, the authors have created a new method for reversely restoring the excessively corrected medial epicanthal fold using skin-redraping epicanthoplasty (Plast Reconstr Surg. 2007;119:703-710). METHODS: During the interval between January 2009 and April 2011, 35 patients received surgery for restoration of the epicanthal fold using the authors' method, which involves sufficiently elevating the skin flap and redraping it to reconstruct the epicanthal fold. This method is very simple to design and perform, and it effectively covers the excessively exposed lacrimal lake. In addition, it can be used independently of the type of prior epicanthoplasty. RESULTS: After the surgery, 2 patients experienced overcorrection, and we repeated the epicanthoplasty. In the other patients, there was no severe complication except for mild redness, a condition that improved after several months. The mean measured distance between the medial canthi after the surgery was 36.8 mm, corresponding to a total lengthening effect of 4.5 mm. This improved the aggressive facial expression caused by the exposed lacrimal lake, and the eyes no longer appeared to be too close together. Moreover, in the case of patients who had more visible scars due to prior epicanthoplasty on the medial epicanthal area, the overall scar length decreased. CONCLUSIONS: This method is simple in design and easy to perform. It can also control the degree of restoration with an additional advantage of reducing a prior scar. Using this method, we could effectively restore the overcorrected epicanthal fold.

Numerical and Experimental Studies of Mechanical Performance and Structural Enhancement of Industrial Building SSMRs.

In response to the increasing demands of high-technology industrial buildings, renovated standing seam metal roofs (SSMRs) are widely used in the construction of such buildings due to their superior performance regarding heat insulation and waterproofing. However, studies to identify realistic mechanical performance and structural defects in newly applied SSMRs are still limited due to their recent development. In our previous full-scale experiment, the ultimate failure of the roof under wind pressure corresponded to mid-clip failure rather than end clip failure and seam separation; therefore, in this study, the lab-scale experimental programs mainly focused on the mid-clip and the metal roof sheet. Here, the plastic saddle type of the SSMR was chosen as the lab-scale experiment specimen under various loading speeds and angled plastic saddle conditions. The JC material properties were calibrated against experimental results and simulated to predict the dynamic failure response of SSMRs. An additional experimental study was conducted to identify the effect of strengthening SSMRs with wind clips, which showed that 20.77% of the peak load was enhanced after reinforcing the SSMR with wind clips. On the basis of this result, the failure wind speed was computed according to ASCE 7-10 standards with the assumption of a wind clip installed on the corner and edge of the roof panel, indicating that the failure wind speed increased with the wind clip by about 6 to 7 m/s. The current research results suggest a methodology for enhancing the structural performance of renovated industrial building SSMRs.

The effect of epidermal growth factor on autogenous fat graft.

Autogenous fat grafting is widely used for the correction of soft tissue contour deformity. However, the high absorption rate results in the need for overcorrection, and graft longevity is unpredictable. The authors hypothesized that epidermal growth factor (EGF), a potent stimulator of neovascularization, would improve fat graft survival. The experiment used two groups of New Zealand White Rabbit ear. Inguinal fat was harvested and injected with EGF or saline (n = 24, each group). The 48 cases of fat grafting were managed for observation of volume and morphologic change. The fat was harvested 3 months after the autogenous graft. The survival rate and the degree of neovascularization were measured. The grafts in the EGF group had a significantly higher survival rate than those in the control group. Histologic examination of the grafts demonstrated an increase in neovascularization and maintenance of fat cell morphology. These findings show that EGF can enhance fat graft survival and degree of neovascularization. Further well-controlled studies are required before EGF is used for clinical purposes.