Wegener's granulomatosis (WG) is a systemic disease characterized by necrotizing granulomas and vasculitis involving the upper and lower respiratory tract as well as the kidneys. Limited form of WG usually involves the head and neck, lacks renal involvement, and may not progress to generalized disease. We report the case of limited form of WG who presented not systemic symptom but several times relapsed multiple ulcerating lesions on the face, uveitis and keratoconjunctivitis. A 23 year-old female initially presented with ulcerative skin lesions on the left cheek and nose. The skin lesion had commenced as an ulcerative and nodulopapular lesion on her right cheek initially, 8 months ago. Subsequently, there was progression of the disease to her left cheek and nose. The patient was treated with oral prednisolone and oral cyclophosphamide. Two weeks later, skin lesion had started to heal, oral prednisolone tapered to 15 mg. Eight weeks later, all of skin lesions were healed well. With silicone gel sheets and Laser therapies, we gained excellent cosmetic results. In the aesthetic aspect, early recognition of rare variants of limited form of WG, facial chronic ulcerative wounds that are nonresponsive to conservative treatment, is very important as appropriate therapy can prevent facial mutilation.
Cheek ; Cosmetics ; Cyclophosphamide ; Female ; Granuloma ; Head ; Humans ; Keratoconjunctivitis ; Kidney ; Laser Therapy ; Neck ; Nose ; Prednisolone ; Respiratory System ; Silicone Gels ; Skin ; Ulcer ; Uveitis ; Vasculitis ; Wegener Granulomatosis

The object of this study is to introduce a novel method of foreheadplasty. The new foreheadplasty can lower the anterior hairline and results in reduction of the vertical forehead length and mid-face lift can be performed at the same time. A 54 year-old female who had a long forehead visited the clinic for rejuvenation of the mid-face. The authors performed dual-vector foreheadplasty and were able to lower the anterior hairline by the advancement of the posterior scalp flap. Mid-face lift was performed by elevation of the malar fat pads. The surgical results were analyzed by measuring the length of the forehead before and 2 years after the surgery. Medical photographs were taken at the same period. The preoperative length of the forehead was 75.5 mm and decreased to 63.0 mm after the surgery. The shortened forehead was well maintained even 2 years after the operation (63.3 mm). The patient suffered from partial sensory loss of the parietal region but resolved simultaneously after 2 months. No other complications, such as, hypertrophic scarring, infection, prolonged inflammation and alopecia occurred. In conclusion the dual-vector foreheadplasty is a relatively simple and safe way to lower the anterior hair line with the elevation of the mid-face.
Adipose Tissue ; Alopecia ; Cicatrix, Hypertrophic ; Female ; Forehead ; Hair ; Humans ; Inflammation ; Rejuvenation ; Rhytidoplasty ; Scalp

Gluteoplasty is getting more concerns among female population with their rather flat contour of upper hips. We experienced a case of wound infection after intramuscular gluteal augmentation and cured with several steps of treatment protocol. We hereby report the case with treating devices and treatment protocol. A 38-year-old female who underwent gluteal augmentation with silicone implant 9 days ago, presented with prulent discharge at the suture site with general myalgia. Under IV general anesthesia, the wound was explored and more than 50 cc of prulent discharge was evacuated from the right gluteal pocket and subcutaneous tunnel. Massive irrigation and wound debridement was done with the help of Water-jet device and left the wound open for drainage. Several cautious steps are applied for reoperation including isolation of perianal skin, protection from skin maceration and contamination, Water-jet debridement, tight bleeding control with endoscope, progressive tension sutures, negative suction drains, occlusive dressings and stabilizing the buttock with Fixmull cotton tape splints. Wound infection is not a rare complication in gluteal augmentation surgery but if it is not treated properly, that would lead to a disastrous result. Therefore surgeons must be well accustomed to the treatment protocol for treating gluteal infection.
Adult ; Anesthesia, General ; Buttocks ; Clinical Protocols ; Debridement ; Drainage ; Endoscopes ; Female ; Hemorrhage ; Hip ; Humans ; Occlusive Dressings ; Reoperation ; Silicones ; Skin ; Splints ; Suction ; Sutures ; Wound Infection

Silicone implants for augmentation rhinoplasty have been used by many surgeons over the past few decades. However, no clinical evaluation of the nasal bones beneath the silicone implant has been conducted to date. Between 2010 and 2012, we reviewed patients' facial computed tomography scans and finally selected 13 patients according to the exclusion criteria. To evaluate the extent of bone resorption, we measured the angle (theta) of the deformed portion. And we measured the thickness of nasal bones to evaluate the bony resorption.A total of 13 patients had some evidence of bone resorption or bony deformity on their computed tomography. An evaluation of the CT scan of the nasal bones showed deformity of the bones underneath the implant. The bones had lost the dome shaped convexity and showed flat configuration under the implant. The values of the angle (theta) ranged from 45to 75 degrees (mean 58.1 degree). The thickness of nasal bone showed statistically significant results at the tip of bony vault. This study has demonstrated of bone deformation beneath the silicone implants in humans.
Bone Resorption ; Congenital Abnormalities ; Humans ; Nasal Bone ; Rhinoplasty ; Silicones

BACKGROUND: One of the most common breast reconstruction techniques that uses autologous tissue is the free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap. However, patients hesitate to choose this method because of the long transverse scar between the anterior superior iliac spines. Furthermore, traditional reconstruction using a free MS-TRAM flap entails donor site morbidities such as pain, hematoma, or seroma. Here, we introduce a mini-abdominoplasty-designed free TRAM flap with flap beveling, which can be a good method for breast reconstruction in Asian patients who have small breasts. METHODS: Breast reconstruction with free MS-TRAM flaps using the mini-abdominoplasty design and flap beveling was performed in 10 patients following mastectomy. Patient age, presurgical brassiere cup size, tumor type, operation type, excised breast weight, elevated flap weight, flap weight used for the breast, recipient vessel, operation time, day that the abdominal drain was removed, and complications associated with both the flap and donor site were documented for all flaps and patients. RESULTS: For all 10 mini-abdominoplasty-designed free TRAM flap procedures, no flap loss or donor site morbidity was noted over a mean follow-up time of 16 months. CONCLUSIONS: The mini-abdominoplasty-designed free TRAM flap can safely and satisfactorily be implanted for the reconstruction of mastectomy defects. It can transfer the lower abdominal skin and subcutaneous tissue for breast reconstruction with minimal donor site scarring and morbidity, especially in Asian patients, who generally have smaller breasts.
Abdominoplasty ; Asian Continental Ancestry Group ; Breast* ; Cicatrix ; Female ; Follow-Up Studies ; Free Tissue Flaps* ; Hematoma ; Humans ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap ; Rectus Abdominis ; Seroma ; Skin ; Spine ; Subcutaneous Tissue ; Tissue Donors

BACKGROUND: Most patients who desire breast augmentation have higher expectations than the outcomes that can be achieved. The purpose of this article is to propose strategies for coping with each patient's expectation, and selecting the most appropriate surgical method. METHODS: Data were retrospectively reviewed for 138 women who underwent breast augmentation between July 1, 2012 and June 30, 2014. The augmentation methods were selected based on the patients' expectations. According to each expectation, we recommended the optimal procedure and material for each patient, and performed the augmentation in accordance with this as much as possible. The patients were asked postoperatively whether they were satisfied with their outcomes. RESULTS: Most patients (85%) were satisfied with their results during the mean postoperative follow-up period of 21.4 +/- 7.6 months (range, 8-32 months). The remaining, dissatisfied patients (15%) accepted their final results after receiving explanations or additional procedures. CONCLUSIONS: We classified common expectations of breast augmentation patients into nine categories. To minimize the gap between expectations and outcomes, we preoperatively provided realistic explanations about the limitations of the chosen materials and surgical methods with each patient. We then performed breast augmentation in consideration of the patient's expectations. Consequently, we were able to appropriately deal with each patient's expectations.
Breast Implantation ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Patient Satisfaction ; Retrospective Studies

BACKGROUND: Noninvasive radiofrequency (RF) and lasers have been used for skin tightening and body contouring since the 1990s. The safety, efficacy, and patient satisfaction with the procedure using a novel RF device (BodyTite(TM); Invasix Ltd, Yokneam Ilit, Israel) were evaluated. METHODS: We retrospectively included 13 patients who were treated with the BodyTite(TM) to rejuvenate neck skin from May 2012 to May 2014. The power of the device was set between 10 and 15 W. The target temperature was set at 38degrees C. Three independent evaluators were asked to grade baseline and 6- to 12-month follow-up photographs using a comprehensive quantitative 4-point laxity grading scale. All patients were asked to rate their satisfaction with the aesthetic outcome and quality of life after treatment. RESULTS: Grading results of baseline and follow-up photographs of patients were statistically significant with an average grade improvement of 1.01 points on the 4 point scale. Using a patient satisfaction scale, patients were also significantly more satisfied (poor, 0%; fair, 15%; good, 46%; and excellent, 39%). There were transient complications, such as minimal erythema, mild edema, and focal hardness, which resolved spontaneously within 1 week. There were no significant adverse effects or complications. CONCLUSIONS: The BodyTite(TM) is a minimally invasive, RF treatment that was demonstrated to improve skin laxity without significant adverse effects or complications. The BodyTite(TM) provides a nonsurgical option for the safe and effective rejuvenation of neck skin under local anesthesia.
Anesthesia, Local ; Edema ; Erythema ; Follow-Up Studies ; Hardness ; Humans ; Neck* ; Patient Satisfaction ; Quality of Life ; Rejuvenation* ; Retrospective Studies ; Skin

BACKGROUND: Various surgical techniques have been developed to address senile upper eyelids. Upper blepharoplasty has limited efficacy in natural periorbital rejuvenation for severe lateral hooding of the upper eyelids, as well as often producing a 'surprised look'. Subbrow excision is a popular method in East Asia for the correction of eyelid drooping, especially on the lateral side as periorbital rejuvenation. However, medial upper eyelid skin redundancy often tends to be undercorrected. Here, we present a few cases of revisional blepharoplasty, especially for medial crease formation, to improve aesthetic results. METHODS: Five patients, for a total of 10 eyelids, who underwent revisional blepharoplasty from January 2011 to January 2015 after a previous subbrow excision, were included. Patients were dissatisfied with uncorrected excessive skin on the medial part of the upper eyelid after a previous subbrow excision; thus, they underwent revisional blepharoplasty for medial crease formation. RESULTS: During the follow-up period, patients were aesthetically satisfied with the postoperative results. No patients suffered from any complications during the follow-up period. CONCLUSIONS: After a previous unfavorable subbrow excision, medial crease formation, via a very minimally invasive technique, could be a favorable option to improve patient satisfaction without postoperative complication or discomfort.
Blepharoplasty ; Eyebrows ; Eyelids ; Far East ; Follow-Up Studies ; Humans ; Patient Satisfaction ; Postoperative Complications ; Rejuvenation ; Skin

A 50-year-old woman visited our hospital for two palpable masses on her sternal and left upper abdominal areas. She had augmentation mammoplasty 12 years prior. Based on the physical examination, the mass in the sternal area was firm, movable, and round. The size of the mass was approximately 3.0x3.0x1.0 cm3. The mass in the upper-left abdomen showed similar characteristics, with a size of approximately 10.0x15.0x1.5 cm3. Ultrasonography revealed a 3.9x1.0x3.4 cm3 hypoechoic lesion in the sternal area. On enhanced-mode computed tomography, a rupture of the left breast implant was noted. Both masses had similar densities as the implant. After rupture of the breast implant, surgery was performed under general anesthesia. Using an inframammary approach, both breast implants and masses were removed using the site of the previous mammoplasty incision. Intraoperative findings revealed that the left breast implant was ruptured and the masses consisted of implant gel components. After surgery, the patient's recovery was uneventful. The patient was discharged without any problem on hospital day 9.
Abdomen ; Anesthesia, General ; Breast Implants* ; Female ; Humans ; Mammaplasty ; Middle Aged ; Physical Examination ; Rupture ; Silicone Gels* ; Ultrasonography

Blepharoplasty is one of the most common anti-aging operations. Although rare, complications such as ectropion may occur. Thus, we introduced an operative technique to prevent ectropion of the lower lid after blepharoplasty. From January 2012 to August 2013, we performed a nonincisional suspension suture (NISS) technique for 30 patients who visited our clinic for lower blepharoplasty. These patients had a distance of greater than 7 mm on the distraction test and were suspected of having horizontal lid laxity. We performed a slit incision 3 mm superior to the junction between the lateral epicanthus and the orbital bone during lower blepharoplasty. We passed a 7-0 nylon suture through the subcutaneous layer and the orbicularis oculi muscle. Then, we punctured the tarsal plate at the lateral limbus and fixed it to the lateral orbital rim by puncturing the periosteum. We tied a suspension knot through the slit incision. Thirty patients had satisfactory results without major complications, such as scleral exposure or ectropion. The NISS technique could be an effective method by which to prevent postoperative ectropion in cases with a mild to moderate degree lower lid laxity. The use of a NISS procedure is also a simple surgical technique, which saves time and is minimally invasive.
Blepharoplasty* ; Ectropion* ; Eyelids* ; Humans ; Nylons ; Orbit ; Periosteum ; Surgical Procedures, Minimally Invasive ; Sutures*