The concept and surgical technique of "Bright-eye surgery" in Asian is introduced in this paper. From Jan 2006 to Oct 2012, external levator/Muller surgeries were performed in 1,075 patients (1952 eyes) who did not have functional complaint of eyelid ptosis, in an attempt to make their eyes more bright-looking. The mean patient age was 31.6 (range from 16 to 64). During the first year of beginning the procedure, revision surgeries were required in 48 patients (23.4%). Afterwards, revision rates decreased to 7.1% with experience and technical refinement. The cause for the revision varied: more precise correction of asymmetry, overcorrection or under-correction of the palpebral opening, with the demand for getting more attractive exposure of iris-pupil complex. Overall, 98.4% of the patients were satisfied with their outcomes of "Bright-eye surgery", even though some of them underwent second or third operations. Unlike practices and ideas of Caucasian upper eyelid surgery (mainly for levator/Muller surgery), their Asian application needs different aesthetic concept and surgical approach for patient satisfaction. Achieving favorable amount of iris-pupil exposure (i.e. 85~92% in young lady) through posterior lamella surgery in Asians is the key to achieve this goal.
Asian Continental Ancestry Group ; Blepharoplasty ; Blepharoptosis ; Eye ; Eyelids ; Humans ; Patient Satisfaction

In combined techniques of a buried suture and an incision method, the eyes are opened easily with minimal effort, because the strength of the levator palpebrae muscle in the early stage of the eye opening process is firstly transmitted to the tarsal plate. The power of eye opening is efficiently transmitted without diminishing its strength. In addition, postoperative swelling on the lower flap is minimal, without loss of the power of eye opening, which allows for effective correction of ptosis in case of weak levator function. The elevation force of the upper eyelid is mainly initiated from the contraction of the levator palpebrae superioris and transmitted to the levator aponeurosis which is inserted into the anterior surface of the tarsal plate. The classical surgical procedure for bleoharoptosis is accomplished by strengthening the weak levator aponeurosis by means of levator plication, shortening, or Muller tucking procedure. The levator sheath thickens to form the superior transverse ligament of Whitnall and runs continuously inferiorly anterior to the levator aponeurosis and forms the deep layer of the orbital septum. The author has used the levator sheath to reinforce the weak levator aponeurosis effectively in cases of all ptotic eyelids. The elevation effect of the levator sheath plication is more than 1mm of the eyelid level in average and it is same effect to more than 3-4mm plication of the levator aponeurosis.
Blepharoplasty ; Blepharoptosis ; Contracts ; Eye ; Eyelids ; Ligaments ; Muscles ; Orbit ; Sutures

As the newly reconstructed nipple tends to be flattened, especially if submitted to pressure, prudent dressings using various protective devices as a physical support against pressure on a new nipple is important. We used a breathing bag connecting tube as a protective device in nipple reconstruction. A breathing bag connecting tube recycled was cut and trimmed at 1cm above the height of the reconstructed nipple. Before stitch out, the newly reconstructed nipple with a local flap was dressed and protected in this way for 10 days after surgery. After stitch out, patients learnt how to manage the new nipple at home. The sole means of nipple dressing was affixing the breathing bag connecting tube with adhesive tape. Two patients had worn the tube for two months with the best compliance. Owing to the soft composition of the tube material, it is possible for a surgeon to have an easy cutting and trimming of the tube at appropriate heights as well as for a patient to show better compliance yielding better results. The cost factor is another advantage.
Adhesives ; Bandages ; Compliance ; Fibrinogen ; Humans ; Nipples* ; Protective Devices ; Respiration*

Keloid is a scar tissue that undergoes recovery and excessive growth over the original wounds when the collagen is excessively accumulated in the dermis during the wound healing process. The common sites of keloid occurrence include the anterior thorax, shoulder, upper extremities and ear. To our knowledge, however, there are few cases of keloid that occurs in the axilla. In addition, there are fewer cases of keloid that bilaterally occurs at the operated sites postoperatively in individuals with no past or family history. 21-year-old male had undergone subdermal shaving for the management of osmidrosis but had not received appropriate scar management during the military service. He visited us with a keloid-like scar formed in the bilateral axillae. We excised the scar tissue and treated it with local steroid injection and postoperative axilla compression. In histopathological report, no flattening of the overlying epidermis, and presence of keloid collagen which confirms diagnosis of keloid. We report our clinical experience with a rare case of keloid occurring in the axilla and treatment process.
Apocrine Glands ; Axilla ; Cicatrix ; Collagen ; Dermis ; Diagnosis ; Ear ; Epidermis ; Humans ; Keloid* ; Male ; Military Personnel ; Shoulder ; Thorax ; Upper Extremity ; Wound Healing ; Wounds and Injuries ; Young Adult

Mondor's disease is a benign, self-limited process with spontaneous resolution, which is frequently caused by breast surgery, such as axillary lymph node dissection. We present a case of Mondor's disease that occurred after an axillary osmidrosis operation, which is a less invasive procedure; Mondor's disease may be considered as a possible postoperative complication following an axillary osmidrosis surgery.
Breast ; Lymph Node Excision ; Postoperative Complications

Eyelid complications after cataract surgery can occur including ectropion, entropion and blepharoptosis. Among them, blepharoptosis has been reported at high rate about 13%. Various causes of ptosis after cataract surgery have been reported. We report the case of three patients treated for blepharoptosis after cataract surgery. All these patients received cataract extraction by a local ophthalmology before they visited our clinics. They presented aponeurotic dehiscence, it was graded as partial and underwent surgical correction by levator aponeurosis advancement. The postoperative course was uneventful. Ptosis was corrected and there was no recurrence during the period of follow-up. All three of them were pleased with the final result. Since post-cataract extraction ptosis is frequent but a preventable complication, understanding the causes of ptosis after surgery is very important. That can help a surgeon prevent its occurrence with careful surgical planning.
Blepharoptosis* ; Cataract Extraction ; Cataract* ; Ectropion ; Entropion ; Eyelids ; Follow-Up Studies ; Humans ; Ophthalmology ; Recurrence

BACKGROUND: Burn injuries of the extremity can result in cosmetically offensive appearance. Postburn scar can improve by the combination of tangential excision and thin split-thickness skin graft. METHODS: From January 2005 and December 2012, 17 patients (10 males and 7 females) with postburn scar of the extremity underwent the combined techniques. The median time from initial injury to surgery was 66.2 months (range: 11-288 months). In the operation, burn scar was excised until viable dermis could be observed using electrical dermatome, after which thin split thickness skin graft was performed. RESULTS: Tangential excision and thin split thickness skin graft gave excellent grafting results without the need of reoperation. Depigmentation in the majority of patients were recovered within a year by the operation of thin split thickness skin graft. Recovery of range of motion and cosmetic results were good in all patients. CONCLUSIONS: Tangential excision and thin split thickness skin graft are a good way of the reconstruction of deformed and depigmented skin from burns on extremity.
Burns* ; Cicatrix* ; Dermis ; Extremities ; Humans ; Male ; Range of Motion, Articular ; Reoperation ; Skin* ; Transplants*

BACKGROUND: Liposuction and laser ablation for treatment of osmidrosis are leading treatment methods for osmidrosis and have less complication compare to conventional surgical method. We treated patients with the two methods simultaneously to maximize the efficiency for less complication. METHODS: Eighteen patients with axillary osmidrosis (total 36 axillae) were included in this study. They had been treated by liposuction with diode laser ablation from December 2011 to August 2012. The results of operation was assessed by questionnaire subjectively and microscopic study objectively. RESULTS: Eighteen patients were followed over 10 months postoperatively (range, 10 to 18 months; mean, 13.8 months). The patients were satisfied with their results in terms of reduced foul odor except one patient. No hematoma, infections, skin necrosis, hair loss or hypertrophic scar occurred. And there was quantitative reduction of apocrine glands in microscopic study. CONCLUSIONS: We suggest that simultaneous apply of liposuction with laser ablation which is clinically and histologically proven method for treatment of axillary osmidrosis could be more effective method than treatment with each method alone, and has same morbidity allowing the patients early exercise.
Apocrine Glands ; Cicatrix, Hypertrophic ; Hair ; Hematoma ; Humans ; Hyperhidrosis ; Laser Therapy ; Lasers, Semiconductor* ; Lipectomy* ; Methods ; Necrosis ; Odors ; Skin ; Surveys and Questionnaires

BACKGROUND: Depressed scars are usually corrected using subcutaneous fillers such a dermal fat grafting or an autologous fat grafting. But, fillers are absorbed over time and cannot be appropriately used for the correction of large or deep depressed scars. Therefore, we tried new methods to correct challenging cases of deep depressed scars. METHODS: From 2005 to 2013, deep depressed scar were corrected in 10 patients. The location of the scars were as follows: 6 neck, 4 lower extremities. Preoperative marking was done involving the scar on the skin in an oval shape including the long axis of relaxed skin tension line, and the epithelium of the scar was removed. Both ends of the dermal layer of the residual scar were dissected and then isolated from the subcutaneous layer of the adjacent skin. Then, we folded both ends of the flap like hinge flaps and thereby appropriately restored the depressed part of the dermal layer. And we directly closed skin for scar revision. RESULTS: All ten patients had a good result and satisfaction without complication, such as wound infection, dehiscence, at a mean follow-up of seven months. Correction of depression area made the depressed scar less noticeable. Moreover, the problems like donor morbidity, color and texture matching in case of using our techniques, are not issued. CONCLUSIONS: We folded residual scar tissue like a hinge flap in the correction of depressed scar. We obtained good outcomes and report our new methods and their outcomes with a review of literatures.
Axis, Cervical Vertebra ; Cicatrix* ; Depression ; Epithelium ; Follow-Up Studies ; Humans ; Lower Extremity ; Methods ; Neck ; Skin ; Tissue Donors ; Transplants ; Wound Infection

BACKGROUND: Female hairline correction surgery is being more popular among Korean women. However, there has been no report about detailed techniques and methods in secondary female hairline correction surgery. METHODS: The author retrospectively reviewed medical records and medical photos of 36 patients who had secondary hairline correction surgery in one private clinic, with long-term followed up for more than 6 months. RESULTS: All the results were satisfactory and there was no incidence of complications or adverse reactions. Three out of total 36 patients (8.3%) had touch-up procedures for intensifying hair density. The implanted amount for intensifying density was from 86 to 460 hairs, with an average of 286 hairs. All the patients were pleased with the retouching results. CONCLUSIONS: Natural hairline can be accomplished by secondary hairline correction surgery through various methods such as follicular unit extraction, laser hair removal, and new hairline creation with a high degree of delicate transplant techniques.
Female* ; Hair ; Hair Follicle ; Hair Removal ; Humans ; Incidence ; Laser Therapy ; Medical Records ; Retrospective Studies