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

Encephalocraniocutaneous lipomatosis (ECCL) is a rare congenital neurocutaneous syndrome that was characterized by unilateral, smooth, hairless fatty tissue nevi of the scalp, termed nevus psiloliparus, facial lesions, multiple anomalies involving the eye, and ipsilateral porencephalic cysts with cortical atrophy, cranial asymmetry, marked developmental delays, and mental retardation. A 12-month-old boy was referred to our clinic for evaluation of non-scarring alopecia on the left side with an underlying fatty mass in the left parietal scalp and left-sided multiple periocular masses. It showed a large lipomatous mass on the scalp with overlying alopecia. Multiple skin tags and defects in the left periocular area were also observed. Additional ocular anomalies included epibulbar lipodermoid, iris coloboma, and localized peripapillary hypopigmentation lesions. After complete excision, the wound was covered with a local flap. The histologic examination revealed a mass surrounded by a well-developed capsule within the dermal layer, adipose tissue and connective tissue septa extending into the reticular dermis. No recurrence was observed at follow-up. It is essential to differentiate suspected ECCL from other syndromes which present with epibulbar chorisotomas. Neuroimaging, and pathological studies may be helpful for correct diagnosis. We will correct multiple periocular lesions in preschool age and follow up developmental problems like developmental delay and mental retardation constantly.
Adipose Tissue ; Alopecia ; Atrophy ; Coloboma ; Connective Tissue ; Dermis ; Eye ; Eye Diseases ; Follow-Up Studies ; Humans ; Hypopigmentation ; Infant ; Intellectual Disability ; Iris ; Lipomatosis ; Neurocutaneous Syndromes ; Neuroimaging ; Nevus ; Recurrence ; Scalp ; Skin

We report a case of Mycobacterium fortuitum infection of the face and abdomen in a 25 years old man following cosmetic autologous fat injection. The goal of this manuscript is to increase awareness and suspicion of such as atypical mycobacterial infections complicating liposuction and fat injection. The clinical presentation, laboratory studies utilizing acid-fast stains and cultures, prevention and treatment including surgical debridement, and pharmacologic regimens in the ultimate diagnosis for Mycobacterium fortuitum infections are discussed.
Abdomen ; Coloring Agents ; Cosmetics ; Debridement ; Lipectomy ; Mycobacterium ; Mycobacterium fortuitum

As hyaluronic acid filler commonly applied in many cosmetic fields, tissue necrosis due to filler embolism is reported infrequently. Herein we report the first case of nasal hyaluronic acid filler injection resulting in nasal necrosis, multifocal brain infarction and ocular ischemia with hypotonia. A 25-year-old female, who had received an injection of hyaluronic acid filler along the nasal dorsum a month before, visited our hospital to manage the skin ulcer of nasal ala. Immediately after the injection, the patient had complained of nausea, vomiting, headache and nose pain without neurologic symptom. The skin had bluish change at her nose and forehead. And the right eyelid ptosis was observed with decreased eyeball movement and visual loss. Multifocal punctuated infarctions were found on both frontal lobes on brain MRI. The necrotic skin of right nasal ala was healed in 3 months. But, the width of the right nasal ala was smaller than the left side, and the right eye remained blind with extropia at 8 months after injection. Although hyaluronic acid filler is safe in most cases, patients should be informed of the possibility of this rare complication.
Adult ; Blepharoptosis ; Blindness ; Brain ; Brain Infarction ; Cosmetics ; Embolism ; Eye ; Female ; Forehead ; Frontal Lobe ; Headache ; Humans ; Hyaluronic Acid ; Infarction ; Ischemia ; Muscle Hypotonia ; Nausea ; Necrosis ; Neurologic Manifestations ; Nose ; Paralysis ; Skin ; Skin Ulcer ; Vomiting

Several freeze-dried human acellular dermal matrix have been introduced and they helped to facilitate implant based breast reconstruction by providing support to the breast lower pole, firm fixation of inframammary fold, and simple operation procedure. We evaluated clinical outcomes of recently produced human acellular dermal matrix, CG Derm(TM), prospectively. CG Derm(TM) was used in six patients and eight breasts for implant breast reconstruction. Complete blood cell count test, rountine chemisty(including ESR) test, and CRP test were performed before and after the surgery. Postoperative complication was evaluated including infection, seroma, implant malpostion, rippling deformity, and capsular contracture. Randomly selected two patients underwent breast MRI after reconstruction. Finally we examine patients' satisfaction survey and plastic surgeons' evaluation. Satisfactory breast lower pole fullness, symmetric inframammary folds and breast shapes were achieved in most patients. Overall, patients had sufficient aesthetic satisfaction and surgeon's evaluation was also good. There was no major complication except four cases of seroma which healed with conservative management. Implant breast reconstruction using CG Derm(TM) was safe and obtain good aesthetic results. But further and larger scale study should be performed to reveal out the relatively high risk of seroma.
Acellular Dermis ; Blood Cell Count ; Breast ; Breast Implants ; Congenital Abnormalities ; Contracture ; Female ; Humans ; Mammaplasty ; Postoperative Complications ; Prospective Studies ; Seroma ; Skin, Artificial ; Transplantation, Homologous

There have been few studies investigating the differences in the perception of facial attractiveness according to gender, races and ethnicity. This study was conducted to determine whether different races or genders show actual differences in the perception of beauty. Using 5 composite faces of different races, this survey was designed on 486 participants from different races and ethnicities. Photographs of the composite faces were displayed on a large poster at Incheon International Airport and passersby were asked to take part in the survey regarding which composite face was the most attractive. Data were statistically analyzed to determine differences in beauty perception in terms of gender, race and ethnicity. There were significant differences in the perception of the most attractive face and the least attractive face according to gender. There were significant differences in the perception of the most and least attractive face according to race. Multivariate analysis also revealed that there were different perceptions of facial attractiveness according to ethnic backgrounds. The results of this study suggest that the perception of facial attractiveness may differ according to gender, race and ethnicity, and that some unique or peculiar patterns of beauty perception may exist.
Airports ; Beauty ; Continental Population Groups ; Gender Identity ; Humans ; Multivariate Analysis ; Population Groups

Midface is one of the most important structures which impresses, combining with eyes and nose. Youthful midface shows the blending of lower eyelid and the anterior cheek, therefore the goals of midface rejuvenation is harmony between the lower eyelid and anterior cheek. The purpose of this article is to provide an overview of current concept of midface rejuvenation including preoperative patient assessment, surgical methods, postoperative management and complications. A critical understanding of patient expectation, anatomy and operative technique is important to achieve satisfactory results and to avoid complications.
Adipose Tissue ; Adolescent ; Blepharoplasty ; Cheek ; Eye ; Eyelids ; Humans ; Nose ; Rejuvenation ; Rhytidoplasty

Breast contour deformities, lack of volume and asymmetry are common confronted problems after breast augmentation with implants. These problems can be corrected by using temporary fillers or autologous fat grafts. The purpose of this study was to introduce our experience using long lasting temporary filler (Aquafilling(R)) for the correction of unfavorable results after breast augmentation with silicone implants. Two non-pregnant, non-breastfeeding women unsatisfied with previous breast augmentation with silicone implants were recruited for this study. All procedures were performed under local anesthesia with sedation. Efficacy and safety assessments were carried out at follow-up visits (1, 3, and 6 months). The study showed that Aquafilling(R) could provide satisfactory improvement in breast shape and volume. Also it showed that the corrected volume and shape were lasting without affecting the breasts' original volume. Patients reported high satisfaction as Aquafilling(R) was generally well tolerated with no inflammatory reactions or serious adverse events. We recommend that Aquafilling(R) as a new option for the correction of minor problems after breast augmentation surgery with implants. However, further follow-up studies are required to observe long-term results.
Anesthesia, Local ; Breast Implants ; Breast* ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Silicones* ; Transplants

A 21-year-old woman underwent bilateral augmentation mammoplasty by injection of an unknown volume of fat obtained via trochanteric and abdominal liposuction. The procedure was performed by a surgeon untrained in plastic surgery, at a clinic not affiliated with a hospital. Six months later, she presented to our clinic with a palpable left breast lump. Physical examination revealed a large firm mass occupying the entire upper outer quadrant of the left breast and a normal right breast. Breast ultrasound showed a large, well-defined isoechoic mass in the left upper outer breast. Considering her age, the patient underwent core needle biopsy, since the mass mimicked a phyllodes tumor on ultrasonography. The 14-gauge core needle biopsy demonstrated multiple lipid droplets with some white-yellowish tissue, caused by liquefaction of the injected fat. Histopathologic examination demonstrated the presence of a pseudocyst with fat necrosis, granulomatous reaction to lipid material, and cystic formations containing oily fluid. No signs of malignancy were detected. Surgical excision was performed, and histopathology revealed findings consistent with fat necrosis.
Biopsy, Large-Core Needle ; Breast* ; Fat Necrosis ; Female ; Femur ; Humans ; Lipectomy ; Mammaplasty ; Phyllodes Tumor ; Physical Examination ; Surgery, Plastic ; Ultrasonography ; Young Adult