Facial beauty depends on the form, proportion and position of its various units. The chin is the most prominent element of the lower third of the face, both in the frontal view and in profile. Whether it is advisable to perform rhinoplasty first, followed by genioplasty, or the reverse depends on the type and severity of the deformities of the nose and chin. The selection of material is a matter of the plastic surgeon's preference. Fat is an ideal tissue filler substance because it is living tissue and from the patient's own body. So it is nonallergenic. The procedure can be performed alone as a chin augmentation with fat grafting or in combination with rhinoplasty or other facial surgery. The technique requires minimally traumatic fat harvesting, fat preparation, and multi-level facial infiltration. Remnant fat in the initial procedure is frozen and stored at -18C and can be used successfully for minor touch-up procedures. We have performed a review of chin surgery, the multiple aesthetic analyses available and the advantages and disadvantages of the various materials. Autologous fat transfer to the chin is safe, cost effective, and can produce long term aesthetic improvement. Although there are many synthetic fillers available, autologous fat is perhaps the best option for genioplasty. This simple, fast procedure is a very good alternative for patients with some form of microgenia or when patients and surgeons are not likely to use alloplastic implants.
Adipose Tissue ; Beauty ; Chin ; Congenital Abnormalities ; Genioplasty ; Humans ; Mandible ; Nose ; Rhinoplasty ; Transplantation, Autologous ; Transplants

The reduction of nasal bone fracture has been done by a simple procedure. The nasal bone fracture was not a serious problem and patients are usually treated as outpatients. However it is causing increased demand for medical services far cosmetic reasons. We studied the nasal bone fracture by retrospective analysis, it comprising 606 patients with nasal bone fractures in various accidents and treated of Chonnam University Hospital from March 1995 to February 1998. We reviewed and analyzed the medical records and facial bone CT scans of 606 patients. The following results were obtained. 1. The prevalent age group was in the third decade, the most common cause was traffic accidents, while nasal swelling, tenderness, nasal deviation and crepitation were examined 2. The classification of nasal bone fracture was done by facial bone CT. Class 1: Nasal tip depressed fracture(16%) Class 2: Displaced nasal bone fracture without depression(30%) Class 3: Displaces nasal bone fracture with depression(12%) Class 4: Comminuted nasal bone fracture (10%) Class 5: Simple fracture of nasal bone and frontal process of maxilla(14%) Class 6: Comminuted fracture of nasal bone and frontal process of maxilla(11%) Class 7: Nasal bone fracture without displacement(9%) .
Accidents, Traffic ; Classification* ; Facial Bones ; Fractures, Comminuted ; Humans ; Jeollanam-do ; Medical Records ; Nasal Bone* ; Outpatients ; Retrospective Studies ; Tomography, X-Ray Computed

The accurate measurement is essential in evaluating the patients in the aesthetic plastic surgery. So many plastic surgeons would have increased the accuracy of photograph. But the results of the efforts are not satisfactory. Now, we can use the 3-D scanner possibly. We want to investigate the reliability of the 3-D scanner by comparing real measurements with the 3-D scanner measurements. Between Apr, 2003 and Nov, 2005, the Korean agency for technology and standards(ATS) investigates the size of 15,576 Korean by real measurements and 5,186 Korean by the 3-D scanner measurements. We selected the measurements of female aged from 20 to 24. These measurements divide into the sections of height, width, thickness, circumference, and compared in each sections. The statistical analysis was performed by STATA 9.0. If the datum points were fixed, unstable and the data was easily measured by the measuring devices such as height, the 3-D scanner measurements were almost coincident with the real measurements. The p-value was statistically not significant. Otherwise, If the datum points were unfixed and the data was measured by a measuring tape, the 3-D scanner measurements were not coincident with the real measurements. The p-value was statistically significant. According to these results, the height can be measured by the 3-D scanner instead of real measurements. But the circumference, thickness and width by the 3-D scanner is almost incompatible with that of the real measurements. The new paradigm of anthropometry is needed.
Anthropometry ; Female ; Humans ; Surgery, Plastic*

The latissimus dorsi has been used as an excellent donor site for free flap because of many advantages such as reliable anatomy, long pedicle with large-caliber vessels, easiness of dissection, and minimal functional deficit of the donor site. It is also one of the most versatile free flaps due to its carrying skin, muscle, and bone components. Nevertheless, bulkiness limits its use for resurfacing the defect in thin regions such as hand, foot, and anterior tibial area. To reduce its excessive volume when bulk is considered a disadvantage, surgical modifications were introduced: muscle sectioning, reduced musculocutaneous flap, muscle splitting, and thoracodorsal perforator-based cutaneous flap. Although the thoracodorsal perforator-based cutaneous flap excluding muscle component is thinner than others, it also needs secondary debulking procedures to resurface the thin regions. Thinning of the cutaneous flap was successfully performed in paraumbilical perforator-based flap and anterolateral thigh flap. These thinned flaps depend for their circulation on the subdermal plexus originating from their pedicled vessel. Based on their survival concept, we made the thoracodorsal perforator-based cutaneous flap thin and clinically applied it to 7 patients as a free flap. They were all survived and there was no need for secondary debulking procedures. This flap adds the advantage of little bulkiness to the conventional latissimus dorsi flap. However, it has some disadvantages such as technical difficulties in dissection of the perforator, anatomical variation in the location of the perforator, and nonsensory flap.
Foot ; Free Tissue Flaps* ; Hand ; Humans ; Myocutaneous Flap ; Skin ; Superficial Back Muscles ; Thigh ; Tissue Donors

PURPOSE: Full-thickness skin grafts are usually used in facial reconstruction, but on occasion, split-thickness skin graft is also used from the scalp due to the limitation of donor site. However, there were complications, such as alopecia, folliculitis and blood loss. In addition, it can not be used in patients with baldness. Under the circumstances, we used medial arm skin as split-thickness skin graft donor site in lieu of scalp. We investigated the efficacy of the medial arm skin as a donor site of facial skin graft in comparison with scalp. METHODS: From 2000 to 2005, the split-thicknesss skin grafts were performed using the medial arm skin in 10 patients and the scalp in 10 patients. We inspected the skin color match, texture match by the visual analogue scale. Scar contracture was estimated by the Visitrak grade(R)(Smith & Nephew). The statistical analysis was performed by SPSS 12.0. RESULTS: There was a more satisfaction in color match, texture, and scar contracture in medial arm skin than in scalp. CONCLUSION: According to these results, medial arm skin may be used efficiently as an alternative donor site of scalp in the facial reconstruction.
Alopecia ; Arm* ; Cicatrix ; Contracture ; Folliculitis ; Humans ; Scalp ; Skin* ; Tissue Donors ; Transplants*

PURPOSE: Full-thickness skin grafts are usually used in facial reconstruction, but on occasion, split-thickness skin graft is also used from the scalp due to the limitation of donor site. However, there were complications, such as alopecia, folliculitis and blood loss. In addition, it can not be used in patients with baldness. Under the circumstances, we used medial arm skin as split-thickness skin graft donor site in lieu of scalp. We investigated the efficacy of the medial arm skin as a donor site of facial skin graft in comparison with scalp. METHODS: From 2000 to 2005, the split-thicknesss skin grafts were performed using the medial arm skin in 10 patients and the scalp in 10 patients. We inspected the skin color match, texture match by the visual analogue scale. Scar contracture was estimated by the Visitrak grade(R)(Smith & Nephew). The statistical analysis was performed by SPSS 12.0. RESULTS: There was a more satisfaction in color match, texture, and scar contracture in medial arm skin than in scalp. CONCLUSION: According to these results, medial arm skin may be used efficiently as an alternative donor site of scalp in the facial reconstruction.
Alopecia ; Arm* ; Cicatrix ; Contracture ; Folliculitis ; Humans ; Scalp ; Skin* ; Tissue Donors ; Transplants*

Augmentation rhinoplasty is one of the most popular aesthetic procedure in Asians. Numerous alloplastic implants have been used until now, but no accurate comparative analysis about the implant materials has been reported yet. This study in animal model was designed to determine the safety and effectiveness of various implant materials in augmentation rhinoplasty. The 15 x 15 x 2 mm sized square shaped plate of Gore-Tex(R), silicone rubber, and 15 x 15 x 1.5 mm sized Medpor(R) were implanted under panniculus carnosus of the abdomen wall of rat. And tissue specimens including the implant and surrounding soft tissue were obtained by en bloc excision in 6 months after implantation. The implants were estimated in weight and volume, and also the specimens were examined grossly and microscopically. The results revealed that increase of average weight 26.9%, decrease of average volume 55.4% in Gore-Tex(R) implant, increase of each average weight and volume 62.6%, 8.7% in Medpor(R) implant and very slight increase of both average weight and volume 4.7%, 1.1% in silicone rubber implant. Grossly, the Gore-Tex(R) was deformed, Medpor(R) was strongly adherent to surrounding soft tissue and the silicone rubber was well encapsulated and easily peeled off. Microscopically, silicone rubber showed foreign body reaction slightly and there were no inflammatory responses in all alloplastic implants. In our study, silicone rubber showed very proper alloplastic features for augmentation rhinoplasty due to causing no inflammatory response, no physical change, and no deformity.
Abdomen ; Animals ; Asian Continental Ancestry Group ; Congenital Abnormalities ; Foreign-Body Reaction ; Humans ; Models, Animal ; Rats* ; Rhinoplasty ; Silicone Elastomers

PURPOSE: Congenital insensitivity to pain with anhidrosis(CIPA) is a rare form of autosomal recessive peripheral sensory neuropathy. Patients with CIPA show loss of pain sensation, which leads to corneal ulcers and opacities, self-mutilation of the tongue and fingertips, as well as fractures with subsequent joint deformities and chronic osteomyelitis. The purpose of this report is to highlight the fact that pressure sores also are a potential complication of CIPA. METHODS: This case report describes a patient presenting with pressure sores resulting from CIPA. A 5-year-old boy was referred to our department for the treatment of a 5x5cm sacral pressure sore as a result of a hip spica cast applied for the treatment of a left hip joint dislocation. He had a history suggesting CIPA such as multiple bony fractures, mental retardation, recurrent hyperpyrexia, anhidrosis, and clubbing fingers due to oral mutilation. A microscopic examination of the sural nerve showed mainly large myelinated fibers, a few small myelinated fibers and an almost complete loss of unmyelinated fibers. After wound preparation for two weeks, the exposed bone was covered with two local advancement flaps. RESULTS: Two weeks later, complete wound healing was achieved. A 16-month follow-up showed no recurrence. However, the patient presented with a new pressure sore on the left knee due to orthosis for the treatment of the left hip joint dislocation. CONCLUSION: The early diagnosis of CIPA and special care of pressure sores are important for preventing and treating pressure sores resulting from CIPA.
Child, Preschool ; Congenital Abnormalities ; Dislocations ; Early Diagnosis ; Fingers ; Follow-Up Studies ; Hereditary Sensory and Autonomic Neuropathies* ; Hip ; Hip Joint ; Humans ; Hypohidrosis ; Intellectual Disability ; Joints ; Knee ; Male ; Myelin Sheath ; Nerve Fibers, Myelinated ; Orthotic Devices ; Osteomyelitis ; Pain Insensitivity, Congenital* ; Pressure Ulcer* ; Recurrence ; Sensation ; Sural Nerve ; Tongue ; Ulcer ; Wound Healing ; Wounds and Injuries

Human cysticercosis is an infestation with C. cellulosae, the larval stage of the tapeworm T. solium. It prevails in regions of poverty and where personal hygiene is poor. They can lodge in almost any tissue, but cysticerci are most frequently found in brain, skeletal muscle, subcutaneous tissues. We experienced a 41-year old male with 5 x 12 cm sized movable non tender brownish hard mass at lateral abdominal wall. The laboratory study didn't show any specific symptoms except peripheral blood eosinophilia and positive parasite ELISA screen for cysticercosis. The ultrasonogram revealed multiple ill-defined mixed echoic inflamatory lesion. Excisied cyst showed multiple severe foul-odor gelatinous subcutaneous mass. Microscopic examination disclosed necrotic body with foreign body reaction, massive eosinophilia and dead parasitic organism, compatible with cysticercosis. There was no evidence of recurrence during 12 months follow-up.
Abdominal Wall* ; Adult ; Brain ; Cestoda ; Cysticercosis* ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Follow-Up Studies ; Foreign-Body Reaction ; Gelatin ; Humans ; Hygiene ; Male ; Muscle, Skeletal ; Parasites ; Poverty ; Recurrence ; Subcutaneous Tissue ; Taenia solium ; Ultrasonography

PURPOSE: For facial reconstruction, skin color match is crucial to achieve great aesthetic result. Forehead flap and full thickness skin graft have been used for many years to reconstruct facial defect. Their results are aesthetically valuable with remarkable resemblance and harmony of the skin color between donor and recipient sites. The purpose of this study is to evaluate and compare the aesthetic outcome of the two methods as the analysis of skin color match. METHODS: From January 1995 to December 2005, ten forehead flaps and ten full thickness skin grafts were performed. The reconstructed areas of forehead flaps were five noses and five eyelids. Recipient sites of full thickness skin grafts were seven eyelids, two noses and one forehead. In order to obtain the objective validity, the skin color of flap(or graft) and the recipient sites were measured by chromameter. The skin colors were quantified according to a three-dimensional coordinate system used in chromameter, L*(brightness), a*(redness), and b*(yellowness). RESULTS: There was no significant color difference between forehead flap site and adjacent skin in all color values. On the other hand, the L* and b* values of graft sites were significantly lower than those of the adjacent skins. The a* values of graft sites were higher than those of the adjacent skins. CONCLUSION: This study reveals that skin color match of forehead flap is greater than that of full thickness skin graft. As forehead flap has adequate volume and great color match, it can be useful to reconstruct deep facial defect such as nasal defect. On the other hand, full thickness skin graft can be used for superficial defect like partial eyelid defect.
Eyelids ; Forehead ; Hand ; Humans ; Nose ; Skin ; Tissue Donors ; Transplants