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*

PURPOSE: Chondroid syringoma, previously known as 'mixed tumor of the skin', is a rare benign tumor. It usually presents an asymptomatic solitary firm intradermal or subcutaneous slowly growing nodule. It occurs frequently in the head and neck region of middle-aged men. We would like to report an uncommon chondroid syringoma about the clinical and histologic presentation. about the clinical and histologic presentation. METHODS: We experienced two cases of chondroid syringoma on the nose and the upper lip, each other. Both masses were totally excised with clear margin. RESULTS: On histologic examination, the masses showed a biphasic pattern-an epithelial component exhibiting apocrine/eccrine differentiation and a stromal component exhibiting myxoid/collagenous change-consistent with the diagnosis of chondroid syringoma. There have been no evidence of recurrence and malignant transformation during postoperative follow-up. CONCLUSION: There is no one distinctive clinical feature that is specific for chondroid syringoma. However, it should be included in the differential diagnosis of a solid nodule in head and neck region with long standing duration, such as epidermal inclusion cyst, pilomatrixoma, dermoid cyst, sebaceous cyst, neurofibroma, and basal cell carcinoma.
Adenoma, Pleomorphic* ; Carcinoma, Basal Cell ; Dermoid Cyst ; Diagnosis ; Diagnosis, Differential ; Epidermal Cyst ; Follow-Up Studies ; Head ; Humans ; Lip* ; Male ; Neck ; Neurofibroma ; Nose ; Pilomatrixoma ; Recurrence

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

Ingrowing toenail has been treated conventionally by various surgical treatment modlities. However, none of these procedures are perfect to achieve esthetic results with low cost, recurrence, and complication rates. Although mild cases can be treated conservatively, in severe recurrent cases, surgical treatment is preferred. The purpose of this study is to evaluate the effectiveness and safety of using partial matricectomy and paronychial advancement flap for correction of recurrent ingrowing toenail. Eight patients suffering from recurrent ingrowing toenail were operated using partial matricectomy and paronychial advancement flap in our department from August 2004 to August 2005. The number of recurrent episodes ranged from 2 to 5. With digital nerve block, the excision area was marked on nailplate and inflammed lateral nail fold. The horizontally designed paronychial flap considering defect size was effective for wide exposure of the neighboring germinal matrix, which is later to be completely excised or cauterized because remnant germinal matrix made postoperative spicule formation. The nailplate on the affected side was removed about 3-5mm width longitudinally, being cautious not to damage the proximal dorsal nail fold. The same width of the sterile matrix including germinal matrix was excised longitudinally with inflammed granulation tissue and partial lateral nail fold on the affected side. The subcutaneously elevated paronychial flap was advanced to cover the defect and was anatomically sutured with 5-0 nylon sutures. We evaluated our procedure's effectiveness by examining some factors such as cosmetic results, recurrence, spicule formation, postoperative pain and duration of return to normal activities. In eight patients, no complication was observed such as recurrence, severe pain and spicule formation except for 1 case of infection. Postoperative discomfort was minimal. Average duration of return to normal activities was 12 days. Cosmetically the results were acceptable in all patients. The partial matricectomy and paronychial advancement flap for correction of recurrent ingrowing toenail were found to be technically simple, efficient procedure with a relative low recurrence rate and better cosmetic results.
Granulation Tissue ; Humans ; Nails* ; Nerve Block ; Nylons ; Pain, Postoperative ; Recurrence ; Sutures

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