The chest wall and breast asymmetry varies from severe pectus deformities to an isolated breast hypoplasia. In addition to the chest abnormality, a natural-looking breast is the aesthetic challenge in women. Considering that the most common indication of operations is an aesthetic one, any procedures leaving much scars and deformities at the donor site aren't preferred by patients. A 31-year-old female had a 4 x 10 x 2.5 cm sized pectus-excavatum deformity on her right chest, and a slightly hypoplastic breast compared with the left one. The nipple of her right breast was located supero-medially and pectoralis muscles were preserved to some degree at the right side. Through a bilateral submammary and subxiphoid incision, the deformed cartilage was resected from 3th to 7th rib bilaterally and chondrotomy was done at the sternum partially. After this modified Ravitch's technique, two-metal pins were fixated between right 4th~5th ribs and left 4th rib, and the depressed sternum was elevated over the metal pins. The deficient volume of her right breast was corrected by inserting a siliconegel breast implant (120 cc) submuscularly to restore a adequately projected breast. The results of twelve months' follow-up demonstrated a symmetric and well- projected breast. There were no significant chest wall depression or capsular contracture. Restoring a fundamental bony structure would decrease the amount of augmentation needed in the soft tissues. And a silicone-gel breast implant may be used as an the alternative material for whose axillary fold is preserved to some degree.
Adult ; Breast Implants ; Breast* ; Cartilage ; Cicatrix ; Congenital Abnormalities* ; Contracture ; Depression ; Female ; Follow-Up Studies ; Humans ; Nipples ; Pectoralis Muscles ; Ribs ; Sternum ; Thoracic Wall* ; Thorax* ; Tissue Donors

Septorhinoplasty in Asians is very challenging in terms of shortage of septal cartilage. Many cases in correction of dorsal and caudal septal deformities requires septal surgery including cartilaginous graft. Septoplasty is a well-known procedure which preserves majority of quadrangular cartilage, however, it is hardly adopted in Asians. The preoperative evaluation is accomplished using nasal endoscopy. The posterior and inferior chondrotomy for septal swinging-door procedure can be performed under endoscopic view. Also, the precise amount of bony spur and excessive cartilage can be excised. Endoscopy is also indispensable to precise hemostasis and turbinoplasty. Asian septoplasty is usually performed with maximal central submucous resection leaving critical L-strut, because surgeons need as much cartilages as possible for proper graft. In caudal septum, posterior septal angle loses its integrity after swinging-door procedure, and also loses the tip projection. This should be reinforced. Furthermore, in patients who have weak septal cartilage, key stone area needs to be reinforced by unilateral or bilateral spreader graft at the same time. Proper bilateral strut at the posterior septal angle continuous with spreader graft at rhinion may confirm the newly made solid L-strut. This solid caudal septum will be the new nasal base for the next tip plasty.
Asian Continental Ancestry Group ; Cartilage ; Congenital Abnormalities ; Endoscopy ; Hemostasis ; Humans ; Nasal Cartilages ; Nasal Septum ; Reinforcement (Psychology) ; Rhinoplasty ; Transplants

PURPOSE: The epicanthus is a specific feature in Asian. Many techniques have been described to eliminate the epicanthal fold: resection of glabellar skin, resection of medial canthal skin, V-Y advancement, V-W technique, modified Z-plasty, multiple Z-plasties, and others. The authors observed postoperative epiphora after correction of epicanthal fold by periciliary skin flap without damaging lacrimal duct. METHODS: A 19-year-old woman underwent non-incisional blepharoplasty, septorhinoplasty, and periciliary epicanthoplasty. On her history, she didn't have any symptom of epiphora preoperatively. And there was no specific complaint of epiphora during the postoperative two weeks. However epiphora got worse from one month after the surgery. She was out of this country, so the patient re-visited the clinic on the postoperative six months for this on-going symptom. On an ophthalmologic examination, patient's lacrimal duct and sac was intact but both lacrimal puncta of the patient were covered with a thin membrane. This membrane was punctuated by a 25 gauge needle and dilated with a standard dilator. RESULTS: After ophthalmologic treatment, no recurrence was observed during five weeks of follow-up periods. CONCLUSION: Both lacrimal puncta of the patient were only covered with membranes. And we could not confirm the direct relationship between periciliary epicanthoplasty and postoperative epiphora. The probable factors will be a predisposing narrowed punctum, post operative peri-punctal edema and decrease in muscular function of orbicularis oculi.
Asian Continental Ancestry Group ; Blepharoplasty ; Edema ; Female ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Membranes ; Needles ; Recurrence ; Skin ; Young Adult

BACKGROUND: Nasal tip support is an essential consideration for rhinoplasty in East Asians. There are many techniques to improve tip projection, and among them, the columellar strut is the most popular technique. However, the conventional design is less supportive for rotating the tip. The amount of harvestable septal cartilage is relatively small in East Asians. For an optimal outcome, we propose an L-shaped design for applying the columellar strut. METHODS: To evaluate the anthropometric outcomes, the change in nasal tip projection and the columella-labial angle were analyzed by comparing preoperative and postoperative photographs. The anthropometric study group consisted of 25 patients who underwent the same operative technique of an L-shaped strut graft using septal cartilage and were followed up for more than 9 months. RESULTS: There were statistically significant differences between the preoperative and postoperative values in the nasal tip projection ratio and columella-labial angle. We did not observe any complications directly related to the L-shaped columellar strut in the anthropometric study group. CONCLUSIONS: The L-shaped columellar strut has advantages not only in the controlling of tip projection and rotation, but in that it needs a smaller amount of cartilage compared to the conventional septal extension graft. It can therefore be an alternative technique for nasal tip plasty when there is an insufficient amount of harvestable septal cartilage.
Asian Continental Ancestry Group ; Cartilage ; Humans ; Nasal Septum ; Rhinoplasty ; Transplants ; Treatment Outcome

PURPOSE: A common side effect of the scalp reduction is a creation of a 'slot' with the hair growing in the opposite directions away from the scar. Overcoming the unnatural appearance of the slot has been a vexing problem in the scalp reduction surgery. None of the conventional corrective surgical techniques provides a complete and satisfactory aesthetic result. The Frechet flap is a triple transposition flap used for the correction of the slot defect secondary to scalp reduction surgery, seldom needing further scar revision. The Frechet technique provides a solution to the problem of the central slot concealment that is unattainable by other means, such as; Z-plasty and mini-graft. METHODS: Authors applied the Frechet technique to Asian patients who had undergone scalp reduction and operated on 4 patients from March, 2000 to January, 2001. Average follow-up period was 13 months. Patients with long scars passing through the temporoparietoccipital zone were excluded. All the undermining was performed in the subgaleal plane, reaching the upper auricular sulcus and stopping just above the nuchal ridge. RESULTS: None of the patients experienced infection, hematoma, nor any permanent hair loss. Transient telogen effluvium at the distal end of flap 2 and 3 was noticeable in one case. CONCLUSION: In conclusion, the results are aesthetically satisfactory without any significant complications.
Asian Continental Ancestry Group ; Cicatrix ; Follow-Up Studies ; Hair* ; Hematoma ; Humans ; Scalp

No abstract available.
Parotid Gland* ; Salivary Ducts*

PURPOSE: As the use of computed tomographic scanning spread, the diagnosis of blow-out fractures of the medial orbital wall increased. Conventionally, the surgery of blow-out fractures in medial orbital wall was performed by various approaches with external incision or endoscopic approach. Although the field of orbital surgery has progressed significantly during the last decade, accurate realignment and replacement of component is difficult due to lack of visualization of the fracture site, blind dissection of the orbital wall, and difficulty in insertion of implant. In order to overcome these shortcomings, we explored the use of endoscopic transnasal approach together with subciliary approach. METHODS: The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically, and the bone defect of medial orbital wall was reconstructed with Medpor(R) insertion via subciliary approach. This technique was applied to 13 patients who had medial orbital wall fracture. RESULTS: The patients were followed-up for 3 to 24 months with an average of 9 months. The postoperative courses were satisfactory in all cases. CONCLUSION: The conjunction of endoscopic transnasal and subciliary approach technique seems to produce good results in medial orbital wall fracture.
Diagnosis ; Ethmoid Sinus ; Humans ; Orbit* ; Orbital Fractures

PURPOSE: Adipose-derived stromal cells (ASCs) are readily harvested from lipoaspirated tissue or subcutaneous adipose tissue fragments. The stromal vascular fraction (SVF) is a heterogeneous set of cell populations that surround and support adipose tissue, which includes the stromal cells, ASCs, that have the ability to differentiate into cells of several lineages and contains cells from the microvasculature. The mechanisms that drive the ASCs into the osteoblast lineage are still not clear, but the process has been more extensively studied in bone marrow stromal cells. The purpose of this study was to investigate the osteogenic capacity of adipose derived SVF cells and evaluate bone formation following implantation of SVF cells into the bone defect of human phalanx. METHODS: Case 1 a 43-year-old male was wounded while using a press machine. After first operation, segmental bone defects of the left 3rd and 4th middle phalanx occurred. At first we injected the SVF cells combined with demineralized bone matrix (DBM) to defected 4th middle phalangeal bone lesion. We used P (L/DL)LA [Poly (70L-lactide-co-30DL-lactide) Co Polymer P (L/DL)LA] as a scaffold. Next, we implanted the SVF cells combined with DBM to repair left 3rd middle phalangeal bone defect in sequence. Case 2 was a 25-year-old man with crushing hand injury. Three months after the previous surgery, we implanted the SVF cells combined with DBM to restore right 3rd middle phalangeal bone defect by syringe injection. Radiographic images were taken at follow-up hospital visits and evaluated radiographically by means of computerized analysis of digital images. RESULTS: The phalangeal bone defect was treated with autologous SVF cells isolated and applied in a single operative procedure in combination with DBM. The SVF cells were supported in place with mechanical fixation with a resorbable macroporous sheets acting as a soft tissue barrier. The radiographic appearance of the defect revealed a restoration to average bone density and stable position of pharyngeal bone. Densitometric evaluations for digital X-ray revealed improved bone densities in two cases with pharyngeal bone defects, that is, 65.2% for 4th finger of the case 1, 60.5% for 3rd finger of the case 1 and 60.1% for the case 2. CONCLUSION: This study demonstrated that adipose derived stromal vascular fraction cells have osteogenic potential in two clinical case studies. Thus, these reports show that cells from the SVF cells have potential in many areas of clinical cell therapy and regenerative medicine, albeit a lot of work is yet to be done.
Adipose Tissue ; Adult ; Bone Density ; Bone Matrix ; Durapatite ; Fingers ; Follow-Up Studies ; Hand Injuries ; Humans ; Hypogonadism ; Male ; Mesenchymal Stromal Cells ; Microvessels ; Mitochondrial Diseases ; Ophthalmoplegia ; Osteoblasts ; Osteogenesis ; Polymers ; Regenerative Medicine ; Stromal Cells ; Subcutaneous Fat ; Surgical Procedures, Operative ; Syringes ; Tissue Therapy

Although there has not yet been a clear determination of the structures responsible for nasal tip support, it is generally agreed that for Caucasians the components of nasal tip support include the attachment between the upper and lower lateral cartilage, the attachment between the lateral crus and the pyriform aperture, the attachment between the paired domes of the lower lateral cartilages, and the medial crural attachments of the caudal septum. To our knowledge, there has been no anatomical study of the nasal tip supporting structures for Asian patients. The purpose of this study is to determine these structures and how they differ from those of Caucasian patients. Ten noses of fresh cadavers were investigated. Dissection was performed and the above-mentioned nasal tip supporting structures were observed and excised. Histological examination was done with hematoxylin and eosin stains and Van Gieson elastin stains. Based on our results, we propose that the structures between upper and lower lateral cartilages, between lateral crus and pyriform aperture, between the paired domes of lower lateral cartilages should referred to as an intercartilaginous ligament, sesamoid fibromuscular tissure, and interdomal loose connective tissue, respectively. There is no identified specific tissue between medial crus and caudal septum. We consider that the loose connection between the domes of the middle crura and the lack of a specific structure between the medial crus and caudal septum might be the reasons why the nasal tips of Asian patients tend to be broad and unprojected with a wide base.
Asian Continental Ancestry Group ; Cadaver ; Cartilage ; Coloring Agents ; Connective Tissue ; Elastin ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Ligaments ; Nose