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Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):271-276.

PURPOSE: The purpose is to present an useful and simple surgical method to improve the aging of upper third face in patients with high frontal hairline as well as low frontal hairline. METHODS: Forty eight female patients were treated with subcutaneous forehead lift using an anterior hairline incision over 14 years. This surgical technique is performed under direct vision utilizing a beveled incision made 4 to 5mm into the anterior hairline with subcutaneous dissection, which is continued near to eyebrow, sometimes extended to supraorbital rim to remove corrugator and procerus muscles. In patients with high frontal hairline, excess forehead skin anterior to incision line is removed. On the contrary in the patients with low frontal hairline, scalp posterior to incision line is removed. RESULTS: This technique provided constant and good results with the forty six patients, who were satisfied with eyebrow elevation and removal of wrinkles in forehead and glabellar region. However two patients were undercorrected, and focal alopecia developed in another two patients. One patient complained of pruritus over one year, but subsided spontaneously without any treatment. Temporary paresthesia developed in the forehead and frontal scalp of all cases after operation but permanent sensory loss never occurred in all the patients. CONCLUSION: Subcutaneous forehead lift using an anterior hairline incision is suggested to be one of the effective surgical methods to improve the aging of upper third face in the patients with high frontal hairline as well as low frontal hairline.
Aging ; Alopecia ; Eyebrows ; Female ; Forehead ; Humans ; Muscles ; Paresthesia ; Pruritus ; Scalp ; Skin ; Vision, Ocular

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Correlation Analysis of Ocular Dominance and Levator Palpebrae Superioris Muscle Function.

Ki Young HA ; Hyeun Woo SUH ; Boo Yeong KIM ; Tae Yeon KIM ; Sung Gyu PARK

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):265-270.

PURPOSE: Most of the bilateral structures in our body are not perfectly balanced, such that one side is preferred than the other or it has physiological superiority. Eyes also have an imbalance; the eye with sensory and motional superiority compared to the other is called dominant eye. Authors of this study focused on analyzing the correlation between the dominant eye and levator palpebrae superioris muscle. METHODS: The subject of this study was 42 patients with no ptosis and with no past history of blepharoplasty. Hand dominance was identified through questionnaire and dominant eye was identified by hole-in-the-card dominance test (Dolman's test) in all patients. The function of levator palpebrae superioris muscle was measured by MLD (marginal limbal distance). During the measuring procedure, frontalis muscle was not inhibited to avoid the eyelid skin hooding. RESULTS: Out of 42 patients, 27 patients(64.3%) were right ocular dominant, 15 patients(35.7%) were left ocular dominant, 36 patients(85.7%) were right hand dominant and 4 patients(9.5%) were left hand dominant. Out of 27 right ocular dominant patients, right MLD was larger than the left in 26 patients(96.3%). It was larger in average of 0.47mm(p<0.001) in 27 right ocular dominant patients. Also, left MLD was larger than the right in 11 patients (73.3%) out of 15 left ocular dominant patients. It was larger in average of 0.57mm(p=0.003) in 27 left ocular dominant patients. MLD on the side of the dominant eye was larger in average of 0.50mm(p<0.001) than the MLD of non-dominant eye side. Right MLD was larger than the left in average of 0.28mm(p=0.010) in right hand dominant patients, and left MLD was larger than the right in average of 1.15mm(p=0.025) in left hand dominant patients. CONCLUSION: The function of levator palpebrae muscle differs in right and left, and the difference correlates with the dominant eye. Also, the function of levator palpebrae muscle is stronger in the dominant eye. We were able to present statistical evidence regarding the difference of the function in right and left levator palpebrae muscle. This may be a factor worth consideration in terms of balancing the eyes during the blepharoplasty.
Blepharoplasty ; Dominance, Ocular ; Eye ; Eyelids ; Hand ; Humans ; Muscles ; Surveys and Questionnaires ; Skin

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Tip Plasty using Biodegradable Plate as a Columella Strut.

Soo Young KIM ; Soo Hyang LEE ; Eun A HWANG ; Hyun Gon CHOI ; Soon Heum KIM ; Dong Hyeok SHIN ; Ki Il UHM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):259-264.

PURPOSE: Most surgeons have used autogenous cartilage for columella strut graft. But the supply of autogenous cartilage is often limited. So, this study is to investigate the usefulness of biodegradable plate as columella strut material. METHODS: We studied 19 patients who have secondary cleft nasal deformity. Patients were divided into two groups. Group A patients who were not closed their growth plate underwent columella strut graft only with biodegradable plate through endonasal approach. The biodegradable plate was inserted between nasal tip and anterior nasal spine. Group B patients were closed their growth plate. They had an operation for columella strut graft with biodegradable plate fixed with autogenous conchal cartilage. If nasal tip projection was insufficient, we performed additionally onlay graft on nasal tip with autogenous soft tissue or remnant cartilage. RESULTS: As a result of mean 14 months follow-up, we achieved a good nasal tip projection, narrowing of interalar distance and symmetrical nostril shape. No specific complications were reported except 2 cases, which were the extrusion of biodegradable plate into the nasal cavity and Staphylococcus aureus infection. CONCLUSION: The columella strut graft using biodegradable plate is simple and effective method. Biodegradable plate can be a good substitute for columella strut in patients who can not use autogenous cartilages.
Absorbable Implants ; Cartilage ; Congenital Abnormalities ; Follow-Up Studies ; Growth Plate ; Humans ; Inlays ; Nasal Cavity ; Rhinoplasty ; Spine ; Staphylococcus aureus ; Transplants

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Predicting the Degree of Breast Size in Augmentation with Cohesive Gel Implant.

Jung Ho LEE ; Je Won SEO ; Paik Kwon LEE ; Deuk Young OH ; Jong Won RHIE ; Sang Tae AHN

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):256-258.

PURPOSE: Predicting the change in breast size for a specific patient's need is a challenging problem in breast augmentation. We intended to investigate the post-augmentation degree of breast size according to the size of cohesive silicone gel implant. METHODS: To predict post-augmentation breast size, we measured 100 patients' pre-and postoperative 3 month's bust circumference. All patients were performed by total subfascial breast augmentation with moderate profile cohesive silicone gel implant through areolar omega (transareolar-perinipple) incision. RESULTS: According to this study, each additional one pair of 100mL in implant size yielded an approximate 1.5cm increase in bust circumference(p=0.006). CONCLUSION: From this result, we conclude that each additional one pair of 100mL in implant volume yielded about 1.5cm increase in bust circumference. Although this result may not be applied to every patient, we believe that it yields a practical chart that can help to predict the amount of increase in breast size with the use of cohesive silicone gel implant of a specific size preoperatively.
Breast ; Humans ; Silicone Gels

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Correction of Pincer Nail using Autogenous Dermofat Graft.

Hyun Sung KIM ; Chul Han KIM ; Sang Gue KANG ; Min Seong TARK

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):250-255.

PURPOSE: Pincer nail is a relatively rare deformity characterized by an increase in transverse curvature along the longitudinal axis of the nail. This curvature commonly increases from proximal to distal end of nail, leading to pinching, curling, and distortion of the underlying soft tissue and resulting frequently in severe pain. Numerous surgical procedures have been reported. Preserving the width of the nail in the correction of the pincer nail is very important for functional and aesthetic reasons. We report the results of the correction of the pincer nail using autogenous dermofat graft with a good result. METHODS: From May 2006 to September 2008, dermofat graft was performed in 6 patients with pincer nail. Patients were four women and two men, and the average age was 51. The affected digits were the unilateral great toes in four patients and the unilateral thumbs in two patients. Average follow-up period was 13 months. Surgical procedure was removal of nail using an elevator to avoid damage to the nail bed. An incision was created in distal portion of hyponychium. Paronychium was dissected from distal phalanx by periosteal elevator through incision of hyponychium and tunnel was made. Then dermofat grafts harvested from inguinal area were inserted into the tunnel. Finally, a silicone sheet was inserted eponychial fold for prevention of synechia. Objective assessment was evaluated by use of the width index and height index. RESULTS: All patients reported resolution of the pain and soft tissue pinching sensation that they had before the operation. There was good adherence between the nail plate and the underlying nail bed. The nails have regrown and were corrected in a normal and flattened appearance. The width index and height index were improved. CONCLUSION: The autogenous dermofat graft seems to provide an effective treatment of the pincer nail with preservation of the nail matrix.
Axis, Cervical Vertebra ; Congenital Abnormalities ; Elevators and Escalators ; Female ; Follow-Up Studies ; Humans ; Male ; Nails ; Sensation ; Silicones ; Thumb ; Toes ; Transplants

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High-pressure Injection Injuries in the Hand.

Seong Ki KIM ; Si Gyun ROH ; Nae Ho LEE ; Kyung Moo YANG

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):245-249.

PURPOSE: High-pressure injection injury is caused by accidental injection of the high-pressure injection devices in industry. The initial benign appearance of the wound fools patients into delays in an adequate treatment. And it can result in disastrous outcomes such as necrosis and amputation. To avoid the poor prognosis, the injuries require a prompt surgical intervention. The purpose of this article is to recognize the poor outcome of the high-pressure injection injury and to introduce an adequate treatment in need. METHODS: We have 4 cases of the high-pressure injection injuries in the hand from April, 2005 to March, 2009. Average age is 39 years (30-49 years old), 2 cases are the palm of dominant hand, 1 case is the thumb of dominant hand, and 1 case is the palm of non-dominant hand, respectively. We followed up these patients for 20 months on average. In 3 cases, the immediate, aggressive surgical intervention was carried out, but the other one was delayed in early adequate treatment. The wounds were covered by local advancement flap, anterolateral thigh free flap, conservative treatment with antibiotics and dressing. RESULTS: No pathogens after culture were found nor any findings of fracture in imaging study. Conservative treatment, local advancement flap and anterolateral thigh free flap for the open wound resulted in a desirable aesthetic outcome. In a long-term follow up, functional capability of the patient was also satisfactory. CONCLUSION: Upon initial evaluation, most high-pressure injection injuries present as innocuous wounds with very few symptoms and result in delaying the proper management. And the majority of high-pressure injection injuries will produce significant morbidity to the hand, amputation. And the initial aggressive surgical debridement was needed to prevent the poor outcome. The key to success in treating high-pressure injection injuries of the hand is the prompt aggressive surgical intervention.
Amputation ; Anti-Bacterial Agents ; Bandages ; Debridement ; Follow-Up Studies ; Free Tissue Flaps ; Hand ; Humans ; Necrosis ; Prognosis ; Thigh ; Thumb

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Clinical Report of Intravascular Papillary Endothelial Hyperplasia.

Jeong Woo LEE ; Ho Yun CHUNG ; Seok Jong LEE ; Gui Rak KIM ; Kang Young CHOI ; Jung Dug YANG ; Byung Chae CHO

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):239-244.

PURPOSE: Intravascular papillary endothelial hyperplasia(IPEH), also known as Masson's pseudoangiosarcoma, is a rare disease which is now considered as a reactive process of the endothelium rather than a benign neoplasm. It can occur in any blood vessels in the body but more common in the head and neck region as a solitary, often tender, bluish or reddish nodule. IPEH is characterized by the development of endothelial-lined papillary projections in a vascular lumen, usually associated with thrombotic material, the endothelial cells in the papillary structures showing only slight atypia and occasional mitotic Figures, the absence of tissue necrosis. METHODS: 8 patients with IPEH were enrolled in the study from 2002 to 2007. All 8 lesions were surgically excised for histopathologic diagnosis. RESULTS: 4 patients were female. The duration of the lesions ranged from 3 months to 15 years. The tumors were first noted between the ages of 20 and 72 years. 4 patients had lesions on the head; 2 on the toe; 1 on the back; and 1 on the finger, respectively. All lesions were solitary, ranged in size from 2mm to 27 mm. There were no recurrences. CONCLUSION: The clinical appearance of IPEH is not specific, presented as a primary neoplasm, and the diagnosis can be established by microscopic examination. Complete surgical excision is the best choice of therapy for patients with IPEH, and is both diagnostic and curative. Awareness of this lesion will prevent incorrect diagnosis and overly aggressive treatment.
Blood Vessels ; Endothelial Cells ; Endothelium ; Female ; Fingers ; Head ; Humans ; Hyperplasia ; Neck ; Necrosis ; Rare Diseases ; Recurrence

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120 Cases of Facial Foreign Body Granuloma.

Tae Hwan PARK ; Sang Won SEO ; June Kyu KIM ; Choong Hyun CHANG

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):233-238.

PURPOSE: As the use of soft tissue fillers becomes more popular, complications such as foreign body granuloma (FBG) are increasing. We report 120 cases of facial FBG and review the available literatures. METHODS: 120 patients of facial FBG in our clinic from Mar. 2003 to Feb. 2008 were complied and analyzed. A retrospective chart review was done and patient satisfaction was evaluated with a questionnaire using 5 score scale. Patients with severe inflammation sign or bizarre deformity underwent surgical excision and those with minimal symptoms or a history of hyaluronic acid injection received injection therapy using hyaluronidase. RESULTS: 100 females and 20 males were observed. The average age was 43.7 years(from 16 to 74). 84 patients received surgical therapy and 36, injection therapy. Deformity of facial contour, foreign body sensation and inflammation sign were the three main chief complaints. 84 patients did not know what the injection materials were. The known materials are as follows: collagen, hyaluronic acid, silicone oil, paraffin. 92 cases were performed by unlicensed practitioners, 29 by physicians. Anatomical site most frequently affected by the foreign body granuloma was the cheek (25.8%), followed by forehead(19.2%), lips (15.8%), nose (9.2%), mentum(8.3%), eyelid and eyebrow (4.3%) and temple(0.8%). In 21 patients(17.5%), FBGs were found on multiple sites. Patients with inflammation sign got the highest satisfaction(3.19+/-0.73)(p=0.001) among 3 chief complaints. And patient satisfaction was statistically higher in surgical therapy group(3.43+/-0.72) than in injection therapy group(2.97+/-0.88)(p=0.003). CONCLUSION: We suggest that it may be beneficial to tailor the type of treatment for FBG relying on wound state and patient's chief complaints. In surgical therapy, resolute approach is necessary to correct facial deformity definitely and to minimize inflammation. Injection therapy could be another option for those with minimal symptoms or a history of hyaluronic acid injection. To prevent foreign body granuloma, not only plastic surgeons but also other physicians should inject soft tissue fillers with great caution and we should warn the public of disastrous consequences associated with illegal medical practice.
Cheek ; Collagen ; Congenital Abnormalities ; Eyebrows ; Eyelids ; Female ; Foreign Bodies ; Granuloma, Foreign-Body ; Humans ; Hyaluronic Acid ; Hyaluronoglucosaminidase ; Inflammation ; Lip ; Male ; Nose ; Paraffin ; Patient Satisfaction ; Surveys and Questionnaires ; Retrospective Studies ; Sensation ; Silicone Oils

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Vacuum Assisted Wound Closure Appliance and Continuous Irrigation on Infected Chronic Wound.

Jinwook JEONG ; Junhyung KIM ; Yung Jin JUNG ; Musik PARK ; Daegu SON ; Kihwan HAN

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):227-232.

PURPOSE: Continuous irrigation method is an important step in managing wound infection. V.A.C. devices have been used in intractable wounds for reducing discharge, improving local blood flow, and promoting healthy granulation tissue. We expect synergistic effects of reduced infection and more satisfactory, accelerated wound healing when using both methods simultaneously. This study evaluated continuous irrigation combined with V.A.C. appliance for treatment of infected chronic wounds. METHODS: We reviewed data from 17 patients with infected intractable chronic wounds. V.A.C. device(Group A) was used in 9 patients, and V.A.C. with antibiotics irrigation(Group B) was used in 8 patients. We placed Mepitel(R) on the surface of wound and placed an irrigation and aspiration tube on each side. A sponge was placed on the Mepitel(R) and covered with film dressing. The wound was irrigated continuously with mixed antibiotics solution at the speed of 200 cc/hr and aspirated through the wall suction at the pressure of -125 mmHg. V.A.C. applied time, wound culture and wound size were compared between the two groups. RESULTS: No complication were seen in two groups. Compared with Group A, in the Group B, V.A.C. applied time was shortened from 32.7 days to 25.6 days and showed efficacy in the reduction rate of wound size. No statistical differences were shown in bacterial reversion. CONCLUSION: V.A.C. appliance with continuous irrigation is an effective new method of managing infected chronic wounds and useful to reduce treatment duration and decrease wound size. Moreover it could be applied more widely to infected wound.
Anti-Bacterial Agents ; Bandages ; Granulation Tissue ; Humans ; Porifera ; Suction ; Vacuum ; Wound Healing ; Wound Infection

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The Wound Healing Effect of PDRN(polydeoxyribonucleotide) Material on Full Thickness Skin Defect in the Mouse.

Yo Han KIM ; Jong Hoon LEE ; Kyung Hee MIN ; Sung Hee HONG ; Won Mi LEE ; Jin Hyun JUN

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(3):220-226.

PURPOSE: Many topical agents had been used for burn or wound treatment. An awareness of topical agents on various aspects of wound healing permits the clinician to choose the most appropriate material to advantageously control the wound process and final results. Although polydeoxyribonucleotide(PDRN) was used as a tissue repair stimulating agent in a number of human diseases, such as ulcers and burns, its wound healing effects were largely unreported. We aimed to compare the wound-healing effects of PDRN and common dressing materials on full-thickness skin defect in the mouse. METHODS: Full-thickness skin defects were made on the back of mice(N=60). The mice were divided into the following 4 groups according to the dressing used for the wounds: group O(Polydeoxyribonucleotide cream), group I (Polydeoxyribonucleotide solution), group M(Medifoam(R)), and group G(dry gauze, control group). We analyzed the gross findings, wound sizes and histological findings for the groups. RESULTS: The rate of wound size was decreased in order of group I, group O, group M and group G. The histological findings revealed that the I group showed more reepithelialization and granulation tissue formation and less inflammatory cell infiltration than the other materials. The grade score of wound healing was increased in order of group I, group O, group M and group G. CONCLUSION: PDRN applicated wound dressings can be used for treating a full-thickness skin defect wounds. Considering its superior efficacy in comparison to the efficacies of other wound dressings, PDRN soaked gauze dressing should be preferentially used for the treatment of full-thickness skin wounds.
Animals ; Bandages ; Burns ; Granulation Tissue ; Humans ; Mice ; Skin ; Ulcer ; Wound Healing

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