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Periumbilical Dermal Graft as a Good Option for Volume Enhancement in Secondary Cleft Lip Deformity: A Case Report.

Seung Bum PYO ; Hong Sil JU ; Soo A LIM ; Jin Kyung SONG ; Seong Yoon LIM

Archives of Aesthetic Plastic Surgery.2017;23(1):53-56. doi:10.14730/aaps.2017.23.1.53

Volume deficiency and poorly defined cupid's bow of the upper lip are frequently encountered problems in secondary cleft lip deformities. In this report, we present the method of a periumbilical dermal graft for correcting secondary cleft lip deformity. A 17-year-old male patient presented with a poorly defined notching cupid's bow and volume deficiency of the upper lip. He had undergone cleft lip surgery when he was 2 years old. We planned to perform a periumbilical dermal graft. There were sufficient amount of periumbilical subdermis and fat tissue thickness to obtain abundant volume. The periumbilical contour was similar to the natural contour of the lip. Less scarring was expected. There was no need to change the posture during operation, making it easy to harvest. Postoperative evaluations showed vermilion symmetry. Ideal cupid's bow shape and position were achieved without color mismatch. As a result, we obtained an ideal volume of the upper lip. Therefore a periumbilical dermal graft is a good option for correcting volume deficiency of the lip with good aesthetic outcomes.
Adolescent ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities* ; Dermis ; Humans ; Lip ; Male ; Methods ; Posture ; Transplants* ; Umbilicus

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A Case of Cold Urticaria Mistaken as Congestion Status during Breast Reconstruction with Deep Inferior Epigastric Perforator Free Flap Coverage.

Yoon Jae LEE ; Hyun Jun CHO ; Deuk Young OH

Archives of Aesthetic Plastic Surgery.2017;23(1):49-52. doi:10.14730/aaps.2017.23.1.49

We present the first reported case of cold urticaria, which was mistaken as congestion status, in a patient undergoing breast reconstruction with deep inferior epigastric perforator (DIEP) flap coverage. A 53-year-old woman underwent an immediate bilateral breast reconstruction with DIEP flap coverage. The harvested DIEP flap was wrapped with wet gauze and kept above an ice pack to minimize ischemic damage before flap in-setting to the mastectomy site. After the transfer of the harvested DIEP flap, she had suddenly developed an erythematous and edematous lesion, specifically on the flap. The room temperature was raised and a single dose of steroid and antihistamine was given intravenously. At the first instance, flap congestion was suspected; however, as the rash gradually spread throughout the body, we could deduce that it was cold urticaria. The erythematous rash and whirl resolved soon after receiving medication. Patients with known cold urticaria undergoing surgical procedures require several precautions (e.g., antihistamine, relatively warm operation room) to lessen the risk of severe reaction. Especially in patients with DIEP free flap, the lack of preoperative treatment could result in a pinkish flap due to urticaria, which could be mistaken by the surgeon as a congested flap.
Breast* ; Estrogens, Conjugated (USP)* ; Exanthema ; Female ; Free Tissue Flaps* ; Humans ; Hyperemia ; Ice ; Mammaplasty* ; Mastectomy ; Middle Aged ; Urticaria*

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A Novel Lactiferous Duct Preserving Method for Inverted Nipples: An Inlay Wrap-Around Flaps Supporting the Nipple Column.

Jun Ho PARK ; Syeo Young WEE ; Hyun Gyo JEONG ; Chang Yong CHOI

Archives of Aesthetic Plastic Surgery.2017;23(1):45-48. doi:10.14730/aaps.2017.23.1.45

BACKGROUND: Inverted nipples can pose aesthetic and functional problems, especially for young women. The objectives of inverted nipple correction are both sufficient aesthetic projection of the nipple and postoperative functional preservation of the lactiferous ducts. Recurrence of nipple inversion is still an unsolved problem in many cases. We present a new nipple suspension technique using nipple- and areola-based dermal flaps for correcting inverted nipples and preserving the lactiferous duct to minimize the risk of recurrence. METHODS: We corrected six inverted nipples in three patients, which were classified as grade II using the Han and Hong classification of nipple inversion. The anteroposterior and lateral medical-quality photographs of the respective patients were identified for nipple protrusion and recurrence during a 6-month follow-up period to evaluate aesthetical goal and assess the sensitivity of the nipple to confirm preservation of the main lactiferous ducts. Surgical details are described within the main text. RESULTS: Preoperative and postoperative photography revealed good nipple protrusion during the 6-month follow-up period without any complications such as skin necrosis and recurrence. We were unable to directly identify breast-feeding function because all three patients were young and unmarried women. However, we assumed preservation of the main lactiferous duct since no nipple sensory change was identified in the postoperative examination when compared with the preoperative examination. CONCLUSIONS: With this method, we were able to confirm the hardness of the column and minimize the injury of the main lactiferous duct.
Breast ; Classification ; Female ; Follow-Up Studies ; Hardness ; Humans ; Inlays* ; Methods* ; Necrosis ; Nipples* ; Photography ; Recurrence ; Single Person ; Skin ; Surgical Flaps

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Occurrence and Surgical Treatment of Massive Morel-Lavallée Lesion after Large-Volume Liposuction: A Rare Clinical Case.

Byeong Jun KIM ; Chul Hoon CHUNG ; Seung Jun LEE

Archives of Aesthetic Plastic Surgery.2017;23(1):41-44. doi:10.14730/aaps.2017.23.1.41

A soft tissue injury can cause the formation of a pseudocyst in the subcutaneous tissue due to a hematoma, seroma, or liquefied fat. These cysts are Morel-Lavallée lesion. A 30-year-old male patient had previously received a large-volume Liposuction. After a couple of years, Morel-Lavallée lesion has formed on the abdomen. So after the two communicating massive sacs were resected, we advanced the upper flap inferiorly and resected a margin of the redundant tissue.
Abdomen ; Adult ; Hematoma ; Humans ; Lipectomy* ; Male ; Seroma ; Soft Tissue Injuries ; Subcutaneous Tissue

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Single-Layer vs. Double-Layer Donor Scalp Wound Closure in Strip Harvest.

Muhammad AHMAD

Archives of Aesthetic Plastic Surgery.2017;23(1):36-40. doi:10.14730/aaps.2017.23.1.36

BACKGROUND: To know the difference between single and double-layer wound closure. METHODS: The study was conducted in ten patients undergoing first session of hair restoration surgery by ‘strip method’ under local anaesthesia. Informed consent was obtained from all the patients. The length and width of the strip were marked pre-operatively. Three points were marked, one in the midline ‘O’ and one on either side, ‘A’&‘B’ at 8 cm from ‘O’. After removing the strip, five deep, interrupted, absorbable sutures were applied on left half but not on the right half. Lower edge trichophytic closure was performed with no undermining of the skin edges. A single continuous non-absorbable sutures was used to close the skin. The stitches were removed on the 10th postoperative day. The patients were assessed at 9 months interval postoperatively. RESULTS: The mean age of the patients was 33.8 years. The average width of the strip removed was 15.1 mm. The average width of the scar on single-layer closure was 1.57 mm and 1.58 mm on the double-layer closure. The mobility of the scar was 7.9 mm on single-layer closure and 6.2 mm on double-layer closure. There was no statistical significance in the scar size and mobility of single-layer vs double-layer closure. The time of surgery was more in double-layer closure and the extra cost of the suture material. CONCLUSIONS: There was no difference in scar quality. The extra time and money was saved in single-layer closure. The mobility of the scar was also found to be better in single-layer closure.
Cicatrix ; Hair ; Humans ; Informed Consent ; Scalp* ; Skin ; Suture Techniques ; Sutures ; Tissue Donors* ; Wounds and Injuries*

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Reduction Foreheadplasty: For Reducing the Vertical Height of Forehead and Facial Proportion.

Kook Hyun KIM ; Sang Hun KIM ; Jin Young KIM ; Eun Soo PARK

Archives of Aesthetic Plastic Surgery.2017;23(1):30-35. doi:10.14730/aaps.2017.23.1.30

BACKGROUND: A face is considered beautiful if the forehead is presented with a width and proportion similar to the golden ratio or so called Cannon ratio. The most previously performed plastic surgeries on the forehead was a procedure to fill depressed parts so as to make the appearance of a smooth but convex three-dimensional forehead. However, this study focused on making a beautiful facial contour from the creation of a forehead adequately proportional to the overall ratio through a method of correcting the large forehead. METHODS: Based on the measurement by gliding test, start the designing in a zig-zag form along the hair line. Flap is dissected as designed between the galea aponeurotica and above the periosteum. In order to reposition and fix the scalp flap to the desired place, Endotine forehead® is used. RESULTS: The amount of forehead reduction ranged from 12 to 23 mm, the average being 15.9 mm. The post-operative scar was matured 5 to 6 months after the surgery, and became faded and invisible in most of the patients. CONCLUSIONS: The method used by the authors may be referred to as a surgical method with an emphasis on reducing the area on the forehead directly. This was done by lowering the location of the trichion, shortening the length of the forehead, and consequently reducing the size of a broad forehead. Satisfactory results were obtained from the tension-minimized forehead reduction procedure used in this study.
Cicatrix ; Esthetics ; Forehead* ; Hair ; Humans ; Methods ; Periosteum ; Plastics ; Scalp ; Surgical Flaps

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Measurement of the Exposed Eyeball Area and Vertical Dimension of Palpebral Fissure after Double Eyelidplasty.

Seung Hun YEO ; Dong Gil HAN

Archives of Aesthetic Plastic Surgery.2017;23(1):24-29. doi:10.14730/aaps.2017.23.1.24

BACKGROUND: Although the technique of double eyelidplasty is well recognized, there have been a few reports on the measurement of the eyelid after the operation. Herein, we measured the changes of the eyelids photogrammatically and compared them with others. METHODS: Database of patients who had undergone double eyelidplasty using a three-partial-incision technique, along with a follow-up of more than 6 months, were identified. The changes of eyelid were measured by exposed eyeball area (EEA) and vertical dimension of palpebral fissure (VDPF) using preoperative and postoperative photographs. RESULTS: Between January 2012 and December 2013, there were 28 patients who were followed-up for more than 6 months. All patients were female between the age of 16 and 37 years; the average follow-up period was 11.4 months. The mean preoperative value of EEA was 74.6±9.1% and that of VDPF was 7.4±1.0 mm. Conversely, the mean postoperative value of EEA was 83.9±6.3% and that of VDPF was 8.5±1.0 mm. CONCLUSIONS: The mean values of EEA and VDPF after double eyelidplasty had changed with statistical significance.
Blepharoplasty ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Vertical Dimension*

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The Effect of Acellular Dermal Matrix in Implant-Based Immediate Breast Reconstruction with Latissimus Dorsi Flap.

Yu Gil PARK ; Eun Soo PARK ; Jin Su SHIN ; Ho Seong SHIN ; Seung Min NAM

Archives of Aesthetic Plastic Surgery.2017;23(1):17-23. doi:10.14730/aaps.2017.23.1.17

BACKGROUND: Capsular contracture is the most frequently reported complication after implant-based breast reconstruction. This study was first undertaken to present our experience with acellular dermal matrix for prevention of capsular contracture in implant-based immediate breast reconstruction with latissimus dorsi flap, and to assess the final aesthetic outcome. METHODS: We performed a retrospective review of all patients who underwent immediate latissimus dorsi flap breast reconstruction in combination with implant and acellular dermal matrix from January 2014 to December 2015. Demographics and clinical characteristics and postoperative complications, especially focused on capsular contracture, were assessed. They were also analyzed as the potential risk factors for the development of capsular contracture. The aesthetic outcome of the overall reconstruction and the final outcome of the inframammary fold were evaluated. RESULTS: During the study period, a total of 30 patients (30 breasts) were reviewed. The mean Baker grades for all 29 breasts (one breast was dropped out due to implant loss), evaluated at one year after reconstruction, was 1.21±0.49 capsular contracture. None of risk factors except seroma/hematoma (P=0.033) were significantly associated with the development of capsular contracture. Overall aesthetic outcome was 8.2±1.2 and aesthetic outcome of the inframammary fold was 3.5±0.6 for physician and 3.4±0.6 for patients. CONCLUSIONS: In this study, we have shown the ability of acellular dermal matrix to prevent capsular contracture observed in implant-based immediate breast reconstruction with latissimus dorsi flap and its use was proven to create superior aesthetic results.
Acellular Dermis* ; Breast Implants ; Breast* ; Contracture ; Demography ; Female ; Humans ; Mammaplasty* ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Superficial Back Muscles* ; Surgical Flaps

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Early Complications from Absorbable Anchoring Suture Following Thread-Lift for Facial Rejuvenation.

Seung Hun YEO ; Young Bae LEE ; Dong Gil HAN

Archives of Aesthetic Plastic Surgery.2017;23(1):11-16. doi:10.14730/aaps.2017.23.1.11

BACKGROUND: Thread lifting has been known as a minimally invasive procedure compared with the standard incisional surgery for facial rejuvenation. Although there have been several reports on acute or delayed complications after using nonabsorbable thread type, there have only been a few studies on such complications after using absorbable thread type. Hence, the aim of this study was to introduce various complications of thread lifting using the absorbable anchoring type for facial rejuvenation and to discuss about how to resolve it. METHODS: A retrospective review of 144 cosmetic patients, who underwent absorbable barbed thread lifting between July 2013 and December 2015, was performed. The procedure was done using the temporal anchoring technique. The thread used in this study are polydioxanone molding cog (PMC) and polydioxanone cutting cog (PCC), which are both the absorbable type. RESULTS: The results are as follows: Dimple was developed in 3 cases (2.1%); thread exposure was developed in 5 cases (3.5%); alopecia was developed in 3 cases (2.1%); undercorrection was developed in 3 cases (2.1%); asymmetry was developed in 1 case (0.7%); and parotid gland injury was developed in 1 case (0.7%). Out of the total 144 patients, sixteen (11.1%) patients developed at least 1 complication. There was no detectable inflammation or consistent skin excavation. CONCLUSIONS: Most complications of absorbable thread lifting are minor ones, and such complications resolve by retouching or widening the anchoring gap, but it is important to keep in mind the possibility of parotid gland injury.
Alopecia ; Fungi ; Humans ; Inflammation ; Lifting ; Parotid Gland ; Polydioxanone ; Rejuvenation* ; Retrospective Studies ; Rhytidoplasty ; Skin ; Suture Anchors ; Sutures*

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A New Method of Umbilical Transposition.

Bommie Florence SEO ; Seong Yeon KIM ; Hyun Ho HAN ; Suk Ho MOON ; Jong Won RHIE ; Sang Tae AHN ; Deuk Young OH

Archives of Aesthetic Plastic Surgery.2017;23(1):1-10. doi:10.14730/aaps.2017.23.1.1

BACKGROUND: Creating a natural-looking umbilicus during closure of the donor-site in abdominally based free flap breast reconstruction is a factor of satisfaction for both the patient and surgeon. We present a simple method of umbilical transposition that results in an aesthetic, natural-looking umbilicus. METHODS: From March 2011 to November 2014, fifty three consecutive female patients received abdominal flap breast reconstruction. Twenty patients (from March 2011 to February 2013) underwent umbilical transposition through a cross like incision in the abdominal flap, with fascial fixation sutures but no dermal flaps. Thirty three patients (March 2013 to November 2014) received umbilical transposition in the following method. An oval-shaped incision is made at the location of the new umbilicus on the abdominal flap. This oval is deepithelialized, and full-thickness incisions are made at the 2, 6, and 10 o'clock directions to create three triangular dermal flaps. These are pulled down to the abdominal fascia using sutures that pass through the umbilical stalk and the abdominal fascia at the 3, 9, and 12 o'clock directions. This results in an umbilical stalk lined with dermal flaps, creates a natural periumbilical concavity, and anchors the abdominal flap inward to minimize tension. The cranial flap enhances superior hooding. RESULTS: Patient and surgeon satisfaction, surveyed 2 months after surgery with a satisfaction scoring system, were higher in the dermal flap group. CONCLUSIONS: The technique using three dermal flaps in an oval skin incision is simple, relatively easy to learn, and results in an aesthetic, natural-looking umbilicus.
Abdominoplasty ; Fascia ; Female ; Free Tissue Flaps ; Humans ; Mammaplasty ; Methods* ; Skin ; Surgical Flaps ; Sutures ; Umbilicus

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