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V-Y Advancement Flap: Aesthetic Reconstruction for Auriculotemporal Keloid Excision.

Bommie Florence SEO ; Hyo Sun KO ; Ho KWON ; Sung No JUNG

Archives of Aesthetic Plastic Surgery.2017;23(3):164-167. doi:10.14730/aaps.2017.23.3.164

Keloid scars are commonly found on the ears. Treatment modalities include compression, intralesional steroid injection, and surgical excision with or without radiotherapy, depending on the size and location of the keloid scar. Excision may be a curative solution, but it always requires the immediate reconstruction of the excised defect. Herein, we report the case of a keloid scar located at the helical base of the auriculotemporal sulcus that was treated by excision and a V-Y temporal advancement flap.
Cicatrix ; Ear ; Ear Auricle ; Keloid* ; Radiotherapy ; Surgical Flaps

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Aesthetic Correction of Severe Facial Asymmetry in a Deformational Plagiocephaly Patient: A Case Report and Literature Review.

Jae Yeon PARK ; Hyo Joong KIM ; Seil LEE ; Sung Gyun JUNG

Archives of Aesthetic Plastic Surgery.2017;23(3):159-163. doi:10.14730/aaps.2017.23.3.159

Deformational plagiocephaly (DP) (also referred to as positional plagiocephaly) has long posed challenges for plastic surgeons because it is difficult to differentiate from several other diseases, such as unilateral coronal synostosis, hemifacial microsomia, and unilateral lambdoidal craniosynostosis. These diseases can actually masquerade as DP or vice versa. Only in recent years has the differential diagnosis among these diseases become possible through improved imaging modalities, such as computed tomography, and a greater understanding of their pathophysiology. Herein, we report a rather rare, yet severe, form of DP that can easily be confused with the aforementioned diseases.
Blepharoplasty ; Craniosynostoses ; Diagnosis, Differential ; Facial Asymmetry* ; Goldenhar Syndrome ; Humans ; Plagiocephaly ; Plagiocephaly, Nonsynostotic* ; Plastics ; Surgeons

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Actinomycosis in a Mucosal Lesion on a Created Perioral Dimple: A Case Report.

Ui Geon KIM ; Chung Hun KIM ; Kyung Suk KWON ; Euna HWANG

Archives of Aesthetic Plastic Surgery.2017;23(3):155-158. doi:10.14730/aaps.2017.23.3.155

Facial dimple creation is a simple surgical procedure. Nonetheless, several complications can occur. Actinomycosis is a rare chronic granulomatous infection caused by Actinomyces species. Some conditions that can cause actinomycosis are trauma, oral surgery, and poor dental hygiene. We report a case of actinomycosis that developed on a created facial dimple. A 51-year-old woman presented with a palpable mass on her left cheek that was approximately 1 cm in size. She had undergone facial dimple-creating surgery on both perioral areas at a local clinic 12 years previously. She had not experienced any problems until she was diagnosed with rheumatoid arthritis and diabetes mellitus about 2 years previously, for which she took leflunomide and methotrexate. The mass was completely excised through an intraoral approach. The specimen was grossly described as a gray-yellow cystic mass containing non-absorbable suture material. The filamentous nature of the Actinomyces organisms was observed in dark-stained foci on a histologic examination, confirming the diagnosis of actinomycosis. Indwelling non-absorbable suture materials may increase the risk for opportunistic infections, such as actinomycosis, in immunocompromised patients. Therefore, plastic surgeons should be aware of a patient's general hygiene, immune condition, and medical history when using these materials.
Actinomyces ; Actinomycosis* ; Arthritis, Rheumatoid ; Cheek ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Hygiene ; Immunocompromised Host ; Immunosuppressive Agents ; Methotrexate ; Middle Aged ; Opportunistic Infections ; Oral Hygiene ; Plastics ; Surgeons ; Surgery, Oral ; Sutures

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Correction of Severely Asymmetric Calf using Latissimus Dorsi Musculocutaneous Free Flap and Customized Silicone Implant.

Min Su JUNG ; Hii Sun JEONG ; Byeong Ho LEE ; Joo Hyun KIM ; Seong Hoon PARK ; Duk Kyun AHN ; In Suck SUH

Archives of Aesthetic Plastic Surgery.2014;20(2):124-127. doi:10.14730/aaps.2014.20.2.124

Calves can be easily seen in daily life and are an important part of the body contour. Asymmetric calves can develop from unbalanced distribution and deposition of fat and muscles between the legs. Calf asymmetry may be due to congenital factors, disease (e.g., poliomyelitis, cerebral palsy, or infection), spinal cord injury, or the effects of surgical treatment and may have severe adverse psychological and social implications. Generally, an asymmetric calf is diagnosed when the difference of the longest circumference between both calves is more than 2 cm. Several surgical methods have been introduced for the correction of an asymmetric calf. Implant insertion or fat injection is used to augment a hypotrophic calf. Selective neurectomy, liposuction, muscle resection, radiofrequency, and botulinum toxin injection are used to treat a hypertrophic calf. With the development of microsurgery, the authors planned to use a latissimus dorsi musculocutaneous free flap (LDMC free flap) with silicone implant to add calf volume to obtain natural calf contour. The authors present the first successful case of correction of a severely asymmetric calf using an LDMC free flap and customized silicone implant.
Botulinum Toxins ; Cerebral Palsy ; Free Tissue Flaps* ; Leg ; Lipectomy ; Lower Extremity ; Microsurgery ; Muscles ; Poliomyelitis ; Silicones* ; Spinal Cord Injuries ; Superficial Back Muscles*

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Treatment of Botulinum Toxin Type A in Parotid Fistula after Face Lifting.

Min Su JUNG ; Byeong Ho LEE ; Joo Hyun KIM ; Seong Hoon PARK ; Duk Kyun AHN ; Hii Sun JEONG ; In Suck SUH

Archives of Aesthetic Plastic Surgery.2014;20(2):120-123. doi:10.14730/aaps.2014.20.2.120

Botulinum toxin type A has an inhibitory action not only on neuromuscular junctions, but also postganglionic sympathetic and cholinergic autonomic parasympathetic acetylcholine release at the secretary end of the salivary gland. Use of botulinum toxin to treat sialorrhea was first reported in 1997 by Bushara. Parotid duct or gland injuries with parotid fistula are uncommon but troublesome complications of surgical trauma. Here, we report two patients with constant leakage of serous fluid and a swelling cheek after facelift surgery. Each patient underwent an amylase test, starch iodine test, and sialography. After diagnosis of parotid fistula, a total of 50 units botulinum toxin was injected into the parotid gland. Facial bandage, scopolamine, and minimizing temporomandibular joint motion were instructed. Leakage volume decreased gradually, and symptoms subsided within 2 weeks. Neither functional problems nor complications occurred. In conclusion, a parotid fistula after facial surgery can be treated effectively with botulinum toxin; this treatment option should be considered before proceeding with invasive surgical treatment.
Acetylcholine ; Amylases ; Bandages ; Botulinum Toxins ; Botulinum Toxins, Type A* ; Cheek ; Diagnosis ; Fistula* ; Humans ; Iodine ; Neuromuscular Junction ; Parotid Gland ; Rhytidoplasty* ; Salivary Glands ; Scopolamine Hydrobromide ; Sialography ; Sialorrhea ; Starch ; Temporomandibular Joint

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Efficacy of Early Application of Ablative Fractional CO2 Laser on Secondary Skin Contracture after Skin Graft.

Hyungwoo YOON ; Yoon Kyu CHUNG ; Jiye KIM

Archives of Aesthetic Plastic Surgery.2014;20(2):114-119. doi:10.14730/aaps.2014.20.2.114

BACKGROUND: Ablative fractional carbon dioxide laser is widely used for the treatment of various scars including burn injuries. We applied ablative fractional CO2 laser on the skin graft scar of faces. METHODS: Fourteen patients between 2010 and 2013 who underwent facial skin graft were included in this study. The ablative fractional CO2 laser was applied to 7 patients in the laser therapy group. It was initiated at 5th week after the skin graft. Clinical photographs were taken, and Patient Scar Assessment Score (PAS) was obtained during every visit from a patient at the outpatient clinic and 4 weeks after the last laser treatment. In the untreated control group, clinical photographs and PAS were taken at 5th and 21st weeks after the skin graft. Vancouver Scar Scale (VSS) and Observer Scar Assessment score (OAS) was rated by single independent plastic surgeon with the clinical photographs. RESULTS: In the laser therapy group, VSS, PAS, and OAS improved after fractional laser treatment. In the untreated group, VSS was also improved by the natural process of scar maturation. However, the laser treated group showed significant improvement compared with the untreated group. CONCLUSIONS: The ablative fractional CO2 laser can be a viable option for the treatment of skin graft scar. Further study with sufficient patients and long term follow-up is necessary for definite conclusions.
Ambulatory Care Facilities ; Burns ; Cicatrix ; Contracture* ; Humans ; Laser Therapy ; Lasers, Gas* ; Skin* ; Transplants*

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Effects of Minimizing Scar Formation by Early Fractional CO2 Laser Resurfacing.

Soo Chung HONG ; Eun Soo PARK ; Yong Bae KIM ; Seung Min NAM

Archives of Aesthetic Plastic Surgery.2014;20(2):109-113. doi:10.14730/aaps.2014.20.2.109

BACKGROUND: Much of the theory regarding the treatment of surgical scars advocates a wait-and-see approach. The use of lasers prophylactically against scarring in the early postoperative period is relatively new. We introduced lasers during the early treatment of scars. METHODS: We present results using the Vancouver Scar Scale (VSS) Score and discuss the efficacy and safety of our approach. Fractional CO2 lasers (Line-Xel) were used 4 weeks after injury, which is the early remodeling phase, at 4-week intervals. Five treatments were performed. VSS scores were counted before treatment and 5 months after final treatment. RESULTS: Each VSS score showed great improvement over time and finally achieved near-normal skin values. No adverse effects or complications, such as wound disruption, postinflammatory hyperpigmentation, or dyspigmentation, occurred in the present study. CONCLUSIONS: This study shows that the use of early fractional CO2 lasers 4 weeks after surgery or trauma is an effective and safe method to minimize scar formation.
Cicatrix* ; Hyperpigmentation ; Lasers, Gas* ; Postoperative Period ; Skin ; Wound Healing ; Wounds and Injuries

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Follicular Unit Transplantation: Comparison of Video Microscopic vs. Combination Methods.

Cheol Keun KIM ; Hyung Suk KIM ; Dae Young KIM

Archives of Aesthetic Plastic Surgery.2014;20(1):61-64. doi:10.14730/aaps.2014.20.1.61

BACKGROUND: In 2004, Sharon Keene introduced a video microscope to the hair transplant field and discussed about the benefits such as ergonomics, quality assurance, and easy teaching. In 2009, our clinic set up digital video microscope systems. CCD-chip-loaded hand-held digital video microscope was connected to a 19-inch high definition (HD) LCD monitor. We compared the transection rates and graft-cutting time of two graft-dissecting methods to decide which one is more efficient. METHODS: Two technicians performed follicular unit graft dissection via two different methods of video microscopic and a combination of video microscope for slivering and loupe magnification for graft-cutting. All the procedures were recorded on high-definition digital video camera and cross-checked on the video clips. RESULTS: The transection rate of digital video microscope use was 2.2% while the combination method with 1.6%. For comparison of graft-producing time, the combination method could produce about equal amount of grafts in 186% faster the time. CONCLUSIONS: The work efficiency was greater with the combination method. The total graft productivity was nearly 2 times larger while the transection rates of two methods showed very close results.
Efficiency ; Hair ; Human Engineering ; Transplants

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Asian Female Hairline Surgery Using Follicular Unit Extraction.

Sung Jae YI

Archives of Aesthetic Plastic Surgery.2014;20(1):52-60. doi:10.14730/aaps.2014.20.1.52

BACKGROUND: Asian female hairline surgery is unique part among hair transplantation surgerys. Most of Asian female hairline surgery had been done by single strip harvesting technique which leave noticeable linear scar. As follicualr unit extraction is introduced1, female hairline surgery can take advantage of the Follicular Unit Extraction technique;leaving no linear donor scar. There has been a belief among surgeons who are somewhat reluctant to use follicular unit extraction for female hairline surgery that the inspection of the naturally occurring curl direction of hair, which is believed one of the critical steps for appropriate operative result in Asian female hairline surgery, is impossible in follicular unit extraction. So follicular unit extraction has to be 'plan B' in respect of Asian female hairline surgery. But author thought differently about this belief. METHODS: From December 2012 to May 2013, 78 consecutive cases of female hairline surgerys were done by follicular unit extraction. The ages of patients were 18 to 57 and mean was 34.5. The cases can be categorized in 3 groups; 1) Correction of fronttemporal recession only. 2) Whole hairline correction (including fronto-temporal recession, temporal recession and lowering of the central hairline). 3) Correction of the hairline with scar by previous aesthetic surgery just like forehead lift or forehead reduction surgery. Donor hair was harvested by follicular unit extraction and preparation of donor area was done by micro-strip shave pattern, by which no short haircut window was needed. Follow up periods were 4 months to 8 months. RESULTS: Aesthetic results of the all cases were satisfactory. There were three cases which needed small session (less than 100 hairs) for relatively less survival area (all of these areas were the anterior part of hair part) and two cases of small 'moth-eaten pattern' on donor area which need no treatment or another session for aesthetic improvement. There was no lumpy graft which can be look unnatural or literal wall of plug graft in anterior part of corrected hairline. There was no linear harvesting scar, which is in-evitable in single strip harvesting, on donor area. CONCLUSIONS: Follucualr unit extraction can be versatile technique for hair restoration surgery and also hold good for Asian female hairline surgery.
Asian Continental Ancestry Group* ; Cicatrix ; Female* ; Follow-Up Studies ; Forehead ; Hair ; Humans ; Tissue Donors ; Transplants

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Total Hairline Correction in Female Patient.

Jae Heon JUNG ; In Sik YUN

Archives of Aesthetic Plastic Surgery.2014;20(1):44-51. doi:10.14730/aaps.2014.20.1.44

BACKGROUND: The shape of the hairline and the ratio of the forehead to the face are both important factors for a balanced and attractive face. Because males primarily have a hairline with a rectangular or M shape (a frontotemporal-recessed shape), females with such shapes often have a strong masculine image and appear older. Follicular unit (FU) transplantation was used recently so that the forehead could be reduced naturally and effectively by changing the rectangular or M-shape hairline to a round-shape hairline, thus reducing the forehead. So the author is going to introduce a harmonious, balanced correction, named as total hairline correction that presents not only the frontal midpoint and fronto-temporal line, but also a temporal point, infra-temporal area, and/or sideburn. METHODS: Author studied 300 operation patients in last three years whose mean age was 29.3 years (range 19-57 years). RESULTS: The average reduced length was followed: frontal mid-point: 0.63 (0-1.5 cm), frontotemporal apex: 3.38 (1-4.5 cm), Rt 3.18 (1-4.5 cm) Lt, temporal point: 0.91 (0-3 cm) Rt, 0.88 (0-3 cm) Lt, infratemporal apex: 0.92 (0-1.5 cm) Rt, 0.93 (0-2 cm) Lt. CONCLUSIONS: In female patient with M shaped or rectangular hairline, total hairline correction which included not only mid-frontal area and fronto-temporal recession, but also temporal peak, infratemporal area and sideburn is better than simple correction of frontotemporal recess in reducing the facial area and maintaining the aesthetic facial balance.
Female* ; Forehead ; Humans ; Male

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