Schwannoma is a slow-growing, well-demarcated, benign soft tissue tumor of the peripheral nerve sheath. It commonly develops in the head and neck region, usually in the parapharyngeal space. In this case, a 42-year-old woman visited the outpatient department to manage a painless mass on her left cheek. She had no history of concern and no neurological symptoms were observed. In the enhanced computed tomography scan, a 2.8 × 2.8 × 1.8 cm, heterogeneously enhanced tumor was detected in the left masseter muscle. A tumor resection under general anesthesia was planned. For the resection, a facelift incision was chosen; branches of the facial nerve were identified and retrogradely dissected. A well-marginated, yellowish, solid mass was found in the left masseter muscle. The mass was excised and given a histopathological diagnosis of schwannoma. A definite diagnosis of schwannoma, originating in the masseter muscle, is difficult to arrive at with radiographic findings alone; it is often misdiagnosed as intramuscular hemangioma. Histopathological examinations, including fine-needle aspiration or histological biopsy after surgery, are necessary. Using a facelift incision with retrograde facial nerve dissection, tumor resection in an intramasseteric lesion can be performed efficiently, without nerve damage, or leaving conspicuous scars on the face.
Adult ; Anesthesia, General ; Biopsy ; Biopsy, Fine-Needle ; Cheek ; Cicatrix ; Diagnosis ; Facial Nerve ; Female ; Head ; Hemangioma ; Humans ; Masseter Muscle ; Neck ; Neurilemmoma ; Outpatients ; Peripheral Nerves ; Rhytidoplasty

BACKGROUND AND OBJECTIVES: The purpose of the present study was to compare the results of V-shaped and modified facelift incisions for parotidectomy. SUBJECTS AND METHOD: Ninety parotidectomy patients who underwent V-shaped and modified facelift incisions from 2014 to 2018 were enrolled in this study. Patient characteristics, tumor profiles, surgical outcomes, postoperative complications, and cosmetic results were assessed for the V-shaped (n=20) and modified facelift (n=70) incision groups. RESULTS: The tumor size was significantly larger in the modified facelift incision group than in the V-shaped incision group (2.6 cm vs. 1.9 cm, p < 0.001). There were no significant differences between the two groups regarding other baseline tumor characteristics, operating time, and postoperative complications. Although the results of Vancouver Scar Scale was similar in both groups, the V-shaped incision group showed higher subjective scar satisfaction scores than the modified facelift incision group (9.3 vs. 8.6, p=0.001). CONCLUSION: The results suggest that the V-shaped incision is feasible and can provide better subjective scar satisfaction in selected parotidectomy patients without increased complications.
Cicatrix ; Humans ; Methods ; Parotid Neoplasms ; Postoperative Complications ; Rhytidoplasty*

We recently experienced a case of transoral endoscopic thyroidectomy combined with a modified radical neck dissection (MRND) using a facelift approach in a patient with keloid-prone skin. A 35-year-old female was diagnosed with a papillary thyroid carcinoma, which was 1.2 cm in diameter and showed level II-III lateral cervical metastases. The patient required total thyroidectomy and MRND; however, she was concerned about the neck incision because she had keloid-prone skin. We first performed a transoral, endoscopic total thyroidectomy combined with bilateral central node dissection via a tri-vestibular approach, and then followed it by MRND (II-V) using a facelift approach with the Da Vinci robotic system. We noted no significant complications, such as vocal cord palsy, hypoparathyroidism, or permanent loss of the lower lip or auricle. This new method of combining transoral and facelift approaches will be useful for patients with small thyroid cancers and lateral neck metastases.
Adult ; Female ; Humans ; Hypoparathyroidism ; Lip ; Methods ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Rhytidoplasty ; Skin ; Thyroid Neoplasms ; Thyroidectomy ; Vocal Cord Paralysis

BACKGROUND: Successful aesthetic plastic surgery is devoid of both unsightly scarring and postoperative disfigurement. Patients undergoing midface-lifting surgery are very often disconcerted by an altered side hairline, including sideburns, despite considerable amelioration of facial wrinkles. This study was conducted to identify an effective means of approaching an altered hairline and the unavoidable scarring arising from midface-lifting surgery. METHODS: A total of 37 patients who underwent corrective surgery with hair transplantation for hair loss or scar deformity arising from midface-lifting surgery from June 2014 to June 2017, and were observed for more than 6 months thereafter, were enrolled in the study. Prior to corrective surgery, the patients were administered a multiple-choice survey regarding their dissatisfaction arising from midface-lifting surgery. Among the 37 patients, 24, 12, and one underwent donor harvesting by the strip method, non-shaven follicular unit extraction, and partial shaving follicular unit extraction, respectively. Additionally, 33 of the 37 patients underwent hair transplantation in the frontotemporal recess area along with hairline correction surgery. The average number of transplanted grafts was 1,025. RESULTS: Surgery resulted in a natural and satisfactory appearance in all patients. The average patient and physician subjective satisfaction scores were 4.6 and 4.8, respectively. No adverse events such as folliculitis occurred. CONCLUSIONS: Side-hairline correction surgery by hair transplantation can be considered an effective method of realigning an altered hairline accompanied by scars following midfacelifting surgery.
Cicatrix ; Congenital Abnormalities ; Folliculitis ; Hair Follicle ; Hair ; Humans ; Lifting ; Methods ; Rhytidoplasty ; Surgery, Plastic ; Tissue Donors ; Transplants

INTRODUCTIONThe detachment planes used in endoscopic facelifts play an important role in determining the results of facial rejuvenation. In this study, we introduced the use of multiple detachment planes for endoscopic facelifts of the frontal and temporal areas, and examined its outcome.

METHODSThis study included 47 patients (38 female, 9 male) who requested frontal and temporal facelifts from January 2009 to January 2014. The technique of dissection in multiple planes was used for all 47 patients. In this technique, the frontal dissection was first carried out in the subgaleal plane, before being changed to the subperiosteal plane about 2 cm above the eyebrow line. Temporal dissection was carried out in both the subcutaneous and subgaleal planes. After detachment, frontal and temporal fixations were achieved using nonabsorbable sutures, and the incisions were closed. During follow-up (ranging from 6-24 months after surgery), the patients were shown their pre- and postoperative images, and asked to rate their satisfaction with the procedure. Complications encountered were documented.

RESULTSAll 47 patients had complete recovery without any serious complications. The patient satisfaction rate was 93.6%. Minor complications included dimpling at the suture site, asymmetry, overcorrection, transitory paralysis, late oedema, haematoma, infection, scarring and hair loss. These complications resolved spontaneously and were negligible after complete recovery.

CONCLUSIONDissection in multiple planes is valuable in frontal and temporal endoscopic facelifts. It may be worthwhile to introduce the use of this technique in frontal and temporal facelifts, as it may lead to improved outcomes.

Adult ; Endoscopy ; Face ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Retrospective Studies ; Rhytidoplasty ; Surgery, Plastic ; Treatment Outcome

Perioperative hypertension is a phenomenon in which a surgical patient's blood pressure temporarily increases throughout the preoperative and postoperative periods and remains high until the patient's condition stabilizes. This phenomenon requires immediate treatment not only because it is observed in a majority of patients who are not diagnosed with high blood pressure, but also because occurs in patients with underlying essential hypertension who show a sharp increase in their blood pressure. The most common complication following facelift surgery is hematoma, and the most critical risk factor that causes hematoma is elevated systolic blood pressure. In general, a systolic blood pressure goal of <150 mm Hg and a diastolic blood pressure goal of >65 mm Hg are recommended. This article discusses the causes of increased blood pressure and the treatment methods for perioperative hypertension during the preoperative, intraoperative, and postoperative periods, in order to find ways to maintain normal blood pressure in patients during surgery. Further, in this paper, we review the causes of perioperative hypertension, such as anxiety, epinephrine, pain, and postoperative nausea and vomiting. The treatment methods for perioperative hypertension are analyzed according to the following 3 operative periods, with a review of the characteristics and interactions of each drug: preoperative antihypertensive medicine (atenolol, clonidine, and nifedipine), intraoperative intravenous (IV) hypnotics (propofol, midazolam, ketamine, and dexmedetomidine), and postoperative antiemetic medicine (metoclopramide and ondansetron). This article focuses on the knowledge necessary to safely apply local anesthesia with IV hypnotics during facelift surgery without the assistance of an anesthesiologist.
Anesthesia, Local* ; Anxiety ; Blood Pressure ; Clonidine ; Epinephrine ; Hematoma ; Humans ; Hypertension* ; Hypnotics and Sedatives* ; Ketamine ; Midazolam ; Postoperative Nausea and Vomiting ; Postoperative Period ; Propofol ; Rhytidoplasty* ; Risk Factors

Periauricular paresthesia may afflict patients for a significant amount of time after facelift surgery. When performing face and neck lift surgery, temple and posterior auricular flap dissection is undertaken directly over the auriculotemporal, great auricular, and lesser occipital nerve territory, leading to potential damage to the nerve. The auriculotemporal nerve remains under the thin outer superficial fascia just below the subfollicular level in the prehelical area. To prevent damage to the auriculotemporal nerve and to protect the temporal hair follicle, the dissection plane should be kept just above the thin fascia covering the auriculotemporal nerve. Around the McKinney point, the adipose tissue covering the deep fascia is apt to be elevated from the deep fascia due to its denser fascial relationship with the skin, which leaves the great auricular nerve open to exposure. In order to prevent damage to the posterior branches of the great auricular nerve, the skin flap at the posterior auricular sulcus should be elevated above the auricularis posterior muscle. Fixating the superficial muscular aponeurotic system flap deeper and higher to the tympano-parotid fascia is recommended in order to avoid compromising the lobular branch of the great auricular nerve. The lesser occipital nerve (C2, C3) travels superficially at a proximal and variable level that makes it vulnerable to compromise in the mastoid dissection. Leaving the adipose tissue at the level of the deep fascia puts the branches of the great auricular nerve and lesser occipital nerve at less risk, and has been confirmed not to compromise either tissue perfusion or hair follicles.
Adipose Tissue ; Fascia ; Hair Follicle ; Humans ; Mastoid ; Neck* ; Paresthesia ; Perfusion ; Rhytidoplasty ; Skin ; Subcutaneous Tissue

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*

Supported by recent literature on the signs of aging of the middle and lower face, our clinical research has documented a loss of volume of the deep structural components of the central face and a progressive descent of the nasolabial fat and the jowl fat, leading to facial fragmentation. The signs that appear around the age of 45 to 50 years are well targeted by the mini-invasive technique described here. We focused on refitting the jowl fat and the nasolabial fat associated with cutaneous tightening. The use of absorbable barbed sutures (Quill) led to significant improvements, enabling the fitting of fat on fat. In the past 4 years, 167 operations were performed using this technique. The clinical results were very satisfactory, yielding a natural effect caused by the mobilization and strong fixation of the nasolabial fat and the jowl fat in the direction opposite to their displacement.
Aging ; Cheek* ; Minimally Invasive Surgical Procedures ; Rejuvenation* ; Rhytidoplasty ; Sutures

Pachydermoperiostosis (PDP) is a male predominant rare genodermatosis. Various clinical presentations includes pachydermia (thickened and folded skin), periostosis and digital clubbing. Both the skin and the extremity findings are seen in the complete form, whereas the incomplete form lacks the skin findings. We report a case of primary form of pachydermoperiostosis together with literature review.
Extremities ; Humans ; Male ; Osteoarthropathy, Primary Hypertrophic* ; Rhytidoplasty ; Skin