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안덕선,위성윤,구상환,박승하 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6
The purpose of this study was to evaluate the histological changes and depth of vaporization and thermal injury that occur after resurfacing using an ultrapulse CO2 laser on an animal model. It also addresses the appropriate fluence for skin resurfacing using the ultrapulse CO2 laser in clinical cutaneous surgery. The ultrapulse CO2 laser resurfacing of 9 guinea pig skins were investigated. Macroscopic and microscopic observation of the resurfacing sites were evaluated for 3 months. In groups 1,2, and 3 with a radient exposure if 250 mJ at 5 Watt were irradiated with 1,2, and 3 passes respectively. In groups 4,5, and 6,400 mJ at 5 Watt were irradiated with 1,2,and 3 passes respectively. In group 7,8, and 9,500 mJ at 5 Watt were irradiated with 1,2, and 3 passes respectively. the depth of resurfacing and thermal damage were investigated on the first day of application. The tissue reepithelialization and middermal wound healing were observed after 3 days, 1 week, 2 weeks, 4 weeks, 6 weeks, and 3 months, respectively. The results are as follows : 1. Macroscopically, unscarred skin reepithelialization was seen within 2-3 weeks. Reepithelialization occurred sequentially, beinning at group 1 and ending at group 9. 2. The mean vaporization depths were 13,16, and 22 μm in groups 1,2 and 3, respectively. In groups 4,5 and 6, the mean vaporization depths were 25,31, and 42 μm, respectively. In groups 7,8, and 9, the mean vaporization depths were 32,53, and 83 μm respectively. 3. The depth of thermal damage was approximately 50 μm in group 1, 70 μm in group 4, and 80 μm in group 7; namely it was proportioned to fluence. 4. In wound healing using laser resurfacing , reepithelialization was thicker than the control in groups 1, 2, 3, 4, 5, and 7 on the third day of application. In the other groups, reepithelialization was thinner than the control. All the groups lacked a granular therefore, showing immature appearance. After the first 2 weeks, reepithelialization of the wound using laser resurfacing resulted in the multiplying of epidermal layers. After 1 weeks, all the groups, except group 9, showed epidermal hyperplasia with a focal granular layer. After the second week, the epidermal layer was thicker than the first week. Also , the epidermis showed mature appearance including a granular layer. After the fourth week, the epidermal thickness decreased. In the sixth week, the epidermal thickness was 20-30% thicker and flatter than the control. 5. Capillary congestion and decreased dermal integuments and relative transversely arranged collagen fibers within the papillary dermis were observed at the end of the first week. By the end of 2 weeks, more marked capillary congestion and more transverse arrangement of collagen fibers were observed. By the end of 4 weeks, the restored papillary dermal collagen showed a relative compact configuration and a greater cellularity. By the end of 3 months, these transversely collagen fibers continued their transverse arrangement. In conclusion, the ultrapulse CO2 laser in an effective and safe modality for the resurfacing of aging skin and treatment of cutaneous lesions.
김우경,위성윤,한승규,이병일 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6
The most important factor in facial aesthetics is the harmony on the facial skeleton and soft tissue. Although the mandible constitute lower one third of the facial skeleton, minimal alterations can produce a wide range of facial deformities because of its prominent location and the intimate interrelationships of the facial bone. There are several deformities such as prominent mandibular angles, prognathism, microgenia, and asymmetry that are regarded as poor facial aesthetics. We carried out a retrospective review of the 56 mandibular contouring surgery, which were performed in the period from January 1988 to January 1995 in Guro hospital. The age range was 18 to 42 years and female was approximately 2 times more frequent than male. The types of the mandibular deformities included 24 prominent mandibular angles, 9 prognathisms, 8 microgenias, 5 asymmetries, and 10 deformities with combinations of aforementioned problems and midfacial deformities. To plan the mandibular contouring, photographs with planimetry, cephalogram, and panoramic view of the mandible were obtained. 24 prominent mandibular angles were contoured through intraoral approach. Angle ostectomy was performed in conjunction with malar reduction, for correction of prominent malar eminences, in 3 cases. Angle ostectomy was performed in conjunction with sliding advancement genioplasty, for correction of microgenia, in 4 cases. 9 prognathisms were corrected with vertical ramus osteotomy. 8 microgenias were corrected with sliding advancement genioplasty. Among these, 3 cases were performed in conjunction with bone graft due to their severity. 5 asymmetries were corrected by genioplasty and bone graft. The results were evaluated based on the consideration of the deformity by means of radiology, photography, and interview with the patients. In prominent mandibular angles, most patients were pleased with the results. In prognathisms, the mean horizontal changes of hard and soft pogonion were 9.3 mm and 8.5 mm, respectively. The soft tissue response to bone adjustment was approximately 1 : 0.91. In microgenias, the mean horizontal changes of hard and soft pogonion were 8.8 mm and 6.5 mm, respectively. The soft tissue response to bone adjustment was approximately 1 : 0.75. One case showed infection in mandibular angle ostectomy group which was solved with intraoral incision and drainage, and antibiotics. In microgenias, 1 partial mental nerve damage nerve damage was encountered but it was recovered spontaneously after 3 months. In a case of combination angle ostectomy with sliding genioplasty, prolonged lower lip edema remained for 1 month. We concluded that osteotomy for mandibular contouring procedure was a safe, reliable, and simple procedure due to development of operative techniques and tools.