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Harvesting grafts at another area in facial surgery would be complicating and troublesome. Moreover the additional scar would be remarkable. So authors have harvested grafts from the postauricular area. Between March of 2004 and January of 2008, we had harvested grafts from the postauricular area in 132 patients. We incised along the postauricular hair line. We made deep incision until we found adequate tissues. Then we dissected to the side as much as the right size. After harvesting, we closed the wound and made an aseptic compressive dressing. We compared pre-operative states to post-operative results with medical photos and made a survey of the patient's degree of satisfaction. We obtained various grafts such as the skin, hair, dermis, dermofat, fascia, fasciofat and bone from the postauricular area. We could use these in the eyelid, nose, chin, scar and anywhere. The fat graft was useful in the thin area such as eyelid. We got good results by using dermofat graft in nasal dorsum and fasciofat graft in nasal tip area. The scar was not seen in the frontal view and camouflaged by the hair easily. By harvesting grafts from the postauricular area, we can get various grafts in the same operative field and this procedure is very simple. Moreover the scar is not seen easily. Therefore this method is not only the good choice but also the best choice of the graft donor site.
Two most common pathologic mechanisms which cause secondary rhinoplasty are related with nasal framework and it's envelope. The reasonable definition defining key features of the secondary rhinoplasty 'Scarred nasal soft tissue envelope overlying adherent and distorted nasal framework' gives full explanation about main deformities in the secondary rhinoplasty, and leads us to focus on reconstructing and reinforcing both structures when the secondary rhinoplasty is performed. Moreover, artificial alloplastic implants and injectable materials, popularly used for augmentation rhinoplasty, erode skin and give damages to skin and appendages. It is, therefore, essential to understand the importance of skin problem and to know that one must be ready to suffer from another more difficult operations and its unpredictable results, unless it is properly reinforced. I have used several autogenous materials (n=294) and two kinds of xenografts (n=35) in the secondary rhinoplasties during the last 8 years for reinforcing the envelopes in pathologic conditions and augmenting the dorsal volume. I have learned a lesson from these 8 years of experience about dorsal augmentation in secondary rhinoplasty. 1) Even though it seems to be time consuming and annoying to harvest and prepare autogenous graft materials, no xenografts or artificial materials are safer and more consistent than autogenous materials, and no convenience is more valuable than consistency and safety in secondary rhinoplasty. 2) If you need to augment nasal dorsum in secondary rhinoplasty, get the permission from the nasal envelope. 3) Remind this aphorism: Alloplastics are only convenient on the day of surgery.
Silicone gel-filled breast implants were developed in 1962, however, failed to obtain approval of the U.S. Food and Drug Administration until 1976 and were not classified as class III devices until 1988. In 1992, U.S. FDA declared a moratorium on the sale of silicone breast implants. On November, 2006, the U.S. FDA approved Allergan and Mentor’s application to market its silicone-filled breast implants. On July, 2007, the Korea FDA approved the application of both manufacturer’s. Cohesive silicone gel implants are more soft and natural than saline implants. Therefore, most patients for breast augmentation nowadays tend to choose cohesive silicone gel implants. The author think that cohesive silicone gel implants are more suitable for thin Asian patients. Many patients who had saline implants want to replace saline implants with cohesive silicone gel. I strongly believe that many more patients would like to make similar decisions in future.
For the last 20 years, several different techniques of fat injections have been developed. However,a standard technique of fat grafts has not yet been adopted for all practitioners. The purpose of this study was to evaluate the safety and long-term results of fat grafts using the modified Colman’s technique. A total of 234 patients who underwent fat injections were retrospectively reviewed. The results were evaluated by patient satisfaction and photographs. The patient satisfaction was assessed using visual analogous scale (VAS), and photographs were evaluated by medical professionals. The fat was harvested using tumescent liposuction with a two hole Coleman harvesting cannula, and centrifuged at 3000 rpm for 3 minutes. The refined fatty tissue was then transferred into a 1-ml syringe, and injected subcutaneously using 17-gauge cannula. The amount of fat tissue placed with each withdrawal of a cannula was 0.3~ 0.5 mL. This technique showed good results with long-lasting volume consistency and few complications. The average value of VAS scored by patients was 8.7, and that by surgeons was 8.5, showing statistically no significant difference between the values evaluated by patients and surgeons. Author’s fat injection procedure is a good choice for the correction of cosmetic defects and facial rejuvenation. (J Korean Soc Aesthetic Plast Surg 16: 35, 2010)
Nowadays, several surgical options are available for correction of gynecomastia. The present authors combined subcutaneous mastectomy with liposuction and analyzed the postoperative results to find out an effective surgical method with few complications and good cosmetic result. From January, 2000 to October, 2008, 22 patients(41 breasts) underwent subcutaneous mastectomy through "Zigzag" wavy-line periareolar incision, and liposuction was done on peripheral region through the same approach site. The results were evaluated in terms of postoperative complications, character of the scar on periareolar region and subjective satisfaction of patients. Three patients(7.3%) experienced complicated with hematoma, however, all of them were healed by simple removal and compressive dressing without leaving any problem. Most of the patients were tolerable with operative scar on periareolar region, however, hypertrophic scar developed in 1 patient(2.4%) and regular follow-up with intralesional triamcinolone injection is now in progress. On the period of over 6 months, all of the patients were satisfied with postoperative contour of their breasts. By subcutaneous mastectomy with peripheral liposuction through "Zigzag" wavy-line periareolar incision for correction of gynecomastia, it was possible to excise sufficient volume of breast tissue with minimum postoperative scar and complications.
Chin augmentation with silicone implants has long been considered as a simple and effective operation to increase chin projection. However, insertion and subsequent removal of silicone chin implant are not a reversible procedure, as commonly believed. Removal of silicone chin implant is usually associated with mentalis displacement, chin ptosis, and abnormal contraction of mentalis muscle, leading to "bizarre chin configurations" that are refractory to surgical treatment. I also experienced a patient who developed bizarre ball-like appearance on her chin pad after the removal of chin implant because of pain, which was inserted subperiosteally through an intraoral approach 6months ago. In order to improve the chin deformity and decrease bizarre chin configuration aggravated by an abnormal overactivity of underlying mentalis muscle, fusiform skin with underlying soft tissue was excised vertically and chin pad was tightened. Postoperative 2 months photograph showed improvement of chin disfigurement, and vertical scar was acceptable. (J Korean Soc Aesthetic Plast Surg 16: 53, 2010)
Augmentation rhinoplasty using silicone implant is one of the most common cosmetic procedures in Korea, but is not without several complications such as exposure of the implant, its deviation and deformity. Above all, infection and extrusion through the skin is most serious complication. The purpose of this study was to determine the type of microbial colonization on silicone implant removed from symptomatic patients and to prevent from the infection. Over the past 11 years, from February of 1996 to February of 2007, we have done 134 aesthetic rhinoplasties using silicone implant in our clinic, patient ages ranged from 15 to 62 years with an average of 29.2 years. 78 percent of patients (105) were female, and 22 percent (29) were male. Among them, four cases had the local infection. The infection rate was 2.9 percent. Total six cases of implant including the other two case augmented elsewhere having the infection were removed and submitted for Gram stain, standard aerobic and anaerobic bacterial culture, and fungal cultures. Staphylococcus aureus was isolated most frequently (four cases), followed by Pseudomonas aeruginosa (one case) and Proteus mirabilis (one case). No fungal infections were identified. In order to reduce the infection rates after augmentation rhinoplasty using silicone implant, rhinorrhea as a source of bacterial nutrients should thoroughly be managed perioperatively. The hairs of the nostril should appropriately be shaved, and the patient's entire face and internal nares meticulously prepared. The implant should be shaped to be shorter, smaller and thinner, appropriately to the patient's nasal phenotype. Also, subperiosteal implantation rather than subcutaneous or subfascial is better choice.