Summary:Hyaluronic acid injection is 1 of the most popular procedures in facial rejuvenation and augmentation. It is widely popular in the cosmetic surgery due to several advantages, which include rapid effect, minimal injury, and a short postoperative recovery period. With continuous increase in hyaluronic acid injections, many cases of hyaluronic acid injection-induced embolism have been reported. At present, methods for early treatment of hyaluronic acid injection–induced embolism include local injection of hyaluronidase, topical application of nitroglycerin ointment, massage, hot compression, and intravenous injections of antibiotics and hormones. Although early warm massage may facilitate hyaluronic acid degradation by hyaluronidase, local application of heat will also increase metabolic rate in the tissue, thereby reducing the ischemic tolerance of the tissue. Therefore, in this study, warm massage was limited to the first 30 minutes after hyaluronidase injection and was followed by local cooling using a gauze pad soaked with antibiotic saline solution. Excellent therapeutic effects were achieved with this approach. The methods of treatment for tissue ischemia caused by hyaluronic acid injection–induced embolism and clinical cases are introduced in the article.
Background:In East Asians, the main steps of rhinoplasty include the regulation of the nasal tip projection along with dorsal augmentation. A complete septal extension graft and columella strut graft are effective tools for the correction of unprojected tips and short noses. However, autologous cartilages cannot provide enough cartilage for the graft. Moreover, use of rib cartilages will leave an additional scar on the patient's chest, and these are not considered a common source of cartilage. Therefore, the authors used porous high-density polyethylene (Medpor) sheets to rebuild extensional midline framework in rhinoplasty.Objective: To study the possibility and the method of porous high-density polyethylene (Medpor) sheets used as extensional midline framework in rhinoplasty.Methods: From May 2012 to May 2016, 78 patients underwent primary rhinoplasty with a midline framework built with Medpor. The patients' ages ranged from 22 to 48 years (mean±SD, 26±5.2 years). Seventy-five patients were women, and three were men. The patients selected Medpor because of a lack of adequate autogenous septal cartilage and refusal to use rib cartilage.Results: The patients were followed up for 6 months to 4 years, with a mean follow-up period of 18 months, in 3-month intervals, and examined for extrusion, infection, and aesthetic outcomes. In the 78 patients, 156 pieces of Medpor graft were used with 78 extensional septal grafts and 78 columella strut grafts. Nasal tip projection and columella-labial angle were changed significantly after the surgery in 67 of the 78 patients. Complications occurred in 11 patients, of whom one had two minor complications of deviated tip and columella. Conclusion:The porous high-density polyethylene sheets are easier to handle and effective as materials to build an extensional midline framework in rhinoplasty. However, the size of the porous high-density polyethylene sheets should be tailored carefully based on the preoperative assessment; otherwise, severe complications will occur.
To introduce a new method of breast reconstruction using tissue expander followed by serial autologous fat transfer (AFT). From May 1, 2013, to April 30, 2016, six breasts from six female patients (age range, 35-62 years) were reconstructed using tissue expansion followed by serial AFT. Clinical data were obtained, and each step of the operative methods was recorded. All six patients presented satisfactory symmetry in the contralateral breast. Three AFTs were performed in one patient, whereas four and five AFTs were performed in one patient and four patients, respectively. The intervals between the two adjacent AFTs were 3-5 months. A 450-ml round expander was used in this series, and the volume of each AFT was 50-150 ml. Two patients underwent mastopexy on the contralateral breasts to correct severe breast ptosis. Two patients underwent nipple-areola complex reconstruction 6 months after the last AFT. Tissue expansion followed by serial AFT is a safe and effective method for breast reconstruction. It can be an option for patients who do not prefer pedicled TRAM or DIEP flap transfer or pedicled latissimus dorsi myocutaneous flap coverage with implant placement and those who cannot afford the Brava plus fat graft.
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