Objective : Conventional pterional approach is a commonly used neurosurgical technique for the treatment of cerebral aneurysms. However, this technique requires more extensive brain exposure than other key hole approaches and is sometimes associated with surgical traumatization or cosmetic problems. The aim of this study was to compare the postoperative outcome between pterional and supraorbital keyhole approaches in the patients with anterior circulation aneurysms. Methods :The authors reviewed patients with anterior circulation aneurysms who underwent aneurysm clipping via pterional or supraorbital keyhole approach at a single institute over a period of 2 years. Ninety-eight patients harboring 108 aneurysms were included in this study. Various outcomes were recorded, which included clinical grade, cosmetic problems, patients' satisfaction and complications such as chewing discomfort, frontal muscle weakness, hyposmia, infection. Results :The supraorbital approach exhibited a shorter operation time compared with the pterional approach. Complications such as chewing discomfort occurred less frequently in the supraorbital approach group. Moreover, the cosmetic outcome was significantly better in the supraorbital group than in the pterional group. Conclusion : The supraorbital keyhole approach reduced intra-and postoperative complications, including chewing discomfort and cosmetic disturbances, compared with the conventional pterional approach.

To investigate the prevalence and type of congenital inverted nipple, and realizing that the condition is a disease for which treatment is necessary, 1,625 unmarried women aged between 19 and 26 were physically examined and responded to questions about inverted nipple. Fifty-three of 1,625 subjects (3.26%) presented with this malformation, and it was found in 3.05% of the 3,250 nipples examined. In 46 of the 53 (86.79%), the condition was bilateral, and in 7 (13.21%), it was unilateral. In such cases, inversion was found on the right side in two subjects and on the left side in five. Of the total number of congenital inverted nipples, 96.23% were umbilicated and 3.77% were invaginated. Nine of the 53 subjects with inverted nipple considered that the condition should be corrected. Prior to counseling and possible surgery, the medical practitioner must carefully consider all available information, and the data contained in this report may thus be useful.

As the number of high velocity injuries increases, orbital wall fractures that involve other facial bone fractures, especially those showing multiple crushed fractures have become increasingly common. However, owing to its complex anatomic structure, our inability to visualize details and relatively thin orbital wall, corrective restorations and fixations are very difficult. Recently several reports have claimed good results using titanium implants to repair orbital fracture. Over a period of 36 months, Titanium mesh screen 1.0 (SYNTHES) were applied to the repair of orbital fracture in various ways, taking 39 examples of orbital wall fracture patients requiring operating treatment. A titanium mesh screen 1.0 was used either as an onlay implant after it was shaped to fit the anatomical shape of the fracture portion, or as cover implant to fix bony pieces after repairing a severely crushed fracture on the orbital rim or maxillary wall segments. 1.3-mm micro-screws were used to fix the titanium mesh screen when needed. The titanium mesh screen 1.0 was rigid, yet malleable enough to get the desired shape. It could be folded and screwed easily, and was also easy for follow-up with fewer artifacts on the CT findings. Therefore, we could restore and fix much easier and faster even crushed tiny bony pieces without loss and achieve more accurate three-dimensional anatomical reconstruction of orbital wall fracture.

There is often a preexisting acute columella-labial angle in Asian noses and in most of these cases, the nasal spine is underdeveloped or sometimes even absent. Moreover, nasal tip projection by a tip graft or cephalic rotation of the nasal tip may get worse at the retracted columella-labial junction in the Asian nose with an underdeveloped anterior nasal spine, thus requiring the use of a maxillary spine graft or an implant. In many instances, however, the ideal source of autogenous tissue may not be available or the donor site for these tissues may be objectionable. So I have designed the lambda-shaped silicone implant for augmenting the underdeveloped anterior nasal spine (ANS) to correct the acute columella-labial angle. From March, 1996 until September, 1999, I have done ANS augmentations using the lambda-shaped silicone implant in Asian rhinoplasty on 37 female patients. The correction of an acute columella-labial angle was readily accomplished by application of the lambda-shaped implant using the unilateral intranasal approach. The author suggests that ANS augmentation with the lambda-shaped implant is a simple and effective method as an ancillary procedure in Asian rhinoplasty providing esthetically pleasing results in properly selected Asian patients.

To evaluate outcomes of aesthetic facial plastic surgery objectively the authors developed a photogrammetric profile analysis method, which they call "balanced angular profile analysis" (BAPA). To develop standards and ways to determine the conformation of various soft tissue segments analytically, 19 mean angular values acquired from the photographs of 71 famous female models (53 Eastern models and 18 Western models) were standardized to provide reference data (recommended aesthetic mean angles [RAMA]), which contain some of the common features and differences between ethnic groups and races. On the basis of the data prepared from angular profile analyses of these photographs, the authors apply their developed method in a practical way to the pre- and postoperative photographs of patients. By using the data provided by BAPA, the clinician can identify delicate profile problems correctly, perform appropriate aesthetic operations, and thus produce better aesthetic results. The authors' harmonized and balanced angular profile analysis can provide surgeons with a way of determining the conformational problems associated with various soft tissue segments of the face. It also offers aesthetic plastic surgeons reference information concerning the creation of an attractive face during the first patient consultation. The authors hope that their straightforward method of profile analysis will provide facial plastic surgeons with a simple tool for profile analysis and surgical planning designed to create an attractive face.