Background: Correcting infraorbital hollowness is an important procedure for midface rejuvenation. Sub-orbicularis oculi fat lift is a commonly used method. However, adipose tissue, which has been thought of as sub-orbicularis oculi fat, has recently been controversial. The objective of this study was to introduce a method of midface rejuvenation using deep nasolabial fat lift (MRDN) by means of lower blepharoplasty and to compare surgical outcomes between MRDN and lower blepharoplasty with fat transposition (LBF). Methods: The medical records of patients who had undergone midface rejuvenation with lower blepharoplasty between 2013 and 2020 were retrospectively reviewed. Questionnaires, digital photographs, and charts were used to evaluate the surgical outcomes and complications. The degree of aging was graded as mild, moderate, or severe. LBF and MRDN were used for mild and severe grades, respectively. For the moderate grade, the preferred surgical method of the two methods was selected and surgical outcomes were compared. The MRDN technique included LBF. Results: Postoperative satisfaction was significantly higher (P < 0.001), recurrence rate for tear trough (P = 0.046) and fat bulging (P = 0.005) was significantly lower, duration of swelling (P < 0.001) was significantly longer, and incidence of chemosis (P = 0.024) was significantly higher in the MRDN group than in the LBF group. Regarding lid malposition, transient retraction was higher in the LBF group, whereas cicatricial ectropion was higher in the MRDN group; however, these differences were not significant. Conclusion: MRDN is associated with higher patient satisfaction and surgical longevity without serious complications than LBF.
Purpose: Unfractionated heparin (UFH) is more commonly used as an anticoagulant after digital replantation than low-molecular-weight heparin (LMWH). We compared the success and complication rates of these two anticoagulants, since only a few studies have made this comparison directly. Methods: Forty-four patients who underwent digital replantation for complete or incomplete digital amputation in the past 7 years at a single institution were included. The patients were divided into LMWH and UFH groups according to the anticoagulant administered. The success rates for each group were obtained, and the postoperative serum aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were analyzed to compare the complication rates.Results: All patients, except one, had successful recovery of circulation after replantation, and the success rate did not show a statistically significant difference between the two groups. The statistical analysis showed that the proportion of patients with abnormal serum AST or ALT levels in the LMWH group was significantly lower than that in the UFH group.Conclusion: Although there was no significant difference in the success rate between the two groups, the risk of hepatotoxicity was significantly lower in the LMWH group than in the UFH group. Considering the advantages of LMWH, its extensive use is highly recommended for anticoagulation therapy in patients after digital replantation.
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