Background: Transconjunctival lower blepharoplasty (TCLB) and traditional subciliary incision blepharoplasty (TSIB) are most commonly used to improve the appearance of an aged lower eyelid. The lid/cheek junction (LCJ) is located between the lower lid and midface, where structural changes caused by aging associated with both areas occur simultaneously. Thus, it may be a landmark that reflects the rejuvenation effects of lower blepharoplasty. However, there is no research-based proof yet.Objective: The purpose of this study was to investigate the rejuvenation effects of these two lower blepharoplasty procedures by observing changes in LCJ length and shape. Methods:The changes in LCJ length and shape in 32 patients with good follow-up among patients who underwent lower blepharoplasty between 2012 and 2016 were investigated. The patients were categorized as either TCLB (Group 1) or TSIB (Group 2) patients. Each group was further divided into the subgroups G1p, G1n, G2p, and G2n, according to the positive/negative globe-toskeletal relationship. Results:The shape of LCJ changed from a V-shape to a round shape, and its length decreased in G1p, G2p, and G2n, but increased in G1n. The pattern of LCJ was also affected, corresponding to the partial deformity of the zygomaticomaxillary bone. Aged lower lids were significantly improved in all groups, but infraorbital hollowness was not improved, and indeed was even worse, in G1n. Conclusion:Patients undergoing TCLB and TSIB surgeries significantly showed rejuvenation effects for fat protrusion, skin laxity, and wrinkles without any volume restoration, and particularly, G1n showed a worse result. Therefore, TCLB should not be recommended in G1n, and combination procedures that change a negative vector into a positive vector and improve infraorbital hollowness are necessary to achieve better outcomes.
Deep nasolabial folds (NLFs) are a common concern among aging patients. Hyaluronic acid (HA) filler is the first treatment choice. However, migration, spread to the surrounding space, and unnatural contours with lateral bulges occur frequently. Polydioxanone (PDO) thread has also been used by insertion of cogged PDO threads in the midface and the fold. Unfortunately, lifting lasts for only a few weeks. In the present case, a combination procedure using HA filler and PDO thread in the shape of the mesh tube was performed to improve the deep NLF in a 67-year-old woman. The intention of this combination was to unfold the NLFs and restore their volume without lateral migration of the injected filler. NLFs were divided into three parts: the lateral folded part (LFP), medial depressed part (MDP), and central crease part (CCP). Five PDO threads (6.0 cm length) were sequentially inserted into the LFP, MDP, and then under the CCP of each NLF. Total 4.0 ml of the filler was also sequentially injected into the both NLFs in a manner similar to the mesh thread insertion. They were mainly placed at the subdermal and superficial fat layer in the entire NLF and at the submuscular layer in the regions of the lateral part of the NLF, mouth corners, and submalar area. Three months after PDO thread insertion and HA filler injection, softened NLFs without filler migration, restored volume and lifted midface with a natural and charming smile, and reduction of perioral wrinkles were observed. These changes could be explained by the suppression of laughter movement accompanied by myo-modulation and increased firmness of the NLFs by the restoration of midface volume. These results suggest that the combination of PDO insertion and HA injection may be useful for correction of NLF.
Despite the popularity of transcutaneous lower blepharoplasty (TLB) for the correction of the aged lower lids, ectropion, scar long the incision line, persistent skin laxity with fine wrinkles remain to be a huge setback associated with the procedure. With the advance of recent technologies, scar treatment methods using various kinds of devices have been widely adopted. Among them, fractional microneedle radiofrequency (FMR) has been proven to be highly effective on the improvement of acne scars, widened pores, and skin laxity by means of soft tissue regeneration. A fractional microneedle device called the Inus TM developed in Korea exhibits unique properties of delivering bipolar radiofrequency current through specialized vacuum edge line for optimal needle insertion into highly sensitive areas such as the eyelid and the neck. Usage of the Inus TM to treat patients experiencing complications from TLB have shown remarkable improvement in various aspects not only limited to the improved appearance of ectropion, scars, wrinkles, skin thickness and laxity, but also the contour of the eyelid and the overall facial volume, and shape. The report will delineate findings from three clinical cases that suggest the efficacy and safety of FMR on the rejuvenation of the lower lids.
Background: In Asia, augmentation rhinoplasty is very common. Although various surgical methods and materials have recently been developed, rhinoplasty using silicone implant remains the most common procedure. However, no standards for the shape and size of the silicone implants exist, and many patients suffer from complications such as deviation, perforation, skin thinning, and extrusion. Objective: We analyzed the effect of performing augmentation rhinoplasty using implant design that craved into the resembled shape of "aerocraft" on nose proportion and complication rates. Methods: From January 2014 to December 2016, 310 patients who qualified for silicone rhinoplasty based on the indication, considering five parts of silicone corresponding to the nasal anatomy (columella, tip, supratip, dorsum and nasion) underwent augmentation rhinoplasty using the "aerocraft silicone implant." The results of the surgeries and the rates of complications were studied. We performed retrospective analysis of preoperative and postoperative photographs of randomly chosen 42 patients and compared their nose proportion profile. Results: The results of the modified nasofacial angle showed statistically significant change, but changes in the nasofrontal angle, nasolabial angle, nasomental angle, and nasal tip ratio were not statistically significant. Most of the patients for whom "aerocraft silicone" was used for the rhinoplasty showed very satisfactory aesthetic results during a follow-up of 1 month to 18 months and had only minor complications; the implant removal rate was very low as well. Conclusion: The use of "aerocraft silicone" for nasal augmentation is safe and effective when performed in selective cases. Good results will be accomplished when the implant is crafted to fit into the patient's nasal anatomy and limits the augmentation to avoid long-term complications.
Orbital fat protrusion, skin laxity with wrinkling, and tear trough deformity with hyperpigmentation of the lower eyelid make individuals appear fatigued and elderly. For cosmetic correction of the aged lower eyelid, either invasive blepharoplasties or less invasive procedures such as filler, high frequency device therapy or laser therapy are popularly performed. Currently in Korea, polydioxanone (PDO) thread is commonly utilized to tighten and lift the aged face. We present a case report demonstrating improvement of orbital fat protrusion, skin laxity with wrinkles, and tear trough deformity following insertion of PDO threads into the lower eyelid of an aging patient. Twenty PDO threads (6.0 USP, 30 mm in length, New Up PDO suture Kit ® produced by Meditronic Dongjun) were inserted at 1-mm intervals into the submuscular layer and the protruded orbital fat pads of both lower eyelids of a 54-year-old patient. Two months following intervention, the patient presented with flattening of the protruded orbital fat, skin tightening and wrinkle improvement, volume restoration in tear trough deformity, and skin whitening; the patient was satisfied with the results of the therapy. Common complications such as persistent swelling, hematoma, skin irregularity, and infection were not observed during follow-up assessments. Our findings suggest that PDO thread insertion may be a useful, non-invasive procedure to rejuvenate the aged lower eyelid of patients with anxieties regarding potential complications due to invasive lower blepharoplasty.
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