BackgroundTemporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients’ confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue.MethodsAutologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman’s strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit.ResultsThe thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0–32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5–7.1 mL) and 4.6 mL on the left side (IQR, 3.7–5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year.ConclusionsDespite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.

These results may be used to establish the precise locations and the courses of the important midface structures, and represent valuable data that may help to prevent complications during surgery for face lifting and reconstruction of the facial nerve and PD.

Tear trough deformity has been an area that has received much attention in terms of esthetic improvements. Fat transposition has been commonly used for the treatment of tear trough deformity. As some patients have had minimal improvement by that method, we propose the use of fat grafting combined with open blepharoplasty to complement the sunken area, including some of anterior maxilla region, and evaluate and precisely remove the excessive tissue.Lower blepharoplasty was performed by separating the skin and muscle flap. The excessive or laxed tissue was evaluated during the procedure and resected in each flap. Fat grafting was performed after completing a lower blepharoplasty, to ensure accurate placement on the spot where the surgeon originally intended. Overcorrection is not recommended.No serious complications were reported during a period of 10 years. Only 4 patients required a secondary fat injection.Patients who require structural correction of the lower eyelid area (eg, aggressive herniated fat, excessive skin laxity, or bulky orbicularis oculi muscle) and who need complementary material to fill the lower lid area (eg, deep, wide sunken area or relative exophthalmos) are good candidates for blepharoplasty with a fat grafting procedure.

As bioabsorbable mesh can provide strong support, results in good esthetic outcomes, and causes minimal complications, it can be used in septorhinoplasty for cleft patients.

Background An electrosurgery unit (ESU) is the mainstay of bleeding control in blepharoplasty. There are two different types of ESUs: monopolar (m‐ESU) and bipolar (b‐ESU). Aims We used m‐ and b‐ESUs in upper, lower, and combined blepharoplasty and compared their outcomes. Patients/Methods In this retrospective file review of 292 blepharoplasty patients, we excluded 14 who were lost to follow‐up or had missing data; among the 278 enrolled patients, we recorded operative time, a surgeon panel's score for edema and ecchymosis on the third postoperative day, patients’ scores of their satisfaction and inconvenience, and postoperative complications. Results One hundred thirty‐nine patients were included in the m‐ESU and b‐ESU group. Overall, 105 patients underwent upper blepharoplasty, 77 underwent lower blepharoplasty, and 96 underwent combined blepharoplasty. The total mean operative time in the m‐ESU and b‐ESU was 67.94 and 62.82 minutes, respectively. This difference was not significant (P > .05). The panel's edema and patient satisfaction and inconvenience scores were significantly better in the b‐ESU group (P < .05). There were no significant differences in the panel's ecchymosis score and frequency as well as nature of complications between the m‐ESU and b‐ESU group (P > .05). Conclusions In this cohort of blepharoplasty patients, minimally invasive b‐ESUs were efficient in obtaining reliable surgical results with higher satisfaction and lower inconvenience rates of patients than m‐ESUs. We would like to recommend the use of b‐ESUs in blepharoplasty, especially for plastic surgeons inexperienced in periorbital esthetic surgery.

It is well known that facial beauty is dictated by facial type, and harmony between the eyes, nose, and mouth. Furthermore, facial impression is judged according to the overall facial contour and the relationship between the facial structures. The aims of the present study were to determine the optimal criteria for the assessment of gathering or separation of the facial structures and to define standardized ratios for centralization or decentralization of the facial structures.Four different lengths were measured, and 2 indexes were calculated from standardized photographs of 551 volunteers. Centralization and decentralization were assessed using the width index (interpupillary distance / facial width) and height index (eyes-mouth distance / facial height). The mean ranges of the width index and height index were 42.0 to 45.0 and 36.0 to 39.0, respectively. The width index did not differ with sex, but males had more decentralized faces, and females had more centralized faces, vertically. The incidence rate of decentralized faces among the men was 30.3%, and that of centralized faces among the women was 25.2%.The mean ranges in width and height indexes have been determined in a Korean population. Faces with width and height index scores under and over the median ranges are determined to be "centralized" and "decentralized," respectively.

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Background: Clinically assessing the changing status of wounds is important in determining management of pressure ulcers. A mobile three-dimensional measurement system (3DWMS) with a laser-assisted sensor camera was recently introduced in several pilot studies. In this study, we used the 3DWMS on pressure ulcer wounds in actual clinical cases. Methods: A total of 26 wounds out of 232 pressure ulcers of various sizes and shapes were reviewed. Widths, lengths, depths, surface areas and volumes of the wounds were assessed two different ways at the same time, using eKare inSight and manual measurements using rulers, transparent adhesive films, and saline filling techniques to obtain reference values. Results: According to the paired samples t-tests, the mean differences in the results from the two assessments were not significant for width, length, and surface area (P > 0.05), whereas the mean differences for maximum depth and volume were found significant (P < 0.05). However, based on the Bland-Altman plot, the two methods were not to be assumed as interchangeable. Conclusion: 3DWMS was found to be reliable for two-dimensional area analysis, whereas for three-dimensional analysis such as depths and volumes, its results were less suited for immediate application to clinical environments. Therefore, clinicians are to decide how to assess pressure ulcer wounds after carefully considering the strengths and weaknesses of each method.