Management of Ala Columella Disproportion in South East Asian Noses

2020 ◽  
Vol 36 (05) ◽  
pp. 505-516
Author(s):  
Eduardo Yap
Keyword(s):  
East Asian ◽  
Frontal View ◽  
Aesthetic Outcome ◽  
Posterior Angle ◽  
Nasal Vestibule ◽  
Aesthetic Result ◽  
Tip Projection ◽  
Good Aesthetic Result ◽  
Extension Graft ◽  
Alar Rim

AbstractSouth East Asian noses have a characteristic ala and columella disproportion and mostly manifest as hanging ala. Simultaneous correction during rhinoplasty is recommended to achieve a good aesthetic result. Since hanging ala is a common feature, a classification system is presented as a guide for surgical management. The classification is based on the frontal view showing the alar rim connecting to the columella lobule area simulating the wings of a gull in gentle flight. A mild deformity has the gull's wing in the horizontal direction. A moderate deformity has the gull's wing in a slight inferior direction. A severe hanging deformity has the gull's wing in the inferior direction, ending below the columella lobule area, and this is mostly accompanied by retracted columella. There are various techniques for the surgical correction of hanging ala. The author has made a modification of the internal approach called “sail excision” using the groove within the lateral nasal vestibule as a landmark. The author terms this area as the vestibular groove. Sail excision involves removal of a triangular portion of tissue anterior to this vestibular groove. Another aesthetic deformity noticed in South East Asian noses is that the alar rim base is lower than the columellar base. In correcting hanging ala with involvement of the alar rim base, the sail excision is extended posteriorly following the vestibular groove as its guide to the amount to be excised. To enhance the overall aesthetic outcome, the acute columella labial angle seen in South East Asian noses has to be made fuller through surgery. This is accomplished using septal extension graft for tip projection, with preservation of the posterior angle of the caudal septum. Plumping grafts are used as filler material in the premaxillary area.

Special Consideration in the Management of Hump Noses in Asians

2020 ◽  
Vol 36 (05) ◽  
pp. 554-562
Author(s):  
Yong Ju Jang ◽  
Hyun Moon
Keyword(s):  
East Asian ◽  
Significant Problem ◽  
Special Consideration ◽  
Nasal Dorsum ◽  
Aesthetic Outcome ◽  
East Asians ◽  
Utmost Care ◽  
Hump Reduction ◽  
Extension Graft ◽  
Tremendous Impact

AbstractAlthough not as prevalent as in Caucasian rhinoplasty, correction of a hump nose also poses a significant problem for East Asian rhinoplasty. The hump noses in East Asians can be classified as generalized humps, isolated humps, and relative humps with a low tip. Appropriate management of the Asian hump nose demands a good understanding of the anatomical characteristics unique to East Asians. As the East Asians generally prefer to have a nose with a prominent tip and well-augmented nasal dorsum, the concept of redistribution is significant in managing convex dorsum of the East Asians. Hump reduction should be done in a conservative and incremental manner, including careful removal of the bony cap and cartilaginous hump. Tip augmentation using a septal extension graft is an essential maneuver to achieve an aesthetically pleasing tip height, which has a tremendous impact on the overall aesthetic outcome. Midvault reconstruction, dorsal augmentation, and camouflage are additional key elements for the success of the operation. Complications such as undercorrection and dorsal irregularities are not uncommon, requiring surgeons to take utmost care to address them.

scholarly journals Extended Hueston Flap: New Solution for Primary Closure

2018 ◽  
Vol 10 (03) ◽  
pp. 155-157
Author(s):  
Tito Brambullo ◽  
Erica Dalla Venezia ◽  
Vincenzo Vindigni ◽  
Franco Bassetto
Keyword(s):  
Primary Closure ◽  
Clinical Case ◽  
Donor Site ◽  
Hand Trauma ◽  
Aesthetic Result ◽  
Contact Areas ◽  
Thumb Amputation ◽  
Frequent Use ◽  
Good Aesthetic Result

AbstractThumb tip injuries are very common in hand trauma, and several flaps are available to restore the defect. One of them is the Hueston flap. It is very simple and quick to harvest, but it could lead to donor site problems. The variant “radial extended” of this flap, proposed in this article, allows a primary closure of donor site avoiding making scar on contact areas subject to frequent use. We performed this technique in a clinical case that presented a distal thumb amputation with good aesthetic result and satisfactory function.

Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Antonella Pino ◽  
◽  
Lorenzo Gasco ◽  
Daqi Zhang ◽  
Paolo Carcoforo ◽  
...  
Keyword(s):  
Body Dysmorphic Disorder ◽  
The Body ◽  
University Hospital ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Scar Assessment ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

S104 – Treatment of a Brown Recluse Spider Bite to the Face

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P112-P112
Author(s):  
Katherine K. Hamming ◽  
Peter A Hilger ◽  
Holly Boyer
Keyword(s):  
Conservative Management ◽  
Treatment Options ◽  
Complete Healing ◽  
Aesthetic Outcome ◽  
Upper Lip ◽  
Aesthetic Result ◽  
The Face ◽  
Topical Treatments ◽  
Spider Bites ◽  
Spider Bite

Objectives 1) To raise awareness among otolaryngologists about the presentation, complications, and treatment options of brown recluse spider bites. 2) To present a case of a brown recluse spider bite to the face that was treated conservatively and had an excellent aesthetic result. Methods A 48-year-old woman was referred to the otolaryngology clinic with a dermonecrotic wound on the left upper lip from a brown recluse spider bite. The lesion consisted of a 4mm eschar with surrounding erythema, and the necrosis extended almost through the lip, sparing only the oral mucosa. She was given antibiotics and followed clinically. The eschar was left in place without debridement or topical treatments, and it fell off on day 40. Results After the eschar fell off on its own, the patient was left with complete healing of the necrotic area and a 1mm scar with mild erythema, giving her an excellent aesthetic result. Conclusions This case represents conservative management of a self-limited dermonecrotic lesion of the upper lip that resulted from a brown recluse spider bite. Conservative management should be considered with brown recluse spider bites, especially on the face, which has an excellent blood supply and where good aesthetic outcome is crucial.

scholarly journals Correction of alar rim retraction by lateral crural extension graft

2020 ◽  
Vol 40 (3) ◽  
pp. 211-216
Author(s):  
Tito Matteo Marianetti ◽  
Antonio Moretti
Keyword(s):  
Extension Graft ◽  
Alar Rim

scholarly journals Local facial flaps: a workhorse for reconstruction of facial malignancies defects

2019 ◽  
Vol 5 (3) ◽  
pp. 755
Author(s):  
Nikita G. Rolekar ◽  
Pradeep Goil ◽  
Jagdeep Rao
Keyword(s):  
Cell Carcinoma ◽  
Advancement Flap ◽  
Medium Size ◽  
Limberg Flap ◽  
Aesthetic Result ◽  
Skin Malignancy ◽  
Facial Defects ◽  
Aesthetic Results ◽  
Texture Match ◽  
Good Aesthetic Result

<p class="abstract"><strong>Background:</strong> Face represents complete personality of a human being, so adequate cosmetic correction of facial defects arising due to skin malignancy is very important. After excision, treatment option varies according to size and location of defect for small- or moderately-sized circular defects. In our study, we have evaluated versatility of local flap of face.</p><p class="abstract"><strong>Methods:</strong> We have included 30 cases of skin malignancy on face in our Institute within the period of June 2016 to May 2018. 20 patients (66.6%) were male and 10 patients (33.3%) were female, in age group from 45 to 65 years. 17 cases had basal cell carcinoma, 10 cases had squamous cell carcinoma and 3 cases had malignant melanoma. Tumours were excised with safe margins and defects reconstructed with local facial flaps. We evaluated the early postoperative complications and after 6months, cosmetic outcome and patient satisfaction was evaluated.  </p><p class="abstract"><strong>Results:</strong> 30 patients with small to medium-sized defect (3-6 cm), 8 cases were managed with V-Y advancement flap, 7 cases nasolabial flap, 8 cases forehead flap and, 4 cases Limberg flap, 4 cases cheek advancement flap. Postoperatively none of the cases had complications and the functional and aesthetic outcomes were quite acceptable. Aesthetic results were excellent in 15 patients (50%), while in 8 patients good results (27%) and 5 patient fair results (17%) after 6 month.</p><p class="abstract"><strong>Conclusions:</strong> Local facial flaps are the simple and best option to reconstruct the small to medium size facial malignancies defects and provides excellent skin colour and texture match with gives good aesthetic result.</p>

TREATMENT OF PROGRESSIVE HEMIFACIALATROPHY (PARRYROMBERG SYNDROME) WITH POLYMETHYL METHACRYLATE: A CASE REPORT.

2020 ◽  
pp. 1-2
Author(s):  
Roberto Chacur ◽  
Honório Sampaio Menezes ◽  
Nívea Maria Bordin da Silva Chacur ◽  
Danuza Dias Alves ◽  
Rodrigo Cadore Mafaldo ◽  
...  
Keyword(s):  
Case Report ◽  
Polymethyl Methacrylate ◽  
Hemifacial Atrophy ◽  
Aesthetic Result ◽  
Tissue Augmentation ◽  
Progressive Hemifacial Atrophy ◽  
Subcutaneous Layer ◽  
Parry Romberg Syndrome ◽  
Good Aesthetic Result

Progressive hemifacial atrophy, also called Parry-Romberg Syndrome (PRS), is a craniofacial disorder that typically involves the subcutaneous layer of one side of the face.This article We reports a case of a patient treated with polymethylmethacrylate for tissue augmentation and facial volume recovering asymmetry. Polymethylmethacrylate is effective and safe for treating progressive hemifacial atrophy and can leads a good aesthetic result.

Nasal Tip Surgery in Asians

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P31-P31
Author(s):  
Tae-Bin Won ◽  
Hong-Ryul Jin ◽  
Hyeon-Jong Lee
Keyword(s):  
Surgical Techniques ◽  
Tertiary Hospital ◽  
Initial Diagnosis ◽  
Saddle Nose ◽  
Nasal Tip ◽  
Tip Projection ◽  
Septal Extension Graft ◽  
Low Profile ◽  
Extension Graft ◽  
Onlay Grafts

Objective The authors intended to review our surgical techniques used in Asian tip surgery and to suggest effective techniques, according to the types of the nasal tip that are addressed. Methods 107 patients who had nasal tip surgery from Jan. 2005 to Dec. 2006 in a tertiary hospital were enrolled in the study. Medical records, graphic operation records, and standardized patient photographs were retrospectively reviewed. Initial diagnosis, types of nasal tip surgery, associated operative techniques, surgical results and complications were analyzed. Results Initial diagnosis included deviated nose, hump nose, combine deviated and saddle nose, low profile nose, short nose, and cleft nose deformity, in order of frequency. Nasal tip surgery included augmentation of projection, control of rotation, restoration of symmetry and volume reduction, among which augmentation was used in all cases. External approach was used in 74% and intranasal approach in 26%. For augmentation of the tip projection, onlay grafts (39%), septal extension grafts (25%), and tip modifying suture with onlay grafts (20%) were the most commonly used methods. Infection or extrusion of the grafts was not found. Complications included tip deviation due to the deviation of the septal extension graft in 1 case, visible tip graft in 1 case, and slight upward rotation of the tip in 1 case. Conclusions In Asians, augmentation of the tip projection is the main issue in tip surgery and is best performed with cartilage onlay grafts or septal extension graft rather than suture modification.

Folded Cymba Concha: Is It Large and Stable Enough for Caudal Septal Extension Graft in Asian Rhinoplasty?

2021 ◽  
Author(s):  
Sik Namgoong ◽  
Soobyn Kim ◽  
Hyung-Rok Kim ◽  
Seong-Ho Jeong ◽  
Seung-Kyu Han ◽  
...  
Keyword(s):  
Septal Cartilage ◽  
Men And Women ◽  
Nasal Tip ◽  
Tip Projection ◽  
Tongue In Groove ◽  
Physical Validity ◽  
The Mean ◽  
Nasal Tip Projection ◽  
Extension Graft

Abstract Background Septal extension grafting (SEG) is used for nasal tip projection and positioning. Often, insufficient quadrangular cartilage is available for grafting in Asians and in most secondary cases, the septum is already harvested. We utilized the folded cymba concha as an alternative for caudal SEG (CSEG) by modifying a tongue-in-groove technique. Objectives To evaluate the physical validity of the cymba concha for CSEG and compare its outcomes with those of septal quadrangular cartilage. Methods The mean length and width of 311 harvested consecutive folded cymba conchae were measured from intraoperative photographs. Data from 220 patients with &gt;12 months of follow-up were retrospectively reviewed for clinical outcomes. Clinical demography was determined based on the need for additional spreader grafts. For clinical reliability, anthropometric photographs of patients in whom folded cymba conchae were used were compared with those in whom quadrangular cartilage was used. Results Mean lengths and widths of the folded cymba conchae in men and women were 24.2 ± 3.9 and 22.4 ± 3.7 mm, and 7.8 ± 1.9 and 7.2 ± 1.9 mm, respectively. Using the folded cymba concha graft significantly increased nasal tip projection by 28.9% and columellar-labial angle by 9.7%, improving both aspects postoperatively. Anthropometric comparison revealed no significant differences between folded cymba conchae and septal cartilage in terms of nasal tip projection (p = 0.264) and postoperative columellar-labial angle (p = 0.182). Conclusions Folded cymba conchal cartilage can be a primary option for CSEG in Asian septorhinoplasty cases or for individuals with insufficient septal cartilage remnants.

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