• Archives of Plastic Surgery
• /
• v.33 no.4
• /
• pp.525-529
• /
• 2006

Purpose: Facial nerve injury is a rare but feared complication of face lift. Uncertainty as to the depth and vulnerability of the facial nerve in face lift dissection causes some surgeon, particularly novices, to dissect slowly. Excessively thin flaps can be made because of fear of nerve injury, contributing to skin slough. Methods: From September 1998 to February 2003, the authors operated on 34 aging face patients using classical face-lift. We had analysed about quantity of skin removal and degree of elevated flap. The authors have found quantity of skin removal was 1.5-2.0 cm, degree of elevated flap was 40-45 degree on average. Results: The authors performed preauricular pre-excision face-lift technique on 12 aging face patients from July 2003 to Feburary 2005 based on experienced surgery. This technique reduced fear of dissecting skin flap necrosis and facial nerve injury because of firmly attached pre-auricular skin removed in advance. Conclusions: We easily dissected SMAS without visual field disturbance, nerve damage and reduced operation time and bleeding loss compared to classical face-lift.

• Biomedical Science Letters
• /
• v.16 no.4
• /
• pp.365-376
• /
• 2010

The purpose of this study was to clarify the effect of light emitting diode (LED) irradiation on healing of impaired wound and alteration of mast cells in experimental diabetic rats. Twenty-four male Sprague-Dawley rats were divided into four groups: excision (Ex), excision-LED irradiation (Ex-LED), diabetes + excision (DM) and diabetes + excision + LED irradiation (DM-LED). Diabetes was induced in rats by streptozotocin (STZ) injection (70 mg/kg, single dose) and 6 mm punch excision wounds were created on the back after shaving hair. The LED-irradiated rats were treated to a daily dose of $5\;J/cm^2$ LED (630 nm) light for 11 days after surgery, and were killed at day 1, 3, 7 and 11. The lesion and adjacent skin tissues were excised, fixed with 10% buffered formalin and embedded with paraffin. For evaluation of wound healing, hematoxylin-eosin (HE) and Masson trichrome staining were performed. Mast cells (MCs) were stained with toluidine blue (pH 0.5) and quantified using a computerized image analysis system. The proliferation activity of keratinocyte in skin tissues was analyzed on sections immunostained with proliferative cell nuclear antigen (PCNA). The results showed that wound healing rate, collagen density and neo-epidermis length, number of PCNA-positive cells, fibroblasts and mast cells were significantly higher in the LED-irradiated rats than in the DM and Ex rats throughout the periods of experiment. Exceptionally, the number of MCs was significantly lower at day 11 compared with day 7 after surgery in the all groups. These findings suggest that the LED irradiation may promote the tissue repair process by accelerating keratinocyte and fibroblast proliferation and collagen production in normal rats as well as in diabetic rats, and MCs may play an important role at an early stage of skin wound healing in normal and diabetic rats.

• Archives of Plastic Surgery
• /
• v.36 no.2
• /
• pp.194-199
• /
• 2009

Purpose: The orbital fat buldging may cause irregular contour of lower eyelid, which is not youthful appearance. The conventional method of fat excision may cause the eyeball to move backward and downward, making enopthalmia is inevitable. The transcutaneous approach to reach the orbital septum can increase the risks of scleral show resulting from scarification at the level of the septum orbicularis junction and damaging the vertical motor branches of the preseptal orbicularis oculi muscle of the lower eyelid. Method: From July 2007 to March 2008, total of 21 patients underwent transconjunctival capsulopapebral fascia fixation procedure. In 8 patients, the herniated fat pad of the lower eyelid was relocated back into the orbit without external skin excision using capsulopalpebral fascia fixation. But in 13 patients, excision of redundant skin of the lower eyelid was performed using pinching technique, not involving orbicularis oculi muslce. In 5 patients, lateral canthotomy was done bilaterally for good visual field. In 6 patients, lateral canthopexy was also combined to correct loosening of lower eyelid. Results: Most of the patients were satisfied after at least 5 months of follow up. No patient showed scleral show. But 2 patients complained of undercorrection slightly, without secondary operation in 1 patient and re - capsulopalpebral fascia fixtation through transconjunctival approach in another patient. Conclusion: Orbital fat repositioning using transconjunctival capsulopalpebral fascia fixation is a good procedure to show youthful appearance without increasing the risk of scleral show and also showed fast recovery compared to the conventional transcutaneous approach.

• Archives of Plastic Surgery
• /
• v.36 no.4
• /
• pp.507-511
• /
• 2009

Purpose: Adenoid cystic carcinoma (ACC) is a rare malignant epithelial neoplasm derived from the salivary glands. In some cases, ACC may arise in other primary sites, such as skin. We report a case of adenoid cystic carcinoma arising the scalp skin of 69 - year - old woman. Methods: A 69 - year - old woman presented with a tender scalp nodule. A local wide excision was performed. Histopathologic examination was revealed the adenoid cystic carcinoma with basaloid cells in a cribriform pattern. The resection margins were free of tumor. Two years later a tumor recurred in the scarred area. The lesion was removed surgically and the histopathological diagnosis of adenoid cystic carcinoma was again established. After two years, tumor recurred again and diatant metastasis of the lung was diagnosed. A surgical wide excision was done and the close regular follow - up for recurrence was done. Two years later, third recurrence of the scalp was observed. We also performed the wide local excision with tumor free margin. Results: We experience the recurrent adenoid cystic carcinoma of the scalp with pulmonary metastasis. We have performed the wide local excision for three times. The patient has been followed up for 10 years with regular work - up for recurrence and metastasis Conclusion: primary cutaneous adenoid cystic carcinoma is a rare skin neoplasm with a high potential for recurrence after local excision. The standard treatment of ACC is wide local excision with tumor - free margins established by permanent section.

• Archives of Craniofacial Surgery
• /
• v.21 no.5
• /
• pp.315-318
• /
• 2020

Side effects of tattoos can occur due to unexpected body responses. Concerns about the side effects of tattoos are growing concomitantly with the increasing number of tattooed individuals. We report a rare case of basal cell carcinoma (BCC) on a tattooed eyebrow. A 48-year-old woman with no family history or occupational risk of skin cancer had her eyebrows tattooed 6 years prior, and she noticed a black mass on her right eyebrow 1 year before presentation. Staged excision was planned due to the patient's reluctance regarding the possibility of a wide scar. After the first surgical procedure, a histopathological examination confirmed BCC. Wide excision and primary closure were performed for remnant BCC, and no recurrence was observed. The mechanism of skin neoplasms involving tattoos has not been clearly identified. Unapproved tattoo inks contain carcinogenic substances, and previous case reports indicate that skin neoplasms may differ depending on the tattoo color. Therefore, the carcinogenic effects of these unknown components of tattoo ink might cause skin neoplasms. Accurate component analysis and systematic management of tattoo ink is necessary, and medical practitioners must also pay attention to this possibility because it is easy to overlook tattoos as a causal factor contributing to cancer.

• Archives of Plastic Surgery
• /
• v.46 no.5
• /
• pp.480-483
• /
• 2019

Repairing surgical defects of the nose is still challenging due to its tridimensional shape and its aesthetic concern. Difficulty in reconstructing nasal subunits lies in their contour, skin texture and limited availability of adjacent skin. For lower nasal dorsum and supra-tip regions, we design a new combined local flap as existing local flaps may give disappointing results. This combination flap was performed on two patients for reconstruction of the lower nasal dorsum area after basal cell carcinoma excision. Size of the excision ranged from 20 to 25 mm diameter and safe margins were obtained. The defects were reconstructed with a local flap that combined a rotation nasal flank flap and a V-Y advancement nasolabial flap. Excision and reconstruction were performed in a one-stage surgery under intravenous sedation and local anesthesia. There were no postoperative complications and no flap loss occurred. Aesthetic and functional results after 6 months postoperatively were satisfying without modification of nasal shape. This flap is reliable and offers interesting functional and aesthetic outcomes. It can be considered as a new reconstruction alternative for supra-tip and lower nasal dorsum skin defects performed in a one-stage procedure under local anesthesia.

• Archives of Plastic Surgery
• /
• v.40 no.4
• /
• pp.380-386
• /
• 2013

Background Xanthelasma palpebrarum (XP) is a benign disorder manifesting as yellowish cholesterol-laden plaques on the eyelids. This paper presents the outcomes in patients with XP who have undergone surgical excision as the main modality of treatment. Methods A retrospective review of patients who received surgery for xanthelasma palpebrarum from March 2007 to March 2011 was conducted. Patients were classified into four grades according to the location and extent of the lesion, with grade I being the mildest and grade IV being the most diffuse. Simple excision was performed in grade I and II lesions, while local flaps and skin grafts were performed in the more advanced grades. Results Ninety-five cases from March 2007 to March 2011 were included in this study. 66 cases (70%), were treated by simple excision. Twenty-four cases (25%) and 5 cases (5%) were treated by simple excision in combination with or without local flaps and skin grafts. In approximately 1/4 of the patients, orbicularis oris muscle involvement was observed. 4 patients (4.2%) developed scar contracture postoperatively, which required a secondary procedure. Recurrence was reported in 3 patients (3.1%). Otherwise. There were no other reports of major complications or disfigurement. Conclusions We found that for lesions involving the deep dermis and/or muscle, surgical excision was the most appropriate therapeutic option.

• Archives of Plastic Surgery
• /
• v.41 no.4
• /
• pp.418-420
• /
• 2014

Congenital melanocytic nevus consists of congregations of nevomelanocytes. It is found in approximately 1% of new born infants. Congenital melanocytic nevus needs to be excised before it transforms into a malignant lesion. Many strategies have been attempted for the removal and reconstruction of the nevus. Serial excision enables wound closure to be accomplished with a shorter scar than if the original lesion was elliptically excised in a single stage and reorientation of the scar closer to the relaxed skin lines. The routine utilization of an elliptical serial excision as a standard method of closure often leads to the formation of elongated scars and waste of skin. The "Cogwheel pattern" serial excision is a new technique for reducing the size of the nevus efficiently. Reducing the final scar length, distributing the tension over many directions, and having the chance of decrease in operation numbers are ultimately achieved with the use of the "Cogwheel pattern" serial excision.

• Archives of Plastic Surgery
• /
• v.38 no.5
• /
• pp.711-714
• /
• 2011

Purpose: Angiosarcoma is a rare malignant neoplasm of endothelial type cells that line vessel walls. It tends to occur in aged male and the prognosis of angiosarcoma is very poor because of frequent local recurrence and early metastasis. The treatment regimen is yet to be established from its rare occurrence but the wide excision in early stage is known to be the most effective. The authors report two cases of near totally excised angiosarcoma with more than a safety margin of 5 cm. Methods: The two subjects were aged male patients, one of the two was diagnosed with angiosarcoma from our institution confirmed by the biopsy. The other one went through the wide excision with a safety margin of 2 cm and split-thickness skin graft but local recurrence was observed. The two patients underwent near total excision with more than a safety margin of 5 cm, leaving only the periosteum. After confirming that the angiosarcoma had not infiltrated the excision margin, reconstruction with split-thickness skin graft was performed. Results: Based on 6 months and 24 months post-surgery assessment, no local recurrence or remote metastasis in the lungs, liver, bones, and lymph nodes at the neck, where remote metastasis is common, was reported by the two subjects who underwent near total excision with a safety margin of 5 cm. Conclusion: Angiosarcoma has very poor prognosis from its frequent recurrence and metastasis. To enhance the survival rate of angiosarcoma patients, early diagnosis, timely surgical treatment, and radiotherapy after surgery are critical. In addition, authors suggest that it is necessary to further study the efficacy of wide excision using a wider safety margin as much as possible, and to apply this to more cases.

• Archives of Plastic Surgery
• /
• v.50 no.2
• /
• pp.142-147
• /
• 2023

Some of Asian eyelids have double fold and some do not. Many people tend to prefer double eyelid in aesthetic and functional reasons. Since the mechanism of double eyelid is bonding the eyelid skin to the eye-opening tissue, the principle of double eyelid surgery is also connecting the eyelid skin to levator component. Double eyelids are differentiated by their shape according to the height and curvature. The double eyelid surgery procedure is divided into incision method and nonincision method. And the incision method is subdivided into double fold line design, skin and oculi muscle incision or excision, pretarsal or preaponeurotic soft tissue excision, fixation of posterior lamella to anterior lamella, and skin suture. The nonincision method is to connect the posterior lamella and the anterior lamella as a thread only without an incision. A successful double eyelid surgery creates a fold well-balanced in height, curvature, and depth of the fold based on patient's preference. In this article, the author's own methods of performing surgery are described, with a step-by-step guide and surgical tips.