• Archives of Craniofacial Surgery
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• v.24 no.6
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• pp.260-265
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• 2023

Background: The traditional nasolabial V-Y advancement flap is widely used for midface reconstruction, particularly for the lower third of the nose and upper lip, as its color and texture are similar to these areas. However, it provides insufficient tissue to cover large defects and cannot restore the nasal convexity, nasal ala, and adjacent tissues. The purpose of this study is to investigate the modified nasolabial V-Y advancement flap with extension limbs the along alar crease for the reconstruction of complex midface defects. Methods: A retrospective analysis of 18 patients, who underwent reconstruction with the modified nasolabial V-Y advancement flap, was performed between September 2014 and December 2022. An extension limb was added along the alar crease, adjacent to the defect area, and was hinged down as a transposition flap at the end of the advancement flap. Results: The extension limb along the alar crease successfully covered large and complicated defects, including those of the ala, the alar rim, the alar base, the nostrils, and the upper lip, with minor complications. Conclusion: The alar crease is a good donor site for the reconstruction of large and complex nasal and upper lip defects.

• Archives of Plastic Surgery
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• v.42 no.5
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• pp.572-579
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• 2015

Background Facial rejuvenation can be achieved using a variety of techniques. Since minimally invasive procedures for face lifting have become popular because of their convenience and short operating time, numerous minimally invasive surgical procedures have been developed. In this study, a nonabsorbable polypropylene mesh is introduced as a new face lifting instrument, with the nasolabial fold as the main target area. In this paper, we report the efficacy and safety of a polypropylene mesh in midface rejuvenation. Methods Thirty-three subjects with moderate-to-severe nasolabial folds were enrolled from two medical institutions for a noncomparative single-sample study. A mesh was inserted above the superficial muscular aponeurotic system layer, reaching the nasolabial folds through a temporal scalp incision. After 3 weeks, the temporal end of the mesh was pulled to provide a lifting effect. Then, the mesh was fixed to the deep temporal fascia using nonabsorbable sutures. To evaluate efficacy, we compared the scores on the Wrinkle Severity Rating Scale and a visual analog scale for patient satisfaction between the baseline and 7 weeks postoperatively. In addition, we evaluated safety based on the incidence of adverse events. Results The treatment was deemed effective at improving wrinkles in 23 of 28 cases, and patient satisfaction improved significantly during the study period. There were seven cases of skin or subcutaneous tissue complications, including edema and erythema, but there were no suspected serious adverse events. Conclusions Face lifting using a nonabsorbable mesh can improve nasolabial folds without serious adverse effects. Thus, this technique is safe and effective for midface rejuvenation.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.4 no.1
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• pp.23-36
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• 1995

The purpose of this artic1e is to compare soft tissue profiles between Korean adults with normal occ1usion and malocclusin and to identify the differences between them. The subjects of this cephalometric study were 40 males with normal occlusion(Group 1), 27 females with normal occlusion(Group 2), 28 adults with Angle's Class II malocclusion(Group 3) and 41 adults with Angle's Class III malocclusion(Group 4). The results of this study were as follows ; 1) People with Angle's Class II malocclusion had tendency to have more labial tipping of lower teeth than people with normal occ1usion. Through NOA angle measurement, it was determined that people with Angle's Class II malocclusion had more protruding midface than people with normal occlusion and people with Angle's Class III malocclusion had retruding midface. 2) Through Powell's esthetic triangle analysis, it was determined that people with Angle's Class II malocclusion had retruding chin and protruding nose. 3) No significant differences between people with normal occlusion and maloclusion could be identified by measuring soft tissue profile angle basis of S-NS plane. 4) There were significant differences between groups with normal occlusion and malocclusion by measuring Facial convexity angle(Significance level 99%). 5) By measuring the distance between each landmark basis of N-Pog plane, People with Angle's Class II malocclusion were identified as having more protruding midface, but there were no significant differences between people with normal occlusion and Angle's Class III malocclusion. 6) By measuring the vertical dimension of the face, it was determined that the lower facial height was higher than the upper facial height in all groups, particularly in group with Angle's Class III malocclusion. 7) By measuring the lips basis of E-line and S-line, it was determined that people with Angle's Class III malocclusion had more, protruding lower lips than people with normal occlusion, while people with normal occlusion, while people with Angle's Class II malocclusion had more protruding upper lips. By measuring the distance between the superior sulcus and inferior sulcus basis of H-line, people with Angle's Class II malocclusion had thicker upper lips than the other's.

• The korean journal of orthodontics
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• v.48 no.5
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• pp.346-346
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• 2018

• The Journal of the Korean dental association
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• v.24 no.4 s.203
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• pp.345-357
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• 1986

Computerized tomography has become more widely available in numerous centers throughout the world and is now recognized in many specialities as an important diagnostic procedure. The use of computerized tomography in oral and maxillofacial surgery is discussed. It has been found to be of special value in the diagnosis and assesment of expanding and infiltrating lesions of the jaws, fracture and infections, especially in the midface, in both adults and children.

• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.20-24
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• 2016

Background: Midface concavity is a relatively common facial feature in East Asian populations. Paranasal augmentation is becoming an increasingly popular procedure for patients with mild concavity and normal occlusion. In this study, we evaluate clinical outcomes following a series of paranasal augmentation. Methods: A retrospective review was performed for patients with Class I occlusion who had undergone bilateral paranasal augmentation using custom-made silicone implants, between October 2005 and September 2013. Patient charts were reviewed for demographic information, concomitant operations, and postoperative complications. Preoperative and postoperative (1-month) photographs were used to evaluate operative outcome. Results: The review identified a total of 93 patients meeting study criteria. Overall, aesthetic outcomes were satisfactory. Five-millimeter thick silicone implant was used in 81 cases, and the mean augmentation was 4.26 mm for this thickness. Among the 93 patients, 2 patients required immediate implant removal due to discomfort. An additional 3 patients experienced implant migration without any extrusion. Nine patients complained of transient paresthesia, which had resolved by 2 weeks. There were no cases of hematoma or infection. All patients reported improvement in their lateral profile and were pleased at follow-up. Complications that arose postoperatively included 9 cases of numbness in the upper lip and 3 cases of implant migration. All cases yielded satisfactory results without persisting complications. Sensations were fully restored postoperatively after 1 to 2 weeks. Conclusion: Paranasal augmentation with custom-made silicone implants is a simple, safe, and inexpensive method that can readily improve the lateral profile of a patient with normal occlusion. When combined with other aesthetic procedures, paranasal augmentation can synergistically improve outcome and lead to greater patient satisfaction.

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.198-201
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• 2016

Background: Zygomatic arch is a bony arch constituting the lateral midface, which consists of 25% of all midface fractures. There are a number of ways to evaluate the extent of zygomatic arch fracture. Some authors have reported successful treatment outcomes using ultrasound (U/S). To add to the previous methods, we have considered ways to accurately display the location of the fracture line while using U/S with 23 gauge needle marking. We introduce our method, which provided satisfactory results for reduction using a portable U/S, and it can evaluate the fracture line simultaneously when reduction of an isolated zygomatic arch fracture is necessary, and needle marking, which can easily point out the fracture line on U/S. Methods: We studied 21 patients with an isolated zygomatic arch fracture who underwent closed reduction using U/S and needle marking between 2013 and 2015. Results: We achieved satisfactory results in all our cases with respect to reduction by using the Dingman elevator after performing a temporal approach incision, while confirming relative positioning between needle marking and zygomatic fracture at the same time, after insertion of a 23 gauge needle in the skin above the zygomatic arch fracture line parallel to it. Conclusion: We treated 21 patients with an isolated zygomatic arch fracture using U/S and the needle marking method, which provided satisfactory results because the extent of reduction of the fracture could be evaluated in real-time during the operation and exposure to radiation was reduced.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.353-359
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• 1999

Purpose : A new method of lateral cephalometric analysis for midface, focusing on zygomatic bone, was created in this study, and measured in Korean adults. The purposes of this study are understanding about new approach for midfacial depression, especially zygomatic bone, and using to make adequate diagnosis and treatment plan. Materials and methods : In this study, esthetic Korean adults, 25 males and 25 females who were between $0^{\circ}$ and $4^{\circ}$ in ${\angle}ANB$, and between 62% and 70% in P/A facial height ratio, and had normal overbite and overjet, were used. Orbitale(Or) and Soft tissue orbitale(Or') were used for indicators of anteroposterior position of zygomatic area. And, mean value and standard deviation of linear and angular measurements, and ratio about each linear measurements, were obtained. then, standard deviation diagram - wiggle diagram - was made for visualization of results. Results : Mean values, standard deviations and ranges of 19 measurements were obtained, and among them, 5 linear measurements that had large standard deviation were excluded and the others were used for making standard deviation diagram. In standard deviation diagram, the following results were obtained. 1. If the measurements are located on more left side of mean-value-vertical -line, the potential of midfacial hypoplasia are stronger, especially zygomatic area. 2. If the measurements are located on more right side of mean-value-vertical-line, the potential of midfacial hypoplasia are decreased. Conclusion : This study presented a new method of lateral cephalometric analysis focusing on zygomatic bone in Korean adults. We expect that the results of this study can be used as parameter when clinicians make decisions about diagnosis and treatment plan for rehabilitation of esthetics and function. But, it is necessary to prove its usefulness, and to further evaluate the results.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.250-257
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• 2007

Purpose: Aging changes of midface include drooping of lower lid, wrinkles of malar area, orbitomalar groove and deepening of nasolabial fold from drooping of malar fat pad. Improvement of lower lid can be achieved through lower blepharoplasty, but improvement of cheek can not be gained. Superficial subciliary cheek lift(by Moelleken, 1996) is a method that lifts malar fat pad through extended subciliary incision. We obtained simultaneous improvement of lower lid, malar wrinkles and orbitomalar groove with modification of this technique. Methods: From December 2003 to January 2006, we performed this method on 21 patients among volunteers for lower blepharoplasty who wanted to correct orbitomalar groove and malar wrinkles. Under local anesthesia, lateral extension of subciliary incision is done 1cm from the lateral orbital rim. Skin-muscle flap is elevated, and dealing of orbital fat and septum is the same as with ordinary lower blepharoplasty. After downward subcutaneous dissection through extended incision, exposing the upper 1/3 level of malar fat pad, superolateral fixation is done to superior deep temporal fascia. Excision of the upper part of fat pad is performed, if needed. After excision of overlapped skin-muscle flap, skin closure is done. Results: We obtained satisfactory results with this simple method for improvement of orbitomalar groove and malar wrinkles among patients for lower blepharoplasty. During a follow-up period of 5 months on the average, no revision was performed. Conclusion: Under local anesthesia, lower blepharoplasty and improvement of orbitomalar groove and malar wrinkles can be achieved at the same time. It is good for patients who do not want conventional midface-lifting. But surgeons should select patients and perform cautiously for it may leave a scar of the extended incision that require over 2 months for maturation and it is insufficient for improvement of nasolabial fold compared to conventional mid face-lifts.

• Archives of Plastic Surgery
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• v.48 no.5
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• pp.503-510
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• 2021

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided.