• Archives of Plastic Surgery
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• v.41 no.1
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• pp.3-11
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• 2014

Background This study aimed at overcoming the disadvantages of septal extension grafts and keeping the nasal tip as natural as possible by using different forms of the graft and additional supporting methods depending on the case. Methods Among 458 patients who received a septal extension graft from March 2008 to September 2011, 107 patients were selected who underwent at least a 6-month follow-up. Patients were categorized according to the primary objective of the operation; an upturned tip correction or tip lengthening, tip lengthening with tip projection, or retracted columella correction. Each group of patients received a different type of septal extension graft out of 3 different types of grafts based on the purpose of the operation. The evaluation of the results was made from by comparing preoperative and postoperative photographs of the tip angle, projection, and nasolabial angle. Results The average tip angle for the patients in the upturned tip correction group was reduced to 98.3 from 124.9 degrees. For the patients in the tip lengthening with tip projection group, the average tip angle was reduced to 96.8 from 122.4 degrees and the average tip projection was increased to 27.5 from 23.2 mm. The average nasolabial angle for the patients in the retracted columella correction group was increased to 94.6 from 74.8 degrees. Conclusions Sufficient nasal tip lengthening and projection could be achieved by applying a septal extension graft using the graft best suited for the group of patients categorized by surgical objective.

• Archives of Plastic Surgery
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• v.40 no.4
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• pp.348-352
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• 2013

Background Temporalis muscle transfer produces prompt surgical results with a one-stage operation in facial palsy patients. The orthodromic method is surgically simple, and the vector of muscle action is similar to the temporalis muscle action direction. This article describes transferring temporalis muscle insertion to reconstruct incomplete facial nerve palsy patients. Methods Between August 2009 and November 2011, 6 unilateral incomplete facial nerve palsy patients underwent surgery for orthodromic temporalis muscle transfer. A preauricular incision was performed to expose the mandibular coronoid process. Using a saw, the coronoid process was transected. Three strips of the fascia lata were anchored to the muscle of the nasolabial fold through subcutaneous tunneling. The tension of the strips was adjusted by observing the shape of the nasolabial fold. When optimal tension was achieved, the temporalis muscle was sutured to the strips. The surgical results were assessed by comparing pre- and postoperative photographs. Three independent observers evaluated the photographs. Results The symmetry of the mouth corner was improved in the resting state, and movement of the oral commissure was enhanced in facial animation after surgery. Conclusions The orthodromic transfer of temporalis muscle technique can produce prompt results by applying the natural temporalis muscle vector. This technique preserves residual facial nerve function in incomplete facial nerve palsy patients and produces satisfying cosmetic outcomes without malar muscle bulging, which often occurs in the turn-over technique.

• Archives of Plastic Surgery
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• v.44 no.5
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• pp.400-406
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• 2017

Background The purpose of this study was to evaluate changes in nasal growth after the implementation of a preoperative nasal retainer in patients with bilateral incomplete cleft lip. Methods Twenty-six infants with bilateral incomplete cleft lip and cleft palate were included in the study. A preoperative nasal retainer was applied in 5 patients from the time of birth to 2.6-3.5 months before primary cheiloplasty. Twenty-one patients who were treated without a preoperative nasal retainer were placed in the control group. Standard frontal, basal, and lateral view photographs were taken 3 weeks before cheiloplasty, immediately after cheiloplasty, and at the 1- and 3-year postoperative follow-up visits. The columella and nasal growth ratio and nasolabial angle were indirectly measured using photographic anthropometry. Results The ratio of columella length to nasal tip protrusion significantly increased after the implementation of a preoperative nasal retainer compared to the control group for up to 3 years postoperatively (P<0.01 for all time points). The ratios of nasal width to facial width, nasal width to intercanthal distance, columellar width to nasal width, and the nasolabial angle, for the two groups were not significantly different at any time point. Conclusions Implementation of a preoperative nasal retainer provided significant advantages for achieving columellar elongation for up to 3 years postoperatively. It is a simple, reasonable option for correcting nostril shape, preventing deformities, and guiding development of facial structures.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.382-387
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• 2019

Background: Defects of the nasal ala and tip have a complex three-dimensional structure that makes them challenging to reconstruct. Many reconstructive options have been described for nasal ala and tip defects, ranging from primary closure to local flaps and skin grafts. However, it is difficult to determine which method will yield the best cosmetic results in each individual case. Thus, the purpose of this study was to determine which surgical procedures for reconstructing defects of the nasal ala and tip have better cosmetic results. Methods: From 2008 to 2018, 111 patients underwent surgery to reconstruct skin defects after resection of skin cancer in the nasal ala or tip. Their charts were reviewed to obtain data on age, sex, surgical location, size of the defect, surgical method, and cosmetic results using a visual analog scale (VAS). Results: For nasal ala reconstruction, the most commonly used surgical technique was the nasolabial flap (n= 42). This method also had the highest VAS score (7/10). The most commonly selected surgical method for nasal tip reconstruction was the bilobed flap (n= 13), and bilobed flaps and primary closure had the highest VAS score (7/10). Conclusion: Nasolabial flaps showed excellent cosmetic results for the reconstruction of nasal ala defects, while primary closure and bilobed flaps yielded excellent cosmetic results for the reconstruction of nasal tip defects.

• The korean journal of orthodontics
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• v.32 no.5 s.94
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• pp.355-360
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• 2002

After orthodontic treatment, there are several changes in soft tissue profile. Changes appear at lower anterior facial profile area, especially upper and lower lip. But there are many individual variations in the pattern of changes. So, this study was conducted to find out that the basic upper lip thickness could be one of the factors that could influence the treatment results. The samples were composed of 43 adult patients who had their 4 first premolars extracted. Groups were classified by their basic lip thickness. In group 1(thin upper lip group), there was negative relationship between mentolabial angle and lower lip change. In group 2(average lip thickness group), upper lip change was related to upper incisor change, lower incisor change, lower lip change and nasolabial angle change. And lower lip change was related to upper lip change, upper incisor change, lower incisor change. In group 3(thick upper lip group), there was no relation between both lip change and other variables.

• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.6
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• pp.385-392
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• 2020

Objectives: This study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy. Materials and Methods: All 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively. Results: Cluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups: Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for A'/ANS and Ls/Is (P<0.001) was significant; A'/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation. Conclusion: The ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.

• Archives of Craniofacial Surgery
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• v.23 no.1
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• pp.17-22
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• 2022

Background: Reconstruction of large facial defects is challenging as both functional and cosmetic results must be considered. Reconstruction with forehead flaps on the face is advantageous; nonetheless, reconstruction of large defects with forehead flaps alone results in extensive scarring on the donor site. In our study, the results of reconstruction using a combination of forehead flaps and other techniques for large facial defects were evaluated. Methods: A total of 63 patients underwent reconstructive surgery using forehead flaps between February 2005 and June 2020 at our institution. Reconstruction of a large defect with forehead flaps alone has limitations; because of this, 22 patients underwent a combination of procedures and were selected as the subjects of this study. This study was retrospectively conducted by reviewing the patients' medical records. Additional procedures included orbicularis oculi musculocutaneous (OOMC) V-Y advancement flap, cheek advancement flap, nasolabial V-Y advancement flap, grafting, and simultaneous application of two different techniques. Flap survival, complications, and recurrence of skin cancer were analyzed. Patient satisfaction was evaluated using questionnaires. Results: Along with reconstructive surgery using forehead flaps, nasolabial V-Y advancement flap was performed in nine patients, local advancement flap in three, OOMC V-Y advancement flap in two, grafting in five, and two different techniques in three patients. No patient developed flap loss; however, cancer recurred in two patients. The overall patient satisfaction was high. Conclusion: Reconstruction with a combination of forehead flaps and other techniques for large facial defects can be considered as both functionally and cosmetically reliable.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.2
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• pp.217-223
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• 1996

In order to evaluate the changes before and after secondary operations in the patients with cleft lip objectively using full face photographs, the author analyzed results of improvement on nasal width and mouth width and asymmetry of nostril. 1. The ration of asymmetry of thenostril is changed from average 1.24 preoperatively to average 1.08 postoperaively : 61.2% is improved postoperatively. 2. The ratio of nasal width compared with intermedial canthal distance is changed from average 1.15 preoperatively to average 1.10 postoperatively : 3.8% is reduced posteroperatively. 3. The ratio of mouth width compared with intermedial canthal distance is changed from average 1.08 preoperatively to average 1.03 postoperathvely : 4.1% is reduced posteroperatively.

• The Journal of the Korean dental association
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• v.50 no.10
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• pp.616-619
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• 2012

The aim of this study was to clarify the arrangement of the zygomaticus major muscle, and to describe morphology of zygomaticus minor muscle. After a detailed dissection, the zygomaticus muscles were observed in 66 embalmed cadavers. It was found that the insertion of zygomaticus major was divided into superficial and deep bands(42/70, 60%). Zygomaticus minor was inserted not only upper lip also alar portion(5/54, 9.2%). The arrangement and insertion patterns of the zygomaticus muscles in this study are expected to provide critical information for understanding or smile pattern and treatment or fold.