Anh H. Nguyen

Physical Evaluation of the Asian Blepharoplasty Patient

In contrast with Caucasian blepharoplasty, which is usually done for rejuvenation purposes, eyelid surgery for Asians is mainly done for cosmetic reasons. Here the authors present preoperative evaluation methods of Asian eyelids to overcome anatomical variations and determine the right aesthetic options. Proper selection of the most suitable operative methods guarantees optimal surgical results.

The Asian Eyelid: Relevant Anatomy

The eyelid of Asians has its own unique characteristics. If the surgeon does not acknowledge this, aesthetically pleasing results will seldom be achieved. Here the authors review and summarize important up-to-date anatomical and relevant clinical studies of the Asian upper eyelid, aiming to help surgeons thoroughly understand its unique features, including Asian eyelid morphology, anatomical details, and the mechanisms of upper eyelid crease formation. Hopefully, an in-depth understanding of the Asian eyelid will aid surgeons to accomplish their work and lead to novel new techniques in this field.

Asian Rhinoplasty: Preoperative Simulation and Planning Using Adobe Photoshop.

A rhinoplasty in Asians differs from a rhinoplasty performed in patients of other ethnicities. Surgeons should understand the concept of Asian beauty, the nasal anatomy of Asians, and common problems encountered while operating on the Asian nose. With this understanding, surgeons can set appropriate goals, choose proper operative procedures, and provide an outcome that satisfies patients. In this article the authors define the concept of an Asian rhinoplasty-a paradigm shift from the traditional on-top augmentation rhinoplasty to a structurally integrated augmentation rhinoplasty-and provide a step-by-step procedure for the use of Adobe Photoshop as a preoperative program to simulate the expected surgical outcome for patients and to develop a preoperative plan for surgeons.

The Evolution of Looks and Expectations of Asian Eyelid and Eye Appearance.

Since Mikamo developed the double blepharoplasty technique at the end of the 19th century, there has been significant developments in the idealized periorbital appearance of the Asian patient. Currently there are four potential vectors of change possible (upper, lower, medial, and lateral). South Korea is the only country that most often utilizes the change in all four vectors. There is additionally a stark contrast between Asia-based and Western-based approach to the Asian eyes. In Asia, outside of South Korea, many surgeries employ a combined vertical upward vector and a medial directional change, particularly for the young eyes. In Western-based approaches, Asian blepharoplasty remains at this time primarily an open incision, upward vector change.

Nasal Analysis and Anatomy: Anthropometric Proportional Assessment in Asians-Aesthetic Balance from Forehead to Chin, Part II.

Caucasians usually have reduction or correction rhinoplasty; however, Asian nasal surgery is mainly for augmentation rhinoplasty. Therefore, an Asian rhinoplasty should start with a precise understanding of ethnic anatomical differences. The authors summarize the anatomical characteristics of Asians to ensure the best results.

Avoiding Unfavorable Results in Microsurgical Reconstruction in Upper-Extremity Trauma

The treatment of hand and upper-extremity injuries is complex. The treatment goals are to restore maximal hand function and, if possible, preinjury form. Several complications are frequently encountered while treating hand and upper-extremity injuries. Complications such as edema, direct structural destruction, and nerve palsies are the result of the inflicting injury. Skin graft contraction, fascial adhesions causing restricted tendon motion, and diminution of muscle function with time during staged reconstructions are treatment-related complications. The nature of these complications as well as means for their prevention and treatment are reviewed.

Milestones of Asian Rhinoplasty.

The field of plastic surgery originally developed out of the necessity to reconstruct the human body after the destruction of war. However, injured soldiers were not the only people who desired a change in appearance. After World War II, many people in Asian countries sought to attain a more Western look through surgery. Along with eyes, the nose was the main focus for these cosmetic procedures. In this article, the authors examine the evolution of Asian rhinoplasty from its original description in 1964 to the present. The characteristic anatomical differences between the Western and Asian nose are identified in relation to the technical challenges for rhinoplasty surgeons. Then the benefits and risks of the two major surgical approaches, autograft versus alloplast, are detailed. Finally, the coevolution of techniques and implant usage is traced from a dorsum-only implant, to an L-shaped implant, a cartilaginous cap graft with a one-piece rhinoplasty, an I-shaped implant, and a two-piece augmentation rhinoplasty. Outlining these changes demonstrates the advancement of the field of plastic surgery and the growing expectations of the patient. These advancements have provided the tools necessary to better align a patients aesthetic goals and their unique anatomical presentation with a specific surgical approach.

Reconsideration of the Epicanthus: Evolution of the Eyelid and the Devolutional Concept of Asian Blepharoplasty

Double eyelidplasty is the most frequent cosmetic procedure for Asians; however, the epicanthal fold has been a conundrum that has limited the cosmetic results of Asian blepharoplasty. To achieve satisfactory results in an Asian double eyelidplasty, the key is an understanding of the true nature of the epicanthus. We propose that the epicanthus developed in the eyelids evolutionary process. Selective detachment and superomedial reposition of the preseptal portion of the upper orbicularis muscle can resolve the primary cause of epicanthal formation without functional impairment. The vertical skin shortage and resultant skin tension of the upper eyelid can be corrected by subcutaneous dissection and transverse advancement of skin flap. An epicanthoplasty is part of the core surgery for Asian double eyelidplasty, especially when forming a parallel type of double eyelid. Combined epicanthoplasty and double eyelidplasty need to be considered as one complete and inseparable procedure in surgery of the Asian eye.

Simple Implant Augmentation Rhinoplasty.

Augmentation rhinoplasty among Asian patients is often performed to improve the height of the nasal dorsum. As the use of autogenous tissues poses certain limitations, alloplastic materials are a viable alternative with a long history of use in Asia. The superiority of one implant prosthesis over another for augmentation rhinoplasty is a matter of debate, with each material representing varying strengths and weaknesses, indications for use, and precautions to consider in nasal implant placement. An implant prosthesis should be used on a case-by-case basis. Augmentation rhinoplasty requires the consideration of specific anatomical preoperative factors, including the external nose, nasal length, nasofrontal angle, humps, and facial proportions. It is equally important to consider several operative guidelines to appropriately shape implants to minimize the occurrence of adverse effects and postoperative complications. The most common postoperative complications include infection, nasal height change, movement of implant prosthesis, and silicone implant protrusion. In addition, the surgeon should consider the current standards of Asian beauty aesthetics to better understand the patients desired outcome.

Treatment of Infected Facial Implants

Alloplastic facial implants have a wide range of uses to achieve the appropriate facial contour. A variety of materials such as metals, polymers, ceramics and synthetic injectable fillers are available to the reconstructive and aesthetic surgeon. Besides choosing the right surgical technique and the adequate material, the surgeon must be prepared to treat complications. Infection is an uncommon but serious complication that can cause displeasing consequences for the patient. There are few references in literature regarding treatment and management of facial implant-related infections. This study aims to discuss the role of biofilm in predisposing alloplastic materials to infection, to provide a review of literature, to describe our own institutional experience, and to define a patient care pathway for facial implant-associated infection.