Burçak Tümerdem

Forehead Lift: A Combined Approach Using Subperiosteal and Subgaleal Dissection Planes

Abstract. The eyelid–eyebrow region is the center for facial expression. Youth and beauty are associated with smooth, wrinkle-free skin and proportional facial features. The position of the eyebrows conveys emotion, and consequently, even a minor change in brow position can alter the expression of an individuals face. Repositioning the eyebrows and reducing the prominence of the glabellar frown lines can change the expression from one of anger and hostility to one that is more pleasant and natural. Various methods have been used for rejuvenation of the upper face. The height or length of the forehead is a useful guide for choosing the appropriate technique. We performed the coronal browlift using the subgaleal dissection plane, with subperiosteal dissection of 2.5 cm of the periosteal band over the supraorbital rim. We believe that this technique provided us with the benefits of the two dissection planes, with a more permanent result.

Free Nipple Reduction Mammaplasty with a Horizontal Scar in High-Risk Patients

Women with extremely large and ptotic breasts have many complaints and difficulties during daily life. Conventional reduction mammaplasty techniques are not convenient because the presence of excess tissue beneath and over a long pedicle may cause nipple-areola complex necrosis. These patients mostly have systemic health problems so they benefit from a shorter operative procedure. The amputation method is an option providing rapid surgical operation time and little blood loss but it may lead to a flat, unaesthetic breast with poor projection. In this paper we present an alternative amputation with the use of a backfolded dermoglandular flap and free nipple graft. The inferior pole is amputated. The deepithelialized breast tissue is left on the superior pedicle extending below the 7-cm vertical limb mark. This deepithelialized tissue is tucked to give more central mound projection. The aesthetic outcomes, such as well-rounded breasts with good projection and a hidden scar at the submammary sulcus, have led us to perform this technique, which was first described by the Mansteins in 1997.

Rupture of a Silicone Gel Mammary Prosthesis and Amyloidosis: A Case Report

There has been a great deal of controversy regarding the safety of silicone breast implants. Silicone gel prostheses older than 10 years have the risk of either leakage or outright rupture. The role of silicone gel in relation to connective tissue disease or amyloidosis has not been proved by current serologic, immunologic, or epidemiologic tests. In this paper, we present a case with renal amyloidosis and a history of untreated silicone implant rupture for five years.

The use of the ipsilateral versus contralateral pedicle and vertical versus horizontal flap inset models in TRAM flap breast reconstruction: The aesthetic outcome

The use of an ipsilateral or a contralateral rectus abdominis muscle as a pedicle and comparison of their advantages and disadvantages in TRAM flap breast reconstruction have been reported in the literature. In our clinical experience with 22 pedicled TRAM flap breast reconstructions, the use of either an ipsilateral or contralateral pedicle was found to be equivocal regarding the flap viability and the aesthetic outcome. Thus, it seems better to decide their use according to the needs of an individual patient.In our series, the contralateral pedicled TRAM flap with a vertical flap inset was preferred in patients with a small opposite breast or in patients with infraclavicular tissue losses (four patients). The ipsilateral pedicled TRAM flap reconstruction with a horizontal flap inset was preferred in patients with a full and attractive opposite breast, unless they received adjuvant radiotherapy (six patients). In patients who received adjuvant radiotherapy the contralateral pedicle was used regardless of the inset model preferred (10 patients). Bilateral TRAM flap breast reconstruction was applied in one of our cases, which is not included in the three categories above mentioned. The aesthetic outcome was determined by analyzing a patient satisfaction questionnaire. Overall satisfaction was achieved in 17 patients. Four patients were dissatisfied.We think that choosing the correct flap inset model is one of the most important factors in achieving a satisfactory aesthetic outcome. Choosing the correct pedicle regarding the type of the flap inset model is equally important to facilitate technical ease during flap transposition and to improve flap survival.

Modification of Vertical Scar in Vertical Mammaplasty Technique

Abstract. Vertical mammaplasty is a simple and safe procedure that relies on an upper pedicle to the areola with lower central breast reduction and glandular shaping. We applied this technique to six patients adding a modification of the vertical scar which distributed skin tension both to the areola and vertical suture line. It prevented an unacceptable puckering vertical scar and enlargement of areola. This modification also provided satisfactory breast shape with a good vertical scar especially at the early postoperative period.

Augmentation mammaplasty by medial periareolar incision.

Various techniques and different types of incisions have been used for breast augmentation, the choice of which depends on regional and physical characteristics of the patient, an indication for the operation, and the decision of the patient and the operator. The periareolar approach is ideal for cases of developmental hypomastia that have adequate skin and glandular tonus and with minimum ptosis. The disadvantages of this method are a hypopigmented scar on the pigmented areola and a decrease in sensitivity of the nipple-areola. This article presents the experiences of the Department of Plastic and Reconstructive Surgery of the University of Istanbul, Faculty of Medicine between 1995 and 1998, on medial periareolar submuscular augmentation approaches to five cases. During this follow-up period we had no major complications.