Emi Okada

Three-Dimensional Facial Simulations and Measurements : Changes of Facial Contour and Units Associated with Facial Expression

Recent innovations in laser scanning technology provide a potentially useful technique for accurate three-dimensional documentation of the face. In this study, linear and area measurements of the facial contour and facial units have been recorded in a variety of chosen facial postures using surface laser scanning combined with three-dimensional lighting techniques on seven healthy volunteers and three patients with facial nerve paralysis. Three-dimensional surface measurement of the face was taken using a laser light scanner. Computer graphics lighting techniques were used to produce facial images constituted by highlights and shadows, which emboss facial contour and units. Then quantitative measurement of changes in facial angles and areas were made to analyze morphological changes of the face accompanying facial expression. Changes of angles and widths of the cheek and nasal units were found to be associated with dimensional changes imposed by the action of the underlying mimetic muscles. This system has potential value for both dynamic monitoring and evaluation of facial contour, units, and movement.

Promoted activation of matrix metalloproteinase (MMP)-2 in keloid fibroblasts and increased expression of MMP-2 in collagen bundle regions: implications for mechanisms of keloid progression.

Aims:  Keloid is characterized by excessive deposition of collagen, resulting from aberrant extracellular matrix (ECM) production and degradation. The aim was to investigate the role of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) in pathological wound healing in keloids.

Medial canthal reconstruction with glabellar combined Rintala flaps.

Background: In medial canthal reconstruction, the continuity of color and texture and the reproduction of natural external appearance are required, and reconstruction with a flap adjacent to the defect is frequently performed as the first choice. The authors have performed reconstruction with a glabellar flap combined with a Rintala flap in five patients. Methods: A glabellar flap, which is rectangular according to the unit principle, was elevated, and after thinning and trimming to the defect shape, was transferred to the medial canthal defect. The donor site of the glabellar flap was closed with a Rintala flap. Results: Reconstruction by means of this procedure was performed in five patients with defects after resection of medial canthal basal cell carcinoma. In one patient with extension of the defect to the upper and lower eyelids, the tip of the glabellar flap was divided into two portions and transferred to the defective site. No recurrence was observed in any patient, and satisfactory results including aesthetic results were obtained in all patients. Conclusions: This technique can be performed readily and is applicable to the reconstruction of relatively large defects and is also aesthetically excellent because of a postoperative suture line that is consistent with the topographic curve. This technique may be useful for medial canthal reconstruction.

A simple method for forehead unit reconstruction.

The supratrochlear and supraorbital vessel-based island flap was used to avoid excessive scarring during reconstruction of the unilateral forehead defects after surgical excision of a malignant tumor. This method had a number of advantages: operation time was short, it was a one-stage procedure, the technique was relatively simple, a good match of the texture and color could be achieved, and scars were inconspicuous.

The V-Y advancement myotarsocutaneous flap for upper eyelid reconstruction

The V-Y advancement myotarsocutaneous flap was used to avoid excessive scarring during reconstruction of a full-thickness upper eyelid defect following surgical excision of a malignant tumor. This method has a number of advantages: It has a short operative time, it is a one-stage procedure, it does not require lining by auricular or septal cartilage, the technique is relatively simple, and the scar is inconspicuous, since both flap margins are placed in skin creases. The V-Y myotarsocutaneous flap is best suited for the repair of full-thickness upper eyelid defects ranging from 25 to 50 percent of the lid width when the remaining lateral canthal structures are adequate to support the flap.

A simple method for earlobe reconstruction

We describe a technique for earlobe construction using the V-shaped flap with rotation and transposition techniques. This technique produces a natural appearing lobule without unpleasant secondary deformity. This method has been used on two patients, with very good results.

Endoscopic Extraction of Lipomas Using an Ultrasonic Suction Scalpel

Lipomas were extracted with an ultrasonic suction scalpel, assisted by an endoscope, with good results. The combined surgical technique is described in this paper. Preoperative clinical findings and diagnostic imaging of the patients provided a preoperative diagnosis of lipomas. For the procedure, the endoscope was inserted through a small incision immediately above the tumor. The tumor was endoscopically confirmed and then extracted with an ultrasonic scalpel. Complete lipoma extraction was achieved in all patients without recurrence. The patients had good cosmetic results with only minimal postoperative scarring. The endoscopic extraction of lipomas with an ultrasonic scalpel is proven to be highly useful, especially for large tumors, and permits a less invasive and more reliable surgical operation.

Nasal augmentation using calcium phosphate cement.

This report describes a simple technique for augmentation rhinoplasty using calcium phosphate cement paste for postoperative and posttraumatic nasal deformities. This biomaterial was used to correct traumatic nasal bone deformity in one patient and for augmentation rhinoplasty after removal of the nasal implant in two patients. These patients were followed for a minimum 6 months and a maximum of 26 months. The esthetic results were satisfactory with no complication. Calcium phosphate cement consisting of alpha-tricalcium phosphate, dicalcium phosphate dibasic, and tetracalcium phosphate monoxide has been used for bone replacement and augmentation because of its good biocompatibility and osteoconductivity. This technique is easy and safe. It seems to be a suitable material for augmentation rhinoplasty in the Orient. Its long-term safety and reliability require proof with longer follow-up periods, however.

Bilobed fasciocutaneous flap for primary repair of a large upper arm defect with secondary closure of the donor site without a skin graft.

Primary repair of 2 patients with large upper arm defects with the bilobed fasciocutaneous flap is reported. In this procedure the repair of a large soft-tissue defect with a flap prepared adjacent to the defect and closure of the flap donor site are performed at the same time without a skin graft. This procedure enabled regional reconstruction and provided excellent aesthetic results. It is simple and reliable. In addition, primary repair of large upper arm defects can be expected.

Treatment of Vaginal Agenesis with an Expanded Vulval Flap

We propose a vaginal reconstruction method using an expanded vulval flap. This technique avoids long-term dilation and combines the advantages of commonly used methods of treatment for vaginal agenesis, resulting in good functional outcome.