Yu-Hao Huang

Fat Grafting for Recontouring Sunken Upper Eyelids With Multiple Folds in Asians-Novel Mechanism for Neoformation of Double Eyelid Crease.

BackgroundThis study reviewed the mini invasive technique, microautologous fat transplantation (MAFT), as a strategy in simultaneously treating sunken upper eyelids with multiple folds and recreating a double eyelid crease in Asian people. MethodsThe MAFT was performed with the assistance of a patented medical device, the MAFT-GUN, on 34 patients who had sunken upper eyelids and multiple folds. Each delivered fat parcel was accurately and consistently maintained at 1/240 mL during placement. Follow-up was regularly performed with photography for comparison. ResultsFifty-eight sunken upper eyelids with multiple folds were reconstructed. In addition to the ameliorative recontouring of hollowness, a natural eyelid crease was created postoperatively. Temporary swelling and bruising were noted several days after surgery without morbidities, such as fibrosis or nodulation. All of the patients were satisfied with the 1-time MAFT procedure. ConclusionsFat grafting for sunken upper eyelids with multiple folds has been reported in the literature. However, temporal effects and complications, such as nodulation and irregularity, have often occurred. A new method, MAFT, demonstrated its reliability as a modality for sunken upper eyelids with multiple folds in Asians. Moreover, MAFT might serve as an alternative for neoformation of double eyelids in these candidates.

Microautologous Fat Transplantation for Primary Augmentation Rhinoplasty: Long-Term Monitoring of 198 Asian Patients

Background Numerous techniques and materials are available for increasing the dorsal height and length of the nose. Microautologous fat transplantation (MAFT) may be an appropriate strategy for augmentation rhinoplasty. Objectives The authors sought to determine the long-term results of MAFT with the so-called one-third maneuver in Asian patients who underwent augmentation rhinoplasty. Methods A total of 198 patients who underwent primary augmentation rhinoplasty with MAFT were evaluated in a retrospective study. Fat was harvested by liposuction and was processed and refined by centrifugation. Minute parcels of purified fat were transplanted to the nasal dorsum with a MAFT-Gun. Patient satisfaction was scored with a 5-point Likert scale, and aesthetic outcomes were validated with pre- and postoperative photographs. Results The mean age of the patients was 45.5 years. The mean operating time for MAFT was 25 minutes, and patients underwent 1-3 MAFT sessions. The mean volume of fat delivered per session was 3.4 mL (range, 2.0-5.5 mL). Patients received follow-up for an average of 19 months (range, 6-42 months). Overall, 125 of 198 patients (63.1%) indicated that they were satisfied with the results of 1-3 sessions of MAFT. There were no major complications. Conclusions The results of this study support MAFT as an appropriate fat-transfer strategy for Asian patients undergoing primary augmentation rhinoplasty. Level of Evidence: 4 Therapeutic

The role of frontalis orbicularis oculi muscle flap for correction of blepharoptosis with poor levator function.

AbstractOn the basis of the close anatomical interdigitation between the longitudinal-oriented frontalis muscle and the horizontal-oriented orbicularis oculi muscle (OOM), frontalis OOM (FOOM) flap was developed to treat blepharoptosis. Retrospective study during an 11-year period, 66 patients with 81 poor levator function ptotic eyelids accepted FOOM flap shortening (65 lids; 80.2%) or double-breasted FOOM flap advancement (16 lids; 19.8%) to correct blepharoptosis. There were 51 (77.3%) patients with unilateral ptosis and 15 (22.7%) patients with bilateral ptosis. Severity of blepharoptosis included severe type in 72 (88.9%) lids, moderate type in 5 (6.2%) lids, and mild type in 4 (4.9%) lids. The underlying etiology included congenital origin in 43 (65.1%) patients, involutional change in 19 (28.8%) patients, and neurologic origin in 4 (6.1%) patients. Marginal reflex distance 1 and lid slit distance improved from −1.6 (2.0) to 3.3 (1.2) and 3.2 (2.0) to 7.2 (1.4) mm, respectively, after operation. The postoperative outcome includes good results in 54 (81.8%) patients, fair results in 10 (15.2%) patients, and poor results in 2 (3.0%) patients. The undercorrection or recurrence rate is 14.8%, and secondary revision rate is 11.1%. Positive Hering law is 17.6% among patients with unilateral ptosis. Overall patients’ satisfaction rate is 95.1%. Both FOOM flap shortening and double-breasted FOOM flap advancement are effective to treat poor levator function blepharoptosis. Double-breasted FOOM flap advancement is highly recommended because of the more natural contour and minimal lagophthalmos postoperatively, because of the maximal preservation of OOM.

Long-Term Outcome of Microautologous Fat Transplantation to Correct Temporal Depression.

Objective: Sunken temporal fossa appears oftentimes in Asians and resembles bad fortune that people wish to change. Numerous techniques and materials have been applied clinically for augmenting the sunken temporal fossa with variable results. The microautologous fat transplantation (MAFT) technique proposed by Lin et al in 2006 has demonstrated favorable results in facial rejuvenation. In the present study, the authors applied the MAFT technique with an innovative instrument in sunken temporal fossa and reported its results. Methods: Microautologous fat transplantation was performed on 208 patients during the 4-year period starting in January 2010. Fat was harvested by liposuction, processed and refined by centrifugation at 1200 g for 3 minutes. Then purified fat was microtransplanted to the temporal fossa with the assistance of an instrument, MAFT-Gun. The patients were followed up regularly and photographs were taken for comparison. Results: On average, the MAFT procedure took 48 minutes to complete. The average delivered fat was 6.8 ± 0.2 mL/6.5 ± 0.3 mL for the right/left side. The average follow-up period was 18 months. No complication including skin necrosis, vascular compromise, nodulation, fibrosis, and asymmetry was noted. The patient-rated satisfaction 5-point Likert scale demonstrated that 81.3% of all patients had favorable results (38.5% very satisfied and 42.8% satisfied). Conclusions: The concept and technique of MAFT along with the micro- and precise controlling instrument enabled surgeons to perform fat grafting accurately and consistently. In comparison with other strategies for volume restoration, the MAFT procedure demonstrated the patients’ high satisfaction with the long-term results. Therefore, the potential of MAFT as an alternative strategy in sunken temporal fossa in Asians was emphasized.

In situ pedicle lengthening of the anterolateral thigh flap

85e In Situ Pedicle Lengthening of the Anterolateral Thigh Flap Sir: H a wide range of applications, the anterolateral thigh flap has almost been the most representative soft tissue with minimal donor-site morbidity.1 Most important of all, with the vascular pedicle mostly arising from the descending branch of the lateral circumflex femoral artery, it can offer a sufficient length for microanastomosis to recipient vessels, especially in the field of head and neck reconstruction. Nevertheless, the complexity of the local vasculature of the anterolateral thigh flap has been well documented. Several studies have pointed out the possibility of no sizable perforators, even with Doppler vascular mapping preoperatively. Also, microsurgeons may need a backup procedure or an alternative.2 In addition, a substantial number of reported variations concerning the lateral circumflex femoral artery plus its branches emphasize the unpredictability of the perforators’ origin. If the only sizable perforator arises from the proximal thigh, it can only provide pedicle length that is less than 10 cm.3 The patient, a 42-year-old man, had been diagnosed with secondary right maxillary squamous cell carcinoma. Due to previous flap surgery, preoperative angiography was performed and only left-side neck vessels were relatively available for the recipient site. The desired pedicle length was determined to be 18 to 20 cm from the right-side upper face to the left superior thyroid artery and external jugular vein. A planned right anterolateral thigh flap was dissected. Nonetheless, the only sizable perforator that could be found was located at 7 cm proximal to the midpoint of the thigh. The perforator retrogradely originated from the oblique branch of the lateral circumflex femoral artery. The pedicle was estimated to be only 6 cm. In order to elongate the pedicle of the anterolateral thigh flap, the perforator was traced to the very beginning of the oblique branch and cut without influencing the blood flow of the descending branch of the lateral circumflex femoral artery. In addition, the descending branch was dissected to the most distal part as a vascular bundle bridge. Without separating the flap in advance, a one-artery and two-venae comitantes anastomosis was performed in situ of the anterolateral thigh incision wound (Fig. 1; Fig. 2, left and center). Utilizing this innovative method, we effectively elongated the pedicle from 6 cm to 18 cm (Fig. 2, right). Without sacrificing any other tissue or incising any other wound for vascular grafts, we successfully lengthened the pedicle of the anterolateral thigh flap and overcame the problems (Fig. 3). No complications were encountered postoperatively, and the flap survived completely. Kun Yong Sung, M.D. Department of Plastic and Reconstructive Surgery Kangwon National University Hospital Chuncheon City, Korea

Angular artery cutaneous flap for reconstruction of difficult oronasal fistulas.

Background:Oronasal fistulas after oromaxillary surgery may sometimes be encountered and remain a challenging problem. They can cause significant disabilities such as phonetic problems and food or liquid regurgitation while swallowing. A few methods are reported to solve this problem, including using a dental appliance, local tissue rotation, or even free-tissue transfer. Materials and Methods:An angular artery cutaneous flap was designed to repair the defect. The flap that included the skin and superficial fascia fed by the flow of angular artery was rotated through the buccal mucosa into the oral cavity to cover the palate defect. Case Reports:Two oronasal fistula cases were reported in this series.Case 1: A 71-year-old man had hard palate cancer and had received wide excision in our hospital 2 years previously. He had received adjuvant radiotherapy (28 times) and was transferred to the plastic surgery department for dealing with oronasal fistula. The palate defect was 2 × 2 cm.Case 2: A 72-year-old woman was a patient with left palate mucoepidermoid carcinoma. She had received an operation and adjuvant radiotherapy 10 years previously. For her oronasal fistula and hypernasality, she had received reconstructive operations 3 times with local rotation flap for left-side palate defect at a previous hospital. However, the local flap failed and the fistula persisted. She then approached our plastic surgery department for help. The palate defect was about 1 × 1 cm. We successfully reconstructed the oronasal fistula by using the angular artery cutaneous flap. The flap successfully sealed the oral cavity during the follow-up period. Conclusion:Angular artery cutaneous flap is a good alternative for reconstruction of the oronasal fistula. Especially in elderly patients, donor-site comorbidities are fewer due to the redundant aging skin and the missing tooth.

Micro-Autologous Fat Transplantation for Treating a Gummy Smile

Abstract Background A gummy smile is treated using many techniques, including botulinum toxin injection and various surgical interventions. Micro-autologous fat transplantation (MAFT) is a potentially advantageous alternative approach that has not been previously evaluated. Objectives This study sought to determine the long-term results of MAFT in patients with a gummy smile. Methods Seven patients with gummy smiles were evaluated for MAFT treatment between October 2015 and April 2017. Centrifuged purified fat was micro-transplanted into the nasolabial groove, ergotrid, and upper lip areas using the MAFT-GUN while the patients were under total intravenous anesthesia. Results The mean age of the 7 patients was 31 years (range, 23-40 years). The mean operating time for MAFT was 52 minutes (range, 40-72 minutes), and the mean volume of fat delivered to the nasolabial groove, ergotrid, and upper lip was 16.1 mL. The mean decreases of gingival display in the right canine incisor, left canine incisor, right canine, and left canine teeth were 4.9, 4.6, 3.8, and 4.4 mm, respectively. The smiles of the 7 patients showed significant improvement at an average follow-up time of 12.9 months. Conclusions Gummy smile treatment using MAFT is an effective, reliable, and relatively simple method, with high patient satisfaction and minimal risk of complications. Level of Evidence: 4

A Secure Technique for Microvascular Anastomosis in Arteries with Intimal Dissection: Intimal Sleeve Fold-Over Technique.

BackgroundIntimal dissection can cause an irregular internal surface with intimal flaps and subendothelial collagen exposure. This has been associated with a high risk of thrombosis. Trimming the artery to a healthy level is routinely recommended to avoid intimal dissection. However, this method is limited when there is inadequate vascular length to work with. MethodsWe dealt with an artery exhibiting severe intimal dissection by using a new suture technique: the intimal sleeve fold-over technique. Severe arterial intimal dissections were observed in 9 (6.9%) of 130 arterial microvascular anastomoses in free flap reconstruction for oral cancer patients from January 2013 to December 2013. We used this technique in 6 of the 9 patients. ResultsAll 6 patients were discharged as scheduled without perioperative problems and complications during follow-ups. The mean diameters of the recipient and pedicle arteries with intimal dissection were 2.13 and 2.20 mm. The mean time for performing sleeve fold-over procedure of on each artery was 5.1 minutes. ConclusionsA secure intima-to-intima contact can be achieved using this technique. This technique can provide an alternative method to intimal dissection when the length of the artery is limited.