Facial Aesthetic Units Research Articles

Three-dimensional Analysis of Lifting Effects after High-intensity Focused Ultrasound (Ultraformer-MPT) across Seven Facial Aesthetic Units Considering SonoAnatomy.

This investigation delves deep into the lifting degree for each area of noninvasive facial rejuvenation through high-intensity focused ultrasound (HIFU). The study meticulously examines the lifting effects of HIFU treatment across seven distinct facial aesthetic-units, using advanced three-dimensional scanner analysis. The study examined a cohort of 50 patients treated with HIFU. Pre- and immediate posttreatment evaluations were conducted using three-dimensional scanner analysis, allowing for precise quantification of lifting effects across seven aesthetic units. Treatment protocols were tailored to leverage five cartridges with micropulsed mode options, optimizing outcomes based on sonographic anatomy. The forehead was lifted by 1.24 mm; crow's feet, 2.25; malar region, 2.46; posterior cheek, 3.40; jowl, 2.90; mandible, 3.09; and neck, 3.53. The forehead showed a lift of 1.24 mm, attributed to the thin tissue requiring a cautious approach to avoid discomfort. A lift of 2.25 mm in the crow's feet area demonstrated the efficacy of HIFU in addressing fine lines and wrinkles. Significant lift of 2.47 mm in the malar region highlights HIFU's effectiveness in addressing mid-face laxity and restoring volume to the cheeks. The most substantial lift of 3.38 mm in the posterior cheek underscores targeted energy application for enhanced lifting and contouring. Notable lifting effect of 2.90 mm in the jowl area benefits sagging along the jawline, refining facial contour. Lift of 3.10 mm in the mandible shows improvement of lower facial laxity, defining the jawline. The highest lift of 3.55 mm in the neck region addresses laxity and sagging for a defined neck profile.

Trapezius Island Myocutaneous Flap for Head, Neck, and Facial Reconstruction in Neurofibromatosis Type 1-Associated Plexiform Neurofibromas.

Reconstruction of significant soft tissue defects in the head and neck region after resection of extensive plexiform neurofibromas, as well as preservation and restoration of cosmetic and functional aspects, presents a considerable challenge. The purpose is to evaluate the feasibility of eTMF in repairing substantial defects after the complete resection of NF1 PN. Patients diagnosed with substantial neurofibromatosis (NP) type 1 (NF1), according to the revised criteria, underwent complete resection and remodeling of the facial aesthetic unit. An extended vertical lower trapezius island myocutaneous flap (eTIMF) was used for the defect reconstruction. Perioperative complications were evaluated using the Clavien-Dindo classification. ECOG PS was assessed. Postoperative follow-up at 6 months and completion of UW-QOL. The questionnaire included swallowing, chewing, speech, and quality of life scores. Two patients had pathogenic missense variants: c.5609G>A (p.Arg1870Gln) in exon 38 of NF1 in the first case, and c.4600C>T (p.Arg1534*) in exon 35 in the second case. Two eTMFs were harvested successfully. Five facial esthetic units were remodeled, and 4 units were remodeled. Two extensive tumors were nearly entirely removed. No severe complications were noted. The ECOG PS improved from grade 3 in the first week postsurgery to grade 0 by the eighth week. The UW-QOL results indicated that swallowing, chewing, and speaking functions returned to their preoperative levels, with a 40% improvement in quality of life, reaching 60% and 80%, respectively. eTMF to repair substantial defects following total resection of NF1 PN and facial esthetic unit remodeling enhances appearance, function, and psychosocial outcomes. This technique is safe, efficient, resource-conserving, and simple to implement.

Large facial malignant tumor defect reconstruction using keystone flap: a case report

Background: Facial defects resulting from a large malignant tumor excision are often too extensive for primary closure, necessitating the use of skin flaps or grafts. The challenge is particularly pronounced when the defects occur in the facial region. Deciding how to reconstruct facial defects involves considering various factors, with aesthetics taking precedence over other body parts. The preferred method for closing these defects is ideally by transposing local tissues with similar qualities, especially in cases where primary closure is not feasible due to the size of the defect. Case presentation: A case report study of a 60-years-old female patient referred to H. Adam Malik Hospital and underwent excision of malignant tumor and left with large defect on the right cheek and 2/3 upper & 1/3 lower vermillion. Skin flap techniques, such as the advancement flap, rotation flap, and transposition flap, are useful for closing small defects. When dealing with moderate to large-sized defects, especially in high-tension areas, a combination of flap types may be necessary. Over the past two decades, pedicled perforator flaps, notably the keystone flap design, have gained popularity as a viable option. Understanding facial aesthetic units, subunits, and factors influencing incision/scar placement is crucial for clinicians aiming to achieve the most cosmetically pleasing outcome. Conclusions: The presented case details the successful closure of a sizable cheek defect post squamous cell carcinoma excision surgery, achieved through the utilization of a KPIF Type IIA. Patient showed good flap survival.

Aesthetic Reconstruction Based on Facial Subunit Principle for Basal Cell Carcinoma of the Face: A Retrospective Analysis.

Background and objective Basal cell carcinoma (BCC) is the most common malignancy of the skin. Reconstruction of post-excisional defects in BCC should follow the subunit principle for better outcomes. The location of BCC of the faceis determined based on facial units; however, very few studies have described the involvement of multiple units and multiple subunits in BCC. In this study, we aimed to provide valuable insights into the management of BCC involving various facial units and subunits, thereby contributing to improved patient care and outcomes. Materials and methods We conducted a retrospective studyat the Plastic Surgery Department of the SCB Medical College in Cuttack, Odisha, from January 2020 to January 2022, after obtaining ethical approvalfrom the SCB Medical College IRB (no: 1155). We examined 35 patients with BCC of the face. The inclusion criteria were as follows: patients with early-stage and primary tumors that were mobile, not attached to underlying bone or cartilage, and amenable to surgical resection. Conversely, patients with late-stage, neglected, and recurrent tumors, fixed tumors, or those infiltrating the underlying bone or cartilage were excluded from the study. Data collection involved retrieving pertinent information from medical records, including parameters such as age, sex, tumor site, type of flap utilized, follow-up, and any complications observed. The tumor sites were further divided into six separate groups based on facial aesthetic units: the forehead, the nose, the area around the eyes, the cheek, the mouth, and the area around the ear, each with its own subunits. Results A total of 35 patients were included in this study, comprising 15 males (42.85%) and 20 females (57.15%), with a male-to-female ratio of 1:1.33. The ages of the patients ranged from 42 to 68 years. Among the facial units, the nose was the most commonly involved (in seven cases), while the lip was the least commonly affected (in one case). In 24 cases, a single unit was involved, while 11 cases involved multiple units. Furthermore, single subunits were affected in 18 cases, double subunits in 10 cases, three subunits in five cases, four subunits in one case, and five subunits in another case. Notably, no cases exhibited flap necrosis, wound dehiscence, wound hematoma, or seroma, indicating excellent surgical outcomes. All flaps remained viable, and all patients were followed up for a minimum of one year, with no reported recurrence during the follow-up period ranging from 6 to 18 months, reaffirming the effectiveness of the treatment approach. Conclusions For small, superficial lesions, full-thickness skin grafts (FTSG) are a suitable treatment option. However, when dealing with larger lesions that encompass multiple subunits, the preferred approach involves reconstructing with locoregional flaps. It is essential to plan the procedure carefully, taking into account the goal of positioning the final scar along the junction of facial subunits. This strategic plan aims to achieve superior aesthetic outcomes.

Cervicofacial Pediatric Tissue Expansion: Aesthetic Unit-Based Algorithm.

Tissue expansion is a powerful tool for reconstruction of pediatric soft-tissue pathologies, but complication rates for children have been reported as high as 40%. Infection and implant extrusion lead to premature removal and delays in reconstruction. Expanding the head and neck is uniquely challenging because the confluence of facial aesthetic units must be respected. These challenges have prompted the senior author's creation of an aesthetic-unit based algorithm. A retrospective study of pediatric patients who underwent cervicofacial tissue expander placement by the senior author (R.J.R) was performed over a 17-year period. Predictor variables included age, sex, race, indication, number of expanders placed at each operation, serial expansion, expander type, expander size, home versus clinic inflation, and prophylactic antibiotics. Univariate and multivariate analyses were performed to identify risk factors for complications. An aesthetic-unit based reconstructive algorithm is proposed. Forty-eight pediatric patients had 111 cervicofacial tissue expanders placed. Twenty expanders were associated with complications (18%) for surgical site-infection (12.6%), extrusion (4.5%), and expander deflation (6.3%). Expanders placed for congenital nevi (p=0.042) and use of textured expander (p=0.027) were significantly associated with decreased complications. When controlling for covariates, serial expansion of the same site was associated with increased rates of readmission (p=0.027) after having just one prior expander. Iatrogenic ectropion occurred in 13.5% of the study population; expanders with at least one complication during tissue expansion were significantly associated with incidence of iatrogenic ectropion (p=0.026). By using an aesthetic-unit based algorithm, reconstructive outcomes can be optimized for pediatric cervicofacial tissue expansion.

2. Cervicofacial Pediatric Tissue Expansion: A Single Surgeon’s 16-year Experience & Aesthetic Unit-based Algorithm

PURPOSE: Tissue expansion is a powerful tool for the reconstruction of soft-tissue defects in pediatric patients. However, complications have been reported as high as 48% for cervicofacial pathology. Unique challenges include respecting the confluence of facial aesthetic units and avoiding ectropion. The senior author’s experience with pediatric cervicofacial tissue expander (TE) placement is presented with an aesthetic-unit based algorithm. METHODS: A retrospective study of pediatric patients who underwent cervicofacial TE placement by the senior author was performed over a 16-year period (1/2006 to 2/2022). Predictor and outcome variables were included. Univariate and multivariate logistics regressions were performed on all variables. A p≤0.05 was considered statistically significant. RESULTS: There were 111 TEs included with an 87.4% successful reconstruction rate. An aesthetic-unit based reconstructive algorithm is proposed based on the senior surgeon’s experience. Complications occurred in 21.6% of TEs. Iatrogenic ectropion was noted in 13.5% of patients; revisional surgery corrected 66.7% of cases. TEs that had at least one complication during expansion were significantly associated with the incidence of iatrogenic ectropion following flap advancement (O.R., 4.99; 95% C.I., 1.22-20.46; p=0.026). CONCLUSION: By using an aesthetic-unit based algorithm, pediatric cervicofacial tissue expansion can be optimized.

Application of a Modified Perforator Flap of the Transverse Facial Artery for Zygomaticofacial Skin Defect Repair After Tumor Resection.

The transverse facial artery is an important source of zygomaticofacial blood, but its perforator flap is rarely reported. The aim of this study was to investigate the utility of a modified perforator flap based on facial aesthetic units and previous anatomic studies of transverse facial arteries. All 18 elderly patients with zygomatic facial tumors underwent Mohs surgery. The V-Y and propeller flaps were designed according to the aesthetic unit of the defect site. Only a small portion of the fascia and fat surrounding the blood vessel are left, the rest of the flap is pruned to a thickness closer to the surrounding tissues. The surgical effect was comprehensively evaluated by an expert group. To assess the patient's postoperative quality of life, we administered the FACT-H & N (v 4.0) scale before and after surgery. Among the 18 flaps, 10 were V-Y flaps and 8 were propeller flaps. The flaps of 18 patients survived, with adequate cheek, facial symmetry, and proper mouth opening. The flaps worked well and looked good at both the recipient and donor sites. According to the scale survey, the postoperative patients had a higher quality of life in terms of physiology, psychology, function, and other areas than the preoperative patients ( P <0.05). A modified flap of the transverse facial artery can rotate flexibly and repair a larger area, as the blood flow is relatively constant near the zygomatic arch. It has a high clinical value in the treatment of zygomaticofacial tumors.

Accuracy of Three-Dimensional Soft-Tissue Prediction Considering the Facial Aesthetic Units Using a Virtual Planning System in Orthognathic Surgery.

Virtual surgical planning (VSP) is commonly used in orthognathic surgery. A precise soft-tissue predictability would be a helpful tool, for determining the correct displacement distances of the maxilla and mandible. This study aims to evaluate the soft-tissue predictability of the VSP software IPS CaseDesigner® (KLS Martin Group, Tuttlingen, Germany). Twenty patients were treated with bimaxillary surgery and were included in the study. The soft-tissue simulation, done by the VSP was exported as STL files in the engineering software Geomagic Control XTM (3D systems, RockHill, SC, USA). Four months after surgery, a 3D face scan of every patient was performed and compared to the preoperative simulation. The quality of the soft-tissue simulation was validated with the help of a distance map. This distance map was calculated using the inter-surface distance algorithm between the preoperative simulation of the soft-tissue and the actual scan of the postoperative soft-tissue surface. The prediction of the cranial parts of the face (upper cheek, nose, upper lip) was more precise than the prediction of the lower areas (lower cheek, lower lip, chin). The percentage of correctly predicted soft-tissue for the face in total reached values from 69.4% to 96.0%. The VSP system IPS CaseDesigner® (KLS Martin Group; Tuttlingen, Germany) predicts the patient’s post-surgical soft-tissue accurately. Still, this simulation has to be seen as an approximation, especially for the lower part of the face, and continuous improvement of the underlying algorithm is needed for further development.

Consideration of Facial Aesthetic Units When Resecting Malignant Facial Lesions

Consideration of Facial Aesthetic Units When Resecting Malignant Facial Lesions

Is More Better? Benefits of Hyaluronic Acid Soft Tissue Filler on the Psychological- and Social-Related Quality of Life Dimensions.

Hyaluronic acid (HA) soft tissue fillers are popular for volumizing, sculpting, or rejuvenating the face. Their effect beyond these cosmetic benefits remains poorly defined, especially the changes in the psychological and social dimensions of health following cosmetic HA filler injections. To determine whether injecting more facial aesthetic units with HA soft tissue filler will improve the health-related quality of life dimension of patients. A prospective study was conducted to assess the psychological and social benefits of treating multiple facial aesthetic units with HA soft tissue filler using 3 validated FACE-Q scales at baseline and 4 weeks posttreatment between January and August 2022. Data for 28 participants (n = 26 females [93%]; mean age: 49.7 ± 10.1 years) are available and reveal significant improvements on the psychological (+24.5; P < .001) and social functioning (+18.5; P < .001) FACE-Q scales and a reduction in the appearance-related distress score (-17.8; P < .001) posttreatment compared to baseline. A mean volume of 4.7 mL (range 1.0-15.2 mL) was injected. However, patients who had >2 facial aesthetic units injected did not statistically score better on the FACE-Q scales. Facial treatment with HA fillers was associated with a marked improvement in the health-related quality of life dimension. While understanding patients' aims and motivation, an individualized treatment approach is strongly encouraged instead of a "whole-face" approach.

Aesthetic Unit-Based Reconstruction of Facial Defects with Local Flaps after Surgical Excision of Basal Cell Carcinoma

Background: Basal cell carcinoma (BCC) represents themost common type of facial skin cancer in Middle East andEgypt. It rarely metastasizes, but because of its locally destructivenature, it can cause high morbidity. Reconstructionby local flap after surgical excision depends on the size ofthe defect and the affected facial aesthetic unit.Aim: To reveal the prevalence of facial BCC, relation ofits site to facial aesthetic units and type of local flaps usedfor reconstruction per units.Patients and Methods: A retrospective study was conductedon 80 patients with facial BCC that admitted to the outpatientclinic, Plastic Surgery Department, Qena University Hospitalfrom June 2018 to May 2020 (2 years duration). Only earlystageand primary tumors were included. Statistical analysis:Data was analyzed using the Statistical Package for SocialSciences (SPSS) version 24. A p-value significant.Results: 80 patients with facial basal cell carcinoma (BCC)were collected from medical records. 45 (56.25%) patientswere males and 35 (43.75%) patients were females (M:F =1.3:1). Ages ranged from 52-78 years old (SD = 65±13).Nodular subtype was the most common clinical type of BCCand presented in 45 (56.25%) patients. Nasal unit was themost common site in 18 (22.5%) patients. The most randomflap applied was the rhomboid (Limberg) flap in 15 cases.The most axial flap used was the nasolabial flap in 9 cases.Complications (6 cases, 7.5%) included: Wound dehiscencein 3 cases, infection in 2 cases and skin slough in 1 case. TheSCAR scale score result ranged from 0-2 score.Conclusion: Facial defects reconstruction after surgeryfor basal cell carcinoma is a complex endeavor that requirescareful consideration. There are many different local flapsavailable depending on the particular facial subunit thatrequires reconstruction. Careful recognition of the principlesof the facial subunits will equip the surgeon to achieve thebest possible functional and aesthetic outcomes.

Nasal Aesthetic Evaluation Following Pre-Surgical Naso-Alveolar Molding Application: A Single-Blinded Cohort Retrospective Study in Indonesia

Introduction: As a major facial aesthetic unit, the nose is one of the significant features in cleft lip and palate repair. The use of a naso-alveolar molding (NAM) device was known to help narrow the cleft gap and improve nasal aesthetics. This study aims to evaluate post-operative nasal morphology in unilateral cleft lip and palate patients who had used presurgical NAM, particularly in an established craniofacial centre in one of developing countries. Methods: A cohort retrospective study was conducted at Cleft Craniofacial Centre, Cipto Mangunkusumo Hospital Indonesia, comparing the nasal symmetry in unilateral cleft lip patients with and without prior application of NAM (NAM and control group), twelve months following primary cheiloplasty. Differences between the cleft and normal side were assessed using standard basilar view photographs based on five points nasal measurements. Results: A total of twelve patients were enrolled, six with a history of NAM application and six without (control). Overall nasal measurements confirmed a lower mean of differences in the NAM group compared to the control, showing statistically significant results in nostril height, nasal dome height, and columellar height (p &lt;0.05). Conclusion: This study provides an insight that cleft lip patients with a history of NAM application had superior nasal symmetry compared to patients without presurgical NAM application 1-year post-cheiloplasty. Presurgical NAM application is recommended for patients with unilateral cleft lip and palate.

Lipofilling after Laser-Assisted Treatment for Facial Filler Complication: Volumetric and Regenerative Effect.

Nonresorbable substances are still injected to enhance soft-tissue volumes and fill subcutaneous defects. The minimally invasive intralesional laser treatment can remove foreign substances and the inflammatory reaction, eventually leaving depression and scar tissue in the treated area. Fat grafting can restore volume loss and improve scar tissue. From March of 2010 to February of 2017, 33 patients were studied. All of them had suffered from inflammatory reactions to permanent facial fillers and had been treated with the 808-nm diode laser at the authors' institution. The evacuation of material had left facial asymmetry and visible depression. To restore facial aesthetic units, fat grafting was performed. The minimum follow-up was 6 months. Volume restoration was recognized (according to the Global Aesthetic Improvement Scale) as significantly improved in 22 patients, moderately improved in eight patients, and slightly improved in three patients. Improvement in atrophic and scarred tissues (with an apparent thickening of the skin or even elimination of scars) was also assessed with the following results: 25 patients were very much improved and eight were moderately improved. This is the first study on filler-induced complications of the face treated by intralesional laser treatment followed by lipofilling. A systematic approach to volume restoration is proposed to patients who had filler removal of the face. There was a high degree of patient satisfaction with this technique. Therapeutic, IV.

Total nasal reconstruction with a forehead flap: Focusing on the facial aesthetic subunit principle

The nasal aesthetic subunit principle has been widely accepted as the standard for nasal reconstruction with forehead flaps. However, in our experience, one's impression of a reconstructed face can easily be represented by the nose's entire appearance rather than a single nasal component. Accordingly, we hypothesized that total nasal reconstruction focusing more on the facial aesthetic subunit principle would be superior to focal nasal subunit partial reconstruction. Here, we investigated the indication range of total nasal reconstruction and analyzed its effectiveness. Between July 2006 and December 2017, 32 patients who underwent total or subtotal nasal reconstruction were recruited. The total nasal reconstruction group (n = 20) was treated according to our modified facial aesthetic unit concept, while the subtotal reconstruction group (n = 16) was treated according to the nasal aesthetic subunit principle. Using retrospective reviews, we compared surgical details and aesthetic, and functional outcomes with visual analog scale scores. In aesthetic evaluation, nose contour (p = 0.009), nasal symmetry (p = 0.001), and nostril shape (p = 0.041) were superior in the total nasal reconstruction group. Satisfaction regarding the nose (p = 0.036) was significantly higher than that regarding the forehead and labial folds in the total group. Regarding function, there were no significant intergroup differences in nasal airflow, snoring, or olfaction. We suggest that total nasal reconstruction is not a strategy to avoid because of its aggressive nature. For selected suitable patients, the use of the total nose reconstruction focusing on our one nose concept can be a successful surgical option, and the reconstructed nose can be visualized as a real part of the face.

Using rational strategies for children's scars based on more than 5 years assessment after burn

BackgroundPaediatric patients with scars after burn are regularly encountered. Discussion of rational strategies for management are of value. The objective of the study was to describe development and utilisation of strategies for paediatric burn scars up to five years after injury. MethodsWe included 164 cases aged from 5 to 8 years old in our study; all had burn scar deformities. ResultsAssessments were made up to December 31, 2019. The following strategies were used: sequential treatment, reconstruction based on facial aesthetic units, predicting the effect of surgery on development, releasing skin tension and application of photoelectric technology or other non-surgical measures. ConclusionsUsing rational strategies for paediatric burn scars is very important.

A Survey of Aesthetic Standards of the Ear.

The aesthetic standards of the ear are very important for evaluation of auricular surgery. Few studies have previously assessed ear aesthetics, especially in China. This study aimed to investigate aesthetic standards of the ear in a Chinese population. A questionnaire was administered to Chinese individuals, which included assessment of the general impressions of the ear and other facial aesthetic units, the individual aesthetic subunits of the ear, the effects of different ear subunits on ear symmetry and the degree of the subunits to which the participants wanted to change. Answers were recorded on a five-point Likert-style scale. Statistical analysis was performed using SPSS ver. 17.0. A total of 319 responses were received, 50.3% women and 49.7% men. The external ear received the lowest degree of attention either on the front or on the lateral view of the face in both genders. Among the individual aesthetic units, the earlobe received the most attention and the fine structures the lowest. The helix had the greatest effect on the ear symmetry. The structure that participants most wanted to change was the earlobe in males and the helix in females. There were significant differences on the evaluation of the helix and crus of helix among the groups divided according to educational background (P < 0.001). The results showed that the structures that people were most concerned about were the helix and earlobe. There were gender differences in the results which were also influenced by education background.

Facial Reconstruction According to Aesthetic Units.

Context:The facial subunit principle organizes the facial skin into subunits. Facial reconstruction for skin cancer based on aesthetic units consists of replacing the entire subunit when a large part of a subunit has been removed.Aims:To determine the prevalence of facial skin cancer, their location by facial aesthetic units, and the type of facial reconstruction used in each of them.Settings and Design:An observational cross-sectional study was conducted at the Head and Neck Surgery Service of a general hospital between 2017 and 2018.Materials and Methods:A population census was conducted during this period.Statistical Analysis Used:The categorical variables were expressed as frequencies (percentages). Continuous variables were described as the means and standard deviations or medians and interquartile ranges.Results:The most common skin cancer was basal cell skin cancer, followed by epithelial skin cancer and, at last, melanoma. In general, the most frequent localization of these cancers was the nose.Conclusions:In spite of primary closure being the most common form of reconstruction, a considerable number of patients required facial reconstruction based on aesthetic facial units, with satisfying results.

The effects of estrogens and phytoestrogens on human skin and its topical use for prevention of skin aging - Literature Review

It is noteworthy the range of facial treatments, with aesthetic purpose, with which we can preserve the balance of the shape or beauty of our patients. Fillers, botulinum toxin, laser, and other technologies are widely used in dermatology. Eyelids can also be treated with these and other therapeutic resources. However, herniation of the fat pockets of the upper eyelids does not present significant results with these methods. The advancement of techniques known as minimally invasive and other technologies does not satisfy the treatment of this facial aesthetic unit. Thinking about the global rejuvenation of the face, it is unlikely that we will achieve a result of excellence without acting on the eyelids. Upper blepharoplasty remains irreplaceable, and it is the treatment of choice for skin redundancy and herniation of fat pockets. This surgery, with a long history in Dermatology, has a unique and fundamental role in facial rejuvenation. In this study, we tried to demonstrate the surgical technique of superior blepharoplasty educationally and to prove its efficacy and safety, with good aesthetic and functional results. With full knowledge of this anatomical region and technical precepts, we recognize that we can perform it safely

The Use of Rotation Flap to Cover a Facial Defect—A Case Study

Background: There are often situations that require the correction of facial defects. Local fasciocutaneous flaps provide a reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Among the various options of local flaps is the use of a rotation flap. Aim: The aim of this work is to demonstrate the reliability of the rotation flap in the correction of facial defects and its ability to achieve a good aesthetic outcome by applying the knowledge of facial aesthetic units. Case Presentation : This is a case report of a 28-year-old woman who suffered an avulsion injury to the face with loss of facial tissue resulting in exposure of the left zygomatic bone. The defect measured 5 cm × 6 cm. A rotation flap was used to cover the defect after the wound had been previously irrigated and debrided. Her wounds healed well. She suffered no facial nerve injury. The rotation flap resulted in a good colour match with no disruption of facial contour. Conclusion: The Rotation flap provides a reasonable option for reconstruction of facial defects with good colour and texture match.

Comparison of aesthetic outcome of different facial reconstruction techniques after resection of cutaneous squamous cell carcinoma

PurposeThe aim of the study was to compare local and distant flaps for facial reconstruction after resection of cutaneous squamous cell carcinoma. Patients and methodFifty patients with facial CSCC and subsequent facial reconstruction were retrospectively analysed. All complications such as wound infection, wound dehiscence, flap necrosis, partial or total flap loss were recorded. The aesthetic outcome was evaluated using colour prints of patients’ photographs of different flaps in terms of skin colour, texture and scars by three judges. To compare the aesthetic outcome of distant and local flaps a Wilcoxon-Mann-Whitney-U-Test was applied. ResultsThe overall complication rate was low. Colour and texture of local flaps presented statistically significantly better results compared to distant flaps. There were no statistically significant differences between scars of local flaps and distant flaps (p = 0.528). A slight tendency was found showing scars of local flaps to be less visible than scars of distant flaps in defects extending in more than one facial aesthetic unit. ConclusionLocal flaps show statistically significant ly better aesthetic results compared to distant flaps in terms of colour and texture. Scars of local flaps seem to be slightly less visible compared to distant flaps in cases where defects were bridging more than one facial aesthetic unit. We conclude that local flaps should be preferred over free flaps whenever possible as far as the aesthetic outcome is concerned.