Preoperative Photographs Research Articles

The Effect of Buccal Fat Pad Graft in the Palatoplasty and the Risk Factor of Postoperative Palatal Fistula.

The aim of this study was to evaluate the effect of buccal fat pad (BFP) in the palatoplasty and to investigate the risk factors associated with postoperative palatal fistula formation. Sixty-five cleft palate patients were enrolled for this study. Clinical data regarding sex, age, type of cleft, surgical technique, the ratio of cleft width, and BFP graft were collected. The ratio of cleft width was measured and calculated using preoperative clinical photographs. In 36 patients, the BFP was harvested and grafted on the cleft palate to prevent palatal fistula formation. The patients were followed up, the incidence of fistula formation was investigated, and the risk factors related with the fistula were evaluated. Four patients had postoperative palatal fistula and were not BFP grafted during operation. The BFP graft and ratio of cleft width are significant factors in palatal fistula formation (P = .035, .003). There was a significant difference in the ratio of cleft width between the normal and fistula groups (P = .006). In the logistic regression analysis, there was significant association between high ratio of cleft width and palatal fistula formation in the no BFP group (odds ratio; 11.15, P = .036). The ratio of cleft width and BFP graft was a significant factor in palatal fistula formation. The BFP graft is a reliable procedure to prevent palatal fistula formation and increase the success of palatoplasty.

The Prevalence of Blepharoptosis in Facial Rejuvenation Patient Population.

Facial rejuvenation results, commonly seen in publications or national presentations, are fraught with uncorrected eyelid ptosis. This study was conducted to investigate the frequency of blepharoptosis in the rejuvenation population and to help increase awareness in recognizing this under corrected condition. Fifty-nine consecutive patients being evaluated for facial rejuvenation were included in the study. Patients who had previous eyelid or forehead surgery, congenital abnormalities, or post-traumatic deformities were excluded. Standard preoperative photographs were obtained. Each photograph was analyzed to determine blepharoptosis by measuring the distance between the upper eyelid margin and the upper limbus in each eye using Adobe Photoshop. Patient age, gender, and race were reported. Ptosis was defined as more than 1.0mm overlap between the upper eyelid margin and the upper limbus. Mean age was 63.7. Among 59 patients, 34 patients (57.6%) had blepharoptosis and 25 patients did not. Patients with blepharoptosis were likely to be older and male. Blepharoptosis becomes more common as patients age due to involution of eyelid and orbital tissue. It is commonly missed due to patient compensation by recruiting the frontalis muscle to lift the eyelids. It is imperative for the patient and the plastic surgeon to be aware of existing blepharoptosis and discuss expectations and formulate a comprehensive surgical plan. Awareness of the high prevalence of ptosis in the facial rejuvenation population allows plastic surgeons to provide better outcomes and higher patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy of bevacizumab injection after pterygium excision and limbal conjunctival autograft with limbal fixation suture.

To determine the efficacy of subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture. This retrospective study included a total of 150 eyes of 150 patients with primary pterygium who received three different procedures after pterygium excision, i.e., 49 eyes with limbal conjunctival graft (group A), 48 eyes with limbal conjunctival autograft with limbal fixation suture (group B), and 53 eyes with limbal conjunctival autograft with limbal fixation suture followed by bevacizumab injection (group C). Image analysis was performed using preoperative anterior segment photographs to measure parameters including relative length, relative width, relative area, and vascularity index of pterygium. Recurrence of pterygium was determined at 1year after surgery, and outcomes were compared between the 3 groups. Risk factors related to recurrence were evaluated using univariate and multivariate analyses. Recurrence rates after 1year were 18.4% (9/49), 8.3% (4/48), and 1.9% (1/53)in groups A, B, and C, respectively (P= 0.004). Multivariate analysis showed that patients in group C had significantly reduced risk of recurrence compared with those in group A (P= 0.009), whereas the risk of recurrence was not significantly different between groups A and B (P= 0.227) and groups B and C (P= 0.068), respectively. Among various parameters, higher vascularity index had significant correlation with increased risk of recurrence (P= 0.008). Bevacizumab injection after limbal conjunctival autograft and limbal fixation suture may effectively reduce recurrence after pterygium excision. The vascularity of pterygium was associated with a higher risk of recurrence.

What Constitutes Shoulder Imbalance in Adolescent Idiopathic Scoliosis? Aesthetic Threshold for Surgical Correction

To determine what constitutes clinical shoulder imbalance and the aesthetic unsightliness of the torso region in patients with scoliosis. How can it be measured? Shoulder imbalance is one of the most perplexing problems in scoliosis. There are no standard clinical or radiologic criteria for diagnosing shoulder imbalance, and hence its impact and prevention are poorly understood. This prospective cohort study aims to determine the clinical parameters in the torso region that are most aesthetically disfiguring in scoliosis, and the measures with their threshold values that can define shoulder imbalance. Twenty-six consecutive patients with adolescent idiopathic scoliosis formed the patient cohort. Only preoperative clinical photographs (not x-rays) of these patients were used for the study. Forty random observers were asked to rate the shoulder disfigurement in these patients as acceptable or unacceptable. An independent researcher plotted and measured 10 different deformity markers on these photographs. Three regions of the torso, the neck, shoulder, and axillary region, were studied separately. Receiver operating characteristic analysis was used to determine significance of each measure. The patients with unacceptable deformation had statistically significant values in each of the 3 regions. The patients with acceptable appearance also had several measures that proved significant. Threshold values for each of these parameters were established from the analysis. Shoulder imbalance in scoliosis is defined based on 3 regions: the neck, shoulder, and axillary region. Each has a specific threshold for producing cosmetically unacceptable deformation and they can be measured on clinical photographs. Measurement of the shoulder level alone is less representative.

Change in Lower Eyelid Contour Following Ectropion Repair With Lateral Tarsal Strip.

To evaluate the change in lateral canthal angle (LCA), inferior ocular surface exposed (IOSE), lower eyelid curvature, and margin-to-reflex distance 2 in those undergoing lower eyelid ectropion repair using a lateral tarsal strip technique. This is an Institutional Review Board-approved retrospective analysis of patients undergoing lower eyelid ectropion repair. This study included all patients from 2012 to 2018 operated on by a single surgeon at the University of Texas Southwestern Medical Center. For each patient, LCA, IOSE, and eyelid curvature were measured on preoperative and postoperative photographs using NIH Image J photographic analysis. These measurements were compared using paired 1-tail t-tests for LCA and IOSE and paired 2-tail t-tests for eyelid curvature. This study was Health Insurance Portability and Accountability Act-compliant with protection of individually identifiable information. Fifty-one patients with lower eyelid ectropion underwent lower eyelid ectropion repair using a lateral tarsal strip technique. Forty-three of the patients underwent a bilateral lower eyelid ectropion repair. There was no statistically significant difference in the LCA. There was a reduction in IOSE among both cohorts. The fourth degree polynomial trendlines generated to assess eyelid curvature demonstrated statistical significance, suggesting a flattening of eyelid curvature. margin-to-reflex distance 2 also had a statistically significant decrease postoperatively. Lower eyelid ectropion repair using a lateral tarsal strip approach causes a reduction in IOSE, a more gradual lower eyelid curvature, and a decrease in margin-to-reflex distance 2 without causing a statistically significant change in LCA.

Avulsion Fat Graft Gluteoplasty: Technique Overview.

The popularity of gluteoplasty has grown significantly in recent years, and there are a variety of techniques described to address gluteal aesthetic deformities. The aim of this study was to describe the avulsion fat graft gluteoplasty technique. A review of all consecutive patients undergone avulsion fat graft gluteoplasty from February 2018 to March 2019 was performed. Data included demographics, operative details, and clinical outcomes. A total of 7 patients with a minimum of 6 months follow-up were analyzed and included in the study. The avulsion fat graft gluteoplasty technique is described in a step-by-step fashion and illustrated by preoperative, postoperative, and intraoperative photographs, as well as video. The average total weight of the avulsed specimen was 372 g (range, 176-596 g) per patient. The average total volume of fat grafting was 593 mL (range, 344-900 mL) per patient. The avulsion fat graft gluteoplasty is a powerful technique with consistent results and low-risk profile. It provides durable lift and augmentation and produces a predictable and aesthetic scar.

Keloids: Which Types Can Be Excised without Risk of Recurrence? A New Clinical Classification.

Background:A surgical team from Interplast-Germany removed 387 keloids in 302 patients during 4 visits to Goma, Democratic Republic of the Congo, from 2015-2018. Preoperative and postoperative photographs and a thorough anamnesis of keloids were done for all patients. In addition, 18 selected biopsies from 4 types of keloids were histologically examined in Germany.Methods:Treatment options were tested and keloid recurrence rates were compared with data from questionnaires, photographs, and histology.Results:Keloids were classified accordingly as follows: (1) fresh nodular (continuously growing) keloids had a 30% recurrence rate after surgery: no common adjuvant therapy but triamcinolone acetonide (TAC) injections on onset, only; (a) earlobe keloids had the lowest recurrence rate after complete excision with negative resection margins; (2) superficial spreading (or butterfly) keloids were treated with TAC injections only; (3) mature (nongrowing or burned-out) keloids had also a low recurrence rate of 4.5%, which were then treated with TAC on onset, only; and (4) multiple keloids comprise various types in different stages.Conclusions:According to this classification, about 50% of keloids may be removed surgically without risk of recurrence in the examined patient population in Africa, where only TAC injections, but no radiation, are available. Adjuvant TAC or radiation should be started at the onset of recurrence and not generally.

Aesthetic outcomes after surgical repair of pectus excavatum in females: Differences between patients and professional evaluators.

BackgroundPectus excavatum is less common in females than in males, and it often aggravates a coexistent breast asymmetry. We conducted a study comparing female patients’ versus medical professionals’ evaluation of pectus excavatum repair to assess differences in aesthetic outcome ratings. Moreover, we evaluated the influence of surgical correction on patients’ self-perception.MethodsOf 30 female patients who were initially screened, 18 patients (mean age, 20 years) who underwent bar removal after surgical correction of pectus excavatum deformity participated in the survey (60%). They completed a questionnaire rating their appearance before and after surgery and responded to a psychological questionnaire about the changes that they had experienced. The mean interval between pectus bar removal and evaluation was 28 months. Standardized preoperative and postoperative patient photographs were evaluated using the same questionnaire by a panel of medical professionals and students (n=24) and the results were compared.ResultsPatients rated their preoperative deformity as more severe than the other evaluators, revealing the significant impact of the deformity on patients’ self-perception. Postoperatively, patient and professional evaluations were much better than before and were very similar. The psychological evaluation showed a clear improvement in well-being. The ratings of the medical professionals were not influenced by their degree of medical education.ConclusionsSurgical correction of pectus excavatum in female patients positively influences body perception and psychological well-being. It should therefore not be considered as a merely aesthetic correction, but as an important procedure to restore a patient’s self-perception.

Parallel-excision infrabrow blepharoplasty with extensive excision of the orbicularis oculi muscle in an Asian population.

BackgroundInfrabrow blepharoplasty has become a common surgical method used to rejuvenate aged upper eyelids in Asians. In this paper, we describe the parallel excision method for infrabrow blepharoplasty as a useful alternative to the conventional elliptical excision method. The authors’ experience over a 3-year period is presented and reviewed.MethodsA retrospective review of parallel excision infrabrow blepharoplasty cases at our hospital between 2014 and 2017 was performed. Three oculoplastic surgeons compared preoperative and postoperative photographs using the Strasser grading system.ResultsFrom the medical records of 123 patients, a total of 93 patients with moderate-to-severe bilateral dermatochalasis were selected as subjects. The exclusion criterion was levator function less than 8 mm. The total mean follow-up period was 2 years (range, 0.5–3.5 years). The mean skin excision height and width were 9.75 mm (range, 5–16 mm) and 58.51 mm (range, 42–75 mm), respectively. All patients who underwent surgery recovered without major complications, and all patients had high levels of satisfaction and improvements in their visual field. In the Strasser evaluation performed by the oculoplastic surgeons, most patients were found to have excellent results.ConclusionsThe parallel excision method for infrabrow blepharoplasty is a safe and effective technique that yields more natural- and youthful-looking eyelids than the conventional elliptical excision method. In our method, more effective manipulation of the orbicularis oculi muscle led to a reduction in frontalis compensation, resolution of sunken eyelids, and correction of lateral hooding.

Secondary Unilateral Cleft Rhinoplasty Using Natural Curvature of Rib Cartilage as Alar Rim Graft: A Three-Dimensional Evaluation of Long-Term Results

Since 2012, the senior author has incorporated the natural curvature of rib cartilage as an alar rim graft in addition to the diced cartilage technique for unilateral cleft rhinoplasty. The aim of this study is to describe this modification and evaluate its long-term results regarding nasal symmetry using three-dimensional stereophotogrammetric assessment (3dMDface system). From 2012 to 2018, 47 consecutive patients that underwent secondary unilateral cleft rhinoplasty were reviewed retrospectively. Sixteen patients with both preoperative and postoperative three-dimensional photographs taken at least 6 months after the operation were included. SimPlant O&O software was used to measure parameters on three-dimensional photographs: nostril heights, nostril widths, nasal dorsum heights, alare width, nostril areas, overlapping nostril area, nasal tip protrusion, nasal length, and nasal height before and after surgery. The ratios between cleft and noncleft sides were calculated. In addition, the overlapping nostril area ratio, tip protrusion-width index, and nasal index were compared before and after surgery. The preoperative nostril height ratio (0.79), nostril width ratio (1.24), and nasal dome height ratio (0.84) between cleft and noncleft sides were significantly improved after surgery to 0.93, 1.06, and 0.97, respectively. The preoperative overlapping nostril area ratio (72.33 percent), nasal tip protrusion-width index (0.48), and nasal index (0.81) also showed significant improvement postoperatively to 83.91 percent, 0.57, and 0.74, respectively. This preliminary study supports the use of natural curvature of rib cartilage as alar rim graft in secondary unilateral cleft rhinoplasty, with long-term improvement regarding nasal symmetry and nasal profile. Therapeutic, IV.

The Results of Preoperative Topical Brimonidine Usage in Pterygium Surgery.

Purpose: To evaluate the reduction of conjunctival and episcleral hyperemia and bleeding in pterygium surgery following the use of topical brimonidine preoperatively. Methods: In this study, 45 patients who had undergone pterygium surgery under topical anesthesia were enrolled. Brominidine tartrate 0.15% eye drops were applied topically to 25 eyes of 25 patients at the sixth and third minutes preoperatively, and no drops were applied to 20 eyes of 20 patients for vasoconstriction. Preoperative and postoperative photographs and video images were taken. Results: Vasoconstriction effects of topical brimonidine tartrate on surface vessels were observed. The surface area of blood vessels was reduced 60% within 5 min; this effect was observed with the help of Photoshop and ImageJ programs and it lasted for ∼20 min. The surgery lasts for 7 min, on average, so the conjunctival whitening formed by brimonidine tartrate provides a safe and comfortable operative area throughout the surgery. Conclusion: We recommend applying brimonidine tartrate before pterygium surgery due to its conjunctival whitening effect to provide a safe and comfortable operative area throughout the surgery.

Augmented Reality Technology for the Positioning of the Auricle in the Treatment of Microtia.

The positioning of the auricle is a key factor in successful ear reconstruction. However, the position of the ear is usually determined by transferring the auricle image of the nonaffected side to the affected side using a transparent film. Augmented reality (AR) is becoming useful in the surgical field allowing computer-generated images to be superimposed on patients. In this report, we would like to introduce an application of AR technology in ear reconstruction. AR technology was used to determine the position of the reconstructed ear of a 10-year-old male with right microtia. Preoperative 3-dimensional photographs of the nonaffected side were taken using VECTRAH1. Then, the image was horizontally inverted and superimposed on the three-dimensional image of the affected side with reference to the anatomical landmarks of the patient's face. These images were projected onto the patient in the operation room using Microsoft's HoloLens. The design and positioning of the auricle was done with reference to the AR image. To confirm the accuracy of the AR technique, we compared it to the original transparent film technique. After the insertion of the cartilage framework into the skin pocket, the position and shape of the reconstructed ear was confirmed using the AR technology. The positioning of the reconstructed ear was successfully performed. The deviation between the 2 designated positions using the AR and the transparent film was within 2 mm. The AR technology is a promising option in the surgical treatment of microtia.

A Nipple-Areola Stencil for Three-Dimensional Tattooing: Nipple by Number.

Medical tattooing is a critical reconstructive component in women following mastectomy. Recently, novel three-dimensional tattooing techniques mimicking depth by using light and shadow principles have allowed for aesthetically superior results. However, results are variable between providers, and professionals skilled in tattooing are often inaccessible to patients. To assess the need and obtain more background information regarding current practices, the authors recorded survey results from 753 plastic and reconstructive surgery offices. Results showed that 23 percent of facilities that offer reconstruction do not perform or refer for nipple-areola complex tattooing, leaving the patients to seek the service on their own. In this article, the authors present the nipple-by-number device, a three-dimensionally-printed stencil to ensure an accurate, consistent, and personalized aesthetic result during three-dimensional nipple-areola complex tattooing. The nipple-by-number device permits the plastic surgeon or supervised treating specialist to inexpensively, efficiently, and expeditiously perform the three-dimensional nipple-areola complex tattooing in their office. Furthermore, the device gives the patients the option of having their premorbid nipple-areola complex anatomy restored through preoperative photographs or choosing a different nipple-areola complex from a catalogue of designs. The device can be applied on any reconstructed breast mound whether or not a nipple projection procedure has been performed.

Face Lifting in Bald Male Patients: New Trends and Specific Needs.

Aesthetic surgery has recently become popular also among men. The ever-increasing number of bald men wishing to undergo facial surgery represents a challenge for the surgeon, as the scars cannot be hidden in the hair and must therefore be as short as possible. The authors present their experience in face lifting in bald male patients and propose an innovative technique to handle the skin excess to achieve practically invisible scars. A 10-year observational study was carried out on 68 bald male face-lift patients. All patients underwent deep plane lifting with a specific method for handling skin excess. This technique is the innovation presented in this article. Subjective and objective methods were used to evaluate the results. The well-known FACE-Q questionnaire was sent to all the patients together with an explanatory letter. Three ad hoc questions were added to the questionnaire to assess the degree of satisfaction with the scars. The objective method involved the evaluation of preoperative and postoperative photographs by a three-member jury. The average follow-up period was 12 months. All patients showed a high degree of satisfaction with the final appearance of the surgical scars and appreciation of the overall quality of the result, 1 year after face-lift surgery. No patient expressed regret about choosing to undergo this type of surgery. Very high scores were registered for the overall facial appearance and for the various critical areas examined, including scars, from patients and experts alike. The face-lifting technique for bald men proposed by the authors, involving a peculiar and innovative way of handling the skin excess, has proven to be reliably effective in obtaining virtually invisible scars.

Centering a Deviated Nose by Caudal Septal Extension Graft and Unilaterally Extended Spreader Grafts.

The deviated nose presents a tremendous challenge for rhinoplasty surgeons, especially the correction of the cartilaginous dorsum deviation. In this study, we introduce the surgical techniques of correcting a deviated cartilaginous vault by creating a new center of the lower third using a caudal septal extension graft combined with unilaterally extended spreader grafts. This retrospective observational study was conducted in a university-based tertiary medical center from December 2014 to January 2018. Thirty-two patients who underwent primary open rhinoplasty for correction of a deviated nose using this method participated in the study. Patient characteristics and surgical records were collected. Anthropometric measurements and analyses were performed based on preoperative and postoperative photographs. The aesthetic outcome consensus of three rhinoplasty surgeons was evaluated specifically for nasal dorsum deviation correction. Postoperative complications were reviewed from the medical records. Among the 32 patients, there were 18 males and 14 females. The mean (SD) age of the patients was 26.7 (8.76) years. Anthropometric measurements showed significant improvements in dorsal deviation angle (a 3.7° change towards midline, P < .001), nasal tip projection (increase of 6.96% measured by Goode's method, P < .001), and nostril shape (nostril axis inclination decrease of 11.7°, P < .001) after surgery. The nasolabial angle showed no significant change. Aesthetic outcomes were excellent in seven patients (21.9%), good in fourteen patients (43.7%), fair in eight patients (25.0%), and no change in three patients (9.4%). Minor postoperative complications (four patients) were observed during follow-up. Centering the cartilaginous vault using a caudal septal extension graft combined with unilaterally extended spreader grafts is a useful technical option in the correction of a deviated nose, and provides improvement in nasal tip projection and nostril shape.

Subbrow Blepharoplasty Combined with Periorbital Muscle Manipulation for Periorbital Rejuvenation in Asian Women.

With advancing age, Asian women are often plagued by lateral hooding of the upper eyelid skin, eyebrow ptosis, and obvious periorbital wrinkles. The authors propose a novel technique to revive the natural eyelid shape with a stable eyebrow position and alleviate periorbital wrinkles in Asian women. Sixty-six patients underwent subbrow blepharoplasty combined with periorbital muscle manipulation. An ellipse shape of the skin and subcutaneous tissue below the eyebrow was measured, demarcated, and removed. Then, the orbicularis oculi muscle beneath the subcutaneous tissue was exposed and dissected at the upper third. The lower muscle flap was fixed to the supraorbital rim periosteum and the upper musculocutaneous flaps, forming a cross flap for interlocking fixation. The lateral border of the orbicularis oculi muscle was detached from the subcutaneous tissue, splayed out, and sutured upward and inward to the periosteum. The corrugator supercilii muscle temporal to the origin of the supraorbital nerve notch was separated by 1 to 2 mm. The operation results were evaluated by patient satisfaction and comparisons between preoperative and postoperative photographs. Subbrow blepharoplasty combined with periorbital muscle manipulation significantly corrected lateral hooding with a stable eyebrow position and reduced the crow's feet and glabellar frown lines in all patients. The persistence of the improved outcome was stable during the follow-up period. Postoperative scarring was inconspicuous; however, eight cases had transient postoperative forehead numbness. This novel procedure provides a simple, effective, and comprehensive technique for improving periorbital aging in Asian women. The surgical outcomes are predictable, and the postoperative scarring is inconspicuous. Therapeutic, IV.

Forehead Fat Grafting: Asian Facial Contouring and Augmentation.

Aesthetic facial contouring procedures, particularly forehead augmentation, continue to increase in popularity in the Asian population. However, there are very few reports in the literature specifically examining the long-term outcomes of forehead fat grafting. In the present study, the authors aimed to objectively evaluate the efficacy of autologous forehead fat grafting through evaluation of facial proportions and patient-reported outcomes. Patients who underwent autologous fat grafting for forehead contouring procedures between July of 2011 and June of 2017 were recruited for participation in the study. Patient demographic and clinical variables were collected preoperatively and postoperatively. Facial proportion analysis was collected and compared from preoperative and postoperative photographs. Satisfaction with outcome was assessed by the patient, the surgeon, and a layperson postoperatively. A related-samples Wilcoxon signed rank test was used for statistical analysis. Postoperative outcomes were evaluated in a total of 24 patients who underwent forehead autologous fat-grafting procedures. The average postoperative follow-up was 8.1 months. There were no intraoperative or postoperative complications. More than 50 percent of the postoperative results were evaluated as "satisfactory" by all three groups (i.e., patient, surgeon, and layperson) in terms of aesthetic contouring. Average forehead projection increased 0.24 U (ratio of horizontal distance from midforehead plane to cornea plane/cornea diameter) after one round of fat grafting (p = 0.01). Seven patients (29.2 percent) required more than a single round of fat grafting to achieve optimal results. Autologous fat grafting remains a viable option for forehead contouring and augmentation. The findings of this study demonstrate that the operation is effective and offers stable satisfactory results after long-term follow-up. Therapeutic, IV.

Management of Congenital Melanocytic Nevus on Face Using Multiple Re-expansion Method: Aesthetic and Psychosocial Results.

Congenital giant melanocytic nevus on the face is a challenging condition, especially in the pediatric population. It can produce significant cosmetic deformity with negative psychosocial effects in pediatric patients even after treatment. The objective of this study was to report aesthetic and psychosocial results in the management of congenital melanocytic nevus on the face using multiple reexpansion. Data of 6 patients with congenital melanocytic nevus on the face who underwent excision and multiple reexpansion at our center from September 2004 to August 2017, were retrospectively reviewed. To evaluate aesthetic outcomes, preoperative and final photographs of each patient were reviewed by 3 other plastic surgeons and 4 laypersons. For comparison, 6 other patients who were treated with conventional surgery during the same period were reviewed. After final reconstruction surgery, the authors surveyed patients' satisfaction via telephone. Six patients were followed up for an average of 87.66 months (range, 55-123 months). The mean number of tissue expander insertions was 3.33 and the mean number of total expanders inserted was 4.83. Complication associated with expander exposure occurred in 1 patient during the fifth expansion. The average score of aesthetic outcome in the multiple reexpansion group was superior to that of the conventional group (2.60 versus 2.10, P = 0.03). During the telephone survey, patients did not rate their appearance as positive, although they were comparatively satisfied with the surgical procedure. Considering the low rate of malignancy involving congenital melanocytic nevus in childhood, multiple reexpansion is an attractive option to obtain better results compared with other reconstructive methods.

Treatment of chalazia by incision and curettage versus intralesional triamcinolone acetonide injection

Purpose: To compare the outcomes of treatment of primary chalazion with intralesional Triamcinolone Acetonide (TA) and Incision & Curettage(I&C) in patients with failed conservative treatment. Materials and Methods Study Design: Prospective randomized study Place and Duration: The study was conducted from November 2017 to January 2019 in The Department of Ophthalmology, Narayana medical college, and Hospital, Nellore. Methodology: 40 patients with primary chalazia who, after failed conservative treatment were randomized to either intralesional TA injection (4 mg) or I&C performed under local anesthesia. Preoperative photograph of the lesion was taken. Complete resolution was considered as lesion regression of 95% to 100%. Treatment was considered a failure if no resolution was achieved after the first attempted I&C or TA injection. Lesion resolution measured as 95% to 100% regression. Results: Out of 40 patients, 20 were randomized to I&C and 20 to TA injection group. Complete resolution was achieved in 16 cases in the I&C group and 17cases in TA group. The average time of resolution in TA group was four days. No significant complications were noted in either of the groups. Conclusions: Intralesional TA injection is as effective as I&C in cases of primary chalazia. So, injection may be considered as an alternative first-line treatment in cases where no biopsy is required. Keywords: Chalazion, Incision & curettage, Triamcinolone acetonide, Transconjunctival approach, Resolution

Forehead deformities after tissue expansion: Retrospective analysis and recommendations

Tissue expanders can lead to bone deformity as well as bone resorption. Not all changes in the cranial bone can be completely normalised after tissue expander extraction. This study aimed to investigate the potential factors for persistent forehead deformities after tissue expansion. Cases of forehead tissue expansion performed from 2011 to 2015 were retrospectively reviewed. Demographic and clinical data were collected. Two plastic surgeons (Y.Q. and C.Q.) evaluated changes in the forehead by comparing preoperative and most recent postoperative photographs. The Fisher exact, chi-square and Student t tests, and univariate and multivariate logistic regression analyses were performed in this study. Sixty-seven patients underwent forehead expanded flap reconstructions and continuous follow-ups were done in the outpatient service. The mean duration of the follow-ups after expander removal was 33.86 months. Overall, 28 (41.8%) patients had forehead changes. Age, sex, indications for tissue expansion and follow-up time were not associated with forehead changes. There were significant differences in the total injection volume and expansion period between patients with forehead changes (41.8%) and those without (58.2%). No significant negative correlation was found between the duration of pressure bandage usage post-operatively and the occurrence of forehead changes. Our recommendations for performing tissue expansion in the skull area are as follows: (1) always choose expanders with the largest base dimension; (2) perform tissue expansion as quickly as possible and (3) do not cause overexpansion. In addition, there was no proven benefit of using pressure bandages when skeletal changes occurred.