Medical Publications

Background: Dr. Kenneth Kim, a recognized expert in Asian rhinoplasty and a well-published authority in the field, was invited by Plastic and Reconstructive Journal (PRS) to lend his expertise to a peer-reviewed publication on rhinoplasty correction for contracted noses. Dr. Kim was asked to review the study and author a Discussion piece, providing his specialized insights and professional feedback. His contribution highlights advanced techniques and considerations in addressing complex Asian rhinoplasty revisions.

Background: Overdevelopment of zygomatic bones often results in protrusion and flaring of the midfacial region. This makes the face appear squarer than the more favorable oval shape. Therefore, zygoma reduction surgery has become a commonly performed procedure in patients seeking to obtain an ideal facial shape. Facial soft-tissue ptosis is one of the main complications of zygoma reduction surgery. Previously, the evaluation of cheek soft-tissue ptosis was subjectively based on patients and surgeons. Our study aimed to provide an objective evaluation of softtissue sagging in the cheek region after zygoma reduction surgery using artificial
intelligence (AI).

Abstract: Traditional horizontal osteotomies for small and short chins often yield suboptimal results due to limited bone advancement, resulting in deep labiomental folds and heightened bone resorption risks.

Background: Malar/zygoma reduction is an effective procedure to change a broader, flatter facial appearance to an oval facial shape. Of the intraoral and coronal approaches, the intraoral is the more commonly used technique than the coronal, due to the perception that complications with the coronal approach are significant, and intraoral results are satisfactory. We compared the postoperative effects of both approaches.

Background: A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence- based recommendations to improve patient care.

Subbrow Lift Using Frontalis Sling to Correct Lateral Orbital Laxity

In order to correct upper lid laxity, upper blepharoplasty, subbrow excision, and forehead lift have been utilized. Our newly developed subbrow excision attaches the orbicularis oculi muscle to the frontalis mus- cle. This improves the longevity of the result without inhibiting the gliding plane of the periorbita.

The application of a retromammary adipofascial flap is an effective method of producing natural breast shape and providing additional soft tissue to the caudal breast region.

AMPSA may be an effective procedure for correcting blepharoptosis where the MRD-1 is less than 2 mm.

Using a wide double-layer dissection, high folds were lowered success- fully even in situations where there was no redundant upper eyelid skin for excision. Read article for further information.

Preoperative injection of isolated adipose- derived stromal cells into the contracted nasal scar tissue resulted in softening of the nasal enve- lope. Intraoperative release of remaining scar tis- sue and reconstruction of the internal framework with autologous grafts resulted in stable postop- erative results. There were no recurrences of con- tracture and there were no ischemic injuries to the overlying skin.

The authors introduce a double-eyelid surgery technique us- ing the SAJT. This SAJT fixation technique creates a dynamic double-eyelid fold. Our study showed a high patient satisfaction rate and that the resulting fold mimics the movement of the congenital supratarsal fold in Asians.

In secondary rhinoplasty after a silicone implant was used in the primary setting, the use of the capsular flap to preserve the dorsal SSTE volume was safe and reliable. There were no cases of recurrent capsular contracture, capsular resorption, or postoperative infection (Fig. 3). This technique avoids the dorsal irregularity and nasal SSTE vascular compromise that can occur with complete capsule removal.

The advancement technique using the levator aponeurosis–Müller’s muscle–lamina propria mucosa of conjunctiva composite was effective in the treatment of severe blepharoptosis with levator function of 2 to 7 mm. The technique produced elevating motion of the physiologic eyelid in a superior-posterior direction. There were no serious complications, such as long-term lagophthalmos or lid lag.

The transareolar-perinipple (areolar omega) zigzag incision resulted in satisfactory postoperative scarring and surgical results in Asian patients. This method increases the opening of the areolar incision and can be performed in patients with small (<3.5 cm) areolas. This approach can be an alternative in patients who are prone to hypertrophic scarring.

It is very difficult to correct eyelid retraction caused by tissue fibrosis and muscle degeneration. Correction of the retraction by levator lengthening using the pretarsal tissue is simpler to execute, measurable during surgery, and easy to adjust, and offers high predictability in its result.

In our study, we have found lower lateral cartilage repositioning and ear cartilage grafting techniques to be effective in correcting short nose in Asians, with a low incidence of complications. Advantages of this technique include elongation of the entire nasal tip and ala, which results in more comprehensive and proportioned nasal augmentation. The mobile nasal tip is maintained by adequately freeing the retaining forces of the lower lateral cartilage while providing enough structural support.

Our new findings further define a critical role for Runx2 on TβRI expression by osteoblasts, and that Runx2 may act independently of other active elements such as Sp1 that drive basal TβRI synthesis by many cells (Ji et al., 1997). They emphasize the significance of regulatory mechanisms, generated in part by TGF-β itself that can limit its own effects within the skeleton, which may occur to maintain a balanced and controlled progression of events required for proper bone remodeling. Studies like these may further improve our understanding of development and disease in other cell types where Runx2 or other Runx isoforms are expressed, and where TGF-β activity has prominent biological effects.

Our current studies continue to reveal novel interactions between PKA-activating hormones and glucocorticoids and potential mechanisms for the permissive effects of glucocorticoids on IGF-I expression and protein synthesis by osteoblasts. Future studies will be necessary to define in more detail the complex molecular events that distinguish the permissive and suppressive effects of glucocorticoids on osteoblast function and skeletal integrity .

Our results predict that gene expression through these two transcription factors can occur in multiple ways. As modeled in Fig. 7A, some genes (denoted as X), including C/EBP , could be regulated directly by Runx proteins, and other genes (denoted as Y) could be regulated directly by C/EBP gene family members.

Similar IGFBPs are expressed by less differentiated periosteal bone cells and osteoblast-enriched cultures from fetal rat bone. Expression of IGFBP-3, IGFBP-4, and IGFBP-5 was enhanced by activators of PKA, while potent activators of PKC inhibited IGFBP-5 expression.

This article introduces the minimally invasive double eyelid surgical technique, in which a permanent suture is used in order to make the double eyelid crease and correct mild ptosis without making an incision. The advantages are minimal to no scarring, quick recovery time, and minimal trauma to the eyelid tissue. Lastly, the advantage of the present method is its technical simplicity and relatively short operating time.