Biomedical subjects

Byung Gun Kim

Publications and source records attributed to Byung Gun Kim.

4 recordsLinked to original sources

PubMed2006

Management of adhesion using a pretarsal fibromuscular flap or graft in secondary blepharoplasty.

BACKGROUND: In double eyelid operations, if the eyes have too little fat and soft tissue, or if too much of the orbital fat was removed during the operation, the double eyelid crease is placed too high and the supratarsal recess becomes hollow and adhesion of the eyelid crease occurs even in the orbital septum and levator muscle. A secondary double eyelid operation in response to these problems needs to correct the height of the eyelid crease by releasing the inadequately high eyelid fold and preventing readhesion. Moreover, in case the muscle and scar tissue are bulged below the incision line, the height of the double eyelid should be appropriately lowered and the bulky lower flap should be flattened. In cases where the adjacent tissue (e.g., preaponeurotic fat) was excessively removed during the primary double eyelid operation, a free fat or dermis fat graft was performed to correct supratarsal depression and readhesion. These graft materials are extracted from a distant donor site. METHODS: Even if the adjacent tissue was not sufficient, the authors made the superiorly based local flap or graft of pretarsal scar-muscle tissue obtained after thinning the bulky lower flap. In these cases, the fibrous muscle flap or graft compensated tissue depletion with a proper mass around the double eyelid crease, thus helping to prevent readhesion. RESULTS: Of the 1225 patients with high placement of the supratarsal fold with a bulky lower skin flap, we used pretarsal fibromuscular flaps in 914 patients and pretarsal fibromuscular grafts in treating 311 patients between November of 1997 and October of 2004. In the authors' series, 425 of 1225 patients underwent follow-up ranging from 2 to 23 months. Most of these patients were satisfied; however, 33 patients (7.8 percent) expressed dissatisfaction with the postoperative results based on their subjective judgment; 29 patients (6.8 percent) had mild asymmetry, and surgical revision was required in only 17 patients (4 percent). CONCLUSIONS: The authors eventually found that the pretarsal fibromuscular flap or graft was successful in making a natural eye shape and preventing readhesion, with no requirement of a distant donor site. They also found that the operation was effective in reducing the operative time and lowering the risk of postoperative infection.

Adult↗

PubMed2004

Mandibular angle reduction versus mandible reduction.

The terms "mandibular angle reduction" and "reduction angleplasty" refer to operations to reduce the width of the lower face and change a square face to an oval one. Because the terms emphasize the word angle, however, they imply that the operations apply to the mandibular angle. The most frequent complaint after these operations is that the change in the lateral appearance is clear but that the change in the frontal appearance is not noticeable. Such a result is related to the fact that bone resection is performed mainly in the mandibular angle area and is focused particularly on resection of the posterior projection through curved ostectomy. That is, because operations limited to the mandibular angle area cannot properly satisfy patients' requirements, the operation must be applied to a larger area. Therefore, it seems reasonable to change the terms "mandibular angle reduction" and "reduction angleplasty" to "mandible reduction" and "reduction mandibuloplasty." In addition, the most important technique in the operation is the resection of the outer cortex of the mandible. In particular, the corticectomy technique using a reciprocating saw is quite safe and effective for the maximum resection of lateral flaring within a very short time.

Adult↗

PubMed2003

Lateral septoaponeurotic artery: source of bleeding in blepharoplasty performed in asians.

In standard blepharoplasty, the orbital septum is opened commonly to enter the preaponeurotic space. This is to anchor the leading edge of the levator palpebral fascia to the skin of a proposed supratarsal fold and to remove supraorbital fat. Incision of the orbital septum is involved occasionally with accidental injury to an inconstant arterial branch at its lateral side, which causes severe bleeding. Anatomic knowledge of the vessel on the orbital septum is conducive to preventing accidental arterial injury. The authors encountered a relatively large artery running vertically at the lateral side of the orbital septum in 50 eyelids of 230 blepharoplasty patients (460 eyelids). They investigated the branch by injecting red latex into the ophthalmic arteries in 20 hemidissected faces of fresh cadavers. At the lateral aspect of the orbital septum, a branch of the superior lateral palpebral artery, which we named the lateral septoaponeurotic artery (LASA), was confirmed in five of 13 specimens. The LASA originates from the superior lateral palpebral artery just after it divides into peripheral and marginal arcades. The LASA pierces the levator aponeurosis and orbital septum at the upper level of the tarsal plate. It anastomoses with a branch of the supraorbital artery at the superior aspect of the orbit. The authors think severe bleeding occurs when the LASA is injured during blepharoplasties. Cautious treatment of the lateral septoaponeurotic vessel minimizes undesirable complications.

Arteries↗

PubMedDate not supplied

Unexpected bleeding caused by arterial variation inferolateral to levator palpebrae.

When incisional or nonincisional double-eyelid operations are in process, unexpected bleeding adjacent to the lateral canthal area is often encountered. The unexpected bleeding may result in intraoperative hematoma and swelling. It may also cause temporary intraoperative ptosis. The intraoperative swelling along the designed double-eyelid line or temporary ptosis may prevent surgeons from taking an accurate measurement of the height of fold. Therefore, surgeons might have difficulties making symmetrical double-eyelid lines. Among the detailed dissections of 230 eyelids along the orbital septum and levator palpebrae during incisional double-eyelid operations, 25 cases of noticeable arterial variation were found adjacent to the inferolateral end of levator palpebrae. The artery is located 4-5 mm medial from the lateral canthus, at the inferior margin of levator palpebrae. During the dissections, the artery was found to be superficial to the orbital septum and it could be traced down into a deeper layer along the inferior end of levator palpebrae. It connects to the lateral canthal artery behind the levator palpebrae. During double-eyelid operations, accidental tearing of this artery, even at the superficial layer of orbital septum, might cause the retraction of the cleaved arterial end down into the levator palpebrae. The bleeding from the retracted arterial end rapidly makes a large hematoma posterior to the levator palpebrae, causing temporary intraoperative ptosis and an asymmetric double fold, and possibly retrobulbar hematoma and blindness. We should bear in mind the possibility of presence of this artery. Once bleeding of this artery begins, clamping this artery and the inferolateral portion of levator palpebrae with a hemostat is effective in preventing massive hematoma posterior to levator palpebrae and ptosis, but electocoagulation is not effective. A cadaver dissection study, with red colored latex injection into the ophthalmic artery, is in progress.

Arteries↗