Ways of prevention of thread extrusion after insertion of polydioxanone thread for nasal tip projection

Kyoungjin Kang(Kyoungjin Kang),Jaeran Hong(Jaeran Hong),Yibeom Shin(Yibeom Shin) 대한미용의학회 2023 대한미용의학회지 Vol.7 No.1

Cogged polydioxanone (PDO) thread, which is inserted into the blunt cannular, is cosmetically used for non-surgical projection of the nasal tip. However, thread extrusion is a frequently occurring side effect despite the production technology of the thread has improved. To prevent this, we changed the location of the insertion site from the middle of the tip to 0.5 cm above the supratip break point and applied the cannular, which was manually bent about 30°, 1.5 cm from the cannular tip. The bent cannular was located in the supraperichondral layer of the upper lateral cartilages, moved down to middle of the tip, rotated 180°, and the columella inserted inwards to the nasal spine by holding the nose in the desired position of tip projection with the non-dominant hand. For tip projection, 4 threads were inserted. For dorsal augmentation, 1.0 ml hyaluronic acid (HA) filler was injected as a single approach, and both 8 threads and 1.3 ml HA filler were used as a combination approach. The effect was maintained for at least 2 years after the procedure, without any thread extrusion. The patient was greatly satisfied with the natural appearance. This method is an easy and reliable technique for both tip projection and preventing thread extrusion.

Subperiosteal chin augmentation with hyaluronic acid filler in patients with a small chin

Kyoungjin Kang,FKCCS,Choongyee Chai 대한미용의학회 2018 대한미용의학회지 Vol.2 No.1

Background: For correction of small chin, surgical genioplasty, allograft implantation, and injectable filler have been widely used. Among these, the injectable fillers is a simple, non-invasive procedure that has minimal downtime and low risk of complications. It has been commonly injected at intradermal, subdermal, submuscular and supraperiosteal layer. However, common complications such as nodules, bumps, lumps, migration, asymmetry, overcorrection, and chin ptosis frequently happened. Objective: The main objective of this study was injecting filler into sub-periosteal layer in a small chin and evaluated its effect and incidence of complications. Methods: A total of 14 subjects aged between 33 and 64 years had been performed Elravie ?? hyaluronic acid filler injection subperiosteally and Medytoxin ?? as a botulinum toxin treatment intramuscularly. Morphological change were observed through the photos. Changes of proportion of lower 1/3 face, Modified Legan’s angle, and open gap distance of lips were measured. Follow-up patient satisfaction surveys were conducted from 2 to 3 weeks. Results: Proportion of lower face was significantly changed that the ratio of upper and middle 1/3 were decreased (5.26%, 3.85%) and the ratio of lower 1/3 was increased (8.33%). Modified Legan’s angle was significantly decreased (37.4±16.5%). Open gap distance between lips was decreased (66.2±17.9%) and dry mouth was significantly decreased. Lower facial contour was changed from round shape to elliptical shape and mouth looked smaller and less protruded. Upper lip was everted, but lower lip was inverted. Perioral wrinkles, labio-mandibular folds, and mental dimples were significantly decreased. There was no significant incidence of common complications including chin ptosis. Conclusion: Subperiosteal filler injection is easy, safe and effective in improvement of small chin and interestingly, showed additional beneficial effects such as improvement of dry mouth, lips contour, and perioral wrinkles. Level of Evidence: IV

Intraoperative visible iris sign detected during ptosis surgery in seven Korean patients who wore eye masks when sleep

Kyoungjin Kang 대한미용의학회 2019 대한미용의학회지 Vol.3 No.2

Background: A visible iris sign (VIS) is the apparent visibility of iris color or contour through a closed upper eyelid in patients with aponeurotic ptosis from Western countries. This has been popularly reported in individuals from Western countries because the soft tissue of their lids is much thinner than that in individuals of Oriental descent. There is no report on VIS in individuals of Oriental descent pre- and intraoperatively. Objective: This study aimed to evaluate patients who wore eye masks when sleeping at night and assess the association between VIS and habitual wearing of sleeping mask while dissecting the eye lids to correct ptosis. Methods: Among the patients who visited the clinic for cosmetic blepharoplasty from 2018 to 2019, seven patients complained about the inconvenience of wearing eye masks for sleeping at night. Of these, two patients were diagnosed with pseudoptosis, and the others were diagnosed with aponeurotic ptosis preoperatively. Moreover, they presented with allergy, contact lens use, habitual eye rubbing, and dry eye syndrome. VIS was assessed pre- and intraoperatively, and pre- and intraoperative images were obtained. VIS was analyzed intraoperatively. Conventional blepharoplasty with ptosis correction was performed, and morphological characteristics of the lid layers were observed. Results: Preoperative VIS was not observed in all patients. However, positive intraoperative VIS was detected in six patients, which appeared as a black-colored region due to the defect from the orbital septum, aponeurosis, and Müller muscle. Five patients were diagnosed with aponeurotic ptosis. Moreover, two patients were finally diagnosed with subclinical aponeurotic ptosis because the anatomical defects were observed in these two patients who were preoperatively diagnosed with pseudoptosis. Conclusion: A sleeping eye mask was most likely used to decrease light transmission through the anatomical defects in patients with positive intraoperative VIS.

Correction of nasolabial fold by combination of polydioxanone thread and hyaluronic acid filler: a case report

Kang Kyoungjin,Choung Hanwool,Hwang Uekyoung 대한미용의학회 2021 대한미용의학회지 Vol.5 No.2

Deep nasolabial folds (NLFs) are a common concern among aging patients. Hyaluronic acid (HA) filler is the first treatment choice. However, migration, spread to the surrounding space, and unnatural contours with lateral bulges occur frequently. Polydioxanone (PDO) thread has also been used by insertion of cogged PDO threads in the midface and the fold. Unfortunately, lifting lasts for only a few weeks. In the present case, a combination procedure using HA filler and PDO thread in the shape of the mesh tube was performed to improve the deep NLF in a 67-year-old woman. The intention of this combination was to unfold the NLFs and restore their volume without lateral migration of the injected filler. NLFs were divided into three parts: the lateral folded part (LFP), medial depressed part (MDP), and central crease part (CCP). Five PDO threads (6.0 cm length) were sequentially inserted into the LFP, MDP, and then under the CCP of each NLF. Total 4.0 ml of the filler was also sequentially injected into the both NLFs in a manner similar to the mesh thread insertion. They were mainly placed at the subdermal and superficial fat layer in the entire NLF and at the submuscular layer in the regions of the lateral part of the NLF, mouth corners, and submalar area. Three months after PDO thread insertion and HA filler injection, softened NLFs without filler migration, restored volume and lifted midface with a natural and charming smile, and reduction of perioral wrinkles were observed. These changes could be explained by the suppression of laughter movement accompanied by myo-modulation and increased firmness of the NLFs by the restoration of midface volume. These results suggest that the combination of PDO insertion and HA injection may be useful for correction of NLF.

A case of temporary correction of drooping nose due to postoperative descent of silicone implant using a filler injection

Kyoungjin Kang,Moon Hee Kim,Hyeon Seob Byeon 대한미용의학회 2020 대한미용의학회지 Vol.4 No.1

Drooping of the nasal tip is one of the main complications of rhinoplasty. Herein we describe the case of a 42-year-old female who underwent simple augmentation rhinoplasty using an I-shaped silicone implant approximately 3 years ago visited our clinic for the correction of a drooping nose. The contour of the I-shaped silicone was observed in the dorsum of the nasal skin above the supra-tip break point, which caused the nasal tip to droop. The patient refused revision rhinoplasty and requested to temporarily correct the drooping nose using a noninvasive procedure. Sequential augmentation of filler injection (SAFI) for rotation, projection, and augmentation was recommended to correct the condition. In total, 0.6 ml of hyaluronic acid (HA) filler was first injected into the dead space between the anterior nasal spine and end of the medial crus of the lower lateral cartilage and columella for tip rotation. It was then placed intranasally on top of the middle crus of the lower lateral cartilage for tip projection (0.2 ml). Finally, it was injected into the upper lateral cartilage around the supra-tip break for dorsal augmentation (0.4 ml). A total of 1.2 ml of filler was injected. After 2 weeks, 0.2 ml of HA filler was injected for tip rotation. After 4 months, a postoperative follow-up study was performed. The nasolabial angle had changed from 90° to 105°. Tip projection was significantly increased. The abnormal contour of the silicone implant in the dorsum was no longer visible. The drooping nose remarkably improved with the sequential combination of rotation, projection, and augmentation using the SAFI technique, which considers the dynamic structure of the nasal tip. We were able to demonstrate that the SAFI technique can be a reliable technique for filler rhinoplasty.

Lifting effect of sequential autologous fat injection (SAFI) in three patients with small and flat malar bones

Kyoungjin Kang 대한미용의학회 2019 대한미용의학회지 Vol.3 No.2

Various fat grafting techniques are commonly performed to restore the facial volume deficiency in the soft tissue. Generally, the purified fat is evenly injected into the whole layer in the volume deficit area. The sequential autologous fat injection (SAFI) technique is known to have a volumetric lifting effect. In patients with small and flat malar bones, the soft tissue foundation becomes weak; hence, the soft tissue overlying the bone easily sags even in young patients. Therefore, the author tried to apply the SAFI technique to correct the sagging face. The fat was harvested and purified by the Coleman’s method, and sequentially injected into each defective region in the superolateral to anteroinferior direction. Furthermore, the fat was injected consequently in the deep, middle, and superficial layers to increase the skeletal support for the soft tissue using the SAFI technique. An increase in the volume in the malar and sub-malar areas and decrease in the volume in the deep nasolabial folds and jowls were simultaneously observed. Moreover, the facial contour changed from square to inverted triangle type with shallow nasolabial folds and lifted appearance of the jowls in these 3 cases. The results indicated that the SAFI technique could be used for volumetric face lifting, because it focuses on the correction of the skeletal deformity in order to improve the soft tissue foundation.

How to correct and prevent mid-face widening after using floating (or non-fixation) type polydioxanone thread-lift

Kyoungjin Kang,Sun Woo Lee,Phoebe Kar Wai Lam 대한미용의학회 2020 대한미용의학회지 Vol.4 No.2

Thread-lifting is a minimally invasive face-lifting procedure that lifts and reposition ptotic soft tissue associated with ageing. This procedure has become increasingly more popular in the last decade. mid-face widening (MFW) is a frequent complaint after thread-lifting, as the descended ptotic soft tissues gathered to the middle of the thread during repositioning. The bunching up of the lax soft tissue increases both the facial volume and the MFW. We attempt to overcome the MFW as an unexpected common complication. Three patients underwent our thread-lifting procedure and followed up for six months. The assessment parameter, bizygomatic diameter (BZD), taken at baseline, three and six-month follow-up with standardised digital computerised 3-dimensional (3D) images using MIRAGE 3D, Taiwan. The floating 90 mm and 115 mm threads, were inserted in the following sequence: first, two single-layers (temporal and high temporal, along the superior temporal line) and then, one dual-layer (zygomatic/cheek region). This thread arrangement aims to overcome and correct the position-dependent downward sagging and volume loss associated with facial ageing, but without increasing the MFW of the patients. None of the patients developed MFW following thread-lifting at three- and six months following treatment. An observed reduction between 4.7-17.9 mm (average, 11.3 mm) in BZD recorded at six-month follow-up. There was no significant discomfort or complications have been reported. Based on the results of our cases, this floating technique, combining two single and one dual-layer, in the three regions (temporal, high temporal and zygomatic/cheek) appears favourable in achieving satisfactory face-lifting and rebalancing facial volume without an increase in MFW.

Sequential autologous fat injection techniques for volumetric face lifting in young Korean females

Kyoungjin Kang 대한미용의학회 2020 대한미용의학회지 Vol.4 No.2

Background: Various fat grafting techniques have been preferentially performed to restore facial volume deficiency. However, no reports have focused on simultaneous volume deficiency and sagging appearance improvements, barring the sequential autologous fat injection (SAFI) technique. Objective: This study aimed to show real evidence of volumetric lifting using the SAFI technique. Methods: From 2007 to 2009, we performed the SAFI technique on 10 patients in their 20s. Fat was purified using Coleman’s method and sequentially injected into each defective region from the superolateral to the anteroinferior direction. The fat was placed subsequently in the supra-periosteal, deep, and superficial layers (approximately 60%, 30%, and 10% of the injected volume, respectively) of each region to increase the skeletal support for the soft tissue. Morphological changes were evaluated by comparing pre- and postoperative photographs. The effects were monitored from 3 months to 1.5 years. Results: We included 10 patients with an average age of 25.4±2.56 years, having relatively small and flat malar bones with negative globe-to-skeletal rim relations; moreover, they were injected averagely with 38.8±4.89 ml of fat. In most of the cases, the facial contour changed from a rectangular to an oval shape. Furthermore, the appearance was lifted through great volume restoration in the midface and volume reduction in the deep nasolabial folds (NLFs) and jowls. The wrinkle severity rating scale (WSRS) grade decreased in 7 patients (3 on both sides and 4 on either side) and increased in 3 patients. The WSRS improvement was not statistically significant; however, NLFs showed a younger, more natural, and lifted look in all cases. Patient satisfaction was relatively high (4.4±0.5). Conclusion: The results indicated that the SAFI technique could be used for both volume deficiency and sagging appearance improvements because it preferentially focused on both skeletal deformity and soft tissue defect corrections.

Complementary effect of fat grafting on traditional subciliary incisional lower blepharoplasty: estimated by the change of lid-cheek junction

Kyoungjin Kang,Choongyee Chai 대한미용의학회 2018 대한미용의학회지 Vol.2 No.1

Background: Traditional subciliary incision lower blepharoplasty (TSILB) is commonly used for improving aged lower eyelid. Fat grafting has been popularly performed to correct shortcomings of TSILB such as infraorbital hollowness and incomplete blending of lid-cheek junction (LCJ). LCJ has been known as an objective index to measure the aging of lower eyelid. However, there was no study on the changes of LCJ length and shape with complementary fat grafting. Objective: This study aimed to evaluate the effect of complementary fat grafting by observing the changes in length and shape of the LCJ. Methods: Between 2010 and 2016, the authors observed the change of LCJ in 33 patients who were followed-up for more than 3 months among patients who underwent TSILB alone (Group 1, G1) or TSILB combined with fat grafting (Group 2, G2). The fat graft was performed by sequential autologous fat injection method, having the concept of volumetric face lifting. The groups were further divided into subgroups G1p, G1n, G2p, and G2n according to positive (p) or negative (n) globe-to-skeletal rim relations. Suborbicularis oculi fat lifting and lateral retinacular canthopexy were mainly performed in patients who had negative vector. Results: The length of LCJ in G2 decreased significantly compared to that of G1. There was no significant difference between G1p and G1n, and G2p and G2n. The shape of LCJ changed diversely from V-shape to flat shape and was more dramatic in G2 than in G1. In G1, superolateral shifting in lateral points of LCJ was a typical change, but in G2, superolateral shifting and vertical shifting of LCJ were more prominently occurred at medial and middle points of LCJ, which were mainly induced by fat grafting. Conclusion: Complementary fat grafting showed better rejuvenation effect through further changes of LCJ in length (shortening) and shape (flattening) than that of TSILB alone. Level of Evidence: IV

Cosmetic surgery on YouTube: a content analysis of East Asian blepharoplasty-related videos in South Korea

Kyoung-Min Kang,Yongil Shin,Kyoungjin Kang 대한미용의학회 2020 대한미용의학회지 Vol.4 No.2

Background: As social media gets commonly used worldwide, there is an enormous amount of information available on YouTube. While cosmetic surgery-related content in English on YouTube has been studied priorly, those in Korean have not been explored. Objective: The purpose of this study is to analyze the status quo of aesthetic-related content, specifically on East Asian blepharoplasty, on YouTube in South Korea. Methods: The 535 returned videos for the search term ‘SSangkkeopul Susul’, the Korean word for East Asian blepharoplasty, were collected on July 9, 2020, and classified by types of content and uploader, view counts, and length of videos, then, analyze, using Excel (Microsoft). Results: Fifty five percent of collected videos was to provide surgery-related information, and 20.0% was to show patient experience. Also, 76.8% of the videos were uploaded by medical doctors or clinics, while 13.6% was uploaded by personal accounts and 5.4% by content creators. The most common type of content was surgery-related information uploaded by medical doctors and clinics, followed by patient experience posted by personal channels. The average length of all videos was 4 minutes 46 seconds. However, among the ten most-viewed videos, only one was uploaded by medical doctor and the others were uploaded by non-medical personnel. Conclusion: Medical doctors have a quantitatively huge influence on cosmetic surgery-related content on YouTube in Korea, which leads the information in those videos more reliable. However, due to the lack of clarity in relevant regulations and the absence of constant monitoring, potentially harmful or sensitive contents are still available on YouTube. Thus, preventative measures at the governmental level are needed.