Eyebrow Transplantation

BACKGROUND: Reconstruction of the eyebrow has historically been accomplished with temporal scalp pedicle flap formation or free composite scalp grafts. These two techniques may be associated with substantial morbidity and a false, overly dense eyebrow appearance. Hair transplantation of the eyebrows has been described with excellent results, but is relatively underreported in the literature. OBJECTIVE: To determine whether modern techniques of micrograft hair transplantation can suitably re-create an aesthetic eyebrow in a case of iatrogenic eyebrow alopecia. METHODS: A 33-year-old woman with iatrogenic eyebrow alopecia underwent four sessions of eyebrow micrograft hair transplantation to re-create both eyebrows. RESULTS: Suitable aesthetic eyebrows were re-created in a symmetric fashion with proper hair orientation. The process was time consuming and tedious, but highly effective. CONCLUSION: Eyebrow transplantation is a suitable alternative to pedicle flap formation and composite scalp grafting. It is a straightforward procedure that can be performed in the office under local anesthesia with minimal attendant morbidity. The result may be superior to that seen with more involved eyebrow replacement procedures.     

The Webster-Type Face and Neck Lift: An Extensive Cervico-Facial Rhytidectomy Employing a Minimally Invasive Technique

BACKGROUND: Facelifting has incorporated a wide range of new techniques and developments over the past few decades. Many techniques employ a more aggressive surgical approach that may be advocated for seeming advantage, yet upon closer review may be unwarranted for the average patient seeking facial rejuvenation. The Webster-type face and neck lift utilizes a minimally invasive approach to thoroughly resupport the face and neck substructure and skin. This approach affords the patient excellent results while limiting untoward complications. OBJECTIVE: To evaluate the efficacy of the Webster-type face and neck lift. METHODS: The Webster-type face and neck lift was utilized in 200 facelift patients. We reviewed these cases for aesthetic results and associated complications. RESULTS: The great majority of patients have been uniformly pleased with the aesthetic restoration via the Webster-type lift. Postoperative courses have been routinely uneventful and major complications have been avoided. CONCLUSION: The evolution of more invasive approaches to cervicofacial rhytidectomy has not been shown to produce consistently better or longer-lasting results. Many of these aggressive techniques have extended the operating time, heightened the potential morbidity of the operation, and prolonged the duration of convalescence. The Webster-type lift is a proven, modern approach that provides comparable and lasting results while limiting risk and avoiding serious complications.     

Total scalp replantation based on one artery and one vein

A successful replantation of a totally avulsed scalp, including both eyebrows, with only one arterial and one venous anastomosis to the superficial temporal vessels is described. Apart from a small partial skin necrosis of the right eyebrow, the entire transplant survived. Subsequently, the patient required only minor additional skin grafting, correction of scars with a skin expander, and reconstruction of the eyebrow with hair micrografts. Replantation of the total scalp based on two or more vessels has previously been recommended and reported elsewhere. In the present case, complete survival of the scalp on only one artery and one vein was demonstrated, indicating that replantation should be considered even if available vessels for anastomosis are minimal. © 1993 Wiley-Liss Inc.     

Nostrilplasty: Raising,lowering, widening,and symmetry correction of the alar rim

Background: Although the alar rim has frequently been neglected in correction of nasal deformities, techniques for its improvement have been proposed and used successfully. Objective: Two techniques for correction of the deformed alar rim are described. Methods: To lower the alar rim, the internal skin of the vestibule is dissected away from the areolar tissue and brought down as a flap. A segment of cartilage is taken from the septum or upper portion of the lower lateral cartilage. The cartilage graft is placed in the rim and the vestibular mucosa is folded over the graft and sutured to hold the cartilage in place. Raising of the alar rim is accomplished through direct excision to raise the rim and to make the nostril longer or wider. This technique is applicable to correction of a dropped rim, pinched nostrils, hidden columella, sigmoid ala, small nostrils, and foreshortened nose. Results: These techniques have been used to treat primary, secondary, and traumatic nasal deformities in more than 200 patients during the past 20 years with few complications. Conclusions: Although the techniques described require a learning curve, once mastered they can be combined with other techniques used routinely in rhinoplasty to successfully treat a variety of nasal deformities. (Aesthetic Surg J 2002;22:227-237.)     

Correction of webbed neck defects

The posterior approach for correction of the webbed neck defect involves wide anterolateral skin undermining and skin resections from the nape of the neck. The redundant tissue and the underlying defect are corrected and the resultant scar is hidden in the scalp rather than being exposed on the lateral aspect of the neck or shoulder as would be the case with a Z-plasty procedure. In addition, the hairline remains smooth and in a relatively natural position. The surgical dissection is not difficult, and few anatomical structures are involved. The procedure has been employed in 4 patients and has proved to be effective and safe, with long-lasting improvement and acceptable aesthetic results.     

Total scalp, ear, and eyebrow avulsion: aesthetic adjustment of the replanted tissue

A case of successful replantation of a total scalp avulsion, including both ears and one eyebrow, is presented with bilateral anastomoses to the superficial temporal vessels. While over 90 percent of the replant survived, partial loss of occipital and posterior neck skin and the inferior half of the left ear occurred. The patient subsequently required additional procedures, including skin grafting, scar revisions, and staged ear reconstructions. Thus, while microsurgery often provides the only hope for tissue salvage, there is a frequent need for additional revisions and aesthetic adjustment of portions of the replanted tissue.     

Eyebrow reconstruction following burn injury

Facial burns represent between one-fourth and one-third of all burns. Absence of the eyebrows or distortions in their position alter the character of the face. Thus, eyebrow repair or reconstruction can be an important "finishing touch" in the overall reconstruction of a burned face. Generally, there are three ways to reconstruct the eyebrow: use of superficial temporal artery island flap; composite graft from scalp; and mini or micrografts from scalp. This report presents 20 patients reconstructed with the above techniques. Eleven patients (eight male and three female) with superficial temporal artery island flaps; seven patients (two male and five female) with composite grafts from scalp; and two patients (female) with minigrafts. The results suggest that superficial temporal artery island flaps were more suitable for males and composite graft for females who generally require thinner and less dense eyebrows. Our experience with minigrafts for burn alopecia has not been adequate. Here in this article, different methods of eyebrow reconstruction are presented with the greater emphasis on superficial temporal artery flap.     

The occipitofrontalis muscle is composed of two physiologically and anatomically different muscles separately affecting the positions of the eyebrow and hairline.

After the surgical correction of aponeurotic blepharoptosis or blepharoplasty, the positions of the eyebrow and hairline change as if the frontal belly is independent from the occipital belly of the occipitofrontalis muscle. Therefore, the occipitofrontalis muscle was studied physiologically with electromyographic evaluation in healthy subjects and anatomically with cadaver dissections. Along with contraction of the levator muscle to maintain an adequate visual field, at a less upward gaze position, contraction of only the frontal belly was induced, and at a more upward gaze position, contraction of both the frontal and the occipital bellies was always induced to lift the eyebrow with the upper eyelid skin. The superficial fascia overlying the occipital belly becomes the temporoparietal fascia and ends at the superior end of the frontal belly, thus creating a superficial musculoaponeurotic system that lifts the eyebrow and pulls the scalp forwards. Beneath the superficial musculoaponeurotic system, the occipital belly of the occipitofrontalis muscle becomes the galea aponeurotica and inserts into the underside of the frontal belly, thus creating a deep musculoaponeurotic system that pulls the superficial musculoaponeurotic system with the scalp backwards. Thus, the occipitofrontalis muscle appears to be composed of two physiologically and anatomically different muscles.     

Cervical lift: Surgical correction of fat contour problems combined with full-width platysma muscle flaps

Correction of neck deformities due to fat, platysma muscle bands, or a combination of these deformities along with sagging of all neck tissue can be satisfactorily corrected by surgery. A knowledge of the anatomy of the face and neck is necessary in order to make an accurate diagnosis of the anatomical causes and to execute appropriate and safe surgical correction. A combination of thorough fat removal and full-width platysma muscle flaps converted into deep-layer sling support can eliminate the objectionable neck features, prevent recurring vertical muscle bands, produce pleasing neck contours along with a definition of the mandibular border, and avoid the problems which frequently occur when techniques which rely on skin tension or skin traction alone are used.     

Partial reconstruction of the eyebrow

Summary Classical techniques of total eyebrow reconstruction with flaps or grafts from the scalp are not suitable for partial reconstruction. In such cases, we prefer flaps from the same eyebrow or grafts from the other, or a combination of both techniques.     

Bilateral eyebrow reconstruction using a unilateral extended superficial temporal artery flap

In cases of the bilateral eyebrow reconstruction in men, two superficial temporal artery (STA) flaps are usually designed for both temporal regions according to the flap movable range and the direction of hair growth. Recently, the authors have successfully reconstructed bilateral eyebrows with normal directions of hair growth using a unilateral STA flap, extended by anastomosis of the STA and the occipital artery, with two hair-bearing skin islands. Using this method, the direction of the hair growth can be optimally selected by changing the direction of the skin islands for each eyebrow. The authors were able to reconstruct symmetric eyebrows with the hair growing laterally and a little upward. The invasiveness, bleeding, and operating time required for this method are less than those for the bilateral STA flap method. For cases in which one temporal scalp could not be used, bilateral eyebrow reconstruction remains possible with this method.     

不同部位皮肤扩张的时间及并发症的探讨

目的　探讨扩张部位与扩张效率的关系。方法　根据 115例患者 2 18例扩张器埋置部位的不同 ,分为耳后、头、面、颈、胸部 5组 ,对比扩张器不同的埋置部位对并发症及扩张时间的影响。结果　耳后、头、面、颈、胸部 5组并发症发生率分别为 33.33%、5 .88%、12 .2 0 %、6 .6 7%、8.11% ,耳后的并发症发生率明显高于其他部位 (P <0 .0 5 ) ,其中耳后与头部比较 ,差异有显著性意义 (P <0 .0 1) ,其他部位之间差异无显著意义。耳后、头、面、颈、胸部 5组扩张器注水时间分别为 (5 5 .88± 2 7.4 2 )、(73.6 9±5 1.2 3)、(6 6 .35± 2 7.12 )、(85 .11± 37.72 )、(77.86± 2 7.6 7)d ,颈部扩张时间明显长于其他部位 (P <0 .0 5 ) ,其中颈部与面部差异有显著性意义 (P <0 .0 1)。结论　耳后、面部并发症较多 ,要控制扩张速度 ;颈部扩张时间较长 ,并发症少 ,可以加快扩张速度     

A multi-staged approach to the reconstruction of a burnt Asian face

This article describes the management of chemical burns to the Asian face with resultant full thickness loss to the right side of the face including the eyelid and nose. We detail the techniques used to reconstruct the face which include skin grafting according to the aesthetic units of the face, accurate placement of junction lines, use of a chondrocutaneous graft to reconstruct the alar grove and scalp strip grafting for eyebrow reconstruction. We obtained a successful result that minimised scar formation in the burnt Asian face.     

Hair transplantation to the eyebrow, eyelashes, and other parts of the body

Since its earliest applications, hair transplantation has been used for treating not only the scalp in pattern baldness but also other parts of the body, commencing with eyebrow reconstruction. The earliest micrografts were applied to the eyebrow more than 30 years before their application to the scalp became the standard of care. Today hair transplantation is applied to a number of other areas. The principle behind transplanting these areas is the same-once transplanted, the hairs continue to grow because of the phenomenon of donor dominance. This article reviews the role and technique of hair transplantation to the eyebrows and eyelids, chest, beard and moustache, and pubic escutcheon.     

毛发单元移植行眉毛美容性修复再造

目的 探索应用毛发单元移植技术治疗各种原因所引起的眉毛永久性缺损。方法 切取后近发际区域处含有完整毛发毛囊的条形头皮组织，在手术放大镜下，将其分割，制备成毛发单元（每单元含1-3根毛发）即显微毛发移植物。然后，将这些植物按眉的自然走向植入到眉毛脱失区内预制的洞穴中。结果 自1998年4月至2000年2月，共完成了32例48侧眉的美容性再造。所有患者一期手术均取得满意的美容效果。经1年以上的临床随访再造眉毛生长良好。即使在瘢痕区域内，成活率也可达到95%，再造的眉形态走向较自然，接近于正常的眉毛。结论 毛发单元移植技术再造的眉毛与其它方式相比，手术方法简便，创伤小，更加自然，是目前眉毛美容性再造的理想方法。     

Surgical treatment of forehead and glabellar wrinkles]

Many surgeons concerned with aging in the jowl and neck often overlook more objectionable changes in the upper face. These changes produce not only an old or aged appearance but inappropriate expressions as well. This paper outlines the elements of aging in the upper face and details the planning and execution of the foreheadplasty. Topics discussed include inappropriate facial expressions, upper facial aesthetics, incisions for bald or balding men and techniques for minimizing scars. For many years the evolution and application of techniques for rejuvenation of the upper face lagged behind that of procedures used to correct aging in the cheek and neck. Men were generally overlooked as candidates for foreheadplasties by surgeons who believed these procedures not to be possible on bald or balding scalps. In addition, patients were frequently disappointed after surgery due to objectionable secondary deformities. These include bizarre expressions from over-resection of forehead muscles, contour irregularities following imprecise muscle sculpturing, inappropriate appearances due to eyebrow malpositioning and aesthetic imbalances resulting from hairline shifting. For these and other reasons some surgeons deemed the procedure to be of questionable value. The author would like to share current concepts and new techniques which have overcome these problems and delivered satisfaction and happiness to many patients.     

Subcutaneous approach to forehead, brow, and modified temple incision.

Placing the incision at the hairline or just posterior to the boundary of the hair, with subcutaneous elevation of the flaps, is a more effective way to correct the aging upper face, whether it be "crow's feet," excess forehead skin, or eyebrow ptosis. Furthermore, by placing the facial rhytidectomy incision at the sideburn boundary caudally and anteriorly, the sideburn can be preserved, regardless of the amount of skin removed. Patient selection and procedure have been described. Patients who are candidates for this type of surgery include those who have a long forehead, a short forehead, deep wrinkles, or thinner skin, as well as patients with deep frown lines and hyperactive corrugator muscles. The scars are generally minimal but can be camouflaged in one of many ways if they are visible. The most effective method is medical-grade tattooing. There are many advantages to the technique, the most important of which is control of forehead length and preservation of sensory and motor nerves. The results are far superior to most other available techniques in properly selected cases. In today's world of aesthetic surgery finesse, those who have expertise with a variety of approaches are more equipped to best serve the patients, and the techniques described here should be part of the aesthetic surgery armamentarium.     

上睑皮肤松弛矫正术方法选择研究

目的:探索一种个性化矫正上睑皮肤松弛的手术方法以获得最佳临床效果。方法:按照个性化特点,依据上睑皮肤松弛程度,选择重睑切口、眉下缘切口、眉上缘切口、切眉切口、睑缘切口方法矫正,并对其临床疗效进行总结分析,从而探寻治疗上睑皮肤松弛的最佳手术方法。结果:本组505例患者,其中490例对术后效果满意,满意率为97%。15例患者效果欠佳,其中,6例重睑臃肿不自然,2例眉上切口瘢痕明显,1例眉下切口眉形变平,1例上睑出现纵褶,1例重睑线不流畅,4例皮肤松弛矫正不明显,均为重睑线去皮法。结论:对上睑皮肤松弛手术治疗者,应根据个性化特点,上睑皮肤松弛程度及眉的外形等情况选择不同的手术方式,可获得最佳临床效果。     

Minimal incision facelift

Many procedures have been developed in an attempt to improve facial ptosis. These have ranged from subcutaneous dissections with skin excision to deeper dissections focused on supporting the superficial musculoaponeurotic system and even the periosteal layer. These deeper dissections, although theoretically giving better and longer lasting results, also carry an increased risk of complications. This article describes a new facelift technique that minimizes complications while maximizing cosmetic results (especially in the neck and jowl areas) and patients' comfort and satisfaction. Aesthetic results (as determined by pre- and postoperative photographs) and complications of 35 consecutive patients undergoing both traditional rhytidectomy and minimal incision facelift are compared. The minimal incision facelift technique has shown improved cosmetic results and a decreased complication rate compared with traditional rhytidectomy and is a safe and very effective technique for the treatment of facial ptosis.     

内固定技术在眉成形术中的应用

目的 探讨内固定技术在眉内小切口提眉术及眉下缘切口上睑成形术中的临床应用及效果.方法 对138例诊断有眉下垂或上睑皮肤松弛的受术者,在眉毛内或眉下缘设计皮肤切口线,切开皮肤或去皮后,在切口线垂直下方分离显露深额部骨膜组织,在相应位置上用4-0慕丝线挂住骨膜一针,然后再缝合切口上下缘皮下组织,打结后可使眉部位置上提,也可更加有效地提拉松弛的上睑外侧皮肤,同时改善鱼尾纹.结果 术后138例受术者眉下垂、外侧上睑皮肤松弛下垂及鱼尾纹均得到明显改善.结论 内固定技术可更好地提升眉部组织,改善上睑皮肤松弛下垂及鱼尾纹.