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Background The nasolabial flap is ideal for reconstruction of the nasal alar subunit due to its proximity, color and contour match, and well-placed donor scar. When raised as a random-pattern flap, there is a risk of vascular compromise to the tip with increased flap length and aggressive flap thinning. Surgical delay can greatly improve the chances of tip survival, allowing the harvest of longer flaps with greater reach. Methods We describe our technique of lengthening the nasolabial flap through multiple delay procedures. A bipedicled flap was first raised and then transferred as a unipedicled flap with a 6:1 length-to-width ratio. During the delay process, the flap tip was thinned to the subdermal layer. Results In our case series of seven patients, defects as far as the medial canthal area and contralateral ala were reconstructed successfully with no incidence of tip necrosis or flap loss. The resultant flaps were thin enough to be folded over for the reconstruction of alar rim defects. Conclusions We highlight the success of our surgical technique in creating thin and robust nasolabial flaps for the reconstruction of full-thickness defects around the nose.

Background We conducted this clinical study to compare the efficacy and safety between Neuramis Deep and Restylane in the correction of nasolabial folds. Methods In this phase III, randomized, multi-center, double-masked, matched-pairs, active-controlled trial (ClinicalTrials.gov Identifier: NCT01585220), we evaluated a total of 67 subjects (n=67). All the subjects underwent Neuramis Deep treatment on one side and Restylane on the contralateral side of the bilateral nasolabial folds at a ratio of 1:1. To compare the efficacy of Neuramis Deep and Restylane, we evaluated the Wrinkle Severity Rating Scale scores and those of the Global Aesthetic Improvement Scale. In addition, we compared the safety of Neuramis Deep and Restylane based on adverse events, physical examination, and clinical laboratory tests. Results Neuramis Deep was not inferior in improving the nasolabial folds as compared with Restylane. In addition, there was no significant difference in the efficacy between Neuramis Deep and Restylane. There were no significant differences in safety parameters between Neuramis Deep and Restylane. Conclusions In conclusion, our results indicate that Neuramis Deep may be a safe, effective material for improving the nasolabial folds. However, further studies are warranted to compare the tolerability of Neuramis Deep and Restylane based on histopathologic findings.

Background Classical flaps for perinasal defect reconstruction, such as forehead or nasolabial flaps, have some disadvantages involving limitations of the arc of rotation and two stages of surgery. However, a perforator-based flap is more versatile and allows freedom in flap design. We introduced our experience with reconstruction using a facial artery perforator-based propeller flap on the perinasal area. We describe the surgical differences between different defect subtypes. Methods Between December 2005 and August 2013, 10 patients underwent perinasal reconstruction in which a facial artery perforator-based flap was used. We divided the perinasal defects into types A and B, according to location. The operative results, including flap size, arc of rotation, complications, and characteristics of the perforator were evaluated by retrospective chart review and photographic evaluation. Results Eight patients were male and 2 patients were female. Their mean age was 61 years (range, 35-75 years). The size of the flap ranged from 1 cm×1.5 cm to 3 cm×6 cm. Eight patients healed uneventfully, but 2 patients presented with mild flap congestion. However, these 2 patients healed by conservative management without any additional surgery. All of the flaps survived completely with aesthetically pleasing results. Conclusions The facial artery perforator-based flap allowed for versatile customized flaps, and the donor site scar was concealed using the natural nasolabial fold.

Background Previous studies have investigated facial artery perforators, but have reported inconsistent results regarding lateral nasal artery (LNA) perforators. Although several authors have described the use of LNA perforators for ala nasi and nasal sidewall reconstruction, the literature contains little information regarding the cadaveric dissection of LNA perforators, and most previously published studies have focused on facial artery perforators. Methods Sixteen hemifaces from eight fresh cadavers were dissected to study the LNA perforators. After the dissection was performed, the total length and diameter of the LNA and its perforators were measured. The quantity and the distribution of the LNA perforators supplying the overlying skin were then assessed. LNA perforator flaps were used for reconstruction in 10 nasal and perinasal defects. Results The mean total lengths of the LNA and its perforators were 49.37 mm and 16.06 mm, respectively. The mean diameters of the LNA and its perforators were 2.08 mm and 0.91 mm, respectively. Based on our findings, we mapped the face to indicate zones with a higher probability of finding perforators. No infection, hematoma, or complete flap necrosis were observed after the procedures. Conclusions Nasal reconstruction is a challenging procedure, and LNA propeller/V-Y perforator flaps are an excellent reconstructive option in certain cases. Based on our cadaveric study, we were able to identify an area in the upper third of the nasolabial groove with a high density of perforators.

Background Facial rejuvenation can be achieved using a variety of techniques. Since minimally invasive procedures for face lifting have become popular because of their convenience and short operating time, numerous minimally invasive surgical procedures have been developed. In this study, a nonabsorbable polypropylene mesh is introduced as a new face lifting instrument, with the nasolabial fold as the main target area. In this paper, we report the efficacy and safety of a polypropylene mesh in midface rejuvenation. Methods Thirty-three subjects with moderate-to-severe nasolabial folds were enrolled from two medical institutions for a noncomparative single-sample study. A mesh was inserted above the superficial muscular aponeurotic system layer, reaching the nasolabial folds through a temporal scalp incision. After 3 weeks, the temporal end of the mesh was pulled to provide a lifting effect. Then, the mesh was fixed to the deep temporal fascia using nonabsorbable sutures. To evaluate efficacy, we compared the scores on the Wrinkle Severity Rating Scale and a visual analog scale for patient satisfaction between the baseline and 7 weeks postoperatively. In addition, we evaluated safety based on the incidence of adverse events. Results The treatment was deemed effective at improving wrinkles in 23 of 28 cases, and patient satisfaction improved significantly during the study period. There were seven cases of skin or subcutaneous tissue complications, including edema and erythema, but there were no suspected serious adverse events. Conclusions Face lifting using a nonabsorbable mesh can improve nasolabial folds without serious adverse effects. Thus, this technique is safe and effective for midface rejuvenation.

Deepening of the nasolabial crease is an esthetically unpleasing aging phenomenon occurring in the midface. Various treatment modalities have been introduced to improve the appearance of prominent nasolabial folds, all of which have pros and cons. Currently, a minimally invasive technique using synthetic dermal fillers is most commonly used. A simple and easy subcision procedure using a wire scalpel has also been used and reported to be effective for prominent nasolabial fold correction, with minimal complications. As an alternative to the wire scalpel, we used a 20-gauge metal type spinal needle cannula (Hakko Co.) and 4-0 Vicryl suture (Ethicon Inc.) for subcision of nasolabial folds. This technique is less expensive than the use of a wire scalpel and easily available when needed. Therefore, on the basis of favorable results, our modified subcision technique may be considered effective for prominent nasolabial fold correction.

Hemangiopericytoma is rare in occurrence worldwide, including Korea. It was initially described by Stout and Murrary [1] in 1942. It is derived from a type of smooth muscle cell attached to pericytoma, capillaries also known as Zimmerman pericytes, and it is characterized by a "staghorn" shape on microscopic findings, in other words, a tumor with a diffuse pattern of branching, and dilated, thin-walled blood vessels surrounded by short spindle cells. Hemangiopericytoma has the very unusual characteristic of growing slowly, mainly in the lower extremities and pelvic retroperitoneum, but it can also be found in any part of the body such as the head and neck [1,2]. We introduce here a case of hemangiopericytoma found in the nasolabial fold because it rarely occurs in that area. Hemangiopericytomas in the head and neck are uncommon, but have been found in the neck, orbit, nasal cavity, parapharyngeal area, or tongue. A 57-year-old male with no specific underlying disease was admitted to our hospital due to an increasing mass in the nasolabial fold as the chief complaint. The mass had been growing in size for 1 year. The mass was painless, non-fixed, movable, and round in shape. The mass grew in size until the nasolabial fold was more pronounced than the opposite side. The skin and buccal mucosa area around the mass were intact, and there was no drainage (Fig. 1). The computed tomography and magnetic resonance imagining findings showed a well-defined, solid mass with isoattenuation and heterogeneous enhancement in the premaxillary area (2.4×3.4×3.5 cm3) (Fig. 2). Fig. 1 Preoperative photograph shows a mass near the right nasolabial fold. Fig. 2 T1-weighted magnetic resonance imagining findings show a solid mass enhanced in the premaxillary area (2.4×3.4×3.5 cm3). The operation was carried out under general anesthesia. The mass was large and considered to be a hemangioma or any other benign mass. However, the possibility of malignancy was not completely ruled out, and the incision was made through the nasolabial fold for minimal scarring. An approximately 5 cm incision was made along the right nasolabial fold, undermining the muscle layer. Complete excision of the mass was performed, and the mass was slightly irregular in shape and encapsulated, and was not attached to the surrounding tissues (Fig. 3). Fig. 3 Photograph of an extracted specimen after complete excision. Microscopically, the tumor was composed of variably sized ectatic vessels showing a staghorn configuration and surrounding closely packed spindle or ovoid cells (Fig. 4). The tumor cells showed a small amount of pale cytoplasm and mild nuclear atypia, but had a low mitotic rate (less than 1 mitosis in 10 high power fields [HPF]). The tumor cells were diffusely positive in CD34 and CD99 immunostains (Fig. 5). There was no evidence of a tumor in the surgical margin. Postoperative chemotherapy and radiotherapy were not performed. Fig. 4 Tumor composed of ectatic, staghorn-shaped vessels and closely packed tumor cells, showing short spindle to round cells with a small amount of pale cytoplasm (H&E, ×200). Fig. 5 The tumor cells are positive for CD34 based on the immunostain (×100). The patient did not mention any particular complaints for 3 months after surgery. There were no obvious facial changes or an awkward appearance when talking or showing emotions. The affected nasolabial fold had no significant difference from the opposite side. It seems that the dermal elasticity and subcutaneous adipose layer, which define the shape of the nasolabial fold, were not affected by the operation or the mass. Hemangiopericytoma is characterized as a slow growing painless mass. When it occurs in the head and neck, patients are admitted to the hospital with symptoms caused by the mass physically affecting the surrounding tissues. The tumor is composed of spindle or round CD34 positive cells surrounding staghornshaped vessels. However, these features are overlapped with a solitary fibrous tumor; nevertheless, a solitary fibrous tumor has more prominent collagen, less prominent vessels, and less cellular pattern than a hemangiopericytoma. The clinical features of both tumors are also similar. Recently both types of tumors are considered to be the same entity with the two ends of one process. Hemangiopericytoma has a varied spectrum of biological behavior: benign to malignant. The prediction of the clinical behavior of hemangiopericytomas is not clear. Generally, a large size (>5 cm), increased mitotic rate (>4 mitosis/10 HPF) with the presence of atypical mitosis, high cellularity, pleomorphic tumor cells, and foci of hemorrhage and necrosis predict a highly malignant course [3,4]. The main treatment of hemangiopericytoma is complete surgical excision. Preoperative embolization can be helpful for decreasing the size of the mass. Radiotherapy, chemotherapy, or a combination of both can effectively improve the survival rates when the mass is inoperable or cannot be completely removed, or metastasis occurs. Hemangiopericytoma has a varied spectrum of biological behavior: benign to malignant. Multiple articles have shown non-eventful life-long results after complete excision of hemangiopericytomas; however, it is better to consider a hemangiopericytoma to be malignant throughout a patient's lifespan because the tumor has the possibility of metastasis or recurrence. Therefore, long-term follow-up seems to be essential [4].