Using these parameters we have chosen for the ala the nosecheek flap, for the dorsum the frontglabellar flap, the. The glabellar flap is effective in the reconstruction of defects within the medial. This video demonstrates repair of a deep medial canthal defect which straddles the medial canthal tendon with a combination mustarde and glabellar flap. Hence, using the combination of nasolabial vy advancement flap and glabellar rotation flap is a useful alternative method for the reconstruction of large. Complex aesthetic subunits and limited available adjacent mobile skin with varying color, texture, and thickness all contribute to this task. It may be helpful or detrimental in changing the position of an anatomic structure e. Cause of glabellar lines and how can it be remedied.
Its blood supply can be based on muscular perforators so that the skin base can be narrowed or the flap converted to an island. The most frequent location was the nasal ala 24,1 percent, followed by the dorsum 20,9 percent, tip 16,4 percent, and sidewall 15,8 percent. The single transposition flap lacks the versatility of some other transposition flaps, but has its indications. Glabella rejuvenation via corrugator excision and volume replacement linton a. I have gotten 2530 units of botox every 3 months for the past year.
The glabellar flap can be used by itself or in combination with other procedures to reconstruct the medial canthus. The rotation flap is commonly described as a semicircular flap that is rotated about a pivot point to close a triangular defect. Aesthetic reconstruction of soft tissue nasal sidewall loss has an important influence on the appearance of the nose. Our observations showed that the most prominent glabellar frown lines gfls are very. Skin flaps in periorbital reconstruction 257 necessary. Use of skin flaps for nasal reconstruction after neoplastic. Glabellar frown lines as a reliable landmark for the. Eyelid reconstruction riva lee asbell philadelphia, pa. We have developed a minimally invasive endoscopic pericranial flap for endoscopic skull base reconstruction. Glabellar and lateral rotational flaps were designed. Jan 03, 2018 this video illustrates how to perform a glabellar flap. The glabellar flap is effective in the reconstruction of defects within the medial canthal region. A rectangular glabellar flap was designed in accordance with the. Dec 04, 2016 this feature is not available right now.
Reconstruction was performed with glabellar flap, bilobed flap, vy advancement flap, dorsal nasal or miter flap, and nasolabial and forehead flap. However, in some situations, large defects cannot be closed with single flap. Surgical treatment with locoregional flaps for the eyelid. It is a rotationadvancement sickleshaped flap, based on branches of the angular artery as it descends along the. Skin flaps in periorbital reconstruction sciencedirect. Pdf on jan 1, 2017, amitabh jena and others published reconstruction with dorsal. The glabellar flap is a vy flap used for medial canthal reconstruction. Flip pdf is your easy way to batch convert ordinary pdf files into stunning booklets with amazing pageflipping animations and sound. Report from a swedish prospective screening study of congenital toxoplasmosis with two years of follow. The sliding nasolabial flap, frequently used for defects at the labial border of the nose, is especially advantageous for persons who are elderly and typically have excessive skin in this area. The glabellar flap was raised and transposed to cover the superior portion of the defect.
The unique contour of the medial canthal region presents a challenge in the surgical planning of. If the defect is superior to the medial canthal tendon, a glabellar flap is a reasonable choice. The midpoint of the triangle is midline, extending a few centimeters above the superior border of the eyebrow. Mar 12, 2016 it is the first quick, less invasive and effective, nonsurgical technique for both brow lift and rhytid treatment. The narrowing of its vascular pedicle to the cutaneous arterial branch of the angular artery categorizing it as an axial flap pattern. Preservation of the supratrochlear vascular pedicle svp during use of the paramedian forehead flap can be accomplished by the aid of doppler imaging. Overelevation of the medial eyebrows was another problem with the coronal lift, which i eventually managed to avoid when i stopped excising scalp from the central half of the forehead flap. Reconstructive options for cutaneous defects of the nose. We used a myocutaneous nasal root island flap based on the periocular muscles for the reconstruction of these defects with primary closure of the donor site. Zimbler is recognized as an expert in the field of facial plastic surgery. A 15 blade is used to make an incision through the skin and subcutaneous fat. Glabella rejuvenation via corrugator excision and volume. Imagine being able to create digital magazines and catalogs.
The unique character of this subunit and the complex relationships with a number of different facial or nasal subunits make the excision of large tumors difficult to manage. We have evaluated the versatility of vy perforator flap for reconstruction of skin defects. Pdf vy advancement flap for reconstruction of defects after. Listing a study does not mean it has been evaluated by the u. Valladaresnarganes and others published combination of a glabellar flap and a transposition flap for the reconstruction of 2 noncontiguous nasal defects find. Glabellar flaps in nasal reconstruction glabellar flap. Glabellar flaps have traditionally been used to cover nasal skin and soft tissue defects. Nasal root island flap for reconstruction of glabellar defec. Glabellar flaps in nasal reconstruction plastic surgery key.
Glabellar flaps in nasal reconstruction request pdf. Combination of glabellar and vy cheek advancement flaps for. Trilobed flaps have demonstrated utility in the reconstruction of lower nasal defects. A new glabellar flap modification for the reconstruction of medial canthal and nasal dorsal defects. Principles and techniques of eyelid reconstruction springerlink. By uploading your videos here you can share your knowledge with a worldwide community of surgeons. But at least there are a variety of different options to treat it. The same group demonstrated in 2010 that botulinum toxin type a injection to the glabella has been shown to improve both dynamic glabellar rhytides and those in repose. Other options for medial canthal reconstruction include a bilobed flap, rhomboid flap, and fullthickness skin graft eye 86. The oncologic resection resulted in moderate sized glabellar defects. Two versatile local flaps for nasal reconstruction are the glabellar flap and an extension of the glabellar flap, the dorsal nasal flap. In order to avoid unnecessary facial distortion a vy cheek advancement flap measuring 3.
A glabellar transpositional flap is a standard technique for medial canthal reconstruction 3. A bilobed flap was used for the reconstruction of the nasal tip in 6 46. Feb 19, 2020 mediumsized defects of the nose can be closed by rotation flaps with skin borrowed from the glabella, upper nasal dorsum, or nasolabial sulci. Colour atlas of ophthalmic plastic surgery, boston, 2008. As you can see the treatment of your glabellar lines is not an easy problem to solve. It is elevated in a submuscular plane to protect the blood supply. Here the border of the defect becomes the leading edge of the flap with the remainder of the flap outline being drawn as the arc of a circle fig. Superiorly based bilobed flap for inferior medial canthal and nasojugal fold defect reconstruction julian d. The ideal approach to treating glabellar creases must address both the muscular activity and the etched skiin itself. Oct 29, 2018 the glabellar region is an area from which a number of local flaps have been designed to reconstruct wounds of the superior and lateral nose.
Apr 25, 2017 the glabellar flap can be used by itself or in combination with other procedures to reconstruct the medial canthus. Combination of glabellar and vy cheek advancement flaps. Whitaker is professor of surgery and director, center for human appearance, university of pennsylvania, philadelphia, pa. A periodontal flap is a section of gingiva andor mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface. Expanded applications of the dorsal nasal flap facial plastic. The incision can be well hidden in glabellar furrows figure 7 figure 8 dorsal nasal flap rieger flap. Combination of nasolabial vy advancement flap and glabellar.
Basal cell carcinoma bcc is the most common skin cancer. Lateral rotationalglabellar flaps for medial canthal defects. Nasal reconstruction following soft tissue resection. Using a flap provides a satisfying texture and colour match with adjacent tissues and ensures short contraction. In between the two lies the placement of a dermal fat graft or allogeneic dermis graft threaded into each one of the glabellar grooves. The glabellar defect figure 1e is closed in an at fashion figure 1f after. Advancement perforator cheek flap for aesthetic onestage. Combination of at advancement flap and crescentic flap. Nasolabial flap definition of nasolabial flap by medical. In general, these flaps are most useful for medial canthal defects that are superior to the medial canthal tendon. Surgical technique the glabellar flap is designed in a triangular shape over the area of maximal skin laxity the in the glabellar region.
Medial canthal region reconstruction should be performed with local flaps considering colour and tissue match. This can be due to prior surgical resection or involvement of the nasal septum by sinonasal cancer. The 3 most popular methods of transferring skin from the glabellar region include the median glabellar flap, the vtoy rotation glabellar flap, and the transposition glabellar flap. Superiorly based bilobed flap for inferior medial canthal and. The use of a pericranial scalp flap for reconstruction. Dec 07, 2006 a study of botox for the treatment of glabellar lines the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. I found that limiting scalp excision to the lateral ends of the coronal incision line provided good lateral eyebrow elevation in almost all patients. The medial canthal angle was then recreated by engaging the periosteum of the posterior lacrimal crest with a 40 polyglactin 910 suture on a p2 needle followed by the medial portion of the eyelid defect. A study of botox for the treatment of glabellar lines full. Three cases are presented, the first of which typifies the standard glabellar flap with an intact skin and subcutaneous pedicle. Transformation of the glabellar flap into an island flap.
A novel approach to repair surgical defect above the eyebrow snehal desale, chihjung hsu department of dermatology, china medical university hospital, taichung. Lateral open forehead lift aesthetic surgery journal. Surgical treatment with locoregional flap for the nose. Pdf reconstruction with dorsal nasal flap after excision of basal.
Objective to describe new applications for the dorsal nasal flap technique of facial. The dorsonasal flap by rieger 32 is a rotation advancement flap of dorsal and glabellar skin based superolaterally for defects of the middle and lower third of the nose figure 3a, 3b. This flap utilized the loose glabellar skin to the nasal radix to repair defects in this area. The patient is status post excision of a basal cell carcinoma which has also resulted in an upper and lower canalicular defect. Simply treating the muscles does not eliminate these creases. Department of ophthalmology, cole eye institute, cleveland clinic foundation, cleveland, ohio, u. Numerous techniques are described in the literature, but a primary reconstruction with a final good. Code all procedures performed by the oculoplastic surgeon. Balance complexity of techniques with improvements in outcome. The croissant like keystone perforator island flap ckpif and the. The ideal reconstruction of nasal defects recruits tissue of similar color, texture, and thickness to that of the defect. Tenzel semicircular advancement flap is a useful technique in eyelid reconstruction both superior and. Feb 08, 2017 glabellar flaps in nasal reconstruction glabellar flap.