Chinese face reading is an ancient art that has been developed over centuries, not only in China but over the wider area of Asia owing to China's cultural dominance in Asia during its imperial rule. Similar to feng shui, Chinese face reading is based on a philosophy held by Chinese people all over the world that expresses itself in contemporary daily life and practices by coloring people's choices, likes, and dislikes. It is inevitable that the aesthetic sense is also affected by face reading principles, especially among those who are most familiar with them. An understanding of these principles and beliefs would help surgeons better understand their Asian patients' requests and perhaps allow them to better communicate appropriate suggestions accordingly.

Objective To review my experience in both malar reduction and mandibular reshaping techniques to establish optional, effective, and reliable surgical procedures. A square-shaped face is considered aesthetically unfavorable among East Asians; therefore, reduction malarplasty and mandibular reshaping are becoming more acceptable for aesthetic facial skeleton recontouring.

Methods The techniques of zygoma arch infracture or mandibular angle reduction were used until 2 alternative techniques were introduced in 2002: the wedge-section osteotomy in the malar complex and inclined-fullness osteotomy in the mandibular angle and margin. Both osteotomies were selected according to personal experience and communication with patients. The wedge-section zygoma osteotomy was performed in the lower zygomatic body via an intraoral approach and greenstick infracture of the posterior zygomatic arch through a tiny preauricular incision. The prominent malar complex could be reduced by being pressed inward and was stabilized only by surgical suture or self-stabilization without any fixation, and the latter method was chosen in my recent cases. For the lower face, I designed an inclined-fullness osteotomy to address the mandibular angle and margin along the diagonal of marked projection of the mental foramen on the margin of the mandible and the projection of mandibular foramen on the ramus. The surgical indications, major complications, and levels of patient satisfaction for the different techniques were compared, and thus the pros and cons of wedge-section osteotomy and mandibular reshaping vs conventional procedures were analyzed.

Results A total of 585 patients who had undergone either reduction malarplasty or mandibular reshaping in the craniofacial center at the Shanghai Ninth People's Hospital from May 1988 through December 2008 were reviewed in this study. Intraoral incision was the dominant method of access in both types of osteotomies. Wedge-section malarplasty osteotomy was more effective and reliable compared with other conventional methods. More than half of the patients in cases of the mandibular reshaping have undergone surgery that included both reduction of the mandibular angle and shaving of the mandibular margin.

Conclusion As optimal strategy for aesthetic facial contouring surgery in East Asians, reduction malarplasty and mandibular reshaping were proven to be safe, effective, and easily handled techniques for modifying the square-shaped face.

Objective To study the effect of an anchor fixation stitch in combination with the external incision technique in Asian upper blepharoplasty.

Methods Combined with an upper eyelid blepharoplasty using a conventional external incision procedure, an anchor stitch was used to fixate the dermal layer of the pretarsal skin and the upper edge of the tarsal plate. The procedure was performed in 72 patients with creaseless eyes (50 cases) or with laxity of the upper eyelids due to aging (22 cases). The patients were followed up for 6 to 12 months. The upper eyelid folds were evaluated by the surgeons and by the patients, and the outcome was graded as excellent, good, fair, or poor.

Results Of the 72 patients, 52 (72%) had excellent results and 20 (28%) had good results; no patients had fair or poor results. There were no cases of crease loss after 6 to 12 months of follow-up. All patients were satisfied with the results.

Conclusions The findings show that the combined anchor suture with external surgery is a reliable approach to Asian upper eyelid blepharoplasty both in young creaseless eyelids and in eyelids with laxity due to aging. We suggest that the anchor suture could be used as a routine procedure in Asian blepharoplasty.

Objectives To summarize the types and causes of unsatisfactory double eyelid results after double-eyelid blepharoplasty in Asian patients and to explore the corrective methods.

Methods Various methods are used to repair different types of unsatisfactory double-eyelid results following double-eyelid blepharoplasty. The basic principles are that scar adhesions should be released as much as possible, the normal anatomic structure is restored, the radian of the double eyelid is adjusted, and the position of the double eyelid is relocated.

Results After 3 months to 5 years of follow-up, most patients who initially had unsatisfactory double-eyelid results after double-eyelid blepharoplasty were satisfied with the results of corrective surgery.

Conclusion It is important to avoid complications at the first double-eyelid blepharoplasty because corrective surgery is difficult.

Objective To report a new surgical approach that results in a natural size and contour of the external malformed constricted ear.

Methods A total of 62 consecutive patients with constricted ear underwent surgery between July 1, 2005, and December 31, 2007. Depending on the features and severity of the deformity, the methods of tumbling cartilage flap (CF), free auricular composite graft, or a combination of these 2 techniques were applied.

Results A total of 45 patients were treated with the method of tumbling CF. Twelve were treated with an auricular composite graft from the contralateral ear, and in 5 patients a combination of the 2 methods was used. In all cases, there was an improvement in the size, shape, and symmetry of the ears, and most patients were satisfied with the outcome. Complications were rare, and there was no donor site deformity.

Conclusions The technique of tumbling CF and free auricular composite graft provides a simple and promising treatment for constricted ears. Furthermore, this technique is easy to apply with a predictable good outcome.

Objective To optimize the long-term results and reduce complications of augmentation rhinoplasty using expanded polytetrafluoroethylene (e-PTFE).

Methods There are certain key principles. The implant should be shaped to conform to the contour of the underlying nasal structure. It should be formed in a gentle curve, without twisting the implant, to preserve mechanical stability as well as to maintain aesthetic appearance. A strict sterile technique during the procedure and a good aseptic technique in the postoperative period are important to prevent infection. External fixation of the implant helps stabilize it.

Results Based on the above principles, 1700 patients underwent augmentation rhinoplasty with e-PTFE from 1999 to 2009. The criteria evaluated included complications and postoperative results: (1) bleeding volume, (2) postoperative swelling of the nose, and (3) pathologic and aesthetic outcomes. Extrusion of the prosthesis developed in 3% of cases; malposition of the prosthesis in 3%; slight bleeding and swelling in 80%; moderate bleeding and swelling in 18%; severe bleeding and swelling in 2%; and infection in 1%. Ninety-three percent of the patients reported aesthetic satisfaction.

Conclusion In this study, adherence to these operative principles played an important role in reducing complications, in preserving the stability of the position of the prosthesis, and in maintaining the aesthetic contour of the nose.

Objectives To form and test a prefabricated, 3-dimensional tip graft structure from autologous cartilage pieces and octyl-2-cyanoacrylate adhesive (Dermabond). Displacement and instability of grafted cartilage are common drawbacks of endonasal tip surgery, and we evaluated the feasibility and efficacy of octyl-2-cyanoacrylate adhesive for clinical use.

Methods Three New Zealand rabbits were examined in this study. We cut auricular cartilage into pieces of approximately 1 x 2 cm and glued them together with octyl-2-cyanoacrylate. Three months after subcutaneous implantation in the rabbits, we histopathologically analyzed foreign body reactions, histotoxic effects, and the structure of the regenerative tissue in the implanted cartilage. Furthermore, from human patients we harvested small pieces of autologous cartilage and cemented them together with octyl-2-cyanoacrylate adhesive to prefabricate 3-dimensional tip grafts, which we then inserted into the nasal tips of patients via an endonasal approach to project and contour the nasal tip. The changes in tip definition of 42 Asian patients were analyzed.

Results Octyl-2-cyanoacrylate adhesive interacts well with cartilage tissues with no systemic or local adverse effects. Its ability to bond cartilage instantaneously allows for the fabrication of intricate cartilage implant components. The aesthetic results in 42 cases were excellent, and the implants were both safe and effective.

Conclusion Our results demonstrate that octyl-2-cyanoacrylate can be safely used in endonasal tip surgery to produce excellent cosmetic outcomes in Asian subjects.

Objective To investigate septal cartilage compressive changes as a result of bilateral extended spreader grafts (ESGs), which are commonly used in rhinoplasty. The buckling, rupturing, or necrosis of the recipient site leads to nasal tip structural deformity. These pathologic changes associated with bilateral ESGs warrant the clinician's attention and in-depth basic and clinical research.

Methods The basic experimental study involves New Zealand rabbits, randomly assigned to groups A, B, C, and D, with group A as a reference. The right auricular cartilage was harvested and transplanted into a corresponding anatomic location of the left ear. The compressive effect was studied by gross observation and microscopic examination with hematoxylin-eosin staining after 3 months. In a clinical experiment, revision rhinoplasty surgical procedures were performed in 10 human patients 6 months to 1 year after placement of bilateral ESGs. The compressive changes of septal cartilages between the ESGs were observed intraoperatively.

Results In group A of the rabbits, no pathologic change was noted, but 2 cases of attenuation were observed in group B (33.3%), 6 cases of central fracture (100%) with 1 case of perforation (16.7%) in group C, and 6 cases of different degrees of defects in group D (100%). Clinical intraoperative observations revealed 1 case of defects and necrosis (10%), 4 cases of attenuations and cracks (40%), and 5 cases of attenuations (50%).

Conclusions Septal cartilage compressive necrosis leading to structural damage by bilateral septal ESGs is a clinically significant complication of rhinoplasty. Owing to its affect on the viability of the original septal cartilages, we believe the unilateral ESG with columellar strut is preferred, especially in Asian patients.

Objective To evaluate the effect of University of Wisconsin (UW) solution on composite facial flaps in dogs to offer a preservation time limit for clinical application.

Methods The experiment included 2 parts. In part 1, 32 half facial flaps were cold stored for 12, 24, 36, and 48 hours in UW solution (experimental group) or normal saline (control group). In part 2, 8 flaps that had been cold stored in UW solution for 24 (group A, n = 3), 36 (group B, n = 3), and 48(group C, n = 2) hours were autotransplanted.

Results After preservation in part 1, the viability of each tissue type (skin, mucosa, muscle, blood vessel, nerve, and gland) in the experimental groups was better than that in the control group. Muscle viability decreased more quickly than did the viability of other tissue. In the experimental groups, the viability of all tissue preserved for 12 and 24 hours was better than that of tissue preserved for 36 and 48 hours. After 48 hours of preservation, tissue had good structure and integrity in the experimental group but showed degeneration in the control group. In part 2, the flap survival percentages were 100%, 100%, and 99.7% in group A; 93.2%, 95.7%, and 94.1% in group B; and 87.2% and 86.1% in group C. Six months after surgery, the dogs in group A showed contraction potential and corneal reflex.

Conclusion Twenty-four hours could be considered a reference time for clinical application of UW solution flap preservation.

A simple, minimally invasive stitch method to construct the superior palpebral fold in Asian upper eyelids is described. With the use of a clear 6-0 monofilament polypropylene suture and a continuous stitch and by securing multiple consecutive transcutaneous intratarsal fixations, we were able to produce a consistent, natural result with high success rates and no noticeable scarring in 1648 cases over a 9-year period at 2 surgical centers in Toronto, Ontario, Canada, and Chengdu, China.

To explore an epicanthoplasty with a good aesthetic effect and a small scar we designed a modified Y-V epicanthoplasty to raise and enlarge the medial canthus. From January 2006 to April 2009, 68 patients were treated with this method, using a simple procedure to eliminate the medial epicanthal fold of the upper eyelid. Scarring of the medial canthal area has not been a problem with this technique because we designed incisions along the eyelashes and the skin-mucosal junctions. By raising the point of the new medial canthus to a particular physiological position, the angle of medial canthus is enlarged to reveal the lacrimal lake. Our technique is a simple, graded procedure that leaves no visible scar.