인제대학교

(1)

Forehead Augmentation with MMA

인제대학교

인제대학교 백병원 백병원 성형외과 성형외과

유 유 영 영 준 준

(2)

Anatomical Reviews

(3)

Definition of Forehead

Aesthetic unit whose contours are primarily dependent on the shape of the

frontal bone

^,

^the supraorbital rims ,

and the zygoma ; the action of frontalis , corrugator, and temporalis muscles

and the characteristics of the skin and the

soft tissue

(4)

Very Important Structures I

Zone of fixation

-- 6mm wide medial to temporal fusion line, continue to STL Transverse band

-- 2.5cm wide just

superior to orbital rim

; Periosteum adherent

densely

(5)

Very Important Structures II

V1

STN : medial forehead SON-S

SON-D LN

V2

Zygomaticotemporal(ZTN)

(6)

Classifications of

Forehead

(7)

Degree of bossing

4 -3<Dep

37 -2<Dep<0

11 0<Dep<2

(8)

Degree of recline

3 Severe

18 Moderate

31 Mild

(9)

Male forehead

Extensive

supraorbital bossing

Above this :

Flat area begin the

convex curvature of

upper forehead

(10)

Female forehead

Less

supraorbital bossing frequently nonexistent

Above this : Less flatness continuous

mild curvature

(11)

Objects of Foreheadplasty

(12)

Forehead restructuring methods

1. Reshaping existing bone (contouring) 2. Augmentation

3. Osteotomy with advancement, recession, altering of vertical position

( beyond realm of normal aesthetic

consideration )

(13)

Feminization of the forehead

-- Contour changing to improve female aesthetics

-- Some women have masculine skeletal character

Forehead contouring ;

1. Reduce masculine characteristics

2. Increase the feminine characteristics

(14)

Materials

1. Should be quite inert, neither chemically modified nor dissolved

2. Little or no tissue reaction

3. Not epileptogenic or carcinogenic

4. Rigid enough to maintain its contour 5. Exactly fitting contour

6. Little or no resistence to X-rays 7. Easily removable when develop

complication

(15)

MMA

- Compound of monomerous powder and polymerous liquid

- Polymerization of MMA

- Fixing agent in orthopedic prosthetic

replacement

(16)

MMA

1. Rigid and hard 2. Light – weight 3. Radio – lucent

4. Implantable in a single stage 5. Comfirm to multiple contours 6. Can be modified at surgery

7. No evidence of implant displacement 8. No evidence of bone erosion

9. No capsular contraction

No evidence of any long term complications

(17)

History

- MMA has been used since world war II for reconstruction of major skull defect - Gonzles-Ulloa and Stevens (1964)

- Not new ; Definite advantage

(18)

Operation Technique

1. Important point of technique SELL – Safe

Easy

Low cost

Low Possibility of doing harm

2. Result obtained would be based on one’s

ability to sculpt MMA

(19)

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Results

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Results

(25)

Results

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Results

(27)

Results

(28)

Tip

The only way to reduce scar

-- “ Save hair follicle!”

(29)

(30)

Various factors affecting result

Shape

Thickness Elasticity

Tightness between bone and periosteum Temperature of operating room

Multiple states of operator & modulator

(31)

Conclusions

“ In attempting to normalize(sculpture) the forehead contour, perhaps no alloplastic material or method

presently available is better for this

than is MMA ”

(32)