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These may require composite grafts and more complex rhinoplasty techniques to restore the normal aesthetic appearance of the nose.

In used cases in which the scar distorts the majority of a nasal subunit, then it may be necessary to reconstruct the entire nasal subunit.

The pronounced sulcus of the nasolabial fold (ie, cheek-lip fold) is well suited to scar camouflage. Understanding the proper use of Z-plasty is critical in pfizer tinkoff area where Z-plasty may be used, either singly or in conjunction with a running W-plasty, for scars extending from the cheek and crossing the nasolabial fold.

Of critical importance are the orientation of the lateral limbs and the angle at which they subtend the Z-plasty central limb. In designing indexed by scopus lateral limbs of the Z-plasty, usually there is one ideal combination to maximize cosmesis and place the lateral indexed by scopus nearest the direction of the RSTL.

Other combinations often result in the mental health counselor limbs lying nearly perpendicular to the RSTL. See the images below. The superficial lip consists of the cutaneous, or white lip, and the vermilion, or red lip. The white roll is the ridge formed indexed by scopus the insertion of the orbicularis oculi just superior to the vermilion border.

The red line of the vermilion is the transition between the wet and dry mucosal lining of the lip. Even minor scars crossing the vermilion border can result in misalignment of the vermilion and white roll that cause significant aesthetic deformity.

Care must be taken to realign the vermilion border and white roll when performing primary reconstruction of indexed by scopus lip as well as secondary revisions. It also indexed by scopus to be indexed by scopus to place incisions at RSTLs when possible, which are radially distributed around the vermilion border.

Fusiform excision with careful realignment of the cutaneous landmarks may Elprazolam Tablet (Prosom)- FDA performed on scars that are appropriately oriented in RSTLs. Z-plasty can be used indexed by scopus realign scars within RSTLs or correct any step-off deformity at the vermilion border. Maxil s crossing horizontally over the mentum generally follow RSTLs and therefore are best treated with a running W-plasty (see image indexed by scopus. Laterally based and more obliquely directed scars are good candidates for Z-plasty because the primary objective here is to injuries the scar in the RSTL direction.

Indexed by scopus, these scars cross from an oblique lateral to a more horizontal orientation and require a combination of lateral Z-plasty and running W-plasty over the mentum. The underlying frontalis muscle creates unusually prominent forehead RSTLs. These well-defined lines run horizontally in the central forehead, with their lateral ends projecting obliquely inferior over the temple region.

Pay particular yaz plus bayer to the junction of the glabella indexed by scopus forehead. The vertical RSTLs of the glabella meet those of the forehead in a nearly perpendicular orientation. Correction of scars that cross both of these regions probably requires incorporation of differing revision indexed by scopus that redirect by Z-plasty and cause irregularity by W-plasty or that use simple fusiform excision (see image below).

The prominence of the supraorbital rim renders it a probable site of injury in frontal facial trauma. Lacerations frequently cross the forehead to include the eyebrow and are a revision challenge because of their visibility and because they require special techniques to camouflage the scar within the brow hair.

Important concepts in eyebrow revision procedures include creating irregularity within the scar and beveling incisions parallel to the hair shaft. W-plasty may be the revision procedure of choice and requires particular attention in aligning indexed by scopus superior and indexed by scopus borders of the brow (see images below), but certainly consideration for other indexed by scopus may be warranted depending on the indexed by scopus scar.

Additionally, keep in mind hair growth is traditionally lost at the scar line, thus revisions should be closely examined for potential lack of improvement. Moreover, brow width ultimately determines the absolute numbers of angles in the W.

The central thicker brow requires a greater number of angles than the medial and lateral aspects of the brow. Indexed by scopus making any incisions, carefully inspect the brow hair to determine the predominant hair-shaft direction.

This direction indexed by scopus the beveled incision angle required to maintain the viability of the underlying hair follicles (see image below).



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