Background: With the aging process, changes in the facial proportions occurs. The auricular lobule has a significant role in the ear and facial aesthetics. With aging, the ear lobule gets distorted in shape. Objective:The aim of this study is to address the ear lobule ptosis with primary facelift procedure.Patients and Methods: Fifteen patients with facial skin redundancy and true ear lobule ptosis having primary facelift, were operated in Ain Shams University Hospital and Private Hospital from September 2020 to May 2022. An informed consent was obtained from all patients. Preoperative evaluation was done for the face and ptotic ear lobule was examined for its deflation, width and length measurements. Pre operative and post operative photography were taken. Primary facelift was done and ear lobule management according to degree of ptosis.Results: Fifteen patients underwent primary facelift procedure, age was ranging from 48-60 years (average 53), with ear lobule management (nine cases had fat injection for correction of loss of volume and six cases had surgical reduction for ptosis correction) with high satisfaction scores (13/15) with no lobuloplasty complications. Conclusion:Aesthetic consideration of ear lobule rejuvenation in primary facelift procedure augments the final aesthetic outcome of the procedure and patients' satisfaction.

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Background: The use of pedicled distant flaps remains of significant importance in the reconstruction of the complex soft tissue defects of the upper extremity.Objective: In this article, we present contralateral paraumbilical perforator pedicled flap for reconstructing complex soft tissue defects of the hand with or without distal forearm.Patients and Methods: Twenty patients (19 men, 1 woman) had contralateral paraumbilical perforator pedicled flaps for the reconstruction of complex soft tissue defects of the hand with or without distal forearm. Patients' age ranged between 16 and 52 years (mean age was 38.4 years). Flaps size, dimension and orientation were designed individually for each defect and ultrasound Doppler was used for perforator marking. Flap pedicle division was done after 3 weeks after the first operation. Donor areas were closed directly in all patients with a follow up of 6-month duration.Results: In all the twenty cases, the flaps survived completely without having any major complication postoperatively except for two cases of seroma, three cases of wound disruption and only one case of distal flap necrosis. Flap dimensions ranged from 6x10 to 16x26cm. The surgical outcome was found to be functionally and aesthetically satisfactory during the follow-up period. Conclusion:Paraumbilical perforator pedicled flap is a reliable surgical option for the reconstruction of complex soft tissue defects of the hand with or without distal forearm. The contralateral paraumbilical perforator flap should be a considerable alternative in hand reconstruction due to its ease of application, with no need for specialized equipment (no available microsurgery), low donor site morbidity with satisfactory functional and aesthetic outcomes.