ObjectiveExposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly inadequate soft tissue coverage, soft tissue thinning and scar dehiscence over the edge of the pacemaker are the primary predisposing event. Multiple local surgical options have been described, however, with all these designs, the final scar still remains over the edge of the pacemaker and continue to have a tendency of thinning out with time. We have described a local skin flap which can be de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge, thereby preventing further recurrence.MethodsThree patients admitted in the Cardiology Department presented with impending exposure (n=2)and exposed implant (n=1) over the edge of pacemaker with superficial infection. Local modified rotation skin flap which was de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge was performed under local anaesthesia in all the cases.ResultsFlaps settled well in all patients with no evidence of infection, scar dehiscence and recurrence over a follow-up period of 2 years.ConclusionsThis flap technique is recommended for cases of impending pacemaker exposure resulting due to scar dehiscence over the edge and helps by addressing the predisposing factors at an initial stage. In our experience, this technique also helped to salvage exposed pacemaker with superficial infection. To our bestof knowledge this technique has not been described before in the literature.

The upper eyelid crease is an indentation at the level where fibers from the levator aponeurosis insert into the skin. Typically, Asian eyes are described as creaseless and puffy and the aim of blepharoplasty is to achieve an eyelid crease, without losing the ethnicity of the individual. We aim to describe the most commonly performed technique as well as the peculiar points to be kept in mind from the Indian perspective.

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The forehead is an important determinant of masculine or feminine look of the face. There are many methods described to achieve forehead augmentation for a more feminine face, and they include fillers, autologous fat grafting, silicone implant or methyl methacrylate. We present a case of a “Barbie doll forehead,” which is an interesting trend in Asian countries. Availability of silicone implants of various sizes are not uniform and currently unavailable in India. Alternatively, we devised carved silicone block using computer-aided design (CAD). We also discuss the various methods described for forehead augmentation with their advantages and disadvantages.