No abstract

One of the primary goals of the phalloplasty for female-to-male transsexuals is to gain the voiding ability in the standing position. However, achieving the competence of urethra, sensation and rigidity of the neophallus is still a significant challenge. Serious complications such as urethral fistula, obstruction and stricture were encountered in this surgery. In experienced hands, this seems to be associated with urethroplasty technique. The authors performed phalloplasty with radial forearm osteocutaneous free flap method in 70 patients of female-to-male transsexuals. In 38 cases which were enrolled before 2001, we had carried out the urethroplasty by our own method, but since 2001, we have applied the modified method of urethroplasty to reduce the incidence of urethrocutaneous fistula. Thirty-four cases have undergone a new modified method of ours. For construction of the urethra, an anteriorly based vaginal wall flap and labium minoral flaps were used in this technique. In our new method series, 1 case (1.4%) of flap loss occurred after phalloplasty. The incidence of urethrocutaneous fistula was 30%. Before the year 2001, of 38 patients, there were 14 cases (36.8%) who developed urethrocutaneous fistula. On the other hand, 7 of 32 patients (21.9%) who underwent urethroplasty by the modified labium minoral flap and anteriorly based vaginal flap had urethrocutaneous fistula after 2001. One-stage total phalloplasty and urethroplasty is associated with a significant increase of urethral fistula and obstruction. However, the urethrocutaneous fistula at the level of the female external urethral orifice can be successfully reduced using this new method.

Rhinoplasty is one of the most common aesthetic surgical procedures in Korea today. However, simple augmentation rhinoplasty results often failed to satisfy the high expectations of patients. As a result, many procedures have been developed to improve the appearance of the nasal tip and nasal projection. However, the characteristics of Korean nasal tips including the bulbous appearance (attributable to the thickness of the skin), flared nostrils, and restriction of the nasal tip attributable to an underdeveloped medical crus of the alar cartilage and a short columella have made such procedures difficult. Currently, most plastic surgeons perform rhinoplasty simultaneously with various nasal tip plasty techniques to improve the surgical results. An important part of an aesthetically pleasing result is to ensure an adequate nasal tip positioned slightly higher than the proper dorsum, with the two tip defining points in close proximity to each other, giving the nose a triangular shape from the caudal view. From June 2002 to November 2003, the authors performed rhinoplasty with simultaneous nasal tip plasty using various techniques according to the tip status of 55 patients (25 deviated noses, 9 broad noses, 15 low noses, and 6 secondary cleft lip and nose deformities). The surgery included realignment of alar cartilage by resection and suture, fibroareolar and subcutaneous tissue resection, tip graft, and columellar strut. The postoperative results over an average period of 10 months were entirely satisfactory. There were no patient complaints, nor complications resulting from the procedures. Good nasal tip projection, natural columellar appearance, and improvement of the nasolabial angle were achieved for most patients. In conclusion, rhinoplasty with simultaneous nasal tip plasty, achieved by a variety of techniques according to patients' tip status, is an effective method for improving the appearance of the nose and satisfying the desires of the patients.

By performing Mulliken's method, we can achieve natural lip and nasal shape, harmonious Cupid's bow, appropriate nasal projection, and natural philtrum.