Congenital double lip is rare and usually involves the upper lip. A part from a deformity that interferes with speech and mastication, operation may be indicated for cosmetic reasons. We report a case of 12 years old patient with double lip deformities who was operated in our department for cosmetic reasons. We used an elliptical excision of the mucosal excess. Satisfactory aesthetic results were achieved. INTRODUCTION Congenital double lip is rare and generally involves the upper lip (1). A double vermilion with a transverse furrow between the two borders appears when the orbicularis oris muscle contracts during a smile. The incidence of this anomaly is not known and it may be either isolated or in association with other congenital abnormalities. (2) Treatment is by excision of the excess mucosa and submucosal tissue. We present a case of congenital double lip with literature review. CASE REPORT A 13-year-old boy was evaluated for excess maxillary labial mucosa with the resulting appearance of a maxillary double lip (Fig. 1). The deformities had been present since birth and became more prominent as he grew. No other congenital deformities were noted. The appearance of the lip was due to folding of the mucosa as the lip was retracted when smiling (Fig. 2). The excess labial mucosa was localized to either side of the midline (Fig. 3), forming a sessile, hypertrophied mass that extended mediolaterally the distance between the midpoints of the maxillary lateral incisors. We operated under general anaesthesia. The excess buccal mucosa was excised by two elliptical excisions, one on each half of the lip, and combined with a central Z-plasty to release the constricting band (Fig. 4). Closure was by running 4/0 polyglactin 910 (Vycril) suture (Fig. 5). Postoperative recovery was uneventful apart from swelling that resolved in about 10 days. He was happy with the cosmetic results. After two years there were no signs of relapse or late complications. Figure 1 Fig.1: The upper lip when the mouth is open; note the short central constriction and mucosal bulging on both sides Mucosal reduction for correction of congenital maxillary double lip. 2 of 4 Figure 2 Fig.2: Double lip deformity when the patient smiles Figure 3 Fig.3: The excess labial mucosa was localized to either side of the midline Figure 4 Fig.4: Diagram of the Z-plasty with two elliptical excisions Figure 5 Fig.5: Appearance of the lip at the end of operation DISCUSSION Double lip (DL) may be either a congenital abnormality or an acquired deformity. The congenital form usually involves the upper lip, but it may also affect the lower lip. (3, 4) It usually occurs as a redundant fold of tissue on the mucosal part of the lip. During the development of the mucosa, the upper lip consists of two transverse zones viz, an outer zone, which is smooth and similar to the skin called the pars glabrosa and the inner zone, which is villous and similar to the oral mucosa, termed as the pars villosa (5).The DL develops during the second or third intrauterine month as a result of the persistence of the horizontal sulcus between the pars glabrosa and the pars villosa. (5, 6) Acquired double lip deformity can occur after an injury, in association with Ascher syndrome, or as a result of habitual pulling of the mucosa through a diastema (1). Differential diagnosis of double lip include hemangioma, lymphangioma, angioedema, cheilitis glandularis and cheilitis granulomatosis (6). Various operations to correct a double lip have been described. Guerrero-Santos and Altamirano described the use of a W-plasty (7). Simple excision through an elliptical incision was advocated by Reddy and Kotewara (8). In patients with a short central constriction band as our case, the use of two elliptical incisions combined with a vertical Z-plasty result in a pleasing appearance of the upper lip with a natural-looking tubercle (9). The postoperative swelling can need about 10 days to be Mucosal reduction for correction of congenital maxillary double lip. 3 of 4 resolved (9). The cosmetic results are generally very good and make psychic satisfaction. The relapse and complications such as glandular hypertrophy or mucocele are extremely rare. CONCLUSION Congenital double lip is a rare oral anomaly. Surgical treatment is indicated when the excess tissue interferes with mastication or speech or more often for esthetic reasons. The results are generally very good and complications are extremely rare

The goal of treatment with a unique, bipolar radiofrequency (RF) ablation device is to provide the surgeon with a minimally invasive and neurotoxin altrernative, percutaneous approach to glabellar frowning. Therapeutic RF energy delivered via the probe tip area produces thermal effects that inhibit the designated nerve and produce selective conduction block. In our prospective study, significant glabellar frown reduction was immediately achieved in 80% of patients (40). All 40 of these patients maintained significant results at the 3-month time period, and 78% at the 6-month time period. Bruising and swelling were seen in 6% and 92% of patients respectively, mostly during the first week and resolving within two weeks. The cohort continues to be followed for longer term follow up. Further studies will help determine mass market viability of thermal deneveration as an alternative to injectable nerve paralytic agents.

Chronic venous leg ulcers still represent a problem for an increasingly number of population1, 2. Many of patients usually undergo several operations without remarkable improvement over a long time. Post phlebitis ulcers accompany the post phlebitic Syndrome represent one of the problematic cases. In this study the authors tried to know the real reasons of development of these ulcers, then they could find out an easy solution for treating them. Patients: This study included 65 cases of chronic resistant venous ulcers. Place: These cases were treated over the period from September 2001 until September 2007 in three places, University Malaya Medical Center, UniMAS (Sarawak General Hospital), and University Technology Mara (Selayang Hospital), Malaysia. The technique which we used was based upon venous hypo-vascularization of the skin of the leg before any attempt to deal with the ulcer. Results: Results showed very good and successful healing of these ulcers in a short time evaluated by 2 to 3 weeks after surgery. Most of the cases had very long history of having these ulcers ranging from 3 to 9 years and of average 4 years. Surgery for Chronic venous leg ulcers now facilitated the perfect and effective closure which is sound and complete without recurrence if compared with other techniques as compression bandage and other methods3.

Proboscis Lateralis is a rare congenital anomaly, which is embryologically related to the median facial cleft, and may be associated with other anomalies of the eye and its adnexa and cleft lip and palate. A child with Group three proboscis lateralis was treated by using the flaps of the proboscis lateralis, one for the correction of maxillary hypoplasia and the other for correction of the grooving in the nasolabial region. This technique helped in achieving a good cosmetic outcome. Various methods have been suggested for the treatment of proboscis lateralis, ranging from the extirpation of the proboscis, to the tunneling method. We have suggested the use of the flaps from the proboscis, which gave us the advantage of a one-stage correction of the proboscis along with the maxillary hypoplasia, and to minimize the grooving in the nasolabial region.

Purpose: To determine electrophysiological and ultrasonographic features of the carpal tunnel during flexion and extension of the wrist. Methods: This study included 35 right-handed healthy volunteers, of whom 24 were females and 11 males. The mean age of females and males were 37,5 ± 2.4 and 42 ± 1,9 years respectively. All subjects gave oral informed consent. Anterio-posterior and medio-laterally diameters of the carpal tunnel were measured on ultrasonography during flexion and extension of the wrist. Electrophysiological features of the median nerve sensorimotor conduction in the first digit of the right hand were determined during flexion and extension of the hand. Data from ultrasonographic and electrophysiological measurements were analyzed with SPSS 10.0 package program and the data were compared with ANOVA and Tukey tests. Results: There was a decrease in median n. motor amplitude on flexion and extension of the wrist (p<0.0001), while median n. motor conduction speed decreased only on extension of the wrist (p<0.005). Median n. sensory conduction decreased (p<0.0001) and distal latency lengthened (p<0.0001) on flexion of the wrist. On ultrasonography, the medio-laterally diameter of the carpal tunnel increased on flexion and extension of the wrist (p<0.0001), wile there was a considerable decrease in anterioposterior diameter of the tunnel on flexion of the wrist (p<0.0001). Conclusions: The diagnosis of carpal tunnel syndrome (CTS) is usually based on clinical and electrophysiological findings and then an appropriate treatment alternative is determined accordingly. Incorporation of ultrasonography (US), computed tomography (CT) and/or magnetic resonance imaging (MRI) into diagnostic efforts will help determine both etiopathogenesis and the most apropriate treatment alternative.

Although many visual apparatus were designed and invented, classical headlamps are still widely used by many plastic surgeons in rhinoplasty, breast and abdominal aesthetic surgery. Until today, ideal features of the headlamps were described in the literature but there was no data about the prices. We believe that cheap headlamps which produced for general puposes can be used instead of expensive headlamps. INTRODUCTION Visualization of the surgical site is one of the most important factors for the best results in all kind of operations. Good visualization requires good lightening. Headlamps are indispensable devices for the most surgeons. The first paper about headlamp was presented in 1959 by Cutler1 in the literature and one of the most detailed one was presented in same year by Morey2. According to this study headlamp should have following standarts : the light must be of high intensity; 1. the beam must be either coincident with, or parallel 2. to and in line with, the visual axes; the light must be focused into a clear homogeneous 3. circle; the whole apparatus must be light in weight and 4. not be too bulky; it must not get too hot. 5. After 1949, technology was changed so much. Although many visual apparatus were designed and invented, classical headlamps are still widely used by many plastic surgeons in rhinoplasty, breast and abdominal aesthetic surgery. Until today, ideal features of the headlamps were described in the literature but there was no data about the prices. Undoubtedly, prices are related with the technology and crude material of the devices. Prices varied between from 100 to 2500 USD on the searching of the internet by Google.3 METHODS We use 12 Led headlamp which produced for the camp and general purposes (figure 1and 2). Figure 1 Figure 1: The headlamp for general purposes The cheapest headlamp for Plastic Surgery 2 of 3 Figure 2 Figure 2: Illumination of the lamp Price of lamp was less than 5 USD. It consists of high intensity 12 LED with adjustable headstrap. Inclination of the lamp can be adjustable, also. It works with three 1.5 volt AAA batteries ad batter life is maximum 120 hours. RESULTS There were no problems related with using of this headlamp. Different surgeons were used and no complaints were reported. Good visualization were achieved. Figure 3 Figure 3: Headlamp in the operation There was no need extra illumination. Application of the headlight and focusing were quite easy. DISCUSSION There are three important study about using of the headlamp in Plastic Surgery. One of them was presented by Furnas4 . He described ideal headlamp for overseas surgery. Other one is presented by editor of our journal, Rohrich5 . He strongly emphasized that potentially, the most detrimental combination for a surgeon's cervical spine is the use of the headlight with loupes. While attempting to adjust the head and neck to match the focal length of the loupes and the light together, we set ourselves up for a cervical spine sprain or strain. Always put on your headlight and focus it before you scrub, as it is more accurately done by the surgeon. The last study was presented by Okoro et al. in 20076. The use of surgical headlights is ubiquitous in plastic surgery. According to their study, ideal operating light should have five components. First three conditions were defined by Kaye in 1976 : light must be centered on the surgeon's immediate 1. field, it must illuminate a wide or narrow field with high2. intensity light, it must penetrate into the cavity or under a flap7. 3. the light source must be cool and 4. the light source must not hinder the surgeon's 5. mobility CONCLUSION Finally, according to our experience headlamps can not be commuted of the surgical ceiling lamps but we believe that the cheapest lamps can be used in many operations instead of the expensive ones.