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The aim of this study is to capture the enduring fascination with youth and transformation. These themes, epitomized by the myth of Medea, resonate in the context of modern plastic surgery and cosmetic enhancements. Book 7 of Metamorphosis was read and analyzed. Medea is a sorceress and daughter of King Aeëtes. Her magical abilities are highlighted in 2 notable stories: (1) her rejuvenation of Aeson and (2) her attempt to rejuvenate herself. Aeson, the father of Jason, had grown old and frail. Medea, eager to assist Jason's father, employed her magical abilities to restore Aeson's youth. Medea concocted a powerful potion that required a variety of rare ingredients and intricate rituals. This process involved herbs, incantations, and a cauldron for boiling the mixture. To prove her magical prowess to the onlookers, Medea performed a demonstration using an old ram. She dismembered the ram, boiled the pieces in her cauldron with her magical brew, and from the pot emerged a young lamb. Encouraged by this success, she then applied the same magical process to Aeson, rejuvenating him and restoring his vigor. Medea, having endured considerable personal loss and turmoil, resolved to use her magical abilities to restore her youth. She collected the required ingredients, conducted the rituals, and either drank the potion or bathed in it, which rejuvenated her. This act demonstrates her determination to transcend the constraints of mortality. These stories speak to the timeless human quest for youth and immortality while also exploring the themes of power, knowledge, and ethical boundaries., Competing Interests: The author reports no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Competing Interests: The author reports no conflicts of interest.

The aim of this review is to explore the reasons behind the prevalence of cosmetic surgery in Korea from the viewpoint of "basic values." In societies characterized by high levels of prejudice, the hierarchy of values from highest to lowest is as follows: (1) political, (2) economic, (3) religious, (4) social, (5) theoretical, and (6) aesthetic. Conversely, in societies with low levels of prejudice, the ranking of values from highest to lowest is: (1) aesthetic, (2) social, (3) religious, (4) theoretical, (5) economic, and (6) political. In mature societies, higher levels of stability, cultural development, emphasis on quality of life, and greater tolerance and openness drive the appreciation of aesthetic values. As Korea's economy has developed and basic needs have been met, there has been an increasing emphasis on aesthetic values, including beauty standards and self-presentation. This trend is evident in the flourishing Korean beauty industries (K-beauty). There is a growing societal focus on physical appearance, fashion, and plastic surgery, which has become normalized in certain aspects of Korean culture. Rapid modernization, shifting social norms, competitive pressures, and evolving interpretations of traditional values have normalized and even popularized cosmetic surgery in Korean society. The combination of cultural expectations, advanced medical care, and social factors has positioned South Korea as a world leader in cosmetic surgery, despite its relatively small population. To keep pace with the rapidly evolving aesthetic values of Korean society, plastic surgeons must align with contemporary beauty standards, thoroughly understand surgical anatomy, and strive to minimize patient dissatisfaction., Competing Interests: The author reports no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study is to analyze the transformation of aged women into yokai in Japanese literature, examining this metamorphosis from the perspectives of plastic surgery and gerontophobia. The Noh play "Adachigahara" explores the transformation of an outcast into a monstrous figure, highlighting how poverty, isolation, and aging can lead to a person's demonization, both metaphorically and literally. In "Rokujō no Miyasudokoro", Lady Rokujō's transformation into a vengeful spirit is tied to themes of aging, abandonment, and the societal devaluation of women as they grow older. Her supernatural metamorphosis is a way to reclaim power in a society that has rendered her invisible. In "The Life of an Amorous Woman", the transformation is symbolic, as the woman's loss of beauty and status leads her to be ostracized, reflecting how society often dehumanizes those who are old and poor. The Yamauba legend encapsulates the fear of the elderly, especially women who live on the fringes of society. Her transformation into a yokai represents the culmination of societal rejection, fear of aging, and isolation. From the view of plastic surgery, the transformation of women into yokai reflects contemporary anxieties about aging and the extreme measures some take to maintain youth. These women morph into beings that embody society's vilification of the elderly, particularly targeting those who defy or do not conform to ideals of youthfulness. From the perspective of aversion to the elderly, the transformation into yokai symbolizes society's rejection of the elderly, portraying them as figures of fear and revulsion., Competing Interests: The author reports no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to analyze "The House of the Sleeping Beauties" (れる) by Yasunari Kawabata from the perspectives of plastic surgery, and psychiatry/psychology. The central theme of the novel focuses on aging, desire, and the human connection to beauty and mortality. The protagonist, Eguchi, frequents a brothel where elderly men lie next to young women who are drugged and remain unconscious. This setting highlights the longing for youth and vitality, themes that are prevalent in plastic surgery. From this perspective, the novel offers a somber reflection on the extremes to which individuals might go in an effort to reconnect with their youth, even if it is only symbolic or temporary. Eguchi's journey serves as a metaphor for aging individuals who turn to beauty treatments or cosmetic enhancements in an attempt to regain their lost youth. Unlike the temporary illusion of rejuvenation provided by plastic surgery or anti-aging treatments, the novel highlights the futility and inherent sadness of attempting to recapture what is irretrievably lost. From a psychiatric perspective, the novel may be seen as an exploration of escapism, sexual repression, or unresolved trauma. The setting, characterized by the objectification and infantilization of women, could represent a dissociative mechanism. In this scenario, elderly men project their fantasies and desires onto unconscious women, thereby sidestepping the harsh realities of aging, intimacy, and rejection. In the anti-aging surgery of male patients, it is crucial to recognize their longing for youth and vitality, a sentiment shared by both Kawabata and Eguchi., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to analyze facial bone fractures at the Armed Forces Capital Hospital of Korea (AFCH) from 2013 to 2022. This review included individuals who visited AFCH for treatment. The inclusion criteria for the study were fractures resulting from external trauma, specifically coded as S02.1-4 and S02.6-9. The exclusion criteria comprised fractures caused by factors other than external trauma. This retrospective study of 178 facial bone fractures included 176 males (98.9%) and 2 females (1.1%) (22.5±5.1 years). The most common causes of injury were bumps (72.5%), followed by slips (7.3%), assaults (5.6%), and falls (5.1%). The majority of facial bone fractures occurred during sports activities (33.7%), training (31.5%), or everyday activities (28.7%). Nasal bone fractures were the most prevalent (47.7%), followed by fractures of the maxilla (19.2%), orbit (18.7%), mandible (10.3%), and zygoma (3.3%). The interval between the injury and hospital arrival was 6.0±8.0 days. Among the 164 patients, 110 (67.1%) underwent surgery. The overall complication rate was 8.9%. The highest complication rate was mandibular fractures (22.7%), followed by nasal bone fractures (9.8%). Among the 208 recorded facial bone fractures, 145 patients (69.7%) received treatment at AFCH, whereas 63 (30.3%) were treated in a civilian hospital; 59 patients (28.4%) by their own choice and 4 patients (1.9%) on a consignment basis. The average follow-up period was 202.0±183.2 days. The relatively high rate (28.4%) of treatment at civilian hospitals is attributable to legislation allowing injured soldiers the option to choose between military and civilian medical facilities., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

In this paper, the authors aim to explore the reasons behind human makeup from both medical and literary perspectives. In a PubMed search for "makeup and cosmetics," 509 titles were identified. Of these, 64 abstracts were reviewed, and ultimately, 8 full texts were referenced. The poem "A Woman Young and Old" written by William Butler Yeats was analyzed. In Research Information Sharing Service ( https://www.riss.kr ), 4 full texts about the poem "A Woman Young and Old" were found and referenced. Common motivations for using makeup include enhancing natural features, boosting confidence, expressing creativity, covering imperfections, fulfilling cultural and social expectations, and meeting professional requirements. Makeup can make women appear younger. Makeup enhances the reward value of human facial appearance. Makeup can conceal blemishes, scars, dark circles, and other skin imperfections, resulting in a more even and flawless complexion. In a poem by Yeats "A Woman Young and Old," he describes a young woman applying makeup and captures a moment in which she engages in the ritual of enhancing her beauty. The line "I'm looking for the face I had before the world was made" speaks to a longing for something beyond the mundane, a yearning for a deeper connection with existence. "Before this world was made" is a typical poetic turn of phrase that compares women to eternal beauty. The reasons why women use makeup are diverse and multifaceted, reflecting a combination of personal preferences, societal influences, and individual motivations. Makeup can be a powerful tool for expressing oneself, boosting one's confidence, and enhancing one's natural beauty., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

I read "The Pilgrim's Progress," by John Bunyan, and this book echoes the journey I have taken from medical school to the present. Christian's journey symbolizes the spiritual path of a believer in the pursuit of salvation. This narrative serves as an allegory for the Christian life, highlighting themes such as faith, redemption, and perseverance through trials. It includes twelve key stage. Comparing the life of a surgeon, from medical student to master surgeon approaching retirement, to Christian's journey in "The Pilgrim's Progress" makes for a fascinating allegory. Both paths involve growth, challenges, and perseverance toward a final goal: (1) Medical Student (City of Destruction), (2) Basic Training (Slough of Despond), (3) Residency (Wicket Gate and Hill of Difficulty), (4) Becoming a Junior Surgeon (Interpreter's House), (5) First Independent Operations (The Cross and the Burden Lifted), (6) Early Career (Palace Beautiful), (7) Facing Major Challenges (Valley of Humiliation and Shadow of Death), (8) Mid-Career Success and Worldly Temptations (Vanity Fair), (9) Crisis of Confidence (Doubting Castle and Giant Despair), (10) Mastery and Maturity (Delectable Mountains), (11) Facing Retirement (Enchanted Ground), and (12) Retirement and Legacy (Celestial City). In this allegory, the life of a surgeon mirrors Christian's spiritual journey-a path marked by challenges, doubts, triumphs, and ultimately, the fulfillment of a calling. Both are in pursuit of a final "rest" in their respective fields, whether it be spiritual salvation or the surgeon's sense of a lasting contribution to humanity. The journey of the surgeon is similar to that of the pilgrim., Competing Interests: The author reports no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study is to analyze the role played by the appearance of female ghosts in their redemption. In the literature on ghosts, entries on female ghosts highlight their "beautiful appearance": Arang (Korean), Otsuyu (Japanese), The White Lady (Europe), Nie Xiaoqian (Chinese), and Maria Makiling (Filipino). Ghosts are women who died tragically, leaving behind unfulfilled desires-particularly those related to romantic or societal expectations such as marriage, love, and motherhood. In death, they seek out men who might help them resolve these unresolved issues. Their beauty, often used to attract men, is marked by an undertone of sorrow or danger. The ghost's beauty highlights her humanity and vulnerability, juxtaposing her external allure with her internal suffering. These stories commonly convey that only a virtuous or courageous man can redeem the ghost, implying that moral integrity and kindness are essential to break the curse or free the spirit from its torment. The beauty of a female ghost increases her chances of redemption, serving as a form of social currency even after death. Her attractiveness typically symbolizes her value, prompting men to sympathize with her, fall in love, or attempt to rescue her. Although beauty serves as a device to elicit empathy or offer a pathway to redemption, these tales also highlight broader cultural concerns regarding the objectification of women and the societal focus on physical appearance as an indicator of virtue and value. In this context, plastic surgeons, by enhancing patient's physical appearance, can be seen as creators of virtue and value., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Purpose of Review: The literature was reviewed for all noninvasive central nervous system (CNS) stimulation techniques, which includes transcranial brain or trans-spinal stimulation, in the aging population. Given the rising ubiquity of this technology, noninvasive nature, and low side-effect profile reported, this technology can have a big impact on the aging population. As patients afflicted with neurogenic disorders are living longer lives, a special emphasis is placed on the aging neurogenic population., Recent Findings: Noninvasive CNS stimulation techniques have been applied to major bladder and pelvic floor disorders such as voiding dysfunction, chronic pelvic pain, urgency and urge incontinence, lower urinary tract dysfunction, and situational urge incontinence in both the idiopathic and neurogenic populations. Overall, these noninvasive technologies demonstrate effectiveness for the treatment of these conditions with some studies showing effectiveness with longer-term follow-up suggesting lasting CNS remodeling., Summary: Most manuscripts had a generally small number of patients and an even smaller number of geriatric patients represented. No studies were specifically designed to investigate geriatric outcomes. It is the hope of this systematic review to help model future studies according to existing literature, but with a focus on the geriatric population as they stand to gain the most from noninvasive technologies with limited adverse events., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The aim of this paper is to review portraits from the Renaissance to the Romantic eras, created before the invention of photography, and to discuss their usefulness to plastic surgeons. Before photography and film were invented, portraits played a critical role in documenting individuals, conveying power, and immortalizing people's appearance and identity. Portraits were not merely simple representations of a person's physical appearance; they played a crucial role in conveying the subject's inner qualities and social position, as well as the cultural values of the era. Artists often idealized or embellished certain features to align with the cultural and aesthetic ideals of their time. Portraits of the Renaissance to Romantic eras could have a significant impact on plastic surgeons' understanding of beauty and aesthetics. A plastic surgeon drawing on Renaissance ideals might prioritize symmetry and balanced facial features, which continue to be regarded as attractive in contemporary beauty standards. Beauty standards during these times favored curvaceous and lively figures, potentially inspiring modern plastic surgeons to focus on creating more dramatic or unique appearances. A plastic surgeon inspired by Romantic art might value uniqueness and avoid rigid beauty standards, focusing instead on enhancing a person's natural traits rather than conforming to a singular "ideal" appearance. Plastic surgeons could gain a richer, more classical perspective on aesthetics by studying historical art, potentially leading to more personalized and balanced outcomes. However, integrating these classical ideals into modern practice must also consider the diverse and varying definitions of beauty prevalent in today's multicultural society., Competing Interests: The author reports no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

I present a case involving a portrait of David Bailly, containing 2 images portraying changes over a period of ∼40 years, and I compare the facial features that illustrate the aging process. He was 67 years old when he painted "Self-Portraits With Vanitas Symbols" (1651). By juxtaposing past representations with present reality, the painting suggests that the young artist is contemplating his future aging. The young man, appearing so vividly within the painting's immediate reality, actually symbolizes a bygone era Compared with the young portrait, the older portrait exhibits a slightly drooped eyebrow tail, indicative of brow ptosis. In the young portrait, the lid margin is aligned with the upper border of the iris, whereas in the older portrait, it is aligned with the upper border of the pupil. The margin reflex distance 1 decreases with age. In addition, the older portrait shows baggy lower eyelids. The nasojugal groove is more pronounced, and the nasolabial fold is deeper. The beard and mustache are more extensive, and silver strands are interspersed among the black hairs. Presenting 2 images from a 40-year interval, the older portrait exhibits more pronounced signs of facial aging than the younger portrait. Portraits from that era, whether painted by western or eastern artists, demonstrate that the painters had an understanding of facial skin lines and the aging process. The process of creating portraits provides insights into historical contexts and remains significant in contemporary settings, particularly concerning perceptions and identity., Competing Interests: The author reports no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to analyze the beauty pageants that were held in Korea during the Japanese colonial era (1931, 1940). Through searches of www.google.com and www.naver.com , 3 pageants were found: (1) 1931, Miss Korea, organized by Samchunli (a magazine): Any Korean woman, with the exception of Korean geishas, could apply by submitting her photographs. The number of candidates was 326. Nine Korean judges evaluated the photos of the candidates. Among them, the victor was an 18-year-old Korean woman. (2) 1931 (Oct), Miss Joseon, organized by Osaka Mainichi Shimbun: The candidates were categorized into 2 groups: 10 "internals" (Japanese) and 10 Koreans. Their heights and weights, along with their photographs, were provided for the readers' reference. The winners were determined based on the readers' votes. The Japanese victor was a 21-year-old student with a height of 150 cm and a weight of 52 kg (body mass index [BMI] 23.11 kg/m 2 ). The Korean winner was a 19-year-old student standing at 157 cm and weighing 53 kg (BMI 21.50 kg/m 2 ). (3) 1940, Venus of the Peninsula, organized by Modern Japan (a magazine): The candidates were Korean women residing in Japan or Korea. The panel of judges evaluated the photographs of the candidates. The victor was a 20-year-old Korean geisha. Her winning photograph was featured in the Korean edition of the magazine Modern Japan. She stood at 157 cm in height and weighed 45 kg (BMI 18.25 kg/m 2 ). As beauty standards evolved over time, the beauty standards of the 1930s were markedly different from those of today., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to analyze perceptions of nasal profiles and the origins of augmentation rhinoplasty in Korea during the Japanese colonial era. Through ( www.google.com ) and ( www.naver.com ), the archives of newspapers and magazines were searched for references to "nasal augmentation." The following topics were identified: the ideal nasal profile in the corresponding era, nasal augmentation by nonsurgical methods, camouflage makeup for noses with a low profile, the earliest literature on augmentation rhinoplasty in Japan, a case of augmentation rhinoplasty in a Korean woman, an estimate of the year when augmentation rhinoplasty was first performed in Korea, and augmentation rhinoplasty by injection. In 1922, the Nose Lifter (nose uplifting clip) was already commercially available to Korean women. The following year, in 1923, Nishihata and Yoshida published their work on augmentation rhinoplasty using ivory in Japan. By 1925, some hospitals had performed augmentation rhinoplasty, but the procedure had not yet gained popularity among Koreans. In 1927, a Japanese author emphasized the importance of an ideal nasal profile harmonizing with the lips, chin, and neck. Also, in 1927, rhinoplasty gained popularity and was performed at various ENT clinics throughout Korea using various methods. In 1929, a 3-dimensional makeup method was introduced to camouflage a low-profile nose. By 1935, there was a belief that augmentation by injection was not harmful. The authors believe that augmentation rhinoplasty began in 1925 and gained popularity among Koreans by 1927. It was not until 1935 that the complications associated with injectable augmentation were recognized., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study is to analyze the process of metamorphosis of a tall and ugly woman through plastic surgery as depicted in The Life and Loves of a She-Devil (1983) of Fay Weldon. The process of plastic surgeries and the psychology of the protagonist of this novel were analyzed. A highly unattractive woman (Ruth, 185 cm) takes revenge on her husband (Bobbo, 175 cm) and his attractive lover (Mary Fisher, 160 cm). To transform her appearance, Ruth remodels her jaw, has her teeth extracted (2-jaw surgery or facial contouring surgery), straightens and trims her nose (corrective rhinoplasty), flattens her cheekbones (reduction malarplasty), reduces her breast size (reduction mammoplasty), and shortens both her arms and legs (limb reduction surgery). Following the series of surgeries, Ruth ultimately made herself look identical to Mary Fisher, her husband's lover. She believes her inadequacies stem from her body's failure to meet societal beauty standards, prompting her decision to "remake" herself. She declares, "I will be what I want, not what God ordained." Ruth's aspiration is not to acquire a new face but to attain the face of Mary Fisher. When confronted with pain and harm, Ruth does not waver but acknowledges it. "Of course it hurts. Andersen's little mermaid wanted legs instead of a tail. And, like her, I welcome it. I don't complain." In this study, we derived insights into why patients who want to change their entire bodies undergo plastic surgery, what these patients really want, and patients' attitudes toward the pain caused by surgical procedures., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to conduct an anthropometric analysis of the 5 portraits painted by Botticelli that depict Simonetta Vespucci. Five images in the Simonetta series by Botticelli workshop were measured. The anthropometric measurements of the face included 22 parameters on the lateral view (in 4 portraits; 18 distances and 4 angles) and 17 distances on the frontal view (in one portrait), which were measured using Adobe Photoshop. The absolute distances were calculated relative to the vertical corneal diameter (10.6 mm), which was calculated by multiplying the distance from the pupil's center to the lower margin of the iris. In the lateral faces, the nasofrontal angle (g-n-prn) was 157.6±2.4 degrees, and the nasal tip angle (n-prn-sn) was 99.7±3.4 degrees. The nasolabial angle (prn-sn-ls) was 125.7±4.9 degrees, and the labiomental angle (li-sl-pg) was 131.6±4.4 degrees. The ratio of the upper lip height to the lower lip height (sn-sto/sto-sl) was 85.4±9.0%. The ratio of the upper lip vermillion to the upper lip height (ls-sto/sn-sto) was 27.7±3.9%. The ratio of the lower lip vermillion to the lower lip height (sto-li/sto-sl) was 47.2±6.6%. Comparing the data with 21st-century Italian females, forehead II height (tr-n), physiognomical face height (tr-gn), and morphologic face height (n-gn) of the beauties of the 15th century were significantly greater than those of 21st-century Italian females. However, there were no significant differences in lower face height (sn-gn) and nose height (n-sn). Considering the ongoing cultural relevance of Renaissance art, the esthetic proportions from this study may have reflection to the present day plastic surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to investigate the appearance of the faces of Chinese women in leadership positions through an anthropometric analysis of Women of China from 1949 to 2022. Photographs of cover women of Women of China were gathered and a total of 380 frontal and 101 lateral photographs were collected. The photographs were divided into 3 time phases: phase I (1949-1978): from the launch of Women of China magazine, up until the time of reform and opening; phase II (1978-2010): from the time of reform and opening until when Google China was blocked; and phase III (2010-2022): to the present. The horizontal corneal diameter (11.52 mm) was set as the reference value for the frontal face. The anthropometric results showed the width of the face, midface, and lower face decreased over time. The women at phase I had larger and round faces, smaller and narrower eyes, wider noses, and thicker lips; relatively masculine and hard-working woman image, as the occupations of women were mainly described as workers, farmers, and civil servants. Phase II showed smaller but still round faces, relatively wide-set round eyes, narrower noses, and smaller lips than in phase I; neutral features as skilled workers, engineers, entrepreneurs, civil servants, and researchers. Phase III showed oval faces, almond eyes, narrower noses, smaller full lips, and wider chins, reflecting a process of feminization; working in entertainment, sports, and science. The data from this study might serve as the recommended aesthetic proportions when performing plastic surgical procedures for talented woman., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Study Design: Cross-sectional radioanatomic study., Objective: To introduce a classification system using MRI to describe psoas morphology and examine the position of nearby neurovascular structures., Summary of Background Data: Oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) offer sagittal malignment correction and reduced morbidity. LLIF has a higher incidence of nerve injuries, while OLIF has a higher incidence of vascular injuries., Methods: Measurements were completed on the left psoas at the inferior L4 endplate. Class A was designated if the ventral border of the psoas muscle was >2 mm anterior; B if it was ≤ 2 mm anterior or posterior to the vertebral body, and C if >2 mm posterior to the vertebral body ventral border. Modified oblique corridor, measured as the distance between two lines, one at the medial border of the psoas muscle and the other at the lateral border of the nearest vascular structure, and a preferred LLIF trajectory was projected onto an axial image of the left psoas. If the trajectory violated the posterior third of the psoas, it was considered a dangerous approach due to potential iatrogenic nerve injury., Results: 100 patient MRIs (Class A: 44; Class B: 27; Class C: 29) were analyzed. Average modified oblique corridor was 7.49 mm. Modified oblique corridor varied amongst the three types of psoas morphologies (A: 8.99 mm vs. B: 8.10 mm vs. C: 4.66 mm, P=0.040). LLIF trajectory intersected the 'danger zone' in 34.1%, 3.7%, and 0.0% of patients, (P<0.001) respectively., Conclusion: Class A psoas had the largest modified oblique corridor but highest proportion of those with a dangerous LLIF trajectory. Class C psoas had the narrowest modified oblique corridor, but no dangerous LLIF trajectories were identified., Competing Interests: Conflict of Interest declaration: The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

In medicine, dogmas are subject to evolution and refinement as new research and technologies emerge. The aim of this study was to search for dogmas which were challenged and potentially revised in the plastic surgery field. A search on PubMed for "dogma and plastic surgery" yielded 80 papers. The queries "surgical dogma and craniofacial surgery" and "surgical dogma and flap" returned 9 and 21 papers, respectively. "Surgical dogma and hand" and "surgical dogma and wound healing" produced 41 and 25 papers, respectively. Removing 35 duplicate papers, 141 abstracts were reviewed. Of these, 78 were excluded, leaving 63 papers for analysis. The dogmas being challenged within the field of plastic surgery were classified into various categories. The distribution of these challenged dogmas was as follows: wound healing: 14.29%, epinephrine use: 9.52%, flap surgery: 7.94%, breast reconstruction: 6.35%, rhinoplasty: 7.94%, hand surgery: 4.76%, pressure sores: 4.76%, chemical peel: 4.76%, and hand injuries: 3.17%. The widespread focus on improving wound healing techniques indicates a need for more effective treatments and faster recovery times. Significant attention has been directed toward the use of epinephrine, particularly in fingers, which may reflect ongoing debates about its safety. Innovations and improvements in flap surgery could lead to better reconstructive outcomes. Challenging existing dogma is a vital process and a driving force in the advancement of clinical science. These challenges and potential revisions reflect the dynamic nature of plastic surgery, where ongoing research, patient outcomes, and evolving societal norms drive continuous improvement and adaptation in practices and principles., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Competing Interests: The author reports no conflicts of interest.

This study aimed to analyze images of the modern beauty of Korea during the Japanese colonial era. Searches were conducted on Google ( www.google.com ) and Naver ( www.naver.com ) for archives of newspapers and magazines that contained images of beauty. Beauty of the face and neck (the early 1920s): an article (1922) detailed the contemporary beauty standards. It specifies the desired characteristics of the eyes, nose, and mouth and dictates that "the cheeks ought to be plump enough to obscure the cheekbones" and "the neck and shoulders should also be full, concealing the collarbones." Images of beauty showing balance and proportion (the late 1920s): in 1928, a magazine article introduced the concept of "the world's beauty from a scientific perspective," which represented Western esthetics as reflected in the "Canon" of body proportions and Vitruvian Man. From the face to the body (from the late 1920s to 1930s): in 1927, a daily newspaper established the standard for global beauty. During this period, there was an increased emphasis on maintaining the body, rather than just the face, as a crucial aspect of beauty. From the mid-1930s, the concept of a "streamlined" female body shape gained popularity. Male gaze, which fragmented and objectified women's bodies, had been visualized and mass-produced. It is essential to understand how preferences have evolved and to possess skilled hands capable of improving the face and body. To properly sculpt the face and body, keen eyes and adept hands are needed., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The authors present a narrative that details the cause and process of a woman's transformation from beauty to ugliness in a Japanese tale. In " Tokaido Yotsuya Kaidan ," the metamorphosis from a beauty to an ugly woman is analyzed. After taking medication to recover from childbirth, Oiwa's face became disfigured and grotesque. Oiwa: It seems to be good for my blood, but when I drink it, it causes fraying and breakdown, causing sudden pain. I feel a numbing dullness. When she looked at herself in the mirror, she was shocked. Oiwa: What's wrong with my face? I hate this, it's such a disgusting thing. Neighbor: It was a lie that the medicine you drank was a helpful medicine that protects the appearance of people's faces. Your face is that of a wicked woman (). Oiwa: Is it really me? Why does she have the face of an evil woman? Her hair falls out in a gruesome combing scene, driving her mad. The poison Oiwa took was aconite, which grows wild in Japan. Both aconite tincture and raw aconite roots contain high concentrations of Aconitum alkaloids, which can penetrate the stratum corneum following the diffusion gradient. As her hair fell out during a horrific combing session, she abandoned her maternal role and sought revenge, having lost what she considered a symbol of her femininity. In treating female patients with facial disfigurement, it is important to be mindful of their psychological state, akin to that of Oiwa, who became disfigured through no fault of her own., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

This study aims to identify criticisms of rejuvenation and cosmetic surgery through an analysis of "Dr Heidegger's Experiment" (1837), written by Nathaniel Hawthorne. Dr Heidegger an eccentric, aged scientist, invites 4 elderly friends to be his subjects of study. The guests drink the water from the "fountain of Youth." As their youth is restored, they revert to the foolish behaviors of their younger days. The 3 men soon start vying for the affection of the now youthful and attractive widow. In the midst of their rivalry over the widow, the vase is shattered, and miraculous water spills out. The guests revert to their elderly states. To regain their lost youth, they journey in search of the fountain. Hawthorne viewed rejuvenation procedures as consumptive and physically destructive transformations. His novel captures the modern anxiety surrounding rejuvenation and cosmetic surgery through the lens of literary fantasy. Observing the transformation of the 4 guests, Dr Heidegger understands that youth is too meager a prize to trade for the wisdom that comes with old age. Advancements in medical science have alleviated modern individuals' concerns regarding rejuvenation and cosmetic surgery. Eugen Holländer and Erich Lexer independently performed a facelift in Germany (1901). Charles Conrad Miller first described the blepharoplasty technique in the United States (1906). Suzanne Noël performed a rhytidectomy in France (1912). For the plastic surgeon, it is important to sculpt the face in a way that reflects the patient's virtues, such as wisdom and dignity-qualities that Hawthorne highlighted through the character of Dr Heidegger., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The authors introduce a short story about the lifestyle of a cleft lip woman in Korea, published in 1936, about 2 decades before Dr Millard operated on his first patient in Korea. A short story entitled "Ugly Thing," written by Yao-hsieh Chu, analyzed by Eonnyeon, a girl born in a rural area with a cleft lip and palate who excelled at household tasks such as sewing. Her forehead was bulging, and her eyes were protruding. She had a low-profile nose with wide nostrils. She had a left unilateral complete primary cleft, including an alveolar cleft. There was midface retraction, accompanied by a relatively prominent chin. Her voice exhibited hypernasality. People often laugh when they see Eonnyeon eating her food, exclaiming, "She's eating like a rabbit!" However, she married a young man who deserted her on their wedding night because of her appearance. Subsequently, she moved to an urban area and found work as a housemaid. One day, she was raped by a middle-aged water delivery man, who then fled. Ten months later, she gave birth to a girl who also had a cleft lip. In a moment of despair, Eonnyeon attempted to smother her baby with a pillow but stopped herself. She resolved to raise her daughter despite the challenges ahead. The mockery directed at her could be viewed as an expression of the latent sadism inherent in human nature. It is remarkable to consider the progress made since Millard performed his first cleft lip surgery in Korea in 1954., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

In Victor Hugo's The Man Who Laughs, the protagonist has a facial cleft. The authors aimed to comprehend the psychological experience of a patient with a facial cleft by analyzing this novel. The novel concerns the life of a young nobleman, Gwynplaine, disfigured as a child, who travels with his protector and companion, the vagabond philosopher Ursus, and Dea, a baby girl he rescued. During the oppressive rule of the king, one of his adversaries was Lord Linnaeus Clancharlie, who had taken refuge in Switzerland. The tyrannical monarch ordered the execution of Gwynplaine's father and commissioned a surgeon, Dr Hardquannone, to carve the boy's face into a perpetual grin. The king declared that he should "laugh forever at his fool of a father." Subsequently, the king sold the boy to a group who specialized in the mutilation and disfigurement of children. On the psychology of a boy with an appearance giving the impression of laughing, Hugo wrote: "By laughing Gwynplaine made people laugh. However, he wasn't laughing. His face laughed, his thoughts did not." When Ursus met Gwynplaine, Ursus asked the boy: "What are you laughing at?" The boy replied: I'm not laughing. Ursus: Then you are terrible. Gwynplaine's unnatural laughter, which stems from an artificial deformation of the muscles, is a silent form of laughter. It represents the eternal laughter of those who do not truly laugh, signifying emotional emptiness and an accompanying sense of indifference. Plastic surgeons can restore an "unnatural laughing face" to a "natural smiling face.", Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to analyze the origins of the double-eyelid procedure in Korea during the Japanese colonial era. Through Google (www.google.com) and Naver (www.naver.com), the archives of newspapers and magazines were searched. The following topics were identified: ideal eyes in the Japanese colonial era, creating double eyelids using a non-surgical method, the first case of a double-eyelid operation in a Korean woman, and the presumed first case of a double-eyelid operation in Korea. By 1935, possessing double eyelids had come to be recognized as a symbol of modern beauty. An article suggested that women with small eyes consider surgery to transform their "single eyelid" into a "double-eyelid." It endorsed plastic surgery as a marker of "worldly progress." In 1939, a magazine featured an advertisement for Aihon tape, which was promoted to create "double eyelids." Oh Yeop-ju, the first Korean hairdresser, underwent double-eyelid surgery at an Ophthalmology Clinic in Japan, sometime between 1927 and 1932. She is celebrated as a beauty icon who broadened the beauty horizons of Korean women. After returning in 1933 with a "very beautiful" appearance resulting from successful double-eyelid surgery, she received a special invitation to the Kong Eye Center in Seoul, which opened in 1937. Upon hearing her detailed account and examining her eyelids, the clinic began offering double-eyelid surgery. The technique for double-eyelid surgery was introduced from Japan and disseminated through a medical journal and to patients who had undergone the procedure in Japan., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Competing Interests: The authors report no conflicts of interest.

The aim of this study was to analyze the appearance of women viewed as "ugly but capable" in ancient China. A Google search was conducted for the "Four Great Ugly Women." Information on 3 women was collected from Lienüzhuana, a collection of biographies of eminent women compiled by the Former Han period. With the addition of 1 (Huang Yueying), 7 "ugly but capable" women were analyzed. The manifestations of their ugliness in the texts were recorded. Among the 7 women, 5 exhibited physical manifestations, whereas the remaining 2 were simply described as "ugly" without specific characteristics. Among the discernible body characteristics of the 5 women deemed unattractive, the most common feature was dark skin (80%), followed by body shape (60%). Other frequently observed traits included sparse or yellow hair, an upturned or overly large nose, a convex forehead, and an unattractive neck (each at 40%), with the latter potentially exhibiting a protruding Adam's apple, a thick neck, or a neck mass. Less common features were sunken eyes, a large head, and a masculine skeleton, each occurring in 20% of cases. Based on the depiction of women considered unattractive, the authors can infer that dark skin, a fat body, a large or upturned nose, sparse hair, a protruding forehead, a thick neck, deep-set eyes, and a large head were elements associated with ugliness. Through the description of the ugly woman, authors can infer the standards of ugliness in ancient China., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to determine how the aging-related changes of a beautiful woman were described in Japanese literature. A poem written by Ono no Komachi was reviewed. Images of her were also searched through Google search. Komachi's poem in Hyakunin Isshu reads: "How the color has faded from the flowers. As I gaze in reverie at the falling rain, I find my beauty, too, has fallen in this world's esteem." Tamatsukuri Komachiko's Death Book describes: "She became thin and looked tired. Her hair looks like a lotus with frost. Her skin resembles a frozen pear. Her bones stick out and her tendons are visible. Her face is dark, and her teeth are yellow". Color woodblock print shows an old woman: She retains her intelligence and beauty even in her advanced years. Her posture was stooped, with a pronounced forward curvature of the spine, resulting as "turtle neck." Her hair was long and gray. Visible signs of aging included forehead wrinkles, crow's feet, deepened nasolabial folds, and marionette lines. Her upper jaw appeared retracted, a "witch's chin." She exhibited neck wrinkles as well as on her hands and wrists, which grasped a bamboo walking stick. Her eyes were sunken, accompanied by a drooping of the upper eyelids. We think that the narrative of her transformation into an ugly and poor woman was intended to convey to men the fleeting nature of women's beauty, and to women that the power of beauty is not ultimately of major significance., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study is to ascertain how women of that era looked to a Korean diplomat who visited Japan in the 18th century. During 1763-1764, the "Documents on Joseon Tongsinsa (diplomatic mission)" contain 10 records of Korea and 2 records of Japan. Among them, "The Song of a Grand Trip to Japan" (), a Joseon gasa, was reviewed. In the diary entries dated February 2 and 3, 1764, when he was in Nagoya, the author (Kim Ingyeom) described the physical appearance of Japanese women in the city. The peoples of here are bright and beautiful/ All the women are peerless beauties. With eyes like stars and cinnabar-red lips / A clear complexion like white jade, eyebrows like butterflies,/ Hands like budding sprouts, forehead like a cicada. They look like carved ice and as if lumped together with snow. How are they so beautiful despite having the flesh and blood of a human being? Though Zhao Feiyan and Yang Guifei (queens of China) are called the eternal beauties,/ They would look less beautiful compared to women here. If they dressed in Korean costumes and were decorated with jewels,/ We would forget ourselves and mistaken them as goddesses. He highlighted features such as prominent foreheads, eyebrows shaped like butterflies, star-like eyes, red lips, slender hands, and pale skin. He portrayed Japanese women as having a superior appearance compared to Chinese or Korean women. This record suggests that a diplomat admired the appearance of Japanese women during the Meiwa Era (1764-1772)., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Competing Interests: The authors report no conflicts of interest.

Competing Interests: The authors have no conflict of interest to declare.

The skull most commonly symbolizes death, mortality, and the unachievable nature of immortality. However, in Korean Buddhist art, skulls are rarely found. The aim of this study was to explore the image and meaning of the skull in the Joseon dynasty (1392 to 1910) of Korea. The terms [Buddhist] and [painting] and [Korea] were used to search Google (www.google.com), and the Research Information Sharing Service of Korea (https://www-riss-kr-ssl.openlink), was also searched for [Buddhism] () and [art] () and [skull] (). This study focused on paintings or statues of Avalokiteśvara because Avalokiteśvara was often depicted holding various items in the hands, especially the multiarmed Avalokiteśvara. The corresponding Buddhist texts were searched on "Archives of Buddhist Culture" (http://kabc.dongguk.edu). In the paintings and statues of the 42-armed Sahasra-bhuja Avalokiteśvara, one of the hands was holding a skull rod. In the royal version of the "Five Great Dhārāṇis Collection ()," which was published in 1458, a skull was found in a rod held by a 42-armed Avalokiteśvara. This corresponds to one of the verses of the "42-Hand Mantras" (Om dhuna vajra ha). The purpose of the mantra was to communicate with and manipulate ghosts. The meaning in the original Susiddhikara Sutra is quite different from the 42-Hand Mantras in the Joseon dynasty of Korea. The reason for this difference is thought to be the merger of esoteric Buddhism with the folk religions of China and Korea., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of this study was to investigate the aesthetic characteristics of Chinese beauty through an anthropometric analysis of beauty pageant winners from 1952 to 2021. Photographs from 5 renowned Chinese beauty pageants (Miss World Pageant, Miss Earth Pageant, Miss Universe Pageant, Miss International Pageant, and Miss Chinese Cosmos Pageant) were gathered and a total of 294 frontal and 31 lateral photographs were collected. The photos were divided into 3 time phases: phase I (1952-1977): from the first time when Chinese girls participated in beauty pageants, up until the time of reform and opening; phase II (1978-2002): from reform and opening to the re-opening of the Miss Chinese Cosmos Pageant; phase III (2003-2021): to the present. The horizontal corneal diameter (11.52 mm) was set as the reference value for the frontal face. Among the 35 anthropometric items of frontal faces (26 distances and 9 angles) and 41 anthropometric items of lateral faces (33 distances and 8 angles), 21 anthropometric items (16 distances and 5 angles) and 8 proportional indices of frontal faces showed significant differences. On lateral pictures, 2 angles showed significant differences among the 3 phases. Regarding the anthropometric measurements that decreased across the 3 phases, the width of the face, midface, and lower face exhibited the greatest changes. The lower face width showed the most striking changes, with a decrease from 128.5 to 112.0 mm. The quadratic regression revealed a significant turning point after 1978, coinciding with the period of Chinese reform and opening, which had a profound impact on aesthetics., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Competing Interests: The author has no conflict of interest to declare.

The aim of this paper is to present how to free and stretch the palatine vessels from the greater palatine foramen in palatoplasty. After a mucoperiosteal flap is raised, periosteal elevator is passed behind the palatine vessels to detach the periosteum around the vessels. Then, a blunt right-angle instrument is placed behind the palatine vessels, and the vessels are pulled from the foramen in the superior aspect, slightly forward (63 degrees) and medially (19 degrees) according to the direction to the greater palatine canal (GPC). The nasal mucosa is also released from the hard palate and from the lateral pharyngeal wall. After dividing the palatal aponeurosis and elevating the anterior flap, the first suture is inserted through the nasal layer of the mucosa at the level of the posterior border of the hard palate (A suture). The nasal layer is approximated and sutured. After the closure of the buccal layer, the 2 posterior flaps are joined to the small anterior flap. Finally, A suture is tied. In 60 cases of pushback palatoplasty, the palatine vessels were stretched from the greater palatine foramen. In literatures, the length of GPC is 26.97 mm. Anteroposterior diameter of the upper opening of GPC is 3.88 mm. The angle between the vertical plane and the axis of GPC is 19.09 degrees. The angle between the transverse plane and the axis of GPC is 62.63 degrees. Probably, this information is the values obtained in adults. As a matter of fact, similar values were obtained in our study on this subject., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Competing Interests: The author reports no conflicts of interest.

In our previous study, we classified nasal bone fractures into 6 types based on computed tomography and the patterns of the nasal bone fractures (NBF) in 503 patients treated between 1998 and 2004. In the present study, we analyzed 3785 patients treated between 2005 and 2021. The age, sex, etiology, associated injuries, pattern of fractures, and treatments were reviewed, and radiographic studies were analyzed. The highest incidence was in the age group of 10 to 19 years (N=870, 23.0%), followed by 20 to 29 years (N=792, 20.9%) and 30 to 39 years (N=635, 16.8%). The most common causes of injury were slip or fall-down (42.3%), violence (24.3%), sports (19.2%), traffic accidents (8.9%), and work-related (5.3%). Most of the patients had tenderness (96.1%) and swelling (78.8%). Other findings were depression (27.1%) and nasal deviation (25.8%). Crepitus was heard in only 0.4% of the patients. The patterns of the NBFs classified by computed tomography findings were type IIA (unilateral simple fracture with displacement/without telescoping, 1283 cases, 33.9%), IIB (bilateral simple fracture with displacement/without telescoping, 786 cases, 20.8%), IIAs (unilateral simple fracture with septal fracture and displacement/without telescoping, 566 cases, 14.9%), IIBs (bilateral simple fracture with septal fracture and displacement/without telescoping 530 cases, 14.0%), I (simple fracture without displacement, 522 cases, 13.8%), and III (comminuted with telescoping or depression, 98 cases, 2.6%). In most of the cases (3,666, 96.9%), closed reduction was performed. The present analysis is one of the largest data sets on NBF in Korea, which could provide reference values for diagnosing and managing nasal bone fractures., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2023 by Mutaz B. Habal, MD.)

This study aimed to provide anatomical data on the platysma for clinical procedures. The authors obtained 25 specimens from 15 adult Korean cadavers (9 men, 6 women; mean age, 72 years; range, 61-85 years). Lines connecting the gonion with the gnathion (G-GN) and the acromial end (acromial end of the clavicle) with the sternal end (sternal end of the clavicle) were used as references. Modified Sihler staining was used to trace the nerves distributed in the platysma. The superior border values of the platysma were 12.1 ± 2.7 mm, 31.5 ± 5.3 mm, 42.4 ± 5.6 mm, and 61.7 ± 6.4 mm, respectively, for sections 2 through 5 on the G-GN line. The inferior border values of the platysma were 83.6 ± 19.1 mm, 80.1 ± 14.0 mm, 74.8 ± 14.5 mm, 67.2 ± 13.7 mm, and 54.6 ± 7.1 mm, respectively, for the 5 sections on the acromial end of the clavicle-sternal end of the clavicle line. In the hyoid bone, cricoid cartilage, and jugular notch, the mean distance between the bilateral platysma was 14.4 ± 2.2 mm, 22.6 ± 10.6 mm, and 51.1 ± 15.7 mm, respectively. The mean angle at the cervical branch of the facial nerve and the anterior border of the sternocleidomastoid muscle sternal head was 28.7 ± 2.6 degrees and 53.4 ± 7.7 degrees from the G-GN line, respectively. The upper third of the platysma was supplied by branches of the facial artery and submental artery. The middle third was supplied by branches of the occipital artery and received its direct blood supply from branches of the external carotid artery. The lower third was supplied by branches of the transverse cervical artery. The authors hope that the results of this study will be helpful for rejuvenation procedures of the neck., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

The aim of this study was to determine the exact site of digital compression on the origin of the nasal branch of the ophthalmic artery during filler augmentation, by conducting a review of anatomical literature and examining plastinated specimens. According to 4 textbooks (Gray's Anatomy, Whitnall's Anatomy on the Human Orbit, Wolff's Anatomy, and Duke-Elder's System of Ophthalmology), the dorsal nasal artery leaves the orbit by piercing the orbital septum between the trochlea and the medial palpebral ligament and anastomoses with the angular part of the facial artery. In plastinated arterial specimens, the ophthalmic artery exits the orbit and divides into the supratrochlear artery and the dorsal nasal artery at the upper border of the lacrimal fossa. The dorsal nasal artery then anastomoses with the angular part of the facial artery. Branches of the dorsal nasal artery anastomose with their counterparts on the opposite side. During filler augmentation of the nose, bilateral digital compression is applied to the origins of the nasal branches of the ophthalmic artery, specifically at the point where the ophthalmic artery pierces the orbital septum. Applying compression just above the medial palpebral ligament against the bone, directly above the lacrimal sac, using the index finger and thumb can help prevent the migration of injected droplets to the ophthalmic artery. This straightforward maneuver, grounded in anatomical understanding, aims to prevent the migration of injected droplets to the ophthalmic artery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

The aim of this study is to elucidate the meaning of the skulls depicted in emblem books of the 17th century. Three emblem books of the 17th century were reviewed and analyzed: (1) Rollenhagen emblem: Gabrielis Rollenhagii Selectorum emblematum centuria secunda (1613), (2) Quarles' emblems; illustrations engraved by William Marshall and others (1635), and (3) Wither's emblem: A collection of emblemes, ancient and moderne: quickened with metricall illustrations, both morall and divine: and disposed into lotteries (1635). Among the 100 illustrations in Rollenhagen's book, 4 (4.0%) had skulls. Among the 76 illustrations in Quarles' book, 6 (7.9%) had skulls. Among the 256 illustrations in Wither's book, 12 (4.7%) had skulls. Thereafter, 22 (5.1%) of 432 illustrations had skulls. Four emblems in Rollenhagen's book were exactly identical to those in Wither's book. Therefore, 18 emblems (6 Quarles' emblem, 12 Wither's emblem) were analyzed. The most frequent meaning of skulls in 18 emblems was death (12, 66.7%), followed by resurrection (2, 11.2%). Other meanings were grief, the brevity of life, vanity of love, and pain, respectively (1 each). The most frequent of the theme of the emblems, which included skulls, was 'Memento mori' (remember death, 6, 33.3%), followed by an earnest desire for salvation or resurrection (3, 16.7%), and importance of knowledge or learning (2, 11.1%). Since these emblem books were published after Vesalius' Fabrica (1543), the drawing of the bones of the arm and legs had anatomic correlations. However, skulls were not sufficiently precise, showing each part of the facial bones., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

The aim of this study was to introduce teaching models for correct rhombic flaps. For the line of maximal extensibility (LME) and flap design, surgical fabric (model 1), scored corrugated cardboard (model 2), and scored polyethylene sheet (model 3) were used. For choosing the correct flaps, a silicone face (model 4) was used. Seven participants in the Plastic Surgery Department were recruited for the workshop. In models 1 to 3, a 2-cm diameter circle and relaxed skin tension line were indicated. Participants were requested to design Limberg flaps. Each flap was elevated, transposed, and fixed with sutures (model 1) or cellophane tape (models 2 and 3). In model 4, a 1-cm diameter circle was indicated on the cheek. Participants were requested to design correct Limberg flaps. Although participants were not provided an article describing how to create correct Limberg flaps, they eventually created correct flaps through trial and error. Participants drew 2 parallel lines tangential to the defect and following the LME, perpendicular to the relaxed skin tension lines, which are the same as the scoring marks. They then drew 2 other sides of 2 possible parallelograms by tilting them medially and laterally with angles of 60 and 120 degrees each. Thus, 4 possible Limberg flaps to close the defect were drawn. Among the 8 possible flaps, 4 flaps that did not follow the LME were eliminated. Scored polyethylene sheet had the best extensibility and least distortion among the 3 models. Through this workshop, participants learned to design rhombic flaps correctly, using 2 parallel LMEs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)