Basic rheology of dermal filler

Dermal injectables are the most popular material for facial enhancement, including volumizing and wrinkle correction. However, although hyaluronic acid is the most common component of dermal injectables, the character of hyaluronic acid products is quite variable. These materials can be described in terms of their viscoelastic properties using four parameters. In this article, the author would like to describe these properties in detail. Although many physicians consider this material to be convoluted, thoroughly understanding the characteristics of various injectables enables us to tailor procedures accordingly and to enhance the final results.

Short-term safety of facial rejuvenation using an absorbable polydioxanone monofilament thread in patients with mild-to-moderate facial skin sagging

Background@#Facial rejuvenation techniques using thread lifts are performed by passing sutures under the facial skin to treat sagging and facial flaccidity, and their advantages include a relatively short recovery time and relatively small incisions. In this study, we describe the short-term safety of a facial rejuvenation technique involving an absorbable polydioxanone monofilament thread (Mint Lift) in patients with mild-to-moderate facial skin sagging. @*Methods@#The current multicenter, retrospective, case-series study was conducted in a total of 196 patients who visited the Grace Plastic Surgery Clinic or the Songdo IB Clinic between 2016 and 2018. The patients underwent insertion of the Mint Lift 43 and 17 in the deep temporal fascia and the deep subcutaneous layer, respectively. Of these patients, 179 met the eligibility criteria and their medical records were retrospectively reviewed. @*Results@#The patients comprised six men (3.4%) and 173 women (96.6%), with a mean age of 44.4±14.4 years. In our series, postoperative complications included ecchymosis (1.7%), infection (0.4%), thread extrusion (1.1%), and skin dimpling (1.5%). No cases of iatrogenic nerve injury were observed, and all postoperative complications spontaneously resolved. @*Conclusions@#The Mint Lift 43 and 17 may be safe for thread lifting in patients with mildto-moderate facial skin sagging. However, further long-term follow-up studies are warranted.

Bone Morphogenetic Protein 2-Conjugated Silica Particles Enhanced Early Osteogenic Differentiation of Adipose Stem Cells on the Polycaprolactone Scaffold

BACKGROUND: Silica particles (SPs) induce cell proliferation and osteogenic differentiation. We reported that SPs in the scaffold induced early stage osteogenic differentiation. METHODS: A polycaprolactone (PCL) scaffold was fabricated with a 10 wt% SPs. The surface of PCL scaffold was coated with a 10 µg/mL collagen solution. Next, the scaffold was conjugated with 2 µM SPs, 2 µg/mL bone morphogenetic protein 2 (BMP2), or 2 µM BMP2-conjugated SPs (BCSPs). Green fluorescent protein-coupled BMP2 was applied to fabricate the scaffold. The fluorescence intensity was analyzed by confocal microscopy. The mRNA levels of the early osteogenic differentiation marker, alkaline phosphatase (ALP), were analyzed by real-time quantitative polymerase chain reaction. Levels of BMP2, RUNX2, ERK1/2, and AKT were assessed by western blotting. RESULTS: ALP mRNA levels were significantly higher in the BCSP-conjugated scaffold than in the other scaffolds. In the early stage of osteogenic differentiation, the protein levels of BMP2, RUNX2, ERK1/2, and AKT in cells were significantly higher in the BCSP-conjugated scaffold than in other scaffolds. Thus, the BCSP composite scaffold induced rapid osteogenic differentiation. CONCLUSION: These results suggest that BCSP composite can be used to promote early stage osteogenic differentiation and show promise as a material for use in scaffolds for bone regeneration.

Transconjunctival Lowering of the Lateral Lower Eyelid by Shortening of the Posterior Lamellae

Commonly, the lateral canthus is located higher than medial canthus and many people are often shown short lateral palpebral fissure. This seemed to be shown as wild, anxious, and pierced eye. Many surgeons have made desperate efforts to improve this by anchoring lateral canthus to lower part of orbital bone. But, authors would like to show the two-third portion of the lateral lower eyelid by anchoring to capsulopalpebral fascia via transconjunctival approach. Authors performed this operation since 2009 and first named it by "Nun-Mit-Teuim" in Korean. Key of this operation is that anchoring of the lower tarsus and capsulopalpebral fascia via transconjunctival approach without resection of skin. It is not necessary to remove a redundant conjunctiva. Commonly, the lateral canthoplasty is performed simultaneously to descend a lower eyelid easily. After the operation, it can be observed that the lower eyelid lift up a little bit for 1~2 weeks and redundant conjunctiva will be constricted in several months. The operation is defined as anchoring the lower tarsus to capsulopalpebral fascia. The limit of the operation is it cannot change the position of the lateral canthus. Over-lowering the lower eyelid to increase palpebral fissure, results in scleral show and unfavorable line. Thus, it is important that surgeons should remind the purpose and limitation of this operation.

Study for Histopathologic Findings of the Hepatic Artery in the Living Related Liver Transplantation Patients

Living related liver transplantation(LRLT) is theoretically the best treatment option for end stage liver disease and nonresectable hepatocellular carcinomas. Anastomosed hepatic artery is at high risk in thrombosis after LRLT, which directly related to the patient's life. Usually, recipient hepatic artery is so friable and intimal separation and blood clot between intima and media were noted frequently. From December 2001 to June 2003, consecutive 30 hepatic arteries were harvested from 45 LRLTs patients with end stage liver disease. All hepatic artery were anastomosed with #9-0 nylon by plastic surgeon. All hepatic arteries were patent intraoperatively and postoperatively. In the histopathologic study of hepatic artery, some had intimal thickening, myxoid change and intimal hyperplasia in 14 out of 30 cases. Since pathologic changes may develop as a result of transarterial chemoembolization(TACE) and others causes, we postulated that the prevalence of hepatic arterial thrombosis, a catastrophic graft-threatening complication of LRLT, might be increased in this subset of LRLT patients who received TACE. But, in our study, patients who underwent hepatic arterial chemoembolization statistically do not show an increased risk of developing hepatic arterial thrombosis or other hepatic arterial complications after LRLT. And pathologic changes are statistically not correlate with the TACE.

The 'White-eyed Blowout' Fracture

Blow-out fractures of the orbital floor are comparatively rare in children. They have some characteristics. We have come across a group of young patients(less than 16 years of age) with little or no clinical evidence "White-eyed" of soft tissue trauma(e.g., edema, ecchymosis), diplopia with restriction of vertical gaze, lack of enophthalmos and radiologic signs of minimal bone displacement. Some investigators advocate 2-week waiting period has been found to be of little benefit in these persons and possibly harmful to their motility, so surgery within the first few days after injury as it may help to avoid permanent motility restriction in "white-eyed blowout". This paper reviews our experience of six "White-eyed blowout" patients. One of the six patients has continued mild extraocular movement restriction by 7 months. But, in one patient, symptoms resolved rapidly by 1 month after surgery. We suggest that "White-eyed blowout" can be the new categories of blowout fracture.

Spindle Cell Lipoma of the Flank: A Case Report

Spindle cell lipoma (SCL) is a relatively uncommon, benign tumor that usually presents in the subcutaneous fat of adult men. Histopatholgical findings show the lipomatous tissue to be replaced by a mixture of uniform spindle cells and mature fat cells closely within a mucoid matrix. We report a first case of SCL in a 24-year-old female. She had a solitary subcutaneous mass on right flank. Immunohistochemical staining shows positive for vimentin, CD34, but negative for S-100 protein. The patient was excised and showed no evidence of recurrence.

Vulvoperineal Reconstruction Using Various Fasciocutaneous Flaps

The reconstruction after radical vulvectomy presents a difficult challenge. Ideal flap for vulvoperineal reconstruction has thin character, constant vascular supply, and presents concealed scar after reconstruction. Various flaps are used for reconstruction of the vulvar area, have their own advantages and disadvantages. The authors performed 15 vulvoperineal reconstructions using three kinds of different 28 fasciocutaneous flaps. Gluteal fold fasciocutaneous island flap seems like labia major and remains concealed donor scar along the gluteal fold. But secondary debulking procedure is sometimes required. Vulvoperineal V-Y advancement fasciocutaneous flap is thin, reliable, easily elevated, and matches with regional skin quality, but donor site scar is conspicuous on medial thigh. Gluteal fold V-Y advancement fasciocutaneous flap is also reliable, easily elevated, and matches with regional skin quality with thin flap and concealed donor scar on gluteal fold. Also, it can be advanced even a long distance. Through our experiences, these flaps are very useful for vulvar reconstruction, but in the aspect of donor site scar, thickness, and degree of advancement, gluteal fold V-Y advancement fasciocutaneous flap is superior to the other two patterns for the reconstruction of the large sized vulvoperineal defect.

Epithelioid Hemangioma of Nasal Tip

Epithelioid hemangioma was firstly described by Enzinger and Weiss. It belongs to a group of unusual vascular proliferation accompanying prominent eosinophilic infiltration and synonymous with angiolymphoid hyperplasia with eosinophilia(ALHE). Histopathologically, the lesion is characterized by localized, marginated and relatively symmetrical proliferation of capillaries around a medium-sized vessel with an epithelioid hyperplasia of endothelial cell and marked infiltration of inflammatory cells, eosinophils and lymphocytes. The lesion occurs usually in the dermal and subcutaneous tissue of the head and neck area. We report a case of epithelioid hemangioma occuring on the nasal tip in a 72-years-old man. Microscopically, the lesion consisted of a proliferating vessels surrounded by inflammatory infilatration predominantly composed of eosinophils and lymphocytes. But vessels were lined by conventional-appearing endothelial cells.

Intramuscular Hemangioma of the Mentalis Muscle: A Case Report

Intramuscular hemangiomas are uncommon tumors of the head and neck, consistituting of 0.8% of all hemangioma, but often occur in the trunk and extremities. In the head and neck area, the masseter and trapezius muscle occur frequently, in which diagnosis is often difficult even with accurate preoperative imaging. The definitive diagnosis is made by histological study of the surgical biopsy specimen. Treatment of choice is complete surgical excision. This is, to our knowledge, the first case of intramuscular hemangioma of the mentalis muscle to be reported in korea.

Atypical Case of Granuloma Annulare / 대한피부과학회지

Granuloma annulare is a benign, usually self-limited chronic dermatasia of unknown cause, charaeterized by akin colored papules that may be arranaged in an annular configuraticn. Histopathologically, it is charicterized by camplete or incomplete foeal degeneration of collagen of chronic infliammatory cells. The authors obaerved an atypical case of granuloma annulare in a 4-year-old girl. She showed multiple papules and nodule on hands and feet. On inital examination, her skin lesions suggested histiacytosis, xanthanulama, rheumatoid nodule, or benign skin tumor. But the skin biopey revealed typica1 findings of granuloma awulare. Focal degeneration of colagen was confirmed by toluictine blue stain. Her skin lesions were almoatly cleared by skin biopsy and intralesional injectian of corticosteroid.

A Case of Multiple Basal Cell Epitheliomas Arising in An Epidermal Nevi / 대한피부과학회지

Basal cell epithelioma arising from epidermis and its appendages is a common skin tumor. But multiple occurence of basal cell epitheliomas and that of arising in an epidermal nevi are extremely rsre. Since the first report by Toyama and Kojima in 1937, only few cases were reported in the world literatures. We observed a case of multiple basal cell epitheliomas arising in an epidermal nevi in a 54-year-old female patient who had rhomboidal verrucous patch on the right side of the cheek and arciform erythematous verrucous eruption from the right side of the eyebrow to the lower eyelid. Clinical features were not compatible with any type of basal cell epithelioma. But histological finding revealed basal cell epithelioma with epidermal nevi. Literatures were briefly reviewed.