Effects of lower eyelid blepharoplasty on palpebral bags with different etiology / 中华医学美学美容杂志

Objective:To address a new classification method in term of the three-dimensional space of orbit and to present the different surgical approaches correspondingly.Methods:In a retrospect study from April of 2015 to June of 2018, 102 patients were performed lower eyelid blepharoplasty, including 20 males and 82 females, aged 21-65 years, with an average of 45.2 years. These patients were divided into five groups, which were described in term of three-dimensional structure of orbit, based on the following points: the presence and extent of herniated orbital fat, the presence of inferior orbitopalpebral sulcus, amount of excess skin, and the skin wrinkles in the lower eyelid. And then patients in different group were treated with different kinds of blepharoplasty. All patients in this study ranged in follow-up from 1 month to 12 months. With patients＇ permit, photographs and clinical information were taken to evaluate the preoperative and postoperative outcome.Results:In type 1, all the 32 cases healed well, no complications such as hematoma, infection and ectropion occurred. During the follow-up of more than 1 months, the overall effect was good, and the pouch-shaped appearance of lower eyelid pouch was significantly improved. In types 2, 8 cases had no complications, and the incision healed well; the patients were followed up for more than 3 months, the lower eyelid bag and lower eyelid skin relaxation were significantly improved, and the lower eyelid skin was tighter than before. In types 3, there were no complications in these 19 cases, and the incision was healed well. The patients were followed up for more than 3 months, the deformity of lower eyelid bag was improved obviously, and no obvious local bulge was found under static and dynamic expression. In type 4, there were no complications in all 34 cases, and the incision healed well; during the follow-up of more than 3 months, the lower eyelid pouch deformity and lower eyelid skin relaxation were greatly improved, except for 1 case with mild bulge (untreated). In type 5, 9 cases had no complications, and the incision healed well; during the follow-up of more than 3 months, the fold of the lower eyelid skin disappeared.Conclusions:Little information is available about classification of lower eyelid bags. And the exact surgical approach remains controversial and largely dependent upon surgeon preference and a patient＇s stated cosmetic desire. In this study, an objective classification based on clinical appearance combined with forming reasons of lower eye bags is little available, and the appropriate surgical approach remains controversial as well.

The association between ABO blood-group system and congenital microtia / 中华整形外科杂志

Objective@#To investigate the association between ABO blood-group system and congenital microtia.@*Methods@#Patients with congenital microtia treated in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 1, 2017 to February 28, 2019 were collected as the case group. Non-malformed patients admitted to the same hospital from January 1, 2017 to February 28, 2019 were collected as the control group. ABO blood group was determined by tube agglutination test. The distribution of ABO blood group in both group was counted and Chi-square test was used for statistical analysis with a significance level α=0.05. Then spilt chi-square test was applied to compare the difference between blood groups using Bonferroni correction for multiple comparisons (significance level α′=0.008 3) if a statistically significant difference was found in chi-square test. Odds ratio (OR) and its 95% confidence intervals (CI) were calculated to compare the association between ABO blood group and risk of microtia by using Woolf’s method . All statistical analysis was performed with SPSS version 25.0.@*Results@#2 317 patients with congenital microtia (case group) and 5 411 patients without malformation (control group) were included in this study. The distribution of ABO blood types in congenital microtia group was 29.39% (681/2 317) for type A, 31.89% (739/2 317) for type B, 9.75% (226/2 317) for type AB, and 28.97% (671/2 317) for type O. The distribution of blood group was B>A>O>AB. While, the distribution of blood groups in the control group was O>B>A>AB, which was statistically different from the congenital microtia group (χ2=8.387, P=0.039). The incidence of congenital microtia differed significantly between A blood group and O blood group (χ2=7.448, P=0.006). The risk of congenital microtia was significantly lower in blood group O (OR=0.863, 95% CI: 0.776-0.960, P=0.007) and relatively higher in blood group A (OR=1.110, 95% CI: 0.997-1.236).@*Conclusions@#In the population managed in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, ABO blood group is correlated with the occurrence of congenital microtia. O blood group is a potential protective factor. While A blood group is susceptible to congenital microtia.

The review of common external birth defects / 中华整形外科杂志

Birth defects is one of the most important problems of human society. External birth defect is one of the major research fields of plastic surgery. This kind of disorders damages the body image of patients in mild or severe way, affects severely the social confidence of the patients themselves and their families. we summarized the research progress of the common external birth defects (the incidence top 10) from the aspects of pathogenesis, prevention, treatments and so on, in order to provide reference materials to the prevention and treatment of them.

Experimental research in athymic nude mice for autologous lymph nodes fragmentary transplantation combined with VEGF-C / 中华整形外科杂志

Objective@#Autologous lymph nodes fragmentary transplantation combined with vascular endothelial growth factor-C (VEGF-C) on athymic nude mice to explore the association between regeneration of lymphatic vessel and tumor cell migration.@*Methods@#A total of 45 nude mice were randomly divided into 3 groups: Group A, simple autologous lymph nodes fragmentary transplantation, n=15; Group B, autologous lymph nodes fragmentary transplantation together with VEGF-C, n=15; Group C, without any intervention, n=15. At 1 month, 2 months and 6months after surgeries, the axillary lymph nodes of 5 mice in each group were dynamically examined by in vivo indocyanine green (ICG) fluorescence imaging respectively. The regenerated lymph nodes and relevant skin were evaluated using hematoxylin-eosin (H&E) staining and the skin was quantitatively analyzed via immunofluorescence staining for lymphatic vessel endothelial hyaluronan receptor 1(LYVE-1) as well.@*Results@#One month after surgery, the right regenerated axillary lymph nodes in group B (5/5) were visible by in vivo ICG fluorescence imaging, whereas the same signals were not detected in group A (0/5). The results were the same at 2 and 6 months after surgery. HE staining showed that the cortical, paracortical, and medullary regions of the right axillary lymph nodes of the experimental group B were clear, and the lymphatic vessel structure was present, accompanied by lymphocyte infiltration. Immunofluorescence staining of the right upper limb showed that the expression of LYVE-1 in the lymphatic endothelium of the B group was significantly higher than that in group A (P<0.001) and the control group (both P<0.001).@*Conclusions@#Due to the promising consequence of regenerated lymph nodes, the procedure of autologous lymph nodes fragmentary transplantation combined with VEGF-C in athymic nude mice provides a reliable animal model for the next stage research.

Combination of orbicularis oculi muscular myolemma release and orbital septum reset to create double eyelid / 中华整形外科杂志

Objective@#To explore a surgical method for the reconstruction of naturally dynamic double eyelid by fully reserving orbicularis oculi muscle.@*Methods@#Incisional double eyelid blepharoplasty were performed on 352 patients. Orbicularis oculi muscle in incisional and pretarsal area were completely preserved. Muscle was elevated from plate by resecting deep muscular myolemma and muscles to form pretarsal myocutaneous flap. Thereafter, the orbital septum was completely exposed. The free end of muscle flap was fixed to a higher position of the levator aponeurosis. The orbital septum was repaired at the same time.@*Results@#From June 2009 to December 2017, 352 patients were performed double eyelid blepharoplasty using above technique. They are 337 females and 15 males. Fifty-two patients were followed up for 6-60 months, with the mean time of 27 months. All the incisions were uneventfully healed. The new double eyelid presented smooth appearance, and the so-called " sausage" phenomena were not noticed. There was no concave groove or step-like deformity when eyes closed. Forty-five patients were satisfied with the outcomes. Two patients had shallower supratarsal folds on one side, and 1 patient underwent secondary repair. Two patients complained about asymmetry. Two patients suffered from mild unilateral eyelash eversion (without need of reparation).@*Conclusions@#The combined application of deep and superficial myolemma release of the orbicularis oculi muscle, and orbital septum reset, could create a double eyelid with natural and dynamic appearance.

Combination of orbicularis oculi muscular myolemma release and orbital septum reset to create double eyelid / 中华整形外科杂志

Objective@#To explore a surgical method for the reconstruction of naturally dynamic double eyelid by fully reserving orbicularis oculi muscle.@*Methods@#Incisional double eyelid blepharoplasty were performed on 352 patients. Orbicularis oculi muscle in incisional and pretarsal area were completely preserved. Muscle was elevated from plate by resecting deep muscular myolemma and muscles to form pretarsal myocutaneous flap. Thereafter, the orbital septum was completely exposed. The free end of muscle flap was fixed to a higher position of the levator aponeurosis. The orbital septum was repaired at the same time.@*Results@#From June 2009 to December 2017, 352 patients were performed double eyelid blepharoplasty using above technique. They are 337 females and 15 males. Fifty-two patients were followed up for 6-60 months, with the mean time of 27 months. All the incisions were uneventfully healed. The new double eyelid presented smooth appearance, and the so-called " sausage" phenomena were not noticed. There was no concave groove or step-like deformity when eyes closed. Forty-five patients were satisfied with the outcomes. Two patients had shallower supratarsal folds on one side, and 1 patient underwent secondary repair. Two patients complained about asymmetry. Two patients suffered from mild unilateral eyelash eversion (without need of reparation).@*Conclusions@#The combined application of deep and superficial myolemma release of the orbicularis oculi muscle, and orbital septum reset, could create a double eyelid with natural and dynamic appearance.

Progress in Nanofat transplantation / 中华整形外科杂志

Since the autologous fat transplantation was reported by a German surgeon, Gustav Neuber, in 1893, the technical method of autologous fat transplantation, the transplantation concepts and application range have undergone tremendous changes and progress. In recent years, with the advanced research on adipose derived stem cells (ADSCs), the application field of autologous fat has been widespread. From initially used for soft tissue filling, it gradually expanded to orthopedic surgery, reconstructive surgery and cosmetic surgery, such as treatment of scar, skin and tendon adhesion, Renault syndrome, breast enhancement, facial rejuvenation and body shaping. The Nanofat transplantation technology originated from autologous fat transplantation, and it is not an exact nanotechnology for the technology itself. However, due to its remarkable effect on local skin rejuvenation, the Nanofat transplantation has become one of the hot issues in orthopedics in recent years.

Applications of virtual reality and augmented reality technology in plastic surgery / 中华整形外科杂志

As emerging digital technologies, virtual reality and augmented reality technology have been widely and deeply applied in the medical field, especially in plastic surgery. This paper reviewed the development of virtual reality and augmented reality technology, indispensable components in realization process of virtual reality and augmented reality technology in plastic surgery as well as applications in preoperative planning, intraoperative navigation, surgical training of plastic surgery. At last, there is a summary of the applications, deficiencies and the future direction of virtual reality and augmented reality technology in plastic surgery.

Application of Bmp5 short ear mouse model in the study of congenital microtia / 中华整形外科杂志

Objective@#To study the construction of Bmp5 short ear homozygous mouse model and the feasibility of its application in the study of congenital microtia.@*Methods@#Twelve Bmp5 short-ear mouse were introduced from JAX laboratory in the United States. Ten pregnant Bmp5 short-ear mouse were obtained by breeding. DNA was extracted from the tail of 86 fetal rats aged 14.5 days and sequenced by Sanger method. Three pregnant mice were born normally, and the young mouse was fed conventionally. Three 40-day-old mice with auricle deformity and normal auricle were stained with Alcian blue, and the result were compared and analyzed.@*Results@#The auricle of Bmp5 short ear homozygous mouse was significantly shorter than that of their sibling normal auricles. Sanger sequencing showed that the point mutation of Bmp5 was the seventh base at the bottom of exon 2, and the base mutated from C to T. The result of Alcianblue staining showed that the size of homozygous mutant mouse was small and the development of sternum and ribs was obviously abnormal.@*Conclusions@#The model of Bmp5 short ear mouse can be completely suitable for the study of human congenital microtia. The model of Bmp5 short ear mouse is a suitable animal model to study the development mechanism of congenital microtia.

Application of Prkralear-3J mouse as an animal model in the study of congenital microtia / 中华整形外科杂志

Objective@#To explore the feasibility of using Prkralear-3J mouse (also known as: little ears 3 Jackson) as an animal model in the study of congenital microtia.@*Methods@#Six Prkralear-3J mice of the same litter were introduced from JAX laboratory in the United States. 13 pregnant Prkralear-3J mice were obtained through breeding. A total of 75 fetus tails with gestational age of 14.5 days were obtained, and DNA was extracted and sequenced by Sanger method. Three pregnant mice were normally produced, and the young mice were routinely reared after birth. Three 40-day-old mice with auricle deformity and normal auricle were used respectively to perform skeletal alcian blue staining and comparative analysis.@*Results@#The auricle of Prkralear-3J homozygous mice was significantly smaller than that of the wild-type mice, and the substructure morphology of the normal mouse auricle was lost. The mutation site was a G-to-A mutation on chromosome 76, 643, 218 bp (GRCm38), which was located after the third exon. The results of alcian blue staining showed that the overall body size of Prkralear-3J homozygous mouse was smaller than that of wild type mouse, and the bone development of limbs was basically normal, but it was thin and short, especially in the hind limbs, the ribs were smaller, the tailbone was shorter, and the skull was slightly smaller.@*Conclusions@#The Prkralear-3J mouse is a suitable animal model for studying the developmental mechanism of congenital microtia.

Deep analysis of methylation profile in congenital microtia and verification of the differential genes / 中华整形外科杂志

Objectives@#To explore the differences in signal pathway and gene expression related to the pathogenesis of congenital microtia by the in-depth analysis of DNA methylation profiling of auricular chondrocytes from congenital microtia patients.@*Methods@#Genome wide methylation profile of congenital microtia was obtained by MeDIP chip technology, and analyzed by Gene ontology (GO) and Pathway analysis. The gene expression levels of Wnt1 and Wnt11 were evaluated by Real-time PCR in the auricular cartilage from the healthy side and affected side of the congenital microtia patients , and healthy controls.@*Results@#The GO and Pathway assay showed that Wnt signal pathway was enriched in differential methylated levels. The Wnt1 and Wnt11 genes were with higher methylation in the promoter region and CpG islands in healthy control group than that in microtia group, in addition the methylation level in the affected side auricular cartilage was lower than that in the healthy side. There was no difference in Wnt1 and Wnt11 gene expression in microtia patients and healthy controls. The higher Wnt11 gene expression was detected in the affected side residual cartilage tissues than in the healthy side cartilage tissues of the same congenital microtia patient.@*Conclusions@#The over expression of Wnt11 during embryonic development might be associated with the pathogenesis of congenital microtia. The mechanism of the difference in methylation levles of Wnt11 affecting pathogenesis of congenital microtia needs further research.

Ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty for correction of cryptotia / 中华整形外科杂志

Objective@#To explore the curative effect of ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty for correction of cryptotia.@*Methods@#Four cases (six ears) were corrected by ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty method from 2016 to 2017. Following ear release, the flap is rotated into the defect and donor site covered by a razor-thin graft raised in continuity with the flap, the posterior flap was advanced and sutured with Z-plasty.@*Results@#All corrected auricles four cases (six ears) were followed up from 3 months to 1 year and abtained satisfactory and stable appearance.@*Conclusions@#The shape of auricle is natural and satisfactory after operation. The method is simple and no skin grafting is needed. The adhesion of the hidden muscles and cartilages were sufficiently released.

Application of digital technology aided in auricle location and personalized framework design in ear reconstruction for microtia patients with craniomaxillofacial asymmetry / 中华整形外科杂志

Objective@#To seek an accurate and objective method to locate reconstructed auricles and design frameworks with digital technology for microtia patients with craniomaxillofacial asymmetry, improving the symmetry of the postoperative ears.@*Methods@#From September 2014 to February 2016, 50 unilateral microtia patients with craniomaxillofacial asymmetry who were scheduled for auricular reconstruction were included in the study. The digital models of the patients′ ears and heads were based on the scan data preoperatively, which were collected by the three dimensional(3D) photogrammetric scanning technique. The reconstructed auricle was positioned by the mirror image of the contralateral side on the digital models. Based on the location, the morphological parameters and the corrective parameters of the autogenous cartilage frameworks could be obtained. With the guidance of the above information, ear reconstruction with tissue expander could be carried out.@*Results@#Auricular and craniofacial morphology could be reflected vividly by the digital models. Meanwhile, the location and parameters of the reconstructed ear could be acquired. And the outcomes of the 50 reconstructed ears were satisfactory with symmetrical appearance. With 1 to 8 months (average 6.8 months) of follow-up, both the doctors and the patients were satisfied with the postoperative result.@*Conclusions@#Utilizing the location and parameters which were obtained from the digital models based on 3D photogrammetric scanning is an accurate and objective way to gain more symmetrical result in clinical ear reconstruction for microtia patients with craniomaxillofacial asymmetry.

Correction of preauricular depression using the composite flap of microtic cartilage and soft tissue in tragus reconstruction / 中华整形外科杂志

Objective@#To summarize the clinical effect of using the composite flap of microtic cartilage and soft tissue in tragus reconstruction to correct preauricular depression.@*Methods@#From January 2015 to November 2016, we corrected preauricular depression of 523 patients with congenital microtia that were treated with tragus reconstruction by using the composite flap of residual ear cartilage and soft tissue.@*Results@#All the composite flap of residual ear cartilage and soft tissue were transplanted successfully. No blood circulation disorder and significant contracture occurred. All patients were followed up for 6-14 months with an average of 10 months. The reconstructed tragus looked projective and the preauricular depression was corrected, demonstrating a similar looking to the healthy side. The patients were satisfied with the results.@*Conclusions@#The residual ear tissue could form the composite flap of residual ear cartilage and tissue. Using the composite flap to fill the preauricular depression was effective, which was not easily absorbed. The residual ear tissue is the best resource for filling the preauricular depression. It should not be discarded in ear reconstructive surgery, but reserved for the next operation for tragus reconstruction.

Recent progress in the vascularized lymph node transfer for the treatment of lymphedema / 中华整形外科杂志

The lymphedema is the most common cause of the refractory extremity thickness, which severely affects the quality of patients′ life and is also an intractable issue for therapy. Among the surgical therapies currently being practiced for lymphedema, free vascularized lymph nodes transfer(VLNT) is a promising option. The purpose of this review is to summarize specific issues of VLNT with regard to the mechanism, the surgical technique, agents application, postoperative care and outcomes.

Physical attractiveness from psychological perspective / 中华整形外科杂志

Try to explore the motivation of human beings pursuing attractiveness of appearance from psychological perspective, and how the social psychological factors influence on the aethetic standard. Firstly, from the perspectives of social cognition, evolutionary psychology and mate choice psychology, the paper analyzes the individual′s motivation of pursuing the attractiveness of appearance, and proposes that the halo effect affects people′s cognition of beauty, and then makes people have a beautiful expectation effect. This expectation forms a Self-fulfilling prophecy, thus achieving people′s aspirations for the pursuit of the attractiveness of appearance. However, what is the standard of appearance attractiveness, and through the analysis of psychology research result such as appearance attractiveness, synthetic photograph and intercultural face, we come to several criteria of appearance attractiveness and put forward the social psychological factors such as exposure effect, familiarity and so on Affect people′s judgment on appearance attractiveness, and further explain that the social psychological needs affect the individual′s subjective experience of beauty.

Early non-surgical treatment of congenital auricular deformity / 中华整形外科杂志

Objective@#To investigate the effect of auricle deformity corrector in non-surgical treatment of congenital auricular deformity.@*Methods@#The auricular deformity correctors were applied for non-surgical treatment of congenital auricular deformities. The patients were divided into three groups according to the treatment starting age (<1 month old, 1-3 months old, 3-6 months old), followed up for every month respectively after treatment. According to the improvement of auricle morphology, the treatment results were divided into four levels (e, g, f, p) and the effective rate (e+ g)% was calculated.@*Results@#From January 2014 to December 2016, there were 140 ears of congenital malformations in children aged less than 6 months who were treated and followed up. Among them, 33 ears had helical rim abnormalities, 29 with cup-shaped ears, 12 with prominent ears, 4 with Stahl′s ears, and 62 with cryptotia ears. The therapeutic efficacies (<1 month old, 1-3 months old, 3-6 months) of these ear malformations were: cryptotia ear (100%, 100%, 87.5%), helical rim abnormality (100%, 90.47%, 66.67 %), prominent ear (-, 100%, 50%), cup ear (100%, 78.57%, 53.33%), Stahl′s ear (-, 100%, 33.33%). Follow-up more than 6 months after treatment, up to a year and a half, no recurrence was found.@*Conclusions@#The auricular deformity corrector can be used as an effective approach for achieving natural outcomes and correcting cosmetic abnormalities. Rate of satisfaction is dependent on types of deformity, the neonatal age in which treatment started and also parents′ compliance to treatment methods and principals. The method is noninvasive, easy to wear and works well. Early proper treatment can avoid future operations and save social medical resources.

Strategy for dealing with failed reconstructed ears / 中华整形外科杂志

Objective@#To discuss the strategy for dealing with the failed reconstructed ears.@*Methods@#From January 2010 to January 2015, 14 cases (14 ears) were admitted to our department because of failed reconstructed ears. It was impossible to improve their appearance greatly just by adjusting the original structures. We had to take out the framework and re-reconstruct the ear with autologous costal cartilages. Depending on the conditions of soft tissue, we divided them into three groups: Group 1, 8 ears(57.1%), the soft tissue could be reused simultaneously after being dealt with appropriately although the original frameworks were distorted badly. We took out the original frameworks, harvested cartilages again, fabricated the new frameworks and wrapped them with the original soft tissue. Group 2, 4 ears(28.6%), the structures were damaged completely, just with the constricted scars and skin graft clinging on the mastoid bone. We wrapped the new framework with axial temporal superficial fascia flap and then covered the wound with skin graft; Group 3, 2 ears(14.3%), the structures were distorted seriously. The skin flap covering the framework constricted badly while the post-auricular fascia flap was unspent. We took out the framework, implanted the skin expander under the spread skin flap, and then re-reconstructed the ear with expansion method.@*Results@#13 of 14 cases( 92.9%)were rebuilt successfully. The new ears maintained the landmark subunits 1 month after surgery. In 1 case (7.1%) from group 3, the creased skin had a rupture during skin expansion period. The expander had been taken out, and then a new one was replaced 3 months later. Follow-up period was 3-12 months. The structures of all the 14 rebuilt ears were stable and much better than before.@*Conclusions@#Good results could be achieved when appropriate method was selected for failed reconstructed ear. The condition of soft tissue of distorted reconstructed ear should be considered.

The evolution of the human body aesthetics in western art works / 中华整形外科杂志

The beauty of human body is the professional pursuit of plastic surgeon. Beauty-appreciation education is one of the most important component of plastic surgery quality-oriented education. The expression of human body in western art not only comes from the reality , but also has the idealistic color. With the human body aesthetic as the main line, theauthorsappreciated and analyzed some western art works, so as tostudy the trajectory and enlighten the think about the beauty of human body.

Treatment and outcome of postoperative infection of rib cartilage framework in ear reconstruction / 中华整形外科杂志

Objective@#To investigate treatment and outcome of rib cartilage framework in ear reconstruction.@*Methods@#12 cases of rib cartilage framework infection in ear reconstruction were retrospectively analysed in the latest four years. Lab examination results showed that staphylococcus aureus were found in 5 cases, coagulase negative staphylococcus in 3 cases, Klebsiella pneumonia in 2 cases, aeromonas hydrophila in 1 case and no bacteria were found in 1 case with regular culture. Debridement, systemic antibiotic therapy, saline irrigations and unobstructed drainage were utilized to treat the infection.@*Results@#The average duration of dressing change was 35 days in 12 cases (12-67 days), of which six cases were cured leaving no obvious or mild change of cartilage framework. Cartilage framework was totally damaged by infection in one case, so the framework had to be removed and debridement was then carried out to control infection. Secondary repair should be taken at least 6 months later. In the rest 5 cases, frameworks were taken out in the early stage of infection. The infected portion of the cartilage was removed and the healthy part was buried subcutaneously in the chest. The expanded postauricular flap and fascia were smoothened. Secondary repair should be performed after 6 months.@*Conclusions@#Effective debridement, irrigations and drainage can be used to control infection of cartilage framework and maintain normal contour and structure of reconstructed auricle. With regards to severe infection, framework should be removed as early as possible and infected portion of cartilage should be cleared out, while healthy part could be used for secondary reconstruction of auricular contour after complete control of infection.