"The Evolution of Eyebrow Morphology: The Westmore Model Revisited".

BACKGROUND: The most widely recognized eyebrow model was described by Westmore in 1974. With the rapidly changing concept of beauty, an accurate up-to-date model is needed. METHODS: The Westmore model was tested on fashion models that were randomly selected from the covers of the 1965-1975 (group 1) and 2006-2016 (group 2) Vogue magazine. The eyebrows of fashion models, which represent the beauty ideals of these decades, were objectively measured and compared. We proposed a modified eyebrow model more adapted to the modern standards of beauty, applied it to group 2, and objectively compared it to the Westmore model. This new model was validated on a group of randomly selected Caucasian women. RESULTS: Thirty women were included in each group. The medial edge of the eyebrow was better defined by the Westmore model in group 1 compared to group 2. The lateral edge of the eyebrow was better defined by the Westmore model in group 2. The peak of the eyebrow was not well defined by the Westmore model in both groups. The new model was more adapted than the Westmore model for both the medial edge and the peak of the eyebrow in group 2. It was also accurate in non-model Caucasian women. CONCLUSION: Eyebrow morphology has evolved since the description of the Westmore model. Our model represents a simple way to accurately predict the eyebrow landmarks according to the modern ideals of beauty.

Lower Body Lift in the Massive Weight Loss Patient: A New Classification and Algorithm for Gluteal Augmentation.

BACKGROUND: An often-neglected part of the lower body lift procedure is the gluteal region. The objective of this study was to classify massive weight loss patients undergoing a body lift procedure and provide a safe, standardized approach for gluteal augmentation. METHODS: A retrospective review of all body lift procedures performed between January of 2012 and January of 2017 was conducted. Patients undergoing a lower body lift with or without gluteal augmentation were included for analysis. Patients were classified as follows: type I, minimal lower and upper back fat and deflated buttock; type II, substantial lower back fat, minimal upper back fat, and deflated buttock; type III, substantial lower and upper back fat and deflated buttock; and type IV, good buttock projection. Type I patients had gluteal implants, type II patients had autologous flap augmentation, type III patients had gluteal lipofilling, and type IV patients did not have any gluteal augmentation. RESULTS: Two hundred eighty patients were included for analysis. Two hundred thirty-eight underwent concomitant gluteal augmentation (85 percent): 213 had autologous flaps (76 percent), 13 had gluteal implants (5 percent), and 12 had large-volume lipofilling (4 percent). Forty-two patients underwent a body lift with no gluteal augmentation (15 percent). Gluteal augmentation did not increase the rate of complications. In both groups, no skin necrosis, venous thrombosis, or pulmonary embolism was reported. Patients who had a sleeve gastrectomy had significantly lower odds of complications compared with gastric bypass (OR, 0.45; p = 0.017). CONCLUSION: A standardized algorithmic approach for gluteal augmentation may optimize the result without increasing the complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Labia Majora Augmentation: A Systematic Review of the Literature.

BACKGROUND: Currently, there is no standardized approach for labia majora augmentation and controversies still exist regarding this subject. OBJECTIVES: This systematic review aimed to assess the evidence in the literature regarding labia majora augmentation. METHODS: On November 20, 2016, we conducted an online search of published articles in the Medline, Embase, and Cochrane databases. All articles describing labia majora augmentation were included in this review. RESULTS: Nine studies were selected for inclusion in the systematic review. Only 2 studies were prospective trials. The most commonly used technique was fat grafting with a total of 4 articles and 183 patients. The mean total injected fat volume ranged from 18 mL to 120 mL per session. Two articles described hyaluronic acid injection techniques. The total injected volume of hyaluronic acid ranged from 2 to 6 mL per session. Three articles used surgical techniques for labia majora augmentation. All included articles did not report any major or life-threatening complications. All techniques demonstrated high satisfaction rates. CONCLUSIONS: Labia majora augmentation appears to be a safe, efficient technique with a high satisfaction rate and no reported major complications. However, further randomized controlled trials are warranted. LEVEL OF EVIDENCE: 4.

Gluteal Implants Versus Autologous Flaps in Patients with Postbariatric Surgery Weight Loss: A Prospective Comparative Study of 3-Dimensional Gluteal Projection After Lower Body Lift.

BACKGROUND: Deformities and excess skin resulting from massive weight loss are corrected with circumferential lower body lift (LBL). The gluteal area is frequently flattened due to aggressive skin excision during LBL. Gluteal implants can circumvent this problem. OBJECTIVES: We aimed to objectively evaluate the outcomes of gluteal augmentation with implants versus flap surgery performed simultaneously with LBL. METHODS: Between January 2014 and June 2015, twenty-seven patients underwent LBL with gluteal implants (10 patients), flaps (14 patients), or no gluteal augmentation (3 patients) in our hospital. Three-dimensional analysis was used to assess gluteal projection preoperatively and at 6 months. Gain in projection, pain scores, complications, and patient and surgeon satisfaction were compared. RESULTS: The mean follow-up duration was 18 months. The mean gain in projection at 6 months was 4.9 mm in the implant group, -0.5 mm in the flap group (P = 0.1), and -9.6 mm in the control group. The mean implant volume was 294.5 mL. Operation time was shorter in the flap group (192 min) than in the implant group (218 min, P = 0.001). Surgeon satisfaction was higher in the implant group (P = 0.007). Implants were more painful than flaps at 4 days and 2 weeks (P = 0.004 for both). There were 6 minor complications (60%) in the implant group versus 7 (50%) in the flap group (P = 0.94). CONCLUSIONS: In selected patients, LBL with gluteal implants is safe and slightly increases gluteal projection. LEVEL OF EVIDENCE: 2.

Row for your life: a century of mortality follow-up of French olympic rowers.

BACKGROUND/AIM: Strenuous endurance training required to participate in the highest sports level has been associated with deleterious effects on elite athletes' health and cardiac abnormalities. We aimed to describe overall mortality and main causes of deaths of male French rowers participating in at least one Olympic Game (OG) from 1912 to 2012 in comparison with the French general population. METHODS: Identity information and vital status of French Olympic rowers were validated by National sources from 1912 to 2013 (study's endpoint) among 203 rowers; 52 out of 255 (20.3%) were excluded because their vital statuses could not be confirmed. Main causes of deaths were obtained from the National registry from 1968 up to 2012. Overall and disease-specific mortalities were calculated through standardised mortality ratios (SMRs) with its 95% confidence intervals (CIs). The overall mortality was calculated for the whole rowers' cohort (PT) and for two periods apart: (P1) including rowers from 1912 to 1936 OG, a cohort in which all rowers have deceased and (P2) considering rowers from 1948 to 2012 OG. RESULTS: Among the 203 rowers analysed, 46 died before the study's endpoint, mainly from neoplasms (33%), cardiovascular diseases (21%) and external causes (18%). PT demonstrates a significant 42% lower overall mortality (SMR: 0.58, 95% CI: 0.43-0.78, p<0.001), P1 a 37% reduction (SMR: 0.63, 95% CI: 0.43-0.89, p = 0.009) and P2 a 60% reduction (SMR: 0.40, 95% CI: 0.23-0.65, p<0.001) compared with their compatriots. Mortality due to cardiovascular diseases is significantly reduced (SMR: 0.41, 95% CI: 0.16-0.84, p = 0.01) among rowers. CONCLUSIONS: French Olympic rowers benefit of lower overall mortality compared with the French general population. Among rowers' main causes of death, cardiovascular diseases are reduced in relation to their compatriots. Analytical studies with larger samples are needed to understand the reasons for such reductions.

Altered fat differentiation and adipocytokine expression are inter-related and linked to morphological changes and insulin resistance in HIV-1-infected lipodystrophic patients.

OBJECTIVE: To achieve a better understand of the pathophysiology of HIV-related lipoatrophy, we compared the mRNA expression of adipocytokines in fat samples from patients and healthy HIV-seronegative controls together with fat morphology and we studied the relationship between changes in fat morphology, adipocytokine expression, markers of adipose tissue differentiation and whole body insulin sensitivity. DESIGN: Cross-sectional analytical study. SUBJECTS AND METHODS: The mRNA expression of adipocytokines and transcriptional factors in fat samples from 26 patients with peripheral lipoatrophy (all under anti-retroviral therapy associating protease inhibitor and nucleoside-analogue reverse transcriptase inhibitors) and from 16 non-HIV-infected controls was measured by real time quantitative RT-PCR. Fat morphology was assessed histologically on a subgroup of 10 patients and six controls: collagen fibres by Sirius Red staining, apoptosis by the TUNEL technique, vessels by smooth muscle alpha-actin staining and macrophages by CD68 staining. Insulin resistance was assessed by using the homeostasis model assessment. RESULTS: The patients' fat showed higher values of apoptosis (P=0.005), fibrosis (P<0.05), vessel density (P=0.001) and macrophage infiltration (P<0.05) than the controls' fat, together with lower adiponectin and leptin mRNA levels and higher interleukin (IL)-6 and tumour necrosis factor (TNF)alpha mRNA levels. TNFa and IL-6 expression correlated positively with the level of apoptosis (P=0.05 and P<0.05, respectively) and negatively with CCAAT-enhancer binding protein (C/EBP)alpha (P<0.001 and P<0.05, respectively). Apoptosis correlated negatively with the expression level of sterol-regulatory-element-binding-protein-1c (SREBP1c) (P=0.01) and C/EBPalpha (P=0.01) whilst the vessel density correlated negatively with SREBP1c (P<0.005), C/EBPalpha (P=0.001) and beta (P=0.001). Adiponectin and leptin expression correlated positively with each other, and also with adipogenic marker expression and overall insulin sensitivity. These relationships were also present when the patient group was studied separately. Finally, fat morphological abnormalities correlated positively with whole body insulin resistance. CONCLUSIONS: Adipose tissue from patients with HIV-1-related lipoatrophy shows increased apoptosis, together with decreased adipocyte differentiation. Increased TNFalpha and IL-6 expression could be a major phenomenon linking these alterations. Decreased adiponectin and leptin expression, which may result from decreased adipocyte differentiation, could be involved in the observed whole body insulin resistance.

Association between altered expression of adipogenic factor SREBP1 in lipoatrophic adipose tissue from HIV-1-infected patients and abnormal adipocyte differentiation and insulin resistance.

BACKGROUND: Lipodystrophy is a major side-effect of antiretroviral therapy but its pathophysiology remains elusive. In-vitro studies show that HIV-1-protease inhibitors affect adipocyte differentiation at an early step involving sterol-regulatory-element-binding-protein-1 (SREBP1), but in-vivo studies are lacking. METHODS: We compared fat morphology and mRNA and protein expression of major adipocyte differentiation markers and cytokines in subcutaneous abdominal adipose tissue from 26 HIV-1-infected patients who developed peripheral lipoatrophy while on protease inhibitors and from 18 HIV-1-seronegative healthy controls. FINDINGS: Patients' fat contained a higher proportion of small adipocytes than control fat, together with lower mRNA concentrations of the adipogenic differentiation factors CCAAT-enhancer binding protein (C/EBP) beta and alpha, peroxisome proliferator-activated receptor (PPAR) gamma, and the 1c isoform of SREBP1, with a median decrease of 93% in the latter. The SREBP1 protein concentration was increased 2.6-fold, whereas the PPARgamma protein concentration was decreased by 70%. The expression of adipocyte-specific markers, including leptin, was lower in fat from patients than in fat from controls, whereas expression of tumour necrosis factor (TNF) alpha was higher and correlated negatively with the expression of SREBP1c and downstream adipogenic factors. SREBP1c mRNA concentrations correlated negatively, and TNFalpha mRNA concentrations positively, with glycaemia and insulin resistance, but did not correlate with lipid variables. INTERPRETATION: The altered differentiation status of peripheral adipocytes in HIV-1-infected patients with antiretroviral-induced lipoatrophy is associated with greatly reduced SREBP1c expression. Since the differentiation factor SREBP1 is rapidly targeted by protease inhibitors in vitro, our results suggest that SREBP1c could be an important mediator of peripheral lipoatrophy in this setting, leading to metabolic alterations such as insulin resistance.

Skin expansion and external tissue extension techniques in the treatment of a traumatic scalp defect.

Large scalp defects that include periosteum set surgeons problems in closing the defect and in reconstruction of the hair-bearing area. The external tissue extension (ETE) technique together with a skin expansion device allowed us to reduce a 12 x 7.5 cm scalp defect and to construct a self-closing flap.