Aesthetic doctors' perception and attitudes toward tolerance in botulinum toxin.

BACKGROUND: Botulinum toxin is a crucial therapeutic tool with broad indications in both cosmetic and medical fields. However, the expanding cosmetic use and increased dosages of botulinum toxin have raised concerns about resistance, making it essential to study the awareness and management practices among healthcare professionals. METHODS: A survey was conducted among clinical physicians using botulinum toxin. The study investigated their experiences, awareness, and management practices related to toxin resistance. Real-time mobile app-based surveys were administered to clinicians attending the 45th International Academic Conference of the Korean Academy of Laser and Dermatology (KALDAT) on December 3, 2023. RESULTS: Among 3140 participants, 673 clinical physicians completed the survey. Of these, 363 clinicians (53.9%) reported experiencing botulinum toxin resistance. Regarding the resistance rate, 59.4% indicated less than 1%, 36% reported approximately 1%-25%, and 95.4% reported less than 25%. Efforts to prevent resistance included maintaining intervals of over 3 months (54.8%), using products with lower resistance potential (47.0%), employing minimal effective doses (28.2%), and minimizing re-administration (14.9%). CONCLUSION: In the South Korean aesthetic medicine community, a majority of clinical physician's report encountering botulinum toxin resistance. Given the potential loss of various benefits associated with resistance, there is a need to establish appropriate guidelines based on mechanistic studies and current status assessments. Educating clinicians on applicable guidelines is crucial.

A prospective clinical study evaluating the efficacy and safety of a Laminin-5 fragment contained soothing cream in post-laser treatment care.

BACKGROUND: Photothermolysis effect, resulting from laser procedures, can cause redness/erythema, skin irritation and burning sensation, these symptoms may persist more than several days after the procedure and leading to discomfort for patients. Proper management is necessary for the better outcome, especially in early period after the laser procedure. Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®), is believed to have the calming/soothing effect on overheated/irritated skin after undergoing the laser treatment. It is assumed that cream can help alleviate the redness, erythema and burning sensation commonly experienced after laser treatments. This study aimed to assess the effectiveness and safety of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) during the early post-laser care period. MATERIALS AND METHODS: This prospective split-face study involved 28 patients who underwent CO2 laser procedures and met inclusion criteria. The laser treatment was performed on both sides of the midface, and subsequently, the Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) was applied to one side of the midface. The efficacy of the cream was evaluated through objective measures, including photographic evaluation by two independent evaluators and assessment using an automatic skin analysis device. Subjective evaluations were also conducted. RESULTS: The objective evaluation, based on the erythema score, revealed a statistical significant difference (p < 0.05) between the side treated with Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) and the control side. The erythema score was 1.34 ± 2.469 after the laser treatment with subsequent application of the cream for 10 min and 0.7 ± 2.28 on the second day after the procedure. The subjective evaluation showed a statistically significant high of patient satisfaction. No complications were observed during the follow-up period. CONCLUSION: The application of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) after the CO2 laser treatment was found to be effective, particularly when applied for 10 min after the laser treatment and on the second day after the procedure. Both objective and subjective evaluations yielded significantly different results. Patients reported a high satisfaction rate with the characteristics of the cream during the follow-up period.

Elucidating the role of a unique step-like interfacial structure of η4 precipitates in Al-Zn-Mg alloy.

Al-Zn-Mg alloys are widely used in the transportation industry owing to their high strength-to-weight ratio. In these alloys, the main strengthening mechanism is precipitation hardening that occurs because of the formation of nano-sized precipitates. Herein, an interfacial structure of η4 precipitates, one of the main precipitates in these alloys, is revealed using aberration-corrected scanning transmission electron microscopy and first-principles calculations. These precipitates exhibit a pseudo-periodic steps and bridges. The results of this study demonstrate that the peculiar interface structure of η4/Al relieves the strain energy of η4 precipitates thus stabilizing them. The atomistic role of this interfacial structure in the nucleation and growth of the precipitates is elucidated. This study paves the way for tailoring the mechanical properties of alloys by controlling their precipitation kinetics.

Overlapping Intravelar Veloplasty Improves the Speech Outcomes in Submucous Cleft Palate.

BACKGROUND: Submucous cleft palate (SMCP) is a subgroup of cleft palate that can present as velopharyngeal insufficiency due to muscle displacement. The pharyngeal flap and Furlow palatoplasty have been introduced to correct SMCP patient with velopharyngeal insufficiency. However, pharyngeal flap and Furlow palatoplasty can occur various complications. We consider the overlapping intravelar veloplasty (IVVP) can overcome these complications. Therefore, we present the speech outcomes of overlapping IVVP for the treatment of patients with SMCP. METHODS: We retrospectively reviewed 12 patients with SMCP underwent overlapping IVVP between April 2016 and October 2018. The patients who underwent speech evaluation, nasometry, and nasoendoscopy before and after surgery and who were followed up for >18 months were enrolled in this study. RESULTS: The average age of the patients was 5 years (range, 3-11 years) and the postoperative follow-up period ranged from 18 to 24 months (mean, 20 months). The preoperative perceptual speech evaluation was moderate and the postoperative evaluation was normal ( P < 0.01). The preoperative and postoperative nasalance scores obtained using a nasometer were 37.00 and 12.50, respectively, ( P < 0.01). Preoperative and postoperative velopharyngeal movements were grades 3 and 0, respectively, ( P < 0.01). CONCLUSIONS: Our study showed that overlapping IVVP could provide successful correction of velopharyngeal insufficiency in patients with SMCP, including relatively old patients.

Comparative Analysis of Sterile Freeze-Dried Versus Sterile Pre-Hydration Acellular Dermal Matrix in Implant-Based Breast Reconstruction.

INTRODUCTION: Implant-based breast reconstruction currently represents the most popular form of breast reconstruction. Acellular dermal matrix (ADM) is a biological scaffold which is used for inferolateral implant coverage in implant-based breast reconstruction. There are two types in the way when using ADM, freeze-dried type and pre-hydrated type. In this study, we focused on complication and aesthetic outcome resulting from freeze-dried type or pre-hydrated type. PATIENTS AND METHOD: Through retrospective chart review, we analysed 78 patients (using 26 freeze-dried type, 52 pre-hydrated type, MegaDerm; L&C BIO, Seongnam, Korea) from January 2016 to February 2019. Complications such as skin inflammation, wound dehiscence, skin necrosis, infection, nipple-areolar necrosis were assessed with medical chart review with post-operative photographic findings by two independent assessors. Drainage amount of operative site and retention period of drainage was checked. Assessment for aesthetic outcome categorized into five parts, shape, volume, symmetry, nipple-areolar complex and scar. Two independent assessors undertook visual analogue scale of 1 (very dissatisfied) to 5(very satisfied) at 1 year after the surgery. And the symmetry of breast was evaluated subjectively by the patient for the same scale. If the implant was removed, aesthetic outcome assessment has not been implemented. RESULTS: In aesthetic assessment, the category of shape assessed by clinician and symmetry assessed by patient showed higher in pre-hydrated type group with significant differences. In the pre-hydrated type group, the other aesthetic outcomes including the categories of shape, size, symmetry and texture were not statistically significant, but higher. In complication, the result showed no significant difference between the two groups. In addition, there was no difference in the amount of drainage. CONCLUSIONS: Pre-hydrated type ADM is designed to be softer than freeze-dried type. We could predict pre-hydrated type would provide better texture of breast. Indeed, in this study, the shape showed better in pre-hydrated group, which was related to the nature of texture. Also, it also showed better results in the volume, symmetry, nipple-areolar complex and scar and may be related to skin thickness or remaining soft tissue after mastectomy procedure. In future studies, it should be conducted with consideration of post-mastectomy factors. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness of Absorbable Plates for the Treatment of Nasal Septal Cartilage Fractures.

BACKGROUND: Nasal bone fractures are the most common type of facial fracture. Nasal bone fractures often occur in combination with septal cartilage fractures, because the nasal septal cartilage acts as a vertical strut and provides structural support for the nose and bilateral nasal airway. However, the treatment for nasal septal cartilage fracture remains controversial, and if untreated, nasal septal cartilage fracture can lead to various complications, such as nasal obstruction and posttraumatic nasal and septal deformity. This study aimed to evaluate the effectiveness and safety of our procedure in which septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. METHODS: Between January 2017 and November 2020, 21 patients with nasal septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. The severity of the septal cartilage fracture was graded from 0 to 3 according to the computed tomography septal grading system. The numeric graded scale of nasal septal cartilage fracture was evaluated preoperatively and 6 months postoperatively using a computed tomography scan. RESULTS: Of 21 patients with septal cartilage fractures, 12 were treated with a polycaprolactone (PCL) mesh plate, and 9 were treated with a polydioxanone (PDS) plate. In the PDS plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.50 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.25, P = 0.023). In the PCL mesh plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.00 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.50, P = 0.034). The effectiveness of the PCL mesh plate and that of the PDS plate group according to the septal grading scale were 1.45 (SD, 0.522) and 1.18 (SD, 0.603), respectively. However, these differences were not statistically significant. CONCLUSIONS: Our study shows that septoplasty using absorbable plates provides satisfactory and safe clinical outcomes in patients with nasal septal cartilage fractures.

Fatigue-Induced Surface Modification of Zr-Based Metallic Glass under Environmental Conditions.

Metallic glass (MG), an intrinsic heterogeneous structure at the atomic scale, is one of the promising engineering materials with intriguing physical properties. MG often suffers from the fatigue issue caused by the repetitive mechanical loading, but it is still elusive how the local heterogeneity evolves and affects the macroscale fatigue and deformation against bulky external stress. In this study, we investigate the fatigue effect in Zr-Cu-Al ribbon using a bending fatigue method. We used scanning probe microscopy (SPM) in parallel with X-ray diffraction and X-ray photoelectron spectroscopy to figure out the loading effect on the local heterogeneities. The spatially resolved SPM images show that there is a local fluctuation of mechanical and electrical properties on the fatigued side along with morphological deformation compared to the unloaded side. Approaching the broken edge where the fatigue failure occurs, the decaying tendency is not only more dominant but also accelerated by surface oxidation of the fatigued regions. Our study provides a useful guideline on how to monitor structural changes of MGs under fatigue conditions in service and will open a door toward commercialization of high-performance structural engineering materials.

Experimental study on polycaprolactone scaffold cell-based nasal implant using 3D printing.

BACKGROUND: This study was conducted to address the potential of combining porous biocompatible scaffolds with primary cells or autologous diced cartilage in cartilage tissue engineering in the animal model. The purpose of this study is an experimental evaluation of polycaprolactone (PCL) scaffold cell-based nasal implant using three-dimensional (3D) printing. METHODS: In this study, we applied hollow PCL cage scaffolds with 200 and 400 µm pore sizes. The scaffolds were divided into three groups (n = 4 for each group): (1) PCL cage scaffolds loaded with agarose gel and chondrocytes; (2) PCL cage scaffolds loaded with agarose gel and fibroblasts, and (3) PCL cages loaded with autologous diced cartilage. In each group, chondrocytes and fibroblasts were seeded into the agarose gel at the density of 5 × 106 cells/mL. RESULTS: All implants showed sufficient integration into the surrounding tissue. It was revealed that chondrocytes were proliferated and differentiated better in the "400 µm" scaffolds than in the "200 µm" group. However, a pore size of 200 µm was optimal for fibroblasts' proliferation. In addition, the results of our study showed that the use of PCL-based scaffolds can achieve the desirable stable augmentation effect with almost none of the changes of contour. CONCLUSION: In this study, both groups: (1) PCL cage scaffolds loaded with agarose gel and chondrocytes and (2) PCL cages loaded with autologous diced cartilage demonstrated chondrogenic potential with scaffolds with 400 µm pore size. The PCL cage scaffolds loaded with agarose gel and fibroblasts demonstrated potential in cartilage tissue formation within the pore size of 200 µm.

Development of a Multi-Layer Marking Toolkit for Layout-Printing Automation at Construction Sites.

In this study, the development of a multi-layer marking toolkit was investigated to improve construction quality and mitigate the problem of irregular designs in the layout-printing work performed at construction sites. The quality of conventional layout-printing work is dependent on the skill of the worker, and construction quality can suffer owing to inconsistencies in drawings resulting from human error. In this study, these problems were analyzed, and a construction-site-layout-marking toolkit apparatus and mechanical unit, with a structure that allowed for multi-layer installation for automated implementation at construction sites, were developed. The marking toolkit and mechanical unit with the multi-layer structure were developed in a modular form so that each module can operate independently. Furthermore, each module was developed in manual mode to improve the system by acquiring information on the movement of the marking toolkit and multi-layer structure. Additionally, data on the layout-printing method was developed by connecting the system via Ethernet and operating a wireless joystick. Finally, experiments were performed on a road surface covered with B4 paper and concrete panels to confirm the operational feasibility of the system, which was developed to operate manually.

Subacute Oral Toxicity Evaluation of Expanded-Polystyrene-Fed Tenebrio molitor Larvae (Yellow Mealworm) Powder in Sprague-Dawley Rats.

Tenebrio molitor larvae, as known as edible insects, has advantages of being rich in protein, and has been recognized as a suitable alternate protein source for broiler and pig feed. Moreover, given their ability to biodegrade polystyrene, a major pollutant, Tenebrio molitor larvae has been proposed as an innovative solution to environmental problems. In the present study, we investigated the toxicity of Tenebrio molitor larvae powder (TMlp) ingested with expanded-polystyrene (W/ eps) through in vitro and in vivo experiments. The objective of this study was to determine whether TMlp W/ eps can be applied as livestock alternative protein source. For in vitro experiments, cytotoxicity test was performed to investigate the effects of TMlp-extract on the viability of estrogen-dependent MCF-7 cells. The possibility of estrogen response was investigated in two groups: Expanded-polystyrene-fed (W/ eps) TMlp group and without expanded-polystyrene-fed (W/o eps) TMlp group. For in vivo experiments, The male Sprague-Dawley rats were divided based on the dosage of TMlp administered and oral administration was performed to every day for 5 weeks. A toxicological assessments were performed, which included clinical signs, food consumption, body and organ weights, hematology, serum chemistry, and hematoxylin and eosin staining of liver and kidney. There were no specific adverse effect of TMlp W/ eps-related findings under the experimental conditions of this study, but further studies on both sexes and animal species differences should be investigated. In conclusion, TMlp W/ eps was considered non-toxic and observed to be applicable as an alternative protein source for livestock feed.

Ultrasonographic Assessment of the Cutaneous Changes Induced by Topical Use of Novel Peptides Comprising Laminin 5.

Background Laminin 5, which is found in the basement membrane of dermal-epidermal junction (DEJ), is a major adhesive component and associated with proliferating and migrating keratinocytes. In this study, we hypothesized that the topical application of the skin care products containing the novel peptides might restore the DEJ structure by deriving deposition of laminin 5 and promoting the keratinocyte migration. Here, we evaluated the restoration of DEJ by measuring the skin thickness. Methods Single-center retrospective analysis was performed on a total of 13 patients who underwent skin care using Baume L.C.E. (France, Laboratories d' Anjou) between January and March 2021. All patients applied the skin care agent for 2 weeks only on their left hand dorsum. Before the initiation of the application and after 2 weeks, both their hands were evaluated on photography and ultrasound. And the patients were asked to rate their satisfaction with the questionnaire after 2 weeks. Results There was no obvious improvement in photographic assessment and questionnaire. The post-pre difference of skin thickness in ultrasound images was, in left hand, 0.1 ± 0.37 in distal point and 0.1 ± 0.35 in proximal point; and, in right hand, 0 ± 0.17 in distal point and 0 ± 0.15 in proximal point, respectively. The pre-post difference was statistically significant in proximal point ( p = 0.035). Conclusion Topical application of novel peptide derivative comprising laminin 5 demonstrated cutaneous changes including skin thickness, as assessed by ultrasound. Further studies using other modalities including dermal density measurement, three-dimensional photography, optical coherence tomography, or skin biopsy would be helpful to determine the skin-improving effects.

Improvement in linear depressed atrophic scar using 755-nm picosecond alexandrite laser vs. ablative fractional carbon dioxide laser.

ABBREVIATIONS: AFL = ablative fractional laser, CO2= carbon dioxide, LiOB = laser-induced optical breakdown, PIH = postinflammatory hyperpigmentation, mVSS = Modified Vancouver scar scale.

Pushing the Boundaries of Multicomponent Alloy Nanostructures: Hybrid Approach of Liquid Phase Separation and Selective Leaching Processes.

ConspectusAlloying, or mixing of multiple metallic elements, is the classical way of novel materials development since the Bronze age. Increased numbers of principal elements expand the compositional space for alloy design vastly, leading to nearly endless possibilities of unexpected and unique materials properties. In contrast to bulk alloying processes represented by casting of molten metal mixtures, the fabrication of multicomponent alloy (MCA) nanostructures such as nanoparticles and nanofoams with more than three elements is often challenging, and a few methodologies for directly synthesizing alloy nanostructures up to denary systems have been suggested recently. However, forming alloy nanoparticles inside another metal matrix, instead of inside aqueous media in wet-chemical synthesis, is a fairly well understood strategy in terms of physical metallurgy. Extracting those alloy nanophases from the matrix could provide an alternative way to fabricate novel MCA nanostructures.In this Account, we describe a hybrid approach of metallurgical bottom-up and chemical top-down processes for fabricating MCA nanostructures including nanoparticles and nanofoams. The former utilizes a liquid-state phase separation process that resembles "oil and water" but occurs at the nanoscale due to thermodynamic mixing relations among alloying elements and a rapid quenching process. Thermodynamic prediction of the immiscible boundary in a temperature-composition space (miscibility gap) plays a key role in designing precursor alloys for MCA nanostructures. Selective leaching, the chemical top-down process for extracting the alloy nanostructures from the precursors, uses the chemical reactivity difference between the embedded nanostructures and the matrix phase against a certain chemical solution. We discuss here that the precise control of alloy composition and cooling rate based on thermodynamic assessments enables researchers to prepare phase-separating precursor alloys for fabricating both nanoparticles and nanofoams with a broad size range from a few nanometers to a few hundred nanometers. Depending on the alloy systems, the atomic structure of alloy nanostructures could be controlled from fully amorphous to nanocrystalline and even to quasicrystalline structure. We demonstrate how the different sizes of alloy nanostructures fabricated by a single hybrid procedure can be effectively exploited for investigating size-dependent physical properties. The future and potential research directions for this hybrid approach are also briefly discussed. This unique approach for fabricating nanosized alloys provides an extended methodology to discover novel metallic nanomaterials with promising properties in diverse compositional spaces of MCA systems.

Comparison of Effectiveness and Safety of a Botulinum Toxin Monotherapy and a Combination Therapy with Hyaluronic Acid Filler for Improving Glabellar Frown.

BACKGROUND: Among numerous cosmetic procedures for face rejuvenation performed all over the world, botulinum toxin type A (BoNT-A) for wrinkles is one of the most widely practiced procedures. However, for severe frowns, the application of botulinum toxin is often insufficient. In this study, the effects of hyaluronic acid filler combination therapy and the BoNT-A alone were evaluated. METHODS: Forty subjects with 2 or higher points (moderate to severe) of a facial wrinkle scale (FWS) when frowning in the glabellar area were assigned to 2 group: Botulinum toxin type A monotherapy group and a combination regimen of the toxin and hyaluronic acid filler group. Subjects visited outpatient department every 4 weeks until 28 weeks after the injection, and the assessment of the efficacy using FWS, subject satisfaction at both resting and maximum frowning and safety analysis were performed. RESULTS: Subjects of both group was administered 18U of BoNT-A and the subjects of the combination group received additional 0.45mL of hyaluronic acid filler regimen. Both at rest and maximum frown, the combination group scored lower FWS than the toxin and showed significance in the week-20 and week-28. And at final visit, subject satisfaction score of the combination was higher than that of toxin group. CONCLUSION: For patients with moderate to severe glabellar frown, the combined administration of BoNT-A and hyaluronic acid filler could be a considerable treatment for improving wrinkles. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Medial Epicanthoplasty With the Classic and Modified Skin Redraping Method: A Retrospective Case Control Study.

ABSTRACT: The skin redraping method for medial epicanthoplasty is characterized by some shortcomings which warrants modification. In this study, clinical data of 193 patients who underwent medial epichanthoplasty by the modified skin redraping technique or the classic skin redraping technique were reviewed retrospectively. The patients underwent operation between May 2018 and June 2020 and were followed up for not less than 6 months. Interepicanthal distance, interpupillary distance, patient satisfaction, and postoperative complications were evaluated. In terms of interepicanthal distance/inter-pupillary distance ratio ( P > 0.05) and satisfaction score ( P = 0.759), the modified skin redraping technique and the classic skin redraping technique were similar. In the classic skin redraping group, there were 3 cases of visible scarring in the lower eyelid, corresponding to significantly more cases than in the modified skin redraping group (n = 0, P < 0.001). There were more out-fold cases in the modified skin redraping group (76/90) than in the classic skin redraping group (17/88) ( P < 0.001). Utilizing the modified skin redraping medial epicanthoplasty can prevent medial hooding of the upper eyelid, reduce the probability of visible scarring, and produce more out-fold with concurrent double eyelidplasty compared with classic skin redraping epicanthoplasty. Level of evidence: IV.

Immunogenicity of botulinum toxin.

Botulinum toxin treatment is the most common non-surgical cosmetic treatment. Although there are many available treatments using botulinum toxin, their effects are temporary and repeated injections are required. These frequent injections can trigger an immunological response. In addition, botulinum toxin acts as an antigen in the body; thus, its effect disappears progressively due to this immunological reaction, which may cause treatment failure. Active botulinum toxin consists of a core neurotoxin and complexing proteins, the exact effects of which remain unclear. However, the complexing proteins are closely related to the immune response and the formation of neutralizing antibodies. Since neutralizing antibodies can lead to treatment failure, their formation should be prevented. Furthermore, various methods of detecting neutralizing antibodies have been used to predict treatment failure.

Histological and molecular biological analysis on the reaction of absorbable thread; Polydioxanone and polycaprolactone in rat model.

INTRODUCTION: One of the most frequently performed anti-aging surgical procedures is thread facelift. Since the 2010s, thread lifts using absorbable polydioxanone (PDO) thread were developed and have become increasingly popular. This research aims to identify the changes in and the mechanisms of absorbable thread-lifting components, namely, PDO (polydioxanone) and PCL (polycaprolactone), with varied absorption periods in the body. METHODS: Four different types of threads, namely, single-stranded thread, 4-stranded thread, 12-stranded thread, and barbed Cog thread, were used for each component. Histological changes in the thread and neighboring tissue of rat model were investigated for 2-week interval, and PCR was conducted for genes related to fibroblast proliferation including type 1α1 collagen, type 3α1 collagen, transforming growth factor beta 1 (TGF-ß1). RESULTS: An increase in the collagen formation in all types of PDO and PCL groups was observed during the first 12 weeks and decreased afterward. Collagen formation decreased later in the PCL thread group significantly than the POD group. PCL thread remained logner in the tissue for over a year regarding POD requiring around 24 weeks of absorption-degradation. A larger surface area between the thread and the tissue induces a greater response in the tissue, resulting in an increase in inflammatory cells, myofibroblasts, and fibroblasts. Results showed a similar pattern of increase in type 1α1 collagen and TGF-ß in the PDO thread group. This suggests that TGF-ß signal transduction leads to fibroblast proliferation that stimulates collagen formation and tissue re-formation. In contrast, only type 3α1 collagen increased in the PCL thread group. CONCLUSION: More collagen formation and tissue responses are induced by PCL thread, remaining longer in the tissue than PDO, leading to more tissue tightening effects that is one of the most important points of face lifting. Morphological comparison of threads shows that not only an increase in surface area between thread and tissue but also multi-strand increase tissue response, which in turn increases tissue maintenance effects.

A comparative study of porous polyethylene versus absorbable polydextro- and polylevolactic-lactide plate in reconstruction of isolated medial orbital wall fracture.

BACKGROUND: Several materials for medial orbital wall reconstruction have been mentioned in the literature. Our main purpose was to investigate postoperative enophthalmos and diplopia after medial orbital wall reconstruction with polydextro- and polylevolactic (poly-L/DL) acid (P[L/DL]LA) mesh plates and porous polyethylene plates. METHODS: Using a retrospective study design, we enrolled a cohort of isolated medial blowout fracture patients treated during a 58-month interval. The predictor variable was medial orbital wall reconstruction materials (P(L/DL)LA mesh plate and porous polyethylene plate. The main outcome variables included the occurrence of postoperative enophthalmos and diplopia at 1 week, 1, 3, 6, and 12 months post-surgery. Appropriate descriptive, uni- and bivariate statistics were computed, and P < 0.05 was considered significant. RESULTS: Three hundred-two isolated medial blowout fracture patients were included (24.5% females, 67% treated with P(L/DL)LA mesh plate). Exophthalmos measured highest in both groups 1 week after surgery and decreased steadily for 6 months postoperatively. Statistically significant differences were observed between both groups at 1 week, 1 month, and 3 months after surgery, with a higher incidence of exophthalmos observed in the P(L/DL)LA mesh plate group (P < 0.001). No significant differences were observed at 6 and 12 months after surgery. CONCLUSION: The occurrence of enophthalmos after medial blowout fracture reconstruction with P(L/DL)LA mesh plate is comparable with the use of porous polyethylene plate. Both P(L/DL)LA mesh and porous polyethylene plates are, therefore, reliable implants for medial orbital wall reconstruction.

Nasal Reconstruction of a Frontonasal Dysplasia via Septal L-Strut Reconstruction Using Costal Cartilage.

OBJECTIVE: Frontonasal dysplasia (FND) is a rare congenital condition. Its major features include hypertelorism, a large and bifid nasal tip, and a broad nasal root. We present our technique of septal L-strut reconstruction using costal cartilage. DESIGN: Retrospective review from June 2008 and August 2017. METHODS: Under general anesthesia, 6 patients with FND underwent septal reconstruction using costal cartilage via open rhinoplasty. We reconstructed the nasal and septal cartilaginous framework by placing columellar struts and cantilever-type grafts. RESULTS: The patients ranged in age from 6 to 13 years old. All were female. The follow-up period ranged from 8 months to 2 years; we encountered no postoperative complications (infection, nasal obstruction, or recurrence). All patients were satisfied with their nasal appearance. CONCLUSIONS: Although the results were not entirely satisfactory from an esthetic point of view, we found that FND can be treated via septal reconstruction with costal cartilage and that the clinical outcomes are reliable and satisfactory. Our approach is a useful option for FND patients.