Damage from periorbital ageing to the multilayered structures and resilience of the skin in Chinese population.

Ageing dynamically disrupts the multilayered supporting components of the skin that are held together by cell adhesion molecules (CAMs). Skin specimens from 33 female Chinese patients undergoing lower blepharoplasty were divided into three age groups and examined by haematoxylin and eosin (H&E) staining, immunohistochemistry (IHC) and Elastica-van Gieson (EVG) stains, western blotting, surface electron microscopy (SEM) and biomechanical tension analysis. The SEM density (skin surface topology) showed a negative linear relationship with age. The triangular pattern of the skin surface in the younger group gradually broke down into quadrangular and irregular patterns in the older group. Collagens and elastic fibres in the dermis showed anisotropy and decreased density in the older groups compared with the younger group, especially in the papillary dermis. Anisotropy means that physical properties differ according to the direction of measurement. E-cadherin and integrin αv (whose functions are to bind epidermal and dermal elements respectively) increased and decreased, respectively, in the oldest group. Skin resilience decreased significantly in this group under repetitive stress. In conclusion, a loss of skin surface textures, integrin αv expressions, epidermal-dermal connections and dermal compactness led to the multilayered structure of the skin becoming separated. This in turn decreased resilience during ageing. These findings may therefore explain why aged skins cannot tolerate repetitive facial expressions, and why this action produces further dynamic wrinkles.

Dynamic analysis of modified transcutaneous lower blepharoplasty based on biochemical and biophysical principles.

In this study, we analyzed the key parameters of modified transcutaneous lower blepharoplasty based on multidisciplinary principles (biochemical findings and biophysical wrinkling theory). A total of 408 female patients received our subciliary lower blepharoplasty between March 2002 and January 2010. The severity of the eyebags (dynamic wrinkle numbers and prolapse) was evaluated through preoperative and postoperative photography, whereas the excised lower eyelid skin specimens from 56 patients were investigated with hematoxylin and eosin staining. The modified techniques produced significant improvements in the severity of eyebags in all age groups (P < 0.001). Poor surgical outcome was found to correlate significantly with preoperative dynamic wrinkle numbers (P < 0.001). Age, dynamic wrinkle numbers, and prolapse correlated significantly with dermal fiber density (P = 0.004, 0.000, and 0.000, respectively) but not epidermal, rete ridge, and dermal thickness or the number of rete ridges. In conclusion, modified transcutaneous lower blepharoplasty provides significant improvement to dynamic wrinkles and prolapse in the eyebags. Periorbital aging progressively disturbs the dermal compactness (fiber density) until the structure can no longer hold its integrity at the critical age (around the age of 40).

Taiwanofungus camphoratus (Syn Antrodia camphorata) extract and amphotericin B exert adjuvant effects via mitochondrial apoptotic pathway.

The use of multiple drugs in cancer therapy increases the efficacy of the potential therapeutic effects. In this study, the authors investigated the adjuvant effects of an ethanol extract of solid-state cultivated Taiwanofungus camphoratus (TCEE) and amphotericin B (AmB) in the human cancer cell lines RPMI7951 and MG63. Taiwanofungus camphoratus is a well-known Chinese medicine in Taiwan, and AmB is a widely used antifungal agent. The authors demonstrated that TCEE pretreatment followed by AmB treatment effectively inhibited cell growth. The combination of sublethal doses of TCEE and AmB revealed a significant growth inhibitory effect in both cell lines. The combination of TCEE and AmB but not AmB alone induced phosphatidylserine externalization and loss of mitochondrial membrane potential. Cell cycle analyses revealed that combination of TCEE and AmB triggered G2/M arrest and significant apoptosis after 48 hours. These effects were greater than those achieved using TCEE or AmB alone. Furthermore, the authors demonstrated that the drugs increased the levels of p21(Cip1/Waf1) and pro-apoptotic protein Bax and reduced the level of anti-apoptotic protein Bcl-2. Taken together, the results showed that the combination treatment of TCEE and AmB displays strong adjuvant effects, which are indicated by the inhibition of cell proliferation in 2 human cancer cell lines, RPMI7951 and MG63. These findings suggest possible therapeutic applications and alternative medicines using this drug combination.

Pretreatment with an ethanolic extract of Taiwanofungus camphoratus (Antrodia camphorata) enhances the cytotoxic effects of amphotericin B.

Taiwanofungus camphoratus, a well-known Chinese medicine used in Taiwan, possesses several pharmacological functions, including anticancer effects. In the present study, we aimed to investigate a novel anticancer effect by pretreating cancer cells with an ethanolic extract of T. camphoratus (TCEE) followed by the administration of an antifungal agent amphotericin B (AmB). Both TCEE and AmB showed significant dose-dependent cytotoxicity in HT29 cells. Pretreatment with a nontoxic dose of TCEE enhanced the cytotoxicity of AmB. Furthermore, significant apoptotic cell death was found in cells treated with TCEE and AmB. A combination treatment with AmB plus TCEE resulted in a significant repression of tumor growth in HT29 xenografts. Collectively, our results indicated that combined treatment with AmB and TCEE effectively induced apoptosis and inhibited tumor growth. In the future, TCEE may serve as a potential complementary and alternative medicine to treat patients suffering from colorectal cancer.

Analysis of medical litigation among patients with medical disputes in cosmetic surgery in Taiwan.

BACKGROUND: This study aimed to investigate the key factors in medical disputes (arguments) among female patients after cosmetic surgery in Taiwan and to explore the correlates of medical litigation. METHODS: A total of 6,888 patients (3,210 patients from two hospitals and 3,678 patients from two clinics) received cosmetic surgery from January 2001 to December 2009. The inclusion criteria specified female patients with a medical dispute. Chi-square testing and multiple logistic regression analysis were used to analyze the data. RESULTS: Of the 43 patients who had a medical dispute (hospitals, 0.53%; clinics, 0.73%), 9 plaintiffs eventually filed suit against their plastic surgeons. Such an outcome exhibited a decreasing annual trend. The hospitals and clinics did not differ significantly in terms of patient profiles. The Chi-square test showed that most patients with a medical dispute (p < 0.05) were older than 30 years, were divorced or married, had received operations under general anesthesia, had no economic stress, had a history of medical litigation, and eventually did not sue the surgeons. The test results also showed that the surgeon's seniority and experience significantly influenced the possibility of medical dispute and nonlitigation. Multiple logistical regression analysis further showed that the patients who did decide to enter into litigation had two main related factors: marital stress (odds ratio [OR], 10.67; 95% confidence interval [CI], 1.20-94.73) and an education level below junior college (OR, 9.33; 95% CI, 1.01-86.36). CONCLUSION: The study findings suggest that the key characteristics of patients and surgeons should be taken into consideration not only in the search for ways to enhance pre- and postoperative communication but also as useful information for expert testimony in the inquisitorial law system.

Clinical outcomes of patients with prominent nasolabial folds corrected by the technique: dermo-fascial detachment and fat grafting.

BACKGROUND: Prominent nasolabial folds (NLFs) due to ageing are a major aesthetic concern among Asian women. The main causes are drooping of the cheek mass, depressions (folds) and dermal attachments. We have conducted a study to analyse the long-term outcomes of the conventional dermo-fascial detachment and fat grafting technique. METHODS: A total of 209 patients with NLFs of different severity were included in the study. Dermo-fascial detachment was used to completely dissect the attachments; then, the space was filled with fat grafts. The outcomes and related factors were analysed statistically based on the classification of NLF grades. RESULTS: The average operating time was 28.4 min, and no postoperative infections were found. A high improvement ratio was noted: at the 3-month, 1-year and 2-year follow-up consultations; the improvement ratio was about 100%, 97.4±2.6% and 66.7±9.2%, respectively. At the 2-year follow-up, the improvement ratio of the severe grade group (71.4±10.1%) remained higher than that of the mild grade group (50.0±22.3%). Six cases relapsed to the original grade (15.4%), and two cases were worse after 2 years (5.1%). No statistical correlation between age and the grade of the condition was determined (p=0.746). Total filling amounts with fat grafts made no statistical difference to the outcomes of the long-lasting group (1.93±0.26 cc) and the non-long-lasting group (1.84±0.19 cc) (p=0.435). CONCLUSION: Dermo-fascial detachment and fat grafting is a safe and reliable technique for the correction of prominent NLFs with high improvement ratios, minimal morbidities and long-lasting outcomes.

Analysis of nasal periosteum and nasofrontal suture with clinical implications for dorsal nasal augmentation.

BACKGROUND: Subperiosteal placement of nasal implants has been performed widely for dorsal nasal augmentation in Asia. The authors introduced anatomical and biomechanical studies to investigate the influence of the periosteum on the subperiosteal technique. METHODS: Nasal periosteum on 20 cadavers was investigated by hematoxylin and eosin staining and biomechanical methods. Nasal profiles (n = 160) and motility testing (n = 1317) were used to analyze patients who underwent augmentation rhinoplasty between 2003 and 2008. An alternative high-split subperiosteal technique was developed for higher placement of the nasal implant. RESULTS: In the cadaver study, the authors discovered that the periosteum and bone were bound together by Sharpey's fibers below the nasion (1.3 +/- 0.6 mm) that penetrated into the nasofrontal suture. The nasal periosteum above the nasofrontal suture (1.77 +/- 0.19 mm) was thicker than the one below the suture (0.83 +/- 0.15 mm) (p < 0.001). Men had relatively thicker periosteum (1.41 +/- 0.49 mm) compared with women (1.18 +/- 0.5 mm), and the difference was statistically significant (p < 0.001). Motility testing for clinical cases revealed that there was a higher percentage of the mobilized implant in women than in men (p = 0.042). When the subperiosteal technique was compared with the subcutaneous technique, analysis of the Poisson ratio for the periosteum (0.33 +/- 0.02) indicated greater strength than in the subcutaneous tissue (0.45 +/- 0.02). The alternative high-split subperiosteal technique significantly shortened the radix-to-glabella distance, increased the radix height, and made the nasofrontal angle more obtuse than the conventional subperiosteal technique (p < 0.001, p < 0.001, and p = 0.02, respectively). CONCLUSION: Analysis of the nasal periosteum provided scientific support for using the subperiosteal technique in dorsal nasal augmentation.

Correlation between scoliosis and breast asymmetries in women undergoing augmentation mammaplasty.

BACKGROUND: Breast asymmetries and scoliosis influence the results of augmentation mammaplasty. Although a variety of methods have been proposed to resolve breast asymmetries, to date, no simple preoperative algorithm has been proposed for predicting the breast volume and decreasing breast asymmetries in the place of subjective or expensive evaluation. The relationship between the scoliosis and breast volume asymmetry was further analyzed statistically in this study. METHODS: The study enrolled 60 scoliotic patients from 780 patients undergoing augmentation mammaplasty between January 2000 and March 2008. The average follow-up period was 2 years. The inclusion criteria required hypoplastic breasts, a difference in bilateral breast volumes greater than 20 ml, and scoliosis with a Cobb angle greater than 10 degrees . The authors' surgical algorithm demonstrated an anthropomorphic equation for predicting breast volume and selecting the correct implant size. RESULTS: Pearson regression analysis showed that the breast volume asymmetry difference was significantly correlated with the severity of scoliosis (Cobb angle) (correlation coefficient, 0.901). No correlation between the difference in pre- and postoperative nipple and inframammary levels and the severity of scoliosis was noted. Augmentation mammaplasty significantly decreased the breast asymmetry differences (volume and nipple level) (p < 0.001). The average preoperative estimated breast volume was 45.3 ml for the smaller breast and 88.4 ml for the larger breast. CONCLUSION: This study found that the severity of scoliosis showed significant correlation with the breast volume asymmetry differences. Augmentation mammaplasty for breast asymmetries decreased not only the volume difference but also the difference in nipple levels.

Correction of asymmetric calf hypertrophy with differential selective neurectomy.

Contour asymmetry of the legs is a major aesthetic concern among Asian women. This study enrolled 60 patients with asymmetric calf hypertrophy, defined as a differential calf circumference exceeding 0.6 cm. Differential selective neurectomy techniques, which depend on the sizes of the small and large calves, were performed exactly via a 1-cm popliteal wound. The pre- and postoperative mean differences between the larger and smaller calf circumferences at the 1-year follow-up consultation were 1.38 +/- 0.65 and 0.42 +/- 0.38 cm, respectively (p < 0.01). The reduction was significantly greater in the leg that was initially larger. The procedure was effective in reducing circumference discrepancies so that leg contours were more balanced. All the patients were able to ambulate normally within 5 months after the procedure without disability. The authors posit that differential neurectomy is a safe and reliable technique for the correction of asymmetric calf hypertrophy, with minimal morbidities.