Cross-linked Sodium Hyaluronate Gel with PLLA-b-PEG Microsphere for Facial Contouring in Chinese: A Retrospective Study.

BACKGROUND: In Asia, the demand for cosmetic facial treatments has surged due to technological advancements, increased social acceptability, and affordability. Poly-L-lactic acid (PLLA) fillers, known for their biocompatibility and biodegradability, have emerged as a popular choice for facial contouring, yet studies specifically addressing their use in Asian populations are scarce. METHODS: This retrospective study examined 30 Chinese patients who underwent facial contouring with PLLA fillers, focusing on product composition, injection techniques, and safety measures. A comprehensive clinical evaluation was performed, including the Global Aesthetic Improvement Scale (GAIS) and Global Impression of Change Scale (GICS) for effectiveness and patient satisfaction, respectively. RESULTS: No significant difference in GAIS scores was observed between injectors and blinded evaluators over a 12-month period, indicating consistent effectiveness. Patient satisfaction remained high, with GICS scores reflecting positive outcomes. The safety profile was favorable, with no serious adverse events reported. The study highlighted the importance of anatomical knowledge to avoid complications, particularly in areas prone to blindness. CONCLUSIONS: PLLA fillers offer a safe, effective option for facial contour correction in the Asian population, achieving high patient satisfaction and maintaining results over time. The study underscores the need for tailored approaches in cosmetic procedures for Asians, considering their unique facial structures and aesthetic goals. Further research with larger, multicenter cohorts is recommended to validate these findings and explore long-term effects. 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 .

A Study on the Aesthetic Parameters and Proportions of the External Contour for Minimally Invasive Facial Injection.

OBJECTIVE: The aim of this study was to further guide the diagnosis and treatment programs for clinical facial contouring with injectable fillers by studying the facial contour parameters and proportion preferences consistent with Asian aesthetics. METHODS: A total of 89 subjects (42 males and 47 females aged 20-60 years) who met the inclusion criteria were enrolled in this study. The subjects were grouped by age, sex, and external contour attractiveness score, and the external contour aesthetic parameters and proportions of the subjects in different groups were measured and analysed. RESULTS: The upper facial breadth and lower facial breadth decreased with age, with significant differences between the 50-60-year age group and other age groups (P < 0.01). The nasomental angle showed a decreasing trend with age, with significant differences between the 40-49-year age group and the 20-29-year and 30-39-year age groups (P < 0.05). Males and females were significantly different in calva height, total head height, lower facial height, and calva height to total head height ratio (P < 0.05). With increasing age, the external contour attractiveness scores of males and females both showed decreasing trends, with significant differences between the 50-60-year age group and other age groups (P < 0.05). CONCLUSION: The calva height and the cranioauricular angle have a significant impact on external contour attractiveness. In general, temporal depression, cheek sagging, lateral cheek depression, and an ill-defined mandibular border will occur due to ageing, collagen loss, ligament laxity and sagging, and soft tissue atrophy and sagging, reducing the attractiveness of the external contour. LEVEL OF EVIDENCE IV: 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 .

The effects of vasonatrin peptide on random pattern skin flap survival.

BACKGROUND: A lot of methods have been intensively investigated to improve random skin flap survival. Decreasing inflammation and alleviating tissue injury have been reported to be effective in improving survival ratio. Vasonatrin peptide (VNP) is a chimera of atrial natriuretic peptide (ANP) and C-type natriuretic peptide (CNP). The current study demonstrates that VNP possesses the venodilating actions of CNP, the natriuretic actions of ANP, and the unique arterial vasodilating actions not associated with either ANP or CNP. However, its effects on skin flap survival have not been previously reported. METHODS: Sprague-Dawley rats, weighing 220 to 260 g, were randomly divided into 2 groups, namely, the VNP-treated group and the control group. Rectangular random dorsal skin flaps measuring 3 × 9 cm including the panniculus carnosus were elevated, then the flaps were sutured into their original places. In the VNP group, 0.1 mg/kg of VNP was administered intravenously (IV) after surgery and then daily for 3 days. In the control group, 1 mL/kg of saline was administered IV after surgery and then daily for 3 days. To observe the effects of VNP, blood perfusion, histopathological examination, the inflammatory mediators (tumor necrosis factor α, interleukin 1ß, and interferon γ), and biochemical analysis (malondialdehyde, glutathione, and myeloperoxidase) were detected and the flap viability was evaluated 7 days after surgery by measuring necrotic flap area and total flap area. RESULTS: The viability measurements showed the percentage of flap survival was increased in the VNP-treated group (76.53% ± 6.36%) as compared with the control group (61.12% ± 4.92%) (P < 0.05), and the histological and biochemical assays corroborated the data. The blood perfusion of flaps in the VNP-treated group was higher than the control group (P < 0.05). The inflammatory mediators (tumor necrosis factor α, interleukin 1ß, and interferon γ) were significantly lower in the VNP-treated group than the control group (P < 0.05). CONCLUSIONS: This study found that VNP, which could elevate the tissue blood perfusion and mitigate the tissue damage and inflammatory reaction, is associated with a higher percentage of survival random pattern skin flap area.

[Expression of Notch receptors, ligands and downstream target genes in epidermis of hypertrophic scar].

OBJECTIVE: To study the expression of Notch receptors, ligands and downstream target genes in hypertrophic scar and normal skin, and to investigate its role in the development of hypertrophic scar. METHODS: By immunohistochemistry, the expression of epidermal differentiation markers- beta1 integrin, keratin 14 (K14) and keratin 19 (K19), as well as Notch 1-4 and Jagged1 were examined in hypertrophic scars and normal skins. The expression of Notch downstream genes- P21 and P63 was analyzed with real-time quantitative PCR and immunohistochemistry staining. RESULTS: Histological analysis revealed a significant epidermal thickening in the hypertrophic scars, with excessive cell layers above the basal layer. Compared to the normal epidermis, the expression of beta1 integrin, K19 and K14 decreased in hypertrophic scars (P <0.05). Positive expression rate of Notch1 and Jagged1 in keratinocytes was significantly higher in hypertrophic scar than in normal skin (P < 0.05), while there was no difference in Notch2 and 3 positive expression rate. Furthermore, the expression of P21 was significantly up-regulated, while the expression of P63 was down-regulated in keratinocytes of hypertrophic scar (P < 0.05). CONCLUSIONS: Notch signal may play an important role in hypertrophic scar pathogenesis. Over-differentiation of Keratinocytes in hypertrophic scar may be related to the overexpression of Notch1 and Jagged1, up-regulation of P21 gene and down-regulation of P63 gene.

[A modified technique for the repair of secondary defect of unilateral cleft lip].

OBJECTIVE: To investigate the effect of a modified technique for repairing secondary defect of unilateral cleft lip. METHODS: The incision line was designed along the oral-nasal contour line. The lateral crus of nasal alar were rotated and repositioned in order to reconstruct the nasal sill and base. V-Y plasty was performed with a muco-cartilage flap inside the nasal cavity to reset the alar cartilage backwards and correct the nasal deformity. RESULTS: Satisfactory results were achieved in all 69 patients with this modified technique. The post-operative scar was inconspicuous. CONCLUSIONS: This modified technique with advantages of contour line incision and alar cartilage backward re-reposition is a good option for the repair of secondary defect of unilateral cleft lip.

[Rapid development of cosmetic medicine in China].

OBJECTIVE: To review and summarize the development during the last 20 years and the current status of cosmetic medicine, i.e., cosmetic surgery, in China, for the healthier development of this specialty in the future. METHODS: Literature concerned was reviewed, including conference abstracts, papers, and publications, and the present status and problems were analyzed. RESULTS: Cosmetic medicine was recognized as an independent specialty and gained its clear definition. The development of cosmetic medicine is an inevitable trend of the changing medical modules and the developing science and civilization. This trend fulfilled the need of the people. The related problems consisted of a high complication rate, confusion of management, and insufficient specific knowledge in part of the providers. CONCLUSION: The development of cosmetic medicine is an inevitable trend of the civilization development. For the healthy development of this specialty, scientific management and systemic education for the providers are crucial. Only those who have the plastic surgery background are able to participate in this practice.

[The design of the expanded flap for the repair of the temporal and cheek area].

OBJECTIVE: To explore the design of an expanded flap at the temporal and cheek area. METHODS: The expanded flap was used for the repair of 619 temporal and cheek defects secondary to scar, nevus or hemangioma excision. In the frontal area, the rotational flap was usually used. For the repair of the cheek, the applied flap included the rotational, advanced, and transposition flap from the neck, as well as the pedicle flap from the thoracic area. RESULTS: Eight thoracic-deltoid flaps had distal necrosis of 1 approximately 5 cm. Of them, 5 flaps were repositioned with subsequent good result; the other 3 flaps underwent skin grafting. The five facial expanded flaps showed distal necrosis of 0.5 approximately 1 cm. Of them, 4 flaps occurred delayed healing, 1 flap underwent skin grafting. Expander extrusion happened in 41 cases (6.62%), which resulted in deficiency of the expanded area. Satisfactory results were achieved in all the other cases. CONCLUSIONS: According to our experience, careful design of the flap is very important for obtainingbetter surgical results and decreasing complications.

[Change of expression of P-selectin in avulsion-injured vessels].

OBJECTIVE: To determine the change of P-selectin in avulsion-injured vessels. METHODS: Different stretch forces of 60, 70, 80 and 90 g were applied to a vascular injury model. The expression changes of P-selectin were evaluated by RT-PCR. RESULTS: The expression of P-selection mRNA in the injured vessels increased with the stretch force. CONCLUSION: The result associated with our previous study indicated that P-selectin may be involved in thrombosis.

[Rhinoplasty of unilateral cleft lip].

OBJECTIVE: To investigate the technique for unilateral cleft lip nasal deformities. METHODS: Through the traditional columella margin incision, the alar cartilage and the lateral nasal cartilage were exposed. After the mucosa between the two cartilages was divided, a mucosa-cartilage flap was developed and anchored, moving the lateral crus upwardly and medially, correcting the nasal deformity. RESULTS: 52 cases of primary nasal deformities and 18 cases of secondary nasal deformities were corrected with this technique. Satisfactory results were achieved. CONCLUSION: This technique is recommendable, which is more likely to restore the physiological characters of the nose than the conventional technique.