The latest medical research on Cosmetic Medicine

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Rhinoplasty with Simultaneous Autologous Full-Face Fat Transfer for Asian Facial Contouring Balance: A Retrospective Study.

Aesthetic Plastic Surgery

The aesthetic facial contouring procedures have gained an increasing popularity in the Asian population. Nevertheless, currently, there are few specific literature assessments and studies on the outcomes of rhinoplasty combined with full-face fat graft contouring. To conduct an objective evaluation of the efficacy of Asian rhinoplasty combined with autologous facial fat transfer in terms of 3-dimensional measurement and patient-reported outcomes.

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 .

Twenty patients completed rhinoplasty with full-face fat transfer. The average postoperative follow-up was 10.2 months (range 6-24 months). The nasal length, and the nasal protrusion rate were significantly increased (p < 0.05) after surgery, and the median number of nasolabial angles decreased from 106° to 101°, which was closer to the aesthetic standard of 90°-100°. The topographical projection images of whole face indicated that the volume of frontal, temporal, inner cheek and chin regions were increased obviously. All cases received satisfaction outcome based on surgeons' satisfaction scale, ROE scale, FACE-Q overall facial satisfaction scale, and FACE-Q Rhinoplasty scale. Additionally, no patients had intraoperative or postoperative complications.

Rhinoplasty combined with full-face fat transfer is a reliable and effective method of augmenting and contouring the facial convexity in the Asian populations.

Evaluation of Paste-Type Micronized Acellular Dermal Matrix for Soft Tissue Augmentation: Volumetric and Histological Assessment in a Mouse Model.

Aesthetic Plastic Surgery

A biological injectable material, paste-type micronized acellular dermal matrix (ADM), has been proven effective in wound healing by filling defects through tissue replacement. This study aimed to compare the efficacy of paste-type micronized ADM on soft tissue augmentation with that of the conventional fillers in animal experiments.

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

According to the CT images at week 8, the mADM and mADM+GEL showed a higher volume persistence rate of 113.54% and 51.12%, compared with 85.09% and 17.65% for HA and COL+PMMA, respectively. The 2-week interval ultrasound images revealed that the mADM showed a volume increase in width rather than in height, and an increase in height for HA did not vary much. Histological analysis showed marked fibrous invasion and neovascularization with the mADM and mADM+GEL compared to that of the conventional fillers.

Paste-type micronized ADM showed soft tissue augmentation with similar effectiveness to that of conventional fillers. Therefore, paste-type micronized ADM has potential as an alternative material for a soft tissue filler in tissue replacement.

Ultrasound-Assisted Liposuction (UAL) Arm Contouring in Non-Post-Bariatric Patients: No Rush for Brachioplasty.

Aesthetic Plastic Surgery

A witnessed rise in patients' requests for arm contouring reflects the parallel public's pursuit of slimmed bodies and rapid advancement in weight reduction methods. Brachioplasty with its known complications is still the traditional method of management, but nearly all patients feel worried about the length and appearance of the scar and seek other non-excisional alternatives. The authors wanted to share their experience in arm contouring in non-post-bariatric patients using ultrasound-assisted liposuction (UAL).

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 .

There were no complications in the study group. The outcome evaluation survey has shown high patient satisfaction. The outcome survey demonstrated that 85.71% of the patients were very satisfied, while 14.29 % were satisfied with the procedure and all of them recommend the procedure to others. On the other hand, the independent surgeon evaluation showed that 92.86% of the results were excellent and 7.14 % were very good.

Our work has shown how versatile is the UAL in contouring a wide spectrum of arm lipodystrophy stages in non-post-bariatric patients and presents a non-excisional alternative for arm aesthetic refinements without a rush for brachioplasty with its unpleasant complications.

Fine-Tuning of the Supratip in Rhinoplasty: An External Approach.

Aesthetic Plastic Surgery

Supratip deformity, also known as the pollybeak deformity, accounts for one of the most common iatrogenic deformities requiring revision surgery in rhinoplasty. We aimed to present a novel technique to prevent supratip deformity and increase the tip definition, especially in patients with thick skin.

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

The ESS maneuver had better results in the supratip region according to the two parameters which were statistically significant (p < 0.05). No ischemic complications were observed.

This simple and reliable external approach is a powerful maneuver which can be an effective technique not only in patients with thick skin, but also in moderate skin patients who requires better supratip definition. It enables surgeon to reduce the nasal volume efficiently in patients with noncompliant skin by controlling skin redraping by adhering to Auersvald's hemostatic net principles. We believe that this approach will find a place in the armamentarium of rhinosurgeons.

The Novel Role of Crocus sativus L. in Enhancing Skin Flap Survival by Affecting Apoptosis Independent of mTOR: A Data-Virtualized Study.

Aesthetic Plastic Surgery

Despite the improvements to enhance skin flap viability, the effects of ischemia-reperfusion (IR), oxidative stress, necrosis, and apoptosis are still challenging. Crocus sativus L. (Saffron) is highly noticeable due to its tissue-protective and antioxidant properties. So, we aimed to investigate its effects on skin flap viability, oxidative stress, apoptosis markers, histopathological changes, and mTOR/p-mTOR expression.

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors

Saffron administration decreased flap necrosis percentage (p < 0.01), which was not dose-dependent. Treatment groups showed significant histological healing signs (Neovascularization, Fibroblast migration, Epithelialization, and Epithelialization thickness), decreased MDA content (p < 0.01), increased SOD (p < 0.01) and decreased MPO activity (p < 0.01). Bax and Bcl-2 expression, decreased and increased respectively in treated groups (p < 0.0001). mTOR and p-mTOR expression were not changed significantly in Saffron treated groups.

Saffron could increase skin flap viability, alleviate necrosis, decrease oxidative stress and decrease apoptotic cell death, after skin flap surgery, but it acts independent of the mTOR pathway. So, Saffron could potentially be used clinically to enhance skin flap viability.

Laser ablation of anal fistulae: a 6-year experience in a tertiary teaching hospital in Malaysia.

Lasers in Medical Science

Several studies have investigated the role of laser ablation of anal fistulae in the European setting. However, long-term follow-up results following laser fistula ablations are not widely investigated and no study was performed in the Asia-Pacific, a region with a distinctive prevalence of tuberculosis. The primary objective of this study is to report a single-centre experience with laser ablation of anal fistulae in Malaysia over a period of 6 years.

This was a retrospective observational study assessing the outcomes following 70 laser ablations of anal fistulae from February 2014 till December 2019. All cases were assessed using endoanal ultrasound. The laser ablation procedures were performed using laser systems and fibres from Endoteq Medizinische Laser GmBH, Germany, and Biolitec AG, Jena, Germany. Laser fibres were introduced into the fistula tract and laser energy was emitted radially in continuous mode when activated during the procedure. Pre-defined post-procedural outcomes (primary healing, healing failure or recurrence) were recorded as either present or absent during subsequent follow-up appointments and the data was analysed.

Over a median follow-up period of 10 months, primary healing was reported following 42 procedures (60.0%). Healing failure was reported following 28 procedures (40.0%) whilst recurrence was seen after 16 procedures (22.86%). No new cases of incontinence were reported following the procedure.

The reported primary healing rate following laser ablation of anal fistulae in this study appears consistent with existing literature published by other international centres. The most apparent clinical advantage of this procedure is sphincter-function preservation. However, the primary healing rate after isolated laser fistula ablation is still suboptimal. Judicious patient selection and application in anal fistulae with suitable characteristics could potentially improve the post-procedural outcomes.

A giant penis-like vulval soft fibroma in a case of external genital malformation.

J Cosmet Dermatol

Soft fibroma is a common benign skin tumour. The size varies from 1 to 10 mm, and giant soft fibromas were rare. Mostly, the appearances of soft fi...

Dermoscopic Evaluation of the Efficacy of Combination of topical spironolactone 5% and minoxidil 5% Solutions in the Treatment of Androgenetic Alopecia: A cross sectional- comparative study.

J Cosmet Dermatol

Androgenetic alopecia (AGA) is a common chronic dermatological illness that affects both men and women.

To assess and compare dermoscopically the impact of a combination of topical minoxidil solution (5%) and topical spironolactone solution (5%) in treating AGA in both sexes.

one hundred and twenty patients diagnosed with AGA were divided into three groups; each group is composed of 40 patients. Group A (n=40) were treated with a 5% topical minoxidil solution, group B (n=40) were treated with a 5% topical spironolactone solution and group C (n=40) were treated with a 5% topical minoxidil and spironolactone combination.

Following initiation of treatment and at 6 weeks ( midterm) , reduction in all dermoscopic features was observed in all groups however it was not statistically significant except for vellus hair reduction ( p=0.033). On the other hand, upright regrowing hairs were insignificantly increased in all groups (p=1.088). The pattern of dermoscopic features remained to insignificantly decrease towards the end of 12 weeks treatment (full term) in all studied groups except for vellus hair that showed further significant reduction towards the end of the study (p = 0.011).

Both spironolactone as a 5% topical solution and minoxidil as a 5% topical solution might be used safely in a twice-daily dosage to treat AGA in both genders. Furthermore, combining them in a single topical dose form can boost efficacy and yield greater advantages.

Microliposuction and radiofrequency combined with the thread technique as a new method used in lower face lifting.

J Cosmet Dermatol

Minimally invasive facial rejuvenation is a popular and well-established treatment for patients seeking facial lifting.

The authors combined facial microliposuction, radiofrequency and thread lifting technology as a comprehensive treatment (LRT) for facial rejuvenation in a case series of 57 patients.

A total of 76 patients underwent surgery, and 75% completed 6 months of follow-up (57 patients); the patients were aged 26 to 51 (33.6 ± 4.5) years. All patients were followed up for hematoma within 1 week after the operation and for skin numbness and muscle paralysis at 1 week and 3 months postoperatively. Patient satisfaction with the postoperative aesthetic effects was analyzed by Face-QTM at 6 months after the operation.

The score for hematoma within 1 week was 1.21±0.33, scores for postoperative skin numbness within 1 week and 3 months were 2.06±0.51 and 1.17±0.32, respectively, and scores for postoperative muscle paralysis within 1 week and 3 months were 1.31±0.55 and 1.00 ± 0, respectively. Fifty-seven patients completed Face-QTM (score: 22.1±1.8, standard score: 82.2±14.8).

LRT is a minimally invasive method that can achieve a synergistic and satisfactory result for patients with mild to moderate facial skin sagging.

Evaluation of Skin-Soft Tissue Envelope Thickness by Ultrasonography after Primary and Revision Rhinoplasty.

Aesthetic Plastic Surgery

Excessive nasal edema is among the complications after rhinoplasty translating into Skin-Soft Tissue Envelope (SSTE) thickening and disruption in the nasal framework's definition. Revision rhinoplasties are suspected of causing even more nasal edema. The objective postoperative SSTE thickness between revisionary and primary rhinoplasties is compared in this study.

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 .

Of the 36 participants analyzed, the SSTE was significantly thicker after revisionary surgery in all the follow-up sessions and nasal regions, except for the 1-month follow-up in the nasion (p = 0.273) and 12-month follow-up in the rhinion (p = 0.050). Mean nasal SSTE thickness showed decreasing trends in each region after either primary or revisionary surgery, with a lower level of resolution in the nasion region after revision rhinoplasty (p < 0.001).

The nasal SSTE had been significantly thicker in most regions after revisionary procedures than primary ones, and the swelling had subsided slightly slower. Surgeons are recommended to consider revisionary rhinoplasties based on these findings cautiously.

Volumetric Assessment of the Anterior Digastric Muscles: A Deeper Understanding of the Volumetric Changes With Aging.

Aesthetic Surgery Journal

Recently we have seen an expanding practice of targeting the deeper, subplatysmal structures in the neck. In particular, interventions targeting the "bulky" anterior digastric (AD) muscle have been described with excellent results. However, much remains to be understood about the deep anatomy of the neck and the age-associated changes of the AD.

To examine the relationship between AD volume and age.

This retrospective study calculated the AD volume utilizing MRI segmentation in subjects between the ages of 20-92 with prior MRIs. Those with compromised imaging due to pathology or artifact were excluded. Subjects were divided into four age-defined cohorts for clinical applicability.

This study included 129 patients (male n=64) with a mean age of 52.3. The AD volume of the reference group was 3.2 cm3. A linear decrease in muscle volume was observed with age compared to the reference group: age 45-54 cohort, 2.95 cm3 (p=.3), 55-64 cohort, 2.7 cm3 (p=.05) and >65 cohort, 2.45 cm3 (p<0.001). Male sex (p=.0001) and laterality (p=.003) were associated with significantly larger volumes. Overweight and obese BMI classification was not associated with a significantly different volume than normal or underweight subjects (p=.067).

Our findings suggest an age-associated reduction in AD volume. Gender and laterality significantly affected volume, while BMI did not. While our results do not support the theory of muscular hypertrophy with aging, they reveal that the perceived bulkiness may be due to changes in the surrounding anatomy affecting the morphology of the AD and subsequent blunting of the cervicomental angle.

Enhancing Patient Outcomes in Aesthetic Breast Implant Procedures Using Proven Antimicrobial Breast Pocket Irrigations: A 20 Year Follow-up.

Aesthetic Surgery Journal

Capsular contracture (CC) remains the most common complication of implant based aesthetic and reconstructive breast surgery. With subclinical infection being proven to be the primary etiology, antimicrobial breast pocket irrigation has been recommended as the key step to reduce this complication. Despite the data of well proven of anti-microbial breast pocket irrigations, there exists a lack of universal adoption.

The purpose of this study is to perform a review of CC rates using previously described and proven anti-microbial breast pocket irrigations.

Data from patients undergoing cosmetic breast augmentation were recorded prospectively from 1997-2017. The irrigation solutions used was either the betadine containing (50% betadine or "betadine triple") or non-betadine triple antibiotic regimen. The database was assessed to determine the type of implant used, the incidence of CC, and possible contributing factors. The degree of CC was recorded as per Baker classification.

A 20 year prospective data collection yielded 2088 patients with 4176 implants. 826 patients had textured implants and 1262 patients had smooth implants. The rate of grade III/IV CC was found to be 0.57% in all patients undergoing primary breast augmentation. The incidence was found to be 1.21% in textured implants and 0.16% in smooth implants.

This study constitutes the largest and longest review of CC in a controlled, single surgeon setting. The low incidence of CC is low and reinforces the efficacy/utility of anti-microbial breast pocket irrigation. Both the betadine and non-betadine antibiotic regimens were found to be effective, with our preference being the betadine regimen. Universal adoption of betadine containing anti-microbial breast pocket irrigation is recommended to reduce CC and other device-associated infection.